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Freezing of gait (FOG) in Parkinson’s disease (PD) has a poorly understood pathophysiology, which hinders treatment development. Recent work showed a dysfunctional fronto-striato-limbic circuitry at rest in PD freezers compared to non-freezers in the dopamine “OFF” state. While other studies found that dopaminergic replacement therapy alters functional brain organization in PD, the specific effect of dopamine medication on fronto-striato-limbic functional connectivity in freezers remains unclear.

Objective: The objective of this study is to identify, examine, and map the literature on infection prevention and control (IPAC) education and training for visitors to long-term care (LTC) homes. Introduction: Visitor restrictions during infectious outbreaks in LTC homes aim to reduce virus transmission to vulnerable residents. The COVID-19 pandemic highlighted the negative impacts of such restrictions, prompting the need for IPAC education for visitors. Inclusion Criteria: This review includes research, narrative papers, and grey literature on IPAC education and training for LTC visitors. It focuses on intentional education aimed at preventing infection transmission. Studies not involving visitors or offered in other settings were excluded. Methods: Following the JBI methodology for scoping reviews, bibliographic databases (CINAHL, Embase, AgeLine, Medline, and ERIC) were searched from 1990 to present in English or French. Data were extracted by two reviewers, focusing on the educational content, delivery mode, frequency, timing, and qualifications of educators. A narrative summary and descriptive statistics were produced. Results: The 26 included documents contained guidelines, policies, educational resources, and opinion papers. Pre-2020, healthcare workers were responsible for educating visitors. Post-2020, more detailed recommendations emerged on the frequency, content, and delivery methods. Key topics included hand hygiene (92.3%), respiratory hygiene (80.8%), and PPE use (73.1%). Conclusions: IPAC education and training for LTC visitors is essential for safe visitation. Future research should evaluate the effectiveness of these educational interventions. [ABSTRACT FROM AUTHOR]

Dementia often manifests with profound alterations in perception, but it is unclear if and to what extent time perception is altered among people living with dementia compared to those experiencing normal aging. Thus, this scoping review aimed to answer the following research questions: (1) What study designs, participants, time intervals, paradigms, tests, and scores have been employed and in which countries were these methods employed to study time perception in dementia? (2) In which ways do time perception differ across individuals living with and without dementia? (3) In which ways do time perception differ across individuals living with different types of dementia? After deduplication, title and abstract screening, and full-text review, a total of 12 studies were included in this scoping review. Findings generally indicated that people living with dementia perceive time differently than people living without dementia, and that some differences across dementia diagnoses may exist, but the body of literature on time perception in dementia was quite limited. Future research should focus on replicating findings while extending the research to look beyond the dementia versus non-dementia dichotomy as differences across dementia diagnoses may exist. Moreover, if people living with dementia (and, in particular, living with different dementia diagnoses) experience time differently from those experiencing normal aging, we need to begin to address these differences in dementia-friendly initiatives to improve well-being for this population. [ABSTRACT FROM AUTHOR]

Purpose: This study, which is a cross-sectional survey, aims to investigate health-care academics, clinicians and students' perspectives of health-care simulation-based learning (SBL) and extended reality (XR) haptics use within health-care education. Participants' views regarding the application, barriers and facilitators of SBL and XR haptics were explored. Design/methodology/approach: The authors conducted an online international cross-sectional survey of 178 participants. Findings: The survey found high health-care SBL use (n = 97, 55.1%) but low awareness (n = 48, 27.3%) or prior use of XR haptics (n = 14, 7.9%). Participants expressed interest in XR haptic technology emphasising its potential in SBL, particularly for understanding anatomy and physiology, enhancing clinical reasoning and consultation and practical skills. Research limitations/implications: Whilst there was interest in XR haptics, few participants described previous experience of using this technology in SBL. A large percentage of the participants were UK-based. Most participants were from a nurse or physiotherapy professional background. Practical implications: XR haptics is a developing technology for SBL in health-care education. Whilst there was clear interest from survey participants, further research is now required to develop and evaluate the feasibility of using this technology in health-care education. Originality/value: Health-care students, educators and clinicians views on XR haptics have not previously been explored in the development and application of this technology. The findings of this survey will inform the development of XR learning scenarios that will be evaluated for feasibility in health-care SBL. [ABSTRACT FROM AUTHOR]

