Linking the Rapid Cascade of Visuo-Attentional Processes to Successful Memory Encoding.

While it is broadly accepted that attention modulates memory, the contribution of specific rapid attentional processes to successful encoding is largely unknown. To investigate this issue, we leveraged the high temporal resolution of electroencephalographic recordings to directly link a cascade of visuo-attentional neural processes to successful encoding: namely (1) the N2pc (peaking ~200 ms), which reflects stimulus-specific attentional orienting and allocation, (2) the sustained posterior-contralateral negativity (post-N2pc), which has been associated with sustained visual processing, (3) the contralateral reduction in oscillatory alpha power (contralateral reduction in alpha > 200 ms), which has also been independently related to attentionally sustained visual processing. Each of these visuo-attentional processes was robustly predictive of successful encoding, and, moreover, each enhanced memory independently of the classic, longer-latency, conceptually related, difference-due-to memory (Dm) effect. Early latency midfrontal theta power also promoted successful encoding, with at least part of this influence being mediated by the later latency Dm effect. These findings markedly expand current knowledge by helping to elucidate the intimate relationship between attentional modulations of perceptual processing and effective encoding for later memory retrieval.

Older adults benefit from more widespread brain network integration during working memory.

Neuroimaging evidence suggests that the aging brain relies on a more distributed set of cortical regions than younger adults in order to maintain successful levels of performance during demanding cognitive tasks. However, it remains unclear how task demands give rise to this age-related expansion in cortical networks. To investigate this issue, functional magnetic resonance imaging was used to measure univariate activity, network connectivity, and cognitive performance in younger and older adults during a working memory (WM) task. Here, individuals performed a WM task in which they held letters online while reordering them alphabetically. WM load was titrated to obtain four individualized difficulty levels with different set sizes. Network integration-defined as the ratio of within-versus between-network connectivity-was linked to individual differences in WM capacity. The study yielded three main findings. First, as task difficulty increased, network integration decreased in younger adults, whereas it increased in older adults. Second, age-related increases in network integration were driven by increases in right hemisphere connectivity to both left and right cortical regions, a finding that helps to reconcile existing theories of compensatory recruitment in aging. Lastly, older adults with higher WM capacity demonstrated higher levels of network integration in the most difficult task condition. These results shed light on the mechanisms of age-related network reorganization by demonstrating that changes in network connectivity may act as an adaptive form of compensation, with older adults recruiting a more distributed cortical network as task demands increase.

Online repetitive transcranial magnetic stimulation during working memory in younger and older adults: A randomized within-subject comparison.

Working memory is the ability to perform mental operations on information that is stored in a flexible, limited capacity buffer. The ability to manipulate information in working memory is central to many aspects of human cognition, but also declines with healthy aging. Given the profound importance of such working memory manipulation abilities, there is a concerted effort towards developing approaches to improve them. The current study tested the capacity to enhance working memory manipulation with online repetitive transcranial magnetic stimulation in healthy young and older adults. Online high frequency (5Hz) repetitive transcranial magnetic stimulation was applied over the left dorsolateral prefrontal cortex to test the hypothesis that active repetitive transcranial magnetic stimulation would lead to significant improvements in memory recall accuracy compared to sham stimulation, and that these effects would be most pronounced in working memory manipulation conditions with the highest cognitive demand in both young and older adults. Repetitive transcranial magnetic stimulation was applied while participants were performing a delayed response alphabetization task with three individually-titrated levels of difficulty. The left dorsolateral prefrontal cortex was identified by combining electric field modeling to individualized functional magnetic resonance imaging activation maps and was targeted during the experiment using stereotactic neuronavigation with real-time robotic guidance, allowing optimal coil placement during the stimulation. As no accuracy differences were found between young and older adults, the results from both groups were collapsed. Subsequent analyses revealed that active stimulation significantly increased accuracy relative to sham stimulation, but only for the hardest condition. These results point towards further investigation of repetitive transcranial magnetic stimulation for memory enhancement focusing on high difficulty conditions as those most likely to exhibit benefits.

Complementary topology of maintenance and manipulation brain networks in working memory.

