Blood transfusion practices in dialysis patients in a dynamic regulatory environment.

BACKGROUND: In 2011, Medicare implemented a prospective payment system (PPS) covering an expanded bundle of services that excluded blood transfusions. This led to concern about inappropriate substitution of transfusions for other anemia management methods. STUDY DESIGN: Medicare claims were used to calculate transfusion rates among dialysis patients pre- and post-PPS. Linear probability regressions adjusted transfusion trends for patient characteristics. SETTING & PARTICIPANTS: Dialysis patients for whom Medicare was the primary payer between 2008 and 2012. PREDICTOR: Pre-PPS (2008-2010) versus post-PPS (2011-2012). OUTCOMES & MEASUREMENTS: Monthly and annual probability of receiving one or more blood transfusions. RESULTS: Monthly rates of one or more transfusions varied from 3.8%-4.8% and tended to be lowest in 2010. Annual rates of transfusion events per patient were -10% higher in relative terms post-PPS, but the absolute magnitude of the increase was modest (-0.05 events/patient). A larger proportion received 4 or more transfusions (3.3% in 2011 and 2012 vs 2.7%-2.8% in prior years). Controlling for patient characteristics, the monthly probability of receiving a transfusion was significantly higher post-PPS (ß = 0.0034; P < 0.001), representing an -7% relative increase. Transfusions were more likely for females and patients with more comorbid conditions and less likely for blacks both pre- and post-PPS. LIMITATIONS: Possible underidentification of transfusions in the Medicare claims, particularly in the inpatient setting. Also, we do not observe which patients might be appropriate candidates for kidney transplantation. CONCLUSIONS: Transfusion rates increased post-PPS, but these increases were modest in both absolute and relative terms. The largest increase occurred for patients already receiving several transfusions. Although these findings may reduce concerns regarding the impact of Medicare's PPS on inappropriate transfusions that impair access to kidney transplantation or stress blood bank resources, transfusions should continue to be monitored.

Face inversion increases attractiveness.

Assessing facial attractiveness is a ubiquitous, inherent, and hard-wired phenomenon in everyday interactions. As such, it has highly adapted to the default way that faces are typically processed: viewing faces in upright orientation. By inverting faces, we can disrupt this default mode, and study how facial attractiveness is assessed. Faces, rotated at 90 (tilting to either side) and 180°, were rated on attractiveness and distinctiveness scales. For both orientations, we found that faces were rated more attractive and less distinctive than upright faces. Importantly, these effects were more pronounced for faces rated low in upright orientation, and smaller for highly attractive faces. In other words, the less attractive a face was, the more it gained in attractiveness by inversion or rotation. Based on these findings, we argue that facial attractiveness assessments might not rely on the presence of attractive facial characteristics, but on the absence of distinctive, unattractive characteristics. These unattractive characteristics are potentially weighed against an individual, attractive prototype in assessing facial attractiveness.

Vision-for-action: the effects of object property discrimination and action state on affordance compatibility effects.

When a person views an object, the action the object evokes appears to be activated independently of the person's intention to act. We demonstrate two further properties of this vision-to-action process. First, it is not completely automatic, but is determined by the stimulus properties of the object that are attended. Thus, when a person discriminates the shape of an object, action affordance effects are observed; but when a person discriminates an object's color, no affordance effects are observed. The former, shape property is associated with action, such as how an object might be grasped; the latter, color property is irrelevant to action. Second, we also show that the action state of an object influences evoked action. Thus, active objects, with which current action is implied, produce larger affordance effects than passive objects, with which no action is implied. We suggest that the active object activates action simulation processes similar to those proposed in mirror systems.

Gaze cuing and affective judgments of objects: I like what you look at.

When we see another person look somewhere, we automatically attend to the same location in space. This joint attention emerges early in life and has a great impact on social interactions in development and in everyday adult life. The direction of another's gaze indicates what object is of current interest, which may be the target for a subsequent action. In this study, we found that objects that are looked at by other people are liked more than objects that do not receive the attention of other people (Experiment 1). This suggests that observing averted gaze can have an impact on the affective appraisals of objects in the environment. This liking effect was absent when an arrow was used to cue attention (Experiment 2). This underlines the importance of other people's interactions with objects for generating our own impressions of such stimuli in the world.

