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1.
Annu Rev Neurosci ; 44: 449-473, 2021 07 08.
Artigo em Inglês | MEDLINE | ID: mdl-33882258

RESUMO

Adaptive behavior in a complex, dynamic, and multisensory world poses some of the most fundamental computational challenges for the brain, notably inference, decision-making, learning, binding, and attention. We first discuss how the brain integrates sensory signals from the same source to support perceptual inference and decision-making by weighting them according to their momentary sensory uncertainties. We then show how observers solve the binding or causal inference problem-deciding whether signals come from common causes and should hence be integrated or else be treated independently. Next, we describe the multifarious interplay between multisensory processing and attention. We argue that attentional mechanisms are crucial to compute approximate solutions to the binding problem in naturalistic environments when complex time-varying signals arise from myriad causes. Finally, we review how the brain dynamically adapts multisensory processing to a changing world across multiple timescales.


Assuntos
Atenção , Percepção Auditiva , Encéfalo , Aprendizagem , Percepção Visual
2.
J Neurophysiol ; 132(3): 770-780, 2024 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-39081210

RESUMO

Implicit sensorimotor adaptation keeps our movements well calibrated amid changes in the body and environment. We have recently postulated that implicit adaptation is driven by a perceptual error: the difference between the desired and perceived movement outcome. According to this perceptual realignment model, implicit adaptation ceases when the perceived movement outcome-a multimodal percept determined by a prior belief conveying the intended action, the motor command, and feedback from proprioception and vision-is aligned with the desired movement outcome. Here, we examined the role of proprioception in implicit motor adaptation and perceived movement outcome by examining individuals who experience deafferentation (i.e., individuals with impaired proprioception and touch). We used a modified visuomotor rotation task designed to isolate implicit adaptation and probe perceived movement outcomes throughout the experiment. Surprisingly, both implicit adaptation and perceived movement outcome were minimally impacted by chronic deafferentation, posing a challenge to the perceptual realignment model of implicit adaptation.NEW & NOTEWORTHY We tested six individuals with chronic somatosensory deafferentation on a novel task that isolates implicit sensorimotor adaptation and probes perceived movement outcome. Strikingly, both implicit motor adaptation and perceptual movement outcome were not significantly impacted by chronic deafferentation, posing a challenge for theoretical models of adaptation that involve proprioception.


Assuntos
Adaptação Fisiológica , Propriocepção , Desempenho Psicomotor , Humanos , Propriocepção/fisiologia , Adaptação Fisiológica/fisiologia , Masculino , Feminino , Desempenho Psicomotor/fisiologia , Adulto , Pessoa de Meia-Idade , Movimento/fisiologia , Idoso , Distúrbios Somatossensoriais/fisiopatologia
3.
J Neurophysiol ; 131(4): 723-737, 2024 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-38416720

RESUMO

The brain engages the processes of multisensory integration and recalibration to deal with discrepant multisensory signals. These processes consider the reliability of each sensory input, with the more reliable modality receiving the stronger weight. Sensory reliability is typically assessed via the variability of participants' judgments, yet these can be shaped by factors both external and internal to the nervous system. For example, motor noise and participant's dexterity with the specific response method contribute to judgment variability, and different response methods applied to the same stimuli can result in different estimates of sensory reliabilities. Here we ask how such variations in reliability induced by variations in the response method affect multisensory integration and sensory recalibration, as well as motor adaptation, in a visuomotor paradigm. Participants performed center-out hand movements and were asked to judge the position of the hand or rotated visual feedback at the movement end points. We manipulated the variability, and thus the reliability, of repeated judgments by asking participants to respond using either a visual or a proprioceptive matching procedure. We find that the relative weights of visual and proprioceptive signals, and thus the asymmetry of multisensory integration and recalibration, depend on the reliability modulated by the judgment method. Motor adaptation, in contrast, was insensitive to this manipulation. Hence, the outcome of multisensory binding is shaped by the noise introduced by sensorimotor processing, in line with perception and action being intertwined.NEW & NOTEWORTHY Our brain tends to combine multisensory signals based on their respective reliability. This reliability depends on sensory noise in the environment, noise in the nervous system, and, as we show here, variability induced by the specific judgment procedure.


