Development and testing of patient-centered education about hormone replacement therapy for women at high genetic risk of breast and ovarian cancer.

OBJECTIVE: In this study, we aimed to develop education to assist BRCA mutation carriers in making informed decisions about HRT in the context of risk-reducing surgery, while simultaneously clarifying their treatment-specific values and reducing decisional conflict. METHODS: We enrolled premenopausal BRCA mutation carriers ages 19-49 without prior cancer or risk-reducing salpingo-oophorectomy to structured interviews in which they reviewed education about the risks and benefits of HRT. Materials included literature-derived data demonstrating associations between HRT and commonly considered health outcomes (breast cancer, vasomotor symptoms, sexual functioning, cardiovascular disease, osteoporosis, and blood clots). Participants completed the 16-item Decisional Conflict Scale (DCS) before and after education, communicated their preferences by rating and ranking the six outcomes, and provided feedback to inform iterative revisions of the educational content. RESULTS: 25 participants completed interviews. DCS scores decreased significantly from 54.6 to 22.8 following education (p < 0.001); sub-scores for uncertainty (71.7 to 37.3), informed (71.7 to 15.3), values clarity (53.7 to 17.0), effective decision (44.2 to 25.5), and support (35.0 to 17.7) also decreased significantly. Participants ranked cardiovascular disease as the most important outcome to consider, followed by breast cancer, osteoporosis, blood clots, decline in sexual function, and hot flashes. Participants with prior mastectomy (N = 10) ranked breast cancer as the most important outcome 25% of the time, compared to 80% in participants without mastectomy (N = 15). CONCLUSION: Following education, BRCA mutation carriers had significantly less decisional conflict regarding the choice to use HRT. This pilot study was successful in generating a prototype educational aid for further testing.

The role of local meaning in infants' fixations of natural scenes.

As infants view visual scenes every day, they must shift their eye gaze and visual attention from location to location, sampling information to process and learn. Like adults, infants' gaze when viewing natural scenes (i.e., photographs of everyday scenes) is influenced by the physical features of the scene image and a general bias to look more centrally in a scene. However, it is unknown how infants' gaze while viewing such scenes is influenced by the semantic content of the scenes. Here, we tested the relative influence of local meaning, controlling for physical salience and center bias, on the eye gaze of 4- to 12-month-old infants (N = 92) as they viewed natural scenes. Overall, infants were more likely to fixate scene regions rated as higher in meaning, indicating that, like adults, the semantic content, or local meaning, of scenes influences where they look. More importantly, the effect of meaning on infant attention increased with age, providing the first evidence for an age-related increase in the impact of local meaning on infants' eye movements while viewing natural scenes.

Rapid Extraction of the Spatial Distribution of Physical Saliency and Semantic Informativeness from Natural Scenes in the Human Brain.

Physically salient objects are thought to attract attention in natural scenes. However, research has shown that meaning maps, which capture the spatial distribution of semantically informative scene features, trump physical saliency in predicting the pattern of eye moments in natural scene viewing. Meaning maps even predict the fastest eye movements, suggesting that the brain extracts the spatial distribution of potentially meaningful scene regions very rapidly. To test this hypothesis, we applied representational similarity analysis to ERP data. The ERPs were obtained from human participants (N = 32, male and female) who viewed a series of 50 different natural scenes while performing a modified 1-back task. For each scene, we obtained a physical saliency map from a computational model and a meaning map from crowd-sourced ratings. We then used representational similarity analysis to assess the extent to which the representational geometry of physical saliency maps and meaning maps can predict the representational geometry of the neural response (the ERP scalp distribution) at each moment in time following scene onset. We found that a link between physical saliency and the ERPs emerged first (∼78 ms after stimulus onset), with a link to semantic informativeness emerging soon afterward (∼87 ms after stimulus onset). These findings are in line with previous evidence indicating that saliency is computed rapidly, while also indicating that information related to the spatial distribution of semantically informative scene elements is computed shortly thereafter, early enough to potentially exert an influence on eye movements.SIGNIFICANCE STATEMENT Attention may be attracted by physically salient objects, such as flashing lights, but humans must also be able to direct their attention to meaningful parts of scenes. Understanding how we direct attention to meaningful scene regions will be important for developing treatments for disorders of attention and for designing roadways, cockpits, and computer user interfaces. Information about saliency appears to be extracted rapidly by the brain, but little is known about the mechanisms that determine the locations of meaningful information. To address this gap, we showed people photographs of real-world scenes and measured brain activity. We found that information related to the locations of meaningful scene elements was extracted rapidly, shortly after the emergence of saliency-related information.

