Self-initiated Action Research Articles

Lifelong Fitness in Ambulatory Children and Adolescents with Cerebral Palsy I: Key Ingredients for Bone and Muscle Health.

Physical activity of a sufficient amount and intensity is essential to health and the prevention of a sedentary lifestyle in all children as they transition into adolescence and adulthood. While fostering a fit lifestyle in all children can be challenging, it may be even more so for those with cerebral palsy (CP). Evidence suggests that bone and muscle health can improve with targeted exercise programs for children with CP. Yet, it is not clear how musculoskeletal improvements are sustained into adulthood. In this perspective, we introduce key ingredients and guidelines to promote bone and muscle health in ambulatory children with CP (GMFCS I-III), which could lay the foundation for sustained fitness and musculoskeletal health as they transition from childhood to adolescence and adulthood. First, one must consider crucial characteristics of the skeletal and muscular systems as well as key factors to augment bone and muscle integrity. Second, to build a better foundation, we must consider critical time periods and essential ingredients for programming. Finally, to foster the sustainability of a fit lifestyle, we must encourage commitment and self-initiated action while ensuring the attainment of skill acquisition and function. Thus, the overall objective of this perspective paper is to guide exercise programming and community implementation to truly alter lifelong fitness in persons with CP.

Mesoscale cortex-wide neural dynamics predict self-initiated actions in mice several seconds prior to movement

Volition - the sense of control or agency over one's voluntary actions - is widely recognized as the basis of both human subjective experience and natural behavior in nonhuman animals. Several human studies have found peaks in neural activity preceding voluntary actions, for example the readiness potential (RP), and some have shown upcoming actions could be decoded even before awareness. Others propose that random processes underlie and explain pre-movement neural activity. Here, we seek to address these issues by evaluating whether pre-movement neural activity in mice contains structure beyond that present in random neural activity. Implementing a self-initiated water-rewarded lever-pull paradigm in mice while recording widefield [Ca++] neural activity we find that cortical activity changes in variance seconds prior to movement and that upcoming lever pulls could be predicted between 3 and 5 s (or more in some cases) prior to movement. We found inhibition of motor cortex starting at approximately 5 s prior to lever pulls and activation of motor cortex starting at approximately 2 s prior to a random unrewarded left limb movement. We show that mice, like humans, are biased toward commencing self-initiated actions during specific phases of neural activity but that the pre-movement neural code changes over time in some mice and is widely distributed as behavior prediction improved when using all vs. single cortical areas. These findings support the presence of structured multi-second neural dynamics preceding self-initiated action beyond that expected from random processes. Our results also suggest that neural mechanisms underlying self-initiated action could be preserved between mice and humans.

Self-Initiated Actions Under Different Choice Architectures Affect Framing and Target Evaluation Even Without Verbal Manipulation.

Logically equivalent but different descriptions (i.e., manipulation of verbal expressions) affect decision-making in a phenomenon known as the framing effect. A choice architecture changes decision-makers’ actions, which in turn create different frames, but little is known about whether the frame created by their action can change their judgments. We examined whether self-initiated action induced by a choice architecture changed evaluations. In two experimental studies (N = 271), we found that self-initiated actions whose final goal was completely the same and for which no verbal expressions were manipulated led to different evaluations. In particular, we found that a difference in the placement of rewards, which required participants to behave differently, changed their ratings of satisfaction with the rewards. This study provides evidence that the framing effect can occur without verbal manipulation. This finding advances our understanding of how participants’ actions lead to different evaluations.

Operant self-stimulation of thalamic terminals in the dorsomedial striatum is constrained by metabotropic glutamate receptor 2.

