Familiarity Alters the Bandwidth of Perceptual Awareness.

Results from paradigms like change blindness and inattentional blindness indicate that observers are unaware of numerous aspects of the visual world. However, intuition suggests that perceptual experience is richer than these results indicate. Why does it feel like we see so much when the data suggests we see so little? One possibility stems from the fact that experimental studies always present observers with stimuli that they have never seen before. Meanwhile, when forming intuitions about perceptual experience, observers reflect on their experiences with scenes with which they are highly familiar (e.g., their office). Does prior experience with a scene change the bandwidth of perceptual awareness? Here, we asked if observers were better at noticing alterations to the periphery in familiar scenes compared with unfamiliar scenes. We found that observers noticed changes to the periphery more frequently with familiar stimuli. Signal detection theoretic analyses revealed that when observers are unfamiliar with a stimulus, they are less sensitive at noticing (d') and are more conservative in their response criterion (c). Taken together, these results suggest that prior knowledge expands the bandwidth of perceptual awareness. It should be stressed that these results challenge the widely held idea that prior knowledge fills in perception. Overall, these findings highlight how prior knowledge plays an important role in determining the limits of perceptual experience and is an important factor to consider when attempting to reconcile the tension between empirical observation and personal introspection.

Perceptual Awareness Occurs Along a Graded Continuum: No Evidence of All-or-None Failures in Continuous Reproduction Tasks.

Does sensory information reach conscious awareness in a discrete, all-or-nothing manner or a gradual, continuous manner? To answer this question, we examined behavioral performance across four different paradigms that manipulate visual awareness: the attentional blink, backward masking, the Sperling iconic memory paradigm, and retro-cuing. We then asked how well we could account for participants' (N = 112 adults) behavior using a signal detection framework that factors in psychophysical scaling to model participants' responses along a single continuum. We found that this model easily accounted for the data from each of these diverse paradigms. Moreover, we reanalyzed the data from prior studies that had posited a discrete view of perceptual awareness and found that our continuous signal detection model outperformed the models that had been used to support an all-or-nothing view of consciousness. This set of data is consistent with the idea that conscious awareness occurs along a graded continuum.

The limits of color awareness during active, real-world vision.

Color ignites visual experience, imbuing the world with meaning, emotion, and richness. As soon as an observer opens their eyes, they have the immediate impression of a rich, colorful experience that encompasses their entire visual world. Here, we show that this impression is surprisingly inaccurate. We used head-mounted virtual reality (VR) to place observers in immersive, dynamic real-world environments, which they naturally explored via saccades and head turns. Meanwhile, we monitored their gaze with in-headset eye tracking and then systematically altered the visual environments such that only the parts of the scene they were looking at were presented in color and the rest of the scene (i.e., the visual periphery) was entirely desaturated. We found that observers were often completely unaware of these drastic alterations to their visual world. In the most extreme case, almost a third of observers failed to notice when less than 5% of the visual display was presented in color. This limitation on perceptual awareness could not be explained by retinal neuroanatomy or previous studies of peripheral visual processing using more traditional psychophysical approaches. In a second study, we measured color detection thresholds using a staircase procedure while a set of observers intentionally attended to the periphery. Still, we found that observers were unaware when a large portion of their field of view was desaturated. Together, these results show that during active, naturalistic viewing conditions, our intuitive sense of a rich, colorful visual world is largely incorrect.

Distinguishing the Neural Correlates of Perceptual Awareness and Postperceptual Processing.

