Neural fate of seen and unseen faces in visuospatial neglect: A combined event-related functional MRI and event-related potential study

This is a post print version of the article. The official published version can be obtained from the link below.To compare neural activity produced by visual events that escape or reach conscious awareness, we used event-related MRI and evoked potentials in a patient who had neglect and extinction after focal right parietal damage, but intact visual fields. This neurological disorder entails a loss of awareness for stimuli in the field contralateral to a brain lesion when stimuli are simultaneously presented on the ipsilateral side, even though early visual areas may be intact, and single contralateral stimuli may still be perceived. Functional MRI and event-related potential study were performed during a task where faces or shapes appeared in the right, left, or both fields. Unilateral stimuli produced normal responses in V1 and extrastriate areas. In bilateral events, left faces that were not perceived still activated right V1 and inferior temporal cortex and evoked nonsignificantly reduced N1 potentials, with preserved face-specific negative potentials at 170 ms. When left faces were perceived, the same stimuli produced greater activity in a distributed network of areas including right V1 and cuneus, bilateral fusiform gyri, and left parietal cortex. Also, effective connectivity between visual, parietal, and frontal areas increased during perception of faces. These results suggest that activity can occur in V1 and ventral temporal cortex without awareness, whereas coupling with dorsal parietal and frontal areas may be critical for such activity to afford conscious perception. Right parietal damage may cause a loss of awareness for contralateral (left) sensory inputs, such as hemispatial neglect and extinction (1–3). Visual extinction is the failure to perceive a stimulus in the contralesional field when presented together with an ipsilesional stimulus (bilateral simultaneous stimulation, BSS), even though occipital visual areas are intact and unilateral contralesional stimuli can be perceived when presented alone. It reflects a deficit of spatial attention toward the contralesional side, excluding left inputs from awareness in the presence of competing stimuli (2, 3). Spatial attention involves a complex neural network centered on the right parietal lobe (4, 5), but how parietal and related areas interact with sensory processing in distant cortices is largely unknown. Here we combined event-related functional MRI (fMRI) and event-related potentials (ERPs) to study the regional pattern and temporal course of brain activity produced by seen and unseen stimuli in a patient with chronic neglect and extinction caused by parietal damage. In keeping with intact early visual areas in such patients, behavioral studies suggest that some residual processing may still occur for contralesional stimuli without attention, or without awareness, including “preattentive” grouping (e.g., refs. 6 and 7) and semantic priming (e.g., ref. 8). It has been speculated (3, 9) that such effects might relate to separate cortical visual streams, with temporal areas extracting object features for identification, and parietal areas encoding spatial locations and parameters for action (10). Because neglect and extinction follow parietal damage, residual perceptual and semantic processing still might occur in occipital and temporal cortex without awareness, in the absence of normal integration with concomitant processing in parietal regions. Our study tested this hypothesis by using event-related imaging and electrophysiology measures, which are widely used to study mechanisms of normal attention (11, 12). There have been few imaging (e.g., ref. 13) or ERP (e.g., ref. 14) studies in neglect, and most examined activity at rest or during passive unilateral visual stimulation, rather than in relation to awareness or extinction on bilateral stimulation. However, a recent ERP study (15) found signals evoked by perceived, but not extinguished, visual stimuli in a parietal patient. By contrast, functional imaging in another patient (16) showed activation of striate cortex by extinguished stimuli, although severe extinction on all bilateral stimuli precluded any comparison with normal perception. In our patient we used both fMRI and ERPs during a similar extinction task to determine the neural correlates of two critical conditions: (i) when contralesional stimuli are extinguished, and (ii) when the same stimuli are seen. Stimulus presentation was arranged so as to obtain a balanced number of extinguished and seen contralesional events across all bilateral trials. Like Rees et al. (16), we used face stimuli to exploit previous knowledge that face processing activates fusiform areas in temporal cortex (e.g., refs. 17 and 18), and elicits characteristic potentials 170–200 ms after stimulus onset (e.g., refs. 19–21) in addition to other visual components such as P1 and N1 (e.g., ref. 11). We reasoned that such responses might help trace the neural fate of contralesional stimuli (seen or extinguished) at both early and later processing stages in the visual system

Do Doctors Vote?

