To examine how color affects the identification of flavors, we created a new experimental design, measuring flavor identification while manipulating the probabilities that color cues are associated with flavor outcomes. Stimuli were mixtures with varying relative proportions of two fruit flavorants, either banana+peach (five subjects) or orange+watermelon (another five subjects). The mixtures could be colored either green or red, such that color was a reliable, although not perfect, predictor of the greater component in the mixture. In one condition, red and green were equally associated with their flavor outcomes, while in the other two conditions, one color or the other appeared more frequently. We found, in line with predictions, that subjects used color to improve identification rates. Moreover, also in line with predictions, flavor identification rates were associated with changes in the underlying joint probabilities of color cues and flavor outcomes in the three conditions. From the perspective of statistical learning, these results are consistent with the view that the effect of color on subject’s identification of flavor depends on contiguity (conjoint probability) or sensitivity (conditional probability of associated color, given specific flavor), rather than validity (conditional probability of associated flavor, given specific color).

MUSICAL TIMBRE IS OFTEN DESCRIBED USING terms from non-auditory senses, mainly vision and touch; but it is not clear whether crossmodality in timbre semantics reflects multisensory processing or simply linguistic convention. If multisensory processing is involved in timbre perception, the mechanism governing the interaction remains unknown. To investigate whether timbres commonly perceived as "bright-dark" facilitate or interfere with visual perception (darkness-brightness), we designed two speeded classification experiments. Participants were presented consecutive images of slightly varying (or the same) brightness along with task-irrelevant auditory primes ("bright" or "dark" tones) and asked to quickly identify whether the second image was brighter/darker than the first. Incongruent prime-stimulus combinations produced significantly more response errors compared to congruent combinations but choice reaction time was unaffected. Furthermore, responses in a deceptive identical-image condition indicated subtle semantically congruent response bias. Additionally, in Experiment 2 (which also incorporated a spatial texture task), measures of reaction time (RT) and accuracy were used to construct speed-accuracy tradeoff functions (SATFs) in order to critically compare two hypothesized mechanisms for timbre-based crossmodal interactions, sensory response change vs. shift in response criterion. Results of the SATF analysis are largely consistent with the response criterion hypothesis, although without conclusively ruling out sensory change.

Abstract: For the majority of patients with non-metastatic breast cancer, radiation therapy (RT) plays an integral role as part of breast-conserving therapy and in the post-mastectomy setting. RT reduces the risk of local and regional recurrence and, albeit to a lesser degree, distant recurrence and mortality. Improvements in RT-based planning/delivery technologies have improved the therapeutic ratio (i.e. increased effectiveness and/or reduced morbidity). These techniques are better able to restrict the therapeutic dose to the target tissues and evolving technologies may yield further improvements. Given the integral role of RT as part of the overall treatment approach, radiation oncologists should be part of the multidisciplinary team from the initial phase of the diagnostic–therapeutic pathway. The interaction between local–regional and systemic treatments is complex. Most of the benefit of RT on survival is expected for low-risk patients, who do not receive systemic treatment, and for high-risk patients, receiving effective systemic therapy.

Flavorants such as lemon extract that activate olfactory receptors may also evoke or enhance flavor qualities such as sour and sweet that are typically considered gustatory. Similarly, flavorants such as sucrose and citric acid that activate gustatory receptors may enhance flavors such as citrus that are typically considered olfactory. Here, we ask how lemon extract, sucrose, and citric acid, presented separately and together, affect sweet, sour, and citrus flavors. We accomplished this by testing, in the same 12 subjects, lemon extract and sucrose (Experiment 1), lemon extract and citric acid (Experiment 2), and lemon extract, sucrose, and citric acid (Experiment 3). Results showed that both lemon extract and citric acid increased the ratings of citrus and sour intensity. Lemon extract did not affect sweet, but citric acid did, mainly in Experiment 3. Sucrose systematically increased only sweet intensity and modulated the effect of lemon extract on sour. The most robust multiquality effect was the enhancement of sour by lemon extract. These outcomes suggest, first, a role played by experience with the statistical associations of gustatory and olfactory flavorants and, second, that lemon flavor is complex, having citrus and sour qualities that may not be fully separable in perception.

