Improving the Bias of Comparator Methods in Analytical Performance Assessments Through Recalibration

BACKGROUND

In analytical performance studies, the choice of comparator method plays an important role, as studies have shown that there exist relevant systematic differences (bias) between laboratory analyzers. The feasibility of retrospective recalibration of measurement results through comparison with methods or materials of higher metrological order to minimize bias was therefore assessed.

METHOD

Existing data from performance studies of continuous and blood glucose monitoring systems were retrospectively analyzed. Comparison with a higher-order method was performed for two different data sets. In both cases, subject samples were measured, and a subset was also measured on a higher-order method. Recalibration based on higher-order materials (standard reference material [SRM]) was conducted for two different data sets containing results from SRM and subject samples. Linear regression analysis was performed for each device separately. Resulting equations were applied to the respective complete data set of subject samples. Bias between devices in a data set across all subject samples was assessed before and after recalibration.

RESULTS

Bias between devices was reduced from -3.6% to +0.6% in one data set and from +11.0% to +0.3% in the other by recalibration based on higher-order method. Using higher-order materials, bias was also reduced by recalibration, but mixed results were found: Bias was reduced from -3.1% to -0.1% in one data set and from -4.3% to -2.7% in the other.

CONCLUSIONS

Recalibration did lead to a decrease in bias and thus can reduce the impact of the choice of comparator method. The procedure should be verified in a prospectively designed setting.

Multisensory perception depends on the reliability of the type of judgment

The brain engages the processes of multisensory integration and recalibration to deal with discrepant multisensory signals. These processes consider the reliability of each sensory input, with the more reliable modality receiving the stronger weight. Sensory reliability is typically assessed via the variability of participants' judgments, yet these can be shaped by factors both external and internal to the nervous system. For example, motor noise and participant's dexterity with the specific response method contribute to judgment variability, and different response methods applied to the same stimuli can result in different estimates of sensory reliabilities. Here we ask how such variations in reliability induced by variations in the response method affect multisensory integration and sensory recalibration, as well as motor adaptation, in a visuomotor paradigm. Participants performed center-out hand movements and were asked to judge the position of the hand or rotated visual feedback at the movement end points. We manipulated the variability, and thus the reliability, of repeated judgments by asking participants to respond using either a visual or a proprioceptive matching procedure. We find that the relative weights of visual and proprioceptive signals, and thus the asymmetry of multisensory integration and recalibration, depend on the reliability modulated by the judgment method. Motor adaptation, in contrast, was insensitive to this manipulation. Hence, the outcome of multisensory binding is shaped by the noise introduced by sensorimotor processing, in line with perception and action being intertwined.NEW & NOTEWORTHY Our brain tends to combine multisensory signals based on their respective reliability. This reliability depends on sensory noise in the environment, noise in the nervous system, and, as we show here, variability induced by the specific judgment procedure.

Recalibration of the stress response system over adult development: Is there a perinatal recalibration period?

During early life-sensitive periods (i.e., fetal, infancy), the developing stress response system adaptively calibrates to match environmental conditions, whether harsh or supportive. Recent evidence suggests that puberty is another window when the stress system is open to recalibration if environmental conditions have shifted significantly. Whether additional periods of recalibration exist in adulthood remains to be established. The present paper draws parallels between childhood (re)calibration periods and the perinatal period to hypothesize that this phase may be an additional window of stress recalibration in adult life. Specifically, the perinatal period (defined here to include pregnancy, lactation, and early parenthood) is also a developmental switch point characterized by heightened neural plasticity and marked changes in stress system function. After discussing these similarities, lines of empirical evidence needed to substantiate the perinatal stress recalibration hypothesis are proposed, and existing research support is reviewed. Complexities and challenges related to delineating the boundaries of perinatal stress recalibration and empirically testing this hypothesis are discussed, as well as possibilities for future multidisciplinary research. In the theme of this special issue, perinatal stress recalibration may be a mechanism of multilevel, multisystem risk, and resilience, both intra-individually and intergenerationally, with implications for optimizing interventions.

Poor comparability of plasma renin activity measurement in determining patient samples: the status quo and recommendations for harmonization

OBJECTIVES

This study aims to investigate and update the consistency and comparability of plasma renin activity (PRA) assays in measuring clinical samples. The contributions of recalibration, blank subtraction, and incubation strategies to interchangeability were also explored.

METHODS

Five different laboratories were evaluated using forty-six individual plasma samples, including four liquid chromatography-tandem mass spectrometry (LC‒MS/MS) assays and one chemiluminescence immunoassay (CLIA). Spearman correlation coefficient (R), Passing-Bablok regression, and Bland‒Altman plot analyses were used to evaluate the consistency among assays. Consistency before and after recalibration, blank subtraction, and incubation strategy unification was compared.

RESULTS

A good correlation was observed among all assays (R>0.93). None of the samples measured by all assays showed coefficient variation (CV) <10 %, and 37 % of samples showed overall CVs >20 %. The 95 % confidence intervals (CIs) for slopes did not contain 1 for most assay pairs. Large relative biases (-85.1-104.2 %) were found, and 76 % (52-93 %) of samples had unacceptable biases. Recalibration reduced the calibration bias. Ignoring blank subtraction improved the comparability across all assays while unifying incubation did not.

CONCLUSIONS

The interchangeability of PRA measurement was unsatisfying. Harmonization on calibrator and ignoring blank were recommended. Unifying incubation strategy was unnecessary.

An examination of perceptual-motor recalibration in a 1-vs-1 anticipation test

This study examined the processes of perceptual-motor calibration/recalibration of defensive football players in a 1-vs-1 scenario. Ankle weights were used to reduce the acceleration capabilities of players performing an anticipation test, with the aim being to examine the player's response to the disturbance in terms of when movement was initiated and the impact on the mechanisms that underpinned anticipation, namely gaze behaviour. The ankle weights disturbed the perceptual-motor system and players initiated movement significantly earlier in the 1-vs-1 anticipation test. Analyses of perceptual-motor calibration/recalibration revealed that players acted closer to their maximal action capabilities prior to the addition of ankle weights, which negatively influenced the scaling of action capabilities. Moreover, players were unable to recalibrate whilst wearing ankle weights. However, following the withdrawal of the ankle weights, players were able to recalibrate within 11-15 trials. Players did not adapt gaze behaviour as a result of the disturbance being placed on the perceptual-motor system, but task familiarization resulted in more efficient eye movements. The results of this study show the importance of providing players the opportunity to "scale" action to perceptual information.

Crossmodal interactions in human learning and memory

Most studies of memory and perceptual learning in humans have employed unisensory settings to simplify the study paradigm. However, in daily life we are often surrounded by complex and cluttered scenes made up of many objects and sources of sensory stimulation. Our experiences are, therefore, highly multisensory both when passively observing the world and when acting and navigating. We argue that human learning and memory systems are evolved to operate under these multisensory and dynamic conditions. The nervous system exploits the rich array of sensory inputs in this process, is sensitive to the relationship between the sensory inputs, and continuously updates sensory representations, and encodes memory traces based on the relationship between the senses. We review some recent findings that demonstrate a range of human learning and memory phenomena in which the interactions between visual and auditory modalities play an important role, and suggest possible neural mechanisms that can underlie some surprising recent findings. We outline open questions as well as directions of future research to unravel human perceptual learning and memory.

