Psychophysical Evaluation of Visual vs. Computer-Aided Detection of Brain Lesions on Magnetic Resonance Images.

BACKGROUND: Magnetic resonance imaging (MRI) diagnosis is usually performed by analyzing contrast-weighted images, where pathology is detected once it reached a certain visual threshold. Computer-aided diagnosis (CAD) has been proposed as a way for achieving higher sensitivity to early pathology. PURPOSE: To compare conventional (i.e., visual) MRI assessment of artificially generated multiple sclerosis (MS) lesions in the brain's white matter to CAD based on a deep neural network. STUDY TYPE: Prospective. POPULATION: A total of 25 neuroradiologists (15 males, age 39 ± 9, 9 ± 9.8 years of experience) independently assessed all synthetic lesions. FIELD STRENGTH/SEQUENCE: A 3.0 T, T2 -weighted multi-echo spin-echo (MESE) sequence. ASSESSMENT: MS lesions of varying severity levels were artificially generated in healthy volunteer MRI scans by manipulating T2 values. Radiologists and a neural network were tasked with detecting these lesions in a series of 48 MR images. Sixteen images presented healthy anatomy and the rest contained a single lesion at eight increasing severity levels (6%, 9%, 12%, 15%, 18%, 21%, 25%, and 30% elevation in T2 ). True positive (TP) rates, false positive (FP) rates, and odds ratios (ORs) were compared between radiological diagnosis and CAD across the range lesion severity levels. STATISTICAL TESTS: Diagnostic performance of the two approaches was compared using z-tests on TP rates, FP rates, and the logarithm of ORs across severity levels. A P-value <0.05 was considered statistically significant. RESULTS: ORs of identifying pathology were significantly higher for CAD vis-à-vis visual inspection for all lesions' severity levels. For a 6% change in T2 value (lowest severity), radiologists' TP and FP rates were not significantly different (P = 0.12), while the corresponding CAD results remained statistically significant. DATA CONCLUSION: CAD is capable of detecting the presence or absence of more subtle lesions with greater precision than the representative group of 25 radiologists chosen in this study. LEVEL OF EVIDENCE: 1 TECHNICAL EFFICACY: Stage 3.

Consciousness as the Temporal Propagation of Information.

Our ability to understand the mind and its relation to the body is highly dependent on the way we define consciousness and the lens through which we study it. We argue that looking at conscious experience from an information-theory perspective can help obtain a unified and parsimonious account of the mind. Today's dominant models consider consciousness to be a specialized function of the brain characterized by a discrete neural event. Against this background, we consider subjective experience through information theory, presenting consciousness as the propagation of information from the past to the future. We examine through this perspective major characteristics of consciousness. We demonstrate that without any additional assumptions, temporal continuity in perception can explain the emergence of volition, subjectivity, higher order thoughts, and body boundaries. Finally, we discuss the broader implications for the mind-body question and the appeal of embodied cognition.

Balance recovery stepping responses during walking were not affected by a concurrent cognitive task among older adults.

BACKGROUND: Most of older adults' falls are related to inefficient balance recovery after an unexpected loss of balance, i.e., postural perturbation. Effective balance recovery responses are crucial to prevent falls. Due to the considerable consequences of lateral falls and the high incidence of falls when walking, this study aimed to examine the effect of a concurrent cognitive task on older adults' balance recovery stepping abilities from unannounced lateral perturbations while walking. We also aimed to explore whether cognitive performance accuracy is affected by perturbed walking and between task trade-offs. METHODS: In a laboratory-based study, 20 older adults (> 70 years old) performed the following test conditions: (1) cognitive task while sitting; (2) perturbed walking; and (3) perturbed walking with a concurrent cognitive task. The cognitive task was serial numbers subtraction by seven. Single-step and multiple-step thresholds, highest perturbation achieved, 3D kinematic analysis of the first recovery step, and cognitive task performance accuracy were compared between single-task and dual-task conditions. Between task trade-offs were examined using dual-task cost (DTC). RESULTS: Single-step and multiple-step thresholds, number of recovery step trials, number of foot collision, multiple-step events and kinematic recovery step parameters were all similar in single-task and dual-task conditions. Cognitive performance was not significantly affected by dual-task conditions, however, different possible trade-offs between cognitive and postural performances were identified using DTC. CONCLUSIONS: In situations where postural threat is substantial, such as unexpected balance loss during walking, balance recovery reactions were unaffected by concurrent cognitive load in older adults (i.e., posture first strategy). The study was approved by the Helsinki Ethics Committee of Soroka University Medical Center in Beer-Sheva, Israel (ClinicalTrials.gov Registration number NCT04455607 , ID Numbers: Sor 396-16 CTIL; 02/07/2020).

