Initial Choice Research Articles

51-Year-Old Man With Ascites and Abdominal Pain

51-Year-Old Man With Ascites and Abdominal Pain

Noisy waters can influence young-of-year lobsters’ substrate choice and their antipredatory responses

Offshore human activities lead to increasing amounts of underwater noise in coastal and shelf environments, which may affect commercially-important benthic invertebrate groups like the re-stocked Helgoland European lobster (Homarus gammarus) in the German Bight (North Sea). It is crucial to understand the impact tonal low-frequency noises, like maritime transport and offshore energy operations, may have on substrate choice and lobsters' behavior to assess potential benefits or bottlenecks of new hard-substrate artificial offshore environments that become available. In this study, we investigated the full factorial effect of a tonal low-frequency noise and predator presence on young-of-year (YOY) European lobsters' in a diurnal and nocturnal experiment. Rocks and European oyster shells (Ostrea edulis) were offered as substrate to YOY lobsters for 3 h. Video recordings (n = 134) allowed the identification of lobsters' initial substrate choice, diel activity and key behaviors (peeking, shelter construction, exploration and hiding). To ensure independence, YOY lobsters in the intermolt stage were randomly selected and assigned to the experimental tanks and used only once. We provide the first evidence that stressors alone, and in combination, constrain YOY lobsters' initial substrate choice towards rocks. During nighttime, the joint effect of exposure to a constant low-frequency noise and predator presence decreased antipredator behavior (i.e., hiding) and increased exploration behavior. Noise may thus interfere with YOY lobsters' attention and decision-making processes. This outcome pinpoints that added tonal low-frequency noise in the environment have the potential to influence the behavior of early-life stages of European lobsters under predator pressure and highlights the importance of including key benthic invertebrates' community relationships in anthropogenic noise risk assessments. Among others, effects of noise must be taken into consideration in plans involving the multi-use of any offshore area for decapods’ stock enhancement, aquaculture, and temporary no-take zones.

Neural Correlates of Willingness to Pay: An Activation Likelihood Estimation Meta-Analysis of Functional Magnetic Resonance Imaging Studies

The hormones oxytocin, vasopressin, and testosterone have been implicated in cooperative behaviours and have attracted increasing research interest for their potential to regulate human cooperation in both healthy and clinical populations. However, the behavioural effects of the administration of these hormones remain to be verified. The current analysis included 41 studies involving 3,269 participants with a narrow age range. We examined the administration effects of these hormones on cooperative behaviour and the regulatory effects of individual characteristics, hormone interventions, and task structure and context. Results revealed a moderate positive effect size of oxytocin intranasal administration, a large negative effect size of vasopressin intranasal administration, and nonsignificant effects of testosterone administration on cooperative behaviours. Participants with mental dysfunctions were less sensitive to oxytocin and vasopressin administration. Oxytocin administration was effective in an in-group situation and for initial choices, corroborating a Tit-for-Tat strategy.

Educational debt and the gender gap: Understanding factors influencing orthodontists’ career decisions

Orthodontic residents face challenges unparalleled to their predecessors, including competitive marketplaces, rising debt burdens, and changing demographics that have contributed to the shift in initial career choice from owner to employee. We aim to understand factors important to orthodontists at different career stages and the impact on job satisfaction through a sequential mixed methodology study. Semistructured interviews were conducted with 25 orthodontic residents and practitioners. A survey was developed from qualitative findings that explored career decision-making of orthodontic residents and practicing orthodontists, with descriptive and bivariate statistical analyses (n=343 orthodontists and 185 residents). Graduating orthodontic residents are choosing employment over ownership as their initial job, prioritizing high income to offset the educational debt. The majority of residents report thinking about their debt very often to all of the time and find it very to extremely stressful. Current residents have long-term goals of ownership, whereas practicing doctors of both genders became owners at equal frequencies. However, on average, women earn $119,000 less per year and report being the primary family caretaker more often than men. Excellent patient care, work-life balance, and sufficient income are the most important drivers for career choices and job satisfaction for orthodontists of all ages. Despite debt, most residents and working orthodontists report a high level of job satisfaction and would recommend the field of orthodontics to others.

