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Economic implications of pain management. By Loeser JD. Acta Anaesthesiol Scand 1999; 43:957–95. Reprinted with permission. Multidisciplinary pain management was an invention of John J. Bonica, M.D. He started the Multidisciplinary Pain Clinic at the University of Washington in 1960. This clinical service evolved over the years, and when John Loeser, M.D., became its director in 1982, he collaborated with Bill Fordyce, Ph.D., to create what was known as “the structured program.” The program has served as the model for pain treatment programs throughout the world, many of which have fared better than that at the University of Washington. The migration of Stephen Butler, M.D., to Uppsala, Sweden, in 2000 has given us the opportunity to contrast multidisciplinary pain management in the Nordic countries with that in the United States.

The tenets of dignity, safety and privacy are potentially challenged when patients are required to remove their own clothes and wear the hospital gown for medical procedures. The current study aimed to explore healthcare workers’ views (n = 3371) on the utility of the hospital gown and its perceived impact on patient wellbeing using a cross-sectional online survey with closed and open-ended questions. Findings suggested that the gown was often used when it was not medically necessary and that it was perceived to negatively impact on patient wellbeing (leaving patients feeling uncomfortable, vulnerable, cold, exposed and self-conscious). The majority of healthcare workers suggested alternatives and/or modifications to the hospital gown in order for it to be more patient centred. Barriers and practical challenges in promoting patients wearing their own clothing were identified with recommendations for improving choice, quality, safety and dignity in patent clothing across diverse healthcare settings.

Social media has become a core feature of daily life, with 3.8 billion users worldwide. Research on individual differences in social media use has tended to focus on the effect of differing levels of engagement on specific mental health outcomes. In contrast, few studies have directly investigated users’ own perceptions of the impact of their social media use, attempts to regulate their behaviour through periods of ‘detox’, and the drivers that compel them to return to these platforms. Therefore, in this study, we examined users’ current attitudes towards their social media use, their awareness of the impact it had on other aspects of their life, their experiences of self-initiated periods of ‘detox’, and their reasons for re-engagement. A sample of 208 UK social media users (aged 18-28), partitioned into typical and frequent user groups using the SMAQ and the SMES, were tested on all measures. The findings, derived from both quantitative and qualitative data, showed that users across both groups were aware of the impact of overuse, they were able to successfully engage in sustained periods of social media detox, from which they derived positive effects (e.g., on sleep, mood, productivity), and the primary driver for continued use was a desire for social connectedness and information, rather than a ‘craving’ for social media per se. Taken together, these findings provide novel data on users’ perceptions of their social media use, and in particular, evidence in support of the positive benefits of periods of social media ‘detox’.

Facial expressions play an important role during communications, allowing information regarding the emotional state of an individual to be conveyed and inferred. Research suggests that automatic facial expression recognition is a promising avenue of enquiry in mental healthcare, as facial expressions can also reflect an individual's mental state. In order to develop user-friendly, low-cost and effective facial expression analysis systems for mental health care, this paper presents a novel deep convolution network based emotion analysis framework to support mental state detection and diagnosis. The proposed system is able to process facial images and interpret the temporal evolution of emotions through a new solution in which deep features are extracted from the Fully Connected Layer 6 of the AlexNet, with a standard Linear Discriminant Analysis Classifier exploited to obtain the final classification outcome. It is tested against 5 benchmarking databases, including JAFFE, KDEF,CK+, and databases with the images obtained ‘in the wild’ such as FER2013 and AffectNet. Compared with the other state-of-the-art methods, we observe that our method has overall higher accuracy of facial expression recognition. Additionally, when compared to the state-of-the-art deep learning algorithms such as Vgg16, GoogleNet, ResNet and AlexNet, the proposed method demonstrated better efficiency and has less device requirements. The experiments presented in this paper demonstrate that the proposed method outperforms the other methods in terms of accuracy and efficiency which suggests it could act as a smart, low-cost, user-friendly cognitive aid to detect, monitor, and diagnose the mental health of a patient through automatic facial expression analysis.