Dorsal striatal manipulations including stimulation of dopamine release and activation of medium spiny neurons (MSNs) are sufficient to drive reinforcement-based learning. Glutamatergic innervation of the striatum by the cortex and thalamus is a critical determinant of MSN activity and local regulation of dopamine release. However, the relationship between striatal glutamatergic afferents and behavioral reinforcement is not well understood. We evaluated the reinforcing properties of optogenetic stimulation of thalamostriatal terminals, which are associated with vesicular glutamate transporter 2 (Vglut2) expression, in the dorsomedial striatum (DMS), a region implicated in goal-directed behaviors. In mice expressing channelrhodopsin-2 (ChR2) under control of the Vglut2 promoter, optical stimulation of the DMS reinforced operant lever-pressing behavior. Mice also acquired operant self-stimulation of thalamostriatal terminals when ChR2 expression was virally targeted to the intralaminar thalamus. Stimulation trains that supported operant responding evoked dopamine release in the DMS and excitatory postsynaptic currents in DMS MSNs. Our previous work demonstrated that the presynaptic G protein-coupled receptor metabotropic glutamate receptor 2 (mGlu2) robustly inhibits glutamate and dopamine release induced by activation of thalamostriatal afferents. Thus, we examined the regulation of thalamostriatal self-stimulation by mGlu2. Administration of an mGlu2/3 agonist or an mGlu2-selective positive allosteric modulator reduced self-stimulation. Conversely, blockade of these receptors increased thalamostriatal self-stimulation, suggesting that endogenous activation of these receptors negatively modulates the reinforcing properties of thalamostriatal activity. These findings demonstrate that stimulation of thalamic terminals in the DMS is sufficient to reinforce a self-initiated action, and that thalamostriatal reinforcement is constrained by mGlu2 activation.

The effects of age on cerebral responses to self-initiated actions during social interactions: An exploratory study

Self-initiated action is critical to social interaction and individuals with social anxiety find it particularly difficult to initiate social interactions. We showed earlier that social exclusion encumbered self-initiated actions in the Cyberball task in young adults. Here, we examined whether the behavioral performance and regional responses during self-initiated actions vary with age in 53 participants (21–74 years; 27 men). Behaviorally, participants were slower in tossing the ball during exclusion (EX) than during fair game (FG) sessions in both men and women. In women but not in men the reaction time (RT) burden (RT_EX – RT_FG; RT prolonged during social exclusion) of ball toss was positively correlated with age despite no observed sex difference in Social Interaction Anxiety Scale scores. The pregenual anterior cingulate cortex, thalamus, left occipital cortex (OC) and left insula/orbitofrontal cortex responded to ball toss in EX vs. FG in negative correlation with age in women but not in men. Further, the activation of left OC fully mediated the relationship between age and RT burden in women. Thus, older women are more encumbered in self-initiated action during social exclusion, although this behavioral burden is not reflected in subjective reports of social anxiety. Age-related diminution in OC activities may reflect the neural processes underlying the difficulty in initiating social interactions in women. Together, the findings identified age-sensitive behavioral and neural processes of self-initiated action in the Cyberball task and suggest the importance of considering age and sex differences in studies of social interaction.

Do readiness potentials happen all the time?

The Readiness Potential (RP) is a slow negative EEG potential found in the seconds preceding voluntary actions. Here, we explore whether the RP is found only at this time, or if it also occurs when no action is produced. Recent theories suggest the RP reflects the average of accumulated stochastic fluctuations in neural activity, rather than a specific signal related to self-initiated action: RP-like events should then be widely present, even in the absence of actions. We investigated this hypothesis by searching for RP-like events in background EEG of an appropriate dataset for which the action-locked EEG had previously been analysed to test other hypotheses [Khalighinejad, N., Brann, E., Dorgham, A., Haggard, P. Dissociating cognitive and motoric precursors of human self-initiated action. Journal of Cognitive Neuroscience. 2019, 1-14]. We used the actual mean RP as a template, and searched the entire epoch for similar neural signals, using similarity metrics that capture the temporal or spatial properties of the RP. Most EEG epochs contained a number of events that were similar to the true RP, but did not lead directly to any voluntary action. However, these RP-like events were equally common in epochs that eventually terminated in voluntary actions as in those where voluntary actions were not permitted. Events matching the temporal profile of the RP were also a poor match for the spatial profile, and vice versa. We conclude that these events are false positives, and do not reflect the same mechanism as the RP itself. Finally, applying the same template-search algorithm to simulated EEG data synthesized from different noise distributions showed that RP-like events will occur in any dataset containing the 1⁄f noise ubiquitous in EEG recordings. To summarise, we found no evidence of genuinely RP-like events at any time other than immediately prior to self-initiated actions. Our findings do not support a purely stochastic model of RP generation, and suggest that the RP may be a specific precursor of self-initiated voluntary actions.

