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In human adults, multiple cortical regions respond robustly to faces, including the occipital face area (OFA) and fusiform face area (FFA), implicated in face perception, and the superior temporal sulcus (STS) and medial prefrontal cortex (MPFC), implicated in higher-level social functions. When in development, does face selectivity arise in each of these regions? Here, we combined two awake infant functional magnetic resonance imaging (fMRI) datasets to create a sample size twice the size of previous reports (n = 65 infants; 2.6-9.6â months). Infants watched movies of faces, bodies, objects, and scenes, while fMRI data were collected. Despite variable amounts of data from each infant, individual subject whole-brain activation maps revealed responses to faces compared to nonface visual categories in the approximate location of OFA, FFA, STS, and MPFC. To determine the strength and nature of face selectivity in these regions, we used cross-validated functional region of interest analyses. Across this larger sample size, face responses in OFA, FFA, STS, and MPFC were significantly greater than responses to bodies, objects, and scenes. Even the youngest infants (2-5â months) showed significantly face-selective responses in FFA, STS, and MPFC, but not OFA. These results demonstrate that face selectivity is present in multiple cortical regions within months of birth, providing powerful constraints on theories of cortical development.
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Mapeamento Encefálico , Reconhecimento Facial , Imageamento por Ressonância Magnética , Humanos , Feminino , Lactente , Masculino , Reconhecimento Facial/fisiologia , Estimulação Luminosa/métodos , Córtex Cerebral/fisiologia , Córtex Cerebral/diagnóstico por imagem , Desenvolvimento Infantil/fisiologiaRESUMO
Understanding the impact of family planning policy and actions is essential for building effective strategies to increase contraceptive use. This study identifies policies that correlate with modern contraceptive prevalence rate (mCPR) and private-sector contraceptive method mix strategies (the number of contraceptive methods offered in the private sector) in low-income and middle-income countries. While education, contraceptive choices, and economic growth are known determinants of contraceptive prevalence, many national policies intended to increase contraceptive prevalence in the short term to medium term have ambiguous evidence that they indeed do so. By developing beta and Poisson regression models using 12 years of reported Contraceptive Security Indicators Survey data (2010-2021) from 59 countries, this study investigated the effect of 20 independent variables on mCPR or method mix strategies. Furthermore, to help interpret the potential consequences of economic status, separate models segmented by gross national income (low, low-middle, and upper-middle) were assessed. Of 20 independent variables, 10 are implicated with mCPR and 6 with a method mix strategy. Of these, increasing the share of domestic financing (versus donor funding) for contraceptives had the broadest and strongest contribution. mCPR is also predicted by the existence of national insurance systems that cover contraceptive costs, contraceptive security committees, family planning logistics management information systems, and, inversely, by client fees. A comprehensive private-sector method mix strategy-which itself influences mCPR-is also driven by these, as well as the inclusion of more contraceptives on the national essential medicines list. These findings have implications for countries seeking to expand access to and use of contraceptives through policy initiatives.
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Anticoncepção , Países em Desenvolvimento , Política de Planejamento Familiar , Serviços de Planejamento Familiar , Humanos , Anticoncepção/estatística & dados numéricos , Estudos Longitudinais , Feminino , Comportamento Contraceptivo/estatística & dados numéricos , Prevalência , Setor Privado , AnticoncepcionaisRESUMO
Results from paradigms like change blindness and inattentional blindness indicate that observers are unaware of numerous aspects of the visual world. However, intuition suggests that perceptual experience is richer than these results indicate. Why does it feel like we see so much when the data suggests we see so little? One possibility stems from the fact that experimental studies always present observers with stimuli that they have never seen before. Meanwhile, when forming intuitions about perceptual experience, observers reflect on their experiences with scenes with which they are highly familiar (e.g., their office). Does prior experience with a scene change the bandwidth of perceptual awareness? Here, we asked if observers were better at noticing alterations to the periphery in familiar scenes compared with unfamiliar scenes. We found that observers noticed changes to the periphery more frequently with familiar stimuli. Signal detection theoretic analyses revealed that when observers are unfamiliar with a stimulus, they are less sensitive at noticing (d') and are more conservative in their response criterion (c). Taken together, these results suggest that prior knowledge expands the bandwidth of perceptual awareness. It should be stressed that these results challenge the widely held idea that prior knowledge fills in perception. Overall, these findings highlight how prior knowledge plays an important role in determining the limits of perceptual experience and is an important factor to consider when attempting to reconcile the tension between empirical observation and personal introspection.
