Resilin is an elastomeric protein typically occurring in exoskeletons of arthropods. It is composed of randomly orientated coiled polypeptide chains that are covalently cross-linked together at regular intervals by the two unusual amino acids dityrosine and trityrosine forming a stable network with a high degree of flexibility and mobility. As a result of its molecular prerequisites, resilin features exceptional rubber-like properties including a relatively low stiffness, a rather pronounced long-range deformability and a nearly perfect elastic recovery. Within the exoskeleton structures, resilin commonly forms composites together with other proteins and/or chitin fibres. In the last decades, numerous exoskeleton structures with large proportions of resilin and various resilin functions have been described. Today, resilin is known to be responsible for the generation of deformability and flexibility in membrane and joint systems, the storage of elastic energy in jumping and catapulting systems, the enhancement of adaptability to uneven surfaces in attachment and prey catching systems, the reduction of fatigue and damage in reproductive, folding and feeding systems and the sealing of wounds in a traumatic reproductive system. In addition, resilin is present in many compound eye lenses and is suggested to be a very suitable material for optical elements because of its transparency and amorphousness. The evolution of this remarkable functional diversity can be assumed to have only been possible because resilin exhibits a unique combination of different outstanding properties. Schistocerca gregaria) , Aeshna [Elastomeric proteins occur in a large range of organisms and biological structures, and the spectrum of their biological functions is very broad . They fe, Aeshna . Additio, Aeshna –4 result, Aeshna . Resilin, Aeshna . Within , Aeshna –8. Such , Aeshna .The mechanical properties of resilin strongly depend on the degree of hydration because resilin is plasticised by water . When re44Until today, resilin has been found to exist mainly in insect exoskeleton structures where this protein has a number of different functions, which include (1) the storage of elastic energy in jumping systems –20, (2) The properties of resilin-containing exoskeletons can strongly differ between structures and organisms. The reason is that in biological structures resilin seems to be rarely present in pure or nearly pure form but is known to commonly exist together with other proteins and/or chitin fibres in resilin-containing composites, which exhibit a mixture of the properties of the single components. In such composites, the resilin properties can even be ‘overlain’ by the properties of the other components making an identification of the presence of resilin in the respective structures with the criteria of Andersen and Weis-Fogh  very difIn order to allow a classification of exoskeleton structures as resilin-containing exoskeleton according to the definition of Andersen and Weis-Fogh , these sDrosophila melanogaster pro-resilin (rec1-resilin) was developed and has been shown to be cross-reactive and to label resilin in different insects [13The described resilin identification and visualization methods are not absolutely specific. Therefore, it is strongly advisable to apply not only one single method but a combination of several different ones to increase the reliability of the identification and detection of resilin. In recent years, an antibody to a recombinant  insects –1341–42.The development and improvement of methods applying techniques such as micromechanical testing, atomic force microscopy and confocal laser scanning microscopy (CLSM) have facilitated detailed studies of the distribution, composition and mechanical properties of resilin-containing exoskeleton structures in diverse organisms and at different levels of their organisation. One of these methods utilises a combination of different autofluorescences. In addition to resilin, other arthropod exoskeleton materials also exhibit autofluorescences, which can be efficiently visualized with fluorescence microscopy. This allows the production of overlays consisting of different micrographs that show different autofluorescences. Such overlays nicely exhibit differences in the autofluorescence composition, which are good indications for differences in the material composition and clearly reveal structures with relatively large resilin proportions within the analysed specimens ,23,43. HIf the autofluorescences are visualized by means of CLSM, the results will be very detailed and precise . With a Very often, gradients of the material composition with a considerably changing proportion of resilin are present in arthropod exoskeleton structures. Such resilin proportion gradients must also be reflected by gradients of the mechanical properties of the respective resilin-containing composites. The material composition of adhesive tarsal setae of beetles  represenResilin is known from numerous arthropod exoskeletons where it is present in diverse structures and allows manifold functions, which in most cases are based on its very pronounced elasticity and its ability to completely recover after deformation. For example, resilin plays an important role in flight systems of insects, in particular in insects that use a wing beat with a low frequency 10–50 Hz) (see below). Resilin-containing exoskeleton structures have been described for various mechanical systems including leg joints ,50, vein Hz  , for example, membranous cuticle with large proportions of resilin forms a spring-like (or joint-like) element (Membranous cuticle often contains large proportions of resilin . Example element –C that m element .Libellula depressa) contains relatively large proportions of resilin, while the neighbouring sclerites are mainly composed of sclerotised chitinous material [The neck membrane of dragonflies is another example. This flexible cuticle connects the neck sclerites and enables an extensive mobility of the head . A recenmaterial   (Cercopidae), the complete extension of the hind leg takes less than one millisecond [In Auchenorrhyncha and Sternorrhyncha, the jumps are performed by metathoracic muscles that are directly connected to the trochanter of the hind leg and responsible for the movements of both trochanter and coxa ,74 Figu. In the lisecond  ) and a long fatigue time are of key importance for the functioning of this structure.One of these flight system elements is a sausage-like swollen thoracic dragonfly tendon, which consists of virtually pure resilin and connects the pleuro-subalar muscle  to the subalar sclerite, which in turn connects to the axillary sclerites of the wing base  Figure ,B. TogetCalliphora, Bombus, Apis and Oryctes [The wing hinge ligament of the forewing of locusts is located between the (meso-)pleural wing process and the second axillary wing sclerite . In Odon Oryctes ,84. So f Oryctes ,81,83,85The prealar arm is located at the front edge of the mesotergum and establishes a connection to the first basalar sclerite of the pleural thoracic wall via a tough, flexible ligament . The basCross veins in wings of dragonflies and damselflies were shown to form either stiff, inflexibly fused joints or flexible, resilin-bearing joints to the adjacent longitudinal veins –2678,86 26Apis mellifera) and assumed that they might play an analogous role in increasing the chordwise wing flexibility. Based on the distribution of resilin patches, wing veins, the occurrence of a flexible hook-mediated forewing–hindwing connection and observed wing deformations, they further suggested the existence of five flexion lines in one forewing–hindwing entity and assumed that these probably increase the cordwise flexibility and support camber formation. In addition, Mountcastle and Combes [By artificially stiffening single flexible, resilin-bearing vein joints in bumblebee wings through the application of micro-splints (extra-fine polyester glitter glued with cyanoacrylate), it was experimentally shown that even a single resilin-bearing joint plays an important role in overall wing flexibility and vertical aerodynamic force production . Ma et ad Combes  demonstrd Combes .Forficula auricularia) and the lesser earwig (Labia minor)) or by wing flapping  [The occurrence of resilin in several broadened vein patches as well as in membranous folding lines was described for fan-like dermapteran hind wings ,92. Thesmus sp.) ,93. Bothmus sp.) ,93. Thesmus sp.) .In beetle wings, resilin was found to occur at the marginal joint, between veins that separate during folding, and along flexion lines in membranous areas, leading to the hypothesis that elastic energy storage by resilin can support wing unfolding also in beetle wings . HoweverCalliphora vicina), resilin is mainly present in the proximal part of the wing, predominantly in the form of resilin-bearing patches between veins [In wings of the urban bluebottle blowfly (en veins . The occen veins .Coccinella septempunctata) [The contact formation of insect adhesive pads on substrates depends on the ability of the pads to adapt to the surface topography. In this context, specific micro- and nanostructures can enhance the quality of the contact –101. In unctata)   . Since tunctata)   .Tettigonia viridissima) (Ensifera) and the migratory locust (Locusta migratoria) (Caelifera), whose adhesive pads generally have a similar structural organisation [L. migratoria feature a clearly thicker superficial layer as well as a higher density of rods than those of T. viridissima  lose water much faster than those of L. migratoria . This prey-capture apparatus can be protruded towards a prey within a few milliseconds. When sticky pads (modified paraglossae), which are located at the distal end of the prementum, adhere to the prey, the labium is withdrawn immediately, and thereby the prey is transported to the mouth region of the beetle where it can be seized with the mandibles [A remarkable resilin-containing adhesive prey-capture device, which is formed by the elongated labium, exists in rove beetles of the genus andibles –118. TheCentropages hamatus feature two larger and relatively compact teeth , this organ is located on the right side of the ventral abdomen part where it is visible as a notch-like modification of the posterior edge of the fifth segment that exposes the subjacent intersegmental membrane and cuticle of the sixth segment , for example, hair plate sensilla with rather long and relatively thick hairs are present  in compound eye lenses has been described for different arthropods ,131–134 Exoskeleton structures with large proportions of resilin are common among arthropods. This review demonstrates the broad range of resilin functions in various exoskeleton structures. Resilin facilitates flexibility and compliance, elastic energy storage, elastic recovery, fatigue and damage reduction, sealing and transparency and thereby makes the respective exoskeleton systems rather effective. Due to its remarkable combination of different properties, resilin is a highly efficient multi-functional protein. In addition, together with other compounds and materials, it often forms complex and powerful composites that combine the properties and benefits of the single components and are capable of performing rather specific and challenging functions. These characteristics have very likely been the reason for the evolution of the large functional diversity of resilin-containing exoskeleton structures in arthropods.


