Misdiagnosis of primary immune thrombocytopenia and frequency of bleeding: lessons from the McMaster ITP Registry.

Nonspecific diagnostic criteria and uncertain estimates of severe bleeding events are fundamental gaps in knowledge of primary immune thrombocytopenia (ITP). To address these issues, we created the McMaster ITP Registry. In this report, we describe the methodology of the registry, the process for arriving at the diagnosis, and the frequency of bleeding. Consecutive patients with platelets <150 × 109/L from a tertiary hematology clinic in Canada were eligible. Patients completed a panel of investigations and were managed per clinical need. Two hematologists initially determined the cause of the thrombocytopenia using standard criteria and reevaluated the diagnosis over time, which was adjudicated at regular team meetings. Bleeding was graded from 0 (none) to 2 (severe) prospectively using an ITP-specific tool. Data were validated by duplicate chart review and source verification. Between 2010 and 2016, 614 patients were enrolled. Median follow-up for patients with >1 visit was 1.7 years (interquartile range, 0.8-3.4). At registration, 295 patients were initially diagnosed with primary ITP; of those, 36 (12.2%) were reclassified as having a different diagnosis during follow-up. At registration, 319 patients were initially diagnosed with another thrombocytopenic condition; of those, 10 (3.1%) were ultimately reclassified as having primary ITP. Of 269 patients with a final diagnosis of primary ITP, 56.5% (95% confidence interval [CI], 50.4-62.5] experienced grade 2 bleeding at 1 or more anatomical site, and 2.2% (95% CI, 0.8-4.8) had intracranial hemorrhage. Nearly 1 in 7 patients with primary ITP were misdiagnosed. Grade 2 bleeding was common. Registry data can help improve the clinical and laboratory classification of patients with ITP.

Tools for water quality monitoring and mapping using paper-based sensors and cell phones.

In this paper we describe a combination of paper-based sensors and a novel smart-phone application for on-site quantification of colorimetric readouts as an ultra-low cost solution to monitoring water quality. The system utilizes a paper-based analytical device (µPAD) that produces a colorimetric signal that is dependent on the concentration of a specific target; a cell phone equipped with a camera for capturing images of two µPADs - one tested with a water sample and the other tested with clean water that is used as a control; and an on-site image processing app that uses a novel algorithm for quantifying color intensity and relating this to contaminant concentration. The cell phone app utilizes a pixel counting algorithm that performs with less bias and user subjectivity than the typically used lab-based software, ImageJ. The use of a test and control strip reduces bias from variations in ambient lighting, making it possible to acquire and process images on-site. The cell phone is also able to GPS tag the location of the test, and transmit results to a newly developed website, WaterMap.ca, that displays the quantitative results from the water samples on a map. We demonstrate our approach using a previously developed µPAD that detects the presence of organophosphate pesticides based on the inhibition of immobilized acetylcholinesterase by these contaminants. The objective of this paper is to highlight the importance and potential of developing and integrated monitoring system consisting of µPADs, cell-phones and a centralized web portal for low-cost monitoring environmental contaminants at a large-scale.

Decoding stimulus duration from neural responses in the auditory midbrain.

Neurons with responses selective for the duration of an auditory stimulus are called duration-tuned neurons (DTNs). Temporal specificity in their spiking suggests that one function of DTNs is to encode stimulus duration; however, the efficacy of duration encoding by DTNs has yet to be investigated. Herein, we characterize the information content of individual cells and a population of DTNs from the mammalian inferior colliculus (IC) by measuring the stimulus-specific information (SSI) and estimated Fisher information (FI) of spike count responses. We found that SSI was typically greatest for those stimulus durations that evoked maximum spike counts, defined as best duration (BD) stimuli, and that FI was maximal for stimulus durations off BD where sensitivity to a change in duration was greatest. Using population data, we demonstrate that a maximum likelihood estimator (MLE) can accurately decode stimulus duration from evoked spike counts. We also simulated a two-alternative forced choice task by having MLE models decide whether two durations were the same or different. With this task we measured the just-noticeable difference threshold for stimulus duration and calculated the corresponding Weber fractions across the stimulus domain. Altogether, these results demonstrate that the spiking responses of DTNs from the mammalian IC contain sufficient information for the CNS to encode, decode, and discriminate behaviorally relevant auditory signal durations.

Dichotic sound localization properties of duration-tuned neurons in the inferior colliculus of the big brown bat.

Electrophysiological studies on duration-tuned neurons (DTNs) from the mammalian auditory midbrain have typically evoked spiking responses from these cells using monaural or free-field acoustic stimulation focused on the contralateral ear, with fewer studies devoted to examining the electrophysiological properties of duration tuning using binaural stimulation. Because the inferior colliculus (IC) receives convergent inputs from lower brainstem auditory nuclei that process sounds from each ear, many midbrain neurons have responses shaped by binaural interactions and are selective to binaural cues important for sound localization. In this study, we used dichotic stimulation to vary interaural level difference (ILD) and interaural time difference (ITD) acoustic cues and explore the binaural interactions and response properties of DTNs and non-DTNs from the IC of the big brown bat (Eptesicus fuscus). Our results reveal that both DTNs and non-DTNs can have responses selective to binaural stimulation, with a majority of IC neurons showing some type of ILD selectivity, fewer cells showing ITD selectivity, and a number of neurons showing both ILD and ITD selectivity. This study provides the first demonstration that the temporally selective responses of DTNs from the vertebrate auditory midbrain can be selective to binaural cues used for sound localization in addition to having spiking responses that are selective for stimulus frequency, amplitude, and duration.

Recovery cycle times of inferior colliculus neurons in the awake bat measured with spike counts and latencies.