Visuo-proprioceptive recalibration and the sensorimotor map

Spatial perception of our hand is closely linked to our ability to move the hand accurately. We might therefore expect that reach planning would take into account any changes in perceived hand position; in other words, that perception and action relating to the hand should depend on a common sensorimotor map. However, there is evidence to suggest that changes in perceived hand position affect a body representation that functions separately from the body representation used to control movement. Here we examined target-directed reaching before and after participants either did (Mismatch group) or did not (Veridical group) experience a cue conflict known to elicit recalibration in perceived hand position. For the reaching task, participants grasped a robotic manipulandum that positioned their unseen hand for each trial. Participants then briskly moved the handle straight ahead to a visual target, receiving no performance feedback. For the perceptual calibration task, participants estimated the locations of visual, proprioceptive, or combined cues about their unseen hand. The Mismatch group experienced a gradual 70 mm forward mismatch between visual and proprioceptive cues, resulting in forward proprioceptive recalibration. Participants made significantly shorter reaches after this manipulation, consistent with feeling their hand to be further forward than it was, but reaching performance returned to baseline levels after only 10 reaches. The Veridical group, after exposure to veridically-aligned visual and proprioceptive cues about the hand, showed no change in reach distance. These results suggest that perceptual recalibration affects the same sensorimotor map that is used to plan target-directed reaches.

Validation, Recalibration, and Predictive Accuracy of Published V̇O 2max Prediction Equations for Adults Ages 50-96 Yr

PURPOSE

Maximal oxygen uptake ( ) is the criterion measure of cardiorespiratory fitness. Lower cardiorespiratory fitness is a strong predictor of poor health outcomes, including all-cause mortality. Because testing is resource intensive, several non-exercise-based V˙O 2max prediction equations have been published. We assess these equations' ability to predict measured V˙O 2max , recalibrate these equations, and quantify the association of measured and predicted V˙O 2max with all-cause mortality.

METHODS

Baltimore Longitudinal Study of Aging participants with valid V˙O 2max tests were included ( n = 1080). Using published V˙O 2max prediction equations, we calculated predicted V˙O 2max and present performance metrics before and after recalibration (deriving new regression estimates by regressing measured V˙O 2max on Baltimore Longitudinal Study of Aging covariates). Cox proportional hazards models were fit to quantify associations of measured, predicted, and recalibration-predicted values of V˙O 2max with mortality.

RESULTS

Mean age and V˙O 2max were 69.0 ± 10.4 yr and 21.6 ± 5.9 mL·kg -1 ·min -1 , respectively. The prediction equations yielded root mean square error values ranging from 4.2 to 20.4 mL·kg -1 ·min -1 . After recalibration, these values decreased to 3.9-4.2 mL·kg -1 ·min -1 . Adjusting for all covariates, all-cause mortality risk was 66% lower for the highest quartile of measured V˙O 2max relative to the lowest. Predicted V˙O 2max variables yielded similar estimates in unadjusted models but were not robust to adjustment.

CONCLUSIONS

Measured V˙O 2max is an extremely strong predictor of all-cause mortality. Several published V˙O 2max prediction equations yielded the following: 1) reasonable performance metrics relative to measured V˙O 2max especially when recalibrated, and 2) all-cause mortality hazard ratios similar to those of measured V˙O 2max , especially when recalibrated, yet 3) were not robust to adjustment for basic demographic covariates likely because these were used in the equation for predicted V˙O 2max .

Validation in Indonesia of two published scores for mortality prediction after cardiac surgery

Introduction

No mortality risk prediction model has previously been validated for cardiac surgery in Indonesia. This study aimed at validating the EuroSCORE II and Age Creatinine Ejection Fraction (ACEF) score as predictors for in-hospital mortality after cardiac surgery a in tertiary center, and if necessary, to recalibrate the EuroSCORE II model to our population.

Methods

This study was a single-center observational study from prospectively collected data on adult patients undergoing cardiac surgery from January 2006 to December 2011 (n = 1833). EuroSCORE II and ACEF scores were calculated for all patients to predict in-hospital mortality. Discrimination was assessed using the area under the curve (AUC) with a 95% confidence interval. Calibration was assessed with the Hosmer-Lemeshow test (HL test). Multivariable analysis was performed to recalibrate the EuroSCORE II; variables with P < 0.2 entered the final model.

Results

The in-hospital mortality rate was 3.8%, which was underestimated by the EuroSCORE II (2.1%) and the ACEF score (2.4%). EuroSCORE II (AUC 0.774 (0.714-0.834)) showed good discrimination, whereas the ACEF score (AUC 0.638 [0.561-0.718]) showed poor discrimination. The differences in AUC were significant (P = 0.002). Both scores were poorly calibrated (EuroSCORE II: HL test P < 0.001, ACEF score: HL test P < 0.001) and underestimated mortality in all risk groups. After recalibration, EuroSCORE II showed good discrimination (AUC 0.776 [0.714- 0.840]) and calibration (HL test P = 0.79).

Conclusions

EuroSCORE II and the ACEF score were unsuitable for risk prediction of in-hospital mortality after cardiac surgery in our center. Following recalibration, the calibration of the EuroSCORE II was greatly improved.

High-Accuracy 3D Gaze Estimation with Efficient Recalibration for Head-Mounted Gaze Tracking Systems

The problem of 3D gaze estimation can be viewed as inferring the visual axes from eye images. It remains a challenge especially for the head-mounted gaze tracker (HMGT) with a simple camera setup due to the complexity of the human visual system. Although the mainstream regression-based methods could establish the mapping relationship between eye image features and the gaze point to calculate the visual axes, it may lead to inadequate fitting performance and appreciable extrapolation errors. Moreover, regression-based methods suffer from a degraded user experience because of the increased burden in recalibration procedures when slippage occurs between HMGT and head. To address these issues, a high-accuracy 3D gaze estimation method along with an efficient recalibration approach is proposed with head pose tracking in this paper. The two key parameters, eyeball center and camera optical center, are estimated in head frame with geometry-based method, so that a mapping relationship between two direction features is proposed to calculate the direction of the visual axis. As the direction features are formulated with the accurately estimated parameters, the complexity of mapping relationship could be reduced and a better fitting performance can be achieved. To prevent the noticeable extrapolation errors, direction features with uniform angular intervals for fitting the mapping are retrieved over human’s field of view. Additionally, an efficient single-point recalibration method is proposed with an updated eyeball coordinate system, which reduces the burden of calibration procedures significantly. Our experiment results show that the calibration and recalibration methods could improve the gaze estimation accuracy by 35 percent (from a mean error of 2.00 degrees to 1.31 degrees) and 30 percent (from a mean error of 2.00 degrees to 1.41 degrees), respectively, compared with the state-of-the-art methods.

Evidence For Selective Adaptation and Recalibration in the Perception of Lexical Stress

Individuals vary in how they produce speech. This variability affects both the segments (vowels and consonants) and the suprasegmental properties of their speech (prosody). Previous literature has demonstrated that listeners can adapt to variability in how different talkers pronounce the segments of speech. This study shows that listeners can also adapt to variability in how talkers produce lexical stress. Experiment 1 demonstrates a selective adaptation effect in lexical stress perception: repeatedly hearing Dutch trochaic words biased perception of a subsequent lexical stress continuum towards more iamb responses. Experiment 2 demonstrates a recalibration effect in lexical stress perception: when ambiguous suprasegmental cues to lexical stress were disambiguated by lexical orthographic context as signaling a trochaic word in an exposure phase, Dutch participants categorized a subsequent test continuum as more trochee-like. Moreover, the selective adaptation and recalibration effects generalized to novel words, not encountered during exposure. Together, the experiments demonstrate that listeners also flexibly adapt to variability in the suprasegmental properties of speech, thus expanding our understanding of the utility of listener adaptation in speech perception. Moreover, the combined outcomes speak for an architecture of spoken word recognition involving abstract prosodic representations at a prelexical level of analysis.

