Neural representations of perspectival shapes and attentional effects: Evidence from fMRI and MEG.

Does the human brain represent perspectival shapes, i.e., viewpoint-dependent object shapes, especially in relatively higher-level visual areas such as the lateral occipital cortex? What is the temporal profile of the appearance and disappearance of neural representations of perspectival shapes? And how does attention influence these neural representations? To answer these questions, we employed functional magnetic resonance imaging (fMRI), magnetoencephalography (MEG), and multivariate decoding techniques to investigate spatiotemporal neural representations of perspectival shapes. Participants viewed rotated objects along with the corresponding objective shapes and perspectival shapes (i.e., rotated round, round, and oval) while we measured their brain activities. Our results revealed that shape classifiers trained on the basic shapes (i.e., round and oval) consistently identified neural representations in the lateral occipital cortex corresponding to the perspectival shapes of the viewed objects regardless of attentional manipulations. Additionally, this classification tendency toward the perspectival shapes emerged approximately 200 ms after stimulus presentation. Moreover, attention influenced the spatial dimension as the regions showing the perspectival shape classification tendency propagated from the occipital lobe to the temporal lobe. As for the temporal dimension, attention led to a more robust and enduring classification tendency towards perspectival shapes. In summary, our study outlines a spatiotemporal neural profile for perspectival shapes that suggests a greater degree of perspectival representation than is often acknowledged.

The language of tactile thought.

The target article argues that language-of-thought hypothesis (LoTH) is applicable to various domains, including perception. However, it focusses exclusively on the visual case, which is limited in this regard. I argue for two ideas in this commentary: first, their case can be extended to other modalities such as touch; and second, the status of those six criteria needs to be further clarified.

Perspectival shapes are viewpoint-dependent relational properties.

Recently, there is a renewed debate concerning the role of perspective in vision. Morales et al. (2020) present evidence that, in the case of viewing a rotated coin, the visual system is sensitive to what has often been called "perspectival shapes." It has generated vigorous discussions, including an online symposium by Morales and Cohen, an exchange between Linton (2021) and Morales et al. (2021), and most recently, a fierce critique by Burge and Burge (2022), in which they launch various conceptual and empirical objections. Although Morales and Firestone (2022) have responded to them recently, and we are in agreement with Morales and Firestone in general, there are further problems in Burge and Burge (2022) that are worth highlighting. The main point of this comment is that what the Burge-Burge team call "viewpoint-dependent relational properties" are simply instances of what the Morales-Firestone team call "perspectival shapes"; the confusion arises from Burge and Burge's misconstrual of Morales et al.'s claims. This shows that conceptually, the two teams are in large agreement, as Morales and Firestone (2022) also point out, and the focus should be put on the empirical disagreements, which has been covered by Morales and Firestone (2022). Relatedly, we argue that Burge and Burge (2022) misinterpret Morales et al. (2020) as supporting a new entity in perception science, and that this misinterpretation is a primary source of their apparent disagreement. This is worth pointing out because such misunderstanding generates many unnecessary quarrels that hinder progress. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Taking Conceptual Issues Really Seriously: One Next Step for the Cognitive Science of Consciousness.

In this letter we focus on the cognitive science of consciousness. The general message is that, while this interdisciplinary area has made much progress in recent years, there is a tendency of downplaying conceptual issues, and therefore underestimating the difficulties of various problems. We briefly focus on a few prominent examples only, due to the space limit, but the general message should be clear: this recent tendency can be problematic for the progress of the consciousness branch of cognitive sciences.

Illusions, objectivity, and non-reductive emergentism: Reply to Rose.

In the target article, David Rose makes an interesting and substantive case against a certain kind of sceptical view: "veridical perception is impossible in principle," combined with a certain version of anti-realism. He proceeds by first illustrating several ideas from George Orwell's seminal work, and then proposes that a certain kind of non-reductive, levelled emergentist metaphysics can help us respond to such scepticism. In this commentary, I join forces with Rose's case, but will point out that we need to take seriously two discussions in contemporary philosophy in order to make the realist case stronger: the argument from illusion and hallucination, and the causal exclusion argument. Only then do Rose and his allies can have a more satisfactory case for objectivity and realism.

Psychometric Properties of the Trail Walking Test for People With Stroke.