Population-based assessment of Tourette syndrome (TS) and other tic disorders produces a paradox. On one hand, ideally diagnosis of tic disorders requires expert observation. In fact, diagnostic criteria for TS explicitly require expert assessment of tics for a definite diagnosis. On the other hand, large-scale population surveys with expert assessment of every subject are impracticable. True, several published studies have successfully used expert assessment to find tic prevalence in a representative population . However, extending these studies to larger populations is daunting. We created a multimedia tool to demonstrate tics to a lay audience, discuss their defining and common attributes, and address features that differentiate tics from other movements and vocalizations. A first version was modified to improve clarity and to include a more diverse group in terms of age and ethnicity. The result is a tool intended for epidemiological research. It may also provide additional benefits, such as more representative minority recruitment for other TS studies and increased community awareness of TS. Some important questions in Tourette Syndrome (TS) require large-scale epidemiological studies. To give one example, studies have not yet had the power to definitively establish whether TS is equally common in people of African versus European descent. In the U.S., although diagnosis and treatment are about twice as common in European Americans , three pWe were especially concerned that some respondents with tics, or whose children had tics, might not correctly interpret written descriptions of tics but would recognize the tics if they saw them. Supporting the potential importance of this concern, epidemiological studies that included expert examination  generallTo address these issues, we developed a multimedia screening interview to enhance population-based ascertainment of tic disorders by lay interviewers . We dubbed the final product VISIT-TS, for “Video-Integrated Screening Instrument for Tics and Tourette Syndrome” . It was also shared with about a dozen other movement disorders experts and we reviewed their feedback. In response to this initial experience and feedback, we made many changes, including new video clips, thereby reducing the amount of time the narrator is shown and showing more diversity in ethnicity and age. We added and improved graphics, including written text while examples of tics appear in the background. To avoid confusion, we removed videos showing examples of non-tic movements, and we eliminated medical terms unfamiliar to the general public, such as chorea. Finally, we restored an unintentionally omitted question on lower facial tics. Here we describe the revised product, version 2 of VISIT-TS.https://zenodo.org/collection/user-kjb or athttp://dx.doi.org/10.5281/zenodo.55604.The revised VISIT-TS multimedia tool includes almost 100 video clips defining and demonstrating tics including simple and complex motor tics as well as simple and complex vocal tics, edited to a length of 5 minutes. Following the clips, 16 questions are presented in written and spoken form, one at a time, accompanied in most cases by brief video of the phenomenon being ascertained (seeThis approach is based on the premise that survey respondents will respond more accurately about tics in themselves (or their children) after the interviewer shows them a brief video about tics than they would if only asked about history by questionnaire or by cross-sectional lay observation. Because tics can come and go, can be suppressed, and often resemble intentional movement or vocalizations, diagnosis of tic disorders can be challenging .positive children was only 18%.Some data are available to judge the sensitivity of lay diagnostic instruments for tic disorders. In two studies, about half of the children who had previously been diagnosed with TS were missed by research screening: 1 of 2 inThe most detailed data on the sensitivity of questionnaires for tic diagnosis come from the study ofi.e., they showed a videotape of tics as part of an initial lecture to parents and teachers, followed by a survey that included a short written description of tics. Independently, “all children were directly observed in the classroom by an expert clinician in the field of tics who diagnosed tics based exclusively on the characteristics of the movements”, with a limit of 20 minutes’ observation per classroom (p. 2107). However, the authors note limitations of their work including the fact that children were observed collectively, for a relatively brief period of time, and while engaged in school work, when tics may have been suppressed. The questionnaires actually identified more children (98) than the expert (57), suggesting either that parents and teachers overdiagnosed some movements as tics, or that they were describing tics present in the past but no longer present, or that the classroom observation was not an adequately sensitive clinical comparison. A videotape demonstrating tics was released  or other abnormal movements, and after all such differential diagnosis generally requires clinical expertise. Nevertheless, a 5- to 10-minute video-illustrated questionnaire is probably a reasonable compromise for epidemiological or other tic studies that require screening large population samples for tic disorders. Finally, the video inquires separately about tics in different body locations, in hopes of improving sensitivity. However, since our primary intent was to identify presence or absence of tics, not to distinguish tics by body part affected, further experience with VISIT TS may allow shortening the video further by reducing the number of questions.The VISIT-TS also has limitations. The DSM and TSSG criteria explicitly require application by properly trained experts, so VISIT-TS is primarily intended as a screening tool rather than as a substitute for clinical expertise. The sensitivity of VISIT-TS has not been reported. Furthermore, its specificity may be limited; the video includes only minimal information that could help distinguish tics from chorea, dystonia, stereotypies , this article presents a tool without any properties, results of use, or other such data. Thus, the abstract can be enhanced by describing the limitations of this tool  while still making it clear that the instrument is being offered to the research and lay communities given the lack of adequate tools for population studies on tic disorders. The abstract represents a suitable summary of the work and is adequate in its description of the study tool and design. Unlike articles presenting instruments along with psychometric properties . This would be adequate to assist the readers of this journal to make some assessment of the suitability of this procedure for scientific research. Alternatively, the information about the unpublished reliability and validity studies conducted by the authors can be presented as a separate pilot study.A group of lay individuals could be trained to use this strategy. Then the trained raters could be presented a series of new videotapes of people with and without tics. The findings could be compared and contrasted with the findings of expert raters.Populations from the community could be given tests about tics before and after viewing the video to assess whether the video is an effective tool to educate children, parents, teachers, and members of the general community how to identify tics.Evaluation of the reliability and validity of this procedure could be performed in multiple future studies with different populations. The discussion could be improved by focusing a little more on the actual VISIT-TS and what is known about it, and less on the limitations of our current research methods and tools. Some of the latter information would be better incorporated into the introduction, which already reviews the current state of epidemiological research in tic disorders and makes a case for why the VISIT-TS is needed. Readers would also be very interested in the authors’ ideas regarding possible future research directions or studies that could be performed with this multimedia tool, such as: Both the included video and list of questions are very helpful for the readers’ understanding regarding how this tool is administered and what the experience is like for the participants.We have read this submission. We believe that we have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. The authors carefully reviewed the epidemiology of tics and Tourette syndrome and explained the need for more sensitive, broadly applicable screening tools. To address this need, they have developed a 10-minute video that shows nearly 100 tic examples and then asks a brief screening questionnaire.et al,. 2012). The introductory section could benefit from some reference to the Avon study, which is considered landmark, as it was the only prospective, population-based study on prevalence of chronic tic disorders in a birth cohort  were given. Repetitive hand washing was a great example. However repeating a movement a certain number of times “because it feels right” may not be an appropriate example. Compulsions are performed to relieve anxiety, however compulsive tics are performed in order to relieve an urge (which can include evening out or repetition.) There is still equipoise about how to classify compulsive tics, therefore; in order to maintain sensitivity of the instrument, this clip might best be modified to use a more classic example of a compulsion  There are a couple of concerns about the diagnostic utility of the questionnaire at the end of the video. Question #10 on the screening interview at the end of the video (“Have you ever done things over and over like:)”) gave 2 apt examples (“obscene gestures” and “patting yourself”) but there rest are habits that are probably not specific enough for tic disorders. These include “twisting your hair,” “scratching your foot inside your shoe” or “adjusting your clothes.”  Unless there is data to support these behaviors as being specific to tic disorders, the examples in this question might be appropriately replaced with behaviors that are more specific to tic disorders. Examples might include, “repeating words or phrases,”  “flicking your fingers” and  “poking or hitting yourself.” Another concern is that the questionnaire appears to be designed according to DSM-IV criteria, likely because the project was started before the DSM-V criteria for TS were finalized in 2013 . DSM-V removed the requirement that one year of tics be present consecutively during childhood . DSM-V also removed a 3-month tic free period as exclusion for the diagnosis of TS. This video appears to specifically ask about the 3-month tic free period. If it is going to be used to screen according to current DSM-V criteria, then this question should be removed. et al,. 