Working memory (WM) is assumed to consist of a process that sustains memory representations in an active state (maintenance) and a process that operates on these activated representations (manipulation). We examined evidence for two distinct, concurrent cognitive functions supporting maintenance and manipulation abilities by testing brain activity as participants performed a WM alphabetization task. Maintenance was investigated by varying the number of letters held in WM and manipulation by varying the number of moves required to sort the list alphabetically. We found that both maintenance and manipulation demand had significant effects on behavior that were associated with different cortical regions: maintenance was associated with bilateral prefrontal and left parietal cortex, and manipulation with right parietal activity, a link that is consistent with the role of parietal cortex in symbolic computations. Both structural and functional architecture of these systems suggested that these cognitive functions are supported by two dissociable brain networks. Critically, maintenance and manipulation functional networks became increasingly segregated with increasing demand, an effect that was positively associated with individual WM ability. These results provide evidence that network segregation may act as a protective mechanism to enable successful performance under increasing WM demand.

Descripción de las intervenciones quirúrgicas recogidas en el registro español de cirugía de Mohs (REGESMOHS) (2013-2015) / Characterization of Surgical Procedures in the Spanish Mohs Surgery Registry (REGESMOHS) for 2013-2015

Introducción: El Registro Español de Cirugía de Mohs recoge los datos de aplicación y resultados de esta técnica en España. Se describen los datos de las intervenciones realizadas desde el inicio del Registro en julio de 2013 a enero de 2016. Se analizan los datos de las cirugías tanto perioperatorios como intraoperatorios. Material y métodos: Estudio de cohortes prospectivo en el que participan 18 centros. Se recogen los datos de las intervenciones quirúrgicas como tipo de anestesia, técnica quirúrgica, ingreso hospitalario, número de estadios, manejo de factores de riesgo preoperatorios, tratamientos complementarios, tratamientos previos, tipo de tumor, tiempo empleado en la cirugía y complicaciones. Resultados: Se analizan 1.796 intervenciones quirúrgicas. El tumor intervenido con más frecuencia es el carcinoma basocelular (85,96%), seguido del carcinoma epidermoide (6,18%), lentigo maligno (2,81%) y dermatofibrosarcoma protuberans (1,97%). El 66,9% de los tumores eran primarios, el 19,2% recurrentes y el 13,9% persistentes. El tratamiento previo más frecuente fue quirúrgico. La cirugía de Mohs se realizó con más frecuencia bajo anestesia local (86,7%) y de forma ambulatoria (71,8%). En el 89,5% de los casos se utilizó la técnica de Mohs en congelación. El número de etapas requerido para alcanzar márgenes libres de tumor fue una en 56,45% de los pacientes, 2 en 32,1%, 3 en 7,1%, 4 en 2,7% y 5 o más en 1,8%. El propio dermatólogo reconstruyó el defecto en el 98% de los pacientes y la técnica reconstructiva más utilizada fue el colgajo (47,2%). Solo el 1,62% de los pacientes presentó alguna complicación intraoperatoria y la mediana de la duración de la cirugía fue 75 (p25:60-p75:100). Conclusión: Las características de los pacientes y tumores tratados son similares a las descritas en estudios de las mismas características en otras áreas geográficas. Existe un porcentaje mayor de lentigo maligno y dermatofibrosarcoma protuberans. La reconstrucción la realiza el dermatólogo con más frecuencia que en otras series. El tiempo de utilización de quirófano no es mucho mayor que para otras técnicas y la tasa de complicaciones intraoperatorias es muy reducida (AU)