Recalibration Methods for Improved Clinical Utility of Risk Scores

BACKGROUND

An established risk model may demonstrate miscalibration, meaning predicted risks do not accurately capture event rates. In some instances, investigators can identify and address the cause of miscalibration. In other circumstances, it may be appropriate to recalibrate the risk model. Existing recalibration methods do not account for settings in which the risk score will be used for risk-based clinical decision making.

METHODS

We propose 2 new methods for risk model recalibration when the intended purpose of the risk model is to prescribe an intervention to high-risk individuals. Our measure of risk model clinical utility is standardized net benefit. The first method is a weighted strategy that prioritizes good calibration at or around the critical risk threshold. The second method uses constrained optimization to produce a recalibrated risk model with maximum possible net benefit, thereby prioritizing good calibration around the critical risk threshold. We also propose a graphical tool for assessing the potential for recalibration to improve the net benefit of a risk model. We illustrate these methods by recalibrating the American College of Cardiology (ACC)-American Heart Association (AHA) atherosclerotic cardiovascular disease (ASCVD) risk score within the Multi-Ethnic Study of Atherosclerosis (MESA) cohort.

RESULTS

New methods are implemented in the R package ClinicalUtilityRecal. Recalibrating the ACC-AHA-ASCVD risk score for a MESA subcohort results in higher estimated net benefit using the proposed methods compared with existing methods, with improved calibration in the most clinically impactful regions of risk.

CONCLUSION

The proposed methods target good calibration for critical risks and can improve the net benefit of a risk model. We recommend constrained optimization when the risk model net benefit is paramount. The weighted approach can be considered when good calibration over an interval of risks is important.

Tilt Sensor with Recalibration Feature Based on MEMS Accelerometer

The main errors of MEMS accelerometers are misalignments of their sensitivity axes, thermal and long-term drifts, imprecise factory calibration, and aging phenomena. In order to reduce these errors, a two-axial tilt sensor comprising a triaxial MEMS accelerometer, an aligning unit, and solid cubic housing was built. By means of the aligning unit it was possible to align the orientation of the accelerometer sensitive axes with respect to the housing with an accuracy of 0.03°. Owing to the housing, the sensor could be easily and quickly recalibrated, and thus errors such as thermal and long-term drifts as well as effects of aging were eliminated. Moreover, errors due to local and temporal variations of the gravitational acceleration can be compensated for. Procedures for calibrating and aligning the accelerometer are described. Values of thermal and long-term drifts of the tested sensor, resulting in tilt errors of even 0.4°, are presented. Application of the sensor for monitoring elevated loads is discussed.

The Effects of Continuous vs. Intermittent Prism Adaptation Protocols for Treating Visuospatial Neglect: A Randomized Controlled Trial

Visuospatial neglect may interfere with activities of daily living (ADL). Prism adaptation (PA) is one treatment option and may involve two components: recalibration (more strategic) and realignment (more implicit). We examined whether recalibration or realignment is the driving force in neglect rehabilitation using PA. In a randomized controlled trial with two recruitment series and a cross-over design, 24 neglect patients were allocated to a continuous (PA-c) or intermittent (PA-i) PA procedure. During the PA-c condition, goggles were worn without doffing. In the PA-i condition, patients donned goggles twice (first series of patients) or three times (second series) during training to induce more recalibrations. Primary outcome parameters were performance (omissions) on the Apples Cancellation Test and ADL scores. To assess the efficacy of the PA treatment, we compared effect sizes of the current study with those from three groups from previous studies at the same rehabilitation unit: (1) a passive treatment with a similar intensity, (2) a placebo treatment with a similar intensity, and (3) a PA treatment with fewer therapy sessions. Treatment conditions did not significantly predict scores on primary and most secondary outcome parameters. However, the spontaneous ipsilesional body orientation improved only in patients receiving the PA-i condition and this improvement also appeared in patients showing a strong after-effect (irrespective of condition). Effect sizes for the Apples Cancellation Test and the Functional Independence Measure were larger for both PA treatment protocols than the historical control groups. We conclude that more recalibrations during an intermittent PA treatment may have a beneficial effect on spontaneous body orientation but not on other aspects of neglect or on ADL performance. Clinical Trial Registration: German Clinical Trials Register, identifier: DRKS00018813, DRKS00021539.

Recalibrating SARS-CoV-2 Antigen Rapid Lateral Flow Test Relative Sensitivity from Validation Studies to Absolute Sensitivity for Indicating Individuals Shedding Transmissible Virus

Testing for SARS-CoV-2 internationally has focused on COVID-19 diagnosis among symptomatic individuals using reverse transcriptase polymerase chain reaction (PCR) tests. Recently, however, SARS-CoV-2 antigen rapid lateral flow tests (LFT) have been rolled out in several countries for testing asymptomatic individuals in public health programmes. Validation studies for LFT have been largely cross-sectional, reporting sensitivity, specificity and predictive values of LFT relative to PCR. However, because PCR detects genetic material left behind for a long period when the individual is no longer infectious, these statistics can under-represent the sensitivity of LFT for detecting infectious individuals, especially when sampling asymptomatic populations. LFTs (intended to detect individuals shedding SARS-CoV-2 antigens) validated against PCR (intended to diagnose infection) are not reporting against a gold standard of equivalent measurements. Instead, these validation studies have reported relative performance statistics that need recalibrating to the purpose for which LFT is being used. We present an approach to this recalibration. We derive a formula for recalibrating relative performance statistics from LFT vs PCR validation studies to give likely absolute sensitivity of LFT for detecting individuals who are shedding shedding SARS-CoV-2 antigens. We contrast widely reported apparent sensitivities of LFT with recalibrated absolute sensitivity for detecting individuals shedding SARS-CoV-2 antigens. After accounting for within-individual viral kinetics and epidemic dynamics within asymptomatic populations we show that a highly performant test for SARS-CoV-2 antigen should show LFT-to-PCR relative sensitivity of less than 50% in conventional validation studies, which after re-calibration would be an absolute sensitivity of more than 80%. Further studies are needed to ascertain the absolute sensitivity of LFT as a test of infectiousness in COVID-19 responses. These studies should include longitudinal series of LFT and PCR, ideally in cohorts sampled from both contacts of cases and the general population.

Perceptual Inference, Learning, and Attention in a Multisensory World

Adaptive behavior in a complex, dynamic, and multisensory world poses some of the most fundamental computational challenges for the brain, notably inference, decision-making, learning, binding, and attention. We first discuss how the brain integrates sensory signals from the same source to support perceptual inference and decision-making by weighting them according to their momentary sensory uncertainties. We then show how observers solve the binding or causal inference problem-deciding whether signals come from common causes and should hence be integrated or else be treated independently. Next, we describe the multifarious interplay between multisensory processing and attention. We argue that attentional mechanisms are crucial to compute approximate solutions to the binding problem in naturalistic environments when complex time-varying signals arise from myriad causes. Finally, we review how the brain dynamically adapts multisensory processing to a changing world across multiple timescales.