A Pilot Study of a Screening Program for Human Papillomavirus-Related Squamous Intraepithelial Lesion and Malignancy in Gynecologic Oncology Patients.

OBJECTIVE: Human papillomavirus (HPV)-related squamous intraepithelial lesion (SIL) or malignancy is associated with a significantly increased risk of second-site SIL or malignancy. The primary objective of this study was to determine the feasibility and acceptability of concurrent anal, cervical, and vulvovaginal screening in patients with a history of HPV-related gynecologic high-grade SIL or malignancy. The secondary objective was to assess subjects' knowledge regarding HPV screening and risks. METHODS: Women with high-grade cervical, vulvar, or vaginal SIL or malignancy were enrolled during a 1-year pilot period. Subjects with cervical SIL or malignancy underwent vulvar examination and anoscopy. Subjects with vulvovaginal SIL or malignancy underwent Pap test if indicated and anoscopy. Appropriate referrals were made for abnormal findings. Feasibility was assessed by compliance using study acceptance rate, screening procedure adherence, and referral adherence. Acceptability was assessed using a Likert-scaled question after completion of screening procedures. RESULTS: One hundred three women with a diagnosis of high-grade vulvovaginal or cervical SIL or carcinoma were approached regarding study enrollment; of these, 74 (71.8%) enrolled. The median score on the HPV knowledge assessment was 8.1 ± 1.6 (max score 10). Seventy-three (98.6%) of 74 patients rated the screening procedures as acceptable (score of 5/5). On examination, 14 (18.9%) subjects had abnormalities noted; 7 (9.5%) were referred for colorectal surgical evaluation, and 6/7 (85.7%) were compliant with their referral appointments. CONCLUSIONS: Screening examinations for other HPV-related SILs and malignancies, including Pap tests, vulvovaginal inspection, and anoscopy, are acceptable to patients, with abnormal findings in almost 1 in 5 women.

Linking patterns of infant eye movements to a neural network model of the ventral stream using representational similarity analysis.

Little is known about the development of higher-level areas of visual cortex during infancy, and even less is known about how the development of visually guided behavior is related to the different levels of the cortical processing hierarchy. As a first step toward filling these gaps, we used representational similarity analysis (RSA) to assess links between gaze patterns and a neural network model that captures key properties of the ventral visual processing stream. We recorded the eye movements of 4- to 12-month-old infants (N = 54) as they viewed photographs of scenes. For each infant, we calculated the similarity of the gaze patterns for each pair of photographs. We also analyzed the images using a convolutional neural network model in which the successive layers correspond approximately to the sequence of areas along the ventral stream. For each layer of the network, we calculated the similarity of the activation patterns for each pair of photographs, which was then compared with the infant gaze data. We found that the network layers corresponding to lower-level areas of visual cortex accounted for gaze patterns better in younger infants than in older infants, whereas the network layers corresponding to higher-level areas of visual cortex accounted for gaze patterns better in older infants than in younger infants. Thus, between 4 and 12 months, gaze becomes increasingly controlled by more abstract, higher-level representations. These results also demonstrate the feasibility of using RSA to link infant gaze behavior to neural network models. A video abstract of this article can be viewed at https://youtu.be/K5mF2Rw98Is.

Investigating factors that influence genetic counselors' decisions to refer patients to mental health providers.

