Invited Session V: Binocular vision and interactions: Harnessing interactions within binocular vision to treat amblyopia

Inexpensive virtual reality (VR) headsets have enabled at-home therapy for binocular dysfunctions, including amblyopia. Healthy binocular vision is exquisite, which is achieved though interactions among various visual subsystems. As a result, however, binocular vision has multiple points of weakness, so development can go wrong in many different ways. Furthermore, the visual system has many ways it can adapt to dysfunctions to improve vision. It is therefore not surprising that amblyopias are idiosyncratic from one person to the next. Habitual interocular suppression is a typical adaption in amblyopia, and by treating suppression in VR, acuity can be improved by 0.1 to 0.2 logMAR. However, the amblyopic visual system shows complicated patterns of interaction between suppression, acuity, stereopsis, motor vergence, accommodation, and motion perception; and each of those subsystems is itself complex. Thus, to improve acuity and stereopsis in amblyopia, a multifaceted approach would seem more promising. In a VR headset, one can addresses suppression, stereopsis, vergence ability, and even accommodation, simultaneously. I will describe Vivid Vision's approach to this problem, along with preliminary results from independent researchers.

Modified HEART score, utilising a single high-sensitive troponin sample, allows early, safe discharge of suspected acute coronary syndrome: a prospective multicentre cohort study of 3016 patients

Background

Combining HSTnT (high sensitive troponin T) values at low levels with composite risk scores may improve early safe, discharge in suspected acute coronary syndromes (ACS). We tested this hypothesis by a prospective study of 3016 consecutive patients with suspected ACS in 2 large hospitals.

Methods

Consecutive chest pain (CP) presentations with HSTnT sampled and ECG undertaken at presentation were prospectively defined in 2 time periods (2011-12, n=1642 [derivation] 2018, n=1376 [validation]).

The HstnT input was modified: dichotomous HSTnT input was lowered to <5 (limit of detection, LOD) or ≥5ng/l (mod TIMI and GRACE), HEART score was re-calibrated (<5 = 0 [LOD], ≥5–14 = 1, >14 = 2 [99th percentile]). All biomarker positive CP index and re-admissions to any regional hospital (catchment population 2.6 million) were independently adjudicated for MI by 2 experienced physicians. Primary outcome was MACE (adjudicated type 1 MI, unplanned coronary revascularisation and all cause death) at 6 weeks.

Results

In the 2 cohorts demographic factors were similar: median age 59 and 56, male 52% and 52%, previous MI 20% and 14% for 2011-12 and 2018 respectively. At 6 weeks 180 (11%) and 75 (5.4%) suffered type 1 MI and 211 (12.9%) and 92 (6.7%) patients suffered MACE in the 2011-12 and 2018 cohorts respectively.

Only Mod HEART ≤3 and undetectable HSTnT, with a nonischaemic ECG, achieved prespecified NPV of >99.5% in both derivation and validation cohorts (table). However Modified HEART ≤3 score could discharge approximately 12% more patients as compared to undetectable HSTnT strategy.

Conclusion

Modified HEART score ≤3, with the use of a single HSTnT, appears the optimum early discharge strategy for suspected ACS

Funding Acknowledgement

Type of funding source: Public Institution(s). Main funding source(s): Liverpool university Hospitals, North-West Educational Cardiac Group

A Binaural CI Research Platform for Oticon Medical SP/XP Implants Enabling ITD/ILD and Variable Rate Processing

We present the first portable, binaural, real-time research platform compatible with Oticon Medical SP and XP generation cochlear implants. The platform consists of (a) a pair of behind-the-ear devices, each containing front and rear calibrated microphones, (b) a four-channel USB analog-to-digital converter, (c) real-time PC-based sound processing software called the Master Hearing Aid, and (d) USB-connected hardware and output coils capable of driving two implants simultaneously. The platform is capable of processing signals from the four microphones simultaneously and producing synchronized binaural cochlear implant outputs that drive two (bilaterally implanted) SP or XP implants. Both audio signal preprocessing algorithms (such as binaural beamforming) and novel binaural stimulation strategies (within the implant limitations) can be programmed by researchers. When the whole research platform is combined with Oticon Medical SP implants, interaural electrode timing can be controlled on individual electrodes to within ±1 µs and interaural electrode energy differences can be controlled to within ±2%. Hence, this new platform is particularly well suited to performing experiments related to interaural time differences in combination with interaural level differences in real-time. The platform also supports instantaneously variable stimulation rates and thereby enables investigations such as the effect of changing the stimulation rate on pitch perception. Because the processing can be changed on the fly, researchers can use this platform to study perceptual changes resulting from different processing strategies acutely.

Behavior and handling of physically and immunologically castrated market pigs on farm and going to market

Physical castration is a common management practice on commercial swine farms in the United States to reduce the incidence of boar taint and aggressive behavior. One alternative to physical castration (PC) is to immunologically castrate (IC) male pigs by blocking the gonadotropin-releasing factor (GnRF), thereby reducing levels of LH, FSH, testosterone, and androstenone. The objectives of this study were to evaluate the effects of IC on pig behavior, human-pig interactions, and handling during and after transport. Pigs were given the first immunization at wk 7 of the grower-finisher period, and second immunizations were given at wk 11, 13, or 14 of the grower-finisher period. Behaviors of PC and IC barrows were sampled at 3 time points after entering finishing at 9 wk of age: 7 wk before first injection, 16 wk (after immunization was complete) into finishing, and 1 d before marketing (16 to 19 wk into finishing). Handling during loading and unloading of trailers going to market was also quantified. Before the first injection, intact males showed increased aggression (P=0.014) and mounting (P=0.048), whereas PC barrows spent more (P=0.003) time feeding than intact males. There were treatment×time interactions for lying (P=0.018), aggression (P<0.001), and standing (P=0.009) behaviors. Few differences were observed in pig-human interactions between PC and IC barrows, with IC and PC approaching people in the same amount of time, but IC barrows were more (P<0.001) aggressive in chewing and rubbing on the test person's pant leg and boots. When handling and loading for processing in the home barn, PC barrows were more (P<0.05) vocal than IC barrows. Fewer dead and down pigs were observed among IC (0%) compared with PC barrows (1.17%). Immunological castration may result in similar or improved animal welfare compared to the stress of physical castration without pain relief.

Disambiguating Necker cube rotation using a location cue: what types of spatial location signal can the visual system learn?

The direction of rotation of a wire-frame (Necker) cube, which is perceptually bistable, can be trained to depend on stimulus location (Q. Haijiang, J. A. Saunders, R. W. Stone, & B. T. Backus, 2006). However, it is not known which aspects of "location" are important to this learning. We therefore explored "location" in a series of experiments that separately assessed testing venue, location relative to the observer, and location in the retinal image as types of location signal that could potentially be recruited by the visual system. Subjects were trained using wire-frame cubes with rotation direction disambiguated by depth cues. Training cubes were presented at two locations, rotating in opposite directions. On interleaved test trials, ambiguous monocular cubes were presented at the same two locations. The extent to which test cubes were perceived to rotate according to the trained location-rotation contingency was our measure of location-cue recruitment. We found that only retinal position was recruited as a cue for apparent rotation direction. Furthermore, the learned retinal location cue was robust to ocular transfer. Our findings are consistent with a relatively low-level site of learning, such as MT.