Using a haptic dynamic clamp to reduce arousal: preference, arousal, and coordination stability are related.

We have developed a haptic dynamic clamp dedicated to the regulation of arousal. It takes the form of a vibrating stress ball to be squeezed, called Viball, controlled by Righetti's nonlinear adaptive Hopf oscillator. Participants squeezed an adaptive Viball which adapts its frequency of vibration to the current frequency of human squeezing. The adaptive Viball was compared to three non-adaptive Viballs, parametrized to vibrate at a lower, equal, or higher frequency than the participants' preferred frequency. While squeezing the ball, participants looked at stressful or calming pictures and their electrodermal activity was recorded. Using the preference paradigm, we show that participants preferred to interact with the adaptive Viball rather than with the most slowly vibrating ball that most strongly reduced arousal. The stability of the human-ball coordination was the highest with the adaptive Viball. There was also a positive correlation between the stability of coordination and arousal. The data are discussed in light of the energy-based interpretation of coordination dynamics.

Multiple Brain Sources Are Differentially Engaged in the Inhibition of Distinct Action Types.

Most studies contributing to identify the brain network for inhibitory control have investigated the cancelation of prepared-discrete actions, thus focusing on an isolated and short-lived chunk of human behavior. Aborting ongoing-continuous actions is an equally crucial ability but remains little explored. Although discrete and ongoing-continuous rhythmic actions are associated with partially overlapping yet largely distinct brain activations, it is unknown whether the inhibitory network operates similarly in both situations. Thus, distinguishing between action types constitutes a powerful means to investigate whether inhibition is a generic function. We, therefore, used independent component analysis (ICA) of EEG data and show that canceling a discrete action and aborting a rhythmic action rely on independent brain components. The ICA showed that a delta/theta power increase generically indexed inhibitory activity, whereas N2 and P3 ERP waves did so in an action-specific fashion. The action-specific components were generated by partially distinct brain sources, which indicates that the inhibitory network is engaged differently when canceling a prepared-discrete action versus aborting an ongoing-continuous action. In particular, increased activity was estimated in precentral gyri and posterior parts of the cingulate cortex for action canceling, whereas an enhanced activity was found in more frontal gyri and anterior parts of the cingulate cortex for action aborting. Overall, the present findings support the idea that inhibitory control is differentially implemented according to the type of action to revise.

Oestrus ovis external ophtalmomyiasis: a case report in Burgundy France.

BACKGROUND: External ophtalmomyiasis (EOM) is a zoonosis related to the presence of Oestrus ovis larvae at the ocular level in small ruminants (i.e. ovine, caprine). In humans, EOM is a rare cosmopolitan disorder, mostly described in warm and dry rural areas in patients living close to livestock areas. In metropolitan France (excluding Corsica), EOM is an exceptional disease with less than 25 cases recorded since 1917. CASE PRESENTATION: We report a case of EOM in a 19-years old man in the last week of September 2016 in Burgundy. CONCLUSION: The diagnosis of an EOM in Burgundy, a French region described as cold and humid, is surprising and could be due to a more marked climatic warming during the vegetative season in Burgundy resulting in the implantation of Diptera of the genus Oestrus sp. in this region.

A parsimonious oscillatory model of handwriting.

We propose an oscillatory model that is theoretically parsimonious, empirically efficient and biologically plausible. Building on Hollerbach's (Biol Cybern 39:139-156, 1981) model, our Parsimonious Oscillatory Model of Handwriting (POMH) overcomes the latter's main shortcomings by making it possible to extract its parameters from the trace itself and by reinstating symmetry between the [Formula: see text] and [Formula: see text] coordinates. The benefit is a capacity to autonomously generate a smooth continuous trace that reproduces the dynamics of the handwriting movements through an extremely sparse model, whose efficiency matches that of other, more computationally expensive optimizing methods. Moreover, the model applies to 2D trajectories, irrespective of their shape, size, orientation and length. It is also independent of the endeffectors mobilized and of the writing direction.

Haptic coordination: Squeezing a vibrating stress ball decreases anxiety and arousal.

We evaluated the effect of haptic coordination on anxiety and arousal. Participants looked at a stressful or calming image and then repeatedly squeezed a vibrating stress ball for 20 s. Using a pre-post paradigm with a control group, we showed that squeezing the vibrating ball reduced anxiety and arousal, as assessed by the State-Trait Anxiety Inventory and electrodermal activity, respectively. The stability of haptic coordination was manipulated by varying the detuning between the spontaneous squeezing frequency and the intrinsic frequency of ball vibration. Coordination stability affected arousal and stress affected stability. The data were discussed in the light of Kahneman's attentional resource-sharing model.