Assuntos
Julgamento , Percepção Visual , Humanos , Julgamento/fisiologia , Percepção Visual/fisiologia , Reprodutibilidade dos Testes , Mãos/fisiologia , Movimento/fisiologia , Propriocepção/fisiologia
4.
Eur J Neurosci ; 59(11): 2979-2994, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38570828

RESUMO

Differences between autistic and non-autistic individuals in perception of the temporal relationships between sights and sounds are theorized to underlie difficulties in integrating relevant sensory information. These, in turn, are thought to contribute to problems with speech perception and higher level social behaviour. However, the literature establishing this connection often involves limited sample sizes and focuses almost entirely on children. To determine whether these differences persist into adulthood, we compared 496 autistic and 373 non-autistic adults (aged 17 to 75 years). Participants completed an online version of the McGurk/MacDonald paradigm, a multisensory illusion indicative of the ability to integrate audiovisual speech stimuli. Audiovisual asynchrony was manipulated, and participants responded both to the syllable they perceived (revealing their susceptibility to the illusion) and to whether or not the audio and video were synchronized (allowing insight into temporal processing). In contrast with prior research with smaller, younger samples, we detected no evidence of impaired temporal or multisensory processing in autistic adults. Instead, we found that in both groups, multisensory integration correlated strongly with age. This contradicts prior presumptions that differences in multisensory perception persist and even increase in magnitude over the lifespan of autistic individuals. It also suggests that the compensatory role multisensory integration may play as the individual senses decline with age is intact. These findings challenge existing theories and provide an optimistic perspective on autistic development. They also underline the importance of expanding autism research to better reflect the age range of the autistic population.


Assuntos
Percepção da Fala , Percepção Visual , Humanos , Adulto , Pessoa de Meia-Idade , Masculino , Feminino , Adolescente , Idoso , Percepção da Fala/fisiologia , Adulto Jovem , Percepção Visual/fisiologia , Transtorno Autístico/fisiopatologia , Transtorno Autístico/psicologia , Estimulação Acústica/métodos , Estimulação Luminosa/métodos , Ilusões/fisiologia , Fatores Etários , Percepção Auditiva/fisiologia
5.
Cardiovasc Diabetol ; 23(1): 244, 2024 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-38987773

RESUMO

OBJECTIVE: To adapt risk prediction equations for myocardial infarction (MI), stroke, and heart failure (HF) among patients with type 2 diabetes in real-world settings using cross-institutional electronic health records (EHRs) in Taiwan. METHODS: The EHRs from two medical centers, National Cheng Kung University Hospital (NCKUH; 11,740 patients) and National Taiwan University Hospital (NTUH; 20,313 patients), were analyzed using the common data model approach. Risk equations for MI, stroke, and HF from UKPDS-OM2, RECODe, and CHIME models were adapted for external validation and recalibration. External validation was assessed by (1) discrimination, evaluated by the area under the receiver operating characteristic curve (AUROC) and (2) calibration, evaluated by calibration slopes and intercepts and the Greenwood-Nam-D'Agostino (GND) test. Recalibration was conducted for unsatisfactory calibration (p-value of GND test < 0.05) by adjusting the baseline hazards of original equations to address variations in patients' cardiovascular risks across institutions. RESULTS: The CHIME risk equations had acceptable discrimination (AUROC: 0.71-0.79) and better calibration than that for UKPDS-OM2 and RECODe, although the calibration remained unsatisfactory. After recalibration, the calibration slopes/intercepts of the CHIME-MI, CHIME-stroke, and CHIME-HF risk equations were 0.9848/- 0.0008, 1.1003/- 0.0046, and 0.9436/0.0063 in the NCKUH population and 1.1060/- 0.0011, 0.8714/0.0030, and 1.0476/- 0.0016 in the NTUH population, respectively. All the recalibrated risk equations showed satisfactory calibration (p-values of GND tests ≥ 0.05). CONCLUSIONS: We provide valid risk prediction equations for MI, stroke, and HF outcomes in Taiwanese type 2 diabetes populations. A framework for adapting risk equations across institutions is also proposed.


