Functional Movement Disorders: Updates and Clinical Overview.

Functional movement disorder(FMD) is a type of functional neurological disorder(FND) that is common, but often difficult to diagnose or manage. FMD can present as various phenotypes including tremor, dystonia, myoclonus, gait disorders and Parkinsonism. Conducting a clinical examination appropriate for the assessment of a patient with suspected FMD is important, and various diagnostic testing maneuvers may also be helpful. Treatment involving a multi-disciplinary team, either outpatient or inpatient, has been found to be most effective. Examples of such treatment protocols are also discussed in this review. While recognition and understanding of the disorder appears to have improved over the past few decades, as well as development of treatments, it is not uncommon for patients and physicians to continue to experience various difficulties when dealing with this disorder. In this review, I provide a practical overview of FMD and discuss how the clinical encounter itself can play a role in patients' acceptance of the diagnosis. Updates on recent neuroimaging studies that aid in the understanding of the pathophysiology are also discussed.

Towards a rights-based approach for disabled women's access to abortion.

This article adds to the still limited scholarship on the impact of abortion laws and policies on people with disabilities and those with diminished capacity who seek abortion. We argue that neither the legal nor policy framework currently operating in England and Wales adequately incorporates and protects the rights of people with disabilities or those experiencing mental ill-health. Rather, the law and policy framework jeopardizes their reproductive agency. We argue that greater attention to and incorporation of standards contained within the UN Convention on the Rights of Persons with Disabilities (including the sources produced by its Committee) and implementation of guidelines produced by the World Health Organization would result in a rights-affirming framework that supports disabled women's reproductive agency, enhances their effective enjoyment of human rights, and supports them in accessing quality abortion care.

A relational approach to youth healthcare: Examining young people's, parents' and clinicians' experiences in the context of variations in sex characteristics.

According to popular understandings, children grow from a state of dependence to eventually become independent adults. Interdependence helps to disrupt the in/dependence binary and is a useful concept for making sense of the experiences young people with variations in sex characteristics in relation to healthcare. This study used semi-structured interviews with 32 health professionals, 33 caregivers and 12 young people recruited in the UK and Sweden. The analysis is guided by the questions: (1) how do young people, carers and health professionals position themselves in the adult/young person relationship in the context of healthcare? (2) how is the (in/ter)dependence of young people imagined when young people, carers and health professionals talk about healthcare? Our analysis shows how carers and health professionals might support dominant understandings about young people growing towards independence while providing little opportunity for young people's agency and voice. Interviews with young people gave clear examples of their negotiating relational ways of being, seeking agency in the context of healthcare and not simply becoming independent of adults. This analysis also draws attention to the ways young people might be silenced within healthcare contexts. The present paper is based on secondary analysis of data from the SENS. It works with concepts of relationality and interdependence to draw out the possibilities of voice and agency for young people with variations in sex characteristics in healthcare contexts.

The time course of Temporal Binding in social and nonsocial interactions.

Temporal Binding (TB) is the subjective compression of action-effect intervals. While the effects of nonsocial actions are highly predictable, it is not the case when interacting with conspecifics, who often act under their own volition, at a time of their choosing. Given the relative differences in action-effect predictability in non-social and social interactions, it is plausible that TB and its properties differ across these situations. To examine this, in two experiments, we compared the time course of TB in social and nonsocial interactions, systematically varying action-effect intervals (200-2,100 ms). Participants were told they were (a) interacting with another person via a live webcam, who was in fact a confederate (social condition), (b) interacting with pre-recorded videos (nonsocial condition), or (c) observing two pre-recorded videos (control condition; Experiment 2). Results across experiments showed greater TB for social compared to nonsocial conditions, and the difference was proportional to the action-effect intervals. Further, in Experiment 1, TB was consistently observed throughout the experiment for social interactions, whereas nonsocial TB decreased from the first to the second half of the experiment. In Experiment 2, the nonsocial condition did not differ from control, whereas the social condition did, exhibiting enhanced binding. We argue these results suggest that the sociality of an interaction modulates the 'internal clock' of time perception.

