The human primary somatosensory cortex encodes imagined movement in the absence of sensory information

Classical systems neuroscience positions primary sensory areas as early feed-forward processing stations for refining incoming sensory information. This view may oversimplify their role given extensive bi-directional connectivity with multimodal cortical and subcortical regions. Here we show that single units in human primary somatosensory cortex encode imagined reaches in a cognitive motor task, but not other sensory–motor variables such as movement plans or imagined arm position. A population reference-frame analysis demonstrates coding relative to the cued starting hand location suggesting that imagined reaching movements are encoded relative to imagined limb position. These results imply a potential role for primary somatosensory cortex in cognitive imagery, engagement during motor production in the absence of sensation or expected sensation, and suggest that somatosensory cortex can provide control signals for future neural prosthetic systems

The human primary somatosensory cortex encodes imagined movement in the absence of sensory information

Classical systems neuroscience positions primary sensory areas as early feed-forward processing stations for refining incoming sensory information. This view may oversimplify their role given extensive bi-directional connectivity with multimodal cortical and subcortical regions. Here we show that single units in human primary somatosensory cortex encode imagined reaches in a cognitive motor task, but not other sensory–motor variables such as movement plans or imagined arm position. A population reference-frame analysis demonstrates coding relative to the cued starting hand location suggesting that imagined reaching movements are encoded relative to imagined limb position. These results imply a potential role for primary somatosensory cortex in cognitive imagery, engagement during motor production in the absence of sensation or expected sensation, and suggest that somatosensory cortex can provide control signals for future neural prosthetic systems

Emotional abuse of girls in Swaziland:Prevalence, perpetrators, risk and protective factors and health outcomes

Background: Research on emotional child abuse in sub–Saharan Africa is scarce. Few studies thus far have examined prevalence, risk and protective factors for emotional child abuse or the associations between emotional abuse and girls’ health. Methods: A nationally representative two–stage, cluster–sampled, household survey of females aged 13–24 years (n=1244) on childhood abuse victimisation was conducted. Participants completed interviewer–assisted questionnaires. Associations between emotional abuse and putative risk, and protective factors and health outcomes were analyzed using separate logistic regression models accounting for sampling design. Marginal effects of cumulative risk factors for emotional abuse victimisation were examined. Results: Lifetime prevalence of emotional abuse was 28.5% with 58.3% of these girls reporting many abusive incidents. The most common perpetrators were female (27.8%) and male (16.7%) relatives and, more rarely, biological parents. Risk factors associated with emotional abuse were frequent caregiver changes (odds ratio (OR) 1.42, 95% confidence interval (CI) 1.03–1.970, poverty (OR 1.51, 95% CI 1.12–2.03), physical abuse (OR 1.98, 95% CI 1.45–2.71) and sexual abuse (OR 2.22, 95% CI 1.57–3.10) victimisation. Being close to one’s mother was a protective factor (OR 0.88, 95% CI 0.80–0.97). Risk for emotional abuse increased from 13% with no risk factors present to 58.4% –with all four risk factors present. Health outcomes associated with emotional child abuse were suicidal ideation (OR 1.85, 95% CI 1.30–2.63) and feeling depressed (OR 1.89, 95% CI 1.31–2.71). Conclusions: Girls in Swaziland experience high levels of emotional abuse victimisation. Emotional abuse is associated with economic disadvantage, family factors, other types of abuse victimisation and poor mental health. Therefore, a holistic approach to prevention is needed, incorporating poverty reduction and programmes to improve parent– child relationships, reduce the use of harsh criticism, and change parenting social norms

The UK EndoVascular Aneurysm Repair (EVAR) randomised controlled trials: long-term follow-up and cost-effectiveness analysis.