To identify the neural correlates of perceptual awareness, researchers often compare the differences in neural activation between conditions in which an observer is or is not aware of a stimulus. While intuitive, this approach often contains a critical limitation: to link brain activity with perceptual awareness, observers traditionally report the contents of their perceptual experience. However, relying on observers' reports is problematic because it is difficult to know whether the neural responses being measured are associated with conscious perception or with postperceptual processes involved in the reporting task (e.g., working memory, decision-making). To address this issue, we combined a standard visual masking paradigm with a recently developed "no-report" paradigm in male/female human participants. In the visual masking paradigm, observers saw images of animals and objects that were visible or invisible, depending on their proximity to masks. Meanwhile, on half of the trials, observers reported the contents of their perceptual experience (i.e., report condition), while on the other half of trials they refrained from reporting about their experiences (i.e., no-report condition). We used electroencephalography to examine how visibility interacts with reporting by measuring the P3b event-related potential, one of the proposed canonical "signatures" of conscious processing. Overall, we found a robust P3b in the report condition, but no P3b whatsoever in the no-report condition. This finding suggests that the P3b itself is not a neural signature of conscious processing and highlights the importance of carefully distinguishing the neural correlates of perceptual awareness from postperceptual processing.SIGNIFICANCE STATEMENT What are the neural signatures that differentiate conscious and unconscious processing in the brain? Perhaps the most well established candidate signature is the P3b event-related potential, a late slow wave that appears when observers are aware of a stimulus, but disappears when a stimulus fails to reach awareness. Here, however, we found that the P3b does not track what observers are perceiving, but instead tracks what observers are reporting. When observers are aware of simple visual stimuli, the P3b is nowhere to be found unless observers are reporting the contents of their experience. These results challenge the well established notion of the P3b as a neural marker of awareness and highlight the need for new approaches to the neuroscience of consciousness.

Management of high-risk breast lesions diagnosed on core biopsies and experiences from prospective high-risk breast lesion conferences at an academic institution.

BACKGROUND: The management of high-risk breast lesions diagnosed on image-guided core biopsy remains controversial. We implemented a high-risk breast conference attended by breast pathologists, imagers, and surgeons to prospectively review all contemporary cases in order to provide a consensus recommendation to either surgically excise or follow on imaging at 6-month intervals for a minimum of 2 years. METHODS: Between May, 2015 and June, 2019, 127 high-risk lesions were discussed. Of these 127 cases, 116 had concordant radiology-pathology (rad-path) findings. The remaining 11 patients had discordant rad-path findings. Of the 116 concordant cases, 6 were excluded due to lack of the first imaging follow-up until analysis. Of the remaining 110 patients, 43 had atypical ductal hyperplasia (ADH), 12 had lobular carcinoma in situ (LCIS), 19 had atypical lobular hyperplasia (ALH), 33 had radial scar (RS), 2 had flat epithelial atypia (FEA), and 1 had mucocele-like lesion (ML). We recommended excision for ADH if there were > 2 ADH foci or < 90% of the associated calcifications were removed. For patients with LCIS or ALH, we recommended excision if the LCIS or ALH was associated with microcalcifications or the LCIS was extensive. We recommended excision of RS when < 1/2 of the lesion was biopsied. We recommended all patients with FEA and ML for 6-month follow-up. RESULTS: Following conference-derived consensus for excision, of the 27 ADH excised, 9 were upgraded to invasive carcinoma or ductal carcinoma in situ. Of the six LCIS cases recommended for excision, none were upgraded. Nine excised radial scars revealed no upgrades. Additionally, 3 patients with ADH, 2 with ALH, 1 with LCIS, and 2 with RS underwent voluntary excision, and none were upgraded. All other patients (13 with ADH, 5 LCIS, 17 ALH, 22 RS, 2 FEA and 1 ML) were followed with imaging, and none revealed evidence of disease progression during follow-up (187-1389 days). All 11 rad-path discordant cases were excised with 2 upgraded to carcinoma. CONCLUSIONS: The results of this prospective study indicate that high-risk breast lesions can be successfully triaged to surgery versus observation following establishment of predefined firm guidelines and performance of rigorous rad-path correlation.

Management of Lobular Neoplasia Found on Core Needle Biopsy Performed for Calcifications Using Precise Radiologic-Pathologic Correlation.

