Multi-sensory feedback improves spatially compatible sensori-motor responses

To interact with machines, from computers to cars, we need to monitor multiple sensory stimuli, and respond to them with specific motor actions. It has been shown that our ability to react to a sensory stimulus is dependent on both the stimulus modality, as well as the spatial compatibility of the stimulus and the required response. However, the compatibility effects have been examined for sensory modalities individually, and rarely for scenarios requiring individuals to choose from multiple actions. Here, we compared response time of participants when they had to choose one of several spatially distinct, but compatible, responses to visual, tactile or simultaneous visual and tactile stimuli. We observed that the presence of both tactile and visual stimuli consistently improved the response time relative to when either stimulus was presented alone. While we did not observe a difference in response times of visual and tactile stimuli, the spatial stimulus localization was observed to be faster for visual stimuli compared to tactile stimuli.

Serum biomarkers associated with radiographic skeletal maturity indicators: A systematic review and meta-analysis

Objective:

To evaluate the relevant scientific literature to determine the association between different serum biomarker levels and radiographic skeletal maturity indicators.

Data Search, Screening and Eligibility:

A literature search was carried out on PubMed, Cochrane Library, Google Scholar, Semantic Scholar, Science Direct and Opengrey.eu up to November 2021 and 7466 records were retrieved via the electronic search. Study selection, data extraction and subsequent risk of bias assessment (RoB) was carried out independently by two authors. In case of any discrepancy, a third author was consulted.

Results:

After the exclusion of duplicates and the application of inclusion exclusion criteria, 19 studies (published in 25 articles) were included in the systematic review out of which 17 had a cross-sectional and two had a cohort study design. For the meta-analysis, based on the homogeneity, five cross-sectional studies measuring serum IGF-1 levels were incorporated. The meta-analysis revealed that the serum IGF-1 levels peak at the CS4 stage (401.77 ng/mL [333.50 – 470.05]) in the pooled group. However, in the subgroup analysis, it was found that the serum IGF-1 levels peak at CS3 in women (422.82 ng/mL [377.46–468.18]) and CS4 in men (487.04 ng/mL [391.83–582.25]).

Conclusion:

Among the various biomarkers evaluated, serum IGF-1 was the most associated with different stages of radiographic skeletal maturity indicators with its levels peaking at CS3 in women and CS4 in men.

STUDY OF EFFECTIVENESS OF SHELTERING FROM RADIATION EXPOSURE DUE TO ACCIDENTAL RELEASE OF RADIOACTIVITY

Sheltering is one of the important protective actions as a part of emergency response during the early phases of an accident-mostly precautionary in nature. Sheltering via structural shielding reduces the direct exposure from plume/cloud shine and ground shine doses as well as the airborne radioactivity concentration and hence inhalation dose. The present study was aimed at estimating the shielding factor in the case of Indian houses for external exposure pathways using the FLUKA Monte Carlo based radiation transport code. Furthermore, the dose reduction factor due to exposure from the inhalation pathway was estimated using an indoor aerosol model. These factors were assessed for the three major types of dwellings, and they provided important inputs for decision-making for sheltering or evacuation in case of any sudden release of radionuclides into the environment.

Biomechanical effects of Skeletally anchored Class III elastics on the maxillofacial complex: a 3D finite element analysis

Background

Although, the outcomes and changes in the maxillofacial complex after the application of intraoral bone anchored Class III elastics, have been reported by multiple clinical studies, there was no finite element study to assess and evaluate the stress pattern and displacement on maxillomandibular complex with bimaxillary anchorage. The present study aims to evaluate the biomechanical effects on maxillomandibular complex of Skeletally anchored Class III elastics with varying angulations using the 3D finite element analysis.

Methodology

Two 3-dimensional analytical models were developed using the Mimics 8.11 (Materialise: Leuven, Belgium) and ANSYS software Version 12.1 (ANSYS Inc, Canonsburg, PA, USA) from sequential computed tomography images taken from a Skeletal Class III subject. The models were meshed into 465,091 tetrahedral elements and 101,247 nodes. Intraoral mechanics for skeletally anchored maxillary protraction (I-SAMP) were applied on two models i.e. A and B (without and with maxillary expansion respectively) between miniplates on maxilla and mandible on both right and left sides with three different angulations of forces—10°, 20° and 30°).

Results

Although the craniomaxillary complex in both the models (A and B) displaced forward while demonstrating rotations in opposite directions, the displacements and rotations decreased gradually with the increase of the angle of load application from 10° to 30°. The mandible rotated clockwise in both the simulations, but the displacement of mandibular surface landmarks was higher in Simulation A. However, the antero-inferior displacement of the glenoid fossa was higher in Simulation B than in A.