In the UK, more and more people are suffering from various kinds of cognitive impairment. Its early detection and diagnosis can be of great importance. However, it is challenging to detect cognitive impairment in the early stage with high accuracy and low costs, when most of the symptoms may not fully appear. Some currently popular methods include cognitive tests and neuroimaging techniques which have their own drawbacks. Whilst viewing videos, studies have shown that the facial expressions of people with cognitive impairment exhibit abnormal corrugator activities compared to those without cognitive impairment. The aim of this paper is to explore promising computer vision and pattern analysis techniques in the case of detecting cognitive impairment through facial expression analysis. Normally, automatic facial expression recognition often involves three steps: face detection and alignment, facial feature extraction and facial feature classification. This paper presents a survey of computer vision techniques to detect facial features for early diagnosis of cognitive impairment. Additionally, this paper reviews and compares the advantages and disadvantages of such techniques. Automatic facial expression analysis has the potential to be used for cognitive impairment detection in the elderly. In the case of detecting cognitive impairment through facial expression analysis, it may be better to use a local method of facial components alignment, and employ static approaches in facial feature extraction and facial feature classification.

Background and aims Social media use has become a ubiquitous part of society, with 3.8 billion users worldwide. While research has shown that there are positive aspects to social media engagement (e.g. feelings of social connectedness and wellbeing), much of the focus has been on the negative mental health outcomes which are associated with excessive use (e.g. higher levels of depression/anxiety). While the evidence to support such negative associations is mixed, there is a growing debate within the literature as to whether excessive levels of social media use should become a clinically defined addictive behaviour. Methods Here we assess whether one hallmark of addiction, the priority processing of addiction related stimuli known as an ‘attentional bias’, is evident in a group of social media users ( N = 100). Using mock iPhone displays, we test whether social media stimuli preferentially capture users' attention and whether the level of bias can be predicted by platform use (self-report, objective smartphone usage data), and whether it is associated with scores on established measures of social media engagement (SMES) and social media ‘addiction’ severity scales (BSNAS, SMAQ). Results Our findings do not provide support for a social media specific attentional bias. While there was a large range of individual differences in our measures of use, engagement, and ‘addictive’ severity, these were not predictive of, or associated with, individual differences in the magnitude of attentional capture by social media stimuli. Conclusions More research is required before social media use can be definitively placed within an addiction framework.

Facial expressions are important in people’s daily communications. Recognising facial expressions also has many important applications in the areas such as healthcare and e-learning. Existing facial expression recognition systems have problems such as background interference. Furthermore, systems using traditional approaches like SVM (Support Vector Machine) have weakness in dealing with unseen images. Systems using deep neural network have problems such as requirement for GPU, longer training time and requirement for large memory. To overcome the shortcomings of pure deep neural network and traditional facial recognition approaches, this paper presents a new facial expression recognition approach which has image pre-processing techniques to remove unnecessary background information and combines deep neural network ResNet50 and a traditional classifier-- the multiclass model for Support Vector Machine to recognise facial expressions. The proposed approach has better recognition accuracy than traditional approaches like Support Vector Machine and doesn’t need GPU. We have compared 3 proposed frameworks with a traditional SVM approach against the Karolinska Directed Emotional Faces (KDEF) Database, the Japanese Female Facial Expression (JAFFE) Database and the extended Cohn-Kanade dataset (CK+), respectively. The experiment results show that the features extracted from the layer 49Relu have the best performance for these three datasets.

Dementia has been declared a Global Challenge [1]. However, strategies to tackle it are far from global. Epidemiological forecasts are more alarming for low and middle-income countries (LMIC) than for high-income countries (HIC), and yet provisions to support the former are scarce and, in some cases, as we discuss below, impractical. New initiatives are emerging to close these gaps. The Latin America and Caribbean Consortium on Dementia (LAC-CD) [2] and the Global Dementia Prevention Program (GloDePP Consortium; Wang, H. from Peking University and Chan, K.Y. from University of Edinburgh. Preventing dementia and improving dementia care: setting and addressing research priorities in China. Supported by Global Challenges Research Fund Networking Grants). They are seeking strategies to meet and map local and global challenges. Both consortia agree that actions to improve diagnosis and post-diagnostic support are of utmost priority. Here we discuss theory-driven, culturally valid, and interdisciplinary approaches that can yield affordable, reliable, and practical solutions to meet these outstanding needs.

