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INTRODUCTION: Heart failure hospitalization is a hallmark of disease progression associated with increased morbidity and mortality. Benefits of multidisciplinary clinics have been established in the care of heart failure patients and can be particularly impactful post-hospital discharge. OBJECTIVE: This study aimed to investigate the impact of a clinical pharmacist-integrated model of care within a Heart Failure Bridge Clinic (HFBC) at a large tertiary care referral center. METHODS: In this single-center retrospective study, patients with left ventricular ejection fraction (LVEF) ≤40% discharged from Mission Hospital (Asheville, North Carolina) between August 2018 and July 2019 were screened. Patients in the HFBC arm had a clinic visit inclusive of a clinical pharmacist within 30 days of hospital discharge and were compared with a control group of patients with a usual care provider clinic visit. The HFBC provided clinical assessment, detailed heart failure education, and medication reconciliation and adjustment with an emphasis on optimization of Guideline Directed Medical Therapy (GDMT). Patients were followed for 90 days for the primary end point of hospitalization, emergency department (ED) visit, or death. RESULTS: A total of 1463 patients (HFBC, n = 307; control, n = 1156) comprised our final cohort. After accounting for baseline variables, 90-day cumulative probability of hospitalization, ED visit, or death favored HFBC patients (26% vs 32%, P = .0275). Comprehensive review of medications prior to and after HFBC appointment demonstrated significant alterations to therapies (30% GDMT addition, 27% GDMT titration, 7.2% discontinuation of medications associated with worsening heart failure, and 28% loop diuretic adjustment). CONCLUSION: Clinical pharmacist-integrated HFBC allows for focused medication review and optimization and is associated with a 19% relative risk reduction in hospitalization, ED visit, or death at 90 days.

Sound symbolism is a property of certain words which have a direct link between their phonological form and their semantic meaning. In certain instances, sound symbolism can allow non-native speakers to understand the meanings of etymologically unfamiliar foreign words, although the mechanisms driving this are not well understood. We examined whether sound symbolism might be mediated by the same types of cross-modal processes that typify synaesthetic experiences. Synaesthesia is an inherited condition in which sensory or cognitive stimuli (e.g., sounds, words) cause additional, unusual cross-modal percepts (e.g., sounds trigger colours, words trigger tastes). Synaesthesia may be an exaggeration of normal cross-modal processing, and if so, there may be a link between synaesthesia and the type of cross-modality inherent in sound symbolism. To test this we predicted that synaesthetes would have superior understanding of unfamiliar (sound symbolic) foreign words. In our study, 19 grapheme-colour synaesthetes and 57 non-synaesthete controls were presented with 400 adjectives from 10 unfamiliar languages and were asked to guess the meaning of each word in a two-alternative forced-choice task. Both groups showed superior understanding compared to chance levels, but synaesthetes significantly outperformed controls. This heightened ability suggests that sound symbolism may rely on the types of cross-modal integration that drive synaesthetes' unusual experiences. It also suggests that synaesthesia endows or co-occurs with heightened multi-modal skills, and that this can arise in domains unrelated to the specific form of synaesthesia.

A large body of prior research has evaluated how humans combine multiple sources of information pertaining to stimuli drawn from continuous dimensions, such as distance or size. These prior studies have repeatedly demonstrated that in these circumstances humans integrate cues in a near-optimal fashion, weighting cues according to their reliability. However, most of our interactions with sensory information are in the context of categories such as objects and phonemes, thereby requiring a solution to the cue combination problem by mapping sensory estimates from continuous dimensions onto task-relevant categories. Previous studies have examined cue combination with natural categories (e.g., phonemes), providing qualitative evidence that human observers utilize information about the distributional properties of task-relevant categories, in addition to sensory information, in such categorical cue combination tasks. In the present study, we created and taught human participants novel audiovisual categories, thus allowing us to quantitatively evaluate participants’ integration of sensory and categorical information. Comparing participant behavior to the predictions of a statistically optimal observer that ideally combines all available sources of information, we provide the first evidence, to our knowledge, that human observers combine sensory and category information in a statistically optimal manner.

