Confidence Is the Bridge between Multi-stage Decisions

Demanding tasks often require a series of decisions to reach a goal. Recent progress in perceptual decision-making has served to unite decision accuracy, speed, and confidence in a common framework of bounded evidence accumulation, furnishing a platform for the study of such multi-stage decisions. In many instances, the strategy applied to each decision, such as the speed-accuracy trade-off, ought to depend on the accuracy of the previous decisions. However, as the accuracy of each decision is often unknown to the decision maker, we hypothesized that subjects may carry forward a level of confidence in previous decisions to affect subsequent decisions. Subjects made two perceptual decisions sequentially and were rewarded only if they made both correctly. The speed and accuracy of individual decisions were explained by noisy evidence accumulation to a terminating bound. We found that subjects adjusted their speed-accuracy setting by elevating the termination bound on the second decision in proportion to their confidence in the first. The findings reveal a novel role for confidence and a degree of flexibility, hitherto unknown, in the brain's ability to rapidly and precisely modify the mechanisms that control the termination of a decision.We thank the Wellcome Trust, the Human Frontier Science Program, the Royal Society (Noreen Murray Professorship in Neurobiology to D.M.W.), Howard Hughes Medical Institute, National Eye Institute grant EY11378 to M.N.S., a Sloan Research Fellowship to R.K., and Simons Collaboration on the Global Brain grant 323439 to R.K

Confidence Is the Bridge between Multi-stage Decisions

Demanding tasks often require a series of decisions to reach a goal. Recent progress in perceptual decision-making has served to unite decision accuracy, speed, and confidence in a common framework of bounded evidence accumulation, furnishing a platform for the study of such multi-stage decisions. In many instances, the strategy applied to each decision, such as the speed-accuracy trade-off, ought to depend on the accuracy of the previous decisions. However, as the accuracy of each decision is often unknown to the decision maker, we hypothesized that subjects may carry forward a level of confidence in previous decisions to affect subsequent decisions. Subjects made two perceptual decisions sequentially and were rewarded only if they made both correctly. The speed and accuracy of individual decisions were explained by noisy evidence accumulation to a terminating bound. We found that subjects adjusted their speed-accuracy setting by elevating the termination bound on the second decision in proportion to their confidence in the first. The findings reveal a novel role for confidence and a degree of flexibility, hitherto unknown, in the brain's ability to rapidly and precisely modify the mechanisms that control the termination of a decision.We thank the Wellcome Trust, the Human Frontier Science Program, the Royal Society (Noreen Murray Professorship in Neurobiology to D.M.W.), Howard Hughes Medical Institute, National Eye Institute grant EY11378 to M.N.S., a Sloan Research Fellowship to R.K., and Simons Collaboration on the Global Brain grant 323439 to R.K

Beta-blockers have no impact on survival in pancreatic ductal adenocarcinoma prior to cancer diagnosis

Previous studies have suggested that β-adrenergic signaling may regulate the growth of various cancers. The aim of our study is to investigate the association between the incidental use of beta-blockers for various conditions on the overall survival of patients with pancreatic ductal adenocarcinoma (PDAC). Patients with histologically-confirmed PDAC between 2007 and 2011 were extracted from Surveillance, Epidemiology, and End Results registry (SEER)-Medicare linked database. Kaplan Meier and multivariable Cox Proportional-Hazard models were used to examine the association between beta-blocker usage before diagnosis and overall survival adjusting for appropriate confounders. As an additional analysis we also examined continuous beta-blocker use before and after diagnosis. From 2007 to 2011, 13,731 patients were diagnosed with PDAC. Of these, 7130 patients had Medicare Part D coverage in the 6-month period before diagnosis, with 2564 (36%) of these patients using beta-blockers in this period. Patients receiving beta-blockers had a mean survival time of 5.1 months compared to 6 months for non-users (p < 0.01). In multivariable analysis, beta-blockers usage was not associated with improved survival (Hazard Ratio (HR) 1.04, 95%, Confidence Interval (CI) 0.98–1.1, p = 0.2). When patients were stratified by conditions with indications for beta-blocker usage, such as hypertension, coronary artery disease and cardiac arrhythmia, differences in survival were insignificant compared to non-users in all groups (p > 0.05). After stratification by receptor selectivity, this lack of association with survival persisted (p > 0.05 for all). As a subgroup analysis, looking at patients with continuous Medicare Part D coverage who used beta-blockers in the 6-month period before and after cancer diagnosis, we identified 7085 patients, of which 1750 (24.7%) had continuous beta blocker use. In multivariable analysis, continuous beta-blockers usage was associated with improved survival (Hazard Ratio (HR) 0.86, 95%, Confidence Interval (CI) 0.8–0.9, p < 0.01). Beta-blocker usage before diagnosis does not confer a survival advantage in patients with PDAC, though continuous use before and after diagnosis did confer a survival advantage. Prospective studies into the mechanism for this advantage are needed

Large Language Models for Granularized Barrett's Esophagus Diagnosis Classification