Social anxiety, posterior insula activation, and autonomic response during self-initiated action in a Cyberball game

BackgroundAn earlier study characterized the neural correlates of self-initiated actions in a Cyberball game in healthy individuals. It remains unclear how social anxiety may influence these neural processes. MethodsWe examined regional activations to self-initiated actions in 25 adults with low and 25 with high social anxiety (LA and HA, respectively). Skin conductance was recorded concurrently with fMRI. We followed published routines in the analyses of imaging and skin conductance data. ResultsWe hypothesized that HA as compared to LA individuals would demonstrate increased cortical limbic activations during self-initiated actions (tossing or T > receiving or R trials, to control for motor activities) in social exclusion (EX) vs. fair game (FG) scenario. At a corrected threshold, HA as compared with LA group showed increases in bilateral posterior insula activation during T vs. R trials in EX as compared to FG. Further, HA as compared to LA showed higher skin conductance response to tossing trials during EX as compared to FG. LimitationsWith a limited sample size, we did not examine potential sex effects. Further, we cannot rule out the effects of depression on the findings. ConclusionsTogether, the results suggest that individuals with more severe social anxiety engaged the somatosensory insula to a greater extent and exhibited higher physiological arousal when initiating ball toss during social exclusion in the Cyberball game. Posterior insula response to self-initiated action may represent a biomarker of social anxiety. It remains to be investigated whether interventions to decrease physiological arousal may alleviate social anxiety.

Cerebral responses to self-initiated action during social interactions.

Social interaction involves self-initiated actions that engage subjective awareness of one's own volition. Individuals with social communication needs or social anxiety find it particularly difficult to initiate social interactions. However, extant studies have not specifically addressed how perceived exclusion may influence self-initiated actions during social interaction. As a first step to address this question, we scanned 24 healthy adults participating in a Cyberball game with two fictive players. By contrasting events of observing, receiving, and initiating ball toss during a scenario of fair game (FG) and of exclusion (EX), we examined the neural correlates of self-initiated action during social interactions. Behaviorally, participants were faster in catching but slower in tossing the ball in EX compared with FG, suggesting a burden during self-initiated actions during social exclusion. Tossing versus receiving (or observing) engaged higher activity during EX than FG in the precuneus and angular gyrus, regions that have been widely implicated in theory of mind processing and social emotions. Across subjects these cortical activities correlated positively with the difference between EX and FG in the percentage of trials where participants tossed the ball back to the same player (r = 0.69, p < 0.001). Together, the results suggested that, in healthy adults, social exclusion encumbered and engaged higher posterior cortical activations during self-initiated actions. The findings may facilitate future research of neural markers of social behavioral disorders.

Two Distinctions That Help to Chart the Interplay Between Conscious and Unconscious Volition.

Research initiated by Benjamin Libet suggests that short-term conscious intentions are not the onsets of bodily actions. However, other research, particularly on longer-term intentions, seems to show that at least some conscious intentions are effective. This leads to the idea that volition is a complex interplay between conscious and unconscious processes. The nature and structure of this interplay is mostly uncharted territory. In this article, I will highlight two currently neglected distinctions that will help to chart the territory. The first distinction is between intentions we become conscious of (passive) and consciously formed intentions (active). The second is Fred Dretske’s distinction between structuring and triggering causes. I will introduce both distinctions by discussing how they tie in with and strengthen recent criticism of free selection paradigms and support the idea that consciously self-initiated action issues from processes of conscious deliberation and/or information integration. I will argue that consciously self-initiated action typically involves consciously formed intentions that are the structuring causes of our actions. This notion of conscious intentional action allows us to identify at least four stages in which unconscious processes co-determine our actions—without undermining their self-initiated character.

Dissociating Cognitive and Motoric Precursors of Human Self-Initiated Action.

Across-trial variability of EEG decreases more markedly before self-initiated than before externally triggered actions, providing a novel neural precursor for volitional action. However, it remains unclear whether this neural convergence is an early, deliberative stage or a late, execution-related stage in the chain of cognitive processes that transform intentions to actions. We report two experiments addressing these questions. Participants viewed randomly moving dots on a screen. At a random time, all dots started moving coherently to the left or right side of the screen. Participants were rewarded for correctly responding to the direction of coherent dot movement. However, the waiting time before coherent dot motion onset could be extremely long. Participants had the option to skip waiting by pressing a "skip" key. These self-initiated "skips" were compared with blocks where participants were instructed to skip. EEG variability decreased more markedly before self-initiated compared with externally triggered "skip" actions, replicating previous findings. Importantly, this EEG convergence was stronger at frontomidline electrodes than at either the electrode contralateral or ipsilateral to the hand assigned to the "skip" action in each block (Experiment 1). Furthermore, convergence was stronger when availability of skip responses was "rationed," encouraging deliberate planning before skipping (Experiment 2). This suggests that the initiation of voluntary actions involves a bilaterally distributed, effector-independent process related to deliberation. A consistent process of volition is detectable during early, deliberative planning and not only during late, execution-related time windows.

