Differential impact of posterior lesions in the left and right hemisphere on visual category learning and generalization to contrast reversal

Hemispheric differences in the learning and generalization of pattern categories were explored in two experiments involving sixteen patients with unilateral posterior, cerebral lesions in the left (LH) or right (RH) hemisphere. In each experiment participants were first trained to criterion in a supervised learning paradigm to categorize a set of patterns that either consisted of simple geometric forms (Experiment 1) or unfamiliar grey-level images (Experiment 2). They were then tested for their ability to generalize acquired categorical knowledge to contrast-reversed versions of the learning patterns. The results showed that RH lesions impeded category learning of unfamiliar grey-level images more severely than LH lesions, whereas this relationship appeared reversed for categories defined by simple geometric forms. With regard to generalization to contrast reversal, categorization performance of LH and RH patients was unaffected in the case of simple geometric forms. However, generalization to of contrast-reversed grey-level images distinctly deteriorated for patients with LH lesions relative to those with RH lesions, with the latter (but not the former) being consistently unable to identify the pattern manipulation. These findings suggest a differential use of contrast information in the representation of pattern categories in the two hemispheres. Such specialization appears in line with previous distinctions between a predominantly lefthemispheric, abstract-analytical and a righthemispheric, specific-holistic representation of object categories, and their prediction of a mandatory representation of contrast polarity in the RH. Some implications for the well-established dissociation of visual disorders for the recognition of faces and letters are discussed.

The influence of posterior corneal surface astigmatism on residual astigmatism

It has often been found that corneal astigmatism exceeds the amount exhibited by the eye as a whole. This difference is usually referred to as residual astigmatism. Scrutiny of the studies of corneal astigmatismreveal that what has actually been measured is the astigmatic contributionof the anterior corneal surface alone. This anterior surface is easily measured whereas measurement of the posterior corneal surface is much more difficult. A method was therefore developed to measure the radius and toricity of the posterior corneal surface. The method relies upon photography of the first and second Purkinje images in three fixed meridians. Keratometry, comparison of anterior and posterior corneal Purkinje images and pachometricdata were applied to three meridional analysis equations, allowing the posterior corneal surface to be described in sphero-cylindrical form. Measurements were taken from 80 healthy subjects from two distinct age groups. The first consisted of 60 young subjects, mean age 22.04 years and the second consisted of 20 old subjects, mean age 74.64 years. The young group consisted of 28 myopes, 24 emmetropes and 8 hyperopes. The old group consisted of 6 myopes and 14 hyperopes. There was an equal number of males and females in each group. These groupings allowed the study of the effects of age, ametropia and gender on the posterior corneal toricity. The effect of the posterior corneal surface on residual astigmatism was assessed and was found to cause an overall reduction. This reduction was due primarily to the posterior corneal surface being consistently steeper relative to the anterior surface in the vertical meridian compared to the horizontal meridian.

Shape of the posterior vitreous chamber in human emmetropia and myopia

PURPOSE - To compare posterior vitreous chamber shape in myopia to that in emmetropia. METHODS - Both eyes of 55 adult subjects were studied, 27 with emmetropia (MSE =-0.55; <+0.75D; mean +0.09 ±0.36D) and 28 with myopia (MSE -5.87 ±2.31D). Cycloplegic refraction was measured with a Shin Nippon autorefractor and anterior chamber depth and axial length with a Zeiss IOLMaster. Posterior vitreous chamber shapes were determined from T2-weighted MRI (3-Tesla) using procedures previously reported by our laboratory. 3-D surface model coordinates were assigned to nasal, temporal, superior and inferior quadrants and plotted in 2-D to illustrate the composite shape of respective quadrants posterior to the second nodal point. Spherical analogues of chamber shape were constructed to compare relative sphericity between refractive groups and quadrants. RESULTS - Differences in shape occurred in the region posterior to points of maximum globe width and were thus in general accord with an equatorial model of myopic expansion. Shape in emmetropia is categorised distinctly as that of an oblate ellipse and in myopia as an oblate ellipse of significantly less degree such that it approximates to a sphere. There was concordance between shape and retinotopic projection of respective quadrants into right, left, superior and inferior visual fields. CONCLUSIONS - The transition in shape from oblate ellipse to sphere with axial elongation supports the hypothesis that myopia may be a consequence of equatorial restriction associated with biomechanical anomalies of the ciliary apparatus. The synchronisation of quadrant shapes with retinotopic projection suggests that binocular growth is coordinated by processes that operate beyond the optic chiasm.

