Neuroimaging evidence for the direct role of auditory scene analysis in object perception.

Auditory Scene Analysis (ASA) refers to the grouping of acoustic signals into auditory objects. Previously, we have shown that perceived musicality of auditory sequences varies with high-level organizational features. Here, we explore the neural mechanisms mediating ASA and auditory object perception. Participants performed musicality judgments on randomly generated pure-tone sequences and manipulated versions of each sequence containing low-level changes (amplitude; timbre). Low-level manipulations affected auditory object perception as evidenced by changes in musicality ratings. fMRI was used to measure neural activation to sequences rated most and least musical, and the altered versions of each sequence. Next, we generated two partially overlapping networks: (i) a music processing network (music localizer) and (ii) an ASA network (base sequences vs. ASA manipulated sequences). Using Representational Similarity Analysis, we correlated the functional profiles of each ROI to a model generated from behavioral musicality ratings as well as models corresponding to low-level feature processing and music perception. Within overlapping regions, areas near primary auditory cortex correlated with low-level ASA models, whereas right IPS was correlated with musicality ratings. Shared neural mechanisms that correlate with behavior and underlie both ASA and music perception suggests that low-level features of auditory stimuli play a role in auditory object perception.

Manipulation of low-level features modulates grouping strength of auditory objects.

A central challenge of auditory processing involves the segregation, analysis, and integration of acoustic information into auditory perceptual objects for processing by higher order cognitive operations. This study explores the influence of low-level features on auditory object perception. Participants provided perceived musicality ratings in response to randomly generated pure tone sequences. Previous work has shown that music perception relies on the integration of discrete sounds into a holistic structure. Hence, high (versus low) ratings were viewed as indicative of strong (versus weak) object formation. Additionally, participants rated sequences in which random subsets of tones were manipulated along one of three low-level dimensions (timbre, amplitude, or fade-in) at one of three strengths (low, medium, or high). Our primary findings demonstrate how low-level acoustic features modulate the perception of auditory objects, as measured by changes in musicality ratings for manipulated sequences. Secondarily, we used principal component analysis to categorize participants into subgroups based on differential sensitivities to low-level auditory dimensions, thereby highlighting the importance of individual differences in auditory perception. Finally, we report asymmetries regarding the effects of low-level dimensions; specifically, the perceptual significance of timbre. Together, these data contribute to our understanding of how low-level auditory features modulate auditory object perception.

Increasing Pediatric to Adult Healthcare Transition Services Through Clinical Decision Supports.

PURPOSE: Despite American Academy of Pediatrics recommendations that adolescents receive healthcare transition (HCT) services starting at age 12, few do. Electronic health record-based clinical decision support (CDS) tools are effective at promoting healthcare provider adherence to clinical guidelines. This study's purpose was to increase provider HCT services engagement through implementation of a transition-specific CDS and participation in a transition-focused Learning Collaborative (LC). DESIGN AND METHODS: Three pediatric primary care sites of an urban, academic medical center implemented a transition CDS tool for ≥14-year-olds. Previously, one site had a version for ≥16-year-olds. Two sites participated in a LC with Plan-Do-Study-Act cycles targeting HCT services engagement, measured by CDS use and practice-level guideline implementation. RESULTS: From July 2018 through June 2019, providers at LC-participating sites engaged in HCT services at 8.0% (n = 480) and 5.3% (n = 145) of eligible patient visits compared to the control's 3.1% (n = 69). Engagement was highest for ≥18-year-olds at the LC-participating sites, 26.0% (n = 263) and 12.0% (n = 80), compared to the control's 7.2% (n = 31). After expanding from ≥16 to ≥14-year-olds, engagement decreased by 9.5% at ≥16-year-old visits. LC-participating sites reported increased HCT guideline adherence. CONCLUSIONS: Implementation of a transition-specific CDS with LC participation increased provider HCT services engagement and practice-level guideline implementation. Expansion to younger adolescents contributed to decreased engagement for older patients. Future research should assess opportunities to improve uptake and patient outcomes of transition CDS engagement. PRACTICE IMPLICATIONS: Quality improvement activities and transition clinical decision supports can improve provider engagement in recommended transition services for adolescents and young adults.

A Multidisciplinary Transition Consult Service: Patient Referral Characteristics.