Balancing ethical norms and duties for the introduction of new medicines through conditional marketing authorization: a research agenda.

The European Medicines Agency's conditional marketing authorization (CMA) aims to expedite patient access to medicines for unmet medical needs by shifting a part of the drug development process post-authorization. We highlight ethical issues surrounding CMA, comprising (i) the complexity of defining unmet medical need; (ii) poor understanding of CMA and its impact on informed consent; (iii) hope versus unrealistic optimism; (iv) implications of prolonged post-authorization studies and potential patient harm; (v) rights and duties of patients surrounding participation in post-authorization studies; (vi) access to previously authorized CMA medicines; and (vii) the "benefit slippage" phenomenon, defined as the gradual shift of strict criteria to less strict criteria. We propose a comprehensive research agenda to address these ethical issues, and stress the need for multi-stakeholder engagement to ensure patient-centered use of CMA.

Infertility as Trauma: Understanding the Lived Experience of Involuntary Childlessness.

Infertility, to those who are affected by it, is much more than whether one manages (or not) to have a child: it can be a traumatizing experience. Based on a clinical case study that involved one-to-one psychotherapy sessions and semi-structured interviews with six involuntarily childless women living in Norway, this article develops the argument that there is a need to treat infertility as trauma, both conceptually and from the perspective of therapeutic practice. The analysis contributes to our understanding of trauma as a disruptive event that erodes a person's moral agency. It does so by outlining conceptual and therapeutic tools that illuminate what happens in the psyche as a result of the trauma: they help explaining why the moral agency of different individuals is damaged to different extents, and how therapy can repair it. In relation to the issue of involuntary childlessness, the analysis shows where infertility fits within one's traumabiography-a map of the way adverse experiences over the life-course have affected one's psyche and behavior-both as traumatizing in itself and connected to previous traumas. This understanding enables more effective therapeutic support and better care for many individuals whose long-term suffering would otherwise remain unacknowledged and untreated.

Decoloniality and women's agency in sex education in Zambia.

In 2018, 22 teachers and four government officers started a six-month development process, designed to integrate a gender-equity lens into sex education in Eastern Province, Zambia. The initiative was funded by the Dutch Government. In this article, I explore the emancipatory potential and limits of this gender transformative approach. Civil society privileges the empowerment of women's and girls' voices through participatory methods. This situated women-led 'encounter of change' between men and women addressed the 'harmful practices' of Chewa initiation, transcending patriarchal opposition in the process. Using an applied anthropological lens, I explore what enabled this contingent change in narrative among teachers, but I also question the coloniality inherent in efforts to transform the gender and sexuality of others through the ubiquity of voice.

Integrating critical thinking on gender and power within sexuality education has been praised for its ability to reduce unwanted pregnancies and sexually transmitted infections, including HIV. The Dutch government has been investing in this 'gender transformative approach' by strengthening the capacity of 64 schools in Zambia. I draw on findings of a multi-sited ethnography on the experiences of 22 male and female teachers and government officials in Zambia, who underwent training in this approach from 2018 to 2019. Female teachers and government workers utilized this training to critique and change harmful initiation rites of the Chewa peoples. However, this attempt at norm change was hindered by the 'fluidity of patriarchy,' which refers to the ability of powerful men to adapt to outside interventions. In this case, they undermined the project. Labeling this resistance simply as 'dealing with opposition', as Western NGOs have started doing recently, overlooks the ways in which traditions are reimagined and reinvented to sustain patriarchy and gender inequality. In this article, I critique the way Western programs listen to the voices of the young people they aim to support. Due to NGO jargon and a focus on evidence and effectiveness, these voices often go unheard. I urge policymakers and practitioners to ask self-critical questions about who gets to set the research agenda, whose voices are prioritized, and (ironically) how their own masculinist leadership norms and neoliberal practices may embody expressions of coloniality and patriarchy.