The management of posterior vitreous detachment by an optometrist

Acute posterior vitreous detachment (PVD) is the most common cause of retinal detachment. The management of this condition can be variable and often undue reliance is placed upon associated signs and symptoms which can be a poor indicator of pathology. Optometrists undertake a number of extended roles, however involvement in vitreo-retinal sub-specialities appears to be limited. One objective was to directly compare an optometrist and ophthalmologist in the assessment of patients with PVD, for this a high level of agreement was found (95% sensitivity, 99% specificity, 0.94 kappa). A review of 1107 patients diagnosed with acute PVD that were re-evaluated in a PVD clinic a few weeks later was undertaken to determine whether such reviews are necessary. One-fifth of patients were found to have conditions undiagnosed at the initial assessment, overall 4% of patients had retinal breaks when examined in the PVD clinic and a total of 7% required further intervention. The sensitivity of fundus examination with +90D and 3-mirror lenses was 85-88% for detecting retinal breaks and 7-85% for pigment in the anterior vitreous for the presence of retinal breaks. Therefore patients with acute PVD should be examined by indirect ophthalmoscopy with indentation at the onset of PVD and 4-6 weeks later. The treatment of retinal breaks with laser retinopexy is performed by ophthalmologists with a primary success rate 54-85%. In a pioneering development, an optometrist undertaking this role achieved a comparable primary success rate (79%). Mid-vitreous opacities associated with PVD are described, and noted in 100% of eyes with PVD. The recognition of this sign is important in the diagnosis of PVD and retinal breaks. The importance of diagnostic imaging is also demonstrated, however the timing in relation to onset may be vital.

Acute Posterior Ankle Pain in a Female Recreational Soccer Player

Os trigonum syndrome, a musculoskeletal disorder causing posterior ankle pain, occurs in approximately one in every 13 people. This condition can be challenging for the athletic trainer when evaluating an acute ankle injury. We present a unique case of an os trigonum successfully treated with conservative rehabilitation without a definitive diagnosis.

As compreensões do construtivismo de Ernst Von Glasersfeld e John Fossa: intermediando um diálogo em busca de novas significações

The present thesis, orientated by a letter sent by Ernst von Glasersfeld to John Fossa, is the product of a theoretical investigation of radical constructivism. In this letter, von Glasersfeld made three observations about Fossa’s understanding of radical constructivism. However, we limited our study to the second of these considerations since it de als with some of the core issues of constructivism. Consequently, we investigated what issues are raised by von Glasersfeld’s observation and whether these issues are relevant to a better understanding of constructivism and its implications for the mathema tics classroom . In order to realize the investigation, it was necessary to characterize von Glasersfeld’s epistemological approach to constructivism, to identify which questions about radical constructivism are raised by von Glasersfeld’s observation, to i nvestigate whether these issues are relevant to a better understanding of constructivism and to analyze the implications of these issues for the mathematics classroom. Upon making a hermeneutic study of radical constructivism, we found that what is central to it is its radicalism, in the sense that it breaks with tradition by its absence of an ontology. Thus, we defend the thesis that the absence of an ontology, although it has advantages for radical constructivism, incurs serious problems not only for the theory itself, but also for its implications for the mathematics classroom. The advantages that we were able to identify include a change from the usual philosophical paths to a very different rational view of the world, an overcoming of a naive way of thi nking, an understanding of the subject as active in the construction of his/her experiential reality, an interpretation of cognition as an instrument of adaptation, a new concept of knowledge and a vision of knowledge as fallible (or provisional). The prob lems are associated with the impossibility of radical constructivism to explain adequately why the reality that we build up is regular, stable, non - arbitrary and publicly shared. With regard to the educational implications of radical constructivism, the ab sence of an ontology brings to the mathematics classroom not only certain relevant aspects (or favorable points) that make teaching a process of researching student learning, empowering the student to learn and changing the classroom design, but also certa in weaknesses or limitations. These weaknesses or limitations of constructivism in the classroom are due to its conception of knowledge as being essentially subjective. This requires it to work with one - on - one situations and, likewise, makes the success of teaching dependent on the teacher’s individual skills. Perhaps the most important weakness or limitation, in this sense, is that it makes teaching orientated by constructivist principles unable to reach the goal of the formation of a community. We conclud e that issues raised by von Glasersfeld’s observation are absolutely relevant to the context of a better understanding of radical constructivism and its implications for education, especially for Mathematics Education.

