Deep-sea permanent magnet motor equipped with fluid compensated pressure-tolerant system is compressed by the high pressure fluid both outside and inside. The induced stress distribution in stator core is significantly different from that in land type motor. Its effect on the magnetic properties of stator core is important for deep-sea motor designers but seldom reported. In this paper, the stress distribution in stator core, regarding the seawater compressive stress, is calculated by 2D finite element method (FEM). The effect of compressive stress on magnetic properties of electrical steel sheet, that is, permeability, BH curves, and BW curves, is also measured. Then, based on the measured magnetic properties and calculated stress distribution, the stator iron loss is estimated by stress-electromagnetics-coupling FEM. At last the estimation is verified by experiment. Both the calculated and measured results show that stator iron loss increases obviously with the seawater compressive stress. In recent ocean exploitation, permanent magnet motors have been increasingly applied owing to the benefits of high efficiency and low maintenance costs –4. For dGenerally, the realization of pressure-tolerant systems is done with fluid compensated and casted systems. A deep-sea PMSM with oil-filled compensator is shown in As has been confirmed by experiment results, the compressive stress acts on the electrical steel sheet can deteriorate the magnetic properties and increase the iron loss –10. TherSince the theoretical model of the increase in iron loss caused by stress is far from mature at present , researcDetermination of stress distribution is frequently realized by finite element method (FEM), while experimental method can also be found in reports. In this paper FEM is applied. For conventional land type motors, compressive stress in stator core is induced mostly by the production process. Shrink fitting and stamping are identified as the main sources. Generally, the stress distribution is not uniform in the whole stator core but confined in some specific regions. For example, the effect of press-fitting only acts upon the yoke and the teeth are almost not affected. Obviously, it is quite different from the stress induced by deep-sea environment which acts on the whole stator. In fact different stress distributions can change the magnetic properties of stator core in different way.The measurement of magnetic properties of stator core under compressive stress has been extensively reported in literature for land type motors. To impose stress on the specimen, various exclusive apparatus are presented varying from purpose-built mechanical rig  to hydraAs for iron loss calculation, it is dominated by stress-electromagnetics-coupled 2D FEM at present. The effect of shrink fitting, punching, and anisotropy of nonoriented core on iron loss of actual motor is examined using measured properties of stator core in . The iroSince the effect of stamping can be avoided by preparing stator core using wire cutting , in thisThe 8-pole 9-slot surface permanent magnet motor (SPM) model investigated in this paper is shown in E is Young's module, ν is Poisson's ratio, and ε is the strain caused by both the shrink fitting and the compressive stress.In 2D plane, components of stress are defined asThe compressive stress in the stator core is always evaluated using the Von Mises stress. The Von Mises stress is given by the following equation: process . In thisWhen the motor operates on land, the normal atmospheric environment exerts a 0.1 MPa pressure. When it submerges to about 7000 m deep sea, the compressive stress of seawater is 70 MPa. The hydraulic pressure acts on both the outside surface of ring frame and the inner surface of stator core and the direction is perpendicular to the surface. Therefore, in the FEM model the effect of circumstance pressure takes the form as an equivalent compressive stress in perpendicular direction setting on the outside surface of frame and inner surface of stator core.Based on the conditions above, the stress distribution in the stator core caused by shrink fitting and ambient compressive stress is calculated using commercial FEM software. Figures In In Due to mechanical stress, the magnetic characteristics of electrical steel become worse and the iron loss increases. To evaluate the effect of seawater compressive stress on the magnetic properties of iron steel, a novel experimental method is proposed in this paper, by which the magnetic properties, that is, permeability and B-H and B-W curves, are tested in this paper.To simulate the compressive stress applied on the actual stator core, a measuring system is designed in laboratory as shown in Magnetic properties of the laminated specimen, that is, the permeability and B-H and B-W curves, are measured under various stresses by applying a 400 Hz sinusoidal flux.Figures Based on the results of stress distribution calculation and magnetic properties measurement, iron loss of stator core under seawater pressure is evaluated using 2D electromagnetic transient FEM calculation considering no load operation of the motor.By setting the speed of motor at 6000 rpm , the flux distribution and iron loss density in stator core are calculated. The results are shown in Figures The maximum flux density in 3, which is much higher than that in 3.However, the case is not so for iron loss. In fact a sharp increase of iron loss density in the stator core arises when the compressive stress is imposed. In Under certain compressive stress, stator iron losses at various operation speeds are calculated and the results are shown in It can be seen that the stator iron loss increases obviously with the rise of stress, but the rate of increase reduces as the stress increases. At the speed of 6000 rpm, compared with normal atmosphere the iron loss of motor increases to 1.4 times when the motor is compressed by 70 MPa pressure.To measure the effect of ambient compressive stress on stator iron loss, an experiment scheme is designed as shown in An imitational motor is manufactured according to the studied motor. The imitation is almost a copy of its template, except that its rotor has nonmagnetized permanent magnets. When external voltage source inverter (VSI) drives the motor at the speed of 6000 rpm, the imitation will rotate as an accompaniment on condition of coaxial coupling as shown in pFe is the iron loss, po is the viscous drag loss, and pm is the mechanical loss. It should be noted that with nonmagnetized permanent magnets the imitation has no iron loss. Then, subtract pB from two times pA, and iron loss is separated:Power loss of the system can be measured by detecting the input power on the cable. Then the power losses of the two tests in Measured iron losses under different stresses, together with the estimated ones, are shown in It is clear that the two curves show the same trend as the compressive stress increases. In other words, the estimated and measured results are coincident showing that stator iron loss increases obviously with the seawater compressive stress.In addition, the measured iron loss under 70 MPa pressure is 1.58 times of that under normal atmosphere while the estimated increase factor is 1.4 times.Although the estimation is verified by the measurement, a considerable divergence exists between them. The possible reason would be that the iron loss of steel sheets shown in Part III is measured with alternating magnetic field while the actual operational magnetic field in motor is rotating field. The iron loss in rotating magnetic field can be much bigger than that in alternating magnetic field . Therefothe oil inside and seawater outside compress the stator core significantly in both the teeth and the back yoke. The stress distribution in stator core is quite different from land type motors;large compressive stress exerted by seawater deteriorates the magnetic properties of the electrical steel. The permeability of the steel sheet decreases obviously while the iron loss increases rapidly. The increase rate of iron loss reduces gradually along with the climb of compressive stress;compared with on land operation, the stator iron loss of the studied deep-sea PMSM increases 40% under 70 MPa seawater compressive stress at the rated speed;based on the results of stress distribution calculation and magnetic properties measurement, the iron loss of stator core is estimated using stress-electromagnetics-coupling FEM. The estimated result is verified by the measured result.The estimation of stator iron loss in a deep-sea PMSM is investigated considering the stress distribution. The results show that


In 2010, gynecologic malignancies were the 4th leading cause of death in U.S. women and for patients with extensive primary or recurrent disease, treatment with interstitial brachytherapy may be an option.However, brachytherapy requires precise insertion of hollow catheters with introducers into the tumor in order to eradicate the cancer. In this study, a software solution to assist interstitial gynecologic brachytherapy has been investigated and the software has been realized as an own module under (3D) Slicer, which is a free open source software platform for  biomedical research. The developed research module allows on-time processing of intra-operative magnetic resonance imaging (iMRI) data over a direct DICOM connection to a MR scanner. Afterwards follows a multi-stage registration of CAD models of the medical brachytherapy devices  to the patient’s MR images, enabling the virtual placement of interstitial needles to assist the physician during the intervention. In 2010, gynecologic cancer – including cervical, endometrial, and vaginal/vulvar types – is with over 80,000 new cases and over 25,000 deaths the 4th leading cause of death in women in the United States  is introduced, within the new software module has been realized. In the next paragraph the Software Design for the module is presented. Finally, the last paragraph of this section describes the detailed Application Workflow for the presented software module.This section describes the Material and Methods that have been used for this study, resulting in an open source software module for enhanced visualization during MR-guided interstitial gynecologic brachytherapy. Thereby, this section starts with a paragraph about the The Advanced Multimodality