The Neurophysiological Basis of the Trial-Wise and Cumulative Ventriloquism Aftereffects

Our senses often receive conflicting multisensory information, which our brain reconciles by adaptive recalibration. A classic example is the ventriloquism aftereffect, which emerges following both cumulative (long-term) and trial-wise exposure to spatially discrepant multisensory stimuli. Despite the importance of such adaptive mechanisms for interacting with environments that change over multiple timescales, it remains debated whether the ventriloquism aftereffects observed following trial-wise and cumulative exposure arise from the same neurophysiological substrate. We address this question by probing electroencephalography recordings from healthy humans (both sexes) for processes predictive of the aftereffect biases following the exposure to spatially offset audiovisual stimuli. Our results support the hypothesis that discrepant multisensory evidence shapes aftereffects on distinct timescales via common neurophysiological processes reflecting sensory inference and memory in parietal-occipital regions, while the cumulative exposure to consistent discrepancies additionally recruits prefrontal processes. During the subsequent unisensory trial, both trial-wise and cumulative exposure bias the encoding of the acoustic information, but do so distinctly. Our results posit a central role of parietal regions in shaping multisensory spatial recalibration, suggest that frontal regions consolidate the behavioral bias for persistent multisensory discrepancies, but also show that the trial-wise and cumulative exposure bias sound position encoding via distinct neurophysiological processes.

SIGNIFICANCE STATEMENT Our brain easily reconciles conflicting multisensory information, such as seeing an actress on screen while hearing her voice over headphones. These adaptive mechanisms exert a persistent influence on the perception of subsequent unisensory stimuli, known as the ventriloquism aftereffect. While this aftereffect emerges following trial-wise or cumulative exposure to multisensory discrepancies, it remained unclear whether both arise from a common neural substrate. We here rephrase this hypothesis using human electroencephalography recordings. Our data suggest that parietal regions involved in multisensory and spatial memory mediate the aftereffect following both trial-wise and cumulative adaptation, but also show that additional and distinct processes are involved in consolidating and implementing the aftereffect following prolonged exposure.

Evaluation of the precision of operative augmented reality compared to standard neuronavigation using a 3D-printed skull

OBJECTIVE

Augmented reality (AR) in cranial surgery allows direct projection of preregistered overlaid images in real time on the microscope surgical field. In this study, the authors aimed to compare the precision of AR-assisted navigation and standard pointer-based neuronavigation (NV) by using a 3D-printed skull in surgical conditions.

METHODS

A commercial standardized 3D-printed skull was scanned, fused, and referenced with an MR image and a CT scan of a patient with a 2 × 2-mm right frontal sinus defect. The defect was identified, registered, and integrated into NV. The target was physically marked on the 3D-printed skull replicating the right frontal sinus defect. Twenty-six subjects participated, 25 of whom had no prior NV or AR experience and 1 with little AR experience. The subjects were briefly trained in how to use NV, AR, and AR recalibration tools. Participants were asked to do the following: 1) "target the center of the defect in the 3D-printed skull with a navigation pointer, assisted only by NV orientation," and 2) "use the surgical microscope and AR to focus on the center of the projected object" under conventional surgical conditions. For the AR task, the number of recalibrations was recorded. Confidence regarding NV and AR precision were assessed prior to and after the experiment by using a 9-level Likert scale.

RESULTS

The median distance to target was statistically lower for AR than for NV (1 mm [Q1: 1 mm, Q3: 2 mm] vs 3 mm [Q1: 2 mm, Q3: 4 mm] [p < 0.001]). In the AR task, the median number of recalibrations was 4 (Q1: 4, Q3: 4.75). The number of recalibrations was significantly correlated with the precision (Spearman rho: -0.71, p < 0.05). The trust assessment after performing the experiment scored a median of 8 for AR and 5.5 for NV (p < 0.01).

CONCLUSIONS

This study shows for the first time the superiority of AR over NV in terms of precision. AR is easy to use. The number of recalibrations performed using reference structures increases the precision of the navigation. The confidence regarding precision increases with experience.

Comparison of three different chemiluminescence assays and a rapid liquid chromatography tandem mass spectrometry method for measuring serum aldosterone

Background This study aimed to quantify and compare serum aldosterone (sALD) levels through three different chemiluminescence immunoassays (CLIAs) and liquid chromatography tandem mass spectrometry (LC-MS/MS) analysis. Methods Serum samples from 221 patients with suspected primary aldosteronism (PA) were retrospectively included in this study conducted at the Peking Union Medical College Hospital from June to August in 2017. sALD levels were determined using the LC-MS/MS method and three different CLIA systems, viz., DiaSorin® XL, iSYS and Auto Lumo A2000. Pooled fresh serum samples were used for recalibration. Passing-Bablok regression analysis, correlation matrix, and Bland-Altman plots were used to evaluate the concurrence among ALD levels determined using the three CLIAs. Results Within-laboratory precision of the four assays ranged from 2.1% to 9.4%, except the coefficient variation (CV) of one of the CLIAs, which exceeded 20.0% for samples with low sALD levels. sALD levels determined using LC-MS/MS were significantly lower than those determined using the other three CLIAs (p < 0.0001). Spearman's correlation coefficient of the four assays ranged from 0.745 to 0.950 (p < 0.0001). The Bland-Altman plot showed that the average bias (%) for the three CLIAs and LC-MS/MS ranged from -69.3 to -49.2. After recalibration, this correlation did not improve among the assays. However, the bias and bias percentage at the medical decision level improved between LC-MS/MS and DiaSorin® XL/iSYS. Conclusions Significant inconsistencies between the results of CLIAs and LC-MS/MS indicate that different sALD measures cannot be used interchangeably.

Correcting Decalibration of Stereo Cameras in Self-Driving Vehicles

Camera systems in autonomous vehicles are subject to various sources of anticipated and unanticipated mechanical stress (vibration, rough handling, collisions) in real-world conditions. Even moderate changes in camera geometry due to mechanical stress decalibrate multi-camera systems and corrupt downstream applications like depth perception. We propose an on-the-fly stereo recalibration method applicable in real-world autonomous vehicles. The method is comprised of two parts. First, in optimization step, external camera parameters are optimized with the goal to maximise the amount of recovered depth pixels. In the second step, external sensor is used to adjust the scaling of the optimized camera model. The method is lightweight and fast enough to run in parallel with stereo estimation, thus allowing an on-the-fly recalibration. Our extensive experimental analysis shows that our method achieves stereo reconstruction better or on par with manual calibration. If our method is used on a sequence of images, the quality of calibration can be improved even further.

Differential effects of the temporal and spatial distribution of audiovisual stimuli on cross-modal spatial recalibration

Visual input constantly recalibrates auditory spatial representations. Exposure to isochronous audiovisual stimuli with a fixed spatial disparity typically results in a subsequent auditory localization bias (ventriloquism aftereffect, VAE), whereas exposure to spatially congruent audiovisual stimuli improves subsequent auditory localization (multisensory enhancement, ME). Here, we tested whether cross-modal recalibration is affected by the stimulation rate and/or the distribution of audiovisual spatial disparities during training. Auditory localization was tested before and after participants were exposed either to audiovisual stimuli with a constant spatial disparity of 13.5° (VAE) or to spatially congruent audiovisual stimulation (ME). In a between-subjects design, audiovisual stimuli were presented either at a low frequency of 2 Hz, as used in previous studies of VAE and ME, or intermittently at a high frequency of 10 Hz, which mimics long-term potentiation (LTP) protocols and which was found superior in eliciting unisensory perceptual learning. Compared to low-frequency stimulation, VAE was reduced after high-frequency stimulation, whereas ME occurred regardless of the stimulation protocol. In two additional groups, we manipulated the spatial distribution of audiovisual stimuli in the low-frequency condition. Stimuli were presented with varying audiovisual disparities centered around 13.5° (VAE) or 0° (ME). Both VAE and ME were equally strong compared to a fixed spatial relationship of 13.5° or 0°, respectively. Taken together, our results suggest (a) that VAE and ME represent partly dissociable forms of learning and (b) that auditory representations adjust to the overall stimulus statistics rather than to a specific audiovisual spatial relationship.

