Eliciting Beliefs about COVID-19 Prevalence and Mortality: Epidemiological Models Compared with The Street.

Subjective belief elicitation about uncertain events has a long lineage in the economics and statistics literatures. Recent developments in the experimental elicitation and statistical estimation of subjective belief distributions allow inferences about whether these beliefs are biased relative to expert opinion, and the confidence with which they are held. Beliefs about COVID-19 prevalence and mortality interact with risk management efforts, so it is important to understand relationships between these beliefs and publicly disseminated statistics, particularly those based on evolving epidemiological models. The pandemic provides a unique setting over which to bracket the range of possible COVID-19 prevalence and mortality outcomes given the proliferation of estimates from epidemiological models. We rely on the epidemiological model produced by the Institute for Health Metrics and Evaluation together with the set of epidemiological models summarised by FiveThirtyEight to bound prevalence and mortality outcomes for one-month, and December 1, 2020 time horizons. We develop a new method to partition these bounds into intervals, and ask subjects to place bets on these intervals, thereby revealing their beliefs. The intervals are constructed such that if beliefs are consistent with epidemiological models, subjects are best off betting the same amount on every interval. We use an incentivised experiment to elicit beliefs about COVID-19 prevalence and mortality from 598 students at Georgia State University, using six temporally-spaced waves between May and November 2020. We find that beliefs differ markedly from epidemiological models, which has implications for public health communication about the risks posed by the virus.

Successful Treatment of Postdural Puncture Headache Using Epidural Fibrin Glue Patch after Persistent Failure of Epidural Blood Patches.

OBJECTIVES: Epidural blood patch is the gold standard for the treatment of postdural puncture headache (PDPH) when conservative treatments have failed to provide any relief. However, alternative therapies are lacking when epidural blood patch persistently fails to improve symptoms. Failure to treat PDPH may lead to significant functional impairment of daily living. Alternative therapies should be sought to accelerate recovery from PDPH. CASE REPORT: This case describes a woman who developed PDPH secondary to accidental dural puncture during a spinal cord stimulator trial. She was successfully treated with epidural fibrin glue patch after multiple trials of epidural blood patches. CONCLUSION: Percutaneous injection of fibrin glue to seal the dural defect demonstrated promising outcomes for both immediate and long-lasting resolution of persistent PDPH in our patient. In the event of epidural blood patch failure, epidural fibrin glue patch may be a reasonable alternative for the treatment of persistent PDPH.

Modeling the dynamics of evaluation: a multilevel neural network implementation of the iterative reprocessing model.

We present a neural network implementation of central components of the iterative reprocessing (IR) model. The IR model argues that the evaluation of social stimuli (attitudes, stereotypes) is the result of the IR of stimuli in a hierarchy of neural systems: The evaluation of social stimuli develops and changes over processing. The network has a multilevel, bidirectional feedback evaluation system that integrates initial perceptual processing and later developing semantic processing. The network processes stimuli (e.g., an individual's appearance) over repeated iterations, with increasingly higher levels of semantic processing over time. As a result, the network's evaluations of stimuli evolve. We discuss the implications of the network for a number of different issues involved in attitudes and social evaluation. The success of the network supports the IR model framework and provides new insights into attitude theory.

Classification Performance and Feature Space Characteristics in Individuals With Upper Limb Loss Using Sonomyography.

Objective: Sonomyography, or ultrasound-based sensing of muscle deformation, is an emerging modality for upper limb prosthesis control. Although prior studies have shown that individuals with upper limb loss can achieve successful motion classification with sonomyography, it is important to better understand the time-course over which proficiency develops. In this study, we characterized user performance during their initial and subsequent exposures to sonomyography. Method: Ultrasound images corresponding to a series of hand gestures were collected from individuals with transradial limb loss under three scenarios: during their initial exposure to sonomyography (Experiment 1), during a subsequent exposure to sonomyography where they were provided biofeedback as part of a training protocol (Experiment 2), and during testing sessions held on different days (Experiment 3). User performance was characterized by offline classification accuracy, as well as metrics describing the consistency and separability of the sonomyography signal patterns in feature space. Results: Classification accuracy was high during initial exposure to sonomyography (96.2 ± 5.9%) and did not systematically change with the provision of biofeedback or on different days. Despite this stable classification performance, some of the feature space metrics changed. Conclusions: User performance was strong upon their initial exposure to sonomyography and did not improve with subsequent exposure. Clinical Impact: Prosthetists may be able to quickly assess if a patient will be successful with sonomyography without submitting them to an extensive training protocol, leading to earlier socket fabrication and delivery.

Subjective beliefs and economic preferences during the COVID-19 pandemic.

The COVID-19 pandemic presents a remarkable opportunity to put to work all of the research that has been undertaken in past decades on the elicitation and structural estimation of subjective belief distributions as well as preferences over atemporal risk, patience, and intertemporal risk. As contributors to elements of that research in laboratories and the field, we drew together those methods and applied them to an online, incentivized experiment in the United States. We have two major findings. First, the atemporal risk premium during the COVID-19 pandemic appeared to change significantly compared to before the pandemic, consistent with theoretical results of the effect of increased background risk on foreground risk attitudes. Second, subjective beliefs about the cumulative level of deaths evolved dramatically over the period between May and November 2020, a volatile one in terms of the background evolution of the pandemic. Supplementary Information: The online version contains supplementary material available at 10.1007/s10683-021-09738-3.

