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Whilst previous research has linked attenuation of the mu rhythm to the observation of specific visual categories, and even to a potential role in action observation via a putative mirror neuron system, much of this work has not considered what specific type of information might be coded in this oscillatory response when triggered via vision. Here, we sought to determine whether the mu rhythm contains content-specific information about the identity of familiar (and also unfamiliar) graspable objects. In the present study, right-handed participants (N = 27) viewed images of both familiar (apple, wine glass) and unfamiliar (cubie, smoothie) graspable objects, whilst performing an orthogonal task at fixation. Multivariate pattern analysis (MVPA) revealed significant decoding of familiar, but not unfamiliar, visual object categories in the mu rhythm response. Thus, simply viewing familiar graspable objects may automatically trigger activation of associated tactile and/or motor properties in sensorimotor areas, reflected in the mu rhythm. In addition, we report significant attenuation in the central beta band for both familiar and unfamiliar visual objects, but not in the mu rhythm. Our findings highlight how analysing two different aspects of the oscillatory response - either attenuation or the representation of information content - provide complementary views on the role of the mu rhythm in response to viewing graspable object categories.
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Reconocimiento en Psicología , Humanos , Masculino , Femenino , Adulto Joven , Adulto , Reconocimiento en Psicología/fisiología , Ondas Encefálicas/fisiología , Electroencefalografía , Reconocimiento Visual de Modelos/fisiología , Estimulación LuminosaRESUMEN
Perceptual decisions are derived from the combination of priors and sensorial input. While priors are broadly understood to reflect experience/expertise developed over one's lifetime, the role of perceptual expertise at the individual level has seldom been directly explored. Here, we manipulate probabilistic information associated with a high and low expertise category (faces and cars respectively), while assessing individual level of expertise with each category. 67 participants learned the probabilistic association between a color cue and each target category (face/car) in a behavioural categorization task. Neural activity (EEG) was then recorded in a similar paradigm in the same participants featuring the previously learned contingencies without the explicit task. Behaviourally, perception of the higher expertise category (faces) was modulated by expectation. Specifically, we observed facilitatory and interference effects when targets were correctly or incorrectly expected, which were also associated with independently measured individual levels of face expertise. Multivariate pattern analysis of the EEG signal revealed clear effects of expectation from 100 ms post stimulus, with significant decoding of the neural response to expected vs. not stimuli, when viewing identical images. Latency of peak decoding when participants saw faces was directly associated with individual level facilitation effects in the behavioural task. The current results not only provide time sensitive evidence of expectation effects on early perception but highlight the role of higher-level expertise on forming priors.
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Electroencefalografía , Reconocimiento Facial , Humanos , Masculino , Femenino , Adulto , Reconocimiento Facial/fisiología , Adulto Joven , Estimulación Luminosa , Tiempo de Reacción/fisiología , Percepción Visual/fisiología , Cara/fisiologíaRESUMEN
Microsampling allows the collection of blood samples using a method which is inexpensive, simple and minimally-invasive, without the need for specially-trained medical staff. Analysis of whole blood provides a more holistic understanding of per- and polyfluoroalkyl substances (PFAS) body burden. Capillary action microsamplers (Trajan hemaPEN®) allow the controlled collection of whole blood as dried blood spots (DBS) (four 2.74 µL ± 5 %). The quantification of 75 PFAS from DBS was evaluated by comparing five common extraction techniques. Spiked blood (5 ng/mL PFAS) was extracted by protein precipitation (centrifuged; filtered), acid-base liquid-liquid extraction, trypsin protease digestion, and weak anion exchange (WAX) solid-phase extraction with analysis by high-performance liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS). Filtered protein precipitation was the most effective extraction method, recovering 72 of the 75 PFAS within 70 to 130 % with method reporting limit (MRL) for PFOS of 0.17 ng/L and ranging between 0.05 ng/mL and 0.34 ng/mL for all other PFAS. The optimised method was applied to human blood samples to examine Inter- (n = 7) and intra-day (n = 5) PFAS blood levels in one individual. Sixteen PFAS were detected with an overall Σ16PFAS mean = 6.3 (range = 5.7-7.0) ng/mL and perfluorooctane sulfonate (branched and linear isomers, ΣPFOS) = 3.3 (2.8-3.7) ng/mL being the dominant PFAS present. To the authors knowledge, this minimally invasive self-sampling protocol is the most extensive method for PFAS in blood reported and could be a useful tool for large scale human biomonitoring studies.