Consistent with the right hemispheric dominance for face processing, a left perceptual bias (LPB) is typically demonstrated by younger adults viewing faces and a left eye movement bias has also been revealed. Hemispheric asymmetry is predicted to reduce with age and older adults have demonstrated a weaker LPB, particularly when viewing time is restricted. What is currently unclear is whether age also weakens the left eye movement bias. Additionally, a right perceptual bias (RPB) for facial judgments has less frequently been demonstrated, but whether this is accompanied by a right eye movement bias has not been investigated. To address these issues older and younger adults’ eye movements and gender judgments of chimeric faces were recorded in two time conditions. Age did not significantly weaken the LPB or eye movement bias; both groups looked initially to the left side of the face and made more fixations when the gender judgment was based on the left side. A positive association was found between LPB and initial saccades in the freeview condition and with all eye movements (initial saccades, number and duration of fixations) when time was restricted. The accompanying eye movement bias revealed by LPB participants contrasted with RPB participants who demonstrated no eye movement bias in either time condition. Consequently, increased age is not clearly associated with weakened perceptual and eye movement biases. Instead an eye movement bias accompanies an LPB (particularly under restricted viewing time conditions) but not an RPB.

Recognizing facial expressions is important in many fields such as computer-human interface. Though different approaches have been widely used in facial expression recognition systems, there are still many problems in practice to achieve the best implementation outcomes. Most systems are tested via the lab-based facial expressions, which may be unnatural. Particularly many systems have problems when they are used for recognizing the facial expressions being used during conversation. This paper mainly conducts an experimental study on Eigenface algorithm-based facial expression recognition. It primarily aims to investigate the performance of both lab-based facial expressions and facial expressions used during conversation. The experiment also aims to probe the problems arising from the recognition of facial expression in conversations. The study is carried out using both the author’s facial expressions as the basis for the lab-based expressions and the facial expressions from one elderly person during conversation. The experiment showed a good result in lab-based facial expressions, but there are some issues observed when using the case of facial expressions obtained in conversation. By analyzing the experimental results, future research focus has been highlighted as the investigation of how to recognize special emotions such as a wry smile and how to deal with the interferences in the lower part of face when speaking.

Our reliance on face photos for identity verification is at odds with extensive research which shows that matching pairs of unfamiliar faces is highly prone to error. This process can therefore be exploited by identity fraudsters seeking to deceive ID checkers (e.g., using a stolen passport which contains an image of a similar looking individual to deceive border control officials). In this study we build on previous work which sought to quantify the threat posed by a relatively new type of fraud: morphed passport photos. Participants were initially unaware of the presence of morphs in a series of face photo arrays and were simply asked to detect which images they thought had been digitally manipulated (i.e., “images that didn’t look quite right”). All participants then received basic information on morph fraud and rudimentary guidance on how to detect such images, followed by a morph detection training task (Training Group, n = 40), or a non-face control task (Guidance Group, n = 40). Participants also completed a post-guidance/training morph detection task and the Models Face Matching Test (MFMT). Our findings show that baseline morph detection rates were poor, that morph detection training significantly improved the identification of these images over and above basic guidance, and that accuracy in the mismatch condition of the MFMT correlated with morph detection ability. The results are discussed in relation to potential countermeasures for morph-based identity fraud. Electronic supplementary material The online version of this article (10.1186/s41235-018-0113-8) contains supplementary material, which is available to authorized users.

The anti-saccade task has been used to measure attentional control related to general anxiety but less so with social anxiety specifically. Previous research has not been conclusive in suggesting that social anxiety may lead to difficulties in inhibiting faces. It is possible that static face paradigms do not convey a sufficient social threat to elicit an inhibitory response in socially anxious individuals. The aim of the current study was twofold. We investigated the effect of social anxiety on performance in an anti-saccade task with neutral or emotional faces preceded either by a social stressor (Experiment 1), or valenced sentence primes designed to increase the social salience of the task (Experiment 2). Our results indicated that latencies were significantly longer for happy than angry faces. Additionally, and surprisingly, high anxious participants made more erroneous anti-saccades to neutral than angry and happy faces, whilst the low anxious groups exhibited a trend in the opposite direction. Results are consistent with a general approach-avoidance response for positive and threatening social information. However increased socio-cognitive load may alter attentional control with high anxious individuals avoiding emotional faces, but finding it more difficult to inhibit ambiguous faces. The effects of social sentence primes on attention appear to be subtle but suggest that the anti-saccade task will only elicit socially relevant responses where the paradigm is more ecologically valid.