Diagnostic codes for Barrett's esophagus (BE), a precursor to esophageal cancer, lack granularity and precision for many research or clinical use cases. Laborious manual chart review is required to extract key diagnostic phenotypes from BE pathology reports. We developed a generalizable transformer-based method to automate data extraction. Using pathology reports from Columbia University Irving Medical Center with gastroenterologist-annotated targets, we performed binary dysplasia classification as well as granularized multi-class BE-related diagnosis classification. We utilized two clinically pre-trained large language models, with best model performance comparable to a highly tailored rule-based system developed using the same data. Binary dysplasia extraction achieves 0.964 F1-score, while the multi-class model achieves 0.911 F1-score. Our method is generalizable and faster to implement as compared to a tailored rule-based approach

The dermal skeleton of the jawless vertebrate Tremataspis mammilata (Osteostraci, stem-Gnathostomata)

Osteostracans are the closest jawless relatives of jawed vertebrates, informing the gradual assembly of the vertebrate mineralised skeleton. Conflicting interpretations of their dermal skeletal histology arise from failure to account for topological variation, obscuring their significance in elucidating vertebrate skeletal evolution. To resolve this, we characterize the cranial and trunk dermal skeleton of a single individual of Tremataspis mammilata (Osteostraci, Thyestiida) at submicron resolution using synchrotron tomography. Our results show that the architecture of the Tremataspis dermal skeleton is, for the most part, conserved over the skeleton and is broadly consistent with previous histological hypotheses based on 2-dimensional thin section study. We resolve debate over the homology of the basal layer, identifying it as osteogenic acellular isopedin rather than odontogenic elasmodine or metaplastic ossification of the stratum compactum of the dermis. We find topological variation between all dermal skeletal elements studied, and particularly between the cranial and postcranial dermal skeleton. This variation can be largely explained by reduction in differentiation due to geometric constraints imposed within smaller skeletal elements, such as scales. Our description of the dermal skeleton of Tremataspis mammilata provides a foundation for interpreting data from cursory topological samples of dermal skeletal diversity obtained in other osteostracans. This reveals general aspects of histological structure that must be primitive for osteostracans and, likely, ancestral jawed vertebrates. Finally, we draw the distinction between hypotheses and descriptions in palaeohistology

Immune reconstitution disease associated with parasitic infections following antiretroviral treatment

HIV-associated immune reconstitution disease (IRD) is the clinical presentation or deterioration of opportunistic infections that results from enhancement of pathogen-specific immune responses among patients responding to antiretroviral treatment (ART). The vast majority of reported cases of IRD have been associated with mycobacterial, chronic viral and invasive fungal infections; such cases result from dysregulated augmentation of cell-mediated type 1 cytokine-secreting host immune responses. However, the spectrum of infections now recognized as associated with IRD is expanding and includes a number of parasitic infections, which may be mediated by different immunopathological mechanisms. These include leishmaniasis (visceral, cutaneous, mucosal and post kala azar dermal leishmaniasis), schistosomiasis and strongyloidiasis. Since the major burden of HIV lies in resource-limited countries where access to ART is now rapidly expanding, increased awareness and knowledge of these phenomena is important. Here we review the clinical spectrum and pathogenesis of IRD associated with parasitic infections

Knotty-Centrality: Finding the Connective Core of a Complex Network

A network measure called knotty-centrality is defined that quantifies the extent to which a given subset of a graph’s nodes constitutes a densely intra-connected topologically central connective core. Using this measure, the knotty centre of a network is defined as a sub-graph with maximal knotty-centrality. A heuristic algorithm for finding subsets of a network with high knotty-centrality is presented, and this is applied to previously published brain structural connectivity data for the cat and the human, as well as to a number of other networks. The cognitive implications of possessing a connective core with high knotty-centrality are briefly discussed

A mineralogical study in contrasts: highly mineralized whale rostrum and human enamel

The outermost enamel of the human tooth and the rostrum of the whale Mesoplodon densirostris are two highly mineralized tissues that contain over 95wt.% mineral, i.e., bioapatite. However, the same mineral type (carbonated hydroxylapatite) does not yield the same material properties, as revealed by Raman spectroscopy, scanning electron microscopy, electron microprobe analysis, and synchrotron X-ray diffraction analysis. Overall, the outermost enamel of a tooth has more homogeneous physical and chemical features than the rostrum. Chemical comparison of rostrum and enamel shows bioapatite in the rostrum to be enriched in Na, Mg, CO3, and S, whereas the outermost enamel shows only a slightly enriched Cl concentration. Morphologically, mineral rods (at tens of μm scale), crystallites and prisms (at μm and sub-μm scale), and platelets (at tens of nm scale) all demonstrate less organized texture in the rostrum than in enamel. Such contrasts between two mineralized tissues suggest distinct pathways of biomineralization, e.g., the nature of the equilibrium between mineral and body fluid. This study illustrates the remarkable flexibility of the apatite mineral structure to match its chemical and physical properties to specific biological needs within the same animal or between species.The work was partially funded by NIH grant 1R21AR055184-01A2 and SRF for ROCS, SEM