Conclusion

Significant displacement of maxillofacial sutures and structures was witnessed with I-SAMP with maxillary expansion and Class III elastics for correction of Skeletal Class III with maxillary retrognathism. Thus, I-SAMP with maxillary expansion is a desired protocol for treatment of maxillary retrognathism. However, the prescribed angulation of the Class III elastics should be as low as possible to maximise the desired effects.

Effect of fixed functional appliances on pharyngeal airway dimensions in Skeletal Class II individuals - A scoping review

BACKGROUND

Skeletal Class II malocclusion due to a retrognathic mandible produces a backwardly positioned tongue and soft palate, emanating compromised upper airway dimensions and breathing difficulties.

AIMS

The present review aims to explore and concise the findings of the existing studies assessing the effects of fixed functional appliances on pharyngeal airway dimensions by advancing the mandible.

DESIGN

A literature search was carried out on MEDLINE/PubMed, Cochrane Library, Science direct, Semantic Scholar and Google Scholar databases for studies up to December 2020, resulting in 1037 studies. Specified inclusion/exclusion criteria guided the selection of 18 relevant articles. The sample size, type of the appliance, method of assessment and outcomes of these articles were assessed in detail and tabulated.

RESULTS

Out of 18 studies included, 12 were retrospective longitudinal and the remaining were clinical trials. Majority of the studies (72%) reported a positive influence of the fixed functional appliances on the dimensions of the oropharyngeal and hypopharyngeal airways with minimal effects on nasopharyngeal airway.

CONCLUSION

Thus, it can be concluded that fixed functional appliances have a beneficial effect on the middle and lower pharyngeal airway dimensions by advancing the mandible.

Effect of fixed mechanotherapy on psychosocial impact of malocclusion using PIDAQ in the Indian population - A follow up study

Background

The presence of malocclusion in an individual not only distresses the oral form and function but also has a significant impact on the psychological and social well-being of an individual. Adoption of a patient centered approach during the correction of malocclusion serves to benefit both the individual and the orthodontic fraternity, as it aims to improve the function, aesthetics and subsequently, the overall quality of life.

Materials and methods

In this study, the psychosocial impact of malocclusion was evaluated on 93 patients using the IOTN (Index of Orthodontic Treatment Needs) and the PIDAQ (Psychosocial impact of dental aesthetics questionnaire) indices. The questionnaires were paired accordingly and statistically analysed. Association of the age and gender with the psychosocial impact of malocclusion was also assessed.

Results

Mean total and the individual component scores of the PIDAQ were assessed pre and post treatment and a significant reduction in the scores was observed. The IOTN-AC (IOTN - Aesthetic Component) scores also improved drastically with treatment. However, no statistically significant association of age, education level or socioeconomic class with the psychosocial impact of malocclusion was observed.

Conclusion

The significant improvement in the mean PIDAQ and IOTN-AC scores obtained after completion of fixed orthodontic treatment, indicate the high initial psychosocial impact of malocclusion which significantly reduced with treatment, accenting the role of orthodontics in improving the overall psychological and social well-being of an individual.

Determination of calibration matrix for HPGe-based in vivo monitoring system for estimation of 241Am in lungs and liver

The detection of internal contamination may be carried out by direct or indirect methods. The lung counting technique using an array of High Purity Germanium (HPGe) detectors is one of such direct detection methods. It is known from the literature that the estimation of activity by organ counting can lead to erroneous results if an amount of activity is possessed by an adjacent organ. In the case of HPGe-based lung monitoring, the estimation could be misleading if the activity is possessed by the liver, which is a proximal organ. In such cases the measured activity should be modified using cross-talk coefficients which account for the contribution from adjacent organs. The determination of cross-talk coefficients for ²⁴¹Am was carried out by placing the detectors over inactive lungs of an Lawrence Livermore National Laboratory phantom when the source activity was contained in the liver and vice versa. A calibration matrix was formulated with calibration coefficients as diagonal elements and cross-talk coefficients as off-diagonal elements. The measured activities may be modified by matrix multiplication with the inverse of the calibration matrix to nullify the contribution from adjacent organs. The current work has empirically determined the fitting equations which relate calibration and cross-talk coefficients for lungs and liver measurement geometries with muscle-equivalent chest wall thickness (MEQ-CWT) values. The values of these coefficients were determined for an average MEQ-CWT of 1.77 cm for lungs and 1.33 cm for liver. The calculations showed that the activity contribution from liver to lungs was 29% higher than that of lungs to liver. A verification exercise was conducted to demonstrate this method. For the given calibration source, the percent overestimation was reduced for lung activity, while the liver activity was slightly underestimated. In the case of old exposure follow-up monitoring cases, the ²⁴¹Am activity built up in liver could interfere with the lung monitoring results and this method using the calibration matrix may be used for estimation of more accurate results.

