Innate Biases

Entrepreneurs face a host of innate biases that inhibit their ability to make optimal and objective decisions under conditions of uncertainty. Biases include overconfidence bias, illusion of control bias, anchoring and adjustment bias, confirmation bias, curse of knowledge bias, and optimism bias. Through awareness, collaboration and inquiry, open discussion, and the deliberate challenging of consensus, entrepreneurs can mitigate these innate biases

Changes in Intraocular Pressure with Use of Periocular Triamcinolone Cream

Purpose: To evaluate the effect of periocular topical triamcinolone cream on intraocular pressure. Methods: A retrospective chart review identified 57 patients, 114 eyes using triamcinolone cream (0.1%, 0.025%) with subsequent intraocular pressure (IOP) checks at three follow-up visits. Descriptive, univariate, and multivariate analyses were performed to assess effects of age, therapy duration, consecutive weeks on steroid, prescription strength, time of day, and method of measurement on IOP levels. Generalized Estimating Equations were used in regression models to account for correlation of eyes within subjects and across visits. Results: We identified 57 patients using triamcinolone cream for allergic or eczematous dermatitis of the eyelid. Prescription strengths were 0.025% or 0.1% and patients were followed for a median of 4.9 months. Measurements of IOP at baseline did not change as compared to all IOP measurements at follow-ups and did not change with steroid strength. The mean change in IOP at all follow-up visits was 0.07 mm Hg (95% confidence interval [CI]: –0.36, 0.50). After adjustment for the method of tonometer and the patient’s age, the mean change was 0.03 mm Hg (95% CI: –0.68, 0.73, P = 0.93). Prescription strength and consecutive weeks of therapy were not associated with IOP. Two patients experienced a significant elevation in IOP of >10 mm Hg, one through the concomitant consequences of systemic corticosteroids usage and the other through prolonged topical application. Conclusion: In patients taking periocular triamcinolone cream, there was no clinically meaningful change in mean IOP between baseline and follow-up visits, and IOP measurements were not related to variances in prescription strength or duration of therapy

Risk Factors for Diagnosis of Psoriatic Arthritis, Psoriasis, Rheumatoid Arthritis, and Ankylosing Spondylitis : A Set of Parallel Case-control Studies

