Low Probability Research Articles

Glycaemia and ischaemia-reperfusion brain injury in patients with ischaemic stroke treated with mechanical thrombectomy (GLIAS-MT): an observational, unicentric, prospective study protocol

IntroductionPoststroke hyperglycaemia is an independent risk factor for poorer outcomes in patients treated with mechanical thrombectomy (MT) and is associated with a lower probability of functional recovery and higher mortality...

Bayesian multistate models for measuring invasive carp movement and evaluating telemetry array performance.

Understanding the movement patterns of an invasive species can be a powerful tool in designing effective management and control strategies. Here, we used a Bayesian multistate model to investigate the movement of two invasive carp species, silver carp (Hypophthalmichthys molitrix) and bighead carp (H. nobilis), using acoustic telemetry. The invaded portions of the Illinois and Des Plaines Rivers, USA, are a high priority management zone in the broader efforts to combat the spread of invasive carps from reaching the Laurentian Great Lakes. Our main objective was to characterize the rates of upstream and downstream movements by carps between river pools that are maintained by navigation lock and dam structures. However, we also aimed to evaluate the efficacy of the available telemetry infrastructure to monitor carp movements through this system. We found that, on a monthly basis, most individuals of both species remained within their current river pools: averaging 76.2% of silver carp and 75.5% of bighead carp. Conversely, a smaller proportion of silver carp, averaging 14.2%, and bighead carp, averaging 13.9%, moved to downstream river pools. Movements towards upstream pools were the least likely for both species, with silver carp at an average of 6.7% and bighead carp at 7.9%. The highest probabilities for upstream movements were for fish originating from the three most downstream river pools, where most of the population recruitment occurs. However, our evaluation of the telemetry array's effectiveness indicated low probability to detect fish in this portion of the river. We provide insights to enhance the placement and use of these monitoring tools, aiming to deepen our comprehension of these species' movement patterns in the system.

Spruce bark beetle phenological modelling and drought risk within framework of TANABBO II model

Global warming plays a major role in the disruption of forest ecosystems by bark beetle outbreaks. Decreasing precipitation and more frequent droughts create the conditions for water stress in trees. The Eurasian spruce bark beetle (Ips typographus L.) is more dangerous for Norway spruce (Picea abies (L.) Karst.) forests in Central Europe under these conditions, because even healthy trees under water stress have a lower probability of survival during massive spruce bark beetle outbreaks. This critical issue highlights the importance of targeted research and intervention strategies in affected regions; hence, this study has a focus on the Horní Planá region in Central Europe, which is managed by the Military Forests and Farms of the Czech Republic (VLS).The study presents the results of the drought risk assessment of the operational part of TANABBO II and its validation. TANABBO is a high spatial resolution risk assessment tool for spruce bark beetle infestation in Central European forests, incorporating 30 m spatial resolution and extensive meteorological data, which outperforms existing models in its ability to accurately predict bark beetle activity based on the PHENIPS phenological model. The operational part integrates environmental factors such as global radiation, temperature, precipitation and, in particular, water stress, which is assessed by using a transpiration deficit. The drought risk assessment included the calculation of Drought Indices (DI) and Cumulative Transpiration Deficit Indices (CTDI) on a daily basis, and the estimation of spruce bark beetle swarming time using the PHENIPS model. The risk assessment was validated by comparing it with the number of bark beetles caught in traps and the value of the drought index. Generalised additive models (GAM) were used for validation, with the most effective models incorporating the CTDI. The model with the highest predictive accuracy achieved an adjusted R-squared value of 0.478. The study highlights the critical role of high-resolution environmental data in understanding and managing bark beetle outbreaks, particularly in the context of climate change.

The impact of socioeconomic determinants on the access to care and survival in patients with spinal chordomas- a national cancer database analysis.