BACKGROUND:Clinical practice guidelines recommend that all medical providers address tobacco use with patients, as the long-term health benefits of becoming tobacco free are well documented. What happens, though, when a patient has an incurable malignancy and, therefore, will not reap the long-term benefits? Clinical Consideration: Our case study encourages providers to consider the relevance of tobacco use treatment for those with incurable diseases. DISCUSSION:Although long-term benefits will not provide realistic motivation, other equally important rewards (e.g., decreased shortness of breath), a sense of accomplishment shared by patients and family, and the ability to exert control over a behavior can be equally motivating for some patients.

Judgments of taste intensity often show contextual contrast but not assimilation, even though both effects of stimulus context appear in other sense modalities, such as hearing. Four experiments used a paradigm that shifts the stimulus context within a test session in order to seek evidence of assimilation in judgments of the taste intensity of sucrose and, for comparison, the loudness of 500-Hz tones. Experiment 1 found no assimilation in taste using three response scales, magnitude estimation, labeled magnitude, and visual analog, but did find evidence of contrast. Experiments 2 and 3 found no clear evidence of either assimilation or contrast in taste, but found consistent evidence of assimilation in loudness. Experiment 4 found no assimilation in loudness, however, when the intervals between successive stimuli increased from about 6 to 30 s in order to match the interval used with sucrose in Experiments 1 to 3. Taken together, these findings suggest that the assimilation found in intensity judgments in other sensory modalities may not appear in taste perception because of the slower rates presenting of taste stimuli.

Radiation (RT) associated cardiac injury in patients with lung cancer is of unclear significance. RTOG 0617 demonstrated reduced overall survival (OS) with dose-escalated RT for Stage III NSCLC, with higher heart doses predicting for worse OS. We assessed the impact of heart doses on toxicity and survival for patients enrolled on several prospective RT dose-escalation trials. From 1996-2009, 133 patients with Stage III NSCLC (ECOG PS 0-1) were treated on six prospective trials using induction/concurrent chemotherapy and dose-escalated conformal RT to 70-90 Gy. Broad clinical outcomes (e.g. OS) were prospectively assessed. RT plans were reviewed, cardiac structures were defined, and dose/volume metrics were computed. Patient records were retrospectively reviewed for post-RT symptomatic cardiac events (symptomatic pericardial effusion, acute coronary syndrome, and pericarditis). Baseline cardiac risk was calculated using the World Health Organization / International Society of Hypertension (WHO/ISH) score. A competing risks model accounting for the risk of death was used for statistical analysis. 112 patients were included in the final analysis. Median f/u was 19 mo. (75 mo. for the 39 patients without documented progression). Median OS and PFS were 22 and 12 mo. Median prescribed RT dose was 74 Gy. 15 patients (13%) had symptomatic cardiac events (6 pericardial effusion, 5 myocardial infarction, 2 unstable angina, 2 pericarditis) at median 26 mo. post-RT (range, 7-68). On univariate analysis, Heart mean dose (p=0.001), Heart V5Gy (p<0.001), and Heart V30Gy (p=0.002) were associated with symptomatic cardiac events, whereas baseline WHO/ISH score (p=0.204) and coronary artery disease (p=0.109) were not. Heart doses were higher in patients with vs without events (mean 22Gy vs 11Gy, V5Gy 60% vs 35%, V30Gy 35% vs 14%). On multivariate pair analysis accounting for baseline risk, heart doses remained significant predictors of cardiac events (e.g. Heart mean dose, p=0.001, HR 1.05 / 1Gy). 2-year competing risk-adjusted rate of symptomatic cardiac events was 11.1% vs 1.5% for Heart mean dose ≥15Gy vs <15Gy (p=0.003, HR 6.7). 34 patients (30%) had asymptomatic pericardial effusions. There was no association between heart doses and OS. Clinically significant symptomatic cardiac events following high-dose thoracic RT for Stage III NSCLC occurred in 13% of patients at a median 2 years post-RT, with the rate appearing to be heart dose dependent. RT-associated cardiac toxicity in the definitive treatment of Stage III NSCLC may occur earlier than historically understood, and heart doses should be minimized. Supported in part by NIH grant CA69579.

