Daltonization or colour enhancement: potential uses and limitations [Invited].

The main perceptual-cognitive limitations of CDOs (Colour Deficient Observers) are analysed, along with the uses and limitations of tools that either transform images so that CNOs (Colour Normal Observers) see them as CDOs (simulation) or transform images so that CDOs can use them as CNOs (daltonization). The four main uses of colour (comparative, denotative, connotative, and aesthetic) are analysed, along with their relation to, alternatively, the ability to discriminate colour stimuli or to categorize colours. These uses of colour are applied to analyse the possible effects of daltonization tools.

"Red-Green" or "Brown-Green" Dichromats? The Accuracy of Dichromat Basic Color Terms Metacognition Supports Denomination Change.

Two experiments compared "Red-Green" (R-G) dichromats' empirical and metacognized capacities to discriminate basic color categories (BCCs) and to use the corresponding basic color terms (BCTs). A first experiment used a 102-related-colors set for a pointing task to identify all the stimuli that could be named with each BCT by each R-G dichromat type (8 protanopes and 9 deuteranopes). In a second experiment, a group of R-G dichromats (15 protanopes and 16 deuteranopes) estimated their difficulty discriminating BCCs-BCTs in a verbal task. The strong coincidences between the results derived from the pointing and the verbal tasks indicated that R-G dichromats have very accurate metacognition about their capacities (they only had considerable difficulty discriminating 13 out of the total of 55 possible BCT pairs) and limitations (Brown-Green and Blue-Purple pairs were rated especially difficult to differentiate) in the use of BCTs. Multidimensional scaling (MDS) solutions derived from both tasks were very similar: BCTs in R-G dichromats were properly represented in 2D MDS solutions that clearly show one chromatic dimension and one achromatic dimension. Important concordances were found between protanopes and deuteranopes. None of these dichromats showed substantial difficulty discriminating the Red-Green pair. So, to name them "R-G" dichromats is misleading considering their empirical capacities and their metacognition. Further reasons to propose the use of the alternative denomination "Brown-Green" dichromats are also discussed. We found some relevant differences between the "Brown-Green" dichromats' empirical and self-reported difficulties using BCTs. Their metacognition can be considered a "caricature" of their practical difficulties. This caricature omits some difficulties including their problems differentiating "white" and "black" from other BCTs, while they overestimate their limitations in differentiating the most difficult pairs (Brown-Green and Blue-Purple). Individual differences scaling (INDSCAL) analyses indicated that the metacognition regarding the use of BCTs in "Brown-Green" dichromats, especially deuteranopes, is driven slightly more by the chromatic dimension and driven slightly less by the achromatic dimension, than their practical use of BCTs. We discuss the relevance of our results in the framework of the debate between the linguistic relativity hypothesis (LRH) and the universal evolution (UE) theories.

Frequency, Regional Variation, and Predictors of Undetermined Cause of Death in Cardiometabolic Clinical Trials: A Pooled Analysis of 9259 Deaths in 9 Trials.

BACKGROUND: Modern cardiometabolic clinical trials often include cardiovascular death as a component of a composite primary outcome, requiring central adjudication by a clinical events committee to classify cause of death. However, sometimes the cause of death cannot be determined from available data. The US Food and Drug Administration has indicated that this circumstance should occur only rarely, but its prevalence has not been formally assessed. METHODS: Data from 9 global clinical trials (2009-2017) with long-term follow-up and blinded, centrally adjudicated cause of death were used to calculate the proportion of deaths attributed to cardiovascular, noncardiovascular, or undetermined causes by therapeutic area (diabetes mellitus/pre-diabetes mellitus, stable atherosclerosis, atrial fibrillation, and acute coronary syndrome), region of patient enrollment, and year of trial manuscript publication. Patient- and trial-level variables associated with undetermined cause of death were identified using a logistic model. RESULTS: Across 127 049 enrolled participants from 9 trials, there were 9259 centrally adjudicated deaths: 5012 (54.1%) attributable to cardiovascular causes, 2800 (30.2%) attributable to noncardiovascular causes, and 1447 (15.6%) attributable to undetermined causes. There was variability in the proportion of deaths ascribed to undetermined causes by trial therapeutic area, region of enrollment, and year of trial manuscript publication. On multivariable analysis, acute coronary syndrome or atrial fibrillation trial (versus atherosclerotic vascular disease or diabetes mellitus/pre-diabetes mellitus), longer time from enrollment to death, more recent trial manuscript publication year, enrollment in North America (versus Western Europe), female sex, and older age were associated with greater likelihood of death of undetermined cause. CONCLUSIONS: In 9 cardiometabolic clinical trials with long-term follow-up, approximately 16% of deaths had undetermined causes. This provides a baseline for quality assessment of clinical trials and informs operational efforts to potentially reduce the frequency of undetermined deaths in future clinical research.

