Incremental mortality associated with nontuberculous mycobacterial lung disease among US Medicare beneficiaries with chronic obstructive pulmonary disease.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a common comorbidity in patients with nontuberculous mycobacterial lung disease (NTMLD). Both conditions are associated with increased morbidity and mortality, but data are lacking on the additional burden associated with NTMLD among patients with COPD. Thus, the goal of this study was to assess the incremental mortality risk associated with NTMLD among older adults with COPD. METHODS: A retrospective cohort study was conducted using the US Medicare claims database (2010-2017). Patients with preexisting COPD and NTMLD (cases) were matched 1:3 by age and sex with patients with COPD without NTMLD (control patients). Patients were followed up until death or data cutoff (December 31, 2017). Incremental risk of mortality was evaluated by comparing the proportions of death, annualized mortality rate, and mortality hazard rate between cases and control patients using both univariate and multivariate analyses adjusting for age, sex, comorbidities, and COPD severity. RESULTS: A total of 4,926 cases were matched with 14,778 control patients. In univariate analyses, a higher proportion of cases (vs. control patients) died (41.5% vs. 26.7%; P < 0.0001), unadjusted annual mortality rates were higher among cases (158.5 vs. 86.0 deaths/1000 person-years; P < 0.0001), and time to death was shorter for cases. This increased mortality risk was also reflected in subsequent multivariate analyses. Patients with COPD and NTMLD were more likely to die (odds ratio [95% CI], 1.39 [1.27-1.51]), had higher mortality rates (rate ratio [95% CI], 1.36 [1.28-1.45]), and had higher hazard of death (hazard ratio [95% CI], 1.37 [1.28-1.46]) than control patients. CONCLUSIONS: The substantial incremental mortality burden associated with NTMLD in patients with COPD highlights the importance of developing interventions targeting this high-risk group and may indicate an unmet need for timely and appropriate management of NTMLD.

Visual Attention, Bias, and Social Dispositions Toward People With Facial Anomalies: A Prospective Study With Eye-Tracking Technology.

BACKGROUND: Facial attractiveness influences our perceptions of others, with beautiful faces reaping societal rewards and anomalous faces encountering penalties. The purpose of this study was to determine associations of visual attention with bias and social dispositions toward people with facial anomalies. METHODS: Sixty subjects completed tests evaluating implicit bias, explicit bias, and social dispositions before viewing publicly available images of preoperative and postoperative patients with hemifacial microsomia. Eye-tracking was used to register visual fixations. RESULTS: Participants with higher implicit bias scores fixated significantly less on the cheek and ear region preoperatively (P = 0.004). Participants with higher scores in empathic concern and perspective taking fixated more on the forehead and orbit preoperatively (P = 0.045) and nose and lips (P = 0.027) preoperativel. CONCLUSIONS: Participants with higher levels of implicit bias spent less visual attention on anomalous facial anatomy, whereas participants with higher levels of empathic concern and perspective taking spent more visual attention on normal facial anatomy. Levels of bias and social dispositions such as empathy may predict layperson gaze patterns toward those with facial anomalies and provide insights to neural mechanisms underlying the "anomalous is bad" paradigm.

The scope of using pragmatic language tests for early detection of dementia: A systematic review of investigations using figurative language.

INTRODUCTION: Dementia cases are expected to rise to 81.1 million in 2040. Efforts are underway to develop diagnostic methods to facilitate early detection of the disease. Herein we review research findings focusing on pragmatic dysfunction in patients with dementia and evaluate the usefulness of assessing dementia and its progress with a battery of tests assessing figurative language skills. METHODS: A total of 74,778 article titles were identified from EMBASE, PubMed, and Google Scholar databases. After systematic screening, 51 journal articles were selected for the final review. RESULT: The review suggests that impaired figurative language might be a marker for early cognitive decline. Different forms of figurative language may be impaired at different stages of the disease and in different types of dementia involving different neuropathologies. CONCLUSION: The use of pragmatic tests in combination with the existing diagnostic protocols might increase the probability of early diagnosis. HIGHLIGHTS Pragmatic impairment could be a marker of early cognitive impairment. Figurative language-an important pragmatic aspect-is disrupted in mild cognitive impairment (MCI) and early Alzheimer's disease (AD). Figurative language impairment might precede literal language impairment. Pragmatic tests could be more sensitive than standard neuropsychological tests. Inclusion of pragmatic tests in diagnostic guidelines might bolster early detection.

