Surgical Care in Specialist Ophthalmology Departments: Structure and Impact of the COVID-19 Pandemic.

BACKGROUND: Specialist ophthalmology departments contribute to the surgical care of German patients. Outpatient and inpatient surgeries were restricted during the COVID-19 pandemic and led to a sharp decline in the number of cases in ophthalmological care. The aim of this analysis was to improve the understanding of the logistic structures of medical facilities as well as the effects of the pandemic. MATERIAL AND METHOD: Based on reported process data, a sample of the specialist ophthalmological departments were examined based on operation and procedure codes (OPS) and data submitted between 01.01.2017 and 31.05.2021 according to the benchmarking programmes of the Professional Association of German Anaesthetists (BDA), the Professional Association of German Surgeons (BDC), and the Association for Operating Theatre Management (VOPM). RESULTS: Eighteen ophthalmology departments from Germany were analysed. After the decline in the number of cases (by temporarily up to 48%) during the first wave of the pandemic, the case numbers of all interventions assessed as nonurgent continued to be reduced. While intravitreal injections hardly decreased during the first wave (- 16%), significant drops in the coverage of cataract surgery (- 79%), vitrectomies (- 35%), glaucoma surgery (- 59%), strabismus surgery (- 95%), and eyelid surgery (- 52%) were found. One exception was intravitreal injection, which stabilised at a lower level early on during the pandemic. Overall, the number of cases during the later phases of the pandemic were significantly reduced below the level of previous years, despite the maintenance of emergency care. The underuse was variable for different interventions. CONCLUSION: In addition to self-reported figures, the analysed process data demonstrates the effect that various factors had on elective as well as urgent operations within hospital care during the pandemic. Despite partial stabilisation of some services, a relevant supply gap for outpatient and inpatient interventions was identified, with corresponding effects on the eye health of the population, while compensation or performance enhancement have not taken place to date. Facing the growing preload and the demographic development, future structures must therefore allow for an increase in the performance of specialist ophthalmological departments.

The joint influence of intelligence and practice on skill development throughout the life span.

The relative importance of different factors in the development of human skills has been extensively discussed. Research on expertise indicates that focused practice may be the sole determinant of skill, while intelligence researchers underline the relative importance of abilities at even the highest level of skill. There is indeed a large body of research that acknowledges the role of both factors in skill development and retention. It is, however, unknown how intelligence and practice come together to enable the acquisition and retention of complex skills across the life span. Instead of focusing on the 2 factors, intelligence and practice, in isolation, here we look at their interplay throughout development. In a longitudinal study that tracked chess players throughout their careers, we show that both intelligence and practice positively affect the acquisition and retention of chess skill. Importantly, the nonlinear interaction between the 2 factors revealed that more intelligent individuals benefited more from practice. With the same amount of practice, they acquired chess skill more quickly than less intelligent players, reached a higher peak performance, and arrested decline in older age. Our research demonstrates the futility of scrutinizing the relative importance of highly intertwined factors in human development.

What would an 'ideal' glaucoma examination be like? - A conjoint analysis of patients' and physicians' preferences.

PURPOSE: To structurally determine patients' and physicians' preferences for glaucoma diagnostic methods in order to improve glaucoma patient care and improve patient compliance with follow-up visits. METHODS: Forty-one patients with glaucoma and 32 ophthalmologists were included in this cross-sectional study. Profiles representing glaucoma examinations were created using conjoint analysis (CA). The following factors of a glaucoma examination method were evaluated: (1) examination comfort, (2) examination frequency, (3) follow-up examination necessary in case of suspicious result, (4) cost for the patient, (5) travel time to examination site, (6) sensitivity and (7) specificity of the examination method. RESULTS: Preferences were highest in both groups for examination sensitivity, followed by cost and specificity for the patient group. For the physician group, specificity was second most important, followed by cost. Least important was travel time for the patients and follow-up examinations for the physicians. CONCLUSIONS: Participants would rather pay more and travel longer to get a highly sensitive examination. This form of care is present in university eye hospitals. Consequently, it would be advisable to enhance capacities of these centers. Outpatient practices that offer glaucoma service should be fully equipped and should employ a glaucoma specialist.