Addressing Stillbirth in India Must Include Men

BACKGROUND

Millennium Development Goal 4, to reduce child mortality, can only be achieved by reducing stillbirths globally. A confluence of medical and sociocultural factors contribute to the high stillbirth rates in India. The psychosocial aftermath of stillbirth is a well-documented public health problem, though less is known of the experience for men, particularly outside of the Western context. Therefore, men's perceptions and knowledge regarding reproductive health, as well as maternal-child health are important.

METHODS

Key informant interviews (n = 5) were analyzed and 28 structured interviews were conducted using a survey based on qualitative themes.

RESULTS

Qualitative themes included men's dual burden and right to medical and reproductive decision making power. Wives were discouraged from expressing grief and pushed to conceive again. If not successful, particularly if a son was not conceived, a second wife was considered a solution. Quantitative data revealed that men with a history of stillbirths had greater anxiety and depression, perceived less social support, but had more egalitarian views towards women than men without stillbirth experience. At the same time fathers of stillbirths were more likely to be emotionally or physically abusive. Predictors of mental health, attitudes towards women, and perceived support are discussed.

CONCLUSIONS

Patriarchal societal values, son preference, deficient women's autonomy, and sex-selective abortion perpetuate the risk for future poor infant outcomes, including stillbirth, and compounds the already higher risk of stillbirth for males. Grief interventions should explore and take into account men's perceptions, attitudes, and behaviors towards reproductive decision making.

Point-of-care testing in India: missed opportunities to realize the true potential of point-of-care testing programs

BACKGROUND

The core objective of any point-of-care (POC) testing program is to ensure that testing will result in an actionable management decision (e.g. referral, confirmatory test, treatment), within the same clinical encounter (e.g. POC continuum). This can but does not have to involve rapid tests. Most studies on POC testing focus on one specific test and disease in a particular healthcare setting. This paper describes the actors, technologies and practices involved in diagnosing major diseases in five Indian settings - the home, community, clinics, peripheral laboratories and hospitals. The aim was to understand how tests are used and fit into the health system and with what implications for the POC continuum.

METHODS

The paper reports on a qualitative study including 78 semi-structured interviews and 13 focus group discussions with doctors, nurses, patients, lab technicians, program officers and informal providers, conducted between January and June 2013 in rural and urban Karnataka, South India. Actors, diseases, tests and diagnostic processes were mapped for each of the five settings and analyzed with regard to whether and how POC continuums are being ensured.

RESULTS

Successful POC testing hardly occurs in any of the five settings. In hospitals and public clinics, most of the rapid tests are used in laboratories where either the single patient encounter advantage is not realized or the rapidity is compromised. Lab-based testing in a context of manpower and equipment shortages leads to delays. In smaller peripheral laboratories and private clinics with shorter turn-around-times, rapid tests are unavailable or too costly. Here providers find alternative measures to ensure the POC continuum. In the home setting, patients who can afford a test are not/do not feel empowered to use those devices.

CONCLUSION

These results show that there is much diagnostic delay that deters the POC continuum. Existing rapid tests are currently not translated into treatment decisions rapidly or are not available where they could ensure shorter turn-around times, thus undermining their full potential. To ensure the success of POC testing programs, test developers, decision-makers and funders need to account for such ground realities and overcome barriers to POC testing programs.

Barriers to Point-of-Care Testing in India: Results from Qualitative Research across Different Settings, Users and Major Diseases

BACKGROUND

Successful point-of-care testing, namely ensuring the completion of the test and treat cycle in the same encounter, has immense potential to reduce diagnostic and treatment delays, and impact patient outcomes. However, having rapid tests is not enough, as many barriers may prevent their successful implementation in point-of-care testing programs. Qualitative research on diagnostic practices may help identify such barriers across different points of care in health systems.

METHODS

In this exploratory qualitative study, we conducted 78 semi-structured interviews and 13 focus group discussions in an urban and rural area of Karnataka, India, with healthcare providers (doctors, nurses, specialists, traditional healers, and informal providers), patients, community health workers, test manufacturers, laboratory technicians, program managers and policy-makers. Participants were purposively sampled to represent settings of hospitals, peripheral labs, clinics, communities and homes, in both the public and private sectors.

RESULTS

In the Indian context, the onus is on the patient to ensure successful point-of-care testing across homes, clinics, labs and hospitals, amidst uncoordinated providers with divergent and often competing practices, in settings lacking material, money and human resources. We identified three overarching themes affecting point-of-care testing: the main theme is 'relationships' among providers and between providers and patients, influenced by the cross-cutting theme of 'infrastructure'. Challenges with both result in 'modified practices' often favouring empirical (symptomatic) treatment over treatment guided by testing.

