Development of multisensory integration capabilities in superior colliculus (SC) neurons was examined in cats whose visual-auditory experience was restricted to a circumscribed period during early life (postnatal day 30-8 mos). Animals were periodically exposed to visual and auditory stimuli appearing either randomly in space and time, or always in spatiotemporal concordance. At all other times animals were maintained in darkness. Physiological testing was initiated at approximately 2 years of age. Exposure to random visual and auditory stimuli proved insufficient to spur maturation of the ability to integrate cross-modal stimuli, but exposure to spatiotemporally concordant cross-modal stimuli was highly effective. The multisensory integration capabilities of neurons in the latter group resembled those of normal animals and were retained for more than 16 months in the absence of subsequent visual-auditory experience. Furthermore, the neurons were capable of integrating stimuli having physical properties differing significantly from those in the exposure set. These observations suggest that acquiring the rudiments of multisensory integration requires little more than exposure to consistent relationships between the modality-specific components of a cross-modal event, and that continued experience with such events is not necessary for their maintenance. Apparently, the statistics of cross-modal experience early in life define the spatial and temporal filters that determine if the components of cross-modal stimuli are to be integrated or treated as independent events, a crucial developmental process that determines the spatial and temporal rules by which cross-modal stimuli are integrated to enhance both sensory salience and the likelihood of eliciting an SC-mediated motor response.

It is commonly believed that the ability to integrate information from different senses develops according to associative learning principles as neurons acquire experience with co-active cross-modal inputs. However, previous studies have not distinguished between requirements for co-activation versus co-variation. To determine whether cross-modal co-activation is sufficient for this purpose in visual–auditory superior colliculus (SC) neurons, animals were reared in constant omnidirectional noise. By masking most spatiotemporally discrete auditory experiences, the noise created a sensory landscape that decoupled stimulus co-activation and co-variance. Although a near-normal complement of visual–auditory SC neurons developed, the vast majority could not engage in multisensory integration, revealing that visual–auditory co-activation was insufficient for this purpose. That experience with co-varying stimuli is required for multisensory maturation is consistent with the role of the SC in detecting and locating biologically significant events, but it also seems likely that this is a general requirement for multisensory maturation throughout the brain.

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ObjectivesPrimary care is the key element of health reform in China. The objective of this study was to compare patient assessed quality of public primary care between Hong Kong, a city with established primary care environment influenced by its colonial history, and Shanghai, a city leading primary care reform in Mainland China; and to measure the equity of care in the two cities.MethodsCross sectional stratified random sampling surveys were conducted in 2011. Data were collected from 1,994 respondents in Hong Kong and 811 respondents in Shanghai. A validated Chinese version of the primary care assessment tool was employed to assess perceived quality of primary care with respect to socioeconomic characteristics and health status.ResultsWe analyzed 391 and 725 respondents in Hong Kong and Shanghai, respectively, who were regular public primary care users. Respondents in Hong Kong reported significant lower scores in first contact accessibility (1.59 vs. 2.15), continuity of care (2.33 vs. 3.10), coordination of information (2.84 vs. 3.64), comprehensiveness service availability (2.43 vs. 3.31), comprehensiveness service provided (2.11 vs. 2.40), and the total score (23.40 vs. 27.40), but higher scores in first contact utilization (3.15 vs. 2.54) and coordination of services (2.67 vs. 2.40) when compared with those in Shanghai. Respondents with higher income reported a significantly higher total primary care score in Hong Kong, but not in Shanghai.ConclusionsRespondents in Shanghai reported better quality of public primary care than those in Hong Kong, while quality of public primary care tended to be more equitable in Shanghai.

ObjectiveTo assess changes in the quality of primary care in two megacities following the introduction of health system reforms in China.MethodsWe conducted multistage stratified random face-to-face surveys of patients visiting community health centres in Shanghai in 2011 and 2013, and Shenzhen in 2012 and 2013. Quality of primary care was measured using an assessment tool. Difference-in-difference analyses based on multiple linear regressions were used to compare the changes over time, after controlling for potential confounders.FindingsMost (2721) of the 3214 participants used a community health centre as their regular source of care and were included in our analyses. The mean total scores for quality of primary care were similar for Shanghai and Shenzhen at baseline. In Shenzhen, the mean total scores for all participants and those on low incomes had worsened by 0.922 (95% CI: 0.629 to 1.215) and 1.203 (95% CI: 0.397 to 2.009), respectively. In Shanghai, however, there were improvements in the mean total scores which included increases in the scores for first-contact utilization, continuity, coordination of information and comprehensiveness.ConclusionThe quality of primary care improved in Shanghai but not in Shenzhen. This may be because, in Shanghai, beneficial long-term relationships between patients and general practitioners were supported by capitation payments and the provision of services tailored to the local health priorities.