[Cost Comparison of Licensed Intravitreal Therapies for Insufficiently Anti-VEGF Responding Fovea Involving Diabetic Macular Edema in Germany]. / Kostenvergleich zugelassener intravitrealer Therapien bei nicht ausreichend auf primäre Therapie ansprechendem diabetischem Makulaödem mit fovealer Beteiligung in Deutschland.

BACKGROUND: In the treatment of center-involving diabetic macular edema, despite initial therapy with an anti-VEGF compound, an insufficient response may occur. Further therapy options include a switch of anti-VEGF products or to corticosteroid implants, such as Fluocinolone acetonide or Dexamethasone. OBJECTIVES: Firstly, to investigate systematically which evidence-based study data are available describing the efficacy of in-label treatments after primary anti-VEGF treatment, secondly, to investigate which costs go along for the healthcare provider. METHODS: A systematic literature review (SLR) for randomized controlled trials (RCT) was performed in Medline and Embase. A short-term cost-cost model was built in MS Excel with a 3 year time horizon to compare in-label intravitreal options Ranibizumab (Lucentis®), Aflibercept (Eylea®), Fluocinolone acetonide implant (Iluvien®), and Dexamethasone implant (Ozurdex®). Cost components comprised of drug and injection costs, optical coherence tomography (OCT) procedures, and adverse events such as endophthalmitis, IOP-lowering drugs and surgery and cataract surgery. RESULTS: A total of 42 publications of 20 RCTs were identified. No study had a clearly defined population after first line anti-VEGF treatment, thus no direct efficacy comparison was possible. In the short-term cost-cost model total costs were 17,542 € for Ranibizumab, 15,896 € for Aflibercept, 10,826 € for Fluocinolone acetonide implant and 12,365 € for Dexamethasone implant. For all treatment regimens, drug costs were the predominant cost component, followed by injection costs (with variations dependent on the specific drug) and OCT costs. In the uni- and multivariate sensitivity analyses, the results obtained were robust to changes of model inputs. CONCLUSIONS: In summary, the short-term cost-cost comparison demonstrates that steroid implants can provide significant cost savings versus in-label anti-VEGF treatment for center-involving diabetic macular edema. Single application of the long-lasting Fluocinolone acetonide implant is the most cost-efficient in-label treatment option.

[Patient-Reported Treatment Satisfaction with Stereotactic Radiotherapy in Neovascular Age-Related Macular Degeneration]. / Patientenzufriedenheit nach stereotaktischer Radiotherapie bei exsudativer altersbedingter Makuladegeneration.

BACKGROUND: Stereotactic radiotherapy (SRT) in conjunction with the common intravitreal injections (IVI) is a new adjuvant approach in neovascular age-related macular degeneration (AMD) patients. The aim of our study was to investigate factors influencing patient satisfaction one year after SRT. METHODS: A questionnaire was administered to 35 AMD patients who had consecutively undergone SRT using the IRay®-device at the Department of Ophthalmology, University of Lübeck. In addition to descriptive statistics, responses were evaluated by correlation analysis. Moreover, subgroup analyses were performed, using a classification of IVI responders (annual injection rate after SRT ≤ 3), visual acuity (VA) responders (VA improvement ≥ 0.2 logMAR) and double responders (annual injection rate after SRT ≤ 3 as well as VA improvement ≥ 0.2 logMAR). RESULTS: The response rate was 86%. With respect to their treatment expectations, twice as many patients hoped to receive less injections instead of a better vision. Those hoping for less injections were significantly more satisfied with their clinical outcome. In addition, IVI-responders were significantly more satisfied than IVI-non-responders, while VA-responders were not, compared to VA-non-responders. CONCLUSIONS: Patient satisfaction seems to depend on patients' comprehension of how SRT affects their disease and what kinds of expectations were set. It is of utmost importance to provide the patients with adequate and comprehensible education and to define realistic goals prior to SRT.

Cost-effectiveness of early treatment of ACPA-positive rheumatoid arthritis patients with abatacept.

