Trial by Numbers

This is the final version of the article. Freely available from the publisher via the link in this record.Legal cases often require jurors to use numerical information. They may need to evaluate the meaning of specific numbers, such as the probability of match between a suspect and a DNA sample, or they may need to arrive at a sound numerical judgment, such as a money damage award. Thus, it is important to know how jurors understand numerical information, and what steps can be taken to increase juror comprehension and appropriate application of numerical evidence. In this Article, we examine two types of juror decisions involving numbers––decisions in which jurors must convert numbers into meaning (such as by understanding numerical evidence in order to determine guilt or liability), and decisions in which jurors must convert meaning into numbers (such as by understanding qualitative evidence and converting this into a numerical damage award amount). In each of these areas we analyze legal cases and research to examine areas in which dealing with numbers leads to sound or sub-optimal decision making in jurors. We then examine psychological theory and research on numerical decision making to understand how informed, fair, and consistent juror decision making about numbers can be promoted. We conclude that what is often most important is juror understanding of the meaning of numbers in context rather than technically precise numerical ability, supporting the role of the lay jury. We also suggest how to improve juror understanding, so that jury decisions better reflect considered community judgment.Preparation of this Article was supported in part by the Martha E. Foulk Fellowship awarded to Rebecca K. Helm, by National Science Foundation award SES-1536238: “Quantitative Judgments in Law: Studies of Damage Award Decision Making” to Valerie P. Hans and Valerie F. Reyna, by a grant from Cornell University’s Institute for Social Sciences to Valerie P. Hans and Valerie F. Reyna, and by National Institute of Health (National Institute of Nursing Research) award RO1NR014368-01 to Valerie F. Reyna

From Meaning to Money: Translating Injury Into Dollars

This is the author accepted manuscript. The final version is available from the American Psychological Association via the DOI in this record.Legal systems often require the translation of qualitative assessments into quantitative judgments, yet the qualitative-to-quantitative conversion is a challenging, understudied process. We conducted an experimental test of predictions from a new theory of juror damage award decision making, examining how 154 lay people engaged in the translation process in recommending money damages for pain and suffering in a personal injury tort case. The experiment varied the presence, size, and meaningfulness of an anchor number to determine how these factors influenced monetary award judgments, perceived difficulty, and subjective meaningfulness of awards. As predicted, variability in awards was high, with awards participants considered to be “medium” (rather than “low” or “high”) having the most dispersion. The gist of awards as low, medium, or high fully mediated the relationship between perceived pain/suffering and award amount. Moreover, controlling for participants’ perceptions of plaintiffs and defendants, as well as their desire to punish and to take economic losses into account, meaningful anchors predicted unique variance in award judgments: A meaningful large anchor number drove awards up and a meaningful small anchor drove them down, whereas meaningless large and small anchors did not differ significantly. Numeracy did not predict award magnitudes or variability, but surprisingly, more numerate participants reported that it was more difficult to pick an exact figure to compensate the plaintiff for pain and suffering. The results support predictions of the theory about qualitative gist and meaningful anchors, and suggest that we can assist jurors to arrive at damage awards by providing meaningful numbers.Preparation of this article was funded by National Science Foundation grant SES1536238: “Quantitative Judgments in Law: Studies of Damage Award Decision Making” to Valerie P. Hans and Valerie F. Reyna

Guiding Jurors’ Damage Award Decisions: Experimental Investigations of Approaches Based on Theory and Practice

This is the author accepted manuscript. The final version is available from the American Psychological Association via the DOI in this recordTheory and practitioner “scaling” advice informed hypotheses that guidance to mock jurors should (a) increase validity (vertical equity), decrease variability (reliability), and improve coherence in awards; (b) improve subjective experience of jurors’ decision-making (rated helpfulness, confidence, and difficulty); and (c) have the greatest impact when it includes both verbal and numerical benchmarks. Three mock juror experiments (N = 197 students, N = 476 Amazon Mechanical Turk workers, and N = 391 students) tested novel scaling approaches and predictions from the Hans-Reyna model of damage award decision-making. Jurors reviewed a legal case and provided a dollar award to compensate plaintiffs for pain and suffering following concussions. Experiments varied injury severity (low vs. high) and the plaintiff attorney’s guidance (no guidance, verbal guidance, numerical guidance, and verbal-plus-numerical guidance) between subjects. Results support predictions that, even without guidance, mock jurors appropriately categorize the gist of injuries as low or high severity, and dollar awards reflect that gist. Participants gave a higher award for more severe injuries, indicating that they extracted the qualitative gist of damages. Also, as expected, guidance, particularly verbal-plus-numerical guidance, had beneficial effects on jurors’ subjective experience, with participants reporting that it was a helpful aid in decision-making. Numerical guidance, both with and without verbal guidance, reduced award variability in severe injury cases in all three experiments. Scaling guidance did not improve the already strong gist-verbatim correspondence or award validity. Both grasping the gist of damages and mapping that gist onto numbers are important, but jurors appear to benefit from assistance with numerical mapping