Fluidity in the perception of auditory speech: Cross-modal recalibration of voice gender and vowel identity by a talking face

Humans quickly adapt to variations in the speech signal. Adaptation may surface as recalibration, a learning effect driven by error-minimisation between a visual face and an ambiguous auditory speech signal, or as selective adaptation, a contrastive aftereffect driven by the acoustic clarity of the sound. Here, we examined whether these aftereffects occur for vowel identity and voice gender. Participants were exposed to male, female, or androgynous tokens of speakers pronouncing /e/, /ø/, (embedded in words with a consonant-vowel-consonant structure), or an ambiguous vowel halfway between /e/ and /ø/ dubbed onto the video of a male or female speaker pronouncing /e/ or /ø/. For both voice gender and vowel identity, we found assimilative aftereffects after exposure to auditory ambiguous adapter sounds, and contrastive aftereffects after exposure to auditory clear adapter sounds. This demonstrates that similar principles for adaptation in these dimensions are at play.

Pubertal stress recalibration reverses the effects of early life stress in postinstitutionalized children

Nonhuman animal models reveal that the hypothalamic-pituitary-adrenocortical (HPA) axis calibrates to the harshness of the environment during a sensitive period in infancy. Humans exposed to depriving institutional care in infancy show reduced HPA axis responsivity, even years after they are placed in supportive, well-resourced families. This study examined whether puberty opens a window of opportunity to recalibrate the HPA axis toward more typical reactivity when children shift from harsh deprived conditions in infancy into supportive conditions in childhood and adolescence. Participants (n = 129 postinstitutionalized, 68.2% female; n = 170 comparison, 52.4% female) completed 3 annual sessions beginning at ages 7 to 15 (M = 11.28, SD = 2.31). Each session assessed pubertal stage via nurse examination and cortisol reactivity to the Trier social stress test for children. The linear mixed-effects model controlling for sex and between-individual differences in pubertal stage showed a significant group by pubertal stage interaction: within-individual increases in pubertal stage were associated with increases in cortisol stress reactivity for postinstitutionalized youth but not nonadopted comparison youth. This study indicates that pubertal development reopens a window of opportunity for the HPA axis to recalibrate based on significant improvements in the supportiveness of the environment relative to that in infancy. The peripubertal period may be an important time in development where the caregiving environment has a substantial impact on the HPA axis and, perhaps, other stress-mediating systems. Future research is needed to examine the mechanisms of recalibration and whether HPA recalibration impacts physical and psychological health.

The Ventriloquist Illusion as a Tool to Study Multisensory Processing: An Update

Ventriloquism, the illusion that a voice appears to come from the moving mouth of a puppet rather than from the actual speaker, is one of the classic examples of multisensory processing. In the laboratory, this illusion can be reliably induced by presenting simple meaningless audiovisual stimuli with a spatial discrepancy between the auditory and visual components. Typically, the perceived location of the sound source is biased toward the location of the visual stimulus (the ventriloquism effect). The strength of the visual bias reflects the relative reliability of the visual and auditory inputs as well as prior expectations that the two stimuli originated from the same source. In addition to the ventriloquist illusion, exposure to spatially discrepant audiovisual stimuli results in a subsequent recalibration of unisensory auditory localization (the ventriloquism aftereffect). In the past years, the ventriloquism effect and aftereffect have seen a resurgence as an experimental tool to elucidate basic mechanisms of multisensory integration and learning. For example, recent studies have: (a) revealed top-down influences from the reward and motor systems on cross-modal binding; (b) dissociated recalibration processes operating at different time scales; and (c) identified brain networks involved in the neuronal computations underlying multisensory integration and learning. This mini review article provides a brief overview of established experimental paradigms to measure the ventriloquism effect and aftereffect before summarizing these pathbreaking new advancements. Finally, it is pointed out how the ventriloquism effect and aftereffect could be utilized to address some of the current open questions in the field of multisensory research.

No "Self" Advantage for Audiovisual Speech Aftereffects

Although the default state of the world is that we see and hear other people talking, there is evidence that seeing and hearing ourselves rather than someone else may lead to visual (i.e., lip-read) or auditory "self" advantages. We assessed whether there is a "self" advantage for phonetic recalibration (a lip-read driven cross-modal learning effect) and selective adaptation (a contrastive effect in the opposite direction of recalibration). We observed both aftereffects as well as an on-line effect of lip-read information on auditory perception (i.e., immediate capture), but there was no evidence for a "self" advantage in any of the tasks (as additionally supported by Bayesian statistics). These findings strengthen the emerging notion that recalibration reflects a general learning mechanism, and bolster the argument that adaptation depends on rather low-level auditory/acoustic features of the speech signal.

External validation and recalibration of the Brock model to predict probability of cancer in pulmonary nodules using NLST data

INTRODUCTION

We performed an external validation of the Brock model using the National Lung Screening Trial (NLST) data set, following strict guidelines set forth by the Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis statement. We report how external validation results can be interpreted and highlight the role of recalibration and model updating.

MATERIALS AND METHODS

We assessed model discrimination and calibration using the NLST data set. Adhering to the inclusion/exclusion criteria reported by McWilliams et al, we identified 7879 non-calcified nodules discovered at the baseline low-dose CT screen with 2 years of follow-up. We characterised differences between Pan-Canadian Early Detection of Lung Cancer Study and NLST cohorts. We calculated the slope on the prognostic index and the intercept coefficient by fitting the original Brock model to NLST. We also assessed the impact of model recalibration and the addition of new covariates such as body mass index, smoking status, pack-years and asbestos.

RESULTS

While the area under the curve (AUC) of the model was good, 0.905 (95% CI 0.882 to 0.928), a histogram plot showed that the model poorly differentiated between benign and malignant cases. The calibration plot showed that the model overestimated the probability of cancer. In recalibrating the model, the coefficients for emphysema, spiculation and nodule count were updated. The updated model had an improved calibration and achieved an optimism-corrected AUC of 0.912 (95% CI 0.891 to 0.932). Only pack-year history was found to be significant (p<0.01) among the new covariates evaluated.

CONCLUSION

While the Brock model achieved a high AUC when validated on the NLST data set, the model benefited from updating and recalibration. Nevertheless, covariates used in the model appear to be insufficient to adequately discriminate malignant cases.

Reading-Induced Shifts in Speech Perception in Dyslexic and Typically Reading Children

One of the proposed mechanisms underlying reading difficulties observed in developmental dyslexia is impaired mapping of visual to auditory speech representations. We investigate these mappings in 20 typically reading and 20 children with dyslexia aged 8–10 years using text-based recalibration. In this paradigm, the pairing of visual text and ambiguous speech sounds shifts (recalibrates) the participant’s perception of the ambiguous speech in subsequent auditory-only post-test trials. Recent research in adults demonstrated this text-induced perceptual shift in typical, but not in dyslexic readers. Our current results instead show significant text-induced recalibration in both typically reading children and children with dyslexia. The strength of this effect was significantly linked to the strength of perceptual adaptation effects in children with dyslexia but not typically reading children. Furthermore, additional analyses in a sample of typically reading children of various reading levels revealed a significant link between recalibration and phoneme categorization. Taken together, our study highlights the importance of considering dynamic developmental changes in reading, letter-speech sound coupling and speech perception when investigating group differences between typical and dyslexic readers.

Measuring lipoprotein-associated phospholipase A2 activity in China: Protocol comparison and recalibration

BACKGROUND

Lp-PLA2 is a novel inflammation marker in cardiovascular disease. While several manufactures have registered Lp-PLA2 activity reagents, few studies have investigated the consistency among these assays. In this study, we compared and recalibrated Lp-PLA2 activity assays.

