Balanced Choice Research Articles

Immune Thrombocytopenia in Children: Consensus and Controversies.

Newly diagnosed immune thrombocytopenia (ITP) is a relatively common disorder of childhood that does not require an exhaustive laboratory workup for diagnosis. A history and physical exam with a review of the peripheral smear are crucial for excluding secondary causes of thrombocytopenia. Several guidelines have been published to guide physicians in the management of ITP. However, the decision for treatment can be arduous. The management strategy should not be focussed on the platelet count but the severity of bleeding symptoms. Agents for treating acute ITP, including corticosteroids, immunoglobulin and anti-D immunoglobulin, do not seem to have a significant impact on the natural history of the disease. The majority of children with ITP do not need therapy and have a spontaneous resolution of the disease. Some children can develop chronic ITP that is not commonly life-threatening but can lead to impaired quality of life. Traditional therapies such as rituximab and splenectomy for chronic ITP are not without significant adverse effects. Thrombopoietin receptor agonists are newer agents for the treatment of chronic ITP and hold promise, however, their cost currently precludes use in most of the patients in low-middle-income countries. This review compares and contrasts the specific treatments available for the treatment of ITP to help the reader make a balanced choice. This review, based on a series of case examples, will help physicians in making decisions about choosing a practical management strategy for patients with newly diagnosed as well as chronic ITP.

From Pink-Collar to Lab Coat: Cultural Persistence and Diffusion of Socialist Gender Norms

The fall of the Iron Curtain in 1989 led to a massive migration wave from the Former Soviet Union (FSU) to Israel. We document the persistence and transmission of the Soviet unconventional gender norms, both vertically across generations of immigrants, and horizontally through neighborhood and school peer effects. Tracking the educational and occupational choices of a cohort of young Israeli women, we identify the persistence of two important features of the Soviet culture: the prioritization of science and technology, and the strong female attachment to paid-work. Women born in the FSU, who immigrated in infancy, are significantly more likely than natives and other immigrants to major in STEM in high school. In tertiary education, they remain over-represented in STEM, but also differ significantly from other women by their specific avoidance of study fields leading to “pink collar” jobs, such as education and social work. They also display a specific choice of work-life balance reflecting a greater commitment to paid-work. Finally, the choice patterns of native women shift towards STEM and away from traditional female study fields as the share of FSU immigrants in their lower-secondary school increases.

ОБ ОЦЕНКЕ СНИЗУ В ЗАДАЧЕ ПРИБЛИЖЕННОГО ВОССТАНОВЛЕНИЯ ФУНКЦИЙ ПО ИХ ЗНАЧЕНИЯМ ПРЕОБРАЗОВАНИЙ РАДОНА

In this paper, we study the problem of function reconstruction by values of Radon transforms within the framework of the Computational (Numerical) Diameter (C(N)D) approach. The meaning of C(N)D is to solve two independent problems: obtaining lower bounds of the reconstruction error by exact information and specifying the computing tool that implements the upper bounds (preferably coinciding with the lower bound up to constants). The C(N)D approach is a mathematical model of experiments for describing various processes (physical, chemical, technical, etc.). An important role in setting up such experiments is played by types of measuring instruments, which is reflected in C(N)D as types of functionals. The next important point is the choice of location and balancing of instruments, i.e. selection of functionals’ parameters. The final step is to build an optimal computing tool using the obtained data. The most studied types of functionals are function values at points and Fourier coefficients. An important difference of this work from previously obtained results is the study of the approximation capabilities of another type of functionals – Radon transforms, i.e. mathematical model of the use of tomography and similar technologies. This paper is devoted to obtaining lower bounds for the error in reconstructing functions from Sobolev and Korobov spaces.