PURPOSE: Children's hospitals must provide developmentally appropriate care to increasing numbers of young adults with complex healthcare needs as they transition to adult-oriented care. This article describes the patients, service, and short-term outcomes of an interprofessional healthcare transition (HCT) consult team comprised of nurses, social workers, a community health worker, and physicians. DESIGN AND METHODS: The Adult Consult Team's tiered population framework stratifies patients by medical complexity. The team coordinates HCT services for patients with the highest complexity. Patients at least 18 years old are eligible if they have at least two specialists or an intellectual or developmental disability (IDD). Through a comprehensive medical and psychosocial assessment, the team prepares patients/families for adult-oriented healthcare. RESULTS: The Adult Consult Team received 197 referrals from July 2017 to June 2018. Patients had at least two specialists (73%), IDD (71%), technology dependence (e.g., gastrostomy tube, 37%) and Medicaid insurance (57%). The team assisted patients seen in its outpatient clinic with navigating mental health services (39%), insurance issues (13%), IDD services (15%), and the guardianship process (37%) and creating comprehensive care plans. CONCLUSIONS: The Adult Consult Team transferred 30 patients with medical complexity to adult primary and specialty care, significantly improving pediatric inpatient and outpatient capacity for pediatric-aged patients. A broad range of young adult medical, psychosocial, legal, educational, and vocational needs were addressed. PRACTICE IMPLICATIONS: An interprofessional team approach can help large pediatric healthcare systems address the multi-faceted needs of patients who are medically and psychosocially complex as they enter adulthood.

Opportunity Cost Neglect Attenuates the Effect of Choices on Preferences.

The idea that choices alter preferences has been widely studied in psychology, yet prior research has focused primarily on choices for which all alternatives were salient at the time of choice. Opportunity costs capture the value of the best forgone alternative and should be considered as part of any decision process, yet people often neglect them. How does the salience of opportunity costs at the time of choice influence subsequent evaluations of chosen and forgone options? In three experiments, we found that there was a larger postchoice spread between evaluations of focal options and opportunity costs when opportunity costs were explicit at the time of choice than when they remained implicit.

Long-term Follow-up Study of Fecal Microbiota Transplantation for Severe and/or Complicated Clostridium difficile Infection: A Multicenter Experience.

GOAL: Our aim was to investigate fecal microbiota transplantation (FMT) efficacy in patients with severe and/or complicated Clostridium difficile infection (CDI). BACKGROUND: FMT is successful for recurrent CDI, although its benefit in severe or complicated CDI has not specifically been evaluated. STUDY METHODS: A multicenter long-term follow-up study was performed in patients who received FMT for severe and/or complicated CDI (diagnosed using standard criteria). Pre-FMT and post-FMT questionnaires were completed. Study outcomes included cure rates and time to resolution of symptoms. RESULTS: A total of 17 patients (82% inpatients, 18% outpatients) were included (76.4% women; mean age, 66.4 y; mean follow-up, 11.4 mo). Patients had severe and complicated (76.4%) or either severe or complicated (23.6%) CDI. Sixteen patients (94.1%) had diarrhea, which resolved in 12 (75%; mean time to resolution, 5.7 d) and improved in 4 (25%) after FMT. Eleven patients (64.7%) had abdominal pain, which resolved in 8 (72.7%; mean time to resolution, 9.6 d) and improved in 3 (27.3%) after FMT. Two of 17 patients experienced early CDI recurrence (≤90 d) after FMT (primary cure rate, 88.2%); and in 1 patient, a second FMT resulted in cure (secondary cure rate, 94.1%). Late CDI recurrence (≥90 d) was seen in 1 of 17 patients (5.9%) in association with antibiotics and was successfully treated with a repeat FMT. No adverse effects directly related to FMT occurred. CONCLUSIONS: FMT was successful and safe in this cohort of patients with severe or complicated CDI. Primary and secondary cure rates were 88.2% and 94.1%, respectively.

Sofosbuvir and simeprevir is effective for recurrent hepatitis C in liver transplant recipients.

