Spontaneous rates exhibit high intra-individual stability across movements involving different biomechanical systems and cognitive demands.

Spontaneous rhythmic movements are part of everyday life, e.g., in walking, clapping or music making. Humans perform such spontaneous motor actions at different rates that reflect specific biomechanical constraints of the effector system in use. However, there is some evidence for intra-individual consistency of specific spontaneous rates arguably resulting from common underlying processes. Additionally, individual and contextual factors such as musicianship and circadian rhythms have been suggested to influence spontaneous rates. This study investigated the relative contributions of these factors and provides a comprehensive picture of rates among different spontaneous motor behaviors, i.e., melody production, walking, clapping, tapping with and without sound production, the latter measured online before and in the lab. Participants (n = 60) exhibited high intra-individual stability across tasks. Task-related influences included faster tempi for spontaneous production rates of music and wider ranges of spontaneous motor tempi (SMT) and clapping rates compared to walking and music making rates. Moreover, musicians exhibited slower spontaneous rates across tasks, yet we found no influence of time of day on SMT as measured online in pre-lab sessions. Tapping behavior was similar in pre-lab and in-lab sessions, validating the use of online SMT assessments. Together, the prominent role of individual factors and high stability across domains support the idea that different spontaneous motor behaviors are influenced by common underlying processes.

When direction matters: Neural correlates of interlimb coordination of rhythm and beat.

In a previous experiment, we found evidence for a bodily hierarchy governing interlimb coordination of rhythm and beat, using five effectors: 1) Left foot, 2) Right foot, 3) Left hand, 4) Right hand and 5) Voice. The hierarchy implies that, during simultaneous rhythm and beat performance and using combinations of two of these effectors, executing the task by performing the rhythm with an effector that has a higher number than the beat effector is significantly easier than vice versa. To investigate the neural underpinnings of this proposed bodily hierarchy, we here scanned 46 professional musicians using fMRI as they performed a rhythmic pattern with one effector while keeping the beat with another. The conditions combined the voice and the right hand (V + RH), the right hand and the left hand (RH + LH), and the left hand and the right foot (LH + RF). Each effector combination was performed with and against the bodily hierarchy. Going against the bodily hierarchy increased tapping errors significantly and also increased activity in key brain areas functionally associated with top-down sensorimotor control and bottom-up feedback processing, such as the cerebellum and SMA. Conversely, going with the bodily hierarchy engaged areas functionally associated with the default mode network and regions involved in emotion processing. Theories of general brain function that hold prediction as a key principle, propose that action and perception are governed by the brain's attempt to minimise prediction error at different levels in the brain. Following this viewpoint, our results indicate that going against the hierarchy induces stronger prediction errors, while going with the hierarchy allows for a higher degree of automatization. Our results also support the notion of a bodily hierarchy in motor control that prioritizes certain conductive and supportive tapping roles in specific effector combinations.

Burnout and Its Consequences among Vascular Surgeons and Trainees: A Danish National Survey.

BACKGROUND: Burnout among physicians has widespread negative consequences. Little is known about burnout among European vascular surgeons (VS). A previously published study found that 82% of VS and vascular surgical trainees (VST) in Denmark experience burnout symptoms. The present study aimed to investigate work- and health-related consequences of burnout. STUDY DESIGN: An electronic survey was distributed to all VS/VST in Denmark in January 2020. Validated assessment tools were used to measure burnout, mental health, and psychosocial work environment aspects. RESULTS: Of 104 invited VS/VST, 82% (n = 85) completed the survey. VS accounted for 72% (n = 61) of the respondents, and 40% (n = 33) were female. Statistically significant associations were found between higher levels of burnout and a range of work- and health-related outcomes, including a sense of meaning at work, workplace commitment, conflicts between work and private life, work stress, sick leave, and depressive symptoms. VS/VST using pain medication daily or weekly had significantly higher burnout scores than respondents who rarely or never use pain medication. A significant association between burnout and job satisfaction and retention was found, with respondents indicating an intention to stay within the specialty having significantly lower burnout scores than those who considered leaving within 5 years. Among those who indicated leaving the specialty, 35% (n = 13) attributed this to their current working conditions. CONCLUSIONS: Burnout among VS/VST in Denmark is negatively associated with various work- and health-related outcomes. The work environment seems to play an essential role in these associations, and alterations in workplace organization may remedy this situation.