Funding Information: This work was supported in part by the National Institutes of Health (NIH), Grant K23 AR063764, to the principal investigator AO, and internal funds from the University of Pennsylvania. MD was supported by the NIH, Grant K23 AR06912701. 1E. Meer, BA, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA; 2T. Thrastardottir, MPH, T.J. Love, MD, PhD, Department of Medicine/Rheumatology, University of Iceland and Landspitali, Reykjavik, Iceland; 3X. Wang, MD, Y. Chen, PhD, Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA; 4M. Dubreuil, MD, Department of Medicine/Rheumatology, Boston University, Boston, Massachusetts, USA; 5J.M. Gelfand, MD, MSCE, Department of Biostatistics, Epidemiology and Informatics, and Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA; 6A. Ogdie, MD, MSCE, Department of Biostatistics, Epidemiology and Informatics, and Department of Medicine/ Rheumatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA. JMG has served as a consultant for BMS, Boehringer Ingelheim, Lilly, Janssen Biologics, Novartis, UCB (DSMB), Neuroderm (DSMB), Dr. Reddy’s Labs, Pfizer, and Sun Pharma, receiving honoraria; receives research grants (to the Trustees of the University of Pennsylvania) from AbbVie, Boehringer Ingelheim, Janssen, Novartis, Celgene, Ortho Dermatologics, and Pfizer; and received payment for continuing medical education work related to psoriasis that was supported indirectly by Lilly, Ortho Dermatologics, and Novartis. JMG is a co-patent holder of resiquimod for treatment of cutaneous T-cell lymphoma, is a Deputy Editor for the Journal of Investigative Dermatology, receiving honoraria from the Society for Investigative Dermatology, and is a member of the Board of Directors for the International Psoriasis Council, receiving no honoraria. TJL has received reimbursement from Celgene for speaking about guidelines for the treatment of psoriatic arthritis. AO has served as a consultant for AbbVie, Amgen, BMS, Celgene, Corrona, Global Health Living Foundation, Janssen, Lilly, Novartis, Pfizer, and Takeda, and has received grants to the University of Pennsylvania from Pfizer and Novartis and to Forward from Amgen; her husband has received royalties from Novartis. EM, TT, MD, XW, and YC declare no conflicts of interest relevant to this article. Address correspondence to Dr. A. Ogdie, University of Pennsylvania, Division of Rheumatology, 3400 Civic Center Blvd., Philadelphia, PA 19104, USA. Email: [email protected]. Accepted for publication July 16, 2021. Publisher Copyright: © 2022 The Journal of Rheumatology.Objective. To compare potential risk factors for the diagnosis of psoriatic arthritis (PsA), psoriasis (PsO), rheumatoid arthritis (RA), and ankylosing spondylitis (AS). Methods. Four parallel case-control studies were conducted within The Health Improvement Network using data between 1994 and 2015. Patients with PsA, PsO, RA, or AS were identified using validated code lists and matched to controls on age, sex, practice, and year. Risk factors were selected in the time prior to diagnosis. Multivariable logistic regression models were constructed for each disease using automated stepwise regression to test potential risk factors. Results. Patients with incident PsA (n = 7594), PsO (n = 111,375), RA (n = 28,341), and AS (n = 3253) were identified and matched to 75,930, 1,113,345, 283,226, and 32,530 controls, respectively. Median diagnosis age was 48 (IQR 38–59), 43 (IQR 28–60), 60 (IQR 48–71), and 41 (IQR 32–54) years, respectively. In multivariable models, there were some shared and some differing risk factors across all 4 diseases: PsA was associated with obesity, pharyngitis, and skin infections; PsA and PsO were associated with obesity and moderate alcohol intake; PsA and AS were associated with uveitis; and PsA and RA were associated with preceding gout. Both RA and AS were associated with current smoking, former moderate drinking, anemia, osteoporosis, and inflammatory bowel disease. All shared former or current smoking as a risk factor; statin use was inversely associated with all 4 diseases. Conclusion. Shared and different risk factors for PsA, PsO, RA, and AS were identified. Statin use was inversely associated with all 4 conditions.Peer reviewe

Excessive Deliberation in Social Anxiety: Using Neuroeconomic Applications to Improve Characterizations, Diagnostic Criteria, and Treatment Options for Social Anxiety Disorder.

Recent work has suggested that mental health disorders may be understood in terms of dysfunction in the brain’s goal-directed Reinforcement-Learning (RL) architecture. More specifically, recent work has linked the compulsive aspect of drugs of abuse, and other disorders such as OCD and General Anxiety Disorder, to excessive use of automatic (model-free) over deliberative (model-based) action evaluation. In addition, a converse pathology of excess deliberation (model-based action evaluation) has been suggested to relate to other disorders (e.g. rumination in mood disorders). By assessing how symptoms of social anxiety disorder (SAD) predict model-based (vs model-free) learning in a socially framed RL task, we seek to investigate this hypothesis. In this experiment, we used a data-driven approach, employing large-scale online testing of 489 participants from a general population sample (Amazon Mechanical Turk). Social Anxiety Disorder (SAD) is then particularly interesting, and practical, to focus on both because of its prevalence in the Turk population, and due to it’s specific susceptibility to socially framed tasks. Therefore, subjects completed the Liebowitz Social Anxiety Scale (LSAS), and played 80 rounds of a competitive economic game, the Patent Race, against a computerized opponent. Previous research has captured human choices and neural responses on such tasks with a class of computational models referred to as the Experience Weighted Attraction (EWA) model. The EWA model nests two RL strategies, learning action values by a weighted combination of model-free reward sampling, vs. model-based learning (marginalizing) of the opponent’s move distribution. Estimating the parameters of the EWA model that best fit each subject’s choices, we extract parameters that characterize prior belief decay rate, belief updating, and learning rate. In accordance with our hypothesis, we found that self-reported social anxiety is related to a model parameter, delta, thought to reflect higher order belief learning selectively associated with increased use of model-based evaluation (P < .01; 6% increase in model-based learning per 1 SD increase in LSAS). These results are consistent with prior models of SAD that suggest the root of the disorder lies in excessive post-event processing that leads to paralysis in social situations, characterized by overthinking, heightened levels of mentalizing, and upward counterfactual thoughts. Yet, these results are unique in that they associate clinical symptomology with greater computational ability. By grounding the adverse symptoms of SAD in well-delineated neuro-computational mechanisms, these results illuminate the mental processes specific to SAD, and offer a rare example of enhanced function in disease

Ocular complaints and diagnoses in spaceflight.

