Payments for Ecosystem Services-Hydrological program (PSA-H) has targeted deforestation and forest degradation shows that both the process of identifying the eligible areas and the choice of the selection criteria for enrolling forest parcels have been under the influence of competing agendas. In the present paper we study the influence of the PSA-H multi-level governance on the environmental effectiveness of the program–the degree to which forest at high risk of deforestation is enrolled- building from a “policyscape” framework. In particular, we combine governance analysis with two distinct applications of the policyscape framework: First, at national level we assess the functional overlap between the PSA-H and other environmental and rural programs with regard to the risk of deforestation. Second, at regional level in the states of Chiapas and Yucatan, we describe the changing policy agenda and the role of technical intermediaries in defining the temporal spatialization of the PSA-H eligible and enrolled areas with regard to key socio-economic criteria. We find that, although at national level the PSA-H program has been described as coping with both social and environmental indicators thanks to successful adaptive management, our analysis show that PSA-H is mainly found in communities where deforestation risk is low and in combination with other environmental programs (protected areas and forest management programs). Such inertia is reinforced at regional level as a result of the eligible areas’ characteristics and the behaviour of technical intermediaries, which seek to minimise transaction costs and sources of uncertainty. Our project-specific analysis shows the importance of integrating the governance of a program in the policyscape framework as a way to better systematize complex interactions at different spatial and institutional scales between policies and landscape characteristics.Government based Payments for Ecosystem Services (PES) have been criticized for not maximizing environmental effectiveness through appropriate targeting, while instead prioritizing social side-objectives. In Mexico, existing literature on how the  Payment for Ecosystem Services-Hydrological program (PSA-H), to protect critical forests for water provision and regulation services [ejidos (collective lands granted to modern settlers) and traditional communities: We use the term communities to signify both. Private owners can also be contracted but represent a minority of the total number of beneficiaries. So far, PSA-H impact evaluation literature has focussed on the impact of on forest cover, with current findings estimating that the program helped to reduce the expected land-cover loss by 41–50% while also generating small but positive poverty alleviation [http://www.conapo.gob.mx/es/CONAPO/Indices_de_Marginacion_Publicaciones) as a result of an adaptive management strategy [Mexico has been one of the pioneer Latin American countries to have implemented a nation-wide Payment for Ecosystem Services (PES) program, here referred as the services . The proeviation ,3. When policyscape [Achieving two targets with only one instrument is a policy problem sensitive to the governance dynamics of program implementation and to the social-ecological characteristics of the landscape . A mix oicyscape . Since ticyscape ,9.Indeed, the geographical distribution of a policy depends on its governance dynamics, especially in countries like Mexico where targeting is politically sensitive and dependant on the negotiation power of the public and private actors involved . AlthougIn this paper, we confront governance dynamics at federal  and regional levels with the spatial distribution of the PAS-H and other environmental programs in order to explain the links between the multi-level governance of the programme and its capacity to target both deforestation and poverty objectives. We build a conceptual framework that combines governance analysis along two distinct policyscape applications: (i) First, at national level we compare the outcomes of federal stakeholder negotiations where the selection criteria to enrol forest parcels were decided with regard to the functional overlap between environmental policies and the risk of deforestation; (ii) Second, at regional level for the states of Chiapas and Yucatan, we analyse the spatialization of the PAS-H during the 2005–2010 period in terms of key socio-economic criteria  with regard to the role played by the changing political agenda and the structure of incentives from technical intermediaries.The paper is organised as follows: Section 2 presents the conceptual framework and the case study. Section 3 presents the results as a combination of qualitative stakeholder and statistical analysis at national and regional level. Section 4 discusses the implications of the multi-level governance in shaping the policyscape with regard to the objective of tackling deforestation and poverty and the utility of the proposed framework to analyse the spatial outcomes of multi-level policy processes.A multi-level governance analysis implies understanding how government and non-government organisations articulate their interests along the policy cycle of a program . A classdraw these areas using spatially explicit geo-physical  and socio-economic  data. Decision upon how final eligible areas will look like needs the formal approval of forest-related government bodies, such as the National Commissions for Water (CONAGUA), for Biodiversity (CONABIO) and for Natural Protected Areas (CONANP). Eligible areas are the spatial corset from which communities can potentially apply to the program. Then, forest parcels submitted to CONAFOR are classified based on a scoring system of selection criteria decided at federal level by a multi-stakeholder commission composed of public, private and civil society representatives [The policy cycle of the Mexican PSA-H program is characterised by different governance spaces at federal and regional levels that coexist in a complex organisational architecture where a large number of actors and institutions interact. Such multi-level governance architecture makes possible the confluence of public and private actors that intervene at three different phases of program implementation: the definition of the eligible areas, the selection criteria for enrolling forest parcels, and the final selection of proposals . Eligiblntatives . After eTo understand the influence of the PSA-H multi-level governance on the resulting policyscape we use an analysis framework  that comDescriptive statistical analyses are performed at two levels: At national level, we describe the functional overlap between environmental (including the PSA-H) and production support programs and the deforestation risk. We used data from the National Survey of Agrarian and Forestry Settlements of 2011 (ENNAF), a national survey previously performed in 2002 for a nationally representative random sample of 324 rural communities. Besides gathering data on the socio-economic characteristics and forest economic activities, the questionnaire gathers unique data on what programs are being implemented in each interviewed community. These programs fall into seven government programs: payments to support traditional maize agriculture (PROCAMPO), payments to support health-care costs of cattle (PROGAN), support to reforestation and soil restoration in forest areas (PROCOREF), support to forest management (PRODEFOR), payments for biodiversity (PSA-B), payments for hydrological services (PSA-H) and natural protected areas (NPAs). All forest programs  are included under the umbrella of the ProArbol—Renamed as PRONAFOR in 2013- macro-program .Then, at regional level for the states of Yucatan and Chiapas, we compiled a spatially explicit database of rural and forest communities by linking information from several secondary sources . The datMcAffee and Shapiro-Garza  and ShapWhat has been the impact of the negotiation process on the overlap between environmental policies and the deforestation risk? To answer this question we explore what policymixes exist in our ENNAF national sample of 324 forest communities. Programs analysed are PROGAN, PROCOREF, PROCAMPO, ProArbol  and NPAs. To explore statistical association trends among programs we perform a principal component analysis (PCA) . The thrNext, we assess the functional overlap between the four identified groups of policymixes and the deforestation risk of forest communities by plotting the probability of finding each policymix with regard to an axis accounting for the deforestation risk . The proThese patterns suggests that environmental policies, in close association with the PSA-H, are implemented in forests with low opportunity costs, where forest programs are economically attractive. This can be the result of both the failure of existing payment levels to attract forest communities with high deforestation opportunity costs and the result of governance dynamics that have prioritised social and environmental selection criteria, which correspond to forest communities with a low risk of deforestation.PSA-H eligible areas have been in constant change during the 2004–2011 period as a result of fluctuating political agendas from different stakeholders. The first phase, during the years 2004 to 2006, correspond to the kick-off of the program. As part of a learning by doing process, in 2004 federal institutions set eligible areas to protect recharging areas of overexploited and vulnerable aquifers based on the presence of dense forest and on data from CONAGUA. Additionally, as part of the vertical governance process described in During the second phase, from 2007 to 2009: In 2007, a major political change came into the scene. The newly elected president F. Calderón made the fight against poverty one of his political priorities, with an explicit reference to the support towards rural communities that assure the provision of forest ecosystem services to the country . Such poThe third phase, from the year 2010 to 2012 saw a major administrative change. In 2010, the biodiversity and hydrological payments for environmental services were officially merged into one program, divided in six spatially different regions: The first 3 ones with the highest payments were devoted to hydrological services, whereas the last 3 ones with smaller payments were under biodiversity services eligible areas  to participate in the program. In order to capture their possible role in defining the spatialization of the PSA-H, we assess the characterisitics of enrolled vs non-enrolled communities within eligible areas . In the To crosscheck the statistical results we explored, during the two expert workshops with stakeholders, what structure of incentives guided the choice of TI with regard to what communities they would prefer to support. In Yucatan TI were mainly small consulting firms specialised in rural development. They expressed a preference to work with communities with large forests and fewer households. They also prioritise communities where governance is transparent, with a good leadership. Finally, they prefer to exclude communities where forest is under high deforestation pressure, near cities or affected by future infrastructure developments , since thay are aware that payments will not compete with potential gains from deforestation. In the state of Chiapas TI are composed of environmental and biodiversity conservation NGOs whose agenda is tied to supporting conservation and development activities in NPAs, areas where they have a working record.http://www.conanp.gob.mx/difusion/comunicado.php?id_subcontenido=75). Working in areas where intermediaires have a working record–i.e. in NPAs- also disminishes this source of uncertainty while being able to adopt a long term support strategy. A second source of uncertainty is related to the mistrust towards the capacity of the administration to assure funds for the whole 5-year cycle of payments. TI will prefer selecting communities with large forests in order to get larger payments and bigger commissions for their services.Such behavior is in line with the objective of minimising contracting transaction costs   but alsoNational government PES programs entail large and complex governance structures involving multiple sequential implementation steps at different geographic scales. For policy targeting to assure program objectives, the multi-level governance has to be aligned to program objectives all along the policy process . The MexThe selection criteria operates as a filter within the eligible areas to enroll best-suited communities. The eligible area, settled at federal level after consulting different government and non-government stakeholders, increased along the years as a result of the integration of more objectives–in a similar manner as the design of the selection criteria- and a sharp budget increase under the political will of the F. Calderon presidency. Interestingly, the mean values of key socio-economic criteria in eligible areas remained fairly similar across the yearswhich suggests a resilient eligibility strategy from the federal forest administration since its implementation. Nevertheless, the spatialization of the PSA-H emerges only after technical intermediaries come into action. Existing theorethical models on the influence of technical intermediaries of the effectiveness of PES point out that they select communities mainly based on the minimisation of transaction costs and sources of uncertainty ,22. By tLarge public PES programs rely on targeting to assure that political and institutional objectives are met. In the present paper we assess the impact of the multi-level governance of the Mexican program of payments for hydrological services on the targeting process for enrolling communities with high deforestation risk and marginality as the main two policy objectives. We combine the policyscape framework with a governance analysis at national and regional level for the states of Chiapas and Yucatan. At national level, PSA-H implementation can’t cope with high deforestation risk areas where land uses are specialized towards agricultural production. As a consequence, PSA-H is implemented together with and reinforcing already existing conservation programs like NPAs, and forest management programs. At regional level in the states of Yucatan and Chiapas, we explore the socio-economic characteristics of communities within eligible and enrolled areas. In both states, both eligible and enrolled communities fall in areas with extensive forests and associated with low deforestation risk. In Chiapas, eligible and enrolled areas include also high marginal zones, as a result of a political will. Finally, technical intermediaries seek to maximize profits while minimizing sources of uncertainty: They prioritize communities with large forests, reinforcing this specific feature of eligible areas, but also communities less densely populated and with good governance, in order to minimize negotiations costs and uncertainty with respect to the behavior of contracted parties. The combination of a quantitative policyscape framework with multi-level governance analysis is a useful tool to clarify the complex interactions between governance dynamics and policy spatial implementation outcomes in order to assess the degree of syncronisation between governance dynamics, policy objectives and landscape characteristics.S1 Appendix(DOCX)Click here for additional data file.S2 Appendix(DOCX)Click here for additional data file.S1 Table(DOCX)Click here for additional data file.S2 Table(DOCX)Click here for additional data file.S3 Table(DOCX)Click here for additional data file.