Assuntos
Diabetes Mellitus Tipo 2 , Registros Eletrônicos de Saúde , Fatores de Risco de Doenças Cardíacas , Insuficiência Cardíaca , Infarto do Miocárdio , Valor Preditivo dos Testes , Acidente Vascular Cerebral , Humanos , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiologia , Medição de Risco , Masculino , Feminino , Idoso , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/diagnóstico , Taiwan/epidemiologia , Reprodutibilidade dos Testes , Prognóstico , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/diagnóstico , Técnicas de Apoio para a Decisão , Fatores de Tempo , Fatores de Risco
6.
BMC Med Res Methodol ; 24(1): 128, 2024 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-38834992

RESUMO

BACKGROUND: Clinical prediction models can help identify high-risk patients and facilitate timely interventions. However, developing such models for rare diseases presents challenges due to the scarcity of affected patients for developing and calibrating models. Methods that pool information from multiple sources can help with these challenges. METHODS: We compared three approaches for developing clinical prediction models for population screening based on an example of discriminating a rare form of diabetes (Maturity-Onset Diabetes of the Young - MODY) in insulin-treated patients from the more common Type 1 diabetes (T1D). Two datasets were used: a case-control dataset (278 T1D, 177 MODY) and a population-representative dataset (1418 patients, 96 MODY tested with biomarker testing, 7 MODY positive). To build a population-level prediction model, we compared three methods for recalibrating models developed in case-control data. These were prevalence adjustment ("offset"), shrinkage recalibration in the population-level dataset ("recalibration"), and a refitting of the model to the population-level dataset ("re-estimation"). We then developed a Bayesian hierarchical mixture model combining shrinkage recalibration with additional informative biomarker information only available in the population-representative dataset. We developed a method for dealing with missing biomarker and outcome information using prior information from the literature and other data sources to ensure the clinical validity of predictions for certain biomarker combinations. RESULTS: The offset, re-estimation, and recalibration methods showed good calibration in the population-representative dataset. The offset and recalibration methods displayed the lowest predictive uncertainty due to borrowing information from the fitted case-control model. We demonstrate the potential of a mixture model for incorporating informative biomarkers, which significantly enhanced the model's predictive accuracy, reduced uncertainty, and showed higher stability in all ranges of predictive outcome probabilities. CONCLUSION: We have compared several approaches that could be used to develop prediction models for rare diseases. Our findings highlight the recalibration mixture model as the optimal strategy if a population-level dataset is available. This approach offers the flexibility to incorporate additional predictors and informed prior probabilities, contributing to enhanced prediction accuracy for rare diseases. It also allows predictions without these additional tests, providing additional information on whether a patient should undergo further biomarker testing before genetic testing.


Assuntos
Teorema de Bayes , Diabetes Mellitus Tipo 2 , Doenças Raras , Humanos , Diabetes Mellitus Tipo 2/diagnóstico , Doenças Raras/diagnóstico , Estudos de Casos e Controles , Feminino , Diabetes Mellitus Tipo 1/diagnóstico , Masculino , Biomarcadores/análise , Adolescente , Adulto , Criança
7.
Exp Brain Res ; 242(9): 2249-2261, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-39042277

RESUMO

It is unclear how explicit knowledge of an externally imposed mismatch between visual and proprioceptive cues of hand position affects perceptual recalibration. The Bayesian causal inference framework might suggest such knowledge should abolish the visual and proprioceptive recalibration that occurs when individuals perceive these cues as coming from the same source (their hand), while the visuomotor adaptation literature suggests explicit knowledge of a cue conflict does not eliminate implicit compensatory processes. Here we compared visual and proprioceptive recalibration in three groups with varying levels of knowledge about the visuo-proprioceptive cue conflict. All participants estimated the position of visual, proprioceptive, or combined targets related to their left index fingertip, with a 70 mm visuo-proprioceptive offset gradually imposed. Groups 1, 2, and 3 received no information, medium information, and high information, respectively, about the offset. Information was manipulated using instructional and visual cues. All groups performed the task similarly at baseline in terms of variance, weighting, and integration. Results suggest the three groups recalibrated vision and proprioception differently, but there was no difference in variance or weighting. Participants who received only instructional cues about the mismatch (Group 2) did not recalibrate less, on average, than participants provided no information about the mismatch (Group 1). However, participants provided instructional cues and extra visual cues of their hands during the perturbation (Group 3) demonstrated significantly less recalibration than other groups. These findings are consistent with the idea that instructional cues alone are insufficient to override participants' intrinsic belief in common cause and reduce recalibration.


