Vaginal douching and vaginal substance use among sex workers in KwaZulu-Natal, South Africa

A local cultural practice that may enhance sexually transmitted infections (STIs) and HIV transmission is vaginal douching and vaginal substance use. These activities also have potential implications for the acceptability of HIV-prevention strategies such as the use of condoms and vaginal microbicides. We aimed to establish the prevalence, determinants and reasons for these practices among sex workers in KwaZulu-Natal, South Africa. A structured questionnaire was administered to 150 sex workers, who were being screened for a vaginal microbicide-effectiveness trial in the province. The questionnaire sought information on the frequency, reasons for and nature of vaginal douching and vaginal substance use and was drawn up on the basis of findings from a pilot study. Seventy per cent (95% CI: 62.0-77.2%) of the sex workers were HIV positive and on average they had five sexual partners per day. Vaginal douching and vaginal substance use were common among the sex workers. Vaginal douching was reported by 97% (n = 146) of the respondents and 94% reported vaginal substance use for 'dry sex'. A combination of traditional remedies, patent medicines, antiseptics and household detergents was used to clean and make the vagina dry and tight. The primary reasons reported for dry sex were to increase men's sexual pleasure (53%) and to attract clients and generate more money (20%). Sixty-five per cent of the women reported the practice of douching mainly for hygienic purposes and 13% for the prevention and treatment of sexually transmitted infections. Douching and dry-sex practices may increase women's risk of HIV and STI infection, and may have implications for the acceptability and development of HIV-prevention barrier methods such as microbicides and the use of condoms. These barrier methods may enhance or reduce sexual pleasure for men and women who engage in the practice of vaginal douching and vaginal substance use for 'dry sex'

Properties of Visual Field Maps in Health and Disease

The visual world that surrounds us is represented in and processed by multiple topographically organised maps in the human brain. The organising principle underlying these retinotopic maps is also apparent across other sensory modalities and appears highly conserved across species. Moreover, the template for these visual maps is laid down during development, without the need for visual experience. This thesis binds and summarises seven publications describing work to characterise the functional properties of visual maps in the human brain. Initially, we describe TMS and fMRI measurements designed to probe the functional specificity of two spatially distinct but spatially adjacent maps, LO-1 and LO-2. Concurrently I developed software (visualisation tools) for precise dissection of these areas and to more broadly facilitate the visualisation of neuroimaging data. Our experiment revealed a double dissociation in the functional specificity of these areas, with preferential processing of orientation and shape information by LO-1 and LO-2, respectively. We then used fMRI to examine the effect of spatial attention on the responses measured from visual field maps. We showed that attention modulated visual responses by both enhancing attended locations and suppressing unattended locations; these effects were evident in the maps of early visual cortex and subcortical structures including the lateral geniculate and pulvinar nuclei. Finally, we examined the properties of visual field maps in patients with retinal lesions. Although maps can be abnormally organised with certain congenital visual deficits, we asked whether normally developed maps were able to reorganise when input to them is lost later in life, specifically due to central retinal lesions. Our measurements showed no evidence of reorganisation in the maps of patients with macular degeneration: the extent of activity measured in these maps was both highly predictable based on individual retinal lesions and could be reliably simulated in normally sighted individuals

An Orientation Dependent Size Illusion Is Underpinned by Processing in the Extrastriate Visual Area, LO1

We use the simple, but prominent Helmholtz’s squares illusion in which a vertically striped square appears wider than a horizontally striped square of identical physical dimensions to determine whether functional magnetic resonance imaging (fMRI) BOLD responses in V1 underpin illusions of size. We report that these simple stimuli which differ in only one parameter, orientation, to which V1 neurons are highly selective elicited activity in V1 that followed their physical, not perceived size. To further probe the role of V1 in the illusion and investigate plausible extrastriate visual areas responsible for eliciting the Helmholtz squares illusion, we performed a follow-up transcranial magnetic stimulation (TMS) experiment in which we compared perceptual judgments about the aspect ratio of perceptually identical Helmholtz squares when no TMS was applied against selective stimulation of V1, LO1, or LO2. In agreement with fMRI results, we report that TMS of area V1 does not compromise the strength of the illusion. Only stimulation of area LO1, and not LO2, compromised significantly the strength of the illusion, consistent with previous research that LO1 plays a role in the processing of orientation information. These results demonstrate the involvement of a specific extrastriate area in an illusory percept of size

Multivariate Patterns in the Human Object-Processing Pathway Reveal a Shift from Retinotopic to Shape Curvature Representations in Lateral Occipital Areas, LO-1 and LO-2

Representations in early visual areas are organized on the basis of retinotopy, but this organizational principle appears to lose prominence in the extrastriate cortex. Nevertheless, an extrastriate region, such as the shape-selective lateral occipital cortex (LO), must still base its activation on the responses from earlier retinotopic visual areas, implying that a transition from retinotopic to “functional” organizations should exist. We hypothesized that such a transition may lie in LO-1 or LO-2, two visual areas lying between retinotopically defined V3d and functionally defined LO. Using a rapid event-related fMRI paradigm, we measured neural similarity in 12 human participants between pairs of stimuli differing along dimensions of shape exemplar and shape complexity within both retinotopically and functionally defined visual areas. These neural similarity measures were then compared with low-level and more abstract (curvature-based) measures of stimulus similarity. We found that low-level, but not abstract, stimulus measures predicted V1–V3 responses, whereas the converse was true for LO, a double dissociation. Critically, abstract stimulus measures were most predictive of responses within LO-2, akin to LO, whereas both low-level and abstract measures were predictive for responses within LO-1, perhaps indicating a transitional point between those two organizational principles. Similar transitions to abstract representations were not observed in the more ventral stream passing through V4 and VO-1/2. The transition we observed in LO-1 and LO-2 demonstrates that a more “abstracted” representation, typically considered the preserve of “category-selective” extrastriate cortex, can nevertheless emerge in retinotopic regions