Older adults living in long term care (LTC) settings are vulnerable to fall-related injuries. There is a need to develop and implement evidence-based approaches to address fall injury prevention in LTC. Knowledge translation (KT) interventions to support the uptake of evidence-based approaches to fall injury prevention in LTC need to be responsive to the learning needs of LTC staff and use mediums, such as videos, that are accessible and easy-to-use. This article describes the development of two unique educational videos to promote fall injury prevention in long-term care (LTC) settings. These videos are unique from other fall prevention videos in that they include video footage of real life falls captured in the LTC setting.Two educational videos were developed (2012–2013) to support the uptake of findings from a study exploring the causes of falls based on video footage captured in LTC facilities. The videos were developed by: (1) conducting learning needs assessment in LTC settings via six focus groups (2) liaising with LTC settings to identify learning priorities through unstructured conversations; and (3) aligning the content with principles of adult learning theory.The videos included footage of falls, interviews with older adults and fall injury prevention experts. The videos present evidence-based fall injury prevention recommendations aligned to the needs of LTC staff and: (1) highlight recommendations deemed by LTC staff as most urgent (learner-centered learning); (2) highlight negative impacts of falls on older adults (encourage meaning-making); and, (3) prompt LTC staff to reflect on fall injury prevention practices .Educational videos are an important tool available to researchers seeking to translate evidence-based recommendations into LTC settings. Additional research is needed to determine their impact on practice. Older adults who live in long term care (LTC) facilities are highly vulnerable to falls and fall-related injuries ,2. Most The Technology for Injury Prevention in Seniors (TIPS) program is a multi-year research program funded by the Canadian Institutes of Health Research (CIHR) that seeks to identify best practices in fall prevention and translate these into practical and sustainable strategies for LTC settings. TIPS used innovative technologies to determine the causes and circumstances of falls among older adults, including:1.) Networks of digital video cameras and wearable sensors to record falls and fall mechanisms and2.) Hip protectors and compliant flooring to reduce the risk for fall-related injuries.As part of the TIPS study, digital video cameras were installed in common areas  of two LTC facilities in British Columbia, Canada. Cameras recorded resident activities and any adverse events, such as falls. This footage provided unique evidence of the causes and mechanisms of falls within older adults’ everyday context . IncorreGiven the significant potential for TIPS to inform multi-factorial fall prevention strategies, and requests from LTC staff to view the video captured falls in efforts to improve their practices around fall and injury prevention, the research team (SKIPS: “Support Knowledge and Injury Prevention in Seniors”) was formed. The goal of SKIPS  was to promote the uptake of TIPS research findings among staff in LTC settings, and included TIPS research team members , geriatrics researchers  and nurses and administrative staff with experience in LTC settings (GG & VS). Given the unique opportunities provided by the video footage of falls, the project team decided to develop two educational videos for use in degree and diploma programs for LTC staff  and as part of continuing education in LTC settings. The decision to make videos was based on the availability of the fall capture videos and requests from LTC to develop fall and injury prevention educational materials that were easy to understand, easy to access and could be delivered on a coffee break (around 15–20 minutes).http://www.youtube.com/sfuTIPS) and accompanying curriculum for classroom and continuing education activities (available at: http://www.sfu.ca/tips), are designed to improve fall injury prevention in LTC settings through increased understanding of the causes of falls and how falls might be prevented. They also provide a seldom seen look at what actual falls look like. Most falls go unwitnessed so these educational videos provide a rare opportunity to stimulate discussion about real fall instances. Based on these educational videos, the objectives of this paper are to: 1) outline the unique aspects of these videos and; 2) provide an overview of the video development process to assist nurse educators (and others) who may wish to conduct similar projects, in future.The two videos were developed in conjunction with the SKIPS team and LTC staff. The videos integrate fall capture video footage and interviews with older adults, LTC staff, and fall prevention researchers and provide a practical, easy-to-understand approach to implement fall prevention recommendations in LTC settings. These educational videos draw upon principles of adult learning theory ,10,11. T, “Everybody Falls Sometime: An Introduction to the Prevention of Falls and Injuries in Long-Term Care” and “Evidence from Real-Life Falls: How to Manage Risk and Prevent Injuries in Long-Term Care”, to support the implementation of evidence-based fall and fall related injury prevention training in LTC settings. Educational videos were identified as the ideal strategy given that video was a medium through which the previously acquired fall capture videos [In 2012, the SKIPS team embarked on a one-year project to develop two educational videose videos . It was An experienced adult educator with a background in visual arts was hired as the Project Coordinator (LBD) to develop the videos in collaboration with the TIPS study team. In addition, the Project Coordinator regularly consulted with healthcare professionals working in LTC settings, including clinical nurse specialists and nurse educators, to enhance the relevance of the video and supporting curriculum for LTC staff. The Project Coordinator also had access to transcripts from six focus groups with the LTC staff on their practices and learning needs with respect to fall and injury prevention. This interdisciplinary approach was rooted in the acknowledgement that, due to the complexities of fall injury prevention in LTC settings and the need for diverse perspectives to develop comprehensive fall prevention strategies. This approach recognized that fall injury prevention is beyond the scope of any single discipline, and that engaging diverse viewpoints allows for the development of a more holistic approach to learning ,15.The Project Coordinator conducted a learning needs assessment for fall injury prevention in LTC settings by drawing on findings from the focus groups, conversations with LTC staff and residents, peer-reviewed articles, and evidenced-based best practice guidelines available online. The project team determined that LTC staff needed further education regarding: (i) how to identify extrinsic and intrinsic risk factors for falls; (ii) how to implement multifactorial risk reduction strategies for fall injury prevention; and, (iii) ethical dilemmas relating to quality of life and autonomy in the context of fall injury prevention. These learning needs informed the development of the video so as to enhance its relevance to LTC staff and consider potential resource limitations in LTC settings.“Everybody Falls Sometime” older adults and long-term care staff shared stories of their experiences with falls and fall injury prevention. Learners are prompted to think about their own experiences in relation to the video [Evidence from Real-Life Falls”, emphasizes evidence-based recommendations for fall and injury prevention, and seeks to highlight steps that the motivated learner can take to minimize falls in LTC settings.To respond to these learning needs, SKIPS was guided by a conceptual approach that was designed to encourage practice reflection. This approach suggests that learners construct knowledge through a process of meaning-making that involves the hearing, telling and recognizing of stories ,16. Thushe video . In thishe video . In thisThe project team met four times over the course of the project. During an initial phone meeting, the project team finalized a project timeline and discussed the video’s objectives. Next, the Project Coordinator developed a video treatment, which outlined the video shoot location , potential participants, approach to the video, and other technical aspects of creating the video. These dimensions of the final product were informed by initial project meetings, site visits to the partnering LTC facility, and lessons learned during the learning needs assessment.The second meeting (in-person) involved ‘pitching’ the video treatment to the project team. Project team members were provided a detailed script that outlined the structure and content of the video in advance of the meeting. The script was revised during the meeting. Project team members viewed TIPS fall capture videos that were linked to key research recommendations and discussed how these might fit within the new video. The project team determined that two nurse educators (GG & VS) and two biomechanical engineers (SNR & FF) would appear in the video, and each would speak to a fall capture video and provide accompanying evidence-based practice recommendations.At the next meeting (in-person) the project team reviewed a rough cut of the video. A feedback form was used to make recommendations that would guide the editing process. Following this meeting, a rigorous editing session was conducted to complete the video. At the final meeting (by phone), the team discussed the video dissemination strategy. As a part of this dissemination strategy, the Project Coordinator worked collaboratively with nurse educators on the project team (VS & GG) and clinical nurse specialists and nurse educators in both of the partnering LTC settings to develop lesson plans to accompany the videos. These lesson plans elaborated upon the videos by linking the narrative content to specific evidence-based recommendations identified in the TIPS project. Lesson plans were designed for LTC and academic settings. At various stages of the project, the project team consulted with nurse educators to ensure content and tone was consistent with the needs of LTC staff and relevant for preparing students enrolled in academic programs to provide care and support to older adults in LTC settings.