Invited Lecture 14: From insight to foresight? Some Lessons for 5G from other “new” technologies & agents

Invited Lecture 14: From insight to foresight? Some Lessons for 5G from other “new” technologies & agents

What to do? A Review of the Academic Time-Based Decision-Making Literature

Time-based activities at Universities are shifting toward a more transactional approach, yet there is little understanding of the time management capabilities of students in adapting to a more flexible structure. Although many studies report on efforts to address engineering students being stressed, surfacelearning oriented, and prone to missing class, few studies address how these relate to students’ time management. In an effort to explore how students value, prioritize, and spend their time, this paper proposes a new term, “Academic Time-Based Decision-Making” (ATBDM), which lies at the crossroads of time management, selfefficacy, and self-regulated learning. Factors influencing ATBDM are currently mostly speculative, although class scheduling, social norms, and the internet and social media are frequent causal suggestions. It is also unknown as to how ATBDM is conducted across the breadth of students, which skills or “tools” are employed, and whether the process or influencing factors change over the course of time. A research study to explore why and how engineering students make academic decisions is proposed. By providing deeper insights into the factors influencing ATBDM, it may be possible to develop more effective support or intervention to assist students in making balanced and positive choices.

2187. Prediction of Patient Outcome During Febrile Neutropenia Despite Anti-infective Treatment Using Machine Learning Algorithms

BackgroundClinical management of prolonged febrile neutropenia despite broad-spectrum empirical antibacterial treatment is a clinical challenge, as standard empirical treatment has failed and a broad spectrum of differential diagnoses has to be considered. Growing prevalence of multi-resistant bacteria and fungi has made a balanced choice of effective anti-infective treatment more difficult. A reliable prediction of complications could indicate options for treatment optimization.MethodsWe implemented a supervised machine learning approach to predict death or admission to intensive care unit within 28 days in cancer patients with prolonged febrile neutropenia (neutrophils < 500/mm3 and body temperature ≥ 38°C longer than 3 days). We analyzed highly granular retrospective medical data of the Cologne Cohort of Neutropenic Patients (CoCoNut) between 2008 and 2014. Random forest and 10-fold cross-validation were used for classification. The neutropenic episodes from 2014 were used for evaluation of prediction.ResultsIn total, 927 episodes of prolonged febrile neutropenia (median age 52 years, interquartile range 42–62; 562/927 [61%] male; 390/927 [42%] acute myeloid leukemia; 297/927 [32%] lymphoma) with 211/927 (23%) adverse outcomes were processed. We computed 226 features including patient characteristics, medication, clinical signs, as well as laboratory results describing changes of state and interactions of medical parameters. Feature selection revealed 65 features with an area under the receiver operating characteristic curve (AUC) of 0.75. In the validation data set the optimized model had a sensitivity/specificity of 36% and 99% (AUC: 0.68; misclassification error: 0.12) and positive/negative predictive values of 89% and 88%, respectively. The most important features were albumin, age, and procalcitonin.ConclusionStructured granular medical data and machine learning approaches are an innovative tool that can be used in a retrospective setting for prediction of adverse outcomes in patients with prolonged febrile neutropenia. This study is the first important step toward clinical decision support based on predictive models in high-risk cancer patients.Disclosures All authors: No reported disclosures.

Efficient intersection between splines of clothoids

A technique for the intersection of two splines of clothoid curves is herein presented. The study is motivated by the motion planning problem for a nonholonomic automated robotic vehicle, where a clothoid spline represents the path of the robot and the presence of an intersection with the path of another robot or with some obstacles boundaries means a possible collision. The algorithm works by segmenting each spline into small tangent triangles and then by organising the resulting, possibly large, number of triangles in a tree structure to exploit an efficient hierarchical check for intersections. Among various possible tree structures, the AABB tree is selected, which is a balanced choice between the complexity of the construction and the cost of evaluation, and avoids the need for extensive comparisons between each pair of clothoid segments that compose the splines. Indeed, only on pairs of intersecting triangles the collision is checked at curve level. This reduction of the computational cost yields an algorithm that can be effectively applied to real time applications.