Impact of initiation of amikacin liposome inhalation suspension on hospitalizations and other healthcare resource utilization measures: a retrospective cohort study in real-world settings.

BACKGROUND: Mycobacterium avium complex lung disease (MAC-LD) is an infection that is increasing in frequency, associated with substantial disease burden, and often refractory to treatment. Amikacin liposome inhalation suspension (ALIS) is the first therapy approved for refractory MAC-LD. In the CONVERT study of adult patients with refractory MAC-LD, adding ALIS to a multidrug background regimen showed evidence of MAC infection elimination in sputum by month 6, which was maintained in most patients through the end of treatment (≤ 12 months post-conversion). This study assessed changes in healthcare resource utilization (HCRU) among patients initiating ALIS in real-world settings. METHODS: This retrospective cohort study of the All-Payer Claims Database (October 2018-April 2020) included patients aged ≥ 18 years with ≥ 1 pharmacy claim for ALIS and ≥ 12 months of continuous health plan enrollment pre- and post-ALIS initiation. Respiratory disease-related (and all-cause) HCRU (hospitalizations, length of stay [LOS], emergency department [ED] visits, and outpatient office visits) were compared 12 months pre- and post-ALIS initiation. Outcomes were reported at 6-month intervals; 0-6 months pre-ALIS initiation was the reference period for statistical comparisons. RESULTS: A total of 331 patients received ALIS, with HCRU highest in the 6 months pre-ALIS initiation. Compared with 26.9% during the reference period, respiratory-related hospitalizations decreased to 19.3% (P < 0.01) and 15.4% (P < 0.0001) during 0-6 and 7-12 months post-ALIS initiation, respectively. Mean number of respiratory disease-related hospitalizations per patient/6-month period decreased from 1.0 (reference period) to 0.6 (P < 0.0005) at both timepoints post-ALIS initiation. A similar pattern was observed for all-cause hospitalizations and hospitalizations per patient/6-month period (both P < 0.005). Reductions in all-cause and respiratory disease-related LOS post-ALIS initiation were significant (both P < 0.05). ED visits were few and unchanged during the study. Significant reductions per patient/6-month period in all-cause and respiratory-related outpatient office visits were observed post-ALIS initiation (all P < 0.01). CONCLUSIONS: In this first real-world study of ALIS, respiratory disease-related (and all-cause) hospitalizations and outpatient visits were reduced in the 12 months following ALIS initiation. The results of this study provide HCRU-related information to better understand the impact of initiating ALIS treatment. TRIAL REGISTRATION: Not appliable.

The role of expertise in the aesthetic evaluation of mathematical equations.

There is a notion that mathematical equations can be considered aesthetic objects. However, whereas some aesthetic experiences are triggered primarily by the sensory properties of objects, for mathematical equations aesthetic judgments extend beyond their sensory qualities and are also informed by semantics and knowledge. Therefore, to the extent that expertise in mathematics represents the accumulation of domain knowledge, it should influence aesthetic judgments of equations. In a between-groups study design involving university students who majored in mathematics (i.e., experts) or not (i.e., laypeople), we found support for the hypothesis that mathematics majors exhibit more agreement in their aesthetic judgments of equations-reflecting a greater degree of shared variance driven by formal training in the domain. Furthermore, their judgments were driven more strongly by familiarity and meaning than was the case for laypeople. These results suggest that expertise via advanced training in mathematics alters (and sharpens) aesthetic judgments of mathematical equations.