“Everybody Falls Sometime” weaves together the stories of older adults and LTC staff in relation to falls and fall injury prevention. It seeks to prompt reflection on fall injury prevention practices among learners by validating their experiences and highlighting the social, emotional and physical impacts of falls. Evidence from Real-Life Falls, is more didactic and presents fall capture videos and interviews with fall injury prevention experts who link falls video footage to evidence-based practice recommendations. “Everybody Falls Sometime” may be particularly valuable to nurse educators who choose to emphasize the affective domain of learning . Evidence from Real-Life Falls is tailored to the cognitive domain of learning . These videos are described below.The final deliverables were one 7 minute video and one 12 minute video, designed to be watched independently or together. To develop this video we adopted widely accepted tenets of adult learning theory; for example, the need to involve adults in the planning and evaluation of their instruction . TherefoParticipant narratives were used to tell the stories of LTC staff and older adults as experienced by staff and residents. The Project Coordinator in liaison with the larger team selected narratives to represent key themes that emerged during interviews with participants . Learning in adulthood is based on lived experience . Thus, tThe second video took a more traditional approach to instruction. Content was comprised of fall prevention experts who discuss four fall-related scenarios. Each case study begins with an introduction to address key issues related to cause and prevention of falls. Next, the video showcases a vivid, fall captured video that represents a common combination of cause and activity leading to a fall . The onscreen case study discussion focused on: (1) what caused this fall; (2) how could the fall have been prevented; and, (3) what could be done to prevent injury in the event of such falls.Researcher interviews in combination with fall capture videos create a synergy of auditory and visual learning styles. Dual-channel processing is more effective than single channel learning and learning is improved when instruction includes both visual and verbal information . The incThe completed videos were disseminated by the Project Team using a multi-dimensional strategy. This strategy engaged local community partners and included web-based distribution of the videos. In the local context, copies of the video and supporting curriculum were distributed to nurse educators in LTC settings across two health regions. Videos were screened at a local Geriatrics Services conference attended by more than 300 health care professionals and were featured at a Nurse Educator meeting hosted by the local health authority, attended by 18 clinical nurse educators and 4 clinical nurse specialists.The project team undertook several activities to expand the reach of the video beyond the local area. First, videos were posted to YouTube along with keywords to attract web traffic. The project team also disseminated information regarding the videos using nursing and geriatrics listservs, newsletters, and social media. Further dissemination plans involve laying videos at LTC staff meetings, presentations at conferences .The videos offer nurse educators a novel compliment or alternative to a traditional lecture format. The portability of the video provides learners and educators the opportunity to view the videos in a variety of settings, . Educational media that is accessible, convenient, and learner-centered may improve the teaching and learning of content . The vidThese visual, teaching and learning tools will be used by LTC staff and integrated into training programs for new staff to promote understanding of mechanisms that cause falls and to improve fall risk assessment and prevention strategies. Nurse Educators might also use these visual methods to highlight other related topics in the curriculum or to tailor learning to specific issues that arise in work settings. Fall capture videos provide learners with the rare opportunity to observe react to and critically examine a real-life fall without the urgency that accompanies bearing witness to one. Lessons learned can be used to inform and perhaps enhance practice, in future.This project encountered several challenges, and had several limitations, that should be considered. First, the relatively short time-frame for this project (one-year) limited the number and depth of consultations with LTC staff during the learning needs assessment. While the previously conducted focus groups had generated insights into the learning needs of LTC staff, they were not specifically focused on educational videos. Second, older adults who participated in the videos experienced multiple health challenges. These limited their ability to participate in video shoot over sustained periods of time. Finally, these videos were designed with a specific use in mind -- to effect positive change in fall and injury prevention in LTC settings only, and may not be relevant to other settings.The videos’ content weaves together the experiences of LTC staff and older adults and expert commentary by researchers to engage the learner. This approach, where the viewer is able to reflect on their own experiences in relation to what is happening in the video can contribute to improved practice . The vidThe authors declare that they have no competing interests.All authors contributed to the conceptualization of this study and development of the videos. LBD wrote the first draft of the manuscript. All authors contributed to the critical revision of the manuscript and approved the final version.The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1472-6920/14/102/prepub


Surface plasmon polaritons (SPPs) propagating at metal nanostructures play an important role in breaking the diffraction limit. Chemically synthesized single-crystalline metal nanoplates with atomically flat surfaces provide favorable features compared with traditional polycrystalline metal films. The excitation and propagation of leaky SPPs on micrometer sized (10–20 μm) and thin (30 nm) gold nanoplates are investigated utilizing leakage radiation microscopy. By varying polarization and excitation positions of incident light on apexes of nanoplates, wave-vector (including propagation constant and propagation direction) distributions of leaky SPPs in Fourier planes can be controlled, indicating tunable SPP propagation. These results hold promise for potential development of chemically synthesized single-crystalline metal nanoplates as plasmonic platforms in future applications. For example, Au nanoplates are demonstrated as ultra-smooth basis for nanoantennas to study the localized SPPs29303032In recent years, considerable interests have been taken in the development of metal nanostructures that support surface plasmon polaritons (SPPs)123567810121314151718202526In this paper, controlling the propagating leaky SPPs on chemically synthesized single-crystalline gold nanoplates is characterized by the LRM. Firstly, both synthesis of gold nanoplates and LRM setup for characterization are presented. These nanoplates possess large sizes of tens of micrometers as well as well-defined crystal orientations with atomically flat surfaces. Secondly, for triangular nanoplates, wave-vector distributions of two kinds of leaky plasmon modes are analyzed in far-field patterns on BFPs. The excitation position and polarization of incident light on the apex of nanoplates are manipulated to control the propagating characteristics of leaky SPPs visualized in both the real image plane and the Fourier plane. Thirdly, the propagation properties of leaky modes in different edges for hexagonal nanoplates are studied. Finally, the conclusion is given.2 and nanoplates with an edge length of tens of micrometres are chosen in experiments to investigate the propagating SPPs. The thickness of nanoplates used in experiments is around 30 nm, thus supporting leaky radiation of propagating SPPs into the substrate.The growth of gold nanoplates used in experiments is achieved following the chemical synthesis procedure described in previous reports28The sketch of the experimental setup is shown in 2-Au-air SPP planar mode (termed as “planar mode”) propagating mainly on the Au nanoplate surface. The other kind is SiO2-Au-air SPP corner mode (termed as “corner mode”) propagating along the nanoplate edges. The field distributions of these two modes  are shown in 2-Au (30 nm)-air SPP planar mode can be regarded as Au-air SPP planar mode slightly affected by the substrate. Therefore, its simulated effective refractive index (1.0168) is close to that of Au-air SPP planar mode (1.0127).Leaky mode analysis on synthesized nanoplates. There are two kinds of leaky modes that can be detected by the LRM at 980 nm wavelength. The first kind is SiO1 and kx2) in two directions along both edges from the apex are observable in the bright field of the real image plane  of leaky SPPs. The yellow dashed outer circle on the Fourier image represents neff = 1.49, which is the NA of the oil immersion objective. The inner circle on the Fourier image demonstrates neff = 1.0, defined by the critical angle of the air-glass interface. Two bright straight lines indicate the wave-vector distributions of the corner modes on the triangular nanoplate in the Fourier plane and the measured effective refractive indexes are 0.98. More importantly, the directions of the two straight lines in the Fourier plane are perpendicular to the edges of the gold nanoplate, indicating the two propagation directions along the edges of the nanoplate. Besides, a bright circular arc is also shown on the Fourier image with the effective refractive index quite near unity. It results from the excited SPP planar mode propagating in different directions over the whole nanoplate surface. The extra fringes shown in the Fourier plane are associated with interference between reflected SPPs from the edges and propagating SPPs. The number of the periodic fringes thus depends on the size of gold nanoplatesThe corresponding Fourier image is depicted in In order to further unveil the propagation properties of the corner modes on the edges of the nanoplate, the focusing position of the incident light is moved to the left or right side about several hundred nanometres away from the apex. As is shown in Additionally, the simulation results based on the finite-difference time-domain (FDTD) method for different focusing positions of incident light are presented in In this part, another method of manipulating propagation directions of SPP corner modes on nanoplates by polarization control of the focused light is investigated. The light is focused at the same positions as those in The experiment results are also verified by the FDTD simulation results, which are provided in The propagating properties of leaky SPP corner modes on hexagonal nanoplates are further studied. As is shown in 1, kx2 and kx3) of SPP corner modes along the three individual edges , two methods are adopted in the experiment. For the first method, the polarization of incident light is adjusted to maximize the excitation of SPP corner modes along one specific direction. This method exhibits the advantage of enhanced intensity of leaky SPP mode along one specific edge and thus can be used to control SPP propagation on hexagonal nanoplates. As are shown in In order to clearly identify the three wave-vectors  are analyzed. Both the propagation constant and propagation direction of leaky SPP modes on triangular and hexagonal nanoplates are obtained in the Fourier planes. The effective refractive indexes for the leaky SPP corner modes on triangular and hexagonal nanoplates are measured to be around 0.98. For triangular nanoplates, by manipulating the focusing position and polarization of incident light, the propagation directions and intensity of corner modes can be controlled between the two edges. When the focusing position of incident light is at the left (right) side of the apex, the leaky SPP corner modes propagating along the right (left) edge can be effectively excited. When the polarization of the incident light is adjusted, the intensity of the leaky SPP corner modes follows a sine function with respect to polarization angles. For hexagonal nanoplates, three wave-vectors of SPP corner modes are clearly demonstrated, thereby providing more degrees of freedom for manipulating the wave-vector of leaky SPPs in the SiOHow to cite this article: Luo, S. et al. Controlling wave-vector of propagating surface plasmon polaritons on single-crystalline gold nanoplates. Sci. Rep. 5, 13424; doi: 10.1038/srep13424 (2015).


