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The neural representations of prior information about the state of the world are poorly understood. To investigate this issue, we examined brain-wide Neuropixels recordings and widefield calcium imaging collected by the International Brain Laboratory. Mice were trained to indicate the location of a visual grating stimulus, which appeared on the left or right with prior probability alternating between 0.2 and 0.8 in blocks of variable length. We found that mice estimate this prior probability and thereby improve their decision accuracy. Furthermore, we report that this subjective prior is encoded in at least 20% to 30% of brain regions which, remarkably, span all levels of processing, from early sensory areas (LGd, VISp) to motor regions (MOs, MOp, GRN) and high level cortical regions (ACCd, ORBvl). This widespread representation of the prior is consistent with a neural model of Bayesian inference involving loops between areas, as opposed to a model in which the prior is incorporated only in decision making areas. This study offers the first brain-wide perspective on prior encoding at cellular resolution, underscoring the importance of using large scale recordings on a single standardized task.

A key challenge in neuroscience is understanding how neurons in hundreds of interconnected brain regions integrate sensory inputs with prior expectations to initiate movements. It has proven difficult to meet this challenge when different laboratories apply different analyses to different recordings in different regions during different behaviours. Here, we report a comprehensive set of recordings from 115 mice in 11 labs performing a decision-making task with sensory, motor, and cognitive components, obtained with 547 Neuropixels probe insertions covering 267 brain areas in the left forebrain and midbrain and the right hindbrain and cerebellum. We provide an initial appraisal of this brain-wide map, assessing how neural activity en- codes key task variables. Representations of visual stimuli appeared transiently in classical visual areas after stimulus onset and then spread to ramp-like activity in a collection of mid- and hindbrain regions that also encoded choices. Neural responses correlated with motor action almost everywhere in the brain. Responses to reward delivery and consumption versus reward omission were also widespread. Representations of objective prior expectations were weaker, found in sparse sets of neurons from restricted regions. This publicly available dataset represents an unprecedented resource for understanding how computations distributed across and within brain areas drive behaviour.

A retrospective epidemiological analysis of 52 patient´s records of patients under 55 years of age, admitted to the Hospital São Lucas de Cascavel (PR), with a diagnosis of stroke carried out. The main type of stroke observed in this population was hemorrhagic stroke (HCV), occurring in 88.4% of the cases, while ischemic stroke was observed in 11.6% of the cases. Among the main risk factors analyzed in these patients, arterial hypertension was the main one, being present in 84.9% of the strokes. In addition to hypertension, other important risk factors were also observed, such as smoking, alcoholism, dyslipidemia, diabetes mellitus and traumatic brain injury. Thus, it is noted that in this study group, the potentially modifiable and controllable risk factors are prevalent, suggesting a greater need for incentives for prevention campaigns and early detection of risks directed at the young population. Se realizó un análisis epidemiológico retrospectivo de 52 prontuarios de pacientes menores de 55 años, ingresados ​​en el Hospital São Lucas de Cascavel (PR) con diagnóstico de accidente cerebrovascular (ACV). El principal tipo de ictus observado en esta población fue el ictus hemorrágico (ACV), ocurriendo en el 88,4% de los casos, mientras que el ictus isquémico se observó en el 11,6% de los casos. Entre los principales factores de riesgo analizados en estos pacientes, la hipertensión arterial se destacó como el principal, estando presente en el 84,9% de los ictus. Además de la hipertensión arterial, también se observaron otros factores de riesgo importantes como el tabaquismo, el consumo de alcohol, la dislipidemia, la diabetes mellitus y el traumatismo craneoencefálico. Así, se advierte que en este grupo estudiado prevalecen factores de riesgo potencialmente modificables y controlables, lo que sugiere una mayor necesidad de incentivar campañas de prevención y detección temprana de riesgos dirigida a la población joven. Realizou-se uma análise retrospectiva epidemiológica de 52 prontuários de pacientes com idade inferior a 55 anos, admitidos no Hospital São Lucas de Cascavel (PR) com diagnóstico de acidente vascular cerebral (AVC). O principal tipo de AVC observado nessa população foi o AVC hemorrágico (AVCh), ocorrendo em 88,4% dos casos, enquanto o AVC isquêmico foi observado em 11,6% dos casos. Dentre os principais fatores de risco analisados nesses pacientes, a hipertensão arterial destacou-se como o principal, estando presente em 84,9% dos AVCs. Além da hipertensão arterial, também foi observado outros fatores de risco importantes como tabagismo, etilismo, dislipidemia, diabetes mellitus e traumatismo crânio encefálico. Dessa forma, nota-se que nesse grupo estudado é prevalente os fatores de risco potencialmente modificáveis e controláveis, sugerindo uma necessidade maior de incentivos para campanhas de prevenção e detecção de riscos precoce direcionado para a população jovem.

