THE INITIATION OF BINOCULAR RIVALRY

Binocular rivalry refers to the perceptual alternation that occurs while viewing incompatible images, in which one monocular image is dominant and the other is suppressed. Rivalry has been closely studied but the neural site at which it is initiated is still controversial. The central claim of this thesis is that primary visual cortex is responsible for its initiation. This claim is supported by evidence from four experimental studies. The first study (described in Chapter 4) introduces the methodology for measuring visual sensitivity during dominance and suppression and compares several methods to see which yields the greatest difference between these two sensitivities. Suppression depth was measured by comparing the discrimination thresholds to a brief test stimulus delivered during dominance and suppression phases. The deepest suppression was achieved after a learning period, with the test stimulus presented for 100 ms and with post-test masking. The second study (Chapter 5) compares two hypotheses for the mechanism of binocular rivalry. Under eye suppression, visibility decreases when the tested eye is being suppressed, regardless of the test stimulus’s features. Feature suppression, however, predicts that reduction of visibility is caused by suppression of a stimulus feature, no matter which eye is suppressed. Eye suppression claims that monocular channels in the visual system alternate between dominance and suppression, while Feature suppression assumes that the features of stimuli inhibit each other perceptually in the high-level cortex. The experiment used a test stimulus similar in features to one, but not the other, rivalry-inducing stimulus. Test sensitivity was found to be lowered when the test stimulus was presented to the eye whose rivalry-inducing stimulus was suppressed. Sensitivity was not lowered when the test stimulus was presented to the other eye, even when the test shared features with the suppressed stimulus. The conclusion is that feature suppression is weak or does not exist without eye suppression, and that rivalry therefore originates in the primary visual cortex. If binocular rivalry is initiated in the primary visual cortex, stimuli producing no coherent activity in that area should produce no rivalry. In the third study (Chapter 6) this idea was tested with rotating arrays of short-lifetime dots. The dots with the shortest lifetime produced an image with no rotation signal, and an infinite lifetime produced rigid rotation. Subjects could discriminate the rotation direction with high accuracy at all but the shortest lifetime. When the two eyes were presented with opposite directions of rotation, there was binocular rivalry only at the longest lifetimes. Stimuli with short lifetimes produce a coherent motion signal, since their direction can be discriminated, but do not produce rivalry. A simple interpretation of this observation is that binocular rivalry is initiated at a level in the visual hierarchy below that which supports the motion signal. The model supported by the results of previous chapters requires that binocular rivalry suppression be small in the primary visual cortex, and builds up as signals progress along the visual pathway. This model predicts that for judgements dependent on activity in high visual cortex: 1. Binocular rivalry suppression should be deep; 2. Responses should be contrast invariant. The fourth and last study (chapter 7) confirmed these predictions by measuring suppression depth in two ways. First, two similar forms were briefly presented to one eye: the difference in shapes required for their discrimination was substantially greater during suppression than during dominance. Second, the two forms were made sufficiently different in shape to allow easy discrimination at high contrast, and the contrast of these forms was lowered to find the discrimination threshold. The results in the second experiment showed that contrast sensitivity did not differ between the suppression and dominance states. This invariance in contrast sensitivity is interpreted in terms of steep contrast-response functions in cortex beyond the primary visual area. The work in this thesis supports the idea that binocular rivalry is a process distributed along the visual pathway. More importantly, the results provide several lines of evidence that binocular rivalry is initiated in primary visual cortex

Ising cubes with enhanced surface couplings

Using Monte Carlo techniques, Ising cubes with ferromagnetic nearest-neighbor interactions and enhanced couplings between surface spins are studied. In particular, at the surface transition, the corner magnetization shows non-universal, coupling-dependent critical behavior in the thermodynamic limit. Results on the critical exponent of the corner magnetization are compared to previous findings on two-dimensional Ising models with three intersecting defect lines.Comment: 4 pages, 2 figures included, submitted to Phys. Rev.