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Conscientização , Reconhecimento Psicológico , Humanos , Conscientização/fisiologia , Reconhecimento Psicológico/fisiologia , Adulto Jovem , Feminino , Masculino , Percepção Visual/fisiologia , Adulto , Estimulação Luminosa , Detecção de Sinal Psicológico/fisiologiaRESUMO
Does sensory information reach conscious awareness in a discrete, all-or-nothing manner or a gradual, continuous manner? To answer this question, we examined behavioral performance across four different paradigms that manipulate visual awareness: the attentional blink, backward masking, the Sperling iconic memory paradigm, and retro-cuing. We then asked how well we could account for participants' (N = 112 adults) behavior using a signal detection framework that factors in psychophysical scaling to model participants' responses along a single continuum. We found that this model easily accounted for the data from each of these diverse paradigms. Moreover, we reanalyzed the data from prior studies that had posited a discrete view of perceptual awareness and found that our continuous signal detection model outperformed the models that had been used to support an all-or-nothing view of consciousness. This set of data is consistent with the idea that conscious awareness occurs along a graded continuum.
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Intermitência na Atenção Visual , Adulto , Humanos , Estado de Consciência , Sinais (Psicologia) , ReproduçãoRESUMO
INTRODUCTION: Utilization an in-situ pedicle of the external carotid artery (ECA) as an arterial donor can allow for the successful augmentation or replacement of flow to a large vascular territory. We propose a mathematical model for quantitatively analyzing and grading the suitability of donor and recipient bypass vessels based on a set of anatomical and surgical variables in order to predict which pair has the greatest possibility for success. Using this method, we analyze all of the potential donor-recipient pairs for each ECA donor vessel-including the superficial temporal (STA), middle meningeal (MMA), and occipital (OA) arteries. METHODS: The ECA pedicles were dissected in frontotemporal, middle fossa, subtemporal, retrosigmoid, far lateral, suboccipital, supracerebellar, and occipital transtentorial approaches. For each approach, every potential donor-recipient pair was identified, and donor length and diameter were measured as well as depth of field, angle of exposure, ease of proximal control, maneuverability, and length and diameter of the recipient segment. Anastomotic pair scores were determined by adding the weighted donor and recipient. RESULTS: The best overall anastomotic pairs were OA-vertebral artery (V3, 17.1) and STA-insular (M2, 16.3) and STA-sylvian (M3, 15.9) segments of the middle cerebral artery. Other strong anastomotic combinations were OA- telovelotonsillar (15) and OA- tonsilomedullary (14.9) segments of the posterior inferior cerebellar artery, and MMA-lateral pontomesencephalic segment of the superior cerebellar artery (14.2). CONCLUSIONS: This novel model for anastamotic pair scoring can serve as a useful clinical tool for selecting the optimal donor, recipient, and approach combination that can help facilitate a successful bypass.
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Revascularização Cerebral , Humanos , Revascularização Cerebral/métodos , Artéria Carótida Externa/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos , Artéria Cerebral Média/cirurgia , Anastomose CirúrgicaRESUMO
Does perceptual awareness arise within the sensory regions of the brain or within higher-level regions (e.g., the frontal lobe)? To answer this question, researchers traditionally compare neural activity when observers report being aware versus being unaware of a stimulus. However, it is unclear whether the resulting activations are associated with the conscious perception of the stimulus or the post-perceptual processes associated with reporting that stimulus. To address this limitation, we used both report and no-report conditions in a visual masking paradigm while participants were scanned using functional MRI (fMRI). We found that the overall univariate response to visible stimuli in the frontal lobe was robust in the report condition but disappeared in the no-report condition. However, using multivariate patterns, we could still decode in both conditions whether a stimulus reached conscious awareness across the brain, including in the frontal lobe. These results help reconcile key discrepancies in the recent literature and provide a path forward for identifying the neural mechanisms associated with perceptual awareness.
