In recent years the video game industry has surpassed both the music and video industries in sales. Currently violent video games are among the most popular video games played by consumers, most specifically First-Person Shooters (FPS). Technological advancements in game play experience including the ability to play online has accounted for this increase in popularity. Previous research, utilising the General Aggression Model (GAM), has identified that violent video games increase levels of aggression. Little is known, however, as to the effect of playing a violent video game online.N = 101) were randomly assigned to one of four experimental conditions; neutral video game—offline, neutral video game—online, violent video game—offline and violent video game—online. Following this they completed questionnaires to assess their attitudes towards the game and engaged in a chilli sauce paradigm to measure behavioural aggression. The results identified that participants who played a violent video game exhibited more aggression than those who played a neutral video game. Furthermore, this main effect was not particularly pronounced when the game was played online.Participants (These findings suggest that both playing violent video games online and offline compared to playing neutral video games increases aggression. The video game industry is now the largest entertainment industry in the UK. 2011 industry figures have identified that game sales, including platform and digital, have exceeded both music and video sales Much of the research that has provided evidence to indicate the negative effects of violent video games has utilised the General Aggression Model (GAM) Carmageddon 2, increased levels of hostile emotion, aggressive thinking and aggressive behaviour. Sherry As noted above, violent content within violent video games has also been identified to increase levels of aggression. Within specific violent video games, progression through gaming levels achieved by engaging in violence poses an additional risk of increasing levels of aggression. Carnagey and Anderson Call of Duty, a military war game, has broken all previous sales records. Call of Duty: Modern Warfare 2, made $550 m (£350 m) in the first five days of sale. This was surpassed by Call of Duty: Black Ops and Call of Duty: Modern Warfare 3, which made $650 m (£412 m) and $775 m (£490 m) in sales respectively One of the most popular violent gaming formats to date is the First Person Shooter (FPS), in which the gamer experiences the action through the eyes of the main protagonist, centred on a projectile weapon. Reports indicate that a specific franchise, utilising the FPS format, Despite the popularity of the genre, to date, there is a lack of research that has attempted to investigate the effect of playing violent video games, specifically FPSs, online on levels of aggression.In the present research, we examined whether playing a FPS online would exacerbate the negative effects of violent video game play on aggression. Further to this we examined the effect of particular game experiences including perceived difficulty, enjoyment and action, previously identified to be associated with increases in aggressive thoughts Ethical approval was given by the University of Sussex's School of Life Sciences Research Governance Committee . All relevant data are within the paper and its Supporting Information files.M = 21.38, SD = 4.00) from a UK University participated in the study in exchange for course credits or payment. After being welcomed by the examiner all participants were asked to complete a consent form. Participants were randomly assigned to one of four experimental conditions; 26 participants in a neutral video game offline, 26 participants in a neutral video game online, 23 participants in a violent video game offline and 26 participants in a violent video game online. Participants were advised that they would be undertaking two unrelated marketing surveys that had been combined for the economy of time. The first would ask for their views about a popular video game and the second would involve a marketing survey for a new recipe of hot chilli sauce.Within this paper the authors report how we determined our sample size, all data exclusions (if any), all manipulations, and all measures in the study. One hundred and one students  depicted a more violent content and more violent graphics compared to the neutral video game LittleBigPlanet 2 , F = 146.97, p<.001, ηp2 = .60.The manipulation check identified that participants in the violent video game condition reported that the violent video game F = 8.63, p = .004, ηp2 = .08. Participants who had played the violent video game were more aggressive  than participants who had played the neutral video game . The main effect of setting, F = 0.35, p = .558, ηp2 = .00, and the interaction were not significant, F = 1.44, p = .234, ηp2 = .02.A 2  x 2 (setting: online vs. offline) analysis of variance (ANOVA) on the amount of chili sauce (aggression measure) revealed a significant main effect of type of video game, M = 16.81, SD = 16.57; contrast weight: 3) compared to participants who had played the violent video game offline , participants who had played the neutral video game online , and participants who had played the neutral video game offline , t(97) = 2.07, p = .041 (t(97) = 2.09, p = .039. Finally, the orthogonal contrast comparing the neutral video game online (contrast weight: 1) with the neutral video game offline (contrast weight: −1) condition was not significant, t(97) = 1.28, p = .202. This pattern of data suggests that both playing violent video games online and offline compared to playing neutral video games increases aggression.To test our specific prediction that aggressive behaviour, grams of chilli sauce dispensed by participants, would be particularly pronounced after playing a violent video game online, planned contrasts were performed, which are particularly adequate to answer such specific research questions p = .041 . Note, hM = 4.11, SD = 1.48) was perceived as being more difficult than the neutral game , F = 27.11, p<.001, ηp2 = .22. Participants also enjoyed the violent video game more  than the neutral game , F = 13.34, p<.001, ηp2 = .12. The violent video game  was also perceived as having faster action than the neutral video game , F = 46.06, p<.001, ηp2 = .32. Note, however, that in a multiple regression the effect of type of video game  was still significant when controlling for these video game ratings, β = .27, t(96) = 2.15, p = .034. Moreover, none of the video game ratings received a significant regression weight, all βs<.15, all ts<1.29, all ps>.202.The violent video game , contains a great deal of competitive content , whereas the neutral video game contains little to no competitive content. Importantly, previous research has demonstrated an effect of competitive video game content  on aggressive behavior in the short-term With the growing popularity and prevalence of online video gaming, more specifically the engagement with violent video games online, and evidence to suggest that playing against human opponents can heighten the gaming experience, we thought it an important endeavor to investigate whether violent video games played online would exacerbate any negative effects on aggression. As expected, online violent video game play relative to the three remaining experimental increased aggression. However, inasmuch as offline violent video game play relative to the neutral video game conditions also significantly increased aggression, we have to conclude that the violent video game affected aggression but that this effect was not further strengthened by playing the game online. Because this is the first study to have examined the effects of online violent video game play on aggression, we hasten to add that more research is needed before the conclusion is warranted that playing online vs. offline has no consequences on the player's social behavior. For instance, future research may address the effects of online violent video game play on behavioural aggression in the long term. Differences in perceived competition when playing video games online and offline should also be explored. Further to this, future research should investigate the properties of violent video games experienced online that impact on players' aggressive cognitions, affect, physiological arousal and behaviour.Consideration could also be given to potential positive effects of playing prosocial video games online. Previous research has shown that playing a prosocial video game (where the main objective of the game is to benefit video game characters) increases prosocial behaviour LittleBigPlanet 2 was selected for its low PEGI rating and ease of operating the controls (unrelated to game difficulty). It should also be conceded that the two online conditions differed in that participants competed against human opponents in the first-person shooter game, whereas the neutral video game allowed players to play competitively and cooperatively. This possible confound might have led to increased aggression in the online/violent (relative to the offline/violent) video game condition and decreased aggression in the online/neutral  video game condition . However, we did not find this interaction, but simply a main effect of type of video game. In fact, it is compelling that despite these differences in online/offline shooter games that they did not differ in their effect on aggression.It is important to acknowledge a limitation in regards to the video games selected in this study. The perspective of the FPS is specific, and the authors are unaware of a neutral video game that utilises the first person perspective. It may be possible, in the future, to identify a non-violent first person perspective video game and thus better match the characteristics of the violent and neutral video games. As a result, Further to this some concerns have been raised as to the suitability of the chilli sauce paradigm as an accurate measurement of behavioural aggression within the laboratory environment In conclusion this study has identified that increases in aggression are not more pronounced when playing a violent video game online in comparison to playing a neutral video game online. This is an important finding in relation to the growing online community and popularity of violent video games, specifically FPSs, and the potential for subsequent increases in aggression. We think there should be concern about the harmful effects of playing violent video games but it appears that playing the game online does not further exacerbate these effects.File S1SPSS data file.(SAV)Click here for additional data file.


