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Writer's cramp (WC) dystonia is a rare disease that causes abnormal postures during the writing task. Successful research studies for WC and other forms of dystonia are contingent on identifying sensitive and specific measures that relate to the clinical syndrome and achieve a realistic sample size to power research studies for a rare disease. Although prior studies have used writing kinematics, their diagnostic performance remains unclear.This study aimed to evaluate the diagnostic performance of automated measures that distinguish subjects with WC from healthy volunteers.A total of 21 subjects with WC and 22 healthy volunteers performed a sentence-copying assessment on a digital tablet using kinematic and hand recognition softwares. The sensitivity and specificity of automated measures were calculated using a logistic regression model. Power analysis was performed for two clinical research designs using these measures. The test and retest reliability of select automated measures was compared across repeat sentence-copying assessments. Lastly, a correlational analysis with subject- and clinician-rated outcomes was performed to understand the clinical meaning of automated measures.Of the 23 measures analyzed, the measures of word legibility and peak accelerations distinguished subjects with WC from healthy volunteers with high sensitivity and specificity and demonstrated smaller sample sizes suitable for rare disease studies, and the kinematic measures showed high reliability across repeat visits, while both word legibility and peak accelerations measures showed significant correlations with the subject- and clinician-rated outcomes.Novel automated measures that capture key aspects of the disease and are suitable for use in clinical research studies of WC dystonia were identified. © 2022 International Parkinson and Movement Disorder Society.

Deep brain stimulation (DBS) is an effective therapy in advanced Parkinson disease (PD). Although both subthalamic nucleus (STN) and globus pallidus (GP) DBS show equivalent efficacy in PD, combined stimulation may demonstrate synergism. OBJECTIVE: To evaluate the clinical benefit of stimulating a combination of STN and GP DBS leads and to demonstrate biomarker discovery for adaptive DBS therapy in an observational study. METHODS: We performed a pilot trial (n = 3) of implanting bilateral STN and GP DBS leads, connected to a bidirectional implantable pulse generator (Medtronic Summit RC + S; NCT03815656, IDE No. G180280). Initial 1-year outcome in 3 patients included Unified PD Rating Scale on and off medications, medication dosage, Hauser diary, and recorded beta frequency spectral power. RESULTS: Combined DBS improved PD symptom control, allowing >80% levodopa medication reduction. There was a greater decrease in off-medication motor Unified PD Rating Scale with multiple electrodes activated (mean difference from off stimulation off medications −18.2, range −25.5 to −12.5) than either STN (−12.8, range −20.5 to 0) or GP alone (−9, range −11.5 to −4.5). Combined DBS resulted in a greater reduction of beta oscillations in STN in 5/6 hemispheres than either site alone. Adverse events occurred in 2 patients, including a small cortical hemorrhage and seizure at 24 hours postoperatively, which resolved spontaneously, and extension wire scarring requiring revision at 2 months postoperatively. CONCLUSION: Patients with PD preferred combined DBS stimulation in this preliminary cohort. Future studies will address efficacy of adaptive DBS as we further define biomarkers and control policy.

The most important division of Paulinism that appears to be quite inexplicable from Jewish premises may for the lack of a better title be called the "redemption doctrine." Briefly stated, it is this: The world and all men in it, Jews and Gentiles alike, are in their natural state under the domination of imperfect heavenly beings, from whose power, however, Christians are delivered by Christ. As the discovery of this system in the epistles is of comparatively recent date, an investigation of it in some detail may be found profitable. Its key is in the word o-roxeia, which St. Paul uses four times, in Gal. 4:3, 9, and Col. 2:8, 20, the other occurrences of the term in the New Testament being Heb. 5:12, where it can mean only "first principles," and in II Pet. 3:10, 12, where it may be translated "elementary substances," although the exact force in this last passage is dubious. For the Pauline passages nearly all older commentaries and not a few of the more recent adopt the meaning in Hebrews, and, at first sight, this sense appears to give a very satisfactory translation. So, for instance, in Gal. 4:3, "we Jews, when we were children, were held in bondage under elementary instruction fit for children, which belongs to this world," a rendition that seems quite appropriate, especially in view of the figure of the Law as our "disciplinary guardian" (wraL6aywybs) in 3:24. But when we attempt to read this force of oTroLxEa into the next paragraph of Galatians (4:8-II) our difficulties begin. 358

(7) When ye shall hear of wars and rumors of wars, be not troubled: these things must needs come to pass; but the end is not yet. (8) For nation shall rise against nation, and kingdom against kingdom; there shall be earthquakes in divers places; there shall be famines: these things are the beginnings of travail. (14) But when ye see the abomination of desolation standing where he ought not (let him that readeth understand), then let them that are in Judea flee unto the mountains: (15) and let him that is on the housetop not go down, nor enter in, to take anything out of his house: (16) and let him that is in the field not return back to take his cloak. (17) But woe unto them that are with child and to them that give suck in those days! (18) And pray ye that it be not in the winter. (Ig) For those days shall be tribulation, such as there hath not been the like from the beginning of creation which God created until now, and never shall be. (20) And except the Lord had shortened the days, no flesh would have been saved; but for the elect's sake, whom he chose, he shortened the days. (24) But in those days, after that tribulation, the sun shall be darkened, and the moon shall not give her light, (25) and the stars shall be falling from heaven, and the powers that are in the heavens shall be shaken. (26) And then shall they see the Son of man coming in clouds with great power and glory. (27) And then shall he send forth his angels, and shall gather together his elect from the four winds, from the uttermost part of earth to the uttermost part of heaven.

to respective sources. Such sections may be said to be "interwoven." They are always a special source of interest to the student, to some degree because of the ingenuity of the processes that dissect them into their component elements, but chiefly because of the profit to be gained through a comparison of these elements after the literarycritical operations have been completed. In this comparison the narratives have a double importance, partly as authorities for the events recorded and partly as authorities for the interests that prevailed when the descriptions were written. That certain "interwoven" sections