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Introduction The COVID-19 pandemic is having a deep impact on emergency surgical services, with a significant reduction of patients admitted into emergency surgical units world widely. Reliable figures of this reduction have not been produced yet. Our international audit aimed at giving a precise snapshot of the absolute and relative changes of emergency surgical admissions at the outbreak of the pandemic. Materials and methods Datasets of patients admitted as general surgical emergencies into 45 internationally distributed emergency surgical units during the months of March and April 2020 (Covid-19 pandemic outbreak) were collected and compared with those of patients admitted into the same units during the months of March and April 2019 (pre-Covid-19). Primary endpoint was to evaluate the relative variation of the presentation symptoms and discharge diagnoses between the two study periods. Secondary endpoint was to identify the possible change of therapeutic strategy during the same two periods. Results Forty-five centres participated sent their anonymised data to the study hub, for a total of 6263 patients. Of these, 3810 were admitted in the pre-Covid period and 2453 in the Covid period, for a 35.6% absolute reduction. The most common presentation was abdominal pain, whose incidence did not change between the two periods, but in the Covid period patients presented less frequently with anal pain, hernias, anaemia and weight loss. ASA 1 and low frailty patients were admitted less frequently, while ASA>1 and frail patients showed a relative increase. The type of surgical access did not change significantly, but lap-to-open conversion rate halved between the two study periods. Discharge diagnoses of appendicitis and diverticulitis reduced significantly, while bowel ischaemia and perianal ailments had a significant relative increase. Conclusions Our audit demonstrates a significant overall reduction of emergency surgery admissions at the outbreak of the Covid-19 pandemic with a minimal change of the proportions of single presentations, diagnoses and treatments. These findings may open the door to new ways of managing surgical emergencies without engulfing the already busy hospitals.

The relationship between neural activation during movement training and the plastic changes that survive beyond movement execution is not well understood. Here we ask whether the changes in resting-state functional connectivity observed following motor learning overlap with the brain networks that track movement error during training. Human participants learned to trace an arched trajectory using a computer mouse in an MRI scanner. Motor performance was quantified on each trial as the maximum distance from the prescribed arc. During learning, two brain networks were observed, one showing increased activations for larger movement error, comprising the cerebellum, parietal, visual, somatosensory, and cortical motor areas, and the other being more activated for movements with lower error, comprising the ventral putamen and the OFC. After learning, changes in brain connectivity at rest were found predominantly in areas that had shown increased activation for larger error during task, specifically the cerebellum and its connections with motor, visual, and somatosensory cortex. The findings indicate that, although both errors and accurate movements are important during the active stage of motor learning, the changes in brain activity observed at rest primarily reflect networks that process errors. This suggests that error-related networks are represented in the initial stages of motor memory formation.

We investigated whether dancing influences the emotional response to music, compared to when music is listened to in the absence of movement. Forty participants without previous dance training listened to "groovy" and "nongroovy" music excerpts while either dancing or refraining from movement. Participants were also tested while imitating their own dance movements, but in the absence of music as a control condition. Emotion ratings and ratings of flow were collected following each condition. Dance movements were recorded using motion capture. We found that the state of flow was increased specifically during spontaneous dance to groovy excerpts, compared with both still listening and motor imitation. Emotions in the realms of vitality (such as joy and power) and sublimity (such as wonder and nostalgia) were evoked by music in general, whether participants moved or not. Significant correlations were found between the emotional and flow responses to music and whole-body acceleration profiles. Thus, the results highlight a distinct state of flow when dancing, which may be of use to promote well-being and to address certain clinical conditions.

Time is often conceptualized in terms of space (mental time line; MTL). A prevalent representation of temporal concepts, indeed, construes the past and the future as respectively behind and in front of the ego. Insofar, however, a major omission of this line of research is that manual responses were restricted to the frontal space. This work provides the first striking demonstration that temporal processing affects the motor programming of active whole-body movements. Participants initiated steps backward much faster in response to past-than to future-related words, whereas they were faster to step forward in response to future-than past-related words. Furthermore, since the reported compatibility effect was limited to movement initiation time, it is likely that the processing of temporal information acted on the early stages of response selection (see Ulrich et al., 2012). Beyond substantiating the longstanding hypothesis that humans spatialize time on an egocentric spatial frame of reference, our findings demonstrate that the intangible domain of time extends to the more concrete domain of space through our body's action in the physical world.