Purpose: This mixed methods study aimed to assess the knowledge and skills related to infection prevention and control amongst visitors to long-term care homes following the removal of visiting restrictions during the Covid-19 pandemic. Methods: Forty visitors to residents in long-term care homes were recruited. Participants' knowledge of the Covid-19, infection prevention and control practices, and self-reported use of protective behaviours were assessed through questionnaires. Handwashing skills, donning and doffing of personal protective equipment and decision-making surrounding hand hygiene moments were assessed through laboratory simulation using observation checklists. Results: Participants' level of knowledge and perceived use of protective behaviours were high. However, no one accurately performed the handwashing steps, few (5.0%) performed all hand hygiene moments recommended, 35.0% donned personal protective equipment and only 12.5% doffed correctly. This is concerning because 90.0% of participants reported receiving infection prevention and control training. Conclusion: These findings suggest educational interventions, resources and policies are needed to strengthen infection prevention and control training for visitors' to long-term care. [ABSTRACT FROM AUTHOR]

Visual hallucinations in Parkinson's disease can be viewed from a systems-level perspective, whereby dysfunctional communication between brain networks responsible for perception predisposes a person to hallucinate. To this end, abnormal functional interactions between higher-order and primary sensory networks have been implicated in the pathophysiology of visual hallucinations in Parkinson's disease, however the precise signatures remain to be determined. Dimensionality reduction techniques offer a novel means for simplifying the interpretation of multidimensional brain imaging data, identifying hierarchical patterns in the data that are driven by both within- and between-functional network changes. Here, we applied two complementary non-linear dimensionality reduction techniques—diffusion-map embedding and t-distributed stochastic neighbour embedding (t-SNE)—to resting state functional MRI data, in order to characterize the altered functional hierarchy associated with susceptibility to visual hallucinations. Our study involved 77 people with Parkinson's disease (31 with hallucinations; 46 without hallucinations) and 19 age-matched healthy control subjects. In patients with visual hallucinations, we found compression of the unimodal-heteromodal gradient consistent with increased functional integration between sensory and higher order networks. This was mirrored in a traditional functional connectivity analysis, which showed increased connectivity between the visual and default mode networks in the hallucinating group. Together, these results suggest a route by which higher-order regions may have excessive influence over earlier sensory processes, as proposed by theoretical models of hallucinations across disorders. By contrast, the t-SNE analysis identified distinct alterations in prefrontal regions, suggesting an additional layer of complexity in the functional brain network abnormalities implicated in hallucinations, which was not apparent in traditional functional connectivity analyses. Together, the results confirm abnormal brain organization associated with the hallucinating phenotype in Parkinson's disease and highlight the utility of applying convergent dimensionality reduction techniques to investigate complex clinical symptoms. In addition, the patterns we describe in Parkinson's disease converge with those seen in other conditions, suggesting that reduced hierarchical differentiation across sensory-perceptual systems may be a common transdiagnostic vulnerability in neuropsychiatric disorders with perceptual disturbances. [ABSTRACT FROM AUTHOR]

The neuromodulatory arousal system imbues the nervous system with the flexibility and robustness required to facilitate adaptive behaviour. While there are well understood mechanisms linking dopamine, noradrenaline and acetylcholine to distinct behavioural states, similar conclusions have not been as readily available for serotonin. Fascinatingly, despite clear links between serotonergic function and cognitive capacities as diverse as reward processing, exploration, and the psychedelic experience, over 95% of the serotonin in the body is released in the gastrointestinal tract, where it controls digestive muscle contractions (peristalsis). Here, we argue that framing neural serotonin as a rostral extension of the gastrointestinal serotonergic system dissolves much of the mystery associated with the central serotonergic system. Specifically, we outline that central serotonin activity mimics the effects of a digestion/satiety circuit mediated by hypothalamic control over descending serotonergic nuclei in the brainstem. We review commonalities and differences between these two circuits, with a focus on the heterogeneous expression of different classes of serotonin receptors in the brain. Much in the way that serotonin-induced peristalsis facilitates the work of digestion, serotonergic influences over cognition can be reframed as performing the work of cognition. Extending this analogy, we argue that the central serotonergic system allows the brain to arbitrate between different cognitive modes as a function of serotonergic tone: low activity facilitates cognitive automaticity, whereas higher activity helps to identify flexible solutions to problems, particularly if and when the initial responses fail. This perspective sheds light on otherwise disparate capacities mediated by serotonin, and also helps to understand why there are such pervasive links between serotonergic pathology and the symptoms of psychiatric disorders. [ABSTRACT FROM AUTHOR]

