Perceptual information supports transfer of learning in coordinated rhythmic movement.

In this paper, we trained people to produce 90° mean relative phase using task-appropriate feedback and investigated whether and how that learning transfers to other coordinations. Past work has failed to find transfer of learning to other relative phases, only to symmetry partners (identical coordinations with reversed lead-lag relationships) and to other effector combinations. However, that research has all trained people using transformed visual feedback (visual metronomes, Lissajous feedback) which removes the relative motion information typically used to produce various coordinations (relative direction, relative position; Wilson and Bingham, in Percept Psychophys 70(3):465-476, 2008). Coordination feedback (Wilson et al., in J Exp Psychol Hum Percept Perform 36(6):1508, 2010) preserves that information and we have recently shown that relative position supports transfer of learning between unimanual and bimanual performance of 90° (Snapp-Childs et al., in Exp Brain Res 233(7), 2225-2238, 2015). Here, we ask whether that information can support the production of other relative phases. We found large, asymmetric transfer of learning bimanual 90° to bimanual 60° and 120°, supported by perceptual learning of relative position information at 90°. For learning to transfer, the two tasks must overlap in some critical way; this is additional evidence that this overlap must be informational. We discuss the results in the context of an ecological, task dynamical approach to understanding the nature of perception-action tasks.

Interventions for improving modifiable risk factor control in the secondary prevention of stroke.

BACKGROUND: People with stroke or transient ischaemic attack (TIA) are at increased risk of future stroke and other cardiovascular events. Stroke services need to be configured to maximise the adoption of evidence-based strategies for secondary stroke prevention. Smoking-related interventions were examined in a separate review so were not considered in this review. This is an update of our 2014 review. OBJECTIVES: To assess the effects of stroke service interventions for implementing secondary stroke prevention strategies on modifiable risk factor control, including patient adherence to prescribed medications, and the occurrence of secondary cardiovascular events. SEARCH METHODS: We searched the Cochrane Stroke Group Trials Register (April 2017), the Cochrane Effective Practice and Organisation of Care Group Trials Register (April 2017), CENTRAL (the Cochrane Library 2017, issue 3), MEDLINE (1950 to April 2017), Embase (1981 to April 2017) and 10 additional databases including clinical trials registers. We located further studies by searching reference lists of articles and contacting authors of included studies. SELECTION CRITERIA: We included randomised controlled trials (RCTs) that evaluated the effects of organisational or educational and behavioural interventions (compared with usual care) on modifiable risk factor control for secondary stroke prevention. DATA COLLECTION AND ANALYSIS: Four review authors selected studies for inclusion and independently extracted data. The quality of the evidence as 'high', 'moderate', 'low' or 'very low' according to the GRADE approach (GRADEpro GDT).Three review authors assessed the risk of bias for the included studies. We sought missing data from trialists.The results are presented in 'Summary of findings' tables. MAIN RESULTS: The updated review included 16 new studies involving 25,819 participants, resulting in a total of 42 studies including 33,840 participants. We used the Cochrane risk of bias tool and assessed three studies at high risk of bias; the remainder were considered to have a low risk of bias. We included 26 studies that predominantly evaluated organisational interventions and 16 that evaluated educational and behavioural interventions for participants. We pooled results where appropriate, although some clinical and methodological heterogeneity was present.Educational and behavioural interventions showed no clear differences on any of the review outcomes, which include mean systolic and diastolic blood pressure, mean body mass index, achievement of HbA1c target, lipid profile, mean HbA1c level, medication adherence, or recurrent cardiovascular events. There was moderate-quality evidence that organisational interventions resulted in improved blood pressure control, in particular an improvement in achieving target blood pressure (odds ratio (OR) 1.44, 95% confidence interval (CI) 1.09 to1.90; 13 studies; 23,631 participants). However, there were no significant changes in mean systolic blood pressure (mean difference (MD), -1.58 mmHg 95% CI -4.66 to 1.51; 16 studies; 17,490 participants) and mean diastolic blood pressure (MD -0.91 mmHg 95% CI -2.75 to 0.93; 14 studies; 17,178 participants). There were no significant changes in the remaining review outcomes. AUTHORS' CONCLUSIONS: We found that organisational interventions may be associated with an improvement in achieving blood pressure target but we did not find any clear evidence that these interventions improve other modifiable risk factors (lipid profile, HbA1c, medication adherence) or reduce the incidence of recurrent cardiovascular events. Interventions, including patient education alone, did not lead to improvements in modifiable risk factor control or the prevention of recurrent cardiovascular events.