32-channel mouse EEG: Visual evoked potentials

BackgroundMeasuring visual evoked potentials (VEP) by means of EEG allows the quasi non-invasive assessment of visual function in mice. Such sensory phenotyping is important to screen for genetic or aging effects on vision in preclinical mouse models. Thus, a standardized EEG-like approach for the assessment of sensory evoked potentials in mice is desirable. New methodWe describe a method to obtain the topographical distribution of flash evoked VEPs with 32-channel thin-film EEG electrode arrays in anesthetized mice. Further, we provide suggestions for the optimal choice of adequate digital filtering, referencing, and stimulus parameters for fast and reliable assessment of VEP parameters and distribution. Results32-channel thin-film electrodes provided clear information on the VEP topography across the skull. Re-referencing, such as bipolar, common average, and local average montages could be used to further refine the information on VEP topography. A balanced choice of digital high-pass filter, signal averaging and stimulus rate allowed to minimize measurement duration and at the same time assured good VEP signal-to-noise ratio. Comparison with existing methodsSubdermal electrodes or single skull screws provide only limited topographical information of the VEP. Assessment of VEPs with 32-channel thin-film electrodes can provide comparable signal quality with superior spatial resolution and standardized topographical and hemispheric information of VEP distribution. ConclusionsEEG-like thin-film electrodes are an efficient tool for fast, comprehensive sensory phenotyping with topographical information in mice. This is a step towards the use of standardized mouse EEG to characterize EEG biomarkers in mouse models of human diseases.

Working on healthy choices

Working on healthy choices

One step preparation of copper–silver self-catalyzed hybrid conductive ink with reduced sintering temperature for flexible electronics

Copper–silver hybrid conductive inks can combine the advantages of lower cost, better conductivity and long-term stability of the copper or silver ink, which have attracted wide research interest in the development of materials for flexible electronics. Although Cu–Ag nanoparticle based inks, such as Cu–Ag core–shell nanoparticle inks and Cu–Ag bimetallic nanoparticle inks, have already been developed and applied to produce conductive patterns using different deposition methods, they are still not ideal because of the complex and time-consuming synthetic process, low yield and high sintering temperature for good conductivity. In this paper, we report synthesis and characterization of novel self-catalyzed Cu–Ag organic complex inks with reduced sintering temperature via a simple one-step method. The effects of Cu–Ag ratio on the thermal property, stability and electrical performance of the formulated inks were investigated, where the Cu1–Ag1 ink was found to be ideal in terms of cost, conductivity and thermal behavior. The presence of silver oxalate in the copper complex ink was beneficial to the thermal decomposition of the Cu complex and able to decrease the sintering temperature by 30 °C due to the catalytic function of silver, making it more compatible with flexible polymer substrate materials. Meanwhile, the addition of a small amount of silver oxalate could improve the conductivity of the Cu ink. The sintered Cu–Ag films showed favorable conductivity which is comparable to the value of the reported Cu–Ag nano inks but with a lower sintering temperature. The Cu1–Ag1 hybrid ink with self-catalyzing capability is a balanced choice when considering the cost and conductivity.

Accept or reject?The nudge effect of response options on making a balanced choice between enhancement and enrichment classes

Accept or reject?The nudge effect of response options on making a balanced choice between enhancement and enrichment classes

Scenario generation and probabilistic forecasting analysis of spatio-temporal wind speed series with multivariate autoregressive volatility models