BACKGROUND & AIMS: Hepatitis C is the most common indication for liver transplantation (LT). Recurrent infection is universal and can lead to progressive liver disease. Widespread use of interferon-based therapy has been limited by intolerability and adverse effects. METHODS: We retrospectively evaluated the safety, tolerability, and efficacy of sofosbuvir and simeprevir in the treatment of recurrent hepatitis C in adult (age >18) LT recipients. RESULTS: Seventy-six percent of the recipients were male and the mean age [±standard deviation (SD)] was 61 (±6.0) years. The mean time (±SD) from LT to treatment initiation was 71.8 (±77.1) months. Of the 26 patients with viral levels measured 4 weeks after starting antiviral therapy, 58% were undetectable. At the end of therapy, viral load was undetectable in all transplant recipients. The 12 week sustained viral response (SVR) was 93%. All recipients were able to complete therapy and no patients required growth factors of blood product transfusion during treatment. No patient required drug interruption of their immunosuppressant therapy. CONCLUSION: The use of sofosbuvir and simeprevir is efficacious, safe, and tolerable and should be considered in LT recipients with recurrent HCV who are candidates for antiviral therapy.

Are you listening? Brain activation associated with sustained nonspatial auditory attention in the presence and absence of stimulation.

Neuroimaging studies investigating the voluntary (top-down) control of attention largely agree that this process recruits several frontal and parietal brain regions. Since most studies used attention tasks requiring several higher-order cognitive functions (e.g. working memory, semantic processing, temporal integration, spatial orienting) as well as different attentional mechanisms (attention shifting, distractor filtering), it is unclear what exactly the observed frontoparietal activations reflect. The present functional magnetic resonance imaging study investigated, within the same participants, signal changes in (1) a "Simple Attention" task in which participants attended to a single melody, (2) a "Selective Attention" task in which they simultaneously ignored another melody, and (3) a "Beep Monitoring" task in which participants listened in silence for a faint beep. Compared to resting conditions with identical stimulation, all tasks produced robust activation increases in auditory cortex, cross-modal inhibition in visual and somatosensory cortex, and decreases in the default mode network, indicating that participants were indeed focusing their attention on the auditory domain. However, signal increases in frontal and parietal brain areas were only observed for tasks 1 and 2, but completely absent for task 3. These results lead to the following conclusions: under most conditions, frontoparietal activations are crucial for attention since they subserve higher-order cognitive functions inherently related to attention. However, under circumstances that minimize other demands, nonspatial auditory attention in the absence of stimulation can be maintained without concurrent frontal or parietal activations.

The object-based shift direction anisotropy is modulated by the horizontal visual field meridian.

Reallocating object-based attention across the visual field meridians is significantly faster horizontally than vertically (termed the shift direction anisotropy; SDA), implicating the meridians in reorienting object-based attention. Here, we tested the modulatory role of the meridians in the emergence of the SDA by manipulating meridian local feature contrast. Considering the notion of separate pools of attentional resources in each cortical hemisphere, we hypothesised that manipulating the horizontal meridian would selectively modulate the SDA. In four experiments, participants were presented with an "L"-shaped object and detected a target that appeared at either a cued location or at one of two equidistant non-cued locations at the far end of the horizontal or vertical object arm. Meridian local feature contrast was manipulated with perceptually strong enhancements (visible lines and colour contrast borders) and perceptually weak enhancements (illusory borders from line texture patterns and inducers). Weak enhancements of the meridians did not significantly modulate SDA magnitude; however, during perceptually strong enhancements of the horizontal meridian, the SDA was significantly reduced compared with both vertical meridian enhancement and no-enhancement conditions. Moreover, horizontal and vertical shift RTs were statistically equivalent when the horizontal meridian was enhanced with a visible line, our strongest manipulation, indicating the SDA was eliminated. These results suggest that the SDA emerges due to reallocating object-based attention across the horizontal meridian. We interpret this finding as evidence in support of the theory by which anatomical segregations of the visual system determine how pools of attentional resources resolve competition between and within cortical hemispheres.

Are neuronal mechanisms of attention universal across human sensory and motor brain maps?

