Losing control: the hidden role of motor areas in decision-making

Decision-making has traditionally been viewed as detached from the neural systems of sensory perception and motor function. Consequently, motor areas have played a relatively minor role in discussions surrounding the control processes and neural origins of decision-making. Empiric evidence, catalysed by technological advances in the past two decades, has proven that motor areas have an integral role in decision-making. They are involved in the generation, modulation, maintenance and execution of decisions and actions. They also take part in a complex hierarchical assessment of multi-modal inputs to ensure that the most appropriate action is generated given the context presented. Clinical conditions such as, alien hand syndrome and utilisation behaviour exemplify the importance of these regulatory controls. This review charts the trajectory of our understanding of the hidden role of motor areas in decision-making and reflects upon the implications of our deepened understanding. The convergence of evidence from multiple modalities underpinning our current knowledge is discussed and the potential applications thereof considered

A comprehensive description of the competencies required for the performance of an ultrasound-guided axillary brachial plexus blockade

We addressed four research questions, each relating to the training and assessment of the competencies associated with the performance of ultrasound-guided axillary brachial plexus blockade (USgABPB). These were: (i) What are the most important determinants of learning of USgABPB? (ii) What is USgABPB? What are the errors most likely to occur when trainees learn to perform this procedure? (iii) How should end-user input be applied to the development of a novel USgABPB simulator? (iv) Does structured simulation based training influence novice learning of the procedure positively? We demonstrated that the most important determinants of learning USgABPB are: (a) Access to a formal structured training programme. (b) Frequent exposure to clinical learning opportunity in an appropriate setting (c) A clinical learning opporunity requires an appropriate patient, trainee and teacher being present at the same time, in an appropriate environment. We carried out a comprehensive description of the procedure. We performed a formal task analysis of USgABPB, identifying (i) 256 specific tasks associated with the safe and effective performance of the procedure, and (ii) the 20 most critical errors likely to occur in this setting. We described a methodology for this and collected data based on detailed, sequential evaluation of prototypes by trainees in anaesthesia. We carried out a pilot randomised control trial assessing the effectiveness of a USgABPB simulator during its development. Our data did not enable us to draw a reliable conclusion to this question; the trail did provide important new learning (as a pilot) to inform future investigation of this question. We believe that the ultimate goal of designing effective simulation-based training and assessment of ultrasound-guided regional anaesthesia is closer to realisation as a result of this work. It remains to be proven if this approach will have a positive impact on procedural performance, and more importantly improve patient outcomes

Exercise and the microbiota

The authors are supported in part by research grants from Science Foundation Ireland including a centre grant (Alimentary Pharmabiotic Centre; Grant Numbers SFI/12/RC/2273 and 12/RC/2273). Dr. Orla O’Sullivan is funded by a Starting Investigator Research Grant from Science Foundation Ireland (Grant number 13/SIRG/2160). Dr. Paul Cotter is funded by a Principal Investigator Award from Science Foundation Ireland P.D.C are supported by a SFI PI award (Grant number 11/PI/1137).peer-reviewedSedentary lifestyle is linked with poor health, most commonly obesity and associated disorders, the corollary being that exercise offers a preventive strategy. However, the scope of exercise biology extends well beyond energy expenditure and has emerged as a great ‘polypill’, which is safe, reliable and cost-effective not only in disease prevention but also treatment. Biological mechanisms by which exercise influences homeostasis are becoming clearer and involve multi-organ systemic adaptations. Most of the elements of a modern lifestyle influence the indigenous microbiota but few studies have explored the effect of increased physical activity. While dietary responses to exercise obscure the influence of exercise alone on gut microbiota, professional athletes operating at the extremes of performance provide informative data. We assessed the relationship between extreme levels of exercise, associated dietary habits and gut microbiota composition, and discuss potential mechanisms by which exercise may exert a direct or indirect influence on gut microbiota.The authors are supported in part by research grants from Science Foundation Ireland including a centre grant (Alimentary Pharmabiotic Centre; Grant Numbers SFI/12/RC/2273 and 12/RC/2273). Dr. Orla O’Sullivan is funded by a Starting Investigator Research Grant from Science Foundation Ireland (Grant number 13/SIRG/2160). Dr. Paul Cotter is funded by a Principal Investigator Award from Science Foundation Ireland P.D.C are supported by a SFI PI award (Grant number 11/PI/1137)

The effect of simulation-based training on initial performance of ultrasound-guided axillary brachial plexus blockade in a clinical setting – a pilot study

BACKGROUND: In preparing novice anesthesiologists to perform their first ultrasound-guided axillary brachial plexus blockade, we hypothesized that virtual reality simulation-based training offers an additional learning benefit over standard training. We carried out pilot testing of this hypothesis using a prospective, single blind, randomized controlled trial. METHODS: We planned to recruit 20 anesthesiologists who had no experience of performing ultrasound-guided regional anesthesia. Initial standardized training, reflecting current best available practice was provided to all participating trainees. Trainees were randomized into one of two groups; (i) to undertake additional simulation-based training or (ii) no further training. On completion of their assigned training, trainees attempted their first ultrasound-guided axillary brachial plexus blockade. Two experts, blinded to the trainees’ group allocation, assessed the performance of trainees using validated tools. RESULTS: This study was discontinued following a planned interim analysis, having recruited 10 trainees. This occurred because it became clear that the functionality of the available simulator was insufficient to meet our training requirements. There were no statistically significant difference in clinical performance, as assessed using the sum of a Global Rating Score and a checklist score, between simulation-based training [mean 32.9 (standard deviation 11.1)] and control trainees [31.5 (4.2)] (p = 0.885). CONCLUSIONS: We have described a methodology for assessing the effectiveness of a simulator, during its development, by means of a randomized controlled trial. We believe that the learning acquired will be useful if performing future trials on learning efficacy associated with simulation based training in procedural skills. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01965314. Registered October 17th 2013

