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Efficient social interactions require taking into account other people's mental states such as their beliefs, intentions or emotions. Recent studies have shown that in some social situations at least, we do spontaneously take into account others' mental states. The extent to which we have dedicated brain areas for such spontaneous perspective taking is however still unclear. Here, we report two brain-damaged patients whose common lesions were almost exclusively in the left posterior temporoparietal junction (TPJp) and who both showed the same striking and distinctive theory of mind (ToM) deficit. More specifically, they had an inability to take into account someone else's belief unless they were explicitly instructed to tell what that other person thinks or what that person will do. These patients offer a unique insight into the causal link between a specific subregion of the TPJ and a specific cognitive facet of ToM., (© The Author (2016). Published by Oxford University Press.)

Recently, a few transcranial magnetic stimulation or transcranial direct current stimulation (tDCS) studies have shown that the right temporo-parietal junction (rTPJ) plays a causal role in moral reasoning especially in cases of accidental harms or attempted harms. The profile of results across studies is, however, not entirely consistent: sometimes the stimulation affects predominantly attempted harms while sometimes the stimulation affects predominantly accidental harms. We argue that such discrepancy could reflect different functional contributions of the rTPJ in moral judgments and that the chosen design parameters or stimulation method may differentially bring to light one or the other functional role of the rTPJ. In the current study, we found that tDCS specifically affected accidental harms but not attempted harms. Low cathodal stimulation of the rTPJ led to a marginally significant increase in the severity of judgments of accidental harms (Experiment 1) while higher cathodal current density led to a highly significant decrease in the severity of judgments of accidental harms (Experiment 2). Our pattern of results in the context of our experimental design can best be explained by a causal role of the rTPJ in processing the mitigating circumstances which reduce a protagonist's moral responsibility. We discuss these results in relation to the idea that the rTPJ may play multiple roles in moral cognition and in relation to methodological aspects related to the use of tDCS.

Thinking about how other people represent objects in the world around them is thought to require deliberate effort. In recent years, interactive "joint action" paradigms have shown how social context can affect our cognitive processing. We tested whether people would represent their partner's point of view in a simple team game. Participants played a game in which they had to judge the magnitude of a number either sat alone, or opposite a partner. Importantly they were never asked to judge their partner's point of view. Remarkably, when playing the game as a team, people were better when their partner happened to share their view of the number, such as when seeing a number 8, than when their partner viewed the number to be different, such as when seeing a number 6 that looked like a number 9 to their partner. In two further experiments, we identified the conditions under which the effect was present. Experiment two showed that the effect was only present after observing the prior involvement of one's partner in the task. Experiment 3, showed that the aspect of the stimulus (its magnitude) that participants were sensitive to did not need to be the aspect of the stimulus to which their partner was paying attention., (Copyright © 2016 Elsevier B.V. All rights reserved.)

A long established distinction exists in developmental psychology between young children's ability to judge whether objects are seen by another, known as "level-1" perspective-taking, and judging how the other sees those objects, known as "level-2" perspective-taking (Flavell, Everett, Croft, & Flavell, 1981a; Flavell, Flavell, Green, & Wilcox, 1981b). Samson, Apperly, Braithwaite, Andrews, and Bodley Scott (2010) provided evidence that there are two routes available to adults for level-1 perspective-taking: one which is triggered relatively automatically and the other requiring cognitive control. We tested whether both these routes were available for adults' level-2 perspective-taking. Explicit judgements of both level-1 and level-2 perspectives were subject to egocentric interference, suggesting a need for cognitive control. Evidence of unintentional perspective-taking was limited to level-1 judgements., (Copyright © 2015 Elsevier B.V. All rights reserved.)

A growing body of work suggests that in some circumstances, humans may be capable of ascribing mental states to others in a way that is fast, cognitively efficient, and implicit (implicit mentalizing hypothesis). However, the interpretation of this work has recently been challenged by suggesting that the observed effects may reflect "submentalizing" effects of attention and memory, with no ascription of mental states (submentalizing hypothesis). The present study employed a strong test between these hypotheses by examining whether apparently automatic processing of another's visual perspective is influenced by experience-dependent beliefs about whether that person can see. Altercentric interference was observed when participants judged their own perspective on stimuli involving an avatar wearing goggles that participants believed to be transparent but not when they believed the goggles to be opaque. These results are consistent with participants ascribing mental states to the avatar and not with the submentalizing hypothesis that altercentric interference arises merely because avatars cue shifts in spatial attention. (PsycINFO Database Record, ((c) 2016 APA, all rights reserved).)

Emotions and perspective-taking are ubiquitous in our daily social interactions, but little is known about the relation between the two. This study examined whether and how emotions can influence even the most basic forms of perspective-taking. Experiment 1 showed that guilt made participants more other-centered in a simple visual perspective-taking task while anger tended to make them more self-centered. These two emotions had, however, no effect on the ability to handle conflicting perspectives. Since the guilt induction method used in Experiment 1 also induced feelings of self-incompetence and shame, Experiment 2 aimed at isolating the effects of these concomitant feelings. Self-incompetence/shame reduced participants' ability to handle conflicting perspectives but did not influence attention allocation. In sum, these results highlight that emotions can affect even the simplest form of perspective-taking and that such influence can be brought about by the modulation of different cognitive mechanisms.

The neurohormone Oxytocin (OT) has been one of the most studied peptides in behavioral sciences over the past two decades. Many studies have suggested that OT could increase trusting behaviors. A previous study, based on the "Envelope Task" paradigm, where trust is assessed by the degree of openness of an envelope containing participant's confidential information, showed that OT increases trusting behavior and reported one of the most powerful effects of OT on a behavioral variable. In this paper we present two failed replications of this effect, despite sufficient power to replicate the original large effect. The non-significant results of these two failed replications clearly exclude a large effect of OT on trust in this paradigm but are compatible with either a null effect of OT on trust, or a small effect, undetectable with small sample size (N = 95 and 61 in Study 1 and 2, respectively). Taken together, our results question the purported size of OT's effect on trust and emphasize the need for replications.