BACKGROUND: Organizational leaders and scholars have issued calls for the medical profession to refocus its efforts on fulfilling the core tenets of professionalism. A key element of professionalism is participation in community affairs. OBJECTIVE: To measure physician voting rates as an indicator of civic participation. DESIGN: Cross-sectional survey of a subgroup of physicians from a nationally representative household survey of civilian, noninstitutionalized adult citizens. PARTICIPANTS: A total of 350,870 participants in the Current Population Survey (CPS) November Voter Supplement from 1996–2002, including 1,274 physicians and 1,886 lawyers; 414,989 participants in the CPS survey from 1976–1982, including 2,033 health professionals. MEASUREMENTS: Multivariate logistic regression models were used to compare adjusted physician voting rates in the 1996–2002 congressional and presidential elections with those of lawyers and the general population and to compare voting rates of health professionals in 1996–2002 with those in 1976–1992. RESULTS: After multivariate adjustment for characteristics known to be associated with voting rates, physicians were less likely to vote than the general population in 1998 (odds ratio 0.76; 95% confidence interval [CI] 0.59–0.99), 2000 (odds ratio 0.64; 95% CI 0.44–0.93), and 2002 (odds ratio 0.62; 95% CI 0.48–0.80) but not 1996 (odds ratio 0.83; 95% CI 0.59–1.17). Lawyers voted at higher rates than the general population and doctors in all four elections (P < .001). The pooled adjusted odds ratio for physician voting across the four elections was 0.70 (CI 0.61–0.81). No substantial changes in voting rates for health professionals were observed between 1976–1982 and 1996–2002. CONCLUSIONS: Physicians have lower adjusted voting rates than lawyers and the general population, suggesting reduced civic participation

Potential antiproteolytic effects of L-leucine: observations of in vitro and in vivo studies

The purpose of present review is to describe the effect of leucine supplementation on skeletal muscle proteolysis suppression in both in vivo and in vitro studies. Most studies, using in vitro methodology, incubated skeletal muscles with leucine with different doses and the results suggests that there is a dose-dependent effect. The same responses can be observed in in vivo studies. Importantly, the leucine effects on skeletal muscle protein synthesis are not always connected to the inhibition of skeletal muscle proteolysis. As a matter of fact, high doses of leucine incubation can promote suppression of muscle proteolysis without additional effects on protein synthesis, and low leucine doses improve skeletal muscle protein ynthesis but have no effect on skeletal muscle proteolysis. These research findings may have an important clinical relevancy, because muscle loss in atrophic states would be reversed by specific leucine supplementation doses. Additionally, it has been clearly demonstrated that leucine administration suppresses skeletal muscle proteolysis in various catabolic states. Thus, if protein metabolism changes during different atrophic conditions, it is not surprising that the leucine dose-effect relationship must also change, according to atrophy or pathological state and catabolism magnitude. In conclusion, leucine has a potential role on attenuate skeletal muscle proteolysis. Future studies will help to sharpen the leucine efficacy on skeletal muscle protein degradation during several atrophic states

High Quality Care and Ethical Pay-for-Performance: A Society of General Internal Medicine Policy Analysis

BACKGROUND: Pay-for-performance is proliferating, yet its impact on key stakeholders remains uncertain. OBJECTIVE: The Society of General Internal Medicine systematically evaluated ethical issues raised by performance-based physician compensation. RESULTS: We conclude that current arrangements are based on fundamentally acceptable ethical principles, but are guided by an incomplete understanding of health-care quality. Furthermore, their implementation without evidence of safety and efficacy is ethically precarious because of potential risks to stakeholders, especially vulnerable patients. CONCLUSION: We propose four major strategies to transition from risky pay-for-performance systems to ethical performance-based physician compensation and high quality care. These include implementing safeguards within current pay-for-performance systems, reaching consensus regarding the obligations of key stakeholders in improving health-care quality, developing valid and comprehensive measures of health-care quality, and utilizing a cautious evaluative approach in creating the next generation of compensation systems that reward genuine quality

Sunflower meal in commercial layer diets formulated on total and digestible amino acids basis

An experiment was conduced to evaluate the inclusion of sunflower meal (SBM) in commercial layer diets formulated on total or digestible amino acids basis. One hundred forty-four 41-week-old Lohmann LSL layers were distributed in a completely randomized experimental design in a 2 x 4 factorial arrangement with three replications of six birds each. Treatments consisted of a combination of four SBM inclusion levels SBM(0%, 4%, 8%, and 12%) and feed formulation according two amino acid recommendations (total or digestible). The experimental period was divided into five periods of fourteen days. Performance parameters (egg production, feed intake, feed conversion, egg mass) were evaluated for each period. In the last two days of each period, three eggs per replication were collected to evaluate egg quality (Haugh units, specific gravity, egg weight, eggshell thickness, and eggshell percentage). Hens fed on total amino acid recommendation presented the highest values for egg weight. Diets formulated on digestible amino acids basis showed an improvement in eggshell percentage and egg specific gravity. SBM addition in commercial layer diets did not influence performance; however, increasing SBM dietary levels SBM improved eggshell quality