Objective: To report the clinical management of a patient with Diabetic Ketoacidosis (DKA), from the a literature review about the theme. Methods: Case study, analyzing treatment protocols about the correlation of the effectiveness of the correction of Ketoacidosis with the incidence of complications secondary to the respective treatment in a patient hospitalized in Pediatric Unit. Results: The patient presented DKA in first decompensation. The reduction speed of blood glucose in the first hour was superior to 100 mg/dL/hour, and the HGT data from the subsequent hours up to the eighth hour of treatment in the medical records were not found. Variable concentrations of glucose and potassium in the plan for basic water and electrolyte needs were utilized within the first 24 hours. The infusion of intermediate NPH began 36 hours after the start of the treatment. Regarding data complications, it was observed that the patient presented hypoglycemia, hypopotassemia, persistence of metabolic acidosis by early withdrawal of regular insulin infusion, with subsequent alkalosis due to the use of bicarbonate in the correction of acidosis. Conclusion: After data collection and analysis in the light of the theoretical reference framework, it was observed the non-existence of a specific protocol to the DKA treatment in the studied service, being that the use of these protocols help in the adequate treatment of the acute complication of diabetes, which avoids a greater risk of complications and reduces morbimortality. Objetivo: Informar el manejo clínico de un paciente con Cetoacidosis Diabética (CAD), a partir de una revisión bibliográfica sobre el tema. Métodos: Estudio de caso, con análisis en protocolos de tratamiento de la correlación de la efectividad de la corrección de Cetoacidosis con la incidencia de complicaciones secundarias al respectivo tratamiento, en un paciente hospitalizado en una Unidad de Pediatría. Resultados: El paciente presentó CAD en descompensación primaria. La tasa de reducción de la glucemia en la 1.ª hora fue superior a 100 mg/dl/hora, y no se encontraron en las historias clínicas datos de HGT para las horas posteriores hasta la 8.ª hora de tratamiento. Se utilizaron concentraciones variables de glucosa y potasio en el plan para los requerimientos básicos de agua y electrolitos durante las primeras 24 horas. La infusión de insulina NPH intermedia se inició a las 36 horas de iniciado el tratamiento. En cuanto a los datos relacionados con las complicaciones, se observó que el paciente presentó hipoglucemia, hipopotasemia, persistencia de acidosis metabólica por suspensión temprana de la infusión de insulina regular, con posterior alcalosis por el uso de bicarbonato en la corrección de la acidosis Conclusión: Tras encuesta y análisis de los datos a la luz del marco teórico de referencia, no existía un protocolo específico para el tratamiento de la CAD en el servicio en estudio, y el uso de estos protocolos ayuda en el tratamiento adecuado de la complicación aguda de la diabetes, lo que evita una riesgo de complicaciones y reduce la morbilidad y la mortalidad. Objetivo: Relatar o manejo clínico de um paciente com Cetoacidose Diabética (CAD), a partir de revisão de literatura sobre o tema. Métodos: Estudo de caso, com análise em protocolos de tratamento da correlação da eficácia da correção de Cetoacidose com a incidência de complicações secundárias ao respectivo tratamento, em um paciente internado em Unidade Pediátrica. Resultados: O paciente apresentou-se com CAD em primo-descompensação. A velocidade de redução da glicemia na 1ª hora foi superior a 100 mg/dL/hora, não sendo encontrado os dados de HGT das horas subsequentes até a 8ª hora de tratamento no prontuário. Foram utilizadas concentrações variáveis de glicose e potássio no plano para necessidades básicas de água e eletrólitos durante as primeiras 24 horas. A infusão de insulina intermediária NPH iniciou-se 36 horas após o início do tratamento. Em se tratando dos dados relativos às complicações, observou-se que o paciente apresentou hipoglicemia, hipopotassemia, persistência de acidose metabólica por suspensão precoce de infusão de insulina regular, com posterior alcalose por uso de bicarbonato na correção da acidose Conclusão: Após levantamento e análise de dados à luz do marco teórico de referência, observou-se a não existência de um protocolo específico para tratamento de CAD no serviço em estudo, sendo que o uso desses protocolos auxiliam no tratamento adequado da complicação aguda do diabetes, o que evita um risco maior de complicações e reduz a morbimortalidade.