Objective: To investigate (i) the inter-rater and test-retest reliability of the trail walking test (TWT) and the minimum detectable change in the TWT completion time; (ii) the correlations between the TWT completion time and stroke-specific impairments; and (iii) the cutoff TWT completion time to distinguish between people with stroke and healthy older adults according to dual-tasking ambulation ability. Design: Cross-sectional study. Setting: University-based rehabilitation center. Participants: In total, 104 people with stroke and 53 healthy older adults. Main Outcome Measures: The TWT, the Fugl-Meyer Assessment of Lower Extremity (FMA-LE), the ankle muscle strength test, the limit of stability (LOS) test, the Berg Balance Scale (BBS), the Timed Up and Go test (TUG), and the Community Integration Measure (CIM). Results: The mean TWT completion time in subjects with stroke was 124.906 s. The TWT demonstrated excellent inter-rater reliability [intraclass correlation (ICC) = 0.999] and good test-retest reliability (ICC = 0.876) in people with stroke. The TWT performance demonstrated significant negative correlations with the FMA-LE scores (r = -0.409), LOS movement velocity (affected and unaffected sides; r = -0.320 and -0.388, respectively), and LOS endpoint excursion (affected and unaffected sides; r = -0.357 and -0.394, respectively); a significant positive correlation with the LOS reaction time (affected side; r = 0.256); a moderate negative correlation with the BBS scores (r = -0.72); and an excellent positive correlation with the TUG completion time (r = 0.944). The receiver operating characteristic curve analysis revealed that an optimal cutoff of 69.61 s for the TWT completion time had an outstanding diagnostic power to distinguish between people with stroke and healthy older adults (area under the curve = 0.919) with high sensitivity (88.5%) and specificity (83.0%). Conclusion: Results of our preliminary study demonstrated that the TWT is a reliable, valid, sensitive, and specific clinical test for evaluating dual-tasking ambulation ability in people with stroke aged 45 years or above and without cognitive impairments. It can differentiate the dual-tasking ambulation ability between people with stroke and healthy older adults.

P3b Does Not Reflect Perceived Contrasts.

It has been shown that P3b is not a signature of perceptual awareness per se but is instead more closely associated with postperceptual processing (Cohen et al., 2020). Here, we seek to investigate whether human participants' attentional states are different in the report and the no-report conditions. This difference in attentional states, if exists, may lead to degraded consciousness of the stimuli in the no-report condition, and it therefore remains unknown whether the disappearance of P3b is because of a lack of reportability or degraded consciousness. Results of our experiment 1 showed that participants did experience degraded contents of consciousness in the no-report condition. However, results of experiment 2 showed that the degraded contents of consciousness did not influence the amplitude of P3b. These findings strengthen the claim that P3b is not a signature of perceptual awareness but is associated with postperceptual processing.

Racemic Ketamine as an Alternative to Electroconvulsive Therapy for Unipolar Depression: A Randomized, Open-Label, Non-Inferiority Trial (KetECT).

BACKGROUND: Ketamine has emerged as a fast-acting and powerful antidepressant, but no head to head trial has been performed, Here, ketamine is compared with electroconvulsive therapy (ECT), the most effective therapy for depression. METHODS: Hospitalized patients with unipolar depression were randomized (1:1) to thrice-weekly racemic ketamine (0.5 mg/kg) infusions or ECT in a parallel, open-label, non-inferiority study. The primary outcome was remission (Montgomery Åsberg Depression Rating Scale score ≤10). Secondary outcomes included adverse events (AEs), time to remission, and relapse. Treatment sessions (maximum of 12) were administered until remission or maximal effect was achieved. Remitters were followed for 12 months after the final treatment session. RESULTS: In total 186 inpatients were included and received treatment. Among patients receiving ECT, 63% remitted compared with 46% receiving ketamine infusions (P = .026; difference 95% CI 2%, 30%). Both ketamine and ECT required a median of 6 treatment sessions to induce remission. Distinct AEs were associated with each treatment. Serious and long-lasting AEs, including cases of persisting amnesia, were more common with ECT, while treatment-emergent AEs led to more dropouts in the ketamine group. Among remitters, 70% and 63%, with 57 and 61 median days in remission, relapsed within 12 months in the ketamine and ECT groups, respectively (P = .52). CONCLUSION: Remission and cumulative symptom reduction following multiple racemic ketamine infusions in severely ill patients (age 18-85 years) in an authentic clinical setting suggest that ketamine, despite being inferior to ECT, can be a safe and valuable tool in treating unipolar depression.