METHODS

Serum samples from 110 patients and 140 healthy individuals were collected for method comparison and reference interval validation, respectively. Fresh human serum pools (847 and 442 U/L) were used for recalibration. Lp-PLA2 activity was analyzed using all five assays with a Beckman AU 5800 analyzer. Passing-Bablok regression equations and Bland-Altman plots were used to estimate the relationship and bias among the results. A 2.5% confidence interval (CI) and 97.5% CI were used to establish a laboratory reference interval.

RESULTS

Assay imprecision varied from 0.8%-2.9%, while the overall coincidence rates ranged from 75.5%-98.2%. Passing-Bablok regression shows excellent linear correlation between Evermed and Diasys (R²  = 0.999), while that between Diazyme and Evermed was poor (R²  = 0.846). The R² and correlation coefficient r among assays were 0.846-0.999 and 0.8947-0.9993, respectively. The mean bias percentages ranged from -71.5%-1.6% and -2.0%-11.6% before and after recalibration. As Diazyme and Diasys were not comparable, the Diazyme assay was not recalibrated. The reference intervals determined for Diasys, Evermed, Hengxiao, and Zybio were 184-605, 208-704, 81-328, and 273-696 U/L, respectively.

CONCLUSIONS

Our results indicate that recalibration increased assay agreement and also highlight the need for each laboratory to establish its own reference interval for Lp-PLA2 activity.

Rapid recalibration of speech perception after experiencing the McGurk illusion

The human brain can quickly adapt to changes in the environment. One example is phonetic recalibration: a speech sound is interpreted differently depending on the visual speech and this interpretation persists in the absence of visual information. Here, we examined the mechanisms of phonetic recalibration. Participants categorized the auditory syllables /aba/ and /ada/, which were sometimes preceded by the so-called McGurk stimuli (in which an /aba/ sound, due to visual /aga/ input, is often perceived as 'ada'). We found that only one trial of exposure to the McGurk illusion was sufficient to induce a recalibration effect, i.e. an auditory /aba/ stimulus was subsequently more often perceived as 'ada'. Furthermore, phonetic recalibration took place only when auditory and visual inputs were integrated to 'ada' (McGurk illusion). Moreover, this recalibration depended on the sensory similarity between the preceding and current auditory stimulus. Finally, signal detection theoretical analysis showed that McGurk-induced phonetic recalibration resulted in both a criterion shift towards /ada/ and a reduced sensitivity to distinguish between /aba/ and /ada/ sounds. The current study shows that phonetic recalibration is dependent on the perceptual integration of audiovisual information and leads to a perceptual shift in phoneme categorization.

Still no Evidence for Sustained Effects of Multisensory Integration of Duration

In studies on temporal order perception, immediate as well as sustained effects of multisensory integration have been demonstrated repeatedly. Regarding duration perception, the corresponding literature reports clear immediate effects of multisensory integration, but evidence on sustained effects of multisensory duration integration is scarce. In fact, a single study [Heron, J. et al. (2013). A neural hierarchy for illusions of time: Duration adaptation precedes multisensory integration, J. Vis. 13, 1-12.] investigated adaptation to multisensory conflicting intervals, and found no sustained effects of the audiovisual conflict on perceived duration of subsequently presented unimodal visual intervals. In two experiments, we provide independent evidence in support of this finding. In Experiment 1, we demonstrate that adaptation to audiovisual conflict does not alter perceived duration of subsequently presented visual test intervals. Thus, replicating the results of Heron et al. (2013), we observed no sustained effect of multisensory duration integration. However, one might argue that the prolonged exposure to consistent multisensory conflict might have prevented or hampered multisensory integration per se. In Experiment 2, we rule out this alternative explanation by showing that multisensory integration of audiovisual conflicting intervals is still effective after exposure to audiovisual conflict. This further strengthens the conclusion that multisensory integration of interval duration affects perception in an immediate, but not in a sustained manner.

Age-Related Changes in Sensorimotor Temporal Binding

The causal relationship between a voluntary movement and a sensory event is crucial for experiencing agency. Sensory events must occur within a certain delay from a voluntary movement to be perceived as self-generated. Therefore, temporal sensitivity, i.e., the ability to discriminate temporal asynchronies between motor and sensory events, is important for sensorimotor binding. Moreover, differences in the physical propagation of external stimuli can sometimes challenge sensorimotor binding, generating illusory asynchrony. To overcome this problem, the brain adjusts the perceptual timing of sensory and motor events. This mechanism, named sensorimotor recalibration, helps keeping causality judgments accurate. As humans age, the broad decline in sensory and motor processing may reduce temporal sensitivity, and compromise sensorimotor recalibration. In the current study, we investigated the effect of aging on sensorimotor temporal binding by measuring changes in both temporal sensitivity and recalibration. Young and elderly adults were exposed to a prolonged physical delay between a voluntary movement (a keypress) and its perceptual consequence (a visual stimulus). Before and after this exposure, participants performed a sensorimotor temporal order judgment (TOJ) task. As expected, elderly adults showed reduced sensorimotor recalibration and sensitivity as compared to young adults, suggesting that aging affects sensorimotor temporal binding.

Event Related Potentials Index Rapid Recalibration to Audiovisual Temporal Asynchrony

Asynchronous arrival of multisensory information at the periphery is a ubiquitous property of signals in the natural environment due to differences in the propagation time of light and sound. Rapid adaptation to these asynchronies is crucial for the appropriate integration of these multisensory signals, which in turn is a fundamental neurobiological process in creating a coherent perceptual representation of our dynamic world. Indeed, multisensory temporal recalibration has been shown to occur at the single trial level, yet the mechanistic basis of this rapid adaptation is unknown. Here, we investigated the neural basis of rapid recalibration to audiovisual temporal asynchrony in human participants using a combination of psychophysics and electroencephalography (EEG). Consistent with previous reports, participant's perception of audiovisual temporal synchrony on a given trial (t) was influenced by the temporal structure of stimuli on the previous trial (t-1). When examined physiologically, event related potentials (ERPs) were found to be modulated by the temporal structure of the previous trial, manifesting as late differences (>125 ms post second-stimulus onset) in central and parietal positivity on trials with large stimulus onset asynchronies (SOAs). These findings indicate that single trial adaptation to audiovisual temporal asynchrony is reflected in modulations of late evoked components that have previously been linked to stimulus evaluation and decision-making.

Target Displacements during Eye Blinks Trigger Automatic Recalibration of Gaze Direction

Eye blinks cause disruptions to visual input and are accompanied by rotations of the eyeball [1]. Like every motor action, these eye movements are subject to noise and introduce instabilities in gaze direction across blinks [2]. Accumulating errors across repeated blinks would be debilitating for visual performance. Here, we show that the oculomotor system constantly recalibrates gaze direction during blinks to counteract gaze instability. Observers were instructed to fixate a visual target while gaze direction was recorded and blinks were detected in real time. With every spontaneous blink-while eyelids were closed-the target was displaced laterally by 0.5° (or 1.0°). Most observers reported being unaware of displacements during blinks. After adapting for ∼35 blinks, gaze positions after blinks showed significant biases toward the new target position. Automatic eye movements accompanied each blink, and an aftereffect persisted for a few blinks after target displacements were eliminated. No adaptive gaze shift occurred when blinks were simulated with shutter glasses at random time points or actively triggered by observers, or when target displacements were masked by a distracting stimulus. Visual signals during blinks are suppressed by inhibitory mechanisms [3-6], so that small changes across blinks are generally not noticed [7, 8]. Additionally, target displacements during blinks can trigger automatic gaze recalibration, similar to the well-known saccadic adaptation effect [9-11]. This novel mechanism might be specific to the maintenance of gaze direction across blinks or might depend on a more general oculomotor recalibration mechanism adapting gaze position during intrinsically generated disruptions to visual input.