Patients with non-familial, unilateral breast cancer have a low risk of contralateral breast cancer. Thus, clinical studies have shown no survival benefit for patients who undergo contralateral prophylactic mastectomy (CPM) compared to those undergoing unilateral surgeries for non-familial unilateral breast cancers. Despite this evidence, there has been a steady increase in rates of CPM in the U.S. Patient factors influencing this choice have been identified in previous studies, but seldom in a prospective manner. This prospective study was designed to assess emotion and any association with a patient's decision to ultimately undergo CPM.We recruited patients with newly diagnosed, unilateral, non-metastatic breast cancer, who had not yet had surgery, to participate in a prospective, longitudinal study to examine the impact of emotions on CPM decision-making.Among the 86 final participants, all completed the pre-visit survey (100%) and 52 patients completed the post-visit survey (60%). Patients undergoing CPM were significantly younger than those who did not. There was no statistically significant association between emotion and receipt of CPM. There was a trend towards undergoing CPM in patients with a less open personality type and those with more negative emotion, though not statistically significant.This study found a trend toward increased CPM receipt in those with less open personality types and more negative emotion, especially post-consultation, but none of these findings was significant. Future work should include development of cancer-specific emotion scales and larger studies of possible connections between emotion, personality type and surgical decision-making for breast cancer patients.

Coniferous trees of the genus Pinus (Pinaceae) are under continuous threats by numerous herbivorous insect species and pathogens attacking nearly all parts and tissues of the plants. To defend themselves, pine trees produce large amounts of oleoresin that is accumulated in a highly developed network of specialized resin ducts, which are distributed in the wood, bark, and needles. Such defense reactions in pines can be induced by the attack of herbivores. The banded pine weevil, Pissodes castaneus (De Geer, 1775) (Coleoptera, Curculionidae), is an important pest of Pinus in Brazil, where it has been an invasive species since 2001. The female lays its eggs under the tree bark of trees and the larvae feed in the phloem of the trunk and branches, interrupting the sap circulation and eventually causing its death. In the present study, we conducted detailed GC–MS analyses of volatiles emitted by twigs of Pinus taeda L. We analyzed how the attack by P. castaneus males and females affects the volatile pattern emitted by the twigs. When comparing volatiles produced by healthy plants and by female- and male-attacked P. taeda, qualitative and quantitative differences were detected, as the decreased production of limonene, germacrene D and (E)-caryophyllene and the increase of α-pinene. Laboratory bioassays showed that plants attacked by male and female P. castaneus were more attractive to the insects. Understanding about what compounds may attract or repel the insects may help in the development of more effective traps, as well as preventing stress to avoid infestation.