Image-Guided Operating (AMIGO) suite at Brigham and Women’s hospital (BWH) allows intraoperative 3 Tesla MR imaging and has been used to develop and test the introduced software module for enhanced visualization during MR-guided interstitial gynecologic brachytherapy. Moreover, the intraoperative MRI (iMRI) data used for this study (acquired in AMIGO) is freely available for download   have been generated using a CAD software from SolidWorks . Therefore, the gynecological CAD models have been reverse-engineered by measuring the precise dimensions from the clinically devices and afterwards converted to an industry standard format (STL). These models are also available online:The CAD models like the interstitial template and the vaginal obturator Figure  needed fhttps://github.com/xjchen/igyne/tree/master/scene for template and obturator. Last accessed on March 2014http://www.slicer.org/), which is a free and open source software platform for visualization and image analysis  design pattern and therefore the classes which implement the core of 3D Slicer, as well as loadable modules, are organized into three main groups , which defines the hierarchies of the data elements and the APIs for accessing and serializing the individual nodes. Furthermore, a C++ class library is used to instantiate the MRML nodes and organize them into a coherent internal data structure called the MRML scene, which maintains the links between the individual data items, their visualization and any other persistent state of the application and modules. The visual elements of the application are provided by the View to the user. The functionality consists of the Graphical User Interface (GUI) and displayable manager classes of the Slicer core, which maintain consistency between the internal MRML state of the Model and the visual appearance of the GUI. The processing and analysis functionality of the application core is encapsulates by the Controller and does not depend on the existence of GUI. However, it is fully aware of the MRML data structures, and the communication between the View and the Controller takes indirectly place through changes in MRML data structures. In addition, the Controller uses the MRML nodes for storing the computation results and the View receives event updates from the MRML scene and individual nodes, which then update the visualization elements.The introduced software of this contribution has been developed within 3D Slicer or Slicer , the acquired images are automatically transferred to this module via the Slicer DICOM module.Initial registration of CAD model of the Template to MR images: A rigid registration (or transformation) between the CAD model of the template and its appearance in the MRI is computed in two steps. First, the user uses the mouse to identify three clearly visible landmarks in the template in the MRI scan . The points on this surface of the CAD model are computed using the locations of the holes. The points on this surface in the MRI scan are obtained interactively from the user; the user is first prompted to create a rough region of interest that encompasses the template, and then to provide a threshold that highlights (approximately) the very bright surgical lubricant filled template holes in the MRI. This set of points is also overlaid as a 3D surface on top of the CAD model, to allow the user to visualize the agreement between the two. The registration refinement method is the Iterative Closest Point (ICP) algorithm  trees . The implementation and workflow of the designed Slicer module has been described in detail and research highlights include:● on-time processing of intra-operative MRI data,● a multi-stage registration of a template● and the virtual placement of interstitial needles.The presented software module allows on-time processing of the intra-operative MRI data realized via a DICOM connection to the scanner. Afterwards, a multi-stage registration of the template and the obturator to the patient’s dataset enables a virtual placement of interstitial needles to assist the physician during the intervention.Areas for future work include the enhancement of the registration method by using the obturator as well as additional physical markers that can be (semi-)automatically detected by image processing. Another area of future work includes the integration of intra-operative navigation, like intraoperative ultrasound (iUS), electromagnetic (EM) tracking or optical navigation via the OpenIGTLink network protocol (Tokuda et al.


Other than well-known motor activities in the precentral gyrus, functional magnetic resonance imaging (fMRI) studies have found that the ventral part of the precentral gyrus is activated in response to linguistic auditory stimuli. It has been proposed that the premotor cortex in the precentral gyrus is responsible for the comprehension of speech, but the precise function of this area is still debated because patients with frontal lesions that include the precentral gyrus do not exhibit disturbances in speech comprehension. We report on a patient who underwent resection of the tumor in the precentral gyrus with electrocorticographic recordings while she performed the verb generation task during awake brain craniotomy. Consistent with previous fMRI studies, high-gamma band auditory activity was observed in the precentral gyrus. Due to the location of the tumor, the patient underwent resection of the auditory responsive precentral area which resulted in the post-operative expression of a characteristic articulatory disturbance known as apraxia of speech (AOS). The language function of the patient was otherwise preserved and she exhibited intact comprehension of both spoken and written language. The present findings demonstrated that a lesion restricted to the ventral precentral gyrus is sufficient for the expression of AOS and suggest that the auditory-responsive area plays an important role in the execution of fluent speech rather than the comprehension of speech. These findings also confirm that the function of the premotor area is predominantly motor in nature and its sensory responses is more consistent with the “sensory theory of speech production,” in which it was proposed that sensory representations are used to guide motor-articulatory processes. Other than well-known motor activities in the precentral gyrus, functional magnetic resonance imaging (fMRI) studies have found that the ventral part of the precentral gyrus is activated in response to linguistic auditory stimuli . Dysarthria is defined as speech disorders resulting from disturbances in muscular control of the speech mechanism  4, and the fact that the convex surface thereof is mostly occupied by the premotor cortex, or BA 6  in an attempt to confirm the reproducibility of the auditory activity that has been previously reported by fMRI studies . The nouns were presented either visually or auditorily in separate trial runs. In the first run, the patient was asked to only listen to auditorily presented nouns. In the remainder of the runs, the patient was asked to make an overt response to each of the nouns that were presented auditorily in the second and fourth runs, and visually in the third and fifth runs after the “Go” signal. The delayed response design was intended to separate and differentiate the neural activities that were related to sensory stimulus processing, motor processing, and the delay period. Each run consisted of the presentation of 33 words and, thus, a total of 66 words were presented for the verb generation tasks in each modality.While in the operating room, all auditory stimuli were presented at a comfortable sound level via a loudspeaker placed 1 m away from the patient, and all visual stimuli were presented in the center of a computer monitor (refresh rate: 60 Hz) placed 0.8 m from the patient; all nouns were presented with an inter-stimulus interval of 6 s. Only concrete high-familiarity nouns were used for this task and the patient was familiarized with the procedure prior to her operation. The intraoperative performance of the patient was 92.4% for the auditory task and 97.0% for the visual task. The electrocorticogram was recorded from electrodes that were temporarily placed directly on and surrounding the precentral gyrus, with an inter-electrode distance of 5 mm Figures . Only sip < 0.05, FDR-corrected) than the mean power during the 1.5 s pre-stimulus baseline period for the same epochs. The increase in power in a given electrode was considered to be significant if a cluster of pixels of power larger than 1.5 dB in the gamma band range was arranged in a continuous array spanning at least 40 Hz in width. The clusters that fulfilled this condition were detected with the Matlab function bwconncomp.m, which was used for finding connected components in an image.The potentials at each electrode were re-referenced to an intracranial average electrode. The signals were digitized at 1000 Hz, recorded onto a computer hard disk, and the data bandpass-filtered at 0.1–300 Hz. Any trial containing an epileptic discharge or other artifact was eliminated from further analysis. Event-related spectral perturbation (ERSP) measures the average dynamic changes in the amplitude of the broadband electroencephalographic frequency spectrum as a function of time relative to an experimental event Makeig, . In the In the present case study, resection of the ventral portion of the precentral gyrus was inevitable due to the following clinical findings: (1) other than the pathological Gadolinium-enhancement on preoperative MRI, which is associated with more aggressive lesions  of 100% Figure . Post-opIn the present study, we recorded ECoG from the pericentral region of a patient with a brain tumor in this area during an awake craniotomy. Activities were observed in the precentral gyrus in response to auditory, but not visual, stimuli, which suggests that the observed responses did not reflect general linguistic processes, such as word production or comprehension, or the premotor preparatory activity that precedes articulation, because no activities were observed in response to the visual presentation of nouns in the same task. Resection of a part of the ventral precentral area, from which a positive ECoG auditory response was detected (Channel 50), was inevitable due to the location of the tumor. Consistent with previous case studies of patients