One's experience of shifting attention from the color to the smell to the act of picking a flower seems like a unitary process applied, at will, to one modality after another. Yet, the unique and separable experiences of sight versus smell versus movement might suggest that the neural mechanisms of attention have been separately optimized to employ each modality to its greatest advantage. Moreover, addressing the issue of universality can be particularly difficult due to a paucity of existing cross-modal comparisons and a dearth of neurophysiological methods that can be applied equally well across disparate modalities. Here we outline some of the conceptual and methodological issues related to this problem and present an instructive example of an experimental approach that can be applied widely throughout the human brain to permit detailed, quantitative comparison of attentional mechanisms across modalities. The ultimate goal is to spur efforts across disciplines to provide a large and varied database of empirical observations that will either support the notion of a universal neural substrate for attention or more clearly identify the degree to which attentional mechanisms are specialized for each modality.

Visuotopic cortical connectivity underlying attention revealed with white-matter tractography.

Visual attention selects behaviorally relevant information for detailed processing by resolving competition for representation among stimuli in retinotopically organized visual cortex. The signals that control this attentional biasing are thought to arise in a frontoparietal network of several brain regions, including posterior parietal cortex. Recent studies have revealed a topographic organization in the intraparietal sulcus (IPS) that mirrors the retinotopic organization in visual cortex, suggesting that connectivity between these regions might provide the mechanism by which attention acts on early cortical representations. Using white-matter imaging and functional MRI, we examined the connectivity between two topographic regions of IPS and six retinotopically defined areas in visual cortex. We observed a strong positive correlation between attention modulations in visual cortex and connectivity of posterior IPS, suggesting that these white-matter connections mediate the attention signals that resolve competition among stimuli for representation in visual cortex. Furthermore, we found that connectivity between IPS and V1 consistently respects visuotopic boundaries, whereas connections to V2 and V3/VP disperse by 60%. This pattern is consistent with changes in receptive field size across regions and suggests that a primary role of posterior IPS is to code spatially specific visual information. In summary, we have identified white-matter pathways that are ideally suited to carry attentional biasing signals in visuotopic coordinates from parietal control regions to sensory regions in humans. These results provide critical evidence for the biased competition theory of attention and specify neurobiological constraints on the functional brain organization of visual attention.

Control of spatial and feature-based attention in frontoparietal cortex.

Visual attention selects task-relevant information from scenes to help achieve behavioral goals. Attention can be deployed within multiple domains to select specific spatial locations, features, or objects. Recent evidence has shown that voluntary shifts of attention in multiple domains are consistently associated with transient increases in cortical activity in medial superior parietal lobule, suggesting that this may be the source of a domain-independent control signal that initiates the reconfiguration of attention. To investigate this hypothesis, we used fMRI to measure changes in cortical activation while human subjects shifted attention between spatial locations or between colors at a location. Univariate multiple regression analysis revealed a common, domain-independent transient signal [in posterior parietal cortex (PPC) and prefrontal cortex] time-locked to shifts of attention in both domains. However, multivariate pattern classification conducted on the cortical surface revealed that the spatiotemporal pattern of activity within PPC differed reliably for spatial and feature-based attention shifts. These results suggest that the posterior parietal cortex is a common hub for the control of attention shifts but contains subpopulations of neurons with domain-specific tuning for cognitive control.

Consumer debt and satisfaction in life.

Life's major purchases, such as buying a home or going to college, often involve taking on considerable debt. What are the downstream emotional consequences? Does carrying debt influence consumers' general sense of satisfaction in life? Seven studies examine the relationship between consumers' debt holdings and life satisfaction, showing that the effect depends on the type of debt. Though mortgages tend to comprise consumers' largest debts, and though credit card balances tend to have the highest interest rates, we found among a diverse sample of American adults (N = 5,808) that the type of debt most strongly associated with lower levels of life satisfaction is student loans. We further found that the extent to which consumers mentally label a given debt type as "debt" drives the emotional consequences of those debt holdings, and compared to the other debt types, student loans are perceived more as "debt." Together the findings suggest that carrying debt can spill over to undermine people's overall subjective well-being, especially when their debt is perceived as such. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Developing a Hospital-Wide Transition Program for Young Adults With Medical Complexity.

