Retinal sensitivity in macular subfields and their association with contrast sensitivity in early and intermediate age-related macular degeneration.

Purpose To evaluate retinal sensitivity in subfields and its association with the novel quick contrast sensitivity function (qCSF) in patients with early age-related macular degeneration (eAMD), in patients with intermediate AMD (iAMD), and in healthy controls. Methods In this prospective longitudinal study retinal sensitivity of a customized 24-point grid was assessed by microperimetry Macular Integrity Assessment (MAIA, CenterVue, Padova, Italy) and divided into different subfields. The Multiple Contrast Vision Meter (Adaptive Sensory Technology, San Diego, CA) was used for qCSF testing. Linear models were used to test the association of functional metrics with variables of interest. Results 92 study eyes from 92 participants were analyzed (13 eAMD, 31 iAMD, and 48 controls). Microperimetry subfield comparison showed significant differences (p<0.0001) in the control group between superior and inferior hemifield as well as between central and peripheral subfields. For eAMD significant differences were found between central and peripheral subfields (p<0.001) and specific subfields (p<0.05) and finally for iAMD between specific quadrants (p<0.05) and specific squares (p<0.05). Significant associations of retinal sensitivity with qCSF metrics were found for the area underneath the logarithmic contrast sensitivity function (AULCSF), contrast acuity (CA) and for the contrast sensitivity at specific spatial frequencies. Conclusions This study showed significant differences in the evaluated retinal sensitivity subfields providing localized natural history data for retinal sensitivity in healthy controls, and patients with eAMD and iAMD.

Intact Serial Dependence in Schizophrenia: Evidence from an Orientation Adjustment Task.

BACKGROUND AND HYPOTHESIS: For a long time, it was proposed that schizophrenia (SCZ) patients rely more on sensory input and less on prior information, potentially leading to reduced serial dependence-ie, a reduced influence of prior stimuli in perceptual tasks. However, existing evidence is constrained to a few paradigms, and whether reduced serial dependence reflects a general characteristic of the disease remains unclear. STUDY DESIGN: We investigated serial dependence in 26 SCZ patients and 27 healthy controls (CNT) to evaluate the influence of prior stimuli in a classic visual orientation adjustment task, a paradigm not previously tested in this context. STUDY RESULTS: As expected, the CNT group exhibited clear serial dependence, with systematic biases toward the orientation of stimuli shown in the preceding trials. Serial dependence in SCZ patients was largely comparable to that in the CNT group. CONCLUSIONS: These findings challenge the prevailing notion of reduced serial dependence in SCZ, suggesting that observed differences between healthy CNT and patients may depend on aspects of perceptual or cognitive processing that are currently not understood.

The influence of different application patterns of propofol on the sedation courses during drug-induced sleep endoscopy.

Objective: The course of sedation during drug-induced sleep endoscopy (DISE) depends on the application pattern of the sedative drug. The depth of sedation should imitate light and deep sleep as well. Moreover, there should be as many breathing cycles as possible available for observation during light and deep sedation. The aim of the study was to evaluate different rates of propofol application with respect to the achieved depth and length of the course of sedation. Methods: Sixty-three consecutive patients with obstructive sleep apnea and/or snoring undergoing DISE were randomly sedated by propofol perfusion at seven different application patterns: 14, 16, 18, 19, 20, 22 mg/kg/h (0.233, 0.267, 0.3, 0.317, 0.333, 0.367 mg/kg/min) per perfusor and individual bolus application 10 mg each. Sedation depth was monitored by BiSpectral Index™ (BIS). The influence of baseline parameters and the courses of sedation were analyzed. Results: The application rate was the only factor that influenced the depth of sedation. Basic parameters (gender, age, body mass index, apnea-hypopnea index) had no influence on the depth of sedation. The sedation depth was dependent on the rate of propofol application. Regimes at 14 and 16 mg/kg/h as well as bolus application did not reach BIS levels below 50 representing deep sleep. Propofol doses of more than 20 mg/kg/h led to rapid decreases of sedation levels below deep sleep niveau. Propofol rates between 18 and 20 mg/kg/h enable BIS levels below 50 representing deep sleep and providing enough breathing cycles for observation. Conclusion: Lower application rates of propofol provide slower courses of sedation and shallower depths of sedation. A rate of 14 mg/kg/h might be appropriate to reach a sedation plateau at light sleep. A rate of 18 mg/kg/h leads to a sedation, corresponding to deep sleep. The combination of both rates might be a suitable pattern for performing sedation-controlled DISE. Level of evidence: 2: Randomized trial.

Patients' Reflections on Treatment Decision After Surgery for Laryngeal Cancer.