Sequence2Script: A Web-Based Tool for Translation of Pharmacogenetic Data Into Evidence-Based Prescribing Recommendations.

Pharmacogenomic (PGx) testing has emerged as an effective strategy for informing drug selection and dosing. This has led to an increase in the use of PGx testing in the clinic and has catalyzed the emergence of a burgeoning commercial PGx testing industry. However, not all PGx tests are equivalent in their approach to translating testing results into prescribing recommendations, due to an absence of regulatory standards. As such, those generating and using PGx data require tools for ensuring the prescribing recommendations they are provided align with current peer-reviewed PGx-based prescribing guidelines developed by expert groups or approved product labels. Herein, we present Sequence2Script (sequence2script.com), a simple, free, and transparent web-based tool to assist in the efficient translation of PGx testing results into evidence-based prescribing recommendations. The tool was designed with a wide-range of user groups (e.g., healthcare providers, laboratory staff, researchers) in mind. The tool supports 97 gene-drug pairs with evidence-based prescribing guidelines, allows users to adjust recommendations for concomitant inhibitors and inducers, and generates a clinical report summarizing the patient's genotype, inferred phenotype, phenoconverted phenotype (if applicable), and corresponding prescribing recommendations. In this paper, we describe each of the tool's features, provide use case examples, and discuss limitations of and future development plans for the tool. Although we recognize that Sequecnce2Script may not meet the needs of every user, the hope is that this novel tool will facilitate more standardized use of PGx testing results and reduce barriers to implementing these results into practice.

Alternating operating theatre utilization is not associated with differences in clinical or economic outcome measures in primary elective knee arthroplasty.

AIMS: The practice of alternating operating theatres has long been used to reduce surgeon idle time between cases. However, concerns have been raised as to the safety of this practice. We assessed the payments and outcomes of total knee arthroplasty (TKA) performed during overlapping and nonoverlapping days, also comparing the total number of the surgeon's cases and the total time spent in the operating theatre per day. MATERIALS AND METHODS: A retrospective analysis was performed on the Centers for Medicare & Medicaid Services (CMS) Limited Data Set (LDS) on all primary elective TKAs performed at the New England Baptist Hospital between January 2013 and June 2016. Using theatre records, episodes were categorized into days where a surgeon performed overlapping and nonoverlapping lists. Clinical outcomes, economic outcomes, and demographic factors were calculated. A regression model controlling for the patient-specific factors was used to compare groups. Total orthopaedic cases and aggregate time spent operating (time between skin incision and closure) were also compared. RESULTS: A total of 3633 TKAs were performed (1782 on nonoverlapping days; 1851 on overlapping days). There were no differences between the two groups for length of inpatient stay, payments, mortality, emergency room visits, or readmission during the 90-day postoperative period. The overlapping group had 0.74 fewer skilled nursing days (95% confidence interval (CI) -0.26 to -1.22; p < 0.01), and 0.66 more home health visits (95% CI 0.14 to 1.18; p = 0.01) than the nonoverlapping group. On overlapping days, surgeons performed more cases per day (5.01 vs 3.76; p < 0.001) and spent more time operating (484.55 minutes vs 357.17 minutes; p < 0.001) than on nonoverlapping days. CONCLUSION: The study shows that the practice of alternating operating theatres for TKA has no adverse effect on the clinical outcome or economic utilization variables measured. Furthermore, there is opportunity to increase productivity with alternating theatres as surgeons with overlapping cases perform more cases and spend more time operating per day. Cite this article: Bone Joint J 2019;101-B:1081-1086.

Higher Volume Surgeons Have Lower Medicare Payments, Readmissions, and Mortality After THA.