Genetic counselors (GC) serve patients who are often in distress at the time of their consultation. GC competency includes providing short-term, client-centered counseling, while using community resources, such as mental health providers (MHPs), for psychosocial support. The purpose of this study was to assess the mental health referral practices of GCs; specifically, the rate of referrals, factors influencing a GC's decision to refer, and barriers to referrals. GCs working in direct patient care for at least one year were recruited to take a novel 27 question survey created based on the results of a previous qualitative study. A link to the web-based survey was distributed through the National Society of Genetic Counselors Student Research Program and American Board of Genetic Counselors by email. A total of 144 individuals opened the survey for an estimated response rate of 3%. A majority of respondents (54.3%) reported they assess a patient's need for a mental health referral at least half of the time. The mean number of referrals made in the past 12 months was 5.13. After post-hoc analyses, there were no differences in referral rates between specialties. Common referral indications included patient history of mental illness, distress about having a genetic condition, and limited social support. Common barriers to referral were financial or insurance related, patient receptiveness, and the patient not perceiving a benefit. GCs felt that providing psychosocial support is within their scope of practice, but that MHPs are better equipped to manage long-term needs and those related to a mental health condition. This study provides insight into how GCs decide when they can manage patient distress, circumstances that prompt a referral to MHPs, and barriers. Recognizing common referral indications and barriers may lead to better strategies for connecting patients with such services.

Looking for Semantic Similarity: What a Vector-Space Model of Semantics Can Tell Us About Attention in Real-World Scenes.

The visual world contains more information than we can perceive and understand in any given moment. Therefore, we must prioritize important scene regions for detailed analysis. Semantic knowledge gained through experience is theorized to play a central role in determining attentional priority in real-world scenes but is poorly understood. Here, we examined the relationship between object semantics and attention by combining a vector-space model of semantics with eye movements in scenes. In this approach, the vector-space semantic model served as the basis for a concept map, an index of the spatial distribution of the semantic similarity of objects across a given scene. The results showed a strong positive relationship between the semantic similarity of a scene region and viewers' focus of attention; specifically, greater attention was given to more semantically related scene regions. We conclude that object semantics play a critical role in guiding attention through real-world scenes.

Meaning and expected surfaces combine to guide attention during visual search in scenes.

How do spatial constraints and meaningful scene regions interact to control overt attention during visual search for objects in real-world scenes? To answer this question, we combined novel surface maps of the likely locations of target objects with maps of the spatial distribution of scene semantic content. The surface maps captured likely target surfaces as continuous probabilities. Meaning was represented by meaning maps highlighting the distribution of semantic content in local scene regions. Attention was indexed by eye movements during the search for target objects that varied in the likelihood they would appear on specific surfaces. The interaction between surface maps and meaning maps was analyzed to test whether fixations were directed to meaningful scene regions on target-related surfaces. Overall, meaningful scene regions were more likely to be fixated if they appeared on target-related surfaces than if they appeared on target-unrelated surfaces. These findings suggest that the visual system prioritizes meaningful scene regions on target-related surfaces during visual search in scenes.

Neural Correlates of Fixated Low- and High-level Scene Properties during Active Scene Viewing.

During real-world scene perception, viewers actively direct their attention through a scene in a controlled sequence of eye fixations. During each fixation, local scene properties are attended, analyzed, and interpreted. What is the relationship between fixated scene properties and neural activity in the visual cortex? Participants inspected photographs of real-world scenes in an MRI scanner while their eye movements were recorded. Fixation-related fMRI was used to measure activation as a function of lower- and higher-level scene properties at fixation, operationalized as edge density and meaning maps, respectively. We found that edge density at fixation was most associated with activation in early visual areas, whereas semantic content at fixation was most associated with activation along the ventral visual stream including core object and scene-selective areas (lateral occipital complex, parahippocampal place area, occipital place area, and retrosplenial cortex). The observed activation from semantic content was not accounted for by differences in edge density. The results are consistent with active vision models in which fixation gates detailed visual analysis for fixated scene regions, and this gating influences both lower and higher levels of scene analysis.

When scenes speak louder than words: Verbal encoding does not mediate the relationship between scene meaning and visual attention.

The complexity of the visual world requires that we constrain visual attention and prioritize some regions of the scene for attention over others. The current study investigated whether verbal encoding processes influence how attention is allocated in scenes. Specifically, we asked whether the advantage of scene meaning over image salience in attentional guidance is modulated by verbal encoding, given that we often use language to process information. In two experiments, 60 subjects studied scenes (N1 = 30 and N2 = 60) for 12 s each in preparation for a scene-recognition task. Half of the time, subjects engaged in a secondary articulatory suppression task concurrent with scene viewing. Meaning and saliency maps were quantified for each of the experimental scenes. In both experiments, we found that meaning explained more of the variance in visual attention than image salience did, particularly when we controlled for the overlap between meaning and salience, with and without the suppression task. Based on these results, verbal encoding processes do not appear to modulate the relationship between scene meaning and visual attention. Our findings suggest that semantic information in the scene steers the attentional ship, consistent with cognitive guidance theory.