Objectives: Deficit in visuospatial functions can influence both simple and complex daily life activities. Despite the fact that visuospatial deficit was reported in schizophrenia, research on visuospatial functions as an independent entity is limited. Our study aims to elucidate the impact of visuospatial deficit in comparison with verbal deficit on global functioning and quality of life in the first psychotic episode of schizophrenia spectrum disorder (FES). The significance of clinical symptoms and antipsychotic medication was also studied.Methods: Thirty-six FES patients and a matched group of healthy controls (HC group) were assessed with a neuropsychological battery focused on visuospatial (VIS) and verbal (VERB) functions. Using multiple regression analysis, we evaluated the cumulative effect of VERB and VIS functions, psychiatric symptoms (PANSS) and antipsychotic medication on global functioning (GAF) and quality of life (WHOQOL-BREF) in the FES group.Results: The FES group demonstrated significant impairment both in VIS and VERB cognitive abilities compared to the HC group. Antipsychotic medication did not significantly affect either VIS or VERB functioning. PANSS was not related to cognitive functioning, apart from the Trail Making Test B. In the FES group, the GAF score was significantly affected by the severity of positive symptoms and VERB functioning, explaining together 60% of GAF variability. The severity of negative and positive symptoms affected only the Physical health domain of WHOQOL-BREF. The degree of VERB deficit was associated with both Physical and Psychological health. Although we did not find any relation between VIS functioning, GAF, and WHOQOL-BREF, a paradoxical finding emerged in the Environment quality domain, where a worse quality of the environment was associated with better VIS functioning.Conclusions: Our results suggest that the deficit in VIS functions is an integral part of cognitive deficit in schizophrenia spectrum disorders, rather than a side effect of symptomatology or antipsychotic medication. Moreover, VERB functioning was a better predictor of GAF and WHOQOL-BREF than VIS functioning. Given the findings of negative or missing effect of VIS deficit on WHOQOL-BREF and GAF, the accuracy of these measures in evaluating the impact of global cognitive deficit on everyday life in schizophrenia could be questioned. Abnormalities in cognitive functions are considered to be one of the key components in Schizophrenia (SZ). Neurocognitive deficit represents a reliable feature, with moderate to large effect size on global functioning across all cognitive domains  antipsychotic treatment on some motor and visuospatial functions , and recognition of territorial boundaries  and global functioning or QOL  Are visuospatial abilities impaired in the first-episode schizophrenia spectrum (FES) patients in comparison with the matched group of healthy controls? If that is the case, is the degree of the deficit the same as in verbal functions?(2) Are the VIS functions in FES patients affected by the antipsychotic medication and the actual psychiatric symptomatology (measured with PANSS)? Is similar effect visible in the VERB functions?(3) Is the global functioning and the quality of life in FES patients affected by VIS functioning when analyzed in the presence of VERB functions and clinical characteristics (symptoms and medication dose)? If so, is the effect of visuospatial and verbal functioning the same?N = 4) and F23.1/F23.2 (N = 32)] were recruited at the National Institute of Mental Health (NIMH). Patients were evaluated once they were stabilized at the end of their first psychiatric hospitalization in partial symptomatic remission state, according to Andreasen's remission criteria (2005). The group was considered in partial remission state rather than in complete remission, as they did not fulfill the criterion of asymptomatic 6-month period. Study subjects were diagnosed in a routine clinical process by two experienced psychiatrists. In case of diagnostic disagreements  the specific case was excluded from the study.Thirty-six subjects  who met ICD-10 criteria for the first psychotic episode of schizophrenia spectrum disorder [F20.X  was recruited from the same socio-demographic background via a local advertisement. The inclusion criteria for both groups were: (a) 17–35 years of age; (b) no history of neurological disease or loss of consciousness longer than 10 min; (c) native in Czech/Slovak language; and (d) additionally for the FES group to meet ICD-10 diagnostic criteria  and to be first admitted to psychiatric care. The main exclusion criterion for the control subjects was personal history of any psychiatric disorder; for the FES group it was the fulfilled diagnostic criterions for another psychiatric disorder. Both groups were carefully matched in terms of sex, age (max 2 years difference tolerance), and level of education  and suggested also by the MATRICS initiative  test was used in order to test spatial attention and working memory without uncontrolled examiner effects . We adjusted the original protocol of the Corsi block-tapping test . The significance level of all statistical analysis was set to 0.05. The group differences in demographic variables  were analyzed using non-parametric Mann–Whitney The raw scores of neurocognitive tests were used to compare performance between the FES subjects and the HC. Raw scores were transformed to z-scores in order to calculate cumulative scores of VERB and VIS scores. Z-scores were calculated as the difference among raw scores of the individual FES subjects and the HC group mean, divided by the HC standard deviation. The cumulative scores (VERB and VIS) were computed as a sum of the standardized z-scores divided by the number of applied measures from the relevant variables list as follows .The group of FES subjects showed significantly lower VIS performance on all three parts of the Rey-Osterrieth Complex Figure Test . The FES group was also slower in the Trail Making Test part A and part B. The average speed of FES subject responses in the PVT was lower and they also had a higher number of lapses (with reaction times above 500 ms). The FES subjects also made more errors on the Road Map Test (RMT). In addition, splitting of individual turns in the RMT ; the phonemic and semantic Verbal Fluency (VFT), abstract executive functions in the Similarities (Sim) and working memory in the DS task. No difference was observed in the immediate recall and attention performance in DS forward.First set of stepwise multiple regression analysis models of psychiatric symptomatology measured using PANSS  showed no effect of symptomatology on the performance in individual visuospatial and verbal tests (dependent variables), except for the performance in one single test—the Trail Making Test part B. Two of the three predictors from the regression model performed by stepwise method were significant: PANSS-N and PANSS-G. They explained more than 40% of performance variability in the TMT-B test  only in one verbal test—the phonemic Verbal Fluency Test (N = 35). CPZ explained 11% of performance variability . This observation would not survive Bonferroni adjustments (p = 0.027). No effect of CPZ level was identified on cumulative VERB and VIS scores.We did not observe any significant influence of medication (CPZ) on the performance in any of the visuospatial tests using the linear regression analysis. We identified negative effect of medication dosage , we performed a multiple regression analysis with the following predictors: PANSS-P, PANSS-N, PANSS-G, CPZ level, and cumulative VIS and VERB scores , verbal functioning (cumulative VERB score) and positive symptoms (PANSS-P score) on perceived quality of Physical health (domain 1) in FES. These predictors together explained nearly 50 % of the observed variability . In contrast, the Environment quality (domain 4) appeared to be affected mostly by one significant parameter, the cumulative VIS score performance. This factor explained together with CPZ level around 27% of the observed variability in domain 4  and in the delayed recall of visuospatial information (RCFT after 3 and 30 min), while the recognition (RCFT recognition) of visuospatial material was comparable with the performance of HC. This finding was characterized by a reduced number of recalled details but not by an increased rate of forgetting. This is consistent with a disturbance in encoding or retrieval from memory but no deficit in information storage  also showed significantly slower processing speed, impaired visuomotor tracking and switching ability. Although the performance on the TMT might be perceived as partly language dependent, since the sequence of numbers or numbers and letters has a verbal component, participants' visuospatial tracking ability is the main cognitive domain assessed by this task. The higher ratio of TMT B/A also pointed out a deficit in executive control function , which to our knowledge has not been previously used in FES patients. The higher number of total errors shows deficit in left/right direction sense, and additionally in perspective taking abilities Schultz, . These aU = 445; p = 0.023).The visuospatial executive planning ability, measured with the Key Search Test (KST), failed to show a deficit in FES subjects. Impairment in KST was previously demonstrated in studies of chronic SZ , and in verbal learning and delayed recall (AVLT). It would be interesting to also analyze the verbal recognition pattern and compare it to the results of visuospatial recognition. Studies addressing this topic in SZ showed that the verbal recognition is preserved . Moreover, the pattern of deviation in both tests was similar  of immediate recall and working memory (WM) showed similar patterns in FES  initiative  were positively associated with overall VERB performance, whereas only one domain (Environment) was related to overall VIS functioning and this association was negative. Better cumulative VIS score was associated with worse environment quality . Some previous studies have reported similar counterintuitive negative correlations  and to identify individual cognitive domains affecting QOL and GAF, a larger sample size is needed.Second, the issue of cross-sectional vs. longitudinal studies in this area is important. The present study, although cross-sectional, has identified some specific effects that can be examined over a longer time period. The next step in this research is, therefore, to track the longitudinal effect of visuospatial functions on global functioning and QOL in schizophrenia. We are currently conducting a follow-up assessment in our study group 1 year after their first hospitalization to measure the cognitive functioning in full remission state. Moreover, studies comparing FES with chronic schizophrenia patients are limited. To address this limitation we are assessing a chronic SZ sample in order to analyze the influence of the illness duration on relations between neurocognition, QOL, and GAF.Third, the fact that the verbal and visuospatial neuropsychological tests were not always matched in terms of the measured cognitive domain, and for psychometric parameters, might be another possible limiting factor. In addition, not all test methods are validated in schizophrenia and some of them are not standardized for Czech population either. Measures validated in schizophrenia population might be expected to be more sensitive when capturing a degree of deficit. We are also aware of the fact that we don't cover all the functions of each cognitive domain. For example we did not include verbal recognition in our analysis; therefore the encoding ability could not be assessed as clearly as in the visuospatial domain. More specific and detailed visuospatial assessment is necessary in order to cover all domains that can be related to functional outcome and QOL in schizophrenia spectrum disorders.Fourth, measures of QOL and global functioning applied in this study could be limited in terms of their association with cognitive functioning in SZ. It would be very helpful to compare them to other methods that might be more related to neurocognition. For example, the Social and Occupational Functional Assessment Scale (SOFAS) could provide a better measurement of functional outcome that is not tied to symptomatology. In addition, only subjective QOL was measured in this study. Objective measures of QOL are needed in order to understand the complex relationships of psychosocial functioning and neurocognition in SZ. According to our results about relation of specific domains of QOL and GAF obtained in the ex post facto measures, we suggest that these associations should be further investigated in future research.Finally, several neurotransmitter functions are affected by atypical antipsychotics and our study applied only the CPZ equivalent. Future study should also address other factors in order to analyze the effects of medication on cognitive abilities in greater detail.MR, KV, and IF designed the study and together with KD, FS, and ZK wrote the original protocol. IF, DL, LK, and KS recruited the participants, and they performed the neuropsychological assessment. IF and KV pre-processed the data and JP undertook the statistical analysis. MR supervised the study. MR and IF wrote the first draft of the manuscript. FS, KV, and KD contributed to data interpretation. All of the authors discussed the results and contributed to the final version of the paper and have approved it.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