Introduction Mindful clinicians are resilient and more likely to provide patient-centered care. We aimed to enhance clinicians' well-being by offering a Mindfulness-Based Stress Reduction (MBSR) course that teaches mindfulness and stress management and then determine whether this impacted their subsequent medical encounters. Methods In a longitudinal cohort study with 27 clinicians, MBSR was taught by a certified instructor. Pre-MBSR and post-MBSR online questionnaires assessed burnout, depression, stress, meaningfulness, and mindfulness. Patients independently rated their clinicians using the Rochester Communication Rating Scale (RCRS) after a clinical encounter before and after their clinician took the MBSR course. Nine medical doctors audiorecorded the consultations before and after MBSR; the tapes were coded and analyzed by an independent team using the Roter interaction analyses system. Results Significant reductions in stress and burnout were found, and increases in mindfulness and meaningfulness. The decrease in stress was correlated with less judgmental attitudes and less reactivity-facets of mindfulness. The decrease in emotional exhaustion was correlated with more acting with awareness and less judgmental attitudes-facets of mindfulness. Patients' perceptions of the clinical encounter suggested that patient-centered care improved after MBSR. Decreased depersonalization was significantly associated with the RCRS subscale, "understanding of the patient's experience of illness." At both time points, doctors dominated the exchange and were patient-centered. Discussion Mindfulness has a direct and positive impact on clinicians' well-being. When clinicians' experienced less depersonalization, their patients reported being better understood.

Background Toning is a form of vocalizing that utilizes the natural voice to express sounds ranging from cries, grunts, and groans to open vowel sounds and humming on the full exhalation of the breath. Music therapists are increasingly utilizing toning in their clinical practice for a variety of therapeutic aims. Yet the effects of toning are not widely understood, with limited research to date. Objective To gather and analyze descriptive data to better understand the experience and effects of self-administered toning. Primary aims were to: 1) understand participants' experiences with toning, and any effects resulting from their experiences; 2) measure participants' emotional response to toning and singing; and 3) examine similarities and differences across the two datasets. Methods Participants were 20 adults, ages 20-40 years, who were non-musicians. We conducted semi-structured interviews and used qualitative content analysis to identify major themes and subcategories related to participants' toning experiences. Participants also completed a 48-item questionnaire on music and emotions. Results from the interview and questionnaire data were then compared and contrasted. Results Results indicate that shifts in attention, awareness, and consciousness frequently occurred when individuals engaged in toning. "Meditative," "calm," and "relaxed" were the three most common descriptors of toning. In contrast, singing evoked stronger emotions and associations than toning, with the three most common descriptors including "nostalgia," "tenderness," and "joyful activation." Findings also suggest that the physical experience with vibrations and the sound of one's own voice may be attributes of toning that likely contribute to its success in inducing altered states of awareness, attention, and consciousness. Conclusions This study significantly expands our understanding of the experience and effects of toning, and has direct implications for clinical practice, including the identification of effective strategies to successfully engage adults in toning.

The early stages of motor skill acquisition are often marked by uncertainty about the sensory and motor goals of the task, as is the case in learning to speak or learning the feel of a good tennis serve. Here we present an experimental model of this early learning process, in which targets are acquired by exploration and reinforcement rather than sensory error. We use this model to investigate the relative contribution of motor and sensory factors to human motor learning. Participants make active reaching movements or matched passive movements to an unseen target using a robot arm. We find that learning through passive movements paired with reinforcement is comparable with learning associated with active movement, both in terms of magnitude and durability, with improvements due to training still observable at a 1 week retest. Motor learning is also accompanied by changes in somatosensory perceptual acuity. No stable changes in motor performance are observed for participants that train, actively or passively, in the absence of reinforcement, or for participants who are given explicit information about target position in the absence of somatosensory experience. These findings indicate that the somatosensory system dominates learning in the early stages of motor skill acquisition.SIGNIFICANCE STATEMENTThe research focuses on the initial stages of human motor learning, introducing a new experimental model that closely approximates the key features of motor learning outside of the laboratory. The finding indicates that it is the somatosensory system rather than the motor system that dominates learning in the early stages of motor skill acquisition. This is important given that most of our computational models of motor learning are based on the idea that learning is motoric in origin. This is also a valuable finding for rehabilitation of patients with limited mobility as it shows that reinforcement in conjunction with passive movement results in benefits to motor learning that are as great as those observed for active movement training.