Basic Color Terms (BCTs) and Categories (BCCs) in Three Dialects of the Spanish Language: Interaction Between Cultural and Universal Factors.

Two experiments were performed to identify and compare the Basic Color Terms (BCTs) and the Basic Color Categories (BCCs) included in three dialects (Castilian, Mexican, and Uruguayan) of the Spanish language. Monolexemic Elicited lists were used in the first experiment to identify the BCTs of each dialect. Eleven BCTs appeared for the Spanish and the Mexican, and twelve did so for the Uruguayan. The six primary BCTs (rojo "red," verde "green," amarillo "yellow," azul "blue," negro "black," and blanco "white") appeared in the three dialects. This occurred for only three derived BCTs (gris "gray," naranja "orange," and rosa "pink") but not for the other five derived BCTs (celeste "sky blue," marrón "brown," café "brown," morado "purple," and violeta "purple"). Color transitions were used in the second experiment for two different tasks. Extremes naming task was used to determine the relation between two different dialects' BCTs: equality, equivalence or difference. The results provided the first evidence for marrón "brown" and café "brown" being equivalent terms for the same BCC (brown in English) as is the case of morado "purple" and violeta "purple." Uruguayan celeste "sky blue" had no equivalent BCT in the other two dialects. Boundary delimitation task required the selection of the color in the boundary between two categories. The task was used to reasonably estimate the volume occupied by each BCC in the color space considering its chromatic area and lightness range. Excluding sky blue (celeste "sky blue") and blue (azul "blue"), the other BCCs color volumes were similar across the three dialects. Uruguayan sky blue and blue volumes conjointly occupied the portion of the color space corresponding to the Castilian and Mexican blue BCC. The fact that the BCT celeste "sky blue" only appeared in Uruguayan very probably derived from specific cultural factors (the use of the color in the flags and the arrival of an important number of Italian immigrants). Nevertheless, these cultural factors seem to nurture from a perceptive structuring of the color space, which nature is universal, as the boundaries of this category can be delimited from the responses of Spanish and Mexican participants.

Is waist-to-height ratio the best predictive indicator of hypertension incidence? A cohort study.

BACKGROUND: The best anthropometric indicator to verify the association between obesity and hypertension (HTN) has not been established. We conducted this study to evaluate and compare the discriminatory power of waist-to-height ratio (WHtR) in relation to body mass index (BMI) and waist circumference (WC) in predicting HTN after 13 years of follow-up. METHODS: This study was an observational prospective cohort study performed in the city of Firminópolis, in Brazilian's midwest. The cohort baseline (phase 1) was initiated in 2002 with the evaluation of a representative sample of the normotensive population (≥ 18 years of age). The incidence of HTN was evaluated as the outcome (phase 2). Sociodemographic, dietary and lifestyle variables were used to adjust proportional hazards models and evaluate risk of HTN according to anthropometric indices. The areas under the receiver operating characteristic (ROC) curves were used to compare the predictive capacity of these indices. The best HTN predictor cut-offs were obtained based on sensitivity and specificity. RESULTS: A total of 471 patients with a mean age of 38.9 ± 12.3 years were included in phase 1. The mean follow-up was 13.2 years, and 207 subjects developed HTN. BMI, WC and WHtR were associated with risk of HTN incidence and had similar power in predicting the disease. However, the associations were only significant for women. The cut-off points with a better HTN predictive capacity were in agreement with current recommendations, except for the WC in men. CONCLUSIONS: The results suggest that both overall obesity (BMI) and central obesity (WC and WHtR) anthropometric indicators can be used in this population to evaluate the risk of developing hypertension.