Musicians show more integrated neural processing of contextually relevant acoustic features.

Little is known about expertise-related plasticity of neural mechanisms for auditory feature integration. Here, we contrast two diverging hypotheses that musical expertise is associated with more independent or more integrated predictive processing of acoustic features relevant to melody perception. Mismatch negativity (MMNm) was recorded with magnetoencephalography (MEG) from 25 musicians and 25 non-musicians, exposed to interleaved blocks of a complex, melody-like multi-feature paradigm and a simple, oddball control paradigm. In addition to single deviants differing in frequency (F), intensity (I), or perceived location (L), double and triple deviants were included reflecting all possible feature combinations (FI, IL, LF, FIL). Following previous work, early neural processing overlap was approximated in terms of MMNm additivity by comparing empirical MMNms obtained with double and triple deviants to modeled MMNms corresponding to summed constituent single-deviant MMNms. Significantly greater subadditivity was found in musicians compared to non-musicians, specifically for frequency-related deviants in complex, melody-like stimuli. Despite using identical sounds, expertise effects were absent from the simple oddball paradigm. This novel finding supports the integrated processing hypothesis whereby musicians recruit overlapping neural resources facilitating more integrative representations of contextually relevant stimuli such as frequency (perceived as pitch) during melody perception. More generally, these specialized refinements in predictive processing may enable experts to optimally capitalize upon complex, domain-relevant, acoustic cues.

Coordination of voice, hands and feet in rhythm and beat performance.

Interlimb coordination is critical to the successful performance of simple activities in everyday life and it depends on precisely timed perception-action coupling. This is particularly true in music-making, where performers often use body-movements to keep the beat while playing more complex rhythmic patterns. In the current study, we used a musical rhythmic paradigm of simultaneous rhythm/beat performance to examine how interlimb coordination between voice, hands and feet is influenced by the inherent figure-ground relationship between rhythm and beat. Sixty right-handed participants-professional musicians, amateur musicians and non-musicians-performed three short rhythmic patterns while keeping the underlying beat, using 12 different combinations of voice, hands and feet. Results revealed a bodily hierarchy with five levels (1) left foot, (2) right foot, (3) left hand, (4) right hand, (5) voice, i.e., more precise task execution was observed when the rhythm was performed with an effector occupying a higher level in the hierarchy than the effector keeping the beat. The notion of a bodily hierarchy implies that the role assigned to the different effectors is key to successful interlimb coordination: the performance level of a specific effector combination differs considerably, depending on which effector holds the supporting role of the beat and which effector holds the conducting role of the rhythm. Although performance generally increased with expertise, the evidence of the hierarchy was consistent in all three expertise groups. The effects of expertise further highlight how perception influences action. We discuss the possibility that musicians' more robust metrical prediction models make it easier for musicians to attenuate prediction errors than non-musicians. Overall, the study suggests a comprehensive bodily hierarchy, showing how interlimb coordination is influenced by hierarchical principles in both perception and action.

A cross-sectional national study of burnout and psychosocial work environment in vascular surgery in Denmark.