We investigated whether dancing influences the emotional response to music, compared to when music is listened to in the absence of movement. Forty participants without previous dance training listened to "groovy" and "nongroovy" music excerpts while either dancing or refraining from movement. Participants were also tested while imitating their own dance movements, but in the absence of music as a control condition. Emotion ratings and ratings of flow were collected following each condition. Dance movements were recorded using motion capture. We found that the state of flow was increased specifically during spontaneous dance to groovy excerpts, compared with both still listening and motor imitation. Emotions in the realms of vitality (such as joy and power) and sublimity (such as wonder and nostalgia) were evoked by music in general, whether participants moved or not. Significant correlations were found between the emotional and flow responses to music and whole-body acceleration profiles. Thus, the results highlight a distinct state of flow when dancing, which may be of use to promote well-being and to address certain clinical conditions.

We evaluated the effect of different forms of singing on cardiorespiratory physiology, and we aimed at disentangling the role of breathing from that of vocal production. Cardiorespiratory recordings were obtained from 20 healthy adults at rest and during: a) singing of familiar slow songs as in the standard form of Western culture; b) improvised vocalization of free vowel sounds, known as toning. To disentangle the role of breathing from that of vocal production, we compared the vocal conditions with matched breathing-only conditions. Toning significantly improved heart rate variability, ventilatory efficiency and slowed respiration to almost exactly six breaths per minute (p

The effects of meditation on arterial and tissue oxygenation are unknown and difficult to assess because respiration is often altered, directly or indirectly, during meditation practice. Thus, changes in respiration may affect cardiovascular responses independently from meditation. In this study, we aim to isolate the specific effect of meditation on arterial and tissue oxygenation and other cardiorespiratory indexes while systematically controlling for the role of respiration. Furthermore, we aim to clarify to what extent prior expertise in meditation practice is needed to observe reliable changes. Eighty participants, half with and half without prior meditation experience, were tested while pacing breathing at predetermined rates, in the presence or absence of mantra meditation instructions, and in a body scan meditation that did not involve controlled breathing. Continuous recordings were acquired for arterial and brain oxygenation, respiratory excursion, electrocardiogram, skin vasomotion, and blood pressure. In both groups, meditation acutely decreased arterial and cerebral oxygen saturation, reduced chemoreflex sensitivity, and prolonged the RR interval, independently of respiration. Conversely, slow breathing improved heart rate variability, independently of concurrent meditation. In addition to the immediate effects of meditation, the individuals with long-term practice of meditation had overall higher arterial and cerebral oxygen saturation, overall lower blood pressure, and slower baseline respiration. Meditation acutely lowers arterial and tissue oxygenation. A repeated exposure to this condition may lead to long-term adaptation and, through increased ventilatory efficiency and improved gas exchanges, to an increase in baseline oxygenation. Meditation induces favorable changes in cardiovascular and respiratory end points of clinical interest.

Observing the actions of others has been shown to affect motor learning, but does it have effects on sensory systems as well? It has been recently shown that motor learning that involves actual physical practice is also associated with plasticity in the somatosensory system. Here, we assessed the idea that observational learning likewise changes somatosensory function. We evaluated changes in somatosensory function after human subjects watched videos depicting motor learning. Subjects first observed video recordings of reaching movements either in a clockwise or counterclockwise force field. They were then trained in an actual force-field task that involved a counterclockwise load. Measures of somatosensory function were obtained before and after visual observation and also following force-field learning. Consistent with previous reports, video observation promoted motor learning. We also found that somatosensory function was altered following observational learning, both in direction and in magnitude, in a manner similar to that which occurs when motor learning is achieved through actual physical practice. Observation of the same sequence of movements in a randomized order did not result in somatosensory perceptual change. Observational learning and real physical practice appear to tap into the same capacity for sensory change in that subjects that showed a greater change following observational learning showed a reliably smaller change following physical motor learning. We conclude that effects of observing motor learning extend beyond the boundaries of traditional motor circuits, to include somatosensory representations. © 2013 the American Physiological Society.