Predictors of overweight/obesity in a Brazilian cohort after 13 years of follow-up.

BACKGROUND: Obesity is a chronic complex disease with an increasing prevalence around the world. Prospective studies in adult cohorts are needed to provide information about predictors of new-onset overweight/obesity on population-based levels. The aim of this study was to identify factors associated with the risk of an adult individual become overweight/obese after 13 years of follow-up. METHODS: Second phase of an observational population-based prospective cohort study in a small town in the Midwest region of Brazil. A representative sample of the adult population (≥18 years) was assessed in 2002 (phase 1). Anthropometric, sociodemographic, dietary intake and lifestyle data were collected. After 13 years of follow-up (2015), the same variables were re-evaluated (phase 2). New-onset overweight/obesity was the outcome variable. RESULTS: A total of 685 subjects were included with a mean age in phase 1 of 42.7 ± 13.8 years and 56.1 ± 13.8 years in phase 2, the mean follow-up time was 13.2 years and female sex counted for 66.3% of the sample. Total weight gain was 5.9 ± 10.2 Kg, body mass index increased 2.6 ± 3.8 Kg/m2 and waist circumference (WC) values increased 8.0 ± 10.5 cm. The prevalence of overweight/obesity went from 49.1% in phase 1 to 69.8% in phase 2 (p < 0.001). The factors associated with a decreased risk of new-onset overweight/obesity were ages between 50 and 64 (RR 0.40; CI 0.24-0.67 - p = 0.001) and ≥65 years (RR 0.15; CI 0.06-0.35 - p < 0.001), being part of the second quartile of fat consumption (RR 0.59; CI 0.35-0.97 - p = 0.041), no alcohol consumption (RR 0.59; CI 0.37-0.93 - p = 0.024) and smoking (RR 0.58; CI 0.39-0.86 - p = 0,007) in phase 1. CONCLUSIONS: We identified in thirteen years of follow-up that older ages, a moderate fat consumption compared to low consumption, no alcohol consumption and smoking habit were related to a decreased risk of new-onset overweight/obesity. Obesity prevention actions must focus on subjects at younger ages and include policies to reduce alcohol consumption.

Robust colour constancy in red-green dichromats.

Colour discrimination has been widely studied in red-green (R-G) dichromats but the extent to which their colour constancy is affected remains unclear. This work estimated the extent of colour constancy for four normal trichromatic observers and seven R-G dichromats when viewing natural scenes under simulated daylight illuminants. Hyperspectral imaging data from natural scenes were used to generate the stimuli on a calibrated CRT display. In experiment 1, observers viewed a reference scene illuminated by daylight with a correlated colour temperature (CCT) of 6700K; observers then viewed sequentially two versions of the same scene, one illuminated by either a higher or lower CCT (condition 1, pure CCT change with constant luminance) or a higher or lower average luminance (condition 2, pure luminance change with a constant CCT). The observers' task was to identify the version of the scene that looked different from the reference scene. Thresholds for detecting a pure CCT change or a pure luminance change were estimated, and it was found that those for R-G dichromats were marginally higher than for normal trichromats regarding CCT. In experiment 2, observers viewed sequentially a reference scene and a comparison scene with a CCT change or a luminance change above threshold for each observer. The observers' task was to identify whether or not the change was an intensity change. No significant differences were found between the responses of normal trichromats and dichromats. These data suggest robust colour constancy mechanisms along daylight locus in R-G dichromacy.