This paper evaluates the application of a family of VAR-mGARCH (Vector AutoRegressive with multivariate AutoRegressive Conditional Heteroskedasticity) volatility models to the problem of modeling (i.e. generating correct in-sample scenarios) and forecasting in a probabilistic way three univariate but mutually dependent wind speed hourly series. The evaluation starts from the consideration that optimal modeling and optimal forecasting are not necessarily attained by the same models, and that they are assessed in different ways. The proposed VAR-mGARCH family, originated in Finance, consists of the VAR-BEKK (VAR - Baba, Engle, Kraft and Kroner) model and the VAR-DCC (VAR - Dynamic Conditional Correlation) model, the latter seen as the simplified and more scalable version of the former. These models were never used in wind speed studies before. Both models will be used with Gaussian innovations, and the VAR-DCC model will be also used with Student’s t innovations. These models, which are able to dynamically couple volatilities, are compared to two benchmark model sets, the first set consisting of three independent univariate AR-GARCH (i.e. non-vector) models, the second set consisting of an individual VAR model without the GARCH sector. These benchmark models cannot dynamically couple volatilities. Both benchmark model sets will be used with Gaussian innovations. The time series used for the evaluation are taken from three North-American wind metering sites located at few tens of kilometers from each other. In order to highlight the usefulness of choosing autoregressive coupled volatility schemes for modeling and forecasting spatially and temporally varying wind speed data, a controlled variance electricity generation portfolio example of Markowitz type, typical of Energy Finance, is also discussed at some length. In all, it is concluded that the VAR-DCC model with Student’s t innovations is the most balanced choice for this data set when the three goals of modeling, forecasting and scalability in the number of considered sites are taken into account at once.

Recreational physical activity and the problem of particulate matter air pollution

Studies reveal the negative impact of exposure to particulate air pollution on human health, especially on respiratory and circulatory systems. At the same time the beneficial effects of maintaining adequate level of physical activity are well known. In this review author presents analysis of chosen current articles about health effects of recreational physical activity in the environment of high level of ambient particulate matter air pollution. Available data suggests that there are complex relations between physical activity and exposure to air pollution. The direct positive effects of recreational physical activity include decrease of diastolic blood pressure and bronchial dilatation. It is proven that particulate air pollution show contrary impact on respiratory and cardiovascular systems. The mechanisms of this influence consist of induction of inflammation in respiratory epithelial cells, increase of oxidative stress and alterations in autonomic nervous system regulation. Changes induced by air pollution, expressed by the decrease of spirometry parameters (most commonly FEV1 decrease) were observed even in young and healthy adults doing recreational physical activity. Nevertheless, several studies suggest modulatory impact of physical exercises, which may limit the pro-inflammatory influence of particulate air pollution. Less expressed short-term negative effects of exposure have been observed in people doing physical exercise in comparison to those being inactive at the same time. In addition, apart from direct health effects, air pollution may also discourage exposed people from doing physical activity. Therefore, balanced choices regarding physical activity are needed, in order to decrease the negative impact of exposure to air pollution, without limiting the positive impact of physical activity. Still, new research is needed in order to fully explain relations between physical activity and exposure to air pollution. This will allow to elaborate physical activity guidelines including current air pollution level, better risk communication and promotion of safe ways of exercise.

Обліково-аналітичне забезпечення управління структурними компонентами потенціалу підприємства: теоретичний аспект

The development of the enterprise to a large extent depends on the ability of its management to make optimal decisions on building up the existing potential and strengthening its structural components. In this context, an important role is played by the organization of accounting and analytical support for the management of enterprise's potential. The purpose of the article is to substantiate the theoretical foundations of accounting and analytical support for making managerial decisions to strengthen the existing enterprise's potential and increase the efficiency of it use, taking into account its structural components. It was determined that the presence of industrial and economic relations on a particular business entity leads to the construction of its own model of the hierarchical structure of the enterprise's potential. This model allows evaluating the actual state of affairs reliably, determining the main priorities of the activity and optimizing the current process of implementing the development strategy for the future. It was proposed to evaluate each type of potential of a lower order by calculating quantitative and qualitative indicators that reflect the presence, condition and size of potential resources and the level of efficiency of their use. At the same time, the formation of these indicators must be carried out taking into account the management objectives and strategic goals of the enterprise in the relevant market. This approach allows making a balanced choice of the model of accounting and analytical support of the management of enterprise's potential to increase the efficiency of its use. It was proposed in each specific production situation to determine the goal of managing the enterprise's potential, taking into account its key structural components, determine the list of necessary information data and develop a logical sequence of accounting and analytical procedures and calculations to form reliable sources of necessary economic information.

