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Random noise in information processing systems is widely seen as detrimental to function. But despite the large trial-to-trial variability of neural activity, humans show a remarkable adaptability to conditions with uncertainty during goal-directed behavior. The origin of this cognitive ability, constitutive of general intelligence, remains elusive. Here, we show that moderate levels of computation noise in artificial neural networks promote zero-shot generalization for decision-making under uncertainty. Unlike networks featuring noise-free computations, but like human participants tested on similar decision problems (ranging from probabilistic reasoning to reversal learning), noisy networks exhibit behavioral hallmarks of optimal inference in uncertain conditions entirely unseen during training. Computation noise enables this cognitive ability jointly through "structural" regularization of network weights during training and "functional" regularization by shaping the stochastic dynamics of network activity after training. Together, these findings indicate that human cognition may ride on neural variability to support adaptive decisions under uncertainty without extensive experience or engineered sophistication.

Perceptual confidence is thought to arise from metacognitive processes that evaluate the underlying perceptual decision evidence. We investigated whether metacognitive access to perceptual evidence is constrained by the hierarchical organization of visual cortex, where high-level representations tend to be more readily available for explicit scrutiny. We found that the ability of human observers to evaluate their confidence did depend on whether they performed a high-level or low-level task on the same stimuli, but was also affected by manipulations that occurred long after the perceptual decision. Confidence in low-level perceptual decisions degraded with more time between the decision and the response cue, especially when backward masking was present. Confidence in high-level tasks was immune to backward masking and benefitted from additional time. These results can be explained by a model assuming confidence heavily relies on postdecisional internal representations of visual stimuli that degrade over time, where high-level representations are more persistent.

Background: It is currently considered that around 30% of chronic pain patients are totally refractory to medical treatment. Among patients who remain responsive to medical treatment, it is estimated that between 20% and 50% are likely to discontinue treatment due to severe side effects. Given these therapeutic difficulties, a significant number of patients turn to complementary therapies., Objective: The LineQuartz® is a medical device that combines 3 complementary therapies, namely, music therapy, light therapy, and chromotherapy. We propose to evaluate its effectiveness in chronic pain patients., Methods: Between October 2021 and October 2022, 44 patients aged between 23 and 85 years (mean: 55.4 years) were included in a prospective study. All patients had background pain intensity greater than 4/10 on the Numerical Pain Scale (NS). Treatment consisted of 4 half-hour sessions, divided into one session per week for 3 weeks (21 days). Patients were assessed by the Brief Pain Inventory (BPI) and the Hospital Anxiety and Depression scale (HAD) the day before starting treatment (Day 0) and the day after the end of treatment (Day 22)., Results: Apart from the BPI item, "relationship with others," all items improved significantly ( p < 0.050). Background pain intensity (NS) and frequency of painful attacks improved very significantly ( p < 0.001). The HAD anxiety subscore was also significantly improved ( p < 0.001). Discussion . This open pilot study supports the idea that LineQuartz® has a place among complementary therapies dedicated to the treatment of chronic pain. However, these results need to be confirmed by a controlled study., Competing Interests: DY and SA are employees of Dycomsas. AS and JPN are not employed by Dycomsas and the other authors declare that they have no conflicts of interest., (Copyright © 2024 Alcira Suarez et al.)

Early life unpredictability is associated with both physical and mental health outcomes throughout the life course. Here, we classified adverse experiences based on the timescale on which they are likely to introduce variability in children's environments: variations unfolding over short time scales (e.g., hours, days, weeks) and labelled Stochasticity vs variations unfolding over longer time scales (e.g., months, years) and labelled Volatility and explored how they contribute to the development of problem behaviours. Results indicate that externalising behaviours at age 9 and 15 and internalising behaviours at age 15 were better accounted for by models that separated Stochasticity and Volatility measured at ages 3 to 5. Both externalising and internalising behaviours were specifically associated with Volatility, with larger effects for externalising behaviours. These findings are interpreted in light of evolutionary-developmental models of psychopathology and reinforcement learning models of learning under uncertainty., (© 2024. The Author(s).)

In an effort to inform interventions targeting littering behaviour, we estimate how much a change in trash-bag colour increases trash can visibility in Paris. To that end, we applied standard Signal Detection techniques to test how much changing trash-bag colour affects subjects' trash can detection rates. In three pre-registered studies, we found that changing trash bag colour from grey to either red, green or blue considerably increases the perception of bins in British (tourist) and Parisian (resident) samples. We found that changing the bag colour from grey to blue increased visibility the most., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Sater et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Human value-based decisions are notably variable under uncertainty. This variability is known to arise from two distinct sources: variable choices aimed at exploring available options and imprecise learning of option values due to limited cognitive resources. However, whether these two sources of decision variability are tuned to their specific costs and benefits remains unclear. To address this question, we compared the effects of expected and unexpected uncertainty on decision-making in the same reinforcement learning task. Across two large behavioral datasets, we found that humans choose more variably between options but simultaneously learn less imprecisely their values in response to unexpected uncertainty. Using simulations of learning agents, we demonstrate that these opposite adjustments reflect adaptive tuning of exploration and learning precision to the structure of uncertainty. Together, these findings indicate that humans regulate not only how much they explore uncertain options but also how precisely they learn the values of these options.

