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Differential beta and gamma activity modulation during unimanual and bimanual motor learning.

Movement-related dynamics in the beta and gamma bands have been studied in relation to motor execution and learning during unimanual movements, but their roles in complex bimanual tasks remain largely unexplored. This study aimed to investigate how beta and gamma activity differs between unimanual and bimanual movements, and how these neural signatures evolve during the learning process. Our motor task incorporated varying levels of bimanual interaction: unimanual, bimanual-equal, and bimanual-unequal. Magnetoencephalography data were recorded in healthy participants (N = 43, 27 females) during task performance, and beta and gamma activity was quantified. As expected, increasing task complexity from unimanual to bimanual-equal, and then to bimanual-unequal movements resulted in slower and less accurate performance. Across all conditions, significant beta event-related desynchronization (ERD) and gamma event-related synchronization (ERS) were observed during movement, as well as beta ERS after movement. Bimanual movements exhibited greater beta ERD, beta ERS, and gamma ERS compared to unimanual movements. With practice, participants demonstrated faster and more accurate movements, accompanied by enhanced beta ERS responses. Furthermore, learning-related reductions in errors correlated with increases in beta ERS. These findings suggest the distinct behavioural and neural demands of unimanual versus bimanual movements and highlight the important role of beta activity in motor performance and learning.Significance statement Bimanual movements, which dominate daily motor behaviours, require finely tuned coordination between the two hands yet remain poorly understood at the neurophysiological level. Using magnetoencephalography, we tested neural responses to a novel movement task incorporating varying levels of bimanual interaction. We demonstrate that greater task complexity elicits enhanced movement-related brain activity in the beta and gamma frequency bands. Motor learning is associated with an increase in beta movement-related synchronization that correlates with improved movement accuracy. This study provides novel insights into how beta and gamma brain activity adapt to increasing movement complexity and motor learning.

Subgrouping autism and ADHD based on structural MRI population modelling centiles.

BACKGROUND: Autism and attention deficit hyperactivity disorder (ADHD) are two highly heterogeneous neurodevelopmental conditions with variable underlying neurobiology. Imaging studies have yielded varied results, and it is now clear that there is unlikely to be one characteristic neuroanatomical profile of either condition. Parsing this heterogeneity could allow us to identify more homogeneous subgroups, either within or across conditions, which may be more clinically informative. This has been a pivotal goal for neurodevelopmental research using both clinical and neuroanatomical features, though results thus far have again been inconsistent with regards to the number and characteristics of subgroups. METHODS: Here, we use population modelling to cluster a multi-site dataset based on global and regional centile scores of cortical thickness, surface area and grey matter volume. We use HYDRA, a novel semi-supervised machine learning algorithm which clusters based on differences to controls and compare its performance to a traditional clustering approach. RESULTS: We identified distinct subgroups within autism and ADHD, as well as across diagnosis, often with opposite neuroanatomical alterations relatively to controls. These subgroups were characterised by different combinations of increased or decreased patterns of morphometrics. We did not find significant clinical differences across subgroups. LIMITATIONS: Crucially, however, the number of subgroups and their membership differed vastly depending on chosen features and the algorithm used, highlighting the impact and importance of careful method selection. CONCLUSIONS: We highlight the importance of examining heterogeneity in autism and ADHD and demonstrate that population modelling is a useful tool to study subgrouping in autism and ADHD. We identified subgroups with distinct patterns of alterations relative to controls but note that these results rely heavily on the algorithm used and encourage detailed reporting of methods and features used in future studies.

Teaching humanities in UK medical schools: towards community-building and coherence

Abstract Medical humanities teaching in UK medical schools has lacked cohesion, having developed opportunistically in different locations. Cohesion is necessary to develop an identifiable community of practice, but within that community there can be multiple readings of what ‘medical humanities’ are and how they may develop. This article details discussions held by medical humanities scholars teaching in UK medical schools at a workshop in January 2025 at the University of Oxford covering five key areas: the role of humanities scholars in medical schools, patients as partners in medical education, core curriculum teaching, intercalated teaching, and assessment. Our discussion highlights opportunities and challenges facing humanities teaching in UK medical schools today and calls for the creation of a community of medical humanities scholars working in UK medical education embracing diversity of opinion and practices. The article is specifically written as a synopsis of a brainstorming symposium.

Neurodegenerative Disease and Association Football (NDAF): Systematic Review and Meta-Analysis.