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Mapeamento Encefálico , Imageamento por Ressonância Magnética , Conscientização/fisiologia , Encéfalo/diagnóstico por imagem , Encéfalo/fisiologia , Mapeamento Encefálico/métodos , Estado de Consciência/fisiologia , Humanos , Mascaramento Perceptivo/fisiologia , Percepção Visual/fisiologiaRESUMO
Successful engagement with the world requires the ability to predict what will happen next. Here, we investigate how the brain makes a fundamental prediction about the physical world: whether the situation in front of us is stable, and hence likely to stay the same, or unstable, and hence likely to change in the immediate future. Specifically, we ask if judgments of stability can be supported by the kinds of representations that have proven to be highly effective at visual object recognition in both machines and brains, or instead if the ability to determine the physical stability of natural scenes may require generative algorithms that simulate the physics of the world. To find out, we measured responses in both convolutional neural networks (CNNs) and the brain (using fMRI) to natural images of physically stable versus unstable scenarios. We find no evidence for generalizable representations of physical stability in either standard CNNs trained on visual object and scene classification (ImageNet), or in the human ventral visual pathway, which has long been implicated in the same process. However, in frontoparietal regions previously implicated in intuitive physical reasoning we find both scenario-invariant representations of physical stability, and higher univariate responses to unstable than stable scenes. These results demonstrate abstract representations of physical stability in the dorsal but not ventral pathway, consistent with the hypothesis that the computations underlying stability entail not just pattern classification but forward physical simulation.
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Mapeamento Encefálico , Encéfalo , Encéfalo/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética/métodos , Redes Neurais de Computação , Estimulação LuminosaRESUMO
Three of the most robust functional landmarks in the human brain are the selective responses to faces in the fusiform face area (FFA), scenes in the parahippocampal place area (PPA), and bodies in the extrastriate body area (EBA). Are the selective responses of these regions present early in development or do they require many years to develop? Prior evidence leaves this question unresolved. We designed a new 32-channel infant magnetic resonance imaging (MRI) coil and collected high-quality functional MRI (fMRI) data from infants (2-9 months of age) while they viewed stimuli from four conditions-faces, bodies, objects, and scenes. We find that infants have face-, scene-, and body-selective responses in the location of the adult FFA, PPA, and EBA, respectively, powerfully constraining accounts of cortical development.
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Reconhecimento Visual de Modelos , Vias Visuais , Adulto , Encéfalo/fisiologia , Mapeamento Encefálico , Humanos , Imageamento por Ressonância Magnética , Reconhecimento Visual de Modelos/fisiologia , Estimulação Luminosa , Vias Visuais/fisiologiaRESUMO
Intratumoral hemorrhage/apoplexy in clival chordomas is extremely uncommon, with only 16 reported cases. The average age of patients was 46.2 years and slightly more than half were men. In cases published before 1990, all patients died from their disease without any intervention. Since then, 11 patients have undergone resection by a variety of approaches and there have been no deaths. The diagnosis of skull base chordomas relies on a combination of clinical presentation and radiographic features related to the location and invasion of the tumor. Chordomas presenting with sudden-onset symptoms should alarm the surgeon of a possible hemorrhage. As an illustration of this presentation, we describe a 58-year-old woman who presented with acute-onset headache and cranial nerve deficits. Computed tomography and magnetic resonance imaging demonstrated a hemorrhagic clival lesion with cavernous sinus extension. The patient underwent transsphenoidal resection of the lesion that resulted in the resolution of her symptoms. Histopathological evaluation of the lesion was consistent with chordoma with acute hemorrhagic components. Although intratumoral hemorrhage is rarely detected in chordomas, it should be considered a differential diagnosis of such lesions because prompt recognition and treatment are critical for patient survival.