What variables are associated with the public's willingness to take measures to maintain a hygienic hospital environment?

Most of the studies on hospital infections have focused on the perceptions and reported behavior of the medical personnel. This research explore the practices undertaken both by Israeli patients and visitors, in order to maintain a hygienic hospital environment, and to locate the variables that are associated with them. An online survey of national representative sample of Israeli hospital's visitors and patients adult population, who were hospitalized in the five years before the interview (n=209), and who visited patients in hospitals in the three years before the interview (n=454). Only a minority of patients (24%) comment to medical personnel about maintaining hygiene, while a majority (67%-69%) took active steps to maintain a hygienic environment. The main variables that were found to be associated with patients' making comments were level of religiousness and gender, whereas priorities, namely whether hospital infections were a high priority, and the frequency of the patient's visits to hospital outpatient clinics, were associated with self-initiated action. In order to reduce barriers to commenting to hospital personnel, we propose framing the subject of hospital hygiene as a matter of health literacy and a subject of public discourse, rather than a sole medical issue.

Precursor processes of human self-initiated action

A gradual buildup of electrical potential over motor areas precedes self-initiated movements. Recently, such “readiness potentials” (RPs) were attributed to stochastic fluctuations in neural activity. We developed a new experimental paradigm that operationalized self-initiated actions as endogenous ‘skip’ responses while waiting for target stimuli in a perceptual decision task. We compared these to a block of trials where participants could not choose when to skip, but were instead instructed to skip. Frequency and timing of motor action were therefore balanced across blocks, so that conditions differed only in how the timing of skip decisions was generated. We reasoned that across-trial variability of EEG could carry as much information about the source of skip decisions as the mean RP. EEG variability decreased more markedly prior to self-initiated compared to externally-triggered skip actions. This convergence suggests a consistent preparatory process prior to self-initiated action. A leaky stochastic accumulator model could reproduce this convergence given the additional assumption of a systematic decrease in input noise prior to self-initiated actions. Our results may provide a novel neurophysiological perspective on the topical debate regarding whether self-initiated actions arise from a deterministic neurocognitive process, or from neural stochasticity. We suggest that the key precursor of self-initiated action may manifest as a reduction in neural noise.

Neural basis of self-initiative in relation to apathy in a student sample

Human behaviour can be externally driven, e.g. catching a falling glass, or self-initiated and goal-directed, e.g. drinking a cup of coffee when one deems it is time for a break. Apathy refers to a reduction of self-initiated goal-directed or motivated behaviour, frequently present in neurological and psychiatric disorders. The amount of undertaken goal-directed behaviour varies considerably in clinical as well as healthy populations. In the present study, we investigated behavioural and neural correlates of self-initiated action in a student sample (N = 39) with minimal to high levels of apathy. We replicated activation of fronto-parieto-striatal regions during self-initiation. The neural correlates of self-initiated action did not explain varying levels of apathy in our sample, neither when mass-univariate analysis was used, nor when multivariate patterns of brain activation were considered. Other hypotheses, e.g. regarding a putative role of deficits in reward anticipation, effort expenditure or executive difficulties, deserve investigation in future studies.

Friendly Competition for Co-Progressive Development: The Asian Infrastructure Investment Bank vs. the Bretton Woods Institutions

The AIIB is the first major multilateral development bank in a generation and the first multinational institution initiated by China to support regional economic growth and inject new impetus to global governance reform. From the beginning, the AIIB must seek ways to set itself apart from the establishment as represented by the BWIs. This article proposes that the new AIIB break with conventional wisdom and the business as usual of the BWIs and adopt the concept of co-progressiveness for international development. Co-progressive development entails a normative principle that puts self-initiation and external inducement as a means of promoting self-initiated action at the center of international development agendas and programs. As a more proactive and effective system of international development is urgently needed, this article argues that the AIIB and the BWIs should engage in a friendly competition in which players compete for a common goal. Within the AIIB, development strategies, models, policies, as well as expertise and knowledge originating from such developing countries as emerging economies should be given equal or even prioritized consideration, as emerging economies have faced similar challenges and succeeded with innovative solutions. In doing so, the AIIB can lend legitimacy to its international foray, while the global development agenda will be advanced more effectively.

