Perceptual-Cognitive Integration for Goal-Directed Action in Naturalistic Environments.

Real-world actions require one to simultaneously perceive, think, and act on the surrounding world, requiring the integration of (bottom-up) sensory information and (top-down) cognitive and motor signals. Studying these processes involves the intellectual challenge of cutting across traditional neuroscience silos, and the technical challenge of recording data in uncontrolled natural environments. However, recent advances in techniques, such as neuroimaging, virtual reality, and motion tracking, allow one to address these issues in naturalistic environments for both healthy participants and clinical populations. In this review, we survey six topics in which naturalistic approaches have advanced both our fundamental understanding of brain function and how neurologic deficits influence goal-directed, coordinated action in naturalistic environments. The first part conveys fundamental neuroscience mechanisms related to visuospatial coding for action, adaptive eye-hand coordination, and visuomotor integration for manual interception. The second part discusses applications of such knowledge to neurologic deficits, specifically, steering in the presence of cortical blindness, impact of stroke on visual-proprioceptive integration, and impact of visual search and working memory deficits. This translational approach-extending knowledge from lab to rehab-provides new insights into the complex interplay between perceptual, motor, and cognitive control in naturalistic tasks that are relevant for both basic and clinical research.

Prevalence of Body Dysmorphic Disorder in Private Aesthetic Clinical Settings in Four Latin American Countries: A Cross-Sectional Study.

BACKGROUND: Body dysmorphic disorder (BDD) is a psychiatric condition characterized by persistent concern with non-existent or minor defects in one's physical appearance. BDD can be difficult to identify as patients often have limited insight into the condition. OBJECTIVE: We aimed to determine the prevalence of BDD in patients presenting to private aesthetic clinical settings in four Latin American countries. METHODS: We conducted a cross-sectional study From August to October 2022 to evaluate the prevalence of BDD among 360 patients seeking nonsurgical cosmetic procedures in Chile, Mexico, Argentina, and Colombia using the Dysmorphic Concern Questionnaire (DCQ). We reported prevalence estimates for the lowest and highest previously proposed DCQ cutoff points. RESULTS: The DCQ total scores in the study population ranged from 0 to 21, with a mean total score of 5.1 ± 3.4. The prevalence of positive screening results for BDD (total DCQ score ≥ 9) was 15.8%. The prevalence of a likely diagnosis of BDD (total DCQ score of ¥ 17) was 0.83%. LIMITATIONS: The convenience sample limited the generalizability of the findings to Latin America. CONCLUSION: We encourage colleagues to be more mindful of this diagnosis and to facilitate earlier psychological evaluation in patients who are positive for BDD. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

[Proposal of an informed consent form to obtain audiovisual material from patients]. / Panel de expertos para la elaboración de un modelo de consentimiento informado de obtención y uso de material audiovisual clínico.

BACKGROUND: An informed consent is mandatory to obtain any clinical audiovisual material from patients. Although there are some documents created for this purpose, there are some barriers for their application, such as the context in which they were created, the language and download availability. AIM: To create a proposal for an informed consent form (ICF) for the capture and different uses for audiovisual material from patients. MATERIAL AND METHODS: A bibliographic search was carried out to obtain different ICFs in Spanish and English, which were subjected to a process of translation, counter-translation and fragmentation. Subsequently, a panel of experts was formed by members of the Chilean Society of Plastic Surgery with extensive experience in social networks. Delphi methodology was applied to reach a consensus about the definitive content of the ICF based on the previously selected fragments. RESULTS: ICFs available for download were identified. The panel was made up of seven Plastic Surgeons and two Delphi rounds were carried out through electronic surveys. At the end of the process, an ICF proposal was obtained for therapeutic, academic or scientific purposes and another for dissemination or education in the mass media. CONCLUSIONS: The proposed ICFs were liberated for their use among health care professionals in Chile, who could use them, provided that they are approved by the local healthcare ethics committees.

Comparison of the Quantra QPlus System With Thromboelastography in Cardiac Surgery.

