Testing visual self-misperception in anorexia nervosa using a symmetrical body size estimation paradigm.

OBJECTIVE: Individuals diagnosed with anorexia nervosa (AN) often report seeing themselves as overweight. While body size estimation tasks suggest that such individuals overestimate their body size, these tasks have failed to establish whether this misestimation stems from visual misperception. Misestimation might, instead, be due to response bias. We designed a paradigm to distinguish between visual and response bias contributions to body size misestimation: the symmetrical body size estimation (s-BSE) paradigm. METHOD: The s-BSE paradigm involves two tasks. In the conventional task, participants estimate the width of their photographed body by adjusting the size of a rectangle to match. In the transposed task, participants adjust the size of a photograph of their body to match the rectangle. If overestimation stems exclusively from visual misperception, then errors in each task would be equal and opposite. Using this paradigm, we compared the performance of women diagnosed with AN (n = 14) against women without any eating disorder (n = 40). RESULTS: In the conventional task, we replicated previous findings indicating that both women with AN and women without any eating disorder overestimate their body size. In the transposed task, neither group adjusted the bodies to be narrower than the rectangle. Participants with AN set their photographs to be significantly wider. DISCUSSION: While we replicated previous findings of body size overestimation amongst women with AN and those without any eating disorder, our results are inconsistent with the hypothesis that such overestimation stems exclusively from visual misperception and instead suggest a substantial response bias effect. PUBLIC SIGNIFICANCE: Women with anorexia nervosa overestimate their own body size. Research has not yet determined whether this overestimation stems from them seeing themselves as larger or other, non-visual factors. We employ a new method for distinguishing these possibilities and find that non-visual factors influence size estimates for women with and without anorexia nervosa. This method can help future research control for non-perceptual influences on participant responses.

Eliciting nurses' perspectives to improve health information exchange between hospital and home health care.

Despite patient safety initiatives to improve care transitions, prior research largely neglects to elicit feedback from home health nurses regarding health information exchange. The goal of this quality improvement study was to identify opportunities to facilitate information transfer during hospital-to-home-health-care transitions for older adults with heart failure. We conducted focus groups with 19 nurses employed by a single healthcare system using two commercially available electronic health record (EHR) vendors. We analyzed interview transcripts following an immersion/crystallization approach to identify themes. Average participants were females in their mid-fifties with 15 years of home health experience. Nurses reported challenges with hospital-to-home-health-care information exchange, specifically: 1) poor medication management, 2) ineffective communication, 3) technology issues, and 4) patient factors. Nurses identified several opportunities for improvement, including discordant EHR-generated medication lists, which may be amenable to technological solutions. Local quality improvement efforts should incorporate nurses' suggestions and leverage existing best practices.

Experimental manipulation of visual attention affects body size adaptation but not body dissatisfaction.

OBJECTIVE: Prolonged exposure to large/small bodies causes aftereffects in perceived body size. Outside the laboratory, individuals repeatedly exposed to small (large) bodies tend to over- (under-) estimate their size and exhibit increased (decreased) body dissatisfaction. Why, among individuals exposed to approximately equivalent distributions of body sizes, only some develop body size and shape misperception and/or body dissatisfaction is not yet fully understood. METHOD: We exposed 61 women to high and low adiposity bodies simultaneously, instructing half to attend to high, and half to low adiposity bodies. RESULTS: Participants in the high adiposity attention condition's perception of "normal" body size significantly increased in adiposity, and vice versa. DISCUSSION: This suggests that visual attention moderates body size aftereffects. Interventions encouraging visual attention to more realistic ranges of bodies may therefore reduce body misperception. No change in body dissatisfaction was found, suggesting that changes in the perceptual component (misperception) may not necessarily affect the attitudinal component (dissatisfaction) of body image distortion.

Adult-onset asthma morbidity and related economic costs in middle age due to intentional chronic absenteeism in high school: An epidemiologic study using the national longitudinal survey of youth 1979 data.