Musical performance requires extremely fast and dexterous limb movements. The underlying biological mechanisms have been an object of interest among scientists and non-scientists for centuries. Numerous studies of musicians and non-musicians have demonstrated that neuroplastic adaptations through early and deliberate musical training endowed superior motor skill. However, little has been unveiled about what makes inter-individual differences in motor skills among musicians. Here we determined the attributes of inter-individual differences in the maximum rate of repetitive piano keystrokes in twenty-four pianists. Among various representative factors of neuromuscular functions, anatomical characteristics, and training history, a stepwise multiple regression analysis and generalized linear model identified two predominant predictors of the maximum rate of repetitive piano keystrokes; finger tapping rate and muscular strength of the elbow extensor. These results suggest a non-uniform role of individual limb muscles in the production of extremely fast repetitive multi-joint movements. Neither age of musical training initiation nor the amount of extensive musical training before age twenty was a predictor. Power grip strength was negatively related to the maximum rate of piano keystrokes only during the smallest tone production. These findings highlight the importance of innate biological nature and explicit training for motor virtuosity. Motor virtuosity represents extremely fast and dexterous motor actions of highly skilled individuals, such as musicians, athletes, and surgeons, which has fascinated people worldwide for centuries2353The maximum movement speed at the limb endpoint  does not necessarily correlate with movement speed at all joints in multi-joint upper-limb movements during musical performance, such as repetitive strikes of piano keys891113The present study aims at identifying attributes of inter-individual differences in the maximum rate of repetitive piano keystrokes in skilled pianists. The repetitive strikes of two keys with the thumb and little finger were used in this study because our previous studies confirmed that a skillful coordination of multiple joints from the shoulder to the finger is required for movement production1016Twenty-four pianists, who ranged from winners of international piano competitions to amateur players, were asked to strike two piano keys repetitively with their thumb and little finger as fast as possible at four different loudness levels. The maximum rate of the piano keystrokes was computed based on key-position data measured using a high-speed camera. We further evaluated neuromuscular functions, such as the tapping rate of the finger, wrist, and elbow, the maximum force of the individual muscles of the upper-limb, power-grip force and the history of musical training, such as the age of starting piano playing and total hours of piano practice until age twenty, as possible predictors. These factors were used as independent variables in a stepwise multiple regression analysis to identify potential predictors of inter-individual differences in the maximum rate of piano keystrokes across the players at each loudness level. We used a stepwise regression to reduce the number of predictor variables because of a relatively small sample size compared to the number of independent variables . The prediction model of the maximum keystroke rate based on these selected variables was then rebuilt using a generalized linear model (GLM).2 = 0.03). The loudness effect indicates that pianists played faster at louder tone production. The mean and standard deviation of the maximum rate of piano keystrokes of each participant was computed for each loudness levels, and a correlation coefficient between these two variables was computed across all participants to further assess whether the faster strikes of pianists were merely due to lower movement accuracy according to a speed-accuracy tradeoff2 and p values of the regression model were 0.68 and 3.49 × 10−5 at p, 0.57 and 1.44 × 10−4 at mp, 0.45 and 0.002 at mf, and 0.31 and 0.005 at f, respectively.A stepwise multiple regression analysis was performed for each loudness level to identify a small set of predictors of the maximum rate of repetitive piano keystrokes. The analysis identified that the maximum muscular forces for extension and flexion were not significant predictors at any of the loudness levels (p > 0.05), except for the elbow extension muscular force at p, mp, and mf . ConcernA GLM was developed at each loudness level using the variables selected by the stepwise regression. We compared models under the assumption of different data distributions  because of the lack of prior information on data distribution and relatively small sample size. The comparison was performed based on AIC computed by GLM . The results demonstrated that the best regression model of the maximum rate of piano keystrokes was obtained when assuming the data distribution as Gaussian at p (AIC = 20.82), Gamma at mp (AIC = 24.65), inverse-Gaussian at mf (AIC = 34.04), and Gaussian at f (AIC = 37.50). Previous studies assessed relationships between finger tapping rate and the amount of practice and the starting age of musical training. Therefore, we further assessed correlations between the maximum rate of finger tapping and these two variables. The results demonstrated that neither the total amount of practice duration  nor the starting age of musical training  significantly correlated with the tapping rate.Previous studies have focused on investigating the precise temporal control of a simple motor task. In contrast, the present study assessed predictors of individual differences in the maximum rate of repetitive piano keystrokes, which involves naturalistic multi-joint upper-limb movements, among twenty-four pianists. Our results demonstrated that two factors predicted individual differences in the keystroke rate: the maximum rate of single finger tapping and the maximum strength of elbow extensor muscles. The fastest tapping rate was used to assess movement quickness at a target body part, such as finger, wrist, and elbow2021Previous studies found changes in the maximum rate of repetitive finger tapping with training in musically untrained individuals2335The second factor was the maximum strength of the elbow extensor muscles. In our previous kinematic study, fast repetitive keystrokes of two keys simultaneously were characterized by tempo-dependent involvement of the elbow extensor musclesNotably, a predictor of the maximum rate of piano keystrokes was limited to the finger-tapping rate when eliciting the loudest tones. Our previous kinematic study found a larger increase in finger flexion velocity with tempo at louder tones during repetitive piano key strikesThe power grip force negatively correlated with the maximum rate of repetitive piano keystrokes only when eliciting the smallest tones, which indicates faster keystrokes in pianists with smaller grip force. Even a small deviation of the key-striking force yields a large change in loudness when eliciting a small piano tone28Notably, several factors were not identified as significant predictors of the rate of repetitive piano keystrokes. For example, the amount of accumulated practice hours before age twenty  was reported as a predictor of the performance of highly skilled movementsTwenty-four pianists  participated in the experiment. Eighteen pianists majored or had majored in piano performance at music conservatories, and eleven of these pianists won prizes at international piano competitions, such as the Queen Elisabeth International Music Competition and Concours International Marguerite-Long-Jacques-Thibaud. Six pianists had not formally studied in music conservatories, but privately studied with piano teachers and practiced piano daily. Participants were recruited to minimize the inclusion of pianists with the same educational background . The local ethics committee of Osaka University approved the experimental protocol, and all participants gave informed consent prior to the experiment. The experiment was performed according to the Declaration of Helsinki.The present study began with experiments that evaluated history of musical training, anatomical characteristics, and neuromuscular functions. Each participant was asked their age, starting age of piano playing, and accumulated practice hours before age twentyFollowing the aforementioned three experiments, each participant was asked to strike two piano keys (E3 and C4) of an upright acoustic piano (YAMAHA U-1) with the thumb and little fingers simultaneously and repetitively as fast and accurately as possible at four loudness levels. The loudness level was determined according to the peak key-descending velocity, which is linearly scaled with loudness A stepwise multiple regression analysis was performed at each loudness level to determine the attributes of individual differences in the maximum movement rate of repetitive multi-joint upper limb piano key strikes across pianists. We used stepwise analysis as a tool for choosing a small set of independent variables as possible predictors and used these selected variables to develop the optimal GLM because of the large number of independent variables relative to the sample size. The stepwise regression analysis was run in both forward and backward directions to ensure that the selected variables were the same regardless of the direction of the analysis. The dependent variable was the rate of the fastest repetitive piano keystrokes, which was computed as the reciprocal of the mean inter-keystroke interval across thirty strikes for each pianist. The inter-keystroke interval was computed based on the time-varying data of the key vertical position. Independent variables related to neuromuscular functions included the maximum rate of single-joint tapping using the finger, wrist, and elbow  and the force exerted during MVC for the flexion and extension of the finger, wrist, elbow, and shoulder joints . The maximum tapping rate was defined as the reciprocal of the mean inter-tap interval derived from the time-varying fingertip force data, and the maximum muscular force was computed as the mean value during the MVC task. Variables related to the history of musical training and anatomical characteristics were also included in the same regression analysis. The fundamental data analyses and stepwise regression analyses were performed using MATLAB (Mathworks co.).The GLM was developed at each loudness level using the independent variables that were selected from the stepwise multiple regression analysis. GLMs that assumed different distribution functions, including Gaussian, Gamma, and inverse-Gaussian, were developed because of the lack of prior information on data distribution and compared according to Akaike’s information criterion (AIC). Therefore, the optimal model exhibited the smallest AIC value. Bootstrap resampling over 1000 times was run for the individual GLM to further obtain the confidence interval of coefficients of the model. GLM and bootstrapping was performed using R (ver. 3.1.1).How to cite this article: Furuya, S. et al. Secrets of virtuoso: neuromuscular attributes of motor virtuosity in expert musicians. Sci. Rep.5, 15750; doi: 10.1038/srep15750 (2015).