Hold your horses: Differences in EEG correlates of inhibition in cancelling and stopping an action.

Behavioral adaptation to changing contextual contingencies often requires the rapid inhibition of planned or ongoing actions. Inhibitory control has been mostly studied using the stop-signal paradigm, which conceptualizes action inhibition as the outcome of a race between independent GO and STOP processes. Inhibition is predominantly considered to be independent of action type, yet it is questionable whether this conceptualization can apply to stopping an ongoing action. To test the claimed generality of action inhibition, we investigated behavioral stop-signal reaction time (SSRT) and scalp electroencephalographic (EEG) activity in two inhibition contexts: Using variants of the stop-signal task, we asked participants to cancel a prepared-discrete action or to stop an ongoing-rhythmic action in reaction to a STOP signal. The behavioral analysis revealed that the discrete and rhythmic SSRTs were not correlated. The EEG analysis showed that the STOP signal evoked frontocentral activity in the time and frequency domains (Delta/Theta range) in a task-specific manner: The P3 onset latency was the best correlate of discrete SSRT whereas N2/P3 peak-to-peak amplitude was the best correlate of rhythmic SSRT. These findings do not support a conceptualization of inhibition as action-independent but rather suggest that the differential engagement of both components of the N2/P3-complex as a function of action type pertains to functionally independent inhibition subprocesses.

Cost-Effectiveness Evaluation of a Remote Monitoring Programme Including Lifestyle Education Software in Type 2 Diabetes: Results of the Educ@dom Study.

INTRODUCTION: Telemedicine programs using health technological innovation to remotely monitor the lifestyles of patients with type 2 diabetes (T2D) can improve glycaemic control and thus reduce the incidence of complications as well as management costs. In this context, an assessment was made of the 1-year and 2-year cost-effectiveness of the EDUC@DOM telemonitoring and tele-education program. METHODS: The EDUC@DOM study was a multicentre randomized controlled trial conducted between 2013 and 2017 that compared a telemonitoring group (TMG) to a control group (CG) merged with health insurance databases to extract economic data on resource consumption. Economic analysis was performed from the payer perspective, and direct costs and indirect costs were considered. The clinical outcome used was the intergroup change in glycated haemoglobin (HbA1c) levels from baseline. Missing economic data were imputed using multiple imputation, and fitted values from a generalized linear mixed model were used to calculate the incremental cost-effectiveness ratio (ICER). Bootstrapped 95% confidence ellipses were drawn in the cost-effectiveness plan. RESULTS: The main analysis included data from 256 patients: 126 in the TMG and 130 in the CG. Incremental costs over 1 and 2 years were equal to €2129 and €5101, respectively, in favour of the TMG. Once imputed and adjusted for confounding factors, the TMG trends to a 21% cost decrease over 1 and 2 years of follow-up (0.79 [0.58; 1.08], p = 0.1452 and 0.79 [0.61; 1.03], p = 0.0879, respectively). The EDUC@DOM program led to a €1334 cost saving and a 0.17 decrease in HbA1c over 1 year and a €3144 cost saving and a 0.14 decrease in HbA1c over 2 years. According to the confidence ellipse, EDUC@DOM was a cost-effective strategy. CONCLUSION: This study provides additional economic information on telemonitoring and tele-education programs to enhance their acceptance and promote their use. In the light of this work, the EDUC@DOM program is a cost-saving strategy in T2D management. TRIAL REGISTRATION: This trial was registered in the Clinical Trials Database on 27 September 2013 under no. NCT01955031 and bears ID-RCB no. 2013-A00391-44.

Cortical sensorimotor activity in the execution and suppression of discrete and rhythmic movements.

Although the engagement of sensorimotor cortices in movement is well documented, the functional relevance of brain activity patterns remains ambiguous. Especially, the cortical engagement specific to the pre-, within-, and post-movement periods is poorly understood. The present study addressed this issue by examining sensorimotor EEG activity during the performance as well as STOP-signal cued suppression of movements pertaining to two distinct classes, namely, discrete vs. ongoing rhythmic movements. Our findings indicate that the lateralized readiness potential (LRP), which is classically used as a marker of pre-movement processing, indexes multiple pre- and in- movement-related brain dynamics in a movement-class dependent fashion. In- and post-movement event-related (de)synchronization (ERD/ERS) observed in the Mu (8-13 Hz) and Beta (15-30 Hz) frequency ranges were associated with estimated brain sources in both motor and somatosensory cortical areas. Notwithstanding, Beta ERS occurred earlier following cancelled than actually performed movements. In contrast, Mu power did not vary. Whereas Beta power may reflect the evaluation of the sensory predicted outcome, Mu power might engage in linking perception to action. Additionally, the rhythmic movement forced stop (only) showed a post-movement Mu/Beta rebound, which might reflect an active "clearing-out" of the motor plan and its feedback-based online control. Overall, the present study supports the notion that sensorimotor EEG modulations are key markers to investigate control or executive processes, here initiation and inhibition, which are exerted when performing distinct movement classes.

