Trained monkeys performed a two-choice perceptual decision-making task in which they reported the perceived orientation of a dynamic Glass pattern, before and after unilateral, reversible, inactivation of a brainstem area involved in preparing eye movements, the superior colliculus (SC). Surprisingly, we found that unilateral SC inactivation produced significant decision biases and changes in reaction times consistent with a causal role for the primate SC in perceptual decision-making. Fitting signal detection theory and sequential sampling models to the data revealed that SC inactivation produced a decrease in the relative evidence for contralateral decisions, as if adding a constant offset to a time-varying evidence signal for the ipsilateral choice. The results provide causal evidence for an embodied cognition model of perceptual decision-making and provide compelling evidence that the SC of primates, a brainstem structure, plays a causal role in how evidence is computed for decisions, a process usually attributed to the forebrain.

Stroke induces network-wide changes in the brain, affecting the excitability in both nearby and remotely connected regions. Brain stimulation is a promising neurorestorative technique that has been shown to improve stroke recovery by altering neuronal activity of the target area. However, it is unclear whether the beneficial effect of stimulation is a result of neuronal or non-neuronal activation, as existing stimulation techniques nonspecifically activate/inhibit all cell types (neurons, glia, endothelial cells, oligodendrocytes) in the stimulated area. Furthermore, which brain circuit is efficacious for brain stimulation is unknown. Here we use the optogenetics approach to selectively stimulate neurons in the lateral cerebellar nucleus (LCN), a deep cerebellar nucleus that sends major excitatory output to multiple motor and sensory areas in the forebrain. Repeated LCN stimulations resulted in a robust and persistent recovery on the rotating beam test, even after cessation of stimulations for 2 weeks. Furthermore, western blot analysis demonstrated that LCN stimulations significantly increased the axonal growth protein GAP43 in the ipsilesional somatosensory cortex. Our results demonstrate that pan-neuronal stimulations of the LCN is sufficient to promote robust and persistent recovery after stroke, and thus is a promising target for brain stimulation.

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Many healthcare facilities are in the process of implementing, or planning to implement, computerized provider order entry (CPOE). In this article, we share our experience of planning for and implementing CPOE. One of our goals was to avoid unintended consequences for nurses that at best require expensive changes after implementation or worst can create unsafe situations. We are a team of nursing informaticists at a 450-bed, not-for-profit, acute-care hospital with an emergency department/level I trauma center seeing more than 300 patients per day and an average daily inpatient census of approximately 280.In our initial planning, we conducted a literature review to determine what knowledge regarding unintended consequences for nurses had already been published. We found that there was a lack of information specific to the effects on nursing of initiating CPOE. An article from the University of Illinois at Chicago, College of Nursing, 1 summarized the published literature about disruptions to nursing workflow with the implementation of clinical information systems. They concluded, as we have, that as of 2010 very little had been published about the unintended consequences to nursing, specifically in regard to CPOE implementation, and what was published did not sufficiently explain the issues or how to prevent them. We found, however, some of the communication, workflow, and workaround issues that affected providers during CPOE implementation would likely have an impact on nurses as well.Our goal was to help prepare our nurses for postimplementation workflow changes and develop a plan to prevent as many negative impacts as possible. Using several sources including the literature, provider-related information, discussions with vendors, and personnel at other sites who had previously implemented CPOE, as well as our own experience, we created a list of unintended consequences for nursing and made plans to mitigate them.After implementation, we were pleased to confirm that we had targeted the greatest areas of risk. The remediation plans presented here include the processes we put into place before and during the implementation to safeguard against identified unintended consequences. The lessons learned are our postimplementation reflections on areas we felt needed emphasis, were particularly difficult, were time consuming, or were unexpected. COMPUTERIZED PROVIDER ORDER ENTRY AWARENESS FOR NURSING: UNINTENDED CONSEQUENCES AND REMEDIATION PLAN(1) Computerized provider order entry-related workflow changes, such as actions, communications, and safeguards used to complete patient care tasks, which are not recognized prior to go-live, cause broken processes and confusion. 2

A popular model of decision-making suggests that in primates, including humans, decisions evolve within forebrain structures responsible for preparing voluntary actions; a concert referred to as embodied cognition. Embodied cognition posits that in decision tasks, neuronal activity generally associated with preparing an action, actually reflects the accumulation of evidence for a particular decision. Testing the embodied cognition model causally is challenging because dissociating the evolution of a decision from preparing a motor act is difficult, if the same neuronal activity instantiates both processes. Ideally, one would show that manipulation of neuronal activity thought to be involved in movement preparation actually alters decisions, and not movement preparation. Here, trained monkeys performed a two-choice perceptual decision-making task in which they judged the orientation of a dynamic Glass pattern before and after unilateral, reversible inactivation of a brainstem area involved in preparing eye movements, the superior colliculus (SC). Surprisingly, we found that unilateral SC inactivation produced significant decision biases and changes in reaction times consistent with a role for the SC in evidence accumulation. Fitting signal detection theory and sequential sampling models (drift-diffusion and urgency-gating) to the data revealed that SC inactivation produced a decrease in the relative evidence for contralateral decisions. Control experiments showed that SC inactivation did not result in eye movement biases ruling out interpretations based on motor preparation or spatial attentional impairment. The results provide causal evidence for an embodied cognition model of perceptual decision-making and provide compelling evidence that the SC of primates plays a causal role in modulating evidence accumulation for perceptual decisions, a process that is usually attributed to the cerebral cortex.