Relevant Biomarkers in Medical Practices: An Analysis of the Needs Addressed by an International Survey

(1) Backround: Technological advances should foster gains in physicians’ efficiency. For example, a reduction of the medical decision time can be enabled by faster biological tests. The main objective of this study was to collect responses from an international panel of physicians on their needs for biomarkers and also to convey the improvement in the outcome to be made possible by the potential development of fast diagnostic tests for these biomarkers. (2) Methods: we distributed a questionnaire on the Internet to physicians. (3) Results: 508 physicians participated in this survey. The mean age was 38 years. General practice and emergency medicine were heavily represented, with 95% CIs of 44% (39.78, 48.41) and 32% (27.84, 35.94)), respectively. The two most represented countries were France (95% CI: 74% (70.20, 77.83)) and the USA (95% CI: 11% (8.65, 14.18)). Ninety-eight percentages of the physicians thought that obtaining cited biomarkers more quickly would be beneficial to their practice and to patient’s care. The main biomarkers of interest identified by our panel were troponin (95% CI: 51% (46.24, 54.94)), C-reactive protein (95% CI: 42% (38.03, 46.62)), D-dimer (95% CI: 29% (24.80, 32.68)), and brain natriuretic peptide (95% CI: 13% (10.25, 16.13)). (4) Conclusions: Our study highlights the real technological need for fast biomarker results, which could be provided by biosensors. The relevance of some answers such as troponin is questionable.

Digital Nudging for Online Food Choices

When people search for what to cook for the day, they increasingly use online recipe sites to find inspiration. Such recipe sites often show popular recipes to make it easier to find a suitable choice. However, these popular recipes are not always the healthiest options and can promote an unhealthy lifestyle. Our goal is to understand to what extent it is possible to steer the food selection of people through digital nudging. While nudges have been shown to affect humans' behavior regarding food choices in the physical world, there is little research on the impact of nudges on online food choices. Specifically, it is unclear how different nudges impact (i) the behavior of people, (ii) the time they need to make a decision, and (iii) their satisfaction and confidence with their selection. We investigate the effects of highlighting, defaults, social information, and warnings on the decision-making of online users through two consecutive user studies. Our results show that a hybrid nudge, which both involves setting a default and adding social information, significantly increases the likelihood that a nudged item is selected. Moreover, it may help decreasing the required decision time for participants while having no negative effects on the participant's satisfaction and confidence. Overall, our work provides evidence that nudges can be effective in this domain, but also that the type of a digital nudge matters. Therefore, different nudges should be evaluated in practical applications.

Monitoring Brain State and Behavioral Performance during Repetitive Visual Stimulation

We tested whether changes in prestimulus neural activity predict behavioral performance (decision time and errors) during a prolonged visual task. The task was to classify ambiguous stimuli—Necker cubes; manipulating the degree of ambiguity from low ambiguity (LA) to high ambiguity (HA) changed the task difficulty. First, we assumed that the observer’s state changes over time, which leads to a change in the prestimulus brain activity. Second, we supposed that the prestimulus state produces a different effect on behavioral performance depending on the task demands. Monitoring behavioral responses, we revealed that the observer’s decision time decreased for both LA and HA stimuli during the task performance. The number of perceptual errors lowered for HA, but not for LA stimuli. EEG analysis revealed an increase in the prestimulus 9–11 Hz EEG power with task time. Finally, we found associations between the behavioral and neural estimates. The prestimulus EEG power negatively correlated with the decision time for LA stimuli and the erroneous responses rate for HA stimuli. The obtained results confirm that monitoring prestimulus EEG power enables predicting perceptual performance on the behavioral level. The observed different time-on-task effects on the LA and HA stimuli processing may shed light on the features of ambiguous perception.

Effect of Health Literacy on Decision Delay in Patients With Acute Myocardial Infarction

Background: Health literacy (HL) is a risk factor for adverse outcomes in patients with cardiovascular disease, and shorter pre-hospital delay time is crucial for successful treatment of acute myocardial infraction (AMI) patients. Most previous studies focused on the influencing factors of pre-hospital delay but ignore the essential contribution of decision delay.Aims: Therefore, the purpose of this study was to explore the effect of HL on decision delay.Methods: Continuously included AMI patients admitted to a grade A class three hospital in Chongqing. HL level was assessed using Brief Health Literacy Screen and categorized as adequate or inadequate. Mann-Whitney U-test and Chi-square test were used to compare the differences between groups, and binary logistic regression was used to analyze the association between HL and decision delay.Results: A total of 217 AMI patients were enrolled in this study, including 166 males (76.5%) and 51 females (23.5%), with the median age was 68 years old; 135 (62.2%) patients had delayed decision-making while 82 (37.8%) did not; 157 (72.7%) patients had inadequate HL and 59 (27.3%) had adequate HL. The total HL score of non-delayed group was higher than that in delayed group (9.22 vs. 7.02, P < 0.000).Conclusion: After adjusting for covariates, HL was significantly negatively associated with decision time. AMI patients with inadequate HL were more likely to delay seeking timely medical care.