While the widely studied allocentric spatial representation holds a special status in neuroscience research, its exact nature and neural underpinnings continue to be the topic of debate, particularly in humans. Here, based on a review of human behavioral research, we argue that allocentric representations do not provide the kind of map-like, metric representation one might expect based on past theoretical work. Instead, we suggest that almost all tasks used in past studies involve a combination of egocentric and allocentric representation, complicating both the investigation of the cognitive basis of an allocentric representation and the task of identifying a brain region specifically dedicated to it. Indeed, as we discuss in detail, past studies suggest numerous brain regions important to allocentric spatial memory in addition to the hippocampus, including parahippocampal, retrosplenial, and prefrontal cortices. We thus argue that although allocentric computations will often require the hippocampus, particularly those involving extracting details across temporally specific routes, the hippocampus is not necessary for all allocentric computations. We instead suggest that a non-aggregate network process involving multiple interacting brain areas, including hippocampus and extra-hippocampal areas such as parahippocampal, retrosplenial, prefrontal, and parietal cortices, better characterizes the neural basis of spatial representation during navigation. According to this model, an allocentric representation does not emerge from the computations of a single brain region  nor is it readily decomposable into additive computations performed by separate brain regions. Instead, an allocentric representation emerges from computations partially shared across numerous interacting brain regions. We discuss our non-aggregate network model in light of existing data and provide several key predictions for future experiments. Central to considering how we represent our spatial surrounding, Edward Subsequent research has often focused on one specific brain area in particular, the hippocampus, in housing the neural machinery underlying the cognitive map. While there is overall broad consensus regarding the involvement of the hippocampus in allocentric memory, there is significantly less consensus across both empirical and theoretical studies, particularly in humans, regarding the primary  role of the hippocampus to all forms of allocentric memory. Here, we will explore some reasons why pinning down a primary role for the human hippocampus in allocentric memory across studies has been challenging, including both the difficulty of identifying “process-pure” allocentric tasks and the fact that multiple brain regions contribute necessary functions to allocentric memory. We then attempt to define a network-based model of spatial navigation addressing some of these potential short-comings.Before we begin our discussion, it is helpful to define and clarify some of the basic assumptions and ideas we will be working with throughout. We use the term “navigation” as a proxy for the processing of a variety of different forms of information during self-movement that may lead to different cognitive strategies useful for ultimately finding our way to a given destination. This information is most often visual but also vestibular, proprioceptive, somatosensory, and auditory. Although humans have a bias toward using visual information, the others are often processed as well, and they may all contribute (either in a combined fashion or independently) to extracting information about the environment , the location of items, and our own location within it. While navigating, we become familiar with the environment and acquire knowledge about it, thereby extracting information from it and storing this information in our memory so that we can recall it later for a variety of purposes. The process of extracting information from our environment can be quite rapid, particularly if we can view useful features, like landmarks, by scanning the environment ; it can Figures 1A,B; see also The use of an allocentric representation will most often be pronounced at decisions points, and in particular, when we make judgments about the relative position of objects based on our memory of the location where they have previously been encountered. For example, when arriving at a landmark, or viewing it from a certain distance, we could remember that our destination is positioned between this landmark and another one, sitting about 2/3 of the way from the 2nd landmark and at a 30∘ angle from the first one. Such decisions on where things are in space with respect to one another and the actual location of the individual, however, do not necessarily depend on an allocentric representation. For example, we could also remember, based on our past experience, that our goal is present 50 and 30∘ to the right of our current position, which would be an egocentric form of spatial judgment .Another form of navigation sometimes taken as an example of allocentric representation is path integration . Path inFigure 1D, we illustrate an example of how short-cuts could potentially be solved using a primarily egocentric form of representation. The importance of landmarks to path integration, however, suggests it is not a purely egocentric strategy either. To be clear, employing short-cuts does not work necessarily at the exclusion of egocentric or allocentric representation; for the reasons outlined above, it cannot be considered a purely, or even primarily, allocentric or egocentric task, either.In practice though, at least in humans, path integration in environments without landmarks involves substantial errors  and evenA final issue we will mention here is an important point regarding the scale of navigational space considered in the task. As elegantly pointed out in a recent review by The above perspective necessitates an important question: to what extent might one observe a process “pure” allocentric task? It has been argued in some reviews that egocentric coding schemes dominate in most human spatial memory studies, such that the only cases in which one might observe an allocentric form of representation is based on the geometry of the room , 2002. IFigure 2A), either when blindfolded or with the targets removed. A subsequent study by Figure 2B). Thus, when asking participants to respond using the relative positions of objects within the environment, pointing accuracy actually improved. This double dissociation suggested that part of what may happen to disoriented participants is that when asked to rely on a task involving their current orientation (like the SOP task), they are unable to access any allocentric knowledge. In contrast, when solving a task like the JRD task, which explicitly asks participants to think in terms of spatial relationships of recently learned objects, they employ a more allocentric-based strategy . While the farthest end of this spectrum might involve a “pure” form of allocentric representation, there is currently no clear situation in which a participant might use an allocentric representation in the complete absence of any egocentric representation. A “pure” allocentric representation might be expected to be present, at least cognitively, when participants make judgments about the positions of landmarks relative to each other (without reference to self-position). Because this “pure” form of allocentric representation is hard to isolate experimentally, it remains difficult to validate.As pointed out in the above arguments and Figure 2D, “interacting model”). The crux of the model argues that egocentric representations are primarily housed in parietal cortex, representing information of one’s current viewpoint based on one’s current position and bearing , (2) brain damage is unlikely to selectively disable either form of representation because both are present in multiple brain systems, and (3) brain imaging will likely fail to identify one region clearly associated with either form of representation, or conversion process, instead showing that both forms of representation involve a mixture of brain areas. This argument is weakened, however, by the fact that lesion and neuroimaging studies suggest some distinct regions participate in tasks involving primarily egocentric vs. allocentric strategies, as we will explore in more detail shortly. The behavioral double dissociations reported by Waller and Hodgson and An important alternative we might consider here is the idea that there is no single egocentric or allocentric representation but instead that all forms of representation involve essentially a hybrid between the two . This coA final point, which we will consider in more detail shortly, is that even if we could identify a process-pure allocentric task, no single brain region serves as the primary neural underpinning for what manifests in behavior as use of an allocentric strategy. This argument is more complex and essentially involves the idea that (some) higher cognitive functions cannot readily be decomposed into the contributions of a single brain region. Thus, it might be that employing an allocentric strategy to solve a task, which we infer involves an allocentric representation, recruits a network of different brain regions, with no single process or brain region contributing a unique, separable process in the form of an allocentric representation. This account would still allow for the idea that lesions to brain “hubs” within this network would be disruptive to solving a task allocentrically but would not require that a single brain region is necessary for all forms of tasks involving an allocentric navigation strategy. We will explore this argument in more detail shortly.As we have argued so far, different tasks likely involve different mixtures of egocentric and allocentric representation. In fact, individuals may differ even in the extent to which they employ one form of representation over another while navigating . We beliWe have already discussed some of the possible limitations with considering the Morris Water Maze as the gold standard of allocentric representation, specifically relating to the fact that the task can be solved based on manipulating a single viewpoint . FurtherModifications to the Morris Water Maze paradigm also suggest situations in which allocentric memory may be preserved even at short delays. Evidence from humans also suggests that some forms of allocentric spatial memory can develop independently of the hippocampus, even at short delays. Numerous functional magnetic resonance imaging (fMRI) studies contrasting primarily allocentric with egocentric forms of navigation report parahippocampal cortex (PHC), rather than hippocampal, activation . For exaIndeed, lesions to the PHC appear to impair some forms of spatial navigation involving allocentric memory in situations in which hippocampal lesions do not. As we discussed above, PHC lesions, in many instances, disrupt the ability of patients to navigate to recently learned locations . Given oAdditional evidence supporting the role of PPA in spatial scene processing comes from an analysis technique termed multivariate voxel pattern analysis (MVPA). In this approach, patterns of voxels are used to predict the stimulus that a participant viewed  based on a prior set of similar stimuli they viewed . This approach consistently indicates that spatial scenes can be readily decoded from PPA and retrosplenial cortex, although less readily from the hippocampus . Thus, tRetrosplenial cortex also shows strong responses to spatial scenes and spatial features, as measured with the fMRI blood oxygen level-dependent (BOLD) signal . FurtherOne proposal to reconcile the conflicting findings on hippocampal vs. PHC/retrosplenial contributions to allocentric spatial memory is that hippocampal contributions may be most evident when spatial information must be held across different temporal intervals , a proceFigures 3A,B. The first perspective is that an allocentric representation depends primarily on a single brain region, with most past studies focusing on the hippocampus as this structure. This perspective, based in large part on considerations of MTL neuroanatomy, argues that the hippocampus sits at the top of a processing pyramid and thus plays the primary role in allocentric representation . The core of this idea is that no one brain region is specialized for allocentric representation and no one brain structure contributes a specific, separable “cognitive” component an allocentric representation. We note that this situation could occur if we think of an allocentric representation itself as not decomposable into elemental entities  functions and the other representing emergent  functions. Along with other attempts to explain cognitive processes in terms of complex systems theory , we propAlthough this is a new and emerging idea within the literature, and more evidence is needed to validate this perspective, we