Caricaturing facial expressions

The physical differences between facial expressions (e.g. fear) and a reference norm (e.g. a neutral expression) were altered to produce photographic-quality caricatures. In Experiment 1, participants rated caricatures of fear, happiness and sadness for their intensity of these three emotions; a second group of participants rated how 'face-like' the caricatures appeared. With increasing levels of exaggeration the caricatures were rated as more emotionally intense, but less 'face-like'. Experiment 2 demonstrated a similar relationship between emotional intensity and level of caricature for six different facial expressions. Experiments 3 and 4 compared intensity ratings of facial expression caricatures prepared relative to a selection of reference norms - a neutral expression, an average expression, or a different facial expression (e.g. anger caricatured relative to fear). Each norm produced a linear relationship between caricature and rated intensity of emotion; this finding is inconsistent with two-dimensional models of the perceptual representation of facial expression. An exemplar-based multidimensional model is proposed as an alternative account.

Signals for a transition from surface to bulk emission in thermal multifragmentation

Excitation-energy-gated two-fragment correlation functions have been studied between E(*)/A = (2-9)A MeV for equilibriumlike sources formed in 8-10 GeV/c pi(-) and p+197Au reactions. Comparison with an N-body Coulomb-trajectory code shows an order of magnitude decrease in the fragment emission time in the interval E(*)/A = (2-5)A MeV, followed by a nearly constant breakup time at higher excitation energy. The decrease in emission time is strongly correlated with the onset of multifragmentation and thermally induced radial expansion, consistent with a transition from surface-dominated to bulk emission expected for spinodal decomposition.

Evaluation of a new commercially available immunoglobulin M and immunoglobulin G immunochromatographic test for diagnosis of melioidosis infection

An immunochromatographic test for the rapid determination of immunoglobulin M (IgM) and IgG antibodies to Burkholderia pseudomallei was evaluated by using sera from bacteriologically confirmed melioidosis patients and high-risk and clinically suspected patients, along with disease control groups. The sensitivities were 100 and 93% for the IgG and IgM tests, respectively, while the specificity was 95% for both assays. The test was rapid and simple to perform, with results obtained in 10 min.

Understanding the diverse needs of the Medicare population: implications for Medicare reform

Meeting the health care needs of millions of elderly and disabled Americans is central to the debate over Medicare's future. Using data from a nationally representative survey of 3,309 beneficiaries, Medicare's most vulnerable beneficiaries were profiled, examining variations in coverage, satisfaction, access, and financial difficulties. A substantial portion of the Medicare population--two thirds--were found to have health problems or low incomes. The analysis found that about 40% of beneficiaries with incomes below the poverty level, in fair or poor health, or with ADL limitations, have difficulties paying their medical bills or getting needed health care. Medicare's disabled, under-65 beneficiaries are at even higher risk: nearly half (47%) have health care access problems or deal with financial hardship due to medical bills. The diverse needs and experiences of the Medicare population are underscored, providing new insights into the challenge of maintaining or improving protection for those with greatest need while assuring the long-term fiscal viability of the program.

The key to the door: Medicaid's role in improving health care for women and children

Medicaid is the nation's major public financing program for providing health insurance coverage and long-term care services to the poor. This article assesses Medicaid's contributions over the last three decades to improving the coverage, access to care, and health of low-income children and women. The article reviews Medicaid's impact on the low-income population covered by this program, demonstrating both the role insurance plays and its limitations as a strategy for improving the health of vulnerable populations. Medicaid has shown over the last three decades that it is an important lever to help open the door to better health care, and ultimately to improved health for America's poor women and children, by substantially expanding coverage of the low-income population and helping to reduce differentials in access to care between the poor and the privately insured. Gaps in coverage and limitations in access persist, but overall the program has resulted in better coverage, access, and health care for millions of poor children and their parents.