OBJECTIVES: Studies have reported that the presence of elevated anti-citrullinated protein antibodies (ACPA)/RF levels, together with joint erosions, is associated with higher disease burden in terms of disability and mortality in rheumatoid arthritis (RA). Abatacept has been shown to be effective in this patient population with favourable comparative data against adalimumab. However, few studies have investigated the cost-effectiveness of abatacept in this population to similar treatments such as TNFs. The objective of the study was to compare the cost-effectiveness of abatacept to adalimumab as a first bDMARD in ACPA-positive RA patients who failed treatment with methotrexate (MTX) in Germany. METHODS: A decision tree model was used to estimate the cost-effectiveness, from a payer's perspective, of different treatment sequences in RA over a two year time frame. The effectiveness criteria were defined as achieving the treatment target measured by the Disease Activity Score 28 (DAS28(CRP)<2.6; "remission"). A treatment switch to a different biologic as 2nd line and 3rd line bDMARD was allowed - in case of not achieving remission with therapy - every 6 months over a two year time period. Effectiveness data was based on randomised controlled trials (RCT) identified by an updated previous systematic literature search by the Institute for Quality and Efficiency in Health Care (IQWiG). Costs of medication and other direct medical costs were considered. Cost-effectiveness of RA treatment was investigated in ACPA-positive patients and presented as overall costs per day in remission. RESULTS: For ACPA-positive patients, treatment strategies including early treatment with abatacept had lower total costs per clinical outcome compared to later use. Treatment sequences starting with abatacept resulted in lower costs per day in remission (mean 330 €/day, range 328-333 €/day) compared to sequences starting with adalimumab (mean 384 €/day, range 378-390 €/day). Choice of the second or third biologic in the treatment sequences appears to have little impact on the costs per outcome. CONCLUSIONS: The results of this analysis suggest that in ACPA-positive RA patients treatment with abatacept appears to have lower costs per response (remission) compared to treatment with adalimumab as a first bDMARD.

Creativity on tap? Effects of alcohol intoxication on creative cognition.

Anecdotal reports link alcohol intoxication to creativity, while cognitive research highlights the crucial role of cognitive control for creative thought. This study examined the effects of mild alcohol intoxication on creative cognition in a placebo-controlled design. Participants completed executive and creative cognition tasks before and after consuming either alcoholic beer (BAC of 0.03) or non-alcoholic beer (placebo). Alcohol impaired executive control, but improved performance in the Remote Associates Test, and did not affect divergent thinking ability. The findings indicate that certain aspects of creative cognition benefit from mild attenuations of cognitive control, and contribute to the growing evidence that higher cognitive control is not always associated with better cognitive performance.

INTRAPAPILLARY PROLIFERATION IN OPTIC DISK PITS: Clinical Findings and Time-Related Changes.

PURPOSE: To investigate the structural changes of intrapapillary proliferations associated with optic disk pits (ODPs) and optic disk pit maculopathy (ODP-M) using enhanced depth-spectral domain-optical coherence tomography (SD-EDI-OCT) and megahertz optical coherence tomography (MHz-OCT). METHODS: Sixteen eyes of patients with ODPs were studied. Papillary and peripapillary areas were repeatedly examined with SD-EDI-OCT over time. To evaluate swept-source OCT, some of the patients additionally received MHz-OCT-imaging. RESULTS: MHz-OCT or SD-EDI images showed the entire form of the pits from opening to bottom in 13 of the 16 cases. The shape of ODPs varied considerably. In patients with unilateral ODP, deep intrapapillary depressions in the optic disk of the contralateral partner eye were a prevalent finding. Intrapapillary proliferations were observed in all ODP-cases during follow-up. The aspect of intrapapillary and prepapillary tissue, septae, and cavities changed over time. This effect was especially pronounced inside the ODP while the eye experienced simultaneous ODP-M. CONCLUSION: All examined eyes with ODP showed signs of intrapapillary and prepapillary tissue, which developed over time. SD-EDI-OCT and MHz-OCT are able to detect characteristic ODP-related findings and are a useful means to monitor time-related changes within intrapapillary and prepapillary tissue related to ODP and ODP-M.

Personality and complex brain networks: The role of openness to experience in default network efficiency.

