No abstract

In this contemporary outpatient HFrEF registry, significant gaps in use and dose of guideline-directed medical therapy remain. Multiple clinical factors were associated with medication use and dose prescribed. Strategies to improve guideline-directed use of HFrEF medications remain urgently needed, and these findings may inform targeted approaches to optimize outpatient medical therapy.

Neuroplasticity can be defined as the ability of the nervous system to respond to intrinsic or extrinsic stimuli by reorganizing its structure, function and connections. Major advances in the understanding of neuroplasticity have to date yielded few established interventions. To advance the translation of neuroplasticity research towards clinical applications, the National Institutes of Health Blueprint for Neuroscience Research sponsored a workshop in 2009. Basic and clinical researchers in disciplines from central nervous system injury/stroke, mental/addictive disorders, paediatric/developmental disorders and neurodegeneration/ageing identified cardinal examples of neuroplasticity, underlying mechanisms, therapeutic implications and common denominators. Promising therapies that may enhance training-induced cognitive and motor learning, such as brain stimulation and neuropharmacological interventions, were identified, along with questions of how best to use this body of information to reduce human disability. Improved understanding of adaptive mechanisms at every level, from molecules to synapses, to networks, to behaviour, can be gained from iterative collaborations between basic and clinical researchers. Lessons can be gleaned from studying fields related to plasticity, such as development, critical periods, learning and response to disease. Improved means of assessing neuroplasticity in humans, including biomarkers for predicting and monitoring treatment response, are needed. Neuroplasticity occurs with many variations, in many forms, and in many contexts. However, common themes in plasticity that emerge across diverse central nervous system conditions include experience dependence, time sensitivity and the importance of motivation and attention. Integration of information across disciplines should enhance opportunities for the translation of neuroplasticity and circuit retraining research into effective clinical therapies.

1. Neurons in the dorsomedial region of the medial superior temporal area (MSTd) have large receptive fields that include the fovea, are directionally selective for moving visual stimuli, prefer the motion of large fields to small spots, and respond to rotating and expanding patterns of motion as well as frontal parallel planar motion. These characteristics suggested that these neurons might contribute to the analysis of the large-field optic flow stimulation generated as an observer moves through the visual environment. 2. We tested the response of MSTd neurons in two awake monkeys by systematically presenting a set of translational and rotational stimuli to each neuron. These 100 X 100 degrees stimuli were the motion components from which all optic flow fields are derived. 3. In 220 single neurons we found 23% that responded primarily to one component of motion (planar, circular, or radial), 34% that responded to two components (planocircular or planoradial, but never circuloradial), and 29% that responded to all three components. 4. The number of stimulus components to which a neuron responded was unrelated to the size or eccentricity of its receptive field. 5. Triple-, double-, and single-component neurons varied widely in the strength of their responses to the preferred components. Grouping these neurons together revealed that they did not form discrete classes but rather a continuum of response selectivity. 6. This continuum was apparent in other response characteristics. Direction selectivity was weakest in triple-component neurons, strongest in single-component neurons. Significant inhibitory responses were less frequent in triple-component neurons than in single-component neurons. 7. There was some indication that the neurons of similar component classes occupied adjacent regions within MSTd, but all combinations of component and direction selectivity were occasionally found in immediate juxtaposition. 8. Experiments on a subset of neurons showed that the speed of motion, the dot density, and the number of different speed planes in the display had little influence on these responses. 9. We conclude that the selective responses of many MSTd neurons to the rotational and translational components of optic flow make these neurons reasonable candidates for contributing to the analysis of optic flow fields.