Sufficient stochastic maximum principle in a regime-switching diffusion model

We prove a sufficient stochastic maximum principle for the optimal control of a regime-switching diffusion model. We show the connection to dynamic programming and we apply the result to a quadratic loss minimization problem, which can be used to solve a mean-variance portfolio selection problem

How do healthcare professionals working in accountable care organisations understand patient activation and engagement? Qualitative interviews across two time points.

ObjectiveIf patient engagement is the new 'blockbuster drug' why are we not seeing spectacular effects? Studies have shown that activated patients have improved health outcomes, and patient engagement has become an integral component of value-based payment and delivery models, including accountable care organisations (ACO). Yet the extent to which clinicians and managers at ACOs understand and reliably execute patient engagement in clinical encounters remains unknown. We assessed the use and understanding of patient engagement approaches among frontline clinicians and managers at ACO-affiliated practices.DesignQualitative study; 103 in-depth, semi-structured interviews.ParticipantsSixty clinicians and eight managers were interviewed at two established ACOs.ApproachWe interviewed healthcare professionals about their awareness, attitudes, understanding and experiences of implementing three key approaches to patient engagement and activation: 1) goal-setting, 2) motivational interviewing and 3) shared decision making. Of the 60 clinicians, 33 were interviewed twice leading to 93 clinician interviews. Of the 8 managers, 2 were interviewed twice leading to 10 manager interviews. We used a thematic analysis approach to the data.Key resultsInterviewees recognised the term 'patient activation and engagement' and had favourable attitudes about the utility of the associated skills. However, in-depth probing revealed that although interviewees reported that they used these patient activation and engagement approaches, they have limited understanding of these approaches.ConclusionsWithout understanding the concept of patient activation and the associated approaches of shared decision making and motivational interviewing, effective implementation in routine care seems like a distant goal. Clinical teams in the ACO model would benefit from specificity defining key terms pertaining to the principles of patient activation and engagement. Measuring the degree of understanding with reward that are better-aligned for behaviour change will minimise the notion that these techniques are already being used and help fulfil the potential of patient-centred care

Ortho-semantic learning of novel words: An event-related potential study of grade 3 children

Introduction: As children become independent readers, they regularly encounter new words whose meanings they must infer from context, and whose spellings must be learned for future recognition. The self-teaching hypothesis proposes orthographic learning skills are critical in the transition to fluent reading, while the lexical quality hypothesis further emphasizes the importance of semantics. Event-related potential (ERP) studies of reading development have focused on effects related to the N170 component—print tuning (letters vs. symbols) and lexical tuning (real words vs. consonant strings)—as well as the N400 reflecting semantic processing, but have not investigated the relationship of these components to word learning during independent reading. Methods: In this study, children in grade 3 independently read short stories that introduced novel words, then completed a lexical decision task from which ERPs were derived. Results: Like real words, newly-learned novel words evoked a lexical tuning effect, indicating rapid establishment of orthographic representations. Both real and novel words elicited significantly smaller N400s than pseudowords, suggesting that semantic representations of the novel words were established. Further, N170 print tuning predicted accuracy on identifying the spellings of the novel words, while the N400 effect for novel words was associated with reading comprehension. Discussion: Exposure to novel words during self-directed reading rapidly establishes neural markers of orthographic and semantic processing. Furthermore, the ability to rapidly filter letter strings from symbols is predictive of orthographic learning, while rapid establishment of semantic representations of novel words is associated with stronger reading comprehension

Barriers to Medical Students’ Electronic Health Record Access Can Impede Their Preparedness for Practice

Medical students need hands-on experience documenting clinical encounters as well as entering orders to prepare for residency and become competent physicians. In the era of paper medical records, students consistently acquired experience writing notes and entering orders as part of their clinical experience. Over the past decade, however, patient records have transitioned from paper to electronic form. This change has had the unintended consequence of limiting medical students’ access to patient records. This restriction has meant that many students leave medical school without the appropriate medical record skills for transitioning to residency. In this article, the authors explore medical students’ current access to electronic health records (EHRs) as well as policy proposals from medical societies, innovative models implemented at some U.S. medical schools, and other possible solutions to ensure that students have sufficient experiential learning opportunities with EHRs in clinical settings. They also contend that competence in the use of EHRs is necessary for students to become physicians who can harness the full potential of these tools rather than physicians for whom EHRs hinder excellent patient care. Finally, the authors argue that meaningful experiences using EHRs should be consistently incorporated into medical school curricula and that EHR-related skills should be rigorously assessed with other clinical skills

Geographic Variation in Pneumonia and Influenza in Long-Term Care Facilities:A National Study

There is large county-level geographic variation in pneumonia and influenza hospitalizations among short-stay and long-stay long-term care facility residents in the United States. Long-term care facilities in counties in the Southern and Midwestern regions had the highest rates of pneumonia and influenza from 2013 to 2015. Future research should identify reasons for these geographic differences

Reduced relative volume in motor and attention regions in developmental coordination disorder: a voxel-based morphometry study.