BACKGROUND: Short-term survival benefits of endovascular aneurysm repair (EVAR) compared with open repair (OR) of intact abdominal aortic aneurysms have been shown in randomised trials, but this early survival benefit is soon lost. Survival benefit of EVAR was unclear at follow-up to 10 years. OBJECTIVE: To assess the long-term efficacy of EVAR against OR in patients deemed fit and suitable for both procedures (EVAR trial 1; EVAR-1); and against no intervention in patients unfit for OR (EVAR trial 2; EVAR-2). To appraise the long-term significance of type II endoleak and define criteria for intervention. DESIGN: Two national, multicentre randomised controlled trials: EVAR-1 and EVAR-2. SETTING: Patients were recruited from 37 hospitals in the UK between 1 September 1999 and 31 August 2004. PARTICIPANTS: Men and women aged ≥ 60 years with an aneurysm of ≥ 5.5 cm (as identified by computed tomography scanning), anatomically suitable and fit for OR were randomly assigned 1 : 1 to either EVAR (n = 626) or OR (n = 626) in EVAR-1 using computer-generated sequences at the trial hub. Patients considered unfit were randomly assigned to EVAR (n = 197) or no intervention (n = 207) in EVAR-2. There was no blinding. INTERVENTIONS: EVAR, OR or no intervention. MAIN OUTCOME MEASURES: The primary end points were total and aneurysm-related mortality until mid-2015 for both trials. Secondary outcomes for EVAR-1 were reinterventions, costs and cost-effectiveness. RESULTS: In EVAR-1, over a mean of 12.7 years (standard deviation 1.5 years; maximum 15.8 years), we recorded 9.3 deaths per 100 person-years in the EVAR group and 8.9 deaths per 100 person-years in the OR group [adjusted hazard ratio (HR) 1.11, 95% confidence interval (CI) 0.97 to 1.27;p = 0.14]. At 0-6 months after randomisation, patients in the EVAR group had a lower mortality (adjusted HR 0.61, 95% CI 0.37 to 1.02 for total mortality; HR 0.47, 95% CI 0.23 to 0.93 for aneurysm-related mortality;p = 0.031), but beyond 8 years of follow-up patients in the OR group had a significantly lower mortality (adjusted HR 1.25, 95% CI 1.00 to 1.56,p = 0.048 for total mortality; HR 5.82, 95% CI 1.64 to 20.65,p = 0.0064 for aneurysm-related mortality). The increased aneurysm-related mortality in the EVAR group after 8 years was mainly attributable to secondary aneurysm sac rupture, with increased cancer mortality also observed in the EVAR group. Overall, aneurysm reintervention rates were higher in the EVAR group than in the OR group, 4.1 and 1.7 per 100 person-years, respectively (p < 0.001), with reinterventions occurring throughout follow-up. The mean difference in costs over 14 years was £3798 (95% CI £2338 to £5258). Economic modelling based on the outcomes of the EVAR-1 trial showed that the cost per quality-adjusted life-year gained over the patient's lifetime exceeds conventional thresholds used in the UK. In EVAR-2, patients died at the same rate in both groups, but there was suggestion of lower aneurysm mortality in those who actually underwent EVAR. Type II endoleak itself is not associated with a higher rate of mortality. LIMITATIONS: Devices used were implanted between 1999 and 2004. Newer devices might have better results. Later follow-up imaging declined, particularly for OR patients. Methodology to capture reinterventions changed mainly to record linkage through the Hospital Episode Statistics administrative data set from 2009. CONCLUSIONS: EVAR has an early survival benefit but an inferior late survival benefit compared with OR, which needs to be addressed by lifelong surveillance of EVAR and reintervention if necessary. EVAR does not prolong life in patients unfit for OR. Type II endoleak alone is relatively benign. FUTURE WORK: To find easier ways to monitor sac expansion to trigger timely reintervention. TRIAL REGISTRATION: Current Controlled Trials ISRCTN55703451. FUNDING: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and the results will be published in full inHealth Technology Assessment; Vol. 22, No. 5. See the NIHR Journals Library website for further project information.Funding for this study was provided by the Health Technology Assessment programme of the National Institute for Health Research

Movement Anticipation and EEG: Implications for BCI-Contingent Robot Therapy

Brain-computer interfacing is a technology that could potentially be used to improve patient effort in robot-assisted rehabilitation therapy. For example, movement intention reduces mu (8-13 Hz) oscillation amplitude over the sensorimotor cortex, a phenomenon referred to as event-related desynchronization (ERD). In an ERD-contingent assistance paradigm, initial BCI-enhanced robotic therapy studies have used ERD as a trigger signal for providing robotic assistance to limb movement. Here we investigated how ERD changed as a function of audio-visual stimuli, overt movement from the participant, and robotic assistance. Eight unimpaired subjects played a musical computer game designed for rehabilitation therapy using the FINGER robotic exoskeleton. In the game, the participant and robot matched finger movement timing to audiovisual stimuli in the form of notes approaching a target on the screen set to the consistent beat of popular music. The audiovisual stimulation of the game alone did not cause ERD, before or after training. In contrast, overt movement by the subject caused ERD, whether or not the robot assisted the finger movement. Notably, ERD was also present when the subjects remained passive and the robot imposed movement. This ERD occurred in anticipation of the passive finger movement with similar onset timing as for the overt movement conditions. These results demonstrate that ERD can be contingent on expectation of robotic assistance; that is, the brain generates an anticipatory ERD in expectation of a robot-imposed but predictable movement. This is a caveat that should be considered in designing BCI interfaces for enhancing patient effort in robotically-assisted therapy

Procedural Justice in the Context of Civil Commitment: A Critique of Tyler\u27s Analysis

This article is a critique of T. R. Tyler\u27s 1992 review of procedural justice and its effect on therapeutic outcome in patients involved in civil commitment hearings. The article clarifies critical elements of Tyler\u27s analysis by drawing on the social cognition construct of information control and elements in the consumerism literature that may mirror and facilitate procedural justice effects. The importance of the committing psychiatrist\u27s role during the commitment hearing is emphasized and issues unique to civil commitment respondents that might affect their susceptibility to procedural justice effects are highlighted. Further research examining the effects of judges\u27, attorneys\u27, and psychiatrists\u27 behavior on the patient\u27s perception of procedural justice and subsequent therapeutic outcome is suggested

Seeding, Evolutionary Growth, and Reseeding: Constructing, Capturing, and Evolving Knowledge in DomainOriented Design Environments

We live in a world characterized by evolution -- that is, by ongoing processes of development, formation, and growth in both natural and human-created systems. Biology tells us that complex, natural systems are not created all at once but must instead evolve over time. We are becoming increasingly aware that evolutionary processes are ubiquitous and critical for technological innovations as well. This is particularly true for complex software systems because these systems do not necessarily exist in a technological context alone but instead are embedded within dynamic human organizations. The Center for LifeLong Learning and Design (L 3 D) at the University of Colorado has been involved in research on software design and other design domains for more than a decade. We understand software design as an evolutionary process in which system requirements and functionality are determined through an iterative process of collaboration among multiple stakeholders, rather than being completel..