Kara Gavin

We all make mistakes, and some cost more than others. Now, researchers have peered inside the brain to see what happens at the moment we realize our error - and its price. Their findings may have implications for understanding obsessive-compulsive disorder.

Dr. Stephan Taylor, an associate professor of psychiatry at the University of Michigan Medical School, and colleagues used fMRI to image 12 healthy adults who were asked to respond to a series of 360 visual-based tests. Results were published April 12 in the 

Some tests carried a monetary reward between a quarter and $2, while some carried penalties of the same size. Others carried no reward or penalty. The participants were told they had a $10 "credit" to begin and that they would receive real cash depending on their balance at the end.

The participants had to correctly, and within a deadline of a few hundred milliseconds, press a button corresponding to one of two alphabetic letter pairs. They were instructed to determine which letter was the odd one out in a series of other letters. Some of the letter sequences were more confusing than others. Subjects received immediate feedback telling them if they were wrong or too late in responding.

Researchers found that a particular part of the brain called the rostral anterior cingulate cortex, or rACC, becomes much more active when a person realizes he or she has made an error that carries consequences, such as losing money.

By contrast, the same area of the brain does not show the same level of activity when the mistake doesn't carry a penalty or when a correct action carries a reward. The rACC is thought to be involved with emotional responses, and scientists had suspected it might also be involved in response to costly errors. But this is the first brain imaging study to test that idea, according to Taylor. 

These researchers had previously shown that the rACC area became much more active in response to a no-penalty error in the brains of a small group of obsessive-compulsive disorder patients, compared with people without the condition. OCD is often characterized by an untoward anxiety or fear about errors or failures in certain aspects of everyday life. Repetitive patterns of behavior are a mechanism to ward off or prevent such events.

"It's very interesting to us that the same part of the brain that responded in our OCD study on regular, no-cost errors also responded in healthy individuals when we made the error count more," Taylor said. 

Investigators want to study patients with OCD using the same experiment to help pinpoint which of their brain circuits have gone awry. 

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Articles

We all make mistakes, and some cost more than others. Now, researchers have peered inside the brain to see what happens at the moment we realize our error -- and its price. Their findings may have implications for understanding obsessive-compulsive disorder.

Imaging tracks down brain’s oops! button

Patients in need of emergency coronary artery angioplasty fare better when treated at a hospital that performs the procedure around the clock than at one that offers angioplasty part time, according to a study in the Jan. 17 issue of 

A team led by University of Michigan and Yale University cardiologists found that patients receive faster treatment and are less likely to die during their hospital stay if they have their emergency angioplasty at a hospital where it is the default treatment used on most patients suffering acute myocardial infarction.

By contrast, delayed treatment and the risk of in-hospital death were both higher for patients treated at a hospital where emergency angioplasty was used in a minority of MI patients. Patients were significantly more likely to die before leaving the hospital, and they waited an average of 20 minutes longer for treatment than those treated at a hospital where most heart attack patients received angioplasty. Many waited far longer than the 90-minute window during which emergency angioplasty is thought to have an edge over fibrinolytics.

Researchers evaluated the records of 37,233 patients who were treated at 463 hospitals divided into four categories: The most specialized group performed emergency angioplasty on more than 88.5% of MI patients. The least specialized group provided emergency angioplasty to fewer than 34% of their heart attack emergency patients. The other two groups fell in between.

The biggest difference in survival and time-to-treatment for angioplasty patients was seen between the highest and lowest groups. A noticeable, though not statistically significant, difference existed between the highest group and the next two groups. There were no significant differences among the groups in death risk or treatment time for patients given fibrinolytic drugs.

All of the patients had suffered a form of heart attack known as ST-elevation MI, and all had arrived at the hospital within 12 hours of the start of their symptoms. None was transferred from an acute-care hospital or had conditions that would have kept them from getting either angioplasty or fibrinolytics.

Surprisingly, the study suggests that a hospital's level of specialization in emergency angioplasty has more to do with patient survival than does the sheer number of emergency angioplasties performed there each year. Previous studies have shown that patients do better when they receive angioplasties and other such treatments at hospitals where many such procedures take place each year.

"In the case of emergency angioplasty, for hospitals it seems that it's not just how many you do, but how used to doing them you are," said lead author Dr. Brahmajee Nallamothu, an assistant professor of internal medicine at the U-M Medical School. "The overall commitment to doing emergency angioplasties, and the protocols and staffing that come out of that commitment, appear to be key."

Hospitals where the default emergency treatment for acute MI is fibrinolytics may want to focus on optimizing that approach or determine better ways to institute emergency angioplasty protocols and staffing for around-the-clock care, according to the study.

Nallamothu noted that public policy can also play a role. Michigan has recently required that hospitals newly licensed to perform emergency angioplasty without onsite cardiac surgery be able to do it 24/7. 

The study was funded by a National Heart, Lung, and Blood Institute grant and used data from the National Registry of Myocardial Infarction (NRMI) collected from 2000 to 2002. 

Funding for the NRMI study that yielded the data was provided by Genentech, which makes two fibrinolytic drugs used to treat acute MI. The company provided access to the NRMI data at no charge and approved the study protocol before the analysis.

For more information from the Diagnostic Imaging archives: 

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Patients in need of emergency coronary artery angioplasty fare better when treated at a hospital that performs the procedure around the clock than at one that offers angioplasty part time, according to a study in the Jan. 17 issue of Circulation.

Kara Gavin

Articles

Imaging tracks down brain’s oops! button

Hospitals specializing in emergency angioplasty show best results