Sympathetic nervous activity in patients with acute coronary syndrome: a comparative study of inflammatory biomarkers.

Previous studies have shown that both sympathetic hyperactivity and enhanced inflammatory responses are associated with poor outcomes in patients with acute coronary syndrome (ACS). Whether there is a correlation between these two characteristics remains unclear. Thirty-four patients with uncomplicated ACS were evaluated; their mean age was 51.7±7.0 years, 79.4% were male, and 94.1% had myocardial infarction (MI). On the fourth day of hospitalization, they underwent muscle sympathetic nerve activity (MSNA) analysis (microneurography), as well as ultrasensitive C-reactive protein (usCRP), interleukin-6 (IL-6), and lipoprotein-associated phospholipase A2 (Lp-PLA2) activity measurements. These evaluations were repeated at 1, 3, and 6 months after hospitalization. Both MSNA and inflammatory biomarkers were elevated during the acute phase of ACS and then decreased over time. At hospitalization, the median usCRP level was 17.75 (IQR 8.57; 40.15) mg/l, the median IL-6 level was 6.65 (IQR 4.45; 8.20), the mean Lp-PLA2 activity level was 185.8 ±52.2 nmol/min per ml, and mean MSNA was 64.2±19.3 bursts/100 heart beats. All of these variables decreased significantly over 6 months compared with the in-hospital levels. MSNA was independently associated with the peak level of creatine kinase isoenzyme MB (CKMB) in the acute phase (P=0.027) and with left ventricular ejection fraction (LVEF) at 6 months (P=0.026). Despite the increased levels of inflammatory biomarkers and sympathetic hyperactivity in the initial phase of ACS, no significant correlations between them were observed in any of the analyzed phases. Our data suggest that although both sympathetic hyperactivity and inflammation are concomitantly present during the early phase of ACS, these characteristics manifest via distinct pathological pathways.

Neurovascular control during exercise in acute coronary syndrome patients with Gln27Glu polymorphism of ß2-adrenergic receptor.

BACKGROUND: Gln27Glu (rs1042714) polymorphism of the ß2-adrenergic receptor (ADRB2) has been association with cardiovascular functionality in healthy subjects. However, it is unknown whether the presence of the ADRB2 Gln27Glu polymorphism influences neurovascular responses during exercise in patients with acute coronary syndromes (ACS). We tested the hypothesis that patients with ACS homozygous for the Gln allele would have increased muscle sympathetic nerve activity (MSNA) responses and decreased forearm vascular conductance (FVC) responses during exercise compared with patients carrying the Glu allele (Gln27Glu and Glu27Glu). In addition, exercise training would restore these responses in Gln27Gln patients. METHODS AND RESULTS: Thirty-days after an ischemic event, 61 patients with ACS without ventricular dysfunction were divided into 2 groups: (1) Gln27Gln (n = 35, 53±1years) and (2) Gln27Glu+Glu27Glu (n = 26, 52±2years). MSNA was directly measured using the microneurography technique, blood pressure (BP) was measured with an automatic oscillometric device, and blood flow was measured using venous occlusion plethysmography. MSNA, mean BP, and FVC were evaluated at rest and during a 3-min handgrip exercise. The MSNA (P = 0.02) and mean BP (P = 0.04) responses during exercise were higher in the Gln27Gln patients compared with that in the Gln27Glu+Glu27Glu patients. No differences were found in FVC. Two months of exercise training significantly decreased the MSNA levels at baseline (P = 0.001) and in their response during exercise (P = 0.02) in Gln27Gln patients, but caused no changes in Gln27Glu+Glu27Glu patients. Exercise training increased FVC responses in Gln27Glu+Glu27Glu patients (P = 0.03), but not in Gln27Gln patients. CONCLUSION: The exaggerated MSNA and mean BP responses during exercise suggest an increased cardiovascular risk in patients with ACS and Gln27Gln polymorphism. Exercise training emerges as an important strategy for restoring this reflex control. Gln27Glu polymorphism of ADRB2 influences exercise-induced vascular adaptation in patients with ACS.

