A martingale analysis of first passage times of time-dependent Wiener diffusion models

Research in psychology and neuroscience has successfully modeled decision making as a process of noisy evidence accumulation to a decision bound. While there are several variants and implementations of this idea, the majority of these models make use of a noisy accumulation between two absorbing boundaries. A common assumption of these models is that decision parameters, e.g., the rate of accumulation (drift rate), remain fixed over the course of a decision, allowing the derivation of analytic formulas for the probabilities of hitting the upper or lower decision threshold, and the mean decision time. There is reason to believe, however, that many types of behavior would be better described by a model in which the parameters were allowed to vary over the course of the decision process. In this paper, we use martingale theory to derive formulas for the mean decision time, hitting probabilities, and first passage time (FPT) densities of a Wiener process with time-varying drift between two time-varying absorbing boundaries. This model was first studied by Ratcliff (1980) in the two-stage form, and here we consider the same model for an arbitrary number of stages (i.e. intervals of time during which parameters are constant). Our calculations enable direct computation of mean decision times and hitting probabilities for the associated multistage process. We also provide a review of how martingale theory may be used to analyze similar models employing Wiener processes by re-deriving some classical results. In concert with a variety of numerical tools already available, the current derivations should encourage mathematical analysis of more complex models of decision making with time-varying evidence

Role of Physicians in Addressing Food Insecurity in Vermont Seniors

Introduction: This study investigated Vermont physicians’ awareness of - and engagement in – addressing food insecurity experienced by their elderly patients. This information is needed to better understand the role physicians play in solving this problem and to know how education and access to services could ensure that the needs of elders are met in a culturally sensitive manner. Many elders must choose between paying bills, buying medication or buying food. Some elders are unaware that they qualify for food assistance, or would feel stigmatized using it. Nationally, 56% of physicians reported that they were not knowledgeable about food insecurity. Food insecurity can be screened for by using Hunger Free Vermont’s Two Question Screen. Screening, followed by a multidisciplinary team approach with contributions from dietitians, geriatricians, social workers and psychologists may be the most effective way of assessing at-risk patients.https://scholarworks.uvm.edu/comphp_gallery/1214/thumbnail.jp

Assessment of Acute Pediatric Pain

Accurate assessment of acute pediatric pain can help dispel myths that children’s experience of pain is less severe than that of adults, aid medical staff and clinicians in accurately diagnosing and treating children’s pain, and allow researchers to investigate pain and its correlates. A range of measures have been developed to quantify children’s acute pain. In general, these assessment tools are either self-report, behavioral observation, or physiological. Although there are a number of psychometrically sound instruments in each of these areas, there continues to be room for improvement

The ASL-LEX 2.0 Project: A Database of Lexical and Phonological Properties for 2,723 Signs in American Sign Language

ASL-LEX is a publicly available, large-scale lexical database for American Sign Language (ASL). We report on the expanded database (ASL-LEX 2.0) that contains 2,723 ASL signs. For each sign, ASL-LEX now includes a more detailed phonological description, phonological density and complexity measures, frequency ratings (from deaf signers), iconicity ratings (from hearing non-signers and deaf signers), transparency (“guessability”) ratings (from non-signers), sign and videoclip durations, lexical class, and more. We document the steps used to create ASL-LEX 2.0 and describe the distributional characteristics for sign properties across the lexicon and examine the relationships among lexical and phonological properties of signs. Correlation analyses revealed that frequent signs were less iconic and phonologically simpler than infrequent signs and iconic signs tended to be phonologically simpler than less iconic signs. The complete ASL-LEX dataset and supplementary materials are available at https://osf.io/zpha4/ and an interactive visualization of the entire lexicon can be accessed on the ASL-LEX page: http://asl-lex.org/

Behavioral Approaches for Infant Pain Relief

Infants experience a host of painful medical procedures including heel sticks, venipuncture, and immunizations. Historically, little attention was given to infant pain management due to misconceived myths and beliefs about the experience and long-term effects of pain in infants. Recent data suggest that there are both short- and long-term negative repercussions associated with unmanaged infant pain. In response, a number of non-pharmacological approaches have been developed to provide infants with pain relief associated with medical events. This paper will review these behavioral approaches including positioning, parent training, distraction, sucrose, and skin-to-skin contact. Recommendations for best practices will be provided and future direction for infant pain management will be outlined

Are binge drinking disparities by sexual identity lower in U.S. states with nondiscrimination statutes that include sexual orientation?

Purpose Studies examining binge drinking disparities by sexual identity focus on intra- and inter-personal minority stressors experienced by lesbian, gay, and bisexual (LGB) populations. State-level statutes are powerful tools that can reduce health disparities. We examined how state-level nondiscrimination statutes that include sexual orientation as a protected ground (i.e., inclusive statutes) are associated with binge drinking disparities between LGB and straight adults. Methods We combined data from the 2015-2018 Behavioral Risk Factor Surveillance System (BRFSS), the Movement Advancement Project (MAP), and administrative data sources for information on binge drinking, sexual identity, nondiscrimination statutes, and individual and state-level factors. We included an interaction term in the logistic regression models to test whether inclusive nondiscrimination statutes modify the association between sexual identity and binge drinking. Results Inclusive statutes modified the association between sexual identity and binge drinking among women, but not men. In states without inclusive statutes, the odds of binge drinking among lesbian [1.71 (95%CI: 1.27–2.31)] and bisexual [1.83 (95% CI: 1.54–2.17)] women were significantly higher compared with straight women. In states with inclusive statutes, the odds of binge drinking comparing lesbian and straight women were not significantly different [1.19 (95% CI: 0.92–1.53)]. The odds ratio for binge drinking comparing bisexual and straight women was 26.8% lower in states with [1.34 (95% CI: 1.13–1.60)] versus states without inclusive statutes. Conclusions The enactment of nondiscrimination statutes inclusive of sexual orientation at the state-level are associated with narrower binge drinking disparities between lesbian, bisexual, and straight women