Interventions to increase or decrease the length of primary care physicians' consultation.

BACKGROUND: Observational studies have shown differences in process and outcome between the consultations of primary care physicians whose average consultation lengths differ. These differences may be due to self selection. This is the first update of the original review. OBJECTIVES: To assess the effects of interventions to alter the length of primary care physicians' consultations. SEARCH METHODS: We searched the following electronic databases until 4 January 2016: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, ClinicalTrials.gov, and World Health Organization International Clinical Trials Registry Platform (WHO ICTRP). SELECTION CRITERIA: Randomised controlled trials and non-randomised controlled trials of interventions to alter the length of primary care physicians' consultations. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data and assessed the risk of bias of included studies using agreed criteria and resolved disagreements by discussion. We attempted to contact authors of primary studies with missing data. Given the heterogeneity of studies, we did not conduct a meta-analysis. We assessed the certainty of the evidence for the most important outcomes using the GRADE approach and have presented the results in a narrative summary. MAIN RESULTS: Five studies met the inclusion criteria. All were conducted in the UK, and tested short-term changes in the consultation time allocated to each patient. Overall, our confidence in the results was very low; most studies had a high risk of bias, particularly due to non-random allocation of participants and the absence of data on participants' characteristics and small sample sizes. We are uncertain whether altering appointment length increases primary care consultation length, number of referrals and investigations, prescriptions, or patient satisfaction based on very low-certainty evidence. None of the studies reported on the effects of altering the length of consultation on resources used. AUTHORS' CONCLUSIONS: We did not find sufficient evidence to support or refute a policy of altering the lengths of primary care physicians' consultations. It is possible that these findings may change if high-quality trials are reported in the future. Further trials are needed that focus on health outcomes and cost-effectiveness.

Admission avoidance hospital at home.

BACKGROUND: Admission avoidance hospital at home provides active treatment by healthcare professionals in the patient's home for a condition that otherwise would require acute hospital inpatient care, and always for a limited time period. This is the third update of the original review. OBJECTIVES: To determine the effectiveness and cost of managing patients with admission avoidance hospital at home compared with inpatient hospital care. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, two other databases, and two trials registers on 2 March 2016. We checked the reference lists of eligible articles. We sought unpublished studies by contacting providers and researchers who were known to be involved in the field. SELECTION CRITERIA: Randomised controlled trials recruiting participants aged 18 years and over. Studies comparing admission avoidance hospital at home with acute hospital inpatient care. DATA COLLECTION AND ANALYSIS: We followed the standard methodological procedures expected by Cochrane and the Effective Practice and Organisation of Care (EPOC) Group. We performed meta-analysis for trials that compared similar interventions and reported comparable outcomes with sufficient data, requested individual patient data from trialists, and relied on published data when this was not available. We used the GRADE approach to assess the certainty of the body of evidence for the most important outcomes. MAIN RESULTS: We included 16 randomised controlled trials with a total of 1814 participants; three trials recruited participants with chronic obstructive pulmonary disease, two trials recruited participants recovering from a stroke, six trials recruited participants with an acute medical condition who were mainly elderly, and the remaining trials recruited participants with a mix of conditions. We assessed the majority of the included studies as at low risk of selection, detection, and attrition bias, and unclear for selective reporting and performance bias. Admission avoidance hospital at home probably makes little or no difference on mortality at six months' follow-up (risk ratio (RR) 0.77, 95% confidence interval (CI) 0.60 to 0.99; P = 0.04; I2 = 0%; 912 participants; moderate-certainty evidence), little or no difference on the likelihood of being transferred (or readmitted) to hospital (RR 0.98, 95% CI 0.77 to 1.23; P = 0.84; I2 = 28%; 834 participants; moderate-certainty evidence), and may reduce the likelihood of living in residential care at six months' follow-up (RR 0.35, 95% CI 0.22 to 0.57; P < 0.0001; I2 = 78%; 727 participants; low-certainty evidence). Satisfaction with healthcare received may be improved with admission avoidance hospital at home (646 participants, low-certainty evidence); few studies reported the effect on caregivers. When the costs of informal care were excluded, admission avoidance hospital at home may be less expensive than admission to an acute hospital ward (287 participants, low-certainty evidence); there was variation in the reduction of hospital length of stay, estimates ranged from a mean difference of -8.09 days (95% CI -14.34 to -1.85) in a trial recruiting older people with varied health problems, to a mean increase of 15.90 days (95% CI 8.10 to 23.70) in a study that recruited patients recovering from a stroke. AUTHORS' CONCLUSIONS: Admission avoidance hospital at home, with the option of transfer to hospital, may provide an effective alternative to inpatient care for a select group of elderly patients requiring hospital admission. However, the evidence is limited by the small randomised controlled trials included in the review, which adds a degree of imprecision to the results for the main outcomes.