Two paradigms have shown that people automatically compute what or where another person is looking at. In the visual perspective-taking paradigm, participants judge how many objects they see; whereas, in the gaze cueing paradigm, participants identify a target. Unlike in the former task, in the latter task, the influence of what or where the other person is looking at is only observed when the other person is presented alone before the task-relevant objects. We show that this discrepancy across the two paradigms is not due to differences in visual settings (Experiment 1) or available time to extract the directional information (Experiment 2), but that it is caused by how attention is deployed in response to task instructions (Experiment 3). Thus, the mere presence of another person in the field of view is not sufficient to compute where/what that person is looking at, which qualifies the claimed automaticity of such computations.

Understanding other people's point of view is crucial for successful social interaction but can be particularly challenging in situations where the other person's point view conflicts with our own view. Such situations require executive control processes that help us resist interference from our own perspective. In this study, we examined how domain-general these executive processes are. We report the performance of two pairs of brain-damaged patients who had sustained lesions in different areas of the prefrontal cortex and who showed deficits in classic executive function tasks. The patients were presented with desire reasoning tasks in which two sources of executive control were manipulated: the need to resist interference from one's own desire when inferring someone else's conflicting desire and the need to resist interference from the ascription of an approach motivation when inferring an avoidance-desire. The pattern of performance of the two pairs of patients conformed to a classic double dissociation with one pair of patients showing a deficit in resisting interference from their own perspective but not from the ascription of an approach motivation while the other pair of patients showed the opposite profile. The results are discussed in relation to the specificity of the processes recruited when we resist interference from our own perspective., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Visual perspective taking is a fundamental feature of the human social brain. Previous research has mainly focused on explicit visual perspective taking and contrasted brain activation for other- versus self-perspective judgements. This produced a conceptual gap to theory of mind studies, where researchers mainly compared activation for taking another's mental perspective to non-mental control conditions. We compared brain activation for visual perspective taking to activation for non-mental control conditions where the avatar was replaced by directional (arrow, lamp) or non-directional (brick-wall) objects. We found domain-specific activation linked to the avatar's visual perspective in right TPJ, ventral mPFC and ventral precuneus. Interestingly, we found that these areas are spontaneously processing information linked to the other's perspective during self-perspective judgements. Based on a review of the visual perspective taking literature, we discuss how these findings can explain some of the inconsistent/negative results found in previous studies comparing other- versus self-perspective judgements., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Objective: We examined the utility of the Birmingham Cognitive Screen (BCoS) in discriminating cognitive profiles and recovery of function across stroke survivors. BCoS was designed for stroke-specific problems across 5 cognitive domains: (a) controlled and spatial attention, (b) language, (c) memory, (d) number processing, and (e) praxis., Method: On the basis of specific inclusion criteria, this cross-section observational study analyzed cognitive profiles of 657 subacute stroke patients, 331 of them reassessed at 9 months. Impairments on 32 measures were evaluated by comparison with 100 matched healthy controls. Measures of affect, apathy, and activities of daily living were also taken. Between-subjects group comparisons of mean performance scores and impairment rates and within-subject examination of impairment rates over time were conducted. Logistic regressions and general linear modeling were used for multivariate analysis of domain-level effects on outcomes., Results: Individuals with repeated stroke experienced significantly less cognitive recovery at 9 months than those with a first stroke despite similar initial level of cognitive performance. Individuals with left hemisphere lesions performed more poorly than those with right hemisphere lesions, but both groups showed similar extent of recovery at 9 months. BCoS also revealed lesion-side-specific deficits and common areas of persistent problems. Functional outcome at 9 months correlated with domain-level deficits in controlled attention, spatial attention, and praxis over and above initial dependency and concurrent levels of affect and apathy., Conclusion: The study demonstrates how BCoS can identify differential cognitive profiles across patient groups. This can potentially help predict outcomes and inform rehabilitation., ((c) 2015 APA, all rights reserved).)

Background: Previous studies have shown that alcohol-dependent (AD) individuals have difficulties inferring other people's emotion, understanding humor, and detecting a faux pas. This study aimed at further understanding the nature of such "Theory of Mind" (ToM) difficulties., Methods: A total of 34 recently detoxified AD and 34 paired controls were compared based on 2 nonverbal and video-based false belief tasks. These tasks were designed to identify 3 different types of deficits: (i) a deficit in dealing with the general task demands, (ii) a selective deficit in self-perspective inhibition, and (iii) a deficit in tracking the other person's mental state. (i) and (ii) are compatible with the hypothesis of a prefrontal cortex dysfunction being at the origin of AD individuals' social difficulties, while (iii) would suggest the possible contribution of a dysfunction of the temporo-parietal junction in explaining the social difficulties., Results: Group analyses highlighted that AD individuals performed worse on the 2 false belief tasks than controls. Individual analyses showed, however, that just under half of the AD individuals were impaired compared to controls. Moreover, most of the AD individuals who were impaired showed a deficit in tracking the other person's belief. This deficit was linked to disease-related factors such as illness duration, average alcohol consumption, and craving but not to general reasoning abilities, depression, anxiety, or demographic variables., Conclusions: Just under half of the AD individuals tested showed a ToM deficit, and in most cases, the deficit concerned the tracking of other people's mental states. Such a type of deficit has previously been associated with lesions to the temporo-parietal brain areas, indicating that a prefrontal cortex dysfunction may not be the sole origin of the social cognition deficits observed in alcohol dependence., (Copyright © 2015 by the Research Society on Alcoholism.)

We report this 47-year-old man who presented with polytrauma following a fall from a roof in March 2011. He sustained a head injury and a complex, comminuted forearm fracture. He underwent an open reduction and internal fixation of the fracture at the time of injury, but later developed a rigid type 2 diaphyseal radioulnar synostosis, with loss of forearm rotation. Synostosis excision and a radial artery perforator-based adipofascial interposition flap to prevent recurrence has resulted in a good functional outcome and no recurrence at 2.5 years follow-up., (2015 BMJ Publishing Group Ltd.)