Meaning guides attention in real-world scene images: Evidence from eye movements and meaning maps.

We compared the influence of meaning and of salience on attentional guidance in scene images. Meaning was captured by "meaning maps" representing the spatial distribution of semantic information in scenes. Meaning maps were coded in a format that could be directly compared to maps of image salience generated from image features. We investigated the degree to which meaning versus image salience predicted human viewers' spatiotemporal distribution of attention over scenes. Extending previous work, here the distribution of attention was operationalized as duration-weighted fixation density. The results showed that both meaning and image salience predicted the duration-weighted distribution of attention, but that when the correlation between meaning and salience was statistically controlled, meaning accounted for unique variance in attention whereas salience did not. This pattern was observed in early as well as late fixations, fixations including and excluding the centers of the scenes, and fixations following short as well as long saccades. The results strongly suggest that meaning guides attention in real-world scenes. We discuss the results from the perspective of a cognitive-relevance theory of attentional guidance.

Scan patterns during real-world scene viewing predict individual differences in cognitive capacity.

From the earliest recordings of eye movements during active scene viewing to the present day, researchers have commonly reported individual differences in eye movement scan patterns under constant stimulus and task demands. These findings suggest viewer individual differences may be important for understanding gaze control during scene viewing. However, the relationship between scan patterns and viewer individual differences during scene viewing remains poorly understood because scan patterns are difficult to analyze. The present study uses a powerful technique called Successor Representation Scanpath Analysis (Hayes, Petrov, & Sederberg, 2011, 2015) to quantify the strength of the association between individual differences in scan patterns during real-world scene viewing and individual differences in viewer intelligence, working memory capacity, and speed of processing. The results of this analysis revealed individual differences in scan patterns that explained more than 40% of the variance in viewer intelligence and working memory capacity measures, and more than a third of the variance in speed of processing measures. The theoretical implications of our findings for models of gaze control and avenues for future individual differences research are discussed.

Pupil Diameter Tracks the Exploration-Exploitation Trade-off during Analogical Reasoning and Explains Individual Differences in Fluid Intelligence.

The ability to adaptively shift between exploration and exploitation control states is critical for optimizing behavioral performance. Converging evidence from primate electrophysiology and computational neural modeling has suggested that this ability may be mediated by the broad norepinephrine projections emanating from the locus coeruleus (LC) [Aston-Jones, G., & Cohen, J. D. An integrative theory of locus coeruleus-norepinephrine function: Adaptive gain and optimal performance. Annual Review of Neuroscience, 28, 403-450, 2005]. There is also evidence that pupil diameter covaries systematically with LC activity. Although imperfect and indirect, this link makes pupillometry a useful tool for studying the locus coeruleus norepinephrine system in humans and in high-level tasks. Here, we present a novel paradigm that examines how the pupillary response during exploration and exploitation covaries with individual differences in fluid intelligence during analogical reasoning on Raven's Advanced Progressive Matrices. Pupillometry was used as a noninvasive proxy for LC activity, and concurrent think-aloud verbal protocols were used to identify exploratory and exploitative solution periods. This novel combination of pupillometry and verbal protocols from 40 participants revealed a decrease in pupil diameter during exploitation and an increase during exploration. The temporal dynamics of the pupillary response was characterized by a steep increase during the transition to exploratory periods, sustained dilation for many seconds afterward, and followed by gradual return to baseline. Moreover, the individual differences in the relative magnitude of pupillary dilation accounted for 16% of the variance in Advanced Progressive Matrices scores. Assuming that pupil diameter is a valid index of LC activity, these results establish promising preliminary connections between the literature on locus coeruleus norepinephrine-mediated cognitive control and the literature on analogical reasoning and fluid intelligence.

Mapping and correcting the influence of gaze position on pupil size measurements.