Eye movements through space interfere with visual processing of time-related words

When people make lexical decisions to words referring to the past or the future, they are faster when their manual responses are compatible with the mental timeline (MTL). That is, future words are responded to faster on the right than the left, while past words are responded to faster on the left than the right. This space-time congruency effect is interpreted to suggest that time words are represented along a spatial continuum that goes from left to right (past to future), at least in Western cultures that use reading-writing systems operating from left to right. All previous experiments used lateralized hand movements to register responses, which would evoke the directionality of writing. To evoke the directionality of reading, we investigated whether the space-time congruency effect would be replicated in a language task when responses were given using the eyes rather than the hand. Thus, participants were asked to make lateralized eye movements to indicate whether letter stimuli were real words or not (lexical decision). Eye movements were perturbed for responses incompatible with the direction of the MTL, both in terms of decision time and motor amplitude. These results confirm that time-related words are embodied through spatial movement in effector-independent motor networks and suggests that the spatial representation of time operates in a body-centered reference frame.

Building a Mobile Stroke Unit Based on 5G Technology – A Study Protocol

Background: In-time treatment of acute stroke is critical to saving people’s lives and improving the quality of post-stroke life. A mobile stroke unit (MSU) with fifth-generation (5G) mobile networks strengthens the interaction of patient information and healthcare resources, thereby reducing response times and improving thrombolysis results. However, clinical evidence of better outcomes compared to regular care is still lacking.Method and Design: In this randomized controlled trial, 484 patients with acute stroke are allocated into the MSU and regular care groups. We establish medical records for each patient and conduct a follow-up of 90 days. The primary outcomes are functional results as defined by utility-weighted modified Rankin Scale (uw-mRS) 90 days after the incidence occurred, whereas secondary outcomes include the alarm to CT scan completed time, the alarm to treatment decision time, the alarm to thrombolytic time, quality of life, and symptomatic intracranial hemorrhage combined with NIHSS score as well as cost-effectiveness.Discussion: This study establishes an innovative MSU (based on 5G) to manage acute stroke, comparing its clinical and economic outcomes to regular care and informing decision-makers of the effectiveness of the stroke emergency system.Clinical Trial Registration: [http://www.chictr.org.cn/showproj.aspx?proj=63874], identifier [ChiCTR2000039695].

Abstract Action Language Processing in Eleven-Year-Old Children: Influence of Upper Limb Movement on Sentence Comprehension

Regarding the embodiment of language processing in adults, there is evidence of a close connection between sensorimotor brain areas and brain areas relevant to the processing of action verbs. This thesis is hotly debated and has therefore been thoroughly studied in adults. However, there are still questions concerning its development in children. The present study deals with the processing of action verbs in concrete and abstract sentences in 60 eleven-year-olds using a decision time paradigm. Sixty-five children mirrored arm movements or sat still and rated the semantic plausibility of sentences. The data of the current study suggest that eleven-year-olds are likely to misunderstand the meaning of action verbs in abstract contexts. Their decision times were faster and their error rates for action verbs in concrete sentences were lower. However, the gender of the children had a significant influence on the decision time and the number of errors, especially when processing abstract sentences. Females were more likely to benefit from an arm movement before the decision, while males were better if they sat still beforehand. Overall, children made quite a few errors when assessing the plausibility of sentences, but the female participants more often gave plausibility assessments that deviated from our expectations, especially when processing abstract sentences. It can be assumed that the embodiment of language processing plays some role in 11-year-old children, but is not yet as mature as it is in adults. Especially with regard to the processing of abstract language, the embodied system still has to change and mature in the course of child development.

DETERMINATION OF VARIANCE OF TIME TO RECRUITMENT WITH INTER-DECISION TIME AS GEOMETRIC PROCESS WHEN THE THRESHOLD HAS THREE COMPONENTS

In this paper, the problem of time to recruitment is analyzed for a single grade manpower system using an univariate CUM policy of recruitment. Assuming policy decisions and exits occur at different epochs, wastage of manpower due to exits form a sequence of independent and identically distributed exponential random variables, the inter-decision times form a geometric process and inter-exist time form an independent and identically distributed random variable. The breakdown threshold for the cumulative wastage of manpower in the system has three components which are independent exponential random variables. Employing a different probabilistic analysis, analytical results in closed form for system characteristics are derived

Computational modeling of the N-Back task in the ABCD study: associations of drift diffusion model parameters to polygenic scores of mental disorders and cardiometabolic diseases

Background. Cognitive dysfunction is common in mental disorders and represents a potential risk factor in childhood. The nature and extent of associations between childhood cognitive function and polygenic risk for mental disorders is unclear. We applied computational modeling to gain insight into mechanistic processes underlying decision making and working memory in childhood and their associations with PRS for mental disorders and comorbid cardiometabolic diseases. Methods. We used the drift diffusion model to infer latent computational processes underlying decision-making and working memory during the N-back task in 3707 children aged 9-10 from the ABCD Study. SNP-based heritability was estimated for cognitive phenotypes, including computational parameters, aggregated N-back task performance and neurocognitive assessments. PRS was calculated for Alzheimer’s disease (AD), bipolar disorder, coronary artery disease (CAD), major depressive disorder, obsessive-compulsive disorder, schizophrenia and type 2 diabetes. Results. Heritability estimates of cognitive phenotypes ranged from 12 to 39%. Bayesian mixed models revealed that slower accumulation of evidence was associated with higher PRS for CAD and schizophrenia. Longer non-decision time was associated with higher PRS for AD and lower PRS for CAD. Narrower decision threshold was associated with higher PRS for CAD. Load-dependent effects on non-decision time and decision threshold were associated with PRS for AD and CAD, respectively. Aggregated neurocognitive test scores were not associated with PRS for any of the mental or cardiometabolic phenotypes.Conclusions. We identified distinct associations between computational cognitive processes to genetic risk for mental illness and cardiometabolic disease, which could represent childhood cognitive risk factors.