Psychological Approaches to Acute Pediatric Pain Management

Children endure numerous acute painful events, most of which occur within the medical arena. For instance, by the time a child reaches the age of 6, the child will have experienced approximately 30 immunization injections (Centers for Disease Control and Prevention, 2008). Grounded in the Gate Control Theory (Melzack & Wall, 1965), psychological methods of pain management have focused on anxiety and pain management via behavioral means. In addition, ample research has been devoted to how best to prepare children and their parents for upcoming painful or distress-provoking procedures (e.g., surgery, hospitalization, injection). This paper will review the preparation literature, which details how to inform and arm children and their parents for impending procedures and will highlight the psychological pain management literature which includes distraction, cognitive behavioral therapy, and additional promising interventions

Non-paretic Forelimb Training Does Not Interfere with Recovery of Paretic Forelimb Strength After Experimental Middle Cerebral Artery Occlusion

Humans often compensate with their unimpaired (non-paretic) forelimb after surviving a stroke. Research in rats suggests that this can be maladaptive after focal motor cortical strokes. Forelimb weakness is understudied in rodent models of stroke. The purpose of the study is to determine whether behavioral experience with the non-paretic forelimb differentially affects paretic forelimb strength recovery after ischemic injury caused by middle cerebral artery occlusion (MCAo). Because behavioral manipulations can influence patterns of neural connectivity post-stroke, the present study also examined how training with non-paretic limb influenced corticostriatal projections. After training to proficiency with the preferred forelimb on the Isometric Pull Task, rats underwent MCAo in the hemisphere contralateral to this limb. One week after MCAo, rats were probed for initial impairment level and then assigned to either Non-Paretic Limb Training (NPT) or non-training control conditions for 14 days. Paretic limb performance was probed one day later. All rats then received six weeks of Rehabilitative Training (RT). The anterograde tract tracer BDA was then injected into the lesioned hemisphere. Training with the non-paretic limb (NPT) does not interfere with paretic limb recovery on the Isometric Pull Task, increase reliance on the impaired forelimb, or influence ipsi corticostriatal axon quantities after MCAo. Compensatory use of the non-paretic forelimb after strokes involving subcortical damage or cortical damage primarily in the somatosensory region may not be maladaptive for strength. Understanding how behavioral recovery varies with lesion locus could influence clinical management of patients

Mental, behavioral and neurodevelopmental disorders in the ICD-11 : An international perspective on key changes and controversies

The Author(s). 2020Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, andreproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link tothe Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.An update of the chapter on Mental, Behavioral and Neurodevelopmental Disorders in the International Classification of Diseases and Related Health Problems (ICD) is of great interest around the world. The recent approval of the 11th Revision of the ICD (ICD-11) by the World Health Organization (WHO) raises broad questions about the status of nosology of mental disorders as a whole as well as more focused questions regarding changes to the diagnostic guidelines for specific conditions and the implications of these changes for practice and research. This Forum brings together a broad range of experts to reflect on key changes and controversies in the ICD-11 classification of mental disorders. Taken together, there is consensus that the WHO's focus on global applicability and clinical utility in developing the diagnostic guidelines for this chapter will maximize the likelihood that it will be adopted by mental health professionals and administrators. This focus is also expected to enhance the application of the guidelines in non-specialist settings and their usefulness for scaling up evidence-based interventions. The new mental disorders classification in ICD-11 and its accompanying diagnostic guidelines therefore represent an important, albeit iterative, advance for the field.Peer reviewedFinal Published versio

Remote home monitoring (virtual wards) for confirmed or suspected COVID-19 patients:a rapid systematic review

Background: the aim of this review was to analyze the implementation and impact of remote home monitoring models (virtual wards) for confirmed or suspected COVID-19 patients, identifying their main components, processes of implementation, target patient populations, impact on outcomes, costs and lessons learnt. Methods: we carried out a rapid systematic review on models led by primary and secondary care across seven countries (US, Australia, Canada, The Netherlands, Ireland, China, UK). The main outcomes included in the review were: impact of remote home monitoring on virtual length of stay, escalation, emergency department attendance/reattendance, admission/readmission and mortality. The search was updated on February 2021. We used the PRISMA statement and the review was registered on PROSPERO (CRD: 42020202888). Findings: the review included 27 articles. The aim of the models was to maintain patients safe in the appropriate setting. Most models were led by secondary care and confirmation of COVID-19 was not required (in most cases). Monitoring was carried via online platforms, paper-based systems with telephone calls or (less frequently) through wearable sensors. Models based on phone calls were considered more inclusive. Patient/career training was identified as a determining factor of success. We could not reach substantive conclusions regarding patient safety and the identification of early deterioration due to lack of standardized reporting and missing data. Economic analysis was not reported for most of the models and did not go beyond reporting resources used and the amount spent per patient monitored. Interpretation: future research should focus on staff and patient experiences of care and inequalities in patients' access to care. Attention needs to be paid to the cost-effectiveness of the models and their sustainability, evaluation of their impact on patient outcomes by using comparators, and the use of risk-stratification tools