An influential model of vision suggests the presence of two visual streams within the brain: a dorsal occipito-parietal stream which mediates action and a ventral occipito-temporal stream which mediates perception. One of the cornerstones of this model is DF, a patient with visual form agnosia following bilateral ventral stream lesions. Despite her inability to identify and distinguish visual stimuli, DF can still use visual information to control her hand actions towards these stimuli. These observations have been widely interpreted as demonstrating a double dissociation from optic ataxia, a condition observed after bilateral dorsal stream damage in which patients are unable to act towards objects that they can recognize. In Experiment 1, we investigated how patient DF performed on the classical diagnostic task for optic ataxia, reaching in central and peripheral vision. We replicated recent findings that DF is remarkably inaccurate when reaching to peripheral targets, but not when reaching in free vision. In addition we present new evidence that her peripheral reaching errors follow the optic ataxia pattern increasing with target eccentricity and being biased towards fixation. In Experiments 2 and 3, for the first time we examined DF's on-line control of reaching using a double-step paradigm in fixation-controlled and free-vision versions of the task. DF was impaired when performing fast on-line corrections on all conditions tested, similarly to optic ataxia patients. Our findings question the long-standing assumption that DF's dorsal visual stream is functionally intact and that her on-line visuomotor control is spared. In contrast, in addition to visual form agnosia, DF also has visuomotor symptoms of optic ataxia which are most likely explained by bilateral damage to the superior parietal-occipital cortex (SPOC). We thus conclude that patient DF can no longer be considered as an appropriate single-case model for testing the neural basis of perception and action dissociations.

With a growing number of elderly people in the UK, more and more of them suffer from various kinds of cognitive impairment. Cognitive impairment can be divided into different stages such as mild cognitive impairment (MCI) and severe cognitive impairment like dementia. Its early detection can be of great importance. However, it is challenging to detect cognitive impairment in the early stage with high accuracy and low cost, when most of the symptoms may not be fully expressed. This survey paper mainly reviews the state of the art techniques for the early detection of cognitive impairment and compares their advantages and weaknesses. In order to build an effective and low-cost automatic system for detecting and monitoring the cognitive impairment for a wide range of elderly people, the applications of computer vision techniques for the early detection of cognitive impairment by monitoring facial expressions, body movements and eye movements are highlighted in this paper. In additional to technique review, the main research challenges for the early detection of cognitive impairment with high accuracy and low cost are analysed in depth. Through carefully comparing and contrasting the currently popular techniques for their advantages and weaknesses, some important research directions are particularly pointed out and highlighted from the viewpoints of the authors alone.

The influence of pain descriptors and mechanical hypersensitivity on pain severity in neuropathic pain has not been well researched and is poorly understood. The aim of this study was to determine the relationship between pain severity and other factors describing chronic neuropathic pain in a large cohort of patients with self-reported neuropathic pain potentially recruited as subjects for a Phase IIa study. A questionnaire specific to the study parameters covering demographics and pain characteristics was sent to potential participants. Overall, 9185 questionnaires were returned from potential subjects who self-reported neuropathic pain. Adjusted odds ratios with 95% confidence intervals were used as a measure of association. These were estimated by unconditional logistic regression. Pain descriptors in the questionnaire were: burning, shooting, shocking, and aching. The presence of self-reported allodynia and hyperalgesia was strongly indicative of both moderate and severe pain, with a significant interaction of both factors in moderate and severe pain. Having 3 or 4 pain descriptors was also strongly indicative of both moderate and severe pain. Female gender, age, and history of serious mental disorders were found to be weaker indicators of both moderate and severe pain. Given the large and varied population with many neuropathic pain diagnoses in the study, the findings are not likely to be merely chance, but are likely to reflect important relationships between pain severity and other factors in those who suffer from chronic neuropathic pain.

The role of self-relevance has been somewhat neglected in static face processing paradigms but may be important in understanding how emotional faces impact on attention, cognition and affect. The aim of the current study was to investigate the effect of self-relevant primes on processing emotional composite faces. Sentence primes created an expectation of the emotion of the face before sad, happy, neutral or composite face photos were viewed. Eye movements were recorded and subsequent responses measured the cognitive and affective impact of the emotion expressed. Results indicated that primes did not guide attention, but impacted on judgments of valence intensity and self-esteem ratings. Negative self-relevant primes led to the most negative self-esteem ratings, although the effect of the prime was qualified by salient facial features. Self-relevant expectations about the emotion of a face and subsequent attention to a face that is congruent with these expectations strengthened the affective impact of viewing the face.