with lesions in the precentral gyrus, the present patient did not develop any post-operative comprehension disorders. However, she did develop AOS which was characterized by dysprosodic, slow, irregular speech with distortion and phoneme substitutions, including multiple sequential errors (pre-positioning and post-positioning). This was likely because the lesion included the auditory-responsive precentral premotor area.In clinical studies, the uniformity of functional structure within the precentral gyrus has rarely been questioned, except for the distinction between BA 4 and BA 6. In experimental studies using monkeys, the ventral premotor area (PMv) is thought to specialize in direct sensory-motor mapping while the dorsal premotor area (PMd) is thought to be involved in indirect sensory-motor mapping  , such as the problem of whether articulatory disturbances should be classified as purely phonetic instead of phonemic. While AOS is predominantly characterized by distorted sounds not attributable to deficits in muscle tone or reflexes, which would reflect disturbances during the encoding of phonological patterns into appropriate speech movements . The most likely interpretation of this behavior is that the patient in the present study had a clear idea of the target syllable in terms of sensory phonology, which is supported by the fact that she was able to write the letter correctly, but she was not able to retrieve an articulatory motor counterpart therefor. However, she was able to overcome this issue using the “50-on,” an overlearned Japanese kana-syllabary, as a contextual cue. This is consistent with the well-accepted characterization of AOS: The affected patient cannot speak properly although he or she is aware of what he or she wants to say and how it should sound (Hillis et al., Turning to the heterogeneity of AOS symptoms, if each patient with AOS is carefully assessed on a case-by-case basis, even patients with circumscribed lesions in the ventral precentral cortex can show a diversity of symptoms (Kasahata, Based on the dual-route model (Hickok and Poeppel, The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


The use of patient-reported questionnaires to collect information on costs associated with routine healthcare services, such as chiropractic, represents a less labour intensive alternative to retrieving these data from patient files. The aim of this paper was to compare patient-report versus patient files for the collection of data describing healthcare usage in chiropractic clinics.As part of a prospective single cohort multi-centre study, data on the number of visits made to chiropractic clinics determined using patient-reported questionnaires or as recorded in patient files were compared three months following the start of treatment. These data were analysed for agreement using the Intraclass Correlation Coefficient (ICC) and the 95% Limits of Agreement.Eighty-nine patients that had undergone chiropractic care were included in the present study. The two methods yielded an ICC of 0.83 (95% CI = 0.75 to 0.88). However, there was a significant difference between the data collection methods, with an average of 0.6 (95% CI = 0.25 to 1.01) additional visits reported in patient files. The 95% Limits of Agreement ranged from 3 fewer visits to 4 additional visits in patient files relative to the number of visits recalled by patients.There was some discrepancy between the number of visits made to the clinic recalled by patients compared to the number recorded in patient files. This should be taken into account in future evaluations of costs of treatments. In a climate of increasing healthcare costs and limited budgets, calculating the costs of caring for patients constitutes an essential component of healthcare evaluations. This information can assist patients and clinicians in making treatment-related decisions as well as policy-makers in allocating resources . Two typThere are different methods of collecting resource usage data including patient-reported questionnaires and diaries as well as patient records . A drawbPatient-reported questionnaires offer an interesting alternative in assessing resource usage. This method of assessing costs allows determination of a broad range of economic data including lost productivity and out-of-pocket expenses with less effort and resources compared to accessing patient records . HoweverStudies that have assessed the agreement between resource usage data collected from patient records and from patient-reported questionnaires have shown conflicting results -8. Some In this context, a study assessing the accuracy of patient-reported number of visits in chiropractic clinics has not yet been conducted. The objectives of this study therefore were: i) to determine the accuracy of patient-reported number of chiropractic visits when compared to the number of visits recorded in patient files, and ii) to determine whether the accuracy of patient-reported visits is dependent on the frequency of visits.. All participants gave written consent to participate, and ethics approval was granted by the Anglo-European College of Chiropractic Research Ethics Sub-Committee.The present study was part of a prospective single cohort multi-centre study in which outcomes, patient experiences and related costs of care were documented in low back pain patients undergoing chiropractic treatment . Participants were recruited consecutively between August 2010 and July 2011 from chiropractic clinics in the United Kingdom, and were assessed prior to the initial consultation in clinics and at three months follow-up by mail using questionnaires. All members of the British Chiropractic Association were invited to participate in the study by collecting data from a maximum of 10 eligible patients each. Inclusion criteria were low back pain patients over the age of 18 with or without leg pain who had not received any treatment for their condition, apart from their GP, in the previous three monthsPatient clinical and socio-demographic characteristics, including health status, were assessed in the baseline questionnaire. Health status was depicted by the Bournemouth Questionnaire, a validated multidimensional outcome measure for use in low back and neck pain patients ,10. Part2 test for categorical variables. The degree of agreement between the number of visits measured using patient-report and from patient files was assessed using the Intraclass Correlation Coefficient (ICC). The ICC indicates the concordance between two measures and is expressed in a score ranging from 0 (no agreement) to 1 (perfect agreement). A single measures two-way mixed consistency model  was selected as the participant effect was random and the measure effect fixed. A drawback of the ICC is that it is dependent on sample heterogeneity, hence this calculation was complemented by the evaluation for comparing methods by Bland and Altman, which indicates a range of differences between methods to be expected for any individual participant [Patient characteristics of the validation sample and the complete cohort were compared using the independent t-test for continuous variables and the chiticipant . This apData on number of visits were available for both methods of collecting data on 89 (37%) of the 238 patients of the complete cohort, and no significant differences (p < 0.05) were found between the validation sample and the complete cohort in the distribution of clinical and demographic variables Table . The ICCThis study assessed the accuracy of patient-reported healthcare usage in chiropractic clinics at three months following the start of treatment. The results suggested that there were differences in the number of visits made to the clinic as reported by patients and the same information recorded in patient files. While these findings were in contrast to those found in two studies comparing the number of visits by patient-report and patient files in general practitioner clinics ,3, they If a recommendation had to be made on whether to use patient files or patient-report for the determination of number of visits, the latter would be a sensible option. Economic data are likely to be of greater use to policy-makers if they cover a broad spectrum of variables including lost productivity and out-of-pocket expenses, which are best determined using patient-report. In addition, since this method is less labour intensive for participating clinicians, it may lead to better participation rates and thus more representative results.Despite these strengths, the economic significance of using patient-report over patient files for the determination of number of visits is unknown. In the present study, participants under-reported the number of visits by on average one visit when compared to the number of visits recorded in patient files. It is likely that the impact on overall cost calculations when varying the number of visits by one additional or less visit in an average total of visits may be minor. However, to confirm this in future studies on the costs of treatments, a sensitivity analysis should be used assessing the robustness of results to variations in the data on the number of visits made to the clinic as reported by patients.The present study must be viewed in light of its limitations. Although patient files have previously been used as a reference comparator, it is uncertain whether this method represents the more reliable source of data on number of visits. Indeed, these data may have been omitted from files by mistake or recorded in such a form that they were not easily accessible to the clinic staff responsible for returning the number of patient visits made to the clinic during the study period. While the participants formed a representative sample of the study population, the findings of this study may not be generalisable to other populations, settings and designs. For instance, it is unclear whether longer recall periods would yield less accurate results.The present study showed that there were differences between the data on number of visits made to chiropractic clinics over a three-month period based on patient-report and actual visits recorded in patient files. Thus, if patient-reported data on number of visits are to be used in evaluations of costs of treatments, the impact of potential errors in reporting this information should be taken into account.