There is increasing concern that head injuries in Association Football (or soccer) may lead to adverse health outcomes. The aim of this study was to determine whether head impacts or injuries are associated with an increased risk of neurodegenerative disease. We performed a systematic search using PubMed, Embase, and Ovid (up to April 2025). Studies included investigated neurodegenerative diseases in football in comparison to control athletic and general populations. Data were extracted according to PRISMA guidelines. Studies with an odds ratio (OR) were included in the meta-analysis. A total of ten studies were included in this review, of which nine were suitable for meta-analysis from eight cohorts. The risk for developing any neurodegeneration was 1.69 OR (95%CI 1.11 to 2.59; p = 0.01); for Dementia, it was 2.16 OR (95%CI 1.60 to 2.93; p < 0.01; for Motor Neurone Disease (MND), it was 1.39 OR (95%CI 0.67 to 2.53; p = 0.21); for Parkinson's Disease (PD), it was 1.14 OR (95%CI 0.55 to 2.89; p = 0.79). Heterogeneity was reduced following the removal of two studies and the revised risk scores for any neurodegenerative disease; Dementia increased, with that for MND reaching significance, 1.81 OR (95%CI 1.22 to 2.30; p = 0.01), but there remained no association with PD. Evidence suggests that professional football significantly increases the odds of neurodegenerative disease.

User requirements for quantitative radiological reports in multiple sclerosis

Objectives: Quantitative radiological reports (QReports) can enhance clinical management of multiple sclerosis (MS) by including quantitative data from MRI scans. However, the lack of consensus on the specific information to include, on and clinicians’ preferences, hinders the adoption of these imaging analysis tools. This study aims to facilitate the clinical implementation of QReports by determining clinicians’ requirements regarding their use in MS management. Materials and methods: A four-phase Delphi panel approach was employed, involving neurologists and (neuro)radiologists across Europe. Initial interviews with experts helped develop a questionnaire addressing various QReport aspects. This questionnaire underwent refinement based on feedback and was distributed through the MAGNIMS network. A second questionnaire, incorporating additional questions, was circulated following a plenary discussion at the MAGNIMS workshop in Milan in November 2023. Responses from both questionnaire iterations were collected and analyzed, with adjustments made based on participant feedback. Results: The study achieved a 49.6% response rate, involving 78 respondents. Key preferences and barriers to QReport adoption were identified, highlighting the importance of integration into clinical workflows, cost-effectiveness, educational support for interpretation, and validation standards. Strong consensus emerged on including detailed lesion information and specific brain and spinal cord volume measurements. Concerns regarding report generation time, data protection, and reliability were also raised. Conclusion: While QReports show potential for improving MS management, incorporation of the key metrics and addressing the identified barriers related to cost, validation, integration, and clinician education is crucial for practical implementation. These recommendations for developers to refine QReports could enhance their utility and adoption in clinical practice. Key Points: Question A lack of consensus on essential features for quantitative magnetic resonance imaging reports limits their integration into multiple sclerosis management. Findings This study identified key preferences, including detailed lesion information, specific brain and spinal cord measurements, and rigorous validation for effective quantitative reports. Clinical relevance This study identified essential features and barriers for implementing quantitative radiological reports in multiple sclerosis management, aiming to enhance clinical workflows, improve disease monitoring, and ultimately provide better, data-driven care for patients through tailored imaging solutions.

The spatial layout of antagonistic brain regions is explicable based on geometric principles

Abstract Brain activity emerges in a dynamic landscape of regional increases and decreases that span the cortex. Increases in activity during a cognitive task are often assumed to reflect the processing of task-relevant information, while reductions can be interpreted as suppression of irrelevant activity to facilitate task goals. Here, we explore the relationship between task-induced increases and decreases in activity from a geometric perspective. Using a technique known as kriging, developed in earth sciences, we examined whether the spatial organisation of brain regions showing positive activity could be predicted based on the spatial layout of regions showing activity decreases (and vice versa). Consistent with this hypothesis we established the spatial distribution of regions showing reductions in activity could predict (i) regions showing task-relevant increases in activity in both groups of humans and single individuals; (ii) patterns of neural activity captured by calcium imaging in mice; and, (iii) showed a high degree of generalisability across task contexts. Our analysis, therefore, establishes that antagonistic relationships between brain regions are topographically determined, a spatial analog for the well documented anti-correlation between brain systems over time.