It is widely accepted that the posterior parietal cortex is critical for the on-line control of action and optic ataxia patients are unable to correct their movements in-flight to changes in target position. The current study investigated on-line correction in patients with left visual neglect, right brain damaged patients without neglect and healthy controls. Participants were asked to reach towards a central target that could jump unexpectedly, at movement onset, to the right or left sides of space. In response to the jump, participants were asked either to follow the target or to stop their movement. Neglect patients were able to correct their ongoing movements smoothly and accurately towards right and left target jumps. They did so even when told to stop their movement, indicating that these corrections occurred automatically (i.e., without instruction). However, the timing of corrections to the left was delayed in neglect patients and this produced a drastic increase in movement time. To our surprise, we also found that neglect patients were impaired at stopping their ongoing reaches, when compared to the control groups, in response to either left or right jump trials. We suggest that the 'automatic pilot' system for the hand is spared in neglect, but its processing speed is unilaterally slowed due to a deficit in orienting of attention to the contralesional side. We relate these findings to the breakdown of a system that combines information for attention, perception and action. Damage to this system may not only slow corrective movements to the contralesional side, but also produce non-lateralized deficits in interrupting an ongoing reach.

According to Milner and Goodale’s model (The visual brain in action, Oxford University Press, Oxford, 2006) areas in the ventral visual stream mediate visual perception and off-line actions, whilst regions in the dorsal visual stream mediate the on-line visual control of action. Strong evidence for this model comes from a patient (DF), who suffers from visual form agnosia after bilateral damage to the ventro-lateral occipital region, sparing V1. It has been reported that she is normal in immediate reaching and grasping, yet severely impaired when asked to perform delayed actions. Here we investigated whether this dissociation would extend to saccade execution. Neurophysiological studies and TMS work in humans have shown that the posterior parietal cortex (PPC), on the right in particular (supposedly spared in DF), is involved in the control of memory-guided saccades. Surprisingly though, we found that, just as reported for reaching and grasping, DF’s saccadic accuracy was much reduced in the memory compared to the stimulus-guided condition. These data support the idea of a tight coupling of eye and hand movements and further suggest that dorsal stream structures may not be sufficient to drive memory-guided saccadic performance.

We tested patients suffering from hemispatial neglect on the anti-saccade paradigm to assess voluntary control of saccades. In this task participants are required to saccade away from an abrupt onset target. As has been previously reported, in the pro-saccade condition neglect patients showed increased latencies towards targets presented on the left and their accuracy was reduced as a result of greater undershoot. To our surprise though, in the anti-saccade condition, we found strong bilateral effects: the neglect patients produced large numbers of erroneous pro-saccades to both left and right stimuli. This deficit in voluntary control was present even in patients whose lesions spared the frontal lobes. These results suggest that the voluntary control of action is supported by an integrated network of cortical regions, including more posterior areas. Damage to one or more components within this network may result in impaired voluntary control.

Experiments using chimeric stimuli have shown that the right hemisphere is more influential in processing facial information. Here, again, we found clear evidence that study participants used the information from the left side of the face to inform their gender decisions when chimeric male/female, female/male stimuli were presented. Most interestingly though, this effect was not only present for upright faces but also for inverted (flipped) faces (although the effect was significantly reduced). We propose that the chimeric bias effects found here argue against the idea that inversion destroys the right hemisphere superiority for faces. If this was indeed the case, flipping the chimeric faces should have resulted in a loss of the left face bias. This was not the case.

We investigated attentional biases with a flicker paradigm, examining the proportion of alcohol relative to neutral changes detected. Furthermore, we examined how measures of the participants initial orienting of attention and of their maintained attention relate to levels of alcohol consumption and subjective craving in social drinkers. The eye movements of 58 participants (24 male) were monitored whilst they completed a flicker-induced change blindness task using both simple stimuli and real world scenes, with both an alcohol and neutral change competing for detection. When examined in terms of consumption levels, we observed that heavier social drinkers detected a higher proportion of alcohol related changes in real world scenes only. However, we also observed that levels of craving were not indicative of levels of consumption in social drinkers. Furthermore, also in real world scenes only, higher cravers detected a greater proportion of alcohol related changes compared to lower cravers, and were also quicker to initially fixate on alcohol related stimuli. Thus we conclude that processing biases in the orienting of attention to alcohol related stimuli were demonstrated in higher craving compared to lower craving social users in real world scenes. However, this was not related to the level of consumption as would be expected. These results highlight various methodological and conceptual issues to be considered in future research.