The brain's default network (DN) has been a topic of considerable empirical interest. In fMRI research, DN activity is associated with spontaneous and self-generated cognition, such as mind-wandering, episodic memory retrieval, future thinking, mental simulation, theory of mind reasoning, and creative cognition. Despite large literatures on developmental and disease-related influences on the DN, surprisingly little is known about the factors that impact normal variation in DN functioning. Using structural equation modeling and graph theoretical analysis of resting-state fMRI data, we provide evidence that Openness to Experience-a normally distributed personality trait reflecting a tendency to engage in imaginative, creative, and abstract cognitive processes-underlies efficiency of information processing within the DN. Across two studies, Openness predicted the global efficiency of a functional network comprised of DN nodes and corresponding edges. In Study 2, Openness remained a robust predictor-even after controlling for intelligence, age, gender, and other personality variables-explaining 18% of the variance in DN functioning. These findings point to a biological basis of Openness to Experience, and suggest that normally distributed personality traits affect the intrinsic architecture of large-scale brain systems. Hum Brain Mapp 37:773-779, 2016. © 2015 Wiley Periodicals, Inc.

Gray matter correlates of creative potential: a latent variable voxel-based morphometry study.

There is increasing research interest in the structural and functional brain correlates underlying creative potential. Recent investigations found that interindividual differences in creative potential relate to volumetric differences in brain regions belonging to the default mode network, such as the precuneus. Yet, the complex interplay between creative potential, intelligence, and personality traits and their respective neural bases is still under debate. We investigated regional gray matter volume (rGMV) differences that can be associated with creative potential in a heterogeneous sample of N=135 individuals using voxel-based morphometry (VBM). By means of latent variable modeling and consideration of recent psychometric advancements in creativity research, we sought to disentangle the effects of ideational originality and fluency as two independent indicators of creative potential. Intelligence and openness to experience were considered as common covariates of creative potential. The results confirmed and extended previous research: rGMV in the precuneus was associated with ideational originality, but not with ideational fluency. In addition, we found ideational originality to be correlated with rGMV in the caudate nucleus. The results indicate that the ability to produce original ideas is tied to default-mode as well as dopaminergic structures. These structural brain correlates of ideational originality were apparent throughout the whole range of intellectual ability and thus not moderated by intelligence. In contrast, structural correlates of ideational fluency, a quantitative marker of creative potential, were observed only in lower intelligent individuals in the cuneus/lingual gyrus.

Training of verbal creativity modulates brain activity in regions associated with language- and memory-related demands.

This functional magnetic resonance (fMRI) study was designed to investigate changes in functional patterns of brain activity during creative ideation as a result of a computerized, 3-week verbal creativity training. The training was composed of various verbal divergent thinking exercises requiring participants to train approximately 20 min per day. Fifty-three participants were tested three times (psychometric tests and fMRI assessment) with an intertest-interval of 4 weeks each. Participants were randomly assigned to two different training groups, which received the training time-delayed: The first training group was trained between the first and the second test, while the second group accomplished the training between the second and the third test session. At the behavioral level, only one training group showed improvements in different facets of verbal creativity right after the training. Yet, functional patterns of brain activity during creative ideation were strikingly similar across both training groups. Whole-brain voxel-wise analyses (along with supplementary region of interest analyses) revealed that the training was associated with activity changes in well-known creativity-related brain regions such as the left inferior parietal cortex and the left middle temporal gyrus, which have been shown as being particularly sensitive to the originality facet of creativity in previous research. Taken together, this study demonstrates that continuous engagement in a specific complex cognitive task like divergent thinking is associated with reliable changes of activity patterns in relevant brain areas, suggesting more effective search, retrieval, and integration from internal memory representations as a result of the training.

Cardiovascular Risk Factors in Central Retinal Artery Occlusion: Results of a Prospective and Standardized Medical Examination.