Naturalizing relevance realization: why agency and cognition are fundamentally not computational.

The way organismic agents come to know the world, and the way algorithms solve problems, are fundamentally different. The most sensible course of action for an organism does not simply follow from logical rules of inference. Before it can even use such rules, the organism must tackle the problem of relevance. It must turn ill-defined problems into well-defined ones, turn semantics into syntax. This ability to realize relevance is present in all organisms, from bacteria to humans. It lies at the root of organismic agency, cognition, and consciousness, arising from the particular autopoietic, anticipatory, and adaptive organization of living beings. In this article, we show that the process of relevance realization is beyond formalization. It cannot be captured completely by algorithmic approaches. This implies that organismic agency (and hence cognition as well as consciousness) are at heart not computational in nature. Instead, we show how the process of relevance is realized by an adaptive and emergent triadic dialectic (a trialectic), which manifests as a metabolic and ecological-evolutionary co-constructive dynamic. This results in a meliorative process that enables an agent to continuously keep a grip on its arena, its reality. To be alive means to make sense of one's world. This kind of embodied ecological rationality is a fundamental aspect of life, and a key characteristic that sets it apart from non-living matter.

To tell or not to tell about bullying-New insights from the study on the perceptions of criminal sanctioning, anticipation of school punishment, agency, and trust toward school staff.

The primary aim of this study was to determine whether perceptions of criminal sanctioning and school punishment predict students' willingness to report different types of bullying (material, physical, sexual, verbal, relational, and cyberbullying). An online survey was conducted with secondary school students (n = 1092) as participants. Traditionally included predictors (trust toward school staff, cost of reporting bullying, gender, and school agency) were also incorporated into a multiple linear regression analysis. The perception of criminal sanctioning for a particular type of bullying was a significant predictor of the willingness to report a given type of bullying, whereas anticipation of school punishment was relevant only in the case of cyberbullying. Trust toward school staff and gender were also significant predictors of willingness to report any type of bullying. School agency helped predict the willingness to report any kind of bullying except cyberbullying. Surprisingly, the costs of reporting bullying were relevant only in the case of material bullying. These results have important implications for stakeholders and school administration in identifying unreported bullying, developing and implementing anti-bullying policies, and introducing programs aimed at improving students' legal awareness.

The functional role of conscious sensation of movement.

This paper proposes a new framework for investigating neural signals sufficient for a conscious sensation of movement and their role in motor control. We focus on signals sufficient for proprioceptive awareness, particularly from muscle spindle activation and from primary motor cortex (M1). Our review of muscle vibration studies reveals that afferent signals alone can induce conscious sensations of movement. Similarly, studies employing peripheral nerve blocks suggest that efferent signals from M1 are sufficient for sensations of movement. On this basis, we show that competing theories of motor control assign different roles to sensation of movement. According to motor command theories, sensation of movement corresponds to an estimation of the current state based on afferent signals, efferent signals, and predictions. In contrast, within active inference architectures, sensations correspond to proprioceptive predictions driven by efferent signals from M1. The focus on sensation of movement provides a way to critically compare and evaluate the two theories. Our analysis offers new insights into the functional roles of movement sensations in motor control and consciousness.

Using structural topic modeling to understand ethnicity-related narratives.

OBJECTIVE: Narrative identity is a promising approach for understanding the content of individuals' ethnic identities but can be limited by the time-intensive nature of human coding and the reliance on preestablished coding systems. BACKGROUND: The aim of our preregistered study is to elucidate the content of individuals' ethnicity-related experiences using a novel statistical approach. METHOD: We applied structural topic modeling (STM), a natural language processing tool, to narratives written by an ethnically diverse sample of 1149 young adults about a moment they felt aware of their ethnicity. RESULTS: We identified 14 topics within ethnicity narratives and analyzed how each topic related to both the participant's ethnicity and the human-coded themes of agency and communion. For example, the topic Gained perspective of structural inequality was associated with greater agency, whereas Peer dynamics was associated with greater communion. Ethnic/cultural celebration was associated with both. CONCLUSIONS: This study introduces STM as a useful tool for extracting topic content in narrative data and demonstrates how the multi-method assessment of ethnicity narratives provides greater insight into the content of ethnic experiences. These findings contribute to our understanding of contextualized aspects of personality, including the innovative ways we might examine them.