Statistical inference is the optimal process for forming and maintaining accurate beliefs about uncertain environments. However, human inference comes with costs due to its associated biases and limited precision. Indeed, biased or imprecise inference can trigger variable beliefs and unwarranted changes in behaviour. Here, by studying decisions in a sequential categorization task based on noisy visual stimuli, we obtained converging evidence that humans reduce the variability of their beliefs by updating them only when the reliability of incoming sensory information is judged as sufficiently strong. Instead of integrating the evidence provided by all stimuli, participants actively discarded as much as a third of stimuli. This conditional belief updating strategy shows good test-retest reliability, correlates with perceptual confidence and explains human behaviour better than previously described strategies. This seemingly suboptimal strategy not only reduces the costs of imprecise computations but also, counterintuitively, increases the accuracy of resulting decisions., (© 2022. The Author(s), under exclusive licence to Springer Nature Limited.)

In uncertain environments, seeking information about alternative choice options is essential for adaptive learning and decision-making. However, information seeking is usually confounded with changes-of-mind about the reliability of the preferred option. Here, we exploited the fact that information seeking requires control over which option to sample to isolate its behavioral and neurophysiological signatures. We found that changes-of-mind occurring with control require more evidence against the current option, are associated with reduced confidence, but are nevertheless more likely to be confirmed on the next decision. Multimodal neurophysiological recordings showed that these changes-of-mind are preceded by stronger activation of the dorsal attention network in magnetoencephalography, and followed by increased pupil-linked arousal during the presentation of decision outcomes. Together, these findings indicate that information seeking increases the saliency of evidence perceived as the direct consequence of one's own actions., Competing Interests: MR, AW, JL, JD, VC No competing interests declared, VW Reviewing editor, eLife, (© 2022, Rouault et al.)

Naturalistic joint action between two agents typically requires both motor coordination and strategic cooperation. However, these two fundamental processes have systematically been studied independently. We presented 50 dyads of adult participants with a novel collaborative task that combined different levels of motor noise with different levels of strategic noise, to determine whether the sense of agency (the experience of control over an action) reflects the interplay between these low-level (motor) and high-level (strategic) dimensions. We also examined how dominance in motor control could influence prosocial behaviors. We found that self-agency was particularly dependent on motor cues, whereas joint agency was particularly dependent on strategic cues. We suggest that the prime importance of strategic cues to joint agency reflects the co-representation of coagents' interests during the task. Furthermore, we observed a reduction in prosocial strategies in agents who exerted dominant motor control over joint action, showing that the strategic dimension of human interactions is also susceptible to the influence of low-level motor characteristics.

Objective: The aim of this study was to assess the effectiveness of sacral nerve modulation (SNM) in a large cohort of patients implanted for at least 10 years, quantify adverse event rates, and identify predictive factors of long-term success., Summary Background Data: Few studies have evaluated the long-term success of SNM., Methods: Data collected prospectively from patients implanted for fecal incontinence (FI) in 7 French centers between January 1998 and December 2008 were retrospectively analyzed. Patient FI severity scores were assessed before and 10 years after implantation. The main evaluation criterion was the success of SNM defined by the continuation of the treatment without additional therapies. The secondary evaluation criteria were the rate of device revisions and explantations. Preoperative predictors of success at 10 years were sought., Results: Of the 360 patients (27 males, mean age: 59 ± 12 years) implanted for FI, 162 (45%) had a favorable outcome 10 years post-implantation, 115 (31.9%) failed, and 83 (23.1%) were lost to follow-up. The favorable outcome derived from the time-to-event Kaplan-Meier curve at 10 years was 0.64 (95% CI 0.58-0.69). FI severity scores were significantly better 10 years post-implantation compared to preimplantation (7.4 ± 4.3 vs 14.0 ± 3.2; P < 0.0001). During the 10-year follow-up, 233 patients (64.7%) had a surgical revision and 94 (26.1%) were explanted. A history of surgery for FI and sex (male) were associated with an increased risk of an unfavorable outcome., Conclusions: Long-term efficacy was maintained in approximately half of the FI patients treated by SNM at least 10 years post-implantation., Competing Interests: Conflict of interest: H.D., G.M., J-L.F., L.S., and A-M.L. are members of the scientific committee of the Medtronic registry of fecal incontinence. The authors report no conflicts of interest., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