The effect of a high-polyphenol Mediterranean diet (Green-MED) combined with physical activity on age-related brain atrophy: the Dietary Intervention Randomized Controlled Trial Polyphenols Unprocessed Study (DIRECT PLUS).

BACKGROUND: The effect of diet on age-related brain atrophy is largely unproven. OBJECTIVES: We aimed to explore the effect of a Mediterranean diet (MED) higher in polyphenols and lower in red/processed meat (Green-MED diet) on age-related brain atrophy. METHODS: This 18-mo clinical trial longitudinally measured brain structure volumes by MRI using hippocampal occupancy score (HOC) and lateral ventricle volume (LVV) expansion score as neurodegeneration markers. Abdominally obese/dyslipidemic participants were randomly assigned to follow 1) healthy dietary guidelines (HDG), 2) MED, or 3) Green-MED diet. All subjects received free gym memberships and physical activity guidance. Both MED groups consumed 28 g walnuts/d (+440 mg/d polyphenols). The Green-MED group consumed green tea (3-4 cups/d) and Mankai (Wolffia-globosa strain, 100 g frozen cubes/d) green shake (+800 mg/d polyphenols). RESULTS: Among 284 participants (88% men; mean age: 51 y; BMI: 31.2 kg/m2; APOE-ε4 genotype = 15.7%), 224 (79%) completed the trial with eligible whole-brain MRIs. The pallidum (-4.2%), third ventricle (+3.9%), and LVV (+2.2%) disclosed the largest volume changes. Compared with younger participants, atrophy was accelerated among those ≥50 y old (HOC change: -1.0% ± 1.4% compared with -0.06% ± 1.1%; 95% CI: 0.6%, 1.3%; P < 0.001; LVV change: 3.2% ± 4.5% compared with 1.3% ± 4.1%; 95% CI: -3.1%, -0.8%; P = 0.001). In subjects ≥ 50 y old, HOC decline and LVV expansion were attenuated in both MED groups, with the best outcomes among Green-MED diet participants, as compared with HDG (HOC: -0.8% ± 1.6% compared with -1.3% ± 1.4%; 95% CI: -1.5%, -0.02%; P = 0.042; LVV: 2.3% ± 4.7% compared with 4.3% ± 4.5%; 95% CI: 0.3%, 5.2%; P = 0.021). Similar patterns were observed among younger subjects. Improved insulin sensitivity over the trial was the parameter most strongly associated with brain atrophy attenuation (P < 0.05). Greater Mankai, green tea, and walnut intake and less red and processed meat were significantly and independently associated with reduced HOC decline (P < 0.05). Elevated urinary concentrations of the polyphenols urolithin-A (r = 0.24; P = 0.013) and tyrosol (r = 0.26; P = 0.007) were significantly associated with lower HOC decline. CONCLUSIONS: A Green-MED (high-polyphenol) diet, rich in Mankai, green tea, and walnuts and low in red/processed meat, is potentially neuroprotective for age-related brain atrophy.This trial was registered at clinicaltrials.gov as NCT03020186.

Numerical cognition: Unitary or diversified system(s)?

Many researchers, including Clarke and Beck, describe the human numerical system as unitary. We offer an alternative view - the coexistence of several systems; namely, multiple systems (general magnitude, parallel individuation, and symbolic) existing in parallel, ready to be activated depending on the task/need. Based on this alternative view, we present an account for the representation of rational numbers.

Expanding the discussion: Revision of the fundamental assumptions framing the study of the neural correlates of consciousness.