OBJECTIVES: Use of viscoelastic testing, such as thromboelastography (TEG), is recommended in cardiac surgery to monitor coagulation and to guide the transfusion of blood products. The Quantra QPlus System is a novel point-of-care platform that uses ultrasonic pulses to characterize dynamic changes in viscoelastic properties of a blood sample during coagulation. Despite the ability to assess similar aspects of clot formation, limited studies addressing the interchangeability of viscoelastic testing parameters exist. The primary aim of the present study was to assess the correlation and agreement between Quantra and TEG5000 results using blood samples from cardiac surgery patients. DESIGN: Tertiary care, academic medical center. SETTING: Prospective observational study. PARTICIPANTS: Twenty-eight patients undergoing elective cardiac surgery undergoing cardiopulmonary bypass were evaluated. MEASUREMENTS AND MAIN RESULTS: Perioperative blood samples were collected and assessed using Quantra, and results were compared with TEG and conventional coagulation testing. Method comparison analysis demonstrated that Quantra parameters (Quantra clot time, clot stiffness, and fibrinogen contribution to clot stiffness) significantly correlated with TEG R and TEG G after induction of anesthesia, during cardiopulmonary bypass, and after rewarming (rs = 0.83, rs = 0.84, and rs = 0.73, respectively). However, Quantra parameters demonstrated poor agreement compared with equivalent TEG5000 parameters. CONCLUSIONS: The Quantra QPlus System significantly correlated with TEG5000, suggesting that this test may be used in a similar clinical context. Despite the strength of correlation between Quantra and TEG parameters, measurements are not interchangeable.

Dengue disease in a pediatric patient with severe idiopathic pulmonary hypertension.

Dengue virus can affect the heart, with complications as bradycardia, arrhythmias, and death. We present a case of a 15-year-old patient, diagnosed 4 years before with severe idiopathic pulmonary hypertension, confirmed by catheterism, with continuous follow up. At that time, she was living in Bogotá (2640 m above sea level). Sildenafil and Macitentan were started. She was recommended to live at low altitude and she moved. The patient was transferred back to Bogota, from that place, due to flu-like symptoms and fever. Immunoglobulin M for dengue was confirmed and second-degree atrioventricular block Mobitz I with bradycardia (40 beats/minute) was documented throughout the clinical course. She recovered.

Co-Training for Visual Object Recognition Based on Self-Supervised Models Using a Cross-Entropy Regularization.

Automatic recognition of visual objects using a deep learning approach has been successfully applied to multiple areas. However, deep learning techniques require a large amount of labeled data, which is usually expensive to obtain. An alternative is to use semi-supervised models, such as co-training, where multiple complementary views are combined using a small amount of labeled data. A simple way to associate views to visual objects is through the application of a degree of rotation or a type of filter. In this work, we propose a co-training model for visual object recognition using deep neural networks by adding layers of self-supervised neural networks as intermediate inputs to the views, where the views are diversified through the cross-entropy regularization of their outputs. Since the model merges the concepts of co-training and self-supervised learning by considering the differentiation of outputs, we called it Differential Self-Supervised Co-Training (DSSCo-Training). This paper presents some experiments using the DSSCo-Training model to well-known image datasets such as MNIST, CIFAR-100, and SVHN. The results indicate that the proposed model is competitive with the state-of-art models and shows an average relative improvement of 5% in accuracy for several datasets, despite its greater simplicity with respect to more recent approaches.

Diffusion phenomena in a mixed phase space.

We show that, in strongly chaotic dynamical systems, the average particle velocity can be calculated analytically by consideration of Brownian dynamics in a phase space, the method of images, and the use of the classical diffusion equation. The method is demonstrated on the simplified Fermi-Ulam accelerator model, which has a mixed phase space with chaotic seas, invariant tori, and Kolmogorov-Arnold-Moser islands. The calculated average velocities agree well with numerical simulations and with an earlier empirical theory.

Magnetic resonance dacryocystography in the horse: A feasibility study.

