Multiplexed modulation of behavioral choice.

Stimuli in the environment, as well as internal states, influence behavioral choice. Of course, animals are often exposed to multiple external and internal factors simultaneously, which makes the ultimate determinants of behavior quite complex. We observed the behavioral responses of European leeches, Hirudo verbana, as we varied one external factor (surrounding water depth) with either another external factor (location of tactile stimulation along the body) or an internal factor (body distention following feeding). Stimulus location proved to be the primary indicator of behavioral response. In general, anterior stimulation produced shortening behavior, midbody stimulation produced local bending, and posterior stimulation usually produced either swimming or crawling but sometimes a hybrid of the two. By producing a systematically measured map of behavioral responses to body stimulation, we found wide areas of overlap between behaviors. When we varied the surrounding water depth, this map changed significantly, and a new feature - rotation of the body along its long axis prior to swimming - appeared. We found additional interactions between water depth and time since last feeding. A large blood meal initially made the animals crawl more and swim less, an effect that was attenuated as water depth increased. The behavioral map returned to its pre-feeding form after approximately 3 weeks as the leeches digested their blood meal. In summary, we found multiplexed impacts on behavioral choice, with the map of responses to tactile stimulation modified by water depth, which itself modulated the impact that feeding had on the decision to swim or crawl.

The Universal Form of Treatment Options (UFTO) as an alternative to Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) orders: a mixed methods evaluation of the effects on clinical practice and patient care.

AIMS: To determine whether the introduction of the Universal Form of Treatment Options (the UFTO), as an alternative approach to Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) orders, reduces harms in patients in whom a decision not to attempt cardiopulmonary resuscitation (CPR) was made, and to understand the mechanism for any observed change. METHODS: A mixed-methods before-and-after study with contemporaneous case controls was conducted in an acute hospital. We examined DNACPR (103 patients with DNACPR orders in 530 admissions) and UFTO (118 decisions not to attempt resuscitation in 560 admissions) practice. The Global Trigger Tool was used to quantify harms. Qualitative interviews and observations were used to understand mechanisms and effects. RESULTS: RATE OF HARMS IN PATIENTS FOR WHOM THERE WAS A DOCUMENTED DECISION NOT TO ATTEMPT CPR WAS REDUCED: Rate difference per 1000 patient-days was 12.9 (95% CI: 2.6-23.2, p-value=0.01). There was a difference in the proportion of harms contributing to patient death in the two periods (23/71 in the DNACPR period to 4/44 in the UFTO period (95% CI 7.8-36.1, p-value=0.006). Significant differences were maintained after adjustment for known confounders. No significant change was seen on contemporaneous case control wards. Interviews with clinicians and observation of ward practice revealed the UFTO helped provide clarity of goals of care and reduced negative associations with resuscitation decisions. CONCLUSIONS: Introducing the UFTO was associated with a significant reduction in harmful events in patients in whom a decision not to attempt CPR had been made. Coupled with supportive qualitative evidence, this indicates the UFTO improved care for this vulnerable group. TRIAL REGISTRATION: Controlled-Trials.com ISRCTN85474986 UK Comprehensive Research Network Portfolio 7932.

The relationship between voltage-sensitive dye imaging signals and spiking activity of neural populations in primate V1.

Voltage-sensitive dye imaging (VSDI) is a powerful technique for measuring neural population responses from a large cortical region simultaneously with millisecond temporal resolution and columnar spatial resolution. However, the relationship between the average VSDI signal and the average spiking activity of neural populations is largely unknown. To better understand this relationship, we compared visual responses measured from V1 of behaving monkeys using VSDI and single-unit electrophysiology. We found large and systematic differences between position and orientation tuning properties obtained with these two techniques. We then determined that a simple computational model could explain these tuning differences. This model, together with our experimental results, allowed us to estimate the quantitative relationship between the average VSDI signal and local spiking activity. We found that this relationship is similar to the previously reported nonlinear relationship between average membrane potential and spike rate in single V1 neurons, suggesting that VSDI signals are dominated by subthreshold synaptic activity. This model, together with the VSDI measured maps for spatial position (retinotopy) and orientation, also allowed us to estimate the spatial integration area over which neural responses contribute to the VSDI signal at a given location. We found that the VSDI-integration area is consistent with a Gaussian envelope with a space constant of ∼230 µm. Finally, we show how this model and estimated parameters can be used to predict the pattern of population responses at the level of spiking activity from VSDI responses.

