Sleep deprivation impacts subjective mood states, but very little research has examined the impact on processing emotional information. In the current study, we investigated the impact of total sleep deprivation on neural responses to emotional facial expressions as well as the accuracy and speed with which these faces were categorized. Forty-nine participants completed two tasks in which they were asked to categorize emotional facial expressions as Happy, Sad, Angry, or Fearful. They were shown the 'full' expression of the emotions in one task and more subtle expressions in a second task in which expressions were 'morphed' with neutral faces so that the intensity of emotion varied. It was expected that sleep deprivation would lead to greater reactivity (indexed by larger amplitude N170 event-related potentials), particularly for negative and more subtle facial expressions. In the full face task, sleep-deprived (SD) participants were significantly less accurate than controls (C) at identifying Sad faces and slower to identify all emotional expressions. P1 was smaller and N170 was larger for the SD compared to C group, but for all emotions, indicating generalized impairment in low-level visual processing. In the more difficult morphed face task, SD participants were less accurate than C participants for Sad faces; as well, the group difference in reaction time was greatest for Sad faces. For the SD group, N170 increased in amplitude with increasing perceptual difficulty for the Fearful and Angry faces, but decreased in amplitude with increasing difficulty for Sad faces. These data illustrate that sleep deprivation led to greater neural reactivity for the threat-related negative emotions as they became more subtle; however, there was a failure to engage these perceptual resources for the processing of Sad faces. Sleep loss preferentially impacted the processing of Sad faces; this has widespread implications for sleep-deprived groups.

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Current models of decision-making assume that the brain gradually accumulates evidence and drifts towards a threshold which, once crossed, results in a choice selection. These models have been especially successful in primate research, however transposing them to human fMRI paradigms has proved challenging. Here, we exploit the face-selective visual system and test whether decoded emotional facial features from multivariate fMRI signals during a dynamic perceptual decision-making task are related to the parameters of computational models of decision-making. We show that trial-bytrial variations in the pattern of neural activity in the fusiform gyrus reflect facial emotional information and modulate drift rates during deliberation. We also observed an inverse-urgency signal based in the caudate nucleus that was independent of sensory information but appeared to slow decisions, particularly when information in the task was ambiguous. Taken together, our results characterize how decision parameters from a computational model (i.e., drift rate and urgency signal) are involved in perceptual decision-making and reflected in the activity of the human brain.YY and AD designed research; YY and MT collected the data; YY, MD, and YZ analyzed the data and contributed methods; and YY, AD, LF, and PC contributed to result interpretation. YY drafted the initial manuscript; all authors contributed to writing of this manuscript.

Primary health care (PHC) includes both primary care (PC) and essential public health (PH) functions. While much is written about the need to coordinate these two aspects, successful integration remains elusive in many countries. Furthermore, the current global pandemic has highlighted many gaps in a well-integrated PHC approach. Four key actions have been recognized as important for effective integration. A survey of PC stakeholders (clinicians, researchers, and policy-makers) from 111 countries revealed many of the challenges encountered when facing the pandemic without a coordinated effort between PC and PH functions. Participants’ responses to open-ended questions underscored how each of the key actions could have been strengthened in their country and are potential factors to why a strong PC system may not have contributed to reduced mortality. By integrating PC and PH greater capacity to respond to emergencies may be possible if the synergies gained by harmonizing the two are realized.