OBJECTIVE. The purpose of our study was to evaluate the upgrade rate of calcified lobular neoplasia (LN) versus incidental noncalcified classic LN found on core needle biopsy performed for the evaluation of suspicious calcifications. MATERIALS AND METHODS. This retrospective study included 390 consecutive image-guided breast core needle biopsies with microcalcifications as the target that were performed between December 2009 and July 2017. In 81 of the 390 core biopsies, the highest-risk lesion was LN that then underwent either excision or imaging follow-up. Core biopsy results were compared with excision and imaging follow-up findings. An upgrade of LN was defined as ductal carcinoma in situ or invasive ductal or lobular carcinoma. RESULTS. Of 81 LN diagnosed on core biopsy performed for calcifications, 16 had calcifications within the LN. Fifteen of these 16 cases underwent surgical excision, and three (3/15, 20.0%) were upgraded on excision. Of the 64 core biopsies showing incidental noncalcified LN with benign concordant entities containing calcifications, 42 underwent surgical excision, and one LN (1/42, 2.4%) was upgraded. Twenty-three total lesions (one calcified LN and 22 noncalcified LN) were followed with imaging rather than excision. No cancers were detected among the follow-up group. One case was deemed to have discordant findings on radiologic-pathologic review and was sent for excision, which showed invasive cancer with tubulolobular and lobular features. CONCLUSION. Women undergoing stereotactic core needle biopsy for calcifications revealing noncalcified incidental classic LN and a benign concordant entity that could explain the presence of the target calcifications have a low risk of upgrade and may be followed with imaging. Surgical excision should be offered to women who have LN with calcifications.

Patients with benign papilloma diagnosed on core biopsies and concordant pathology-radiology findings can be followed: experiences from multi-specialty high-risk breast lesion conferences in an academic center.

BACKGROUND: To determine whether patients with benign papilloma diagnosed on core biopsy can be spared from surgery. METHODS: We prospectively reviewed 150 consecutive core biopsy-diagnosed papilloma cases at a multi-specialty high-risk breast lesion conference to determine whether surgical excision was necessary. Of these 150 cases, 148 had concordant radiologic-pathologic features. Six were excluded due to lack of the first imaging follow-up until analysis. 112 were benign papillomas; 17 were papillomas involved by atypical ductal hyperplasia (atypical papilloma); 6 papillomas had ADH in adjacent tissue but not involving the papilloma; 2 papillomas were involved by atypical lobular hyperplasia (ALH); and 5 papillomas had ALH in adjacent tissue. Two were radiology-pathology (rad-path) discordant. RESULTS: Thirty-nine of the 112 benign papillomas were excised with no upgrade to carcinoma; 73 were followed with no disease progression during follow-up (185-1279 days). Fifteen of 17 atypical papillomas were surgically excised with 4 (26.7%) upgraded to carcinoma. Four of the 6 patients with ADH adjacent to a benign papilloma underwent excision with 2 upgrades to carcinoma. None of the patients with papilloma, which was either involved by ALH or had ALH in adjacent tissue had upgrade or disease progression during follow-up (204-1159 days). Finally, the two cases with discordant path-rad discordant were excised with no upgrade. CONCLUSIONS: Our data confirm that rad-path concordant benign papillomas diagnosed on core biopsy do not require surgery. It also supports the value of a formal multi-specialty review of all benign papilloma cases to create a consensus management plan.

Community-based program to increase use of hearing conservation practices among farm and rural youth: a cluster randomized trial of effectiveness.

BACKGROUND: Noise exposure and associated hearing loss affects an estimated 2 million farm youth who are exposed as farm residents, farm family workers, hired workers, children of migrant or seasonal workers, and farm visitors. Risk factors for farm youth include frequent exposure to high farm noise; farm work from an early age, and exposure to high recreational noise (e.g., firearms, ATVs, and personal listening devices). METHODS: This study compared the effectiveness of two interventions and control. The programs included a community-based interactive youth educational program alone (Group A), a community-based interactive youth educational program followed by an Internet-based booster (Group B), and a no-interaction control (Group C). The study used a cluster randomized control design, with equal allocation ratio to each cluster, without blinding. Inclusion criteria included enrollment in grade 4, parental consent, English speaking, and attending a community-based educational event included in the cluster sampling. A total of 1979 youth were enrolled at 36 sites distributed across the 3 study arms in the following distribution: N = 662 in 13 sites (Group A), N = 680 in 12 sites (Group B), and N = 637 in 11 sites (Group C). RESULTS: Comparison with pre-intervention data showed no difference in intent to use hearing conservation strategies in experimental groups. However, knowledge and attitudes toward hearing conservation were improved in the groups receiving the Internet-based booster. Participants reported frequent exposure to sources of hazardous noise (e.g., loud sporting events, firecrackers, personal listening devices). CONCLUSIONS: It is feasible and acceptable to incorporate hearing health education into an already existing system designed to deliver health and safety educational programming to farm and rural youth. The program was adopted by the partner agency for dissemination to up to 100,000 youth annually. Results of this study inform future intervention studies, interventions aimed at farm youth, and interventions to increase use of hearing conservation strategies, as well as offer a base for developing programs for non-English speaking children. TRIAL REGISTRATION: Clinicaltrials.gov registration CT02472821. Date of trial registration: 06/09/2015 (retrospectively registered).