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Fluorocarburos , Espectrometría de Masas en Tándem , Humanos , Cromatografía Liquida/métodos , Espectrometría de Masas en Tándem/métodos , Pruebas con Sangre Seca/métodos , Cromatografía Líquida de Alta Presión/métodosRESUMEN
Neurons in the primary visual cortex (V1) receive sensory inputs that describe small, local regions of the visual scene and cortical feedback inputs from higher visual areas processing the global scene context. Investigating the spatial precision of this visual contextual modulation will contribute to our understanding of the functional role of cortical feedback inputs in perceptual computations. We used human functional magnetic resonance imaging (fMRI) to test the spatial precision of contextual feedback inputs to V1 during natural scene processing. We measured brain activity patterns in the stimulated regions of V1 and in regions that we blocked from direct feedforward input, receiving information only from non-feedforward (i.e., feedback and lateral) inputs. We measured the spatial precision of contextual feedback signals by generalising brain activity patterns across parametrically spatially displaced versions of identical images using an MVPA cross-classification approach. We found that fMRI activity patterns in cortical feedback signals predicted our scene-specific features in V1 with a precision of approximately 4 degrees. The stimulated regions of V1 carried more precise scene information than non-stimulated regions; however, these regions also contained information patterns that generalised up to 4 degrees. This result shows that contextual signals relating to the global scene are similarly fed back to V1 when feedforward inputs are either present or absent. Our results are in line with contextual feedback signals from extrastriate areas to V1, describing global scene information and contributing to perceptual computations such as the hierarchical representation of feature boundaries within natural scenes.
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Although humans are considered to be face experts, there is a well-established reliable variation in the degree to which neurotypical individuals are able to learn and recognise faces. While many behavioural studies have characterised these differences, studies that seek to relate the neuronal response to standardised behavioural measures of ability remain relatively scarce, particularly so for the time-resolved approaches and the early response to face stimuli. In the present study we make use of a relatively recent methodological advance, multi-variate pattern analysis (MVPA), to decode the time course of the neural response to faces compared to other object categories (inverted faces, objects). Importantly, for the first time, we directly relate metrics of this decoding assessed at the individual level to gold-standard measures of behavioural face processing ability assessed in an independent task. Thirty-nine participants completed the behavioural Cambridge Face Memory Test (CFMT), then viewed images of faces and houses (presented upright and inverted) while their neural activity was measured via electroencephalography. Significant decoding of both face orientation and face category were observed in all individual participants. Decoding of face orientation, a marker of more advanced face processing, was earlier and stronger in participants with higher levels of face expertise, while decoding of face category information was earlier but not stronger for individuals with greater face expertise. Taken together these results provide a marker of significant differences in the early neuronal response to faces from around 100 ms post stimulus as a function of behavioural expertise with faces.
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Reconocimiento Facial , Humanos , Reconocimiento Facial/fisiología , Electroencefalografía , Aprendizaje , Orientación Espacial , Reconocimiento Visual de Modelos/fisiología , Estimulación Luminosa/métodosRESUMEN
Neurons, even in the earliest sensory regions of cortex, are subject to a great deal of contextual influences from both within and across modality connections. Recent work has shown that primary sensory areas can respond to and, in some cases, discriminate stimuli that are not of their target modality: for example, primary somatosensory cortex (SI) discriminates visual images of graspable objects. In the present work, we investigated whether SI would discriminate sounds depicting hand-object interactions (e.g. bouncing a ball). In a rapid event-related functional magnetic resonance imaging experiment, participants listened attentively to sounds from 3 categories: hand-object interactions, and control categories of pure tones and animal vocalizations, while performing a one-back repetition detection task. Multivoxel pattern analysis revealed significant decoding of hand-object interaction sounds within SI, but not for either control category. Crucially, in the hand-sensitive voxels defined from an independent tactile localizer, decoding accuracies were significantly higher for hand-object interactions compared to pure tones in left SI. Our findings indicate that simply hearing sounds depicting familiar hand-object interactions elicit different patterns of activity in SI, despite the complete absence of tactile stimulation. These results highlight the rich contextual information that can be transmitted across sensory modalities even to primary sensory areas.
