Introduction: Although deep brain stimulation often improves levodopa-responsive gait symptoms, robust therapies for gait dysfunction from Parkinson's disease remain a major unmet need. Walking speed could represent a simple, integrated tool to assess DBS efficacy but is often not examined systematically or quantitatively during DBS programming. Here we investigate the reliability and functional significance of changes in gait by directional DBS in the subthalamic nucleus.Methods: Nineteen patients underwent unilateral subthalamic nucleus DBS surgery with an eight-contact directional lead in the most (...) severely affected hemisphere. They arrived off dopaminergic medications >12 h preoperatively and for device activation 1 month after surgery. We measured a comfortable walking speed using an instrumented walkway with DBS off and at each of 10 stimulation configurations at the midpoint of the therapeutic window. Repeated measures of ANOVA contrasted preoperative vs. maximum and minimum walking speeds across DBS configurations during device activation. Intraclass correlation coefficients examined walking speed reliability across the four trials within each DBS configuration. We also investigated whether changes in walking speed related to modification of step length vs. cadence with a one-sample t-test.Results: Mean comfortable walking speed improved significantly with DBS on vs. both DBS off and minimum speeds with DBS on. Pairwise comparisons showed no significant difference between DBS off and minimum comfortable walking speed with DBS on. Intraclass correlations were ≥0.949 within each condition. Changes in comfortable walk speed were conferred primarily by changes in step length.Conclusion: Acute assessment of walking speed is a reliable, clinically meaningful measure of gait function during DBS activation. Directional and circular unilateral subthalamic DBS in appropriate configurations elicit acute and clinically significant improvements in gait dysfunction related to PD. Next-generation directional DBS technologies have significant potential to enhance gait by individually tailoring stimulation parameters to optimize efficacy. (shrink)
Radius is parameter to circles. Mathematical modeling contributes best to sociological theory through parameterizing. Parameters form a seam linking quantitative and qualitative panels of theory. All social construction comes through feedback, and modeling its outcomes requires use of parameters.
Data platforms represent a new paradigm for carrying out health research. In the platform model, datasets are pooled for remote access and analysis, so novel insights for developing better stratified and/or personalised medicine approaches can be derived from their integration. If the integration of diverse datasets enables development of more accurate risk indicators, prognostic factors, or better treatments and interventions, this obviates the need for the sharing and reuse of data; and a platform-based approach is an appropriate model for facilitating (...) this. Platform-based approaches thus require new thinking about consent. Here we defend an approach to meeting this challenge within the data platform model, grounded in: the notion of ‘reasonable expectations’ for the reuse of data; Waldron’s account of ‘integrity’ as a heuristic for managing disagreement about the ethical permissibility of the approach; and the element of the social contract that emphasises the importance of public engagement in embedding new norms of research consistent with changing technological realities. While a social contract approach may sound appealing, however, it is incoherent in the context at hand. We defend a way forward guided by that part of the social contract which requires public approval for the proposal and argue that we have moral reasons to endorse a wider presumption of data reuse. However, we show that the relationship in question is not recognisably contractual and that the social contract approach is therefore misleading in this context. We conclude stating four requirements on which the legitimacy of our proposal rests. (shrink)
The great German theorist Niklas Luhmann argued long ago that meaning is the central construct of sociology. We agree, but our scheme of stochastic processes—evolved over many years as identity and control—argues for switchings of intercalated bits of social network and interpretive domain as the core of meaning processes. We thus challenge Luhmann's central claim that modern society's subsystems are based on communicative self-closure. We assert that there is refuting evidence from sociolinguistics, from how languages are put together and how (...) languages' indexical and reflexive devices are used in social action. Communication is about managing indexicalities, which entail great ambiguity and openness as they are anchored in myriad netdom switchings across social times and spreads. In contrast, Luhmann's concept of communication revolves around binary codes governed recursively and algorithmically within systems in efforts to reduce complexity from the environment. We conclude that systems closure does not solve the problem of uncertainty in social life. In fact, lack of uncertainty is itself a problem. Order is necessary, but order at the edge of chaos. (shrink)
This paper argues that the notion of value has been overly simplified and narrowed to focus on economic returns. Stakeholder theory provides an appropriate lens for considering a more complex perspective of the value that stakeholders seek as well as new ways to measure it. We develop a four-factor perspective for defining value that includes, but extends beyond, the economic value stakeholders seek. To highlight its distinctiveness, we compare this perspective to three other popular performance perspectives. Recommendations are made regarding (...) performance measurement for both academic researchers and practitioners. The stakeholder perspective on value offered in this paper draws attention to those factors that are most closely associated with building more value for stakeholders, and in so doing, allows academics to better measure it and enhances managerial ability to create it. (shrink)
Stakeholder theory focuses on how more value is created if stakeholder relationships are governed by ethical principles such as integrity, respect, fairness, generosity and inclusiveness. However, it has not adequately addressed strategies that stakeholders perceive as harmful to their interests and how this perception can even lead some stakeholders to view the firm’s strategies as unethical. To fill the void, this paper directly addresses strategies that stakeholders perceive as harmful to their interests, or what we refer to as harmful stakeholder (...) strategies. Specifically, it identifies factors associated with stakeholder perceptions of harm that are likely to cause them to consider a strategy unethical, examines the negative implications for firms that pursue such strategies in terms of likely stakeholder responses and damage to stakeholder relationships, and provides theory to help explain how firms are likely to respond to stakeholder claims that a strategy is unethical, based on factors such as the strategic importance of the claim to the firm, how long the strategy has been in use, the costs of remediation, the risk of stakeholder mobilization or new regulation, and whether firms can reasonably rationalize their actions. Assessing harm allows a firm to make a more accurate estimate of the costs of a strategy and can assist managers in allocating resources intended to reduce or remediate harm. (shrink)
It has long been disputed whether Kant's transcendental idealism requires two worlds ? one of appearances and one of things in themselves ? or only one. The one-world view must be wrong if it claims that individual spatio-temporal things can be identified with particular things in themselves, and if it fails to take seriously the doctrine of double affection; versions that insist on one world, without making claims about the identity of individual things, cannot say in what way the world (...) as we know it and the world of things in themselves can be ?the same?. The two-world view must be wrong if it denies Kant's empirical realism, or offers a phenomenalist interpretation of it. On moral grounds Kant ?identifies? each human person with a particular thing in itself, but the relationship here cannot be strict identity; instead its closeness may warrant regarding the two distinct entities as part of a composite whole. Perhaps up to the first edition of the Critique, Kant thought that empirical knowledge required a particular kind of close correspondence between appearances and things in themselves, one that would make it appropriate to speak of composite wholes here also. By the time of the second edition, he saw that there could be no good grounds for thinking that. In this respect something a bit like the one-world theory might make more sense for the first edition than for the second; but in both cases there is room to speak of two worlds as well. Talk of the number of worlds is metaphorical, and both metaphors have their dangers. (shrink)