Introduction: The Spanish Mohs Surgery Registry is used to collect data on the use and outcomes of Mohs micrographic surgery (MMS) in Spain. The aim of this study was to describe perioperative and intraoperative data recorded for MMS procedures performed between July 2013 (when the registry started) and January 2016. Material and methods: Prospective cohort study of data from 18 hospitals. The data collected included type of anesthesia, surgical technique, hospital admission, number of Mohs stages, management of preoperative risk factors, additional treatments, previous treatments, type of tumor, operating time, and complications. Results: Data were available for 1796 operations. The most common tumor treated by MMS was basal cell carcinoma (85.96%), followed by squamous cell carcinoma (6.18%), lentigo maligna (2.81%), and dermatofibrosarcoma protuberans (1.97%). Primary tumors accounted for 66.9% of all tumors operated on; 19.2% of tumors were recurrent and 13.9% were persistent. The most common previous treatment was surgical. MMS was mostly performed under local anesthesia (86.7% of cases) and as an outpatient procedure (71.8%). The frozen section technique was used in 89.5% of cases. One stage was needed to achieve tumor-free margins in 56.45% of patients; 2 stages were required in 32.1% of patients, 3 in 7.1%%, 4 in 2.7%, and 5 or more in 1.8%. The defect was reconstructed by the dermatologist in 98% of patients and the most common technique was flap closure (47.2%). Intraoperative complications were recorded for just 1.62% of patients and the median (interquartile range) duration of surgery was 75 (60-100) minutes. Conclusion: The characteristics of the patients and tumors treated by MMS are similar to those reported for similar studies in other geographic areas. Lentigo maligna and dermatofibrosarcoma protuberans accounted for a higher proportion of cases in our series, and repair of the surgical defect by a dermatologist was also more common. Operating times in MMS are not much longer than those reported for other procedures and the rate of intraoperative complications is very low (AU)

Characterization of Surgical Procedures in the Spanish Mohs Surgery Registry (REGESMOHS) for 2013-2015. / Descripción de las intervenciones quirúrgicas recogidas en el registro español de cirugía de Mohs (REGESMOHS) (2013-2015).

INTRODUCTION: The Spanish Mohs Surgery Registry is used to collect data on the use and outcomes of Mohs micrographic surgery (MMS) in Spain. The aim of this study was to describe perioperative and intraoperative data recorded for MMS procedures performed between July 2013 (when the registry started) and January 2016. MATERIAL AND METHODS: Prospective cohort study of data from 18 hospitals. The data collected included type of anesthesia, surgical technique, hospital admission, number of Mohs stages, management of preoperative risk factors, additional treatments, previous treatments, type of tumor, operating time, and complications. RESULTS: Data were available for 1796 operations. The most common tumor treated by MMS was basal cell carcinoma (85.96%), followed by squamous cell carcinoma (6.18%), lentigo maligna (2.81%), and dermatofibrosarcoma protuberans (1.97%). Primary tumors accounted for 66.9% of all tumors operated on; 19.2% of tumors were recurrent and 13.9% were persistent. The most common previous treatment was surgical. MMS was mostly performed under local anesthesia (86.7% of cases) and as an outpatient procedure (71.8%). The frozen section technique was used in 89.5% of cases. One stage was needed to achieve tumor-free margins in 56.45% of patients; 2 stages were required in 32.1% of patients, 3 in 7.1%%, 4 in 2.7%, and 5 or more in 1.8%. The defect was reconstructed by the dermatologist in 98% of patients and the most common technique was flap closure (47.2%). Intraoperative complications were recorded for just 1.62% of patients and the median (interquartile range) duration of surgery was 75 (60-100) minutes. CONCLUSION: The characteristics of the patients and tumors treated by MMS are similar to those reported for similar studies in other geographic areas. Lentigo maligna and dermatofibrosarcoma protuberans accounted for a higher proportion of cases in our series, and repair of the surgical defect by a dermatologist was also more common. Operating times in MMS are not much longer than those reported for other procedures and the rate of intraoperative complications is very low.

Comunicación, orígenes e identidad en el acogimiento familiar y residencial: el programa “Viaje a mi historia” / No disponible

El presente artículo revisa los principales retos y necesidades que tienen los niños y niñas en el sistema de protección centrándose en la necesidad de saber acerca de su familia de origen y su situación familiar en el acogimiento familiar y residencial. Existe un considerable consenso científico y profesional acerca de la necesidad de hablar con los niños y de que una comunicación abierta, afectuosa y fluida sobre estos temas favorece su mejor adaptación. Sin embargo, diferentes estudios indican que la comunicación entre acogedores y acogidos no es una tarea fácil y que acogedores y profesionales necesitan apoyo y formación específica para abordarla adecuadamente. Al hilo de estos resultados, se exponen las líneas generales del programa Viaje a mi Historia que se lleva a cabo en la Comunidad Autónoma de Andalucía. Este programa ha sido diseñado con el objetivo de apoyar la tarea de acogedores y profesionales y servir de recurso en la comunicación entre acogedores y acogidos de manera que los niños y niñas puedan conocer su historia personal y familiar, las razones por la cuales están acogidos y su futuro en la medida de protección, contribuyendo así a que puedan desarrollar una identidad positiva en su paso por el acogimiento (AU)

