Representation of people of South Asian origin in cardiovascular outcome trials of glucose-lowering therapies in Type 2 diabetes

Aims : Our aim was to investigate the proportional representation of people of South Asian origin in cardiovascular outcome trials of glucose-lowering drugs or strategies in Type 2 diabetes, noting that these are among the most significant pieces of evidence used to formulate the guidelines on which clinical practice is largely based. Methods : We searched for cardiovascular outcome trials in Type 2 diabetes published before January 2015, and extracted data on the ethnicity of participants. These were compared against expected values for proportional representation of South Asian individuals, based on population data from the USA, from the UK, and globally. Results : Twelve studies met our inclusion criteria and, of these, eight presented a sufficiently detailed breakdown of participant ethnicity to permit numerical analysis. In general, people of South Asian origin were found to be under-represented in trials compared with UK and global expectations and over-represented compared with US expectations. Among the eight trials for which South Asian representation could be reliably estimated, seven under-represented this group relative to the 11.2% of the UK diabetes population estimated to be South Asian, with the representation in these trials ranging from 0.0% to 10.0%. Conclusions : Clinicians should exercise caution when generalizing the results of trials to their own practice, with regard to the ethnicity of individuals. Efforts should be made to improve reporting of ethnicity and improve diversity in trial recruitment, although we acknowledge that there are challenges that must be overcome to make this a reality.

The special case of self-perspective inhibition in mental, but not non-mental, representation

The ventrolateral prefrontal cortex (vlPFC) has been implicated in studies of both executive and social functions. Recent meta-analyses suggest that vlPFC plays an important but little understood role in Theory of Mind (ToM). Converging neuropsychological and functional Magnetic Resonance Imaging (fMRI) evidence suggests that this may reflect inhibition of self-perspective. The present study adapted an extensively published ToM localizer to evaluate the role of vlPFC in inhibition of self-perspective. The classic false belief, false photograph vignettes that comprise the localizer were modified to generate high and low salience of self-perspective. Using a factorial design, the present study identified a behavioural and neural cost associated with having a highly salient self-perspective that was incongruent with the representational content. Importantly, vlPFC only differentiated between high versus low salience of self-perspective when representing mental state content. No difference was identified for non-mental representation. This result suggests that different control processes are required to represent competing mental and non-mental content.

Representation, control, or reasoning? Distinct functions for theory of mind within the medial prefrontal cortex

The medial pFC (mPFC) is frequently reported to play a central role in Theory of Mind (ToM). However, the contribution of this large cortical region in ToM is not well understood. Combining a novel behavioral task with fMRI, we sought to demonstrate functional divisions between dorsal and rostral mPFC. All conditions of the task required the representation of mental states (beliefs and desires). The level of demands on cognitive control (high vs. low) and the nature of the demands on reasoning (deductive vs. abductive) were varied orthogonally between conditions. Activation in dorsal mPFC was modulated by the need for control, whereas rostral mPFC was modulated by reasoning demands. These findings fit with previously suggested domain-general functions for different parts of mPFC and suggest that these functions are recruited selectively in the service of ToM.

Eigen-Adaptation and Distributed Representation of 2-D Phase, Energy, Scale and Orientation in Spatial Vision

Distributed representations (DR) of cortical channels are pervasive in models of spatio-temporal vision. A central idea that underpins current innovations of DR stems from the extension of 1-D phase into 2-D images. Neurophysiological evidence, however, provides tenuous support for a quadrature representation in the visual cortex, since even phase visual units are associated with broader orientation tuning than odd phase visual units (J.Neurophys.,88,455–463, 2002). We demonstrate that the application of the steering theorems to a 2-D definition of phase afforded by the Riesz Transform (IEEE Trans. Sig. Proc., 49, 3136–3144), to include a Scale Transform, allows one to smoothly interpolate across 2-D phase and pass from circularly symmetric to orientation tuned visual units, and from more narrowly tuned odd symmetric units to even ones. Steering across 2-D phase and scale can be orthogonalized via a linearizing transformation. Using the tiltafter effect as an example, we argue that effects of visual adaptation can be better explained by via an orthogonal rather than channel specific representation of visual units. This is because of the ability to explicitly account for isotropic and cross-orientation adaptation effect from the orthogonal representation from which both direct and indirect tilt after-effects can be explained.