The NASA human system risk board (HSRB) has long focused on trauma and acute medical illness as a key contributor to high level in-flight medical risk. However, ocular issues, trauma, and complaints during spaceflight are poorly characterized. In a retrospective case series, the NASA data from the life sciences data archieve (LSDA) and the lifetime surveillance of astronaught health (LSAH) was queried for eye related complaints and conditions in spaceflight across international space station (ISS) missions and space shuttle (STS) missions. The ISS dataset included missions from the year 2000 to 2020, and the STS dataset included missions from 1981 to 2011. Data were reviewed and segmented into categories of ocular complaints. 135 STS missions and 63 ISS missions were included in this analysis. Ocular events were only noted across 83 STS missions (61.5%) and 41 ISS missions (65.1%). Overall, the most common ocular complaints were eye irritation (n = 80, 33.1%), ocular foreign body or foreign body sensation (n = 55, 22.7%), dry eye syndromes (n = 38, 15.7%), epiphora or excessive tearing (n = 19, 7.85%). Of all ocular complaints or diagnoses, 9 (3.72%) were considered higher severity (keratitis, corneal ulcer, chemical exposure, and corneal abrasion). However, seemingly none required evacuation from mission. Improved depiction of ocular symptoms and diagnoses, and a more standard classification system and process to describe ocular symptoms, diagnoses, and treatments in space is crucial to provide more effective and comprehensive treatments

Ocular conditions and injuries, detection and management in spaceflight

Ocular trauma or other ocular conditions can be significantly debilitating in space. A literature review of over 100 articles and NASA evidence books, queried for eye related trauma, conditions, and exposures was conducted. Ocular trauma and conditions during NASA space missions during the Space Shuttle Program and ISS through Expedition 13 in 2006 were reviewed. There were 70 corneal abrasions, 4 dry eyes, 4 eye debris, 5 complaints of ocular irritation, 6 chemical burns, and 5 ocular infections noted. Unique exposures on spaceflight, such as foreign bodies, including celestial dust, which may infiltrate the habitat and contact the ocular surface, as well as chemical and thermal injuries due to prolonged CO2 and heat exposure were reported. Diagnostic modalities used to evaluate the above conditions in space flight include vision questionnaires, visual acuity and Amsler grid testing, fundoscopy, orbital ultrasound, and ocular coherence tomography. Several types of ocular injuries and conditions, mostly affecting the anterior segment, are reported. Further research is necessary to understand the greatest ocular risks that astronauts face and how better we can prevent, but also diagnose and treat these conditions in space

Ocular conditions and injuries, detection and management in spaceflight

Abstract Ocular trauma or other ocular conditions can be significantly debilitating in space. A literature review of over 100 articles and NASA evidence books, queried for eye related trauma, conditions, and exposures was conducted. Ocular trauma and conditions during NASA space missions during the Space Shuttle Program and ISS through Expedition 13 in 2006 were reviewed. There were 70 corneal abrasions, 4 dry eyes, 4 eye debris, 5 complaints of ocular irritation, 6 chemical burns, and 5 ocular infections noted. Unique exposures on spaceflight, such as foreign bodies, including celestial dust, which may infiltrate the habitat and contact the ocular surface, as well as chemical and thermal injuries due to prolonged CO2 and heat exposure were reported. Diagnostic modalities used to evaluate the above conditions in space flight include vision questionnaires, visual acuity and Amsler grid testing, fundoscopy, orbital ultrasound, and ocular coherence tomography. Several types of ocular injuries and conditions, mostly affecting the anterior segment, are reported. Further research is necessary to understand the greatest ocular risks that astronauts face and how better we can prevent, but also diagnose and treat these conditions in space