Background: Flaps have been used in upper limb surgery for varied indications including coverage of soft tissue defects, interposition and to provide a pliable bed for gliding structures among others., Methods: We report our use of the radial artery perforator based adipofascial flap in nine patients, five with rigid radioulnar synostosis, three with recalcitrant carpal tunnel syndrome and one with a soft tissue defect., Results: All our patients with radioulnar synostosis regained good functional rotations of the forearm with no recurrence at follow up. The patients with recalcitrant carpal tunnel also had resolution of symptoms with no recurrence. The flap healed well in all the patients., Conclusions: We propose this flap as a viable, versatile reconstructive option for the hand and upper limb.

This report describes a 53-year-old man who presented, following a motocross injury, with a Mayfield stage 1 perilunate dislocation through a pre-existing asymptomatic scaphoid non-union with a degenerative midcarpal joint. A salvage reconstruction with scaphoid excision and four corner midcarpal arthrodesis resulted in a satisfactory outcome. Follow-up at 6 years demonstrated no instability and no further progression of the osteoarthritis., (2014 BMJ Publishing Group Ltd.)

Over the past two years low levels of prednisolone have been reported in bovine urine by a number of laboratories in European Union member states. Concentrations vary, but are reported to be below approximately 3 µg l(-1). Forty per cent of bovine urine samples from the Dutch national control plan had concentrations of prednisolone between 0.11 and 2.04 µg l(-1). In this study the mechanism of formation of prednisolone was investigated. In vitro conversion of cortisol by bacteria from faeces and soil, bovine liver enzymes and stability at elevated temperatures were studied. In vitro bovine liver S9 incubation experiments showed a significant 20% decrease of cortisol within 6 h, and formation of prednisolone was observed from 0.2 g l(-1) at t = 0 to 0.5 g l(-1) at t = 6. Under the influence of faeces, the stability of cortisol in urine is reduced and cortisol breaks down within 50 h. Prednisolone is formed up to 4 µg l(-1) at 70°C after 15 h. However, this decreases again to zero after 50 h. With soil bacteria, a slower decrease of cortisol was observed, but slightly higher overall formation of prednisolone, up to 7 µg l(-1) at 20°C. As opposed to incurred urine, in fortified urine incubated with faeces or soil bacteria no prednisolone was detected. This difference may be explained by the presence of natural corticosteroids in the incurred sample. With UPLC-QToF-MS experiments, in urine and water samples incubated with faeces, metabolites known from the literature could be (tentatively) identified as 20β-hydroxy-prednisolone, cortisol-21-sulfate, oxydianiline, tetrahydrocortisone-3-glucuronide and cortexolone, but for all compounds except 20β-hydroxy-prednisolone no standards were available for confirmation. Based on the results of this study and literature data, for regulatory purposes a threshold of 5 µg l(-1) for prednisolone in bovine urine is proposed. Findings of prednisolone in concentrations up to 5 µg l(-1) in bovine urine can, most likely, originate from other sources than illegal treatment with growth promoters.

The processing of human and nonhuman concepts (e.g., agreeable vs. edible) during basic comprehension and reasoning tasks has become a major topic of scientific inquiry. To ensure that the experimental effects obtained from such studies reflect the hypothesised semantic distinction, potential confounds such as psycholinguistic and/or lexical properties of the exact stimuli chosen need to be addressed. In the current study, normative data of such properties were obtained for a series of 875 French adjectives by asking 8 groups of 20 participants to each rate all words on one dimension of theoretical interest. The collected ratings indicate the extent to which each adjective evokes a sensory experience (concreteness), captures an enduring attribute (temporal stability), refers to a visible characteristic (visibility), denotes a neutral or an affectively laden concept (valence), signifies an attribute of low or high intensity, is familiar to the reader and can be used to describe people and/or inanimate entities such as objects. In addition, for each item its exact grammatical class (adjective vs. past participle adjective), length (i.e., number of letters, number of syllables), and word frequency was retrieved from the lexique3 corpus. The resulting database enables researchers to consider pivotal psycholinguistic and lexical properties when selecting human and nonhuman stimuli for future research.

Arteriovenous malformations (AVMs) of the brain are very complex and intriguing pathologies. Since their initial description by Luschka and Virchow in the middle of the 19th century, multiple advances and innovations have revolutionized their management and surgical treatment. Here, we review the historical landmarks in the surgical treatment of AVMs and then illustrate the most recent and futuristic technologies aiming to improve outcomes in AVM surgeries. In particular, we examine potential advances in patient selection, imaging, surgical technique, neuroanesthesia, and postoperative neuro-rehabilitation and quantitative assessments. Finally, we illustrate how concurrent advances in radiosurgery and endovascular techniques might present new opportunities to treat AVMs more safely from a surgical perspective.

Humans gain a wide range of knowledge through interacting with the environment. Each aspect of our perceptual experiences offers a unique source of information about the world-colours are seen, sounds heard and textures felt. Understanding how perceptual input provides a basis for knowledge is thus central to understanding one's own and others' epistemic states. Developmental research suggests that 5-year-olds have an immature understanding of knowledge sources and that they overestimate the knowledge to be gained from looking. Without evidence from adults, it is not clear whether the mature reasoning system outgrows this overestimation. The current study is the first to investigate whether an overestimation of the knowledge to be gained from vision occurs in adults. Novel response time paradigms were adapted from developmental studies. In two experiments, participants judged whether an object or feature could be identified by performing a specific action. Adult participants found it disproportionately easy to accept looking as a proposed action when it was informative, and difficult to reject looking when it was not informative. This suggests that adults, like children, overestimate the informativeness of vision. The origin of this overestimation and the implications that the current findings bear on the interpretation of children's overestimation are discussed.