Improving Outcomes in Survivors of Sepsis-The Transition from Secondary to Primary Care, and the Role of Primary Care: A Narrative Review.

Sepsis is defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection. The number of patients with sepsis requiring critical care admission is increasing. At the same time, overall mortality from sepsis is declining. With increasing survival to hospital discharge, there are an increasing number of sepsis survivors whose care needs shift from the acute to chronic care settings. Recently, the phrase "post-sepsis syndrome" has emerged to encompass the myriad of complications in patients recovering from sepsis. The aim of this narrative review is to provide a contemporary summary of the available literature on post-sepsis care and highlight areas of ongoing research. There are many incentives for improving the quality of survivorship following sepsis, including individual health-related outcomes (e.g., increased survival, enhanced physical and psychological health) and wider socio-economic benefits (e.g., reduced economic burden on the healthcare systems, reduced physical and psychological burden on carers, ability for individuals (and carers) to return to workforce). Modifiable factors influencing long-term outcomes can be in-hospital or after discharge, when primary care physicians play a pivotal role. Despite national and international guidance being available, this area has been under-recognised historically, despite its profoundly negative impact on both patients and their families or caregivers. Contributing factors likely include the lack of a formally recognised "disease" or pathology, the presence of challenging-to-treat symptoms such as fatigue, weakness and cognitive impairment, and the prevailing assumption that ongoing rehabilitation merely requires time. Our review will focus on the following areas: screening for new cognitive and physical impairments; optimisation of pre-existing comorbidities; transition to primary care; and palliative care. Primary care physicians may have a crucial role to play in improving outcomes in sepsis survivors, and candidate interventions include education on common complications of post-sepsis syndrome.

Inherited retinal disease pathway in the UK: a patient perspective and the potential of AI.

BACKGROUND: Inherited retinal diseases (IRDs) are the leading cause of blindness in young people in the UK. Despite significant improvements in genomics medicine, the diagnosis of these conditions remains challenging, and around 40% do not receive a definite genetic diagnosis after extensive genetic testing. This survey aims to investigate the experience of individuals affected by IRDs, their relatives, friends and caregivers, focusing on their care and diagnostic journey. Additionally, it explores the potential acceptability of artificial intelligence (AI) technologies, such as Eye2Gene, that predict causative genes from retinal images of patients with IRDs. METHODS: This cross-sectional survey included Likert scale and open-ended questions and was distributed electronically using the Qualtrics platform between April and August 2024. The survey included questions on respondent demographics; their journey to receive specialist care and genetic testing; their information needs and their attitude towards AI-augmented diagnosis. Descriptive statistics and content analysis were used to interpret the survey responses. RESULTS: The survey had 247 responses, of which 242 were analysed after removing four duplicates and one without consent; 80.2% were patients and the remainder were relatives, friends or caregivers. There was substantial variability in patient diagnostic journeys in terms of waiting times to see a specialist (IQR, 1-4 years), commute required (IQR, 10-74 miles) and number of visits to reach a diagnosis (IQR, 2-4). A substantial proportion of patients (35.8%) had a change in diagnosis. The majority of respondents (>90%) were overwhelmingly in favour of the integration of AI into the IRD pathway to accelerate genetic diagnosis and improve care. CONCLUSION: This survey identifies several key gaps and disparities in the IRD care pathway which may potentially be bridged with AI. The survey also reveals a favourable attitude towards incorporating AI into diagnostic testing of IRDs.

Oxygen therapy in early warning scores: a systematic review and meta-analysis

Background Early warning systems (EWS) used across the world typically assign a fixed number of points to patients receiving supplemental oxygen, regardless of amount. This ordinal binary approach may fail to recognise deteriorating patients who have an increasing oxygen requirement with otherwise stable observations. It is unclear whether weighting oxygen beyond binary scoring improves recognition of deterioration. Aims We aimed to describe all general adult EWS that grade oxygen beyond binary scoring (part 1). Where reported, we summarised the performance of graded oxygen EWS in comparison to binary scoring (part 2). Methods We systematically reviewed the literature, searching Embase, MEDLINE, CINAHL, Cochrane Central and Web of Science. We included studies of vital-sign-only EWS, for adult inpatients, which included grades of oxygen therapy above binary weighting (‘graded oxygen weighting’). We summarised methods of including graded oxygen therapy. We performed a random-effects meta-analysis of the effects of graded oxygen weighting inclusion in comparison to binary weighting. Risk of bias was assessed using the Prediction model Risk Of Bias ASsessment Tool. Results 15 studies reported the development of 16 EWS with graded oxygen weighting, classified by flow rate, delivery device and/or fraction of inspired oxygen. Four studies compared graded oxygen EWS to binary oxygen EWS. Meta-analysis showed a significant improvement in the performance of graded oxygen EWS over binary oxygen EWS (logit(AUROC)=0.19; 95% CI 0.094 to 0.285; p=0.002). 15/16 models were at high risk of bias. Conclusions 16 EWS with graded oxygen weighting were identified. Graded oxygen models had improved recognition of deterioration. Future work should explore the optimal method of oxygen classification and how this could be integrated into future EWS. PROSPERO registration number CRD42024443362.