A cost effeciency approach to universal access for public transport for disabled people

Purpose To determine the intervendor variability of Agatston scoring determined with state-of-the-art computed tomographic (CT) systems from the four major vendors in an ex vivo setup and to simulate the subsequent effects on cardiovascular risk reclassification in a large population-based cohort. Materials and Methods Research ethics board approval was not necessary because cadaveric hearts from individuals who donated their bodies to science were used. Agatston scores obtained with CT scanners from four different vendors were compared. Fifteen ex vivo human hearts were placed in a phantom resembling an average human adult. Hearts were scanned at equal radiation dose settings for the systems of all four vendors. Agatston scores were quantified semiautomatically with software used clinically. The ex vivo Agatston scores were used to simulate the effects of different CT scanners on reclassification of 432 individuals aged 55 years or older from a population-based study who were at intermediate cardiovascular risk based on Framingham risk scores. The Friedman test was used to evaluate overall differences, and post hoc analyses were performed by using the Wilcoxon signed-rank test with Bonferroni correction. Results Agatston scores differed substantially when CT scanners from different vendors were used, with median Agatston scores ranging from 332 (interquartile range, 114-1135) to 469 (interquartile range, 183-1381; P < .05). Simulation showed that these differences resulted in a change in cardiovascular risk classification in 0.5\%-6.5\% of individuals at intermediate risk when a CT scanner from a different vendor was used. Conclusion Among individuals at intermediate cardiovascular risk, state-of the-art CT scanners made by different vendors produced substantially different Agatston scores, which can result in reclassification of patients to the high- or low-risk categories in up to 6.5\% of cases. © RSNA, 2014

Cost-effectiveness modelling in diagnostic imaging: a stepwise approach

Contains fulltext : 152079.pdf (publisher's version ) (Open Access)Diagnostic imaging (DI) is the fastest growing sector in medical expenditures and takes a central role in medical decision-making. The increasing number of various and new imaging technologies induces a growing demand for cost-effectiveness analysis (CEA) in imaging technology assessment. In this article we provide a comprehensive framework of direct and indirect effects that should be considered for CEA in DI, suitable for all imaging modalities. We describe and explain the methodology of decision analytic modelling in six steps aiming to transfer theory of CEA to clinical research by demonstrating key principles of CEA in a practical approach. We thereby provide radiologists with an introduction to the tools necessary to perform and interpret CEA as part of their research and clinical practice. KEY POINTS: * DI influences medical decision making, affecting both costs and health outcome. * This article provides a comprehensive framework for CEA in DI. * A six-step methodology for conducting and interpreting cost-effectiveness modelling is proposed

Quantification of Respiratory Movement of the Aorta and Side Branches

Purpose: To assess and quantify the magnitude and direction of respiratory movement of the aorta and origins of its side branches. Methods: A quantitative 3-dimensional (3D) subtraction analysis of computed tomography (CT) scans during inspiration and expiration was performed to determine the respiratory geometric movements of the aorta and side branches in 60 patients. During breath-hold expiration and inspiration, 1-mm-thick CT slices of the aorta were acquired in unenhanced and contrast-enhanced scans. The datasets were compared using dedicated multiplanar reformation image subtraction software to determine the change in position of relevant anatomic sections, including the ascending thoracic aorta (AA), the origins of the brachiocephalic artery (BA) and left subclavian artery (LSA), the descending thoracic aorta (DTA) at the level of the tenth thoracic vertebra, as well as the origins of the celiac trunk, superior mesenteric artery, and the renal arteries. Results: Complex movement was visible during inspiration; the regions of interest in the thoracic aorta and side branches moved in the anterior, medial, and caudal directions compared with the expiration state. Mean 3D movement vectors (+/- standard deviation) were 8.9 +/- 3.6 mm (AA), 12.0 +/- 4.1 mm (BA), 11.1 +/- 3.9 mm (LSA), and 4.9 +/- 2.5 mm (DTA). Abdominal side branches moved in the caudal direction 1.3 +/- 1.1 mm. There was significantly less movement in the DTA compared to AA (