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OBJECTIVE. The purpose of our study was to evaluate the upgrade rate of calcified lobular neoplasia (LN) versus incidental noncalcified classic LN found on core needle biopsy performed for the evaluation of suspicious calcifications. MATERIALS AND METHODS. This retrospective study included 390 consecutive image-guided breast core needle biopsies with microcalcifications as the target that were performed between December 2009 and July 2017. In 81 of the 390 core biopsies, the highest-risk lesion was LN that then underwent either excision or imaging follow-up. Core biopsy results were compared with excision and imaging follow-up findings. An upgrade of LN was defined as ductal carcinoma in situ or invasive ductal or lobular carcinoma. RESULTS. Of 81 LN diagnosed on core biopsy performed for calcifications, 16 had calcifications within the LN. Fifteen of these 16 cases underwent surgical excision, and three (3/15, 20.0%) were upgraded on excision. Of the 64 core biopsies showing incidental noncalcified LN with benign concordant entities containing calcifications, 42 underwent surgical excision, and one LN (1/42, 2.4%) was upgraded. Twenty-three total lesions (one calcified LN and 22 noncalcified LN) were followed with imaging rather than excision. No cancers were detected among the follow-up group. One case was deemed to have discordant findings on radiologic-pathologic review and was sent for excision, which showed invasive cancer with tubulolobular and lobular features. CONCLUSION. Women undergoing stereotactic core needle biopsy for calcifications revealing noncalcified incidental classic LN and a benign concordant entity that could explain the presence of the target calcifications have a low risk of upgrade and may be followed with imaging. Surgical excision should be offered to women who have LN with calcifications.
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Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/patologia , Calcinose/diagnóstico por imagem , Carcinoma Lobular/diagnóstico por imagem , Carcinoma Lobular/patologia , Mamografia/métodos , Adulto , Idoso , Biópsia com Agulha de Grande Calibre , Mama/diagnóstico por imagem , Mama/patologia , Feminino , Humanos , Achados Incidentais , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
What can we perceive in a single glance of the visual world? Although this question appears rather simple, answering it has been remarkably difficult and controversial. Traditionally, researchers have tried to infer the nature of perceptual experience by examining how many objects and what types of objects are not fully encoded within a scene (e.g., failing to notice a bowl disappearing/changing). Here, we took a different approach and asked how much we could alter an entire scene before observers noticed those global alterations. Surprisingly, we found that observers could fixate on a scene for hundreds of milliseconds yet routinely fail to notice drastic changes to that scene (e.g., scrambling the periphery so no object can be identified, putting the center of 1 scene on the background of another scene). In addition, we also found that as observers allocate more attention to their periphery, their ability to notice these changes to a scene increases. Together, these results show that although a single snapshot of perceptual experience can be remarkably impoverished, it is also not a fixed constant and is likely to be continuously changing from moment to moment depending on attention. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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BACKGROUND: The management of high-risk breast lesions diagnosed on image-guided core biopsy remains controversial. We implemented a high-risk breast conference attended by breast pathologists, imagers, and surgeons to prospectively review all contemporary cases in order to provide a consensus recommendation to either surgically excise or follow on imaging at 6-month intervals for a minimum of 2 years. METHODS: Between May, 2015 and June, 2019, 127 high-risk lesions were discussed. Of these 127 cases, 116 had concordant radiology-pathology (rad-path) findings. The remaining 11 patients had discordant rad-path findings. Of the 116 concordant cases, 6 were excluded due to lack of the first imaging follow-up until analysis. Of the remaining 110 patients, 43 had atypical ductal hyperplasia (ADH), 12 had lobular carcinoma in situ (LCIS), 19 had atypical lobular hyperplasia (ALH), 33 had radial scar (RS), 2 had flat epithelial atypia (FEA), and 1 had mucocele-like lesion (ML). We recommended excision for ADH if there were > 2 ADH foci or < 90% of the associated calcifications were removed. For patients with LCIS or ALH, we recommended excision if the LCIS or ALH was associated with microcalcifications or the LCIS was extensive. We recommended excision of RS when < 1/2 of the lesion was biopsied. We recommended all patients with FEA and ML for 6-month follow-up. RESULTS: Following conference-derived consensus for excision, of the 27 ADH excised, 9 were upgraded to invasive carcinoma or ductal carcinoma in situ. Of the six LCIS cases recommended for excision, none were upgraded. Nine excised radial scars revealed no upgrades. Additionally, 3 patients with ADH, 2 with ALH, 1 with LCIS, and 2 with RS underwent voluntary excision, and none were upgraded. All other patients (13 with ADH, 5 LCIS, 17 ALH, 22 RS, 2 FEA and 1 ML) were followed with imaging, and none revealed evidence of disease progression during follow-up (187-1389 days). All 11 rad-path discordant cases were excised with 2 upgraded to carcinoma. CONCLUSIONS: The results of this prospective study indicate that high-risk breast lesions can be successfully triaged to surgery versus observation following establishment of predefined firm guidelines and performance of rigorous rad-path correlation.