Editorial Commitment to Trust and Integrity in Science: Implications for Pain and Anesthesiology Research

Academia in the throes of faceless bureaucracy

Pansieri et al. argue that bureaucracy is suffocating research, as an ever increasing administrative burden consumes researchers’ time and diverts focus from discovery to compliance. They highlight ways in which red tape delays progress, wastes funding, and drives researchers out of academia, and call for systemic change.

Investigating heterogeneity across autism, ADHD, and typical development using measures of cortical thickness, surface area, cortical/subcortical volume, and structural covariance.

INTRODUCTION: Attention-deficit/hyperactivity disorder (ADHD) and autism are multi-faceted neurodevelopmental conditions with limited biological markers. The clinical diagnoses of autism and ADHD are based on behavioural assessments and may not predict long-term outcomes or response to interventions and supports. To address this gap, data-driven methods can be used to discover groups of individuals with shared biological patterns. METHODS: In this study, we investigated measures derived from cortical/subcortical volume, surface area, cortical thickness, and structural covariance investigated of 565 participants with diagnoses of autism [n = 262, median(IQR) age = 12.2(5.9), 22% female], and ADHD [n = 171, median(IQR) age = 11.1(4.0), 21% female] as well neurotypical children [n = 132, median(IQR) age = 12.1(6.7), 43% female]. We integrated cortical thickness, surface area, and cortical/subcortical volume, with a measure of single-participant structural covariance using a graph neural network approach. RESULTS: Our findings suggest two large clusters, which differed in measures of adaptive functioning (χ 2 = 7.8, P = 0.004), inattention (χ 2 = 11.169, P 

Imaging the structural connectome with hybrid diffusion MRI-microscopy tractography

Whole brain comparative anatomy using connectivity blueprints

Comparing the brains of related species faces the challenges of establishing homologies whilst accommodating evolutionary specializations. Here we propose a general framework for understanding similarities and differences between the brains of primates. The approach uses white matter blueprints of the whole cortex based on a set of white matter tracts that can be anatomically matched across species. The blueprints provide a common reference space that allows us to navigate between brains of different species, identify homologue cortical areas, or to transform whole cortical maps from one species to the other. Specializations are cast within this framework as deviations between the species’ blueprints. We illustrate how this approach can be used to compare human and macaque brains.

Connectivity profile and function of uniquely human cortical areas.

Determining the brain specializations unique to humans requires directly comparative anatomical information from other primates, especially our closest relatives. Human (Homo sapiens) (m/f), chimpanzee (Pan troglodytes) (f), and rhesus macaque (Macaca mulatta) (m/f) white matter atlases were used to create connectivity blueprints, i.e., descriptions of the cortical grey matter in terms of the connectivity with homologous white matter tracts. This allowed a quantitative comparative of cortical organization across the species. We identified human-unique connectivity profiles concentrated in temporal and parietal cortices, and hominid-unique organization in prefrontal cortex. Functional decoding revealed human-unique hotspots correlated with language processing and social cognition. Overall, our results counter models that assign primacy to prefrontal cortex for human uniqueness.Significance statement Understanding what makes the human brain unique requires direct comparisons with other primates, particularly our closest relatives. Using connectivity blueprints, we compared to cortical organization of the human to that of the macaque and, for the first time, the chimpanzee. This approach revealed human-specific connectivity patterns in the temporal and parietal lobes, regions linked to language and social cognition. These findings challenge traditional views that prioritize the prefrontal cortex in defining human cognitive uniqueness, emphasizing instead the importance of temporal and parietal cortical evolution in shaping our species' abilities.

Predictive Methods and Probabilistic Mapping of Subcortical Brain Components in Fossil Carnivora.