This article reviews the main challenges and needs the children have in the protection system focusing on the need to know about their family of origin and family status in foster care and residential centres. There is considerable scientific and professional consensus today about the need to talk with children and that an open communication, caring and smooth on these issues enables a better adaptation. However, several studies show that communication between carers and children is not an easy task and, conversely, carers and professionals need support and specific training to address it properly. In line with these results, are also set out the broad lines of the program Travel to My Story carried out in the Autonomous Community of Andalusia (Spain). This program was designed with the aim to support the work of carers and professionals, as well as serve as a resource for communication between carers and children so that children can know their personal and family history, the reasons why they are in foster care or protection centres and their future in the protection measures, thus contributing to developing a positive identity on their way through the placement (AU)

Incidencia del ejercicio físico y el entrenamiento vibratorio sobre la amplitud de movimiento de mujeres con fibromialgia / Influence of physical exercise and whole body vibration on flexibility in women with fibromyalgia

Objetivo. En la presente investigación hemos planteado como objetivos principales, por un lado, valorar el efecto del ejercicio físico y el entrenamiento vibratorio sobre la amplitud de movimiento en mujeres con fibromialgia (FM) y, por otro, determinar si existe alguna relación entre dicha variable y el dolor y la rigidez. Método. La muestra estuvo constituida por un total de cuarenta y seis mujeres (edad: 58,2 ± 8,5 años; peso: 72,1 ± 9,6 kg; altura: 156,9 ± 6,1 cm) diagnosticadas con FM. Los participantes fueron divididos aleatoriamente en tres grupos: ejercicio físico y entrenamiento vibratorio (WBV + EJ; n = 15); ejercicio físico sin vibraciones (EJ; n = 15) y un grupo control (GC; n = 16). Los grupos WBV + EJ y EJ realizaron dos sesiones semanales de ejercicio físico durante 8 semanas. Además, los integrantes de WBV + EJ realizaron 3 sesiones semanales de entrenamiento vibratorio (30 Hz, 4 mm). Las pruebas de evaluación incluyeron el test de sit and reach (variable principal), la valoración del número de tender points (TP) y una escala analógica visual (VAS) para determinar la rigidez. Resultados. Los resultados derivados del análisis intra e intergrupo no mostraron diferencias significativas en la rigidez o el número de TP, si bien, la prueba de sit and reach mostró una mejora estadísticamente significativa en WBV + EJ (58%; p < 0,05). El análisis correlacional mostró una relación inversa (r = -0,55; p < 0,05) entre el sit and reach y el número de TP. Conclusión. Como conclusión, podemos indicar que los datos obtenidos en la presente investigación han mostrado los efectos significativos del entrenamiento vibratorio sobre la amplitud de movimiento en mujeres con FM, aunque el número de TP o la rigidez no se vieron afectados en ningún caso(AU)

Objective. The main aim of this investigation was twofold: first to evaluate the effects of exercise and whole body vibration training on flexibility in women with fibromyalgia (FM) and determine whether these improvements are related to symptom severity (stiffness and bodily pain). Method. Forty-six women (mean ± sd, age: 58.2 ± 8.5 years; weight: 72.1 ± 9.6 kg; height: 156.9 ± 6.1 cm) with FM were randomized into one of three groups: exercise and whole body vibration (WBV) training group (WBV + EX; n = 15), exercise training group (EX), and usual-care control group (CG). WBV + EX and EX groups carried out two sessions per week of exercise training for 8 weeks. In addition, WBV + EX group performed 3 vibration-training (30 Hz, 4 mm) sessions per week. Outcome assessed included sit and reach test (primary outcome), tender points (TP) evaluation, and a visual analog scale (VAS) was used to determine the stiffness level. Results. Results showed no statistical intra and intergroup differences in stiffness or the number of TP. However, a significant increment in the sit and reach performance was observed in WBV + EX (58%; p < 0.05). Moreover, correlation analysis showed an inverse and significant relationship (r = -0.55; p < 0.05) between sit and reach and number of TP in WBV+EX group. Conclusion. In conclusion, exercise and WBV seems to be effective on flexibility in women with FM. However, the number of TP and stiffness was not modified after the intervention(AU)

Resting-state functional connectivity of ventral parietal regions associated with attention reorienting and episodic recollection.