Pupil size is correlated with a wide variety of important cognitive variables and is increasingly being used by cognitive scientists. Pupil data can be recorded inexpensively and non-invasively by many commonly used video-based eye-tracking cameras. Despite the relative ease of data collection and increasing prevalence of pupil data in the cognitive literature, researchers often underestimate the methodological challenges associated with controlling for confounds that can result in misinterpretation of their data. One serious confound that is often not properly controlled is pupil foreshortening error (PFE)-the foreshortening of the pupil image as the eye rotates away from the camera. Here we systematically map PFE using an artificial eye model and then apply a geometric model correction. Three artificial eyes with different fixed pupil sizes were used to systematically measure changes in pupil size as a function of gaze position with a desktop EyeLink 1000 tracker. A grid-based map of pupil measurements was recorded with each artificial eye across three experimental layouts of the eye-tracking camera and display. Large, systematic deviations in pupil size were observed across all nine maps. The measured PFE was corrected by a geometric model that expressed the foreshortening of the pupil area as a function of the cosine of the angle between the eye-to-camera axis and the eye-to-stimulus axis. The model reduced the root mean squared error of pupil measurements by 82.5 % when the model parameters were pre-set to the physical layout dimensions, and by 97.5 % when they were optimized to fit the empirical error surface.

Do We Really Become Smarter When Our Fluid-Intelligence Test Scores Improve?

Recent reports of training-induced gains on fluid intelligence tests have fueled an explosion of interest in cognitive training-now a billion-dollar industry. The interpretation of these results is questionable because score gains can be dominated by factors that play marginal roles in the scores themselves, and because intelligence gain is not the only possible explanation for the observed control-adjusted far transfer across tasks. Here we present novel evidence that the test score gains used to measure the efficacy of cognitive training may reflect strategy refinement instead of intelligence gains. A novel scanpath analysis of eye movement data from 35 participants solving Raven's Advanced Progressive Matrices on two separate sessions indicated that one-third of the variance of score gains could be attributed to test-taking strategy alone, as revealed by characteristic changes in eye-fixation patterns. When the strategic contaminant was partialled out, the residual score gains were no longer significant. These results are compatible with established theories of skill acquisition suggesting that procedural knowledge tacitly acquired during training can later be utilized at posttest. Our novel method and result both underline a reason to be wary of purported intelligence gains, but also provide a way forward for testing for them in the future.

Transformers bridge vision and language to estimate and understand scene meaning.

Humans rapidly process and understand real-world scenes with ease. Our stored semantic knowledge gained from experience is thought to be central to this ability by organizing perceptual information into meaningful units to efficiently guide our attention in scenes. However, the role stored semantic representations play in scene guidance remains difficult to study and poorly understood. Here, we apply a state-of-the-art multimodal transformer trained on billions of image-text pairs to help advance our understanding of the role semantic representations play in scene understanding. We demonstrate across multiple studies that this transformer-based approach can be used to automatically estimate local scene meaning in indoor and outdoor scenes, predict where people look in these scenes, detect changes in local semantic content, and provide a human-interpretable account of why one scene region is more meaningful than another. Taken together, these findings highlight how multimodal transformers can advance our understanding of the role scene semantics play in scene understanding by serving as a representational framework that bridges vision and language.

Visual attention during seeing for speaking in healthy aging.

As we age, we accumulate a wealth of information about the surrounding world. Evidence from visual search suggests that older adults retain intact knowledge for where objects tend to occur in everyday environments (semantic information) that allows them to successfully locate objects in scenes, but may overrely on semantic guidance. We investigated age differences in the allocation of attention to semantically informative and visually salient information in a task in which the eye movements of younger (N = 30, aged 18-24) and older (N = 30, aged 66-82) adults were tracked as they described real-world scenes. We measured the semantic information in scenes based on "meaning map" ratings from a norming sample of young and older adults, and image salience as graph-based visual saliency. Logistic mixed-effects modeling was used to determine whether, controlling for center bias, fixated scene locations differed in semantic informativeness and visual salience from locations that were not fixated, and whether these effects differed for young and older adults. Semantic informativeness predicted fixated locations well overall, as did image salience, although unique variance in the model was better explained by semantic informativeness than image salience. Older adults were less likely to fixate informative locations in scenes than young adults were, though the locations older adults' fixated were independently predicted well by informativeness. These results suggest young and older adults both use semantic information to guide attention in scenes and that older adults do not overrely on semantic information across the board. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

A Horse of a Different Color: A Case Report of Streptococcus Equi Meningitis in a Kidney Transplant Recipient.