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Mano , Corteza Somatosensorial , Animales , Corteza Somatosensorial/diagnóstico por imagen , Corteza Somatosensorial/fisiología , Tacto/fisiología , Neuronas/fisiología , Imagen por Resonancia Magnética , Mapeo EncefálicoRESUMEN
Intelligent manipulation of handheld tools marks a major discontinuity between humans and our closest ancestors. Here we identified neural representations about how tools are typically manipulated within left anterior temporal cortex, by shifting a searchlight classifier through whole-brain real action fMRI data when participants grasped 3D-printed tools in ways considered typical for use (i.e., by their handle). These neural representations were automatically evocated as task performance did not require semantic processing. In fact, findings from a behavioural motion-capture experiment confirmed that actions with tools (relative to non-tool) incurred additional processing costs, as would be suspected if semantic areas are being automatically engaged. These results substantiate theories of semantic cognition that claim the anterior temporal cortex combines sensorimotor and semantic content for advanced behaviours like tool manipulation.
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Mapeo Encefálico , Imagen por Resonancia Magnética , Mapeo Encefálico/métodos , Humanos , Imagen por Resonancia Magnética/métodos , Análisis Multivariante , Semántica , Lóbulo Temporal/diagnóstico por imagenRESUMEN
Context: Allopathic, osteopathic, and naturopathic medical education all prepare students to practice medicine yet diverge in certain respects. Despite the significant changes that have occurred in the education of each discipline, a more recent comparison and analysis of these three pathways hasn't been published. Objective: The review intended to examine the five segments of the educational process common to all three pathways: admissions, preclinical education, clinical education, graduate medical education, and continuing medical education. Design: The research team's evaluations and assessments of each pathway are based on publicly available data collected from each pathway's accrediting organizations and from accredited institutions, because these organizations and institutions accurately reflect the generally-accepted standards and practices within each pathway. The research team performed data collection for this study in 2019 to 2020, and the article reflects the changes in the literature up to that point. Setting: The study took place at Rocky Vista University - Southern Utah in Ivins, Utah; the University of Texas at Austin Dell Medical School in Austin, Texas; the Albany Medical Center in Albany, New York; and the National University of Health Sciences in Lombard, Illinois. Results: Naturopathic, allopathic, and osteopathic all undergo rigurous pre clinical training which highlights the basic sciences. Naturopathic schools generally have more in classroom hours and less in person clinical experience than osteopathic and allopathic training programs. All three professions have standardized board exams that cover the required curriculum. Many osteopathic students both take and pass the USMLE which highlights the similarities of their curriculum with the allopathic model. A similar comparison can not be made with naturopathic students as they do not take the USMLE. While all three education models have residency programs, naturopathic are more flexible and less standardized than ostopathic and allopathic residency programs. Limitations: Some data points had to be drawn from conversations as they were not publicly avalable. Credit hours are not sufficient to compare the scope of the curriculum of each education pathway. The NPLEX needs to be compared to both COMLEX and USMLE. Conclusions: Since 1997, the three major branches of educating physicians have continued to converge pedagogically. The currently most-notable similarity among the three pathways is the preclinical years and their basic-science curriculum. The combined match of allopathic and osteopathic residents, as well as increasing similarities and crossovers in curriculum and methods of practice, highlight this fact. Philosophy and methodologies of practice continue to distinguish these educational pathways, but their increasing similarities may lead to further convergence of practice and pedagogical models.
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Studies on low-level visual information underlying pain categorization have led to inconsistent findings. Some show an advantage for low spatial frequency information (SFs) and others a preponderance of mid SFs. This study aims to clarify this gap in knowledge since these results have different theoretical and practical implications, such as how far away an observer can be in order to categorize pain. This study addresses this question by using two complementary methods: a data-driven method without a priori expectations about the most useful SFs for pain recognition and a more ecological method that simulates the distance of stimuli presentation. We reveal a broad range of important SFs for pain recognition starting from low to relatively high SFs and showed that performance is optimal in a short to medium distance (1.2-4.8 m) but declines significantly when mid SFs are no longer available. This study reconciles previous results that show an advantage of LSFs over HSFs when using arbitrary cutoffs, but above all reveal the prominent role of mid-SFs for pain recognition across two complementary experimental tasks.