The outcome was assessed using Schonfeld’s criteria for the eventual outcome of subclinical or clinical FES. Out of 30 patients in each group, six patients developed subclinical FES, whereas three from ciclesonide prophylaxis group and eight from controls developed clinical FES. There is no statistical significance found between the eventual outcomes of subclinical or clinical FES between the ciclesonide prophylaxis and control group. Although there was a trend seen in the possible preventive efficacy of inhalational steroid in the present study, it did not reach the statistically significant level. The prophylactic role of inhalational steroid in post-traumatic subclinical and clinical FES is statistically insignificant in the present study.Fat embolism syndrome (FES) is primarily a lung parenchymal disorder resulting from interstitial and alveolar inflammation triggered by the lipid metabolites in blood circulation. The 'low-dose' corticosteroid is supposed to have a prophylactic effect on the incidence of the FES and arterial hypoxemia by reducing this inflammatory response. It is expected that inhaled corticosteroids (ciclesonide aerosol) may prevent the development of hypoxemia or fat embolism syndrome in high-risk patients by reducing this inflammatory response. Metered-dose inhaler (MDI) steroid preparations can reach the lung parenchyma with minimal systemic effect. Sixty cases of polytrauma patients presenting within eight hours of injury were randomly allocated into one of the two groups. In Group 1 (n Fat embolism syndrome (FES) is a severe and potentially life-threatening complication of long bone fractures with mortality rates ranging from 10 to 36% . The repThough embolism of fat globules following long bone fractures is a common event, FES occurs as a result of damage to interstitial and alveolar inflammation triggered by the lipid metabolites in blood circulation. The 'low-dose' corticosteroids given after the skeletal trauma are believed to have a prophylactic effect on the incidence of the fat embolism syndrome and arterial hypoxemia by reducing this inflammatory response -6. HowevThe aerosol therapy is a modality of drug administration where the main advantage is that for a given therapeutic response, the drug dose is several-fold lower, and the systemic absorption is negligible -10. The Ciclesonide is an inhaled corticosteroid administered via a metered-dose inhaler (MDI). It can reach the lung parenchyma, unlike most of the previous steroid inhalers that were unable to go beyond the bronchial tree and had minimal effect on endogenous cortisol. It has already been used successfully in the treatment of allergic rhinitis and asthma.As FES is primarily a lung parenchyma disorder, it is expected that ciclesonide aerosol given as prophylaxis may be able to stabilize the lung parenchyma. It is also supposed to bear the effects of post-traumatic fat globulinemia and prevent the development of hypoxemia or FES in high-risk patients. To date, there are no published studies on the impact of inhaled steroids in the prophylaxis of FES. Our study was designed to evaluate the role of inhalational corticosteroids in the prevention of fat embolism syndrome in high-risk patients.The study was conducted over a period of two years following the approval from the Institutional Review Board from the Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India. There was no specific approval number assigned at that time. Informed patient consent was obtained prior to treatment.The selection of patients for the study was made from those attending the surgical emergency of our institute. Patients belonging to the age group of 16-40 years and having a fracture of the femoral shaft alone or associated with other skeletal injuries presenting within eight hours of injury were considered for inclusion. Patients with multisystem trauma , open femoral fractures, pathological fractures, or those with pre-existing cardiac or pulmonary disease or chronic smokers were excluded. After obtaining informed consent, 60 patients of either sex were randomly selected for the study. In all of these patients, after initial resuscitation and necessary splinting, appropriate imaging for all skeletal injuries was done. The investigations at the time of admission included a chest roentgenogram, arterial blood gas analysis (ABG), hemoglobin, hematocrit, platelet count, serum biochemistry, blood glucose levels, serum lactate, and coagulation profile.The selected patients were put into one of the two groups depending upon their random allocation number. At the earliest possible time after admission to the hospital, the patients allocated to the Group I (n1=30) were given ciclesonide (640 mcg) with a metered dose inhaler. The steroid dose was repeated once again after 24 hours. Patients allocated to Group 2 (n2=30) were not given any steroids and were taken as controls for the study. All the patients, irrespective of the study group, were taken up for surgical stabilization of their fractures as per their conventional management protocol. All patients were monitored for three days irrespective of the intermediate surgical interventions. Complete records were maintained for repeated clinical evaluation, including four hourly vitals  and 12 hourly ABG estimations for 72 hours. During these three days, once daily chest X-ray, hemogram, and coagulation profiles were taken. A note was made of any side effects of the inhalational steroids observed during the hospital admission period, e.g. oropharyngeal candidiasis, any alteration in serum biochemistry, or wound complications.The outcome was assessed by documentation of any episode of hypoxemia within the 72 hour observation period. The fat embolism index score of all the patients was calculated daily by a blind investigator, based on the Schonfeld, et al. criteria . PetechiThe analysis was done by comparing the incidence of hypoxemia and FES in both groups to determine the effects of prophylactic doses of inhalational steroids. The statistical analysis was done using the ‘Mann-Whitney test’ for quantitative data and Chi-square test for qualitative data. A p-value less than 0.05 were considered to be statistically significant.In the first group, there were 22 males and eight females with a mean age of 29 years (range: 18 to 34 years) whereas in control group there were 23 males and seven females with an average age being 28.5 years (range: 20 to 35 years). The variables were compared in each group at the time of admission and further during follow-up. Age, sex, pre-hospital stabilization of fractures with splints, time since the injury on arrival in the hospital, and vital parameters were statistically insignificant between both groups. There was no significant association between the partial pressure of oxygen, hemoglobin, haematocrit, or biochemical parameters at the time of admission and the subsequent development of FES in both the groups.There were six patients with subclinical FES in each group. Although there were eight cases of clinical FES in the control group and three cases in ciclesonide prophylaxis group, it was statistically insignificant. Thus, the development of FES was not affected by the ciclesonide prophylaxis. Mean values of the arterial blood partial pressure of oxygen are shown in Table Clinical observations made in both groups over 72 hours are shown below in Table There was no statistically significant difference in the values of partial pressure of oxygen at 12 hourly intervals during the 72 hours between the two groups.The fourteen cases of clinical and subclinical FES in the control group and nine cases in the ciclesonide group were followed up for the total duration of episode of hypoxemia, which is defined as arterial partial pressure of oxygen less than 90 mm Hg. The total length of hypoxemia was 70 hours in the ciclesonide group and 79 hours in the control group. This was not found to be statistically significant. One patient in the ciclesonide prophylaxis group and two patients in the control group required ventilatory support. Eventually, all these patients recovered well. There was no mortality in either group.FES is one of the leading causes of morbidity and mortality following skeletal trauma, particularly in long bone and pelvic fractures -16. SympCorticosteroids have been extensively studied in the prophylaxis of the FES, but the evidence regarding their efficacy and safety is not strong enough to recommend their routine use . The 'loThe aerosol therapy is a modality of drug administration where the main advantage is that for a given therapeutic response, the drug dose is several-fold lower, and the systemic absorption is negligible. However, until a few years ago, the aerosol steroid therapy was effective only up to bronchial level. With the discovery of ciclesonide, which can reach up to the lung parenchyma, the effect can be achieved at the alveolar level. The efficacy of inhaled corticosteroids has already been clinically proved in chlorine gas-induced lung injury and acute respiratory distress syndrome due to sepsis -19. As FCiclesonide is a highly potent and relatively safe inhaled corticosteroid. It also has the advantage of very low oral bioavailability. Inhaled ciclesonide has been shown to be free from systemic side effects when used for management of asthma, even at high doses. Doses of 160 to 640 mcg have been employed in the treatment of bronchial asthma. A ciclesonide dose of 320 mcg is equivalent to 440 mcg fluticasone, the most potent inhaled corticosteroid . Out of To the best of our knowledge, this is the first study to examine the role of inhaled corticosteroids in the prophylaxis of post-traumatic subclinical and clinical FES. Although there is a biological plausibility that inhaled steroids may be useful, as shown by the study of intravenous steroids in the literature, as well as a trend seen in the possible preventive efficacy of inhalational steroid in the present study, it did not reach a statistically significant level in our study. The possible explanation could be a true inefficacy of the inhalational steroid, the small number of patients in our study, or the effect may be less pronounced than intravenous steroids that the study was not powered to detect. Therefore, larger study groups may be required to define precisely the role of inhalational steroids in the prophylaxis of post-traumatic subclinical and clinical FES. Moreover, as the etiology and pathogenesis of FES is still not certain, there may be other factors also contributing to the above results. Though the number of patients in the present study is small, it is observed that the prophylactic role of inhalational steroids, i.e. ciclesonide, in post-traumatic clinical and subclinical FES is statistically insignificant.There is no statistical significance found between the eventual outcomes of subclinical or clinical fat embolism syndrome between the ciclesonide prophylaxis and control groups. Although there was a trend seen in the possible preventive efficacy of inhalational steroid in the present study, it did not reach a statistically significant level.


