Optimizing microsurgical skills with EEG neurofeedback

Background By enabling individuals to self-regulate their brainwave activity in the field of optimal performance in healthy individuals, neurofeedback has been found to improve cognitive and artistic performance. Here we assessed whether two distinct EEG neurofeedback protocols could develop surgical skill, given the important role this skill plays in medicine. Results National Health Service trainee ophthalmic microsurgeons (N = 20) were randomly assigned to either Sensory Motor Rhythm-Theta (SMR) or Alpha-Theta (AT) groups, a randomized subset of which were also part of a wait-list 'no-treatment' control group (N = 8). Neurofeedback groups received eight 30-minute sessions of EEG training. Pre-post assessment included a skills lab surgical procedure with timed measures and expert ratings from video-recordings by consultant surgeons, together with state/trait anxiety self-reports. SMR training demonstrated advantages absent in the control group, with improvements in surgical skill according to 1) the expert ratings: overall technique (d = 0.6, p < 0.03) and suture task (d = 0.9, p < 0.02) (judges' intraclass correlation coefficient = 0.85); and 2) with overall time on task (d = 0.5, p = 0.02), while everyday anxiety (trait) decreased (d = 0.5, p < 0.02). Importantly the decrease in surgical task time was strongly associated with SMR EEG training changes (p < 0.01), especially with continued reduction of theta (4–7 Hz) power. AT training produced marginal improvements in technique and overall performance time, which were accompanied by a standard error indicative of large individual differences. Notwithstanding, successful within session elevation of the theta-alpha ratio correlated positively with improvements in overall technique (r = 0.64, p = 0.047). Conclusion SMR-Theta neurofeedback training provided significant improvement in surgical technique whilst considerably reducing time on task by 26%. There was also evidence that AT training marginally reduced total surgery time, despite suboptimal training efficacies. Overall, the data set provides encouraging evidence of optimised learning of a complex medical specialty via neurofeedback training

The Soft-Collinear Bootstrap: N=4 Yang-Mills Amplitudes at Six and Seven Loops

Infrared divergences in scattering amplitudes arise when a loop momentum $\ell$ becomes collinear with a massless external momentum $p$. In gauge theories, it is known that the L-loop logarithm of a planar amplitude has much softer infrared singularities than the L-loop amplitude itself. We argue that planar amplitudes in N=4 super-Yang-Mills theory enjoy softer than expected behavior as $\ell \parallel p$ already at the level of the integrand. Moreover, we conjecture that the four-point integrand can be uniquely determined, to any loop-order, by imposing the correct soft-behavior of the logarithm together with dual conformal invariance and dihedral symmetry. We use these simple criteria to determine explicit formulae for the four-point integrand through seven-loops, finding perfect agreement with previously known results through five-loops. As an input to this calculation we enumerate all four-point dual conformally invariant (DCI) integrands through seven-loops, an analysis which is aided by several graph-theoretic theorems we prove about general DCI integrands at arbitrary loop-order. The six- and seven-loop amplitudes receive non-zero contributions from 229 and 1873 individual DCI diagrams respectively.Comment: 27 pages, 48 figures, detailed results including PDF and Mathematica files available at http://goo.gl/qIKe8 v2: minor corrections v3: figure 7 corrected, Lemma 2 remove

System Dynamics to Model the Unintended Consequences of Denying Payment for Venous Thromboembolism after Total Knee Arthroplasty

Background: The Hospital Acquired Condition Strategy (HACS) denies payment for venous thromboembolism (VTE) after total knee arthroplasty (TKA). The intention is to reduce complications and associated costs, while improving the quality of care by mandating VTE prophylaxis. We applied a system dynamics model to estimate the impact of HACS on VTE rates, and potential unintended consequences such as increased rates of bleeding and infection and decreased access for patients who might benefit from TKA. Methods and Findings: The system dynamics model uses a series of patient stocks including the number needing TKA, deemed ineligible, receiving TKA, and harmed due to surgical complication. The flow of patients between stocks is determined by a series of causal elements such as rates of exclusion, surgery and complications. The number of patients harmed due to VTE, bleeding or exclusion were modeled by year by comparing patient stocks that results in scenarios with and without HACS. The percentage of TKA patients experiencing VTE decreased approximately 3-fold with HACS. This decrease in VTE was offset by an increased rate of bleeding and infection. Moreover, results from the model suggest HACS could exclude 1.5% or half a million patients who might benefit from knee replacement through 2020. Conclusion: System dynamics modeling indicates HACS will have the intended consequence of reducing VTE rates. However, an unintended consequence of the policy might be increased potential harm resulting from over administration of prophylaxis, as well as exclusion of a large population of patients who might benefit from TKA

Eikonal methods applied to gravitational scattering amplitudes

We apply factorization and eikonal methods from gauge theories to scattering amplitudes in gravity. We hypothesize that these amplitudes factor into an IR-divergent soft function and an IR-finite hard function, with the former given by the expectation value of a product of gravitational Wilson line operators. Using this approach, we show that the IR-divergent part of the n-graviton scattering amplitude is given by the exponential of the one-loop IR divergence, as originally discovered by Weinberg, with no additional subleading IR-divergent contributions in dimensional regularization.Comment: 16 pages, 3 figures; v2: title change and minor rewording (published version); v3: typos corrected in eqs.(3.2),(4.1