believe that the difficulties in pinning down a single brain region underlying allocentric representation, and its dynamic nature across tasks, supports this perspective. One early study supporting this perspective, although it did not use connectivity or network analyses specifically, was a study by Similarly, a study by The idea that multiple regions of the brain may interact during spatial representation, with no one area contributing exclusively to allocentric representation, offers a partial reconciliation for seemingly contrasting neuropsychological reports attempting to localize egocentric and allocentric representations to a specific brain region. Specifically, as argued in past reports, networks with similar connectivity and configurations as the brain [termed degenerate networks, see It is important that the development of new theoretical models generates directly testable predictions that are falsifiable. We believe that the network perspective, combined with multivariate analytical techniques such as graph theoretical analysis, allow numerous new predictions on the neurocognitive basis of allocentric representation. This may in turn allow some resolution of discrepant findings in past studies and make progress toward understanding such a complex phenomenon. Described below are what we believe to be the most directly applicable, given the large amount of behavioral, neuropsychological, and brain imaging data already available to researchers.per se, as recruitment of a representation type likely isn’t a binary process , but rather a question of the relative utility of egocentric and allocentric representations to solve spatial questions about an environment. Preserved allocentric processing may also occur through endogenous network reorganization that shifts the topological configuration of task active functional networks engaged during allocentric spatial tasks to utilize residual functional mechanisms.First, if an allocentric representation is indeed primarily dependent on the processing of a distributed network, rather than a single brain region, it is reasonable to assume that lesions affecting the dynamics of this network will impact a person’s ability to solve a spatial task using allocentric information. Although most lesion studies on allocentric representation focus on localized lesions to the hippocampus, as noted above, there is now considerable evidence suggesting both that non-hippocampal lesions can produce allocentric deficits . At the Thus, it is reasonable to predict, based on the idea that if network interactions support allocentric representation, conditions associated with the disruption of functional interactions between brain regions may result in deficits in allocentric processing. Recent support for this idea comes from a study on developmental topographical disorientation (DTD), a lifelong cognitive disorder characterized primarily by an inability to encode large scale environmental layouts . In the necessitates network interactions rather than the activity of a single brain region. This prediction shifts the explanatory emphasis from how a brain region produces a cognitive function toward its role within a network that ultimately results in the cognitive function under investigation. For example, as pointed out previously, if task demands involve integrating multiple locations across different temporal intervals to solve the task, this would likely necessitate the hippocampus. Other situations though, in which locations do not need to be integrated across time yet still involve some relational processing between landmarks, could rely more predominantly on other brain regions, such as PHC and retrosplenial cortex. It is therefore reasonable to speculate that the hippocampus is important for facilitating an exchange of information between regions within a distributed network that needs to be maintained over time intervals, rather than representing spatial information about landmarks per se. Indeed, recent findings demonstrating neurons that code for temporal intervals in the hippocampus  and as decomposable into contributions from individual brain regions . One might argue, as others have (Thus far, we have focused on behavioral, lesion, and fMRI studies, which argue against allocentric navigational strategies depending on a single brain region (ers have , howeverers have , are theers have , are seners have , and remers have . Indeed,ers have . Grid ceers have , may be ers have . Yet lesers have  and impaers have . While mers have , suggesters have . Thus, aWe began our discussion by pointing out some of the difficulties in pinning down the exact nature of the allocentric representation. In many situations in which one might expect a “pure” allocentric representation to predominate, such as reasoning about distances on a map or using short-cuts while navigating, egocentric representations bias how we utilize an allocentric representation. In fact, while we identified situations in which an allocentric representation might dominate, such as when participants make judgments involving relative distances or directions of objects to each other, egocentric representations still serve as important anchors and cues in solving these tasks. Even individuals may vary in the degree to which they utilize a primarily egocentric or allocentric strategy to solve a task, and even within individuals use of these strategies may vary during a task. Our inability to identify “process-pure” allocentric tasks suggested that it might also be difficult to unambiguously identify situations in which lesions to one brain region abolish allocentric memory. This appears to be particularly true in humans, in which multiple brain appear necessary for situations involving allocentric computations, including PHC, retrosplenial cortex, PFC, and hippocampus. The lack of one brain region as central to navigation involving allocentric computations suggested the possibility that this behavior might be better described as a network phenomenon. We discussed two different perspectives on this issue, both of which remain to be fully tested. One view, the additive model, argues that an allocentric representation emerges due to additive computations from individual brain regions. A different perspective, that we advocate here, is that an allocentric representation emerges from non-additive computations shared across multiple interacting brain regions. We concluded with several predictions related to spatial memory tasks that provide critical tests of the non-additive network model vs. the specialized perspective more frequently adopted in the literature.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


To analyze the epidemiological clinical profile of women with maternal near missaccording to the new World Health Organization criteria.A descriptive crosssectional study was conducted, in which the records of patientsadmitted to the obstetric intensive care unit of a tertiary hospital in Recife(Brazil) over a period of four years were analyzed. Women who presented at leastone near miss criterion were included. The variables studied were age, race/color,civil status, education, place of origin, number of pregnancies and prenatalconsultations, complications and procedures performed, mode of delivery,gestational age at delivery, and maternal near miss criteria. The descriptiveanalysis was performed using the program Epi-Info 3.5.1.Two hundred fifty-five cases of maternal near miss were identified, with anoverall ratio of maternal near miss of 12.8/1,000 live births. Among these cases,43.2% of the women had incomplete primary education, 44.7% were primiparous, and20.5% had undergone a previous cesarean section. Regarding specific diagnoses,there was a predominance of hypertensive disorders (62.7%), many of which werecomplicated by HELLP syndrome (41.2%). The laboratory near miss criteria were the most often observed(59.6%), due mainly to the high frequency of acute thrombocytopenia (32.5%).A high frequency of women who had a low level of education and who wereprimiparous was observed. According to the new criteria proposed by the WorldHealth Organization, hypertensive pregnancy disorders are still the most commonamong maternal near miss cases. The high frequency of HELLP syndrome was alsostriking, which contributed to acute thrombocytopenia being the most frequent nearmiss criterion. The incidence of maternal near misscases is higher than that of death, and these cases are currently considered a publichealth problem in Latin America. Itis estimated that for every maternal death, there are on average 15 cases of nearmiss.,4According to the World Health Organization (WHO), a woman who experiences a lifethreatening situation and survives during pregnancy or childbirth or within 42 days ofthe end of pregnancy corresponds to a case of maternal near miss.,6Near miss is a better indicator of maternal health service quality than death is becausenear miss provides information that helps elucidate the factors that contribute to afatal outcome; it is therefore used as a basis for the adoption of measures aimed atimproving maternal care. numerous criteria have been used tocharacterize it.-9 These criteria can be grouped as follows: clinicalcriteria related to a specific disease, criteria related to interventions or procedures,and criteria based on organ dysfunction. The maternal near miss ratio , when considering criteria based on signs and symptoms, is 27.8/1,000LBs, higher than that based on organ dysfunction (10.2) or treatment (2.1) criteria,such as transfusion, intubation, surgery, or hemodialysis. In contrast, there is a greater tendency towardmortality when organ dysfunction criteria are adopted, with one case of maternal deathfor every six near miss cases. When signs and symptoms are used as the definingcriteria, there is one case of death for every 35 cases of near miss.Since the introduction of the near miss concept in 1991 by Stones et al., The adoption of the WHO laboratory and treatmentcriteria to identify maternal near miss cases is a valid and effective method, as wasconcluded in a pre-validation study. That study also provided support for the recommendation to use suchparameters throughout the world.Given the heterogeneity of maternal near miss criteria and the necessity ofstandardizing them, in 2009, the WHO established new defining criteria , which t A secondary analysisof data from a Brazilian demographic health survey, conducted in 2006 and 2007 andinvolving the five Brazilian geographical regions, showed that women over 40 years ofage and with less than eight years of education are at a significantly higher risk ofbecoming a maternal near miss case. By contrast, no association was found between civil status, race,income, place of residence, or parity. These surveys were, however, conducted before maternal near misscriteria were defined by the WHO, and some of the criteria used therefore differed fromthose used currently.,12Regarding the clinical and epidemiological profiles of women with maternal near miss,being over 35 years of age, being without a partner, primiparity, or having had a priorcesarean section (CS) are factors that have an independent association with theoccurrence of maternal near miss. This was the conclusion of a multi-center study,published in 2010, that included 120 hospitals in eight countries across LatinAmerica.,13Given the high frequency of maternal near miss cases, its use as an indicator ofmaternal health, and the emergence of new defining criteria, this article aims todescribe, according to the new WHO criteria, the clinical and epidemiological profile ofpatients with maternal near miss admitted to an intensive care unit (ICU) of a tertiaryreferral hospital in Recife, Brazil.Instituto de Medicina Integral Professor FernandoFigueira (IMIP) according to the principles governing research on humanbeings, Resolution 196/96 of the National Health Council , under number 2028-10 on November 19, 2010. Considering alsothat the study was retrospective and evaluated only data collected from medical records,the REC was asked to grant a waiver of the informed consent form.This study was conducted after approval by the Research Ethics Committee (REC) of theThe study was conducted at the IMIP, a charity located in Recife ,which has an obstetric ICU with 12 beds exclusively for pregnant women and high-riskmothers and an annual hospitalization figure of close to 800 patients.This investigation was a cross-sectional study that, based on the IMIP Obstetric ICUadmissions and discharge records, identified 2,997 patients who were hospitalized duringthe pregnancy-childbirth cycle between January 2007 and December 2010. These patients’records were requested from the hospital archives, and after analysis, those having atleast one WHO-defined maternal near miss criterion were included in the study , totalinFaculdade Pernambucana deSaúde) Course in Medicine, linked to the Institutional Program forScientific Scholarships .Data