Making accurate decisions based on unreliable sensory evidence requires cognitive inference. Dysfunction of n-methyl-d-aspartate (NMDA) receptors impairs the integration of noisy input in theoretical models of neural circuits, but whether and how this synaptic alteration impairs human inference and confidence during uncertain decisions remains unknown. Here we use placebo-controlled infusions of ketamine to characterize the causal effect of human NMDA receptor hypofunction on cognitive inference and its neural correlates. At the behavioral level, ketamine triggers inference errors and elevated decision uncertainty. At the neural level, ketamine is associated with imbalanced coding of evidence and premature response preparation in electroencephalographic (EEG) activity. Through computational modeling of inference and confidence, we propose that this specific pattern of behavioral and neural impairments reflects an early commitment to inaccurate decisions, which aims at resolving the abnormal uncertainty generated by NMDA receptor hypofunction., (© 2022. The Author(s).)

Perceptual confidence is an evaluation of the validity of perceptual decisions. While there is behavioural evidence that confidence evaluation differs from perceptual decision-making, disentangling these two processes remains a challenge at the neural level. Here, we examined the electrical brain activity of human participants in a protracted perceptual decision-making task where observers tend to commit to perceptual decisions early whilst continuing to monitor sensory evidence for evaluating confidence. Premature decision commitments were revealed by patterns of spectral power overlying motor cortex, followed by an attenuation of the neural representation of perceptual decision evidence. A distinct neural representation was associated with the computation of confidence, with sources localised in the superior parietal and orbitofrontal cortices. In agreement with a dissociation between perception and confidence, these neural resources were recruited even after observers committed to their perceptual decisions, and thus delineate an integral neural circuit for evaluating perceptual decision confidence., Competing Interests: TB, PM No competing interests declared, VW Reviewing editor, eLife, (© 2021, Balsdon et al.)

The human brain continuously processes streams of visual input. Yet, a single image typically triggers neural responses that extend beyond 1s. To understand how the brain encodes and maintains successive images, we analyzed with electroencephalography the brain activity of human subjects while they watched ∼5000 visual stimuli presented in fast sequences. First, we confirm that each stimulus can be decoded from brain activity for ∼1s, and we demonstrate that the brain simultaneously represents multiple images at each time instant. Second, we source localize the corresponding brain responses in the expected visual hierarchy and show that distinct brain regions represent, at each time instant, different snapshots of past stimulations. Third, we propose a simple framework to further characterize the dynamical system of these traveling waves. Our results show that a chain of neural circuits, which each consist of (1) a hidden maintenance mechanism and (2) an observable update mechanism, accounts for the dynamics of macroscopic brain representations elicited by visual sequences. Together, these results detail a simple architecture explaining how successive visual events and their respective timings can be simultaneously represented in the brain. SIGNIFICANCE STATEMENT Our retinas are continuously bombarded with a rich flux of visual input. Yet, how our brain continuously processes such visual streams is a major challenge to neuroscience. Here, we developed techniques to decode and track, from human brain activity, multiple images flashed in rapid succession. Our results show that the brain simultaneously represents multiple successive images at each time instant by multiplexing them along a neural cascade. Dynamical modeling shows that these results can be explained by a hierarchy of neural assemblies that continuously propagate multiple visual contents. Overall, this study sheds new light on the biological basis of our visual experience., (Copyright © 2021 King and Wyart.)

Purpose: To compare the current clinical scoring systems used to quantify the severity of symptoms of faecal incontinence (FI) to patients' subjective scoring of parameters of psychosocial well-being., Methods: Patients referred to six European centres for investigation or treatment of symptoms of FI between June 2017 and September 2019 completed a questionnaire that captured patient demographics, incontinence symptoms using St. Mark's Incontinence score (SMIS) and ICIQ-B, psychological well-being (HADS, Hospital Anxiety and Depression Scale), and social interaction (a three-item loneliness scale)., Results: Three hundred eighteen patients completed questionnaires (62 men, mean age 58.7). Sixty percent of the respondents were aged under 65. Median SMIS was 15 (11-18), ICIQ-B bowel pattern was 8 (6-11) and bowel control was 17 (13-22), similar across all demographic groups; however, younger patients were more likely to experience symptoms of depression and anxiety (HADS score > 10, 65.2% of patients age < 65 vs 54.9% of those ages > = 65, p = 0.03) with lower quality of life (ICIQ-B QoL, median score 19 (14-23)) vs age > = 65 (16 (11-21) (p < 0.005)). On loneliness score 25.5% reported often feeling isolated from others. One of the most significant concerns by patients was the fear and embarrassment related to unpredictable episodes of incontinence., Conclusion: The SMIS remains a useful tool for quantifying incontinence symptoms but may underestimate the psychosocial morbidity associated with unpredictable episodes of incontinence. Interventions aimed at decreasing anxiety and to address feelings of disgust may be helpful for a significant number of patients requiring treatment for FI.