The Cerebellum and Beauty: The Impact of the Cerebellum in Art Experience and Creativity.

There is growing interest in the cerebellum's contributions to higher order functions of the human brain. When considering specific activities of the human cerebellum related to art, we differentiate two broad areas. Neural activity within different locations of the cerebellum is involved in art perception and in artistic creativity. The cerebellum plays an underappreciated role in neuroaesthetics, including the perception and evaluation of art objects, their appreciation and affective aesthetic experience. Certain areas of the cerebellum presumably are of particular relevance, incorporating cognitive and affective issues within large-scaled neural networks in perceiving and appraising artworks. For art creativity, many investigations report cerebellar implementations. Important areas in these domains are evolutionary younger parts of the cerebellar hemispheres, in particular the lobule VII with its Crus I and II, influencing crucial networks such as the Default Mode Network in optimizing creativity. These structures help guide pattern recognition and in art appreciation as they may play a role in predicting ongoing neural network activities through a crucial frontoparietal axis. In this chapter, we consider how our current neuroscientific understanding of cerebellar functions point to a likely role of the cerebellum in art appreciation and creativity.

Associations of Facial Proportionality, Attractiveness, and Character Traits.

BACKGROUND: Facial proportionality and symmetry are positively associated with perceived levels of facial attractiveness. OBJECTIVE: The aims of this study were to confirm and extend the association of proportionality with perceived levels of attractiveness and character traits and determine differences in attractiveness and character ratings between "anomalous" and "typical" faces using a large dataset. METHODS: Ratings of 597 unique individuals from the Chicago Face Database were used. A formula was developed as a proxy of relative horizontal proportionality, where a proportionality score of "0" indicated perfect proportionality and more negative scores indicated less proportionality. Faces were categorized as "anomalous" or "typical" by 2 independent reviewers based on physical features. RESULTS: Across the ratings for all faces, Spearman correlations revealed greater proportionality was associated with attractiveness ( ρ = 0.292, P < 0.001) and trustworthiness ( ρ = 0.193, P < 0.001), while lesser proportionality was associated with impressions of anger (ρ = 0.132, P = 0.001), dominance (ρ = 0.259, P < 0.001), and threateningness ( ρ = 0.234, P < 0.001). Mann-Whitney U tests revealed the typical cohort had significantly higher levels of proportionality (-13.98 versus -15.14, P = 0.030) and ratings of attractiveness (3.39 versus 2.99, P < 0.001) and trustworthiness (3.48 versus 3.35, P < 0.001). CONCLUSIONS: This study demonstrated that facial proportionality is not only significantly associated with higher ratings of attractiveness, but also associated with judgements of trustworthiness. Proportionality plays a role in evoking negative attributions of personality characteristics to people with facial anomalies.

Movement in Aesthetic Experiences: What We Can Learn from Parkinson Disease.

Visual art offers cognitive neuroscience an opportunity to study how subjective value is constructed from representations supported by multiple neural systems. A surprising finding in aesthetic judgment research is the functional activation of motor areas in response to static, abstract stimuli, like paintings, which has been hypothesized to reflect embodied simulations of artists' painting movements, or preparatory approach-avoidance responses to liked and disliked artworks. However, whether this motor involvement functionally contributes to aesthetic appreciation has not been addressed. Here, we examined the aesthetic experiences of patients with motor dysfunction. Forty-three people with Parkinson disease and 40 controls made motion and aesthetics judgments of high-motion Jackson Pollock paintings and low-motion Piet Mondrian paintings. People with Parkinson disease demonstrated stable and internally consistent preferences for abstract art, but their perception of movement in the paintings was significantly lower than controls in both conditions. The patients also demonstrated enhanced preferences for high-motion art and an altered relationship between motion and aesthetic appreciation. Our results do not accord well with a straightforward embodied simulation account of aesthetic experiences, because artworks that did not include visual traces of the artist's actions were still experienced as lower in motion by Parkinson patients. We suggest that the motor system may be involved in integrating low-level visual features to form abstract representations of movement rather than simulations of specific bodily actions. Overall, we find support for hypotheses linking motor responses and aesthetic appreciation and show that altered neural functioning changes the way art is perceived and valued.