Importance: Clinicians should understand how patients who were treated with laryngeal cancer surgery think about this later on and what factors may be related with regretting surgery. Objective: To assess variables associated with a positive attitude toward laryngeal cancer surgery. Design, Setting, and Participants: This combination of 2 cohorts, based on patient interviews and questionnaires, was studied in 16 hospitals in Germany. Participants scheduled for laryngeal cancer surgery were enrolled before surgery and followed up until 1 year after surgery. Data collection began on November 28, 2001, and ended on March 15, 2015. Statistical analysis was performed from August 21, 2023, to January 19, 2024. Main Outcomes and Measures: The attitude toward surgery was measured with the Psychosocial Adjustment After Laryngectomy Questionnaire (scores range from 0 to 100, with high scores representing a positive attitude toward the surgery) at 1 year after surgery. In multivariate regression analysis, the following variables were investigated: type of surgery, number of surgeries to the larynx, receipt of radiotherapy and chemotherapy, quality of life, speech intelligibility (objectively measured), age, sex, educational level, employment status, having a partner or not, counseling by patient association, and shared decision-making. Results: Patients (n = 780; mean [SD] age, 60.6 [10.4] years; 701 [90%] male) who had received counseling from the patient association reported a more positive attitude toward surgery (adjusted B = 8.8; 95% CI, 1.0-16.6). Among patients after total laryngectomy, those with a university degree had a less positive attitude toward their surgery (adjusted B = -50.8; 95% CI, -84.0 to -17.6); this result was not observed in patients after partial laryngectomy (adjusted B = -4.8; 95% CI, -15.1 to 5.4). Among patients after partial laryngectomy, the attitude toward surgery was most positive in those who had experienced shared decision-making (mean [SD] questionnaire score, 84 [20] in those without a wish and 83 [20] in those with a wish for shared decision-making). Those who had wished they could decide together with the physician but where this eventually was not experienced expressed the most regret toward surgery (mean [SD] score, 71 [22]). There was no association between attitudes toward surgery and type of surgery (total vs partial laryngectomy) and all other variables tested. Conclusion and Relevance: In this cohort study, most patients with head and neck cancer reported a positive attitude toward surgery, suggesting low levels of decision regret. Counseling by members of patient associations as well as individualized shared decision-making prior to surgery may have a positive impact on decision regret and is advisable in daily practice.

Cognitive-motor interference during walking with modified leg mechanics: a dual-task walking study.

Background: The use of mobile exoskeletons as assistive walking devices has the potential to affect the biomechanics of the musculoskeletal system due to their weight and restricted range of motion. This may result in physical and cognitive load for the user. Understanding how lower extremity loading affects cognitive-motor interference is crucial for the design of wearable devices, including powered exoskeletons, and the development of effective training interventions. Objective: This study aims to examine the effects of modified leg mechanics on cognitive-motor interference in dual-task walking. Gait variability, as an indicator of motor control, was analyzed to investigate its relation to cognitive task difficulty and to determine whether lower extremity loading modifies this relationship. Additionally, the impact on the gait pattern, as represented by the mean values of spatio-temporal gait parameters were investigated. Method: Fifteen healthy young adults walked on a treadmill with and without weight cuffs bilaterally attached to their thighs and shanks while performing a visual-verbal Stroop test (simple task) and a serial subtraction task (difficult task). Dependent variables include mean values and variability (coefficients of variation) of step length, step width, stride time and double support time. Additionally, secondary task performance as correct response rates and perceived workload were assessed. Results: Double support time variability decreased during dual-task walking, but not during walking with modified leg mechanics while performing the difficult secondary task. Walking with modified leg mechanics resulted in increased gait variability compared to normal walking, regardless of cognitive load. During walking with modified leg mechanics, step length, step width, and stride time increased, while double support time decreased. The secondary tasks did not affect the gait pattern. Conclusion: The interplay between an external focus of attention and competition for attentional resources may influence the variability of double support time. The findings suggest that walking with modified leg mechanics could increase cognitive-motor interference for healthy young adults in demanding dual-task situations. Therefore, it is important to analyze the underlying mechanisms of cognitive-motor interference in the context of human-exoskeleton interaction.

Temporal windows of unconscious processing cannot easily be disrupted.