Effects of sexual dimorphism on facial attractiveness

Testosterone-dependent secondary sexual characteristics in males may signal immunological competence and are sexually selected for in several species. In humans, oestrogen-dependent characteristics of the female body correlate with health and reproductive fitness and are found attractive. Enhancing the sexual dimorphism of human faces should raise attractiveness by enhancing sex-hormone-related cues to youth and fertility in females, and to dominance and immunocompetence in males. Here we report the results of asking subjects to choose the most attractive faces from continua that enhanced or diminished differences between the average shape of female and male faces. As predicted, subjects preferred feminized to average shapes of a female face. This preference applied across UK and Japanese populations but was stronger for within-population judgements, which indicates that attractiveness cues are learned. Subjects preferred feminized to average or masculinized shapes of a male face. Enhancing masculine facial characteristics increased both perceived dominance and negative attributions (for example, coldness or dishonesty) relevant to relationships and paternal investment. These results indicate a selection pressure that limits sexual dimorphism and encourages neoteny in humans.

Age and sex distributions of hematological malignancies in the U.K

This paper reports on an analysis of nearly 27,000 hematological malignancies diagnosed in the U.K. in the 10-year period 1984 to 1993. The unique observations provided in this analysis are the similarity of the sex-specific curves by age for acute myeloid leukemia, myelodysplasia types, polycythemia rubra vera, and myelofibrosis (or myelosclerosis). The unusual age-sex-specific distribution of essential thrombocythemia, suggesting a unique epidemiology, has never been reported before. The unusual female excess of the nodular sclerosing adolescent peak in Hodgkin's disease and its rapid fall with time is potentially of great importance. An even younger childhood peak of acute lymphoblastic leukemia is presented. Overall these data represent the most reliable available in the U.K., being population based, specially collected and will form the basis of considerable further investigations.

A specific neural substrate for perceiving facial expressions of disgust

Recognition of facial expressions is critical to our appreciation of the social and physical environment, with separate emotions having distinct facial expressions. Perception of fearful facial expressions has been extensively studied, appearing to depend upon the amygdala. Disgust-literally 'bad taste'-is another important emotion, with a distinct evolutionary history, and is conveyed by a characteristic facial expression. We have used functional magnetic resonance imaging (fMRI) to examine the neural substrate for perceiving disgust expressions. Normal volunteers were presented with faces showing mild or strong disgust or fear. Cerebral activation in response to these stimuli was contrasted with that for neutral faces. Results for fear generally confirmed previous positron emission tomography findings of amygdala involvement. Both strong and mild expressions of disgust activated anterior insular cortex but not the amygdala; strong disgust also activated structures linked to a limbic cortico-striatal-thalamic circuit. The anterior insula is known to be involved in responses to offensive tastes. The neural response to facial expressions of disgust in others is thus closely related to appraisal of distasteful stimuli.

Insurance matters for low-income adults: results from a five-state survey

Using survey data from 2,000 low-income adult respondents in each of five states, this DataWatch assesses how uninsured, low-income adults differ from low-income adults who have public or private insurance and how Medicaid expansions have affected insurance coverage patterns across states with different eligibility policies. Findings show that the proportion of low-income uninsured adults is two to three times higher in states that have not expanded Medicaid eligibility beyond relatively low welfare levels. Compared with persons who have either Medicaid or private insurance, uninsured persons report more difficulties getting needed care, are less likely to have a regular provider, and rate the care they do receive as lower quality.

Computer-enhanced emotion in facial expressions

Benson & Perrett's (1991 b) computer-based caricature procedure was used to alter the positions of anatomical landmarks in photographs of emotional facial expressions with respect to their locations in a reference norm face (e.g. a neutral expression). Exaggerating the differences between an expression and its norm produces caricatured images, whereas reducing the differences produces 'anti-caricatures'. Experiment 1 showed that caricatured (+50% different from neutral) expressions were recognized significantly faster than the veridical (0%, undistorted) expressions. This held for all six basic emotions from the Ekman & Friesen (1976) series, and the effect generalized across different posers. For experiment 2, caricatured (+50%) and anti-caricatured (-50%) images were prepared using two types of reference norm; a neutral-expression norm, which would be optimal if facial expression recognition involves monitoring changes in the positioning of underlying facial muscles, and a perceptually-based norm involving an average of the expressions of six basic emotions (excluding neutral) in the Ekman & Friesen (1976) series. The results showed that the caricatured images were identified significantly faster, and the anti-caricatured images significantly slower, than the veridical expressions. Furthermore, the neutral-expression and average-expression norm caricatures produced the same pattern of results.