2001), trained technicians using 25 different video examples of tics before they went on to conduct a total of 1596 interviews of school children. They found a much higher prevalence of chronic tics, TS, and tics NOS than other epidemiological studies using less sensitive methods have . This is much higher than other epidemiological research, but used a more sensitive (yet less specific instrument). A second improvement to the discussion would be, following the limitations section, a conclusion that proposes next steps. For example, a validation study could be proposed. Additionally, further improvements to the instrument could be considered (in the future) to create educational tools aimed at improving diagnostic sensitivity of clinicians (and researchers) and raising awareness about tics in the general population  The discussion aptly points out how poorly specific a brief interview with children can be for diagnosis of tics (with 37.5% being missed even after 2 hours of observation by an expert.) The discussion could be improved in two ways. First, it could point out an additional potential value of this video beyond screening the public for tics. Along these lines, it could be useful in training researchers and even their staff to conduct broad scale assessments of tics. For example, the Monroe County study at the University of Rochester . We argue that the 3-month question can simply be ignored for DSM-5, and my colleagues and I (at least) are still interested in DSM-IV-TR diagnoses. Nevertheless, to best fit DSM-5, which removed the "many times a day ... nearly every day" requirement, we probably should add a question like, "Was your first tic at least one year before your most recent tic?"Similarly, we may consider changing the age of onset question to ask for a(n approximate) age rather than a dichotomous yes or no regarding before age 18. My read of the science is that the age limit should probably be around age 21-25, and the TSSG criteria required age 21 rather than 18 [1].The comments on the introduction and discussion are also helpful. Again, thanks.I am very appreciative of Dr. Shprecher's thoughtful comments.Arch Neurol. 1993 Oct. 50(10):1013-6. [Medline]. [1] The Tourette Syndrome Classification Study Group. Definitions and classification of tic disorders.  In the article “VISIT-TS version 2: A multimedia tool for population studies on tic disorders” by Vachon, MJ, Striley, CW, Gordon, MR, Schroeder, ML., Bihun, EC, Koller, JM, and Black, KJ, a new method of classifying tics by lay persons is proposed as an aid in larger scale population studies. The authors provide a clear account for the need for improving existing methods of detecting and differentiating tics and present an interesting solution in the form of their new multimedia tool. It is a positive aspect that participants with tics include different age groups, races, and both sexes. However, some of the video clips present one separate tic, whereas several tics are present in the video. The rationale for developing the screening tool is its integration in large-scale epidemiological studies. Even though a few epidemiological studies focusing on tics and Tourette have been carried through, future methods will probably offer possibilities for screening cohorts for several co-occurring conditions. The authors may thus consider the possibility of further pruning the video  and comparing two versions  for their validity against expert ratings. The shorter the time used for a screening, the more it will be used in big cohort studies. This could be integrated into future perspectives at the end of the manuscript. It would also be interesting to carry out similar tests of the sensitivity as mentioned in the article by comparing the VISTS-TS to clinician ratings. Storch et al. (2005) is used as a reference for the YGTSS – the authors might consider adding the reference of Leckman’s (1989) original work.We have read this submission. We believe that we have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. We appreciate the thoughtful suggestions from Drs. Plessen and Hagstrøm. Our primary intent was to help lay people decide whether they (or their child) had any tics, not to distinguish which tics they had. I see from your response that we did not make that point clear. I think there are benefits to presenting and asking about different tics separately, even for our more limited goal, but your perspective also suggests an opportunity to shorten or otherwise improve on the video. You wrote, "some of the video clips present one separate tic, whereas several tics are present in the video." I believe you are saying that some video clips may show two tics while the narration is discussing only one of them. If I understood that correctly, it's a good point that we had not considered. We may be able to address that in a future version of the video.


This paper examines the ethics of using assistive technology such as video surveillance in the homes of people living with dementia. Ideation and concept elaboration around the introduction of a camera-based surveillance service in the homes of people with dementia, typically living alone, is explored. The paper reviews relevant literature on surveillance of people living with dementia, and summarises the findings from ideation and concept elaboration workshops, designed to capture the views of those involved in the care of people living with dementia at home. The research question relates to the ethical considerations of using assistive technologies that include video surveillance in the homes of people living with dementia, and the implications for a person living with dementia whenever video surveillance is used in their home and access to the camera is given to the person’s family. The review of related work indicated that such video surveillance may result in loss of autonomy or freedom for the person with dementia. The workshops reflected the findings from the related work, and revealed useful information to inform the service design, in particular in fine-tuning the service to find the best relationship between privacy and usefulness. Those who took part in the workshops supported the concept of the use of camera in the homes of people living with dementia, with some significant caveats around privacy. The research carried out in this work is small in scale but points towards an acceptance by many caregivers of people living with dementia of surveillance technologies. This paper indicates that those who care for people living with dementia at home are willing to make use of camera technology and therefore the value of this work is to help shed light on the direction for future research. The number of older people (those aged 60 years or over) has increased substantially in recent years in most countries and this ageing population is projected to continue accelerating in coming decades . By 2050The use of video surveillance installed in homes of people living with dementia may provide a more economic and efficient means for caring for those occupants who wish to maintain their independent living. For example, such a video surveillance system would be available to family caregivers and would provide a rapid means of ascertaining the wellbeing of their family member with dementia.However, formal healthcare providers have been reluctant to make use of video surveillance because of ethical concerns in capturing and storing media of people living with dementia as well as others in the home, including formal care staff and other family members that may include other vulnerable people or those who object in principle to video surveillance in their relative’s home .These ethical concerns also more generally relate to damages that can befall our digital world “data-image” with consequent tangible impact on our real world economic, political, social spheres . StoddarAnother, more complex perspective on the ethics of surveillance posits the ‘just war tradition’ as an ethical framework to be used for decision-making on use of surveillance in a particular instance. In the just war traditional framework for surveillance, justification for such operations can be assessed across a number of principles including reason, authority of the surveillant, declaration of intent, whether surveillance is an act of last resort, the likelihood of success and whether surveillance is a proportionate response .Is there an opportunity for the development of a video surveillance service to provide informal caregivers with a capability to observe the person living with dementia? It is not technically unique to provide such a service to informal family caregivers; a number of existing solutions are available.One such system worked by recording video when the motion detection system in the camera detected movement in the home of the person living with dementia . This foHowever, these types of services may be difficult for people to use, evoking arguments for and against such a service. The SCIE review on the use of video and associated technology in health and social care settings highlighted the different perspectives of the institution, the ‘resident’ and the caregiver, and how this can alter the relationship and use of the technology for each perspective . The revThe core issues centre around the utility of the surveillance to the institution and its employees, and the utility to the person being cared for and their circle of caregivers. This paper explores these issues. After describing the background of the impact of dementia on society, the paper describes the related work on the ethical issues of surveillance before describing what a video surveillance system technically comprises. The paper then explains the methodology chosen for a pilot study to gather the views of people living with dementia and their caregivers on surveillance. The results from the mixed methods pilot are presented and discussed.Dementia commonly leads to significant physical and mental health problems in those caring for the person living with dementia. Increased caregiver stress is a key trigger in the decision to move a person living with dementia to institutionalised care . It has People with dementia and their caregivers perceive that as the disease progresses, the need for health and safety monitoring becomes greater . AssistiThe SCIE report on surveillance technologies in health and social care settings found a ‘notable gap’ in terms of service user and caregiver views on video surveillance  indicatiIn their study of people living with dementia living alone at home, Wattmo et al.  concludeThere is a significant body of research in the use of video cameras to support people living with dementia . Much oA study on the use of video surveillance in care facilities revealed four perspectives of use: reflective, real time, reflexive and retrospective monitoring . ReflectSocially transformative technology such as video surveillance in the home of people living with dementia raises ethical issues that need to be considered at an early stage as an intrinsic part of the development of any technology-based solutions. Such ethical frameworks must take account of the heterogeneous needs of prospective users including people living with dementia unable to provide consent .In 2014, HC-One, a UK care home organisation carried out a survey of its staff, residents and their relatives after learning that a UK survey found that 80% of British adults supported the use of visible cameras in care homes . The resEthical frameworks have been developed to support the ‘dignity, rights, safety and well-being of participants’  and suppOf these four areas, perhaps the most significant is that of not causing harm to the person living with dementia, specifically of invading their privacy. Kenner  asks “hoNiemeijer et al.  pointed A participatory study with people living with dementia, their family and healthcare professionals found that while those people living with dementia disliked remote monitoring and surveillance, their caregivers were pragmatic, prioritising safety .Kenner  summarisThe research question arising from these asymmetries