were collected by the principal investigator and two trained research assistantsfrom the Pernambuco School of Health (The studied variables were age (expressed in complete years); race ; civil status ; education (categorized as less than eight years of education or as eight ormore years of education); place of origin ; reproductivehistory ;preexisting conditions; prenatal care; diagnoses during hospitalization ; length of hospital stay; gestational age at delivery; delivery mode; andWHO maternal near miss criteria types.Regarding the definition of maternal near miss criteria, those recommended by the WHOwere adopted . All datIn total, 255 cases of maternal near miss were identified among the patients admitted tothe IMIP obstetric ICU. During the study period, there were 19,940 LBs, yielding amaternal near miss ratio of 12.8/1,000 LBs. The length of hospital stay ranged from fiveto 86 days, averaging 14.8 ± 10.27.The age of the participants was between 14 and 45 years, with a mean of 25.6 ±6.99 years. Furthermore, 57.3% were mixed race, 64.3% had partners, 43.2% had less thaneight years of education, and only 18.8% were from Recife .With respect to obstetric history, 44.7% of patients were primiparous, 18.8% had ahistory of abortion, and 20.5% had a history of previous CS . The maiThe main disorders presented by the study participants were hypertension (62.7%),hemorrhage (53.7%), infections (49%), heart disease (4.7%), and thromboembolism (2.4%).Among the 160 cases of hypertensive disorders, 108 (42.3%) were severe pre-eclampsia, 35(13.7%) were eclampsia, and 17 (6.7%) were chronic hypertension exacerbated bypregnancy. One hundred five (41.2%) participants had HELLP syndrome.The most common infectious disorder was endometritis (25.1%), followed by pneumonia(19.6%) and sepsis, which occurred in 16.9% of patients. Regarding bleeding disorders,there were 90 (35.3%) cases of postpartum hemorrhage, 29 (11.4%) cases of placentalabruption, and four cases of placental accreta. There were also cases of uterine rupture(three) and placenta previa (one). Other complications or procedures performed on theparticipants were acute pulmonary edema (13.7%), blood transfusions (65.1%), centralvenous catheterization (18.8%), laparotomy (14.5%), and tracheostomy (2.4%).Laboratory near miss criteria were present in 59.6% of participants, while clinical andtreatment criteria occurred in 50.2% and 49% of cases, respectively . Most paThe main maternal near miss clinical criteria included shock (17.6%), a respiratory rateexceeding 40 breaths per minute (bpm) (16.5%), and loss of consciousness for 12 hours ormore (13.7%). The main laboratory criteria were platelet count below 50,000 (32.5%),creatinine above 3.5mg/dL (16.1%), and oxygen saturation lower than 90% for more than 60minutes (10.6%). The most prevalent treatment criteria were tracheal intubation (23.5%),hysterectomy (20%), and transfusion of five or more units of packed red blood cells(19.2%) . Clinica In this study, these indicators were 18%and 4.5:1, respectively, with 56 maternal deaths among the patients admitted to the IMIPobstetric ICU during the study period.The indicators proposed by the WHO to monitor the quality of obstetric care are themortality index  and the maternal near miss/maternalmortality rate .,14,15 In a Brazilian demographic health survey of more than 5,000 womenconducted in 2006 that adopted the Mantel and Waterstone criteria, this ratio was21.1/1,000 LBs, above that found in our study, which was 12.8/1,000 LBs. This difference is due in part to thedifferent criteria used. With thestandardization of maternal near miss criteria proposed by the WHO, this wide variationcan be reduced, thus allowing more reliable comparisons. In two other Brazilian studies that adopted the new WHOclassification, the ratio was 9.35 and 13.5/1,000 LBs, which was close to the resultfound in our study.,16 Notably, in calculating the maternal near miss rate,the WHO recommends using LBs as the denominator and not the number of births, asreported in previous studies.The incidence of maternal near miss described in the literature varies widely, from 0.7to 101.7 cases per 1,000 births.,12,16 In this study, the percentage of patients over 35 yearsof age (11.8%), without partners (18.8%), and primiparous (44.7%) was similar to thatfound in a multicenter study of nearly 3,000 cases . The same studyalso identified an independent and positive association between these three factors andthe occurrence of near miss.Some studies characterize maternal near miss as a problem of women at more advancedages, who are single and primiparous. In the presentstudy, the frequency of women with less than eight years of education (43.2%) wasslightly lower than that found in that study (54.5%). It therefore appears that there is a genuine trendtoward a greater association of near miss among older, single, primiparous, and poorlyeducated women.In another database-based retrospective Brazilian study, which included more than 5,000women from the five regions of the country, the risk of maternal near miss was nearlytwice as high among women who were over 40 years of age and had a low level ofeducation. This finding most likely reflects the precariousness of care inthese locations and highlights the need for improvements, which may be achieved byorganizing regional care and decentralizing prenatal and high-risk delivery care, aswell as providing these regions with equipment, laboratory tests, drugs, and specializedprofessionals.Although an association between maternal near miss and place of residence was notdemonstrated, our study draws attention to the high percentage of women frommunicipalities in the interior of the state. This finding demonstrates the expansionof prenatal care and suggests an improvement in reaching the population. However, itsuggests a low quality of these services because, although the majority of women hadaccess to prenatal consultations, almost half of them suffered near miss. Researchingonly the number of consultations might have been inadequate when evaluating prenatalcare; other variables such as the timing of the onset of prenatal care, the number oftests performed, and proper completion of pre-natal records, may be used in thefuture.The percentage of patients who did not receive prenatal care was low-lower than thatfound in a retrospective study conducted in Recife in 2007 (9.7%).,18 Some authors consider CS a factor that increases theodds of a woman becoming a case of near miss by up to five times; however, thisassociation may be affected by confounding factors.,20 Whether CS is a riskfactor for near miss, or whether it is actually a consequence of this condition, isstill therefore unclear.,20 Another multicenter study alsopostulates that high rates of CS may be acceptable among such patients, due to theurgency in resolving the pregnancy and unfavorable cervical or fetalconditions.In a retrospective and observational study in Italy with more than 1,200 cases ofmaternal near miss and another study by the WHO that was cross-sectional andmulticentric with nearly 3,000 cases, CS was the main delivery mode, with a frequency of70% and 59.5%, respectively. This is similar to the findings of the present study(76.4%). In our study, CS in a previous pregnancy was 20.5%, very closeto that found in a WHO survey (18.2%), which showed an independent and positiveassociation between previous CS and the occurrence of near miss .By contrast, CS cause repercussions in a subsequent pregnancy and is recognized as anindependent risk factor in maternal morbidity.,17,19 However, this finding differs from those in studiesconducted in developed countries, in which hemorrhage is ranked first.,22 The main cause of maternal death in Brazil is also hypertensivedisorders, which indicates the seriousness of these situations and their contribution tothe morbidity and mortality of women in pregnancy and childbirth.Severe preeclampsia was the main diagnosis associated with near miss, coinciding withthe findings of other Brazilian studies.,24 This finding may be explained by the numerous riskfactors for postpartum hemorrhage presented by patients with near miss, such aspreeclampsia, CS, and intrauterine infection, among others.,26Bleeding disorders are the second most common complication among cases of near miss, andthe procedure most often performed is blood transfusion (65.1%). These findings aresimilar to those of a Dutch study (66.2%) and a study conducted in Recife(66.2%). Although this diseaseis not one of the most frequent complications, many studies consider it to have a highermortality rate (7.4%), surpassing hemorrhagic (2.8%) and hypertensive (0.4%)disorders.,29Sepsis occurred in 16.9% of patients, but in another Brazilian study, this result was23.7%. In our study, mechanical ventilation was required in less thanone-quarter of cases. This finding may be attributed to local differences inaccessibility to resources and interventions, and is one of the drawbacks of criteria based only on treatmentbecause they require a more complex hospital and laboratory structure.Regarding near miss criteria, the most frequent were laboratory criteria, followed byclinical and treatment criteria. In a five-year retrospective study of 194 near misscases  that adopted only laboratory and treatmentcriteria, the most common were treatment criteria, with almost half of the near misspatients requiring mechanical ventilation (49.6%). The platelet count is an inexpensive and accessibletest and can be requested for the early identification of such cases.Among all the maternal near miss criteria, the most prevalent was acutethrombocytopenia, possibly due to the high frequency of HELLP syndrome. Acutethrombocytopenia is known to increase the risk of maternal death, and a delay in itsrecognition may expose women to life-threatening conditions.Studies with larger samples are necessary for possible comparisons. One advantage ofthese criteria is that they do not require a highly complex laboratory or hospitalstructure and can be applied in low-complexity hospital units. Notably, in a validationstudy of WHO criteria to define maternal near miss, clinical criteria were not tested,and only treatment and laboratory criteria were validated. The same investigation also indicates a need forspecific studies to validate clinical criteria.The main clinical maternal near miss criteria observed were shock, respiratory rateexceeding 40bpm, and loss of consciousness for 12 hours or more. These characteristicsdiffer from those observed by Morse, who found that oliguria, shock, and coagulationdisorder were the most frequent.Premature delivery occurred in more than half of the study participants. This high rateof prematurity, also observed in a study conducted in Campinas (65%), may be explainedby the severe conditions experienced by these patients, which can compromise the fetusand in most cases require immediate resolution. The mortality rate and proportion of near miss cases andmaternal deaths were high in this study. There was one maternal death for every 4.5cases of maternal near miss, indicating that many women with life-threatening conditionsdie; therefore, improvements to care during pregnancy, childbirth or the postpartumperiod are still necessary. Toachieve this goal, it is important to study women who were near death but survived andto study maternal near miss.,30The use of indicators that facilitate comparisons between services, countries, and timemay be associated with the study of maternal near miss.Study limitations include the fact that a prospective follow-up of patients, which mighthave yielded more information and decreased losses, did not occur. In addition, the factthat the data were collected from medical records did not allow some near miss criteria to beidentified. However, the study design allowed the inclusion of a reasonable number ofnear miss cases, a subject of public health interest, directly linked to the reductionof maternal deaths.This study helped to identify and characterize the population of women admitted to theobstetric ICU of the IMIP who experienced maternal near miss, which is a first step inhelping to identify the factors related to these life-threatening situations.Multicenter studies involving a greater number of cases and adopting the criteriaestablished by the WHO for maternal near miss can go further and lead to the developmentof preventive measures.This study showed that, among patients with maternal near miss, there is a highfrequency of women who have a low level of education, who are primiparous, and who havehad a previous cesarean section. The present investigation also determined that the mostfrequent near miss criteria were of the laboratory type and that there was a highprevalence of premature births among these women. In addition, with the adoption of thenew World Health Organization maternal near miss criteria, our study revealed thathypertensive pregnancy disorder is still the most frequent diagnosis among suchcases.