The temporal poles (TPs) are among the brain regions that are often considered as the brain network sustaining our ability to understand other people's mental states or "Theory of Mind" (ToM). However, so far the functional role of the left and right TPs in ToM is still debated, and it is even not clear yet whether these regions are necessary for ToM. In this study, we tested whether the left TP is necessary for ToM by assessing the mentalizing abilities of a patient (C.M.) diagnosed with semantic dementia. Converging evidence from detailed MRI and (18)F-fluoro-2-deoxy-d-glucose PET examinations showed a massive atrophy of the left TP with the right TP being relatively unaffected. Furthermore, C.M.'s atrophy encompassed most regions of the left TP usually activated in neuroimaging studies investigating ToM. Given C.M.'s language impairments, we used a battery of entirely nonverbal ToM tasks. Across five tasks encompassing 100 trials, which probed the patient's ability to attribute various mental states (intentions, knowledge, and beliefs), C.M. showed a totally spared performance. This finding suggests that, despite its consistently observed activation in neuroimaging studies involving ToM tasks, the left TP is not necessary for ToM reasoning, at least in nonverbal conditions and as long as its right counterpart is preserved. Implications for understanding the social abilities of patients with semantic dementia are discussed.

Previous research has shown that calculating if something is to someone's left or right involves a simulative process recruiting representations of our own body in imagining ourselves in the position of the other person (Kessler and Rutherford, 2010). We compared left and right judgements from another's spatial position (spatial perspective judgements) to judgements of how a numeral appeared from another's point of view (visual perspective judgements). Experiment 1 confirmed that these visual and spatial perspective judgements involved a process of rotation as they became more difficult with angular disparity between the self and other. There was evidence of some difference between the two, but both showed a linear pattern. Experiment 2 went a step further in showing that these judgements used embodied self rotations, as their difficulty was also dependent on the current position of the self within the world. This effect was significantly stronger in spatial perspective-taking, but was present in both cases. We conclude that embodied self-rotations, through which we actively imagine ourselves assuming someone else's position in the world can subserve not only reasoning about where objects are in relation to someone else but also how the objects in their environment appear to them.

Processes for perspective-taking can be differentiated on whether or not they require us to mentally rotate ourselves into the position of the other person (Michelon & Zacks, 2006). Until now, only two perspective-taking tasks have been differentiated in this way, showing that judging whether something is to someone's left or right does require mental rotation, but judging if someone can see something or not does not. These tasks differ firstly on whether the content of the perspective is visual or spatial and secondly on whether the type of the judgement is early-developing (level-1 type) or later-developing (level-2 type). Across two experiments, we tested which of these factors was likely to be most important by using four different perspective-taking tasks which crossed orthogonally the content of judgement (visual vs. spatial) and the type of judgement (level-1 type vs. level-2 type). We found that the level-2 type judgements, of how something looks to someone else and whether it is to their left or right, required egocentric mental rotation. On the other hand, level-1 type judgements, of whether something was in front of or behind someone and of whether someone could see something or not, did not involve mental rotation. We suggest from this that the initial processing strategies employed for perspective-taking are largely independent of whether judgements are visual or spatial in nature. Furthermore, early developing abilities have features that make mental rotation unnecessary., (Copyright © 2013 Elsevier B.V. All rights reserved.)

Purpose: We compared the effectiveness of PCA3 (prostate cancer antigen 3) and select comparators for improving initial or repeat biopsy decision making in men at risk for prostate cancer, or treatment choices in men with prostate cancer., Materials and Methods: MEDLINE®, EMBASE®, Cochrane Database and gray literature were searched from January 1990 through May 2012. Included studies were matched, and measured PCA3 and comparator(s) within a cohort. No matched analyses were possible. Differences in independent performance estimates between PCA3 and comparators were computed within studies. Studies were assessed for quality using QUADAS (Quality Assessment of Diagnostic Accuracy Studies) and for strength of evidence using GRADE (Grading of Recommendations Assessment, Development and Evaluation) criteria., Results: Among 1,556 publications identified, 34 observational studies were analyzed (24 addressed diagnostic accuracy and 13 addressed treatment decisions). Most studies were conducted in opportunistic cohorts of men referred for procedures and were not designed to answer key questions. Two study biases (partial verification and sampling) were addressed by analyses, allowing some conclusions to be drawn. PCA3 was more discriminatory than total prostate specific antigen increases (eg at an observed 50% specificity, summary sensitivities were 77% and 57%, respectively). Analyses indicated that this finding holds for initial and repeat biopsies, and that the markers were independent predictors. For all other biopsy decision making comparisons and associated health outcomes, strength of evidence was insufficient. For treatment decision making, strength of evidence was insufficient for all outcomes and comparators., Conclusions: PCA3 had a higher diagnostic accuracy than total prostate specific antigen increases, but strength of evidence was low (limited confidence in effect estimates). Strength of evidence was insufficient to conclude that PCA3 testing leads to improved health outcomes. For all other outcomes and comparators, strength of evidence was insufficient., (Copyright © 2013 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.)

A hallmark of human social interaction is the ability to consider other people's mental states, such as what they see, believe, or desire. Prior neuroimaging research has predominantly investigated the neural mechanisms involved in computing one's own or another person's perspective and largely ignored the question of perspective selection. That is, which brain regions are engaged in the process of selecting between self and other perspectives? To address this question, the current fMRI study used a behavioral paradigm that required participants to select between competing visual perspectives. We provide two main extensions to current knowledge. First, we demonstrate that brain regions within dorsolateral prefrontal and parietal cortices respond in a viewpoint-independent manner during the selection of task-relevant over task-irrelevant perspectives. More specifically, following the computation of two competing visual perspectives, common regions of frontoparietal cortex are engaged to select one's own viewpoint over another's as well as select another's viewpoint over one's own. Second, in the absence of conflict between the content of competing perspectives, we showed a reduced engagement of frontoparietal cortex when judging another's visual perspective relative to one's own. This latter finding provides the first brain-based evidence for the hypothesis that, in some situations, another person's perspective is automatically and effortlessly computed, and thus, less cognitive control is required to select it over one's own perspective. In doing so, we provide stronger evidence for the claim that we not only automatically compute what other people see but also, in some cases, we compute this even before we are explicitly aware of our own perspective.