relates to the ethical considerations of using assistive technologies that include video surveillance in the homes of people living with dementia, and the implications for a person living with dementia whenever video surveillance is used in their home and access to the camera is given to the person’s family.There is a high market availability of Internet Protocol (IP) video camera with huge variation in price and quality and an emphasis on ease of installation and operation. The co-availability of high quality mobile apps used to view output video offers Video Surveillance as a Service (VSaaS), where the camera connects to a service in the Internet ‘Cloud’. People viewing connect to an account in the cloud rather than connecting directly to the camera, making configuration for use relatively easy and based in the software of the app on the mobile device. From the hardware perspective Fig. , the camRecorded video does not need to be stored on the camera or anywhere in the home. Instead the recordings are stored in the cloud. If the camera is temporarily unplugged or switched off the VSaaS becomes automatically restored when the camera is switched back on.In terms of location for the camera in a home of a person living with dementia, the hallway Figs.  and 3 ofAs mentioned, mobile devices are an accessible method in which caregivers can access the video services in real time and via smart notifications. The primary advantage of such mobile access is that the person living with dementia can be conveniently and remotely monitored in real-time by the caregiver via a mobile app , 8 (33%) of participants were male and 16 (66%) female.living labs approach was used to engage with a small group of people living with dementia and their caregivers, using a semi-structured workshop. This approach uses “collaborations of public-private-civic partnerships in which stakeholders co-create new products, services, businesses and technologies in real life environments and virtual networks in multi-contextual spheres” [The spheres” . Living spheres” . Servicespheres” , which ispheres” . The twoCan you describe your views on using a video camera in the home?What are the three worst things in having a video camera in your home?What are the three best things in having a video camera in your home?Can you describe a particular situation where a video camera in the home could be important (good or bad)Do you think video cameras in the home can be used to support older people with dementia?If you could be in charge of designing the use of a video camera in the home, what would your ideas be?Two evenings workshops were held, facilitated by AgeNI, a charity for older people in Northern Ireland, where those involved participated in discussion. The first event was in AgeNI’s facility in Meadowbank, Omagh, Northern Ireland where 11 people participated and the second was at AgeNI’s building in Belfast where 15 people attended. At each event, a short movie, commissioned to illustrate the concepts proposed was shown and used as a starting point for a general discussion of the issues raised on the benefits or not of using video surveillance . These sWhat do you think of the idea of a video camera in the home of people with dementia?How difficult would you think it could be to use the envisaged video system?How appropriate is a video camera in the home of people with dementia?How appropriate is the concept of a video camera in the home of older people generally?The participants were also asked to respond using a questionnaire which explored issues surrounding the use of cameras as an aid to care for a person living with dementia. The results of these questionnaires are presented in Figs. At the workshops, we explored the first two phases of co-creation encompassing the evolution of the idea and the concept of an observation service for caregivers of person living with dementia living at home alone. In doing do, we sought to gather the ideas and perspectives on the concept of a video surveillance system for monitoring persons living with dementia at home.The data from the workshops related to questionnaire responses and analysis of the general comments written by the participants. The questionnaire responses reported that 91% thought that the idea of a video camera in the home of a person living with dementia living alone was a very good or good idea  reported that actually using the envisaged system would be either very easy or easy “If managed appropriately, I feel that this concept could enable someone with dementia to remain at home for longer. Respecting the individual rights is paramount and this concerns me. I think education and demonstration would be beneficial” “If used properly, this could provide great support for those with dementia, provide comfort for those who are caring for them and provide valuable insight into the behaviours that those with dementia exhibit. It could allow relatives living abroad the opportunity of being involved in caring for someone with dementia; like speed cameras, they can change the behaviours of people. Carers who know and are aware of the presence of a camera will afford the person the correct amount of time being paid for and deliver a better quality of care” “Mainly safety, and peace of mind for family” The general sentiment from participants can be illustrated in the following quotes.“Monitoring safety, mobility, bringing peace of mind to carers. Must be suitable circumstances, respecting necessary privacy with proper permissions and for right reasons” “For me it is about the ethics and safeguarding of the vulnerable person. I believe that there are some merits, but I am not totally convinced but can understand that families directly involved would have perhaps divergent views” “If it is limited to movement and hallways I would be more comfortable but in living rooms, bed rooms you are taking away human rights – big issue. Everyone is an individual – even with dementia” “Proper consent from person needs to be sought so that they feel comfortable with this method. System needs to be independent from other government bodies. Only family have access. Should be used by family to eliminate any worries and to identify any support needs to benefit from the care package for the person” .There were also more cautious perspectives from participants, for example,is an individual and has rights. However, obtaining consent from a person living with dementia where the formal care provider therefore also has an ethical obligation of care is difficult and is discussed below.The final two quotes are perhaps the most interesting. Everyone The review of related work on the introduction of a video surveillance service for people living with dementia living at home has provided significant findings that indicate conditional acceptance of the use of such technology. However, the examination at the institutional level  is where the main corpus of the literature on video surveillance of vulnerable people may be found. While telecare does not offer savings at this institutional level , the SCIMore generally, the reported ‘notable gap’ in terms of service user and caregiver views on video surveillance indicated a lack of research on video surveillance in the home from the perspectives of the person living with dementia . The fouOur starting point for examining the literature was the ethical framework encompassing: autonomy, beneficence, non-maleficence and justice . In examThe workshops with people living with dementia and their caregivers were useful in providing guidance on navigating the ethical issues but were also interesting in that the participants were enthusiastic about discussing the issues, the technology and how it could work. This type of workshops could perhaps help to improve the design and implementation processes for solutions such as video surveillance by promoting the voices of the people living with dementia and their caregivers.The workshops did not ask specific questions around consent but the most interesting comment on this concept suggested to exclude organisational participation, to keep it within the family and to obtain consent from the person living with dementia being surveilled. There are various consent mechanisms that can be used beyond the person living with dementia giving consent when they have the mental capacity to do so. The concept of advance directives or ‘living wills’, sometimes called a Ulysses contract, is a binding directive provided by the person when they have the mental capacity to provide such a directive . The dirIn the UK, the law sets out a single test for assessing if a person lacks capacity to make a particular decision at a particular time . The tesThe work carried out in this paper indicates that perhaps a clear description of the meaning of video surveillance in practice would be useful to the person living with dementia and their caregivers. Such a description could be articulated in terms of the impact on the lives of the people involved and not just on the technology and its impact at home. The decisions made by people living with dementia could then form part of their living wills, setting out clear boundaries on use of video surveillance on their home.ethical by design approach would deliver a toolkit that could be used online, in workshops or one-to-one meetings to deliver informed, personalised consent regarding the use of assistive technology in the home. Perhaps technology could support the gaining and maintenance of consent where capacity is or is likely to be an issue, extending approaches where paper forms are specially adapted to suit the needs of people, as used for people, for example, with Huntington’s disease [This idea could be advanced by transforming the privacy by design approach to seek to imbue the views and attitudes of the people living with dementia and their caregivers into the design and configuration of video surveillance services in their homes. This proposed  disease .least restrictive alternative in terms of their rights and basic freedoms. Does the use of AT, such as remote video surveillance, offer a less restrictive alternative to a person’s rights and freedom than moving them out of their home?Interestingly, the law says that anything done for or on behalf of people without capacity must be the The families who participated in this small study have outlined the different perceived effects of video surveillance, including financial, protection, privacy, security, safety, and peace of mind. Those who took part in the workshops generally were supportive of the concept of the use of camera in the homes of people living with dementia, with some significant caveats. A logical next stage is to run a mixed-methods study to gather more evidence on video surveillance of people living with dementia at home.In conclusion, the use of cameras in the home of a person living with dementia where family caregivers could monitor their family member with dementia was supported as useful, ethical and moral providing the right protocol is in place to gain consent. However, when professional caregivers are involved – either as part of the care team and therefore one of the ‘observed’ by the camera or as part of the authorised ‘observation team’ then the degree of ethical discomfort increases as it would be impossible to gain consent from all possible visitors to a home – however experimenters would often use unavoidable signs to indicate when and where a location is under video surveillance.


