A modified rule of three for the one-sided binomial confidence interval.

Consider the one-sided binomial confidence interval L , 1 containing the unknown parameter p when all n trials are successful, and the significance level α to be five or one percent. We develop two functions (one for each level) that represent approximations within α / 3 of the exact lower-bound L = α 1/n . Both the exponential (referred to as a modified rule of three) and the logarithmic function are shown to outperform the standard rule of three L ≃ 1 - 3/n over each of their respective ranges, that together encompass all sample sizes n ≥ 1. Specifically for the exponential, we find that exp - 3 / n is a better lower bound when α = 0.05 and n < 1054 and that exp - 4.6569 / n is a better bound when α = 0.01 and n < 209.

Improving Access to Tertiary Movement Disorders Subspecialty Care: A Team Model Born From the COVID-19 Crisis.

Patient demand continues to outpace growth of the neurology workforce, especially in its subspecialties such as movement disorders. Various strategies have been deployed to address this. The coronavirus disease 2019 pandemic accentuated the mismatch by propelling telemedicine and access demands to the forefront. Previously, we reported improving general neurology access using a physician-advanced practice provider team model. Here, we share our experiences of piloting a similar model in subspecialty care (movement disorders) between September 1 and December 17, 2020. Before the pilot, the wait time to be seen by movement disorders subspecialists exceeded 4 months. Our data show marked improvement in new patient access (23.8% improvement and 214% increase in the number of new patients seen) with excellent patient acceptance. Our approach and the lessons learned may be useful to address access for other neurology subspecialties.

Prelude to passion: limbic activation by "unseen" drug and sexual cues.

BACKGROUND: The human brain responds to recognizable signals for sex and for rewarding drugs of abuse by activation of limbic reward circuitry. Does the brain respond in similar way to such reward signals even when they are "unseen", i.e., presented in a way that prevents their conscious recognition? Can the brain response to "unseen" reward cues predict the future affective response to recognizable versions of such cues, revealing a link between affective/motivational processes inside and outside awareness? METHODOLOGY/PRINCIPAL FINDINGS: We exploited the fast temporal resolution of event-related functional magnetic resonance imaging (fMRI) to test the brain response to "unseen" (backward-masked) cocaine, sexual, aversive and neutral cues of 33 milliseconds duration in male cocaine patients (n = 22). Two days after scanning, the affective valence for visible versions of each cue type was determined using an affective bias (priming) task. We demonstrate, for the first time, limbic brain activation by "unseen" drug and sexual cues of only 33 msec duration. Importantly, increased activity in an large interconnected ventral pallidum/amygdala cluster to the "unseen" cocaine cues strongly predicted future positive affect to visible versions of the same cues in subsequent off-magnet testing, pointing both to the functional significance of the rapid brain response, and to shared brain substrates for appetitive motivation within and outside awareness. CONCLUSIONS/SIGNIFICANCE: These findings represent the first evidence that brain reward circuitry responds to drug and sexual cues presented outside awareness. The results underscore the sensitivity of the brain to "unseen" reward signals and may represent the brain's primordial signature for desire. The limbic brain response to reward cues outside awareness may represent a potential vulnerability in disorders (e.g., the addictions) for whom poorly-controlled appetitive motivation is a central feature.