A Direct Demonstration of Functional Differences between Subdivisions of Human V5/MT

Two subdivisions of human V5/MT+: one located posteriorly (MT/TO-1) and the other more anteriorly (MST/TO-2) were identified in human participants using functional magnetic resonance imaging on the basis of their representations of the ipsilateral versus contralateral visual field. These subdivisions were then targeted for disruption by the application of repetitive transcranial magnetic stimulation (rTMS). The rTMS was delivered to cortical areas while participants performed direction discrimination tasks involving 3 different types of moving stimuli defined by the translational, radial, or rotational motion of dot patterns. For translational motion, performance was significantly reduced relative to baseline when rTMS was applied to both MT/TO-1 and MST/TO-2. For radial motion, there was a differential effect between MT/TO-1 and MST/TO-2, with only disruption of the latter area affecting performance. The rTMS failed to reveal a complete dissociation between MT/TO-1 and MST/TO-2 in terms of their contribution to the perception of rotational motion. On the basis of these results, MT/TO-1 and MST/TO-2 appear to be functionally distinct subdivisions of hV5/MT+. While both areas appear to be implicated in the processing of translational motion, only the anterior region (MST/TO-2) makes a causal contribution to the perception of radial motion

An enhanced role for right hV5/MT+ in the analysis of motion in the contra- and ipsi-lateral visual hemi-fields

Previous experiments have demonstrated that transcranial magnetic stimulation (TMS) of human V5/MT+, in either the left or right cerebral hemisphere, can induce deficits in visual motion perception in their respective contra- and ipsi-lateral visual hemi-fields. However, motion deficits in the ipsi-lateral hemi-field are greater when TMS is applied to V5/MT + in the right hemisphere relative to the left hemisphere. One possible explanation for this asymmetry might lie in differential stimulation of sub-divisions within V5/MT + across the two hemispheres. V5/MT + has two major sub-divisions; MT/TO-1 and MST/TO-2, the latter area contains neurons with large receptive fields (RFs) that extend up to 15° further into the ipsi-lateral hemi-field than the former. We wanted to examine whether applying TMS to MT/TO-1 and MST/TO-2 separately could explain the previously reported functional asymmetries for ipsi-lateral motion processing in V5/MT + across right and left cerebral hemispheres. MT/TO-1 and MST/TO-2 were identified in seven subjects using fMRI localisers. In psychophysical experiments subjects identified the translational direction (up/down) of coherently moving dots presented in either the left or right visual field whilst repetitive TMS (25 Hz; 70%) was applied synchronously with stimulus presentation. Application of TMS to MT/TO-1 and MST/TO-2 in the right hemisphere affected translational direction discrimination in both contra-lateral and ipsi-lateral visual fields. In contrast, deficits of motion perception following application of TMS to MT/TO-1 and MST/TO-2 in the left hemisphere were restricted to the contra-lateral visual field. This result suggests an enhanced role for the right hemisphere in processing translational motion across the full visual field

Retinotopic remapping of the visual system in deaf adults

Sound is a vital cue in helping hearing people orient their gaze and attention towards events outside their central line of sight, especially in the far periphery, where vision is poor. Without sound cues, deaf individuals must rely on vision as an ‘early warning system’ for peripheral events, and in fact numerous behavioural studies demonstrate that deaf adults have superior visual sensitivity, particularly to far peripheral stimuli. We asked whether an increased demand on peripheral vision throughout development might be reflected in early visual brain structures. Using functional magnetic resonance imaging (fMRI), we mapped visual field representations in 16 early, profoundly deaf adults and 16 hearing age-matched controls. To target the far periphery, we used wide-field retinotopic mapping stimuli to map visual field eccentricity out to 72°, well beyond conventional mapping studies. Deaf individuals exhibited a larger representation of the far peripheral visual field in both the primary visual cortex and the lateral geniculate nucleus of the thalamus. Importantly, this was not due to a total expansion of the visual map, as there was no difference between groups in overall size of either structure, but a smaller representation of the central visual field in the deaf group, suggesting a redistribution of neural resources. Here, we demonstrate for the first time that the demands placed on vision due to lifelong hearing loss can sculpt visual maps at the first level of inputs from the retina, increasing neural resources for processing stimuli in the far peripheral visual field

Triple visual hemifield maps in a case of optic chiasm hypoplasia

In humans, each hemisphere comprises an overlay of two visuotopic maps of the contralateral visual field, one from each eye. Is the capacity of the visual cortex limited to these two maps or are plastic mechanisms available to host more maps? We determined the cortical organization of the visual field maps in a rare individual with chiasma hypoplasia, where visual cortex plasticity is challenged to accommodate three hemifield maps. Using high-resolution fMRI at 7T and diffusion-weighted MRI at 3T, we found three hemiretinal inputs, instead of the normal two, to converge onto the left hemisphere. fMRI-based population receptive field mapping of the left V1-V3 at 3T revealed three superimposed hemifield representations in the left visual cortex, i.e. two representations of opposing visual hemifields from the left eye and one right hemifield representation from the right eye. We conclude that developmental plasticity including the re-wiring of local intra- and cortico-cortical connections is pivotal to support the coexistence and functioning of three hemifield maps within one hemisphere