A collaborative accountable care model in three practices showed promising early results on costs and quality of care.

Cigna's Collaborative Accountable Care initiative provides financial incentives to physician groups and integrated delivery systems to improve the quality and efficiency of care for patients in commercial open-access benefit plans. Registered nurses who serve as care coordinators employed by participating practices are a central feature of the initiative. They use patient-specific reports and practice performance reports provided by Cigna to improve care coordination, identify and close care gaps, and address other opportunities for quality improvement. We report interim quality and cost results for three geographically and structurally diverse provider practices in Arizona, New Hampshire, and Texas. Although not statistically significant, these early results revealed favorable trends in total medical costs and quality of care, suggesting that a shared-savings accountable care model and collaborative support from the payer can enable practices to take meaningful steps toward full accountability for care quality and efficiency.

Joint decoding of visual stimuli by IT neurons' spike counts is not improved by simultaneous recording.

Information about visual stimuli such as objects and faces is represented across populations of neurons of the inferior temporal cortex. Does recording from inferotemporal neurons simultaneously tell you more than recording from them sequentially? Equivalently, are neurons conditionally independent given a stimulus? To evaluate these issues, we recorded from two monkeys during a passive viewing task. Multiple neurons were simultaneously recorded on separate electrodes. From spike counts in 50-ms windows, we computed the mutual information between counts and images for each neuron individually and jointly with other simultaneously recorded neurons. To determine the significance of these values, we shuffled the stimulus labels (to test if there was significant information) or shuffled responses across trials involving the same image (to see if there was synergistic coding). We recorded from 127 pairs of neurons where each neuron individually was visually responsive. Depending on the time window, we found up to approximately 90% of these pairs showed significant information about the visual stimulus. Shuffling across trials failed to show evidence for synergistic coding. In summary, if you were given two of our neuronal responses and asked to guess the stimulus which produced them you could not, in principle, do better with two simultaneously recorded spike counts than with any two spike counts selected randomly from trials of the same type.

Target representation of naturalistic echolocation sequences in single unit responses from the inferior colliculus of big brown bats.

Echolocating big brown bats (Eptesicus fuscus) emit trains of frequency-modulated (FM) biosonar signals whose duration, repetition rate, and sweep structure change systematically during interception of prey. When stimulated with a 2.5-s sequence of 54 FM pulse-echo pairs that mimic sounds received during search, approach, and terminal stages of pursuit, single neurons (N = 116) in the bat's inferior colliculus (IC) register the occurrence of a pulse or echo with an average of < 1 spike/sound. Individual IC neurons typically respond to only a segment of the search or approach stage of pursuit, with fewer neurons persisting to respond in the terminal stage. Composite peristimulus-time-histogram plots of responses assembled across the whole recorded population of IC neurons depict the delay of echoes and, hence, the existence and distance of the simulated biosonar target, entirely as on-response latencies distributed across time. Correlated changes in pulse duration, repetition rate, and pulse or echo amplitude do modulate the strength of responses (probability of the single spike actually occurring for each sound), but registration of the target itself remains confined exclusively to the latencies of single spikes across cells. Modeling of echo processing in FM biosonar should emphasize spike-time algorithms to explain the content of biosonar images.

The emergence of temporal hyperacuity from widely tuned cell populations.

Typically, individual neural cells operate on a millisecond time scale yet behaviorally animals reveal sub-microsecond acuity. Our model resolves this huge discrepancy by using populations of many widely tuned cells to attain sub-microsecond resolution in a temporal discrimination task. An echolocating bat uses its auditory system to locate objects and it demonstrates remarkable temporal precision in psychophysical tasks. Auditory cells were simulated using realistic parameters and connected in three ascending layers with descending projections from auditory cortex. Coincidence detection of firing collicular cells at thalamus and subsequent integration of multiple inputs at cortex, produce an estimate of time represented as the mean of the active cortical population. Multiple estimates allow the model bat to use memory to recognize predictable change in stimuli values. The best performance is produced using cortical feedback and a computation of target time based on combining the current and previous estimates. Temporal hyperacuity is attained through population coding of physiologically realistic cells but depends on the inherent properties of the psychophysical task.

Delay accuracy in bat sonar is related to the reciprocal of normalized echo bandwidth, or Q.