As one learns to dance or play tennis, the desired somatosensory state is typically unknown. Trial and error is important as motor behavior is shaped by successful and unsuccessful movements. As an experimental model, we designed a task in which human participants make reaching movements to a hidden target and receive positive reinforcement when successful. We identified somatic and reinforcement-based sources of plasticity on the basis of changes in functional connectivity using resting-state fMRI before and after learning. The neuroimaging data revealed reinforcement-related changes in both motor and somatosensory brain areas in which a strengthening of connectivity was related to the amount of positive reinforcement during learning. Areas of prefrontal cortex were similarly altered in relation to reinforcement, with connectivity between sensorimotor areas of putamen and the reward-related ventromedial prefrontal cortex strengthened in relation to the amount of successful feedback received. In other analyses, we assessed connectivity related to changes in movement direction between trials, a type of variability that presumably reflects exploratory strategies during learning. We found that connectivity in a network linking motor and somatosensory cortices increased with trial-to-trial changes in direction. Connectivity varied as well with the change in movement direction following incorrect movements. Here the changes were observed in a somatic memory and decision making network involving ventrolateral prefrontal cortex and second somatosensory cortex. Our results point to the idea that the initial stages of motor learning are not wholly motor but rather involve plasticity in somatic and prefrontal networks related both to reward and exploration.SIGNIFICANCE STATEMENTIn the initial stages of motor learning, the placement of the limbs is learned primarily through trial and error. In an experimental analog, participants make reaching movements to a hidden target and receive positive feedback when successful. We identified sources of plasticity based on changes in functional connectivity using resting-state fMRI. The main finding is that there is a strengthening of connectivity between reward-related prefrontal areas and sensorimotor areas in the basal ganglia and frontal cortex. There is also a strengthening of connectivity related to movement exploration in sensorimotor circuits involved in somatic memory and decision making. The results indicate that initial stages of motor learning depend on plasticity in somatic and prefrontal networks related to reward and exploration.

The present study aimed at determining whether the observation of two functionally compatible artefacts, that is which potentially concur in achieving a specific function, automatically activates a motor programme of interaction between the two objects. To this purpose, an interference paradigm was used during which an artefact (a bottle filled with orange juice), target of a reaching-grasping and lifting sequence, was presented alone or with a non-target object (distractor) of the same or different semantic category and functionally compatible or not. In experiment 1, the bottle was presented alone or with an artefact (a sphere), or a natural (an apple) distractor. In experiment 2, the bottle was presented with either the apple or a glass (an artefact) filled with orange juice, whereas in experiment 3, either an empty or a filled glass was presented. In the control experiment 4, we compared the kinematics of reaching-grasping and pouring with those of reaching-grasping and lifting. The kinematics of reach, grasp and lift was affected by distractor presentation. However, no difference was observed between two distractors that belonged to different semantic categories. In contrast, the presence of the empty rather filled glass affected the kinematics of the actual grasp. This suggests that an actually functional compatibility between target (the bottle) and distractor (the empty glass) was necessary to activate automatically a programme of interaction (i.e. pouring) between the two artefacts. This programme affected the programme actually executed (i.e. lifting). The results of the present study indicate that, in addition to affordances related to intrinsic object properties, "working affordances" related to a specific use of an artefact with another object can be activated on the basis of functional compatibility.

Although positive effects of rhythm cueing on motor control in neurologic disorders are known, no studies have yet focused on patients suffering from impaired programming of complex actions. One patient suffering from ideomotor apraxia (a potentially ideal experimental paradigm to test the effect of rhythm on high-level motor control) underwent two rehabilitation training sets differing only for the presence or absence of rhythm cueing. Both sets of training increased the patient's proficiency, but rhythm cueing was significantly more effective, during the training as well as during the post-training uncued test. Ideomotor apraxia represents an effective model to test the effects of rhythm on high-level motor control.

Growing evidence shows that individuals consistently match auditory pitch with visual size. For instance, high-pitched sounds are perceptually associated with smaller visual stimuli, whereas low-pitched sounds with larger ones. The present study explores whether this crossmodal correspondence, reported so far for perceptual processing, also modulates motor planning. To address this issue, we carried out a series of kinematic experiments to verify whether actions implying size processing are affected by auditory pitch. Experiment 1 showed that grasping movements toward small/large objects were initiated faster in response to high/low pitches, respectively, thus extending previous findings in the literature to more complex motor behavior. Importantly, auditory pitch influenced the relative scaling of the hand preshaping, with high pitches associated with smaller grip aperture compared with low pitches. Notably, no effect of auditory pitch was found in case of pointing movements (no grasp implied, Experiment 2), as well as when auditory pitch was irrelevant to the programming of the grip aperture, that is, in case of grasping an object of uniform size (Experiment 3). Finally, auditory pitch influenced also symbolic manual gestures expressing "small" and "large" concepts (Experiment 4). In sum, our results are novel in revealing the impact of auditory pitch on motor planning when size processing is required, and shed light on the role of auditory information in driving actions.