Atypical rapid audio-visual temporal recalibration in autism spectrum disorders

Changes in sensory and multisensory function are increasingly recognized as a common phenotypic characteristic of Autism Spectrum Disorders (ASD). Furthermore, much recent evidence suggests that sensory disturbances likely play an important role in contributing to social communication weaknesses-one of the core diagnostic features of ASD. An established sensory disturbance observed in ASD is reduced audiovisual temporal acuity. In the current study, we substantially extend these explorations of multisensory temporal function within the framework that an inability to rapidly recalibrate to changes in audiovisual temporal relations may play an important and under-recognized role in ASD. In the paradigm, we present ASD and typically developing (TD) children and adolescents with asynchronous audiovisual stimuli of varying levels of complexity and ask them to perform a simultaneity judgment (SJ). In the critical analysis, we test audiovisual temporal processing on trial t as a condition of trial t - 1. The results demonstrate that individuals with ASD fail to rapidly recalibrate to audiovisual asynchronies in an equivalent manner to their TD counterparts for simple and non-linguistic stimuli (i.e., flashes and beeps, hand-held tools), but exhibit comparable rapid recalibration for speech stimuli. These results are discussed in terms of prior work showing a speech-specific deficit in audiovisual temporal function in ASD, and in light of current theories of autism focusing on sensory noise and stability of perceptual representations. Autism Res 2017, 10: 121-129. © 2016 International Society for Autism Research, Wiley Periodicals, Inc.

Sensory adaptation for timing perception

Recent sensory experience modifies subjective timing perception. For example, when visual events repeatedly lead auditory events, such as when the sound and video tracks of a movie are out of sync, subsequent vision-leads-audio presentations are reported as more simultaneous. This phenomenon could provide insights into the fundamental problem of how timing is represented in the brain, but the underlying mechanisms are poorly understood. Here, we show that the effect of recent experience on timing perception is not just subjective; recent sensory experience also modifies relative timing discrimination. This result indicates that recent sensory history alters the encoding of relative timing in sensory areas, excluding explanations of the subjective phenomenon based only on decision-level changes. The pattern of changes in timing discrimination suggests the existence of two sensory components, similar to those previously reported for visual spatial attributes: a lateral shift in the nonlinear transducer that maps relative timing into perceptual relative timing and an increase in transducer slope around the exposed timing. The existence of these components would suggest that previous explanations of how recent experience may change the sensory encoding of timing, such as changes in sensory latencies or simple implementations of neural population codes, cannot account for the effect of sensory adaptation on timing perception.

Generalization patterns for reach adaptation and proprioceptive recalibration differ after visuomotor learning

Visuomotor learning results in changes in both motor and sensory systems (Cressman EK, Henriques DY. J Neurophysiol 102: 3505-3518, 2009), such that reaches are adapted and sense of felt hand position recalibrated after reaching with altered visual feedback of the hand. Moreover, visuomotor learning has been shown to generalize such that reach adaptation achieved at a trained target location can influence reaches to novel target directions (Krakauer JW, Pine ZM, Ghilardi MF, Ghez C. J Neurosci 20: 8916-8924, 2000). We looked to determine whether proprioceptive recalibration also generalizes to novel locations. Moreover, we looked to establish the relationship between reach adaptation and changes in sense of felt hand position by determining whether proprioceptive recalibration generalizes to novel targets in a similar manner as reach adaptation. On training trials, subjects reached to a single target with aligned or misaligned cursor-hand feedback, in which the cursor was either rotated or scaled in extent relative to hand movement. After reach training, subjects reached to the training target and novel targets (including targets from a second start position) without visual feedback to assess generalization of reach adaptation. Subjects then performed a proprioceptive estimation task, in which they indicated the position of their hand relative to visual reference markers placed at similar locations as the trained and novel reach targets. Results indicated that shifts in hand position generalized across novel locations, independent of reach adaptation. Thus these distinct sensory and motor generalization patterns suggest that reach adaptation and proprioceptive recalibration arise from independent error signals and that changes in one system cannot guide adjustments in the other.

Assessing the incremental value of blood oxygen saturation (SpO(2)) in the miniPIERS (Pre-eclampsia Integrated Estimate of RiSk) Risk Prediction Model

OBJECTIVE

To assess the incremental value of blood oxygen saturation (SpO(2)) as a predictor in the miniPIERS model, a risk prediction model for adverse outcomes among women with a diagnosis of hypertensive disorder of pregnancy (HDP) in low-resourced settings.

METHODS

Using data from a prospective cohort including 852 women admitted to hospital for a HDP, the association between SpO(2) and adverse maternal outcome was assessed using logistic regression. The miniPIERS model was recalibrated and extended to include SpO(2). The incremental value of adding SpO(2) to the model was measured using a net reclassification index (NRI), sensitivity, specificity, positive and negative predictive values, and likelihood ratios.

RESULTS

SpO(2) of < 93% was associated with a 30-fold increase in risk (95% CI 14 to 68) of adverse maternal outcome compared to women with SpO(2) > 97%. After recalibration and extension, the miniPIERS model including SpO(2) (vs. not including SpO(2)) had improved sensitivity (32.8% vs. 49.6%) at the cost of minimally decreased specificity (91.5% vs. 96.2%) with a NRI of 0.122.

CONCLUSION

SpO(2) is a significant independent predictor of risk in women with a HDP. Adding SpO(2) to the miniPIERS model improved the model's ability to correctly identify high-risk patients who would benefit most from interventions.

Measuring change in quality of life: bias in prospective and retrospective evaluation

OBJECTIVES

Treatment effects on health-related quality of life (QOL) often differ depending on whether they are measured prospectively (before and after treatment) or retrospectively (after treatment only). These two approaches can be subject to different sorts of bias: Prospective evaluations may be biased by scale recalibration (a changed understanding of the response scale), and retrospective evaluations may be biased by recall bias (a wrong assessment of former QOL).

METHODS

On the basis of an analysis of the literature, we present an overview on possible biases in prospective and retrospective measurement of QOL and how these biases are named and defined in the literature.

RESULTS

The definitions of different biases are inconsistent. Many authors do not clearly distinguish measurement bias from true change. Furthermore, some consider only scale recalibration or only recall bias.

CONCLUSIONS

Much of the current discussion on bias in prospective and retrospective QOL measurement suffers from unclear definitions, especially of "response shift" and "recall bias," or from neglecting one of the possible biases. We suggest more elaborate definitions for different types of bias and recommend taking both kinds of bias into consideration when measuring change in QOL. The relevance of the different biases depends on the type of study, and so either prospective or retrospective assessment may be more appropriate.