Overprescription of opioids for acute postoperative pain, plastic surgery procedures included, is contributing to the pervasive opioid epidemic in the United States. This study examines the effect of a statewide legislation limiting postoperative opioids on opioid prescription behavior among providers following outpatient plastic surgery procedures at a high-volume academic center.Retrospective review of all outpatient surgical encounters between June 1, 2016, and November 30, 2018, was performed. Encounters were grouped into two cohorts: prepolicy and postpolicy. Primary outcomes included total oral morphine equivalents prescribed on the day of surgery and proportion of patients prescribed greater than 210 oral morphine equivalents. Secondary outcomes included proportion of patients requiring an opioid refill within 30 days following surgery, and number of refills required.The mean oral morphine equivalents prescribed on the day of surgery was reduced from 271.8 to 150.37 oral morphine equivalents ( p0.001) following implementation of the legislation, with an associated decrease in the standard deviation of oral morphine equivalents prescribed from 225.35 to 196.71 ( p0.001), suggesting a decrease in the variability of prescriber practices. Time series analysis demonstrated the decrease in oral morphine equivalents remained significant when accounting for baseline level of change in opioid prescription patterns.This study provides evidence that legislation at the state level restricting postoperative opioid prescriptions is associated with a decrease in opioid prescriptions without an increase in the need for refills in the acute postoperative setting following outpatient plastic surgery procedures.

Understanding whole-brain-scale electrophysiological recordings will rely on the collective work of multiple labs. Because two labs recording from the same brain area often reach different conclusions, it is critical to quantify and control for features that decrease reproducibility. To address these issues, we formed a multi-lab collaboration using a shared, open-source behavioral task and experimental apparatus. We repeatedly inserted Neuropixels multi-electrode probes targeting the same brain locations (including posterior parietal cortex, hippocampus, and thalamus) in mice performing the behavioral task. We gathered data across 9 labs and developed a common histological and data processing pipeline to analyze the resulting large datasets. After applying stringent behavioral, histological, and electrophysiological quality-control criteria, we found that neuronal yield, firing rates, spike amplitudes, and task-modulated neuronal activity were reproducible across laboratories. To quantify variance in neural activity explained by task variables (e.g., stimulus onset time), behavioral variables (timing of licks/paw movements), and other variables (e.g., spatial location in the brain or the lab ID), we developed a multi-task neural network encoding model that extends common, simpler regression approaches by allowing nonlinear interactions between variables. We found that within-lab random effects captured by this model were comparable to between-lab random effects. Taken together, these results demonstrate that across-lab standardization of electrophysiological procedures can lead to reproducible results across labs. Moreover, our protocols to achieve reproducibility, along with our analyses to evaluate it are openly accessible to the scientific community, along with our extensive electrophysiological dataset with corresponding behavior and open-source analysis code.

PURPOSE: This article attempts to answer the following questions: What key competences and skills should characterise managers in the information technology (IT) sector; is there a skills’ gap, that is, a discrepancy between the desired and actual skills of IT managers; and what activities can contribute to minimising the identified skills’ gap?, DESIGN/METHODOLOGY/APPROACH: Answering the above-mentioned research questions required reviewing the literature on the subject and conducting research. The research covered 504 managers representing all levels of management in IT companies operating in Poland. The collected data were subjected to statistical analysis, based on which conclusions were drawn., FINDINGS: It has been found that the smallest skills’ gap includes: using technological solutions efficiently, cooperating with others, disposing of the knowledge possessed and drawing conclusions based on one’s own mistakes. The greatest skills’ gap occurs in the areas of obtaining funds from outside an enterprise, making accurate assessments of the emotions occurring in a team, and making accurate personnel decisions as well as correcting mistakes, synthetic thinking and managing finances properly., PRACTICAL IMPLICATIONS: The presented results on the skills’ gap is part of a wider research project aimed at identifying and assessing the levels of the key competences of managers employed in IT companies. In order to minimise the identified skills’ gap, specific actions were recommended to be taken to improve these skills., ORIGINALITY/VALUE: The value of the conducted research procedure is the identification of key skills of tactical and operational level managers of IT companies and their arrangement due to the size of the gap between the actual and desired state. Actions to improve key managerial skills were also identified. These activities may help increase the effectiveness and competitiveness of Polish IT companies., peer-reviewed

