Functional lesional neurosurgery for tremor - a protocol for a systematic review and meta-analysis

Introduction: The recent introduction of incision-less lesional neurosurgery using Gamma Knife and MRI-guided focused ultrasound has revived interest in lesional treatment options for tremor disorders. Preliminary literature researches reveal that the consistency of treatment effects after lesional neurosurgery for tremor has not formally been assessed yet. Similarly, the efficacy of different targets for lesional treatment and incidence of persistent side effects of lesional neurosurgical interventions has not been comprehensively assessed. This work therefore aims to describe a suitable process how to review the existing literature on efficacy and persistent side effects of lesional neurosurgical treatment for tremor due to Parkinson’s disease, essential tremor, multiple sclerosis and midbrain/rubral tremor. Methods and analysis: We will search electronic databases (Medline, Cochrane) and reference lists of included articles for studies reporting lesional interventions for tremor in cohorts homogeneous for tremor aetiology and intervention (technique and target). We will include cohorts with a minimum number of five subjects and follow-up of 2 months. One investigator will perform the initial literature search and two investigators then independently decide which references to include for final efficacy and safety analysis. After settling of disagreement, data will be extracted from articles using a standardised template. We will perform a random-effect meta-analysis calculating standardised mean differences (Hedge’s g) for comparison in Forest plots and subgroup analysis after assessment of heterogeneity using I2 statistics. Ethics and dissemination: This study will summarise the available evidence on the efficacy of lesional interventions for the most frequent tremor disorders, as well as for the incidence rate of persisting side effects after unilateral lesional treatment. This data will be useful to guide future work on incision-less lesional interventions for tremor. Systematic review registration: This study has been registered with the PROSPERO database (no. CRD42016048049)

Spectral weight transfer in a disorder-broadened Landau level

In the absence of disorder, the degeneracy of a Landau level (LL) is $N=BA/\phi_0$, where $B$ is the magnetic field, $A$ is the area of the sample and $\phi_0=h/e$ is the magnetic flux quantum. With disorder, localized states appear at the top and bottom of the broadened LL, while states in the center of the LL (the critical region) remain delocalized. This well-known phenomenology is sufficient to explain most aspects of the Integer Quantum Hall Effect (IQHE) [1]. One unnoticed issue is where the new states appear as the magnetic field is increased. Here we demonstrate that they appear predominantly inside the critical region. This leads to a certain ``spectral ordering'' of the localized states that explains the stripes observed in measurements of the local inverse compressibility [2-3], of two-terminal conductance [4], and of Hall and longitudinal resistances [5] without invoking interactions as done in previous work [6-8].Comment: 5 pages 3 figure

Static behaviour of two-tiered Dou-Gong system reinforced by super-elastic alloy

Dou-Gong system in Asian timber structures play an important role in resisting seismic action. Traditional carpentry in Asia uses timber pegs to connect components which enables relative movement between components, and hence provide friction to dissipate energy in an earthquake. This method however has some short falls such as inadequate stiffness to resist large lateral force and therefore the structures tend to exhibit permanent deformation after the earthquakes. This study proposes a new technique by using super-elastic alloy bars to replace the conventional wooden peg connections to enhance the seismic performance of the structures. Static push-over experiments were conducted on full scaled two-tiered Dou-Gong systems and the high-strength steel and conventional wood pegs as benchmarks. The ultimate stiffness of Dou-Gong system has shown increase by using both high-strength steel and super-elastic alloy bars, but only super-elastic alloy can provide a consistent high damping ratio. This technique also involves pre-strain the super-elastic alloy and the outcomes of this series of experiments have shown that pre-strain in the super-elastic alloy can significantly increase the damping ratio in the structure and hence more energy is dissipated. The results of this paper can be used in the projects of timber structures with Dou-Gong system

On the Alexandrov Topology of sub-Lorentzian Manifolds

It is commonly known that in Riemannian and sub-Riemannian Geometry, the metric tensor on a manifold defines a distance function. In Lorentzian Geometry, instead of a distance function it provides causal relations and the Lorentzian time-separation function. Both lead to the definition of the Alexandrov topology, which is linked to the property of strong causality of a space-time. We studied three possible ways to define the Alexandrov topology on sub-Lorentzian manifolds, which usually give different topologies, but agree in the Lorentzian case. We investigated their relationships to each other and the manifold's original topology and their link to causality.Comment: 20 page

Measuring decision quality: psychometric evaluation of a new instrument for breast cancer chemotherapy