PURPOSE: To analyze the underlying risk factors in patients with nonarteritic central retinal artery occlusion (CRAO) in a well-defined and homogenous group of patients enrolled in the European Assessment Group for Lysis in the Eye (EAGLE) study. DESIGN: Analysis of the cardiovascular risk factors in a prospective, randomized clinical trial. PARTICIPANTS: Seventy-seven EAGLE patients with nonarteritic CRAO. METHODS: Analysis of vascular risk factors and underlying diseases detected by questionnaire and standardized physical examination within 1 month after occlusion. MAIN OUTCOME MEASURES: The standardized physical examination included carotid Doppler ultrasonography, echocardiography, electrocardiography, blood pressure monitoring, pulse rate, urine analysis, body mass index analysis, and laboratory tests. RESULTS: Seventy-seven of 84 patients had complete datasets for analysis. Fifty-two (67%) patients had cardiovascular risk factors in their medical history, and comprehensive phenotyping identified at least 1 new risk factor in 60 patients (78%; 95% confidence interval, 67%-87%). Thirty-one (40%) had carotid artery stenosis of at least 70%. Eleven patients experienced a stroke, 5 of those within 4 weeks after the CRAO occurred. Arterial hypertension was found in 56 (73%) patients and was newly diagnosed in 12 (16%) study participants. Cardiac diseases were also highly prevalent (22% coronary artery disease, 20% atrial fibrillation, and 17% valvular heart disease). CONCLUSIONS: Previously undiagnosed vascular risk factors were found in 78% of all CRAO patients. The most meaningful risk factor was ipsilateral carotid artery stenosis. A comprehensive and prompt diagnostic work-up is mandatory for all CRAO patients.

To create or to recall? Neural mechanisms underlying the generation of creative new ideas.

This fMRI study investigated brain activation during creative idea generation using a novel approach allowing spontaneous self-paced generation and expression of ideas. Specifically, we addressed the fundamental question of what brain processes are relevant for the generation of genuinely new creative ideas, in contrast to the mere recollection of old ideas from memory. In general, creative idea generation (i.e., divergent thinking) was associated with extended activations in the left prefrontal cortex and the right medial temporal lobe, and with deactivation of the right temporoparietal junction. The generation of new ideas, as opposed to the retrieval of old ideas, was associated with stronger activation in the left inferior parietal cortex which is known to be involved in mental simulation, imagining, and future thought. Moreover, brain activation in the orbital part of the inferior frontal gyrus was found to increase as a function of the creativity (i.e., originality and appropriateness) of ideas pointing to the role of executive processes for overcoming dominant but uncreative responses. We conclude that the process of idea generation can be generally understood as a state of focused internally-directed attention involving controlled semantic retrieval. Moreover, left inferior parietal cortex and left prefrontal regions may subserve the flexible integration of previous knowledge for the construction of new and creative ideas.

Creating metaphors: the neural basis of figurative language production.

Neuroscience research has thoroughly studied how nonliteral language is processed during metaphor comprehension. However, it is not clear how the brain actually creates nonliteral language. Therefore, the present study for the first time investigates the neural correlates of metaphor production. Participants completed sentences by generating novel metaphors or literal synonyms during functional imaging. Responses were spoken aloud in the scanner, recorded, and subsequently rated for their creative quality. We found that metaphor production was associated with focal activity in predominantly left-hemispheric brain regions, specifically the left angular gyrus, the left middle and superior frontal gyri-corresponding to the left dorsomedial prefrontal (DMPFC) cortex-and the posterior cingulate cortex. Moreover, brain activation in the left anterior DMPFC and the right middle temporal gyrus was found to linearly increase with the creative quality of metaphor responses. These findings are related to neuroscientific evidence on metaphor comprehension, creative idea generation and episodic future thought, suggesting that creating metaphors involves the flexible adaptation of semantic memory to imagine and construct novel figures of speech. Furthermore, the left DMPFC may exert executive control to maintain strategic search and selection, thus facilitating creativity of thought.

Sex differences in the IQ-white matter microstructure relationship: a DTI study.

Sex differences in the relationship between general intelligence and brain structure are a topic of increasing research interest. Early studies focused mainly on gray and white matter differences using voxel-based morphometry, while more recent studies investigated neural fiber tracts using diffusion tensor imaging (DTI) to analyze the white matter microstructure. In this study we used tract-based spatial statistics (TBSS) on DTI to test how intelligence is associated with brain diffusion indices and to see whether this relationship differs between men and women. 63 Men and women divided into groups of lower and higher intelligence were selected. Whole-brain DTI scans were analyzed using TBSS calculating maps of fractional anisotropy (FA), radial diffusivity (RD), and axial diffusivity (AD). The results reveal that the white matter microstructure differs between individuals as a function of intelligence and sex. In men, higher intelligence was related to higher FA and lower RD in the corpus callosum. In women, in contrast, intelligence was not related to the white matter microstructure. The higher values of FA and lower values of RD suggest that intelligence is associated with higher myelination and/or a higher number of axons particularly in men. This microstructural difference in the corpus callosum may increase cognitive functioning by reducing inter-hemispheric transfer time and thus account for more efficient brain functioning in men.