Mesonephric adenocarcinomas in female genital tract: A case series.

Mesonephric adenocarcinoma (MNAC) is a very rare tumor that originates from mesonephric duct remnants of the female genital tract. Only a few cases were reported in the literature, and most of them occurred in the cervix, extremely rare in the uterine body and ovary. MNAC was rarely reported to arise in the uterine corpus, but never was reported in the ovary. Mesonephric-like adenocarcinomas are recently suggested to describe these neoplasms arising from the uterine corpus and ovary. Due to the rareness of the disease, little is known regarding clinical characteristics, pathological diagnosis, prognosis, and optimal management strategy of MNAC in the female reproductive system. We report a series of MNACs arising from the vagina, cervix, uterine corpus, ovary, and fallopian tube, to summarize the clinical characteristics, pathological diagnosis, treatment, and prognosis.We retrospectively analyzed all MNACs in the female genital tract derived from our institute from January 2010 till January 2020. Patients’ clinical details and follow-up were obtained from hospital records and scans were obtained from picture archiving and communication system.A total of 11 patients were included. The median age of onset of symptoms was 52 years. All patients underwent total hysterectomy and bilateral salpingo-oophorectomy, and lymph node dissections were performed in 7/11 (63.6%) patients. Two/eleven (18.2%) received neoadjuvant chemotherapy before surgery and 7/11 (63.6%) received adjuvant chemotherapy after primary surgery. Of the 11 patients, only 1 patient received adjuvant radiation therapy. One patient died at the end point of this study, 9 patients (81.8%) survived and 1 patient was lost to follow-up. The mean follow-up duration was 33.5 months.Although there is no consensus for the optimal treatment of this rare disease, radical surgery is considered to be the initial choice for localized lesion. Given the high malignancy, the majority of MNAC or mesonephric-like adenocarcinoma patients who underwent adjuvant chemotherapy received 4 to 8 cycles of carboplatin/paclitaxel as a first-line treatment after primary surgery with a median progression-free survival of 12 months. Treatment for recurrent disease in these patients included gemcitabine, carboplatin, and paclitaxel. Radiation was very limited in the treatment of the disease.

Downstream consequences of disclosing defaults: influences on perceptions of choice architects and subsequent behavior

ABSTRACT Transparency is a key factor in determining the permissibility of behavior change interventions. Nudges are at times considered manipulative from failing this condition. Ethicists suggest that making nudges transparent by disclosing them to decision makers is a way to mitigate the manipulation objection, but questions remain as to what downstream consequences disclosing decision makers of a nudge may cause. In this registered report, we investigated two such consequences: (1) whether disclosure affects perceptions of the choice architect and (2) whether disclosure influences subsequent behavior. To these ends, we present data from three pilot studies and two main experiments (total N = 2177). In both experiments, we used defaults to nudge participants towards prosocial behaviors with real consequences. Experiment 1 employed a mixed design examining changes in perceptions of the choice architect for participants presented with a nudge disclosure before or after choosing. Experiment 2 extended by investigating the effects of disclosure on the default effect, perceptions of the choice architect, and on a subsequent prosocial choice task. Results showed that (1) when presented before choosing the nudge disclosure did not influence perceptions of the choice architect. However, when presented after, perceptions deteriorated. (2) The disclosure, regardless of when presented, had no effect on participants’ behavior in a subsequent non-nudged choice. Additionally, the disclosure did not affect the nudge’s influence on the initial choice. We conclude that lack of transparency can hurt choice architects’ reputation and discuss under what circumstances this may materialize behaviorally. Materials, data, and code are available at osf.io/463af/.

