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.

Evaluating Contrast Sensitivity in Early and Intermediate Age-Related Macular Degeneration With the Quick Contrast Sensitivity Function.

Purpose: The purpose of this study was to describe, validate, and compare the contrast sensitivity functions (CSFs) acquired with the novel quick CSF (qCSF) method from patients with early and intermediate age-related macular degeneration (eAMD and iAMD) and healthy controls. Methods: This is a cross-sectional analysis of contrast sensitivity (CS) and visual acuity (VA) baseline data from the prospective Multimodal Functional and Structural Visual System Characterization (MUMOVI) study. The qCSF testing was conducted with the manifold contrast vision meter (Adaptive Sensory Technology, San Diego, CA, USA). CS levels at spatial frequencies from 1 cycle per degree (CPD) to 18 CPD, the area underneath the logarithmic contrast sensitivity function (AULCSF), and contrast acuity (CA) were analyzed. The association of functional metrics with variables of interest was tested with linear models. Results: Ninety-four study eyes from 94 study patients were included in the analysis (13 patients with eAMD, 33 patients with iAMD, and 48 healthy controls). Significant differences between the eAMD and the iAMD model estimates were only found for CS at 1 CPD (t value = -2.9, P value = 0.006) and CS at 1.5 CPD (-2.7, 0.01). A specific association between smoking years and CS at 1 CPD (P = 0.02) and CS at 1.5 CPD (P = 0.03) could be described in patients with AMD. Conclusions: The qCSF testing allows the fast measurement of the whole CSF, enabling the integration into clinical routine. We showed that novel qCSF-derived metrics detect slight functional differences between AMD stages, which testing by Pelli-Robson charts or VA testing would miss. This study, therefore, yields novel qCSF-derived candidate metrics for therapeutic trials in AMD.

Rollator usage lets young individuals switch movement strategies in sit-to-stand and stand-to-sit tasks.

The transitions between sitting and standing have a high physical and coordination demand, frequently causing falls in older individuals. Rollators, or four-wheeled walkers, are often prescribed to reduce lower-limb load and to improve balance but have been found a fall risk. This study investigated how rollator support affects sit-to-stand and stand-to-sit movements. Twenty young participants stood up and sat down under three handle support conditions (unassisted, light touch, and full support). As increasing task demands may affect coordination, a challenging floor condition (balance pads) was included. Full-body kinematics and ground reaction forces were recorded, reduced in dimensionality by principal component analyses, and clustered by k-means into movement strategies. Rollator support caused the participants to switch strategies, especially when their balance was challenged, but did not lead to support-specific strategies, i.e., clusters that only comprise light touch or full support trials. Three strategies for sit-to-stand were found: forward leaning, hybrid, and vertical rise; two in the challenging condition (exaggerated forward and forward leaning). For stand-to-sit, three strategies were found: backward lowering, hybrid, and vertical lowering; two in the challenging condition (exaggerated forward and forward leaning). Hence, young individuals adjust their strategy selection to different conditions. Future studies may apply this methodology to older individuals to recommend safe strategies and ultimately reduce falls.

Pre-stimulus alpha activity modulates long-lasting unconscious feature integration.

Pre-stimulus alpha (α) activity can influence perception of shortly presented, low-contrast stimuli. The underlying mechanisms are often thought to affect perception exactly at the time of presentation. In addition, it is suggested that α cycles determine temporal windows of integration. However, in everyday situations, stimuli are usually presented for periods longer than ∼100 ms and perception is often an integration of information across space and time. Moving objects are just one example. Hence, the question is whether α activity plays a role also in temporal integration, especially when stimuli are integrated over several α cycles. Using electroencephalography (EEG), we investigated the relationship between pre-stimulus brain activity and long-lasting integration in the sequential metacontrast paradigm (SQM), where two opposite vernier offsets, embedded in a stream of lines, are unconsciously integrated into a single percept. We show that increases in α power, even 300 ms before the stimulus, affected the probability of reporting the first offset, shown at the very beginning of the SQM. This effect was mediated by the systematic slowing of the α rhythm that followed the peak in α power. No phase effects were found. Together, our results demonstrate a cascade of neural changes, following spontaneous bursts of α activity and extending beyond a single moment, which influences the sensory representation of visual features for hundreds of milliseconds. Crucially, as feature integration in the SQM occurs before a conscious percept is elicited, this also provides evidence that α activity is linked to mechanisms regulating unconscious processing.

