Strategically managing learning during perceptual decision making.

Making optimal decisions in the face of noise requires balancing short-term speed and accuracy. But a theory of optimality should account for the fact that short-term speed can influence long-term accuracy through learning. Here, we demonstrate that long-term learning is an important dynamical dimension of the speed-accuracy trade-off. We study learning trajectories in rats and formally characterize these dynamics in a theory expressed as both a recurrent neural network and an analytical extension of the drift-diffusion model that learns over time. The model reveals that choosing suboptimal response times to learn faster sacrifices immediate reward, but can lead to greater total reward. We empirically verify predictions of the theory, including a relationship between stimulus exposure and learning speed, and a modulation of reaction time by future learning prospects. We find that rats' strategies approximately maximize total reward over the full learning epoch, suggesting cognitive control over the learning process.

Satisfied patients and pediatricians: a cross-sectional analysis.

BACKGROUND: There is a lack of research in the USA comparing patient satisfaction with pediatricians and other primary care physicians (PCPs). We examined and compared patient satisfaction toward their pediatricians and PCPs and characterized factors associated with higher patient satisfaction in these two groups. METHODS: A random coefficient model with random slope and intercept was fit to the data, with patient satisfaction as a function of pediatrician/PCP, covariates, and physician random effects. Effect heterogeneity was assessed by allowing slope to vary as a function of covariates. Mediation analysis using the random coefficient model was conducted to calculate average total effect, average natural direct effect, and average indirect effect of pediatrician/PCP on satisfaction mediated by waiting/visit times. RESULTS: Pediatricians had higher predicted satisfaction ratings than PCPs (total effect = 4.8, 95% CI 3.7-5.9), with population-averaged mean of 82.2 (0.54) vs 77.4 (0.13). The direct effect was 3.9 (2.8-5.0) and the indirect effect was 0.9 (0.9-0.9), suggesting that part but not all of the total effect can be explained by pediatricians having decreased waiting/visit times leading to increased satisfaction. Predictions by subgroup suggested that pediatricians had lower ratings than PCPs for first visit, but higher ratings for all other covariate strata considered. Having longer waiting times and decreased visit times coincided with closer mean ratings between pediatricians and PCPs, other significant effect modifiers included patient sex, provider sex, and region of practice. CONCLUSION: Pediatricians scored higher patient satisfaction ratings than the combined group of other PCPs. Pediatricians had shorter wait times to see their patients compared to PCPs. Shorter wait times and longer visit times were associated with higher patient satisfaction ratings.

Evaluation of the reliability and accuracy of using cone-beam computed tomography for diagnosing periapical cysts from granulomas.

INTRODUCTION: The purpose of this study was to evaluate the reliability and accuracy of cone-beam computed tomographic (CBCT) imaging against the histopathologic diagnosis for the differential diagnosis of periapical cysts (cavitated lesions) from (solid) granulomas. METHODS: Thirty-six periapical lesions were imaged using CBCT scans. Apicoectomy surgeries were conducted for histopathological examination. Evaluator 1 examined each CBCT scan for the presence of 6 radiologic characteristics of a cyst (ie, location, periphery, shape, internal structure, effects on surrounding structure, and perforation of the cortical plate). Not every cyst showed all radiologic features (eg, not all cysts perforate the cortical plate). For the purpose of finding the minimum number of diagnostic criteria present in a scan to diagnose a lesion as a cyst, we conducted 6 receiver operating characteristic curve analyses comparing CBCT diagnoses with the histopathologic diagnosis. Two other independent evaluators examined the CBCT lesions. Statistical tests were conducted to examine the accuracy, inter-rater reliability, and intrarater reliability of CBCT images. RESULTS: Findings showed that a score of ≥4 positive findings was the optimal scoring system. The accuracies of differential diagnoses of 3 evaluators were moderate (area under the curve = 0.76, 0.70, and 0.69 for evaluators 1, 2, and 3, respectively). The inter-rater agreement of the 3 evaluators was excellent (α = 0.87). The intrarater agreement was good to excellent (κ = 0.71, 0.76, and 0.77). CONCLUSIONS: CBCT images can provide a moderately accurate diagnosis between cysts and granulomas.