Big brown bats (Eptesicus fuscus) emit wideband, frequency-modulated biosonar sounds and perceive the distance to objects from the delay of echoes. Bats remember delays and patterns of delay from one broadcast to the next, and they may rely on delays to perceive target scenes. While emitting a series of broadcasts, they can detect very small changes in delay based on their estimates of delay for successive echoes, which are derived from an auditory time/frequency representation of frequency-modulated sounds. To understand how bats perceive objects, we need to know how information distributed across the time/frequency surface is brought together to estimate delay. To assess this transformation, we measured how alteration of the frequency content of echoes affects the sharpness of the bat's delay estimates from the distribution of errors in a psychophysical task for detecting changes in delay. For unrestricted echo frequency content and high echo signal-to-noise ratio, bats can detect extremely small changes in delay of about 10 ns. When echo bandwidth is restricted by filtering out low or high frequencies, the bat's delay acuity declines in relation to the reciprocal of relative echo bandwidth, expressed as Q, which also is the relative width of the target impulse response in cycles rather than time. This normalized-time dimension may be efficient for target classification if it leads to target shape being displayed independent of size. This relation may originate from cochlear transduction by parallel frequency channels with active amplification, which creates the auditory time/frequency representation itself.

Evaluation of an auditory model for echo delay accuracy in wideband biosonar.

In a psychophysical task with echoes that jitter in delay, big brown bats can detect changes as small as 10-20 ns at an echo signal-to-noise ratio of approximately 49 dB and 40 ns at approximately 36 dB. This performance is possible to achieve with ideal coherent processing of the wideband echoes, but it is widely assumed that the bat's peripheral auditory system is incapable of encoding signal waveforms to represent delay with the requisite precision or phase at ultrasonic frequencies. This assumption was examined by modeling inner-ear transduction with a bank of parallel bandpass filters followed by low-pass smoothing. Several versions of the filterbank model were tested to learn how the smoothing filters, which are the most critical parameter for controlling the coherence of the representation, affect replication of the bat's performance. When tested at a signal-to-noise ratio of 36 dB, the model achieved a delay acuity of 83 ns using a second-order smoothing filter with a cutoff frequency of 8 kHz. The same model achieved a delay acuity of 17 ns when tested with a signal-to-noise ratio of 50 dB. Jitter detection thresholds were an order of magnitude worse than the bat for fifth-order smoothing or for lower cutoff frequencies. Most surprising is that effectively coherent reception is possible with filter cutoff frequencies well below any of the ultrasonic frequencies contained in the bat's sonar sounds. The results suggest that only a modest rise in the frequency response of smoothing in the bat's inner ear can confer full phase sensitivity on subsequent processing and account for the bat's fine acuity or delay.

Time-frequency model for echo-delay resolution in wideband biosonar.

A time/frequency model of the bat's auditory system was developed to examine the basis for the fine (approximately 2 micros) echo-delay resolution of big brown bats (Eptesicus fuscus), and its performance at resolving closely spaced FM sonar echoes in the bat's 20-100-kHz band at different signal-to-noise ratios was computed. The model uses parallel bandpass filters spaced over this band to generate envelopes that individually can have much lower bandwidth than the bat's ultrasonic sonar sounds and still achieve fine delay resolution. Because fine delay separations are inside the integration time of the model's filters (approximately 250-300 micros), resolving them means using interference patterns along the frequency dimension (spectral peaks and notches). The low bandwidth content of the filter outputs is suitable for relay of information to higher auditory areas that have intrinsically poor temporal response properties. If implemented in fully parallel analog-digital hardware, the model is computationally extremely efficient and would improve resolution in military and industrial sonar receivers.

Selectivity for echo spectral interference and delay in the auditory cortex of the big brown bat Eptesicus fuscus.

The acoustic environment for an echolocating bat can contain multiple objects that reflect echoes so closely separated in time that they are almost completely overlapping. This results in a single echo with a spectrum characterized by deep notches due to interference. The object of this study was to document the possible selectivity, or lack thereof, of auditory neurons to the temporal separation of biosonar signals on a coarse (ms) and fine (micros) temporal scale. We recorded single-unit activity from the auditory cortex of big brown bats while presenting four protocol designs using wideband FM signals. The protocols simulated a pair of partially overlapping echoes where the separation between the first and second echo varied between 0 and 72 micros, a pulse followed by a single echo at varying delay from 0 to 30 ms, a pulse followed at a fixed delay by a pair of partially overlapping echoes that had a varying temporal separation of 0-72 micros, and a pulse followed, with a varying delay between 0 and 30 ms, by a pair of echoes that themselves had a fixed temporal separation on a microsecond time scale. About half of the cortical units showed increased spike counts to pairs of partially overlapping echoes at particular separations (6-72 micros) compared with a baseline stimulus at 0-micros separation. For many neurons tested with a pulse followed by two overlapping echoes, we observed a sensitivity to the coarse delay between the pulse and pair of overlapping echoes and to the separation between the two echoes themselves. The sensitivity to the partial overlap between the two echoes was not tuned to a single temporal separation. For bats, this means that the absolute range to the closest reflector and range between reflectors may be jointly encoded across a small population of single units. There are several possible neuronal mechanisms for encoding the separation between two nearby echoes based on the sensitivity to spectral notches.