Situación del riesgo de embolia y de hemorragia según las escalas CHADS₂, CHA₂DS₂-VASc y HAS-BLED en pacientes con diagnóstico de fibrilación auricular crónica, en un centro de salud de Madrid

La fibrilación auricular (FA) es la arritmia sostenida más frecuente en la práctica clínica, consistente en la desorganización total de la actividad eléctrica de la aurícula y ausencia de contracción auricular ordenada. Las últimas guías americanas AHA/ACC/HRS del 2014 definen “fibrilación auricular no valvular” (FANV) como aquella que aparece en ausencia de estenosis mitral reumática, prótesis valvular cardíaca o reparación valvular mitral, que en la FA en la que basamos este trabajo. La prevalencia estimada de fibrilación auricular en el mundo desarrollado es de un 1,5-2%, cuya incidencia aumenta escalonadamente en función de las décadas de la vida, siendo la edad media presentación entre los 75 y los 85 años. En España se estima que la FA afecta a un 8,5% de la población mayor de 60 años, es decir que existen más de 1 millón de personas con FA, de los cuales más de 90.000 se encuentran sin diagnosticar. La FA puede aparecer como consecuencia de una cardiopatía estructural, aunque otras enfermedades extracardíacas también se asocian a la FA, por mecanismos hemodinámicos, como la embolia pulmonar, EPOC, SAOS, o bien por la modulación del SNA, como en el caso del hipertiroidismo. La importancia de la FA radica en su creciente prevalencia, así como por la importante carga de morbilidad y mortalidad que genera. La FA está asociada a una tasa aumentada de muerte, ACV y otros episodios tromboembólicos, insuficiencia cardiaca y hospitalizaciones, pérdida de calidad de vida, deterioro cognitivo, capacidad reducida para el ejercicio y disfunción ventricular izquierda. El riesgo de muerte es el doble que el de la población sin dicha patología. Y el riesgo de ictus es de 3-5 veces mayor...

The roles of EFN-1 and seam cell V2 in the transmission of a stop cue for the posterior lateral microtubule in Caenorhabditis elegans

A functional nervous system requires the precise arrangement of all nerve cells and their neurites. To achieve this correct assembly, a myriad of molecular guidance cues works together to direct the outgrowth of neurites to their correct positions. The small nematode C. elegans provides the ideal model system to study the complex mechanisms of neurite guidance due to its relatively simple nervous system, composed of 302 neurons. I used two mechanosensory neurons, called the posterior lateral microtubule (PLM), to investigate the role of the ephrin and Eph receptor protein family in neurite termination in C. elegans. Activation of the C. elegans Eph receptor VAB-1 on the PLM growth cone is sufficient to cause PLM termination, but the identity and location of the activating ligand has not been established. In my thesis I investigated the ability of the ephrin ligand EFN-1 to activate VAB-1 to cause PLM termination when expressed on the same cell (in cis) and on opposing cells (in trans) to the receptor. I showed that EFN-1 is able to activate VAB-1 in cis and in trans to cause PLM termination. I also assessed the hypodermal seam cells as the source of the ephrin stop cue using fluorescently labelled and seam cell mutant transgenic worms. I found that although the PLM shows consistent termination on the seam cell V2 in wild type worms independent of PLM length, this process is not significantly disrupted in seam cell mutants. With this information I have created a new hypothesis that the PLM neurite is able the provide a positional cue for the developing seam cells, and have created a new transgenic strain which can be used to assess the impact of PLM and ALM cell ablation on seam cell position. My research is the first to demonstrate the ability of an ephrin ligand to activate its ephrin receptor in cis, and further research can investigate if this finding has in vivo applications.