Transfer of learning between unimanual and bimanual rhythmic movement coordination: transfer is a function of the task dynamic.

Under certain conditions, learning can transfer from a trained task to an untrained version of that same task. However, it is as yet unclear what those certain conditions are or why learning transfers when it does. Coordinated rhythmic movement is a valuable model system for investigating transfer because we have a model of the underlying task dynamic that includes perceptual coupling between the limbs being coordinated. The model predicts that (1) coordinated rhythmic movements, both bimanual and unimanual, are organised with respect to relative motion information for relative phase in the coupling function, (2) unimanual is less stable than bimanual coordination because the coupling is unidirectional rather than bidirectional, and (3) learning a new coordination is primarily about learning to perceive and use the relevant information which, with equal perceptual improvement due to training, yields equal transfer of learning from bimanual to unimanual coordination and vice versa [but, given prediction (2), the resulting performance is also conditioned by the intrinsic stability of each task]. In the present study, two groups were trained to produce 90° either unimanually or bimanually, respectively, and tested in respect to learning (namely improved performance in the trained 90° coordination task and improved visual discrimination of 90°) and transfer of learning (to the other, untrained 90° coordination task). Both groups improved in the task condition in which they were trained and in their ability to visually discriminate 90°, and this learning transferred to the untrained condition. When scaled by the relative intrinsic stability of each task, transfer levels were found to be equal. The results are discussed in the context of the perception-action approach to learning and performance.

Delay between symptom onset and clinic attendance following TIA and minor stroke: the BEATS study.

BACKGROUND: rapid specialist assessment of patients with transient ischaemic attack (TIA) reduces the risk of recurrent stroke. National guidelines advise that high-risk patients are assessed within 24 h and low-risk patients within 7 days. AIM: to quantify delay and map pathways taken by patients from symptom onset to specialist assessment. DESIGN: retrospective cohort study. SETTING: rapid access TIA clinic. METHODS: structured interviews with 278 patients newly diagnosed with TIA (222) or minor stroke (56), and examination of medical records. RESULTS: of the 133 high-risk TIA patients, 11 (8%) attended the clinic within 24 h of symptom onset; of the 89 low-risk TIA patients, 47 (53%) attended within 7 days. Median delay between symptom onset and seeking help from a healthcare professional (HCP) was 4.0 h (IQR 0.5, 41.3). Delay was less if symptoms were correctly interpreted but not reduced by a publicity campaign (FAST) to encourage an urgent response. Most patients (156, 56%) first contacted a general practitioner (GP) and 46 (17%) called an ambulance or attended the emergency department. Over a third (36%) had a second consultation with an HCP before attending the clinic, and this was more likely in those presenting to paramedics, out of hours GP services or optometry. Time to clinic attendance was less if an emergency pathway was used and greater if patients were seen by a second HCP. CONCLUSIONS: factors contributing to delay include incorrect interpretation of symptoms and failure to invoke emergency services. Delays after presentation could be addressed by direct referral by out of hours services, paramedics and optometrists.

Interventions for improving modifiable risk factor control in the secondary prevention of stroke.