Soldiers and recreational backpackers are often required to carry heavy loads during military operations or hiking. Despite the advances in backpack design, the loads carried by soldiers still impose an extreme physiological strain (soft tissue deformation) which frequently results in discomfort, pain, and musculoskeletal injuries. Shoulder strain, which appears to be one of the limiting factors of load carriage, is thought to result from higher susceptibility to short-term injuries such as soft tissue damage and/or trapped nerves and obstruction of blood vessels. The aim of the current study was to develop a flexible model enabling to simulate real life loading scenarios  and that will help in optimising load carriage systems design and guidelines.Open-MRI scans were used for reconstructing a 3D geometrical model of an unloaded shoulder and for measuring the soft tissue deformations caused by a 25 kg backpack; subsequently, a subject-specific finite element (FE) stress-strain analyses was developed. In this model, loads were applied at the strap-shoulder contact surfaces by pulling the strap towards the shoulder until the desired load was reached. Then, the model enables to calculate and analyse the strains in the soft tissues surrounding the brachial plexus.The newly developed model successfully enabled the prediction of soft tissue deformations in the brachial plexus surrounding tissues, which are caused by different backpack loads. Increasing the loads up to 35 kg  resulted in further increase in strains of the underlying soft tissues: the maximal tensile strain in the brachial plexus for a 25 kg backpack was 12% and while carrying 35 kg the maximal tensile strain increased to 16%. It also had been found in the study that the lateral aspects of the brachial plexus are more vulnerable to a deformation-induced injury, because at these aspects the nerve plexus is less protected against the compressive loads applied during load carriage.In addition, the model allows a better understanding of the more susceptible anatomical regions in the backpack-wearer interface. Based on previous animal studies, the soft tissue strains in the area of the brachial plexus as calculated by the model are substantial and might hamper normal nerve conductivity.This method is potentially a strong working tool allowing further developments of new strap structures and materials or backpack design for alleviating the strains applied on the shoulder's soft tissues.


The intestinal microbiome is defined as the assembly of genomes from microorganisms inhabiting the gut. This microbial ecosystem regulates important functions of the host and its correct composition and functionality is essential for a “healthy status.” Metagenomic studies have highlighted variations of the intestinal microbiota as a function of age and diet. Colonization of the infant gut starts at birth and is influenced by feeding habits (formula vs. breast-feeding), birth mode and antibiotic exposure. The intestinal microbiota of full-term vaginally delivered breast-fed infants is considered the gold-standard, representing the reference for studies of alterations in other pediatric populations. At 2–3 years of age, the intestinal microbiota reaches a composition similar to adults, remaining without noticeable variations until senescence, when microbial instability and changes reappear. Here we summarize the current knowledge on intestinal microbiota alterations at extreme stages of life and tools for designing differentiated nutritional strategies by the use of probiotics, prebiotics and specific nutrients in order to restore a balanced microbiota and to improve immune and nutritional status. It is increasingly clear that the gut microbiota is essential for maintaining health. Until recently its role in human health had remained largely unknown, mainly due to the lack of methods to study unculturable microorganisms, which constitute a large fraction of the gut microbiota. However, in recent years the development of next generation sequencing (NGS) methods has facilitated the performance of metagenomic studies to determine gut microbiome composition. These methods, together with the use of gnotobiotic animals have demonstrated the importance of the microbiota for host health, providing the basis for the use of dietary interventions aimed at counteracting microbiota aberrancies.Bacteroides, Prevotella, and Ruminococcus  and quantitative PCR (qPCR) also allow quantification of selected bacteria in mixed populations, but requires design of probes/primers and therefore cannot detect unknown or low abundance microbial groups. Therefore, total 16S rRNA gene sequencing through NGS platforms  is becoming the gold-standard for overcoming the limitations of the aforementioned methods. NGS platforms are improving to offer cheaper alternatives and better resolution to detect unculturable, unknown and low frequent bacteria  of 16S rRNA gene, coupled to Sanger sequencing . Fluoresbacteria . Signifibacteria  althoughonsuming . Microaronsuming .in vitro enrichment cultures from fecal samples, allowed complete genomes assembly of unculturable methanogenic archaeons, demonstrating that low frequency bacteria encode functionalities that might be relevant in the cross-talk between microbiota and host .In the elderly, the microbiota of a younger population of healthy adults otherwise sharing similar characteristics in terms of geographic location and diet as the older people is considered the benchmark of healthy microbiota. This reference group must have had a past socio-economic status as similar as possible to the elders: a history of exposure to different environments in the two populations may lead to attribute to aging, variations due to the action of different environmental factors such as those linked to social habits, nutritional patterns, or residence location . Loss of targets . Some nu targets . TherefoDifferent approaches have been proposed for restoring a balanced microbiota. Fecal transplantation is known from many years ago ; althougFigure 1.Probiotics are “live microorganisms which when administered in adequate amount confer a health benefit on the host” . The mosThe development of dietary intervention strategies specifically targeted to populations at the extreme ages of life, may constitute an interesting approach . A numbeMoreover, considering the wide impact of the microbiota on host physiology it may be time for addressing new targets such as the age-related chronic-inflammation  or the mThe authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


The Origins of Cancer Symposium is a meeting organized by graduate students at the Van Andel Research Institute and serves as a forum for focused discussion on factors that contribute to the etiology of cancer. The theme for the fifth annual Origins of Cancer held on July 11th, 2014 was Beyond the Tumor Cell, which focused on the complex influences coming from the environment in which the cancer cell exists. Here we report on the meeting proceedings and briefly discuss the far-reaching implications. Beyond the Tumor Cell, which focused on the complex influences coming from the environment in which the cancer cell exists.On July 11, 2014, scientists, clinical oncologists, and students from across the region convened for the fifth annual Origins of Cancer Symposium at the Van Andel Research Institute in Grand Rapids, MI. An adaptation of the original Oncogene meetings established by the Foundation for Advanced Cancer Studies in the 1980s, this one-day symposium was organized by senior Ph.D. students as part of their professional development training at the Van Andel Institute Graduate School . The symThe symposium began with talks highlighting the role of systemic inflammation in both health and disease. In his talk on inflammatory mediators, immune modulation and cancer progression, Raymond Dubois (The Biodesign Institute at Arizona State University) introduced the role of inflammation in cancer focusing on how NSAIDs are used to treat colorectal cancer. He outlined how anti-inflammatory therapy such as aspirin or celecoxib can be used to prevent progression in preclinical models of colon cancer -6. Dr. Din utero, beneficial environmental microbes stimulate integrated immune and neuroendocrine factors throughout the body [Susan Erdman (Massachusetts Institute of Technology) expanded the scope of inflammation and proposed that healthful longevity relies on microbial homeostasis, which properly conditions the immune system. In her talk about gut microbes and the cancer macroenvironment, Dr. Erdman suggested that early the body , 9. Dr. the body . She disJohanna Joyce  described her recent and exciting work targeting innate immunity in glioblastoma. After determining a strong correlation between tumor-associated macrophages and tumor progression, metastasis, and therapeutic resistance in her earlier work, the Joyce Lab has systematically proved that the colony stimulating factor-1 receptor is a viable therapeutic target in preclinical models of cancer, especially glioblastoma , 12. TheDrew Pardoll (Sidney Kimmel Comprehensive Cancer Center) highlighted his work on immunotherapy in his lecture about adaptive crosstalk between cancer and the immune system. He told the audience that immune checkpoint ligands and their receptors block the anti-tumor activity of cytotoxic T-cells in spite of tumor-specific immunity. These ligands are up-regulated in cancer and prevent cytotoxic T-cells from infiltrating the tumor. In support of this, he showed that patients treated with checkpoint blockade therapies have shown significant and persistent responses for even refractory melanomas , 15. AddShifting focus to the extracellular matrix (ECM) surrounding cancer cells, the symposium's afternoon speakers challenged the audience to continue to look beyond the intrinsic causes of cancer. Zena Werb  talked about the insights into cancer she gained by studying ECM proteolysis during development. Her studies of normal breast-ductal cells invading local tissue during development have led Dr. Werb to identify key factors involved in breast tumor cell invasion, such as the metastasis suppressor GATA3. She showed how GATA3 regulates miR29b expression, which in turn alters the expression of proteins that regulate angiogenesis and collagen proteolysis. Loss of GATA3 causes microenvironment remodeling that favors metastasis , 18.In his lecture, Andrei Seluanov (University of Rochester) described his research on a collection of atypical rodent models that led to his discovery of novel anticancer mechanisms in long-lived mole rat species . He demoPatrick Moore (University of Pittsburgh Cancer Institute) shifted the focus to microbes in cancer development and progression in his talk about Merkel cell polyomavirus (MCV) and Merkel cell carcinoma. There have been only seven well-established and characterized tumor viruses, and none of the seven are similar. The Moore-Chang laboratory discovered MCV as the causative agent of Merkel cell carcinomas using a novel technique they developed called digital transcriptome subtraction . MCV cauCrislyn D'Souza-Schorey (University of Notre Dame) switched the focus back to the ECM with an intriguing story about how cancer cells release microvesicles to modify the ECM for cancer cell invasion . Her talIn selecting this year's theme, our objective was to focus discussion on tumor cell extrinsic factors that promote cancer. We wanted to learn about the ways the tumor stroma and the immune system interact with tumor cells to influence cancer progression. What crystallized for us was the astounding concept that a tumor cell has no true autonomy; it is functionally integrated into and actively communicating with its host environment. And what happens to that host environment, locally or distantly in space and time, can profoundly influence disease progression. Dr. DuBois emphasized it best in stating, “Focus on the tumor microenvironment is critical now… . Cells interact in ways you can't understand by studying the tumor alone.” This new concept raises many interesting questions on the origins of cancer that we look forward to answering as we embark on our own careers in science.