Megahertz ultra-wide-field swept-source retina optical coherence tomography compared to current existing imaging devices.

BACKGROUND: To investigate the image quality of wide-angle cross-sectional and reconstructed fundus images based on ultra-megahertz swept-source Fourier domain mode locking (FDML) OCT compared to current generation diagnostic devices. METHODS: A 1,050 nm swept-source FDML OCT system was constructed running at 1.68 MHz A-scan rate covering approximately 70° field of view. Twelve normal eyes were imaged with the device applying an isotropically dense sampling protocol (1,900 × 1,900 A-scans) with a fill factor of 100 %. Obtained OCT scan image quality was compared with two commercial OCT systems (Heidelberg Spectralis and Stratus OCT) of the same 12 eyes. Reconstructed en-face fundus images from the same FDML-OCT data set were compared to color fundus, infrared and ultra-wide-field scanning laser images (SLO). RESULTS: Comparison of cross-sectional scans showed a high overall image quality of the 15× averaged FDML images at 1.68 MHz [overall quality grading score: 8.42 ± 0.52, range 0 (bad)-10 (excellent)] comparable to current spectral-domain OCTs (overall quality grading score: 8.83 ± 0.39, p = 0.731). On FDML OCT, a dense 3D data set was obtained covering also the central and mid-peripheral retina. The reconstructed FDML OCT en-face fundus images had high image quality comparable to scanning laser ophthalmoscope (SLO) as judged from retinal structures such as vessels and optic disc. Overall grading score was 8.36 ± 0.51 for FDML OCT vs 8.27 ± 0.65 for SLO (p = 0.717). CONCLUSIONS: Ultra-wide-field megahertz 3D FDML OCT at 1.68 MHz is feasible, and provides cross-sectional image quality comparable to current spectral-domain OCT devices. In addition, reconstructed en-face visualization of fundus images result in a wide-field view with high image quality as compared to currently available fundus imaging devices. The improvement of >30× in imaging speed over commercial spectral-domain OCT technology enables high-density scan protocols leading to a data set for high quality cross-sectional and en-face images of the posterior segment.

Microaneurysm formation rate as a predictive marker for progression to clinically significant macular edema in nonproliferative diabetic retinopathy.

PURPOSE: To evaluate the predictive value of microaneurysm (MA) formation rate concerning the development of clinically significant macular edema (CSME) in patients with mild-to-moderate nonproliferative diabetic retinopathy as evaluated by an automated analysis of central field fundus 30° photographs. METHODS: Two hundred and eighty-seven eyes were included in the study. Photographs obtained at Day 0, at 6, and 12 months were analyzed using the RetmarkerDR software (Critical Health SA) in a masked manner, and the MA formation rate was documented. A threshold of a calculated MA formation rate of 2 or more was chosen to consider a patient "positive." The ability to predict CSME development was then calculated for a period of up to 5 years. HbA1c values, blood pressure, or duration of diabetes were also evaluated. RESULTS: The study population consisted of 89 male and 59 female patients with a mean age of 57.6 years, a mean HbA1c of 7.8, and a mean duration of diabetes of 12.3 years. Forty-seven of 287 eyes (16.4%) developed CSME during follow-up. An increased MA formation rate of >2 MA was clearly associated with development of CSME. Using the automated analysis and a threshold of 2 or more new MA, the authors were able to identify 70.2% of the eyes that developed CSME during follow-up ("true positive") and using a threshold of up to 2 new MA, 71.7% of the patients that did not develop CSME ("true negative"). No significant differences concerning baseline and 1-year HbA1c levels within patient eyes that developed CSME compared with patient eyes below or over the calculated threshold of 2 MA (P = 0.554 and P = 0.890, respectively) were seen. The positive and negative predictive value was calculated to be 33% versus 92.5%, sensitivity was 70%, and specificity was 72%. CONCLUSION: Using the RetmarkerDR software, the authors were able to identify patients with higher risk to develop CSME during follow-up using a threshold of 2 or more MA formation rate. Together with the high negative predictive value, the automated analysis may help to determine the individual risk of a patient to develop sight-threatening complications related to diabetic retinopathy and schedule individual screening intervals.