Neural responses in the mammalian auditory midbrain (inferior colliculus; IC) arise from complex interactions of synaptic excitation, inhibition, and intrinsic properties of the cell. Temporally selective duration-tuned neurons (DTNs) in the IC are hypothesized to arise through the convergence of excitatory and inhibitory synaptic inputs offset in time. Synaptic inhibition can be inferred from extracellular recordings by presenting pairs of pulses (paired tone stimulation) and comparing the evoked responses of the cell to each pulse. We obtained single unit recordings from the IC of the awake big brown bat (Eptesicus fuscus) and used paired tone stimulation to measure the recovery cycle times of DTNs and non-temporally selective auditory neurons. By systematically varying the interpulse interval (IPI) of the paired tone stimulus, we determined the minimum IPI required for a neuron's spike count or its spike latency (first- or last-spike latency) in response to the second tone to recover to within ≥50% of the cell's baseline count or to within 1 SD of it's baseline latency in response to the first tone. Recovery times of shortpass DTNs were significantly shorter than those of bandpass DTNs, and recovery times of bandpass DTNs were longer than allpass neurons not selective for stimulus duration. Recovery times measured with spike counts were positively correlated with those measured with spike latencies. Recovery times were also correlated with first-spike latency (FSL). These findings, combined with previous studies on duration tuning in the IC, suggest that persistent inhibition is a defining characteristic of DTNs. Herein, we discuss measuring recovery times of neurons with spike counts and latencies. We also highlight how persistent inhibition could determine neural recovery times and serve as a potential mechanism underlying the precedence effect in humans. Finally, we explore implications of recovery times for DTNs in the context of bat hearing and echolocation.

Duration tuning across vertebrates.

Signal duration is important for identifying sound sources and determining signal meaning. Duration-tuned neurons (DTNs) respond preferentially to a range of stimulus durations and maximally to a best duration (BD). Duration-tuned neurons are found in the auditory midbrain of many vertebrates, although studied most extensively in bats. Studies of DTNs across vertebrates have identified cells with BDs and temporal response bandwidths that mirror the range of species-specific vocalizations. Neural tuning to stimulus duration appears to be universal among hearing vertebrates. Herein, we test the hypothesis that neural mechanisms underlying duration selectivity may be similar across vertebrates. We instantiated theoretical mechanisms of duration tuning in computational models to systematically explore the roles of excitatory and inhibitory receptor strengths, input latencies, and membrane time constant on duration tuning response profiles. We demonstrate that models of duration tuning with similar neural circuitry can be tuned with species-specific parameters to reproduce the responses of in vivo DTNs from the auditory midbrain. To relate and validate model output to in vivo responses, we collected electrophysiological data from the inferior colliculus of the awake big brown bat, Eptesicus fuscus, and present similar in vivo data from the published literature on DTNs in rats, mice, and frogs. Our results support the hypothesis that neural mechanisms of duration tuning may be shared across vertebrates despite species-specific differences in duration selectivity. Finally, we discuss how the underlying mechanisms of duration selectivity relate to other auditory feature detectors arising from the interaction of neural excitation and inhibition.

Duration tuning in the auditory midbrain of echolocating and non-echolocating vertebrates.

Neurons tuned for stimulus duration were first discovered in the auditory midbrain of frogs. Duration-tuned neurons (DTNs) have since been reported from the central auditory system of both echolocating and non-echolocating mammals, and from the central visual system of cats. We hypothesize that the functional significance of auditory duration tuning likely varies between species with different evolutionary histories, sensory ecologies, and bioacoustic constraints. For example, in non-echolocating animals such as frogs and mice the temporal filtering properties of auditory DTNs may function to discriminate species-specific communication sounds. In echolocating bats duration tuning may also be used to create cells with highly selective responses for specific rates of frequency modulation and/or pulse-echo delays. The ability to echolocate appears to have selected for high temporal acuity in the duration tuning curves of inferior colliculus neurons in bats. Our understanding of the neural mechanisms underlying sound duration selectivity has improved substantially since DTNs were first discovered almost 50 years ago, but additional research is required for a comprehensive understanding of the functional role and the behavioral significance that duration tuning plays in sensory systems.

Computational models of millisecond level duration tuning in neural circuits.

Discrimination of stimulus duration on the order of milliseconds has been observed in behavioral and neurophysiological studies across a variety of species and taxa. Several studies conducted in mammals have found neurons in the auditory midbrain (inferior colliculus) that are selective for signal duration. Duration selectivity in these cells arises from an interaction of excitatory and inhibitory events occurring at particular latencies from stimulus onset and offset. As previously shown in barn owls, coincidence of delayed, excitatory events can be used by the CNS to respond selectively to specific stimuli in auditory space. This study formulates several computational models of duration tuning that combine existing conceptual models with observed physiological responses in the auditory brainstem and midbrain to evaluate the plausibility of the proposed neural mechanisms. The computational models are able to reproduce a wide range of in vivo responses including best duration tuning, duration-selective response classes, spike counts, first-spike latencies, level tolerance to changes in signal amplitude, and neuropharmacological effects of applying inhibitory neurotransmitter antagonists to duration-tuned neurons. A unified model of duration tuning is proposed that enhances classic models of duration tuning, emphasizes similarities across the models, and simplifies our understanding of duration tuning across species and sensory modalities.

Emotional consciousness: a neural model of how cognitive appraisal and somatic perception interact to produce qualitative experience.

This paper proposes a theory of how conscious emotional experience is produced by the brain as the result of many interacting brain areas coordinated in working memory. These brain areas integrate perceptions of bodily states of an organism with cognitive appraisals of its current situation. Emotions are neural processes that represent the overall cognitive and somatic state of the organism. Conscious experience arises when neural representations achieve high activation as part of working memory. This theory explains numerous phenomena concerning emotional consciousness, including differentiation, integration, intensity, valence, and change.