To start or stop an action depends on which movement we perform: An appraisal of the horse-race model.

In order to gauge the executive processes underlying adaptive behavior, a central criterion in psychology is the extent to which experimental findings generalize across response types. The latency of two major acts of control, action initiation and inhibition, was evaluated using a stop-signal paradigm with two response types, involving either a finger key-pressing or a wrist pen-swiping response. In both conditions, 40 participants were instructed to respond quickly to a GO stimulus but to cancel their responses when a STOP signal was presented, which occurred randomly in 25% of the trials. Taken together, analyses of reaction times and of inhibition probability functions indicated that action initiation generalized across the two response types. In contrast, the finger key-pressing and the wrist pen-swiping responses involved independent inhibition processes. These results challenge a strictly top-down view for some acts of control by showing an interaction between the executive and motor levels in terms of response modality specificity.

Impact of a Remote Monitoring Programme Including Lifestyle Education Software in Type 2 Diabetes: Results of the Educ@dom Randomised Multicentre Study.

INTRODUCTION: Telemonitoring in type 2 diabetes (T2D) is mainly based on glucose monitoring. A new type of connected device which routinely gathers data on weight, physical activity and food intake could improve patients' diabetes control. The main aim of this study was to assess the efficacy of an at-home interventional programme incorporating such devices and lifestyle education software on diabetes control, i.e., change in HbA1c, compared to standard care. METHODS: This multicentre study randomly assigned 282 people with T2D to either a telemonitoring group (TMG) or a control group (CG) for a 1-year intervention period. While routine follow-up was maintained in the CG, TMG subjects were provided with interactive lifestyle educational software (with artificial intelligence algorithms) and connected objects (blood glucose meters, scales and actimeters) for use in their own homes and were remotely monitored by their diabetologists. Changes in HbA1c were compared between groups using a mixed linear model. RESULTS: The mean HbA1c dropped from 7.8 ± 0.8% (62 mmol/mol) to 7.4 ± 1.0% (57 mmol/mol) in the TMG and from 7.8 ± 0.8% (62 mmol/mol) to 7.6 ± 1.0% (60 mmol/mol) in the CG, resulting in an intergroup difference of - 0.16 (p = 0.06) in favour of TMG, after adjustment for confounding factors. Within TMG, the decrease in HbA1c was greater in frequent users: - 0.23% (p = 0.03) in the case of connections to telemonitoring synthesis above the median and - 0.21% (p = 0.05) in the case of connections to tele-education software above the median compared to the CG. Significant weight loss was observed in the TMG but only in women (p = 0.01). FINDINGS: The EDUC@DOM telemonitoring and tele-education device did not highlight a significant decrease in HbA1c levels compared to routine management although a slight, albeit significant improvement in glycaemic control was observed in the frequent user subgroup as well as significant weight loss but only in women. A high level of satisfaction with the connected device was recorded amongst all participants. TRIAL REGISTRATION: This trial was registered in the Clinical Trials Database on September 27, 2013, under no. NCT01955031 and bears ID-RCB number 2013-A00391-44.

Weight Loss Trajectories After Bariatric Surgery for Obesity: Mathematical Model and Proof-of-Concept Study.

BACKGROUND: Obesity surgery has proven its effectiveness in weight loss. However, after a loss phase of about 12 to 18 months, between 20% and 40% of patients regain weight. Prediction of weight evolution is therefore useful for early detection of weight regain. OBJECTIVE: This proof-of-concept study aimed to analyze the postoperative weight trajectories and to identify "curve families" for early prediction of weight regain. METHODS: This was a monocentric retrospective study with calculation of the weight trajectory of patients having undergone gastric bypass surgery. Data on 795 patients after a 2-year follow-up allowed modeling of weight trajectories according to a hierarchical cluster analysis (HCA) tending to minimize the intragroup distance according to Ward. Clinical judgement was used to finalize the identification of clinically relevant representative trajectories. This modeling was validated on a group of 381 patients for whom the observed weight at 18 months was compared to the predicted weight. RESULTS: Two successive HCA produced 14 representative trajectories, distributed among 4 clinically relevant families: Of the 14 weight trajectories, 6 decreased systematically over time or decreased and then stagnated; 4 decreased, increased, and then decreased again; 2 decreased and then increased; and 2 stagnated at first and then began to decrease. A comparison of observed weight and that estimated by modeling made it possible to correctly classify 98% of persons with excess weight loss (EWL) >50% and more than 58% of persons with EWL between 25% and 50%. In the category of persons with EWL >50%, weight data over the first 6 months were adequate to correctly predict the observed result. CONCLUSIONS: This modeling allowed correct classification of persons with EWL >50% and could identify early after surgery the patients with potentially less that optimal weight loss. Further studies are needed to validate this model in other populations, with other types of surgery, and with other medical-surgical teams.