The neuroaesthetics of architectural spaces.

People in developed countries spend over 90% of their time in built environments. Yet, we know little about its pervasive and often hidden effects on our mental state and our brain. Despite growing interest in the neuroscience of architecture, much of this scholarship has been descriptive. The typical approach is to map knowledge of the brain onto constructs important to architecture. For a programmatic line of research, how might descriptive neuroarchitecture be transformed into an experimental science? We review the literature outlining how one might consider experimental architecture first by examining the role of natural features in architectural settings. We then turn to the human experience of occupants, and hypothesized that aesthetic responses to architectural interiors reduce to key psychological dimensions. Conducting Psychometric Network Analysis (PNA) and Principal Components Analysis (PCA) on responses to curated images, we identified three components: coherence (ease of organizing and comprehending a scene), fascination (informational richness and generated interest), and hominess (personal ease and comfort). Coherence and fascination are well-established dimensions for natural scenes. Hominess was a new dimension related to architectural interiors. Central to all three communities in the PNA was emotional valence. We also reanalyzed data from an earlier fMRI study in which participants made beauty and approach-avoidance decisions while viewing the same images. Regardless of task, the degree of fascination covaried with neural activity in the right lingual gyrus. In contrast, coherence covaried with neural activity in the left inferior occipital gyrus only when participants judged beauty, and hominess covaried with neural activity in the left cuneus only when they made approach-avoidance decisions. The visual brain harbours hidden sensitivities to architectural interiors that are captured by the dimensions of coherence, fascination, and hominess. These findings represent first steps towards an experimental neuroarchitecture.

Context matters: Novel metaphors in supportive and non-supportive contexts.

Creative language is defined as linguistic output that is both novel and appropriate. Metaphors are one such example of creative language in which one concept is used to express another by highlighting relevant semantic features. While novelty is an inherent property of unfamiliar metaphors, appropriateness depends on the context. The current study tests the hypothesis that the context in which metaphors are encountered affects their processing. We examined the neural effects of comprehending metaphors in context by comparing neural activations in response to novel metaphors and literal sentences that were either embedded in a meaningful narrative or in matched jabberwocky contexts. We found that the neural correlates of processing metaphoric sentences and their literal counterparts are indistinguishable when embedded in a narrative: both conditions activate bilateral areas along the anterior temporal poles, middle temporal gyri, superior temporal sulci, and the angular gyri. Metaphors embedded in a narrative as compared to their identical counterparts embedded in jabberwocky show increased responses in sensorimotor areas that correspond to the modality of the literal meaning of the target word, perhaps reflecting deeper semantic processing. Our results confirm that context affects neural mechanisms for understanding creative ideas.

Behavioral and Neural Representations of Spatial Directions across Words, Schemas, and Images.