The way one asks a question is shaped by a-priori assumptions and constrains the range of possible answers. We identify and test the assumptions underlying contemporary debates, models, and methodology in the study of the neural correlates of consciousness, which was framed by Crick and Koch's seminal paper (1990). These premises create a sequential and passive conception of conscious perception: it is considered the product of resolved information processing by unconscious mechanisms, produced by a singular event in time and place representing the moment of entry. The conscious percept produced is then automatically retained to be utilized by post-conscious mechanisms. Major debates in the field, such as concern the moment of entry, the all-or-none vs graded nature, and report vs no-report paradigms, are driven by the consensus on these assumptions. We show how removing these assumptions can resolve some of the debates and challenges and prompt additional questions. The potential non-sequential nature of perception suggests new ways of thinking about consciousness as a dynamic and dispersed process, and in turn about the relationship between conscious and unconscious perception. Moreover, it allows us to present a parsimonious account for conscious perception while addressing more aspects of the phenomenon.

Shaping the way from the unknown to the known: The role of convex hull shape in numerical comparisons.

Various studies have shown that numerical processing is modulated by non-numerical physical properties. One such physical property is the convex hull - the smallest convex polygon surrounding all items in an array. The convex hull is usually discussed only in terms of its area. However, our group has shown that observers use the convex hull shape, as defined according to the number of vertices of the convex hull, to make numerical estimations (Katzin, Katzin, Rosén, Henik, & Salti, 2020). Yet, it is still unknown if and how the convex hull shape affects comparison tasks, and how it interacts with its counterpart, convex hull area. Here we re-examine the data collected by Katzin, Salti, and Henik (2019). Using image processing, we extracted the information on the convex hull shape and showed that the shape affects latency and accuracy of numerical comparisons. We found that both the convex hull shape and other physical properties (i.e., convex hull area, average diameter, density, total circumference, and total surface area) have distinct effects on performance. Finally, the convex hull shape effect was found in counting and estimation ranges, however its effect decreased with numerosities above the counting range. Our results indicate that the interplay between convex hull shape and other physical properties, including convex hull area and numerosity, plays an important role in numerical decisions. We suggest that the convex hull shape should be controlled for when designing non-symbolic numerical tasks.

Examining Different Motor Learning Paradigms for Improving Balance Recovery Abilities Among Older Adults, Random vs. Block Training-Study Protocol of a Randomized Non-inferiority Controlled Trial.

Introduction: Falls are the leading cause of fatal and nonfatal injuries among older adults. Studies showed that older adults can reduce the risk of falls after participation in an unexpected perturbation-based balance training (PBBT), a relatively novel approach that challenged reactive balance control. This study aims to investigate the effect of the practice schedule (i.e., contextual interference) on reactive balance function and its transfer to proactive balance function (i.e., voluntary step execution test and Berg balance test). Our primary hypothesis is that improvements in reactive balance control following block PBBT will be not inferior to the improvements following random PBBT. Methods and Analysis: This is a double-blind randomized controlled trial. Fifty community-dwelling older adults (over 70 years) will be recruited and randomly allocated to a random PBBT group (n = 25) or a block PBBT group (n = 25). The random PBBT group will receive eight training sessions over 4 weeks that include unexpected machine-induced perturbations of balance during hands-free treadmill walking. The block PBBT group will be trained by the same perturbation treadmill system, but only one direction will be trained in each training session, and the direction of the external perturbations will be announced. Both PBBT groups (random PBBT and block PBBT) will receive a similar perturbation intensity during training (which will be customized to participant's abilities), the same training period, and the same concurrent cognitive tasks during training. The generalization and transfer of learning effects will be measured by assessing the reactive and proactive balance control during standing and walking before and after 1 month of PBBT, for example, step and multiple steps and fall thresholds, Berg balance test, and fear of falls. The dependent variable will be rank transformed prior to conducting the analysis of covariance (ANCOVA) to allow for nonparametric analysis. Discussion: This research will explore which of the balance retraining paradigms is more effective to improve reactive balance and proactive balance control in older adults (random PBBT vs. block PBBT) over 1 month. The research will address key issues concerning balance retraining: older adults' neuromotor capacities to optimize training responses and their applicability to real-life challenges. Clinical Trial Registration: Helsinki research ethics approval has been received (Soroka Medical Center approval #0396-16-SOR; MOH_2018-07-22_003536; www.ClinicalTrials.gov, NCT04455607).

PVP-coated Gd-grafted nanodiamonds as a novel and potentially safer contrast agent for in vivo MRI.