Binge drinking is a widespread alcohol-consumption pattern in youth and is linked to cognitive consequences, mostly for executive functions. However, other crucial factors remain less explored in binge drinking and notably the emotional-automatic processes. Dual-process model postulates that addictive disorders are not only due to impaired reflective system (involved in deliberate behaviors), but rather to an imbalance between under-activated reflective system and over-activated affective-automatic one (involved in impulsive behaviors). This proposal has been confirmed in alcohol-dependence, but has not been tested in binge drinking. The observation of comparable impairments in binge drinking and alcohol-dependence led to the “continuum hypothesis,” suggesting similar deficits across different alcohol-related disorders. In this perspective, applying the dual-process model to binge drinking might renew the understanding of this continuum hypothesis. A three-axes research agenda will be proposed, exploring: (1) the affective-automatic system in binge drinking; (2) the systems’ interactions and imbalance in binge drinking; (3) the evolution of this imbalance in the transition between binge drinking and alcohol-dependence. Alcohol abuse and dependence constitute a central public health concern  leading to the persistence of maladjusted behaviors despite their long-term negative consequences. Following the dual-process view, recent models The affective-automatic system in binge drinking: as state above, the affective correlates of binge drinking remain nearly unexplored. A first part of this axis will thus be to offer a precise exploration of the automatic system over-activation, by proposing a multi-evaluation using various validated tasks  to assess the impairments presented by binge drinkers as compared to non-drinkers. A second part will be to explore the emotional system in binge drinking. Indeed, future studies should test whether these processes are already impaired in adolescents and young adults binge drinkers by means of a comprehensive exploration ranging from basic emotional abilities  to complex affective skills  and interpersonal aptitudes . As emotional impairments have been found to play a crucial role in the development and maintenance of alcohol-dependence, understanding the early alterations of this affective system and its implications in the first stages of alcohol-dependence is required.(2)The interactions between systems and their imbalance in binge drinking: the main proposal of the dual-process model is that addictions result from an imbalance between reflective and affective-automatic systems. This proposal remains to be confirmed in binge drinking. It has been shown that the combination of hypo-activated reflective system and hyper-activated affective-automatic one might favor the development of excessive alcohol consumption in adolescence The evolution of this imbalance across the successive stages of alcohol-dependence: while several studies have supported the continuum hypothesis by showing that binge drinkers display similar impairments than alcohol-dependent individuals regarding cognitive and emotional abilities, but also at the cerebral level (Maurage et al., The application of dual-process model in alcohol-dependence led to an in-depth renewal of this field, but its validity has not been explored in binge drinking. Indeed, several theoretical models of binge drinking have been proposed (e.g., Oei and Morawska, To conclude, our proposal is that an in-depth exploration of the dual-process model in binge drinking might totally renew this model by adding a developmental perspective, leading to strong implications. At the theoretical level, it would notably renew the continuum hypothesis by extending it toward affective-automatic system’s deficits and systems’ interactions. At the clinical level, it might lead to the creation of prophylactic rehabilitation programs proposing early interventions to re-equilibrate the balance between reflective and affective-automatic systems at early stages of excessive alcohol consumption.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


An unusual case of campylobacter pouchitis resembling the endoscopic appearance of Crohn's disease is reported.  Proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the preferred treatment for medically refractory ulcerative colitis (UC), UC-associated dysplasia or malignancy, and familial adenomatous polyposis. Postoperative complications of IPAA include pouchitis, Crohn's disease of the pouch, cuffitis, and irritable pouch syndrome , 2. Pouc Clostridium difficile PCR, ova and parasites, giardia stool antigen, and cryptosporidium stool antigen were all negative. He subsequently underwent pouchoscopy, which demonstrated an endoscopic pattern resembling Crohn's disease in the pouch and distal ileum with severe inflammation, marked friability, and deep ulcerations within the pouch and prepouch ileum  mass spectrometry. At this point, the patient's stool frequency had improved to 7 bowel movements per day and he had defervesced on piperacillin-tazobactam. He was discharged on Azithromycin 500 mg by mouth daily for a total of 10 days to treat severe Campylobacter coli pouchitis. On follow-up 4 months later a pouchoscopy showed normal mucosa in the pouch and prepouch ileum (Figures On hospital day 4, a stool culture was positive for campylobacter and subsequently further characterized as Figures  and he c Campylobacter species typically present with symptoms of fever followed by abdominal pain, dehydration, and diarrhea and occasionally display endoscopic features that mimic Crohn's disease. Cases of campylobacter enterocolitis causing transmural inflammation resulting in small intestinal obstruction and toxic megacolon in patients without inflammatory bowel disease have been described [Campylobacter is an uncommon cause of pouchitis , but thiescribed , 7. Two escribed . In this


What are the diagnostic features of congenital pouch colon (CPC)?2. What associated anomalies are seen with congenital pouch colon?3. What are various surgical options in the emergency management of congenital pouch colon?4. What specific post-colostomy complications are seen with congenital pouch colon?5. Describe histological features of congenital pouch colon.6. How does early management differ in female neonates with congenital pouch colon?7. What short and long term postoperative care is necessary in children with CPC?8. What are delayed complications after reconstruction for CPC?1. A male patient with CPC often have a wide colovesical fistula and present with anorectal malformation and meconuria; on plain abdominal film, a single large bowel loop occupying more than 50% of the abdominal cavity is also a diagnostic sign. Girls (persistent cloaca/vestibular fistula/anteriorly placed anus etc.) often present late with intractable constipation or multiple episodes of enterocolitis and persistent abdominal distension with common cloaca or anterior ectopic anus/ rectovestibular fistula. The congenital pouch colon can be identified as replacement of a part or entire colon in the configuration of pouch that lacks taenia coli, haustrations, appendices epiploicae, abnormal blood supply and a wide fistula with genitourinary system in a patient of anorectal malformation [1].2. CPC is often associated with a number of genitourinary and gastrointestinal anomalies nevertheless other system’s anomalies are also reported. Bilateral/unilateral hydroureteronephrosis, renal hypoplasia, vesicoureteric reflux, sacral agenesis, prune belly syndrome, megalourethra, genitourinary tract duplication, hypoplastic bladder, ectopic ureter/kidneys, pseudo-exstrophy bladder, bowel diverticulum, peritoneal bands, absent appendix, rudimentary appendix, duplex appendix, esophageal atresia, cardiac malformations, bicornuate uterus, double uterus, septate vagina, double vagina, hypospadias, abnormalities of vasculature of colon .3. Various options that can be opted while dealing a patient of CPC are ileostomy with and without pouch excision (type I and II), colostomy with and without pouch excision (type III and IV), window colostomy in the pouch, tapering of pouch with proximal diversion, tapering and pull through with and without proximal diversion, and pouch excision and pull through with and without proximal diversion etc .4. The complications associated with ileostomy in CPC are excoriation, bleeding; electrolyte imbalance, malnutrition, dehydration, vitamin deficiency. The complications associated with window colostomy are prolapse, stenosis, fecal retention, urinary tract infection, pouch dilatation, pouchitis, enterocolitis, persistent abdominal distension, massive mucosal prolapse, para-colostomy hernia and evisceration etc. Boys with CPC often have a wide fistula with urinary tract. Metabolic acidosis and failure to thrive is also seen secondary to reflux of urine in bowel and absorption [1]. 5. In most of patients CPC on histopathology shows thinning of muscle layers, outer as well as inner; disorganized muscle layers with normal ganglionosis; however in few cases hypoganglionosis, aganglionosis, neuronal hypoplasia, or presence of heterotopic mucosa can be seen. Such changes have led to some surgeons advocating complete excision of the pouch in all patients with CPC [1].6. In female neonates with anorectal malformation and CPC, the initial management is largely a stoma formation and deferring the definitive procedure to infancy or early childhood as they are often associated with genitourinary anomalies and not only CPC but the associated anomalies have to be addressed .7. Short term postoperative care for CPC involves taking care of perineal excoriations, keeping the stool soft, and preventing stenosis of neo-anus with regular dilatation program. Long term post-operative care of CPC involves intensive bowel management, bowel training, stool softeners, diet modification. These children also require monitoring of their urinary tract, upper and lower for early detection and management of neurogenic bladder, vesicoureteric reflux and other urinary problems. A small number of patients may fail to develop continence and may require Antegrade Enema Procedures. As these patients may not have an appendix and their colons may be too short, catheterizable passage has to create from small bowel. Multivitamins and other nutritional management have to be added for proper growth of the patients .8. Common complications of any anorectal reconstruction such as anal stenosis, mucosal prolapse, encopresis, chronic dilatation of retained pouch, chronic fecal retention, retention with overflow and fecal soiling. Dilatation of pouch and fecal overload may cause secondary changes in ureters, kidneys and bladder. Psychosocial problems in patients due to multiple surgical procedures and hospitalization, and encopresis [1].Source of Support: NilConflict of Interest: None declared