Weight loss is one of the most researched and marketed topics in American society. Dietary regimens, medications that claim to boost the metabolism, and the constant pressure to fit into society all play a role in our patient's choices regarding new dietary products. One of the products that are well known to suppress appetite and cause weight loss is amphetamines. While these medications suppress appetite, most people are not aware of the detrimental side effects of amphetamines, including hypertension, tachycardia, arrhythmias, and in certain instances acute myocardial infarction. Here we present the uncommon entity of an acute myocardial infarction due to chronic use of an amphetamine containing dietary supplement in conjunction with an exercise regimen. Our case brings to light further awareness regarding use of amphetamines. Clinicians should have a high index of suspicion of use of these substances when young patients with no risk factors for coronary artery disease present with acute arrhythmias, heart failure, and myocardial infarctions.  Amphetamines are widely known to cause appetite suppression and encourage weight loss. Their other known side effects are hypertension, tachycardia, arrhythmias, and myocardial infarctions . Herein A 35-year-old African American female with no prior history of coronary artery disease and no significant family history presented with sudden onset of exertional chest discomfort with radiation to the back. The patient became unresponsive shortly after arrival to the emergency department and was subsequently found to be in ventricular fibrillation-cardiac arrest (V-fib). The patient was in V-fib for 6 minutes, with conversion after electrical cardioversion and subsequent development of PEA-arrest for a total of 4 minutes. Repeat EKG after return of spontaneous circulation demonstrated inferolateral STEMI . The patThe patient's cardiac function recovered with medical management. Subsequent transthoracic echocardiograms revealed improved ejection fraction to 60–65% after 11 days and a new finding of left ventricular apical thrombus. The patient received anticoagulation with intravenous heparin, as well as continuous treatment with dual antiplatelet therapy with aspirin and clopidogrel.The patient remained in the coronary care unit (CCU) for a total of 17 days. CCU course was further complicated by development of pulmonary edema with diffuse alveolar hemorrhage and developing MRSA and pseudomonas pneumonia.Due to the need for prolonged mechanical ventilation, the patient received a tracheostomy and continued to improve in terms of her pulmonary function while treated with antibiotics for ventilator-associated pneumonia. Her neurological status improved significantly, and on interview, she denied any use of Adderall, amphetamines, or illicit drugs that could have precipitated this event. She reported that recently she had increased her level of physical activity in order to lose weight and was supplementing such efforts with the addition of a natural weight loss dietary supplement.p = 0.0004) [Amphetamine use is strongly associated with coronary artery disease . The imm 0.0004) .There are multiple cases reported in the literature involving the development of an acute myocardial infarction due to amphetamine abuse. Chang and colleagues reported an unusual case of a silent ST elevation myocardial infarction following amphetamine use in a 61-year-old diabetic patient. In their case, the patient presented to the hospital without chest pain and normal cardiac enzymes; however, EKG revealed ST elevations in the inferior leads with reciprocal changes in the precordial leads. Subsequent percutaneous coronary angiography revealed total occlusion of the posterior-lateral segment of the right coronary artery. On further history, the patient had reported abusing amphetamines via inhalation prior to presentation . In a siβ-Methylphenethylamine (B-Methyl), a positional isomer of amphetamine with a similar profile effect as amphetamines [One of the side effects of amphetamine use is decreased appetite, a side effect that is desirable to some patients. The realization of such effect and the potential for inducing weight loss led to the introduction of amphetamines as appetite suppressants in the 1950s and development of the combination of Phentermine and Fenfluramine in the 1990s . The medetamines , in theiIn view of the positive toxicology screen for amphetamines and the lack of history of abuse or use by our patient, we propose the notion that weight loss dietary supplements in fact may contain amphetamines or amphetamine-like substances. With the popularity of such products among patients searching for aids in weight loss, there is a possibility that a portion of the population who regularly use these products might be exposed to unregulated levels of amphetamines or amphetamine-like substances. The acute and chronic consequences of use of these substances can be detrimental to patients, as they are at a higher risk for acute myocardial infarctions, increased risk of accelerated atherosclerosis, and early development of cardiac dysfunction due to recurrent myocardial injury , 5, 12.Our case illustrates how inadvertent use of amphetamines by patients with no history, risk factors, or significant family history of coronary artery disease can be the culprit for life threatening events. Patients often struggle with weight management, looking for alternatives to supplement their efforts to lose weight. Without proper disclosure and recent trend of the addition of amphetamines to dietary supplements , it is i


Populations of the same species can experience different responses to the environment throughout their distributional range as a result of spatial and temporal heterogeneity in habitat conditions. This highlights the importance of understanding the processes governing species distribution at local scales. However, research on species distribution often averages environmental covariates across large geographic areas, missing variability in population-environment interactions within geographically distinct regions. We used spatially explicit models to identify interactions between species and environmental, including chlorophyll a (Chla) and sea surface temperature (SST), and trophic (prey density) conditions, along with processes governing the distribution of two cephalopods with contrasting life-histories (octopus and squid) across the western Mediterranean Sea. This approach is relevant for cephalopods, since their population dynamics are especially sensitive to variations in habitat conditions and rarely stable in abundance and location. The regional distributions of the two cephalopod species matched two different trophic pathways present in the western Mediterranean Sea, associated with the Gulf of Lion upwelling and the Ebro river discharges respectively. The effects of the studied environmental and trophic conditions were spatially variant in both species, with usually stronger effects along their distributional boundaries. We identify areas where prey availability limited the abundance of cephalopod populations as well as contrasting effects of temperature in the warmest regions. Despite distributional patterns matching productive areas, a general negative effect of Chla on cephalopod densities suggests that competition pressure is common in the study area. Additionally, results highlight the importance of trophic interactions, beyond other common environmental factors, in shaping the distribution of cephalopod populations. Our study presents a valuable approach for understanding the spatially variant ecology of cephalopod populations, which is important for fisheries and ecosystem management. Interaction between species distribution and the environment is a central topic in ecology. Not all species or populations are able to inhabit areas with their most favourable conditions due to the presence of competitors, limited resource availability, anthropogenic impacts and other drivers that may prevent their establishment in certain areas. Therefore, populations of the same species can experience different responses to the environment throughout their distributional range, as a result of spatial and temporal heterogeneity in habitat conditions.In species distribution models, environmental covariates  are often averaged across large geographic areas. By applying average conditions homogeneously over space, important local effects on populations and nonlinear species–environment interactions may not be detected ,2, and iSpatially variant or spatially explicit models have become of particular interest in the recent years –6, becauLoligo vulgaris across the Atlantic Ocean and the Mediterranean Sea, which are attributed to adaptation of populations to large-scale environmental variability [Illex coindetii, Eledone cirrhosa and Octopus vulgaris in the western Mediterranean Sea. The seasonal cycles and the inter-annual distributions differ with geographical location in response to contrasting regional environmental drivers, irrespectively of species-specific life history traits [Despite the utility of spatially explicit models for studying heterogeneity in population abundance, especially in species with highly variable dynamics, they have been applied very rarely to marine taxa other than fish ,10. Yet,iability . Similary traits ,14. The y traits ,16 and dy traits ,18 at reIn addition to the environmental influence, trophic relationships are one of the main mechanisms that locally affect spatio-temporal abundance and distribution of marine populations. For