Over elektrocutie in de vroege radiologie en de ontwikkeling van elektrisch veilige röntgentoestellen (About electrocution in early radiology and the development of electrically safe X-ray machines)

The development of electrically safe X-ray machines took about four decades, from 1895-1935. Between 1895 and 1920, electric shocks were common, but they rarely had serious consequences. This low risk was due to the small current that electrifying machines and Ruhmkorff inductors could supply. After 1920, transformers, which could supply currents above the induction threshold for ventricular fibrillation, were responsible for fatal accidents. We found information on 51 fatal and 62 serious electrical accidents, almost all of which occurred between 1920 and 1940

Probability of receiving a high cumulative radiation dose and primary clinical indication of CT examinations: a 5-year observational cohort study

Objective High radiation exposure is a concern because of the association with cancer. The objective was to determine the probability of receiving a high radiation dose from CT (from one or more examinations within a 5-year period) and to assess the clinical context by evaluating clinical indications in the high-dose patient group. Design Observational cohort study. Effective radiation dose received from one or more CT examinations within a predefined 5-year calendar period was assessed for each patient. Setting Hospital setting. Participants All patients undergoing a diagnostic CT examination between July 2013 and July 2018 at the Maastricht University Medical Center. Primary and secondary outcome measures The primary outcome was the probability of receiving a high effective dose, defined as &gt;= 100 mSv, from one or more CT examinations within 5 years as derived from a time-to-event analysis. Secondary outcomes were the clinical indication for the initial scan of patients receiving a high effective dose. Results 100 672 CT examinations were performed among 49 978 patients including 482 (1%) who received a high radiation dose. The estimated probability of a high effective dose from a single examination is low (0.002% (95% CI 0.00% to 0.01%)). The 4.5-year probability of receiving a high cumulative effective dose was 1.9% (95% CI 1.6% to 2.2%) for women and 1.5% (95% CI 1.3% to 1.7%) for men. The probability was highest in age categories between 51 and 74 years. A total of 2711 (5.5%) of patients underwent more than six CT examinations, and the probability of receiving a high effective dose was 16%. Among patients who received a high effective dose, most indications (80%) were oncology related. Conclusions The probability of receiving a high radiation dose from CT examinations is small but not negligible. In the majority (80%) of high effective dose receiving patients, the indication for the initial CT scan was oncology related

RECIST measurements in cancer treatment: is there a role for physician assistants? - A pilot study

Background: Decision making in cancer treatment is influenced by standardized RECIST measurements which are subjective to interobserver variability. Aim of this pilot study was to evaluate whether it is feasible to transfer the radiologist's task of RECIST measurements to a trained radiology physician assistant and whether this influences diagnostic performance. Methods: 177 lesions in twenty patients were measured on baseline and two follow-up CTs using RECIST 1.1: Arm A according to routine clinical practice where various radiologists read scans of the referred patients. Arm B according to the experimental setting where a radiology physician assistant performed RECIST measurements of target lesions defined by the radiologists on baseline scans. Performance and agreement were compared between groups. Results: Standard deviation between lesion measurements of arm A and B was four millimeters. Interobserver agreement comparing response category classification was substantial, kappa = 0.77 (95% CI: 0.66 - 0.87). Sensitivity and specificity for the radiology physician assistant for assessing progressive disease were 100% (95% CI: 61% - 100%) and 94% (95% CI: 81% - 98%) respectively. Conclusion: RECIST measurements performed by a paramedic are a feasible alternative to standard practice. This could impact the workflow of radiological units, opening ways to re-assigning radiologists' important, standardized but time consuming tasks to paramedics

High-sensitivity cardiac troponin t: Risk stratification tool in patients with symptoms of chest discomfort