Frequency of Isolation and Antibiotic Susceptibility of Micro-Organisms Causing Urinary Tract Infections in Children

Objective: To determine the frequency of urinary tract infections and the spectrum of microorganisms causing UTI and their antibiotics susceptibility pattern in children age between 1 month and 12 years. Patients and Methods: In this cross-sectional study, 131 patients of suspected UTI, from the department of pediatric medicine were included, from June-2020 to Nov-2020. 5 milliliters of urine sample were collected and sent to the hospital laboratory for determination of UTI. If UTI was confirmed, samples were further processed to determine the pattern of organisms causing UTI and their antibiotic spectrum. Results: Mean age of the patients included in this study was 6.07±256 years. There were 75 (57.25%) male patients, and 56 (42.75%) female patients. Urinary tract infections were diagnosed in 30 (22.90%) patients. E. coli diagnosed in 14 (46.67%) patients. Resistant strains were diagnosed in 3 (10%) patients. Regarding antibiotic sensitivity, 3rd generation cephalosporins and carbapenems were sensitive to many organisms. Conclusion: E. coli is the predominant uropathogen causing UTIs in children. Third generation cephalosporins are optimal initial choice for management of UTI in children. Keywords: urinary tract infections, causating micro-organisms, antibiotic sensitivity

Why do micro and small merchants use mobile payment systems? A grounded theory study in China

PurposeThis study aims to reveal the decision-making process that micro and small merchants (MSMs) may go through when deciding on the mobile payment system (MPS) adoption and usage and explore how relevant factors may impact this process.Design/methodology/approachThis paper uses the grounded theory approach. Specifically, this paper conducts individual, semi-structured interviews with MSMs in China. Each interview was focused on an MSM’s decisions on initial adoption and continued use of MPSs. The paper then coded the interviews to derive conceptual categories and integrated the categories to form a cohesive framework to explain how MSMs make decisions on MPS adoption and usage.FindingsMSMs make decisions on MPS adoption and usage in three phases: first, due to variations in social and economic surroundings, some merchants develop intentions to adopt MPSs, whereas others do not. Second, merchants developing adoption intentions in phase one have to select which MPS brands to adopt and then begin using them. The brand value affects their selection. Finally, the use of MPSs of their initial choice has consequences for business operations. Merchants with different levels of personal innovativeness evaluate the consequences differently. Satisfied merchants continue using the initial MPSs, while dissatisfied merchants switch to other brands.Originality/valueThe findings first give a more complete depiction of how MSMs make MPS adoption and usage decisions; second show that MSMs’ MPS adoption intention is solely influenced by pro-mobile-payment surroundings and explain what constitutes pro-mobile-payment surroundings and through what mechanisms the surroundings influence adoption intentions; third reveals that selecting which MPS brand to adopt is an important decision phase; fourth explain both why merchants may continue using MPSs and why they may switch from one MPS brand to another.

Who reads customer reviews after product choice? Maximizing, satisficing, and postchoice information search

Not every consumer wants to read customer reviews after making a purchase. The present research examines whether consumers' individual differences in decision-making styles, namely maximizing and satisficing, can affect the extent to which consumers seek additional information such as customer reviews as well as the valence of such information after making a product choice. Findings from two studies show that maximizers exhibit a greater tendency to engage in postchoice information search than satisficers. Drawing upon the two-component model of maximization, the results also suggest that the maximization goal to choose the best is related to seeking additional information in favor of the initial choice (e.g., positive reviews) whereas the maximization strategy of alternative search is related to seeking further information both in favor of and against the initial choice (e.g., positive and negative reviews), which ultimately impacts consumers' choice satisfaction.

Smart City Technologies implemented in public transport in a post-COVID-19 pandemic scenario

With the global pandemic of COVID-19 completing one year, this paper intends to analyse the perceptions of public transport users about the implementation of smart city technologies. Two aspects were analysed, namely: the perception of safety regarding the use of surveillance technologies in the containment of the virus; and the perception of safety of the same technologies regarding data protection and privacy. After the identification and choice of initiatives in smart cities to be addressed, a questionnaire was prepared and made available online, in which 414 replies were considered for the final analysis, respecting the proportionality of the percentage of replies in each region to the respective population percentage. In general, technologies provide a great sense of security regarding the use of public transportation. However, they cause concern regarding data protection and privacy. From this result and with analyses in relation to the regulation of personal data, international experiences and the Brazilian reality were contrasted.

