It Takes Two–Skilled Recognition of Objects Engages Lateral Areas in Both Hemispheres

Our object recognition abilities, a direct product of our experience with objects, are fine-tuned to perfection. Left temporal and lateral areas along the dorsal, action related stream, as well as left infero-temporal areas along the ventral, object related stream are engaged in object recognition. Here we show that expertise modulates the activity of dorsal areas in the recognition of man-made objects with clearly specified functions. Expert chess players were faster than chess novices in identifying chess objects and their functional relations. Experts' advantage was domain-specific as there were no differences between groups in a control task featuring geometrical shapes. The pattern of eye movements supported the notion that experts' extensive knowledge about domain objects and their functions enabled superior recognition even when experts were not directly fixating the objects of interest. Functional magnetic resonance imaging (fMRI) related exclusively the areas along the dorsal stream to chess specific object recognition. Besides the commonly involved left temporal and parietal lateral brain areas, we found that only in experts homologous areas on the right hemisphere were also engaged in chess specific object recognition. Based on these results, we discuss whether skilled object recognition does not only involve a more efficient version of the processes found in non-skilled recognition, but also qualitatively different cognitive processes which engage additional brain areas

Narcolepsy and adjuvanted pandemic influenza A (H1N1) 2009 vaccines – Multi-country assessment

Background: In 2010, a safety signal was detected for narcolepsy following vaccination with Pandemrix, an AS03-adjuvanted monovalent pandemic H1N1 influenza (pH1N1) vaccine. To further assess a possible association and inform policy on future use of adjuvants, we conducted a multi-country study of narcolepsy and adjuvanted pH1N1 vaccines. Methods: We used electronic health databases to conduct a dynamic retrospective cohort study to assess narcolepsy incidence rates (IR) before and during pH1N1 virus circulation, and after pH1N1 vaccination campaigns in Canada, Denmark, Spain, Sweden, Taiwan, the Netherlands, and the United Kingdom. Using a case-control study design, we evaluated the risk of narcolepsy following AS03- and MF59-adjuvanted pH1N1 vaccines in Argentina, Canada, Spain, Switzerland, Taiwan, and the Netherlands. In the Netherlands, we also conducted a case-coverage study in children born between 2004 and 2009. Results: No changes in narcolepsy IRs were observed in any periods in single study sites except Sweden and Taiwan; in Taiwan incidence increased after wild-type pH1N1 virus circulation and in Sweden (a previously identified signaling country), incidence increased after the start of pH1N1 vaccination. No association was observed for Arepanrix-AS03 or Focetria-MF59 adjuvanted pH1N1 vaccines and narcolepsy in children or adults in the case-control study nor for children born between 2004 and 2009 in the Netherlands case-coverage study for Pandemrix-AS03. Conclusions: Other than elevated narcolepsy IRs in the period after vaccination campaigns in Sweden, we did not find an association between AS03- or MF59-adjuvanted pH1N1 vaccines and narcolepsy in children or adults in the sites studied, although power to evaluate the AS03-adjuvanted Pandemrix brand vaccine was limited in our study

Improved Survival in Patients with Viral Hepatitis-Induced Hepatocellular Carcinoma Undergoing Recommended Abdominal Ultrasound Surveillance in Ontario: A Population-Based Retrospective Cohort Study.

The optimal schedule for ultrasonographic surveillance of patients with viral hepatitis for the detection of hepatocellular carcinoma (HCC) remains unclear owing to a lack of reliable studies. We examined the timing of ultrasonography in patients with viral hepatitis-induced HCC and its impact on survival and mortality risk while determining predictors of receiving surveillance before HCC diagnosis. A population-based retrospective cohort analysis of patients with viral hepatitis-induced HCC in Ontario between 2000 and 2010 was performed using data from the Ontario Cancer Registry linked health administrative data. HCC surveillance for 2 years preceding diagnosis was assigned as: i) ≥ 2 abdominal ultrasound screens annually; ii) 1 screen annually; iii) inconsistent screening; and iv) no screening. Survival rates were estimated using the Kaplan-Meier method and parametric models to correct for lead-time bias. Associations between HCC surveillance and the risk of mortality after diagnosis were examined using proportional-hazards regression adjusting for confounding factors. Overall, 1,483 patients with viral hepatitis-induced HCC were identified during the study period; 20.2% received ≥ 1 ultrasound screen annually (routine surveillance) for the 2 years preceding diagnosis. The 5-year survival of those receiving routine surveillance was 31.93% (95% CI: 25.77-38.24%) and 31.84% (95% CI: 25.69-38.14%) when corrected for lead-time bias (HCC sojourn time 70 days and 140 days, respectively). This is contrasted with 20.67% (95% CI: 16.86-24.74%) 5-year survival in those who did not undergo screening. In the fully adjusted model, compared to unscreened patients, routine surveillance was associated with a lower mortality risk and a hazard ratio of 0.76 (95% CI: 0.64-0.91) and 0.81 (95% CI: 0.68-0.97), corrected for the respective lead-time bias. Our findings suggest that routine ultrasonography in patients with viral hepatitis is associated with improved survival and reduced mortality risk in a population-based setting. The data emphasizes the importance of surveillance for timely intervention in HCC-diagnosed patients