OBJECTIVE: Many authors examined the individual and societal impact of school absenteeism. Nevertheless, no empirical study has looked at the potential direct correlation between deliberate school absences and chronic illnesses in mid-adulthood. Our goal is to investigate any potential direct links between purposeful school absences and adult-onset asthma in middle age, as well as measure any associated costs of asthma. METHODS: Data were sourced from the National Longitudinal Survey of Youth 1979, a nationally representative survey. The outcome measure was self-reported asthma in mid-adulthood. School records of absenteeism from grades nine through twelve were the key explanatory variables. Logistic regressions were performed with controls for demographic, economic and health variables. Predicted probabilities from the regressions were used to quantify costs of adult-onset asthma in middle age due to intentional high school absenteeism. RESULTS: More years of chronic absenteeism in high school were associated with higher risk of adult-onset asthma in middle age. Four years of chronic absenteeism in high school during the late 1970s through the early 1980s could potentially have incurred between $817 million to $1 billion of asthma related costs in 2002, when these students were in their mid-adulthood. These potential asthma related costs due to high school absenteeism are sizeable considering that this high school cohort only accounted for six percent of the U.S. population. CONCLUSIONS: Reducing high school absenteeism could lower the incidence of adult-onset asthma in middle age, and its associated future economic burden.

Did you skip leg day? The neural mechanisms of muscle perception for body parts.

While the neural mechanisms underpinning the perception of muscularity are poorly understood, recent progress has been made using the psychophysical technique of visual adaptation. Prolonged visual exposure to high (low) muscularity bodies causes subsequently viewed bodies to appear less (more) muscular, revealing a recalibration of the neural populations encoding muscularity. Here, we use visual adaptation to further elucidate the tuning properties of the neural processes underpinning muscle perception for the upper and lower halves of the body. Participants manipulated the apparent muscularity of upper and lower bodies until they appeared 'normal', prior to and following exposure to a series of top/bottom halves of bodies that were either high or low in muscularity. In Experiment 1, participants were adapted to isolated own-gender body halves from one of four conditions; increased (muscularity) upper (body half), increased lower, decreased upper, or decreased lower. Despite the presence of muscle aftereffects when the body halves the participants viewed and manipulated were congruent, there was only weak evidence of muscle aftereffect transfer between the upper and lower halves of the body. Aftereffects were significantly weaker when body halves were incongruent, implying minimal overlap in the neural mechanisms encoding muscularity for body half. Experiment 2 examined the generalisability of Experiment 1's findings in a more ecologically valid context using whole-body stimuli, producing a similar pattern of results as Experiment 1, but with no evidence of cross-adaptation. Taken together, the findings are most consistent with muscle-encoding neural populations that are body-half selective. As visual adaptation has been implicated in cases of body size and shape misperception, the present study furthers our current understanding of how these perceptual inaccuracies, particularly those involving muscularity, are developed, maintained, and may potentially be treated.

Race-contingent face aftereffects: a result of perceived racial typicality, not categorization.

Opposing aftereffects can be simultaneously induced by adapting to faces of different races distorted in opposite directions, allowing researchers to infer that faces are encoded against race-specific prototypes. This effect also suggests the existence of dissociable pools of neurons sensitive to race, each of which has been differently adapted to cause an opposite aftereffect. More recent studies have suggested that changes in the strength of race-contingent aftereffects reveal evidence of categorical perception, as they are larger when the adapting faces straddle the racial category boundary. We examined whether changes in these effects more closely correspond to a dichotomous categorical judgment, reflecting highly race-selective neural mechanisms, or more continuous perceptions of racial typicality, reflecting visual channels that are more broadly tuned. In Experiment 1, faces with a range of "morph levels" (i.e., relative contributions of Asian/Caucasian faces) were either rated on a continuous scale for Asian/Caucasian typicality, or simply categorized as Asian/Caucasian. As expected, typicality ratings showed a shallow slope (observers were sensitive to morph level over a broad range), while dichotomous racial categorization showed a steep slope (a rapid switch from categorization as Asian-Caucasian). In Experiment 2, race-contingent adaptation was assessed using test faces with various morph levels. Aftereffect size showed a shallow slope, closely resembling the racial typicality ratings, but showing a significant difference to the categorization data. This suggests that although the visual channels processing these faces do show some selectivity to race, they are sensitive to perceptions of racial typicality, showing a gradual transition of activity across a broad range of faces along the racial continuum.