Infant vaccinations are necessary for public health, but are painful, causing distress to the infant and caregivers. Breastfeeding and sucrose effectively reduce infants’ pain during vaccinations, and these strategies are recommended in health care provider (HCP)-targeted education and vaccination pain guidelines. However studies show these strategies are infrequently used. YouTube is a popular medium to publicly share and watch videos, and many consumer posted YouTube videos show distressed infants being vaccinated with no pain treatment. The aims of this study were to evaluate the reach and impact of a consumer-targeted YouTube video demonstrating use of effective pain reduction strategies during infant vaccinations.A brief consumer-targeted video showing two infants being vaccinated was posted onto YouTube on October 2013. One infant was breastfed and another infant received sucrose by mouth before and during the injection. A link to a viewer survey was visible on a banner near the end of the video. An intensive strategically planned knowledge dissemination strategy using the media, social media and messages to professional organizations took place to promote the video. Data analysis of the viewer survey, YouTube analytics of the reach of the video in terms of number of views, country of viewers, and comments relating to the video took place 12 months after the video was posted.Twelve months after posting, the video had 65,478views, 68 comments, 245 likes, 17 dislikes, and 90 shares. Average duration of viewer time was 65% of the video. The viewer survey was completed by 156 (0.24%) viewers; 90 (58%) answered as HCPs and 66 (42%) as parents. Survey results showed that the video was persuasive; intent to use or support breastfeeding or sucrose was high in both parents and HCPs after viewing the video. Comments posted were often emotional in nature, and were related to anti-vaccination ; effectiveness or positive personal experiences ; research team comments or promotion ; pro-vaccination  and barriers to using breastfeeding or sucrose during vaccinations .The video posted onto YouTube demonstrating effective pain treatment during infant vaccinations was viewed by large numbers of people around the world, however the response rate to the linked survey was extremely low. Using YouTube videos for knowledge dissemination has an extensive reach, however it is difficult to evaluate impact on behaviours and practices. Early childhood vaccinations are vital for public health. However,Approaches to improving the uptake of research evidence has traditionally focused on HCPs,  however A consumer-targeted educational video demonstrating the use of effective, recommended vaccination pain treatment strategies was posted on YouTube, and the reach and impact of the video were evaluatedOur study team produced a brief parent-targeted video showing two infants being vaccinated while i) being breastfed; ii) receiving sucrose by mouth before and during vaccinations and posted the video onto YouTube (tinyurl.com/BSweet2Babies). The video was filmed by the research team’s affiliated hospital audiovisual team, in a children’s hospital outpatient clinic. The brief (1 minute 35 seconds) video included simple captions in Canada’s two official languages (English and French) and a brief written statement of the effectiveness of breastfeeding and sucrose as pain reduction strategies during infant vaccinations. More detailed information on how parents and HCPs can implement breastfeeding and sucrose during infant vaccinations was provided in the description accompanying the video.The video contained a link to a REDCap (Research Electronic Data Capture) online survey. The surIn collaboration with the team’s affiliated public relations and communication teams, a comprehensive video dissemination plan was put into place to maximize views during the intervention period. This included the following activities.The video was posted on YouTube on October 21, 2013. Data was collected for 12 months following the posting of the video, from October 21, 2013 to October 20, 2014. The dissemination plan was implemented as follows.The posting of the video and dissemination plan coincided with the annual national and regional flu vaccination promotion efforts.Press releases were sent to media resulting in 18 media interviews including: two radio interviews, seven television interviews and nine text publications (online and print) in Canada, United States of America (USA) and Australia.Pitch letters were sent to popular parent blogger groups , and professional organizations or mailing lists Key words were used to maximize the chances of the intervention video being retrieved in YouTube searches. For example, “baby” and “vaccination” were included in the title and their synonyms  were used throughout the description of the video. In addition, tags (key words) were used to capture possible search terms that viewers would use to find information about vaccination pain. For example: Baby vaccination; Baby injection; Flu shot; Vaccination; Vaccines; Breastfeeding; Pain.Team members’ personal and affiliated organizational social media sites  were used to post and promote the video.Posters and pocket sized cards with information about the video  were disseminated at 31 medical clinics in the inner city of Ottawa, and shared at six national and international professional research conferences.The following comment was posted onto all other YouTube videos identified showing infant vaccinations: “Research shows that breastfeeding and/or small amounts of sugar water effectively reduce pain during vaccinations! Watch this video: Baby vaccination; the secret to a calm and peaceful immunization!”Data analysis of the viewer survey and YouTube analytics of the reach of the video in terms of number of views, country of viewers and comments relating to the video took place 12 months after the video was posted. Results of the reach of the video and viewer survey were summarized using descriptive statistics using means and their standard deviations (SD) if data was normally distributed, and medians and interquartile ranges (IQR) if data was skewed. Comments were reviewed by three authors  and organized by consensus into categories. Direct quotes are used to illustrate the identified categories.The parents and nurses portrayed in the videos provided written informed consent to have the video files posted onto YouTube. The consent processes, as well as the posted intervention video and the study were approved by the first author’s affiliated hospital research ethics board.The infant vaccination YouTube video view count was 65,478 during the 12-month period following posting . The aveThe online survey linked to the video was completed and submitted by 156 viewers . Based oAs presented in http://www.cbc.ca/news/canada/edmonton/measles-vaccines-should-they-be-mandatory-1.2629890) and stories refuting the link between vaccinations and autism (http://www.dailymail.co.uk/news/article-2632526/There-NO-link-autism-childhood-vaccines-major-new-survey-found.html). Stories such as these may have influenced the number of people searching the internet for childhood vaccine related information, further underscoring the importance of ensuring that information concerning effective pain treatment during vaccination has an online presence, is easy to find, and is targeted appropriately at the average online viewer.This study showed that a brief consumer (parent)-targeted educational video disseminated by the YouTube social media platform and demonstrating effective pain reduction (breastfeeding and sucrose) during infant vaccination attracted large numbers of viewers from around the world. This approach resulted in wider viewership than is typical for health-related YouTube videos. ,28–30 Fohttps://www.youtube.com/watch?v=jxnDc2PxGUc&list=PLJH3y0duq2ZEQ_KkfKVkcLwZUk3HPV6xj&index=1) and an updated version, a 13-minute educational video, “Reduce the Pain of Vaccination in Babies’ posted onto YouTube in March 2015 (https://youtu.be/5Oqa1Fag5eQ). However, in the first 12 months of posting, the original video had less than 5000 views, and the updated video has had just over 5000 views after 10-months of posting. These number of views are relatively small compared to many of the consumer-posted videos showing distressed crying babies receiving injections.[The YouTube video posted for this study is just one of a number of YouTube videos relating to pain reduction during childhood vaccination posted by health care researchers or providers,,32 and iimpact of health education videos posted onto YouTube are to date lacking. We cannot determine if the high intent to use or encourage breastfeeding or sucrose during vaccination, as demonstrated in our survey results, actually results in use of these strategies during future vaccinations. In addition, the extremely low response rate of the linked survey to our video; less than 1% of video viewers, is a limitation to using data from surveys linked to YouTube and suggests that this method of data collection may have limited use as an approach to evaluate the impact on consumer behaviours, parent advocacy, beliefs or on clinical practices. This finding corroborates findings of a survey regarding the use and beliefs of using social media for health research, completed by 181 faculty members at the Johns Hopkins School of Public Health, United States of America.[For the 156 viewers who completed the viewer survey linked from our video, results indicated the video was persuasive. Almost 100% of HCPs indicated they would support use of breastfeeding or sucrose for future infant vaccinations, 86% of parents responded they would breastfeed and 73% of parents would use sucrose during future vaccinations. These findings of high intent to use or encourage effective pain treatment strategies are promising. However methods to effectively evaluate the  America. Percepti America. Their re America.Another factor to consider is that utilizing social media to deliver health-related information, means that there is no control over the fidelity of the intervention (the information being delivered). For example, despite our study video being only 1 minute 35 seconds in duration, well within the average length of the most popular viewed YouTube videos of 2 minutes 54 seconds, the averAlthough the aim of our consumer (parents of infants)-targeted video was to demonstrate use and effectiveness of breastfeeding and sucrose for pain reduction during vaccinations, 40% of the comments posted were anti-vaccination and often highly emotional in nature, which in turn, promoted replies or counter-arguments of a pro-vaccination nature. The use of the internet as a public forum for expressing anti-vaccination messages including messages about dangers of vaccines, has been previously described. This higKey strengths of this study relate to the unique and innovative nature of the study methods, bringing a new dimension to health research using social media to disseminate knowledge. Key limitations include extremely low response rate to the linked online survey, and the lack of ability to draw associations between the YouTube video and clinical outcomes.Using social media to disseminate knowledge has the potential to reach a large audience, making this a promising knowledge dissemination strategy. However, evaluation of effectiveness of the knowledge being disseminated is currently limited. To rigorously evaluate the effectiveness of YouTube videos on changing practices, traditional randomized controlled trials (RCT) or cluster RCT research methods, conducted alongside knowledge dissemination strategies using social media platforms may be required.Our brief consumer targeted educational YouTube video demonstrating effective pain reduction during infant vaccination had a large reach, as evidenced by more than 68,000 views in the first 12 months of posting. However, the response rate to the viewer survey was extremely low. This suggests that surveys linked from YouTube videos may not be a useful method of data collection. This highlights the limitations of evaluating effectiveness of publicly accessible health messages posted on YouTube and evaluating their impact on practice change. Further studies using social media platforms for knowledge dissemination are needed to determine the best methods of studying impact. Such effectiveness of knowledge translation intervention studies may need to be conducted alongside traditional and tightly controlled RCTs.S1 FigData used from YouTube Analytics after video had been posted for 12 months.(PDF)Click here for additional data file.S1 TableRaw survey data from parents and health care providers.(XLSX)Click here for additional data file.