OBJECTIVE: Little is known about burnout among European vascular surgeons (VSs). In this study, the prevalence of burnout and its associated risk factors were investigated among all VSs and vascular surgeons in training (VSTs) in Denmark. METHODS: An anonymous electronic survey was distributed to all clinical active VSs and VSTs on January 1, 2020. Validated assessment tools were used to measure burnout and aspects of the psychosocial work environment. RESULTS: A total of 104 VSs and VSTs were invited to participate, and 82% (n = 85) completed the survey. The majority of the respondents were male (60%; n = 50) and VSs (67%; n = 61). Of the respondents, 82% (n = 70) reported either light (54%; n = 46), moderate (22%; n = 19), or severe (6%; n = 5) personal burnout. More than 50% (n = 47) reported work-related burnout, light (39%; n = 33), moderate (9%; n = 8), and severe (7%; n = 6), respectively, whereas 35% (n = 30) reported patient-related burnout, light (31%; n = 26), moderate (2%; n = 2), and severe (2%; n = 2), respectively. Respondents with more than four 24-hour on-call shifts per month had significantly higher work-related burnout scores, whereas respondents with home-living children and those aged 45 to 59 years showed significantly higher personal and patient-related burnout, respectively. There were strong associations between personal and work-related burnout and the psychosocial work environment, especially work organization and interpersonal relations, but not job demands. The prevalence of burnout was unevenly distributed across departments, with the most affected department having a burnout occurrence twice the least affected department. CONCLUSIONS: Based on a national survey conducted among all clinical active VSs and VSTs in Denmark, more than 80% (n = 70) suffered from burnout, of whom 28% (n = 24) suffered from moderate to severe personal burnout. The strong association with the psychosocial work environment, and the significant differences between departments, suggest that burnout is modifiable through changes in the work environment.

Beat perception in polyrhythms: Time is structured in binary units.

In everyday life, we group and subdivide time to understand the sensory environment surrounding us. Organizing time in units, such as diurnal rhythms, phrases, and beat patterns, is fundamental to behavior, speech, and music. When listening to music, our perceptual system extracts and nests rhythmic regularities to create a hierarchical metrical structure that enables us to predict the timing of the next events. Foot tapping and head bobbing to musical rhythms are observable evidence of this process. In the special case of polyrhythms, at least two metrical structures compete to become the reference for these temporal regularities, rendering several possible beats with which we can synchronize our movements. While there is general agreement that tempo, pitch, and loudness influence beat perception in polyrhythms, we focused on the yet neglected influence of beat subdivisions, i.e., the least common denominator of a polyrhythm ratio. In three online experiments, 300 participants listened to a range of polyrhythms and tapped their index fingers in time with the perceived beat. The polyrhythms consisted of two simultaneously presented isochronous pulse trains with different ratios (2:3, 2:5, 3:4, 3:5, 4:5, 5:6) and different tempi. For ratios 2:3 and 3:4, we additionally manipulated the pitch of the pulse trains. Results showed a highly robust influence of subdivision grouping on beat perception. This was manifested as a propensity towards beats that are subdivided into two or four equally spaced units, as opposed to beats with three or more complex groupings of subdivisions. Additionally, lower pitched pulse trains were more often perceived as the beat. Our findings suggest that subdivisions, not beats, are the basic unit of beat perception, and that the principle underlying the binary grouping of subdivisions reflects a propensity towards simplicity. This preference for simple grouping is widely applicable to human perception and cognition of time.

Audiovisual structural connectivity in musicians and non-musicians: a cortical thickness and diffusion tensor imaging study.

Our sensory systems provide complementary information about the multimodal objects and events that are the target of perception in everyday life. Professional musicians' specialization in the auditory domain is reflected in the morphology of their brains, which has distinctive characteristics, particularly in areas related to auditory and audio-motor activity. Here, we combined diffusion tensor imaging (DTI) with a behavioral measure of visually induced gain in pitch discrimination, and we used measures of cortical thickness (CT) correlations to assess how auditory specialization and musical expertise are reflected in the structural architecture of white and grey matter relevant to audiovisual processing. Across all participants (n = 45), we found a correlation (p < 0.001) between reliance on visual cues in pitch discrimination and the fractional anisotropy (FA) in the left inferior fronto-occipital fasciculus (IFOF), a structure connecting visual and auditory brain areas. Group analyses also revealed greater cortical thickness correlation between visual and auditory areas in non-musicians (n = 28) compared to musicians (n = 17), possibly reflecting musicians' auditory specialization (FDR < 10%). Our results corroborate and expand current knowledge of functional specialization with a specific focus on audition, and highlight the fact that perception is essentially multimodal while uni-sensory processing is a specialized task.