Purpose/Objective(s): To estimate the association between different dose-volume metrics of the salivary glands and pharyngeal constrictors with patient reported severity of xerostomia/dysphagia in the setting of deintensified chemoradiation therapy (CRT).Methods and Materials: Forty-five patients were treated on a phase 2 study assessing the efficacy of deintensified CRT for favorable-risk, HPV-associated oropharyngeal squamous cell carcinoma. Patients received 60 Gy intensity modulated radiation therapy with concurrent weekly cisplatin (30 mg/m(2)), and reported the severity of their xerostomia/dysphagia (before and after treatment) using the patient-reported outcome version of the Common Terminology Criteria for Adverse Events (CTCAE) (PRO-CTCAE). Individual patient dosimetric data of the contralateral parotid and submandibular glands and pharyngeal constrictors were correlated with changes in PRO-CTCAE severity. A change in severity (from baseline) of >= 2 was considered clinically meaningful. Associations between dose-volume metrics and patient outcomes were assessed with receiver operating characteristic (ROC) curve and logistic regression model.Results: Sixmonths after CRT, patients reporting <2 change in xerostomia severity (n=14) had an average D-mean = 22 +/- 9 Gy to the sum of the contralateral glands (parotid + submandibular) compared with the patients reporting >= 2 change (n=21), who had an average D-mean = 34 +/- 8 Gy. V15 to V55 for the combined contralateral glands showed the strongest association with xerostomia (area under the curve [AUC] = 0.83-0.86). Based on the regression analysis, a 20% risk of toxicity was associated with V15 = 48%, V25 = 30%, and D-mean=21 Gy. Six months after CRT, patients reporting <2 change in dysphagia severity (n=26) had an average V55 = 76 +/- 13 (%) to the superior pharyngeal constrictor compared with the patients reporting >= 2 change in severity (n=9), who had average V55 = 89 +/- 13 (%). V55to V60 had the strongest association with dysphagia (AUC = 0.70-0.75). Based on the regression analysis, a 20% risk of toxicity was associated with V55 = 78%, V60 = 40%. The findings at 12 months were similar.Conclusions: After deintensified CRT, the rate of patient-reported xerostomia/dysphagia appears to be associated with the V15 of the combined contralateral salivary glands and V55 to V60 of the superior pharyngeal constrictors. (C) 2017 Elsevier Inc. All rights reserved.

Previous research shows that people systematically match tastes with shapes.Here, we assess the extent to which matched taste and shape stimuli share a common semantic space and whether semantically congruent versus incongruent taste/shape associations can influence the speed with which people respond to both shapes and taste words.In Experiment 1, semantic differentiation was used to assess the semantic space of both taste words and shapes.The results suggest a common semantic space containing two principal components (seemingly, intensity and hedonics) and two principal clusters, one including round shapes and the taste word "sweet", and the other including angular shapes and the taste words "salty", "sour", and "bitter".The former cluster appears more positively-valenced whilst less potent than the latter.In Experiment 2, two speeded classification tasks assessed whether congruent versus incongruent mappings of stimuli and responses (e.g., sweet with round versus sweet with angular) would influence the speed of participants' responding, to both shapes and taste words.The results revealed an overall effect of congruence with congruent trials yielding faster responses than their incongruent counterparts.These results are consistent with previous evidence suggesting a close relation (or crossmodal correspondence) between tastes and shape curvature that may derive from common semantic coding, perhaps along the intensity and hedonic dimensions.