We report the results of a study comparing the temporal dynamics of thematic and taxonomic knowledge activation in a picture-word priming paradigm using event-related potentials. Although we found no behavioral differences between thematic and taxonomic processing, ERP data revealed distinct patterns of N400 and P600 amplitude modulation for thematic and taxonomic priming. Thematically related target stimuli elicited less negativity than taxonomic targets between 280–460 ms after stimulus onset, suggesting easier semantic processing of thematic than taxonomic relationships. Moreover, P600 mean amplitude was significantly increased for taxonomic targets between 520–600 ms, consistent with a greater need for stimulus reevaluation in that condition. These results offer novel evidence in favor of a dissociation between thematic and taxonomic thinking in the early phases of conceptual evaluation. The speed and ease with which we recognize visual objects and sounds from our environment is truly impressive, making the question of the principles of organization of such efficient knowledge storage one of the most inspiring in psychology and beyond. In order to understand how the brain constructs meaning, we need to address the matters of content and timing of semantic processing. First, we need to understand what information regarding an object is available when a concept is activated, and second, which kind of information about an object is activated first, or what type of information is the most salient.cat facilitates recognition of the word dog, which suggests that overlapping semantic information between these two concepts is available when the semantic representation of cat is activated. However, two objects rarely share only one type of information. Dog may be facilitated by cat because they share many features, they are members of the same semantic category, because dogs chase cats, or because words cat and dog frequently co-occur in language. Coexistence of different types of relations makes it difficult to untangle the specific effects different types of knowledge have on semantic processing.Meyer and Schvaneveldt  were thepig—horse), scripts (e.g. restaurant—wine) and instrument relations (e.g. broom—floor), were compared while controlling for strength of associative relatedness. Moss and associates ).We identified two main time windows of interest. The first ranges from 280 ms to 460 ms (N400) and the second spreads from 520 ms to 600 ms (P600) post-stimulus interval. After time windows of interest were identified, mean amplitudes for each experimental condition were calculated.Two 4x3x2 repeated measures ANOVAs with within-subjects factors of Match Type , Band , and Laterality (left and right) and mean amplitude as dependent measure were conducted.Zone-by-zone repeated measures ANOVAs with Match Type as within-subjects factor were conducted for the time windows of interest.In order to test for the latency effects, we tested differences between thematic and taxonomic mismatch N400 effect in the early N400 window ranging from 280 to 320 ms, and late N400 window ranging from 420 to 460 ms.Greenhouse–Geissser corrections were applied where necessary.The experimental conditions did not differ during the baseline period. There was no effect of laterality; however, the effect of the band reached statistical significance  = 4.90, p < .05, η = .26). Pairwise comparisons of Band levels did not reach significance.The ERP differed across the scalp  = 27.33, p < .01, η = .66; Laterality: F = 7.37, p < .05, η = .35). Fronto-central region (more negativity) differed from temporal and parieto-occipital. There was less negativity in the left than in the right hemisphere.In this window, the ERP differed significantly between match types  = 17.01, p < .01, η = .55), with generally more negativity for mismatch than for match trials (p < .01). Differences between mismatch trials were not significant, except for a difference between thematic and taxonomic mismatch (p < .05) with more negativity for taxonomic mismatch. There were no significant interactions  and right parieto-occipital region (p = .06) .In addition to the difference in amplitude between the effects of thematic and taxonomic mismatch on N400, In the 520–600 ms time window, the ERP differed across the scalp  = 5.79, p < .01, η = .29; Laterality: F = 5.90, p < .05, η = .30; Band x Laterality: F = 3.59, p < .05, η = .20) and it also differed according to Match Type  = 5.34, p < .01, η = .28).We found less positivity for match than for taxonomic mismatch (p < .01) and thematic mismatch (p < .05)–mirroring the effect detected in the earlier time window.Zone-by-zone analysis uncovered that the effect of Match Type did not reach statistical significance in the fronto-central region . There wIn the temporal and parieto-occipital regions, match elicited less positivity than mismatched trials. In both temporal and parieto-occipital, left and right regions, there was a significant effect of the taxonomic mismatch. Additionally, thematic mismatch differed from match trials in left and right temporal region; and the difference between match and unrelated mismatch reached significance in right temporal region only.The main goal of the studies presented in this paper was to examine the temporal dynamics and salience of thematic and taxonomic categories in tasks that minimize the influence of intentional, strategic processing.Experiment 1 tested relationship type influence in an object verification task. Although related mismatches yielded more errors and took more time to be processed than unrelated mismatches and match trials, there was no significant difference in speed and accuracy between thematic and taxonomic trials. Behavioral results of the ERP study that used the same design, with the exception of the delay introduced between the target item presentation and the moment when participants were allowed to respond, were somewhat different. The null result in the analysis of the relationship type effect on response times could be expected, since delayed response obstructed the detection of subtle differences in the speed of processing. Regarding the accuracy, once again, participants responded most accurately in the unrelated condition. The match condition and taxonomic condition were equally hard, while participants made the most errors in thematic condition. One possible interpretation of the difference in accuracy across the conditions may be attributed to the difference in processing times. It is possible that prolonged response allowed for the integration of thematically related items to take place, which resulted in a higher number of false positives. It should be noted that accuracy was high in both experiments , but that participants were even more careful in the ERP experiment, making more than three times fewer errors on average.In the ERP study, semantic mismatches were followed by a negative component N400, in a time window between 280 and 460 milliseconds after the onset of the target. Concerning the processing of thematic and taxonomic relationships, which is more relevant to our question, analysis has revealed significant differences with more negativity for taxonomic mismatch. Zone by zone analysis showed that the difference between thematic and taxonomic trials was strongest in the right temporal (p < .01) and the right parieto-occipital region (p = .06), while in other regions there was a trend towards the same pattern but differences did not reach significance.cow and milk, compared to taxonomically related items, such as cow and donkey. In other words, milk is a more appropriate semantic context for cow, than donkey. Some researchers also interpret the N400 component in terms of ease of accessing information from semantic memory . Since ory . AnalogERP differences between thematic and taxonomic relations were reported in two recent studies –22, whicAs previously stated, most of the previous studies failed to find a difference in ERP responses of thematic and taxonomic types of relationships –20, at lMoreover, differences between thematic and taxonomic priming in our study were not only marked in amplitude, but also in latency of N400. Negativity elicited by thematic primes was significantly attenuated in the late N400 window (420–460 ms) compared to the effects produced by taxonomic primes. This result is in accordance with the results from visual world paradigm, which have shown that competition effects were longer lasting for taxonomic in comparison to thematic distractors –13. Diffhorse as a cue, there are many comparably good taxonomic matches. Since most or all members of the horse family , or more generally speaking, all category members at the same level of taxonomic hierarchy, have the same likelihood, the cognitive system may need to re-evaluate these other possibilities after initially processing and recognizing the existence of the relationship. On the other hand, groups of highly related thematic matches are more narrow (as a consequence of the differentiation in likelihood of specific thematic matches), which makes this condition more constrained. For example, for the word horse as a prime, saddle is the most likely thematically related word to follow, and there are only a few other competitors . Alternatively, the strength of expectation of a following item may be higher in the thematic condition because thematic relations are often temporally oriented (e.g. A cause/produce B), which is not the case for taxonomic relations (e.g. A and B are members of the same category). A similar interpretation was offered by Chen at al [Although we did not have strong predictions regarding components other than the N400, we detected differences in amplitude of the ERP wave in a later time window between 520 and 600 milliseconds. In this time window (P600), mismatch trials elicited less negativity than match trials. Taxonomic mismatch was different from the match condition across left fronto-central region, and temporal and parieto-occipital regions, while thematic mismatch was different from the match only across temporal regions. Similar results were obtained in a study by Chen et al –40. LargThe present study has shown that both thematic and taxonomic types of knowledge are decoded quickly, unintentionally, and that they both facilitate recognition of the succeeding information. Additionally, it provides evidence for differences in salience and timing of thematic and taxonomic knowledge activation, showing that the distinction long recognized in the psychological literature is also found in neuropsychological correlates of meaning integration and stimulus re-evaluation.Taken together, differences found between thematic and taxonomic conditions in our ERP study suggest easier processing of the thematic information during semantic integration phase (at around 400 ms after the stimulus onset) and a need for additional reprocessing of taxonomic information (at around 600 ms after stimulus onset).So far, ERP differences in thematic and taxonomic processing have rarely been reported, with several studies reporting no differences –20 and aS1 Table(DOCX)Click here for additional data file.