In functional neuroimaging studies, ventral parietal cortex (VPC) is recruited by very different cognitive tasks. Explaining the contributions of VPC to these tasks has become a topic of intense study and lively debate. Perception studies frequently find VPC activations during tasks involving attention-reorienting, and memory studies frequently find them during tasks involving episodic recollection. According to the Attention to Memory (AtoM) model, both phenomena can be explained by the same VPC function: bottom-up attention. Yet, a recent functional MRI (fMRI) meta-analysis suggested that attention-reorienting activations are more frequent in anterior VPC, whereas recollection activations are more frequent in posterior VPC. Also, there is evidence that anterior and posterior VPC regions have different functional connectivity patterns. To investigate these issues, we conducted a resting-state functional connectivity analysis using as seeds the center-of-mass of attention-reorienting and recollection activations in the meta-analysis, which were located in the supramarginal gyrus (SMG, around the temporo-parietal junction-TPJ) and in the angular gyrus (AG), respectively. The SMG seed showed stronger connectivity with ventrolateral prefrontal cortex (VLPFC) and occipito-temporal cortex, whereas the AG seed showed stronger connectivity with the hippocampus and default network regions. To investigate whether these connectivity differences were graded or sharp, VLPFC and hippocampal connectivity was measured in VPC regions traversing through the SMG and AG seeds. The results showed a graded pattern: VLPFC connectivity gradually decreases from SMG to AG, whereas hippocampal connectivity gradually increases from SMG to AG. Importantly, both gradients showed an abrupt break when extended beyond VPC borders. This finding suggests that functional differences between SMG and AG are more subtle than previously thought. These connectivity differences can be explained by differences in the input and output to anterior and posterior VPC regions, without the need of postulating markedly different functions. These results are as consistent with integrative accounts of VPC function, such as the AtoM model, as they are with models that ascribe completely different functions to VPC regions.

Explaining the encoding/retrieval flip: memory-related deactivations and activations in the posteromedial cortex.

The posteromedial cortex (PMC) is strongly linked to episodic memory and age-related memory deficits. The PMC shows deactivations during a variety of demanding cognitive tasks as compared to passive baseline conditions and has been associated with the default-mode of the brain. Interestingly, the PMC exhibits opposite levels of functional MRI activity during encoding (learning) and retrieval (remembering), a pattern dubbed the encoding/retrieval flip (E/R-flip). Yet, the exact role of the PMC in memory function has remained unclear. This review discusses the possible neurofunctional and clinical significance of the E/R-flip pattern. Regarding neurofunctional relevance, we will review four hypotheses on PMC function: (1) the internal orienting account, (2) the self-referential processing account, (3) the reallocation account, and (4) the bottom-up attention account. None of these accounts seem to provide a complete explanation for the E/R-flip pattern in PMC. Regarding clinical relevance, we review work on aging and Alzheimer's disease, indicating that amyloid deposits within PMC, years before clinical memory deficits become apparent. High amyloid burden within PMC is associated with detrimental influences on memory encoding, in particular, the attenuation of beneficial PMC deactivations. Finally, we discuss functional subdivisions within PMC that help to provide a more precise picture of the variety of signals observed within PMC. Collective data from anatomical, task-related fMRI and resting-state studies all indicate that the PMC is composed of three main regions, the precuneus, retrosplenial, and posterior cingulate cortex, each with a distinct function. We will conclude with a summary of the findings and provide directions for future research.

The effect of 6-week exercise programme and whole body vibration on strength and quality of life in women with fibromyalgia: a randomised study.