Red blood cell transfusion associated with increased morbidity and mortality in patients undergoing elective open abdominal aortic aneurysm repair.

BACKGROUND: Red blood cell (RBC) transfusions are associated with increased mortality and morbidity. The aim of this analysis was to examine the association between RBC transfusions and long-term survival for patients undergoing elective open infrarenal abdominal aortic aneurysm (AAA) repair with up to 15 years of follow-up. METHODS: Prospective cohort study using data from The Danish Vascular Registry from 2000-2015. Primary endpoint was all-cause mortality. Secondary endpoints were in-hospital complications. Transfused patients were divided into subgroups based on received RBC transfusions (1, 2-3, 4-5 or > 5). Using Cox regression multi-adjusted analysis, non-transfused patients were compared to transfused patients (1, 2-3, 4-5, >5 transfusions) for both primary and secondary endpoints. RESULTS: There were 3 876 patients included with a mean survival of 9.1 years. There were 801 patients who did not receive transfusions. Overall 30-day mortality was 3.1% (121 patients) and 3.6% (112) for all transfused patients. For the five subgroups 30-day mortality was: No transfusions 1.1% (9 patients), 1 RBC 1.2% (4 patients), 2-3 RBC 2.2% (26 patients), 4-5 RBC 1.9% (14 patients) and > 5 RBC 7.9% (68 patients). After receiving RBCs, the hazard ratio for death was 1.54 (95% CI 1.27-1.85) compared to non-transfused patients. There was a significant increase in mortality when receiving 2-3 RBC: HR 1.32 (95% CI 1.07-1.62), 4-5 RBC: 1.64 (1.32-2.03) and >5 RBC: 1.96 (1.27-1.85) in a multi-adjusted model. CONCLUSION: There is a dose-dependent association between RBC transfusions received during elective AAA repair and an increase in short- and long-term mortality. Approximately 25% of included patients had preoperative anemia. These findings should raise awareness regarding potentially unnecessary and harmful RBC transfusions.

Quality assessment of Ki67 staining using cell line proliferation index and stain intensity features.

Breast cancer is the most frequent cancer among women worldwide. Ki67 can be used as an immunohistochemical pseudo marker for cell proliferation to determine how aggressive the cancer is and thereby the treatment of the patient. No standard Ki67 staining protocol exists, resulting in inter-laboratory stain variability. Therefore, it is important to determine the quality control of a staining protocol to ensure correct diagnosis and treatment of patients. Currently, quality control is performed by the organization NordiQC that use an expert panel-based qualitative assessment system. However, no objective method exists to determine the quality of a staining protocol. In this study, we propose an algorithm, to objectively assess staining quality from segmented cell nuclei structures extracted from cell lines. The cell nuclei were classified into either Ki67 positive or negative to determine the Ki67 proliferation index within the cell lines. A Ki67 stain quality model based on ordinal logistic regression was developed to determine the quality of a staining protocol from features extracted from the segmented cell nuclei in the cell lines. The algorithm was able to segment and classify Ki67 positive cell nuclei with a sensitivity and positive predictive value (PPV) of 0.90 and 0.94 and Ki67 negative cell nuclei with a sensitivity and PPV of 0.78 and 0.78. The mean difference between a manual and automatic Ki67 proliferation index was -0.003 with a standard deviation of 0.056. The ordinal logistic regression model found that the stain intensity for both the Ki67 positive and Ki67 negative cell nuclei were statistically significant as parameters determining the stain quality from the cell line cores. The framework shows great promise for using cell nuclei information from cell lines to predict the staining quality of staining protocols. © 2018 International Society for Advancement of Cytometry.

