BackgroundFreezing of gait is a disabling burden for Parkinson’s disease patients with poor response to conventional therapies. Combined deep brain stimulation of the subthalamic nucleus and substantia nigra moved into focus as a potential therapeutic option to treat the parkinsonian gait disorder and refractory FoG. The mechanisms of action of DBS within the cortical-subcortical-basal ganglia network on gait, particularly at the cortical level, remain unclear.MethodsTwelve patients with idiopathic PD and chronically-implanted DBS electrodes were assessed on their regular dopaminergic medication in (...) a standardized stepping in place paradigm. Patients executed the task with DBS switched off, conventional STN DBS and combined STN+SN DBS and were compared to healthy matched controls. Simultaneous high-density EEG and kinematic measurements were recorded during resting-state, effective stepping, and freezing episodes.ResultsClinically, STN+SN DBS was superior to conventional STN DBS in improving temporal stepping variability of the more affected leg. During resting-state and effective stepping, the cortical activity of PD patients in STIM OFF was characterized by excessive over-synchronization in the theta, alpha, and high-beta band compared to healthy controls. Both active DBS settings similarly decreased resting-state alpha power and reduced pathologically enhanced high-beta activity during resting-state and effective stepping compared to STIM OFF. Freezing episodes during STN DBS and STN+SN DBS showed spectrally and spatially distinct cortical activity patterns when compared to effective stepping. During STN DBS, FoG was associated with an increase in cortical alpha and low-beta activity over central cortical areas, while with STN+SN DBS, an increase in high-beta was prominent over more frontal areas.ConclusionsSTN+SN DBS improved temporal aspects of parkinsonian gait impairment compared to conventional STN DBS and differentially affected cortical oscillatory patterns during regular locomotion and freezing suggesting a potential modulatory effect on dysfunctional cortical-subcortical communication in PD. (shrink)

The authors report and comment on student reactions to a clinical example of moral choice in the microallocation of scarce resources. Four patients require dialysis simultaneously, but only one kidney machine is available. What moral, as opposed to clinical, criteria are available to determine who should have priority?

In the context of the blurring of boundaries between club and theatre, game and theatre, and party and theatre, experiential spectatorship is spilling into the mainstream. This article starts from the recognition of the rapid rise of the experience economy as a turning point in consumer culture towards a specific appeal to the sensory body. The definition of experience in this analysis is key and a distinction is made between experience as it passes moment by moment, erlebnis, and experience as (...) something that is cumulatively built up over time, erfahrung. This paper asks, in a society defined by the crisis of experience, does this rise of the experiential in theatre simply reflect the reduction of experience to a series of consumable sensory moments or is there a mode of experience modelled through performance interaction which moves both beyond this established mode of experience and also beyond the notion of experience as cumulatively formed wisdom? Drawing a parallel between established popular cultural practices of the body and those of the spectator in spectacular promenade performance, Fuerzabruta is used as an illustrative example of popular experiential performance and Hwang’s The Road as an example of experiential performance in which a transformative aesthetic is made possible. (shrink)

A crucial debate currently raging in the fields of cognitive and social science centers around general and specific approaches to understanding the actions of others. When we understand the actions of another person, do we do so on the basis of a general theory of psychology, or on the basis of an effort to place ourselves in the particular position of that specific person? Hans Herbert Kögler and Karsten R. Stueber's Empathy and Agency addresses this other issues vital to current (...) social science in an advanced and diverse analysis of the foundations of social-scientific methodology based on recent cognitive psychology. The book serves as both an introduction to the debate for non-academic audiences and as a catalyst for further discussion for serious theorists. Empathy and Agency provides a solid foundation of the fundamental issues in social and cognitive science, but also presents the most influential paradigms in the field at this time. (shrink)

This paper considers the relevance of the Duhem-Quine thesis in economics. In the introductory discussion which follows, the meaning of the thesis and a brief history of its development are detailed. The purpose of the paper is to discuss the effects of the thesis in four specific and diverse theories in economics, and to illustrate the dependence of testing the theories on a set of auxiliary hypotheses. A general taxonomy of auxiliary hypotheses is provided to demonstrate the confounding of auxiliary (...) hypotheses with the testing of economic theory. (shrink)

In this paper Popper formulates and discusses a new aspect of the theory of mind. This theory is partly based on his earlier developed interactionistic theory. It takes as its point of departure the observation that mind and physical forces have several properties in common, at least the following six: both are located, unextended, incorporeal, capable of acting on bodies, dependent upon body, capable of being influenced by bodies. Other properties such as intensity and extension in time may be added. (...) It is argued that a fuller understanding of the nature of forces is essential for the analysis of the mind-brain problem. The relative autonomy and indeterministic nature of mind is stressed. Indeterminism is treated in relation to a theorem of Hadamard. The computer theory of mind and the Turing test are criticized. Finally the evolution of mind is discussed. (shrink)

At the University of Newcastle, health law and ethics is taught and assessed in each year of the five-year curriculum. However, the critical question for assessment remains: 'Does teaching ethics have a measurable effect on the clinical activity of medical students who have had such courses?' Those responsible for teaching confront this question each year they sit down to construct their assessment tools. Should they assess what the student knows? Should they assess the student's moral reasoning, that is, what decisions (...) the student makes, and, how these decisions are justified, or should they assess what the student actually does when dealing with patients in the clinical setting, and how he or she does it? From 1982 to 1991, assessment at Newcastle was primarily aimed at determining the quality of the students' ethics knowledge base. This paper describes the strengths and limitations of a purely knowledge-based method of evaluation and why in 1992, we are now attempting to redefine and assess, what we call 'clinical ethical competence' in terms of how students actually apply this knowledge base in a controlled clinical context. (shrink)

Why do we persist in the relentless pursuit of artificial nourishment and other treatments to maintain a permanently unconscious existence? In facing the future, if not the present world-wide reality of a huge number of persistent vegetative state (PVS) patients, will they be treated because of our ethical commitment to their humanity, or because of an ethical paralysis in the face of biotechnical progress? The PVS patient is cut off from the normal patterns of human connection and communication, with a (...) life unlike other forms of human existence. Why the struggle to justify ending a life which, it is said, has suffered an irreversible loss of the content of consciousness? Elsewhere, the authors have addressed the ethical controversies and confusion engendered by ambiguous terminology, misuse of medical facts and the differing interpretations of what constitutes 'effective' treatment: in particular, the issue of whether in fact artificial nutrition and hydration is a medical treatment, or simply part of the obligatory care owed to all patients, permanently unconscious or not. In this paper, we intend to argue that recent analyses of medical futility, its meaning and ethical implications, despite an absence of public consensus, permit some tentative re-evaluation of our ethical obligations to the PVS patient. (shrink)

A Pali Grammar. William Geiger. Translated into English by Batakrishna Ghosh, revised and edited by K. R. Norman. Pali Text Society, Oxford 1994. xxix, 220 pp. Hardback £12.95, paperback £6.75.

Dhammapada. Ed. O. von Hinüber and K.R. Norman. Pali Text Society, Oxford 1994. xv, 148 pp. £10.95.

Index to the Digha-nikaya. Compiled by M. Yamazaki, Y. Ousaka, K. R. Norman and M. Cone. Pali Text Society, Oxford 1997. vii, 357 pp. £19.75. ISBN 0 86013 355 9.