Making accurate decisions in uncertain environments requires identifying the generative cause of sensory cues, but also the expected outcomes of possible actions. Although both cognitive processes can be formalized as Bayesian inference, they are commonly studied using different experimental frameworks, making their formal comparison difficult. Here, by framing a reversal learning task either as cue-based or outcome-based inference, we found that humans perceive the same volatile environment as more stable when inferring its hidden state by interaction with uncertain outcomes than by observation of equally uncertain cues. Multivariate patterns of magnetoencephalographic (MEG) activity reflected this behavioral difference in the neural interaction between inferred beliefs and incoming evidence, an effect originating from associative regions in the temporal lobe. Together, these findings indicate that the degree of control over the sampling of volatile environments shapes human learning and decision-making under uncertainty.

Objective: To assess the efficacy and safety of sacral nerve modulation (SNM) in patients with faecal incontinence (FI) after pelvic radiotherapy in comparison with results of SNM for FI related to other conditions., Methods: Prospectively collected data from patients who underwent SNM therapy between January 2010 and December 2015 at 7 tertiary colorectal units were reviewed retrospectively. Patients with FI following pelvic radiotherapy were identified and matched (1:2) for age and sex with 38 patients implanted over the same period for FI without previous radiotherapy. The treatment was considered favourable if the patient reported any therapeutic benefit from SNM, had no further complaints or interventions and did not consider stopping the treatment. Long-term results, surgical revision and definitive explantation rates were compared., Results: Among 352 patients who received a permanent SNM implant, 19 (5.4%) had FI following pelvic radiotherapy. After a mean follow-up of 3.5 ± 1.9 years, the cumulative successful treatment rates were similar between the groups (p = 0.60). For patients with FI following pelvic radiotherapy, the cumulative success rates were 99.4% [85.4-99.8], 96.7% [78.1-99.6], 91.7% [70.4-98.1] and 74.6% [48.4-94.8] at 1, 2, 3 and 5 years respectively. The revision and definitive explantation rates for infection did not differ significantly., Conclusion: The long-term success rate of SNM for FI after pelvic radiotherapy is similar to that of SNM for FI related to other more frequent conditions. Our study suggests that FI after pelvic radiotherapy could be improved with SNM without an increased risk of complication., (Copyright © 2020 Elsevier B.V. All rights reserved.)

It is a trope in psychological science to define the human species as inherently social. Yet, despite its key role in human behaviour, the mechanisms by which social bonding actually shapes social behaviour have not been fully characterized. Across six studies, we show that the motivation for social bonding does not indiscriminately increase individuals' willingness to approach others but that it is instead associated with specific variations in social evaluations. Studies 1-4 demonstrate that social motivation is associated with a larger importance granted to cooperation-related impressions, i.e. perceived trustworthiness, during social evaluations. Studies 5 and 6 further reveal that this weighting difference leads strongly socially motivated participants to approach more partners that are perceived as both dominant and trustworthy. Taken together, our results provide support for the idea that humans' social motivation is associated with specific social preferences that could favour successful cooperative interactions and a widening of people's cooperative circle., Competing Interests: The authors have declared that no competing interests exist.

Perceptual decisions are accompanied by feelings of confidence that reflect the likelihood that the decision was correct. Here we aim to clarify the relationship between perception and confidence by studying the same perceptual task across three different confidence contexts. Human observers were asked to categorize the source of sequentially presented visual stimuli. Each additional stimulus provided evidence for making more accurate perceptual decisions, and better confidence judgements. We show that observers' ability to set appropriate evidence accumulation bounds for perceptual decisions is strongly predictive of their ability to make accurate confidence judgements. When observers were not permitted to control their exposure to evidence, they imposed covert bounds on their perceptual decisions but not on their confidence decisions. This partial dissociation between decision processes is reflected in behaviour and pupil dilation. Together, these findings suggest a confidence-regulated accumulation-to-bound process that controls perceptual decision-making even in the absence of explicit speed-accuracy trade-offs.

When learning the value of actions in volatile environments, humans often make seemingly irrational decisions that fail to maximize expected value. We reasoned that these 'non-greedy' decisions, instead of reflecting information seeking during choice, may be caused by computational noise in the learning of action values. Here using reinforcement learning models of behavior and multimodal neurophysiological data, we show that the majority of non-greedy decisions stem from this learning noise. The trial-to-trial variability of sequential learning steps and their impact on behavior could be predicted both by blood oxygen level-dependent responses to obtained rewards in the dorsal anterior cingulate cortex and by phasic pupillary dilation, suggestive of neuromodulatory fluctuations driven by the locus coeruleus-norepinephrine system. Together, these findings indicate that most behavioral variability, rather than reflecting human exploration, is due to the limited computational precision of reward-guided learning.