Treatment of tracheoesophageal fistulas following laryngectomy by customized prostheses-A bicentric case series.

Objective: Tracheoesophageal fistulas (TEF) following laryngectomy cause immense restrictions due to the inability of oral feeding, loss of voice rehabilitation, penetration of saliva, and permanent need of inflatable tracheal cannulas. Patients are consistently in threat of fatal aspiration pneumonias. The failure rate of surgical approaches to close the fistulas is high and an ultima ratio option by customized silicone prostheses can be considered. Methods: A retrospective analysis of 26 patients with a TEF was performed. Results: The fistulas occurred in average 40 months after laryngectomy caused by an enlargement of the voice fistula in 17 patients and problems in wound healing in 6 patients. The mean diameter of the fistula was 32 × 18 mm. Eight patients were treated by a button-shaped and 18 by a tube-shaped prosthesis. Complete oral feeding was possible in 8 and additional feeding by percutaneous endoscopic gastrostomy tube in 16 patients. Voice rehabilitation by voice prostheses was possible in 18 cases. Fifteen patients died in the course of the treatment either due to oncological progression or other reasons. The median follow-up time of the patients alive was 36 months (max 88 months) with 2.2 protheses replacements in mean (max 11). Conclusion: The treatment of TEF by customized prostheses can be considered as an ultima ration option if other approaches had failed. At least, partial oral nutrition and voice rehabilitation as well as protection from aspiration can be achieved in the majority of the patients. Level of Evidence: 4-Case series.

Do we really measure what we think we are measuring?

Tests used in the empirical sciences are often (implicitly) assumed to be representative of a given research question in the sense that similar tests should lead to similar results. Here, we show that this assumption is not always valid. We illustrate our argument with the example of resting-state electroencephalogram (EEG). We used multiple analysis methods, contrary to typical EEG studies where one analysis method is used. We found, first, that many EEG features correlated significantly with cognitive tasks. However, these EEG features correlated weakly with each other. Similarly, in a second analysis, we found that many EEG features were significantly different in older compared to younger participants. When we compared these EEG features pairwise, we did not find strong correlations. In addition, EEG features predicted cognitive tasks poorly as shown by cross-validated regression analysis. We discuss several explanations of these results.

No Common Factor Underlying Decline of Visual Abilities in Mild Cognitive Impairment.

INTRODUCTION: Recent work has shown an association between cognitive and visual impairments and two main theories were advanced, namely the sensory deprivation and the common cause theories. Most studies considered only basic visual functions such as visual acuity or visual field size and evaluated the association with dementia. OBJECTIVES: To reconcile between these theories and to test the link between visual and cognitive decline in mildly cognitive impaired people. METHODS: We employed a battery of 19 visual tasks on 39 older adults with mild cognitive impairment and 91 without any evidence of cognitive decline, as measured by the Montreal Cognitive Assessment. RESULTS: Our results show a strong association between visual impairment and mild cognitive impairment. In agreement with previous results with younger and healthy older adults, we found also only weak correlations between most tests in older adults with mild cognitive impairment. CONCLUSION: Our results suggest that visual and cognitive abilities decline simultaneously, but they do so independently across visual and cognitive functions and across participants.

Individual computer-assisted 3D planning for placement of auricular prosthesis anchors in combination with an implantable transcutaneous bone conduction hearing device in patients with aural atresia.

BACKGROUND: The simultaneous implantation of the Bonebridge (MED-EL, Innsbruck, Austria), a semi-implantable active transcutaneous bone conduction hearing device and anchors for auricular prostheses can be challenging as both implants contain magnets and compete for the narrow space in the designated implantation area. MATERIAL AND METHODS: A preoperative planning tool (virtual surgery) was used with individual 3D computer models of the skull and implants for finding optimal implant positions for both the floating mass transducer (FMT) and the anchors for the auricular prosthesis. The interaction between the magnetic prosthesis anchors and the FMT was measured by means of static magnetic forces. A retrospective data analysis was conducted to evaluate the surgical and audiological outcome. RESULTS: Between 2014 and 2021, a 3D planning of a simultaneous implantation of the Bonebridge with auricular prosthesis anchors was conducted on 6 ears of 5 patients (3 males, 2 females; age range 17-56 years). The individual preoperative planning was considered very useful for the optimal placement of bone anchors in combination with the Bonebridge. Audiological data showed a clear benefit for hearing 3 months and > 11 months after implantation. No adverse interactions between the magnetic prosthesis anchors and the FMT were observed. In two patients, revision surgery was carried out due to skin inflammation or wound healing problems. No long-term complications were observed 3-5 years after surgery. CONCLUSION: Preoperative 3D planning represents a clear benefit for the simultaneous audiological and esthetic rehabilitation using the Bonebridge and anchors for auricular prostheses.