Posterior Probability Modeling and Image Classification for Archaeological Site Prospection: Building a Survey Efficacy Model for Identifying Neolithic Felsite Workshops in the Shetland Islands

The application of custom classification techniques and posterior probability modeling (PPM) using Worldview-2 multispectral imagery to archaeological field survey is presented in this paper. Research is focused on the identification of Neolithic felsite stone tool workshops in the North Mavine region of the Shetland Islands in Northern Scotland. Sample data from known workshops surveyed using differential GPS are used alongside known non-sites to train a linear discriminant analysis (LDA) classifier based on a combination of datasets including Worldview-2 bands, band difference ratios (BDR) and topographical derivatives. Principal components analysis is further used to test and reduce dimensionality caused by redundant datasets. Probability models were generated by LDA using principal components and tested with sites identified through geological field survey. Testing shows the prospective ability of this technique and significance between 0.05 and 0.01, and gain statistics between 0.90 and 0.94, higher than those obtained using maximum likelihood and random forest classifiers. Results suggest that this approach is best suited to relatively homogenous site types, and performs better with correlated data sources. Finally, by combining posterior probability models and least-cost analysis, a survey least-cost efficacy model is generated showing the utility of such approaches to archaeological field survey.

Progressive Multifocal Leukoencephalopathy and Systemic Lupus Erythematosus: Focus on Etiology

Progressive multifocal leukoencephalopathy (PML) caused by reactivation of the JC virus (JCV), a human polyomavirus, occurs in autoimmune disorders, most frequently in systemic lupus erythematosus (SLE). We describe a HIV-negative 34-year-old female with SLE who had been treated with immunosuppressant therapy (IST; steroids and azathioprine) since 2004. In 2011, she developed decreased sensation and weakness of the right hand, followed by vertigo and gait instability. The diagnosis of PML was made on the basis of brain MRI findings (posterior fossa lesions) and JCV isolation from the cerebrospinal fluid (700 copies/ml). IST was immediately discontinued. Cidofovir, mirtazapine, mefloquine and cycles of cytarabine were sequentially added, but there was progressive deterioration with a fatal outcome 1 year after disease onset. This report discusses current therapeutic choices for PML and the importance of early infection screening when SLE patients present with neurological symptoms. In the light of recent reports of PML in SLE patients treated with rituximab or belimumab, we highlight that other IST may just as well be implicated. We conclude that severe lymphopenia was most likely responsible for JCV reactivation in this patient and discuss how effective management of lymphopenia in SLE and PML therapy remains an unmet need.

Arterial entrapment syndrome in the cubital fossa: a rare cause of acute stress-related arterial thrombosis in a patient with brachial artery duplication

Arterial entrapment syndrome (AES) at elbow level is very rare and to our knowledge no case of AES by lacertus fibrosus in the cubital fossa in presence of brachial artery duplication has been described to date. We describe a rare case of acute arterial thrombosis of one of two brachial arteries highlighted in the cubital fossa which developed after strenuous right elbow flexor muscle activity and hyper-extensions presumably related to AES by lacertus fibrosus at elbow level. A 43-year-old right-handed woman, experienced paleness, coldness and numbness of the right hand, after 8 consecutive hours of gardening. As she worked, her ipsilateral flexor elbow muscles remained in prolonged and inappropriate tension. Clinical examination evidenced the absence of radial artery pulse in the wrist and mild hypothermia in the second and third finger. During surgical exploration two anastomosed brachial arteries were detected in the cubital fossa under the lacertus fibrosus. The lateral superficial brachial artery was occluded. Intraoperative arteriography evidenced brachial artery duplication at the third superior of the arm and normal vascular pattern at the forearm level. In cases of unexplained atypical intermittent upper extremity claudication or acute ischemic symptoms an AES should always be ruled out, particularly when symptoms are exacerbated by strenuous upper extremity activity or when upper limb muscular hypertrophy is evident. In these cases a thorough dynamic clinical and instrumental examination is mandatory to confirm a diagnosis of AES and to avoid possible future ischemic complications.