BACKGROUND: People with stroke or transient ischaemic attack (TIA) are at increased risk of future stroke and other cardiovascular events. Evidence-based strategies for secondary stroke prevention have been established. However, the implementation of prevention strategies could be improved. OBJECTIVES: To assess the effects of stroke service interventions for implementing secondary stroke prevention strategies on modifiable risk factor control, including patient adherence to prescribed medications, and the occurrence of secondary cardiovascular events. SEARCH METHODS: We searched the Cochrane Stroke Group Trials Register (April 2013), the Cochrane Effective Practice and Organisation of Care Group Trials Register (April 2013), CENTRAL (The Cochrane Library 2013, issue 3), MEDLINE (1950 to April 2013), EMBASE (1981 to April 2013) and 10 additional databases. We located further studies by searching reference lists of articles and contacting authors of included studies. SELECTION CRITERIA: We included randomised controlled trials (RCTs) that evaluated the effects of organisational or educational and behavioural interventions (compared with usual care) on modifiable risk factor control for secondary stroke prevention. DATA COLLECTION AND ANALYSIS: Two review authors selected studies for inclusion and independently extracted data. One review author assessed the risk of bias for the included studies. We sought missing data from trialists. MAIN RESULTS: This review included 26 studies involving 8021 participants. Overall the studies were of reasonable quality, but one study was considered at high risk of bias. Fifteen studies evaluated predominantly organisational interventions and 11 studies evaluated educational and behavioural interventions for patients. Results were pooled where appropriate, although some clinical and methodological heterogeneity was present. The estimated effects of organisational interventions were compatible with improvements and no differences in the modifiable risk factors mean systolic blood pressure (mean difference (MD) -2.57 mmHg; 95% confidence interval (CI) -5.46 to 0.31), mean diastolic blood pressure (MD -0.90 mmHg; 95% CI -2.49 to 0.68), blood pressure target achievement (OR 1.24; 95% CI 0.94 to 1.64) and mean body mass index (MD -0.68 kg/m(2); 95% CI -1.46 to 0.11). There were no significant effects of organisational interventions on lipid profile, HbA1c, medication adherence or recurrent cardiovascular events. Educational and behavioural interventions were not generally associated with clear differences in any of the review outcomes, with only two exceptions. AUTHORS' CONCLUSIONS: Pooled results indicated that educational interventions were not associated with clear differences in any of the review outcomes. The estimated effects of organisational interventions were compatible with improvements and no differences in several modifiable risk factors. We identified a large number of ongoing studies, suggesting that research in this area is increasing. The use of standardised outcome measures would facilitate the synthesis of future research findings.

Trajectory Synthesis for Fisher Information Maximization.

Estimation of model parameters in a dynamic system can be significantly improved with the choice of experimental trajectory. For general nonlinear dynamic systems, finding globally "best" trajectories is typically not feasible; however, given an initial estimate of the model parameters and an initial trajectory, we present a continuous-time optimization method that produces a locally optimal trajectory for parameter estimation in the presence of measurement noise. The optimization algorithm is formulated to find system trajectories that improve a norm on the Fisher information matrix (FIM). A double-pendulum cart apparatus is used to numerically and experimentally validate this technique. In simulation, the optimized trajectory increases the minimum eigenvalue of the FIM by three orders of magnitude, compared with the initial trajectory. Experimental results show that this optimized trajectory translates to an order-of-magnitude improvement in the parameter estimate error in practice.

Reduced learning rates but successful learning of a coordinated rhythmic movement by older adults.

Previous work has investigated the information-based mechanism for learning and transfer of learning in coordinated rhythmic movements. In those papers, we trained young adults to produce either 90° or 60° and showed in both cases that learning entailed learning to use relative position as information for the relative phase. This variable then supported transfer of learning to untrained coordinations +/30° on either side. In this article, we replicate the 90° study with younger adults and extend it by training older adults (aged between 55 and 65 years). Other work has revealed a steep decline in learning rate around this age, and no follow-up study has been able to successfully train older adults to perform a novel coordination. We used a more intensive training paradigm and showed that while older adult learning rates remain about half that of younger adults, given time they are able to acquire the new coordination. They also learn to use relative position, and consequently show the same pattern of transfer. We discuss implications for attempts to model the process of learning in this task.

Affordances for throwing: An uncontrolled manifold analysis.