CONCLUSIONS

Even if tests can be conducted on the spot and infrastructure challenges have been resolved, relationships among providers and between patients and providers are crucial for successful point-of-care testing. Furthermore, these barriers do not act in isolation, but are interlinked and need to be examined as such. Also, a test alone has only limited power to overcome those difficulties. Test developers, policy-makers, healthcare providers and funders need to use these insights in overcoming barriers to point-of-care testing programs.

Immediate tool incorporation processes determine human motor planning with tools

Human dexterity with tools is believed to stem from our ability to incorporate and use tools as parts of our body. However tool incorporation, evident as extensions in our body representation and peri-personal space, has been observed predominantly after extended tool exposures and does not explain our immediate motor behaviours when we change tools. Here we utilize two novel experiments to elucidate the presence of additional immediate tool incorporation effects that determine motor planning with tools. Interestingly, tools were observed to immediately induce a trial-by-trial, tool length dependent shortening of the perceived limb lengths, opposite to observations of elongations after extended tool use. Our results thus exhibit that tools induce a dual effect on our body representation; an immediate shortening that critically affects motor planning with a new tool, and the slow elongation, probably a consequence of skill related changes in sensory-motor mappings with the repeated use of the tool.

Feeling the force: returning haptic signals influence effort inference during motor coordination

Our brain is known to automatically optimize effort expenditure during motor coordination, such that for example, during bimanual braking of a bicycle, a well-oiled brake will automatically be used more than a corroded, heavy brake. But how does our brain infer the effort expenditure? All previous motor coordination models have believed that the effort in a task is known precisely to our brain, solely from the motor commands it generates. Here we show that this belief is incorrect. Through experiments and simulation we exhibit that in addition to the motor commands, the returning haptic signals play a crucial role in the inference of the effort during a force sharing task. Our results thus elucidate a previously unknown sensory-motor association that has major ramifications for our understanding of motor coordination and provides new insights into how sensory modifications due to ergonomics, stroke and disease can affect motor coordination in humans.

Two is better than one: physical interactions improve motor performance in humans

How do physical interactions with others change our own motor behavior? Utilizing a novel motor learning paradigm in which the hands of two - individuals are physically connected without their conscious awareness, we investigated how the interaction forces from a partner adapt the motor behavior in physically interacting humans. We observed the motor adaptations during physical interactions to be mutually beneficial such that both the worse and better of the interacting partners improve motor performance during and after interactive practice. We show that these benefits cannot be explained by multi-sensory integration by an individual, but require physical interaction with a reactive partner. Furthermore, the benefits are determined by both the interacting partner's performance and similarity of the partner's behavior to one's own. Our results demonstrate the fundamental neural processes underlying human physical interactions and suggest advantages of interactive paradigms for sport-training and physical rehabilitation.

[Not Available]

Laparoscopic donor nephrectomy is a routine practice but still requires an intense level of attention to prevent complications. We report a rare case of gross hematuria in postoperative period after an uneventful laparoscopic donor nephrectomy.

N-[(1E)-5-(3-Chlorophenyl)-3-methylcyclohex-2-en-1-ylidene]hydroxylamine

The whole of the title mol­ecule, C₁₃H₁₄ClNO, is disordered over two sets of sites with a refined occupancy ratio of 0.560 (6):0.440 (6). The oxime group having a C=N double bond adopts an E conformation. The dihedral angles between the rings (all atoms) are 89.5 (5) (major componenent) and 88.0 (6)° (minor component).

rac-Methyl (1R,3'S)-1',1''-dimethyl-2,2''-dioxo-2H-dispiro-[acenaphthyl-ene-1,2'-pyrrolidine-3',3''-indoline]-4'-carboxyl-ate

In the title compound, C₂₆H₂₂N₂O₄, the pyrrolidine ring adopts a twisted conformation and the other five-membered rings adopt envelope conformations with the spiro C atoms as the flap atoms. The naphthalene ring system of the dihydro­acenaphthyl­ene group forms dihedral angles of 89.2 (9) and 75.5 (6)° with the pyrrolidine and indole rings, respectively. The pyrrolidine ring makes a dihedral angle of 80.1 (9)° with the indole ring. In the crystal, mol­ecules are linked by weak C—H⋯O hydrogen bonds, forming chains along the b-axis direction.