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Neoplasias da Mama , Carcinoma in Situ , Carcinoma Intraductal não Infiltrante , Carcinoma Lobular , Biópsia com Agulha de Grande Calibre , Mama/diagnóstico por imagem , Mama/patologia , Mama/cirurgia , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Carcinoma in Situ/patologia , Carcinoma Intraductal não Infiltrante/diagnóstico , Carcinoma Intraductal não Infiltrante/patologia , Carcinoma Intraductal não Infiltrante/cirurgia , Carcinoma Lobular/patologia , Feminino , Humanos , Hiperplasia/diagnóstico , Hiperplasia/patologia , Estudos ProspectivosRESUMO
OBJECTIVE: To determine the best management option (surgical excision versus imaging surveillance) following the diagnosis of pure radial scars (RSs) and RSs with associated additional high-risk lesions (HRLs) encountered on percutaneous core-needle breast biopsy. METHODS: An IRB-approved retrospective review of the breast imaging reporting system database was performed to identify all cases of pure RS alone or RS plus an additional HRL (papilloma, atypia, lobular neoplasia) diagnosed on core-needle biopsy, from 2007 to 2016, at four breast centers in our institution. Cases with associated malignancy, discordant radiologic-pathologic results, or those lost to follow-up were excluded. The remaining cases were evaluated to determine results of either subsequent surgical excision or long-term follow-up imaging (minimum of two years). Additional data recorded included clinical presentation, breast density, personal and family history of breast cancer, lesion imaging characteristics, and biopsy method. RESULTS: The study cohort included 111 patients with 111 lesions: 56.8% (63/111) with RS alone (pure) and 43.2% (48/111) with RS plus additional HRL(s). Out of the 63 radiologic-pathologic concordant pure RSs, there were no upgrades to malignancy in 51 subsequent surgical excisions or 12 long-term surveillance cases (0/63, 0%). Out of the 48 RSs plus additional HRL(s), there were 2 upgrades to malignancy (2/48, 4.2%). CONCLUSION: Cases of radiologic-pathologic concordant pure RS diagnosed at core-needle biopsy do not require surgical excision. On the other hand, surgical excision should be considered for RS plus additional HRLs diagnosed at core-needle biopsy.
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Dynamic contrast-enhanced (DCE) MRI provides both morphological and functional information regarding breast tumor response to neoadjuvant chemotherapy (NAC). The purpose of this retrospective study is to test if prediction models combining multiple MRI features outperform models with single features. Four features were quantitatively calculated in each MRI exam: functional tumor volume, longest diameter, sphericity, and contralateral background parenchymal enhancement. Logistic regression analysis was used to study the relationship between MRI variables and pathologic complete response (pCR). Predictive performance was estimated using the area under the receiver operating characteristic curve (AUC). The full cohort was stratified by hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2) status (positive or negative). A total of 384 patients (median age: 49 y/o) were included. Results showed analysis with combined features achieved higher AUCs than analysis with any feature alone. AUCs estimated for the combined versus highest AUCs among single features were 0.81 (95% confidence interval [CI]: 0.76, 0.86) versus 0.79 (95% CI: 0.73, 0.85) in the full cohort, 0.83 (95% CI: 0.77, 0.92) versus 0.73 (95% CI: 0.61, 0.84) in HR-positive/HER2-negative, 0.88 (95% CI: 0.79, 0.97) versus 0.78 (95% CI: 0.63, 0.89) in HR-positive/HER2-positive, 0.83 (95% CI not available) versus 0.75 (95% CI: 0.46, 0.81) in HR-negative/HER2-positive, and 0.82 (95% CI: 0.74, 0.91) versus 0.75 (95% CI: 0.64, 0.83) in triple negatives. Multi-feature MRI analysis improved pCR prediction over analysis of any individual feature that we examined. Additionally, the improvements in prediction were more notable when analysis was conducted according to cancer subtype.