Does choice change preferences? An incentivized test of the mere choice effect

Widespread evidence from psychology and neuroscience documents that previous choices unconditionally increase the later desirability of chosen objects, even if those choices were uninformative. This is problematic for economists who use choice data to estimate latent preferences, demand functions, and social welfare. The evidence on this mere choice effect, however, exhibits serious shortcomings which prevent evaluating its possible relevance for economics. In this paper, we present a novel, parsimonious experimental design to test for the economic validity of the mere choice effect addressing these shortcomings. Our design uses well-defined, monetary lotteries, all decisions are incentivized, and we effectively randomize participants’ initial choices without relying on deception. Results from a large, pre-registered online experiment find no support for the mere choice effect. Our results challenge conventional wisdom outside economics. The mere choice effect does not seem to be a concern for economics, at least in the domain of decision making under risk.

Association of Vasopressor Choice with Clinical and Functional Outcomes Following Moderate to Severe Traumatic Brain Injury: A TRACK-TBI Study.

Early hypotension following moderate to severe traumatic brain injury (TBI) is associated with increased mortality and poor long-term outcomes. Current guidelines suggest the use of intravenous vasopressors to support blood pressure following TBI; however, guidelines do not specify vasopressor type, resulting in variation in clinical practice. Minimal data are available to guide clinicians on optimal early vasopressor choice to support blood pressure following TBI. Therefore, we conducted a multicenter study to examine initial vasopressor choice for the support of blood pressure following TBI and its association with clinical and functional outcomes after injury. We conducted a retrospective cohort study of patients enrolled in the transforming research and clinical knowledge in traumatic brain injury (TRACK-TBI) study, an 18-center prospective cohort study of patients with TBI evaluated in participating level I trauma centers. We examined adults with moderate to severe TBI (defined as Glasgow Coma Scale score < 13) who were admitted to the intensive care unit and received an intravenous vasopressor within 48h of admission. The primary exposure was initial vasopressor choice (phenylephrine versus norepinephrine), and the primary outcome was 6-month Glasgow Outcomes Scale Extended (GOSE), with the following secondary outcomes: length of hospital stay, length of intensive care unit stay, in-hospital mortality, new requirement for dialysis, and 6-month Disability Rating Scale. Regression analysis was used to assess differences in outcomes between patients exposed to norepinephrine versus phenylephrine, with propensity weighting to address selection bias due to the nonrandom allocation of the treatment groups and patient dropout. The final study sample included 156 patients, of whom 79 (51%) received norepinephrine, 69 (44%) received phenylephrine, and 8 (5%) received an alternate drug as their initial vasopressor. 121 (77%) of patients were men, with a mean age of 43.1years. Of patients receiving norepinephrine as their initial vasopressor, 32% had a favorable outcome (GOSE 5-8), whereas 40% of patients receiving phenylephrine as their initial vasopressor had a favorable outcome. Compared with phenylephrine, exposure to norepinephrine was not significantly associated with improved 6-month GOSE (weighted odds ratio 1.40, 95% confidence interval 0.66-2.96, p = 0.37) or any secondary outcome. The majority of patients with moderate to severe TBI received either phenylephrine or norepinephrine as first-line agents for blood pressure support following brain injury. Initial choice of norepinephrine, compared with phenylephrine, was not associated with improved clinical or functional outcomes.

A methodological framework for the hydrological model selection process in water resource management projects

AbstractThis study aims to present a process for hydrological model exploration for selecting an appropriate model compatible with the modeling objectives. The process consists of three stages: (1) initial choice based on the modeling objectives; (2) model selection based on intercomparison among underlying conceptualizations of the models; and (3) final model selection based on influencing criteria such as availability of the model software and documentation, and availability of appropriate data. As an applied example, the process was used to find an appropriate model for a project to evaluate water supply and demand under climate and land use change scenarios in the Gorgan‐rud River Basin, Iran. The criteria affecting the final choice of a hydrological model were classified into three categories: (1) criteria related to the model, (2) criteria related to the model user, and (3) criteria related to the study area.