Chordomas are rare malignant neoplasms primarily treated surgically. Disparities related to race and socioeconomic status, may affect patient outcomes. This study aims to identify prognostic factors for access to care and survival in patients with spinal chordomas. The NCDB database was queried between the years 2004 and 2017. Kaplan-Meier curves were constructed to compare survival probabilities among different groups, based on race and socioeconomic determinents. 1769 patients were identified, with 87% being White, 5% Hispanic, 4% Black, and Asian each. The mean age was 61.3 years. Most patients received care at academic/research centers and lived in a large metropolitan area, with no difference between races. A significantly higher percentage of Black patients did not undergo surgery (p < 0.001), with no statistically significant difference in survival between races (p = 0.97). A higher survival probability was seen in patients with other government insurances (p < 0.0001), in higher income quartiles (p < 0.0001), in metropolitan areas (p = 0.023), and at an academic/research center (p < 0.0001). A lower survival probability was seen in patients who are uninsured, in rural areas, and at community cancer programs (p < 0.0001). This study highlights disparities in access to surgical intervention for patients with spinal chordomas, especially among Black individuals. It emphasizes the significant impact of insurance status and income on access to surgical care and highlights geographical and institutional variations in survival rates. Addressing socioeconomic differences is crucial for fostering equity in neurosurgical outcomes.

Comparing Quality, Costs, and Outcomes of VA and Community Primary Care for Patients with Diabetes.

The Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act expanded access to independent community providers outside the Veterans Health Administration (VA). Little is known how quality, costs, and outcomes of primary care received in the community compare to that of the VA. To compare quality, costs, and outcomes of community and VA-provided primary care for patients with diabetes over a 12-month episode. A cross-sectional study using VA administrative data and community care claims. Adjusted analyses were conducted using inverse probability weighted regression adjustment to balance patient characteristics. Veterans with diabetes receiving primary care in the VA or community. Quality measures included receipt of hemoglobin A1C tests, eye exams, microalbumin urine tests, and flu shots. Outcomes were measured by hospitalizations for an ambulatory care sensitive condition (ACSC). Costs were measured for VA and community outpatient care, inpatient care, and prescription drugs. There were 652,648 VA patients and 3650 community care patients. VA patients were less likely to be White, had shorter mean drive time to VA primary care, and were less likely to be rural than community care patients. In adjusted analyses, community care patients had significantly lower probability of receiving a hemoglobin A1C test, eye exam, microalbumin urine test, and flu shot compared to the VA group. There was no difference in probability of an ACSC hospitalization. Community care patients had higher mean total costs ($1741 [95% CI, $431, $3052]), driven by higher inpatient and prescription drug costs but lower emergency care costs than VA patients. Patients receiving community primary care had worse diabetes quality and higher costs than patients receiving VA primary care. There was no difference in health outcomes. Care provided by an integrated delivery system may have advantages in quality and value.

Group-based trajectory analysis of longitudinal employment patterns and predictors for adults with visual impairments

BACKGROUND: A substantial gap in employment rates has been documented between people with and without visual impairments, but most employment-related research for people with visual impairments has focused on employment at one time point. OBJECTIVE: The purpose of this study was to examine longitudinal employment trajectories by visual impairment and investigate factors associated with trajectories for people with visual impairments. METHODS: The data source was the 2014 Panel of the Survey of Income and Program Participation. Participants were 816 adults with visual impairments and a matched comparison group of 816 adults without visual impairments. We used group-based trajectory modeling to estimate employment trajectories, identify predictors of trajectory group membership, and explore the impact of health on employment trajectories. RESULTS: Visual impairment was associated with a lower probability of membership in the Rising, Declining, and High employment trajectory groups compared to the Low group. Predictors of trajectory group membership included disability benefit receipt, non-visual disabilities, gender, race, age, and education. Fair or poor health was associated with decreases in all four trajectories over time. CONCLUSION: Visual impairment is a risk factor for not working across multiple years. Disability benefit receipt was the strongest predictor of trajectory group membership for this population.

Monoclonal Anti-PCSK9 Antibodies: Real-World Data.