Goal-driven control over saccade target selection requires the inhibition of task-irrelevant, stimulus-driven saccades. A widely held assumption is that frontal structures are of critical importance for this function. Here we report the oculomotor capture behaviour of a patient with a right temporo-parietal lesion, which challenges this view. T.H. was asked to search for a target among distractors and to signal its location with a saccade. A task-irrelevant, additional distractor appeared with or without abrupt onset, and it was either similar or dissimilar in its colour to the target. Compared to controls, T.H. showed an elevated level of capture overall. He also showed spatial extinction, which was partially overridden by an abrupt onset distractor. These results support the view that effective oculomotor control depends on an intact network of frontal and posterior brain regions. We argue that stimulus-driven and goal-driven signals are computed at different stages, but are ultimately combined in a common functional salience map.

This article provides basic pharmacologic and behavioral principles and facts to simplify drug therapy for low back pain. It outlines basic protocols for symptom control while definitive treatments are beginning or healing occurs.

Effective interaction with the world requires the brain to signal behaviourally relevant events and organise an appropriate and timely motor response to such events. Unilateral brain lesion typically results in a reduction and slowing of motor behaviour directed to contralesional space. Accumulator models of choice and reaction time can distinguish between two possible functional causes of this deficit: slowed extraction of evidence in favour of a motor response or an increase in the required amount of evidence for response generation. Three patients with unilateral damage to the right hemisphere were tested on a visually guided saccade task. All three patients showed a dramatic increase in the latency of their responses to targets in the contralesional visual field. We fit their saccade latency distributions with a number of competing accumulator models that embody the alternative functional causes of this deficit. The latency difference between the two hemifields was best accounted for as an increase in the amount of evidence required for a contralesional response.

Experiments using chimeric faces, where the left and the right hand side of the face are different, have shown that observers tend to bias their responses toward the information on the left. Here we investigate the effects of aging as well as exposure duration on this leftward bias. Forty female and male blended as well as chimeric faces were presented to 24 young and 23 elderly adults in either sub-saccadic 100 msec, 300 msec or free view conditions. We found firstly that an increase in exposure duration resulted in an increase in the degree of leftward perceptual biases, irrespective of age, in line with hypotheses stressing the contribution of scanning to chimeric face processing. Secondly, fundamental differences in the perceptual biases between the groups were found in so far that the younger subjects demonstrated significant perceptual biases to chimeric face stimuli even at sub-saccadic exposure durations, whilst for older adults this was the case for the 300 msec and free view conditions only. This differential perceptual activity can be viewed in terms of either reduced right hemispheric function, or increased bilateral function as a possible consequence of elderly adults experiencing the task as more effortful.

Spatially lateralised deficits that typically define the hemispatial neglect syndrome have been shown to co-occur with other non-lateralised deficits of attention, memory, and drawing. However even a simple graphic task involves multiple planning components, including the specification of drawing start position and drawing direction. In order to investigate the influence of these factors in neglect we presented patients with a circle-copying task, and specified the drawing start point. The ability to draw from the instructed location was strongly related to tests that measure constructional abilities, but not related to start point laterality. In contrast, the direction in which patients drew the circle was affected by start point laterality: patients with neglect were less likely to draw in a typical direction when the cue was on the affected side of space and this was strongly related to severity of the neglect. Patients with neglect consistently produced circles that were smaller than the model; however, the scaling was not affected by the laterality of the start point, nor was the proportion of drawings correctly started at the cue. These findings demonstrate the complex relationship between neglect and even the simplest test for the syndrome.