Imitation is an important form of social behavior, and research has aimed to discover and explain the neural and kinematic aspects of imitation. However, much of this research has featured single participants imitating in response to pre-recorded video stimuli. This is in spite of findings that show reduced neural activation to video vs. real life movement stimuli, particularly in the motor cortex. We investigated the degree to which video stimuli may affect the imitation process using a novel motion tracking paradigm with high spatial and temporal resolution. We recorded 14 positions on the hands, arms, and heads of two individuals in an imitation experiment. One individual freely moved within given parameters  and a second participant imitated. This task was performed with either simple  or complex  movement difficulty, and either face-to-face or via a live video projection. After an exploratory analysis, three dependent variables were chosen for examination: 3D grip position, joint angles in the arm, and grip aperture. A cross-correlation and multivariate analysis revealed that object-directed imitation task accuracy (as represented by grip position) was reduced in video compared to face-to-face feedback, and in complex compared to simple difficulty. This was most prevalent in the left-right and forward-back motions, relevant to the imitator sitting face-to-face with the actor or with a live projected video of the same actor. The results suggest that for tasks which require object-directed imitation, video stimuli may not be an ecologically valid way to present task materials. However, no similar effects were found in the joint angle and grip aperture variables, suggesting that there are limits to the influence of video stimuli on imitation. The implications of these results are discussed with regards to previous findings, and with suggestions for future experimentation. To effectively imitate, visual information about an action must be combined or compared with a representation of the movements necessary to complete the action . This is particularly worth consideration when much of the research into imitation has used video stimuli presented to a group of solitary observers. There are discrete differences between direct observation of a scene, and observing the same scene reconstructed on a 2D surface . For example, information from binocular disparity in a 3D scene is lost when presented in 2D. The treatment of 2D and 3D stimuli by the visual system varies wildly  were recruited from the University of Reading and the surrounding area. The experimental procedures were approved by the local ethics committee ; participants gave written, informed consent; and the experiments were conducted in accordance with the Declaration of Helsinki. Each experiment required two participants, who took turns to perform as both actor and imitator.https://code.google.com/p/prok-liberty/). We used LabMan and the HandLabToolbox to document and control experiments and analyze data. The associated repositories are freely available at https://github.com/TheHandLaboratory, whilst raw data are available from the Hand Laboratory's website (http://neurobiography.info) and/or on request.The position of participants' heads, right arms and right hands were recorded continuously using a wired Polhemus Liberty  240 Hz, 14 channel (7 per participant) motion tracking system with 6 degrees of freedom . Trackers were attached to the shoulder , elbow (olecranon), wrist (pisiform), thumb (tip), index finger (tip), little finger (tip), and central forehead. Tracking points were attached using adhesive medical tape or Velcro™. The experiment was controlled and data were acquired using custom software written in MATLAB 2014b  and using the ProkLiberty interface  with a recording resolution of 1080p  and frame rate of approximately 30 FPS, to provide a live recording of the actor. A mirror was placed in front of the actor, angled at 70° to be visible by the camera which was positioned overlooking the actor's shoulder  and feedback condition . The task difficulty condition was used in order to test whether any effects of feedback condition depended on the complexity of the imitated actions—it was of interest to test whether more complex tasks would be more greatly affected by video feedback. The simple and complex conditions were tested once for each of the video or face-to-face conditions. Each participant played the role of both actor and imitator, meaning that each individual took part in a total of 2 sessions —one as an actor and one as an imitator, to account for two repetitions of the crossed condition design. Whilst using a single individual as the actor may have reduced variability between participants, we wanted to maintain a more naturalistic task with naïve participants, rather than a potentially biased confederate. Each crossed condition lasted 250 s and consisted of ten 20 s trials with 5 s rest gaps between. The dependent variables were the 6 degrees of freedom across 14 motion tracking points.In each testing period, the two participants were assigned to either the role of actor or imitator, which were then reversed once 1 session (4 crossed conditions) was complete. Each testing session included a face-to-face and video feedback condition, and the order in which they occurred was randomized and counterbalanced . Both participants played both roles in order to maximize the data collected and ensure a balanced design. The simple difficulty conditions were always performed first in each feedback condition. This was done in place of a practice trial, in order to cut down testing time and maintain participant motivation and accuracy. Since we predicted that the simple task would be more accurately imitated anyway, we did not believe that this confound would be heavily altered by practice effects. The simple condition ensured that in each of the feedback conditions, the actor and imitator were quickly introduced to the constraints and demands of the task. Note that the main variable studied here is the feedback condition—face-to-face vs. video—the order of which was fully counterbalanced. A live video feed was used in the video feedback condition primarily to cut down on experimentation time, but also to reduce the variability between the feedback conditions to just the effects of video feedback.In the face-to-face condition, participants sat opposite each other at either end of the table. The imitation boards were placed on the ends of the table in front of each participant who sat approximately 150 mm away. Both participants started with their right index finger and thumb gripping the starting point at the near right hand side of the board. The three balls were randomly distributed across the pegs on the actor's game board at the start of each condition, and the imitator's game board was matched to this. The actor was requested to move balls across the board in two different conditions, whilst the imitator copied the actions in an anatomical fashion , as accurately as possible. Anatomical imitation was used to maintain a more naturalistic imitation task. This is akin to what may happen when one right-handed individual teaches another right-handed individual to perform a motor task, rather than in instances of spontaneous imitation where a mirrored response is more likely to be used by the observer  − y(sin 13)) and y (y = y(cos 13) + x(sin 13)) axes in order to correct for the angled game board.Five pre-processing steps were performed in order to clean the data. First, single time-point spikes (>3 SD from the mean) in each variable's double-differentiated time-series  were deemed electromagnetic artifacts and removed by interpolation across two adjacent samples either side. Second, the position data were filtered using a bidirectional low-pass 4th order Butterworth filter (cutoff frequency 15 Hz). Third, the position data for the actor in the video condition were rotated by 13° clockwise in the x  was measured over 25 discrete tests , resulting in a mean ± SD latency of 111 ± 25 ms.Finally, since data collection was continuous during the entire length of the condition (including rests) and actors often finished their 10 movements before the end of the (20 s) trial time, the lengths of each trial were calculated independent of the total trial time. This was done by defining correct trials  as >100 mm movement of the index finger away from the start point for any period >5 s. This ensured that false starts were excluded from the analysis, and trial onsets were timed to the actors' movements. These variable trial times were also applied to each actor's associated imitator's data, since imitators were requested to begin movement at the same time as the actor.Prior to full data processing, an exploratory analysis of one half of the data (3 pairs of participants) was performed. This was deemed necessary due to the novel methods developed in this experiment, as well as the potential for false positives with such a large dataset and so many dependent variables. We hoped that it would reveal any consistent effects across degrees of freedom, and direct our choice of final analysis parameters based on this. Each crossed condition (task difficulty × feedback condition) yielded 42 dependent variables for each participant : 7 motion trackers × 6 degrees of freedom .r-value between each actor dependent variable and each imitator dependent variable was generated, along with the lag associated with that maximal r-value . The lag at maximum r represents the difference (in time) between the actor and imitator datasets at the point at which the maximum r-value was found. These results were averaged across the 10 action trials per participant and then across the 6 participants to generate the surface plots in Figures A cross-correlation was performed on each of the crossed