Background: Real-world data on the use of lipid-lowering therapy (LLT) in clinical practice show that about 80% of (very) high-cardiovascular (CV)-risk patients disregard the 2019 European Society of Cardiology (ESC) Guidelines' recommendations on dyslipidemias. The availability of proprotein convertase subtilisin/kexin type 9 monoclonal antibodies (PCSK9mAb) should reduce this gap. Our aim was to provide data on PCSK9mAb use in clinical practice, investigating the achievement of the ESC Guidelines' recommendations in the real world. Methods: Between April 2018 and December 2022, patients who started on PCSK9mAb therapy (140 mg of evolocumab or 75 mg or 150 mg of alirocumab, subcutaneous injection every 2 weeks) were included in a prospective registry. Our cohort consisted of 256 patients: 95 (37.1%) were women (mean age: 65.43 ± 11.12 yrs), 53 (20.7%) were at high CV risk, and 203 (79.3%) were at very high CV risk. Results: After one year of PCSK9mAb treatment, nearly 60% of patients demonstrated full adherence to the ESC Guidelines' recommendations, defined as achieving at least a 50% reduction in low-density lipoprotein cholesterol (LDL-C) levels along with reaching LDL-C target levels (≤55 and ≤70 mg/dL for very high and high risk, respectively). Concomitant high-dose statin therapy emerged as the primary predictor of LDL-C target attainment. Heterozygous familial hypercholesterolemia (HeFH), statin intolerance, and female gender were associated with a significant lower probability of achieving LDL-C target levels. Conclusions: Our analysis confirms that PCSK9mAb treatment is safe and effective, enabling 60% of our cohort to fully achieve the LDL-C guideline recommendations. The use of high-intensity statins emerged as a significant predictor of efficacy. Conversely, familial hypercholesterolemia and female gender were identified as predictors of therapeutic failure. Hence, it is crucial to address disparities in cardiovascular disease prevention between genders and to enhance strategies for managing elevated LDL-C in HeFH patients.

Integrated machine learning screened glutamine metabolism-associated biomarker SLC1A5 to predict immunotherapy response in hepatocellular carcinoma

Hepatocellular carcinoma (HCC) stands as one of the most prevalent malignancies. While PD-1 immune checkpoint inhibitors have demonstrated promising therapeutic efficacy in HCC, not all patients exhibit a favorable response to these treatments. Glutamine is a crucial immune cell regulatory factor, and tumor cells exhibit glutamine dependence. In this study, HCC patients were divided into two subtypes (C1 and C2) based on glutamine metabolism-related genes via consensus clustering. The C1 pattern, in contrast to C2, was associated with a lower survival probability among HCC patients. Additionally, the C1 pattern exhibited higher proportions of patients with advanced tumor stages. The activity of C1 in glutamine metabolism and transport is significantly enhanced, while its oxidative phosphorylation activity is reduced. And, C1 was mainly involved in the progression-related pathway of HCC. Furthermore, C1 exhibited high levels of immunosuppressive cells, cytokine-receptor interactions and immune checkpoint genes, suggesting C1 as an immunosuppressive subtype. After stepwise selection based on integrated four machine learning methods, SLC1A5 was finally identified as the pivotal gene that distinguishes the subtypes. The expression of SLC1A5 was significantly positively correlated with immunosuppressive status. SLC1A5 showed the most significant correlation with macrophage infiltration, and this correlation was confirmed through the RNA-seq data of CLCA project and our cohort. Low-SLC1A5-expression samples had better immunogenicity and responsiveness to immunotherapy. As expected, SubMap and survival analysis indicated that individuals with low SLC1A5 expression were more responsive to anti-PD1 therapy. Collectively, this study categorized HCC patients based on glutamine metabolism-related genes and proposed two subclasses with different clinical traits, biological behavior, and immune status. Machine learning was utilized to identify the hub gene SLC1A5 for HCC classification, which also could predict immunotherapy response.