Successful Treatment of Central Pain and Spasticity in Patient With Multiple Sclerosis With Dorsal Column, Paresthesia-Free Spinal Cord Stimulator: A Case Report.

Non-paresthesia-free spinal cord stimulation (PF-SCS) has been successfully used in treating central pain syndromes in multiple sclerosis (MS) patients. However, the efficacy of PF-SCS in MS is unknown. Here, we present the case of an MS patient (13-year history) with late-stage disease. Her concomitant central pain and spasticity failed multiple attempts of medical management despite escalating multimodal pharmacological regimens. A trial and subsequent permanent placement of dorsal column spinal cord stimulator with paresthesia-free programming was successful in managing her central pain, illustrating a potential role of PF-SCS in treating patients with MS.

Academic faculty demonstrate higher well-being than residents: Pennsylvania anesthesiology programs' results of the 2017-2018 ACGME well-being survey.

STUDY OBJECTIVE: Physician burnout and suicide are at epidemic proportions. There is very little data directly comparing resident versus faculty well-being. The 2017-2018 ACGME resident and faculty surveys mark the first time that well-being questions were included. The purpose of this study was to determine whether responses to ACGME well-being questions would differ significantly between anesthesiology residents and academic anesthesiology faculty. DESIGN: 2017-2018 ACGME well-being survey responses. SETTING: All eight Pennsylvania anesthesiology residency programs. PATIENTS: None. INTERVENTIONS: None. MEASUREMENTS: The authors compared the 5-point Likert scale responses (1 = Never through 5 = Very Often) between residents (371/384 responses, 97%) and faculty (277/297 responses, 93%) for each of the twelve well-being questions. Responses were also dichotomized as being ≥4 versus <4 for categorical comparisons. MAIN RESULTS: Faculty responded higher than residents both by mean scores and percent of scores ≥ 4 for 6/12 questions (questions 1 (p < 0.001), 2 (p < 0.001), 4 (p < 0.001), 5 (p < 0.001), 8 (p < 0.001), and 11 (p = 0.001)). Residents responded categorically higher for question 9 (p = 0.022) although this was not considered statistically significant. Residents responded lowest for "Reflected on how your work helps make the world a better place" (question 1), whereas the lowest faculty responses were for questions 1, 9, and 10. Both had high responses for "Had an enjoyable interaction with a patient" (question 11). CONCLUSIONS: Pennsylvania academic anesthesiology faculty survey responses demonstrated a higher level of well-being compared to their residents. The variation in scoring suggests that anesthesiology residents and faculty have differing perceptions of various well-being domains. Information from well-being surveys can help provide programs with focus areas that they can intervene on to improve physician well-being.

A general connectionist model of attitude structure and change: the ACS (Attitudes as Constraint Satisfaction) model.

A localist, parallel constraint satisfaction, artificial neural network model is presented that accounts for a broad collection of attitude and attitude-change phenomena. The network represents the attitude object and cognitions and beliefs related to the attitude, as well as how to integrate a persuasive message into this network. Short-term effects are modeled by activation patterns due to parallel constraint satisfaction processes, and long-term effects are modeled by weight changes due to the settling patterns of activation. Phenomena modeled include thought-induced attitude polarization, elaboration and attitude strength, motivated reasoning and social influence, an integrated view of heuristic versus systematic persuasion, and implicit versus explicit attitude change. Results of the simulations are consistent with empirical results. The same set of simple mechanisms is used to model all the phenomena, which allows the model to offer a parsimonious theoretical account of how structure can impact attitude change. This model is compared with previous computational approaches to attitudes, and implications for attitude research are discussed.

Trans-radial upper extremity amputees are capable of adapting to a novel dynamic environment.

This study investigated differences in adaptation to a novel dynamic environment between eight trans-radial upper extremity (UE) prosthetic users and eight naive, neurologically intact subjects. Participants held onto the handle of a robotic manipulandum and executed reaching movements within a horizontal plane following a pseudo-random sequence of targets. Curl field perturbations were imposed by the robot motors, and we compared the rate and quality of adaptation between the prosthetic and control subjects. Adaptation was quantitatively assessed by peak error, defined as the maximum orthogonal distance between an observed trajectory and an ideal straight trajectory. Initial exposure to the curl field resulted in large errors, and as the subjects adapted to the novel environment, the errors decreased. During the early phase of adaptation, group differences in the rate of motor adaptation were not significant. However, during late learning, both error magnitude and variability were larger in the prosthetic group. The quality of adaptation, as indicated by the magnitude of the aftereffects, was similar between groups. We conclude that in persons with trans-radial arm amputation, motor adaptation to curl fields during reaching is similar to unimpaired individuals. These findings are discussed in relation to mechanisms of motor adaptation, neural plasticity following an upper extremity amputation (UEA), and potential motor recovery therapies for prosthetic users.