OBJECTIVE: To provide a comprehensive anatomical description of the normal equine nasolacrimal duct using magnetic resonance imaging, and to develop a practical protocol for performing magnetic resonance dacryocystography (MRD) in horses. ANIMAL STUDIED: The heads of ten fresh horse cadavers with no history of sinonasal or ophthalmologic disorders were used for this study. PROCEDURE: An MRD technique was developed in this study, which consisted of two parts. In the first part, olive oil and gadolinium were compared as contrast medium, using five horses. Two concentrations of gadolinium were used: 0.25 mmol/mL and 0.5 mmol/mL. In the second part, the influence of different head recumbencies using olive oil as the sole contrast medium was studied in the remaining five horses. RESULTS: Injection with olive oil resulted in better distention and a complete filling of the nasolacrimal duct (ND) in all horses. Injection of 0.25 mmol/mL of gadolinium resulted in incomplete filling of the ND, whereas injection of 0.5 mmol/mL of gadolinium resulted in slightly better filling of the duct. The nondependent duct showed better distention compared to the dependent duct when scanning in lateral recumbency. No differences were observed between ducts in a dorsal recumbency. The degree of distention in dorsal recumbency was slightly less than the degree of distention observed in the nondependent ND in lateral recumbency. CONCLUSIONS: Magnetic resonance dacryocystography is a suitable technique for evaluating the nasolacrimal duct and can be performed during a normal magnetic resonance examination.

Dermatologic care of sexual and gender minority/LGBTQIA youth, Part 2: Recognition and management of the unique dermatologic needs of SGM adolescents.

Sexual and gender minority (SGM) individuals, including lesbian, gay, bisexual, transgender/gender diverse, questioning/queer, intersex, and asexual (LGBTQIA) persons, represent a historically underserved population within the field of medicine, though their unique health needs are increasingly recognized. Part 2 of this two-part review will address unique concerns regarding acne, tanning behavior, sexually transmitted infections, and other health disparities among SGM adolescents. A more comprehensive understanding of the dermatologic needs of SGM youth will better allow pediatric dermatologists to actively and compassionately care for this health disparity population.

Movements of the eyes and hands are coordinated by a common predictive strategy.

Although attempts to intercept a ball in flight are often preceded by predictive gaze behavior, the relationship between the predictive control of gaze and the effector is largely unexplored. The present study was designed to investigate the influence of the spatiotemporal demands of the task on a switch to the predictive control. Ten subjects immersed in a virtual environment attempted to intercept a ball that disappeared for 500 ms of its parabolic approach. The timing of the blank was varied through manipulation of the post-blank duration prior to the ball's arrival, and the shape of the trajectory was manipulated through variation of the pre-blank duration. Results reveal that the gaze movement trajectory during the blank was curvilinear, appropriately scaled to the curvature of the invisible moving ball, and the gaze vector was within 4° of the ball upon reappearance, despite 10° to 13° of ball movement. The timing of the blank did not influence the accuracy of predictive positioning of the paddle at the time of ball reappearance, indicated by the distance of the paddle relative to the ball's eventual passing location. However, analysis of trial-by-trial covariations revealed that, when the gaze vector more accurately predicted the ball's trajectory at reappearance, the paddle was also held closer to the ball's eventual passing location. This suggests that predictive strategies for paddle placement are more strongly mediated by the accuracy of gaze behavior than by the observed range of trajectories, or the timing of the blank.

Assessment of an augmented reality apparatus for the study of visually guided walking and obstacle crossing.

To walk through the cluttered natural environment requires visually guided and anticipatory adjustments to gait in advance of upcoming obstacles. However, scientific investigation of visual contributions to obstacle crossing have historically been limited by the practical issues involved with the repeated presentation of multiple obstacles upon a ground plane. This study evaluates an approach in which the perception of a 3D obstacle is generated from 2D projection onto the ground plane with perspective correction based on the subject's motion-tracked head position. The perception of depth is further reinforced with the use of stereoscopic goggles. To evaluate the validity of this approach, behavior was compared between approaches to two types of obstacles in a blocked design: physical obstacles, and the augmented reality (AR) obstacles projected upon the ground plane. In addition, obstacle height, defined in units of leg length (LL), was varied on each trial (0.15, 0.25, 0.35 LL). Approaches to ended with collision on 0.8% of trials with physical obstacles per subject, and on 1.4% trials with AR obstacles. Collisions were signaled by auditory feedback. Linear changes in the height of both AR and physical obstacles produced linear changes in maximum step height, preserving a constant clearance magnitude across changes in obstacle height. However, for AR obstacles, approach speed was slower, the crossing step peaked higher above the obstacle, and there was greater clearance between the lead toe and the obstacle. These results suggest that subjects were more cautious when approaching and stepping over AR obstacles.