The valence-dominance model applies to body perception.

First impressions of a person, including social judgements, are often based on appearance. The widely accepted valence-dominance model of face perception (Oosterhof and Todorov 2008 Proc. Natl Acad. Sci. USA 105, 11 087-11 092 (doi:10.1073/pnas.0805664105)) posits that social judgements of faces fall along two orthogonal dimensions: trustworthiness (valence) and dominance. The current study aimed to establish the principal components of social judgements based on the perception of bodies, hypothesizing that these would follow the same dimensions as face perception. Stimuli were black and white photographs showing bodies dressed in grey clothing, standing in their natural posture, in left profile. Raters (N = 237) judged the stimuli on the 14 traits used in Oosterhof and Todorov's original study (Oosterhof and Todorov 2008 Proc. Natl Acad. Sci. USA 105, 11 087-11 092 (doi:10.1073/pnas.0805664105)). Data were analysed using principal component analysis (PCA), as in the original study, with an additional exploratory factor analysis (EFA) using oblique rotation. While PCA produced a third dimension in line with several replications of the original study, results from the EFA produced two dimensions, representing trustworthiness and dominance, providing support for the hypothesis that social perceptions of bodies can be summarized using the valence-dominance model. These two factors could represent universal perceptions we have about people. Future research could explore social judgements of humans based on other stimuli, such as voices or body odour, to evaluate whether the trustworthiness and dominance dimensions are consistent across modalities.

Observing Provider Utilization of Electronic Health Records to Improve Clinical Quality Metrics.

Introduction: This study compared changes of healthcare quality in a Michigan Medicaid population before and after physician adoption of electronic health records (EHRs) via the Meaningful Use (MU) program for selected Healthcare Effectiveness Data and Information Set (HEDIS) quality of care measures. Methods: Healthcare measures included well-child visits, cancer screening, and chronic illness quality measures. Utilization data were obtained from Medicaid paid claims and encounter data with providers (N=291) receiving their first MU incentive in 2014 and at least one HEDIS-defined outpatient visit with a Michigan Medicaid enrollee. Paired t-tests with a repeated measures design were utilized to analyze the data. Results: Improvements in quality of infant well-child visits (mean difference = 10.2) and colorectal cancer screening (mean difference = 8.0 percent) were observed. We found no change or slight decreases for the other selected measures. Conclusion: These outcomes inform the performance and ability of EHRs to improve quality of healthcare standards particularly as technology continues to evolve under the Centers for Medicare & Medicaid Services (CMS) Interoperability and Patient Access final rule.

Community acquired bacteremia in young children from central Nigeria--a pilot study.

BACKGROUND: Reports of the etiology of bacteremia in children from Nigeria are sparse and have been confounded by wide spread non-prescription antibiotic use and suboptimal laboratory culture techniques. We aimed to determine causative agents and underlying predisposing conditions of bacteremia in Nigerian children using data arising during the introduction of an automated blood culture system accessed by 7 hospitals and clinics in the Abuja area. METHODS: Between September 2008 and November 2009, we enrolled children with clinically suspected bacteremia at rural and urban clinical facilities in Abuja or within the Federal Capital Territory of Nigeria. Blood was cultured using an automated system with antibiotic removing device. We documented clinical features in all children and tested for prior antibiotic use in a random sample of sera from children from each site. RESULTS: 969 children aged 2 months-5 years were evaluated. Mean age was 21±15.2 months. All children were not systematically screened but there were 59 (6%) children with established diagnosis of sickle cell disease and 42 (4.3%) with HIV infection. Overall, 212 (20.7%) had a positive blood culture but in only 105 (10.8%) were these considered to be clinically significant. Three agents, Staphylococcus aureus (20.9%), Salmonella typhi (20.9%) and Acinetobacter (12.3%) accounted for over half of the positive cultures. Streptococcus pneumoniae and non-typhi Salmonellae each accounted for 7.6%. Although not the leading cause of bacteremia, Streptococcus pneumoniae was the single leading cause of all deaths that occurred during hospitalization and after hospital discharge. CONCLUSION: S. typhi is a significant cause of vaccine-preventable morbidity while S. pneumoniae may be a leading cause of mortality in this setting. This observation contrasts with reports from most other African countries where non-typhi Salmonellae are predominant in young children. Expanded surveillance is required to confirm the preliminary observations from this pilot study to inform implementation of appropriate public health control measures.