Modeling the motion of large vessels due to tsunami-induced currents

This paper describes a model developed to predict the general behavior of large vessels under energetic tsunami conditions using established regional-scale tsunami models. The methodology is based on a two-way coupled approach to account for the interaction between vessels and flow, which becomes increasingly important in restricted waters. A shallow water hydrodynamic solver is modified to include vessels as horizontal pressure distributions, and friction coefficients are adjusted accordingly at the locations of vessels to account for the effects of skin friction. Adequacy of these modifications are then tested against a benchmark case designed in OpenFOAM®, and comparisons demonstrate the modified shallow water solver's ability to provide a reasonable realization for energetic flow passing a floating object. A vessel transport model coupled with the hydrodynamic solver is based on the linear equations of ship motion with three degrees of freedom (surge, sway and the yaw). Finally, the model is equipped with a collision solver founded on the concept of the conservation of momentum and impulse. Results from two large scale applications of the developed tool are presented. These analyses revealed that the flow in and around the ports is indeed strongly affected by the presence of vessels. Also, it is observed that the model can approximate the ship's behavior, but at the same time the model results are very sensitive to the initial choice of the input parameters due to the chaotic nature of the process.

Fair income tax with endogenous productivities and a fresh start

This paper considers a model in which agents have heterogeneous preferences over labour and consumption. Additionally, they also differ in their earning skills, which are a function of both an innate ability and an early investment decision. In this framework we axiomatically derive a social ordering function that, besides compensating agents for their unequal productivities, grants a fresh start to those who regret their initial choices. Next, by assuming a second-best context we characterise the income tax scheme that satisfies this social ordering. This analysis permits us to present an explicit criterion for the assessment of social welfare under different tax policies. We obtain that the optimal scheme aims to compensate those endowed with the lowest marginal productivity. More importantly, on account of the forgiveness ideal positive social marginal weights are assigned to those who earn the lowest income levels, something that induces a progressivity tendency at the bottom of the earnings distribution.

Treatment Algorithm for Managing Chronic Hepatitis B Virus Infection in the United States: 2021 Update

Chronic hepatitis B (CHB) infection remains the most frequent etiology of hepatocellular carcinoma globally as well as a major cause of cirrhosis. Despite vaccination, substantial numbers of persons have already been infected with hepatitis B virus and remain at risk of progressive liver disease. In 2004, a CHB management algorithm was developed by a panel of North American hepatologists, which was subsequently updated in 2006, 2008, and 2015. Since the most recent version, several developments have altered the management of CHB. Tenofovir alafenamide, with a more favorable safety profile than tenofovir disoproxil fumarate, has been introduced as an initial antiviral choice as well as an alternative for long-term therapy. Quantitation of hepatitis B surface antigen is becoming more widely available in clinical practice, with implications for monitoring response to treatment. Additionally, there has been a shift in howthe natural history of CHB is perceived, as newer evidence has challenged the concept that during the immunotolerant phase of infection disease progression is not a concern. Finally, recent analyses indicate that in the United States, the average age of patients with CHB has increased, implying that the presence of comorbidities, including metabolic liver disease, increasing use of biologics associated with aging will increasingly affect disease management. This updated algorithm is intended to serve as a guide to manage CHB while new antiviral strategies are developed. Recommendations have been based on evidence from the scientific literature, when possible, as well as clinical experience and consensus expert opinion. Points of continued debate and areas of research need are also described.

QED driven QAOA for network-flow optimization

We present a general framework for modifying quantum approximate optimization algorithms (QAOA) to solve constrained network flow problems. By exploiting an analogy between flow-constraints and Gauss' law for electromagnetism, we design lattice quantum electrodynamics (QED)- inspired mixing Hamiltonians that preserve flow constraints throughout the QAOA process. This results in an exponential reduction in the size of the configuration space that needs to be explored, which we show through numerical simulations, yields higher quality approximate solutions compared to the original QAOA routine. We outline a specific implementation for edge-disjoint path (EDP) problems related to traffic congestion minimization, numerically analyze the effect of initial state choice, and explore trade-offs between circuit complexity and qubit resources via a particle-vortex duality mapping. Comparing the effect of initial states reveals that starting with an ergodic (unbiased) superposition of solutions yields better performance than beginning with the mixer ground-state, suggesting a departure from the ``short-cut to adiabaticity" mechanism often used to motivate QAOA.