The selective phosphodiesterase 4 inhibitor roflumilast and phosphodiesterase 3/4 inhibitor pumafentrine reduce clinical score and TNF expression in experimental colitis in mice.

The specific inhibition of phosphodiesterase (PDE)4 and dual inhibition of PDE3 and PDE4 has been shown to decrease inflammation by suppression of pro-inflammatory cytokine synthesis. We examined the effect of roflumilast, a selective PDE4 inhibitor marketed for severe COPD, and the investigational compound pumafentrine, a dual PDE3/PDE4 inhibitor, in the preventive dextran sodium sulfate (DSS)-induced colitis model. The clinical score, colon length, histologic score and colon cytokine production from mice with DSS-induced colitis (3.5% DSS in drinking water for 11 days) receiving either roflumilast (1 or 5 mg/kg body weight/d p.o.) or pumafentrine (1.5 or 5 mg/kg/d p.o.) were determined and compared to vehicle treated control mice. In the pumafentrine-treated animals, splenocytes were analyzed for interferon-γ (IFNγ) production and CD69 expression. Roflumilast treatment resulted in dose-dependent improvements of clinical score (weight loss, stool consistency and bleeding), colon length, and local tumor necrosis factor-α (TNFα) production in the colonic tissue. These findings, however, were not associated with an improvement of the histologic score. Administration of pumafentrine at 5 mg/kg/d alleviated the clinical score, the colon length shortening, and local TNFα production. In vitro stimulated splenocytes after in vivo treatment with pumafentrine showed a significantly lower state of activation and production of IFNγ compared to no treatment in vivo. These series of experiments document the ameliorating effect of roflumilast and pumafentrine on the clinical score and TNF expression of experimental colitis in mice

Archetype-based conversion of EHR content models: pilot experience with a regional EHR system

<p>Abstract</p> <p>Background</p> <p>Exchange of Electronic Health Record (EHR) data between systems from different suppliers is a major challenge. EHR communication based on archetype methodology has been developed by openEHR and CEN/ISO. The experience of using archetypes in deployed EHR systems is quite limited today. Currently deployed EHR systems with large user bases have their own proprietary way of representing clinical content using various models. This study was designed to investigate the feasibility of representing EHR content models from a regional EHR system as openEHR archetypes and inversely to convert archetypes to the proprietary format.</p> <p>Methods</p> <p>The openEHR EHR Reference Model (RM) and Archetype Model (AM) specifications were used. The template model of the Cambio COSMIC, a regional EHR product from Sweden, was analyzed and compared to the openEHR RM and AM. This study was focused on the convertibility of the EHR semantic models. A semantic mapping between the openEHR RM/AM and the COSMIC template model was produced and used as the basis for developing prototype software that performs automated bi-directional conversion between openEHR archetypes and COSMIC templates.</p> <p>Results</p> <p>Automated bi-directional conversion between openEHR archetype format and COSMIC template format has been achieved. Several archetypes from the openEHR Clinical Knowledge Repository have been imported into COSMIC, preserving most of the structural and terminology related constraints. COSMIC templates from a large regional installation were successfully converted into the openEHR archetype format. The conversion from the COSMIC templates into archetype format preserves nearly all structural and semantic definitions of the original content models. A strategy of gradually adding archetype support to legacy EHR systems was formulated in order to allow sharing of clinical content models defined using different formats.</p> <p>Conclusion</p> <p>The openEHR RM and AM are expressive enough to represent the existing clinical content models from the template based EHR system tested and legacy content models can automatically be converted to archetype format for sharing of knowledge. With some limitations, internationally available archetypes could be converted to the legacy EHR models. Archetype support can be added to legacy EHR systems in an incremental way allowing a migration path to interoperability based on standards.</p

Dual mobility cup reduces dislocation rate after arthroplasty for femoral neck fracture