A multicenter cross-sectional study in China revealing the intrinsic relationship between medical students’ grade and their perceptions of the learning environment

BackgroundMedical school learning environment (MSLE) has a holistic impact on students’ psychosomatic health, academic achievements, and personal development. Students in different grades perceive MSLE in different ways. Thus, it is essential to investigate the specific role of student’s grade in the perception of MSLE.MethodsUsing the Johns Hopkins Learning Environment Scale (JHLES) as a quantification instrument for the perception level of MSLE, 10,901 medical students in 12 universities in China were categorized into low or high JHLES group according to their questionnaires. We investigated the relationship between student’s grade and JHLES category by univariate analysis employing Pearson Chi-square test and Welch’s ANOVA. Then multivariable logistic regression analysis confirmed the predictive efficacy of student’s grade. A nomogram concerning the prediction of low JHLES score probability in medical students was also constructed.ResultsA significant difference between two JHLES categories among students in different grades was observed (p < 0.001), with the proportion of the high JHLES group dominating in grade 1, 5, and the graduate subgroups (p < 0.001). The mean JHLES score declined especially in the third and fourth graders compared to freshmen (p < 0.001), while the mean score among the fifth graders had a remarkable rebound from the third graders (p < 0.001). Most imperatively, identified by multivariable logistic regression analysis, students in grade 3 (OR = 1.470, 95% CI = 1.265–1.709, p < 0.001) and 4 (OR = 1.578, 95% CI = 1.326–1.878, p < 0.001) perceived more negatively than freshmen. The constructed nomogram provided a promising prediction model for student’s low JHLES score probability, with accuracy, accordance, and discrimination (area under the curve (AUC) = 0.627).ConclusionThe student’s grade was a significant influencing factor in medical students’ perception of MSLE. The perceptions among the third and fourth graders got worse, probably due to the worrying changes in various aspects of MSLE during that period. The relevant and appropriate interventions to improve medical students’ perceptions are urgently needed.

Fish with slow life-history cope better with chronic manganese exposure than fish with fast life-history.

Animals with different life-history types vary in their stress-coping styles, which can affect their fitness and survival in changing environments. We studied how chronic exposure to manganese sulfate (MnSO4), a common aquatic pollutant, affects life-history traits, physiology, and behavior of zebrafish (Danio rerio) with two life-history types: fast (previously selected for fast juvenile growth, early maturation, and small adult body size) and slow life histories (selected for slow juvenile growth, late maturation, and large adult body size). We found that MnSO4 had negative effects on growth and condition factors, but the magnitude of these effects depended on the life-history type. Individuals with fast life histories were more susceptible to MnSO4 than fish with slow life histories as they had lower growth rate, condition factor and feeding probability in high MnSO4 concentrations. Our results demonstrate that MnSO4 can impair fish performance, and life-history variation can modulate the stress-coping ability of individuals.

A study of a loss system with priorities

The Erlang loss formula, also known as the Erlang B formula, has been known for over a century and has been used in a wide range of applications, from telephony to hospital intensive care unit management. It provides the blocking probability of arriving customers to a loss system involving a finite number of servers without a waiting room. Because of the need to introduce priorities in many services, an extension of the Erlang B formula to the case of a loss system with preemptive priority is valuable and essential. This paper analytically establishes the consistency between the global balance (steady state) equations for a loss system with preemptive priorities and a known result obtained using traffic loss arguments for the same problem. This paper, for the first time, derives this known result directly from the global balance equations based on the relevant multidimensional Markov chain. The paper also addresses the question of whether or not the well-known insensitivity property of the Erlang loss system is also applicable to the case of a loss system with preemptive priorities, provides explanations, and demonstrates through simulations that, except for the blocking probability of the highest priority customers, the blocking probabilities of the other customers are sensitive to the service time distributions and that a larger service time variance leads to a lower blocking probability of the lower priority traffic.

Low Probability of Intercept/Detect (LPI/LPD) Secure Communications Using Antenna Arrays Employing Rapid Sidelobe Time Modulation

Low Probability of Intercept/Detect (LPI/LPD) Secure Communications Using Antenna Arrays Employing Rapid Sidelobe Time Modulation

Enhancing experimental design through Bayes factor design analysis: insights from multi-armed bandit tasks