instance, prey-predator spatio-temporal overlap and prey availability are essential for the survival of predators, as proposed by the match-mismatch hypothesis ,20. In tIllex coindetii and the octopus Eledone cirrhosa . (2) In addition to environmental explanatory variables, we test the importance of trophic conditions, i.e. prey densities, as a driver of the variability in spatial distribution patterns. (3) The approach specially focuses in detecting areas where the populations are more sensitive to a given explanatory variable within their distributional range, i.e. spatial local effects.Because recent studies show that temporal variability in the cephalopod populations presents different drivers and responses in neighbouring geographic regions, we hypothesize that spatial variability in the distributions of these species may be sensitive to local variation of drivers influencing the distribution. In this case, the cephalopod populations may present spatially variant effects associated with the variability in environmental and trophic conditions at local scales. Here we aim to develop a spatially explicit modelling approach to (1) identify the spatial variability in the regional distribution of two of the most abundant cephalopods in the western Mediterranean Sea, the squid Biological data were obtained from the annual trawl surveys carried out as part of the Mediterranean International Trawl Survey (MEDITS) project. The sampling was performed under repeated international standardized protocol (details of the survey methods can be found in ). The su2. Cephalopod prey densities were also estimated  as a potential driver influencing the spatial distributions of the two cephalopod species. Based on stomach content analyses , predefined based on different bathymetric strata  with approximately replicated locations . An expeology in ) of 134 -3) and SST (°C) derived from satellite remote sensing, were also included in our analysis. Remotely sensed data were obtained from NOAA’s CoastWatch Program (available: http://coastwatch.noaa.gov/. Accessed 03 June 2014) and NASA's Goddard Space Flight Center (available: http://www.nasa.gov/centers/goddard/. Accessed 05 June 2014) using different sensors to match the time range of the sampled data. Chla datasets were obtained from Sea WiFS (2001 to 2002) and MODIS sensors (available since 2003) and processed with standard color algorithms [Other putative environmental drivers, i.e. surface Chla  and second, only positive density values are used in a Gaussian GAM with a log link function . Finally, to reduce bias of the sub-models and obtain the overall predictions of Delta-GAM (Yij) the results of both model fits are multiplied (Yij = Pij * Dij). For model selection (see below), the same set of covariates was initially included in stages 1 and 2 of the Delta-GAM for simplicity.Due to the high proportion of zeros in the observations of both species (~50%), we used Delta Generalized Additive Models (GAM) ,31 to esStarting from the Delta-GAM, we developed and contrasted two different model formulations: a full Delta-GAM and a variable coefficient Delta-GAM (vc Delta-GAM). The full Delta-GAM assumes that changes in distribution are homogeneous over space and time, and the effects of covariates are independent and additive. Variable coefficient Delta-GAM, by contrast, tests the spatially variant effects of environmental and trophic drivers on cephalopod distributions. This last formulation assumes that the relationship between response (occurrence or density of a species) and covariates is locally linear, but the coefficients of regression are allowed to change smoothly in relation to the geographical position. The formulation of the two approaches (including stages 1 and 2 in both Delta-GAM) is as follows:C is either the probability of cephalopods occurrence  or an estimate of natural logarithm of density when the cephalopods are present . Smoothing functions are denoted by s; ay is the year (y)-specific intercept, geographical position was described by latitude (ϕ) and longitude (λ), DOY indicates the day of the year, prey denotes the natural logarithm of prey densities and Chla and SST are expressed in monthly mean values.A) A full Delta-GAM of the form:B) A variable coefficient Delta-GAM of the form:mgcv and MuMIn packages in R software, version 3.1.1 [All possible combinations of the covariates described above were tested in the model selection. This selection process was applied independently for each stage (occurrence and density) and model formulation (full Delta-GAM and vc Delta-GAM). Independent model structures were used since drivers affecting the presence of a given species are not necessarily the same that influence its abundance ,34–36. Aon 3.1.1 .For both cephalopods, the vc Delta-GAM performed better than the full Delta-GAM formulations in terms of AIC, gCV and deviance explained . DiffereThe distributions predicted by the best models confirmed different spatial patterns between octopus and squid . We founWe observed significant spatially explicit effects of prey density, Chla and SST on the local density of both cephalopod species . For octVery different spatially explicit effects were observed for squid. A positive influence of prey densities on squid was found in the southern region and around the Balearic archipelago . These eIllex coindetii and the octopus Eledone cirrhosa populations in the western Mediterranean Sea. Our results revealed important local species–environment interactions that drive the abundance and distributional patterns in this geographically and oceanographically complex system. The inclusion of delta models in the approach showed that ecological processes governing presence-absence and densities are partially independent for octopus, but this is not necessarily a general pattern, as we observed in squid. The best model obtained for octopus included different covariates in each of the model stages. While the occurrence was determined by the presence of productive areas (prey densities and Chla), densities were also influenced and SST, which usually dictate recruitment peaks in the seasonal cycle of this species [The spatially explicit modelling approach developed in the present study allowed us to examine the heterogeneity in the spatial abundances of the squid  species . In contOne of the most novel results of our study is the contrasting regional distribution pattern obtained for each cephalopod species, observed by combining information from the Balearic Archipelago and the mainland. These contrasting patterns elucidate a species-specific adaptation to the main trophic pathways derived from the bottom-up forcing of primary production regimes observed in the western Mediterranean: the southwards flow of high productive waters originated in the north-western upwelling (the Gulf of Lion) in the case of the octopus and the bottom-up processes triggered by the Ebro river discharges in the case of the squid. The highest occurrence and densities of octopus were located in the northern region and continue towards south-west across the offshore waters and the western shelf of the Balearic Archipelago. This distribution follows the Mediterranean Northern Current pattern , which sBy contrast, the highest densities of squid were located beneath the Ebro river mouth, in the area influenced by the river plume. Ebro run-off is highest during spring ,43, but Octopus vulgaris in this area were observed during spring [The southern region (Alboran Sea) presented very low occurrences and densities of both cephalopod species. This region is characterized by a turbulent mixing due to exchanges of Mediterranean and Atlantic waters and persistent anticyclonic gyres  that creg spring .As we hypothesized, spatially explicit effects associated with the variability of environmental and trophic drivers were found in the two cephalopod species across the study area. Prey densities describe the direct link of potential food availability for adult individuals, while Chla is a proxy of productivity and energy flow in the trophic pathway that ultimately influences the yield of upper trophic levels (indirect link). By contrast, there are multiple mechanistic linkages between SST and population distributions, which effects can be interpreted from the physiological to population perspective ,48,49. SPrey availability usually constitutes the foremost condition for habitat selection or aggregative response of predators ,55. Our A common pattern was observed in the two species related to Chla, which showed negative effects on cephalopod abundances despite their high-density distributions matching areas of high productivity. Although this might seem counterintuitive, it would be in accordance with the argument of competition pressure described above. The food-web in the western Mediterranean is mainly controlled by small pelagic fishes and changes in their biomass have important consequences for all trophic levels ,58, espeSeveral studies demonstrate that species inhabiting the boundaries of their distributional areas display higher sensitivity to environmental variability . In the Eledone cirrhosa and the squid Illex coindetii populations was ascribed to different trophic pathways present in the study area. Contrasting spatially explicit effects were observed in the two species, with stronger effects mostly found in the limits of their distributional range. Additionally, results highlight the importance of trophic interactions, in addition to environmental factors, in shaping cephalopod distributions in a highly oligotrophic system such as the Mediterranean Sea. Local adaptations of cephalopod populations to environmental and trophic conditions were evidenced, suggesting that complex population structures and dynamics are more widespread than expected [Spatially variant models lead us to better understand cephalopod distributions in heterogeneous and complex systems, such as the western Mediterranean Sea. The spatial heterogeneity in abundance observed in the octopus expected ,14,21.Our study highlights that the knowledge of environmental and trophic effects in the abundance and distribution of cephalopod populations at regional and local scales is needed for marine spatial planning, conservation and management. Additionally, the modelling approach used here can be applied in future investigations of biological responses to climate change, which is expected to induce shifts in marine species distributions and abundances including cephalopods –71. ThisS1 TableFrequency of occurrence (%F) of species identified to the lowest possible taxon in stomach contents.(TIF)Click here for additional data file.S2 TableThe frequency of occurence (%F) and cumulative densities (%C.Den) in relation to all potential prey species selected are shown for the 10 main preys found in the MEDITS surveys from 2001 to 2012.(TIF)Click here for additional data file.