A triclinic polymorph of methyl (3R,3'S)-1',1''-dimethyl-2,2''-dioxodispiro-[indoline-3,2'-pyrrolidine-3',3''-indoline]-4'-carboxyl-ate

In the title compound, C₂₂H₂₁N₃O₄, the central pyrrolidine ring adopts a C-envelope conformation with a C atom 0.6593 (13) Å displaced from the mean plane formed by the remaining ring atoms. The indoline ring systems (r.m.s. devisations of 0.0356 and 0.0547 Å) are almost perpendicular to the mean plane of the pyrrolidine ring, making dihedral angles of 89.7 (6) and 82.5 (6)°. The acetate group attached to the pyrrolidine ring assumes an extended conformation. In the crystal,N—H⋯O and C—H⋯O hydrogen bonds connect adjacent molecules, forming an infinite tape extending along [1-1-1]. The crystal packing is further consolidated by strong π–π inter­actions with a centroid–centroid distance of 3.2585 (8) Å. The title compound is a polymorph of previously reported monoclinic structure [Ganesh et al. (2012 ▶). Acta Cryst. E68, o2902–o2903].

(3,4-Dimethoxyphenyl)[2-(thiophen-2-ylcarbonyl)phenyl]methanone

In the title compound, C₂₀H₁₆O₄S, the thiophene ring makes dihedral angles of 72.9 (2) and 60.5 (2)°, respectively, with the dimethoxy benzene and phenyl rings. In the crystal, C—H⋯O hydrogen bonds link the mol­ecules into a C(9) chain along the b axis. The S and C atoms of the thio­phene ring are disordered over two sets of sites [site occupancies = 0.675 (3) and 0.325 (3)]. A short inter­molecular S⋯O contact [3.084 (2) Å] is observed in the crystal structure, which also features C—H⋯π inter­actions.

Methyl (3S,3'R)-1-methyl-2,2''-dioxo-1',2',3',5',6',7',8',8a'-octa-hydro-dispiro-[indoline-3,2'-indolizine-3',3''-indoline]-1'-carboxyl-ate

In the title compound, C(25)H(25)N(3)O(4), the central pyrrolidine ring and the two pyrrolidine rings adopt twisted conformations, whereas the piperidine ring in the octa-hydro-indolizine fused ring system adopts a chair conformation. The indoline ring systems are almost perpendicular with respect to the mean plane of the octa-hydro-indolizine ring system, making dihedral angles of 84.4 (5) and 79.4 (5)°. The acetate group attached to the octa-hydro-indolizine ring system assumes an extended conformation. In the crystal, N-H⋯O hydrogen bonds result in the formation of a helical C(7) chain running parallel to [101]. The crystal packing features C-H⋯O hydrogen bonds and C-H⋯π inter-actions.

(2-Benzoyl-phen-yl)(naphthalen-1-yl)methanone

In the title compound, C(24)H(16)O(2), the naphthalene ring system makes dihedral angles of 78.5 (6) and 65.5 (7)° with the terminal and central benzene rings, respectively. The dihedral angle between the benzene rings is 74.5 (8)°. In the crystal, neighbouring molecules are interlinked through two C-H⋯π interactions, which construct a two-dimensional supramolecular framework extending infinitely along (010).

Methyl (3R*,3'S*)-1',1''-dimethyl-2,2''-dioxodispiro-[indoline-3,2'-pyrrolidine-3',3''-indoline]-4'-carboxyl-ate

In the title compound, C₂₂H₂₁N₃O₄, the central pyrrolidine ring adopts an envelope conformation with the N atom in the flap position. The indoline ring systems are almost perpendic­ular to the mean plane of the pyrrolidine ring, making dihedral angles of 86.4 (8) and 83.1 (8)°. The acetate group attached to the pyrrolidine ring assumes an extended conformation. In thecrystal, N—H⋯O hydrogen bonds result in the formation of a C(7) chain running along [100]. The crystal packing also features π–π inter­actions [centroid–centroid distance = 3.2032 (11) Å].

Methyl (E)-2-({2-[(E)-(hy-droxy-imino)-meth-yl]phen-oxy}meth-yl)-3-(4-methyl-phen-yl)acrylate

In the title compound, C(19)H(19)NO(4), the dihedral angle between the mean planes through the benzene rings is 82.18 (7)°. The C=N double bond is trans-configured. The mol-ecules are linked into centrosymmetric dimers via pairs of O-H⋯N hydrogen bonds with the motif R(2) (2)(6). The crystal packing also features C-H⋯O inter-actions. The methyl group attached to one of the aromatic rings is disordered over two almost equally occupied positions [occpancy ratio = 0.51 (4):0.49 (4)].

(E)-Methyl 2-({2-eth-oxy-6-[(E)-(hy-droxy-imino)-meth-yl]phen-oxy}meth-yl)-3-phenyl-acrylate

In the title compound, C₂₀H₂₁NO₅, the dihedral angle between the mean planes through the two rings is 47.1 (8)°. The enoate group assumes an extended conformation. The hy­droxy­ethanimine group is essentially coplanar with the benzene ring, the largest deviation from the mean plane being 0.061 (1) Å for the O atom. In the crystal, mol­ecules are linked into cyclic centrosymmetric dimers with an R₂²(6) motif via pairs of O—H⋯N hydrogen bonds. Inter­molecular C—H⋯O hydrogen bonds form a C(8) chain along the b axis. The crystal packing is further stabilized by C—H⋯π inter­actions.