Magnetic resonance imaging characteristics of equine head disorders: 84 cases (2000-2013).

The equine head is an anatomically complex area, therefore advanced tomographic imaging techniques, such as computed tomography or magnetic resonance imaging (MRI), are often required for diagnosis and treatment planning. The purpose of this multicenter retrospective study was to describe MRI characteristics for a large sample of horses with head disorders. Horses imaged over a period of 13 years were recruited. Eighty-four horses met the inclusion criteria, having neurological (n = 65), sinonasal (n = 14), and soft tissue (n = 5) disorders. Magnetic resonance imaging accurately depicted the anatomy and allowed identification of the primary lesion and associated changes. There were good correlations between MRI findings and intraoperative or postmortem results. Magnetic resonance imaging showed the exact localization of the lesions, their size, and relation to surrounding structures. However, in the neurological group, there were 45 horses with no MRI abnormalities, 29 of which had a history of recurrent seizures, related to cryptogenic epilepsy. Magnetic resonance imaging was otherwise a valuable diagnostic tool, and can be used for studying a broad range of head disorders using either low-field or high-field magnets.

A 7-week-old Nepali girl with a perianal ulcer: brief report.

Cytomegalovirus (CMV) can rarely present with skin findings. Cutaneous CMV is most often found in patients who are immunocompromised because of acquired immunodeficiency syndrome, lymphoma, or other conditions. We present a rare case of an immunocompetent 7-week-old girl with a perianal ulcer attributed to CMV.

Coordination of gaze and action during high-speed steering and obstacle avoidance.

When humans navigate through complex environments, they coordinate gaze and steering to sample the visual information needed to guide movement. Gaze and steering behavior have been extensively studied in the context of automobile driving along a winding road, leading to accounts of movement along well-defined paths over flat, obstacle-free surfaces. However, humans are also capable of visually guiding self-motion in environments that are cluttered with obstacles and lack an explicit path. An extreme example of such behavior occurs during first-person view drone racing, in which pilots maneuver at high speeds through a dense forest. In this study, we explored the gaze and steering behavior of skilled drone pilots. Subjects guided a simulated quadcopter along a racecourse embedded within a custom-designed forest-like virtual environment. The environment was viewed through a head-mounted display equipped with an eye tracker to record gaze behavior. In two experiments, subjects performed the task in multiple conditions that varied in terms of the presence of obstacles (trees), waypoints (hoops to fly through), and a path to follow. Subjects often looked in the general direction of things that they wanted to steer toward, but gaze fell on nearby objects and surfaces more often than on the actual path or hoops. Nevertheless, subjects were able to perform the task successfully, steering at high speeds while remaining on the path, passing through hoops, and avoiding collisions. In conditions that contained hoops, subjects adapted how they approached the most immediate hoop in anticipation of the position of the subsequent hoop. Taken together, these findings challenge existing models of steering that assume that steering is tightly coupled to where actors look. We consider the study's broader implications as well as limitations, including the focus on a small sample of highly skilled subjects and inherent noise in measurement of gaze direction.

Treatment Comparison for Medial Femoral Condyle Subchondral Cystic Lesions and Prognosis in Yearling Thoroughbred Racehorse Prospects.