Nutri-Educ, a nutrition software application for balancing meals, using fuzzy arithmetic and heuristic search algorithms.

UNLABELLED: OBJECTIVE, METHODS AND RESULTS: Nutri-Educ is a nutrition software application developed in cooperation with the Diabetology Department of Toulouse's Rangueil University Hospital. It aims at helping any person to balance their meals. More specifically, its main goal is to enable a user to describe a meal and assess its content, and in most cases to find a small set of acceptable actions which make it well-balanced and in accordance to the user's energetic needs. Fuzzy numbers are used to represent the inherent imprecision and fuzziness of food quantities and nutrient values as well as to model the gradual boundaries of the daily recommended values associated with each nutrient. Fuzzy arithmetic is used to perform computations on such quantities and fuzzy pattern matching provides measures of the compatibility of data to nutrient norms. Innovative visual gauges have been designed to display this information in a simple, yet comprehensive way. Finally, heuristic search algorithms are used to find a set of actions, acceptable from a nutritional point of view, which will transform the initial meal into a well-balanced one. CONCLUSION: Fuzzy arithmetic proves to be an adequate model for naturally representing food quantities and values as well as for performing all necessary computation and compatibility assessments. By combining it with new interface techniques and heuristic search algorithms, it allows the Nutri-Educ software application to balance and improve meals, a complex qualitative and quantitative problem which is solved in 87% of our benchmark database.

Educ@dom: comparative study of the telemonitoring of patients with type 2 diabetes versus standard monitoring-study protocol for a randomized controlled study.

BACKGROUND: The global prevalence of type 2 diabetes is considerable. To avoid or delay its chronic complications, patients with type 2 diabetes should improve blood glucose management by adapting their life style. This involves changing the way in which diabetes is controlled. We believe that, thanks to technological innovations in connected health-monitoring devices, the telemonitoring of type 2 diabetes patients using therapeutic educational tools is likely to help them adapt their treatment and lifestyle habits, and therefore improve blood glucose management. METHODS: This is a multicenter, randomized, controlled, prospective study. The primary objective is to compare the efficacy of telemonitoring to standard monitoring in terms of changes in glycated hemoglobin levels (HbA1c) after a 1 year follow-up period. The secondary objectives are clinical (changes in knowledge, physical activity, weight, etc.) and medical-economic. 282 patients are required (141 patients in each group) to satisfy the primary objective. For patients in the intervention group, the device will be given to them for 1 year and then withdrawn during the second year of follow-up. CONCLUSIONS: The anticipated benefits of this research are an improvement in blood glucose management in patients with type 2 diabetes by improving their lifestyle whilst rationalizing recourse to consultations in order to reduce the incidence of complications and cost in the long term. If the results of this study show that management of type 2 diabetes by tele monitoring is clinically effective and economical, this device could then be made available to a larger diabetic patient cohort.

Effect of Nutritional Intervention on Food Choices of French Students in Middle School Cafeterias, Using an Interactive Educational Software Program (Nutri-Advice).

OBJECTIVE: To evaluate the impact of interactive Nutri-Advice kiosks on children's nutritional skills and their ability to apply it to food choices in a middle school cafeteria menu (food choice competencies). DESIGN: Quasi-experimental design; pre/post-test. SETTING: Freestanding interactive computer terminals (kiosks) were installed in three middle schools in Toulouse, France. PARTICIPANTS: A total of 580 children were enrolled into the study (mean age, 13 ± 1 years). INTERVENTION: Each child's physiological profile was stored in a personal barcode card. During 1 school year, once a day, each child could access the kiosk with this card, trying to find the most balanced meal according to his or her profile and the food available on the cafeteria menu. MAIN OUTCOME MEASURES: Children's food choice competency changes and body mass index z-score were evaluated. ANALYSIS: Significance of change in food choice competencies (postintervention vs baseline) was examined using paired t test. RESULTS: Across the study, children chose significantly less cheese and pastry or desserts, and significantly more starchy food and dairy, and tended to choose fruits and vegetables more often. Body mass index z-score decreased significantly during the period. CONCLUSIONS AND IMPLICATIONS: Personalized nutrition counseling through an interactive device has the potential to improve the food choice competencies of children.