Investigating the mechanism of action of Deep Brain Stimulation using functional magnetic resonance imaging

Depleted of dopamine, the dynamics of the Parkinsonian brain impact on both “action” and “resting” motor behaviour. Subthalamic nucleus deep brain stimulation (STN DBS) has become an established means of managing these symptoms, although its mechanisms of action remain unclear. Functional magnetic resonance imaging (fMRI) using the blood oxygen level dependent (BOLD) contrast provides the opportunity to study the human brain in vivo, collecting indirect measures of neural activity across the whole brain. To date, technical difficulties and safety concerns have precluded the use of fMRI in DBS patients. Previous work from this department has demonstrated that scanning patients with certain DBS systems and MRI equipment is both safe and feasible. This thesis explores the neuromodulatory actions of STN DBS on both action and resting motor behaviours in patients with Parkinson’s disease (PD) using fMRI. In brief, I present two fMRI studies conducted on STN DBS patients, one task-based, and one resting, collected under a previously approved protocol. I then present experiments exploring the safety of scanning DBS patients using an improved protocol, and then detail two further experiments collected under this new protocol, again one task-based, and one resting. Specifically, I employ statistical parametric mapping to determine DBS-induced changes in motor evoked responses. Using dynamic causal modelling (DCM) and Bayesian model selection, I compare generative models of cortico-subcortical interactions to explain the observed data, inferring which connections DBS may be affecting, and which modulations predict efficacy. I proceed to use stochastic DCM to model the modulatory effects of DBS on endogenous (resting-state) dynamics. Abstract | 4 4 This work casts DBS in terms of modulating effective connectivity within the cortico-basal ganglia motor loops. I discuss how this may explain its current usage in PD, as well as exploratory uses to treat other pathological brain states

Accounting for centre-effects in multicentre trials with a binary outcome - when, why, and how?

BACKGROUND: It is often desirable to account for centre-effects in the analysis of multicentre randomised trials, however it is unclear which analysis methods are best in trials with a binary outcome. METHODS: We compared the performance of four methods of analysis (fixed-effects models, random-effects models, generalised estimating equations (GEE), and Mantel-Haenszel) using a re-analysis of a previously reported randomised trial (MIST2) and a large simulation study. RESULTS: The re-analysis of MIST2 found that fixed-effects and Mantel-Haenszel led to many patients being dropped from the analysis due to over-stratification (up to 69% dropped for Mantel-Haenszel, and up to 33% dropped for fixed-effects). Conversely, random-effects and GEE included all patients in the analysis, however GEE did not reach convergence. Estimated treatment effects and p-values were highly variable across different analysis methods. The simulation study found that most methods of analysis performed well with a small number of centres. With a large number of centres, fixed-effects led to biased estimates and inflated type I error rates in many situations, and Mantel-Haenszel lost power compared to other analysis methods in some situations. Conversely, both random-effects and GEE gave nominal type I error rates and good power across all scenarios, and were usually as good as or better than either fixed-effects or Mantel-Haenszel. However, this was only true for GEEs with non-robust standard errors (SEs); using a robust ‘sandwich’ estimator led to inflated type I error rates across most scenarios. CONCLUSIONS: With a small number of centres, we recommend the use of fixed-effects, random-effects, or GEE with non-robust SEs. Random-effects and GEE with non-robust SEs should be used with a moderate or large number of centres

A comparison of methods to adjust for continuous covariates in the analysis of randomised trials

BACKGROUND: Although covariate adjustment in the analysis of randomised trials can be beneficial, adjustment for continuous covariates is complicated by the fact that the association between covariate and outcome must be specified. Misspecification of this association can lead to reduced power, and potentially incorrect conclusions regarding treatment efficacy. METHODS: We compared several methods of adjustment to determine which is best when the association between covariate and outcome is unknown. We assessed (a) dichotomisation or categorisation; (b) assuming a linear association with outcome; (c) using fractional polynomials with one (FP1) or two (FP2) polynomial terms; and (d) using restricted cubic splines with 3 or 5 knots. We evaluated each method using simulation and through a re-analysis of trial datasets. RESULTS: Methods which kept covariates as continuous typically had higher power than methods which used categorisation. Dichotomisation, categorisation, and assuming a linear association all led to large reductions in power when the true association was non-linear. FP2 models and restricted cubic splines with 3 or 5 knots performed best overall. CONCLUSIONS: For the analysis of randomised trials we recommend (1) adjusting for continuous covariates even if their association with outcome is unknown; (2) keeping covariates as continuous; and (3) using fractional polynomials with two polynomial terms or restricted cubic splines with 3 to 5 knots when a linear association is in doubt

The Detection and Policing of Gun Crime: Challenges to the Effective Policing of Gun Crime in Europe

Despite a shared understanding across the EU that access to firearms by the general public should be restricted, detailed legislation regarding the ownership, use and trade of firearms varies between EU member states. It is unclear however, how such variations impact on the policing of gun enabled crime. By using qualitative data generated from interviews with police, policy and decision makers from thirteen European countries, the authors of this article aim to determine how stakeholders perceive that national variations in firearms legislation impact on the policing of gun enabled crime within and across EU countries. Four main themes were identified from the qualitative data: disparities in Legislation, disparities in Priority given and the Resources allocated to investigations into gun enabled crime as well as Interventions. Due to the aforementioned disparities, cross-national investigations into incidents of gun crime are at risk of remaining impaired in their effectiveness. Therefore, more legislative coherency as well as sustainable long-term interventions will be needed to successfully reduce ownership and use of firearms in the criminal world. In this context, a departure from an exclusive use of an economic model of gun crime is recommended to allow for a better understanding of the dynamics of the black gun market

Is There a Role for Adversariality in Teaching Critical Thinking?

Although there has been considerable recent debate on the topic of adversariality in argumentation, this debate has rarely found its way into work on critical thinking theory and instruction. This paper focuses on the implications of the adversariality debate for teaching critical thinking. Is there a role for adversarial argumentation in critical thinking instruction? Is there a way to incorporate the benefits of adversarial argumentation while mitigating the problems

Postdictive Modulation of Visual Orientation

The present study investigated how visual orientation is modulated by subsequent orientation inputs. Observers were presented a near-vertical Gabor patch as a target, followed by a left- or right-tilted second Gabor patch as a distracter in the spatial vicinity of the target. The task of the observers was to judge whether the target was right- or left-tilted (Experiment 1) or whether the target was vertical or not (Supplementary experiment). The judgment was biased toward the orientation of the distracter (the postdictive modulation of visual orientation). The judgment bias peaked when the target and distracter were temporally separated by 100 ms, indicating a specific temporal mechanism for this phenomenon. However, when the visibility of the distracter was reduced via backward masking, the judgment bias disappeared. On the other hand, the low-visibility distracter could still cause a simultaneous orientation contrast, indicating that the distracter orientation is still processed in the visual system (Experiment 2). Our results suggest that the postdictive modulation of visual orientation stems from spatiotemporal integration of visual orientation on the basis of a slow feature matching process