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We are encouraged by the many positive commentaries on our target article. In this response, we recapitulate some of the points raised and identify synergies between them. We have arranged our response based on the tension between data and architecture that arises in the meta-learning framework. We additionally provide a short discussion that touches upon connections to foundation models.
Psychologists and neuroscientists extensively rely on computational models for studying and analyzing the human mind. Traditionally, such computational models have been hand-designed by expert researchers. Two prominent examples are cognitive architectures and Bayesian models of cognition. Although the former requires the specification of a fixed set of computational structures and a definition of how these structures interact with each other, the latter necessitates the commitment to a particular prior and a likelihood function that – in combination with Bayes' rule – determine the model's behavior. In recent years, a new framework has established itself as a promising tool for building models of human cognition: the framework of meta-learning. In contrast to the previously mentioned model classes, meta-learned models acquire their inductive biases from experience, that is, by repeatedly interacting with an environment. However, a coherent research program around meta-learned models of cognition is still missing to date. The purpose of this article is to synthesize previous work in this field and establish such a research program. We accomplish this by pointing out that meta-learning can be used to construct Bayes-optimal learning algorithms, allowing us to draw strong connections to the rational analysis of cognition. We then discuss several advantages of the meta-learning framework over traditional methods and reexamine prior work in the context of these new insights.
Endovascular thrombectomy (EVT) is effective in reducing disability in selected patients with stroke and large vessel occlusion (LVO), but access to this treatment is suboptimal.
We examined the proportion of patients with LVO who did not receive EVT, the reasons for non-treatment, and the association between time from onset and probability of treatment.
We conducted a retrospective cohort study of consecutive patients with acute stroke and LVO presenting between January 2017 and June 2018. We used multivariable log-binomial models to determine the association between time and probability of treatment with and without adjustment for age, sex, dementia, active cancer, baseline disability, stroke severity, and evidence of ischemia on computerized tomography.
We identified 256 patients (51% female, median age 74 [interquartile range, IQR 63.5, 82.5]), of whom 59% did not receive EVT. The main reasons for not treating with EVT were related to occlusion characteristics or infarct size. The median time from onset to EVT center arrival was longer among non-treated patients (218 minutes [142, 302]) than those who were treated (180 minutes [104, 265], p = 0.03). Among patients presenting within 6 hours of onset, the relative risk (RR) of receiving EVT decreased by 3% with every 10-minute delay in arrival to EVT center (adjusted RR 0.97 CI95 [0.95, 0.99]). This association was not found in the overall cohort.
The proportion of patients with acute stroke and confirmed LVO who do not undergo EVT is substantial. Minimizing delays in arrival to EVT center may optimize the delivery of this treatment.
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