Modern spatial navigation requires fluency with multiple representational formats, including visual scenes, signs, and words. These formats convey different information. Visual scenes are rich and specific but contain extraneous details. Arrows, as an example of signs, are schematic representations in which the extraneous details are eliminated, but analog spatial properties are preserved. Words eliminate all spatial information and convey spatial directions in a purely abstract form. How does the human brain compute spatial directions within and across these formats? To investigate this question, we conducted two experiments on men and women: a behavioral study that was preregistered and a neuroimaging study using multivoxel pattern analysis of fMRI data to uncover similarities and differences among representational formats. Participants in the behavioral study viewed spatial directions presented as images, schemas, or words (e.g., "left"), and responded to each trial, indicating whether the spatial direction was the same or different as the one viewed previously. They responded more quickly to schemas and words than images, despite the visual complexity of stimuli being matched. Participants in the fMRI study performed the same task but responded only to occasional catch trials. Spatial directions in images were decodable in the intraparietal sulcus bilaterally but were not in schemas and words. Spatial directions were also decodable between all three formats. These results suggest that intraparietal sulcus plays a role in calculating spatial directions in visual scenes, but this neural circuitry may be bypassed when the spatial directions are presented as schemas or words.SIGNIFICANCE STATEMENT Human navigators encounter spatial directions in various formats: words ("turn left"), schematic signs (an arrow showing a left turn), and visual scenes (a road turning left). The brain must transform these spatial directions into a plan for action. Here, we investigate similarities and differences between neural representations of these formats. We found that bilateral intraparietal sulci represent spatial directions in visual scenes and across the three formats. We also found that participants respond quickest to schemas, then words, then images, suggesting that spatial directions in abstract formats are easier to interpret than concrete formats. These results support a model of spatial direction interpretation in which spatial directions are either computed for real world action or computed for efficient visual comparison.

Dynamics of aesthetic experience are reflected in the default-mode network.

Neuroaesthetics is a rapidly developing interdisciplinary field of research that aims to understand the neural substrates of aesthetic experience: While understanding aesthetic experience has been an objective of philosophers for centuries, it has only more recently been embraced by neuroscientists. Recent work in neuroaesthetics has revealed that aesthetic experience with static visual art engages visual, reward and default-mode networks. Very little is known about the temporal dynamics of these networks during aesthetic appreciation. Previous behavioral and brain imaging research suggests that critical aspects of aesthetic experience have slow dynamics, taking more than a few seconds, making them amenable to study with fMRI. Here, we identified key aspects of the dynamics of aesthetic experience while viewing art for various durations. In the first few seconds following image onset, activity in the DMN (and high-level visual and reward regions) was greater for very pleasing images; in the DMN this activity counteracted a suppressive effect that grew longer and deeper with increasing image duration. In addition, for very pleasing art, the DMN response returned to baseline in a manner time-locked to image offset. Conversely, for non-pleasing art, the timing of this return to baseline was inconsistent. This differential response in the DMN may therefore reflect the internal dynamics of the participant's state: The participant disengages from art-related processing and returns to stimulus-independent thought. These dynamics suggest that the DMN tracks the internal state of a participant during aesthetic experience.

Differential roles of gestures on spatial language in neurotypical elderly adults and individuals with focal brain injury.

Gestures might serve communicative functions by supplementing spoken expressions or restorative functions by facilitating speech production. Also, speakers with speech deficits use gestures to compensate for their speech impairments. In this study, we examined gesture use in speakers with and without speech impairments and how spoken spatial expressions changed when gestures were restrained. Six patients with speech problems and with left frontal and/or temporal lesions and 20 neurotypical controls described motion events in 3 different conditions (spontaneous gesture, only speech, and only gesture). In addition to the group analyses, we ran case analyses. Results showed that patients used more gestures compared to controls. Gestures served both communicative and restorative functions for patients whereas controls only used gestures for communicative purposes. Case analyses revealed that there were differential patterns among patients. Overall, gesture production is multifunctional and gestures serve different functions for different populations as well as within a population.

Effect of Alteplase vs Aspirin on Functional Outcome for Patients With Acute Ischemic Stroke and Minor Nondisabling Neurologic Deficits: The PRISMS Randomized Clinical Trial.