conditions over each of the 10 (variable length—see data pre-processing) trials. This was done by shifting the imitator's data relative to the actor's sample by sample over lags of −5 to +5 s, and correlating the two time-series for each lag (−1200 to +1200 samples). For each of these 10 trials, an absolute maximum r-value and the lag associated with it varied widely across dependent variables. The most consistently highly correlated values were the corresponding trackers in their corresponding degrees of freedom. This was emphasized by the highly correlated diagonal contours in the surface map of r-values in Figure r-value plots seemed to suggest that it may be better correlated than the video condition; however it was hard to gauge any large differences between correlations in the difficulty conditions. The surface plots in Figure r-value was, surprisingly, lower in the complex vs. the simple conditions. It also appeared that the video conditions may have had slightly lower lags than the face-to-face conditions, though this was less clear.The surface plots suggested that absolute maximum Based on the exploratory analysis it was decided that an analysis of the entire dataset (12 participants) would benefit from parameters that capture the greatest movement information in the fewest dependent variables. As such, we decided to focus on three elements of the task: joint angles in the arm, grip aperture, and grip position, each of which were calculated for actor and imitator. This analysis was performed on all 12 participants' data. Joint angles of the arm were selected because the angles of all the joints in any given effector across time provide a general representation of the whole movement. Thus, by examining the joint angles between the trunk, shoulder, elbow and wrist, it was possible to develop a reasonably accurate measure of the entire arm movement. This would enable us to compare kinematic, rather than goal outcome accuracy of the imitator.1 and q2) are shown in Figure SO starting at the shoulder, S and ending at the origin, O was determined by subtracting the z dimension position value of the elbow from the z dimension position value of the shoulder. By using this vector along with the elbow-shoulder vector ES, a right angle triangle was formed. Angle q1 was calculated as the angle between vectors ES and SOEO between the elbow and origin was created in the x and y dimensions. In the x and y dimension a second right angle triangle was created using the vector EO and a second vector calculated by subtracting the y dimension position of the elbow from the y dimension position of the shoulder. q2 was calculated as the angle between EO and this second vector 3 .The two angles between the shoulder and the body in the x and y dimensions  failure to return their hand to the starting point. The means of the r-values and lags across trials was calculated to provide 7 DVs  for each participant across the two experimental conditions. For each of these new DVs mean r-values between participants across the 10 trials per crossed condition were converted to Z-values using the Fisher transformation r-values.These three new DVs were cross-correlated in an identical manner to the exploratory analysis, resulting in absolute maximum Z-values and lags at absolute maximum r-value, for joint angles (q1–q3) and grip position . A Two-Way repeated measures ANOVA was run on the Z-values and lags at absolute maximum r-value for the grip aperture values. The MANOVAs and ANOVA compared the mean Z-value and mean lag of the 10 trials between the feedback and difficulty conditions across all 12 experiments (24 sessions). The results of the MANOVAs are given in Tables Repeated measures MANOVAs were run on the  angles q–q3 and gZ-values  = 9.41, p = 0.011, partial η2 = 0.461] and y  grip positions showed a significant effect of feedback, with the face-to-face condition more highly correlated than the video condition , providing some support in favor of our hypothesis. The mean Z-values for x were equivalent to r-values of 0.889 for face-to-face feedback and 0.845 for video feedback. For y the equivalent r-values were 0.907 for face-to-face feedback and 0.878 for video feedback. Both the x  and y  grip positions showed significant effects of task difficulty, with the simple condition more highly correlated than the complex . The mean Z-values for x were equivalent to r-values of 0.887 for simple task difficulty and 0.848 for complex task difficulty. For y the equivalent r-values were 0.913 for simple task difficulty and 0.870 for complex task difficulty. These two significant univariate effects also resulted in a significant multivariate effect in multivariate grip position for task difficulty, F = 7.32, p = 0.009, partial η2 = 0.709. The mean Z-values for this multivariate variable were equivalent to r-values of 0.856 for simple task difficulty and 0.811 for complex task difficulty.The MANOVA on es Table , measuri2, F = 5.57, p = 0.038, partial η2 = 0.336, with the video condition showing a longer delay than the face-to-face (mean ± SE difference = 0.302 ± 0.128 s). The multivariate grip position was significant for task difficulty, F = 3.95, p = 0.047, partial η2 = 0.586, with the complex condition significantly more delayed than the simple (mean ± SE difference = 0.155 ± 0.053 s). The y grip position also showed a significant effect of task difficulty, F = 10.7, p = 0.007, partial η2 = 0.494, with the complex condition significantly slower than the simple (mean ± SE difference = 0.178 ± 0.054 s). Finally, there was a significant interaction between task difficulty and feedback in the x grip position, F = 5.93, p = 0.033, partial η2 = 0.350, where simple conditions showed longer imitation lags than complex when observed face-to-face (mean ± SE difference = 0.031 ± 0.087 s), but imitation in the complex conditions was later than the simple when observed via video (mean ± SE difference = 0.268 ± 0.087 s).The lag MANOVA Table  revealedWe examined the effects of face-to-face vs. video feedback on imitation in a transitive imitation task, hypothesizing that video feedback would result in less accurate imitation and that a simpler task would result in more accurate imitation than a complex one. After running an exploratory analysis, we chose to perform a more focused statistical analysis on grip position, joint angles in the arm, and grip aperture.Z-value) analysis, only the grip position variables revealed significant effects of feedback and task complexity. Grip position can be taken as a general measure of accuracy in our imitation task, since it measures the position of the object effectors (index finger and thumb) from the starting point, across the movement of the balls, and then the return of the hand to the starting point. The significant differences suggested that video feedback reduced the accuracy of transitive imitated actions for left-right (x) and forward-back (y) dimensions of motion, but not for up-down (z). This supports our hypothesis that video feedback would be less highly correlated than face-to-face observation. Imitators were worse at completing the imitation task when required to view the actor through a live video feed. The source of this effect is most likely the difference in visual information provided by the video and face-to-face feedback conditions, but it is also possible that increased motivation driven by the ecological validity of the face-to-face condition is responsible , but failing to imitate the broader motion of the actor's arm. This is likely due to our use of a transitive task, and may lend credence to claims that transitive imitation is primarily goal-directed, and that it is the object of the goal that is imitated, rather than the associated body movements . However, the up-down effects were in the same direction as other dimensions Figure , suggest2—the rotation of the upper arm about the shoulder—where imitation was significantly later in the video than face-to-face condition. This may be related to the reach-to-grasp action, and the difference in lag between face-to-face and video conditions may reflect a delayed approach toward the balls by the imitator. This could again be related to the ecological validity or motivation in the video condition. The significant multivariate effect for grip position suggests that overall, imitators acted later to accurately imitate the ball movements in the complex condition. The same effect was also shown in univariate analysis for the forward-back movements, meaning that they were imitated more slowly in complex tasks, potentially reflecting a greater use of this dimension in complex tasks . Movement of grip position left-right showed a significant interaction. Whilst the effect of the video condition was in the predicted direction, the difference in the face-to-face condition for left-right movement may be due to a better level of prediction by the imitators for complex rather than simple conditions in this direction, though it is unclear why this would be the case.The results of the lag analysis were less consistent than the correlation analysis. The most interesting result was for joint angle qThe differences between face-to-face and video observation may partly be due to the ±25 ms SD in the video projection latency. This temporal jitter surprised us, and was not controlled for in our experiment or analysis. This variable is also likely not controlled in previous research using pre-recorded video stimuli, such that researchers cannot be sure of a constant level of visual quality in their stimuli. Varying visual quality at any one time in a video could alter participant responses in a way that is not consistent with the variable being measured. We believe that researchers would benefit from providing this measure of standard deviation, or some other measure of temporal precision of video stimuli.Some aspects of our experimental approach may have limited the reliability and validity of our results. Allowing actors to move in any way they chose, rather than in 10 consecutive movements, may have resulted in data more indicative of real life transitive motor activity. However, we felt it was important to maintain some element of control over the way in which participants moved for a number of reasons. By providing a relatively fixed way in which the actor was required to move, it ensured that their actions had a specific aim. As mentioned above, intention is potentially important in action observation  research using joint angle kinematics , may not be affected by the use of video stimuli. Future research should aim to develop new methods of examining imitation that are less reliant on video stimuli, and more closely adhere to the idea of imitation as a method of social communication. This would ensure the development of a more complete understanding of human imitation.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