Classification of strategies for disturbance attenuation in human-human collaborative tasks

Rigorous analyses of the mechanisms human-human physical interaction are only possible if corresponding means of systematically classifying dyad strategies are in place. Previous suggestions for classification of strategies neglect the high level of redundancy that is present when attenuation of external disturbances is required. To address this, we propose a quantitative classification system based on combined interaction force and EMG recordings of the flexion and extension activities of each partner in a given dyad.

Effect of Grip Force and Training in Unstable Dynamics on Micromanipulation Accuracy

This paper investigates whether haptic error amplification using unstable dynamics can be used to train accuracy in micromanipulation. A preliminary experiment first examines the possible confounds of visual magnification and grip force. Results show that micromanipulation precision is not affected by grip force in both naive and experienced subjects. On the other hand, precision is increased by visual magnification of up to 10×, but not further for larger magnifications. The main experiment required subjects to perform small-range point-to-point movements in 3D space in an unstable environment which amplified position errors to the straight line between start and end point. After having trained in this environment, subjects performing in the free conditions show an increase in success rate and a decrease in error and its standard deviation relative to the control subjects. This suggests that this technique can improve accuracy and reliability of movements during micromanipulation.

Model-based attenuation of movement artifacts in fMRI

Behavioral analysis of multi-joint arm reaching has allowed important advances in understanding the control of voluntary movements. Complementing this analysis with functional magnetic resonance imaging (fMRI) would give insight into the neural mechanisms behind this control. However, fMRI is very sensitive to artifacts created by head motion and magnetic field deformation caused by the moving limbs. It is thus necessary to attenuate these motion artifacts in order to obtain correct activation patterns. Most algorithms in literature were designed for slow changes of head position over several brain scans and are not very effective on data when the movement is of duration below the resolution of a brain scan. This paper introduces a simple model-based method to remove motion artifacts during short duration movements. The proposed algorithm can account for head movement and field deformations due to movements within and outside of the scanner's field of view. It uses information from the experimental design and subject kinematics to focus the artifact attenuation in time and space and minimize the loss of uncorrupted data. Applications of the algorithm on arm reaching experimental data obtained with blocked and event-related designs demonstrate attenuation of motion artifacts with minimal effect on the brain activations.

Reflective writing by final year medical students: lessons for curricular change

BACKGROUND

Reflective writinghas been used in undergraduate medical curricula to inculcate empathetic attitudes in medical students. Journal writing has been used to enhance reflection in a confidential space. We aimed to introduce our medical students to reflective writing of their daily experiences, both to enhance empathetic attitudes as well as to use the entries to Inform curricular changes.

METHODS

We invited 16 final year medical students posted in the Department of Medicine to record their emotional experiences during a 6-week posting. Freedom to abstain without prejudice was emphasized, yet all 16 students complied.

RESULTS

According to the principle of grounded theory, the entries were grouped into 8 themes: (i) doctor-patient relationship; (ii) personal inadequacy; (iii) empathy; (iv) communication skills; (v) doctor's competence; (vi) patient behaviour; (vii) hospital practices; and (viii) personal feelings. There were 179 entries which were evaluable under the above categories, with no significant gender differences. Based on the entries, the following curricular suggestions were made: (i) use of diaries by medical students to express their emotional reactions and make value judgements, followed by guided discussion by experienced facilitators; (ii) introduction of communication skills courses at appropriate points to enhance Interview skills, empathetic listening, conflict resolution and breaking bad news; (iii) encourage reflection on healthcare delivery and its inequities and suggest methods of dealing with individual patients; and (iv) use of positive feedback and encouragement by faculty. Conclusions. Reflective journal writing by medical students in India gives valuable insights into improving communication skills and professionalism. Appropriate curricular changes should be made to meet the challenges posed by the existing healthcare system.

Motor memory and local minimization of error and effort, not global optimization, determine motor behavior

Many real life tasks that require impedance control to minimize motion error are characterized by multiple solutions where the task can be performed either by co-contracting muscle groups, which requires a large effort, or, conversely, by relaxing muscles. However, human motor optimization studies have focused on tasks that are always satisfied by increasing impedance and that are characterized by a single error-effort optimum. To investigate motor optimization in the presence of multiple solutions and hence optima, we introduce a novel paradigm that enables us to let subjects repetitively (but inconspicuously) use different solutions and observe how exploration of multiple solutions affect their motor behavior. The results show that the behavior is largely influenced by motor memory with subjects tending to involuntarily repeat a recent suboptimal task-satisfying solution even after sufficient experience of the optimal solution. This suggests that the CNS does not optimize co-activation tasks globally but determines the motor behavior in a tradeoff of motor memory, error, and effort minimization.

