Learning the values of actions versus stimuli may depend on separable neural circuits. In the current study, we evaluated the performance of rhesus macaques with ventral striatum (VS) lesions on a two-arm bandit task that had randomly interleaved blocks of stimulus-based and action-based reinforcement learning (RL). Compared with controls, monkeys with VS lesions had deficits in learning to select rewarding images but not rewarding actions. We used a RL model to quantify learning and choice consistency and found that, in stimulus-based RL, the VS lesion monkeys were more influenced by negative feedback and had lower choice consistency than controls. Using a Bayesian model to parse the groups' learning strategies, we also found that VS lesion monkeys defaulted to an action-based choice strategy. Therefore, the VS is involved specifically in learning the value of stimuli, not actions.

PURPOSE: Minimization of postoperative complications is important in patients with cancer. We wished to improve compliance with anesthesiology quality measures through staff education reinforced with automated monthly feedback. METHODS: The anesthesiology department implemented a program to capture and report quality metrics. After staff education, monthly e-mail reports were sent to each anesthesiology physician and nurse anesthetist to detail individual compliance rates for a set of quality measures. For each measure, the proportion of patient cases that passed the measure before and after implementation of the program was compared using a two-sample proportion test. RESULTS: After exclusions, we analyzed 15 of 23 quality measures. Of the 15 measures, 11 were process measures, and four were outcome measures. Of the 11 process measures, seven demonstrated statistically significant improvements ( P < .01). The most improved measure was TEMP-02 (core temperature measurement), which increased from 69.6% to 85.7% (16.1% difference; P < .001). Also improved were PUL-02 (low tidal volume, less than 8 mL/kg ideal body weight; 15.4% difference; P < .001) and NMB-01 (train of four taken; 12.2% difference; P < .001). The outcome measure TEMP-03 (perioperative temperature management) had a statistically significant increase of a small magnitude (0.2% difference; P < .001). No other outcome measures showed statistically significant improvement. CONCLUSION: After implementation of a comprehensive quality improvement program, our group observed significant improvements in anesthesia quality measure compliance for several process measures. Future work is needed to determine if this initial success can be preserved and associated with improved outcomes.

Background: Information sampling is the cognitive process of accumulating information before committing to a decision. Patients across numerous disorders show decreased information sampling relative to controls. Aims: Here, we used the Beads and the Best Choice Tasks to study the role of dopamine signaling in information sampling. Methods: Participants were given placebo, amisulpride, or ropinirole in each session, in a double-blind cross-over design. Results: We found that ropinirole (agonist) increased the number of beads drawn in the Beads Task specifically when participants faced a loss, and decreased the rank of the chosen option in the Best Choice Task. Conclusions: These effects are likely driven by a combination of effects at presynaptic D2 receptors, which affect dopamine release, and post-synaptic D2 receptors. Increased D2 relative to D1 receptor activation in the striatum leads to increased sampling in the loss condition in the Beads Task. It also leads to choice of a poorer ranked option in the Best Choice Task. Decreased D2 relative to D1 receptor activation leads to decreased sampling in the Beads Task in the loss condition.

Background-While quality programs have been shown to improve provider compliance, few have demonstrated conclusive improvements in patient outcomes. We hypothesized that there would be increased metric compliance and decreased postoperative complications after initiation of an anesthesiology quality improvement program at our institution.Methods-We performed a retrospective study of all adult inpatients having anesthesia for a twelve-month period that spanned six months before and after program implementation. The