Paleoneurology reconstructs the evolutionary history of nervous systems through direct observations from the fossil record and comparative data from extant species. Although this approach can provide direct evidence of phylogenetic links among species, it is constrained by the availability and quality of data that can be gleaned from the fossil record. Here, we sought to translate brain component relationships in a sample of extant Carnivora to make inferences about brain structure in fossil species. Using high resolution magnetic resonance imaging on extant canids and felids and 3D laser scanning on fossil Carnivora, spanning some 40 million years of evolution, we derived measurements for select brain components. From these primary data, predictive equations of cortical (gray matter mass, cortical thickness, and gyrification index) and subcortical structures (caudate nucleus, putamen, and external globus pallidus mass) were used to derive estimates for select fossil Carnivora. We found that regression equations based on both extant and simulation samples provided moderate to high predictability of subcortical masses for fossil Carnivora. We also found that using exploratory probabilistic mapping of subcortical structures in extant Carnivora, a reasonable prediction could be made of the 3D subcortical morphospace of fossil endocasts. These results identify allometric departures and establish adult species ranges in brain component size for fossil species. The integrative approach taken in this study may serve as a model to promote further dialog between neurobiologists working on extant Carnivora models and paleoneurologists describing the nervous system of fossils from this understudied group of mammals.

Connectivity profile and function of uniquely human cortical areas

Distinct impact modes of polygenic disposition to dyslexia in the adult brain.

Dyslexia is a common and partially heritable condition that affects reading ability. In a study of up to 35,231 adults, we explored the structural brain correlates of genetic disposition to dyslexia. Individual dyslexia-disposing genetic variants showed distinct patterns of association with brain structure. Independent component analysis revealed various brain networks that each had their own genomic profiles related to dyslexia susceptibility. Circuits involved in motor coordination, vision, and language were implicated. Polygenic scores for eight traits genetically correlated with dyslexia, including cognitive, behavioral, and reading-related psychometric measures, showed partial similarities to dyslexia in terms of brain-wide associations. Notably, microstructure of the internal capsule was consistently implicated across all of these genetic dispositions, while lower volume of the motor cortex was more specifically associated with dyslexia genetic disposition alone. These findings reveal genetic and neurobiological features that may contribute to dyslexia and its associations with other traits at the population level.

Generalising XTRACT tractography protocols across common macaque brain templates.

Non-human primates are extensively used in neuroscience research as models of the human brain, with the rhesus macaque being a prominent example. We have previously introduced a set of tractography protocols (XTRACT) for reconstructing 42 corresponding white matter (WM) bundles in the human and the macaque brain and have shown cross-species comparisons using such bundles as WM landmarks. Our original XTRACT protocols were developed using the F99 macaque brain template. However, additional macaque template brains are becoming increasingly common. Here, we generalise the XTRACT tractography protocol definitions across five macaque brain templates, including the F99, D99, INIA, Yerkes and NMT. We demonstrate equivalence of such protocols in two ways: (a) Firstly by comparing the bodies of the tracts derived using protocols defined across the different templates considered, (b) Secondly by comparing the projection patterns of the reconstructed tracts across the different templates in two cross-species (human-macaque) comparison tasks. The results confirm similarity of all predictions regardless of the macaque brain template used, providing direct evidence for the generalisability of these tractography protocols across the five considered templates.

Comparative anatomy of the caudate nucleus in canids and felids: Associations with brain size, curvature, cross-sectional properties, and behavioral ecology.

The evolutionary history of canids and felids is marked by a deep time separation that has uniquely shaped their behavior and phenotype toward refined predatory abilities. The caudate nucleus is a subcortical brain structure associated with both motor control and cognitive, emotional, and executive functions. We used a combination of three-dimensional imaging, allometric scaling, and structural analyses to compare the size and shape characteristics of the caudate nucleus. The sample consisted of MRI scan data obtained from six canid species (Canis lupus lupus, Canis latrans, Chrysocyon brachyurus, Lycaon pictus, Vulpes vulpes, Vulpes zerda), two canid subspecies (Canis lupus familiaris, Canis lupus dingo), as well as three felids (Panthera tigris, Panthera uncia, Felis silvestris catus). Results revealed marked conservation in the scaling and shape attributes of the caudate nucleus across species, with only slight deviations. We hypothesize that observed differences in caudate nucleus size and structure for the domestic canids are reflective of enhanced cognitive and emotional pathways that possibly emerged during domestication.