Movement systems are massively redundant, and there are always multiple movement solutions to any task demand; motor abundance. Movement consequently exhibits 'repetition without repetition', where movement outcomes are preserved but the kinematic details of the movement vary across repetitions. The uncontrolled manifold (UCM) concept is one of several methods that analyses movement variability with respect to task goals, to quantify repetition without repetition and test hypotheses about the control architecture producing a given abundant response to a task demand. However, like all these methods, UCM is under-constrained in how it decomposes a task and performance. In this paper, we propose and test a theoretical framework for constraining UCM analysis, specifically the perception of task-dynamical affordances. Participants threw tennis balls to hit a target set at 5m, 10m or 15m, and we performed UCM analysis on the shoulder-elbow-wrist joint angles with respect to variables derived from an affordance analysis of this task as well as more typical biomechanical variables. The affordance-based UCM analysis performed well, although data also showed thrower dynamics (effectivities) need to be accounted for as well. We discuss how the theoretical framework of affordances and affordance-based control can be connected to motor abundance methods in the future.

Perceptuo-motor learning rate declines by half from 20s to 70/80s.

This study examined perception-action learning in younger adults in their 20s compared to older adults in their 70s and 80s. The goal was to provide, for the first time, quantitative estimates of perceptuo-motor learning rates for each age group and to reveal how these learning rates change between these age groups. We used a visual coordination task in which participants are asked to learn to produce a novel-coordinated rhythmic movement. The task has been studied extensively in young adults, and the characteristics of the task are well understood. All groups showed improvement, although learning rates for those in their 70s and 80s were half the rate for those in their 20s. We consider the potential causes of these differences in learning rates by examining performance across the different coordination patterns examined as well as recent results that reveal age-related deficits in motion perception.

Harms Reporting in Systematic Reviews of the Microvascular Free Flap in Head and Neck Reconstruction.

OBJECTIVE: To evaluate harms reporting in systematic reviews (SRs) of microvascular free flap (MFF) in head and neck reconstruction. DATA SOURCES: This cross-sectional analysis included searches from the following major databases from 2012 to June 1, 2022: MEDLINE (Pubmed and Ovid), Embase, Epistemonikos, and the Cochrane Database of Systematic Reviews. REVIEW METHODS: In a masked duplicate manner, screening was performed using Rayyan, and data were extracted using a pilot-tested Google form. A MeaSurement Tool to Assess systematic Reviews-2 (AMSTAR-2) was used to appraise the methodological quality of reviews and the corrected covered area was calculated to detect primary study overlap across all reviews. Reviews were then grouped in pairs of 2, called dyads, and the corrected covered area was calculated again for each individual dyad. Dyads with high overlap (≥50%) were further investigated for the accuracy of harms reporting. RESULTS: Our initial search yielded 268 records, with 50 SRs meeting the inclusion criteria. A total of 46 (92%) of the included reviews demonstrated 50% or more adherence to the items assessed in our harms checklist. Our corrected covered area tool revealed 0.6% primary study overlap across all reviews, and 1 dyad with high overlap (≥50%). No statistically significant relationship was observed between the completeness of harms reporting and reviews listing harms as a primary outcome, reviews reporting adherence to Preferred Reporting Items of Systematic Reviews and Meta-Analyses, or a review's AMSTAR rating. CONCLUSION: This study identifies how harms reporting in SRs of MFF reconstruction of the head and neck can be improved and provides suggestions with the potential to mitigate the paucity in current literature.

A meta-analysis of "hospital in the home".

OBJECTIVE: To assess the effect of "hospital in the home" (HITH) services that significantly substitute for inhospital time on mortality, readmission rates, patient and carer satisfaction, and costs. DATA SOURCES: MEDLINE, Embase, Social Sciences Citation Index, CINAHL, EconLit, PsycINFO and the Cochrane Database of Systematic Reviews, from the earliest date in each database to 1 February 2012. STUDY SELECTION: Randomised controlled trials (RCTs) comparing HITH care with inhospital treatment for patients aged > 16 years. DATA EXTRACTION: Potentially relevant studies were reviewed independently by two assessors, and data were extracted using a collection template and checklist. DATA SYNTHESIS: 61 RCTs met the inclusion criteria. HITH care led to reduced mortality (odds ratio [OR], 0.81; 95% CI, 0.69 to 0.95; P = 0.008; 42 RCTs with 6992 patients), readmission rates (OR, 0.75; 95% CI, 0.59 to 0.95; P = 0.02; 41 RCTs with 5372 patients) and cost (mean difference, -1567.11; 95% CI, -2069.53 to -1064.69; P < 0.001; 11 RCTs with 1215 patients). The number needed to treat at home to prevent one death was 50. No heterogeneity was observed for mortality data, but heterogeneity was observed for data relating to readmission rates and cost. Patient satisfaction was higher in HITH in 21 of 22 studies, and carer satisfaction was higher in and six of eight studies; carer burden was lower in eight of 11 studies, although not significantly (mean difference, 0.00; 95% CI, -0.19 to 0.19). CONCLUSION: HITH is associated with reductions in mortality, readmission rates and cost, and increases in patient and carer satisfaction, but no change in carer burden.