Modifying N1 amplitude: Training an expectation that delayed auditory sensations result from a self-initiated action

Event Abstract Back to Event Modifying N1 amplitude: Training an expectation that delayed auditory sensations result from a self-initiated action Ruth B. Elijah1*, Mike E. Le Pelley1 and Thomas J. Whitford1 1 UNSW Australia, Australia Aim: Our ability to suppress self-generated sensations is dependent on the length of time between when an action is initiated and when the resultant sensory information is generated. Specifically, sensations that follow immediately from actions are attenuated to a larger degree than delayed sensations. The current study aimed to determine whether cortical responses to delayed self-initiated auditory events can be modified with training. Method: Electroencephalographic (EEG) recordings where undertaken while participants pressed a button to produce a tone that occurred either immediately or 100ms subsequent to the button-press. The event related potential (ERP) to the tone was generated, and the amplitude of N1 was extracted. Fifty participants were randomly assigned to one of two training groups; one group of participants (n=25) were repeatedly exposed to tones that followed immediately from their button-presses, whereas the other group (n=25) were repeatedly exposed to delayed tones. In order to evaluate the effect of training, participants’ evoked responses to immediate and delayed self-initiated tones were assessed before and after training. Results: Pre-training, the mean amplitude of N1 was significantly larger for delayed tones compared to immediate tones. Participants who were trained to the delayed tones showed a reduction in N1 amplitude across training, such that there was no difference in N1 between immediate and delayed tones post-training. This was in contrast to the participants who received training to immediate tones, who maintained a significantly larger N1 to delayed tones over immediate tones post-training. Conclusions: Repeated exposure to delayed sensory consequences of self-generated actions results in new learning about the temporal relationships between the action and the outcome, and, as such, increased cortical attenuation to temporally delayed sensations. This suggests that behavioural training could represent a potential avenue for alleviating sensory suppression deficits, such as those that have consistently been observed in patients with schizophrenia. References Elijah, R.B., Le Pelley, M.E. & Whitford, T.J. (2016). Modifying temporal expectations: Changing cortical responsivity to delayed self-initiated sensations with training. Biological Psychology, 120, 88-95. Keywords: Sensory Attenuation, N1-suppression, temporal expectation, corollary discharge, event-related potential (ERP) Conference: ASP2016 - The 26th Annual Meeting of the Australasian Society for Psychophysiology, Adelaide Australia, Adelaide,SA, Australia, 12 Dec - 14 Dec, 2016. Presentation Type: Oral Presentation Topic: Abstract (student award) Citation: Elijah RB, Le Pelley ME and Whitford TJ (2016). Modifying N1 amplitude: Training an expectation that delayed auditory sensations result from a self-initiated action. Conference Abstract: ASP2016 - The 26th Annual Meeting of the Australasian Society for Psychophysiology, Adelaide Australia. doi: 10.3389/conf.fnhum.2016.221.00027 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 19 Oct 2016; Published Online: 05 Dec 2016. * Correspondence: Ms. Ruth B Elijah, UNSW Australia, Sydney, NSW, 2052, Australia, ruth.elijah@unsw.edu.au Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Ruth B Elijah Mike E Le Pelley Thomas J Whitford Google Ruth B Elijah Mike E Le Pelley Thomas J Whitford Google Scholar Ruth B Elijah Mike E Le Pelley Thomas J Whitford PubMed Ruth B Elijah Mike E Le Pelley Thomas J Whitford Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

Deficits of reach-to-grasp coordination following stroke: Comparison of instructed and natural movements

The present work evaluates whether stroke-induced deficits of reach-to-grasp movements, established by typical laboratory paradigms, transfer unconditionally to more natural situations.Sixteen patients with a stroke to the motor-dominant left hemisphere and 16 age- and gender-matched healthy control subjects executed grasping movements with their left (ipsilesional, non-dominant) hand. All movements started in the same position, were aimed at the same object positioned in the same location, and were followed by forward displacement of that object along the same path. Twenty movements were performed as a repetitive, externally triggered task executed for their own sake (context L, as in typical laboratory tasks). Twenty movements were performed as part of a self-initiated action sequence aimed at winning a reward (context E, similar to many everyday situations). The kinematics and dynamics of the transport, grasp and manipulation component of each reach-to-grasp movement were quantified by 41 parameters.Analyses of variance yielded a significant effect of Context for 29 parameters, a significant effect of Group for 9 parameters (mostly related to the coupling of hand transport and grip aperture), and a significant interaction for 5 parameters (all related to the coupling of hand transport and grip aperture). The interaction reflected the fact that stroke patients' movement parameters were more abnormal in context E than in context L.Our data indicate that unilateral stroke degrades the grasp-transport coupling, and that stroke-related motor deficits may be more pronounced in a natural than in a laboratory context. Thus, for stroke patients, assessments and rehabilitation regimes should mainly use activities that are as natural as possible.

