We tested detection of changes to eye position, eye color (brightness), mouth position, and mouth color in frontal views of faces. Two faces were presented sequentially for 555 ms each, with a blank screen of 120 ms separating the two. Faces were presented either both upright or both inverted. Measures of detection (d') were calculated for several different degrees of change for each of the four dimensions of change. We first compared results to an earlier experiment that used an oddity design, in which subjects indicated which of three simultaneously viewed and otherwise identical faces had been altered on one of these four dimensions. Subjects in both of these experiments were partially cued, in that they knew the four possible types of changes that could occur on a given trial. The change-detection results correlated well with the oddity data. They confirmed that face inversion had little effect upon detection of changes in eye color, a moderate effect upon detection of eye-position or mouth-color changes, and caused a drastic reduction in the detection of mouth-position changes. An experiment in which uncued and fully cued subjects were compared showed that cueing significantly improved detection of feature color changes, but there was little difference between upright and inverted faces. Full cueing eliminated all effects of inversion. Compared to partial cueing, changes in mouth color were poorly detected by uncued subjects. Last, a change in the frequency of the base (unaltered) face in an experiment from 75% to 40% showed that increased short-term familiarity decreased the detection of eye changes and increased the detection of mouth changes, regardless of face orientation and the type of change made (color or position). We conclude that uncued subjects encode the spatial relations of features more than the colors of features, that mouth color in particular is not considered a relevant dimension for encoding, and that familiarization redistributes attention from more to less salient facial regions. Inversion effects are not simply an exaggeration of the salience effects revealed by withdrawing cueing, but represent an interaction of spatial encoding with salience, in that the greatest inversion effects occur for spatial shifts in less salient facial regions, and can be eliminated through the use of focused attention.
IMPORTANCE Alteration in lung microbes is associated with disease progression in idiopathic pulmonary fibrosis. OBJECTIVE To assess the effect of antimicrobial therapy on clinical outcomes. DESIGN, SETTING, AND PARTICIPANTS Pragmatic, randomized, unblinded clinical trial conducted across 35 US sites. A total of 513 patients older than 40 years were randomized from August 2017 to June 2019 (final follow-up was January 2020).INTERVENTIONS Patients were randomized in a 1:1 allocation ratio to receive antimicrobials (n = 254) or usual care alone (n = 259). Antimicrobials included co-trimoxazole (trimethoprim 160 mg/sulfamethoxazole 800 mg twice daily plus folic acid 5 mg daily, n = 128) or doxycycline (100 mg once daily if body weight <50 kg or 100 mg twice daily if Ն50 kg, n = 126). No placebo was administered in the usual care alone group. MAIN OUTCOMES AND MEASURESThe primary end point was time to first nonelective respiratory hospitalization or all-cause mortality. RESULTS Among the 513 patients who were randomized (mean age, 71 years; 23.6% women), all (100%) were included in the analysis. The study was terminated for futility on December 18, 2019. After a mean follow-up time of 13.1 months (median, 12.7 months), a total of 108 primary end point events occurred: 52 events (20.4 events per 100 patient-years [95% CI, 14.8-25.9]) in the usual care plus antimicrobial therapy group and 56 events (18.4 events per 100 patient-years [95% CI, 13.2-23.6]) in the usual care group, with no significant difference between groups (adjusted HR, 1.04 [95% CI, 0.71-1.53; P = .83]. There was no statistically significant interaction between the effect of the prespecified antimicrobial agent (co-trimoxazole vs doxycycline) on the primary end point (adjusted HR, 1.15 [95% CI 0.68-1.95] in the co-trimoxazole group vs 0.82 [95% CI, 0.46-1.47] in the doxycycline group; P = .66). Serious adverse events occurring at 5% or greater among those treated with usual care plus antimicrobials vs usual care alone included respiratory events (16.5% vs 10.0%) and infections (2.8% vs 6.6%); adverse events of special interest included diarrhea (10.2% vs 3.1%) and rash (6.7% vs 0%).CONCLUSIONS AND RELEVANCE Among adults with idiopathic pulmonary fibrosis, the addition of co-trimoxazole or doxycycline to usual care, compared with usual care alone, did not significantly improve time to nonelective respiratory hospitalization or death. These findings do not support treatment with these antibiotics for the underlying disease.
Reduced bone density can be seen in a majority of patients with advanced PAH. Risk factors for reduced bone density include SSC-PAH, reduced 6MWD, need for oxygen during 6MWD testing, reduced FEV1, a history of smoking or corticosteroid use, and postmenopausal status.
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