The stability of rhythmic movement coordination depends on relative speed: the Bingham model supported.

Following many studies showing that the coupling in bimanual coordination can be perceptual, Bingham (Ecol Psychol in 16:45-53, 2001; 2004a, b) proposed a dynamical model of such movements. The model contains three key hypotheses: (1) Being able to produce stable coordinative movements is a function of the ability to perceive relative phase, (2) the information to perceive relative phase is relative direction of motion, and (3) the ability to resolve this information is conditioned by relative speed. The first two hypotheses have been well supported (Wilson and Bingham in Percept Psychophys 70:465-476, 2008; Wilson et al. in J Exp Psychol Hum 36:1508-1514, 2010a), but the third was not supported when tested by de Rugy et al. (Exp Brain Res 184:269-273, 2008) using a visual coordination task that required simultaneous control of both the amplitude and relative phase of movement. The purposes of the current study were to replicate this task with additional measures and to modify the original model to apply it to the new task. To do this, we conducted two experiments. First, we tested the ability to produce 180° visual coordination at different frequencies to determine frequencies suitable for testing in the de Rugy et al. task. Second, we tested the de Rugy et al. task but included additional measures that yielded results different from those reported by de Rugy et al. These results were used to elaborate the original model. First, one of the phase-driven oscillators was replaced with a harmonic oscillator, so the resulting coupling was unidirectional. This change resulted in the model producing less stable 180° coordination behavior beyond 1.5 Hz consistent with the results obtained in Experiment 1. Next, amplitude control and phase correction elements were added to the model. With these changes, the model reproduced behaviors observed in Experiment 2. The central finding was that the stability of rhythmic movement coordination does depend on relative speed and, thus, all three of the hypotheses contained in the original Bingham model are supported.

The masked priming toolbox: an open-source MATLAB toolbox for masked priming researchers.

The Masked Priming Toolbox is an open-source collection of MATLAB functions that utilizes the free third-party PsychToolbox-3 (PTB3: Brainard, Spatial Vision, 10, 433-436, 1997; Kleiner, Brainard & Pelli, Perception, 36, 2007; Pelli, Spatial Vision, 10, 437-442, 1997). It is designed to allow a researcher to run masked (and unmasked) priming experiments using a variety of response devices (including keyboards, graphics tablets and force transducers). Very little knowledge of MATLAB is required; experiments are generated by creating a text file with the required parameters, and raw and analyzed data are output to Excel (as well as MATLAB) files for further analysis. The toolbox implements a variety of stimuli for use as primes and targets, as well as a variety of masks. Timing, size, location, and orientation of stimuli are all parameterizable. The code is open-source and made available on the Web under a Creative Commons License.

The Ecological Task Dynamics of Learning and Transfer in Coordinated Rhythmic Movement.

Research spanning 100 years has revealed that learning a novel perception-action task is remarkably task-specific. With only a few exceptions, transfer is typically very small, even with seemingly small changes to the task. This fact has remained surprising given previous attempts to formalise the notion of what a task is, which have been dominated by common-sense divisions of tasks into parts. This article lays out an ecologically grounded alternative, ecological task dynamics, which provides us with tools to formally define tasks as experience from the first-person perspective of the learner. We explain this approach using data from a learning and transfer experiment using bimanual coordinated rhythmic movement as the task, and acquiring a novel coordination as the goal of learning. 10 participants were extensively trained to perform 60° mean relative phase; this learning transferred to 30° and 90°, against predictions derived from our previous work. We use recent developments in the formal model of the task to guide interpretation of the learning and transfer results.

Decision-making process for introduction of maternal vaccines in Kenya, 2017-2018.