Background: Freezing of gait is a complex paroxysmal phenomenon that is associated with a variety of sensorimotor, cognitive and affective deficits, and significantly impacts quality of life in patients with Parkinson's disease (PD). Despite a growing body of evidence that suggests anxiety may be a crucial contributor to freezing of gait, no research study to date has investigated neural underpinnings of anxiety‐induced freezing of gait. Objective: Here, we aimed to investigate how anxiety‐inducing contexts might "set the stage for freezing," through the ascending arousal system, by examining an anxiety‐inducing virtual reality gait paradigm inside functional magnetic resonance imaging (fMRI). Methods: We used a virtual reality gait paradigm that has been validated to elicit anxiety by having participants navigate a virtual plank, while simultaneously collecting task‐based fMRI from individuals with idiopathic PD with confirmed freezing of gait. Results: First, we established that the threatening condition provoked more freezing when compared to the non‐threatening condition. By using a dynamic connectivity analysis, we identified patterns of increased "cross‐talk" within and between motor, limbic, and cognitive networks in the threatening conditions. We established that the threatening condition was associated with heightened network integration. We confirmed the sympathetic nature of this phenomenon by demonstrating an increase in pupil dilation during the anxiety‐inducing condition of the virtual reality gait paradigm in a secondary experiment. Conclusions: In conclusion, our findings represent a neurobiological mechanistic pathway through which heightened sympathetic arousal related to anxiety could foster increased "cross‐talk" between distributed cortical networks that ultimately manifest as paroxysmal episodes of freezing of gait. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society [ABSTRACT FROM AUTHOR]

Background: Visual illusions (VI) in Parkinson's disease (PD) are generally considered as an early feature of the psychosis spectrum leading to fully formed visual hallucinations (VH), although this sequential relationship has not been clearly demonstrated. Objective: We aimed to determine whether there are any overlapping, potentially graded patterns of structural and functional connectivity abnormalities in PD with VI and with VH. Such a finding would argue for a continuum between these entities, whereas distinct imaging features would suggest different neural underpinnings for the phenomena. Methods: In this case control study, we compared structural and resting state functional MRI brain patterns of PD patients with VH (PD-H, n = 20), with VI (PD-I, n = 19), and without VH or VI (PD-C, n = 23). Results: 1) PD-H had hypo-connectivity between the ILO and anterior cingulate precuneus and parahippocampal gyrus compared to PD-C and PD-I; 2) In contrast, PD-I had hyper-connectivity between the inferior frontal gyrus and the postcentral gyrus compared to PD-C and PD-H. Moreover, PD-I had higher levels of functional connectivity between the amygdala, hippocampus, insula, and fronto-temporal regions compared to PD-H, together with divergent patterns toward the cingulate. 3) Both PD-I and PD-H had functional hypo-connectivity between the lingual gyrus and the parahippocampal region vs. PD-C, and no significant grey matter volume differences was observed between PD-I and PD-H. Conclusion: Distinct patterns of functional connectivity characterized VI and VH in PD, suggesting that these two perceptual experiences, while probably linked and driven by at least some similar mechanisms, could reflect differing neural dysfunction. [ABSTRACT FROM AUTHOR]

COVID-19 and rising student numbers are affecting healthcare education, particularly access to clinical placements. As healthcare education is increasingly supported by technology and non-traditional teaching methods, educational experiences gained through clinical placement also require new approaches. This article explores and discusses the use of a simulated clinical placement for a dietetic student cohort. During this virtual placement, students were able to explore and experience a virtual clinical setting and immerse themselves in a placement experience. A vast range of virtual resources were linked to the online placement portal, including statutory and mandatory training, dietetic resources, patient journeys and interprofessional communication. Advantages of this approach include that all students experience a given situation, unlike in traditional placements where workloads, variety and engagement vary; there is also no risk to patient safety. The aim is to enhance the learning experience to create effective, efficient clinicians. This virtual placement for dietetics is part of a bigger project to develop and evaluate the use of a virtual placement framework in a range of professions. The concept of virtual placement may have been brought forward by the COVID-19 crisis but was inevitable with the move to more technology-enhanced learning tools. [ABSTRACT FROM AUTHOR]

In this article, we examine responses to the March on Washington from the vantage point of Durham University, Durham, UK. As members of a course titled ‘Feminist Geographies of Intimacy’, we viewed the March on Washington as a prudent and timely event with which to think ‘on’ and ‘with’ intimacy and also to consider on a more personal level the significance of the March to our own feminism/s, feminist geographies and everyday lives. This piece is a collaborative effort written together by two instructors and eight students. We reflected on how we encountered ‘the March’ in the classroom in order to consider the varied locations and forms of protest; the range of issues that were fought for or fought against; the role of humour and other emotions when expressing dissent and/or solidarity; and the exclusion and inclusion of bodies which did or did not protest. The March for us, therefore, became a ‘generative space’ in that it provided a pedagogic tool with which to explore geographies of intimacy. [ABSTRACT FROM PUBLISHER]