Assuntos
Sinais (Psicologia) , Propriocepção , Desempenho Psicomotor , Percepção Visual , Humanos , Masculino , Feminino , Propriocepção/fisiologia , Adulto Jovem , Percepção Visual/fisiologia , Adulto , Desempenho Psicomotor/fisiologia , Conflito Psicológico , Adolescente
8.
J Biomed Inform ; 149: 104572, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38081566

RESUMO

OBJECTIVE: Very often the performance of a Bayesian Network (BN) is affected when applied to a new target population. This is mainly because of differences in population characteristics. External validation of the model performance on different populations is a standard approach to test model's generalisability. However, a good predictive performance is not enough to show that the model represents the unique population characteristics and can be adopted in the new environment. METHODS: In this paper, we present a methodology for updating and recalibrating developed BN models - both their structure and parameters - to better account for the characteristics of the target population. Attention has been given on incorporating expert knowledge and recalibrating latent variables, which are usually omitted from data-driven models. RESULTS: The method is successfully applied to a clinical case study about the prediction of trauma-induced coagulopathy, where a BN has already been developed for civilian trauma patients and now it is recalibrated on combat casualties. CONCLUSION: The methodology proposed in this study is important for developing credible models that can demonstrate a good predictive performance when applied to a target population. Another advantage of the proposed methodology is that it is not limited to data-driven techniques and shows how expert knowledge can also be used when updating and recalibrating the model.


Assuntos
Modelos Estatísticos , Humanos , Teorema de Bayes
9.
BMC Public Health ; 24(1): 165, 2024 01 12.
Artigo em Inglês | MEDLINE | ID: mdl-38216900

RESUMO

BACKGROUND: Cardiovascular Diseases (CVD) account for the highest number of deaths and disability globally and within Sri Lanka. A CVD risk prediction tool is a simple means of early identification of high-risk groups which is a cost-effective preventive strategy, especially for resource-poor countries. Distribution of risk factor levels varies in different regions even within the same country, thus a common risk estimation tool for the country may give false local predictions. Since there are few published data related to Sri Lanka the aim of this study was to recalibrate the Framingham equation according to the local risk factor profile of a population in the Kurunegala region in Sri Lanka. METHOD: A cross-sectional study was conducted with the participation of 1 102 persons from the Kurunegala Regional Director of Health Services area and the data was collected using an interviewer-administered questionnaire, anthropometric, blood pressure, and biochemical measurements. CVD risk was estimated using Framingham original and recalibrated CVD risk assessment methods. Current CVD mortality and morbidity data and the recalibration method conducted by the method described by Wilson and colleagues were used for calculations. RESULTS: Original and recalibrated Framingham CVD risk scores predicted 55.5% (N = 612) and 62.3% (N = 687) to be having less than 10% CVD risk respectively. Further, the original and recalibrated CVD Risk Scores predicted 2.2% (N = 24) and 1.8% (N = 20) to be having CVD risk more than 40% respectively. CONCLUSION: These findings show an over prediction of the CVD risk with the original Framingham risk calculations which signifies the importance of development of a region-specific risk prediction tool using local risk factor data in Sri Lanka which will prevent unnecessary expenditure to manage people without risk of CVD.


Assuntos
Doenças Cardiovasculares , Humanos , Sri Lanka/epidemiologia , Estudos Transversais , Fatores de Risco , Medição de Risco/métodos , Doenças Cardiovasculares/prevenção & controle
10.
Adv Exp Med Biol ; 1437: 139-152, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38270858

RESUMO

From before we are born, throughout development, adulthood, and aging, we are immersed in a multisensory world. At each of these stages, our sensory cues are constantly changing, due to body, brain, and environmental changes. While integration of information from our different sensory cues improves precision, this only improves accuracy if the underlying cues are unbiased. Thus, multisensory calibration is a vital and ongoing process. To meet this grand challenge, our brains have evolved a variety of mechanisms. First, in response to a systematic discrepancy between sensory cues (without external feedback) the cues calibrate one another (unsupervised calibration). Second, multisensory function is calibrated to external feedback (supervised calibration). These two mechanisms superimpose. While the former likely reflects a lower level mechanism, the latter likely reflects a higher level cognitive mechanism. Indeed, neural correlates of supervised multisensory calibration in monkeys were found in higher level multisensory cortical area VIP, but not in the relatively lower level multisensory area MSTd. In addition, even without a cue discrepancy (e.g., when experiencing stimuli from different sensory cues in series) the brain monitors supra-modal statistics of events in the environment and adapts perception cross-modally. This too comprises a variety of mechanisms, including confirmation bias to prior choices, and lower level cross-sensory adaptation. Further research into the neuronal underpinnings of the broad and diverse functions of multisensory calibration, with improved synthesis of theories is needed to attain a more comprehensive understanding of multisensory brain function.