Introduction Delusional parasitosis (DP) has been described as among the most challenging diagnosis to manage in dermatology and psychiatry literature. Patients with this perplexing and enigmatic condition present potentially to a wide range of specialties including primary or emergency care, dermatology, infectious diseases, neurology, and psychiatry. DP is probably underdiagnosed from patients' underreporting of symptoms of being infested with parasites, resulting from the associated social stigma. In addition, specialists who most often encounter these patients often possess low familiarity and comfort level in the diagnosis and therapy of this disorder. To our knowledge, we present only the fifth case of delusional parasitosis that was associated with complex visual hallucinations. Both concurrent conditions were treated successfully with aripiprazole. Interestingly, in all of these prior cases including ours, the patients were elderly (age range, 74-95 years). Delusions of ocular parasitosis has been described in fewer than 11 cases. When delusions occur concurrently with hallucinations, the differential diagnosis becomes even more challenging and may include schizophrenia, drug-induced psychosis, Lewy body dementia, and Charles Bonnet syndrome. Our patient's delusions of ocular parasitosis led to ocular damage and severe visual impairment because of his constant need to extract the parasites from his eyes. We speculate that the subsequent complex visual hallucinations that developed can best be understood as Charles Bonnet syndrome. Case presentation A 78-year-old healthy African American male complained of pests and bugs approximately 2 cm in size that infested the skin of his entire body. He also described the life cycle of these parasites, which jumped onto his eyelids and conjunctiva. He developed functional vision blindness from his unwillingness to open his eyelids as a result of his attempts to block the parasites. He was evaluated by dermatology, infectious diseases, ophthalmology, and psychiatry. All specialists agreed with the diagnosis of DP, and recommended antipsychotic therapy. They consistently dismissed the patient's symptoms as anything more than psychiatric, so the patient did not follow-up for further assessments or other therapies. Even months after the diagnosis of DP, he developed complex visual hallucinations. He described new visions in vivid detail: inanimate objects (buildings, jackhammers, torches, planes), animals (bears, doves, sharks), shapes (triangles, rectangles, omega, and mason signs). The objects interacted on high-definition landscapes such as oceans. He refused further psychiatric assessment because he felt strongly that the symptoms were infectious in nature and not psychiatric. However, a therapeutic relationship with his geriatrician was established through empathic communications, goal setting, and shared decision making. He even agreed to start treatment with aripiprazole 2 mg because the shared goal was symptom management of the concurrent delusional parasitosis and complex visual hallucinations. The slow titration of aripiprazole to 6 mg led to a 75% reduction in the delusions and hallucinations. He initially declined higher dosages of the aripiprazole because of sedation and personal wariness of medications in general. However, a therapeutic relationship was nurtured based on respect, careful listening, and provision of options. Eventually, he agreed to a higher dosage of aripiprazole and thus titrate antipsychotic therapy that he rejected when prescribed by the dermatology and psychiatry specialists. We attempted to approximate the 15-mg dosage that led to remission of symptoms in previous case reports.

Mutations in CHMP2B, an ESCRT‐III (endosomal sorting complexes required for transport) component, are associated with frontotemporal dementia (FTD) and amyotrophic lateral sclerosis (ALS). Neurodegenerative disorders including FTD are also associated with a disruption in circadian rhythms, but the mechanism underlying this defect is not well understood. Here, we ectopically expressed the human CHMP2B variant associated with FTD (CHMP2BIntron5) in flies using the GMR‐GAL4 driver (GMR>CHMP2BIntron5) and analyzed their circadian rhythms at behavioral, cellular, and biochemical level. In GMR>CHMP2BIntron5 flies, we observed disrupted eclosion rhythms, shortened free‐running circadian locomotor period, and reduced levels of timeless (tim) mRNA—a circadian pacemaker gene. We also observed that the GMR‐GAL4 driver, primarily known for its expression in the retina, drives expression in a subset of tim expressing neurons in the optic lobe of the brain. The patterning of these GMR‐ and tim‐positive neurons in the optic lobe, which appears distinct from the putative clusters of circadian pacemaker neurons in the fly brain, was disrupted in GMR>CHMP2BIntron5 flies. These results demonstrate that CHMP2BIntron5 can disrupt the normal function of the circadian clock in Drosophila.