The long‐term constancy checked over a period of nine months was less than ±0.6% for measurements, taking into account the angular response of the ionization chambers. No significant effect of the background radiation levels was observed on the measurements.The use of a radioactive check device containing Strontium 90 was investigated to carry out the redundancy checks of Farmer‐type ionization chambers. It was not possible to meet the recommended tolerance limits of the redundancy checks without taking into account the angular response of the ionization chambers. The ionization chambers exhibited a maximum variation of 1% in the angular response in this check device. After accounting for the angular response the maximum variation of the short‐term repeatability was 0.14% with a standard deviation of PACS number(s): 87.53.–j, 87.52.–g The device has an approximate 7‐cm‐deep channel to accommodate a Farmer‐type ion chamber. The diameter of the channel is fixed and is sufficient to accommodate snugly an ionization chamber with a maximum outer diameter of 8.6 mm. When the device is not in use, the channel is covered by a self‐shutting, spring‐loaded, protective lid. There is a second channel in the check device to accommodate a thermometer to measure temperature close to the point of measurement. The device weighs less than 10 kg.The fixed‐geometry check device used in this study was manufactured by the Nuclear Enterprises Ltd., Reading, England. A photographic picture of the device is shown in Fig. The ion chambers used in these investigations were two fully guarded PR‐06G and four unguarded PR‐06C ion chambers manufactured by Capintec Inc., Pittsburgh, PA. The PR‐06G ion chambers were connected to a PTW Unidos Universal Dosemeter . The PR‐06C ion chambers were each connected to a Capintec Model 192 Exposure meter . The PTW Unidos measured the ionization charge collected in coulombs (C) and the Capintec Exposure meters provided readings in arbitrary units of “mR.” Both types of ion chambers have similar structural design. The outer diameter of these ion chambers at the distal end was 7 mm, to a length of 2.4 cm, gradually increasing to a maximum of 8.6 mm. Due to this gradual increase in the diameter, these ion chambers fit quite snugly and reproducibly in the channel of the check device. It took about 45 seconds to collect a charge of 1 nC, in this check device.±0.3% for short‐term repeatability of redundancy check measurements as recommended by the IEC,The short‐term repeatability measurements were performed as described by the IEC.10×10 cm2 field size at depths of 10 cm and dmax in a water phantom with a source to axis distance of 100 cm. As shown in Fig. As shown in this figure, there are some differences between the characteristic angular response curves of the guarded and unguarded ion chambers. The difference between the characteristic shapes of the angular response curves of these two types of ion chambers with otherwise similar structural design is due to the somewhat asymmetric shape of the guard electrode, as pointed out by the manufacturer. As shown here, the ion chambers demonstrated a maximum variation of about 1% in angular response in the check device using a Strontium 90 source. An anisotropy in the angular response of cylindrical chambers is usually due to an eccentricity of the central electrode or a marked nonuniformity of the wall thickness.±0.05% (for ten measurements). The short‐term repeatability measured this way is well within the limits of ±0.3% as recommended by the IEC.Because of this anisotropic angular response exhibited by these ion chambers in this check device the short‐term repeatability measurements were then made by aligning a point on the ion chambers with a fixed point on the check device. The maximum variation of the short‐term reproducibility measurements was 0.14% with a standard deviation σ of The long‐term reproducibility measurements were made by two methods. In the first method, a point marked on the ion chamber was always aligned with a fixed point marked on the check device. In the second method, the measurements were made by inserting an ion chamber in a random angular orientation without aligning a point on the ion chamber with a fixed point on the check device. The measurements were then performed by successively rotating the ion chamber by 90 degrees, three times, relative to the initial random position. The measurements taken this way at four angular positions, 90 degrees apart, were then averaged. The measurements taken using the second method check an ion chamber from all axial directions and are free from procedural errors such as a loss of the mark on the ion chamber, over a long period of time. The long‐term reproducibility measurements were repeated at least twice a month for eight months over a total time span of nine months. We missed the measurements for a month during this period. The long‐term constancy measurements were corrected for temperature and pressure as well as for the decay of the Strontium 90 radioisotope. The results of long‐term reproducibility for a fully guarded (PR‐06G) ion chamber are shown in Fig. ±0.6% and is within the limits of ±0.7%, as recommended for such ion chambers and a check device.,The maximum variation of the long‐term reproducibility is less than In order to check the effect of scattered radiation from nearby objects surrounding the check device, the measurements were made by surrounding the check device using two 4‐cm‐thick lead bricks. The measurements that were made with and without the lead bricks surrounding the check device did not show any significant difference. This results from Strontium 90 being a pure beta emitter producing very small leakage effects. The exposure rate at the surface of the device is less than 7.5 μSv/hr. As the radiation source in this check device is placed very close to the measuring channel, only backscattered radiations scattering through 180 degrees will be able to enter the sensitive volume of an ionization chamber in the device. Considering about 80% attenuation of the backscattered radiations in the shielding walls of this device, the background radiation levels entering the measuring channel will be at 1.3 mR/min. These background radiation levels will produce a signal of about 0.24 pC in a Farmer‐type ionization chamber with a sensitive volume of 0.6 cc. This background signal is much smaller than a typical signal of 1.33 nC/min observed for these ionization chambers in this check device.We found the use of a radioactive check device for redundancy checks of our ion chambers quite user friendly. Due to its easy transportability and no significant effect of surrounding objects on the measurements, it is possible to carry out the redundancy checks of the ion chambers in treatment rooms where some of our ion chambers are permanently located for daily output checks. It is, however, important to take into account the effect of the angular response exhibited by the cylindrical ion chambers in this check device in order to meet the recommended limits for these tests. The recommended limits for the short‐term repeatability and long‐term reproducibility can be met by always inserting an ion chamber in the check device with the same orientation. The limits for the long‐term reproducibility can also be met by taking measurements at four rotation angles, 90 degrees apart, from an initial random position, and averaging the readings. The latter method has the advantage of checking an ion chamber from all axial directions.The authors would like to thank Dr. Douglas Cormack and Dr. William Ziegler for many useful discussions.


About 70% of the beverage alcohol consumed in China annually is spirits. Recorded spirits make up most spirit consumption, but about 25% of total alcohol consumption  is unrecorded spirits (bai jiu), either homemade or made in unregulated distilleries. In some parts of China, the consumption of unrecorded spirits is higher than average. This paper compares the patterns of use of unrecorded distilled spirits and recorded distilled spirits among rural residents in Central China. Interviews were conducted with 3298 individuals in 21 towns/villages in 10 counties in the Hubei, Anhui, and Hebei provinces in the People’s Republic of China. Unrecorded bai jiu drinkers chose it because of its taste and its low price. It was consumed mostly by older men, mostly at home with family, more regularly and at higher alcohol by volume (ABV) compared to recorded alcohol. Recorded bai jiu drinkers were more likely to drink away from their homes, consumed more bai jiu at memorable drinking occasions, and reported feeling sick after drinking more often than unrecorded bai jiu drinkers. This comparison of patterns of use of unrecorded bai jiu and recorded bai jiu does not suggest that unrecorded bai jiu is more problematic for drinkers. The Chinese public does not generally consider alcohol use a significant public health problem. Rather, drinking alcohol is considered a normal part of daily life, a usual part of many meals, an important part of medicine and religion, and an essential adjunct for celebrations, ceremonies, and business . This beCurrent estimates are that 70% of the alcohol consumed in China is spirits, and 25% of total alcohol consumption  is unrecorded spirits (bai jiu), either homemade or made in unregulated distilleries ,4. UnrecBai jiu, which literally means “white spirits”, was selected for study because (1) it is the type of alcohol that has been traditionally preferred by the majority of Chinese drinkers; and (2) the higher ABV  poses potentially more health risks to drinkers compared to lower-ABV beverages such as beer or wine. Chinese-style distilled spirits are readily available for sale everywhere, in the form of commercial brands  and unrecorded spirits . It is legal to make, sell, purchase, and consume unrecorded spirits. This paper uses the terms bai jiu and spirits interchangeably.This study was designed to gather information on individual-level patterns of use of unrecorded and recorded spirits in rural Central China. This paper is the first to begin to offer basic information on patterns of use.Three provinces in Central China were selected for study—Anhui, Hebei, and Hubei—based on common knowledge of widespread use of unrecorded bai jiu in the rural areas.The sampling plan was designed to identify and interview bai jiu drinkers, especially unrecorded bai jiu drinkers and was not designed to be demographically representative of bai jiu use. Multistage sampling was used. In Anhui and Hebei, four counties were selected and then two townships/villages were selected within each county. In Hubei, five towns in two counties were selected. Households within townships/villages were then selected for interviews. Eligible household residents were 18 years and older who had consumed alcohol in the last year. Interviewers were instructed to interview the oldest male, the youngest male over age 15, and one female in the household during the interview period. The male–female ratio reflects the approximate proportion of male and female drinkers in the adult population ,4,10.n = 1110; Anhui n = 1070; Hebei n = 1088).The final sample was from 21 towns/villages in 10 counties in 3 provinces. A total of 3298 individuals were interviewed, and 3268 interviews were successfully completed (99.1%); Hubei The classification of bai jiu drinkers into unrecorded and recorded bai jiu drinkers was based on the answer to the question, “What type of alcohol do you usually drink?” Of the 3048 bai jiu drinkers, 1722 (56.5%) usually drank unrecorded bai jiu and 1326 (43.5%) usually drank recorded bai jiu.Of the 3268 people interviewed, 3048 (93.2%) were self-reported bai jiu drinkers: 84.2% males and 15.1% females. The mean age of males and females was essentially the same: males: 49.1 years; females: 49.8 years. Occupations were typical for people in rural