Objective: The objective was to assess the efficacy and the safety of sacral nerve modulation (SNM) in men with fecal incontinence (FI) compared with those of SNM in women., Method: Prospectively collected data from patients from seven tertiary colorectal units who underwent an implant procedure between January 2010 and December 2015 were reviewed retrospectively. Outcomes and surgical revision and definitive explantation rates were compared between men and women., Results: A total of 469 patients (60 men [12.8%]; mean age = 61.4 ± 12.0 years) were included in the study, 352 (78.1%) (31 men [8.8%]) of whom received a permanent implant. The ratio of implanted/tested men was significantly lower than the ratio of implanted/tested women (p = 0.0004). After a mean follow-up of 3.4 ± 1.9 years, the cumulative successful treatment rates tended to be less favorable in men than in women (p = 0.0514): 88.6% (75.6-95.1), 75.9% (60.9-86.4), 63.9% (48.0-77.3), and 43.9% (26.7-62.7) at one, two, three, and five years, respectively, in men; 92.0% (89.1-94.2), 84.2% (80.3-87.4), 76.8% (72.3-80.7), and 63.6% (57.5-69.3) at one, two, three, and five years, respectively, in women. The revision rate for infection and the definitive explantation rate for infection were higher in men than in women (p = 0.0001 and p = 0.0024, respectively)., Conclusion: Both short- and long-term success rates of SNM for FI were lower in men than in women. The revision and definitive explantation for long-term infection rates were significantly higher in men., (© 2019 International Neuromodulation Society.)

Background: Hirschsprung disease is a rare congenital disease typically requiring surgical treatment during childhood. Quality of life and social condition at adult age can be impaired by disease-specific sequelae., Objective: This study aimed to assess the quality of life and social outcome of adult patients operated on for Hirschsprung disease during childhood., Design: Patients operated on for Hirschsprung disease during childhood were identified and specific questionnaires were sent to them., Settings: Data from 2 referral centers were used., Patients: Patients who completed the questionnaires regarding quality of life and social condition were included., Main Outcome Measures: The Hirschsprung's Disease and Anorectal Malformations Quality of Life disease-specific questionnaire (8 dimensions explored; each scored from 0 to 100 maximum score) and a sociodemographic questionnaire were sent to identified patients. Sociodemographic data were compared with those of the French general population., Results: Thirty-four patients had Hirschsprung disease (men, 76%; mean age, 32 years) were included in the study. Mean total Hirschsprung's Disease and Anorectal Malformations Quality of Life score was 611 of 800 (maximum score 800). The 2 most impaired dimensions were "physical symptoms" and "diarrhea" (62.9/100 and 73.6/100). Fecal continence was only marginally affected (mean score, 89/100). Patients with Hirschsprung disease achieved better educational levels than the French general population. Parental and marital status did not differ between the 2 groups., Limitations: This study had the limitations inherent to a retrospective study., Conclusion: The quality of life of adult patients with Hirschsprung disease sequelae is marginally impaired in this study. Despite the consequences of this congenital abnormality, the condition eventually achieved can be considered as satisfactory. See Video Abstract at http://links.lww.com/DCR/A917.

Objective: Magnetic anal sphincter augmentation is a novel surgical option in the treatment of severe fecal incontinence. This study aimed to analyze functional results, quality of life, and satisfaction after implantation in the mid-term, and to identify factors associated with success of this new treatment., Methods: All patients, who underwent magnetic anal sphincter augmentation procedure at a single center between December 2008 and January 2016, were consecutively included. Symptom severity [Cleveland Clinic Incontinence Score (CCIS)], quality of life [Fecal-Incontinence Quality of Life Questionnaire (FIQL)], bowel diary data, and patients' satisfaction were assessed before and after implantation., Results: Forty-five patients (43 female), mean (s.d.) age 66.82 (±10.07), were followed for a median of 36 months (range 6-84). Two patients were explanted and 1 lost to follow-up. On a 3-week diary, major leakage rate significantly improved as did CCIS and FIQL. No significant difference was seen for flatus and minor leaks. Postoperative decrease of CCIS by ≥5.5 points correlated best with satisfaction, expressed by 22 patients (48% in intention-to-treat analysis). An independent predictive factor for success after implantation was no previous fecal incontinence surgical treatment., Conclusions: Satisfaction, functional, and quality of life outcomes improve significantly following magnetic anal sphincter augmentation.

There is considerable variability in the degree to which individuals rely on their peers to make decisions. Although theoretical models predict that environmental risks shift the cost-benefit trade-off associated with social information use, this idea has received little empirical support. Here we aim to test the effect of childhood environmental adversity on humans' susceptibility to follow others' opinion in the context of a standard face evaluation task. Results collected in a pilot study involving 121 adult participants tested online showed that susceptibility to social influence and childhood environmental adversity are positively associated. Computational analyses further confirmed that this effect is not explained by the fact that participants exposed to early adversity produce noisier decisions overall but that they are indeed more likely to follow the group's opinion. To test the robustness of these findings, a pre-registered direct replication using an optimal sample size was run. The results obtained from 262 participants in the pre-registered study did not reveal a significant association between childhood adversity and task performance but the meta-analysis ran on both the pilot and the pre-registered study replicated the initial finding. This work provides experimental evidence for an association between individuals' past ecology and their susceptibility to social influence., Competing Interests: The authors declare no competing interests.