Cyclohexane-1,2,3,4,5-pentol

In the title compound, C₆H₁₂O₅, the cyclo­hexane ring adopts a chair conformation. The absolute configuration is not defined. However, the relative configuration can be assigned as 1R*,3R*,4S*,S*. In the crystal structure, mol­ecules are linked by strong inter­molecular O—H⋯O hydrogen bonds, producing a three-dimensional network.

(E,E)-1,5-Di-2-thienylpenta-1,4-dien-3-one

In the title compound, C(13)H(10)OS(2), the dihedral angle between the thio-phene rings is 14.3 (1)°. The mol-ecular structure is stabilized by C-H⋯π inter-actions between a thio-phene H atom and an adjacent thio-phene ring, and by inter-molecular C-H⋯O hydrogen bonds.

9-Ethyl-2,3-dihydro-9H-carbazol-4(1H)-one

In the title compound, C₂₈H₃₀N₂O₂, the cyclo­hexene ring system adopts a sofa conformation. The crystal structure is stabilized by C—H⋯O inter­actions between methyl H atoms of the ethyl substituents and the O atoms of carbonyl groups of adjacent mol­ecules, and by an inter­molecular carbon­yl–carbonyl inter­actions [3.207 (2) Å]

Neural correlates of internal-model loading

Skilled object manipulation requires knowledge, or internal models, of object dynamics relating applied force to motion , and our ability to handle myriad objects indicates that the brain maintains multiple models . Recent behavioral studies have shown that once learned, an internal model of an object with novel dynamics can be rapidly recruited and derecruited as the object is grasped and released . We used event-related fMRI to investigate neural activity linked to grasping an object with recently learned dynamics in preparation for moving it after a delay. Subjects also performed two control tasks in which they either moved without the object in hand or applied isometric forces to the object. In all trials, subjects received a cue indicating which task to perform in response to a go signal delivered 5-10 s later. We examined BOLD responses during the interval between the cue and go and assessed the conjunction of the two contrasts formed by comparing the primary task to each control. The analysis revealed significant activity in the ipsilateral cerebellum and the contralateral and supplementary motor areas. We propose that these regions are involved in internal-model recruitment in preparation for movement execution.

A Haptic Interface Based on Potential Mechanical Energy to Investigate Human Motor Control using fMRI

This paper describes a mechanical interface to use in conjunction with fMRI, in order to infer the brain mechanisms of human motor learning. Innovative mechanical concepts based on gravity and elastic forces were used to generate typical stable and unstable dynamic interactions at the hand during multijoint arm movements. Two designs were retained and implemented from MR compatible materials. The first uses a spring constrained between two specially designed surfaces and the other a capstan to transform the force induced by a groove carved on a shaft. These two degree-of-freedom mechanical interfaces have been constructed and tested. The use of a capstan mechanism was found to be limited by excessive friction, however, the method using a machined surface provides a simple and effective interface to investigate human motor control.

Multi-joint arm movements to investigate motor control with FMRI

Performing multi-joint arm movements in controllable dynamic environments during functional magnetic resonance imaging (fMRI) could provide important insights into the brain mechanisms involved in human motor control and related dysfunctions. In order to obtain useful data, these movements must be possible and comfortable for the subject within the narrow bore of the scanner and should not create any movement artifacts in the image. We found that commonly studied arm movements involving the shoulder create movement artifacts, and investigated alternative multijoint arm movements within a mock-up of an MR scanner. We selected movements involving the elbow and wrist joints, with an extension attached to the hand, and propose a dedicated kinematic structure using the MR compatible actuators we have previously developed.

Accurate Real-Time Feedback of Surface EMG During fMRI

Real-time acquisition of EMG during functional MRI (fMRI) provides a novel method of controlling motor experiments in the scanner using feedback of EMG. Because of the redundancy in the human muscle system, this is not possible from recordings of joint torque and kinematics alone, because these provide no information about individual muscle activation. This is particularly critical during brain imaging because brain activations are not only related to joint torques and kinematics but are also related to individual muscle activation. However, EMG collected during imaging is corrupted by large artifacts induced by the varying magnetic fields and radio frequency (RF) pulses in the scanner. Methods proposed in literature for artifact removal are complex, computationally expensive, and difficult to implement for real-time noise removal. We describe an acquisition system and algorithm that enables real-time acquisition for the first time. The algorithm removes particular frequencies from the EMG spectrum in which the noise is concentrated. Although this decreases the power content of the EMG, this method provides excellent estimates of EMG with good resolution. Comparisons show that the cleaned EMG obtained with the algorithm is, like actual EMG, very well correlated with joint torque and can thus be used for real-time visual feedback during functional studies.