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The need for proven disease-specific treatments for the novel pandemic coronavirus SARS-CoV-2 necessitates a worldwide search for therapeutic options. Since the SARS-CoV-2 virus shares extensive homology with SARS-CoV and MERS-CoV, effective therapies for SARS-CoV and MERS-CoV may also have therapeutic potential for the current COVID-19 outbreak. To identify therapeutics that might be repositioned for treatment of the SARS-CoV-2 disease COVID-19, we strategically reviewed the literature to identify existing therapeutics with evidence of efficacy for the treatment of the three coronaviruses that cause severe respiratory illness (SARS-CoV, MERS-CoV, and SARS-CoV-2). Mechanistic and in vitro analyses suggest multiple promising therapeutic options with potential for repurposing to treat patients with COVID-19. Therapeutics with particularly high potential efficacy for repurposing include camostat mesylate, remdesivir, favipiravir, tocilizumab, baricitinib, convalescent plasma, and humanized monoclonal antibodies. Camostat mesylate has shown therapeutic potential, likely by preventing viral entry into epithelial cells. In early research, the targeted antivirals remdesivir and favipiravir appear to benefit patients by decreasing viral replication; clinical trials suggest that remdesivir speeds recovery from COVID-19. Tocilizumab and baricitinib appear to improve mortality by preventing a severe cytokine storm. Convalescent plasma and humanized monoclonal antibodies offer passive immunity and decreased recovery time. This review highlights potential therapeutic options that may be repurposed to treat COVID-19 and suggests opportunities for further research.
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Antivirais/uso terapêutico , Betacoronavirus/efeitos dos fármacos , Infecções por Coronavirus/tratamento farmacológico , Pneumonia Viral/tratamento farmacológico , COVID-19 , Humanos , Pandemias , SARS-CoV-2 , Síndrome Respiratória Aguda Grave/tratamento farmacológicoRESUMO
BACKGROUND: Isolated trigeminal schwannomas occur in 0.07% to 0.3% of intracranial tumors and account for 0.8% to 8% of intracranial schwannomas and 1/3 of Meckel cave tumors. The presence of multisegmental schwannoma is rare, resulting in a limited understanding of its optimal management. OBJECTIVE: To describe potential surgical options to manage this rare entity. METHODS: A 2-institution retrospective review of all patients with pathologically confirmed trigeminal schwannoma managed with resection from January 2009 through January 2019 was conducted. A manual chart review was performed to verify patients' inclusion and collect data about age, sex, tumor size, tumor site, treatment modality, surgical approach, complications, and follow-up duration and status. RESULTS: A total of 4 patients (age range 12-50 yr) who underwent a variety of cranial and orbitocranial approaches for tumor resection were identified. Patients achieved good outcomes with improvement of visual outcomes. One case of infection and 1 case of partial tumor recurrence requiring reresection were identified. CONCLUSION: Multisegmental trigeminal schwannoma is a rare and unique entity, often associated with trigeminal schwannomatosis. Interdisciplinary management has been shown to be the most effective method for improving patient outcomes with these complex and poorly understood diseases.
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Neoplasias dos Nervos Cranianos , Neurilemoma , Neurofibromatoses , Adolescente , Adulto , Criança , Neoplasias dos Nervos Cranianos/diagnóstico por imagem , Neoplasias dos Nervos Cranianos/cirurgia , Humanos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Neurilemoma/diagnóstico por imagem , Neurilemoma/cirurgia , Estudos Retrospectivos , Adulto JovemRESUMO
BACKGROUND: To determine whether patients with benign papilloma diagnosed on core biopsy can be spared from surgery. METHODS: We prospectively reviewed 150 consecutive core biopsy-diagnosed papilloma cases at a multi-specialty high-risk breast lesion conference to determine whether surgical excision was necessary. Of these 150 cases, 148 had concordant radiologic-pathologic features. Six were excluded due to lack of the first imaging follow-up until analysis. 112 were benign papillomas; 17 were papillomas involved by atypical ductal hyperplasia (atypical papilloma); 6 papillomas had ADH in adjacent tissue but not involving the papilloma; 2 papillomas were involved by atypical lobular hyperplasia (ALH); and 5 papillomas had ALH in adjacent tissue. Two were radiology-pathology (rad-path) discordant. RESULTS: Thirty-nine of the 112 benign papillomas were excised with no upgrade to carcinoma; 73 were followed with no disease progression during follow-up (185-1279 days). Fifteen of 17 atypical papillomas were surgically excised with 4 (26.7%) upgraded to carcinoma. Four of the 6 patients with ADH adjacent to a benign papilloma underwent excision with 2 upgrades to carcinoma. None of the patients with papilloma, which was either involved by ALH or had ALH in adjacent tissue had upgrade or disease progression during follow-up (204-1159 days). Finally, the two cases with discordant path-rad discordant were excised with no upgrade. CONCLUSIONS: Our data confirm that rad-path concordant benign papillomas diagnosed on core biopsy do not require surgery. It also supports the value of a formal multi-specialty review of all benign papilloma cases to create a consensus management plan.