Background: Long-term outcome of sacral nerve modulation (SNM) patients after implanted pulse generator (IPG) change for fecal incontinence (FI) is unknown. This study reported the outcome and long-term satisfaction after a change of an exhausted IPG, questioning the need to concurrently change the electrode and looking for factors involved in the maintenance of treatment efficiency., Methods: Patients with fecal incontinence and with a Medtronic IPG implanted in a single center (2001-2016) were prospectively followed up. Satisfaction was graded according to a patient-reported outcome measure from 0 to 10. A pre- and postreplacement FI severity score (Cleveland Clinic Fecal Incontinence Score) and Fecal Incontinence Quality of Life questionnaire were also collected., Results: In 170 patients with SNM, 39 had an IPG replacement. At a median of 29 month after replacement, 32 and 7 patients reported respectively a similar and reduced satisfaction (7.6 ± 1.62 vs. 5.5 ± 0.87), p < .001. Satisfied patients were younger (65 years vs. 76 years, p < .001). Cleveland Clinic Fecal Incontinence Scores were not significantly different, but the satisfied group had a significantly better Fecal Incontinence Quality of Life score (p = .047). Only 5 patients needed an electrode change at the time of the IPG replacement or later., Conclusions: Patient satisfaction and efficiency remain high after IPG replacement. Older age has a negative impact on the outcome. Electrode replacement is rarely required and does not need to be performed routinely when an IPG is exhausted., Conflict of Interest: Paul-Antoine Lehur has a consulting agreement with Medtronic SA. This had no impact with the results of the study. The other authors have no conflict of interests to declare., (© 2018 International Neuromodulation Society.)

Humans considerably vary in the degree to which they rely on their peers to make decisions. Why? Theoretical models predict that environmental risks shift the cost-benefit trade-off associated with the exploitation of others' behaviours (public information), yet this idea has received little empirical support. Using computational analyses of behaviour and multivariate decoding of electroencephalographic activity, we test the hypothesis that perceived vulnerability to extrinsic morbidity risks impacts susceptibility to social influence, and investigate whether and how this covariation is reflected in the brain. Data collected from 261 participants tested online revealed that perceived vulnerability to extrinsic morbidity risks is positively associated with susceptibility to follow peers' opinion in the context of a standard face evaluation task. We found similar results on 17 participants tested in the laboratory, and showed that the sensitivity of EEG signals to public information correlates with the participants' degree of vulnerability. We further demonstrated that the combination of perceived vulnerability to extrinsic morbidity with decoding sensitivities better predicted social influence scores than each variable taken in isolation. These findings suggest that susceptibility to social influence is partly calibrated by perceived environmental risks, possibly via a tuning of neural mechanisms involved in the processing of public information.

Facial morphology has been shown to influence perceptual judgments of emotion in a way that is shared across human observers. Here we demonstrate that these shared associations between facial morphology and emotion coexist with strong variations unique to each human observer. Interestingly, a large part of these idiosyncratic associations does not vary on short time scales, emerging from stable inter-individual differences in the way facial morphological features influence emotion recognition. Computational modelling of decision-making and neural recordings of electrical brain activity revealed that both shared and idiosyncratic face-emotion associations operate through a common biasing mechanism rather than an increased sensitivity to face-associated emotions. Together, these findings emphasize the underestimated influence of idiosyncrasies on core social judgments and identify their neuro-computational signatures.

Although the suboptimality of perceptual decision making is indisputable in its strictest sense, characterizing the nature of suboptimalities constitutes a valuable drive for future research. I argue that decision consistency offers a rarely measured, yet important behavioral metric for decomposing suboptimality (or, more generally, deviations from any candidate model of decision making) into ultimately predictable and inherently unpredictable components.