We investigated the cognitive mechanisms underlying the exploration and decision-making in realistic and novel environments. Twelve human subjects were shown small circular U.S. city maps with two locations highlighted on the circumference, as possible choices for a post office (“targets”). At the beginning of a trial, subjects fixated a spot at the center of the map and ultimately chose one of the two locations. A space syntax analysis of the map paths (from the center to each target) revealed that the chosen location was associated with the less convoluted path, as if subjects navigated mentally the paths in an “ant's way,” i.e., by staying within street boundaries, and ultimately choosing the target that could be reached from the center in the shortest way, and the fewest turns and intersections. The subjects' strategy for map exploration and decision making was investigated by monitoring eye position during the task. This revealed a restricted exploration of the map delimited by the location of the two alternative options and the center of the map. Specifically, subjects explored the areas around the two target options by repeatedly looking at them before deciding which one to choose, presumably implementing an evaluation and decision-making process. The ultimate selection of a specific target was significantly associated with the time spent exploring the area around that target. Finally, an analysis of the sequence of eye fixations revealed that subjects tended to look systematically toward the target ultimately chosen even from the beginning of the trial. This finding indicates an early cognitive selection bias for the ensuing decision process. To make good decisions within a novel environment, we first have to explore it. But how people explore novel environments to make decisions is poorly understood. Consider a hypothetical scenario that you have been accepted by a graduate school and you are visiting the university for the first time to find a house to rent. The school has provided you with a map that marks the student houses around campus and also gives you information about the bus stations, classrooms, libraries, food service, etc. Abstractly, you face an example of a common decision problem, in which you have to explore and evaluate all the alternative options to find the best place to rent. Choosing between alternative options requires assigning and integrating values along a multitude of dimensions . How do people explore novel environments to extract information and make decisions is considered one of the fundamental problems in decision science.After many years of intense research in various disciplines ranging from psychology to economics, substantial progress has been made in understanding the cognitive mechanisms of decision-making in a variety of tasks. A series of experimental studies in humans and animals have provided evidence that the brain makes simple decisions by integrating various relevant determinants of an option into a single subjective value, and then comparing these values to make a choice . The study protocol was approved by the relevant Institutional Review Boards, and an informed consent was obtained from all the participants prior to the study based on the Declaration of Helsinki.Twelve healthy right-handed subjects, 6 women and 6 men, participated in this study as paid volunteers. They ranged in age from 19 to 58 years . The age did not differ significantly between the two genders  colliding grids, i.e., multiple intersecting regular grids rotated with respect to one another, (iii) curvilinear grids, i.e., intersecting patterns of curvilinear streets, (iv) cul-de-sacs, i.e., hierarchically branching street networks, and (v) supergrids, i.e., sparsely spaced orthogonally intersecting main arteries with irregular street patters filling-in the large blocks surrounded by the arteries.Stimuli were 20 circular maps of 1-mile diameter urban areas extracted from street center-line maps representing several U.S. Metropolitan Statistical Areas . The sample was chosen to exemplify 5 different street networks types , and the x-y position of the eyes (sampled at 200 Hz). The eye position was recorded using a video-based pupil/corneal reflection tracing system .The experiment was controlled by a program written in Visual basic . Relevant data included the times of presentation of stimuli, the Isolines were used to characterize the overall spatial distribution of eye positions during map exploration, as follows. For each map, we superimposed the eye positions of all subjects, and computed the probability of the spatial density of eye position, as follows. First, we fitted a regular grid on the map and counted the eye positions that fell within each constituent square (67 m side length) of the grid; points on the edges were assigned randomly to a neighboring square. Next, we transformed these counts to percentages over the total number of eye positions and drew isolines, which connect points of the same probability values. The difference between any two consecutive isolines is the contour interval, and values inside an interval are higher than those outside. The colors of the isolines denote different levels of the contour intervals, with red corresponding to high probability density values, and blue corresponding to low density regions.We were interested to quantify the spatial patterns of the eye positions during map exploration, and, particularly, how much of the exploration was spent around the two targets and the center of the map. For that purpose, we calculated  the mean density  of eye positions around the targets and the center of the stimulus, within circular areas of 2, 4, 6, and 8° of visual angle (DVA) radius centered on these locations. Figure Finally, to better assess whether eye positions were more densely distributed around the selected targets vs. the non-selected ones, and, hence, to test the hypothesis that subjects spent more time exploring the chosen targets, we computed the mean relative density as the ratio of the frequencies of eye positions within a 4 DVA-radius circle centered on the selected and non-selected targets, to the sum of the number of eye positions within these two circular areas .t  and the selected target , to their Euclidean distance to the non-selected target .To study the temporal evolution of the decision process, we computed the natural logarithm of the ratio of the Euclidean distance between the instantaneous eye positions at time M is the trial length. This measure : The length of the shortest available path linking the center to each of the targets, measured in feet. (2) The shortest available angular distance : The sum of angles of direction changes along the straightest available path linking the center to each target. (3) The shortest available intersection distance : The number of street intersections crossed along the simplest available path linking the center to the target; for the purpose of this calculation, an intersection is defined as a node with at least three incident road segments, offering at least two choices for movement. It is noted that while in some cases the same individual path minimizes all three measures, in other cases different paths might be involved. For example, the shortest and straightest path may cross more intersections than a less direct path. In our analysis of the stimuli maps, all the paths available are evaluated according to each measure of distance independently. The first measure was computed using Network Analyst on ArcGIS10. The last two measures were computed using Spatialist-lines, a set of specialized routines for spatial analysis developed at Georgia Tech in collaboration with Perkins + Will. These routines are implemented using Grasshopper, a language for algorithmic modeling associated with design modeling software Rhinoceros. Figure The Cartesian straight-line distance from the center of a stimulus map to a target is half a mile in all stimuli. The actual street network distance varies. To study the spatial properties underlying the choice of the post-office target location, the following measures of street network distance were computed for all targets and stimuli. (1) The shortest available metric distance  or MATLAB® (version R2013b).N = 236 valid trials). We performed an analysis of variance (ANCOVA) to assess the effects of street network type on decision time, where the decision time was the dependent variable, the angle formed by the two radii of the targets was a covariate, and the subject was a random factor. We found a statistically significant effect of the street network type  , the effect of the subject random factor highly significant (P < 0.001) but without a significant effect of the network × subject interaction term (P = 0.747).Subjects decided on the post office choice after 4.113 ± 0.225 s .We were also interested in investigating whether the choice of an option was related to the time that subjects spent exploring the area around it. Our initial hypothesis was that subjects spent more time looking at the selected than the non-selected targets. To test this hypothesis, we calculated the mean relative density (see Methods) of eye positions within the 4 DVA-radius areas around the selected and non-selected targets across trials. We found that subjects spent on average more time exploring the region around the selected location than the non-selected one Figure . In addiLRD (see Methods) to monitor eye position with respect to its proximity to the selected (or non-selected) target. Characteristic LRD time courses from different subjects, trials and maps, are shown in Figure LRD values, respectively. However, we found that, on the average, subjects fixated points nearer the selected (vs. the non-selected) target both at the beginning and the end of the trial. We quantified this observation by aligning all the trials, in different analyses, either (a) to the onset of map presentation, or (b) to the moment of target selection (mouse click) and computing the average instantaneous LRD. The results are shown in Figures LRD for each street network type .We evaluated the alternative options based on 3 network distance measures namely (i) minimum path length, (ii) minimum path rotation, and (iii) minimum street crossings along the path (see Methods Section for more details). The mean and the standard error of these 3 measures across all target locations for each street network type is shown in Figure The ability to explore novel environments and make spatial decisions, such as selecting a place to live or walking toward a landmark, is a fundamental and highly evolved behavior that requires the coordination of cognitive functions. In the recent years, significant progress has been made in understanding the cognitive mechanisms of exploration and decision-making. Many studies have investigated how people and animals explore and navigate in novel environments  before making a decision. This behavior is in accord with the hypothesis that subjects evaluated space syntax network characteristics, as discussed above.Another interesting finding was that the eye fixation biased the decision toward the location that was being fixated most of time. This effect has been also described in value-based decision studies  in a value-based decision task and found that MEG signal deviations from biased decisions occurred as early as 250–750 ms following the stimulus onset (Hedgecock et al., 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.


