Targeted rhythmic visual stimulation at individual participants' intrinsic alpha frequency causes selective increase of occipitoparietal BOLD-fMRI and EEG functional connectivity.

Neural oscillations in distinct frequency bands are ubiquitous in the brain and play a role in many cognitive processes. The "communication by coherence" hypothesis, poses that the synchronization through phase coupling of frequency-specific neural oscillations regulate information flow across distribute brain regions. Specifically, the posterior alpha frequency band (7-12 Hz) is thought to gate bottom-up visual information flow by inhibition during visual processing. Evidence shows that increased alpha phase coherency positively correlates with functional connectivity in resting state connectivity networks, supporting alpha mediates neural communication through coherency. However, these findings have mainly been derived from spontaneous changes in the ongoing alpha rhythm. In this study, we experimentally modulate the alpha rhythm by targeting individuals' intrinsic alpha frequency with sustained rhythmic light to investigate alpha-mediated synchronous cortical activity in both EEG and fMRI. We hypothesize increased alpha coherency and fMRI connectivity should arise from modulation of the intrinsic alpha frequency (IAF) as opposed to control frequencies in the alpha range. Sustained rhythmic and arrhythmic stimulation at the IAF and at neighboring frequencies within the alpha band range (7-12 Hz) was implemented and assessed in a separate EEG and fMRI study. We observed increased cortical alpha phase coherency in the visual cortex during rhythmic stimulation at the IAF as in comparison to rhythmic stimulation of control frequencies. In the fMRI, we found increased functional connectivity for stimulation at the IAF in visual and parietal areas as compared to other rhythmic control frequencies by correlating time courses from a set of regions of interest for the different stimulation conditions and applying network-based statistics. This suggests that rhythmic stimulation at the IAF frequency induces a higher degree of synchronicity of neural activity across the occipital and parietal cortex, which supports the role of the alpha oscillation in gating information flow during visual processing.

Segregated Co-activation Patterns in the Emergence of Decision Confidence During Visual Perception.

Visual metacognition-the introspection and evaluation of one's own visual perceptual processes-is measured through both decision confidence and "metacognitive efficiency." Metacognitive efficiency refers to an individual's ability to accurately judge incorrect and correct decisions through confidence ratings given their task performance. Previous imaging studies in humans and nonhuman primates reported widely distributed brain regions being involved in decision confidence and metacognition. However, the neural correlates of metacognition are remarkably inconsistent across studies concerning spatial outline. Therefore, this study investigates the neural correlates of visual metacognition by examining co-activation across regions that scale with visual decision confidence. We hypothesized that interacting processes of perceptual and metacognitive performance contribute to the arising decision confidence in distributed, but segregable co-activating brain regions. To test this hypothesis, we performed task-fMRI in healthy humans during a visual backward masking task with four-scale, post-decision confidence ratings. We measured blood oxygenation covariation patterns, which served as a physiological proxy for co-activation across brain regions. Decision confidence ratings and an individual's metacognitive efficiency served as behavioral measures for metacognition. We found three distinct co-activation clusters involved in decision confidence: the first included right-centered fronto-temporal-parietal regions, the second included left temporal and parietal regions, and the left basal forebrain (BF), and the third included cerebellar regions. The right fronto-temporal-parietal cluster including the supplementary eye field and the right basal forebrain showed stronger co-activation in subjects with higher metacognitive efficiency. Our results provide novel evidence for co-activation of widely distributed fronto-parieto-temporal regions involved in visual confidence. The supplementary eye field was the only region that activated for both decision confidence and metacognitive efficiency, suggesting the supplementary eye field plays a key role in visual metacognition. Our results link findings in electrophysiology studies and human fMRI studies and provide evidence that confidence estimates arise from the integration of multiple information processing pathways.

Profile and anticoagulation outcomes of patients on warfarin therapy in an urban hospital in Cape Town, South Africa.

BACKGROUND: Warfarin is the most frequently used oral anticoagulant worldwide and it is the oral anticoagulant of choice in South Africa for reducing thrombosis-related morbidity and mortality. However, the safety and efficacy of warfarin therapy depends mainly on careful monitoring and maintenance of the international normalised ratio (INR) within an optimal therapeutic range. AIM: The aim of this study was to describe the profile and the anticoagulation outcomes of patients on warfarin therapy in a major warfarin clinic in the Western Cape Province of South Africa. SETTING: Victoria Hospital - a district hospital in Cape Town. METHODS: A cross sectional review of clinical records of patients on warfarin therapy who attended the INR clinic from 01 January 2014 to 30 June 2014 was done. Data analysis was done with STATA to generate appropriate descriptive data. RESULTS: Our study showed that atrial fibrillation (AF) was the commonest indication for warfarin use in this study and hypertension was the commonest comorbidity among these patients. Only 48.5% achieved target therapeutic range; 51.5% were out-of-range. There was a significant association between alcohol consumption and poor anticoagulation outcomes (p-value < 0.022). Anticoagulation outcomes were better among the older age groups, male patients and in those with AF. The prevalence of thrombotic events while on warfarin treatment was 2.2%, while prevalence of haemorrhagic events was 14%. Most of the patients with bleeding events were on concurrent use of warfarin and other medications with potential drug interactions. CONCLUSION: In our study, patients who achieved target therapeutic control were less than the acceptable 60%.