Importance: More than half of patients with acute ischemic stroke have minor neurologic deficits (National Institutes of Health Stroke Scale [NIHSS] score of 0-5) at presentation. Although prior major trials of alteplase included patients with low NIHSS scores, few without clearly disabling deficits were enrolled. Objective: To evaluate the efficacy and safety of alteplase in patients with NIHSS scores of 0 to 5 whose deficits are not clearly disabling. Design, Setting, and Participants: The PRISMS trial was designed as a 948-patient, phase 3b, double-blind, double-placebo, multicenter randomized clinical trial of alteplase compared with aspirin for emergent stroke at 75 stroke hospital networks in the United States. Patients with acute ischemic stroke whose deficits were scored as 0 to 5 on the NIHSS and judged not clearly disabling and in whom study treatment could be initiated within 3 hours of onset were eligible and enrolled from May 30, 2014, to December 20, 2016, with final follow-up on March 22, 2017. Interventions: Participants were randomized to receive intravenous alteplase at the standard dose (0.9 mg/kg) with oral placebo (n = 156) or oral aspirin, 325 mg, with intravenous placebo (n = 157). Main Outcomes and Measures: The primary outcome was the difference in favorable functional outcome, defined as a modified Rankin Scale score of 0 or 1 at 90 days via Cochran-Mantel-Haenszel test stratified by pretreatment NIHSS score, age, and time from onset to treatment. Because of early termination of the trial, prior to unblinding or interim analyses, the plan was revised to examine the risk difference of the primary outcome by a linear model adjusted for the same factors. The primary safety end point was symptomatic intracranial hemorrhage (sICH) within 36 hours of intravenous study treatment. Results: Among 313 patients enrolled at 53 stroke networks (mean age, 62 [SD, 13] years; 144 [46%] women; median NIHSS score, 2 [interquartile range {IQR}, 1-3]; median time to treatment, 2.7 hours [IQR, 2.1-2.9]), 281 (89.8%) completed the trial. At 90 days, 122 patients (78.2%) in the alteplase group vs 128 (81.5%) in the aspirin group achieved a favorable outcome (adjusted risk difference, -1.1%; 95% CI, -9.4% to 7.3%). Five alteplase-treated patients (3.2%) vs 0 aspirin-treated patients had sICH (risk difference, 3.3%; 95% CI, 0.8%-7.4%). Conclusions and Relevance: Among patients with minor nondisabling acute ischemic stroke, treatment with alteplase vs aspirin did not increase the likelihood of favorable functional outcome at 90 days. However, the very early study termination precludes any definitive conclusions, and additional research may be warranted. Trial Registration: ClinicalTrials.gov Identifier: NCT02072226.

Buildings, Beauty, and the Brain: A Neuroscience of Architectural Experience.

A burgeoning interest in the intersection of neuroscience and architecture promises to offer biologically inspired insights into the design of spaces. The goal of such interdisciplinary approaches to architecture is to motivate construction of environments that would contribute to peoples' flourishing in behavior, health, and well-being. We suggest that this nascent field of neuroarchitecture is at a pivotal point in which neuroscience and architecture are poised to extend to a neuroscience of architecture. In such a research program, architectural experiences themselves are the target of neuroscientific inquiry. Here, we draw lessons from recent developments in neuroaesthetics to suggest how neuroarchitecture might mature into an experimental science. We review the extant literature and offer an initial framework from which to contextualize such research. Finally, we outline theoretical and technical challenges that lie ahead.

Orange is the new aesthetic.

The Distancing-Embracing model proposes that negative emotions are constitutive of aesthetic experiences. This move is welcome and adds depth to empirical aesthetics. However, the model's emphasis on temporality challenges how best to think of static art forms. I suggest that "decisive" and "distilled" moments dilate time in the viewer's mind and might allow the model to accommodate photography and painting.

Stimulus needs are a moving target: 240 additional matched literal and metaphorical sentences for testing neural hypotheses about metaphor.