Background: Decision-making for pulse generator implantation for sacral nerve stimulation in the management of fecal incontinence is based on the results of a test phase. Its duration is still a matter of debate., Objective: The purpose of this study was to determine whether an early positive response during the test phase could predict implantation of a permanent sacral nerve pulse generator., Design: This was a short-term observational cohort study. A positive response was defined as a >50% decrease of fecal leaks compared with baseline. A multivariate logistic regression was computed to predict pulse generator implantation after the first week of the test phase., Settings: The study was conducted in 3 national referral centers., Patients: From January 2006 to December 2012, 144 patients with fecal incontinence enrolled in a prospectively maintained database completed a 2- to 3-week bowel diary, at baseline and during test phase., Main Outcome Measures: The primary outcome was the clinical decision to implant a pulse generator. The primary predictor was a calculated score including the number of leak episodes, bowel movements, and urgencies and the time to defer defecation expressed in minutes during the first screening test week., Results: After the first, second and third week of the test phase, 81 (56%) of 144, 96 (67%) of 144, and 93 (70%) of 131 patients had a positive test. A permanent pulse generator was implanted in 114. Time to defer defecation increased during the 3 weeks of screening. Urgencies were unchanged. The computed score was predictive of a permanent pulse generator implantation (Se = 72.6% (95% CI, 59.8-83.1); Sp = 100% (95% CI, 78.2-100); c-index = 0.86 (95% CI, 0.78-0.94))., Limitations: No cost analysis or projection based on our proposal to reduce the test phase has been made., Conclusions: Permanent pulse generator implantation can be safely proposed early (1-week screening) to fast responders. Nonetheless, permanent implantation may be decided as well in patients exhibiting a delayed response. Whether a rapid response to sacral nerve stimulation could be predictive of a long-term response remains to be determined. See Video Abstract at http://links.lww.com/DCR/A452.

In the past decade the field of cognitive sciences has seen an exponential growth in the number of computational modeling studies. Previous work has indicated why and how candidate models of cognition should be compared by trading off their ability to predict the observed data as a function of their complexity. However, the importance of falsifying candidate models in light of the observed data has been largely underestimated, leading to important drawbacks and unjustified conclusions. We argue here that the simulation of candidate models is necessary to falsify models and therefore support the specific claims about cognitive function made by the vast majority of model-based studies. We propose practical guidelines for future research that combine model comparison and falsification., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Although, the quest to understand emotional processing in individuals with Autism Spectrum Disorders (ASD) has led to an impressive number of studies, the picture that emerges from this research remains inconsistent. Some studies find that Typically Developing (TD) individuals outperform those with ASD in emotion recognition tasks, others find no such difference. In this paper, we move beyond focusing on potential group differences in behaviour to answer what we believe is a more pressing question: do individuals with ASD use the same mechanisms to process emotional cues? To this end, we rely on model-based analyses of participants' accuracy during an emotion categorisation task in which displays of anger and fear are paired with direct vs. averted gaze. Behavioural data of 20 ASD and 20 TD adolescents revealed that the ASD group displayed lower overall performance. Yet, gaze direction had a similar impact on emotion categorisation in both groups, i.e. improved accuracy for salient combinations (anger-direct, fear-averted). Critically, computational modelling of participants' behaviour reveals that the same mechanism, i.e. increased perceptual sensitivity, underlies the contextual impact of gaze in both groups. We discuss the specific experimental conditions that may favour emotion processing and the automatic integration of contextual information in ASD.

Making decisions in uncertain environments often requires combining multiple pieces of ambiguous information from external cues. In such conditions, human choices resemble optimal Bayesian inference, but typically show a large suboptimal variability whose origin remains poorly understood. In particular, this choice suboptimality might arise from imperfections in mental inference rather than in peripheral stages, such as sensory processing and response selection. Here, we dissociate these three sources of suboptimality in human choices based on combining multiple ambiguous cues. Using a novel quantitative approach for identifying the origin and structure of choice variability, we show that imperfections in inference alone cause a dominant fraction of suboptimal choices. Furthermore, two-thirds of this suboptimality appear to derive from the limited precision of neural computations implementing inference rather than from systematic deviations from Bayes-optimal inference. These findings set an upper bound on the accuracy and ultimate predictability of human choices in uncertain environments., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Unlabelled: The reverse hierarchy theory (Hochstein and Ahissar, 2002) makes strong, but so far untested, predictions on conscious vision. In this theory, local details encoded in lower-order visual areas are unconsciously processed before being automatically and rapidly combined into global information in higher-order visual areas, where conscious percepts emerge. Contingent on current goals, local details can afterward be consciously retrieved. This model therefore predicts that (1) global information is perceived faster than local details, (2) global information is computed regardless of task demands during early visual processing, and (3) spontaneous vision is dominated by global percepts. We designed novel textured stimuli that are, as opposed to the classic Navon's letters, truly hierarchical (i.e., where global information is solely defined by local information but where local and global orientations can still be manipulated separately). In line with the predictions, observers were systematically faster reporting global than local properties of those stimuli. Second, global information could be decoded from magneto-encephalographic data during early visual processing regardless of task demands. Last, spontaneous subjective reports were dominated by global information and the frequency and speed of spontaneous global perception correlated with the accuracy and speed in the global task. No such correlation was observed for local information. We therefore show that information at different levels of the visual hierarchy is not equally likely to become conscious; rather, conscious percepts emerge preferentially at a global level. We further show that spontaneous reports can be reliable and are tightly linked to objective performance at the global level., Significance Statement: Is information encoded at different levels of the visual system (local details in low-level areas vs global shapes in high-level areas) equally likely to become conscious? We designed new hierarchical stimuli and provide the first empirical evidence based on behavioral and MEG data that global information encoded at high levels of the visual hierarchy dominates perception. This result held both in the presence and in the absence of task demands. The preferential emergence of percepts at high levels can account for two properties of conscious vision, namely, the dominance of global percepts and the feeling of visual richness reported independently of the perception of local details., (Copyright © 2016 the authors 0270-6474/16/365200-14$15.00/0.)