Streptococcus equi is an opportunistic pathogen in horses that has rarely been transmitted to humans. Here we present a zoonotic S. equi meningitis case in a kidney transplant recipient with exposure to infected horses. We discuss the patient's risk factors, clinical presentation, and management in the context of the limited literature on S. equi meningitis.

Searching for meaning: Local scene semantics guide attention during natural visual search in scenes.

Models of visual search in scenes include image salience as a source of attentional guidance. However, because scene meaning is correlated with image salience, it could be that the salience predictor in these models is driven by meaning. To test this proposal, we generated meaning maps that represented the spatial distribution of semantic informativeness in scenes, and salience maps which represented the spatial distribution of conspicuous image features and tested their influence on fixation densities from two object search tasks in real-world scenes. The results showed that meaning accounted for significantly greater variance in fixation densities than image salience, both overall and in early attention across both studies. Here, meaning explained 58% and 63% of the theoretical ceiling of variance in attention across both studies, respectively. Furthermore, both studies demonstrated that fast initial saccades were not more likely to be directed to higher salience regions than slower initial saccades, and initial saccades of all latencies were directed to regions containing higher meaning than salience. Together, these results demonstrated that even though meaning was task-neutral, the visual system still selected meaningful over salient scene regions for attention during search.

Cryocompression to Reduce Peripheral Neuropathy in Gynecologic Cancer: A Randomized Controlled Trial.

OBJECTIVE: To investigate the efficacy of cryocompression therapy to prevent chemotherapy-induced peripheral neuropathy. METHODS: This single-institution, randomized, self-controlled trial of cryocompression enrolled gynecologic cancer patients planned for five to six cycles neurotoxic chemotherapy. Exclusion criteria were prior neurotoxic chemotherapy or baseline peripheral neuropathy. Participants were randomized to cryocompression on dominant versus non-dominant hand and foot (treatment), with no intervention on the opposite side (control). Compression socks and gloves and ice bags were applied 15 minutes before, during, and 15 minutes after infusion. Primary outcome measures included the PNQ (Patient Neurotoxicity Questionnaire) and the Semmes-Weinstein monofilament test; secondary outcomes included the FACT/GOG-NTX (Functional Assessment of Cancer Therapy/Gynecologic Oncology Group - Neurotoxicity) and patient acceptability and tolerability. Sixty patients completing the study were necessary to detect a 70% reduction in the odds of PNQ grade C or higher peripheral sensory neuropathy with 80% power. RESULTS: Ninety-one patients were enrolled from January 2021 to October 2022; 69 were eligible for final analysis. Of the 91 patients, 64.8% were White, 30.8% were Black, and 1.1% were Hispanic or Latina. With successive cycles, more patients had sensory PNQ grade C or higher neuropathy on the control side compared with the cryocompression side. Cryocompression decreased the odds of sensory neuropathy (PNQ grade C or higher) by 46% at final visit (odds ratio 0.54, 95% CI 0.31-0.94; P =.03). There was no difference in tactile sensitivity based on the monofilament test between sides at the final visit. At the final visit, average FACT/GOG-NTX-11 (Functional Assessment of Cancer Therapy/Gynecologic Oncology Group - Neurotoxicity 11 Item Version) scores were significantly lower on the cryocompression than the control side (estimate -0.97, 95% CI -1.89 to -0.06; P =.04), as were FACT/GOG-NTX-4 (Functional Assessment of Cancer Therapy/Gynecologic Oncology Group - Neurotoxicity 4 Item Version) scores (estimate -0.35, 95% CI -0.64 to -0.05; P =.02). More than 85% of patients assessed the intervention as acceptable and tolerable. CONCLUSIONS: Cryocompression therapy reduces subjective chemotherapy-induced peripheral sensory neuropathy in patients who are receiving paclitaxel or cisplatin for gynecologic cancer. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov , NCT04563130.