With the advent of neuroimaging techniques, it becomes feasible to explore the structure-function relationships in the brain. When the brain is not involved in any cognitive task or stimulated by any external output, it preserves important activities which follow well-defined spatial distribution patterns. Understanding the self-organization of the brain from its anatomical structure, it has been recently suggested to model the observed functional pattern from the structure of white matter fiber bundles. Different models which study synchronization  or global dynamics  have shown success in capturing fundamental properties of the brain. In particular, these models can explain the competition between modularity and specialization and the need for integration in the brain. Graphing the functional and structural brain organization supports the model and can also highlight the strategy used to process and organize large amount of information traveling between the different modules. How the flow of information can be prevented or partially destroyed in pathological states, like in severe brain injured patients with disorders of consciousness or by pharmacological induction like in anaesthesia, will also help us to better understand how global or integrated behavior can emerge from local and modular interactions. Despite decades of research focusing on network based brain activities, the anatomical structure of the observed brain networks and the functional aspects of spatiotemporal brain dynamics remain mysterious . SeveralStarting from the Hodgkin-Huxley conductance-based model , the fieT < Tc) and supercritical (T > Tc) temperature regions, their simulated results at this critical point highlighted a balance between positive and negative correlated networks and were comparable with the correlation and anticorrelation obtained from resting state fMRI. The universal mechanisms underlying the spontaneous emergent phenomena of the 2D Ising model can explain self-organized criticality of neural dynamics in large scale RSNs /z. Here z = ∑eE(t)/kT− is called the partition function, k is the Boltzman constant, and T is the temperature. E measures the integrated energy of a spin configuration, in which the interaction between spins wants to minimize which can be used to quantify the global spin organization. kT instead measures the kinetic energy randomly transferred between the thermal bath and the spin lattice, which produces the segregation effect in spin clusters. Numerical approaches have been developed to simulate the dynamics of an Ising model. The combination of Metropolis algorithm and classical Monte Carlo simulation with periodic boundary conditions establishes the thermalization procedure of magnetic spins when the system is placed in touch with a heat bath of temperature T [T, the spontaneous fluctuation of Ising spins increases. When the temperature reaches a certain critical value (Tc), there is a qualitative change in the organization of the spin clusters as a whole, and the correlation length between neighbouring spins within the cluster (which captures the size of the formed clusters) diverges. The outcome of spin organizations from a 2D Ising model simulation at three different T values is presented in The Ising model of ferromagnetism was firstly introduced by Ernst Ising in 1925 as a statistical model of ferromagnetism . A 2D sqin state , 64. Acc physics , the prorature T . With inT, the spontaneous Monte Carlo spin flips are less probable, and spins in a given configuration are mostly aligned to contribute the minimum energy or ground state energy of the system. A quantity called the magnetization, which is the average of total spins over the whole lattice, determines the magnetic ordering of the system, that is, its ferromagnetic behaviour. When all spins are aligned along the same direction, a magnetization of magnitude “+1” or “−1” will be generated corresponding to a complete order configuration. The large amount of integrated magnetic ordering in this low temperature regime is accompanied by a small information content of the organized spin clusters. At high T, the magnetic ordering is completely lost due to significantly increasing number of spontaneous spin flips and the magnetization tends to “0,” which can be used to characterize the paramagnetic phase. In this case, a large number of laws of nature do not hold due to spontaneous symmetry breaking under global spin flips, and this disordered phase can be seen as the result of the dominating segregation effect over the cluster integration [T, the self-organized criticality, as well as a second order phase transition, are observed in the 2D Ising model through the maximum fluctuation in the magnetization and the susceptibility peak when T reaches a critical value Tc [T < Tc regime and is destroyed above the critical temperature Tc. In T < Tc, T = Tc, and T > Tc. These four different configurations correspond to the same four different time points at three different temperatures. Due to its simplicity of simulating two state spin systems and the richness of its dynamic behaviour in self-organized criticality, the Ising model has been demonstrating unprecedented growth of applications in physics as in many other fields, including computational neuroscience [At low egration . The infalue Tc . In thisoscience , 28, 30.Tc), mean functional organizations of neural dynamics, sampled at four different times and based on the resting state fMRI of 14 healthy subjects is shown in In neuroscience, electrophysiological brain activity in the presence or absence of sensory stimulation can be described by two states: (1) active states in which randomly generated neuronal action potentials collectively process information and provide neuronal communications with each other via functional networking and (2) inactive states in which neurons do not cross the threshold value to fire action potentials . In the Series of earlier studies on fMRI, multielectrode local field potential (LFP), and magnetoencephalography (MEG)  profoundJij between spin i and spin j in a generalized Ising model. In this way, all nodes including left and right hemispheres are interacting with each other, implying that any spin sees all the other spins as nearest neighbor even if with different couplings. Recently, a study on simulating the resting functional activity in monkeys and humans [Tc (not in line with earlier findings) as well as critical exponents of magnetization, specific heat and susceptibility, could explore collective brain activities in different spatial scales [In addition to this earlier work, there has been considerable growing attention on simulating the brain dynamics and its relation to self-organized criticality using the structure of human connectome from the DTI based measurements . The fibd humans , 75 attel scales , 76.T, the spontaneous fluctuation of spin-flips increases, and at critical temperature the dynamic phase transition replicates the long-range ordering in the spin dynamics. This effect of long-range ordering can provide the maximum information flow, which is reduced down abruptly either in the phase of ordered  or completely disordered  spin states. This has been considered as the self-organized criticality of a 2D Ising model, in which the maximum occurrence of metastable states [Criticality in any dynamic system, including the brain, can be characterized by a threshold that describes the boundary of phase transition between ordered and disordered patterns. In order to understand experimental findings of human functional brain activity, for example, the resting state fMRI, a large number of interacting spin systems has been modeled successfully as self-organized criticality . Recentle states  can mimie states , 20, 73.Starting from Turing instabilities in dynamical systems (1950), it has been shown that macrostates of brain wave oscillations can be formed out of cooperative processes, instabilities, rapid transitions between coherent states, pattern formations, and so forth , 78. DueInitial approaches of the network structures based on graph theory have developed a growing interest among the researchers involved in investigating the neuronal systems of the brain. Graph theory is providing a simplified and more generalized approach to studying the complex neuronal structures  in neuroscience . Furtherk [P(k) gives the information about the fraction of nodes having k number of edges and is, therefore, the probability distribution of the degree over the whole network. Clustering coefficient of a graph is another commonly used characteristic which gives the ratio of the number of existing connections to the number of all possible connections [Graph theory is an outstanding basis from which to study the functional and anatomical connections in the brain. A graph related to the brain network is a model of the neurons or group of neurons in patches of cortex  which are interconnected by a set of edges. The edges represent functional or structural connections between cortical and subcortical regional nodes based on analysis of human neuroimaging data . Nodes ik . The disnections , 87, whenections –90 and inections  which ginections . High monections .The networks have been classified, according to their topology, under three categories designated random