Uniform spatial spread of population activity in primate parafoveal V1.

What are the shape and size of the region in primate V1 that processes information from a single point in visual space? This region, a fundamental property termed cortical point image (CPI) (McIlwain 1986), represents the minimal population of V1 neurons that can be activated by a visual stimulus and therefore has important implications for population coding in the cortex. Previous indirect attempts to measure the CPI in macaque V1 using sparse microelectrode recordings resulted in conflicting findings. Whereas some early studies suggested that CPI size is constant throughout V1 (e.g., Hubel and Wiesel 1974), others have reported large changes in CPI size in parafoveal V1 (e.g., Van Essen et al. 1984). To resolve this controversy, we used voltage-sensitive dye imaging in V1 of fixating monkeys to directly measure the subthreshold CPI and several related properties across a range of parafoveal eccentricities. We found that despite large changes in other properties of the retinotopic map, the subthreshold CPI is approximately constant and extends over ∼6 × 8 mm(2). This large and invariant CPI ensures a uniform representation of each point in visual space, with a complete representation of all visual features in V1, as originally proposed by Hubel and Wiesel (1974). In addition, we found several novel and unexpected asymmetries and anisotropies in the shapes of the CPI and the population receptive field. These results expand our understanding of the representation of visual space in V1 and are likely to be relevant for the representations of stimuli in other sensory cortical areas.

Contextual modulation of behavioral choice.

We review the influence of context on behavioral choice. Context can refer to external (environmental) factors such as the season or presence of predators and it can also refer to the internal or behavioral state of an animal. Usually, animals make decisions in the midst of other ongoing behaviors. We discuss recent findings on the impact of both types of contexts, focusing on how context gets encoded at the intersection between the sensory and motor systems, emphasizing the role of neuromodulators. We also review recent technological advances that have made feasible the exploration of neural correlates of decision making in freely moving, behaving animals.

Prevalence and determinants of hyperglycemia in very low birth weight infants: cohort analyses of the NIRTURE study.

OBJECTIVES: To investigate the prevalence and determinants of hyperglycemia in the preterm population, as part of the Neonatal Insulin Therapy in Europe (NIRTURE) Trial. STUDY DESIGN: We conducted prospective cohort analyses of continuous glucose monitoring data from control infants participating in an international randomized controlled trial. Data were collected from 188 very low birth weight infants (<1500 g). RESULTS: In the first week of life, 80% of infants had evidence of glucose levels >8 mmol/L, and 32% had glucose levels >10 mmol/L >10% of the time. Independent risk factors for hyperglycemia included increasing prematurity, small size at birth, use of inotropes, lipid infusions, and sepsis. There was a lack of association between rate of dextrose infused and risk of hyperglycemia. CONCLUSION: The prevalence of hyperglycemia in the very low birth weight infant is high, with marked variability in prevalence between infants, not simply related to rates of glucose infused, but to other potentially modifiable risk factors.

Evaluation of the modified Elmslie-Trillat procedure for patellofemoral dysfunction.

The goal of this study was to evaluate the Elmslie-Trillat procedure for recurrent patellar dislocation, patellofemoral pain (with extensor mechanism malalignment), or a combination of both. Thirty-two patients underwent the modified Elmslie-Trillat procedure, consisting of a lateral retinacular release and medialization of the tibial tuberosity for recurrent patellar dislocation, patellofemoral pain, or both. Twenty-nine of 32 patients were available for follow-up. All patients were evaluated clinically and radiologically. Subjective scores were evaluated using the Cox grading system and objective scores using Fulkerson's functional knee score. Average patient age was 33 years. Mean follow-up was 45 months. Subjectively, using the Cox grading system, 10 patients (34%) had an excellent result, 8 (28%) had a good result, 8 (28%) had a fair result, and 3 (10%) had a poor result. All patients with patella dislocation had an excellent or good subjective result, while only 3 patients (34%) with the primary symptom of patellofemoral pain with extensor mechanism malalignment and 4 patients (44%) with a combination of both symptoms had a good or excellent result. Mean Fulkerson's functional knee score was excellent for patients with dislocation only, and fair for those with only pain or both pain and dislocation. The congruence angle was corrected in all patients with this technique. There were no further dislocations in our series. Two patients required hardware removal. The Elmslie-Trillat procedure is a good surgical option for treatment of recurrent patella instability following failed conservative therapy. However, the results are not as favorable for patients with patellofemoral pain without instability.