OBJECTIVES: The aim of this study was to investigate the effectiveness of a 6-week traditional exercise programme with supplementary whole-body vibration (WBV) in improving strength and health status in women with fibromyalgia (FM). METHODS: Thirty postmenopausal women with FM (mean (SD) age: 59 (7.90) years) were randomised into one of two groups, one intervention group (GEV n=15), which combined exercise training (two days a week) with three days of WBV (3 sets of 45 s at 20 Hz-3 mm and four sets of unilateral static squats at 20 Hz-2 mm) and another control group (n=15), that performed the same physical activity programme but without vibration training (GEnV). The Fibromyalgia Impact Questionnaire (FIQ) and the global score of the SF-36 were used to assess functional capacity and quality of life. Two additional tests were employed to assess muscle strength. Baseline data and pre-test and post-test data were collected before and after the six-week intervention period. RESULTS: Significant improvements in all outcomes measured were found from baseline in both groups. A 5% improvement from baseline in total FIQ score was observed in the exercise groups (p≤0.05), and was accompanied by reductions in SF36 scores of 9.8% (p<0.001) and 7.9% (p<0.001) in the GEV and GEnV group, respectively. Improvements were also observed in muscle strength in both groups but greater in the GEV group. CONCLUSIONS: The results suggest that women with FMS can gain additional health benefits by engaging in a 6-week traditional exercise programme with supplementary WBV.

Fisiopatología y técnicas de registro de los movimientos oculares / Physiopathology and recording techniques of ocular movements

En el control de la motilidad ocular intervienen varios sistemas funcionales. Los reflejos vestíbulo-oculares y optocinéticos son respuestas automáticas para compensar los movimientos de la cabeza y del entorno visual y poder estabilizar la imagen retiniana sobre un determinado punto de fijación. Los movimientos sacádicos son rápidos desplazamientos de la fijación de un punto a otro del campo visual. Los movimientos de persecución lenta consisten en el seguimiento de estímulos móviles con la mirada. Finalmente, existen movimientos involuntarios de muy escasa amplitud que se producen durante el mantenimiento de la fijación. Cada modalidad funcional de movimiento depende de circuitos neuronales específicos que trabajan coordinadamente para codificar la contracción de los músculos oculomotores correspondiente a la posición adecuada en cada momento. Estos sistemas neuronales pueden verse alterados por múltiples procesos neurológicos de diferente naturaleza y localización dando lugar a una variada gama de trastornos oculomotores. Se revisan los aspectos más destacados de la fisiopatología y de los sistemas de registro de los movimientos oculares (AU)

A number of functional systems are involved in the control of eye movements. The vestibulo-ocular and optokinetic reflexes are automatic responses that compensate for the movements of the head and those of the visual environment in order to stabilize the retinal image on a given fixation point. The saccadic movements are quick displacements of fixation from one to another point in the visual field. The smooth pursuit movements consist in the gaze following a moving target. Finally, there are some involuntary movements of very small amplitude during fixation maintenance. Each functional modality of movement depends on specific neuronal circuits that work in a coordinated manner for encoding the contraction of the oculomotor muscles to reach an adequate position at every moment. These neuronal systems can be altered by many neurological processes of different kinds and localizations, causing a broad variety of oculomotor disturbances. The most salient aspects of the physiopathology and the recording systems of eye movements are reviewed (AU)

Atención integral y cuidados paliativos en niñoscon enfermedades neurológicas en fase terminal (y II) / The comprehensive and palliative care of children with

En este trabajo se establece una propuesta de protocolo para la atención global de pacientes que presentan una enfermedad neurológica en fase terminal, con procedimientos de atención y cuidado a corto y medio plazo, y medidas dietéticas y terapéuticas que aporten bienestar al paciente y su familia: hidratación y nutrición con sonda nasogástrica o duodenal, gastrostomía endoscópica percutánea, por vía venosa central; control del ritmo vesical e intestinal; adecuación del ritmo sueño-vigilia; cuidados físicos, psicológicos y sociales; tratamiento del dolor, problemas digestivos, ortopédicos e infecciosos; terapias específicas de la enfermedad; antiepilépticos; rehabilitación física y apoyo psicológico, así como información (actual y anticipatoria) y comunicación al paciente, familiares y personal sanitario; atención continuada con controles de peso, temperatura, frecuencia cardiaca y respiratoria, presión arterial, saturación de O2 y de CO2, presión intracraneal, hemograma, coagulación, bioquímica, proteinograma, densidad y osmolaridad en orina (AU)