The quality of preloaded Wang resins is very important for the success of solid-phase peptide syntheses (SPPS). A critical factor is the capping of remaining hydroxyl groups after loading with the first amino acid, since these free alcohols lead to truncated sequences during the following SPPS steps. Because the detection of hydroxyl groups by color tests is difficult and unreliable, the capping efficiency is often controlled by time-consuming peptide test syntheses. Here, we describe a two-dimensional, high resolution magic angle spinning NMR method for the quantitative determination of remaining 4-alkoxybenzyl alcohols in Fmoc-Xaa-Wang resins with a detection limit of 1 mol-%. The NMR method was validated with samples of known ratios between Fmoc-Ala-Wang and 4-alkoxybenzylalcohol resin. Application to a set of preloaded Fmoc-Ala- and Fmoc-Thr(tBu)-Wang test resins demonstrated that the full range of essential amino acids can be quantified without further spectrometer calibration. Compared to established test synthesis protocols, the NMR method represents not only advantages in terms of time and cost savings but also eliminates all inaccuracies due to further sample treatment like SPPS and cleavage from the resin.

Background: The majority of pain sufferers experience images when in pain. The most distressing of these images (the Index image) provokes intense emotional reactions, appraisal shifts, and increases in pain. The ability of pain sufferers to rescript their Index images, and the consequences of doing so, remain to be determined., Aims: To assess the effects upon emotions, appraisals and pain experience of rescripting Index images in pain sufferers., Method: The Index images of a group of 55 pain sufferers were assessed using a voluntary image induction procedure (VIE) to obtain basal levels of pain, appraisal and emotion. Participants were than randomly allocated to one of two groups: Rescripted Image repetition or Index Image repetition. The two groups were compared on their responses to their Index and Rescripted images respectively., Results: The participants found it easy to rescript their distressing Index images. During rescripting, they reported dramatic reductions in emotion, negative appraisals, and pain. The clinically and statistically significant decrements in pain were found independent of reductions in emotion. The pain levels during rescripting were significantly below their basal levels, with 49% reporting no pain at all while viewing a rescripted image. These changes were not a function of image repetition., Conclusion: Index images of pain sufferers can be easily elicited and rescripted. Rescripting leads to remarkable reductions in emotion, cognitions and pain levels that are not attributable to image repetition. The significant reductions in pain were independent of reductions in emotion. The implications of these results for CBT approaches to pain management are considered.

Topic development and structuring a systematic review of diagnostic tests are complementary processes. The goals of a medical test review are to identify and synthesize evidence to evaluate the impacts alternative testing strategies on health outcomes and to promote informed decision making. A common challenge is that the request for a review may state the claim for the test ambiguously. Due to the indirect impact of medical tests on clinical outcomes, reviewers need to identify which intermediate outcomes link a medical test to improved clinical outcomes. In this paper, we propose the use of five principles to deal with challenges: the PICOTS typology (patient population, intervention, comparator, outcomes, timing, setting), analytic frameworks, simple decision trees, other organizing frameworks and rules for when diagnostic accuracy is sufficient.

Objective: The validity and functional predictive values of the apraxia tests in the Birmingham Cognitive Screen (BCoS) were evaluated. BCoS was developed to identify patients with different forms of praxic deficit using procedures designed to be inclusive for patients with aphasia and/or spatial neglect., Method: Observational studies were conducted from a university neuropsychological assessment centre and from acute and rehabilitation stroke care hospitals throughout an English region. Volunteers from referred patients with chronic acquired brain injuries, a consecutive hospital sample of patients within 3 months of stroke (n=635) and a population based healthy control sample (n=100) were recruited. The main outcome measures used were the Barthel Index, the Nottingham Extended Activities of Daily Living Scale as well as recovery from apraxia., Results: There were high inter-rater reliabilities and correlations between the BCoS apraxia tasks and counterpart tests from the literature. The vast majority (88.3%) of the stroke survivors were able to complete the screen. Pantomime and gesture recognition tasks were more sensitive in differentiating between individuals with left hemisphere damage and right hemisphere damage whereas the Multistep Object Use test and the imitation task had higher functional correlates over and above effects of hemiplegia. Together, the initial scores of the four tasks enabled predictions with 75% accuracy, the recovery of apraxia and independence level at 9 months., Conclusions: As a model based assessment, BCoS offers a quick and valid way to detect apraxia and predict functional recovery. It enables early and informative assessment of most stroke patients for rehabilitation planning.

Pseudomonas aeruginosa meningitis is an uncommon complication of neurosurgical procedures or head trauma. Here, a case of infectious mid basilar artery aneurysm from Pseudomonas meningitis, and its angiographic remission from timely antibiotic therapy, is reported.

Objective: We report data on the validation and functional correlates of Apples Test, which attempts to differentiate between different forms of unilateral neglect., Method: Study 1 presents data from 25 participants with chronic brain lesions who completed the Apples Test and another standard measure of neglect (Star Cancellation). The patients' performance relative to 86 controls was assessed and their relative performance across the two tests compared. Study 2 recruited 115 acute hospital stroke patients who completed the Apples Test as part of the Birmingham University Cognitive Screen procedure. We assessed the relations between the different forms of neglect. Study 3 examined neglect type (as measured by the Apples Test) among the acute stroke group in relation to their activities of daily living abilities and affect., Results: In Study 1 Apples Test scores correlated with Star Cancellation performance, while also differentiating between neglect across the page and neglect of parts of objects. Study 2 confirmed the dissociation from Study 1. "Pure" forms of each type of neglect were equally prevalent after right and left hemisphere lesions, while the presence of both deficits was associated with right hemisphere damage. Study 3 showed that each form of neglect also correlated with other measures of cognition. When compared with pure page-based neglect, object-centered neglect was associated with a lower Barthel score (p < .001), while patients with both forms of neglect had higher level of depression (p < .001) than those with the pure forms., Conclusions: We conclude that the Apples test provides a clinically applicable measure of different forms of neglect. In addition it is a useful predictor of functional outcome. We discuss the nature of the two forms of neglect diagnosed by the test and the functional implications., (PsycINFO Database Record (c) 2011 APA, all rights reserved.)