Assuntos
Demência Frontotemporal , Longevidade , Humanos , Calibragem , Encéfalo
11.
Neuropsychol Rehabil ; : 1-22, 2024 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-38346126

RESUMO

Prism adaptation training (PAT) as a treatment for visuospatial neglect (VSN) involves two components: recalibration and realignment. We conducted a randomized controlled trial with PAT protocols requiring different degrees of recalibration and realignment, by using a single or multi-step protocol and varying visibility of the pointing movement. Twenty-five VSN patients received an alertness treatment without prisms, followed by four PAT protocols, encompassing a multi- or single-step procedure with terminal exposure, a single-step procedure with concurrent exposure, and sham PAT, presented in random order. The primary outcome parameter was the mean response time (RT) to left-sided targets in an endogenous variant of the Posner task, and we also measured the sensorimotor aftereffect. The two protocols without visibility of most of the movement trajectory produced significant aftereffects. The single-step protocol without movement visibility resulted in shorter RTs to left-sided targets. Hence, aftereffects depended on the partial invisibility of the movement. Moreover, only allowing VSN patients to recalibrate several times and direct feedback from the pointing errors had a beneficial effect on non-motor leftward visuospatial attention. We provide preliminary evidence that maximizing the conscious experience of movement errors may be an important component for remediating VSN.Trial registration: German Clinical Trials Register identifier: DRKS00025938.

12.
J Neurophysiol ; 129(5): 1249-1258, 2023 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-37125747

RESUMO

Spatial perception of our hand is closely linked to our ability to move the hand accurately. We might therefore expect that reach planning would take into account any changes in perceived hand position; in other words, that perception and action relating to the hand should depend on a common sensorimotor map. However, there is evidence to suggest that changes in perceived hand position affect a body representation that functions separately from the body representation used to control movement. Here, we examined target-directed reaching before and after participants either did (Mismatch group) or did not (Veridical group) experience a cue conflict known to elicit recalibration in perceived hand position. For the reaching task, participants grasped a robotic manipulandum that positioned their unseen hand for each trial. Participants then briskly moved the handle straight ahead to a visual target, receiving no performance feedback. For the perceptual calibration task, participants estimated the locations of visual, proprioceptive, or combined cues about their unseen hand. The Mismatch group experienced a gradual 70-mm forward mismatch between visual and proprioceptive cues, resulting in forward proprioceptive recalibration. Participants made significantly shorter reaches after this manipulation, consistent with feeling their hand to be further forward than it was, but reaching performance returned to baseline levels after only 10 reaches. The Veridical group, after exposure to veridically aligned visual and proprioceptive cues about the hand, showed no change in reach distance. These results suggest that perceptual recalibration affects the same sensorimotor map that is used to plan target-directed reaches.NEW & NOTEWORTHY If perceived hand position changes, we might assume this affects the sensorimotor map and, in turn, reaches made with that hand. However, there is evidence for separate body representations involved in perception versus action. After a cross-sensory conflict that results in proprioceptive recalibration in the forward direction, participants made shorter reaches as predicted, but only briefly. This suggests perceptual recalibration does affect the sensorimotor map used to plan reaches, but the interaction may be short-lived.


Assuntos
Desempenho Psicomotor , Percepção Visual , Humanos , Adaptação Fisiológica , Retroalimentação Sensorial , Mãos , Propriocepção
13.
Hum Brain Mapp ; 44(17): 6227-6244, 2023 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-37818950