Background: Drawing, and the clock drawing task in particular, is widely used as a diagnostic tool in the study of hemispatial neglect. It is generally assumed that the errors in graphic production, such as the misplacement of numbers, reflect a visuospatial deficit, and that drawing production itself (for example, producing the circle) is unimpaired. Objectives: To test this assumption by examining whether the production of simple circles is affected by neglect. Methods: 16 right hemisphere stroke patients copied circles of various sizes and their drawings were measured for size accuracy. Results: Patients with more severe neglect produced greater scaling errors, consistently drawing the circle smaller than the original. Errors were not in the horizontal axis alone—shrinkage occurred equally in both height and width axes. Conclusions: Neglect can co-occur with constructional difficulties that serve to exacerbate the symptoms presented. This should be taken into account in the assessment of even apparently simple drawing tasks.

Experiments using chimeric faces typically report a perceptual bias towards the viewers left. Here we show that this leftward bias can be elicited even when eye movement should be impossible. Although supporting previous studies arguing that eye movements are not necessary to generate the bias, the effect we found here was significantly reduced, compared to an earlier study which allowed eye movements. We suggest that the chimeric face bias is enhanced by eye movements.

Studies of patients with focal brain lesions and neuroimaging indicate that face processing is predominantly based on right hemisphere function. Additionally, experiments using chimeric faces, where the left and the right-hand side of the face are different, have shown that observers tend to bias their responses toward the information on the left. Here, we monitored eye-movements during a gender identification task using blended face images for both whole and chimeric (half female, half male) faces [Neuropsychologia 35 (1997) 685]. As expected, we found a left perceptual bias: subjects based their gender decision significantly more frequently on the left side of the chimeric faces. Analysis of the first saccade showed a significantly greater number of left fixations independent of perceptual bias presumably reflecting the tendency to first inspect the side of the face better suited to face analysis (left side of face/right hemisphere). On top of this though, there was a relationship between response and fixation pattern. On trials where participants showed a left perceptual bias they produced significantly more left saccades and fixated for longer on the left. In contrast, for trials where participants showed a right perceptual bias there was no reliable difference between the number, or total fixation duration, on the left or the right. These results demonstrate that on a trial-by-trial basis subtle differences in the extent of left or right side scanning are related to the perceptual response of the participant, although an overall initial fixation bias to the left occurs irrespective of response bias.

Using blended chimeric facial stimuli, where the left and the right sides of the face are different, we have previously shown that both young and older observers tend to bias their responses significantly toward the information on the left, supposedly reflecting a right-hemisphere advantage in this task (Butler, Gilchrist, Burt, Perrett, Jones & Harvey, 2005, Neuropsychologia, 43, 52-59; Harvey & Butler, 2004, Perception, 33, 106). Analyses of the eye movement patterns further indicated a tendency for both groups to initially scan to the left side of the chimeric image, presumably reflecting the tendency to first inspect the side of the face better suited to face analysis (left side of face/right hemisphere). As expected, patients with right hemisphere lesions based their gender decisions mainly on the right side of the chimeric face and this was not only the case for patients who suffered from spatial neglect (Mattingley, Bradshaw, Phillips, Bradshaw, 1993, Brain and Cognition, 23, 145-165). More interestingly though, there was no clear relationship between perceptual and eye-movements biases to chimeric stimuli. Although most patients showed more right-sided saccades and longer rightward fixations this was not necessarily reflected in the rightward perceptual bias. One patient in particular showed rightward saccades only, yet based his gender decision on the left hemi-face half the time when he should have shown 100% rightward hemi-face judgements. We would argue that although in healthy subjects face biases and eye-movement biases are tightly coupled, this relationship breaks down with brain damage and that for such patients eye-movement patterns are not a good indicator of perceptual processing (see also Ferber, Danckert, Joanisse, Goltz, Goodale, 2003, Neurology, 60 1826-1829 and Harvey, Olk, Muir, K, 2003, Neuropsychologia, 41, 1114-1121 for supporting evidence).