Ethnicity : UK colorectal cancer screening pilot : final report

27. In summary, the overall evaluation of the UK Pilot has demonstrated that key parameters of test and programme performance observed in randomised studies of FOBt screening can be repeated in population-based pilot programmes. However, our study provides strong evidence of very low CRC screening uptake for ethnic groups in the Pilot area. This is coupled with a very low uptake of colonoscopy for individuals from ethnic groups with a positive FOBt result. 28. It has long been acknowledged that a diverse population may require diverse responses. Following the implementation of the Race Relations Amendment Act 2000, there has been a statutory duty laid upon all NHS agencies to ‘have due regard to the need to eliminate unlawful discrimination’, and to make explicit consideration of the implications for racial equality of every action or policy. 29. Because the observed overall outcomes in the UK Pilot generally compare favourably with the results of previous randomised trials of FOBt screening, the main Evaluation Group has concluded that benefits observed in the trials should be repeatable in a national roll-out. 30. However, our study indicates that any national colorectal cancer screening programme would need to very carefully consider the implications of ethnicity for roll-out, and develop a strategic plan on how best to accommodate this at both a national and local level. Based on our findings, consideration will clearly need to be given to improved access and screening service provision for ethnic minorities. 31. In order to ensure adequate CRC screening provision for a diverse UK population, and to address the explicit implications for racial equality highlighted by our findings, interventions now urgently need to be evaluated to improve access for ethnic minorities. This work should be undertaken as part of the second round of CRC screening currently underway in the English Pilot

Modelling the photopolarimetric variability of AA Tau

We present Monte Carlo scattered light models of a warped disc that reproduce the observed photopolarimetric variability of the classical T Tauri star, AA Tauri. For a system inclination of 75° and using an analytic description for a warped inner disc, we find that the shape and amplitude of the photopolarimetric variability are reproduced with a warp that occults the star, located at 0.07 au, amplitude 0.016 au, extending over radial and azimuthal ranges 0.0084 au and 145°. We also show a time sequence of high spatial resolution scattered light images, showing a dark shadow cast by the warp sweeping round the disc. Using a modified smooth particle hydrodynamics code, we find that a stellar dipole magnetic field of strength 5.2 kG, inclined at 30° to the stellar rotation axis can reproduce the required disc warping to explain the photopolarimetric variability of AA Ta

Application of Dexter’s soil physical quality index: an Irish case study

peer-reviewedHistorically, due to a lack of measured soil physical data, the quality of Irish soils was relatively unknown. Herein, we investigate the physical quality of the national representative profiles of Co. Waterford. To do this, the soil physical quality (SPQ) S-Index, as described by Dexter (2004a,b,c) using the S-theory (which seeks the inflection point of a soil water retention curve [SWRC]), is used. This can be determined using simple (S-Indirect) or complex (S-Direct) soil physical data streams. Both are achievable using existing data for the County Waterford profiles, but until now, the suitability of this S-Index for Irish soils has never been tested. Indirect-S provides a generic characterisation of SPQ for a particular soil horizon, using simplified and modelled information (e.g. texture and SWRC derived from pedo-transfer functions), whereas Direct-S provides more complex site-specific information (e.g. texture and SWRC measured in the laboratory), which relates to properties measured for that exact soil horizon. Results showed a significant correlation between S-Indirect (Si) and S-Direct (Sd). Therefore, the S-Index can be used in Irish soils and presents opportunities for the use of Si at the national scale. Outlier horizons contained >6% organic carbon (OC) and bulk density (Bd) values <1 g/cm3 and were not suitable for Si estimation. In addition, the S-Index did not perform well on excessively drained soils. Overall correlations of Si. with Bd and of Si. with OC% for the dataset were detected. Future work should extend this approach to the national scale dataset in the Irish Soil Information System.Funding was provided as part of Department of Agriculture, Food and the Marine (DAFM) Soil Quality Assessment and Research (SQUARE) Research Stimulus Fund No. 6582.Task 1 output

A Giant Metrewave Radio Telescope/Chandra view of IRAS 09104+4109: A type 2 QSO in a cooling flow

IRAS 09104+4109 is a rare example of a dust enshrouded type 2 QSO in the centre of a cool-core galaxy cluster. Previous observations of this z=0.44 system showed that as well as powering the hyper-luminous infrared emission of the cluster-central galaxy, the QSO is associated with a double-lobed radio source. However, the steep radio spectral index and misalignment between the jets and ionised optical emission suggested that the orientation of the QSO had recently changed. We use a combination of new, multi-band Giant Metrewave Radio Telescope observations and archival radio data to confirm that the jets are no longer powered by the QSO, and estimate their age to be 120-160 Myr. This is in agreement with the ~70-200 Myr age previously estimated for star-formation in the galaxy. Previously unpublished Very Long Baseline Array data reveal a 200 pc scale double radio source in the galaxy core which is more closely aligned with the current QSO axis and may represent a more recent period of jet activity. These results suggest that the realignment of the QSO, the cessation of jet activity, and the onset of rapid star-formation may have been caused by a gas-rich galaxy merger. A Chandra X-ray observation confirms the presence of cavities associated with the radio jets, and we estimate the energy required to inflate them to be ~7.7x10^60 erg. The mechanical power of the jets is sufficient to balance radiative cooling in the cluster, provided they are efficiently coupled to the intra-cluster medium (ICM). We find no evidence of direct radiative heating and conclude that the QSO either lacks the radiative luminosity to heat the ICM, or that it requires longer than 100-200 Myr to significantly impact its environment. [Abridged]Comment: 23 pages, 18 figures and 7 tables. Accepted for publication in MNRA

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