As the cognitive neuroscience of metaphor has evolved, so too have the theoretical questions of greatest interest. To keep pace with these developments, in the present study we generated a large set of metaphoric and literal sentence pairs ideally suited to addressing the current methodological and conceptual needs of metaphor researchers. In particular, the need has emerged to distinguish metaphors along three dimensions: the grammatical class of their base terms, the sensorimotor features of their base terms, and the syntactic form in which the base terms appear. To meet this need, we generated nominal metaphors (and matched literal sentences) using entity nouns as the base terms, with the intention that they be used in concert with already published sets of predicate metaphors or nominal metaphors using event nouns. Using the results of three norming experiments, we provide 120 pairs of closely matched metaphoric and literal sentences that are characterized along 14 dimensions: 11 at the sentence level (length, frequency, concreteness, familiarity, naturalness, imageability, figurativeness, interpretability, ease of interpretation, valence, and valence judgment reaction time), and three related to the base term (visual, motion, and auditory imagery). These items extend previously published stimuli, filling an extant gap in metaphor research and allowing for tests of new behavioral and neural hypotheses about metaphor.

Impact of contour on aesthetic judgments and approach-avoidance decisions in architecture.

On average, we urban dwellers spend about 90% of our time indoors, and share the intuition that the physical features of the places we live and work in influence how we feel and act. However, there is surprisingly little research on how architecture impacts behavior, much less on how it influences brain function. To begin closing this gap, we conducted a functional magnetic resonance imaging study to examine how systematic variation in contour impacts aesthetic judgments and approach-avoidance decisions, outcome measures of interest to both architects and users of spaces alike. As predicted, participants were more likely to judge spaces as beautiful if they were curvilinear than rectilinear. Neuroanatomically, when contemplating beauty, curvilinear contour activated the anterior cingulate cortex exclusively, a region strongly responsive to the reward properties and emotional salience of objects. Complementing this finding, pleasantness--the valence dimension of the affect circumplex--accounted for nearly 60% of the variance in beauty ratings. Furthermore, activation in a distributed brain network known to underlie the aesthetic evaluation of different types of visual stimuli covaried with beauty ratings. In contrast, contour did not affect approach-avoidance decisions, although curvilinear spaces activated the visual cortex. The results suggest that the well-established effect of contour on aesthetic preference can be extended to architecture. Furthermore, the combination of our behavioral and neural evidence underscores the role of emotion in our preference for curvilinear objects in this domain.

Common and unique representations in pFC for face and place attractiveness.

Although previous neuroimaging research has identified overlapping correlates of subjective value across different reward types in the ventromedial pFC (vmPFC), it is not clear whether this "common currency" evaluative signal extends to the aesthetic domain. To examine this issue, we scanned human participants with fMRI while they made attractiveness judgments of faces and places-two stimulus categories that are associated with different underlying rewards, have very different visual properties, and are rarely compared with each other. We found overlapping signals for face and place attractiveness in the vmPFC, consistent with the idea that this region codes a signal for value that applies across disparate reward types and across both economic and aesthetic judgments. However, we also identified a subregion of vmPFC within which activity patterns for face and place attractiveness were distinguishable, suggesting that some category-specific attractiveness information is retained in this region. Finally, we observed two separate functional regions in lateral OFC: one region that exhibited a category-unique response to face attractiveness and another region that responded strongly to faces but was insensitive to their value. Our results suggest that vmPFC supports a common mechanism for reward evaluation while also retaining a degree of category-specific information, whereas lateral OFC may be involved in basic reward processing that is specific to only some stimulus categories.

Dorsal striatum is necessary for stimulus-value but not action-value learning in humans.

Several lines of evidence implicate the striatum in learning from experience on the basis of positive and negative feedback. However, the necessity of the striatum for such learning has been difficult to demonstrate in humans, because brain damage is rarely restricted to this structure. Here we test a rare individual with widespread bilateral damage restricted to the dorsal striatum. His performance was impaired and not significantly different from chance on several classic learning tasks, consistent with current theories regarding the role of the striatum. However, he also exhibited remarkably intact performance on a different subset of learning paradigms. The tasks he could perform can all be solved by learning the value of actions, while those he could not perform can only be solved by learning the value of stimuli. Although dorsal striatum is often thought to play a specific role in action-value learning, we find surprisingly that dorsal striatum is necessary for stimulus-value but not action-value learning in humans.