Background: Women diagnosed with early stage (I or II) breast cancer face a highly challenging decision – whether or not to undergo adjuvant chemotherapy. We developed a decision quality instrument for chemotherapy for early stage breast cancer and sought to evaluate its performance. Methods: Cross-sectional, mailed survey of recent breast cancer survivors, providers, and healthy controls and a retest survey of survivors. The decision quality instrument includes questions on knowledge and personal goals. It results in a knowledge score and concordance score, which reflects the percentage of patients who received treatments that match their goals. Hypotheses related to acceptability, feasibility, validity, and reliability of the survey instrument were examined. Results: Responses were received from 352 patients, 89 providers and 35 healthy controls. The decision quality instrument was feasible to implement with few missing data. The knowledge scores had good retest reliability (intraclass correlation coefficient (ICC) =0.75). Knowledge scores discriminated between providers and patients (mean difference 31.1%, 95% CI 26.9, 35.3) and between patients and healthy controls (mean difference 11.2, 95% CI 5.4, 17.1). Most providers reported that the knowledge items covered essential content. Two of the five goal items had a ceiling effect, and one goal had low content validity. The goal items had moderate retest reliability (ICC’s 0.57 to 0.78). In the multivariable model of treatment, none of the patient goals was associated with receipt of chemotherapy. Age and hormone receptor status were the only variables independently associated with chemotherapy. Most patients (77.6%) had treatment concordant with that predicted by the model. Patients who had concordant treatment had similar levels of confidence and regret as those who did not. Conclusions: The Decision Quality Instrument is a reliable and valid measure of patient knowledge about chemotherapy, but its ability to measure concordance with patient goals is limited. In this sample, patient goals were not associated with treatment, and most patients reported they were not asked their preference, suggesting that goals were not adequately considered in decision making

Modeling and Validating Chronic Pharmacological Manipulation of Circadian Rhythms

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/110096/1/psp4201334-sup-0010.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/110096/2/psp4201334-sup-0009.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/110096/3/psp4201334-sup-0011.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/110096/4/psp4201334-sup-0008.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/110096/5/psp4201334-sup-0005.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/110096/6/psp4201334-sup-0012.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/110096/7/psp4201334-sup-0006.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/110096/8/psp4201334-sup-0013.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/110096/9/psp4201334.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/110096/10/psp4201334-sup-0007.pd

Functional lesional neurosurgery for tremor: back to the future?

For nearly a century, functional neurosurgery has been applied in the treatment of tremor. While deep brain stimulation has been in the focus of academic interest in recent years, the establishment of incisionless technology, such as MRI-guided high-intensity focused ultrasound, has again stirred interest in lesional approaches.In this article, we will discuss the historical development of surgical technique and targets, as well as the technological state-of-the-art of conventional and incisionless interventions for tremor due to Parkinson's disease, essential and dystonic tremor and tremor related to multiple sclerosis (MS) and midbrain lesions. We will also summarise technique-inherent advantages of each technology and compare their lesion characteristics. From this, we identify gaps in the current literature and derive future directions for functional lesional neurosurgery, in particularly potential trial designs, alternative targets and the unsolved problem of bilateral lesional treatment. The results of a systematic review and meta-analysis of the consistency, efficacy and side effect rate of lesional treatments for tremor are presented separately alongside this article

Learn Piano with BACh: An Adaptive Learning Interface that Adjusts Task Difficulty based on Brain State

We present Brain Automated Chorales (BACh), an adaptive brain-computer system that dynamically increases the levels of difficulty in a musical learning task based on pianists\u27 cognitive workload measured by functional near-infrared spectroscopy. As users\u27 cognitive workload fell below a certain threshold, suggesting that they had mastered the material and could handle more cognitive information, BACh automatically increased the difficulty of the learning task. We found that learners played with significantly increased accuracy and speed in the brain-based adaptive task compared to our control condition. Participant feedback indicated that they felt they learned better with BACh and they liked the timings of the level changes. The underlying premise of BACh can be applied to learning situations where a task can be broken down into increasing levels of difficulty

Deep level defect in Si-implanted GaN n +-p junction

The results of deep level transient spectroscopy (DLTS) experiments on GaN junctions, fabricated by silicon implantation, were discussed. An unusual appearance of a minority peak in the majority carrier DLTS spectra within the interfacial region of the junctions was observed. The presence of this minority peak suggested a high concentration of a deep level defect within the interfacial region.published_or_final_versio

On the equivalence between some kinds of implicit and explicit iterations with applications

Author name used in this publication: HW Joseph LeeVersion of RecordPublishe