Facial expression megamix: tests of dimensional and category accounts of emotion recognition

We report four experiments investigating the perception of photographic quality continua of interpolated ('morphed') facial expressions derived from prototypes of the 6 emotions in the Ekman and Friesen (1976) series (happiness, surprise, fear, sadness, disgust and anger). In Experiment 1, morphed images made from all possible pairwise combinations of expressions were presented in random order; subjects identified these as belonging to distinct expression categories corresponding to the prototypes at each end of the relevant continuum. This result was replicated in Experiment 2, which also included morphs made from a prototype with a neutral expression, and allowed 'neutral' as a response category. These findings are inconsistent with the view that facial expressions are recognised by locating them along two underlying dimensions, since such a view predicts that at least some transitions between categories should involve neutral regions or identification as a different emotion. Instead, they suggest that facial expressions of basic emotions are recognised by their fit to discrete categories. Experiment 3 used continua involving 6 emotions to demonstrate best discrimination of pairs of stimuli falling across category boundaries; this provides further evidence of categorical perception of facial expressions of emotion. However, in both Experiment 1 and Experiment 2, reaction time data showed that increasing distance from the prototype had a definite cost on ability to identify emotion in the resulting morphed face. Moreover, Experiment 4 showed that subjects had some insight into which emotions were blended to create specific morphed images. Hence, categorical perception effects were found even though subjects were sensitive to physical properties of these morphed facial expressions. We suggest that rapid classification of prototypes and better across boundary discriminability reflect the underlying organisation of human categorisation abilities.

Impact of a statewide trauma system on rural emergency department patient assessment documentation. OHSU Rural Trauma Research Group

OBJECTIVE

To determine the association of rural ED patient assessment documentation with state trauma system implementation, hospital trauma categorization level (i.e., Level-3 vs Level-4), injury diagnosis, and patient demographics.

METHODS

A pre- vs post-system implementation (historical control) analysis of trauma documentation was performed using a sample of rural ED trauma patients from 4 Level-3 and 5 Level-4 trauma hospitals. The medical records of patients with specific index diagnoses in 4 anatomic regions (head, chest, liver/spleen, and femur/open-tibia) were reviewed for 3-year periods before statewide trauma system implementation and after hospital categorization. Vital sign, % inspired O2, and O2 saturation determinations were identified relative to the first and the last vital signs documented on the ED record. If not documented in the medical chart within 5 minutes of the first or last ED vital sign assessment, these measurements were considered missing. Separately, neurologic documentation (initial and final) also was sought for patients meeting criteria for an index head injury.

RESULTS

Of 1,057 patients entered into the database, 532 were evaluated during the pre-system period and 525 were evaluated during the post-system period. Overall, 47% had a head injury, 34% had a chest injury, 23% had a femur/open-tibia injury, and 12% had a spleen/liver injury. There were 142 (13%) patients with an injury in > 1 index area. Except for initial systolic blood pressure, documentation of all other initial and final patient vital signs increased significantly (p < 0.05). Documentation of the Glasgow Coma Scale score (initial and final; p = 0.0001) and a final pupil examination on head-injured patients (p = 0.025) also increased. The effects of hospital level, injury diagnosis, and patient demographics on documentation rate were minimal.

CONCLUSION

The study found overall improved ED documentation of trauma patient status in association with implementation of a statewide trauma system. This improvement in documentation suggests an enhanced process of care with trauma system participation.

Influence of a statewide trauma system on pediatric hospitalization and outcome

BACKGROUND

During the years 1987-1991, a statewide trauma system was implemented in Oregon (Ore) but not in Washington (Wash). Incidence of hospitalization, frequency of death and risk-adjusted odds of death for injured children (< 19 years) in the two adjacent states were compared for two time periods (1985-1987 and 1991-1993).

METHODS

State populations of injured children (International Classification of Diseases, 9th Revision-Clinical Modification, code 800-959) were identified through a Hospital Discharge Index. Hospitals in counties with a population density < 50 persons/square mile were designated rural. Incidence rates are events/10,000 pediatric population per year.