Tratado Dante Pazzanese de emergências cardiovasculares / Treaty Dante Pazzanese of cardiovascular emergencies

O Tratado Dante Pazzanese de Emergências Cardiovasculares tem como núcleo didático a vastíssima experiência clínica e a casuística do corpo do conceituado Hospital Dante Pazzanese. Como vem diz o seu título, o livro movimenta o seu ensino, prática e procedimento no ambiente do pronto-socorro. É aí que chega o paciente com acometimento cardiovascular agudo, onde com muita frequência são tênues os limites entre a sua estabilização e a evolução para óbito. A equipe do pronto-socorro trabalha contra o relógio. Quanto mais rápidos o diagnóstico e o tratamento, melhor o prognóstico, pois com isso evita-se a cascata de eventos mórbidos que se seguem. A todo momento, o emergencista é chamado a tomar decisões críticas em face da apresentação das mais variadas condições clínicas que lhe chegam. O trabalho é de fôlego e determinação. O manuseio da doença cardiovascular aguda exige a tomada de medidas iniciais de estabilização, a seleção criteriosa dos recursos terapêuticos e o domínio total dos procedimentos emergenciais e meios terapêuticos eficientes para a resolução do acontecimento. Esse é, pois, o objetivo do presente trabalho, que mediante sua leitura, agregada à prática da clínica cardiovascular, capacitará o socorrista e o emergencista a alinharem a sua conduta ao atendimento seguro e eficiente do paciente cardiovascular agudo. O Tratado Dante Pazzanese de Emergências Cardiovasculares apresenta 3 Editores, 58 Capítulos, 145 Colaboradores, num total de 1072 páginas. É livro, pois, destinado a Cardiologistas, Emergencistas, Socorristas, Intensivistas, Clínicos, Residentes em Cardiologia, Emergência Medica, Medicina Intensiva e Clínica Médica.

Atividade nervosa simpática em pacientes com síndromes isquêmicas miocárdicas instáveis: estudo comparativo com marcadores inflamatórios / Sympathetic nervous activity in patients with acute coronary syndromes: a comparative study with inflammatory biomarkers

Em pacientes com síndromes isquêmicas miocárdicas instáveis (SIMI), tanto a hiperatividade simpática quanto a resposta inflamatória exacerbada se associam a pior prognóstico. No entanto, ainda é desconhecido se existe alguma correlação entre esses dois marcadores de evolução desfavorável. OBJETIVOS: Correlacionar a atividade nervosa simpática muscular com marcadores inflamatórios nas fases precoce e tardia de pacientes portadores de SIMI. MÉTODOS: Pacientes hospitalizados com diagnóstico de SIMI e evolução favorável foram incluídos de forma prospectiva desde que apresentassem idade entre 18 e 65 anos e aterosclerose coronária comprovada por cinecoronariografia. Logo após a inclusão no estudo foram coletadas informações basais, e no quarto dia (± 1 dia) de internação os pacientes foram submetidos à avaliação da ANSM e coleta concomitante de amostra sanguínea para dosagem de proteína CReativa ultrassensível (PCR-us), interleucina-6 (IL6), e fosfolipase A2 associada à lipoproteína (Lp-PLA2). ANSM foi obtida pela técnica de microneurografia do nervo fibular. As medidas e respectivas análises de correlação foram repetidas em 1, 3 e 6 meses após a hospitalização. Correlações entre ANSM e marcadores inflamatórios foram analisadas por meio do teste de Pearson (variáveis de distribuição não-paramétrica foram transformadas logaritmicamente). Modelos de regressão linear múltipla foram criados para avaliar os efeitos independentes. RESULTADOS: Foram estudados 34 pacientes com idade média de 51,7±7,0 anos, sendo 79,4% do sexo masculino. A prevalência de hipertensão arterial foi de 64,7%, diabetes mellitus 8,8%, e doença arterial coronária prévia de 20,6%. A apresentação foi IAM com supradesnível de ST em 18 pacientes (52,9%), IAM sem supra de ST em 14 (41,2%) e angina instável em 02 pacientes (5,9%). Tanto ANSM quanto biomarcadores inflamatórios estavam elevados durante a fase aguda das SIMI e diminuíram ao longo do tempo. Na fase hospitalar, a mediana da PCR...