Bayesian statistics are popular in human cognitive neuroscience research because they can incorporate prior knowledge. Although well established for retrospective analysis, the application of Bayesian methods to prospective analysis is less well developed, especially when used in combination with computational model-based analysis of behavioural data. It is therefore important to establish effective methods for testing and optimising experimental designs for these purposes. One potential framework for a prospective approach is Bayes factor design analysis (BFDA), which can be used alongside latent variable modelling to evaluate and visualise the distribution of Bayes factors for a given experimental design. This paper provides a tutorial-style analysis combining BFDA with latent variable modelling to evaluate exploration-exploitation trade-offs in the binary multi-armed bandit task (MAB). This is a particularly tricky example of human decision-making with which to investigate the feasibility of differentiating latent variables between groups as a function of different design parameters. We examined how sample size, number of games per participant and effect size affect the strength of evidence supporting a difference in means between two groups. To further assess how these parameters affect experimental results, metrics of error were evaluated. Using simulations, we demonstrated how BFDA can be combined with latent variable modelling to evaluate and optimise parameter estimation of exploration in the MAB task, allowing effective inference of the mean degree of random exploration in a population, as well as between groups. However, BFDA indicated that, even with large samples and effect sizes, there may be some circumstances where there is a high likelihood of errors and a low probability of detecting evidence in favour of a difference when comparing random exploration between two groups performing the bandit task. In summary, we show how BFDA can prospectively inform design and power of human behavioural tasks.

Trends, outcomes, and complications of surgery for lesional epilepsy in infants and toddlers: A multicenter study.

To assess seizure and developmental outcomes, their predictors, and complications in 160 children who, between 1998 and 2022, underwent surgery for lesional epilepsy with curative intent before the age of 3 years. To compare trends in epilepsy surgery in this age group before and after the year 2014. Retrospective multicenter study. Descriptive and univariate analyses, and multivariable models for all outcomes. These 160 patients (76 F; 47.5%) underwent 169 surgeries (age at surgery 20.4 ± 9.4 months). At the last follow-up (77 ± 57.4 months), 121 patients (75.6%) were in Engel class I, 106 (66.2%) of whom were in Engel class Ia. Antiseizure medications were stopped in 84 patients (52.5%). Complications requiring reoperations were observed in 16 patients (10%; 9.5% of surgeries) and unexpected permanent deficits in 12 (7.5%; 7.1% of surgeries). Postoperative cognitive functions remained unchanged in 56 patients (44.4%), improved in 51 (40.5%), and worsened in 19 (15.1%). Multivariable analyses showed that the probability of achieving Engel class Ia was lower when the duration of epilepsy was longer, patients underwent preoperative video-EEG, and unexpected postoperative permanent deficits occurred. Cognitive improvement after surgery was associated with lower preoperative seizure frequency, better preoperative developmental level, and a longer postoperative follow-up. FCDII and tumors were the histopathologies carrying a higher probability of achieving seizure freedom, while polymicrogyria was associated with a lower probability of cognitive improvement. The number of patients operated on after 2014 was higher than before (61.3% vs. 38.7%), with stable outcomes. Epilepsy surgery is effective and safe in infants and toddlers, although the complication rate is higher than seen in older patients. Shorter duration of epilepsy, lower seizure frequency, no need for video-EEG, tumors, and some malformations of cortical development are robust predictors of seizure and cognitive outcome that may be exploited to increase earlier referral. This study analyzed the results of epilepsy surgery in 160 children who had been operated on before the age of 3 years at four Italian centers between 1998 and 2022. At the last follow-up (77 ± 57.4 months), 121 patients (75.6%) were free from disabling seizures, of which 106 (66.2%) were completely seizure-free since surgery. Major surgical complications occurred in 28 patients (17.5%), which is higher than observed with epilepsy surgery in general, but similar to hemispheric/multilobar surgery. Postoperative cognitive function remained unchanged in 56 patients (44.4%), improved in 51 (40.5%), and worsened in 19 (15.1%). Epilepsy surgery is effective and safe in infants and toddlers.

Neutrophil-to-Lymphocyte Ratio, Platelet-to-Lymphocyte Ratio, Systemic Immune Inflammation Index and Efficacy of Remote Ischemic Conditioning in Acute Ischemic Stroke: A Post Hoc Exploratory Analysis of the RICAMIS Study.