Background and Objectives: Developmental coordination disorder (DCD) is a prevalent childhood movement disorder, impacting the ability to perform movement skills at an age appropriate level. Although differences in grey matter (GM) volumes have been found in related developmental disorders, no such evidence has been linked with DCD to date. This cross-sectional study assessed structural brain differences in children with and without DCD. Methods: High-resolution structural images were acquired from 44 children aged 7.8–12 years, including 22 children with DCD (≤16th percentile on MABC-2; no ADHD/ASD), and 22 typically developing controls (≥20th percentile on MABC-2). Structural voxel-based morphology analysis was performed to determine group differences in focal GM volumes. Results: Children with DCD were found to have significant, large, right lateralised reductions in grey matter volume in the medial and middle frontal, and superior frontal gyri compared to controls. The addition of motor proficiency as a covariate explained the between-group GM volume differences, suggesting that GM volumes in motor regions are reflective of the level of motor proficiency. A positive correlation between motor proficiency and relative GM volume was also identified in the left posterior cingulate and precuneus. Conclusions: GM volume reductions in premotor frontal regions may underlie the motor difficulties characteristic of DCD. It is possible that intervention approaches targeting motor planning, attention, and executive functioning processes associated with the regions of reduced GM volume may result in functional improvements in children with DCD

New sequestrate fungi from Guyana: Jimtrappea guyanensis gen. sp. nov., Castellanea pakaraimophila gen. sp. nov., and Costatisporus cyanescens gen. sp. nov.(Boletaceae, Boletales)

Jimtrappea guyanensis gen. sp. nov., Castellanea pakaraimophila gen. sp. nov., and Costatisporus cyanescens gen. sp. nov. are described as new to science. These sequestrate, hypogeous fungi were collected in Guyana under closed canopy tropical forests in association with ectomycorrhizal (ECM) host tree genera Dicymbe (Fabaceae subfam. Caesalpinioideae), Aldina (Fabaceae subfam. Papilionoideae), and Pakaraimaea (Dipterocarpaceae). Molecular data place these fungi in Boletaceae (Boletales, Agaricomycetes, Basidiomycota) and inform their relationships to other known epigeous and sequestrate taxa within that family. Macro- and micromorphological characters, habitat, and multi-locus DNA sequence data are provided for each new taxon. Unique morphological features and a molecular phylogenetic analysis of 185 taxa across the order Boletales justify the recognition of the three new genera

Optometrists show rudimentary understanding of evidence-based practice but are ready to embrace it: can barriers be overcome?

Evidence-based practice (EBP) involves integration of the best available evidence from research, the patient's preferences or circumstances, the clinical environment and the health practitioner's expertise. There have been several qualitative studies of EBP in health-care but none has focused on the profession of optometry. Therefore, the aim of the present study was to assess optometrists' perceptions of EBP in optometry

Advanced EFL learners' beliefs about language learning and teaching: a comparison between grammar, pronunciation, and vocabulary

This paper reports on the results of a study exploring learners’ beliefs on the learning and teaching of English grammar, pronunciation and vocabulary at tertiary level. While the importance of learners’ beliefs on the acquisition process is generally recognized, few studies have focussed on and compared learners’ views on different components of the language system. A questionnaire containing semantic scale and Likert scale items probing learners’ views on grammar, pronunciation and vocabulary was designed and completed by 117 native speakers of Dutch in Flanders, who were studying English at university. The analysis of the responses revealed that (i) vocabulary was considered to be different from grammar and pronunciation, both in the extent to which an incorrect use could lead to communication breakdown and with respect to the learners’ language learning strategies, (ii) learners believed in the feasibility of achieving a native-like proficiency in all three components, and (iii) in-class grammar, pronunciation and vocabulary exercises were considered to be useful, even at tertiary level. The results are discussed in light of pedagogical approaches to language teaching

Observations of Binary Stars with the Differential Speckle Survey Instrument. IX. Observations of Known and Suspected Binaries, and a Partial Survey of Be Stars

We report 370 measures of 170 components of binary and multiple star systems, obtained from speckle imaging observations made with the Differential Speckle Survey Instrument at Lowell Observatory's Discovery Channel Telescope in 2015 through 2017. Of the systems studied, 147 are binary stars, 10 are seen as triple systems, and 1 quadruple system is measured. Seventy-six high-quality non-detections and fifteen newly resolved components are presented in our observations. The uncertainty in relative astrometry appears to be similar to our previous work at Lowell, namely linear measurement uncertainties of approximately 2 mas, and the relative photometry appears to be uncertain at the 0.1 to 0.15 magnitude level. Using these measures and those in the literature, we calculate six new visual orbits, including one for the Be star 66 Oph, and two combined spectroscopic-visual orbits. The latter two orbits, which are for HD 22451 (YSC 127) and HD 185501 (YSC 135), yield individual masses of the components at the level of 2 percent or better, and independent distance measures that in one case agrees with the value found in the Gaia DR2, and in the other disagrees at the 2-$\sigma$ level. We find that HD 22451 consists of an F6V+F7V pair with orbital period of $2401.1 \pm 3.2$ days and masses of $1.342 \pm 0.029$ and $1.236 \pm 0.026$ $M_{\odot}$. For HD 185501, both stars are G5 dwarfs that orbit one another with a period of $433.94 \pm 0.15$ days, and the masses are $0.898 \pm 0.012$ and $0.876 \pm 0.012$ $M_{\odot}$. We discuss the details of both the new discoveries and the orbit objects