Effect of training on upper-extremity prosthetic performance and motor learning: a single-case study.

OBJECTIVES: To examine the impact of a new prosthesis on an experienced and highly motivated prosthetic limb user, to evaluate the effects of training and the ability of clinical measures to detect change, and to gain insight into the mechanisms by which improvement occurs. DESIGN: A single-case study. SETTING: An outpatient clinic. PARTICIPANT: A bilateral high-arm amputee (right shoulder disarticulation, left above elbow). INTERVENTIONS: Provision of new prosthesis and occupational therapy. MAIN OUTCOME MEASURES: Action Research Arm Test, box and block test of manual dexterity, Jebsen-Taylor Hand Function Test, and speed and accuracy of reaching movements with and without visual guidance. RESULTS: In this experienced prosthesis user, provision of a new prosthesis led to an immediate worsening in functional limitation. With training, the subject recovered his baseline status and then exceeded it in both proximal and distal function. All study clinical measures detected change, but the change detected varied as much as 300-fold depending on the measure chosen. The clinical improvements were associated with modest improvements in the speed of reaching but not the accuracy of reaching under visual guidance. Improvements in reaching accuracy without visual guidance were seen after 10 trials, suggesting that some motor learning had occurred. CONCLUSIONS: Provision of a new prosthesis can cause functional decline even in an experienced user; this decline can be reversed with training. There is wide variability in sensitivity to change among functional limitation measures. Although some training-related improvements may have been due to increased speed and accuracy of reaching without visual guidance, skill in prosthesis use also plays a role.

Re-examining dominance of categories in impression formation: A test of dual-process models.

We carried out tests of the first 2 premises of the Continuum Model (CM) of impression formation (Fiske & Neuberg, 1990). These premises predict that category information will in general be more influential than noncategory information, and that the fit of noncategorical attributes with the category is a major determinant of the relative influence of these types of information. Using stimuli that included sets of (a) text items only, and (b) combinations of photos and text items, we found no support for these claims, even using alternative tests. In addition, many positive effects found in our analyses run counter to the predictions of the CM. We conclude that either significant portions of dual-process models (also, Brewer, 1988) are not applicable to many previously claimed scenarios of impression formation, or that although pieces of them may be roughly accurate, reasonable questions arise as to their predictive and discriminant validity. (PsycINFO Database Record

Lumbar Epidural Blood Patch via a Caudal Catheter After Surgical Dural Tear and Failed Repair: A Case Report.

We report a patient who developed a positional headache and pseudomeningocele after multiple lumbar surgeries for low back and radicular pain. An epidural blood patch via a lumbar approach was not feasible as a result of distorted lumbar anatomy after multiple back surgeries. An epidural blood patch was performed via catheter-threaded cephalad from a caudal approach. The patient had immediate relief after the procedure and at 1 year was still symptom-free. This combination technique may be considered as an alternative approach when a percutaneous lumbar epidural blood patch is disadvantageous.

A neural network model of the structure and dynamics of human personality.

We present a neural network model that aims to bridge the historical gap between dynamic and structural approaches to personality. The model integrates work on the structure of the trait lexicon, the neurobiology of personality, temperament, goal-based models of personality, and an evolutionary analysis of motives. It is organized in terms of two overarching motivational systems, an approach and an avoidance system, as well as a general disinhibition and constraint system. Each overarching motivational system influences more specific motives. Traits are modeled in terms of differences in the sensitivities of the motivational systems, the baseline activation of specific motives, and inhibitory strength. The result is a motive-based neural network model of personality based on research about the structure and neurobiology of human personality. The model provides an account of personality dynamics and person-situation interactions and suggests how dynamic processing approaches and dispositional, structural approaches can be integrated in a common framework.

Feedforward control strategies of subjects with transradial amputation in planar reaching.

The rate of upper-limb amputations is increasing, and the rejection rate of prosthetic devices remains high. People with upper-limb amputation do not fully incorporate prosthetic devices into their activities of daily living. By understanding the reaching behaviors of prosthesis users, researchers can alter prosthetic devices and develop training protocols to improve the acceptance of prosthetic limbs. By observing the reaching characteristics of the nondisabled arms of people with amputation, we can begin to understand how the brain alters its motor commands after amputation. We asked subjects to perform rapid reaching movements to two targets with and without visual feedback. Subjects performed the tasks with both their prosthetic and nondisabled arms. We calculated endpoint error, trajectory error, and variability and compared them with those of nondisabled control subjects. We found no significant abnormalities in the prosthetic limb. However, we found an abnormal leftward trajectory error (in right arms) in the nondisabled arm of prosthetic users in the vision condition. In the no-vision condition, the nondisabled arm displayed abnormal leftward endpoint errors and abnormally higher endpoint variability. In the vision condition, peak velocity was lower and movement duration was longer in both arms of subjects with amputation. These abnormalities may reflect the cortical reorganization associated with limb loss.