Tactile feedback improves auditory spatial localization

Our recent studies suggest that congenitally blind adults have severely impaired thresholds in an auditory spatial bisection task, pointing to the importance of vision in constructing complex auditory spatial maps (Gori et al., 2014). To explore strategies that may improve the auditory spatial sense in visually impaired people, we investigated the impact of tactile feedback on spatial auditory localization in 48 blindfolded sighted subjects. We measured auditory spatial bisection thresholds before and after training, either with tactile feedback, verbal feedback, or no feedback. Audio thresholds were first measured with a spatial bisection task: subjects judged whether the second sound of a three sound sequence was spatially closer to the first or the third sound. The tactile feedback group underwent two audio-tactile feedback sessions of 100 trials, where each auditory trial was followed by the same spatial sequence played on the subject’s forearm; auditory spatial bisection thresholds were evaluated after each session. In the verbal feedback condition, the positions of the sounds were verbally reported to the subject after each feedback trial. The no feedback group did the same sequence of trials, with no feedback. Performance improved significantly only after audio-tactile feedback. The results suggest that direct tactile feedback interacts with the auditory spatial localization system, possibly by a process of cross-sensory recalibration. Control tests with the subject rotated suggested that this effect occurs only when the tactile and acoustic sequences are spatially congruent. Our results suggest that the tactile system can be used to recalibrate the auditory sense of space. These results encourage the possibility of designing rehabilitation programs to help blind persons establish a robust auditory sense of space, through training with the tactile modality.

Accuracy of forecasts in strategic intelligence

The accuracy of 1,514 strategic intelligence forecasts abstracted from intelligence reports was assessed. The results show that both discrimination and calibration of forecasts was very good. Discrimination was better for senior (versus junior) analysts and for easier (versus harder) forecasts. Miscalibration was mainly due to underconfidence such that analysts assigned more uncertainty than needed given their high level of discrimination. Underconfidence was more pronounced for harder (versus easier) forecasts and for forecasts deemed more (versus less) important for policy decision making. Despite the observed underconfidence, there was a paucity of forecasts in the least informative 0.4-0.6 probability range. Recalibrating the forecasts substantially reduced underconfidence. The findings offer cause for tempered optimism about the accuracy of strategic intelligence forecasts and indicate that intelligence producers aim to promote informativeness while avoiding overstatement.

A review on auditory space adaptations to altered head-related cues

In this article we present a review of current literature on adaptations to altered head-related auditory localization cues. Localization cues can be altered through ear blocks, ear molds, electronic hearing devices, and altered head-related transfer functions (HRTFs). Three main methods have been used to induce auditory space adaptation: sound exposure, training with feedback, and explicit training. Adaptations induced by training, rather than exposure, are consistently faster. Studies on localization with altered head-related cues have reported poor initial localization, but improved accuracy and discriminability with training. Also, studies that displaced the auditory space by altering cue values reported adaptations in perceived source position to compensate for such displacements. Auditory space adaptations can last for a few months even without further contact with the learned cues. In most studies, localization with the subject's own unaltered cues remained intact despite the adaptation to a second set of cues. Generalization is observed from trained to untrained sound source positions, but there is mixed evidence regarding cross-frequency generalization. Multiple brain areas might be involved in auditory space adaptation processes, but the auditory cortex (AC) may play a critical role. Auditory space plasticity may involve context-dependent cue reweighting.

Continuous glucose monitoring in newborn infants: how do errors in calibration measurements affect detected hypoglycemia?

Neonatal hypoglycemia is common and can cause serious brain injury. Continuous glucose monitoring (CGM) could improve hypoglycemia detection, while reducing blood glucose (BG) measurements. Calibration algorithms use BG measurements to convert sensor signals into CGM data. Thus, inaccuracies in calibration BG measurements directly affect CGM values and any metrics calculated from them. The aim was to quantify the effect of timing delays and calibration BG measurement errors on hypoglycemia metrics in newborn infants. Data from 155 babies were used. Two timing and 3 BG meter error models (Abbott Optium Xceed, Roche Accu-Chek Inform II, Nova Statstrip) were created using empirical data. Monte-Carlo methods were employed, and each simulation was run 1000 times. Each set of patient data in each simulation had randomly selected timing and/or measurement error added to BG measurements before CGM data were calibrated. The number of hypoglycemic events, duration of hypoglycemia, and hypoglycemic index were then calculated using the CGM data and compared to baseline values. Timing error alone had little effect on hypoglycemia metrics, but measurement error caused substantial variation. Abbott results underreported the number of hypoglycemic events by up to 8 and Roche overreported by up to 4 where the original number reported was 2. Nova results were closest to baseline. Similar trends were observed in the other hypoglycemia metrics. Errors in blood glucose concentration measurements used for calibration of CGM devices can have a clinically important impact on detection of hypoglycemia. If CGM devices are going to be used for assessing hypoglycemia it is important to understand of the impact of these errors on CGM data.

Tendon cell ciliary length as a biomarker of in situ cytoskeletal tensional homeostasis

To determine if tendon cell ciliary length could be used as a biomarker of cytoskeletal tensional homeostasis, 20 mm long adult rat tail tendons were placed in double artery clamps set 18 mm apart to create a 10% laxity. The tendons were allowed to contract over a 7 day period under culture conditions. At 0, 1, 5, and 7 days the tendon cell cilia were stained and ciliary length measured using confocal imaging. There was a significant (p<0.001) increase in ciliary length at 1 day. At day 5 (when the tendon became visibly taut) there was a significant (p<0.001) decrease in ciliary length compared to day 1. By day 7 the tendon remained taut and ciliary length returned to day zero values (p=0.883). These results suggest that cilia length reflects the local mechanobiological environment of tendon cells and could be used as a potential in situ biomarker of altered cytoskeletal tensional homeostasis.

A neural model for temporal order judgments and their active recalibration: a common mechanism for space and time?

When observers experience a constant delay between their motor actions and sensory feedback, their perception of the temporal order between actions and sensations adapt (Stetson et al., 2006). We present here a novel neural model that can explain temporal order judgments (TOJs) and their recalibration. Our model employs three ubiquitous features of neural systems: (1) information pooling, (2) opponent processing, and (3) synaptic scaling. Specifically, the model proposes that different populations of neurons encode different delays between motor-sensory events, the outputs of these populations feed into rivaling neural populations (encoding "before" and "after"), and the activity difference between these populations determines the perceptual judgment. As a consequence of synaptic scaling of input weights, motor acts which are consistently followed by delayed sensory feedback will cause the network to recalibrate its point of subjective simultaneity. The structure of our model raises the possibility that recalibration of TOJs is a temporal analog to the motion aftereffect (MAE). In other words, identical neural mechanisms may be used to make perceptual determinations about both space and time. Our model captures behavioral recalibration results for different numbers of adapting trials and different adapting delays. In line with predictions of the model, we additionally demonstrate that temporal recalibration can last through time, in analogy to storage of the MAE.

Computational characterization of visually induced auditory spatial adaptation

Recent research investigating the principles governing human perception has provided increasing evidence for probabilistic inference in human perception. For example, human auditory and visual localization judgments closely resemble that of a Bayesian causal inference observer, where the underlying causal structure of the stimuli are inferred based on both the available sensory evidence and prior knowledge. However, most previous studies have focused on characterization of perceptual inference within a static environment, and therefore, little is known about how this inference process changes when observers are exposed to a new environment. In this study we aimed to computationally characterize the change in auditory spatial perception induced by repeated auditory–visual spatial conflict, known as the ventriloquist aftereffect. In theory, this change could reflect a shift in the auditory sensory representations (i.e., shift in auditory likelihood distribution), a decrease in the precision of the auditory estimates (i.e., increase in spread of likelihood distribution), a shift in the auditory bias (i.e., shift in prior distribution), or an increase/decrease in strength of the auditory bias (i.e., the spread of prior distribution), or a combination of these. By quantitatively estimating the parameters of the perceptual process for each individual observer using a Bayesian causal inference model, we found that the shift in the perceived locations after exposure was associated with a shift in the mean of the auditory likelihood functions in the direction of the experienced visual offset. The results suggest that repeated exposure to a fixed auditory–visual discrepancy is attributed by the nervous system to sensory representation error and as a result, the sensory map of space is recalibrated to correct the error.