Effects of a visual frame and of low radial accelerations on the visually perceived eye level

The purpose of this study was to determine how the combined effects of a reference frame and of very low gravito-inertial forces produced by centrifugation affect the visually perceived eye level (VPEL). Twenty subjects were instructed to set a luminous target to the VPEL under various experimental conditions involving two main factors: (1) visual context (frameless, frame centered, frame moved down 50 mm, and frame moved up 50 mm) and (2) gravito-inertial context (motionless, Gi₁=9.81001 m/sec² and Gi₂ = 9.95 m/sec²). The visual context significantly reduced the lowering of VPEL in darkness as caused by radial acceleration; this confirms the prevailing role of vision versus propriosomesthesis. However, under condition Gi₂, there was a significant effect on the VPEL in spite of the presence of the luminous frame; this demonstrates that VPEL processing involves both visual and propriosomesthesic information. Furthermore, the VPEL varied linearly with the vertical shift of the luminous frame for any of the gravito-inertial conditions used in this study, but, under condition Gi₂, the VPEL was shifted downward.     

Contribution of ankle, knee, and hip joints to the perception threshold for support surface rotation.

The purpose of the present experiment was to investigate the extent to which subjects can perceive, at very slow velocities, an angular rotation of the support surface about the medio-lateral axis of the ankle, knee, hip, or neck joint when visual cues are not available. Subjects were passively displaced on a slowly rotating platform at .01, .03, and .05 deg/sec. The subjects' task was to detect movements of the platform in four different postural conditions allowing body oscillations about the ankle, knee, hip, or neck joint. In Experiment 1, subjects had to detect backward and forward rotation (pitching). In Experiment 2, they had to detect left and right rotations of the platform (rolling). In Experiment 3, subjects had to detect both backward/forward and left/right rotations of the platform, with the body fixed and the head either fixed or free to move. Overall, when the body was free to oscillate about the ankle, knee, or hip joints, a similar threshold for movement perception was observed. This threshold was lower for rolling than for pitching. Interestingly, in these postural conditions, an unconscious compensation in the direction opposite to the platform rotation was observed on most trials. The threshold for movement perception was much higher when the head was the only segment free to oscillate about the neck joint. These results suggest that, in static conditions, the otoliths are poor detectors of the direction of gravity forces. They also suggest that accurate perception of body orientation is improved when proprioceptive information can be dynamically integrated.     

Contribution of ankle, knee, and hip joints to the perception threshold for support surface rotation

The purpose of the present experiment was to investigate the extent to which subjects can perceive, at very slow velocities, an angular rotation of the support surface about the medio-lateral axis of the ankle, knee, hip, or neck joint when visual cues are not available. Subjects were passively displaced on a slowly rotating platform at .01, .03, and .05 deg/sec. The subjects’ task was to detect movements of the platform in four different postural conditions allowing body oscillations about the ankle, knee, hip, or neck joint. In Experiment 1, subjects had to detect backward and forward rotation (pitching). In Experiment 2, they had to detect left and right rotations of the platform (rolling). In Experiment 3, subjects had to detect both backward/forward and left/right rotations of the platform, with the body fixed and the head either fixed or free to move. Overall, when the body was free to oscillate about the ankle, knee, or hip joints, a similar threshold for movement perception was observed. This threshold was lower for rolling than for pitching. Interestingly, in these postural conditions, an unconscious compensation in the direction opposite to the platform rotation was observed on most trials. The threshold for movement perception was much higher when the head was the only segment free to oscillate about the neck joint. These results suggest that, in static conditions, the otoliths are poor detectors of the direction of gravity forces. They also suggest that accurate perception of body orientation is improved when proprioceptive information can be dynamically integrated.     

Effectiveness of antidepressants: an evidence myth constructed from a thousand randomized trials?

Antidepressants, in particular newer agents, are among the most widely prescribed medications worldwide with annual sales of billions of dollars. The introduction of these agents in the market has passed through seemingly strict regulatory control. Over a thousand randomized trials have been conducted with antidepressants. Statistically significant benefits have been repeatedly demonstrated and the medical literature is flooded with several hundreds of "positive" trials (both pre-approval and post-approval). However, two recent meta-analyses question this picture. The first meta-analysis used data that were submitted to FDA for the approval of 12 antidepressant drugs. While only half of these trials had formally significant effectiveness, published reports almost ubiquitously claimed significant results. "Negative" trials were either left unpublished or were distorted to present "positive" results. The average benefit of these drugs based on the FDA data was of small magnitude, while the published literature suggested larger benefits. A second meta-analysis using also FDA-submitted data examined the relationship between treatment effect and baseline severity of depression. Drug-placebo differences increased with increasing baseline severity and the difference became large enough to be clinically important only in the very small minority of patient populations with severe major depression. In severe major depression, antidepressants did not become more effective, simply placebo lost effectiveness. These data suggest that antidepressants may be less effective than their wide marketing suggests. Short-term benefits are small and long-term balance of benefits and harms is understudied. I discuss how the use of many small randomized trials with clinically non-relevant outcomes, improper interpretation of statistical significance, manipulated study design, biased selection of study populations, short follow-up, and selective and distorted reporting of results has built and nourished a seemingly evidence-based myth on antidepressant effectiveness and how higher evidence standards, with very large long-term trials and careful prospective meta-analyses of individual-level data may reach closer to the truth and clinically useful evidence.     