We conducted a post-hoc analysis of the RICAMIS trial to investigate the effect of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune inflammation index (SII) on the efficacy of remote ischemic conditioning treatment. In this post-hoc analysis, NLR, PLR, and SII were measured before randomization. Patients were divided into two groups based on their cut-off values: high vs low NLR, high vs low PLR, and high vs low SII groups. Each group was further subdivided into RIC and control groups. The primary endpoint was a poor outcome (mRS 2-6 at 90 days). Differences in the primary endpoint between the RIC and control subgroups were compared, and the interactions of treatment assignment with NLR, PLR, and SII were evaluated. A total of 1679 patients were included in the final analysis. Compared with the control group, RIC significantly improved functional outcomes regardless of the inflammation status. The improved probability of poor outcome in the RIC vs control group was numerically greater in the high vs low inflammation group (NLR, 7.8% vs 5.1%; PLR, 7% vs 6.5%; SII, 9% vs 5.3%). However, we did not find an interaction effect of an intervention (RIC or control) with different NLR, PLR, or SII on clinical outcomes (P > 0.05). In addition, the NLR and SII were independently associated with functional outcomes in all patients, regardless of whether they received RIC. Inflammation may not affect the efficacy of RIC in patients with acute moderate ischemic stroke, although a lower probability of poor outcome at 90 days was identified in patients with a high vs low inflammatory status.

My friends made me do it: Peer influences and different types of vaping in adolescence

Vaping is one of the most common forms of substance use among adolescents. Social influences play a key role in the decision to use substances and frequency of use during adolescence, and vaping is no exception. Using a sample of 891 adolescents across two time points (Mage = 15.1 and Mage = 17.2) in this pre-registered study, we explored whether the frequency of vaping nicotine and the frequency of vaping marijuana at age 17 were related to concurrent reports of resistance to peer influence (RPI), perceptions of friends vaping, and perceptions of classmates vaping. Then, we investigated whether resistance to peer influence reported at age 15 was similarly related to age 17 vaping of both substances. Higher RPI at both ages 15 and 17 was associated with a higher probability of abstaining from vaping both substances but was not related to the frequency of vaping among those who vaped. Perceiving that a higher proportion of friends − but not classmates − vaped was associated with a lower probability of abstaining and a greater frequency of vaping among those who vape (for both substances). Higher RPI had an attenuating effect on the relation between perceptions of vaping among peers and an adolescent’s own vaping behavior, but that differed by age and peer group (e.g., friends vs. classmates). Overestimation about the prevalence of classmate vaping may have played a role in the findings, but our results suggest that interventions to strengthen peer resistance across adolescence are warranted.

Statistically decreased weakening rate of typhoons in environments of the Northeast China cold vortex

The impact of the Northeast China Cold Vortex (NCCV) on tropical cyclone (TC) intensity change was studied based on statistics, revealing a significant decrease in the rate of TC weakening and a lower probability of rapid weakening (RW) in the environments of NCCVs. This is mainly attributable to the external dynamic forcing induced by the NCCV as the eddy angular momentum import at upper levels increases significantly, which offsets the unfavorable decrease in sea surface temperature and increase in vertical wind shear. The upper-level positive potential vorticity anomaly band from the NCCV involves into the TC circulation from the southwestern quadrant, helping the development of convections triggered in the downshear right side of the TC. These results elucidate a fundamental relationship between TCs and NCCVs, and the findings contribute to a deeper comprehension of TC behavior under the influence of NCCVs, thereby providing guidance for forecasting intensity changes of TCs entering mid-latitude regions.

Emotion regulation reduces victim blaming of vulnerable sex trafficking survivors.