The EEG multiverse of schizophrenia.

Research on schizophrenia typically focuses on one paradigm for which clear-cut differences between patients and controls are established. Great efforts are made to understand the underlying genetical, neurophysiological, and cognitive mechanisms, which eventually may explain the clinical outcome. One tacit assumption of these "deep rooting" approaches is that paradigms tap into common and representative aspects of the disorder. Here, we analyzed the resting-state electroencephalogram (EEG) of 121 schizophrenia patients and 75 controls. Using multiple signal processing methods, we extracted 194 EEG features. Sixty-nine out of the 194 EEG features showed a significant difference between patients and controls, indicating that these features detect an important aspect of schizophrenia. Surprisingly, the correlations between these features were very low. We discuss several explanations to our results and propose that complementing "deep" with "shallow" rooting approaches might help in understanding the underlying mechanisms of the disorder.

[Individual computer-assisted 3D planning for placement of auricular prosthesis anchors in combination with an implantable transcutaneous bone conduction hearing device in patients with aural atresia. German version]. / Individuelle computergestützte 3D-Planung zur Platzierung von Epithesenankern in Kombination mit einem implantierbaren transkutanen Knochenleitungshörgerät bei Patienten mit Ohrfehlbildungen.

BACKGROUND: The simultaneous implantation of the Bonebridge (MED-EL, Innsbruck, Austria), a semi-implantable active transcutaneous bone conduction hearing device and anchors for auricular prostheses can be challenging as both implants contain magnets and compete for the narrow space in the designated implantation area. MATERIAL AND METHODS: A preoperative planning tool (virtual surgery) was used with individual 3D computer models of the skull and implants for finding optimal implant positions for both the floating mass transducer (FMT) and the anchors for the auricular prosthesis. The interaction between the magnetic prosthesis anchors and the FMT was measured by means of static magnetic forces. A retrospective data analysis was conducted to evaluate the surgical and audiological outcome. RESULTS: Between 2014 and 2021 a 3D planning of a simultaneous implantation of the Bonebridge with auricular prosthesis anchors was conducted on 6 ears of 5 patients (3 males, 2 females; age range 17-56 years). The individual preoperative planning was considered very useful for the optimal placement of bone anchors in combination with the Bonebridge. Audiological data showed a clear benefit for hearing 3 months and > 11 months after implantation. No adverse interactions between the magnetic prosthesis anchors and the FMT were observed. In two patients, revision surgery was carried out due to skin inflammation or wound healing problems. No long-term complications were observed 3-5 years after surgery. CONCLUSION: Preoperative 3D planning represents a clear benefit for the simultaneous audiological and esthetic rehabilitation using the Bonebridge and anchors for auricular prostheses.

Visual masking deficits in schizophrenia: a view into the genetics of the disease through an endophenotype.

Schizophrenia is a severe psychiatric disorder determined by a complex mixture of genetic and environmental factors. To better understand the contributions of human genetic variations to schizophrenia, we performed a genome-wide association study (GWAS) of a highly sensitive endophenotype. In this visual masking endophenotype, two vertical bars, slightly shifted in the horizontal direction, are briefly presented (vernier offset). Participants are asked to indicate the offset direction of the bars (either left or right). The bars are followed by a grating mask, which makes the task both spatially and temporally challenging. The inter-stimulus interval (ISI) between the vernier and the mask was determined in 206 patients with schizophrenia, 109 first-order relatives, and 143 controls. Usually, in GWAS studies, patients are compared to controls (i.e., a binary task) without considering the large differences in performance between patients and controls, as it occurs in many paradigms. The masking task allows for a particularly powerful analysis because the differences in ISI within the patient population are large. We genotyped all participants and searched for associations between human polymorphisms and the masking endophenotype using a linear mixed model. We did not identify any genome-wide significant associations (p < 5 × 10-8), indicating that common variants with strong effects are unlikely to contribute to the large inter-group differences in visual masking. However, we found significant differences in polygenetic risk scores (PRS) between patients and controls, and relatives and controls.