Proposal for a protocol for the comprehensive care of patients with neurological disorders in the terminal phase, with procedures for their short-term and medium-term care, with dietary and therapeutic measures that bring wellbeing and comfort to patients and their families: hydration and nutrition through a nasogastric or duodenal tube, percutaneous endoscopic gastrostomy, central venous route; control of the vesical and intestinal rhythm; adaptation of the sleep-wake rhythm; physical, psychological and social care; treatment of pain, digestive, orthopaedic and infectious problems; specific therapies for the disease; antiepileptic drugs; physical rehabilitation; psychological support. In addition, the provision of (current and proactive) information to, and communication with, the patient, the patient’s family, health care staff. Continuous care through the control of weight, temperature, cardiac and respiratory frequency, blood pressure, O2and CO2 saturation, intracranial pressure, blood count, coagulation, biochemistry, proteinogram, urine density and osmolarity (AU)

Reflexiones sobre la atención integral y los cuidados paliativos en niños con enfermedades neurológicas en fase terminal (I) / Reflections on the comprehensive and palliative care of children with neurological disorders in the terminal phase (I)

La elevada frecuencia de procesos neurológicos con evolución mortal exige una atención global activa y continuada al paciente y su familia por parte de un equipo multidisciplinario, con el objetivo prioritario de conseguir la mejor calidad de vida posible para ellos. La enfermedad neurológica requiere una máxima certeza diagnóstica, y se caracteriza por la falta de respuesta al tratamiento, una evolución progresiva de la enfermedad, que es incurable e irreversible, y un pronóstico mortal en un plazo relativamente corto. Con estas premisas, se propone una atención integral de los pacientes para ayudarles a morir dignamente, limitando las medidas terapéuticas y manteniendo el equilibrio entre costes y beneficios con objetivos consensuados con el paciente, sus familiares y el equipo multidisciplinario de profesionales que lo atienden. El objetivo de este programa es aunar recursos y adecuar la estructura asistencial a los pacientes, aplicando protocolos de atención integral, que conlleven siempre una información completa, y una comunicación y unos apoyos adecuados en el domicilio y/o en el hospital (AU)

The high rate of neurological processes with a catastrophic evolution demands the comprehensive, active and continuous care of patients and their families by a multi-professional team, with the prime objective of achieving the best possible quality of life for the child and the child’s family. The neurological disorder must be characterised by maximum diagnostic certainty, a lack of response to the treatment, a progressive evolution, incurability and irreversibility and a fatal prognosis in a relatively short period of time. With these premises, the aim is to provide the patient with total care to die with dignity, limiting therapeutic measures and maintaining the cost benefitratio through objectives agreed with the patient, the family and the multidisciplinary team of professionals. The objective of this programme is to combine resources and adapt the care structure to the patient’s needs through the application of protocols for comprehensive care, involving information, communication and support provided in the home and/or hospital (AU)

[Physiopathology and recording techniques of the ocular movements]. / Fisiopatología y técnicas de registro de los movimientos oculares.

A number of functional systems are involved in the control of eye movements. The vestibulo-ocular and optokinetic reflexes are automatic responses that compensate for the movements of the head and those of the visual environment in order to stabilize the retinal image on a given fixation point. The saccadic movements are quick displacements of fixation from one to another point in the visual field. The smooth pursuit movements consist in the gaze following a moving target. Finally, there are some involuntary movements of very small amplitude during fixation maintenance. Each functional modality of movement depends on specific neuronal circuits that work in a coordinated manner for encoding the contraction of the oculomotor muscles to reach an adequate position at every moment. These neuronal systems can be altered by many neurological processes of different kinds and localizations, causing a broad variety of oculomotor disturbances. The most salient aspects of the physiopathology and the recording systems of eye movements are reviewed.

Unity and diversity of tonic and phasic executive control components in episodic and working memory.