RESULTS

The pediatric population increased in both states (Ore: 687,000-758,000; Wash: 1,159,000-1,336,000). Incidence of hospitalization for all injured children in entire states declined (Ore: 66.5-38.5; Wash: 54-33); also in rural hospitals (Ore: 67.5-32; Wash: 48 to 31). Seriously injured children (score on the Injury Severity Scale > 15) had a lower incidence in 1991-1993 of admission to rural hospitals (Ore: 2.98; Wash: 2.82) compared with incidence for entire states (Ore: 4.61; Wash: 4.62); in 1985-1987 the incidence was not different. Furthermore risk adjusted odds of death for seriously injured children was significantly lower in Oregon than in Washington in the later time period.

CONCLUSION

Both states show a similar temporal trend toward a declining frequency of death for children hospitalized with injuries. Injury prevention strategies appear to have reduced the number of serious injuries in both states. However, seriously injured children demonstrated a reduced risk of death in Oregon, consistent with benefit from a statewide trauma system.

Unmet long-term care needs of elderly people in the community: a review of the literature

The extent of unmet need, or the extent to which needed assistance is unavailable for insufficient, is an important issue in public policy and financing of health and support services. This article reviews the research of literature to assess how unmet method is measured, and the extent of unmet needs among elderly people in the community. Measurement difficulties include variable definitions and measures of need across studies, the relative dearth of studies which undertake to measure unmet needs, and varying methodologies used to estimate need and unmet need. In addition, some measures of status and need, such as cognitive impairment and care giver burden are excluded from many estimates. Estimates of unmet need range from around 2 percent to about 35 percent of community dwelling elders, depending on what is included or excluded from the definition. Unmet need is associated with higher disability levels and living alone. The literature suggests that estimates of future unmet need will be mitigated by declining disability levels and increased use of assistive devices among the elder population.

A differential neural response in the human amygdala to fearful and happy facial expressions

The amygdala is thought to play a crucial role in emotional and social behaviour. Animal studies implicate the amygdala in both fear conditioning and face perception. In humans, lesions of the amygdala can lead to selective deficits in the recognition of fearful facial expressions and impaired fear conditioning, and direct electrical stimulation evokes fearful emotional responses. Here we report direct in vivo evidence of a differential neural response in the human amygdala to facial expressions of fear and happiness. Positron-emission tomography (PET) measures of neural activity were acquired while subjects viewed photographs of fearful or happy faces, varying systematically in emotional intensity. The neuronal response in the left amygdala was significantly greater to fearful as opposed to happy expressions. Furthermore, this response showed a significant interaction with the intensity of emotion (increasing with increasing fearfulness, decreasing with increasing happiness). The findings provide direct evidence that the human amygdala is engaged in processing the emotional salience of faces, with a specificity of response to fearful facial expressions.

Loss of disgust. Perception of faces and emotions in Huntington's disease

Face perception and emotion recognition were investigated in a group of people with Huntington's disease and matched controls. In conventional tasks intended to explore the perception of age, sex, unfamiliar face identity (Benton test) and gaze direction from the face, the Huntington's disease group showed a borderline impairment of gaze direction perception and were significantly impaired on unfamiliar face matching. With a separate set of tasks using computerinterpolated ('morphed') facial images, people with Huntington's disease were markedly impaired at discriminating anger from fear, but experienced less difficulty with continua varying from male to female, between familiar identities, and from happiness to sadness. In a further test of recognition of facial expressions of basic emotions from the Ekman and Friesen (1976) series, interpolated images were created for six continua that lay around the perimeter of an emotion hexagon (happiness-surprise; surprise-fear; fear-sadness; sadness-disgust; disgust-anger; anger-happiness). In deciding which emotion these morphed images were most like, people with Huntington's disease again showed deficits in the recognition of anger and fear, and an especially severe problem with disgust, which was recognized only at chance level. A follow-up study with tests of facially and vocally expressed emotions confirmed that the recognition of disgust was markedly poor for the Huntington's disease group, still being no better than chance level. Questionnaires were also used to examine self-assessed emotion, but did not show such striking problems. Taken together, these data reveal severe impairments of emotion recognition in Huntington's disease, and show that the recognition of some emotions is more impaired than others. The possibility that certain basic emotions may have dedicated neural substrates needs to be seriously considered: among these, disgust is a prime candidate.