Although cross-modal neural connections and genetic underpinnings are prominent in most current theories regarding the development of synesthesia, the potential role of associative learning in the formation of synesthetic associations has recently been revitalized. In this study, we investigated implicit associative learning in synesthetes and nonsynesthetes by recording reaction times to a target whose color was probabilistically correlated with its shape. A continuous measure of target detection at multiple time points during learning revealed that synesthetes and nonsynesthetes learn associations differently. Specifically, our results demonstrated a "fast-facilitation" learning effect for nonsynesthetes and a "fast-interference, slow-facilitation" learning effect for synesthetes. Additionally, synesthetes exhibited superior long-term memory for the learned associations in a surprise delayed retest. After this retest, participants implicitly learned new (shuffled) shape-color associations. We found that synesthetes experienced greater interference while learning these new shape-color associations. These results detail ways in which implicit associative learning and memory differ between synesthetes and nonsynesthetes.

Synesthesia is a condition in which perceptual or cognitive stimuli (e.g., a written letter) trigger atypical additional percepts (e.g., the color yellow). Although these cross-modal pairings appear idiosyncratic in that they superficially differ from synesthete to synesthete, underlying patterns do exist and these can, in some circumstances, reflect the cross-modal intuitions of nonsynesthetes (e.g., higher pitch sounds tend to be "seen" in lighter colors by synesthetes and are also paired to lighter colors by nonsynesthetes in cross-modal matching tasks). We recently showed that grapheme-color synesthetes are more sensitive to sound symbolism (i.e., cross-modal sound-meaning correspondences) in natural language compared to nonsynesthetes. Accordingly, we hypothesize that sound symbolism may be a guiding force in synesthesia to dictate what types of synesthetic experiences are triggered by words. We tested this hypothesis by examining the cross-modal mappings of lexical-gustatory synesthete, JIW, for whom words trigger flavor experiences. We show that certain phonological features (e.g., front vowels) systematically trigger particular categories of taste (e.g., bitter) in his synesthesia. Some of these associations agree with sound symbolic patterns in natural language. This supports the view that synesthesia may be an exaggeration of cross-modal associations found in the general population and that sound symbolic properties of language may arise from similar mechanisms as those found in synesthesia.

For synesthetes, sensory or cognitive stimuli induce the perception of an additional sensory or cognitive stimulus. Grapheme–color synesthetes, for instance, consciously and consistently experience particular colors (e.g., fluorescent pink) when perceiving letters (e.g.,u). As a phenomenon involving multiple stimuli within or across modalities, researchers have posited that synesthetes may integrate sensory cues differently than non-synesthetes. However, findings to date present mixed results concerning this hypothesis, with researchers reporting enhanced, depressed, or normal sensory integration for synesthetes. In this study wequantitativelyevaluated the multisensory integration process of synesthetes and non-synesthetes using Bayesian principles, rather than employing multisensory illusions, to make inferences about the sensory integration process. In two studies we investigated synesthetes’ sensory integration by comparing human behavior to that of an ideal observer. We found that synesthetes integrated cues for both continuous and categorical dimensions in a statistically optimal manner, matching the sensory integration behavior of controls. These findings suggest that synesthetes and controls utilize similar cue integration mechanisms, despite differences in how they perceive unimodal stimuli.

Tests of rodent visual capacities are typically performed under standard laboratory illumination. However, light level can have subtle and complex effects on behavior in rodents. We tested Mongolian gerbils (Meriones unguiculatus) - a species that shows individual differences in activity pattern - on visual tasks at three ecologically relevant levels of ambient illuminance: approximating moonlight (1 lx), dawn or dusk (10 lx), and low daylight (100 lx). A jumping task and a grating discrimination quantified depth perception and grating acuity, respectively. Illuminance variations had important effects on behavior. Gerbils jumped faster in lower light on the depth discrimination task, but were also less accurate than in bright light. Daytime activity levels (possibly reflecting variations in activity pattern) mediated these effects, with animals that were awake during a lower proportion of daytime hours exhibiting a trend toward jumping faster with lower light level as compared to more day-active gerbils. Moreover, while illuminance did not affect acuity overall, it interacted with activity levels in a complex way: in both the darkest and lowest light levels, animals that were awake during a greater proportion of daytime hours showed higher acuity levels than animals that were less active during the day. These results indicate that gerbils show behavioral profiles in vision tasks that represent an interaction between visual ability and illuminance-sensitive motivational or emotional actors, perhaps including chronotype. Thus, the most ecologically relevant assessments of the visual performance of rodents will likely be achieved by testing at species-specific preferred light levels.