network, small-world network, and scale-free network. Random graphs can be constructed by assigning connections between pairs of nodes with uniform probability. For most of the complex network systems, a random network is a poor estimate. The probability distribution of the degree of a random graph follows a normal distribution as the connections are made randomly between the nodes . The cluTopological connectivity of the brain may characterize different features of dynamic organization. This organization can be expressed by weighted or unweighted graphs. In weighted graphs, nodes represent the regions of interest and edges encode the strength of their correlation  or the density of the fibers connecting them  , while iAnatomical/Structural connectivity between cortical regions of the brain is represented by the connections of axonal fibers. It ranges from inter-neuronal connectivity to inter-regional connectivity in the brain . In MRI Although studying the anatomical connections of the brain allows us to understand the basic structural connectivity throughout the brain, investigating the functional connectivity provides us the knowledge of how this structural architecture relates to brain function. However, functional connectivity is based on statistical computations representing only correlations between nodes exceeding a specific threshold , 94. In Effective connectivity refers to the effect that one neural system or element influences another neural system or element , 31. UsiStudying network properties in graph theory allows a comparison of networks using Ising model data and empirical fMRI data. An important measure in this comparison is the distribution of the degree for the two types of data sets, along with the distribution of the correlation. This will provide the basis to compare the functional behaviour of the brain network in resting state with the critical phenomena of the Ising model.After calculating, for each given temperature, configurations of the 2D Ising model at a chosen number of time points, a correlation matrix can be extracted and compared with the correlation of the empirical data from the resting brain . In FiguThe brain network follows small-world behaviour with higher efficiency and a higher clustering coefficient with respect to random or scale-free networks . MoreoveTo understand the structural organization of the brain network and its functional interaction, research has focused on brain alterations. Patients with severe brain injury are especially interesting to investigate, as alterations in structural connectivity can be isolated and compared to loss of function to further explore the relationship between structural and functional connectivity. Moreover, severe brain injury is characterized by a large-scale network disconnection which is the prime mechanism for the underlying cognitive impairment . A promiAltered states of consciousness can also be observed without changes in the structural connectivity as induced, for example, by the anesthetic propofol. In anesthesia-induced loss of consciousness, functional connectivity is disturbed while the structural connectivity is preserved. In respect to graph theory, this can be interpreted as a decrement of the number of functional connections. Graph theoretical analyses revealed significant changes in the distribution of degree and local functional organizations of brain networks during propofol-induced loss of consciousness  RecentlyThroughout this paper, we have reviewed the structure-function relationship in the brain network with recent ongoing analyses, focusing on the Ising model and graph theory. The Ising model together with graph theory proved to be effective approaches to studying brain dynamics. In particular, the Ising model is involved in characterizing the emergent properties of functional network organizations at the critical temperature and the changes in organization when temperature is departing from its critical value. Three significant temperature values are taken into account as the critical, subcritical, and supercritical temperatures. Much of the earlier efforts have compared brain dynamics with the behaviour of self-organized criticality at the critical point of the Ising model. However, the recent finding of characterising brain dynamics in the Griffith phase has started diminishing the hallmark of self-organized criticality in brain networks, unless the network becomes highly efficient and optimized . Their a5 neurons in a cubic millimeter of neuronal tissue [The brain is one of the most complex networks in nature due to its sophisticated structure-function relationships. Understanding the optimized information processing and transfer in its cortical networks is the prime focus of much current neuroscience research. With recent advancements in neuroimaging techniques like fMRI , EEG, and MEG , any functional activity based measurements could quantify global correlation patterns in wakeful resting brains  or alterl tissue . With thNowadays, multimodal neuroimaging is applied to patients with DOC in order to find diagnostic tools . In FiguA recent review also highlighted the fact that structural brain damage after traumatic brain injury (TBI) could disrupt the functional activity of large-scale intrinsic connectivity networks as well as interactions of the damaged structure with neuroinflammation and neurodegeneration as in Alzheimer disease and chronic traumatic encephalopathy . TraumatGraph theory is a useful tool for understanding the organization of brain networks in different spatial and temporal scales. In the healthy brain during rest, the organization within and between RSNs demonstrates small-world features which maximize the information transfer by a relative low level of wiring cost . Togethe


AbstractScolopendridae is briefly reviewed. Their function in Scolopendraheros Girard, 1853, Scolopendrasubspinipes Leach, 1815, Scolopendramorsitans , Scolopendragalapagoensis Bollman, 1889, Scolopendrahainanum Kronmüller, 2012, Scolopendraspinosissima Kraepelin, 1903 Cormocephalusaurantiipes  and Ethmostigmustrigonopodus , in which they are least specialised has been investigated. Specimens were tapped with forceps on different parts of the trunk to simulate the attack of a predator. When tapped on the first third of the trunk (near the head), the centipedes attacked the forceps with their forcipules. When tapped on the last third or the ultimate legs, they adopted a warning position, raising the ultimate legs to display the ventral and medial prefemoral spines as well as the spined coxopleural processes. In some cases the centipedes attacked the forceps with the claws of the ultimate legs by chopping down on them after lifting the legs high into the warning position. When tapped in the mid part of the trunk, the centipedes curled sideways to reach the forceps with their forcipules and ultimate legs simultaneously. Scolopendragalapagoensis not only lifted the ultimate legs into the warning position but also the last 3-4 pairs of locomotory legs, presenting their distodorsal prefemoral spines. This resembles the warning posture of some spiders. In addition to their function in warning behaviour, defensive stabbing, ritualised meeting reactions and during courtship behaviour, the ultimate legs may in addition act as hooks and perhaps be involved in species recognition. No evidence was found that the ultimate legs are used to catch prey, nor of prey or predators being held between the prefemora.The function of the variously shaped ultimate legs of PageBreak Scolopendropsis, Edentistoma, and Arthrorhabdus and this type Schileyko stated are adapted for capturing prey . Species of the genus Alipes have large leaf-like ultimate legs   Figure  slowly bScolopendra, Cormocephalus and Ethmostigmus.In this paper we review the functions of ultimate legs in those species that have the least modified ultimate legs and report the results of laboratory experiments on species of Scolopendrasubspinipes Leach, 1815, fastened onto a tent near the ventilator hole with their ultimate legs and swung their bodies to one side or the other to seize insects that had alighted nearby. On 4.xi.95 Peter Daszak and Janet Cottingham found a female Scolopendraabnormis Lewis & Daszak, 1996, hanging by her ultimate legs in a hollowed out cavity beneath a slab of tuff on Serpent Island, Mauritius. The anterior part of the body was curled around 40 oval yellow eggs (Lewis unpublished data).Field observations have shown that the ultimate legs of scolopendrids are used as hooks from which the animal can hang. Thus Scolopendragigantea L., 1758, feeding on bats whilst hanging from the roof of a Venezuelan cave to which they anchored using the last five or eight pairs of legs.Scolopendradehaani that escaped the plastic container in the laboratory and was later found hanging on the camera tripod just using the ultimate legs  reported and photographed a s Figure .PageBreakWarning postureScolopendramorsitans L., 1758, raised and splayed its ultimate legs when approached from behind by a large Mecistocephalus (Geophilomorpha). Scolopendraviridis Gervais, 1847, the ultimate legs being spread apart and in Scolopendraheros Girard, 1853, where the legs were raised and waved back and forth, active defence involving biting or “holding” with the