Tuning Attention to Object Categories: Spatially Global Effects of Attention to Faces in Visual Processing.

Feature-based attention is known to enhance visual processing globally across the visual field, even at task-irrelevant locations. Here, we asked whether attention to object categories, in particular faces, shows similar location-independent tuning. Using EEG, we measured the face-selective N170 component of the EEG signal to examine neural responses to faces at task-irrelevant locations while participants attended to faces at another task-relevant location. Across two experiments, we found that visual processing of faces was amplified at task-irrelevant locations when participants attended to faces relative to when participants attended to either buildings or scrambled face parts. The fact that we see this enhancement with the N170 suggests that these attentional effects occur at the earliest stage of face processing. Two additional behavioral experiments showed that it is easier to attend to the same object category across the visual field relative to two distinct categories, consistent with object-based attention spreading globally. Together, these results suggest that attention to high-level object categories shows similar spatially global effects on visual processing as attention to simple, individual, low-level features.

Representational similarity precedes category selectivity in the developing ventral visual pathway.

Many studies have investigated the development of face-, scene-, and body-selective regions in the ventral visual pathway. This work has primarily focused on comparing the size and univariate selectivity of these neural regions in children versus adults. In contrast, very few studies have investigated the developmental trajectory of more distributed activation patterns within and across neural regions. Here, we scanned both children (ages 5-7) and adults to test the hypothesis that distributed representational patterns arise before category selectivity (for faces, bodies, or scenes) in the ventral pathway. Consistent with this hypothesis, we found mature representational patterns in several ventral pathway regions (e.g., FFA, PPA, etc.), even in children who showed no hint of univariate selectivity. These results suggest that representational patterns emerge first in each region, perhaps forming a scaffold upon which univariate category selectivity can subsequently develop. More generally, our findings demonstrate an important dissociation between category selectivity and distributed response patterns, and raise questions about the relative roles of each in development and adult cognition.

Visual search for object categories is predicted by the representational architecture of high-level visual cortex.

Visual search is a ubiquitous visual behavior, and efficient search is essential for survival. Different cognitive models have explained the speed and accuracy of search based either on the dynamics of attention or on similarity of item representations. Here, we examined the extent to which performance on a visual search task can be predicted from the stable representational architecture of the visual system, independent of attentional dynamics. Participants performed a visual search task with 28 conditions reflecting different pairs of categories (e.g., searching for a face among cars, body among hammers, etc.). The time it took participants to find the target item varied as a function of category combination. In a separate group of participants, we measured the neural responses to these object categories when items were presented in isolation. Using representational similarity analysis, we then examined whether the similarity of neural responses across different subdivisions of the visual system had the requisite structure needed to predict visual search performance. Overall, we found strong brain/behavior correlations across most of the higher-level visual system, including both the ventral and dorsal pathways when considering both macroscale sectors as well as smaller mesoscale regions. These results suggest that visual search for real-world object categories is well predicted by the stable, task-independent architecture of the visual system. NEW & NOTEWORTHY: Here, we ask which neural regions have neural response patterns that correlate with behavioral performance in a visual processing task. We found that the representational structure across all of high-level visual cortex has the requisite structure to predict behavior. Furthermore, when directly comparing different neural regions, we found that they all had highly similar category-level representational structures. These results point to a ubiquitous and uniform representational structure in high-level visual cortex underlying visual object processing.