PURPOSE: Testing the potential use of saline suspension of polyvinylpyrrolidone (PVP)-coated gadolinium(Gd)-grafted detonation nanodiamonds (DND) as a novel contrast agent in MRI. METHODS: Stable saline suspensions of highly purified de-agglomerated Gd-grafted DND particles coated by a PVP protective shell were prepared. T1 and T2 proton relaxivities of the suspensions with varying gadolinium concentration were measured at 8 Tesla. A series of ex vivo (phantom) and in vivo dynamic scans were obtained in 3 Tesla MRI using PVP-coated Gd-grafted DND and gadoterate meglumin in equal concentrations of gadolinium, and then T1 -weighted hyperintensity was compared. RESULTS: The proton relaxivities of PVP-coated Gd-grafted DND were found to be r1 = 15.9 ± 0.8 s-1 mM-1 and r2 = 262 ± 15 s-1 mM-1 , respectively, which are somewhat less than those for uncoated Gd-grafted DND but still high enough. Ex vivo MRI evaluation of PVP-coated Gd-grafted DND results with a dose-dependent T1 -weighted hyperintensity with a significant advantage over the same for gadoterate meglumin. The same was found when the 2 contrast agents were tested in vivo. CONCLUSION: The novel MRI contrast agent - saline suspensions of PVP-coated Gd-grafted DND - provides significantly higher signal intensities than the common tracer gadoterate meglumin, therefore increasing its potential for a safer use in clinics.

Putting the world in mind: The case of mental representation of quantity.

A reoccurring question in cognitive science concerns the way the world is represented. Cognitive scientists quantify the contribution of a physical attribute to a sensation and try to characterize the underlying mechanism. In numerical cognition, the contribution of physical properties to quantity perception in comparison tasks was widely demonstrated albeit leaving the underlying mechanism unclear. Furthermore, it is unclear whether this contribution is related solely to comparison tasks or to a core, general ability. Here we demonstrate that the shape of the convex hull, the smallest convex polygon containing all objects in an array, plays a role in the transfer function between quantity and its mental representation. We used geometric probability to demonstrate that the shape of the convex hull is correlated with quantity in a way that resembles the behavioral enumeration curve of subitizing and estimation. Then, in two behavioral experiments we manipulated the shape of the convex hull and demonstrated its effect on enumeration. Accordingly, we suggest that humans learn the correlation between convex hull shape and numerosity and use it to enumerate.

The many faces of music: Attending to music and delight in the same music are governed by different rules of processing.

Music generates manifold experiences in humans, some perceptual and some hedonic. Are these qualia governed by the same principles in processing? In particular, do the loudness and timbre of melodies combine to produce perception and likeability by the same rules of integration? In Experiment 1, we tested selective attention to loudness and timbre by applying Garner's speeded classification paradigm and found both to be perceptually integral dimensions. In Experiment 2, we tested liking for the same music by applying Norman Anderson's functional measurement model and found loudness and timbre to combine by an adding-type rule. In Experiment 3, we applied functional measurement for perception and found loudness and timbre to interact as in Experiment 1. These results show that people cannot or do not attend selectively or perceive separately any one music component, but that they nonetheless can isolate the components when they enjoy (or disenjoy) listening to music. We conclude that perception of the constituent components of a musical piece and the processing of the same components for liking are governed by different rules.

Holistic processing of numerical arrays.

[Correction Notice: An Erratum for this article was reported in Vol 45(6) of Journal of Experimental Psychology: Learning, Memory, and Cognition (see record 2019-25779-001). In experiment 1, in the congruency effect analysis 3 partial Eta squares are missing (page 1017). In addition, in experiment 1 in the analysis of the average diameter group, two more statistics were incomplete (page 1017-1018). Additional details are included in the erratum. All versions of this article have been corrected.] At the early stages of concept acquisition, physical properties are inseparable of the concepts they form. With development, the concept seems to depart from the physical entities from which it emerged and seems to exist beyond its physical attributes. Numerosity is an abstract concept; however, physical properties such as diameter, area, and density have been shown to affect its perception in nonsymbolic comparison tasks. It remains unclear how these properties interact with numerosity and which property is most influential. We equated the ratio of 3 physical properties (average diameter, total surface area, and convex hull area) to the numerical ratio in order to examine which property is most discriminable and, therefore, most likely to be used. Our results demonstrate that convex hull is the most discriminable property. We suggest that holistic processing through global properties, such as convex hull, bridges between the physical world and abstract concepts. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Conscious Perception: Time for an Update?