The present study aimed to delineate the extent to which unitary executive functions might be shared across the separate domains of episodic and working memory. A mixed blocked/event-related functional magnetic resonance imaging (fMRI) design was employed to assess sustained (tonic control) and transient (phasic control) brain responses arising from incrementing executive demand (source versus item episodic memory - vis-à-vis - two-back versus one-back working memory) using load-dependent activation overlaps as indices of common components. Although an extensive portion of the regional load effects constituted differential control modulations in both sustained and transient responses, commonalities were also found implicating a subset of executive core mechanisms consistent with unitary or domain general control. 'Unitary' control modulations were temporally dissociated into (1) shared tonic components involving medial and lateral prefrontal cortex, striatum, cerebellum and superior parietal cortex, assumed to govern enhanced top-down context processing, monitoring and sustained attention throughout task periods and (2) stimulus-synchronous phasic components encompassing posterior intraparietal sulcus, hypothesized to support dynamic shifting of the 'focus of attention' among internal representations. Taken together, these results converge with theoretical models advocating both unity and diversity among executive control processes.

Study of on-line adaptive discriminant analysis for EEG-based brain computer interfaces.

A study of different on-line adaptive classifiers, using various feature types is presented. Motor imagery brain computer interface (BCI) experiments were carried out with 18 naive able-bodied subjects. Experiments were done with three two-class, cue-based, electroencephalogram (EEG)-based systems. Two continuously adaptive classifiers were tested: adaptive quadratic and linear discriminant analysis. Three feature types were analyzed, adaptive autoregressive parameters, logarithmic band power estimates and the concatenation of both. Results show that all systems are stable and that the concatenation of features with continuously adaptive linear discriminant analysis classifier is the best choice of all. Also, a comparison of the latter with a discontinuously updated linear discriminant analysis, carried out in on-line experiments with six subjects, showed that on-line adaptation performed significantly better than a discontinuous update. Finally a static subject-specific baseline was also provided and used to compare performance measurements of both types of adaptation.

A fully on-line adaptive BCI.

A viable fully on-line adaptive brain computer interface (BCI) is introduced. On-line experiments with nine naive and able-bodied subjects were carried out using a continuously adaptive BCI system. The data were analyzed and the viability of the system was studied. The BCI was based on motor imagery, the feature extraction was performed with an adaptive autoregressive model and the classifier used was an adaptive quadratic discriminant analysis. The classifier was on-line updated by an adaptive estimation of the information matrix (ADIM). The system was also able to provide continuous feedback to the subject. The success of the feedback was studied analyzing the error rate and mutual information of each session and this analysis showed a clear improvement of the subject's control of the BCI from session to session.

Triple dissociation in the medial temporal lobes: recollection, familiarity, and novelty.

Memory for past events may be based on retrieval accompanied by specific contextual details (recollection) or on the feeling that an item is old (familiarity) or new (novelty) in the absence of contextual details. There are indications that recollection, familiarity, and novelty involve different medial temporal lobe subregions, but available evidence is scarce and inconclusive. Using functional magnetic resonance imaging (MRI), we isolated retrieval-related activity associated with recollection, familiarity, and novelty by distinguishing between linear and nonlinear oldness functions derived from recognition confidence levels. Within the medial temporal lobes (MTLs), we found a triple dissociation among the posterior half of the hippocampus, which was associated with recollection, the posterior parahippocampal gyrus, which was associated with familiarity, and anterior half of the hippocampus and rhinal regions, which were associated with novelty. Furthermore, multiple regression analyses based on individual trial activity showed that all three memory signals, i.e., recollection, familiarity, and novelty, make significant and independent contributions to recognition memory performance. Finally, functional dissociations among recollection, familiarity, and novelty were also found in posterior midline, left parietal cortex, and prefrontal cortex regions. This is the first study to reveal a triple dissociation within the MTL associated with distinct retrieval processes. This finding has direct implications for current memory models.

Adaptive on-line classification for EEG-based brain computer interfaces with AAR parameters and band power estimates.

We present the result of on-line feedback Brain Computer Interface experiments using adaptive and non-adaptive feature extraction methods with an on-line adaptive classifier based on Quadratic Discriminant Analysis. Experiments were performed with 12 naïve subjects, feedback was provided from the first moment and no training sessions were needed. Experiments run in three different days with each subject. Six of them received feedback with Adaptive Autoregressive parameters and the rest with logarithmic Band Power estimates. The study was done using single trial analysis of each of the sessions and the value of the Error Rate and the Mutual Information of the classification were used to discuss the results. Finally, it was shown that even subjects starting with a low performance were able to control the system in a few hours: and contrary to previous results no differences between AAR and BP estimates were found.