BACKGROUND: The advent of value-based care, in which surgeons and hospitals accept more responsibility for clinical and financial results, has increased the focus on surgeon- and hospital-specific outcomes. However, methods to identify high-quality, low-cost surgeons are not well developed. QUESTIONS/PURPOSES: (1) Is there an association between surgeon THA volume and 90-day Centers for Medicare & Medicaid Services (CMS) Part A payments, readmissions, or mortality? (2) What proportion of THAs in the United States is performed by low- and high-volume surgeons? METHODS: We performed a retrospective analysis of the CMS Limited Data Set on all primary elective THAs performed in the United States (except Maryland) between January 2013 and June 2016 on patients insured by Medicare. This represented 409,844 THAs totaling more than USD 7.7 billion in direct CMS expenditures. Surgeons were divided into five groups based on annualized volume of CMS elective THAs over the study period. Using linear and logistic regression, we calculated and compared 90-day CMS Part A payments, readmissions, and mortality among the groups. For each episode, demographic information (age, sex, and race), geographic location, and Elixhauser comorbidities were calculated to control for major confounding factors in the regression. RESULTS: When compared with the highest volume group, each lower volume group had increased payments, increased readmission rates, and increased mortality rates in a stepwise fashion when controlling for patient-specific variables including Elixhauser comorbidity index, demographic information, region, and background trend. The lowest volume group resulted in 27.2% more CMS payments per case (p < 0.001; 95% confidence interval [CI], 26.6%-27.8%), had an increased readmission odds ratio (OR) of 1.8 (p < 0.001; 95% CI, 1.7-1.9), and an increased mortality OR of 4.7 (p < 0.001; 95% CI, 4.0-5.5) when compared with the highest volume group. There was also variation within volume groups: some lower volume surgeons had lower payments, readmissions, and mortality than some higher volume surgeons despite the general trend. In terms of CMS volume, surgeons who were at least moderate volume (11+ annual cases) performed 78% of THAs and represented 26% of operating surgeons. The low- and lowest volume surgeons (10 or fewer annual cases) performed only 22% of THAs in the United States while representing 74% of unique operating surgeons. CONCLUSIONS: There is a strong association between a surgeon's Medicare volume and lower CMS payments, readmissions, and mortality. Furthermore, the majority of Medicare THAs in the United States are performed by surgeons who perform > 10 CMS operations annually. Compared with previous work, these results suggest a trend toward higher volume surgeons in the Medicare population. The results also suggest a benefit to the shift toward higher volume surgeons in reducing payments, readmissions, and mortality for elective THA in the United States. However, given that payments, readmission, and mortality of surgeons varied widely, it is important to note that available individual CMS data can be used to directly evaluate each individual surgeon based on their actual results well as through association with volume. LEVEL OF EVIDENCE: Level III, therapeutic study.

2018 John Charnley Award: Analysis of US Hip Replacement Bundled Payments: Physician-initiated Episodes Outperform Hospital-initiated Episodes.

BACKGROUND: The Centers for Medicare & Medicaid Services (CMS) launched the Bundled Payment for Care Improvement (BPCI) initiative in 2013 to create incentives to improve outcomes and reduce costs in various clinical settings, including total hip arthroplasty (THA). This study seeks to quantify BPCI initiative outcomes for THA and to determine the optimal party (for example, hospital versus physician group practice [PGP]) to manage the program. QUESTIONS/PURPOSES: (1) Is BPCI associated with lower 90-day payments, readmissions, or mortality for elective THA? (2) Is there a difference in 90-day payments, readmissions, or mortality between episodes initiated by PGPs and episodes initiated by hospitals for elective THA? (3) Is BPCI associated with reduced total Elixhauser comorbidity index or age for elective THA? METHODS: We performed a retrospective analysis on the CMS Limited Data Set on all Medicare primary elective THAs without a major comorbidity performed in the United States (except Maryland) between January 2013 and March 2016, totaling more than USD 7.1 billion in expenditures. Episodes were grouped into hospital-run BPCI (n = 42,922), PGP-run BPCI (n = 44,662), and THA performed outside of BPCI (n = 284,002). All Medicare Part A payments were calculated over a 90-day period after surgery and adjusted for inflation and regional variation. For each episode, age, sex, race, geographic location, background trend, and Elixhauser comorbidities were determined to control for major confounding variables. Total payments, readmissions, and mortality were compared among the groups with logistic regression. RESULTS: When controlling for demographics, background trend, geographic variation, and total Elixhauser comorbidities in elective Diagnosis-Related Group 470 THA episodes, BPCI was associated with a 4.44% (95% confidence interval [CI], -4.58% to -4.30%; p < 0.001) payment decrease for all participants (USD 1244 decrease from a baseline of USD 18,802); additionally, odds ratios (ORs) for 90-day mortality and readmissions were unchanged. PGP groups showed a 4.81% decrease in payments (95% CI, -5.01% to -4.61%; p < 0.001) after enrolling in BPCI (USD 1335 decrease from a baseline of USD 17,841). Hospital groups showed a 4.04% decrease in payments (95% CI, -4.24% to 3.84%; p < 0.01) after enrolling in BPCI (USD 1138 decrease from a baseline of USD 19,799). The decrease in payments of PGP-run episodes was greater compared with hospital-run episodes. ORs for 90-day mortality and readmission remained unchanged after BPCI for PGP- and hospital-run BPCI programs. Patient age and mean Elixhauser comorbidity index did not change after BPCI for PGP-run, hospital-run, or overall BPCI episodes. CONCLUSIONS: Even when controlling for decreasing costs in traditional fee-for-service care, BPCI is associated with payment reduction with no change in adverse events, and this is not because of the selection of younger patients or those with fewer comorbidities. Furthermore, physician group practices were associated with greater payment reduction than hospital programs with no difference in readmission or mortality from baseline for either. Physicians may be a more logical group than hospitals to manage payment reduction in future healthcare reform. LEVEL OF EVIDENCE: Level II, economic and decision analysis.