Contrast and stimulus complexity moderate the relationship between spatial frequency and perceived speed: implications for MT models of speed perception.

Area MT in extrastriate visual cortex is widely believed to be responsible for the perception of object speed. Recent physiological data show that many cells in macaque visual area MT change their speed preferences with a change in stimulus spatial frequency (N. J. Priebe, C. R. Cassanello, & S. G. Lisberger, 2003) and that this effect can accurately predict the dependence of perceived speed on spatial frequency demonstrated in a related psychophysical study (N. J. Priebe & S. G. Lisberger, 2004). For more complex compound gratings and high contrast stimuli, MT cell speed preferences show sharper tuning and less dependence on spatial frequency (Priebe et al., 2003), allowing us to predict that such stimuli should produce speed percepts that are less vulnerable to spatial frequency variations. We investigated the perceived speed of simple sine wave gratings and more complex compound gratings (formed from 2 sine wave components) in response to changes in contrast and spatial frequency. In all cases, high contrast stimuli appeared to translate more rapidly. In addition, high spatial frequencies appeared faster-the opposite effect to that predicted by changes in MT cell spatial frequency preferences. Complex grating stimuli were somewhat "protected" from the effect of spatial frequency (compared to simple gratings), as predicted. However, contrary to predictions, the effect of spatial frequency was larger in high (compared to low) contrast gratings. Our data demonstrate that the previously established links between changes in MT cells' speed preferences and human speed perception are more complex than first thought.

Visual body-size adaptation and estimation of tactile distance.

Estimating the size of bodies is crucial for interactions with physical and social environments. Body-size perception is malleable and can be altered using visual adaptation paradigms. However, it is unclear whether such visual adaptation effects also transfer to other modalities and influence, for example, the perception of tactile distances. In this study, we employed a visual adaptation paradigm. Participants were exposed to images of expanded or contracted versions of self- or other-identity bodies. Before and after this adaptation, they were asked to manipulate the width of body stimuli to appear as 'normal' as possible. We replicated an effect of visual adaptation such that the body-size selected as most 'normal' was larger after exposure to expanded and thinner after exposure to contracted adaptation stimuli. In contrast, we did not find evidence that this adaptation effect transfers to distance estimates for paired tactile stimuli delivered to the abdomen. A Bayesian analysis showed that our data provide moderate evidence that there is no effect of visual body-size adaptation on the estimation of spatial parameters in a tactile task. This suggests that visual body-size adaptation effects do not transfer to somatosensory body-size representations.

The "cheerleader effect" in facial and bodily attractiveness: A result of memory bias and not perceptual encoding.

Individual faces are rated as more attractive when presented in a group compared with when presented individually; a finding dubbed the "cheerleader effect." As a relatively recent discovery, the conditions necessary to observe the effect are not clearly understood. We sought to better define these conditions by examining two parameters associated with the effect. Our first aim was to determine whether the effect is specific to faces or occurs also for human bodies. Both face and body images were rated as being more attractive when presented in groups than when presented in isolation, demonstrating that the cheerleader effect is not restricted to faces. Furthermore, the effect was significantly larger for bodies than faces. Our second aim was to determine whether the cheerleader effect originates from a bias in memory or occurs during perceptual encoding. Participants in the "memory" condition provided attractiveness ratings after images had been removed from the testing screen, whereas participants in the "perceptual" condition provided ratings while the images remained visible, thereby eliminating the memory components of the paradigm. Significant cheerleader effects were only observed in the memory condition. We conclude that the cheerleader effect for faces and bodies is due to a bias in memory and does not occur at an initial stage of perceptual encoding.