Shock Wave Lithotripsy in Solitary Functioning Kidneys: Is Prophylactic Stenting Necessary?

OBJECTIVE

To assess the safety of shock wave lithotripsy (SWL) without prophylactic stents in solitary functioning kidneys.

PATIENTS AND METHODS

Sixteen solitary functioning kidneys with 23 renal stones with a size of <15 mm were treated with SWL as the primary modality. All patients were counseled about the possibility of obstruction, and treatment was offered to those who consented. The safety of SWL was assessed by the need for interventions and the posttreatment renal function.

RESULTS

In 14 patients lithotripsy was uneventful. The duration of treatment ranged from 5 to 35 days. One patient with a 15-mm pelvic calculus presented with anuria which resolved before intervention. In 1 patient fragmentation failed, and percutaneous nephrolithotomy was performed.

CONCLUSIONS

In solitary functioning kidneys, SWL is safe without prophylactic stents in properly selected and closely monitored patients. Avoiding stents decreases costs, duration of treatment, and stent-related morbidity without unduly compromising safety.

Corpora cavernositis caused byActinomycetes

We present the case of a 58-year-old diabetic who developed corpora cavernositis following drainage of a perianal abscess. To our knowledge this is the first such case caused by Actinomycetes, which spread from the perianal abscess by direct extension through Buck's fascia, which was probably breached during drainage of the abscess.

Rapid staining of proteins on polyacrylamide gels and nitrocellulose membranes using a mixture of fluorescent dyes

The present work describes a novel, fluorescence-based method for staining proteins on SDS-PAGE and membrane(s). In this method, proteins are stained using a mixed-dye (sulfo-rhodamine B and 1-anilino-8-naphthalene sulfonic acid (NH(4)(+))) solution. The mixed-dye staining protocol can detect proteins up to a concentration of 15 ng. This method is generally applicable to all proteins and is more sensitive than the conventional Coomassie blue method. The staining method is rapid and efficient. Staining-destaining of proteins using the mixed-dye protocol takes less than half an hour. Another interesting feature of the staining protocol described here is the applicability to the staining of proteins on nitrocellulose membranes.

Proline inhibits aggregation during protein refolding

The in vitro refolding of hen egg-white lysozyme is studied in the presence of various osmolytes. Proline is found to prevent aggregation during protein refolding. However, other osmolytes used in this study fail to exhibit a similar property. Experimental evidence suggests that proline inhibits protein aggregation by binding to folding intermediate(s) and trapping the folding intermediate(s) into enzymatically inactive, "aggregation-insensitive" state(s). However, elimination of proline from the refolded protein mixture results in significant recovery of the bacteriolytic activity. At higher concentrations (>1.5 M), proline is shown to form loose, higher-order molecular aggregate(s). The supramolecular assembly of proline is found to possess an amphipathic character. Formation of higher-order aggregates is believed to be crucial for proline to function as a protein folding aid. In addition to its role in osmoregulation under water stress conditions, the results of this study hint at the possibility of proline behaving as a protein folding chaperone.

The dyad gene is required for progression through female meiosis in Arabidopsis

In higher plants the gametophyte consists of a gamete in association with a small number of haploid cells, specialized for sexual reproduction. The female gametophyte or embryo sac, is contained within the ovule and develops from a single cell, the megaspore which is formed by meiosis of the megaspore mother cell. The dyad mutant of Arabidopsis, described herein, represents a novel class among female sterile mutants in plants. dyad ovules contain two large cells in place of an embryo sac. The two cells represent the products of a single division of the megaspore mother cell followed by an arrest in further development of the megaspore. We addressed the question of whether the division of the megaspore mother cell in the mutant was meiotic or mitotic by examining the expression of two markers that are normally expressed in the megaspore mother cell during meiosis. Our observations indicate that in dyad, the megaspore mother cell enters but fails to complete meiosis, arresting at the end of meiosis 1 in the majority of ovules. This was corroborated by a direct observation of chromosome segregation during division of the megaspore mother cell, showing that the division is a reductional and not an equational one. In a minority of dyad ovules, the megaspore mother cell does not divide. Pollen development and male fertility in the mutant is normal, as is the rest of the ovule that surrounds the female gametophyte. The embryo sac is also shown to have an influence on the nucellus in wild type. The dyad mutation therefore specifically affects a function that is required in the female germ cell precursor for meiosis. The identification and analysis of mutants specifically affecting female meiosis is an initial step in understanding the molecular mechanisms underlying early events in the pathway of female reproductive development.