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Emociones , Expresión Facial , Dolor Facial/clasificación , Dolor Facial/diagnóstico , Reconocimiento Visual de Modelos , Psicofísica/métodos , Adolescente , Adulto , Percepción de Distancia , Cara , Reconocimiento Facial , Femenino , Humanos , Conocimiento , Masculino , Distribución Normal , Reconocimiento en Psicología , Reproducibilidad de los Resultados , Adulto JovenRESUMEN
Most neuroimaging experiments that investigate how tools and their actions are represented in the brain use visual paradigms where tools or hands are displayed as 2D images and no real movements are performed. These studies discovered selective visual responses in occipitotemporal and parietal cortices for viewing pictures of hands or tools, which are assumed to reflect action processing, but this has rarely been directly investigated. Here, we examined the responses of independently visually defined category-selective brain areas when participants grasped 3D tools (N = 20; 9 females). Using real-action fMRI and multivoxel pattern analysis, we found that grasp typicality representations (i.e., whether a tool is grasped appropriately for use) were decodable from hand-selective areas in occipitotemporal and parietal cortices, but not from tool-, object-, or body-selective areas, even if partially overlapping. Importantly, these effects were exclusive for actions with tools, but not for biomechanically matched actions with control nontools. In addition, grasp typicality decoding was significantly higher in hand than tool-selective parietal regions. Notably, grasp typicality representations were automatically evoked even when there was no requirement for tool use and participants were naive to object category (tool vs nontools). Finding a specificity for typical tool grasping in hand-selective, rather than tool-selective, regions challenges the long-standing assumption that activation for viewing tool images reflects sensorimotor processing linked to tool manipulation. Instead, our results show that typicality representations for tool grasping are automatically evoked in visual regions specialized for representing the human hand, the primary tool of the brain for interacting with the world.
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Mapeo Encefálico/métodos , Mano/fisiología , Imagenología Tridimensional/métodos , Desempeño Psicomotor/fisiología , Adolescente , Adulto , Encéfalo/fisiología , Femenino , Fuerza de la Mano/fisiología , Humanos , Imagen por Resonancia Magnética , Masculino , Adulto JovenRESUMEN
Influenza viruses harboring treatment-emergent I38F/M/N/T substitutions in the polymerase acidic (PA) endonuclease exhibited reduced susceptibility to baloxavir and were associated with virus rebound and variable clinical response in clinical trials. US regulatory review of registrational trial data also identified treatment-emergent PA substitutions E23K in A/H1N1 viruses and E23G/K, A37T, and E199G in A/H3N2 viruses, which conferred reduced susceptibility to baloxavir, although to a lesser degree than I38F/M/N/T substitutions, and were associated with virus rebound. Although these non-I38 substitutions emerged less frequently than substitutions at I38, they represent alternate pathways to baloxavir virologic resistance and should be monitored accordingly.
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Sustitución de Aminoácidos , Farmacorresistencia Viral , Gripe Humana/virología , Mutación , Orthomyxoviridae/efectos de los fármacos , Orthomyxoviridae/genética , ARN Polimerasa Dependiente del ARN/genética , Antivirales/farmacología , Antivirales/uso terapéutico , Dibenzotiepinas/farmacología , Dibenzotiepinas/uso terapéutico , Humanos , Virus de la Influenza A/clasificación , Virus de la Influenza A/genética , Virus de la Influenza B/clasificación , Virus de la Influenza B/genética , Gripe Humana/tratamiento farmacológico , Morfolinas/farmacología , Morfolinas/uso terapéutico , Orthomyxoviridae/clasificación , Orthomyxoviridae/enzimología , Piridonas/farmacología , Piridonas/uso terapéutico , Resultado del Tratamiento , Triazinas/farmacología , Triazinas/uso terapéutico , Carga ViralRESUMEN
Face recognition ability is often reported to be a relative strength in Williams syndrome (WS). Yet methodological issues associated with the supporting research, and evidence that atypical face processing mechanisms may drive outcomes 'in the typical range', challenge these simplistic characterisations of this important social ability. Detailed investigations of face processing abilities in WS both at a behavioural and neural level provide critical insights. Here, we behaviourally characterised face recognition ability in 18 individuals with WS comparatively to typically developing children and adult control groups. A subset of 11 participants with WS as well as chronologically age matched typical adults further took part in an EEG task where they were asked to attentively view a series of upright and inverted faces and houses. State-of-the-art multivariate pattern analysis (MVPA) was used alongside standard ERP analysis to obtain a detailed characterisation of the neural profile associated with 1) viewing faces as an overall category (by examining neural activity associated with upright faces and houses), and to 2) the canonical upright configuration of a face, critically associated with expertise in typical development and often linked with holistic processing (upright and inverted faces). Our results show that while face recognition ability is not on average at a chronological age-appropriate level in individuals with WS, it nonetheless appears to be a relative strength within their cognitive profile. Furthermore, all participants with WS revealed a differential pattern of neural activity to faces compared to objects, showing a distinct response to faces as a category, as well as a differential neural pattern for upright vs. inverted faces. Nonetheless, an atypical profile of face orientation classification was found in WS, suggesting that this group differs from typical individuals in their face processing mechanisms. Through this innovative application of MVPA, alongside the high temporal resolution of EEG, we provide important new insights into the neural processing of faces in WS.