Purpose: To update the American Society of Clinical Oncology (ASCO) Technology Assessment guidelines on chemotherapy sensitivity and resistance assays (CSRAs) published in 2004., Methods: An Update Working Group reviewed data published between December 1, 2003, and May 31, 2010. MEDLINE and the Cochrane Library were searched. The literature search yielded 11,313 new articles. The limits for "human and English" were used, and then standard ASCO search strings for randomized controlled trials, meta-analyses, guidelines, and reviews were added, yielding 1,298 articles for abstract review. Of these, only 21 articles met predefined inclusion criteria and underwent full text review, and five reports of randomized controlled trials were included for data extraction., Results: Review of the literature does not identify any CSRAs for which the evidence base is sufficient to support use in oncology practice., Recommendations: The use of CSRAs to select chemotherapeutic agents for individual patients is not recommended outside of the clinical trial setting. Oncologists should make chemotherapy treatment recommendations based on published reports of clinical trials and a patient's health status and treatment preferences. Because the in vitro analytic strategy has potential importance, participation in clinical trials evaluating these technologies remains a priority.

Recent findings from studies of epileptic patients and schizotypes have suggested that disruptions in multi-sensory integration processes may underlie a predisposition to report out-of-body experiences (OBEs: Blanke et al., 2004; Mohr et al., 2006). It has been argued that these disruptions lead to a breakdown in own-body processing and embodiment. Here we present two studies which provide the first investigation of predisposition to OBEs in the normal population as measured primarily by the recently devised Cardiff anomalous perception scale (CAPS; Bell et al., 2006). The Launay-Slade Hallucination scale (LSHS) was also employed to provide a measure of general hallucination proneness. In Study 1, 63 University students participated in the study, 17 of whom (26%) claimed to have experienced at least one OBE in their lifetime. OBEers reported significantly more perceptually anomalies (elevated CAPS scores) but these were primarily associated with specific measures of temporal-lobe instability and body-distortion processing. Study 2 demonstrated that OBEers and those scoring high on measures of temporal-lobe instability/body-distortion processing were significantly impaired, relative to controls, at a task requiring mental own-body transformations (OBTs) (Blanke et al., 2005). These results extend the findings from epileptic patient studies to the psychologically normal population and are consistent with there being a disruption in temporal-lobe and body-based processing underlying OBE-type experiences., (Copyright © 2010 Elsevier Srl. All rights reserved.)

Previous research suggests that perspective-taking and other "theory of mind" processes may be cognitively demanding for adult participants, and may be disrupted by concurrent performance of a secondary task. In the current study, a Level-1 visual perspective task was administered to 32 adults using a dual-task paradigm in which the secondary task tapped executive function. Results suggested that the secondary task did not affect the calculation of perspective, but did affect the selection of the relevant (Self or Other) perspective for a given trial. This is the first direct evidence of a cognitively efficient process for "theory of mind" in adults that operates independently of executive function. The contrast between this and previous findings points to a distinction between simple perspective-taking and the more complex and cognitively demanding abilities more typically examined in studies of "theory of mind". It is suggested that these findings may provide a parsimonious explanation of the success of infants on 'indirect' measures of perspective-taking that do not explicitly require selection of the relevant perspective., (Copyright © 2010 Elsevier B.V. All rights reserved.)

In a series of three visual perspective-taking experiments, we asked adult participants to judge their own or someone else's visual perspective in situations where both perspectives were either the same or different. We found that participants could not easily ignore what someone else saw when making self-perspective judgments. This was observed even when participants were only required to take their own perspective within the same block of trials (Experiment 2) or even within the entire experiment (Experiment 3), i.e. under conditions which gave participants a clear opportunity to adopt a strategy of ignoring the other person's irrelevant perspective. Under some circumstances, participants were also more efficient at judging the other person's perspective than at judging their own perspective. Collectively, these results suggest that adults make use of rapid and efficient processes to compute what other people can see., ((PsycINFO Database Record (c) 2010 APA, all rights reserved).)

Object: Anterolateral cavernomas of the pons have been surgically removed via a variety of approaches, commonly retrosigmoid or transventricular. The goal in this study was to evaluate the presigmoid approach as an alternative., Methods: Clinical data were reviewed in 9 patients presenting with anterolateral pontine cavernomas between 1999 and 2007., Results: All patients were treated via a presigmoid approach, which provided a nearly perpendicular trajectory to the anterolateral pons. The brainstem was entered through a "safe zone" between the trigeminal nerve and the facial/vestibulocochlear nerve complex. Complete resection was achieved in all cases. No patient experienced recurrent events during follow-up (1-24 months). The patients' modified Rankin Scale score improved within 1 year of surgery (1.7 ± 0.4) compared with baseline (2.6 ± 0.2; p < 0.05). Only one patient experienced a new deficit (decreased hearing), which was corrected with a hearing aid., Conclusions: The presigmoid approach is recommended for the resection of anterolateral pontine cavernomas. With this approach, the need for cerebellar retraction is nearly eliminated. The lateral "presigmoid" entry point creates a trajectory that allows complete resection of even deep lesions at this level, or anterior to the internal acoustic meatus.

Background: The incidence of severe, chronic postoperative headache in patients undergoing elective surgery for unruptured aneurysms is unknown. In addition, no clear risk factors have been identified for the development of postoperative headache., Objective: To evaluate intradural drilling of the anterior clinoid process as a mechanism for the development of postoperative headache after open aneurysm repair., Methods: A retrospective review of 128 patients undergoing open surgical treatment for unruptured, proximal carotid aneurysms treated at the University of Texas Southwestern Medical Center between January 2004 and December 2007. Patients who required intradural drilling of the anterior clinoid process were compared with patients in whom additional drilling was not necessary. The presence of postoperative headache and the duration and severity were noted., Results: In 28% of patients who underwent surgery with intradural clinoidectomy severe headache developed vs 7% of patients without clinoidectomy. This result was statistically significant (P < .05, Fisher exact test)., Conclusion: Intradural drilling of the anterior clinoid process was associated with an increased incidence of postoperative headache compared with no resection. This implicates either the dural manipulation necessary to expose the clinoid and optic strut or the introduction of bone dust into the subarachnoid space as potential risk factors for postoperative headache.