RESUMO

When we perform an action, its sensory outcomes usually follow shortly after. This characteristic temporal relationship aids in distinguishing self- from externally generated sensory input. To preserve this ability under dynamically changing environmental conditions, our expectation of the timing between action and outcome must be able to recalibrate, for example, when the outcome is consistently delayed. Until now, it remains unclear whether this process, known as sensorimotor temporal recalibration, can be specifically attributed to recalibration of sensorimotor (action-outcome) predictions, or whether it may be partly due to the recalibration of expectations about the intersensory (e.g., audio-tactile) timing. Therefore, we investigated the behavioral and neural correlates of temporal recalibration and differences in sensorimotor and intersensory contexts. During fMRI, subjects were exposed to delayed or undelayed tones elicited by actively or passively generated button presses. While recalibration of the expected intersensory timing (i.e., between the tactile sensation during the button movement and the tones) can be expected to occur during both active and passive movements, recalibration of sensorimotor predictions should be limited to active movement conditions. Effects of this procedure on auditory temporal perception and the modality-transfer to visual perception were tested in a delay detection task. Across both contexts, we found recalibration to be associated with activations in hippocampus and cerebellum. Context-dependent differences emerged in terms of stronger behavioral recalibration effects in sensorimotor conditions and were captured by differential activation pattern in frontal cortices, cerebellum, and sensory processing regions. These findings highlight the role of the hippocampus in encoding and retrieving newly acquired temporal stimulus associations during temporal recalibration. Furthermore, recalibration-related activations in the cerebellum may reflect the retention of multiple representations of temporal stimulus associations across both contexts. Finally, we showed that sensorimotor predictions modulate recalibration-related processes in frontal, cerebellar, and sensory regions, which potentially account for the perceptual advantage of sensorimotor versus intersensory temporal recalibration.


Assuntos
Desempenho Psicomotor , Percepção do Tempo , Humanos , Desempenho Psicomotor/fisiologia , Retroalimentação , Percepção Visual/fisiologia , Percepção do Tempo/fisiologia , Percepção Auditiva , Tato
14.
Stat Med ; 42(27): 5007-5024, 2023 Nov 30.
Artigo em Inglês | MEDLINE | ID: mdl-37705296

RESUMO

We have previously proposed temporal recalibration to account for trends in survival over time to improve the calibration of predictions from prognostic models for new patients. This involves first estimating the predictor effects using data from all individuals (full dataset) and then re-estimating the baseline using a subset of the most recent data whilst constraining the predictor effects to remain the same. In this article, we demonstrate how temporal recalibration can be applied in competing risk settings by recalibrating each cause-specific (or subdistribution) hazard model separately. We illustrate this using an example of colon cancer survival with data from the Surveillance Epidemiology and End Results (SEER) program. Data from patients diagnosed in 1995-2004 were used to fit two models for deaths due to colon cancer and other causes respectively. We discuss considerations that need to be made in order to apply temporal recalibration such as the choice of data used in the recalibration step. We also demonstrate how to assess the calibration of these models in new data for patients diagnosed subsequently in 2005. Comparison was made to a standard analysis (when improvements over time are not taken into account) and a period analysis which is similar to temporal recalibration but differs in the data used to estimate the predictor effects. The 10-year calibration plots demonstrated that using the standard approach over-estimated the risk of death due to colon cancer and the total risk of death and that calibration was improved using temporal recalibration or period analysis.


Assuntos
Neoplasias do Colo , Humanos , Calibragem , Prognóstico , Modelos de Riscos Proporcionais , Neoplasias do Colo/diagnóstico
15.
Paediatr Perinat Epidemiol ; 37(4): 313-321, 2023 05.
Artigo em Inglês | MEDLINE | ID: mdl-36745113

RESUMO

BACKGROUND: In an external validation study, model recalibration is suggested once there is evidence of poor model calibration but with acceptable discriminatory abilities. We identified four models, namely RISC-Malawi (Respiratory Index of Severity in Children) developed in Malawi, and three other predictive models developed in Uganda by Lowlaavar et al. (2016). These prognostic models exhibited poor calibration performance in the recent external validation study, hence the need for recalibration. OBJECTIVE: In this study, we aim to recalibrate these models using regression coefficients updating strategy and determine how much their performances improve. METHODS: We used data collected by the Clinical Information Network from paediatric wards of 20 public county referral hospitals. Missing data were multiply imputed using chained equations. Model updating entailed adjustment of the model's calibration performance while the discriminatory ability remained unaltered. We used two strategies to adjust the model: intercept-only and the logistic recalibration method. RESULTS: Eligibility criteria for the RISC-Malawi model were met in 50,669 patients, split into two sets: a model-recalibrating set (n = 30,343) and a test set (n = 20,326). For the Lowlaavar models, 10,782 patients met the eligibility criteria, of whom 6175 were used to recalibrate the models and 4607 were used to test the performance of the adjusted model. The intercept of the recalibrated RISC-Malawi model was 0.12 (95% CI 0.07, 0.17), while the slope of the same model was 1.08 (95% CI 1.03, 1.13). The performance of the recalibrated models on the test set suggested that no model met the threshold of a perfectly calibrated model, which includes a calibration slope of 1 and a calibration-in-the-large/intercept of 0. CONCLUSIONS: Even after model adjustment, the calibration performances of the 4 models did not meet the recommended threshold for perfect calibration. This finding is suggestive of models over/underestimating the predicted risk of in-hospital mortality, potentially harmful clinically. Therefore, researchers may consider other alternatives, such as ensemble techniques to combine these models into a meta-model to improve out-of-sample predictive performance.