Highly active multiple sclerosis: options for monoclonal antibody therapy

The clinical course of multiple sclerosis (MS) is characterized by great variability. 'Aggressive' MS, a concept used in the last 10 years, is associated with atypical course of the disease, which is manifested by more frequent exacerbations, the rapid increase in disability and pronounced signs of radiological activity according to MRI. The review presents data on the effectiveness of three monoclonal antibody drugs - natalizumab, alemtuzumab and ocrelizumab. In addition, updated data on the safety of monoclonal antibodies are presented to help the physician make a balanced choice of a drug and therapy strategy.

Highly active multiple sclerosis: options for monoclonal antibody therapy

The clinical course of multiple sclerosis (MS) is characterized by great variability. 'Aggressive' MS, a concept used in the last 10 years, is associated with atypical course of the disease, which is manifested by more frequent exacerbations, the rapid increase in disability and pronounced signs of radiological activity according to MRI. The review presents data on the effectiveness of three monoclonal antibody drugs - natalizumab, alemtuzumab and ocrelizumab. In addition, updated data on the safety of monoclonal antibodies are presented to help the physician make a balanced choice of a drug and therapy strategy.

Experimental design of real human parking behavior in laboratory

With the development of advanced technology, the current people all the time by the impact of a variety of information, Therefore, the parking choice behavior under a lot of information is widely studied in the academic field. At present, there are three main research methods about parking behavior: mathematical analysis, simulation and experimental research. Mathematical analysis method mainly used mathematical model to describe the daily travel of the walker balance or gradual equilibrium choice. The simulation method can simulate the traffic reality and reflect the dynamic characteristics of the traffic system. The experimental study is based on the establishment of controlled experimental environment, in the travel information feedback to study the actual decision-making behavior of the subjects. In this paper, we establish a scenario experiment scheme for real people in virtual environment, For specific experimental problems, that is, the real man parking choice behavior under the action of information, To carry out a fine scene design, highlighting the effective control of the variable, According to the virtual environment provided, to carry out a controlled real human experiment, in order to conduct an in-depth study of parking behavior. Through the experimental study, it can be concluded that the parking information and the driver’s parking experience play an important role in reducing the parking time, At the same time, it can also be concluded that the complete parking information is more conducive to the driver’s more successful completion of the parking behavior.

Shared Decision-Making in Kidney Patients: Involvement in Decisions Regarding the Quality of Deceased Donor Kidneys

ObjectivesThis study examined whether kidney patients want to participate in decisions regarding the minimal acceptable quality of deceased donor kidneys. We also explored patients' opinions about the trade-off between a higher-quality organ with a longer waiting time vs a lower-quality organ with a shorter waiting time. MethodsA questionnaire was distributed among kidney patients. Additionally, a sub-sample of these patients participated in in-depth interviews, which were analyzed using the grounded theory approach. ResultsSixty-three percent of the patients wished to participate in decisions concerning the quality of a deceased donor kidney. The majority of the respondents indicated that they prefer a kidney of good quality and would therefore accept a longer waiting time. Responses to the qualitative interviews illustrated a more balanced choice regarding this trade-off. ConclusionsMany patients wish to be involved in deciding on the quality of the kidney, but it may evoke the experience of decisional conflicts when they have to make rational trade-offs between the desire for the best kidney at the expense of a longer waiting time.

Electronic Exchange and Correlation in van der Waals Systems: Balancing Semilocal and Nonlocal Energy Contributions.