Leading the follower: An fMRI investigation of dynamic cooperativity and leader–follower strategies in synchronization with an adaptive virtual partner

From everyday experience we know that it is generally easier to interact with someone who adapts to our behavior. Beyond this, achieving a common goal will very much depend on who adapts to whom and to what degree. Therefore, many joint action tasks such as musical performance prove to be more successful when defined leader–follower roles are established. In the present study, we present a novel approach to explore the mechanisms of how individuals lead and, using functional magnetic resonance imaging (fMRI), probe the neural correlates of leading. Specifically, we implemented an adaptive virtual partner (VP), an auditory pacing signal, with which individuals were instructed to tap in synchrony while maintaining a steady tempo. By varying the degree of temporal adaptation (period correction) implemented by the VP, we manipulated the objective control individuals had to exert to maintain the overall tempo of the pacing sequence (which was prone to tempo drift with high levels of period correction). Our imaging data revealed that perceiving greater influence and leading are correlated with right lateralized frontal activation of areas involved in cognitive control and self-related processing. Using participants' subjective ratings of influence and task difficulty, we classified a subgroup of our cohort as “leaders”, individuals who found the task of synchronizing easier when they felt more in control. Behavioral tapping measures showed that leaders employed less error correction and focused more on self-tapping (prioritizing the instruction to maintain the given tempo) than on the stability of the interaction (prioritizing the instruction to synchronize with the VP), with correlated activity in areas involved in self-initiated action including the pre-supplementary motor area.

Predictable and self-initiated visual motion is judged to be slower than computer generated motion

Self-initiated action effects are often perceived as less intense than identical but externally generated stimuli. It is thought that forward models within the sensorimotor system pre-activate cortical representations of predicted action effects, reducing perceptual sensitivity and attenuating neural responses. As self-agency and predictability are seldom manipulated simultaneously in behavioral experiments, it is unclear if self-other differences depend on predictable action effect contingencies, or if both self- and externally generated stimuli are modulated similarly by predictability. We factorially combined variation in (1) predictability of action effects, (2) spatial congruence, and (3) performance by the self or computer to dissociate these influences on a visual discrimination task. Participants performed 2AFC speed judgments. Self-initiated motion was judged to be slower than computer-initiated motion when action effect contingencies were predictable, while spatial congruence influenced speed judgments only when action effect contingencies were unpredictable. Results are discussed in relation to current theories of sensory attenuation.

A self-management approach using self-initiated action plans for symptoms with ongoing nurse support in patients with Chronic Obstructive Pulmonary Disease (COPD) and comorbidities: The COPE-III study protocol

BackgroundChronic Obstructive Pulmonary Disease (COPD) frequently coexists with other diseases. Whereas COPD action plans are currently part of usual care, they are less suitable and potentially unsafe for use in the presence of comorbidities. This study evaluates whether an innovative treatment approach directed towards COPD and frequently existing comorbidities can reduce COPD exacerbation days. We hypothesise that this approach, which combines self-initiated action plans and nurse support, will accelerate proper treatment actions and lead to better control of deteriorating symptoms. MethodsIn this multicenter randomised controlled trial we aim to include 300 patients with COPD (GOLD II-IV), and with at least one comorbidity (cardiovascular disease, diabetes, anxiety and/or depression). Patients will be recruited from hospitals in the Netherlands (n=150) and Australia (n=150) and will be assigned to an intervention or control group. All patients will learn to complete daily symptom diaries for 12-months. Intervention group patients will participate in self-management training sessions to learn the use of individualised action plans for COPD and comorbidities, linked to the diary. The primary outcome is the number of COPD exacerbation days. Secondary outcomes include hospitalisations, quality of life, self-efficacy, adherence, patient's satisfaction and confidence, health care use and cost data. AnalysesIntention-to-treat analyses (random effect negative binomial regression and random effect mixed models) and cost-effectiveness analyses will be performed. DiscussionPrudence should be employed before extrapolating the use of COPD specific action plans in patients with comorbidities. This study evaluates the efficacy of tailored action plans for both COPD and common comorbidities.

Why Do Individuals Engage in Proactive Behavior? Understanding Motivations Behind Proactivity

Proactive behavior is self-initiated, future-focused and change-oriented action that aims to bring about positive change in the future. It has been found to be positively linked to various personal...