In the decade post 11 September 2001, numerous states have found the need to legislate against terrorism—frequently defining terrorism. In R v. Gul, the Court of Appeal surveyed some of those legislative definitions in an attempt to discern a customary international law definition of terrorism in one specific context. This paper seeks to broaden that enterprise. In 1989, Schmid and Jongman sent a questionnaire and proposed definition of terrorism to 200 acknowledged terrorism experts; they received 109 responses, which they coded according to 22 word categories; the 109 responses triggered, on average 8 of the 22 codes. Utilizing the Schmid and Jongman methodology, and based on the R v. Gul survey of jurisdictions, this paper examines seven legislative definitions of terrorism. On average, the legislative definitions also triggered 8 of the 22 codes. The article examines the correlations and divergences between the academic consensus definition and the legislative definitions. [ABSTRACT FROM AUTHOR]

Defining the specificities of the anti-human immunodeficiency virus type 1 (HIV-1) envelope antibodies able to mediate broad heterologous neutralization will assist in identifying targets for an HIV-1 vaccine. We screened 70 plasmas from chronically HIV-1-infected individuals for neutralization breadth. Of these, 16 (23%) were found to neutralize 80% or more of the viruses tested. Anti-CD4 binding site (CD4bs) antibodies were found in almost all plasmas independent of their neutralization breadth, but they mainly mediated neutralization of the laboratory strain HxB2 with little effect on the primary virus, Du151. Adsorption with Du151 monomeric gp120 reduced neutralizing activity to some extent in most plasma samples when tested against the matched virus, although these antibodies did not always confer cross-neutralization. For one plasma, this activity was mapped to a site overlapping the CD4-induced (CD4i) epitope and CD4bs. Anti-membrane-proximal external region (MPER) (r = 0.69; P < 0.001) and anti-CD4i (r = 0.49; P < 0.001) antibody titers were found to be correlated with the neutralization breadth. These anti-MPER antibodies were not 4E10- or 2F5-like but spanned the 4E10 epitope. Furthermore, we found that anti-cardiolipin antibodies were correlated with the neutralization breadth (r = 0.67; P < 0.001) and anti-MPER antibodies (r = 0.6; P < 0.001). Our study suggests that more than one epitope on the envelope glycoprotein is involved in the cross-reactive neutralization elicited during natural HIV-1 infection, many of which are yet to be determined, and that polyreactive antibodies are possibly involved in this phenomenon. [ABSTRACT FROM AUTHOR]

The increasing use of emerging technologies in healthcare simulation, particularly virtual reality, has caused in increase in both use and misuse. It is the exploration and study of these types of technology that are key to their success-or failure-in simulation learning and teaching. Therefore, this exploratory study evaluated the most common perceived side effect of virtual reality, that of cybersickness. A total of n=60 undergraduate healthcare students participated in one of four identical learning outcome simulation events, using different simulation techniques. This study compared these four common simulation tools, high-fidelity manikin, standardised patient, video case study and 360-degree virtual reality video, and analysed the self-reported cybersickness symptoms. The results show that some virtual reality tools, in this case 360-degree video, are no more likely to provoke cybersickness symptoms than the other simulation methods used in this study. In addition, virtual reality is reported as less fatiguing than other methods of simulation learning. Virtual reality technologies may be a useful addition to the spectrum of simulation tools and techniques currently in use. This study suggests that there is no greater risk of cybersickness symptoms and this potential barrier to use is not borne out by this study., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2019. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

The genotypes and biological phenotypes of HIV-1 isolates obtained from 40 perinatally infected children in South Africa were analyzed. This included 15 infants who had HIV-related symptoms, most of whom died within 2 years of birth (rapid progressors), and 25 children who survived between 4 and 9 years with varying signs of disease (slow progressors). Heteroduplex mobility assays and sequence analysis confirmed that within the env and gag regions, all isolates were HIV-1 subtype C. Viral isolates from 14 of the 15 rapid progressors used the CCR5 coreceptor, whereas 1 (02ZARP1) used both the CXCR4 and CCR5 coreceptors. Among the 25 slow progressors, 22 isolates used CCR5 only, 2 used CXCR4 only, and 1 used both CCR5 and CXCR4. Two of the slow-progressing children who harbored CXCR4-using viruses had AIDS. All four CXCR4-using viruses had genotypic changes in the V3 region previously shown to be associated with CXCR4 usage. This cross-sectional study shows that HIV-1 subtype C viruses from both rapid- and slow-progressing perinatally infected children used predominantly CCR5. Similar to adults, CXCR4 usage was uncommon among HIV-1 subtype C isolates from pediatric infections.