Predicting not only what will happen, but also when it will happen is extremely helpful for optimizing perception and action. Temporal predictions driven by periodic stimulation increase perceptual sensitivity and reduce response latencies. At the neurophysiological level, a single mechanism has been proposed to mediate this twofold behavioral improvement: the rhythmic entrainment of slow cortical oscillations to the stimulation rate. However, temporal regularities can occur in aperiodic contexts, suggesting that temporal predictions per se may be dissociable from entrainment to periodic sensory streams. We investigated this possibility in two behavioral experiments, asking human participants to detect near-threshold auditory tones embedded in streams whose temporal and spectral properties were manipulated. While our findings confirm that periodic stimulation reduces response latencies, in agreement with the hypothesis of a stimulus-driven entrainment of neural excitability, they further reveal that this motor facilitation can be dissociated from the enhancement of auditory sensitivity. Perceptual sensitivity improvement is unaffected by the nature of temporal regularities (periodic vs aperiodic), but contingent on the co-occurrence of a fulfilled spectral prediction. Altogether, the dissociation between predictability and periodicity demonstrates that distinct mechanisms flexibly and synergistically operate to facilitate perception and action., (Copyright © 2016 the authors 0270-6474/16/362342-06$15.00/0.)

Purpose: The efficacy of sacral nerve stimulation in faecal incontinence relies on an implanted pulse generator known to have a limited lifespan. The long-term use of sacral nerve stimulation raises concerns about the true lifespan of generators. The aim of the study was to assess the lifespan of sacral nerve stimulation implanted pulse generators in daily practice, and the outcome of exhausted generator replacement, in faecal incontinent patients., Methods: Faecal incontinent patients with pulse generators (Medtronic Interstim™ or InterstimII™) implanted in a single centre from 2001 to 2014 were prospectively followed up. Generator lifespan was measured according to the Kaplan-Meier method. Patients with a generator explanted/turned off before exhaustion were excluded. Morbidity of exhausted generator replacement and the outcome (Cleveland Clinic Florida Faecal Incontinence (CCF-FI) and Faecal Incontinence Quality of Life (FIQL) scores) were recorded., Results: Of 135 patients with an implanted pulse generator, 112 (InterstimII 66) were included. Mean follow-up was 4.9 ± 2.8 years. The generator reached exhaustion in 29 (26%) cases. Overall median lifespan of an implanted pulse generator was approximately 9 years (95% CI 8-9.2). Interstim and InterstimII 25th percentile lifespan was 7.2 (CI 6.4-8.3) and 5 (CI 4-not reached) years, respectively. After exhaustion, generators were replaced, left in place or explanted in 23, 2 and 4 patients, respectively. Generator replacement was virtually uneventful. CCF-FI/FIQL scores remained unchanged after generator replacement (CCF-FI 8 ± 2 vs 7 ± 3; FIQL 3 ± 0.6 vs 3 ± 0.5; p = ns)., Conclusion: In this study, the implanted pulse generator observed median lifespan was 9 years. After exhaustion, generators were safely and efficiently replaced. The study also gives insight into long-term needs and costs of sacral nerve stimulation (SNS) therapy.

Introduction: Sacral nerve stimulation (SNS) has been recognised as an effective treatment for faecal incontinence. Many unresolved questions could be answered when comparing large data-series from different centres providing prospective data., Aim: To present data, from an international two-centre SNS prospective database (SNSPD) on functional outcome and management of surgical complications in patients treated with SNS for faecal incontinence., Method: The SNSPD was designed in order to gather detailed pre- and perioperative information followed by a close follow-up in all patients undergoing SNS for bowel dysfunction. The SNSPD was open for inclusion of newly SNS implanted patients in May 2009, and closed on 31 December 2013. Two-centres Aarhus, Denmark, and Nantes, France, included and monitored all patients implanted due to bowel dysfunction according to database criteria., Results: In total, 164 faecal incontinent patients with a median follow-up of 22 (range 1-50) months were implanted. The Wexner incontinence score improved from 15 (range, 3-20) at baseline to 9 (range, 0-20) at latest follow-up (P < 0.001) and VAS impact on daily life improved from 85.5 (range, 3-100) to 20 (range, 0-100) (P < 0.001). Additional surgical intervention was required in 19.5 % during follow-up. Repositioning of the pacemaker due to pain or migration was the most common complication in 12.1 %. Infections leading to explantation occurred in 3.0 %.