Apprendimento a distanza all’università nel periodo del Covid19 e confronto con la modalità F2F: percezioni di studenti e studentesse

The pandemic caused by Covid19 has imposed on educational and training systems the provision of teaching only at a distance, disregarding the initial choices of students who had chosen their favourite way for following the training courses. In this perspective, this study wanted to explore the differences perceived by students between distance learning and face-to-face teaching (F2F), as well as the perceived effectiveness of the distance learning teaching experienced. The qualitative approach of the study required the preparation of a semi-structured interview addressed to 10 students of a master’s degree course at the University of Padova, at the end of a semester of completely remote teaching. The results revealed that, even if the majority of students prefers F2F teaching to satisfy a need for socialization and everyday life, the effectiveness of teaching depends very much on the teaching method and on the level of interaction promoted within the learning community regardless of the way to provide didactics.

Poor clinical outcomes associated with suboptimal antibiotic treatment among older long-term care facility residents with urinary tract infection: a retrospective cohort study

BackgroundAntibiotic use is associated with several antibiotic-related harms in vulnerable, older long-term care (LTC) residents. Suboptimal antibiotic use may also be associated with harms but has not yet been investigated. The aim of this work was to compare rates of poor clinical outcomes among LTC residents with UTI receiving suboptimal versus optimal antibiotic treatment.MethodsWe conducted a retrospective cohort study among residents with an incident urinary tract infection (UTI) treated in Veterans Affairs LTC units (2013–2018). Potentially suboptimal antibiotic treatment was defined as use of a suboptimal initial antibiotic drug choice, dose frequency, and/or excessive treatment duration. The primary outcome was time to a composite measure of poor clinical outcome, defined as UTI recurrence, acute care hospitalization/emergency department visit, adverse drug event, Clostridioides difficile infection (CDI), or death within 30 days of antibiotic discontinuation. Shared frailty Cox proportional hazard regression models were used to compare the time-to-event between suboptimal and optimal treatment.ResultsAmong 19,701 LTC residents with an incident UTI, 64.6% received potentially suboptimal antibiotic treatment and 35.4% experienced a poor clinical outcome. In adjusted analyses, potentially suboptimal antibiotic treatment was associated with a small increased hazard of poor clinical outcome (aHR 1.06, 95% CI 1.01–1.11) as compared with optimal treatment, driven by an increased hazard of CDI (aHR 1.94, 95% CI 1.54–2.44).ConclusionIn this national cohort study, suboptimal antibiotic treatment was associated with a 6% increased risk of the composite measure of poor clinical outcomes, in particular, a 94% increased risk of CDI. Beyond the decision to use antibiotics, clinicians should also consider the potential harms of suboptimal treatment choices with regards to drug type, dose frequency, and duration used.

High rates of therapeutic changes in patients with psoriatic arthritis receiving treatment with disease-modifying antirheumatic drugs: A cross-sectional study

Objectives To characterize treatment patterns for patients with psoriatic arthritis (PsA) currently receiving any disease-modifying antirheumatic drug (DMARD). Methods The Strategy for Psoriatic Arthritis In Germany (SPAIG) study was a retrospective observational study conducted from May to November 2017 at 46 rheumatology centers. Current and previous treatment data were collected at a single visit from adult patients with PsA and psoriasis who received DMARD treatment for ≥6 of the previous 12 months. The primary outcome was the proportion of patients receiving a biologic DMARD (bDMARD). Multinomial logistic regression analysis was used to evaluate associations between current characteristics and initial choice of therapy. Results Mean age of the 316 patients was 55.1 years and mean PsA disease duration was 9.9 years. PsA activity was generally comparable across treatment groups. In this cohort, 57.3% of patients were currently treated with bDMARDs, 37.7% with conventional synthetic DMARDs, and 4.4% with targeted synthetic DMARDs. Almost half (48.4%) of patients reported DMARD modifications in the previous 12 months. Specific comorbidities and patient/disease characteristics were associated with initial therapy. Conclusion DMARD treatment of PsA is frequently modified, suggesting the need for more effective therapies and assessment tools.