Understanding the neural mechanisms underlying conscious perception has become a central endeavor in cognitive neuroscience. In theories of conscious perception, a stimulus gaining conscious access is usually considered as a discrete neuronal event to be characterized in time or space, sometimes referred to as a conscious "episode." Surprisingly, the alternative hypothesis according to which conscious perception is a dynamic process has rarely been considered. Here, we discuss this hypothesis and its implications. We show how it can reconcile inconsistent empirical findings on the timing of the neural correlates of consciousness and make testable predictions. According to this hypothesis, a stimulus is consciously perceived for as long as it is recoded to fit an ongoing stream composed of all other perceived stimuli. We suggest that this "updating" process is governed by at least three factors (1) context, (2) stimulus saliency, and (3) observers' goals. Finally, this framework forces us to reconsider the typical distinction between conscious and unconscious information processing.

Number and Continuous Magnitude Processing Depends on Task Goals and Numerosity Ratio.

A large body of evidence shows that when comparing non-symbolic numerosities, performance is influenced by irrelevant continuous magnitudes, such as total surface area, density, etc. In the current work, we ask whether the weights given to numerosity and continuous magnitudes are modulated by top-down and bottom-up factors. With that aim in mind, we asked adult participants to compare two groups of dots. To manipulate task demands, participants reported after every trial either (1) how accurate their response was (emphasizing accuracy) or (2) how fast their response was (emphasizing speed). To manipulate bottom-up factors, the stimuli were presented for 50 ms, 100 ms or 200 ms. Our results revealed (a) that the weights given to numerosity and continuous magnitude ratios were affected by the interaction of top-down and bottom-up manipulations and (b) that under some conditions, using numerosity ratio can reduce efficiency. Accordingly, we suggest that processing magnitudes is not rigid and static but a flexible and adaptive process that allows us to deal with the ever-changing demands of the environment. We also argue that there is not just one answer to the question 'what do we process when we process magnitudes?', and future studies should take this flexibility under consideration.

Brain-heart interactions reveal consciousness in noncommunicating patients.

OBJECTIVE: We here aimed at characterizing heart-brain interactions in patients with disorders of consciousness. We tested how this information impacts data-driven classification between unresponsive and minimally conscious patients. METHODS: A cohort of 127 patients in vegetative state/unresponsive wakefulness syndrome (VS/UWS; n = 70) and minimally conscious state (MCS; n = 57) were presented with the local-global auditory oddball paradigm, which distinguishes 2 levels of processing: short-term deviation of local auditory regularities and global long-term rule violations. In addition to previously validated markers of consciousness extracted from electroencephalograms (EEG), we computed autonomic cardiac markers, such as heart rate (HR) and HR variability (HRV), and cardiac cycle phase shifts triggered by the processing of the auditory stimuli. RESULTS: HR and HRV were similar in patients across groups. The cardiac cycle was not sensitive to the processing of local regularities in either the VS/UWS or MCS patients. In contrast, global regularities induced a phase shift of the cardiac cycle exclusively in the MCS group. The interval between the auditory stimulation and the following R peak was significantly shortened in MCS when the auditory rule was violated. When the information for the cardiac cycle modulations and other consciousness-related EEG markers were combined, single patient classification performance was enhanced compared to classification with solely EEG markers. INTERPRETATION: Our work shows a link between residual cognitive processing and the modulation of autonomic somatic markers. These results open a new window to evaluate patients with disorders of consciousness via the embodied paradigm, according to which body-brain functions contribute to a holistic approach to conscious processing. Ann Neurol 2017;82:578-591.

Right visual-field advantage in the attentional blink: Asymmetry in attentional gating across time and space.