BACKGROUND Abdominoperineal resection is the treatment for many anorectal malignancies. The laparotomy approach allows for harvest of the rectus abdominis muscle for perineal reconstruction. However, with increasing numbers of robotic abdominoperineal resections being performed, the morbidity associated with a laparotomy incision is avoided. We describe a modification of the previous technique of advancing bilateral fasciocutaneous gluteal flaps into the pelvic cavity for reconstruction. This operation is performed expeditiously in the prone position. The patient is spared a large anterior deficit but reaps the benefits of a robust reconstruction with minimal morbidity. METHODS A retrospective chart review was performed from July 2012 to February 2018 of our institution's electronic record database. All patients who underwent modified V-Y gluteal fasciocutaneous flaps for perineal defects were included. Patient demographics, comorbidities, and adjunctive therapies as well as outcomes and complications were analyzed. RESULTS A total of 31 patients (51 flaps) were identified with 100% flap survival. The total number of patients with minor complications was 42%, consisting of 4 surgical site infections (13%), 13 cases of dehiscence (42%), and 2 cases requiring return to the operating room for abscess drainage (6%). Importantly, dehiscence was defined as any wound separation, regardless of size, with an average of only 3.8 cm. All healed with conservative management. After foregoing bolstering with synthetic mesh, the complication rate decreased from 67% to 37% (odds ratio, 3.4; P = 0.11). CONCLUSIONS This modified technique of bilateral fasciocutaneous gluteal V-Y advancement flaps for perineal wound control is a safe and effective method of reconstructing defects.

Objetivo: Relatar o manejo clínico de um paciente com Cetoacidose Diabética (CAD), a partir de revisão de literatura sobre o tema. Métodos: Estudo de caso, com análise em protocolos de tratamento da correlação da eficácia da correção de Cetoacidose com a incidência de complicações secundárias ao respectivo tratamento, em um paciente internado em Unidade Pediátrica. Resultados: O paciente apresentou-se com CAD em primo-descompensação. A velocidade de redução da glicemia na 1ª hora foi superior a 100 mg/dL/hora, não sendo encontrado os dados de HGT das horas subsequentes até a 8ª hora de tratamento no prontuário. Foram utilizadas concentrações variáveis de glicose e potássio no plano para necessidades básicas de água e eletrólitos durante as primeiras 24 horas. A infusão de insulina intermediária NPH iniciou-se 36 horas após o início do tratamento. Em se tratando dos dados relativos às complicações, observou-se que o paciente apresentou hipoglicemia, hipopotassemia, persistência de acidose metabólica por suspensão precoce de infusão de insulina regular, com posterior alcalose por uso de bicarbonato na correção da acidose Conclusão: Após levantamento e análise de dados à luz do marco teórico de referência, observou-se a não existência de um protocolo específico para tratamento de CAD no serviço em estudo, sendo que o uso desses protocolos auxiliam no tratamento adequado da complicação aguda do diabetes, o que evita um risco maior de complicações e reduz a morbimortalidade.

Realizou-se uma análise retrospectiva epidemiológica de 52 prontuários de pacientes com idade inferior a 55 anos, admitidos no Hospital São Lucas de Cascavel (PR) com diagnóstico de acidente vascular cerebral (AVC). O principal tipo de AVC observado nessa população foi o AVC hemorrágico (AVCh), ocorrendo em 88,4% dos casos, enquanto o AVC isquêmico foi observado em 11,6% dos casos. Dentre os principais fatores de risco analisados nesses pacientes, a hipertensão arterial destacou-se como o principal, estando presente em 84,9% dos AVCs. Além da hipertensão arterial, também foi observado outros fatores de risco importantes como tabagismo, etilismo, dislipidemia, diabetes mellitus e traumatismo crânio encefálico. Dessa forma, nota-se que nesse grupo estudado é prevalente os fatores de risco potencialmente modificáveis e controláveis, sugerindo uma necessidade maior de incentivos para campanhas de prevenção e detecção de riscos precoce direcionado para a população jovem.