Narrative identity in addictive disorders: a conceptual review.

Narrative identity allows individuals to integrate their personal experiences into a coherent and meaningful life story. Addictive disorders appear to be associated with a disturbed sense of self, reflected in problematic and disorganized self-narratives. In recent literature, a growing body of research has highlighted how narrative approaches can make a dual contribution to the understanding of addiction: on the one hand, by revealing crucial aspects of self structure, and, on the other, by supporting the idea that addiction is a disorder related to unintegrated self-states in which dissociative phenomena and the resulting sense of 'loss of self' are maladaptive strategies for coping with distress. This conceptual review identified the main measures of narrative identity, i.e., narrative coherence and complexity, agency, and emotions, and critically examines 9 quantitative and qualitative studies (out of 18 identified in literature), that have investigated the narrative dimension in people with an addictive disorder in order to provide a synthesis of the relationship between self, narrative and addiction. These studies revealed a difficulty in the organization of narrative identity of people with an addictive disorder, which is reflected in less coherent and less complex autobiographical narratives, in a prevalence of passivity and negative emotions, and in a widespread presence of themes related to a lack of self-efficacy. This review points out important conceptual, methodological and clinical implications encouraging further investigation of narrative dimension in addiction.

Making the most of life: environmental choice during rearing enhances the ability of laying hens to take opportunities.

Introduction: The potential of aviary housing for improving laying hen (Gallus gallus domesticus) welfare will be constrained if rearing conditions limit the hens' behavioral ability to take opportunities. Incorporating theories on developmental plasticity and animal agency, this study aimed to determine: (1) whether a choice of litter and perch types during rearing would promote long-lasting changes in use of novel locations and resources, and (2) the influence of timing of choice provision. Methods: Laying hen chicks were assigned to either a "Single-choice" (one litter and perch type) or "Multi-choice" environment (four litter and perch types) during "Early" (day 1-week 4) and "Late" rearing (week 5-15). The environments were switched in half of the 16 pens in week 5, resulting in a 2 × 2 factorial design with four choice environment by period combinations. The allocation of perch and litter space was the same across all treatment combinations. In week 16, all groups were moved to standard aviary laying pens (Laying period, week 16-27). Results: When first moved to the laying pens, hens with Multi-choice in either or both rearing periods were quicker to spread out in their pen than hens with Single-choice throughout rearing. Multi-choice in Early rearing also reduced the latency to use novel elevated structures (perches and nests) in the laying pens. Multi-choice during Late rearing increased success in finding and consuming hidden mealworms (tested in weeks 9-17) and increased the proportion of eggs laid on elevated nesting trays. Numerically, hens switched from Multi-choice to Single-choice in week 5 used the outdoor range less than hens switched from Single-choice to Multi-choice. Discussion: These results support the hypothesis that offering multiple resource choices during rearing improves hens' ability to make the most of new opportunities by being more proactive in exploring and exploiting newly available resources. In different opportunity challenges, hens showed positive outcomes in response to choice during Early, Late or both stages of rearing, suggesting that best results can be obtained by offering environmental choice throughout rearing.

Nanosimilars: A Scientific or A Regulatory Debate?