The advancement in wideband wireless network supports real time services such as IPTV and live video streaming. However, because of the sharing nature of the wireless medium, efficient resource allocation has been studied to achieve a high level of acceptability and proliferation of wireless multimedia. Scalable video coding (SVC) with adaptive modulation and coding (AMC) provides an excellent solution for wireless video streaming. By assigning different modulation and coding schemes (MCSs) to video layers, SVC can provide good video quality to users in good channel conditions and also basic video quality to users in bad channel conditions. For optimal resource allocation, a key issue in applying SVC in the wireless multicast service is how to assign MCSs and the time resources to each SVC layer in the heterogeneous channel condition. We formulate this problem with integer linear programming (ILP) and provide numerical results to show the performance under 802.16 m environment. The result shows that our methodology enhances the overall system throughput compared to an existing algorithm. Rapid advancement in mobile wideband wireless network  supports real time services such as IPTV and live video streaming. Nevertheless, efficient resource allocation is required to satisfy delay requirements and to overcome the bandwidth shortage due to the increased number of users. Because of the sharing nature of the wireless medium, the wireless multicast has attracted much attention when multiple users want to receive the same video service at the same time .Multicast service in wireless heterogeneous networks can adaptively choose a certain modulation and coding scheme (MCS)  based onTo alleviate the video performance degradation caused by the user who has the worst channel status, scalable video coding (SVC)  with adaA key issue arising under this setting is how each layer selects its MCS under the constraint of available radio resources for multicast services. A lot of research has studied the resource allocation problem in wireless multicast streaming video services –10. In pReference  formulatTo overcome these problems, we analyze PSNR models of various SVC encoding methods and choose a utility function to accommodate all the PSNR models. We also formulate a model which varies the slot size based on each MCS and utilize integer linear programming (ILP) to obtain the optimal solution.The rest of the paper is organized as follows. The background and system architecture are discussed in Scalable video coding compresses a raw video sequence into a base layer and one or multiple enhancement layers. The base layer provides video data whose resolution is low, while the higher layers refine the video generated by the lower layer. SVC can provide adaptive video quality in wireless networks, but its performance is poor in terms of video quality compared to single-layer coding. Recently, SVC has improved its coding efficiency. For example, the newly established MPEG-4 SVC provides equal visual quality comparable with H.264/AVC (single-layer coding) but with at most 10% higher bit rate.The quality of video can be measured using PSNR, which is a nondecreasing function of the received video data –15. The In infrastructure-based wireless networks, we consider the video multicast. A video server is equipped in the layered video codec to encode the video into multiple layers as illustrated in Scheduling  in a wireless network MAC is done once for every scheduling frame period whose length is identical to the length of the video frame in our system. A scheduling frame consists of multiple time slots. The size of a time slot is the minimum time required to transmit a packet with a MCS. It means that the maximum number of available slot sizes is equal to the number of MCSs.We consider the heterogeneous wireless networks, and so the users who experience relatively bad channel status can select a relatively high rate that leads to the considerable packet loss. In our system, each user measures its SNR and finds which MCS indicates the maximum data rate that satisfies target BER (bit error ratio) to decode the received data. An AP or base station assigns the radio resource and MCSs to layers to maximize the sum of utilities of all users to find the optimal solution.J users, and F is the size of a scheduling frame period, which is equal to that of video frame period. We assume a set of possible MCSs M = {1,…, M} . High MCS m means a high data rate. If a user can decode the data provided by MCS m by satisfying a target BER, it can also decode the data that is less than MCS m. Mj ∈ M is the maximum MCS, which can be received by user j based on the channel status. User j transfers its MCS Mj ∈ m to its AP (base station). tm is the time slot size given by MCS m. We consider a single multicast session which has L layers. Each layer is divided into many slices, which is also split into the packets of fixed-size. Nl is the number of packets of layer l.We consider the one-hop broadcasting in wireless networks for the problem formulation. There are j can decode a packet if it is transmitted by MCS m′ ≤ Mj. As illustrated in Now, we explain a utility function and the related variables. As aforementioned, the satisfaction of the users is proportional to the quality of multimedia defined as PSNR, which is a function of the received throughput. We assume that there is no packet loss in the wireless channel. That is, user δl which does not increase the video quality in a layer. Let αl,m be the number of received packets which have zero utilities in layer l. The utility function increases linearly when the packets in a layer l are received from the threshold δl to the number of packets Nl of layer l′. Let βl,m be the number of received packets which increases the utility linearly. Denote yl,m as the indicator function that is 1 if layer l is transmitted by ∀m′ ≤ m and 0 otherwise:zl,m as the indicator function that is 1 if all the received packets βl,m are modulated by ∀m′ ≤ m and 0 otherwise:zl,0 = 0 because βl,0 = 0. Hence, with these indicator variables, we utilize the approximated PSNR model as the utility function of the user j given asϕl is the PSNR weight of the packets which increases the utility of layer l linearly. φl is the PSNR weight of the complete reception of layer l. rmtmϕlβl,m in  in  has 1 only if m = m′, otherwise zero.As we can see in given asUj=∑l=1 Lgiven asUj=∑l=1 Lδl = 0, the first scheme can be formulated. If we set δl = 0 and φl = 0, the third scheme can be formulated. If we set φl = Nl, the final scheme can be formulated.Three other methods of the utility function can be easily derived as follows. If we set In this paper, we formulate an ILP problem to assign modulation and coding scheme for each layer in terms of the sum of utilities under any given resource constraints. That is, we have to find outstraints , and 4)(5)α=[α1,l − 1 is transmitted using modulation m′, the packets that have zero utility in layer l use m, and then it must be m ≥ m′. That is, the following condition should be satisfied:zl,m,  that all users have to access the base layer and (2) the time resource required to fit the base layer will diminish with increasing modulation.Nevertheless, since  and 2)  2) have We develop the remaining works to change conditions  and 2)  2) as ILi ∈ {0,1,…, I}, ci ∈ {0, N+}, if binary random variable xi ∈ {0,1} has the following condition:Ai and Bi are the elements of a constant vector and D is a constant and is always larger than ∑i=1IAiBici, conditional equation xi shouluations, . Using Luations,  are chanyl,m should be satisfied byThis can be easily proved by zl,m should be satisfied byThis is can be easily proved by The ILP problem to maximize the sum of utilities of all users in the wireless multicast service streaming can be formulated asstraints , 7), astraints , 10), arstraints , and (15O(JL + LM2F/tM). O(JL) is the complexity which is precalculated to find out the highest MCS to each node. O(LM2F/tM) is the complexity to solve α and β for all 1 ≤ l ≤ L, 1 ≤ m ≤ M, and 1 ≤ m ≤ M. F/tM is the maximum number of slots and tM is the minimum size of a slot. The complexity of the proposed method is pseudopolynomial due to the factor related to the time resource and the number of nodes. Since the complexity is linearly proportional to the number of nodes, the network size does not deteriorate the performance in the proposed methods. Therefore, the complexity of the proposed method is acceptable.In the worst case, since our method utilizes the same domain as the existing method  to find In this section, we present the numerical results for our proposed solution. We consider one base station with 14 mobile users distributed in the circular area from base station. The test is based on the 802.16 m evaluation methodology document .  Table ϕl = {1,0.95,0.9,…, 0.65} and φl = {10,10,…, 10} for l = {1,…, 8} based on [In order to analyze the features of our solution, we consider a single video session. Each video session has a fixed layer rate of 800 kb/s, and the number of layers in each session is 8. This is based on the standard of the SVC extension  of H.264based on .We compare our solution with the fixed-slot solution which was solved by dynamic algorithm , as the m = 2) with more slots than those provided by the fixed-slot solution even though both provide the transmission of all the layers.In this paper, we considered and studied the resource allocation problem in SVC video multicast with AMC in wireless networks. First, we assume that all packets have equal length to consider the real video transmission environments. It is also assumed that each MCS has different slot length, which is the minimum time length required to transmit a packet with the corresponding MCS. We formulated a utility function as a piecewise function for ILP modeling using the existing results , 13. Fin