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Reconocimiento Facial , Síndrome de Williams , Adulto , Niño , Electroencefalografía , Potenciales Evocados , Humanos , Orientación , Orientación Espacial , Reconocimiento Visual de Modelos , Estimulación LuminosaRESUMEN
Rapidly and accurately processing information from faces is a critical human function that is known to improve with developmental age. Understanding the underlying drivers of this improvement remains a contentious question, with debate continuing as to the presence of early vs. late maturation of face-processing mechanisms. Recent behavioural evidence suggests an important 'hallmark' of expert face processing - the face inversion effect - is present in very young children, yet neural support for this remains unclear. To address this, we conducted a detailed investigation of the neural dynamics of face processing in children spanning a range of ages (6-11 years) and adults. Uniquely, we applied multivariate pattern analysis (MVPA) to the electroencephalogram signal (EEG) to test for the presence of a distinct neural profile associated with canonical upright faces when compared both to other objects (houses) and to inverted faces. Results revealed robust discrimination profiles, at the individual level, of differentiated neural activity associated with broad face categorization and further with its expert processing, as indexed by the face inversion effect, from the youngest ages tested. This result is consistent with an early functional maturation of broad face processing mechanisms. Yet, clear quantitative differences between the response profile of children and adults is suggestive of age-related refinement of this system with developing face and general expertise. Standard ERP analysis also provides some support for qualitative differences in the neural response to inverted faces in children in contrast to adults. This neural profile is in line with recent behavioural studies that have reported impressively expert early face abilities during childhood, while also providing novel evidence of the ongoing neural specialisation between child and adulthood.
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Desarrollo Infantil/fisiología , Electroencefalografía/métodos , Potenciales Evocados/fisiología , Reconocimiento Facial/fisiología , Percepción Social , Adulto , Niño , Femenino , Humanos , Masculino , Adulto JovenRESUMEN
Faces transmit a wealth of important social signals. While previous studies have elucidated the network of cortical regions important for perception of facial expression, and the associated temporal components such as the P100, N170 and EPN, it is still unclear how task constraints may shape the representation of facial expression (or other face categories) in these networks. In the present experiment, we used Multivariate Pattern Analysis (MVPA) with EEG to investigate the neural information available across time about two important face categories (expression and identity) when those categories are either perceived under explicit (e.g. decoding facial expression category from the EEG when task is on expression) or incidental task contexts (e.g. decoding facial expression category from the EEG when task is on identity). Decoding of both face categories, across both task contexts, peaked in time-windows spanning 91-170â¯ms (across posterior electrodes). Peak decoding of expression, however, was not affected by task context whereas peak decoding of identity was significantly reduced under incidental processing conditions. In addition, errors in EEG decoding correlated with errors in behavioral categorization under explicit processing for both expression and identity, however under incidental conditions only errors in EEG decoding of expression correlated with behavior. Furthermore, decoding time-courses and the spatial pattern of informative electrodes showed consistently better decoding of identity under explicit conditions at later-time periods, with weak evidence for similar effects for decoding of expression at isolated time-windows. Taken together, these results reveal differences and commonalities in the processing of face categories under explicit Vs incidental task contexts and suggest that facial expressions are processed to a richer degree under incidental processing conditions, consistent with prior work indicating the relative automaticity by which emotion is processed. Our work further demonstrates the utility in applying multivariate decoding analyses to EEG for revealing the dynamics of face perception.