Assuntos
Mortalidade da Criança , Região de Recursos Limitados , Humanos , Criança , Prognóstico , Mortalidade Hospitalar , Hospitais
16.
Exp Brain Res ; 241(9): 2299-2309, 2023 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-37584684

RESUMO

We estimate our hand's position by combining relevant visual and proprioceptive cues. A cross-sensory spatial mismatch can be created by viewing the hand through a prism or, more recently, rotating a visual cursor that represents hand position. This is often done in the context of target-directed reaching to study motor adaptation, the systematic updating of motor commands in response to a systematic movement error. However, a visuo-proprioceptive mismatch also elicits recalibration in the relationship between the hand's seen and felt position. The principles governing visuo-proprioceptive recalibration are poorly understood, compared to motor adaptation. For example, motor adaptation occurs robustly whether the cursor is rotated quickly or slowly, although the former may involve more explicit processes. Here, we asked whether visuo-proprioceptive recalibration, in the absence of motor adaptation, works the same way. Three groups experienced a 70 mm visuo-proprioceptive mismatch about their hand at a Slow, Medium, or Fast rate (0.84, 1.67, or 3.34 mm every two trials, respectively), with no error feedback. Once attained, the 70 mm mismatch was maintained for the remaining trials. Total recalibration differed significantly across groups, with the Fast, Medium, and Slow groups recalibrating 63.7, 56.3, and 42.8 mm on average, respectively. This suggests a slower mismatch rate may be less effective at eliciting recalibration. In contrast to motor adaptation studies, no further recalibration was observed in the maintenance phase. This may be related to the distinct mechanisms thought to contribute to perceptual recalibration via cross-sensory cue conflict versus sensory prediction errors.


Assuntos
Retroalimentação Sensorial , Desempenho Psicomotor , Humanos , Desempenho Psicomotor/fisiologia , Retroalimentação Sensorial/fisiologia , Propriocepção/fisiologia , Mãos/fisiologia , Adaptação Fisiológica/fisiologia , Percepção , Percepção Visual/fisiologia
17.
Clin Chem Lab Med ; 61(10): 1770-1779, 2023 09 26.
Artigo em Inglês | MEDLINE | ID: mdl-37053598

RESUMO

OBJECTIVES: This study aims to investigate and update the consistency and comparability of plasma renin activity (PRA) assays in measuring clinical samples. The contributions of recalibration, blank subtraction, and incubation strategies to interchangeability were also explored. METHODS: Five different laboratories were evaluated using forty-six individual plasma samples, including four liquid chromatography-tandem mass spectrometry (LC‒MS/MS) assays and one chemiluminescence immunoassay (CLIA). Spearman correlation coefficient (R), Passing-Bablok regression, and Bland‒Altman plot analyses were used to evaluate the consistency among assays. Consistency before and after recalibration, blank subtraction, and incubation strategy unification was compared. RESULTS: A good correlation was observed among all assays (R>0.93). None of the samples measured by all assays showed coefficient variation (CV) <10 %, and 37 % of samples showed overall CVs >20 %. The 95 % confidence intervals (CIs) for slopes did not contain 1 for most assay pairs. Large relative biases (-85.1-104.2 %) were found, and 76 % (52-93 %) of samples had unacceptable biases. Recalibration reduced the calibration bias. Ignoring blank subtraction improved the comparability across all assays while unifying incubation did not. CONCLUSIONS: The interchangeability of PRA measurement was unsatisfying. Harmonization on calibrator and ignoring blank were recommended. Unifying incubation strategy was unnecessary.