A mechanism for spatial perception on human skin.

Our perception of where touch occurs on our skin shapes our interactions with the world. Most accounts of cutaneous localisation emphasise spatial transformations from a skin-based reference frame into body-centred and external egocentric coordinates. We investigated another possible method of tactile localisation based on an intrinsic perception of 'skin space'. The arrangement of cutaneous receptive fields (RFs) could allow one to track a stimulus as it moves across the skin, similarly to the way animals navigate using path integration. We applied curved tactile motions to the hands of human volunteers. Participants identified the location midway between the start and end points of each motion path. Their bisection judgements were systematically biased towards the integrated motion path, consistent with the characteristic inward error that occurs in navigation by path integration. We thus showed that integration of continuous sensory inputs across several tactile RFs provides an intrinsic mechanism for spatial perception.

A Pilot Randomized Controlled Trial of a New Supplementary Food Designed to Enhance Cognitive Performance during Prevention and Treatment of Malnutrition in Childhood.

BACKGROUND: Cognitive impairment associated with childhood malnutrition and stunting is generally considered irreversible. OBJECTIVE: The aim was to test a new nutritional supplement for the prevention and treatment of moderate-acute malnutrition (MAM) focused on enhancing cognitive performance. METHODS: An 11-wk, village-randomized, controlled pilot trial was conducted in 78 children aged 1-3 or 5-7 y living in villages in Guinea-Bissau. The supplement contained 291 kcal/d for young children and 350 kcal/d for older children and included 5 nutrients and 2 flavan-3-ol-rich ingredients not present in current food-based recommendations for MAM. Local bakers prepared the supplement from a combination of locally sourced items and an imported mix of ingredients, and it was administered by community health workers 5 d/wk. The primary outcome was executive function abilities at 11 wk. Secondary outcomes included additional cognitive measures and changes in z scores for weight (weight-for-age) and height (height-for-age) and hemoglobin concentrations at 11 wk. An index of cerebral blood flow (CBF) was also measured at 11 wk to explore the use of this measurement as a biological index of cognitive impairment. RESULTS: There were no significant differences in any outcome between groups at baseline. There was a beneficial effect of random assignment to the supplement group on working memory at 11 wk in children aged 1-3 y (P < 0.05). This difference contrasted with no effect in older children and was not associated with faster growth rate. In addition, CBF correlated with task-switching performance (P < 0.05). CONCLUSIONS: These preliminary data suggest that cognitive impairment can be monitored with measurement of CBF. In addition, the findings provide preliminary data that suggest that it may be possible to improve poor cognitive performance in young children through changes in the nutritional formulation of supplementary foods used to prevent and treat MAM. Powered studies of the new supplement formulation are needed. This trial was registered at clinicaltrials.gov as NCT03017209.

Obstacles to Testing Molyneux's Question Empirically.

There have recently been various empirical attempts to answer Molyneux's question, for example, the experiments undertaken by the Held group. These studies, though intricate, have encountered some objections, for instance, from Schwenkler, who proposes two ways of improving the experiments. One is "to re-run [the] experiment with the stimulus objects made to move, and/or the subjects moved or permitted to move with respect to them" (p. 94), which would promote three dimensional or otherwise viewpoint-invariant representations. The other is "to use geometrically simpler shapes, such as the cube and sphere in Molyneux's original proposal, or planar figures instead of three-dimensional solids" (p. 188). Connolly argues against the first modification but agrees with the second. In this article, I argue that the second modification is also problematic (though still surmountable), and that both Schwenkler and Connolly are too optimistic about the prospect of addressing Molyneux's question empirically.