Radial Scars of the Breast Encountered at Core Biopsy: Review of Histologic, Imaging, and Management Considerations.

OBJECTIVE: The purposes of this article are to place the controversy over the management of radial scars diagnosed at core biopsy in perspective and to define reasonable management options. CONCLUSION: The management of radial scars after image-guided core biopsy of the breast for diagnosis remains controversial. Although current literature suggests no premalignant potential of these lesions, it does not fully explain the small but real percentage of these lesions that are upgraded to malignancy after surgical excision. This upgrade phenomenon is probably best explained by core biopsy sampling error. A recommendation minimizing this possibility based on lesion size seems reasonable.

Perception of ensemble statistics requires attention.

To overcome inherent limitations in perceptual bandwidth, many aspects of the visual world are represented as summary statistics (e.g., average size, orientation, or density of objects). Here, we investigated the relationship between summary (ensemble) statistics and visual attention. Recently, it was claimed that one ensemble statistic in particular, color diversity, can be perceived without focal attention. However, a broader debate exists over the attentional requirements of conscious perception, and it is possible that some form of attention is necessary for ensemble perception. To test this idea, we employed a modified inattentional blindness paradigm and found that multiple types of summary statistics (color and size) often go unnoticed without attention. In addition, we found attentional costs in dual-task situations, further implicating a role for attention in statistical perception. Overall, we conclude that while visual ensembles may be processed efficiently, some amount of attention is necessary for conscious perception of ensemble statistics.

Processing multiple visual objects is limited by overlap in neural channels.

High-level visual categories (e.g., faces, bodies, scenes, and objects) have separable neural representations across the visual cortex. Here, we show that this division of neural resources affects the ability to simultaneously process multiple items. In a behavioral task, we found that performance was superior when items were drawn from different categories (e.g., two faces/two scenes) compared to when items were drawn from one category (e.g., four faces). The magnitude of this mixed-category benefit depended on which stimulus categories were paired together (e.g., faces and scenes showed a greater behavioral benefit than objects and scenes). Using functional neuroimaging (i.e., functional MRI), we showed that the size of the mixed-category benefit was predicted by the amount of separation between neural response patterns, particularly within occipitotemporal cortex. These results suggest that the ability to process multiple items at once is limited by the extent to which those items are represented by separate neural populations.

Endoscopic-assisted posterior interhemispheric retrocallosal transfalcine approach for microsurgical resection of a pineal region falcotentorial meningioma: operative video and technical nuances.

Falcotentorial meningiomas are rare tumors of the pineal region that arise from the dural folds where the falx and tentorium meet and are often intimately related to the vein of Galen and straight sinus. These lesions often present with signs and symptoms related to hydrocephalus and brainstem compression. Surgical resection of falcotentorial meningiomas remains the definitive treatment, with a variety of surgical approaches used to resect these lesions. The choice of approach depends on several factors, including the size and location of the tumor relative to the vein of Galen complex. Falcotentorial meningiomas can be technically challenging to remove with significant risk of morbidity because of the close proximity to and occasional invasion of the vein of Galen and straight sinus. In this operative video, the authors demonstrate an illustrative step-by-step technique for endoscopic-assisted microsurgical resection of a falcotentorial meningioma using the posterior interhemispheric retrocallosal transfalcine approach for a superiorly positioned falcotentorial meningioma. The surgical nuances are discussed, including the surgical anatomy, gravity-assisted interhemispheric approach in the lateral position, retrocallosal dissection, transfalcine exposure, tumor removal, and preservation of the vein of Galen complex. In summary, the posterior interhemispheric retrocallosal transfalcine approach is a useful surgical strategy for select superiorly positioned falcotentorial meningiomas. The video can be found here: https://youtu.be/d8mdunsRacs .

Effects of interventions on use of hearing protectors among farm operators: A randomized controlled trial.