ultimate legs. A photo of an Ethmostigmus sp. sent to one of us (J G E L) by Chris Pennington from Krambach, New South Wales, Australia, showed the ultimate legs lifted and splayed revealing the spines on the median surface of the prefemora and on the coxopleural processes. A predator approaching from behind would come into contact with a battery of spines.Lewis (unpublished data) noted in Nigeria that a small Autotomy and sound productionAlipes swing the ultimate legs from side to side and stridulate perhaps to distract or frighten potential predators.. PageBreakThey also use autotomy to detract potential predators like birds, lizards or mammals. In case of an attack, the centipede starts to stridulate which directs the attention of the predator to the ultimate legs which can be autotomised to make the escape easier. When detached with forceps the leaf-like ultimate legs of an Alipesgrandidieri from Tanzania continued to stridulate for more than half a minute.As noted above, in case of danger the members of the genus Rhysidanudatogoensis (now Rhysidaimmarginatatogoensis) slowly bend and straighten when detached and emit a faint creaking sound. This observations were repeated in Northern Nigeria in 1967 by Lewis (unpublished data): an ultimate leg of the same species detached with forceps produced very quiet squeaking for about 75 seconds, flexing at 2–3 second intervals and Kronmüller  observed that the long slender ultimate legs of Rhysidaimmarginataimmarginata  from the Philippines  from various countries in Africa bend and straighten for a few minutes presumably to enable the centipede to flee while potential predators become distracted. In our experiments, when the ultimate legs were detached with forceps,they did not squeak as did those of Rhysidaimmarginatatogoensis.s Figure  as well Alipes sp. showing the typical defence behaviour including the sound of the stridulation as well as the bending movements of the detached ultimate legs of Rhysida sp. can be seen on the website http://www.scolopendromorpha.com.Video clips of Meeting reactionsScolopendracingulata Latreille, 1829 . When two specimens meet, each attempts to grasp the posterior region of the trunk of the other with its last pair of legs  observed that when two http://www.scolopendromorpha.com.A short video clip of this meeting reaction can also be seen on the website PageBreakCourtship behaviourCormocephalusancepsanceps the “defence posture” is adopted both partners use their antennae to tap the posterior part of the body especially the ultimate legs of the opposite sex  or, in one case, an adult captive bred specimen .The centipedes that were used for the experiments were either adult wild caught specimens (Gryllusassimilis).The specimens were kept for at least 12 weeks before the experiments started in plastic containers of different sizes depending on the size of the specimen, with an air temperature of 25 degrees Celsius in day-time (around 10 hours illumination with a neon lamp) and 20–22 degrees Celsius at night-time. The average air humidity was around 70%. All plastic containers had a layer of humus and a piece of bark as a hiding-place. Once a week, the humus was sprayed with water to keep it moist and the specimen was fed one adult cricket  to observe possible differences in defense reactions and to compare the responses of the investigated species.In a second experiment a piece of bark was placed in the container as a refuge and the layer of humus was increased to 10cm. A centipede was placed in the container and as soon as the first third of the trunk was hidden either by the centipede crawling under the bark or by it digging into the humus, the tapping experiments described above were repeated.Photos and short video clips are made with a Canon EOS 60D and a Canon EOS 6D, connected either to a Canon standard lens (18-55mm) or a Canon macro lens (100mm), three Canon Speedlight EX550/EX430 flashes (photos only), a tripod and a remote control (video clips).Ethmostigmustrigonopodus  from Tanzania, length 13 cm. When tapped on the first third of the trunk (near the head), the centipede attacked the forceps with the forcipules. When tapped on the posterior third, or even at the ultimate legs, it adopted the warning position, raising the ultimate legs to display the ventral and medial prefemoral spines as well as the coxopleural processes which are also equipped with spines. In the most cases the centipede directed the warning position towards the forceps by turning the posterior segments. In some cases, depending on the strength and speed of the simulated attack, the centipede counter-attacked the forceps with the claws of the ultimate legs by chopping down on them after lifting them high into the warning position.Initial experiments were carried out on an adult Ethmostigmustrigonopodus was tapped in the mid part of the trunk, the centipede curled sideways to reach the forceps with the forcipules and the ultimate legs simultaneously. These observations were repeated in experiments with Scolopendraherosvar.arizonensis Kraepelin, 1903 (USA), Scolopendragalapagoensis (Peru), Scolopendramorsitans (Pakistan), Scolopendracingulata (Spain), Scolopendrasubspinipes (Indonesia), Scolopendrahainanum Kronmüller, 2012 (China), Scolopendraspinosissima Kraepelin, 1903 (Philippines), and Cormocephalusaurantiipes  . All showed the same warning posture raising the ultimate legs  and the forcipules as well as the anterior pairs of locomotory legs were involved in feeding. In this situation the centipede could not use the forcipules to carry out a warning bite and the only defence behaviour was hitting with the ultimate legs and stabbing with the ultimate leg pretarsi (claws). The experiment was repeated with Ethmostigmustrigonopodus, Scolopendragalapagoensis, Cormocephalusaurantiipes and Scolopendrasubspinipes, which all showed the same results.In the experiments with bark and a thicker layer of humus, no difference was observed in the behaviour depending on whether the specimen was tapped on the mid Otostigmus (Otostigmus) and Rhysida species, have not been investigated.The scolopendrid species investigated here have unmodified and relatively robust ultimate legs. Species with very long thin ultimate legs such as some Scolopendra and Otostigmus, Cryptops and others attack their prey with the last prehensorial anal legs, then the head is rapidly curved behind and the venom claws deeply and firmly buried in the body of the prey.” Cryptops were involved in the capture of prey, instead suggesting that they are defensive; trapping some part of a potential predator and then being autotomised as the centipede makes good its escape. Scolopendrasubspinipesmutilans Koch, 1878  prey was only attacked with the forcipules.We conclude that in the case of the species investigated the use of the ultimate legs is primarily for defence, however, should potential prey make contact with the centipede, the defensive response and defensive biting will lead to feeding whereas in the case of a predator, the centipede will try to escape after one or more warning bites.Rowland Shelley (email dated 03 January 2011) notes “that there are frequently spines on the medial surface of the scolopendrid (ultimate leg) prefemora and I’ve always presumed that these must function to hold something steady I had always thought this would be prey... ” We were unable to confirm that scolopendrid centipedes hold prey or predators between the ultimate leg prefemoral, although in the ritualised meeting reaction in some species, the median spines on the ultimate legs seem to aid the grip.The four main functions in species in which the ultimate legs are little specialised are:Acting as hooks to suspend the animal for example from cave ceilings.Warning position, when the legs are raised and splayed to reveal the prefemoral and coxopleural spines.Stabbing as a defence, especially when the front part of the trunk and the head are unable to carry out any defensive action.PageBreakGrasping, the legs being flexed as when two animals assume the defence posture or as part of the mating ritual. In this case posteriorly directed spines would aid the grip. No evidence was found of objects being held between the prefemora.Scolopendraheros, Scolopendrasubspinipes, Scolopendramorsitans, Scolopendrahainanum, Scolopendragalapagoensis, Scolopendraspinosissima, Cormocephalusaurantiipes, Ethmostigmustrigonopodus) are from different genera, different continents and different types of habitat. Nevertheless, their behaviour in prey capture and defense reaction do not differ. Also the meeting reaction seems to be very similar the same in all observed species.The investigated centipedes (In addition to the behavioural functions of the ultimate legs, two visual signals should be considered:Scolopendra sp. have striking colour patterns. In several species, the colouration of the last trunk segments and the ultimate legs is the same as the colouration of the head and antennae (Figure Some scolopendrid centipedes, especially the giant e Figure . PredatoScolopendragalapagoensis, where the last three or four pairs of locomotory legs are raised in addition to the ultimate pair, resembles that of spiders such as Phoneutria sp. or tarantulas and may be a case of possible signal co-evolution.The warning posture, especially that of