This research applied emotion regulation to negative emotions felt toward a sex trafficking victim so that judgments were made to offer her services rather than to favor her arrest for prostitution. We predicted that participants would favor police not arresting a trafficking survivor for prostitution when she was vulnerable (Hypothesis 1) or she showed no sex work history (Hypothesis 2). We predicted a moderated mediation model (Hypothesis 3), in which emotion regulation training to reduce feelings of contempt, anger, and disgust (CAD) toward the survivor interacted with vulnerability and prior sex work such that the effects of the latter two manipulations were the strongest in the successful emotion regulation conditions (i.e., cognitive reappraisal and cognitive reappraisal with motivation), with CAD emotions mediating those relationships. Participants (N = 421, 54% women, Mage = 42.63 years, 75% White) read a modified version of a sex trafficking case and decided whether the police should arrest the survivor for prostitution. Each participant was randomly assigned to one of 16 conditions in a 4 (emotion regulation: control vs. cognitive reappraisal vs. motivation vs. cognitive reappraisal plus motivation) × 2 (vulnerability: vulnerable background vs. nonvulnerable background) × 2 (prior prostitution history: engaged in prostitution before the trafficking incident vs. not engaged in prostitution before the incident) factorial design. Participants with cognitive reappraisal training, but not controls, who read about a vulnerable survivor were less likely to favor arrest. Moreover, those who trained with cognitive reappraisal plus motivation to decrease their CAD emotions, compared with the controls, showed weaker CAD feelings toward the vulnerable survivor, which in turn predicted a lower probability of favoring arrest. Reducing CAD emotions through emotion regulation supported the impact of emotions on culpability judgments and showed how emotion regulation can be used to support a victim-centered approach to fighting sex trafficking. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Reference-dependent discounting

Reference-dependence has become a widely established phenomenon in decision making under risk, not only for monetary outcomes but also for other outcomes, e.g., related to health. However, when the prospects involve risk about timing (the time of receipt of outcomes), rather than the outcomes themselves, much less is known about reference-dependence. This study extends discounted utility to incorporate reference-dependence and is the first to test it in timing prospects. We are also the first to estimate the probability weighting function for timing prospects. For both timing and outcome risk tasks, we replicate the typical fourfold pattern of risk attitudes: risk seeking for low-probability gains, risk aversion for high-probability gains, risk aversion for low-probability losses and risk seeking for high-probability losses. In other words, we find substantial pessimism with regard to high probabilities in the gain domain and low probabilities in the loss domain, and probabilistic optimism for low probabilities in the gain domain and high probabilities in the loss domain. Furthermore, we report loss aversion for outcome risks, while for timing risks, we find the opposite result, which we term earliness seeking. In sum, we find substantial empirical support for reference-dependent discounting. Our results show that psychological biases are also important when timing is risky, although the direction of bias may differ.

Interpretation of results of PCR and B-D-glucan for the diagnosis of Pneumocystis Jirovecii Pneumonia in immunocompromised adults with acute respiratory failure

BackgroundThe accuracy of a diagnostic test depends on its intrinsic characteristics and the disease incidence. This study aims to depict post-test probability of Pneumocystis pneumonia (PJP), according to results of PCR and Beta-D-Glucan (BDG) tests in patients with acute respiratory failure (ARF).Materials and methodsDiagnostic performance of PCR and BDG was extracted from literature. Incidence of Pneumocystis pneumonia was assessed in a dataset of 2243 non-HIV immunocompromised patients with ARF. Incidence of Pneumocystis pneumonia was simulated assuming a normal distribution in 5000 random incidence samples. Post-test probability was assessed using Bayes theorem.ResultsIncidence of PJP in non-HIV ARF patients was 4.1% (95%CI 3.3-5). Supervised classification identified 4 subgroups of interest with incidence ranging from 2.0% (No ground glass opacities; 95%CI 1.4–2.8) to 20.2% (hematopoietic cell transplantation, ground glass opacities and no PJP prophylaxis; 95%CI 14.1–27.7). In the overall population, positive post-test probability was 32.9% (95%CI 31.1–34.8) and 22.8% (95%CI 21.5–24.3) for PCR and BDG, respectively. Negative post-test probability of being infected was 0.10% (95%CI 0.09–0.11) and 0.23% (95%CI 0.21–0.25) for PCR and BDG, respectively. In the highest risk subgroup, positive predictive value was 74.5% (95%CI 72.0-76.7) and 63.8% (95%CI 60.8–65.8) for PCR and BDG, respectively.ConclusionAlthough both tests yield a high intrinsic performance, the low incidence of PJP in this cohort resulted in a low positive post-test probability. We propose a method to illustrate pre and post-test probability relationship that may improve clinician perception of diagnostic test performance according to disease incidence in predefined clinical settings.