BACKGROUND: Recent studies have demonstrated the association between increased concentrations of high-sensitivity cardiac troponin T (hs-cTnT) and the incidence of myocardial infarction, heart failure, and mortality. However, most prognostic studies to date focus on the value of hs-cTnT in the elderly or general population. The value of hs-cTnT in symptomatic patients visiting the outpatient department remains unclear. The aim of this study was to investigate the prognostic value of hs-cTnT as a biomarker in patients with symptoms of chest discomfort suspected for coronary artery disease and to assess its additional value in combination with other risk stratification tools in predicting cardiac events. METHODS: We studied 1,088 patients (follow-up 2.2 +/- 0.8 years) with chest discomfort who underwent coronary calcium scoring and coronary CT-angiography. Traditional cardiovascular risk factors and concentrations of hs-cTnT, N-terminal pro-brain-type natriuretic peptide (NT-proBNP) and high-sensitivity C-reactive protein (hsCRP) were assessed. Study endpoint was the occurrence of late coronary revascularization (>90 days), acute coronary syndrome, and cardiac mortality. RESULTS: Hs-cTnT was a significant predictor for the composite endpoint (highest quartile [Q4]>6.7 ng/L, HR 3.55; 95%CI 1.88-6.70; P<0.001). Survival analysis showed that hs-cTnT had significant predictive value on top of current risk stratification tools (Chi-square change P<0.01). In patients with hs-cTnT in Q4 versus <Q4, a 2- to 3-fold increase in cardiovascular risk was noticed, either when corrected for high or low Framingham risk score, coronary calcium scoring, or CT-angiography assessment (HR 3.11; 2.73; 2.47; respectively; all P<0.01). This was not the case for hsCRP and NT-proBNP. CONCLUSIONS: Hs-cTnT is a useful prognostic biomarker in patients with chest discomfort suspected for coronary artery disease. In addition, hs-cTnT was an independent predictor for cardiac events when corrected for cardiovascular risk profiling, calcium score and CT-angiography results

High-sensitivity cardiac troponin t: Risk stratification tool in patients with symptoms of chest discomfort

BACKGROUND: Recent studies have demonstrated the association between increased concentrations of high-sensitivity cardiac troponin T (hs-cTnT) and the incidence of myocardial infarction, heart failure, and mortality. However, most prognostic studies to date focus on the value of hs-cTnT in the elderly or general population. The value of hs-cTnT in symptomatic patients visiting the outpatient department remains unclear. The aim of this study was to investigate the prognostic value of hs-cTnT as a biomarker in patients with symptoms of chest discomfort suspected for coronary artery disease and to assess its additional value in combination with other risk stratification tools in predicting cardiac events. METHODS: We studied 1,088 patients (follow-up 2.2 +/- 0.8 years) with chest discomfort who underwent coronary calcium scoring and coronary CT-angiography. Traditional cardiovascular risk factors and concentrations of hs-cTnT, N-terminal pro-brain-type natriuretic peptide (NT-proBNP) and high-sensitivity C-reactive protein (hsCRP) were assessed. Study endpoint was the occurrence of late coronary revascularization (>90 days), acute coronary syndrome, and cardiac mortality. RESULTS: Hs-cTnT was a significant predictor for the composite endpoint (highest quartile [Q4]>6.7 ng/L, HR 3.55; 95%CI 1.88-6.70; P<0.001). Survival analysis showed that hs-cTnT had significant predictive value on top of current risk stratification tools (Chi-square change P<0.01). In patients with hs-cTnT in Q4 versus <Q4, a 2- to 3-fold increase in cardiovascular risk was noticed, either when corrected for high or low Framingham risk score, coronary calcium scoring, or CT-angiography assessment (HR 3.11; 2.73; 2.47; respectively; all P<0.01). This was not the case for hsCRP and NT-proBNP. CONCLUSIONS: Hs-cTnT is a useful prognostic biomarker in patients with chest discomfort suspected for coronary artery disease. In addition, hs-cTnT was an independent predictor for cardiac events when corrected for cardiovascular risk profiling, calcium score and CT-angiography results