Subchondral cystic lesions (SCL) in the medial femoral condyle are a usual finding in Thoroughbred survey and auction repository radiographs. Several treatments with different outcomes have been studied over the years to improve soundness and racing prognosis. Our objective was to report the racing prognosis in Thoroughbred yearlings intended for racing that were diagnosed with SCL in the medial femoral condyle and were treated using four current and different techniques: intralesional injection of corticosteroids, SCL debridement through the joint with a drill bit, translesional cortical screw placement, and absorbable hydroxyapatite implant placement. Data from 182 Thoroughbred yearlings treated for SCL in the medial femoral condyle were collected from 2014 to 2020. Limb affected, age at surgery, sex, and radiographic measurements of the SCL were recorded. Auction price and racing performance were collected for treated horses and compared to 154 maternal siblings free of medial femoral condyle SCL. Analyses were conducted to assess if racing prognosis was affected by SCL size, to detect differences in auction price and selected flat racing outcome parameters between cases and controls, and to compare racing prognosis between the studied treatments. Mares and lesions located in the right stifle were significantly overrepresented. The auction price of treated horses was significantly lower than that of their siblings. Horses treated for SCL had significantly lower chances to start in a race than controls (59% vs. 74% respectively). Wider SCL negatively affected the chances to start at least in one race, and negatively affected the earnings made in the 2-year-olds' racing year. Horses with SCL treated using a bioabsorbable implant had a significantly higher median in starts as 3-year-olds (seven starts) than horses that had the SCL debrided with a drill bit (three starts). In conclusion, Thoroughbred yearlings treated for a medial femoral condyle SCL had lower auction prices and decreased ability to start a race compared to siblings' wider cysts had worse prognosis to start a race and might affect earnings as 2-year-olds; and horses treated with bioabsorbable composite implant placement had more starts as 3-year-olds than with other techniques.

Saccades to future ball location reveal memory-based prediction in a virtual-reality interception task.

Despite general agreement that prediction is a central aspect of perception, there is relatively little evidence concerning the basis on which visual predictions are made. Although both saccadic and pursuit eye-movements reveal knowledge of the future position of a moving visual target, in many of these studies targets move along simple trajectories through a fronto-parallel plane. Here, using a naturalistic and racquet-based interception task in a virtual environment, we demonstrate that subjects make accurate predictions of visual target motion, even when targets follow trajectories determined by the complex dynamics of physical interactions and the head and body are unrestrained. Furthermore, we found that, following a change in ball elasticity, subjects were able to accurately adjust their prebounce predictions of the ball's post-bounce trajectory. This suggests that prediction is guided by experience-based models of how information in the visual image will change over time.

Real-time recording and classification of eye movements in an immersive virtual environment.

Despite the growing popularity of virtual reality environments, few laboratories are equipped to investigate eye movements within these environments. This primer is intended to reduce the time and effort required to incorporate eye-tracking equipment into a virtual reality environment. We discuss issues related to the initial startup and provide algorithms necessary for basic analysis. Algorithms are provided for the calculation of gaze angle within a virtual world using a monocular eye-tracker in a three-dimensional environment. In addition, we provide algorithms for the calculation of the angular distance between the gaze and a relevant virtual object and for the identification of fixations, saccades, and pursuit eye movements. Finally, we provide tools that temporally synchronize gaze data and the visual stimulus and enable real-time assembly of a video-based record of the experiment using the Quicktime MOV format, available at http://sourceforge.net/p/utdvrlibraries/. This record contains the visual stimulus, the gaze cursor, and associated numerical data and can be used for data exportation, visual inspection, and validation of calculated gaze movements.

A neural active inference model of perceptual-motor learning.

The active inference framework (AIF) is a promising new computational framework grounded in contemporary neuroscience that can produce human-like behavior through reward-based learning. In this study, we test the ability for the AIF to capture the role of anticipation in the visual guidance of action in humans through the systematic investigation of a visual-motor task that has been well-explored-that of intercepting a target moving over a ground plane. Previous research demonstrated that humans performing this task resorted to anticipatory changes in speed intended to compensate for semi-predictable changes in target speed later in the approach. To capture this behavior, our proposed "neural" AIF agent uses artificial neural networks to select actions on the basis of a very short term prediction of the information about the task environment that these actions would reveal along with a long-term estimate of the resulting cumulative expected free energy. Systematic variation revealed that anticipatory behavior emerged only when required by limitations on the agent's movement capabilities, and only when the agent was able to estimate accumulated free energy over sufficiently long durations into the future. In addition, we present a novel formulation of the prior mapping function that maps a multi-dimensional world-state to a uni-dimensional distribution of free-energy/reward. Together, these results demonstrate the use of AIF as a plausible model of anticipatory visually guided behavior in humans.