Intelligence, creativity, and cognitive control: The common and differential involvement of executive functions in intelligence and creativity.

Intelligence and creativity are known to be correlated constructs suggesting that they share a common cognitive basis. The present study assessed three specific executive abilities - updating, shifting, and inhibition - and examined their common and differential relations to fluid intelligence and creativity (i.e., divergent thinking ability) within a latent variable model approach. Additionally, it was tested whether the correlation of fluid intelligence and creativity can be explained by a common executive involvement. As expected, fluid intelligence was strongly predicted by updating, but not by shifting or inhibition. Creativity was predicted by updating and inhibition, but not by shifting. Moreover, updating (and the personality factor openness) was found to explain a relevant part of the shared variance between intelligence and creativity. The findings provide direct support for the executive involvement in creative thought and shed further light on the functional relationship between intelligence and creativity.

Neural efficiency as a function of task demands.

The neural efficiency hypothesis describes the phenomenon that brighter individuals show lower brain activation than less bright individuals when working on the same cognitive tasks. The present study investigated whether the brain activation-intelligence relationship still applies when more versus less intelligent individuals perform tasks with a comparable person-specific task difficulty. In an fMRI-study, 58 persons with lower (n = 28) or respectively higher (n = 30) intelligence worked on simple and difficult inductive reasoning tasks having the same person-specific task difficulty. Consequently, less bright individuals received sample-based easy and medium tasks, whereas bright subjects received sample-based medium and difficult tasks. This design also allowed a comparison of lower versus higher intelligent individuals when working on the same tasks (i.e. sample-based medium task difficulty). In line with expectations, differences in task performance and in brain activation were only found for the subset of tasks with the same sample-based task difficulty, but not when comparing tasks with the same person-specific task difficulty. These results suggest that neural efficiency reflects an (ability-dependent) adaption of brain activation to the respective task demands.

Microaneurysm turnover in diabetic retinopathy assessed by automated RetmarkerDR image analysis--potential role as biomarker of response to ranibizumab treatment.

PURPOSE: To evaluate the influence of a ranibizumab treatment on microaneurysm (MA) turnover in diabetic retinopathy. METHODS: Sixty-nine eyes were included in this retrospective study. We compared a group of 33 eyes with ranibizumab treatment for diabetic macular edema to 36 eyes with nonproliferative diabetic retinopathy only. Nonmydriatic ultra-widefield scanning laser ophthalmoscopy (Optomap) images were obtained at a mean 4.76 ± 1.69 days prior to the first ranibizumab injection (baseline) and again 35.94 ± 2.44 days after the third consecutive injection in a 4-week interval. In untreated controls, images were obtained at baseline and 97.81 ± 3.16 days thereafter. Images were analyzed using the RetmarkerDR software (Critical Health SA, Coimbra, Portugal), and the turnover of MAs was documented and analyzed. Thereafter, MA turnover was correlated with central retinal thickness (CRT) as assessed by OCT. RESULTS: At baseline, patients in the treatment group had 5.64 ± 0.75 MAs. One month after 3 ranibizumab injections, measured MAs decreased to 4.03 ± 0.66. In the untreated control group, the initial number of 3.36 ± 0.6 MAs remained almost unchanged over 3-4 months (2.89 ± 0.57 MAs). Dynamic analysis showed that after ranibizumab treatment 3.06 ± 0.5 new MAs appeared, while 5.09 ± 0.79 disappeared. In the control group, 2.11 ± 0.4 new MAs appeared and 2.61 ± 0.48 disappeared. MA turnover was significantly higher with ranibizumab compared to the control group (8.15 ± 1.14 vs. 4.72 ± 0.81, p < 0.001). Consistently, CRT decreased from 444 to 330 µm in the ranibizumab group, while there was no change in the control group (291 vs. 288 µm). CONCLUSION: The treatment of macular edema using ranibizumab does not only reduce macular thickness, but also has an impact on the turnover of MAs in diabetic retinopathy. RetmarkerDR analysis showed that more pre-existent MAs disappeared than new MAs developed, and the absolute number of MAs also decreased.