When two targets are presented in a rapid serial visual presentation (RSVP), recognition of the second target (T2) is usually reduced when presented 150-500 ms after the first target, demonstrating an attentional blink (AB). Previous studies have shown a left visual-field (LVF) advantage in T2 recognition, when T2 was embedded in one of two streams, demanding top-down attention for its recognition. Here, we explored the impact of bottom-up saliency on spatial asymmetry in the AB. When T2 was spatially shifted outside from the RSVP, creating an abrupt onset of T2, right T2s showed a right visual-field (RVF) advantage. In lag-1 trials, right T2s were not only better recognized, but also showed a low T1-T2 order error rate. In contrast, recognized left T2s exhibited high order error rate. Without abrupt onset, symmetrical AB was found and order error rate was similarly low in both sides. Follow-up experiments showed that, while RVF advantage was related to bottom-up saliency, order errors were affected by T1 mask. The discrepancy between LVF and RVF advantage in the AB could be resolved in terms of two mechanisms of attentional gating: top-down attentional gating, which is biased towards LVF, and bottom-up attentional gating, which is biased towards RVF.

Cognitive dissonance resolution depends on episodic memory.

The notion that past choices affect preferences is one of the most influential concepts of social psychology since its first report in the 50 s, and its theorization within the cognitive dissonance framework. In the free-choice paradigm (FCP) after choosing between two similarly rated items, subjects reevaluate chosen items as more attractive and rejected items as less attractive. However the relations prevailing between episodic memory and choice-induced preference change (CIPC) remain highly debated: is this phenomenon dependent or independent from memory of past choices? We solve this theoretical debate by demonstrating that CIPC occurs exclusively for items which were correctly remembered as chosen or rejected during the choice stage. We used a combination of fMRI and intra-cranial electrophysiological recordings to reveal a modulation of left hippocampus activity, a hub of episodic memory retrieval, immediately before the occurrence of CIPC during item reevaluation. Finally, we show that contrarily to a previous influential report flawed by a statistical artifact, this phenomenon is absent in amnesic patients for forgotten items. These results demonstrate the dependence of cognitive dissonance on conscious episodic memory. This link between current preferences and previous choices suggests a homeostatic function of this regulative process, aiming at preserving subjective coherence.

Mirror Neurons and Mirror-Touch Synesthesia.

Since mirror neurons were introduced to the neuroscientific community more than 20 years ago, they have become an elegant and intuitive account for different cognitive mechanisms (e.g., empathy, goal understanding) and conditions (e.g., autism spectrum disorders). Recently, mirror neurons were suggested to be the mechanism underlying a specific type of synesthesia. Mirror-touch synesthesia is a phenomenon in which individuals experience somatosensory sensations when seeing someone else being touched. Appealing as it is, careful delineation is required when applying this mechanism. Using the mirror-touch synesthesia case, we put forward theoretical and methodological issues that should be addressed before relying on the mirror-neurons account.

One tamed at a time: A new approach for controlling continuous magnitudes in numerical comparison tasks.

Non-symbolic stimuli (i.e., dot arrays) are commonly used to study numerical cognition. However, in addition to numerosity, non-symbolic stimuli entail continuous magnitudes (e.g., total surface area, convex-hull, etc.) that correlate with numerosity. Several methods for controlling for continuous magnitudes have been suggested, all with the same underlying rationale: disassociating numerosity from continuous magnitudes. However, the different continuous magnitudes do not fully correlate; therefore, it is impossible to disassociate them completely from numerosity. Moreover, relying on a specific continuous magnitude in order to create this disassociation may end up in increasing or decreasing numerosity saliency, pushing subjects to rely on it more or less, respectively. Here, we put forward a taxonomy depicting the relations between the different continuous magnitudes. We use this taxonomy to introduce a new method with a complimentary Matlab toolbox that allows disassociating numerosity from continuous magnitudes and equating the ratio of the continuous magnitudes to the ratio of the numerosity in order to balance the saliency of numerosity and continuous magnitudes. A dot array comparison experiment in the subitizing range showed the utility of this method. Equating different continuous magnitudes yielded different results. Importantly, equating the convex hull ratio to the numerical ratio resulted in similar interference of numerical and continuous magnitudes.

Toward an integrative approach to numerical cognition.

In response to the commentaries, we have refined our suggested model and discussed ways in which the model could be further expanded. In this context, we have elaborated on the role of specific continuous magnitudes. We have also found it important to devote a section to evidence considered the "smoking gun" of the approximate number system theory, including cross-modal studies, animal studies, and so forth. Lastly, we suggested some ways in which the scientific community can promote more transparent and collaborative research by using an open science approach, sharing both raw data and stimuli. We thank the contributors for their enlightening comments and look forward to future developments in the field.