BACKGROUND: Maternal immunization is a key strategy for reducing morbidity and mortality associated with infectious diseases in mothers and their newborns. Recent developments in the science and safety of maternal vaccinations have made possible development of new maternal vaccines ready for introduction in low- and middle-income countries. Decisions at the policy level remain the entry point for maternal immunization programs. We describe the policy and decision-making process in Kenya for the introduction of new vaccines, with particular emphasis on maternal vaccines, and identify opportunities to improve vaccine policy formulation and implementation process. METHODS: We conducted 29 formal interviews with government officials and policy makers, including high-level officials at the Kenya National Immunization Technical Advisory Group, and Ministry of Health officials at national and county levels. All interviews were recorded and transcribed. We analyzed the qualitative data using NVivo 11.0 software. RESULTS: All key informants understood the vaccine policy formulation and implementation processes, although national officials appeared more informed compared to county officials. County officials reported feeling left out of policy development. The recent health system decentralization had both positive and negative impacts on the policy process; however, the negative impacts outweighed the positive impacts. Other factors outside vaccine policy environment such as rumours, sociocultural practices, and anti-vaccine campaigns influenced the policy development and implementation process. CONCLUSIONS: Public policy development process is complex and multifaceted by its nature. As Kenya prepares for introduction of other maternal vaccines, it is important that the identified policy gaps and challenges are addressed.

Learning a coordinated rhythmic movement with task-appropriate coordination feedback.

A common perception-action learning task is to teach participants to produce a novel coordinated rhythmic movement, e.g. 90 degrees mean relative phase. As a general rule, people cannot produce these novel movements stably without training. This is because they are extremely poor at discriminating the perceptual information required to coordinate and control the movement, which means people require additional (augmented) feedback to learn the novel task. Extant methods (e.g. visual metronomes, Lissajous figures) work, but all involve transforming the perceptual information about the task and thus altering the perception-action task dynamic being studied. We describe and test a new method for providing online augmented coordination feedback using a neutral colour cue. This does not alter the perceptual information or the overall task dynamic, and an experiment confirms that (a) feedback is required for learning a novel coordination and (b) the new feedback method provides the necessary assistance. This task-appropriate augmented feedback therefore allows us to study the process of learning while preserving the perceptual information that constitutes a key part of the task dynamic being studied. This method is inspired by and supports a fully perception-action approach to coordinated rhythmic movement.

Continuous priming effects on discrete response choices.

When primed by backward-masked, target-like stimuli, discrete responses (e.g. button presses) to simple visual targets can be slower when prime and target match (compatible) than when they do not (incompatible). The current study investigated the nature of the stimulus-response mapping underlying this negative compatibility effect (NCE). Discrete left-right responses to arrow targets were primed with arrows oriented in one of 16 directions. Responses were either a standard button press or a 10 cm movement on a graphics tablet. Both tasks showed an identical NCE; importantly, reaction times in both tasks decreased smoothly as the angular distance between prime and target increased (i.e. as compatibility decreased), with the largest NCE evident between the extreme cases (prime-target distances of 0 degrees and 180 degrees ). Primes exerted an effect on the required response in proportion to the amount of overlap (reflecting population vector coding). The mapping between the priming stimulus and response is continuous, not categorical.

Head-torso-hand coordination in children with and without developmental coordination disorder.

AIM: This study investigated the nature of coordination and control problems in children with developmental coordination disorder (DCD). METHOD: Seven adults (two males, five females, age range 20-28 y; mean 23 y, SD 2 y 8 mo) and eight children with DCD (six males, two females, age range 7-9 y; mean 8 y, SD 8 mo), and 10 without DCD (seven males, three females, age range 7-9 y; mean 8 y, SD 7 mo) sat in a swivel chair and looked at or pointed to targets. Optoelectronic apparatus recorded head, torso, and hand movements, and the spatial and temporal characteristics of the movements were computed. RESULTS: Head movement times were longer (p<0.05) in children with DCD than in the comparison group, even in the looking task, suggesting that these children experience problems at the lowest level of coordination (the coupling of synergistic muscle groups within a single degree of freedom). Increasing the task demands with the pointing condition affected the performance of children with DCD to a much greater extent than the other groups, most noticeably in key feedforward kinematic landmarks. Temporal coordination data indicated that all three groups attempted to produce similar movement patterns to each other, but that the children with DCD were much less successful than age-matched children in the comparison group. INTERPRETATION: Children with DCD have difficulty coordinating and controlling single degree-of-freedom movements; this problem makes more complex tasks disproportionately difficult for them. Quantitative analysis of kinematics provides key insights into the nature of the problems faced by children with DCD.