Unlocking crowding by ensemble statistics.

In crowding,1,2,3,4,5,6,7 objects that can be easily recognized in isolation appear jumbled when surrounded by other elements.8 Traditionally, crowding is explained by local pooling mechanisms,3,6,9,10,11,12,13,14,15 but many findings have shown that the global configuration of the entire stimulus display, rather than local aspects, determines crowding.8,16,17,18,19,20,21,22,23,24,25,26,27,28 However, understanding global configurations is challenging because even slight changes can lead from crowding to uncrowding and vice versa.23,25,28,29 Unfortunately, the number of configurations to explore is virtually infinite. Here, we show that one does not need to know the specific configuration of flankers to determine crowding strength but only their ensemble statistics, which allow for the rapid computation of groups within the stimulus display.30,31,32,33,34,35,36,37 To investigate the role of ensemble statistics in (un)crowding, we used a classic vernier offset discrimination task in which the vernier was flanked by multiple squares. We manipulated the orientation statistics of the squares based on the following rationale: a central square with an orientation different from the mean orientation of the other squares stands out from the rest and groups with the vernier, causing strong crowding. If, on the other hand, all squares group together, the vernier is the only element that stands out, and crowding is weak. These effects should depend exclusively on the perceived ensemble statistics, i.e., on the mean orientation of the squares and not on their individual orientations. In two experiments, we confirmed these predictions.

Intact and deficient contextual processing in schizophrenia patients.

Schizophrenia patients are known to have deficits in contextual vision. However, results are often very mixed. In some paradigms, patients do not take the context into account and, hence, perform more veridically than healthy controls. In other paradigms, context deteriorates performance much more strongly in patients compared to healthy controls. These mixed results may be explained by differences in the paradigms as well as by small or biased samples, given the large heterogeneity of patients' deficits. Here, we show that mixed results may also come from idiosyncrasies of the stimuli used because in variants of the same visual paradigm, tested with the same participants, we found intact and deficient processing.

The Irreducibility of Vision: Gestalt, Crowding and the Fundamentals of Vision.

What is fundamental in vision has been discussed for millennia. For philosophical realists and the physiological approach to vision, the objects of the outer world are truly given, and failures to perceive objects properly, such as in illusions, are just sporadic misperceptions. The goal is to replace the subjectivity of the mind by careful physiological analyses. Continental philosophy and the Gestaltists are rather skeptical or ignorant about external objects. The percepts themselves are their starting point, because it is hard to deny the truth of one own's percepts. I will show that, whereas both approaches can well explain many visual phenomena with classic visual stimuli, they both have trouble when stimuli become slightly more complex. I suggest that these failures have a deeper conceptual reason, namely that their foundations (objects, percepts) do not hold true. I propose that only physical states exist in a mind independent manner and that everyday objects, such as bottles and trees, are perceived in a mind-dependent way. The fundamental processing units to process objects are extended windows of unconscious processing, followed by short, discrete conscious percepts.

Random Practice Enhances Retention and Spatial Transfer in Force Field Adaptation.

The contextual-interference effect is a frequently examined phenomenon in motor skill learning but has not been extensively investigated in motor adaptation. Here, we first tested experimentally if the contextual-interference effect is detectable in force field adaptation regarding retention and spatial transfer, and then fitted state-space models to the data to relate the findings to the "forgetting-and-reconstruction hypothesis". Thirty-two participants were divided into two groups with either a random or a blocked practice schedule. They practiced reaching to four targets and were tested 10 min and 24 h afterward for motor retention and spatial transfer on an interpolation and an extrapolation target, and on targets which were shifted 10 cm away. The adaptation progress was participant-specifically fitted with 4-slow-1-fast state-space models accounting for generalization and set breaks. The blocked group adapted faster (p = 0.007) but did not reach a better adaptation at practice end. We found better retention (10 min), interpolation transfer (10 min), and transfer to shifted targets (10 min and 24 h) for the random group (each p < 0.05). However, no differences were found for retention or for the interpolation target after 24 h. Neither group showed transfer to the extrapolation target. The extended state-space model could replicate the behavioral results with some exceptions. The study shows that the contextual-interference effect is partially detectable in practice, short-term retention, and spatial transfer in force field adaptation; and that state-space models provide explanatory descriptions for the contextual-interference effect in force field adaptation.