<p>Abstract</p> <p>Background</p> <p>Hip dislocation after arthroplasty for femoral neck fractures remains a serious complication. The aim of our study was to investigate the dislocation rate in acute femoral neck fracture patients operated with a posterior approach with cemented conventional or dual articulation acetabular components.</p> <p>Methods</p> <p>We compared the dislocation rate in 56 consecutive patients operated with conventional (single mobility) cemented acetabular components to that in 42 consecutive patients operated with dual articulation acetabular components. All the patients were operated via posterior approach and were followed up to one year postoperatively.</p> <p>Results</p> <p>There were 8 dislocations in the 56 patients having conventional components as compared to no dislocations in those 42 having dual articulation components (p = 0.01). The groups were similar with respect to age and gender distribution.</p> <p>Conclusions</p> <p>We conclude that the use of a cemented dual articulation acetabular component significantly reduces the dislocation rates in femoral neck fracture patients operated via posterior approach.</p

ENIGMA and global neuroscience: A decade of large-scale studies of the brain in health and disease across more than 40 countries.

This review summarizes the last decade of work by the ENIGMA (Enhancing NeuroImaging Genetics through Meta Analysis) Consortium, a global alliance of over 1400 scientists across 43 countries, studying the human brain in health and disease. Building on large-scale genetic studies that discovered the first robustly replicated genetic loci associated with brain metrics, ENIGMA has diversified into over 50 working groups (WGs), pooling worldwide data and expertise to answer fundamental questions in neuroscience, psychiatry, neurology, and genetics. Most ENIGMA WGs focus on specific psychiatric and neurological conditions, other WGs study normal variation due to sex and gender differences, or development and aging; still other WGs develop methodological pipelines and tools to facilitate harmonized analyses of "big data" (i.e., genetic and epigenetic data, multimodal MRI, and electroencephalography data). These international efforts have yielded the largest neuroimaging studies to date in schizophrenia, bipolar disorder, major depressive disorder, post-traumatic stress disorder, substance use disorders, obsessive-compulsive disorder, attention-deficit/hyperactivity disorder, autism spectrum disorders, epilepsy, and 22q11.2 deletion syndrome. More recent ENIGMA WGs have formed to study anxiety disorders, suicidal thoughts and behavior, sleep and insomnia, eating disorders, irritability, brain injury, antisocial personality and conduct disorder, and dissociative identity disorder. Here, we summarize the first decade of ENIGMA's activities and ongoing projects, and describe the successes and challenges encountered along the way. We highlight the advantages of collaborative large-scale coordinated data analyses for testing reproducibility and robustness of findings, offering the opportunity to identify brain systems involved in clinical syndromes across diverse samples and associated genetic, environmental, demographic, cognitive, and psychosocial factors

Co-infection of Influenza B and Streptococci causing severe pneumonia and septic shock in healthy women

<p>Abstract</p> <p>Background</p> <p>Since the Influenza A pandemic in 1819, the association between the influenza virus and <it>Streptococcus pneumoniae </it>has been well described in literature. While a leading role has been so far attributed solely to Influenza A as the primary infective pathogen, Influenza B is generally considered to be less pathogenic with little impact on morbidity and mortality of otherwise healthy adults. This report documents the severe synergistic pathogenesis of Influenza B infection and bacterial pneumonia in previously healthy persons not belonging to a special risk population and outlines therapeutic options in this clinical setting.</p> <p>Case Presentation</p> <p>During the seasonal influenza epidemic 2007/2008, three previously healthy women presented to our hospital with influenza-like symptoms and rapid clinical deterioration. Subsequent septic shock due to severe bilateral pneumonia necessitated intensive resuscitative measures including the use of an interventional lung assist device. Microbiological analysis identified severe dual infections of Influenza B with <it>Streptococcus pyogenes </it>in two cases and <it>Streptococcus pneumoniae </it>in one case. The patients presented with no evidence of underlying disease or other known risk factors for dual infection such as age (< one year, > 65 years), pregnancy or comorbidity.</p> <p>Conclusions</p> <p>Influenza B infection can pose a risk for severe secondary infection in previously healthy persons. As patients admitted to hospital due to severe pneumonia are rarely tested for Influenza B, the incidence of admission due to this virus might be greatly underestimated, therefore, a more aggressive search for influenza virus and empirical treatment might be warranted. While the use of an interventional lung assist device offers a potential treatment strategy for refractory respiratory acidosis in addition to protective lung ventilation, the combined empiric use of a neuraminidase-inhibitor and antibiotics in septic patients with pulmonary manifestations during an epidemic season should be considered.</p