Correction to: Visually induced gains in pitch discrimination: Linking audio-visual processing with auditory abilities.

During copy-editing, the y-axes of Fig. 2 (top) and Fig. 3 (top) were erroneously labelled mean BCG (d') in the version of the paper published as Online First. The correct label is meanCE (d').

Visually induced gains in pitch discrimination: Linking audio-visual processing with auditory abilities.

Perception is fundamentally a multisensory experience. The principle of inverse effectiveness (PoIE) states how the multisensory gain is maximal when responses to the unisensory constituents of the stimuli are weak. It is one of the basic principles underlying multisensory processing of spatiotemporally corresponding crossmodal stimuli that are well established at behavioral as well as neural levels. It is not yet clear, however, how modality-specific stimulus features influence discrimination of subtle changes in a crossmodally corresponding feature belonging to another modality. Here, we tested the hypothesis that reliance on visual cues to pitch discrimination follow the PoIE at the interindividual level (i.e., varies with varying levels of auditory-only pitch discrimination abilities). Using an oddball pitch discrimination task, we measured the effect of varying visually perceived vertical position in participants exhibiting a wide range of pitch discrimination abilities (i.e., musicians and nonmusicians). Visual cues significantly enhanced pitch discrimination as measured by the sensitivity index d', and more so in the crossmodally congruent than incongruent condition. The magnitude of gain caused by compatible visual cues was associated with individual pitch discrimination thresholds, as predicted by the PoIE. This was not the case for the magnitude of the congruence effect, which was unrelated to individual pitch discrimination thresholds, indicating that the pitch-height association is robust to variations in auditory skills. Our findings shed light on individual differences in multisensory processing by suggesting that relevant multisensory information that crucially aids some perceivers' performance may be of less importance to others, depending on their unisensory abilities.

Accurate Measurement of Airway Morphology on Chest CT Images.

In recent years, the ability to accurately measuring and analyzing the morphology of small pulmonary structures on chest CT images, such as airways, is becoming of great interest in the scientific community. As an example, in COPD the smaller conducting airways are the primary site of increased resistance in COPD, while small changes in airway segments can identify early stages of bronchiectasis. To date, different methods have been proposed to measure airway wall thickness and airway lumen, but traditional algorithms are often limited due to resolution and artifacts in the CT image. In this work, we propose a Convolutional Neural Regressor (CNR) to perform cross-sectional measurements of airways, considering wall thickness and airway lumen at once. To train the networks, we developed a generative synthetic model of airways that we refined using a Simulated and Unsupervised Generative Adversarial Network (SimGAN). We evaluated the proposed method by first computing the relative error on a dataset of synthetic images refined with SimGAN, in comparison with other methods. Then, due to the high complexity to create an in-vivo ground-truth, we performed a validation on an airway phantom constructed to have airways of different sizes. Finally, we carried out an indirect validation analyzing the correlation between the percentage of the predicted forced expiratory volume in one second (FEV1%) and the value of the Pi10 parameter. As shown by the results, the proposed approach paves the way for the use of CNNs to precisely and accurately measure small lung airways with high accuracy.

[Danish emergency departments are not staffed by consultants 24/7]. / Speciallægen er ikke i front på de danske akutafdelinger.

The Danish health care system is undergoing a major reorganisation, resulting in fewer emergency departments (ED) with consultants in attendance 24/7. This questionnaire-based study evaluates the status of the reorganisation with emphasis on physician attendance and recruitment. 76% of the EDs are not staffed by consultants 24/7, 51% report difficulties in recruiting qualified personnel and 33% report problems connected to retaining them. 71% believe that a specialty in emergency medicine could help solve these problems. Danish EDs do not comply with the visions of the reorganisation plan.