The objective of this pilot study was to assess the inter-rater reliability of a newly developed A3 Quality Assessment (QA) rubric to evaluate the quality of completed Plan-Do-Study-Act (PDSA) projects that used an A3 Thinking Tool (A3) for problem solving. One A3 was independently reviewed by 7 PDSA experts using 5 main levels and 22 sublevels. Evaluations were compared and coded for agreement and used for statistical analysis. Fleiss’ kappa statistics was performed to test for inter-rater reliability between experts across 5 main and 22 sublevels. Preliminary results suggest that the A3 QA rubric meets reliability criteria with a moderate level of agreement beyond chance alone (κ = 0.44) and it is applicable to measure progress on problem solving abilities spearheaded via PDSA cycles. Additional verification testing is needed across multiple A3 improvement projects completed in multiple A3 Thinking templates.

Two experiments presented oral mixtures containing different proportions of the gustatory flavorant sucrose and an olfactory flavorant, either citral (Experiment 1) or lemon (Experiment 2). In 4 different sessions of each experiment, subjects identified each mixture as "mostly sugar" or "mostly citrus/lemon" or rated the perceived intensities of the sweet and citrus components. Different sessions also presented the mixtures in different contexts, with mixtures containing relatively high concentrations of sucrose or citral/lemon presented more often (skew sucrose or skew citral/lemon). As expected, in both experiments, varying stimulus context affected both identification and perceived intensity: Skewing to sucrose versus citral/lemon decreased the probability of identifying the stimuli as "mostly sugar" and reduced the ratings of sweet intensity relative to citrus intensity. Across both contextual conditions of both experiments, flavor identification associated closely with the ratio of the perceived sweet and citrus intensities. The results accord with a model, extrapolated from signal-detection theory, in which sensory events are represented as multisensory-multidimensional distributions in perceptual space. Changing stimulus context can shift the locations of the distributions relative to response criteria, Decision rules guide judgments based on both sensory events and criteria, these rules not necessarily being identical in tasks of identification and intensity rating.

Previous research shows that people systematically match tastes with shapes. Here, we assess the extent to which matched taste and shape stimuli share a common semantic space and whether semantically congruent versus incongruent taste/shape associations can influence the speed with which people respond to both shapes and taste words. In Experiment 1, semantic differentiation was used to assess the semantic space of both taste words and shapes. The results suggest a common semantic space containing two principal components (seemingly, intensity and hedonics) and two principal clusters, one including round shapes and the taste word "sweet," and the other including angular shapes and the taste words "salty," "sour," and "bitter." The former cluster appears more positively-valenced whilst less potent than the latter. In Experiment 2, two speeded classification tasks assessed whether congruent versus incongruent mappings of stimuli and responses (e.g., sweet with round versus sweet with angular) would influence the speed of participants' responding, to both shapes and taste words. The results revealed an overall effect of congruence with congruent trials yielding faster responses than their incongruent counterparts. These results are consistent with previous evidence suggesting a close relation (or crossmodal correspondence) between tastes and shape curvature that may derive from common semantic coding, perhaps along the intensity and hedonic dimensions.

This article discusses the care process among three groups (primary care, radiology, and surgery) aiding a 57-year-old woman during her screening mammography and diagnosis of breast cancer. This is the first in a series of articles exploring principles and topics relevant to teams guiding clinicians involved in cancer care. The challenges demonstrated in this case illustrate how clinicians work within and between groups to deliver this first phase of cancer care. The case helps demonstrate the differences between groups and teams. Focusing on the patient and the overall process of care coordination can help move groups toward becoming teams who deliver better care by identifying and managing goals, roles, and interdependent care tasks. Care providers and researchers can use the case to consider their own work and essential aspects of teamwork needed to improve care, patient outcomes, and the evidence that supports each.