Assuntos
Renina , Espectrometria de Massas em Tandem , Humanos , Cromatografia Líquida , Espectrometria de Massas em Tandem/métodos , Calibragem , Medições Luminescentes , Imunoensaio/métodos
18.
Conscious Cogn ; 109: 103478, 2023 03.
Artigo em Inglês | MEDLINE | ID: mdl-36753896

RESUMO

When we perceive external physical stimuli from the environment, the brain must remain somewhat flexible to unaligned stimuli within a specific range, as multisensory signals are subject to different transmission and processing delays. Recent studies have shown that the width of the 'temporal binding window (TBW)' can be reduced by perceptual learning. However, to date, the vast majority of studies examining the mechanisms of perceptual learning have focused on experience-dependent effects, failing to reach a consensus on its relationship with the underlying perception influenced by audiovisual illusion. The sound-induced flash illusion (SiFI) training is a reliable function for improving perceptual sensitivity. The present study utilized the classic auditory-dominated SiFI paradigm with feedback training to investigate the effect of a 5-day SiFI training on multisensory temporal integration, as evaluated by a simultaneity judgment (SJ) task and temporal order judgment (TOJ) task. We demonstrate that audiovisual illusion training enhances multisensory temporal integration precision in the form of (i) the point of subjective simultaneity (PSS) shifts to reality (0 ms) and (ii) a narrowing TBW. The results are consistent with a Bayesian model of causal inference, suggesting that perception learning reduce the susceptibility to SiFI, whilst improving the precision of audiovisual temporal estimation.


Assuntos
Ilusões , Percepção Visual , Humanos , Teorema de Bayes , Percepção Auditiva , Aprendizagem , Estimulação Acústica , Estimulação Luminosa
19.
Dev Psychopathol ; 35(5): 2315-2337, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37641984

RESUMO

During early life-sensitive periods (i.e., fetal, infancy), the developing stress response system adaptively calibrates to match environmental conditions, whether harsh or supportive. Recent evidence suggests that puberty is another window when the stress system is open to recalibration if environmental conditions have shifted significantly. Whether additional periods of recalibration exist in adulthood remains to be established. The present paper draws parallels between childhood (re)calibration periods and the perinatal period to hypothesize that this phase may be an additional window of stress recalibration in adult life. Specifically, the perinatal period (defined here to include pregnancy, lactation, and early parenthood) is also a developmental switch point characterized by heightened neural plasticity and marked changes in stress system function. After discussing these similarities, lines of empirical evidence needed to substantiate the perinatal stress recalibration hypothesis are proposed, and existing research support is reviewed. Complexities and challenges related to delineating the boundaries of perinatal stress recalibration and empirically testing this hypothesis are discussed, as well as possibilities for future multidisciplinary research. In the theme of this special issue, perinatal stress recalibration may be a mechanism of multilevel, multisystem risk, and resilience, both intra-individually and intergenerationally, with implications for optimizing interventions.


Assuntos
Estresse Fisiológico , Estresse Psicológico , Adulto , Criança , Feminino , Humanos , Gravidez
20.
J Sports Sci ; 41(15): 1471-1482, 2023 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-37902048

RESUMO

This study examined the processes of perceptual-motor calibration/recalibration of defensive football players in a 1-vs-1 scenario. Ankle weights were used to reduce the acceleration capabilities of players performing an anticipation test, with the aim being to examine the player's response to the disturbance in terms of when movement was initiated and the impact on the mechanisms that underpinned anticipation, namely gaze behaviour. The ankle weights disturbed the perceptual-motor system and players initiated movement significantly earlier in the 1-vs-1 anticipation test. Analyses of perceptual-motor calibration/recalibration revealed that players acted closer to their maximal action capabilities prior to the addition of ankle weights, which negatively influenced the scaling of action capabilities. Moreover, players were unable to recalibrate whilst wearing ankle weights. However, following the withdrawal of the ankle weights, players were able to recalibrate within 11-15 trials. Players did not adapt gaze behaviour as a result of the disturbance being placed on the perceptual-motor system, but task familiarization resulted in more efficient eye movements. The results of this study show the importance of providing players the opportunity to "scale" action to perceptual information.


Assuntos
Futebol Americano , Movimento , Humanos , Movimento/fisiologia , Movimentos Oculares , Aceleração
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