Effects of supine body position and low radial accelerations on the visually perceived apparent zenith

The visually perceived eye level (VPEL) has been shown to shift toward the lower part of the body in upright subjects facing toward the axis of rotation on a centrifuge. This shift occurs in the same direction as the shift in the gravito-inertial forces (Gis) produced by very low radial acceleration (centrifugation) combined with gravity. The purpose of this study was to determine whether the same phenomenon affects the visually perceived apparent zenith (VPAZ) in subjects in a supine position. Twelve supine subjects were instructed to set a luminous target to the VPAZ, either while they were in total darkness and motionless or while undergoing very low centrifugation. Data showed that Gis induced a VPAZ shift similar to that observed for the VPEL. Thus, as is the case for the VPEL, the corresponding logarithmic psychophysical function of the VPAZ may be considered to be a type of oculogravic illusion phenomenon with differences in the subjects' that differs from subject to subject, depending on the subject's sensitivity to low radial accelerations. Data on VPEL and VPAZ support the notion that the subjective perception of eye level in total darkness takes into account changes--even if extremely slight-in the direction of the gravito-inertial forces produced by the combination of gravity and low radial accelerations, although subjects are unaware of the Gi shift. However, depending on the intensity of the radial acceleration and the angular deviation of Gi relative to G, the shift of the VPEL and the VPAZ can be either amplified or attenuated. Moreover, differences between VPEL and VPAZ responses suggest two explanatory assumptions--namely, that this is (1) a peripheral phenomenon dependent on the neurophysiological anisotropy of the otolithic system or (2) a central phenomenon dependent on the relevance assigned to the peripheral information by the integrative sensory functions and the associative processes.     

The 9th annual INDUS-EM 2013 Emergency Medicine Summit, “Principles,Practices, and Patients,” a level one international meeting,Kerala University of Health Sciences and Jubilee Mission Medical College and Research Institute,Thrissur, Kerala,India, October 23–27, 2013

INDUS-EM is India’s only level one conference imparting and exchanging quality knowledge in acute care. Specifically, in general and specialized emergency care and training in trauma, burns, cardiac, stroke, environmental and disaster medicine. It provides a series of exchanges regarding academic development and implementation of training tools related to developing future academic faculty and residents in Emergency Medicine in India. The INDUS-EM leadership and board of directors invited scholars from multiple institutions to participate in this advanced educational symposium that was held in Thrissur, Kerala in October 2013.     

The role of cognitive factors in the rod-and-frame effect

We compared the contribution and the effectiveness of modulating the orientation perception of two types of visual information: the visual frame and the visual polarity of objects. In experiment 1, we examined the effect of a square frame, a mouse, an elephant, and a map of France on the apparent vertical. In the upright position, despite the presence of tilted individual component features, the visual objects had no illusory visual tilt effects. When tilted, these objects had a substantial effect on the direction that appeared to be vertical. However, rod-setting errors were smaller in the inducing objects than when observed with the frame display. In the second experiment, the results of experiment 1 were replicated with a meaningful circular contour--a porthole and a clock. The presence of the external circular contour did not abolish the illusion on the apparent vertical. Moreover, in experiment 3, a clock whose numbers were displaced and not tilted--to avoid the possible tilt influence of visual cues--was also able to deflect the subjective visual vertical. This finding suggests that through top-down processing shapes can act as a framework which serves as a reference influencing the perceived orientation of the inner objects.     

Contribution of somesthetic information to the perception of body orientation in the pitch dimension

This study investigated the contribution of otolithic and somesthetic inputs in the perception of body orientation when pitching at very slow velocities. In Experiment 1, the subjects' task was to indicate their subjective postural vertical, in two different conditions of body restriction, starting from different angles of body tilt. In the "strapped" condition, subjects were attached onto a platform by means of large straps. In the "body cast" condition, subjects were completely immobilized in a depressurized system, which attenuates gravity-based somesthetic cues. Results showed that the condition of body restriction and the initial tilt largely influenced the subjective postural vertical. In Experiment 2, subjects were displaced from a vertical position and had to detect the direction of body tilts. Results showed that the threshold for the perception of body tilt was higher when subjects were immobilized in the body cast and when they were tilted backward. Experiment 3 replicated the same protocol from a supine starting position. Compared to results of Experiment 2, the threshold for the perception of body tilt decreased significantly. Overall, these data suggested that gravity-based somesthetic cues are more informative than otolithic cues for the perception of a quasi-static body orientation.     

The reproduction of vertical and oblique orientations in the visual, haptic, and somatovestibular systems

This study investigates whether the vertical orientation may be predominantly used as an amodal reference norm by the visual, haptic, and somato-vestibular perceptual systems to define oblique orientations. We examined this question by asking the same sighted adult subjects to reproduce, in the frontal (roll) plane, the vertical (0°) and six oblique orientations in three tasks involving different perceptual systems. In the visual task, the subjects adjusted a moveable rod so that it reproduced the orientation of a visual rod seen previously in a dark room. In the haptic task, the blindfolded sighted subjects scanned an oriented rod with one hand and reproduced its orientation, with the same hand, on a moveable response rod. In the somato-vestibular task, the blindfolded sighted subjects, sitting in a rotating chair, adjusted this chair in order to reproduce the tested orientation of their own body. The results showed that similar oblique effects (unsigned angular error difference between six oblique orientations and vertical orientation) were observed across the three tasks. However, there were no positive correlations between the visual, haptic,