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Encéfalo/fisiología , Emociones , Expresión Facial , Reconocimiento Facial/fisiología , Adolescente , Adulto , Electroencefalografía , Femenino , Humanos , Masculino , Máquina de Vectores de Soporte , Adulto JovenRESUMEN
OBJECTIVES: In an innovative approach to improve the contribution of health psychology to public health we have analysed the presence and nature of affect within the visual materials deployed in antimicrobial stewardship interventions targeting the public identified through systematic review. DESIGN: A qualitative analysis focused on the affective content of visual materials garnered from a systematic review of antibiotic stewardship (k = 20). METHODS: A novel method was devised drawing on concepts from semiotics to analyse the affective elements within intervention materials. RESULTS: Whilst all studies examined tacitly rely on affect, only one sought to explicitly deploy affect. Three thematic categories of affect are identified within the materials in which specific ideological machinery is deployed: (1) monsters, bugs, and superheroes; (2) responsibility, threat, and the misuse/abuse of antibiotics; (3) the figure of the child. CONCLUSIONS: The study demonstrates how affect is a present but tacit communication strategy of antimicrobial stewardship interventions but has not - to date - been adequately theorized or explicitly considered in the intervention design process. Certain affective features were explored in relation to the effectiveness of antimicrobial resistance interventions and warrant further investigation. We argue that further research is needed to systematically illuminate and capitalize upon the use of affect to effect behaviour change concerning antimicrobial stewardship. Statement of contribution What is already known on this subject? The (mis)use of antibiotics and consequent risk of antimicrobial resistance is a critical public health problem. If sufficient action is not taken, global society will face the 'post-antibiotic' era, in which common infections will lead to death for many millions. Key desirable behavioural changes are decreased patient demands for antibiotics, use of them for targeted purposes alone, and compliance with prescribed dosing. There is a growth of interest in the role of affect in mass media interventions designed to engage publics and produce health-related behavioural change. What does this study add? This article presents a novel analytic approach to understanding and intervening within behaviour change in public health that may complement other types of analysis. We present findings specifically from an 'affective' analysis based on semiotics in which we critically interrogated the visual imagery being deployed in mass media public health interventions concerning antimicrobial stewardship. Three thematic categories of affect are identified within the materials in which specific ideological machinery is deployed and that demonstrate some association with intervention effectiveness worthy of further investigation and testing.
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Programas de Optimización del Uso de los Antimicrobianos , Recursos Audiovisuales , Conductas Relacionadas con la Salud , Medios de Comunicación de Masas , Comunicación Persuasiva , Humanos , Salud PúblicaRESUMEN
BACKGROUND: In patients with rectal cancer who achieve clinical complete response after neoadjuvant chemoradiotherapy, watch and wait is a novel management strategy with potential to avoid major surgery. Study-level meta-analyses have reported wide variation in the proportion of patients with local regrowth. We did an individual participant data meta-analysis to investigate factors affecting occurrence of local regrowth. METHODS: We updated search results of a recent systematic review by searching MEDLINE and Embase from Jan 1, 2016, to May 5, 2017, and used expert knowledge to identify published studies reporting on local regrowth in patients with rectal cancer managed by watch and wait after clinical complete response to neoadjuvant chemoradiotherapy. We restricted studies to those that defined clinical complete response using criteria equivalent to São Paulo benchmarks (ie, absence of residual ulceration, stenosis, or mass within the rectum on clinical and endoscopic examination). The primary outcome was 2-year cumulative incidence of local regrowth, estimated with a two-stage random-effects individual participant data meta-analysis. We assessed the effects of clinical and treatment factors using Cox frailty models, expressed as hazard ratios (HRs). From these models, we derived percentage differences in mean θ as an approximation of the effect of measured covariates on between-centre heterogeneity. This study is registered with PROSPERO, number CRD42017070934. FINDINGS: We obtained individual participant data from 11 studies, including 602 patients enrolled between March 11, 1990, and Feb 13, 2017, with a median follow-up of 37·6 months (IQR 25·0-58·7). Ten of the 11 datasets were judged to be at low risk of bias. 2-year cumulative incidence of local regrowth was 21·4% (random-effects 95% CI 15·3-27·6), with high levels of between-study heterogeneity (I2=61%). We noted wide between-centre variation in patient, tumour, and treatment characteristics. We found some evidence that increasing cT stage was associated with increased risk of local regrowth (random-effects HR per cT stage 1·40, 95% CI 1·00-1·94; ptrend=0·048). In a subgroup of 459 patients managed after 2008 (when pretreatment staging by MRI became standard), 2-year cumulative incidence of local regrowth was 19% (95% CI 13-28) for stage cT1 and cT2 tumours, 31% (26-37) for cT3, and 37% (21-60) for cT4 (random-effects HR per cT stage 1·50, random-effects 95% CI 1·03-2·17; ptrend=0·0330). We estimated that measured factors contributed 4·8-45·3% of observed between-centre heterogeneity. INTERPRETATION: In patients with rectal cancer and clinical complete response after chemoradiotherapy managed by watch and wait, we found some evidence that increasing cT stage predicts for local regrowth. These data will inform clinician-patient decision making in this setting. Research is needed to determine other predictors of a sustained clinical complete response. FUNDING: None.