Previous publications have shown that both sympathetic hyperactivity and enhanced inflammatory response are associated with worse outcomes during acute coronary syndromes (ACS). However, little is known about the correlation between these two pathologic pathways. OBJECTIVE: To correlate muscle sympathetic nerve activity with inflammatory biomarkers in both acute and chronic phase of ACS. METHODS: Patients hospitalized with uncomplicated ACS were enrolled if they were 18-65 years old and have significant atherosclerosis. Baseline characteristics information were collected and at fourth day (± 1 day) of hospitalization they were submitted to muscle sympathetic nerve activity (MSNA) analysis and blood sample were collected for ultrasensitive C-reactive protein (usCRP), interleukin-6 (IL-6) and Lipoprotein-associated phospholipase A2 activity (Lp-PLA2) measurements. MSNA was recorded directly from the peroneal nerve using the microneurography technique. Measurements were repeated at 1, 3 and 6 months after hospitalization. Correlations between MSNA and inflammatory markers and baseline characteristics were made using Pearson's test (nonnormally distributed variables were logarithmically transformed) and multivariate regression models were performed to assess the independent effects. RESULTS: Thirty-four patients were included, 79.4% male, mean age 51.7 (SD 7.0 years). The prevalence of hypertension was 64.7%, diabetes mellitus 8.8%, and previous coronary heart disease 20.6%. The ACS presentation was STEMI in 18 patients (52.9%), NSTEMI in 14 (41.2%) and UA in 02 patients (5.9%). Both MSNA and inflammatory markers were elevated during acute phase of ACS and decreased over time. In the hospitalization phase the median usCRP was 17.75 (8.57; 40.15) mg/L, median IL-6 6.65 (4.45; 8.20), mean Lp-PLA2 185.8 ± 52.2 nmol/min/mL, and mean MSNA 64.2 ± 19.3 bursts/100heart beats. All of these variables decreased significantly over 6 months when...

Color preference in red-green dichromats.

Around 2% of males have red-green dichromacy, which is a genetic disorder of color vision where one type of cone photoreceptor is missing. Here we investigate the color preferences of dichromats. We aim (i) to establish whether the systematic and reliable color preferences of normal trichromatic observers (e.g., preference maximum at blue, minimum at yellow-green) are affected by dichromacy and (ii) to test theories of color preference with a dichromatic sample. Dichromat and normal trichromat observers named and rated how much they liked saturated, light, dark, and focal colors twice. Trichromats had the expected pattern of preference. Dichromats had a reliable pattern of preference that was different to trichromats, with a preference maximum rather than minimum at yellow and a much weaker preference for blue than trichromats. Color preference was more affected in observers who lacked the cone type sensitive to long wavelengths (protanopes) than in those who lacked the cone type sensitive to medium wavelengths (deuteranopes). Trichromats' preferences were summarized effectively in terms of cone-contrast between color and background, and yellow-blue cone-contrast could account for dichromats' pattern of preference, with some evidence for residual red-green activity in deuteranopes' preference. Dichromats' color naming also could account for their color preferences, with colors named more accurately and quickly being more preferred. This relationship between color naming and preference also was present for trichromat males but not females. Overall, the findings provide novel evidence on how dichromats experience color, advance the understanding of why humans like some colors more than others, and have implications for general theories of aesthetics.