Keysar et al. (Keysar, Barr, Balin, & Brauner, 2000; Keysar, Lin, & Barr, 2003) report that adults frequently failed to use their conceptual competence for theory of mind (ToM) in an online communication game where they needed to take account of a speaker's perspective. The current research reports 3 experiments investigating the cognitive processes contributing to adults' errors. In Experiments 1 and 2 the frequency of adults' failure to use ToM was unaffected by perspective switching. In Experiment 3 adults made more errors when interpreting instructions according to the speaker's perspective than according to an arbitrary rule. We suggest that adults are efficient at switching perspectives, but that actually using what another person knows to interpret what they say is relatively inefficient, giving rise to egocentric errors during communication.

Object: Because the risks are reduced, larger basilar apex aneurysms are usually treated endovascularly instead of with surgery. However, small basilar apex aneurysms are more common and an unfavorable shape may prevent definitive endovascular treatment. The goal of this study was to reevaluate the outcome of traditional surgery for small unruptured basilar apex aneurysms as an alternative to the currently more accepted endovascular treatment., Methods: The authors reviewed clinical data obtained in 21 patients who underwent surgery between 2000 and 2007 for unruptured basilar apex aneurysms < 7 mm., Results: The median age of the 21 patients was 52 years (range 29-74 years). All patients experienced a good outcome. Two patients harbored a small residual aneurysm (> 95% occlusion). Eight patients (38%) suffered a temporary third nerve paresis, which resolved in all cases., Conclusions: Surgical clip ligation remains an excellent treatment for small basilar apex aneurysms. The treatment is definitive and in experienced hands is associated with a low risk.

Background and Purpose: Thrombosis of the cerebral venous sinus may cause venous congestion, cerebral edema, and infarction. The role of cerebrovenous disorders in arterial ischemic stroke is unknown. The objective of this study was to examine the contribution of ipsilateral cranial venous abnormalities to the development of cerebral edema in middle cerebral artery infarction., Methods: This is a retrospective study of consecutive patients with large middle cerebral artery infarction admitted to our neurocritical care unit from January 2007 to October 2008. Medical records, laboratory data, and imaging of cerebral edema and cranial venous sinuses were analyzed., Results: Of the 14 patients identified to have large middle cerebral artery infarction and images of cranial venous drainages, 5 (35.7%) had fatal edema with clinical signs of transtentorial herniation. Four of the 5 patients developed fatal edema within 48 hours of ictus and were found to have abnormal ipsilateral cranial venous drainage, including atresia of the transverse sinus (one), occlusion of the internal jugular vein (one), and hypoplasia of the transverse sinus and internal jugular vein (2). The fifth patient had symmetrical bilateral cranial venous drainages and fatal edema at Day 5. Of the 9 patients with nonmalignant middle cerebral artery infarction, all had ipsilateral dominant or symmetrical bilateral venous drainages., Conclusions: In this small case series, we demonstrated that only the patients with hypoplasia or occlusion of the ipsilateral cranial venous drainage developed early fatal edema after large middle cerebral artery infarction. Our results suggest a role of cranial venous outflow abnormalities in the development of brain edema after arterial ischemic stroke.

Neck remodeling devices such as the Neuroform or Enterprise greatly facilitate the endovascular treatment of wide necked basilar apex aneurysms. The complex anatomy of the basilar apex affords opportunity for antegrade, multiple crossing and retrograde device placement strategies to facilitate coil embolization. A retrograde approach is possible in the presence of a posterior communicating artery large enough to allow device navigation. Our experience with a retrograde device placement strategy in three patients is reported. In two patients, device positioning extended from one P1 segment of the posterior cerebral artery to the other across the basilar apex. In one patient, device positioning extended from the P1 segment of the posterior cerebral artery across the basilar apex into the opposite superior cerebellar artery. All patients underwent reconstructive or deconstructive uncomplicated coil embolization after device placement with stable aneurysm occlusion on follow-up angiography. In appropriate anatomic situations, retrograde stent placement across the basilar apex through a posterior communicating artery may represent a preferred strategy for wide necked basilar apex aneurysms.

Staphylococcus lugdunensis is an aggressive, virulent member of the coagulase-negative staphylococci (CoNS) that is responsible for severe, rapidly progressive skin and soft tissue infections and native valve endocarditis. To facilitate prompt identification and appropriate therapy, we describe here a rapid and robust multiplex real-time PCR assay that is able to definitively distinguish S. lugdunensis from other staphylococci. Using melting curve analysis, the assay also identifies Staphylococcus aureus and CoNS other than S. lugdunensis and determines MecA-dependent resistance to methicillin (meticillin). When applied to a panel of well-characterized staphylococcal reference strains, as well as 165 clinical isolates previously identified by conventional methods, the assay was both sensitive and specific for S. lugdunensis, correctly identifying the reference strain and all 47 S. lugdunensis isolates without inappropriate amplification of other staphylococci. Furthermore, rapid biochemical identification using the WEE-TAB system to detect ornithine decarboxylase activity was found to be unsuitable as an alternative to PCR identification, displaying just 31% sensitivity and 77% specificity when tested on a subset (90 isolates) of the clinical strains. We therefore propose that this simple, accurate PCR approach will allow for the routine and timely identification of S. lugdunensis in the clinical microbiology laboratory.

Background: Although various bypass options for the surgical treatment of middle cerebral artery aneurysms have been described, little has been reported about similar options for complex aneurysms of the anterior cerebral artery., Case Description: We report the case of a 15-year-old adolescent girl, in whom a giant A1 segment aneurysm was successfully treated with aneurysm resection followed by saphenous vein interposition grafting., Conclusion: Recognizing the option for a bypass can be the key to success in the surgical management of complex intracranial aneurysms. A potential donor vessel of appropriate size (either arterial or venous) should be prospectively identified. Interposition grafting is technically feasible for proximal anterior cerebral artery aneurysms, although technically demanding.