The paper highlights the necessity for a robust regulatory framework for assessing nanomedicines and their off-patent counterparts, termed as nanosimilar, which could be considered as 'similar' to the prototype nanomedicine,based on essential criteria describing the 'similarity'. The term 'similarity' should be focused on criteria that describe nanocarriers, encompassing their physicochemical, thermodynamic, morphological, and biological properties, including surface interactions and pharmacokinetics. Nanocarriers can be regarded as advanced self-assembled excipients (ASAEs) due to their complexity and chaotic behavior and should be evaluated by using essential criteria in order for off-patent nanomedicines be termed as nanosimilars, from a regulatory perspective. Collaboration between the pharmaceutical industry, regulatory bodies, and artificial intelligence (AI) startups is pivotal for the precise characterization and approval processes for nanomedicines and nanosimilars and embracing innovative tools and terminology facilitates the development of a sustainable regulatory framework, ensuring safety and efficacy. This crucial shift toward precision R&D practices addresses the complexity inherent in nanocarriers, paving the way for therapeutic advancements with economic benefits.

Explicit and implicit sense of agency in depersonalisation experiences.

The sense of agency, the feeling of controlling one's bodily actions and the world is altered in Depersonalisation (DP), a condition that makes people feel detached from one's self and body. To investigate the link between depersonalisation and both implicit and explicit sense of agency, an online study was conducted using the influential Intentional Binding paradigm in a sample of non-clinical DP participants. The results did not reveal significant differences between individuals with low and high occurrences of DP experiences on the implicit and explicit sense of agency. However, participants with high occurrences of DP experiences showed a more time-sensitive explicit sense of agency and greater temporal distortions for short intervals in the absence of self-initiated motion. These results suggest that there is a discrepancy between implicit and explicit sense of agency in people with high levels of depersonalisation. Altogether, these findings call for further investigations of the key role of time perception on altered sense of self and agency in both non-clinical and clinical populations, to disentangle the mechanisms associated with the explicit and implicit sense of agency.

The gender agency gap in fiction writing (1850 to 2010).

Works of fiction play a crucial role in the production of cultural stereotypes. Concerning gender, a widely held presumption is that many such works ascribe agency to men and passivity to women. However, large-scale diachronic analyses of this notion have been lacking. This paper provides an assessment of agency attributions in 87,531 fiction works written between 1850 and 2010. It introduces a syntax-based approach for extracting networks of character interactions. Agency is then formalized as a dyadic property: Does a character primarily serve as an agent acting upon the other character or as recipient acted upon by the other character? Findings indicate that female characters are more likely to be passive in cross-gender relationships than their male counterparts. This difference, the gender agency gap, has declined since the 19th century but persists into the 21st. Male authors are especially likely to attribute less agency to female characters. Moreover, certain kinds of actions, especially physical and villainous ones, have more pronounced gender disparities.

Control over self and others' face: exploitation and exploration.

The face serves as a crucial cue for self-identification, while the sense of agency plays a significant role in determining our influence through actions in the environment. The current study investigates how self-identification through facial recognition may influence the perception of control via motion. We propose that self-identification might engender a belief in having control over one's own face, leading to a more acute detection and greater emphasis on discrepancies between their actions and the sensory feedback in control judgments. We refer to the condition governed by the belief in having control as the exploitation mode. Conversely, when manipulating another individual's face, the belief in personal control is absent. In such cases, individuals are likely to rely on the regularity between actions and sensory input for control judgments, exhibiting behaviors that are exploratory in nature to glean such information. This condition is termed the explorative mode. The study utilized a face-motion mixing paradigm, employing a deep generative model to enable participants to interact with either their own or another person's face through facial and head movements. During the experiment, participants observed either their own face or someone else's face (self-face vs. other-face) on the screen. The motion of the face was driven either purely by their own facial and head motion or by an average of the participant's and the experimenter's motion (full control vs. partial control). The results showed that participants reported a higher sense of agency over the other-face than the self-face, while their self-identification rating was significantly higher for the self-face. More importantly, controlling someone else's face resulted in more movement diversity than controlling one's own face. These findings support our exploration-exploitation theory: When participants had a strong belief in control triggered by the self-face, they became highly sensitive to any sensorimotor prediction errors, leading to a lower sense of agency. In contrast, when the belief of control was absent, the exploration mode triggered more explorative behaviors, allowing participants to efficiently gather information to establish a sense of agency.