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Neoplasias da Mama , Carcinoma Intraductal não Infiltrante , Papiloma , Radiologia , Biópsia com Agulha de Grande Calibre , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/cirurgia , Feminino , Humanos , Papiloma/diagnóstico , Papiloma/cirurgiaRESUMO
BACKGROUND: Noise exposure and associated hearing loss affects an estimated 2 million farm youth who are exposed as farm residents, farm family workers, hired workers, children of migrant or seasonal workers, and farm visitors. Risk factors for farm youth include frequent exposure to high farm noise; farm work from an early age, and exposure to high recreational noise (e.g., firearms, ATVs, and personal listening devices). METHODS: This study compared the effectiveness of two interventions and control. The programs included a community-based interactive youth educational program alone (Group A), a community-based interactive youth educational program followed by an Internet-based booster (Group B), and a no-interaction control (Group C). The study used a cluster randomized control design, with equal allocation ratio to each cluster, without blinding. Inclusion criteria included enrollment in grade 4, parental consent, English speaking, and attending a community-based educational event included in the cluster sampling. A total of 1979 youth were enrolled at 36 sites distributed across the 3 study arms in the following distribution: N = 662 in 13 sites (Group A), N = 680 in 12 sites (Group B), and N = 637 in 11 sites (Group C). RESULTS: Comparison with pre-intervention data showed no difference in intent to use hearing conservation strategies in experimental groups. However, knowledge and attitudes toward hearing conservation were improved in the groups receiving the Internet-based booster. Participants reported frequent exposure to sources of hazardous noise (e.g., loud sporting events, firecrackers, personal listening devices). CONCLUSIONS: It is feasible and acceptable to incorporate hearing health education into an already existing system designed to deliver health and safety educational programming to farm and rural youth. The program was adopted by the partner agency for dissemination to up to 100,000 youth annually. Results of this study inform future intervention studies, interventions aimed at farm youth, and interventions to increase use of hearing conservation strategies, as well as offer a base for developing programs for non-English speaking children. TRIAL REGISTRATION: Clinicaltrials.gov registration CT02472821. Date of trial registration: 06/09/2015 (retrospectively registered).
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Dispositivos de Proteção das Orelhas/estatística & dados numéricos , Exposição Ambiental/prevenção & controle , Educação em Saúde/métodos , Perda Auditiva Provocada por Ruído/prevenção & controle , Adolescente , Criança , Análise por Conglomerados , Fazendas , Feminino , Audição , Perda Auditiva Provocada por Ruído/etiologia , Humanos , Masculino , Ruído/efeitos adversos , Avaliação de Programas e Projetos de Saúde , Fatores de Risco , População RuralRESUMO
Color ignites visual experience, imbuing the world with meaning, emotion, and richness. As soon as an observer opens their eyes, they have the immediate impression of a rich, colorful experience that encompasses their entire visual world. Here, we show that this impression is surprisingly inaccurate. We used head-mounted virtual reality (VR) to place observers in immersive, dynamic real-world environments, which they naturally explored via saccades and head turns. Meanwhile, we monitored their gaze with in-headset eye tracking and then systematically altered the visual environments such that only the parts of the scene they were looking at were presented in color and the rest of the scene (i.e., the visual periphery) was entirely desaturated. We found that observers were often completely unaware of these drastic alterations to their visual world. In the most extreme case, almost a third of observers failed to notice when less than 5% of the visual display was presented in color. This limitation on perceptual awareness could not be explained by retinal neuroanatomy or previous studies of peripheral visual processing using more traditional psychophysical approaches. In a second study, we measured color detection thresholds using a staircase procedure while a set of observers intentionally attended to the periphery. Still, we found that observers were unaware when a large portion of their field of view was desaturated. Together, these results show that during active, naturalistic viewing conditions, our intuitive sense of a rich, colorful visual world is largely incorrect.