Conscious perception is preceded by long periods of unconscious processing. These periods are crucial for analyzing temporal information and for solving the many ill-posed problems of vision. An important question is what starts and ends these windows and how they may be interrupted. Most experimental paradigms do not offer the methodology required for such investigation. Here, we used the sequential metacontrast paradigm, in which two streams of lines, expanding from the center to the periphery, are presented, and participants are asked to attend to one of the motion streams. If several lines in the attended motion stream are offset, the offsets are known to integrate mandatorily and unconsciously, even if separated by up to 450 ms. Using this paradigm, we here found that external visual objects, such as an annulus, presented during the motion stream, do not disrupt mandatory temporal integration. Thus, if a window is started once, it appears to remain open even in the presence of disruptions that are known to interrupt visual processes normally. Further, we found that interrupting the motion stream with a gap disrupts temporal integration but does not terminate the overall unconscious processing window. Thus, while temporal integration is key to unconscious processing, not all stimuli in the same processing window are integrated together. These results strengthen the case for unconscious processing taking place in windows of sensemaking, during which temporal integration occurs in a flexible and perceptually meaningful manner.

[Impact of the COVID-19 pandemic on the diagnosis and treatment of patients with head and neck cancer in Brandenburg and Berlin]. / Einfluss der COVID-19-Pandemie auf die Diagnostik und Therapie bei Patienten mit Kopf-Hals-Tumoren in Brandenburg und Berlin.

BACKGROUND: The impact of the COVID-19 pandemic on potential limitations to the diagnosis and treatment of patients with head and neck tumours has not yet been adequately investigated. There are contradictory data on this subject. Data from larger patient collectives do not exist for Germany so far. OBJECTIVE: The aim of the survey was to clarify in a large cohort whether the COVID-19 pandemic had an influence on the diagnosis and treatment of patients with head and neck tumours. METHODS: A retrospective data analysis of the reporting data of the Clinical and Epidemiological Cancer Registry of Brandenburg and Berlin (Klinisch-epidemiologischen Krebsregisters Brandenburg-Berlin, KKRBB) of 4831 cases with head and neck tumours from 2018 to 2020 was performed. The period before April 01, 2020, was evaluated as a prepandemic cohort and compared with the cases of the pandemic cohort from April 1, 2020, until December 31, 2020, in terms of patient-related baseline data, tumour location, tumour stage, tumour board and treatments administered. RESULTS: No differences were observed between the prepandemic and pandemic cohorts with regard to patient-related baseline data, tumour localisation and tumour stage. Likewise, no temporal delay in diagnosis, tumour board and treatment was evident during the pandemic period. On the contrary, the time interval between diagnosis and start of therapy was shortened by an average of 2.7 days in the pandemic phase. Tumours with T4 stage were more frequently treated surgically during the pandemic compared to the period before (20.8% vs. 29.6%), whereas primary radio(chemo)therapy decreased during the pandemic (53.3% vs. 40.4%). For all other tumour stages and entities, there were no differences in treatment. CONCLUSION: Contrary to initial speculation that the COVID-19 pandemic may have led to a decrease in tumour cases, larger tumour stages at initial presentation and a delay in diagnosis and treatment, the cohort studied for Brandenburg and Berlin showed neither a delay in tumour treatment nor an increase in tumour size and stage at initial presentation. The treatments performed, however, were subject to a change in favour of surgery and it remains to be seen whether this trend will be maintained in the long term.

Weak correlations between visual abilities in healthy older adults, despite long-term performance stability.

Using batteries of visual tests, most studies have found that there are only weak correlations between the performance levels of the tests. Factor analysis has confirmed these results. This means that a participant excelling in one test may rank low in another test. Hence, there is very little evidence for a common factor in vision. In visual aging research, cross-sectional studies have repeatedly found that healthy older adults' performance is strongly deteriorated in most visual tests compared to young adults. However, also within the healthy older population, there is no evidence for a visual common factor. To investigate whether the weak between-tests correlations are due to fluctuations in individual performance throughout time, we conducted a longitudinal study. Healthy older adults performed a battery of eight visual tests, with two re-tests after approximately four and seven years. Pearson's, Spearman's and intraclass correlations of most visual tests were significant across the three testing, indicating that the tests are reliable and individual differences are stable across years. Yet, we found low between-tests correlations at each visit, which is consistent with previous studies finding no evidence for a visual common factor. Our results exclude the possibility that the weak correlations between tests are due to high within-individual variance across time.

Processing load, and not stimulus evidence, determines the duration of unconscious visual feature integration.

Integration across space and time is essential for the analysis of motion, low contrast, and many more stimuli. A crucial question is what determines the duration of integration. Based on classical models of decision-making, one might expect that integration terminates as soon as sufficient evidence about a stimulus is accumulated and a threshold is crossed. However, there is very little research on this question as most experimental paradigms cannot monitor processing following stimulus presentation. In particular, it is difficult to determine when processing terminates. Here, using the sequential metacontrast paradigm (SQM), in which information is mandatorily integrated along motion trajectories, we show that the processing load determines the extent of integration but that evidence accumulation does not. Further, the extent of integration is determined by absolute time instead of the number of elements presented. These results have important implications for understanding the time course and mechanisms of temporal integration.