The rapid identification of mycobacteria from culture is of primary importance for the administration of empirical antibiotic therapy and for the implementation of public health measures, yet there are few commercially available assays that can easily and accurately identify the mycobacteria in culture in a timely manner. Here we report on the development of a multiplex, real-time PCR assay that can identify 93% of the pathogenic mycobacteria in our laboratory in two parallel reactions. The mycobacteria identified by this assay include the Mycobacterium tuberculosis complex (MTC), the M. avium complex (MAC), the M. chelonae-M. abscessus group (MCAG), the M. fortuitum group (MFG), and M. mucogenicum. The primer targets included the 16S rRNA gene and the internal transcribed spacer. The assay was initially validated with a repository of reference strains and was subsequently tested with 314 clinical cultures identified by the AccuProbe assay or high-performance liquid chromatography. Of the 314 cultures tested, multiplex, real-time PCR produced congruent results for 99.8% of the 1,559 targets evaluated. The sensitivity and the specificity were each 99% or greater for MTC (n = 96), MAC (n = 97), MCAG (n = 68), and M. mucogenicum (n = 9) and 95% and 100%, respectively, for MFG (n = 19). We conclude that this multiplex, real-time PCR assay is a useful diagnostic tool for the rapid and accurate identification of MTC and clinically relevant nontuberculous mycobacteria.

When trying to make sense of other people's behaviour we usually invoke their mental states, such as their intentions, beliefs or emotions. This mind reading ability has been traditionally investigated in developmental psychology and comparative psychology but is now receiving increasing attention from the cognitive neurosciences. I will show the important role that neuropsychology plays in unravelling the cognitive and neural basis of our mind reading abilities. I will illustrate this by showing how cases of adults with acquired brain lesions can help us tease apart the different mechanisms that underlie mind reading abilities and can help us understand the nature of these mechanisms, especially their relation to language and executive function.

Background and Purpose: Preoperative embolization facilitates the surgical management of complex cerebral arteriovenous malformations (cAVMs). This analysis aims to investigate the risks for preoperative cAVM embolization with Onyx., Materials and Methods: We retrospectively analyzed clinical data of all patients who underwent embolization with Onyx as a preoperative treatment of cAVMs at our institution since 2005 (US Food and Drug Administration [FDA] approval). Patients with arteriovenous fistulas were excluded. A total of 107 patients were treated for cAVMs during the study period. Of those patients, 41 underwent cAVM embolizations with Onyx in 82 procedures., Results: After the embolization, the cAVM diameter was reduced from 3.71 +/- 1.55 cm to 3.06 +/- 1.89 cm (P < .05). Median volume reduction was 75%. Complete occlusion with embolization alone was achieved in 4 (10%) cAVMs. The recurrence rate for completely occluded cAVMs was 50% (2 patients). A total of 71% of the 41 patients treated with Onyx underwent surgery, and 15% underwent radiosurgery. There were 9% who have not yet received definitive treatment of their residual cAVMs. A new permanent neurologic deficit occurred in 5 patients (6.1% per procedure or 12.2% per patient)., Conclusions: A considerable risk for a permanent neurologic deficit remains for cAVM embolization with Onyx. The risk has to be carefully weighted against the benefit of volume reduction in the treatment of cAVMs.

Objective: The goal of this study was to analyze the natural history of symptomatic brainstem cavernomas (medulla, pons, or midbrain) and outcome after surgical resection., Methods: We retrospectively analyzed clinical data of all patients who presented to our institution with symptomatic brainstem cavernomas between 1995 and 2007 (n = 44)., Results: After a first neurological event, the median event-free interval was 2 years, with an annual event rate of 42%. After a second neurological event (new neurological deficit or significant worsening of the previous deficit), the median event-free interval was only 5 months, with a monthly event rate of 8%. After an observation period of up to 8 years, all patients ultimately underwent surgery. In 95% of the patients, surgery successfully prevented further events during a median follow-up period of 11 months (1 month-7 years; P < 0.001). The postoperative event rate was 5% per year in the first 2 years and 0% thereafter. In the multivariate analysis, only the preoperative modified Rankin scale score was predictive of the surgical outcome (odds ratio, 36.7; P = 0.015). The conditions of 2 patients (5%) were clinically worse compared with their preoperative conditions during the 1-year follow-up period; in one of these patients, this was caused by recurrent events. There was no mortality., Conclusion: The event rate of symptomatic lesions seems to be high, particularly after recurrent events. Surgical morbidity can be low. Timely and complete surgical resection is recommended for symptomatic brainstem cavernomas to prevent patients' functional decline owing to recurrent events.

Background: Treatment of VLGUIA remains a challenge. To reduce mass effect and achieve complete occlusion, open surgery has been our favored treatment. However, endovascular therapy is preferred for lesions in the cavernous sinus or for older patients with complicating medical problems. The goal of this study is to investigate outcome of stent and/or coil treatment of VLGUIA., Methods: Beginning in 2002, the neuroform stent has been available to the University of Texas Southwestern Medical Center in Dallas. Since then until 2006, 15 patients were treated for VLGUIA with stenting and/or coiling at this institution. These 15 patients were used for a retrospective analysis in this study., Results: Median patient age was 65 years, median aneurysm size was 27 mm (20-37 mm), and median follow-up time was 22 months. Eight aneurysms were localized in the cavernous sinus and 7 at the ophthalmic segment of the internal carotid artery. Four aneurysms were completely occluded (100%); 3 aneurysms, nearly complete (90%-99%); and 8 aneurysms, partial (<90% occlusion). Twelve patients required retreatment. Final GOS was 1 (good recovery) in 11 patients, 2 (moderate disability) in 3 patients, and 3 (severely disabled) in 1 patient. No patient died or deteriorated., Conclusions: Stent/coil management of VLGUIA is constantly evolving. Current treatment results are promising, with very low morbidity/mortality. Disadvantage is the frequent persistence of residual aneurysm.