PURPOSE: Transitional age adults (18-24 years) are the fastest growing cohort of patients in children's hospitals across the nation. The purpose of the study was to standardize pediatric to adult healthcare transfers of complex adult patients through a tiered and multimodal population-based intervention. METHODS: The Multidisciplinary Intervention Navigation Team (MINT) was developed to decrease variations in pediatric to adult medical transitions. System-level goals were to (1) increase provider and leadership engagement, (2) increase transition tools, (3) increase use of electronic medical record-based clinical decision supports, (4) improve transition practices through development of transition policies and clinical pathways; (5) increase transition education for patients and caregivers; (6) increase the adult provider referral network; and (7) implement an adult transition consult service for complex patients (MINT Consult). RESULTS: Between July 2015 and March 2017, MINT identified 11 transition champions, increased the number of divisions with drafted transition policies from 0 to 7, increased utilization of electronic medical record-based transition support tools from 0 to 7 divisions, held seven psychoeducational events, and developed a clinical pathway. MINT has received more than 70 patient referrals. Of patients referred, median age is 21 years (range, 17-43); 70% (n = 42) have an intellectual disability. Referring pediatric providers (n = 25) reported that MINT helped identify adult providers and coordinate care with other Children's Hospital of Philadelphia specialists (78%); and that MINT saved greater than 2 hours of time (48%). CONCLUSIONS: MINT improved the availability, knowledge, and use of transition-related resources; saved significant time among care team members; and increased provider comfort around transition-related conversations.

Target-object integration, attention distribution, and object orientation interactively modulate object-based selection.

The representational basis of attentional selection can be object-based. Various studies have suggested, however, that object-based selection is less robust than spatial selection across experimental paradigms. We sought to examine the manner by which the following factors might explain this variation: Target-Object Integration (targets 'on' vs. part 'of' an object), Attention Distribution (narrow vs. wide), and Object Orientation (horizontal vs. vertical). In Experiment 1, participants discriminated between two targets presented 'on' an object in one session, or presented as a change 'of' an object in another session. There was no spatial cue-thus, attention was initially focused widely-and the objects were horizontal or vertical. We found evidence of object-based selection only when targets constituted a change 'of' an object. Additionally, object orientation modulated the sign of object-based selection: We observed a same-object advantage for horizontal objects, but a same-object cost for vertical objects. In Experiment 2, an informative cue preceded a single target presented 'on' an object or as a change 'of' an object (thus, attention was initially focused narrowly). Unlike in Experiment 1, we found evidence of object-based selection independent of target-object integration. We again found that the sign of selection was modulated by the objects' orientation. This result may reflect a meridian effect, which emerged due to anisotropies in the cortical representations when attention is oriented endogenously. Experiment 3 revealed that object orientation did not modulate object-based selection when attention was oriented exogenously. Our findings suggest that target-object integration, attention distribution, and object orientation modulate object-based selection, but only in combination.

Visual field meridians modulate the reallocation of object-based attention.

Object-based attention (OBA) enhances processing within the boundaries of a selected object. Larger OBA effects have been observed for horizontal compared to vertical rectangles, which were eliminated when controlling for attention shifts across the visual field meridians. We aimed to elucidate the modulatory role of the meridians on OBA. We hypothesized that the contralateral organization of visual cortex accounts for these differences in OBA prioritization. Participants viewed "L"-shaped objects and, following a peripheral cue at the object vertex, detected the presence of a target at the cued location (valid), or at a non-cued location (invalid) offset either horizontally or vertically. In Experiment 1, the single displayed object contained components crossing both meridians. In Experiment 2, one cued object and one non-cued object were displayed such that both crossed the meridians. In Experiment 3, one cued object was sequestered into one screen quadrant, with its vertex either near or far from fixation. Results from Experiments 1 and 2 revealed a horizontal shift advantage (faster RTs for horizontal shifts across the vertical meridian compared to vertical shifts across the horizontal meridian), regardless of whether shifts take place within a cued object (Experiment 1) or between objects (Experiment 2). Results from Experiment 3 revealed no difference between horizontal and vertical shifts for objects that were positioned far from fixation, although the horizontal shift advantage reappeared for objects near fixation. These findings suggest a critical modulatory role of visual field meridians in the efficiency of reorienting object-based attention.

Retinotopic information interacts with category selectivity in human ventral cortex.

