Deep Brain Stimulation for Consciousness Disorders; Technical and Ethical Considerations

Disorders of Consciousness (DoC) result in profound functional impairment, adversely affecting the lives of a predominantly younger patient population. Currently, effective treatment options for those who have reached chronicity (prolonged symptom duration over 4 weeks) are extremely limited, with the majority of such cases facing life-long dependence on carers and a poor quality of life. Here we briefly review the current evidence on caseload, diagnostic and management options in the United Kingdom (UK), United States of America (USA) and the European Union (EU). We identify key differences as well as similarities in these approaches across respective healthcare systems, highlighting unmet needs in this population. We subsequently present past efforts and the most recent advances in the field of surgical modulation of consciousness through implantable neurostimulation systems. We examine the ethical dilemmas that such a treatment approach may pose, proposing mediating solutions and methodological adjustments to address these concerns. Overall, we argue that there is a strong case for the utilisation of deep brain stimulation (DBS) in the DoC patient cohort. This is based on both promising results of recent clinical trials as well as technological developments. We propose a revitalization of surgical neuromodulation for DoC with a multicenter, multidisciplinary approach and strict monitoring guidelines, in order to not only advance treatment options but also ensure the safeguarding of patients’ welfare and dignity

Balancing the Brain: Resting State Networks and Deep Brain Stimulation

Over the last three decades, large numbers of patients with otherwise treatment-resistant disorders have been helped by deep brain stimulation (DBS), yet a full scientific understanding of the underlying neural mechanisms is still missing. We have previously proposed that efficacious DBS works by restoring the balance of the brain's resting state networks. Here, we extend this proposal by reviewing how detailed investigations of the highly coherent functional and structural brain networks in health and disease (such as Parkinson's) have the potential not only to increase our understanding of fundamental brain function but of how best to modulate the balance. In particular, some of the newly identified hubs and connectors within and between resting state networks could become important new targets for DBS, including potentially in neuropsychiatric disorders. At the same time, it is of essence to consider the ethical implications of this perspective

Attention Allocation Aid for Visual Search

This paper outlines the development and testing of a novel, feedback-enabled attention allocation aid (AAAD), which uses real-time physiological data to improve human performance in a realistic sequential visual search task. Indeed, by optimizing over search duration, the aid improves efficiency, while preserving decision accuracy, as the operator identifies and classifies targets within simulated aerial imagery. Specifically, using experimental eye-tracking data and measurements about target detectability across the human visual field, we develop functional models of detection accuracy as a function of search time, number of eye movements, scan path, and image clutter. These models are then used by the AAAD in conjunction with real time eye position data to make probabilistic estimations of attained search accuracy and to recommend that the observer either move on to the next image or continue exploring the present image. An experimental evaluation in a scenario motivated from human supervisory control in surveillance missions confirms the benefits of the AAAD.Comment: To be presented at the ACM CHI conference in Denver, Colorado in May 201

Evaluation of 3D C-arm fluoroscopy versus diagnostic CT for deep brain stimulation stereotactic registration and post-operative lead localization

Introduction: DBS efficacy depends on accuracy. CT-MRI fusion is established for both stereotactic registration and electrode placement verification. The desire to streamline DBS workflows, reduce operative time, and minimize patient transfers has increased interest in portable imaging modalities such as the Medtronic O-arm® and mobile CT. However, these remain expensive and bulky. 3D C-arm fluoroscopy (3DXT) units are a smaller and less costly alternative, albeit incompatible with traditional frame-based localization and without useful soft tissue resolution. We aimed to compare fusion of 3DXT and CT with pre-operative MRI to evaluate if 3DXT-MRI fusion alone is sufficient for accurate registration and reliable targeting verification. We further assess DBS targeting accuracy using a 3DXT workflow and compare radiation dosimetry between modalities. Methods: Patients underwent robot-assisted DBS implantation using a workflow incorporating 3DXT which we describe. Two intra-operative 3DXT spins were performed for registration and accuracy verification followed by conventional CT post-operatively. Post-operative 3DXT and CT images were independently fused to the same pre-operative MRI sequence and co-ordinates generated for comparison. Registration accuracy was compared to 15 consecutive controls who underwent CT-based registration. Radial targeting accuracy was calculated and radiation dosimetry recorded. Results: Data were obtained from 29 leads in 15 consecutive patients. 3DXT registration accuracy was significantly superior to CT with mean error 0.22 ± 0.03 mm (p < 0.0001). Mean Euclidean electrode tip position variation for CT to MRI versus 3DXT to MRI fusion was 0.62 ± 0.40 mm (range 0.0 mm–1.7 mm). In comparison, direct CT to 3DXT fusion showed electrode tip Euclidean variance of 0.23 ± 0.09 mm. Mean radial targeting accuracy assessed on 3DXT was 0.97 ± 0.54 mm versus 1.15 ± 0.55 mm on CT with differences insignificant (p = 0.30). Mean patient radiation doses were around 80% lower with 3DXT versus CT (p < 0.0001). Discussion: Mobile 3D C-arm fluoroscopy can be safely incorporated into DBS workflows for both registration and lead verification. For registration, the limited field of view requires the use of frameless transient fiducials and is highly accurate. For lead position verification based on MRI co-registration, we estimate there is around a 0.4 mm discrepancy between lead position seen on 3DXT versus CT when corrected for brain shift. This is similar to that described in O-arm® or mobile CT series. For units where logistical or financial considerations preclude the acquisition of a cone beam CT or mobile CT scanner, our data support portable 3D C-arm fluoroscopy as an acceptable alternative with significantly lower radiation exposure