One-year survival and admission to hospital for cardiovascular events among older residents of long-term care facilities who were prescribed intensive- and moderate-dose statins

BACKGROUND: Guidance from randomized clinical trials about the ongoing benefits of statin therapies in residents of long-term care facilities is lacking. We sought to examine the effect of statin dose on 1-year survival and admission to hospital for cardiovascular events in this setting. METHODS: We conducted a retrospective cohort study using population-based administrative data from Ontario, Canada. We identified 21 808 residents in long-term care facilities who were 76 years of age and older and were prevalent statin users on the date of a full clinical assessment between April 2013 and March 2014, and categorized residents as intensive- or moderate-dose users. Treatment groups were matched on age, sex, admission to hospital for atherosclerotic cardiovascular disease, resident frailty and propensity score. Differences in 1-year survival and admission to hospital for cardiovascular events were measured using Cox proportional and subdistribution hazard models, respectively. RESULTS: Using propensity-score matching, we included 4577 well-balanced pairs of residents who were taking intensive- and moderate-dose statins. After 1 year, there were 1210 (26.4%) deaths and 524 (11.5%) admissions to hospital for cardiovascular events among residents using moderate-dose statins compared with 1173 (25.6%) deaths and 522 (11.4%) admissions to hospital for cardiovascular events among those taking intensive-dose statins. We found no significant association between prevalent use of intensive-dose statins and 1-year survival (hazard ratio [HR] 0.97, 95% confidence interval [CI] 0.90 to 1.05) or 1-year admission to hospital for cardiovascular events (HR 0.99, 95% CI 0.88 to 1.12) compared with use of moderate-dose statins. INTERPRETATION: The rates of mortality and admission to hospital for cardiovascular events at 1 year were similar between residents in long-term care taking intensive-dose statins compared with those taking moderate-dose statins. This lack of benefit should be considered when prescribing statins to vulnerable residents of long-term care facilities who are at potentially increased risk of statin-related adverse events

Observed (uncorrected) and lead time bias corrected median survival times and cumulative survival following hepatocellular carcinoma diagnosis among patients with viral hepatitis by different timing of ultrasonographic surveillance (N = 1,483).

<p>CI, confidence interval.</p><p>*Includes 1 screen annually for 2 years before HCC diagnosis (n = 285) and ≥2 screens annually for 2 years before HCC diagnosis (n = 17).</p><p>Observed (uncorrected) and lead time bias corrected median survival times and cumulative survival following hepatocellular carcinoma diagnosis among patients with viral hepatitis by different timing of ultrasonographic surveillance (N = 1,483).</p

Kaplan-Meier survival estimates of patients diagnosed with viral hepatitis-induced hepatocellular carcinoma by the timing of ultrasonographic surveillance*, 2000–2010: 2a (uncorrected for lead-time bias); 2b (lead-time bias corrected with HCC sojourn time 70 days); 2c (lead-time bias corrected with HCC sojourn time 140 days); 2d 2b (lead-time bias corrected with HCC sojourn time 180 days).

<p>*Routine surveillance: 1 screen annually and ≥2 screens annually for 2 years before HCC diagnosis. Inconsistent screening: at least 1 screen either within 12 months or between 12-<24 months before HCC diagnosis.</p

Predictors of receiving one or more ultrasound screening annually for 2 years before hepatocellular carcinoma diagnosis among patients with viral hepatitis: Log binomial regression.

<p>Overall <i>p</i>-values</p><p>*Age at HCC diagnosis: <i>p</i> = 0.365 (unadjusted)</p><p>^†Income quintile: <i>p</i> = 0.243 (unadjusted)</p><p>^‡Charlson-Deyo Comorbidity Index: <i>p</i> = 0.2436 (unadjusted)</p><p>^¶Outpatient visits in 2 years before HCC diagnosis: <i>p</i> = 0.001 (unadjusted); <i>p</i> = 0.002 (adjusted)</p><p>^¥Viral hepatitis index year: <i>p</i> = 0.673 (unadjusted).</p><p>RR, risk ratio; CI, confidence interval; HCC, hepatocellular carcinoma; ALD, alcoholic liver disease; NAFLD, non-alcoholic fatty liver disease.</p><p>Predictors of receiving one or more ultrasound screening annually for 2 years before hepatocellular carcinoma diagnosis among patients with viral hepatitis: Log binomial regression.</p

Descriptive characteristics of viral hepatitis patients diagnosed with hepatocellular carcinoma by different timing of ultrasonographic surveillance.

<p>‘‘-‘‘, counts less than six have been suppressed.</p><p>*At least 1 screen either within 12 months or between 12-<24 months before HCC diagnosis</p><p>^†1 screen annually for 2 years before HCC diagnosis</p><p>^‡≥2 screens annually for 2 years before HCC diagnosis.</p><p>^¶Missing data: rural residence (n = 2); Income quintile (n = 6).</p><p>^§Decompensated cirrhosis: i.e., cirrhosis and any recorded ascites, esophageal varices, or hepatic encephalopathy.</p><p>Descriptive characteristics of viral hepatitis patients diagnosed with hepatocellular carcinoma by different timing of ultrasonographic surveillance.</p