Dualities for Loop Amplitudes of N=6 Chern-Simons Matter Theory

In this paper we study the one- and two-loop corrections to the four-point amplitude of N=6 Chern-Simons matter theory. Using generalized unitarity methods we express the one- and two-loop amplitudes in terms of dual-conformal integrals. Explicit integration by using dimensional reduction gives vanishing one-loop result as expected, while the two-loop result is non-vanishing and matches with the Wilson loop computation. Furthermore, the two-loop correction takes the same form as the one-loop correction to the four-point amplitude of N=4 super Yang-Mills. We discuss possible higher loop extensions of this correspondence between the two theories. As a side result, we extend the method of dimensional reduction for three dimensions to five dimensions where dual conformal symmetry is most manifest, demonstrating significant simplification to the computation of integrals.Comment: 32 pages and 6 figures. v2: minus sign corrections, ref updated v3: Published versio

A Brain-Computer Interface Based Attention Training Program for Treating Attention Deficit Hyperactivity Disorder

10.1371/journal.pone.0046692PLoS ONE710

Generating All Tree Amplitudes in N=4 SYM by Inverse Soft Limit

The idea of adding particles to construct amplitudes has been utilized in various ways in exploring the structure of scattering amplitudes. This idea is often called Inverse Soft Limit, namely it is the reverse mechanism of taking particles to be soft. We apply the Inverse Soft Limit to the tree-level amplitudes in $\mathcal{N}=4$ super Yang-Mills theory, which allows us to generate full tree-level superamplitudes by adding "soft" particles in a certain way. With the help from Britto-Cachazo-Feng-Witten recursion relations, a systematic and concrete way of adding particles is determined recursively. The amplitudes constructed solely by adding particles not only have manifest Yangian symmetry, but also make the soft limit transparent. The method of generating amplitudes by Inverse Soft Limit can also be generalized for constructing form factors.Comment: 33 pages, 10 figures. v2: figures corrected, JHEP versio

Complex Calculations: How Drug Use During Pregnancy Becomes a Barrier to Prenatal Care

Pregnant women who use drugs are more likely to receive little or no prenatal care. This study sought to understand how drug use and factors associated with drug use influence women’s prenatal care use. A total of 20 semi-structured interviews and 2 focus groups were conducted with a racially/ethnically diverse sample of low-income women using alcohol and drugs in a California county. Women using drugs attend and avoid prenatal care for reasons not connected to their drug use: concern for the health of their baby, social support, and extrinsic barriers such as health insurance and transportation. Drug use itself is a barrier for a few women. In addition to drug use, women experience multiple simultaneous risk factors. Both the drug use and the multiple simultaneous risk factors make resolving extrinsic barriers more difficult. Women also fear the effects of drug use on their baby’s health and fear being reported to Child Protective Services, each of which influence women’s prenatal care use. Increasing the number of pregnant women who use drugs who receive prenatal care requires systems-level rather than only individual-level changes. These changes require a paradigm shift to viewing drug use in context of the person and society and acceptance of responsibility for unintended consequences of public health bureaucratic procedures and messages about effects of drug use during pregnancy

Self-Regulation of Amygdala Activation Using Real-Time fMRI Neurofeedback

Real-time functional magnetic resonance imaging (rtfMRI) with neurofeedback allows investigation of human brain neuroplastic changes that arise as subjects learn to modulate neurophysiological function using real-time feedback regarding their own hemodynamic responses to stimuli. We investigated the feasibility of training healthy humans to self-regulate the hemodynamic activity of the amygdala, which plays major roles in emotional processing. Participants in the experimental group were provided with ongoing information about the blood oxygen level dependent (BOLD) activity in the left amygdala (LA) and were instructed to raise the BOLD rtfMRI signal by contemplating positive autobiographical memories. A control group was assigned the same task but was instead provided with sham feedback from the left horizontal segment of the intraparietal sulcus (HIPS) region. In the LA, we found a significant BOLD signal increase due to rtfMRI neurofeedback training in the experimental group versus the control group. This effect persisted during the Transfer run without neurofeedback. For the individual subjects in the experimental group the training effect on the LA BOLD activity correlated inversely with scores on the Difficulty Identifying Feelings subscale of the Toronto Alexithymia Scale. The whole brain data analysis revealed significant differences for Happy Memories versus Rest condition between the experimental and control groups. Functional connectivity analysis of the amygdala network revealed significant widespread correlations in a fronto-temporo-limbic network. Additionally, we identified six regions — right medial frontal polar cortex, bilateral dorsomedial prefrontal cortex, left anterior cingulate cortex, and bilateral superior frontal gyrus — where the functional connectivity with the LA increased significantly across the rtfMRI neurofeedback runs and the Transfer run. The findings demonstrate that healthy subjects can learn to regulate their amygdala activation using rtfMRI neurofeedback, suggesting possible applications of rtfMRI neurofeedback training in the treatment of patients with neuropsychiatric disorders