Teachers' classroom feedback: still trying to get it right

This article examines feedback traditionally given by teachers in schools. Such feedback tends to focus on children's acquisition and retrieval of externally prescribed knowledge which is then assessed against mandated tests. It suggests that, from a sociocultural learning perspective, feedback directed towards such objectives may limit children's social development. In this article, I draw on observation and interview data gathered from a group of 27 9- to 10-year olds in a UK primary school. These data illustrate the children's perceived need to conform to, rather than negotiate, the teacher's feedback comments. They highlight the children's sense that the teacher's feedback relates to school learning but not to their own interests. The article also includes alternative examples of feedback which draw on children's own inquiries and which relate to the social contexts within which, and for whom, they act. It concludes by suggesting that instead of looking for the right answer to the question of what makes teachers' feedback effective in our current classrooms, a more productive question might be how a negotiation can be opened up among teachers and learners themselves, about how teachers' feedback could support children's learning most appropriately

The AROC annual report: the state of rehabilitation in New Zealand in 2015

This is the fourth comprehensive annual report describing discharge episodes from subacute inpatient rehabilitation programs provided by New Zealand facilities that are members of the Australasian Rehabilitation Outcomes Centre (AROC). The inaugural report was published in 2013 and described the 2012 data; this fourth instalment describes the 2015 data. This report is the first to use the version 4 AN-SNAP classification (to be implemented in Australia in July 2016). For more information about AN-SNAP classification please refer to the AROC website: http://ahsri.uow.edu.au/aroc This report also introduces an extended times series analysis, looking at change in various rehabilitation measures over the most recent five years. The provision of rehabilitation in New Zealand continues to grow in volume, with 2015 seeing a 1.4% real increase in inpatient episodes of rehabilitation provided. The majority of that volume growth is coming from the reconditioning and orthopaedic fractures impairment groups

The potential for dietary factors to prevent or treat osteoarthritis

Osteoarthritis (OA) is a degenerative joint disease for which there are no disease-modifying drugs. It is a leading cause of disability in the UK. Increasing age and obesity are both major risk factors for OA and the health and economic burden of this disease will increase in the future. Focusing on compounds from the habitual diet that may prevent the onset or slow the progression of OA is a strategy that has been under-investigated to date. An approach that relies on dietary modification is clearly attractive in terms of risk/benefit and more likely to be implementable at the population level. However, before undertaking a full clinical trial to examine potential efficacy, detailed molecular studies are required in order to optimise the design. This review focuses on potential dietary factors that may reduce the risk or progression of OA, including micronutrients, fatty acids, flavonoids and other phytochemicals. It therefore ignores data coming from classical inflammatory arthritides and nutraceuticals such as glucosamine and chondroitin. In conclusion, diet offers a route by which the health of the joint can be protected and OA incidence or progression decreased. In a chronic disease, with risk factors increasing in the population and with no pharmaceutical cure, an understanding of this will be crucial

Global marine bacterial diversity peaks at high latitudes in winter.

Genomic approaches to characterizing bacterial communities are revealing significant differences in diversity and composition between environments. But bacterial distributions have not been mapped at a global scale. Although current community surveys are way too sparse to map global diversity patterns directly, there is now sufficient data to fit accurate models of how bacterial distributions vary across different environments and to make global scale maps from these models. We apply this approach to map the global distributions of bacteria in marine surface waters. Our spatially and temporally explicit predictions suggest that bacterial diversity peaks in temperate latitudes across the world's oceans. These global peaks are seasonal, occurring 6 months apart in the two hemispheres, in the boreal and austral winters. This pattern is quite different from the tropical, seasonally consistent diversity patterns observed for most macroorganisms. However, like other marine organisms, surface water bacteria are particularly diverse in regions of high human environmental impacts on the oceans. Our maps provide the first picture of bacterial distributions at a global scale and suggest important differences between the diversity patterns of bacteria compared with other organisms

The magnetic field environment of active region 12673 that produced the energetic particle events of September 2017

Forecasting solar energetic particles (SEPs), and identifying flare/CMEs from active regions (ARs) that will produce SEP events in advance is extremely challenging. We investigate the magnetic field environment of AR 12673, including the AR's magnetic configuration, the surrounding field configuration in the vicinity of the AR, the decay index profile, and the footpoints of Earth-connected magnetic field, around the time of four eruptive events. Two of the eruptive events are SEP-productive (2017 September 4 at 20:00~UT and September 6 at 11:56~UT), while two are not (September 4 at 18:05~UT and September 7 at 14:33~UT). We analysed a range of EUV and white-light coronagraph observations along with potential field extrapolations and find that the CMEs associated with the SEP-productive events either trigger null point reconnection that redirects flare-accelerated particles from the flare site to the Earth-connected field and/or have a significant expansion (and shock formation) into the open Earth-connected field. The rate of change of the decay index with height indicates that the region could produce a fast CME ($v >$ 1500~km~s$^{-1}$), which it did during events two and three. The AR's magnetic field environment, including sites of open magnetic field and null points along with the magnetic field connectivity and propagation direction of the CMEs play an important role in the escape and arrival of SEPs at Earth. Other SEP-productive ARs should be investigated to determine whether their magnetic field environment and CME propagation direction are significant in the escape and arrival of SEPs at Earth.Comment: Accepted in ApJ, 18 pages, 8 Figures, 2 Table

The effects of graded levels of calorie restriction : IV. Non-linear change in behavioural phenotype of mice in response to short-term calorie restriction

We would like to acknowledge the BSU staff for their invaluable help with caring for the animals. The work was supported by the UK Biotechnology and Biological Sciences Research Council BBSRC (BB/G009953/1 and BB/J020028/1).Peer reviewedPublisher PD