Inhibition of object identity in inhibition of return: implications for encoding and retrieving inhibitory processes.

Inhibition of return (IOR) effects, in which participants detect a target in a cued box more slowly than one in an uncued box, suggest that behavior is aided by inhibition of recently attended irrelevant locations. To investigate the controversial question of whether inhibition can be applied to object identity in these tasks, in the present research we presented faces upright or inverted during cue and/or target sequences. IOR was greater when both cue and target faces were upright than when cue and/or target faces were inverted. Because the only difference between the conditions was the ease of facial recognition, this result indicates that inhibition was applied to object identity. Interestingly, inhibition of object identity affected IOR both when encoding a cue face and retrieving information about a target face. Accordingly, we propose that episodic retrieval of inhibition associated with object identity may mediate behavior in cuing tasks.

Inhibition of return affects contrast sensitivity.

Inhibition of return (IOR)-a slow response to targets at recently attended locations, is believed to play an important role in guiding behaviour. In the attention literature it has been shown that attentional capture by an exogenous cue affects contrast sensitivity so that it alters the appearance of low-contrast stimuli. Despite a significant amount of work over the last quarter century on IOR, it is not yet clear whether IOR operates in the same way. In the current study we examined the effect of IOR on contrast sensitivity-a very early, low-level perceptual process. We found in both a detection task and an orientation discrimination task that lower contrast was needed to detect the stimulus (Experiment 1) and determine its orientation (Experiment 2) at the cued location than at the uncued location, at short cue-target delays, while higher contrast was needed at long delays-reflecting IOR. These results clearly demonstrate that IOR affects contrast sensitivity in a similar way as attentional capture does and suggest that IOR increases perceived contrast of an object in the uncued location.

Eye movements during object recognition in visual agnosia.

This paper reports the first ever detailed study about eye movement patterns during single object recognition in visual agnosia. Eye movements were recorded in a patient with an integrative agnosic deficit during two recognition tasks: common object naming and novel object recognition memory. The patient showed normal directional biases in saccades and fixation dwell times in both tasks and was as likely as controls to fixate within object bounding contour regardless of recognition accuracy. In contrast, following initial saccades of similar amplitude to controls, the patient showed a bias for short saccades. In object naming, but not in recognition memory, the similarity of the spatial distributions of patient and control fixations was modulated by recognition accuracy. The study provides new evidence about how eye movements can be used to elucidate the functional impairments underlying object recognition deficits. We argue that the results reflect a breakdown in normal functional processes involved in the integration of shape information across object structure during the visual perception of shape.

Self produced and observed actions influence emotion: the roles of action fluency and eye gaze.

Affective responses to objects can be influenced by cognitive processes such as perceptual fluency. Here we investigated whether the quality of motor interaction with an object influences affective response to the object. Participants grasped and moved objects using either a fluent action or a non-fluent action (avoiding an obstacle). Liking ratings were higher for objects in the fluent condition. Two further studies investigated whether the fluency of another person's actions influences affective response. Observers watched movie clips of the motor actions described above, in conditions where the observed actor could be seen to be looking towards the grasped object, or where the actor's head and gaze were not visible. Two results were observed: First, when the actor's gaze cannot be seen, liking ratings of the objects are reduced. Second, action fluency of observed actions does influence liking ratings, but only when the actor's gaze towards the object is visible. These findings provide supporting evidence for the important role of observed eye gaze in action simulation, and demonstrate that non-emotive actions can evoke empathic states in observers.

Object-based representations facilitate memory for inhibitory processes.

Previous work has shown that in a sequential cueing task, inhibition of the return of attention (IOR) can be observed for up to four or five loci. We have argued that the inhibition processes mediating IOR are associated with object-based representations, and it is object-based representations that are maintained in memory. Experiments presented here show that, compared with standard conditions in which a number of identical grey squares are cued, cueing empty locations tends to reduce the memory for prior inhibitory processes; while cueing objects which are distinctive in colour and shape tends to increase memory for inhibition. Converging with other recent findings, we conclude that memory for the inhibitory processes of attention facilitates visual search and that this memory is dependent on object-based representations.