communities: 52.6% were engaged in crop farming, 9.4% in service industries, 6.4% in construction, 5.0% in livestock farming, 4.5% in transportation, and 22.2% in other occupations including factory work, local government employee, unemployed, and house wife/mother. Most of the participants (91.9%) were married, a majority (77.8%) had completed middle school or less, and about one-fourth (22.1%) had attended high school or technical school of some type.Data were gathered by interview rather than written questionnaire because of the range of literacy among the intended sample and because of the need to clearly explain the definition of alcohol use. Because alcohol tends to be regarded as a banal part of daily diet and of socializing its casual use is often overlooked. For example, to a general question such as “do you drink alcohol?” a person may only mention drinking that is associated with special celebrations and events. Interviewers made clear that people should count all alcohol use, even alcohol taken with meals and alcohol taken as medicine.Before an interview began, interviewers explained the purpose of the interview, and assured participants that they would remain anonymous, could decline to answer any questions, and could leave the interview at any time without any negative consequences. All those interviewed signed a consent form. University graduate students studying epidemiology and public health gathered the interview data after being trained on the study protocols. Each interview took approximately 15 min. The Institutional Review Board for the Use of Human Subjects at the University of Nebraska—Lincoln approved the project . Additional approvals were obtained from Tongji Medical College and from the provincial authorities.A working group of senior Chinese provincial public health officials, Chinese epidemiologists, and United States university epidemiologists and social scientists developed and pretested the questionnaire. The initial framework for the questionnaire was based on previous research in China ,17,18,19http://www.epidata.dk/cn/index.htm) for data entry. Demographic information and data about drinking behaviors, choice of bai jiu, drinking experience, and consequences were analyzed using SAS 9.2 .Data from the interviews were transferred to computer files at Tongi Medical College of Huazhong University of Science and Technology, Wuhan, China, using Epidata 3.0 , it tastes good (27.1%), it was provided by host or as a gift (13.4%), it was easy to get (7.0%), it was good for health (8.3%), and it was at good quality (5.8%). Unfortunately, we did not ask recorded alcohol drinkers why they selected recorded alcohol.On their “last drinking occasion”, unrecorded bai jiu drinkers were most likely to be drinking in their own home (61.3%) with family members (32.4%); the next most likely place was the home of a relative or friend (16.6%) or in the company of relatives or friends (22.8%). Recorded bai jiu drinkers were slightly less likely to be drinking in their own homes (50.1%), less likely to be drinking with family members (24.3%), and more likely to be drinking in the home of a friend or a relative (30.5%) or in the company of friends or relatives (40.4%).On the “most memorable drinking occasion”, only 38.7% of unrecorded bai jiu drinkers were drinking at their own home or in the home of a friend or relative (20.8%). Recorded bai jiu drinkers were less likely to be drinking at their own home (26.5%) than in the home of a friend or relative (33.3%) and much more likely to be drinking in the company of friends and relatives (52.9%) than in the company of family members (18.1%).To gain some insight into the stability of drinkers’ preferences, we asked the bai jiu drinkers what they chose to drink at their last drinking occasion and their most memorable drinking occasion. There were differences between the two groups in the type of bai jiu they selected for different occasions . The proThere were small but not meaningful differences between the proportion of the two groups who pressured others to drink or were themselves pressured to drink by others in the traditional Chinese custom of toasting. Half of the groups experienced being pressured to drink, and nearly two-fifths of the groups had pressured others to drink. Drinkers of unrecorded bai jiu were, however, significantly less likely to report feeling sick or vomiting as a result of drinking than were drinkers of recorded bai jiu .To be eligible for the interview in this study, a person had to have drunk alcohol in the past year; thus, all (100%) of the persons in this study were drinkers. An estimate of the drinking rates was not the purpose of this study. In this sample of rural drinkers, only 6.7% had not or did not drink bai jiu, preferring to drink beer or wine exclusively. More than half of the bai jiu drinkers (56.5%) drank unrecorded spirits as their usual choice of alcohol. WHO’s national estimated average for unrecorded alcohol use in China was 25% ,4, suggeThis study found that the main differences in patterns of use between people who preferred unrecorded bai jiu compared to those who preferred recorded bai jiu were (1) an age-related preference for unrecorded spirits among older men, (2) a preference for higher-strength bai jiu among unrecorded bai jiu drinkers, (3) a greater likelihood of daily drinking among unrecorded bai jiu drinkers, (4) a greater likelihood of drinking at home on the last drinking occasion and the most memorable occasion among the unrecorded bai jiu drinkers, (5) a tendency for unrecorded bai jiu drinkers to cross over to drinking recorded bai jiu at opportunities such as memorable occasions, (6) recorded bai jiu drinkers reported heavier drinking on memorable drinking occasions than unrecorded bai jiu drinkers, and (7) more of the recorded bai jiu drinkers reported feeling sick or vomiting after drinking.Male drinkers were more likely to consume unrecorded bai jiu as their usual drink, and older men showed a preference for unrecorded bai jiu. Traditionally in China drinking for females has been restricted to situations like being offered a drink as a sign of hospitality, festival-related drinking, and special occasion drinking. Females are typically passive drinkers who exercise little choice over the type of alcohol they drink. In contrast, males are actively hosting drinking occasions, using alcohol to celebrate social occasions, and using alcohol to initiate and reinforce social relationships.Unrecorded bai jiu drinkers were more likely to drink daily or more frequently during the week than recorded bai jiu drinkers, and they preferred higher ABV bai jiu. This is likely a reflection of long-standing practice and traditional drinking patterns. Alcohol in these settings is considered an unremarkable beverage that is usually served with meals and for refreshment. Many rural people believe there is a health benefit from the moderate consumption of spirits, and, while acknowledged as an intoxicant, the motivation for drinking is related to alcohol’s properties as a food more than as a mood modifier. The preference for higher ABV beverages may be linked to a tradition of admiring men who drink stronger alcohol ,20. How We attempted to assess the quantity of bai jiu consumed. The average quantity reported per usual drinking occasion was 2.7–2.9 liang. There are several reasons for caution when interpreting self-reported alcohol quantity data from China due to a number of difficult-to-control factors that detract from accuracy ,17,18,19One of the reasons given by respondents for choosing unrecorded bai jiu is that it is cheap. Low cost unrecorded alcohol has been suggested to increase burden of alcohol-related diseases because it potentially enables excessive use . HoweverBai jiu plays a traditional role in festivities, especially in rural China. Spring and Fall Festivals, as well as other traditional feast days, funerals, weddings, and village events are celebrated with toasting and companionable social drinking. These are occasions on which drinking etiquette might allow a greater margin for heavy drinking and some boisterous behavior. Both unrecorded and recorded bai jiu drinkers reported higher alcohol consumption on their “most memorable” drinking occasion, but recorded bai jiu drinkers drank more than the unrecorded bai jiu drinkers.This increased consumption by recorded bai jiu drinkers on “memorable” drinking occasions perhaps explains why they were more likely to report that they “felt sick or vomited after drinking” (a proxy measure for heavy drinking). However, because the unrecorded bai jiu drinkers tended to be older and to drink regularly, they may have developed a degree of tolerance and/or skill in pacing their drinking; therefore, feeling sick or vomiting after drinking may not be strongly associated with heavy episodic drinking. Nevertheless, our data showed that even on their “most memorable” drinking occasions the unrecorded bai jiu drinkers consumed fewer drinks than the recorded bai jiu drinkers.Certain customs that apply to group drinking in China can increase risk of heavy episodic drinking and intoxication: toasting, keeping up with others, topping up drinks, drinking games, and competitions. Drinkers in this study were asked if they had pressured others to drink and if they had been pressured to drink by others. Tellingly, there was no difference between unrecorded bai jiu drinkers and recorded bai jiu drinkers, suggesting that these drinking patterns were independent of the type of spirits involved and likely deeply grounded in Chinese drinking culture.The choice of drinking location could affect the potential risk of unintentional injury. Unrecorded bai jiu drinkers preferred to drink at their own home with family, while the recorded bai jiu drinkers were more likely to drink at the home of friends or relatives. This difference was most evident for “memorable” drinking occasions. In addition to the potential family controls associated with drinking at one’s own home compared to drinking away from home is added the consideration that drinking away from home may involve driving after drinking.Global Strategy to Reduce Harmful Use of Alcohol [Some of the policy recommendations outlined in the WHO’s  Alcohol , such as Alcohol . Ending  Alcohol .Additionally, there is evidence that some proportion of unrecorded bai jiu drinkers would prefer recorded bai jiu if given the opportunity, so unrecorded bai jiu drinking rates may decline as recorded bai jiu becomes more available and more accepted and as the older male population declines.This study compared, in detail, the patterns of use of recorded and unrecorded spirits among people living in rural Central China. As such, these results add to the understanding of unrecorded alcohol in China.The most important conclusion, at this stage, is that unrecorded alcohol is widely consumed in rural parts of China, and deserves to be examined carefully for variations and differences in the role it plays in society and in burden of disease. Only then can coherent policies to reduce public health risk and maintain public health be developed.This paper was based on interviews with 3268 Chinese adults from the rural areas of three provinces in China. As such, the accuracy of the data depended upon the comprehension and honesty of the respondents. The results had significant response process validity because the data collectors were trained to probe to ensure accurate understanding of the questions and understanding the answers given. The sample does not truly represent China or even the provinces sampled or the rural populations, but it does present the first description of the users of two types of the most common alcohol consumed in rural China. The results will have considerable value for those conceptualizing more extensive studies in the future and those considering policy options to reduce risks from all types of alcohol.