OBJECTIVE: The purpose of this study was to compare the effectiveness of three interventions designed to promote hearing protector device (HPD) use. DESIGN: Randomized controlled trial. STUDY SAMPLE: Farm operators (n = 491) were randomly assigned to one of five intervention groups: (1) interactive web-based information with mailed assortment of HPDs; (2) Interactive web-based information only; (3) static web-based information with mailed assortment of HPDs; (4) Static web-based information only; or (5) mailed assortment of HPDs only. Data were analysed using a mixed model approach. RESULTS: HPD use increased among all participants, and increased more among participants receiving the mailed HPDs (with or without information) compared to participants receiving other interventions. Participants receiving the interactive web-based information had comparable increased use of HPDs to those receiving the static web-based information. Participants receiving the mailed HPDs had more positive situational influences scale scores than other participants. Program satisfaction was highest among mailed and web-based information groups. CONCLUSIONS: A mailed assortment of hearing protectors was more effective than information. Interactive and static information delivered via web were similarly effective. Programs interested in increasing HPD use among farmers should consider making hearing protectors more available to farmers.

Visual Awareness Is Limited by the Representational Architecture of the Visual System.

Visual perception and awareness have strict limitations. We suggest that one source of these limitations is the representational architecture of the visual system. Under this view, the extent to which items activate the same neural channels constrains the amount of information that can be processed by the visual system and ultimately reach awareness. Here, we measured how well stimuli from different categories (e.g., faces and cars) blocked one another from reaching awareness using two distinct paradigms that render stimuli invisible: visual masking and continuous flash suppression. Next, we used fMRI to measure the similarity of the neural responses elicited by these categories across the entire visual hierarchy. Overall, we found strong brain-behavior correlations within the ventral pathway, weaker correlations in the dorsal pathway, and no correlations in early visual cortex (V1-V3). These results suggest that the organization of higher level visual cortex constrains visual awareness and the overall processing capacity of visual cognition.

Strategies to enhance participant recruitment and retention in research involving a community-based population.

Challenges associated with recruiting and retaining community-based populations in research studies have been recognized yet remain of major concern for researchers. There is a need for exchange of recruitment and retention techniques that inform recruitment and retention strategies. Here, the authors discuss a variety of methods that were successful in exceeding target recruitment and retention goals in a randomized clinical trial of hearing protector use among farm operators. Recruitment and retention strategies were 1) based on a philosophy of mutually beneficial engagement in the research process, 2) culturally appropriate, 3) tailored to the unique needs of partnering agencies, and 4) developed and refined in a cyclical and iterative process. Sponsoring organizations are interested in cost-effective recruitment and retention strategies, particularly relating to culturally and ethnically diverse groups. These approaches may result in enhanced subject recruitment and retention, concomitant containment of study costs, and timely accomplishment of study aims.

National Policy Influences of Contraceptive Prevalence and Method Mix Strategy: A Longitudinal Analysis of 59 Low- and Middle-Income Countries, 2010-2021.

Understanding the impact of family planning policy and actions is essential for building effective strategies to increase contraceptive use. This study identifies policies that correlate with modern contraceptive prevalence rate (mCPR) and private-sector contraceptive method mix strategies (the number of contraceptive methods offered in the private sector) in low-income and middle-income countries. While education, contraceptive choices, and economic growth are known determinants of contraceptive prevalence, many national policies intended to increase contraceptive prevalence in the short term to medium term have ambiguous evidence that they indeed do so. By developing beta and Poisson regression models using 12 years of reported Contraceptive Security Indicators Survey data (2010-2021) from 59 countries, this study investigated the effect of 20 independent variables on mCPR or method mix strategies. Furthermore, to help interpret the potential consequences of economic status, separate models segmented by gross national income (low, low-middle, and upper-middle) were assessed. Of 20 independent variables, 10 are implicated with mCPR and 6 with a method mix strategy. Of these, increasing the share of domestic financing (versus donor funding) for contraceptives had the broadest and strongest contribution. mCPR is also predicted by the existence of national insurance systems that cover contraceptive costs, contraceptive security committees, family planning logistics management information systems, and, inversely, by client fees. A comprehensive private-sector method mix strategy-which itself influences mCPR-is also driven by these, as well as the inclusion of more contraceptives on the national essential medicines list. These findings have implications for countries seeking to expand access to and use of contraceptives through policy initiatives.