Breaking camouflage: binocular disparity reduces contrast masking in natural images.

Visual overlay masking is typically studied with a mask and target located at the same depth plane. Masking is reduced when binocular disparity separates the target from the mask (G. Moraglia & B. Schneider, 1990). We replicate this finding for a broadband target masked by natural images and find the greatest masking (threshold elevation) when target and mask occupy the same depth plane. Masking was reduced equally whether the target appeared at a crossed or an uncrossed disparity. We measure the tuning of masking and determine the extent of the benefit afforded by disparity. Threshold elevation decreases monotonically with increasing disparity until ±8 arcmin. Two underlying components to the masking are evident; one accounts for around two-thirds of the masking and is independent of disparity. The second component is disparity-dependent and results in additional masking when there is zero disparity. Importantly, the reduction in masking with disparity cannot be explained by interocular decorrelation; we use a single-interval orientation discrimination task to exclude this possibility. We conclude that when the target and mask are presented at different depths they activate distinct populations of disparity-tuned neurons, resulting in less masking of the target.

Accuracy of stereomotion speed perception with persisting and dynamic textures.

It has been established that the motion in depth of stimuli visible to both eyes may be signalled binocularly either by a change of disparity over time or by the difference in the velocity of the images projected on each retina, known as an interocular velocity difference. A two-interval forced-choice stereomotion speed discrimination experiment was performed on four participants to ascertain the relative speed of a persistent random dot stereogram (RDS) and a dynamic RDS undergoing directly approaching or receding motion in depth. While the persistent RDS pattern involved identical dot patterns translating in opposite directions in each eye, and hence included both changing disparity and interocular velocity difference cues, the dynamic RDS pattern (which contains no coherent monocular motion signals) specified motion in depth through changing disparity, but no motion through interocular velocity difference. Despite an interocular velocity difference speed signal of zero motion in depth, the dynamic RDS stimulus appeared to move more rapidly. These observations are consistent with a scheme in which cues that rely on coherent monocular motion signals (such as looming and the interocular velocity difference cue) are less influential in dynamic stimuli due to their lack of reliability (i.e., increased noise). While dynamic RDS stimuli may be relatively unaffected by the contributions of such cues when they signal that the stimulus did not move in depth, the persistent RDS stimulus may retain a significant and conflicting contribution from the looming cue, resulting in a lower perceived speed.

Shining a Light on Race: Contrast and Assimilation Effects in the Perception of Skin Tone and Racial Typicality.

Researchers have long debated the extent to which an individual's skin tone influences their perceived race. Brooks and Gwinn (2010) demonstrated that the race of surrounding faces can affect the perceived skin tone of a central target face without changing perceived racial typicality, suggesting that skin lightness makes a small contribution to judgments of race compared to morphological cues (the configuration and shape of the facial features). However, the lack of a consistent light source may have undermined the reliability of skin tone cues, encouraging observers to rely disproportionately on morphological cues instead. The current study addresses this concern by using 3D models of male faces with typically Black African or White European appearances that are illuminated by the same light source. Observers perceived target faces surrounded by White faces to have darker skin than those surrounded by Black faces, particularly for faces of intermediate lightness. However, when asked to judge racial typicality, a small assimilation effect was evident, with target faces perceived as more stereotypically White when surrounded by White than when surrounded by Black faces at intermediate levels of typicality. This evidence of assimilation effects for perceived racial typicality despite concurrent contrast effects on perceived skin lightness supports the previous conclusion that perceived skin lightness has little influence on judgments of racial typicality for racially ambiguous faces, even when lighting is consistent.

Looking at the Figures: Visual Adaptation as a Mechanism for Body-Size and -Shape Misperception.