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Recently, an experimental model of monoarthritis was described in the rat induced by injection with Freund's adjuvant of the tibio-tarsal joint of one hindlimb. After injection, the clinical and behavioural signs of arthritis are stable from weeks 2 to 6 post-injection. Our purpose was to study the regulation of mu-, delta- and kappa-opioid binding sites in the superficial layers (laminae I-II) of the lumbar and cervical enlargements of the spinal cord 2, 4 and 6 weeks post-injection. Using quantitative receptor autoradiography and highly selective opioid ligands, we found complex changes consisting of a bilateral increase in specific [3H]DAMGO (Tyr*-D-Ala-Gly-NMe-Phe-Gly-ol) and [3H]pCl-DPDPE (Tyr*-D-Pen-Gly-Cl-Phe-D-Pen) binding at 2 weeks post-injection and a bilateral decrease in [3H]U-69593 ((5 alpha,7 alpha,8 beta)-(-)-N-methyl-N-[7-(1-pyrrolidinyl)-1- oxaspiro(4,5)dec-8-yl]) specific binding at 4 weeks post-injection. These changes were restricted to the lumbar level. At 6 weeks post-injection, there was a bilateral increase in [3H]pCl-DPDPE specific binding at both lumbar and cervical levels. Altogether, these results suggest that, after probable local changes in endogenous opioid peptides, the three types of opioid binding sites are differentially involved in the development of the pathological process. These results contrast with the lack of significant modification in mu-, delta- and kappa-opioid binding classically reported at various levels of the spinal cord in polyarthritic rats at 3 weeks post-injection and verified for 2, 4 and 6 weeks post-injection in the present study.

Freund's adjuvant induced polyarthritis in rats has been used extensively to study pain processes of long duration. There are limitations of this model for chronic studies of pain/arthritis since the severe systemic changes provoke ethical concerns and also affect behaviour, physiology and biochemistry. Attempts to limit adjuvant-induced arthritis by plantar injection of the inoculum have been made. In this model, however, the process evolved to produce widespread polyarthritis if followed for the 6-plus-weeks necessary for chronic studies. Therefore, although it offers the researcher a reliable limited model of inflammation and nociception at the outset, for longer studies it may have all the disadvantages of the polyarthritic rat. The purpose of the present study was to produce a limited arthritic process in rats, stable over 6 weeks and suitable for behavioural and neurochemical studies of various chronic pain treatment methods. Injection (0.05 ml) of complete adjuvant containing 300 micrograms Mycobacterium butyricum in the tibio-tarsal joint produces a predictable monoarthritis, stable clinically and behaviourly from weeks 2 through 6 post injection. As revealed by clinical observations and X-ray examinations, the arthritis produced was limited anatomically, pronounced, prolonged and stable. A marked increase in sensitivity to paw pressure was seen in the affected limb. Animals gained weight and remained active, indicating little systemic disturbance as opposed to polyarthritic rats. We propose this limited model of arthritis as a suitable alternative to the polyarthritic rat for prolonged studies.

In order to discuss the clinical presentation of the disorder Reflex Sympathetic Dystrophy (RSD), a definition of the term is necessary.

Beneficial effects have been observed in University of Washington Pain Clinic patients treated with tricyclic antidepressants, but such effects occur much earlier than predicted mood elevation. A laboratory investigation of pain perception was employed to test the hypothesis that doxepin, a tricyclic antidepressant, has analgesic properties. Healthy, normal volunteers were tested over a 4-week period during which they repeatedly performed Sensory Decision Theory tasks while undergoing painful dental stimulation. Doxepin and a placebo were administered after baseline measurement for 4 weeks under double blind conditions. No significant changes due to drug administration were observed in detection threshold or sensory sensitivity indices, but response bias against reporting the stimuli as painful changed dramatically after subjects began ingesting capsules. This effect was evident in both drug and placebo groups, and it was maintained across repeated weeks of testing. These observations suggest that the instructions given patients when the drug is administered have a profound effect on pain report.

In a chronic pain model, the arthritic rat, tricyclic antidepressants (TCAs) have been shown to clearly reduce behavioural signs of nociception [3]. In the present work, using a test of acute nociception (vocalization threshold to graded foot pressure) in the same model, we evaluated the possible potentiation of morphine analgesia by 2 TCAs: amitriptyline (AMIT) and imipramine (IMIP). Using this test of acute nociception, we failed to demonstrate any analgesic effect of AMIT or IMIP given either acutely or chronically. We also failed to demonstrate any potentiation of morphine by these compounds. On the contrary, we found a significant decrease of morphine antinociception after acute AMIT administration and a tendency towards diminution with both TCAs given chronically. These results appear to temper enthusiasm for human application of this combination. They also indicate that careful further studies in a chronic pain model using behaviour evaluations are necessary before definite conclusions can be drawn concerning TCAs/opiate interaction.