Until recently, the general consensus with respect to the organization of ventral visual cortex is that early, retinotopic regions are sensitive to the spatial position of the input stimuli whereas later, higher-order regions are sensitive to the category of the input stimuli. Growing recognition of the bidirectional connectivity of the visual system has challenged this view and recent empirical evidence suggests a more interactive and graded system. Here, based on findings from functional MRI in adult observers, in which meridians and category selective regions are localized and their activation sampled, we support this latter perspective by showing that category effects are present in retinotopic cortical areas and spatial position effects are present in higher-order regions. Furthermore, the results indicate that the retinotopic and later areas are functionally connected suggesting a possible mechanism by which these seemingly disparate effects come to be intermixed in both early and later regions of the visual system.

Saccade latency indexes exogenous and endogenous object-based attention.

Classic studies of object-based attention have utilized keypress responses as the main dependent measure. However, people typically make saccades to fixate important objects. Recent work has shown that attention may act differently when it is deployed covertly versus in advance of a saccade. We further investigated the link between saccades and attention by examining whether object-based effects can be observed for saccades. We adapted the classical double-rectangle cueing paradigm of Egly, Driver, and Rafal (1994), and measured both the first saccade latency and the keypress reaction time (RT) to a target that appeared at the end of one of the two rectangles. Our results showed that saccade latencies exhibited higher sensitivity than did RTs for detecting effects of attention. We also assessed the generality of the attention effects by testing three types of cues: hybrid (predictive and peripheral), exogenous (nonpredictive and peripheral), and endogenous (predictive and central). We found that both RTs and saccade latencies exhibited effects of both space-based and object-based attentional selection. However, saccade latencies showed a more robust attentional modulation than RTs. For the exogenous cues, we observed a spatial inhibition of return along with an object-based effect, implying that object-based attention is independent of space-based attention. Overall, our results revealed an oculomotor correlate of object-based attention, suggesting that, in addition to spatial priority, object-level priority also affects saccade planning.

Tracking the will to attend: Cortical activity indexes self-generated, voluntary shifts of attention.

The neural substrates of volition have long tantalized philosophers and scientists. Over the past few decades, researchers have employed increasingly sophisticated technology to investigate this issue, but many studies have been limited considerably by their reliance on intrusive experimental procedures (e.g., abrupt instructional cues), measures of brain activity contaminated by overt behavior, or introspective self-report techniques of questionable validity. Here, we used multivoxel pattern time-course analysis of functional magnetic resonance imaging data to index voluntary, covert perceptual acts-shifts of visuospatial attention-in the absence of instructional cues, overt behavioral indices, and self-report. We found that these self-generated, voluntary attention shifts were time-locked to activity in the medial superior parietal lobule, supporting the hypothesis that this brain region is engaged in voluntary attentional reconfiguration. Self-generated attention shifts were also time-locked to activity in the basal ganglia, a novel finding that motivates further research into the role of the basal ganglia in acts of volition. Remarkably, prior to self-generated shifts of attention, we observed early and selective increases in the activation of medial frontal (dorsal anterior cingulate) and lateral prefrontal (right middle frontal gyrus) cortex-activity that likely reflects processing related to the intention or preparation to reorient attention. These findings, which extend recent evidence on freely chosen motor movements, suggest that dorsal anterior cingulate and lateral prefrontal cortices play key roles in both overt and covert acts of volition, and may constitute core components of a brain network underlying the will to attend.

The effects of visual search efficiency on object-based attention.

The attentional prioritization hypothesis of object-based attention (Shomstein & Yantis in Perception & Psychophysics, 64, 41-51, 2002) suggests a two-stage selection process comprising an automatic spatial gradient and flexible strategic (prioritization) selection. The combined attentional priorities of these two stages of object-based selection determine the order in which participants will search the display for the presence of a target. The strategic process has often been likened to a prioritized visual search. By modifying the double-rectangle cueing paradigm (Egly, Driver, & Rafal in Journal of Experimental Psychology: General, 123, 161-177, 1994) and placing it in the context of a larger-scale visual search, we examined how the prioritization search is affected by search efficiency. By probing both targets located on the cued object and targets external to the cued object, we found that the attentional priority surrounding a selected object is strongly modulated by search mode. However, the ordering of the prioritization search is unaffected by search mode. The data also provide evidence that standard spatial visual search and object-based prioritization search may rely on distinct mechanisms. These results provide insight into the interactions between the mode of visual search and object-based selection, and help define the modulatory consequences of search efficiency for object-based attention.