Short-range correlations in motion of electrons in matter are captured well by semilocal exchange-correlation (XC) functionals in density functional theory (DFT), but long-range correlations are neglected in such models and must be treated by van der Waals (vdW) dispersion methods. Whereas the effective range of distances at which fluctuations are correlated is usually explicit in the vdW models, the complementary range of semilocal functionals can be observed only implicitly, requiring an introduction of empirical damping functions to couple the semilocal and nonlocal contributions to the XC energy. We present a comprehensive study of the interplay between these short-range and long-range energy contributions in eight semilocal functionals (LDA, PBE, TPSS, SCAN, PBE0, B3LYP, SCAN0, M06-L) and three vdW models (MBD, D3, VV10) on noncovalently bonded organic dimers (S66×8), molecular crystals (X23), and supramolecular complexes (S12L), as well as on a series of graphene-flake dimers, covering a range of intermolecular distances and binding energies (0.5-130 kcal/mol). The binding-energy profiles of many of the DFT+vdW combinations differ both quantitatively and qualitatively, and some of the qualitative differences are independent of the choice of the vdW model, establishing them as intrinsic properties of the respective semilocal functionals. We find that while the SCAN+vdW method yields a narrow range of binding-energy errors, the effective range of SCAN depends on system size, and we link this behavior to the specific dependence of SCAN on the electron localization function α around α = 1. Our study provides a systematic procedure to evaluate the consistency of semilocal XC functionals when paired with nonlocal vdW models and leads us to conclude that nonempirical generalized-gradient and hybrid functionals are currently among the most balanced semilocal choices for vdW systems.

Relationship between dietary habits and nutritional status among adolescents in Abuja municipal area council of Nigeria

Background : Dietary intake assessment is essential to understanding the nutritional status. Healthy eating pattern promotes optimal health, growth and intellectual development and prevents diseases, while poor dietary eating choices may cause malnutrition. Aims : To determine the dietary eating patterns and nutritional status among adolescents in secondary schools within Abuja Municipal area council (AMAC). Subjects and Methods : crosssectional among adolescents, 10 – 19years in secondary schools within AMAC, Nigeria. Using a multistage stratified sampling technique, four urban and four rural schools, 1550 students, were enrolled. Subject’s bio data, dietary habits and knowledge of nutrition and general physical examination were obtained. Dietary assessment included intake of main meals (breakfast, lunch and dinner), skipping meals; methods used to control weight in the previous 30days; knowledge and preference of a balanced diet and food choices. Subject’s height and weight and Body Mass Index (BMI) were determined using the 2007 WHO charts. Data was analyzed using SPSS version 17 statistical package and p value less than 0.05 was significant. Results : 1550 students were recruited, males 688 (44.4%) and females 862 (55.6%); mean age 14.43±1.94 years. Of the 780 urban adolescents, 502 (64.4%) were of upper class and 68 (8.7%) lower class; and of the 770 (49.7%) rural, 206 (26.8%) and 232 (30.1%) belong to upper and lower class respectively, p=.000. Stunting 174(11.2%) and overweight 195(12.6%) were the major forms of malnutrition recorded. Food preferences was based mainly on good taste in 546 (35.2%), balanced diet 530 (34.2%); and 539 (34.8%) had good nutritional knowledge of a balanced diet. Five hundred and forty six (35.2%) admitted to taking carbonated drinks within the previous 7days and 147 (9.5%) missed breakfast, lunch and supper as single meal. Breakfast only was skipped by 71(4.6%) while 160 (10.3%) took lunch outside the home. The methods used to control weight were eating less food or fats, fasting, use of diet pills, inducing vomiting/use of laxatives. Skipping meals and taking meals outside the home was significant for the sex, (p value <0.05), school setting (p value .000) and the infrequent intake of fruits/ vegetables (p value .025). Those that skipped meals showed significant stunting (p value .009), while those who took fruits and vegetables infrequently had significant wasting (p value .049). Conclusion : poor dietary habits were identified among the adolescent. Malnutrition especially stunting and wasting was identified among those that skipped meals and took little fruits and vegetables. Key words : dietary habits, adolescent, urban, rural, prevalence, nutritional status, carbonated drinks.