Many individuals experience body-size and -shape misperception (BSSM). Body-size overestimation is associated with body dissatisfaction, anxiety, depression, and the development of eating disorders in individuals who desire to be thinner. Similar symptoms have been noted for those who underestimate their muscularity. Conversely, individuals with high body mass indices (BMI) who underestimate their adiposity may not recognize the risks of or seek help for obesity-related medical issues. Although social scientists have examined whether media representations of idealized bodies contribute to the overestimation of fat or underestimation of muscle, other scientists suggest that increases in the prevalence of obesity could explain body-fat underestimation as a form of renormalization. However, these disparate approaches have not advanced our understanding of the perceptual underpinnings of BSSM. Recently, a new unifying account of BSSM has emerged that is based on the long-established phenomenon of visual adaptation, employing psychophysical measurements of perceived size and shape following exposure to "extreme" body stimuli. By inducing BSSM in the laboratory as an aftereffect, this technique is rapidly advancing our understanding of the underlying mental representation of human bodies. This nascent approach provides insight into real-world BSSM and may inform the development of therapeutic and public-health interventions designed to address such perceptual errors.

Muscle and fat aftereffects and the role of gender: Implications for body image disturbance.

Body image disturbance - a cause of distress amongst the general population and those diagnosed with various disorders - is often attributed to the media's unrealistic depiction of ideal bodies. These ideals are strongly gendered, leading to pronounced fat concern amongst females, and a male preoccupation with muscularity. Recent research suggests that visual aftereffects may be fundamental to the misperception of body fat and muscle mass - the perceptual component of body image disturbance. This study sought to establish the influence of gender on these body aftereffects. Male and female observers were randomly assigned to one of four adaptation conditions (low-fat, high-fat, low-muscle, and high-muscle bodies) and were asked to adjust the apparent fat and muscle levels of male and female bodies to make them appear as 'normal' as possible both before adaptation and after adaptation. While neither the gender of observers nor of body stimuli had a direct effect, aftereffect magnitude was significantly larger when observers viewed own-gender (compared with other-gender) stimuli. This effect, which may be due to attentional factors, could have implications for the development of body image disturbance, given the preponderance of idealized own-gender bodies in media marketed to male and female consumers.

Vection strength increases with simulated eye-separation.

Research has previously shown that adding consistent stereoscopic information to self-motion displays can improve the vection in depth induced in physically stationary observers. In some past studies, the simulated eye-separation was always close to the observer's actual eye-separation, as the aim was to examine vection under ecological viewing conditions that provided consistent binocular and monocular self-motion information. The present study investigated whether large discrepancies between the observer's simulated and physical eye-separations would alter the vection-inducing potential of stereoscopic optic flow (either helping, hindering, or preventing the induction of vection). Our self-motion displays simulated eye-separations of 0 cm (the non-stereoscopic control), 3.25 cm (reduced from normal), 6.5 cm (approximately normal), and 13 cm (exaggerated relative to normal). The rated strength of vection in depth was found to increase systematically with the simulated eye-separation. While vection was the strongest in the 13-cm condition (stronger than even the 6.5-cm condition), the 3.25-cm condition still produced superior vection to the 0-cm control (i.e., it had significantly stronger vection ratings and shorter onset latencies). Perceptions of scene depth and object motion-in-depth speed were also found to increase with the simulated eye-separation. As expected based on the findings of previous studies, correlational analyses suggested that the stereoscopic advantage for vection (found for all of our non-zero eye-separation conditions) was due to the increase in perceived motion-in-depth.

Meaningful Use: Does Physician Participation Move the Needle on Quality Metrics?

INTRODUCTION: To determine the association between pattern of participation in the Meaningful Use (MU) initiative and self-reported clinical quality metrics. METHODS: We used state-level Medicaid electronic health record (EHR) incentive program data to categorize physicians based on receipt of MU payments (single year vs. multiple years) and self-reported quality metrics from 2011 to 2016. RESULTS: Among 4,198 participating physicians, only 36% received more than one EHR incentive payment. Physicians participating for a single year had better cancer-screening metrics. By comparison, physicians who participated for multiple years reported better medication-related metrics and chronic disease management metrics. CONCLUSIONS: Nature of participation may have varying degrees of influence on types of clinical quality metrics. Sustained participation may support management of chronic conditions. Administrative claims data will help to elucidate our findings.