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Quimioradioterapia , Terapia Neoadyuvante , Neoplasias del Recto/patología , Neoplasias del Recto/terapia , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Inducción de Remisión , Espera VigilanteRESUMEN
OBJECTIVES: Changing public awareness of antimicrobial resistance (AMR) represents a global public health priority. A systematic review of interventions that targeted public AMR awareness and associated behaviour was previously conducted. Here, we focus on identifying the active content of these interventions and explore potential mechanisms of action. METHODS: The project took a novel approach to intervention mapping utilizing the following steps: (1) an exploration of explicit and tacit theory and theoretical constructs within the interventions using the Theoretical Domains Framework (TDFv2), (2) retrospective coding of behaviour change techniques (BCTs) using the BCT Taxonomy v1, and (3) an investigation of coherent links between the TDF domains and BCTs across the interventions. RESULTS: Of 20 studies included, only four reported an explicit theoretical basis to their intervention. However, TDF analysis revealed that nine of the 14 TDF domains were utilized, most commonly 'Knowledge' and 'Environmental context and resources'. The BCT analysis showed that all interventions contained at least one BCT, and 14 of 93 (15%) BCTs were coded, most commonly 'Information about health consequences', 'Credible source', and 'Instruction on how to perform the behaviour'. CONCLUSIONS: We identified nine relevant TDF domains and 14 BCTs used in these interventions. Only 15% of BCTs have been applied in AMR interventions thus providing a clear opportunity for the development of novel interventions in this context. This methodological approach provides a useful way of retrospectively mapping theoretical constructs and BCTs when reviewing studies that provide limited information on theory and intervention content. Statement of contribution What is already known on this subject? Evidence of the effectiveness of interventions that target the public to engage them with AMR is mixed; the public continue to show poor knowledge and misperceptions of AMR. Little is known about the common, active ingredients of AMR interventions targeting the public and information on explicit theoretical content is sparse. Information on the components of AMR public health interventions is urgently needed to enable the design of effective interventions to engage the public with AMR stewardship behaviour. What does this study add? The analysis shows very few studies reported any explicit theoretical basis to the interventions they described. Many interventions share common components, including core mechanisms of action and behaviour change techniques. The analysis suggests components of future interventions to engage the public with AMR.
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Farmacorresistencia Bacteriana , Conductas Relacionadas con la Salud , Comunicación en Salud/métodos , Conocimientos, Actitudes y Práctica en Salud , Promoción de la Salud/métodos , Humanos , Masculino , Estudios RetrospectivosRESUMEN
Facial expressions of emotion are signals of high biological value. Whilst recognition of facial expressions has been much studied in central vision, the ability to perceive these signals in peripheral vision has only seen limited research to date, despite the potential adaptive advantages of such perception. In the present experiment, we investigate facial expression recognition and detection performance for each of the basic emotions (plus neutral) at up to 30 degrees of eccentricity. We demonstrate, as expected, a decrease in recognition and detection performance with increasing eccentricity, with happiness and surprised being the best recognized expressions in peripheral vision. In detection however, while happiness and surprised are still well detected, fear is also a well detected expression. We show that fear is a better detected than recognized expression. Our results demonstrate that task constraints shape the perception of expression in peripheral vision and provide novel evidence that detection and recognition rely on partially separate underlying mechanisms, with the latter more dependent on the higher spatial frequency content of the face stimulus.