Uncertain Outcome Research Articles

Aversion, interpretation and determinability: Three factors of uncertainty that may play a role in psychopathology.

This opinion piece considers the construct of tolerance of uncertainty and suggests that it should be viewed in the context of three psychological factors: uncertainty aversion, uncertainty interpretation, and uncertainty determinability. Uncertainty aversion refers to a dislike of situations in which the outcomes are not deterministic and is similar to conventional conceptions of (in)tolerance of uncertainty. Uncertainty interpretation refers to the extent to which variability in an observed outcome is interpreted as random fluctuation around a relatively stable base-rate versus frequent and rapid changes in the base-rate. Uncertainty determinability refers to the (actual or perceived) capacity of the individual to generate any meaningful expectancy of the uncertain outcome, which may be undeterminable if predictions are updated too quickly. We argue that uncertainty interpretation and determinability are psychological responses to the experience of probabilistic events that vary among individuals and can moderate negative affect experienced in response to uncertainty. We describe how individual differences in basic parameters of associative learning (modelled by a simple learning window) could lead to this variation. To explain these hypotheses, we utilise the distinction between aleatory uncertainty (the inherent unpredictability of individual stochastic events) and epistemic uncertainty (obtainable knowledge that the individual lacks or perceives to be lacking). We argue that when expectancies are updated quickly, epistemic uncertainty will dominate the individual's representation of the events around them, leading to a subjective experience of the world as one that is volatile and unpredictable.

Renewable Energy Transition Facilitated by Bitcoin

Reduction of greenhouse gas emissions has been a top priority for activists, scientists, and policy makers across the globe, and it is one of the main drivers for the transition to renewable energy generation. Bitcoin is a decentralized global transaction network of an eponymous digital currency. It has been praised for its openness, decentralization, and censorship resistance, as well as criticized for its inefficiency, criminal use, and enormous electricity consumption. We discuss the challenges in the renewable energy transition, properties of the bitcoin network, and the role of bitcoin mining operations in the global energy production and consumption. Although the adoption path for bitcoin is likely to be volatile with an uncertain outcome, the opportunities offered by bitcoin mining in reduction of the greenhouse gas emissions and renewable energy transition are greater than generally assumed.

Anthropocène et action politique : l’émergence d’un nouveau temps baroque

The Anthropocene, as a geological and biological fact, is a baroque moment insofar as it is the meeting with an uncertain outcome between two irreconcilable truths. The truth hitherto considered as such, classic, is put in doubt by another truth, without this one being able to impose itself. The awareness of this confrontation, irreconcilable for the moment, favors in the human species a spectacular and rhetorical political action, that is to say baroque.

Implementation of Virtual Fontan Heart Camps During a Pandemic.

Children with a Fontan operation represent a unique form of congenital heart disease (CHD) that requires multiple cardiac surgeries and procedures with an uncertain long-term outcome. Given the rarity of the types of CHD that require this procedure, many children with a Fontan do not know any others like them. With the cancelation of medically supervised heart camps due to the COVID-19 pandemic, we have organized several physician-led virtual day camps for children with a Fontan operation to connect with others in their province and across Canada. The aim of this study was to describe the implementation and evaluation of these camps via the use of an anonymous online survey immediately after the event and reminders on days 2 and 4 postevent. Fifty-one children have participated in at least 1 of our camps. Registration data showed that 70% of participants did not know anyone else with a Fontan. Postcamp evaluations showed that 86% to 94% learned something new about their heart and 95% to 100% felt more connected to other children like them. We have demonstrated the implementation of a virtual heart camp to expand the support network for children with a Fontan. These experiences may help to promote healthy psychosocial adjustments through inclusion and relatedness.

Systematic review regarding treatment of tibial tuberosity avulsion fractures in young dogs

Tibial tuberosity avulsion fractures represent a small proportion of proximal tibial fractures in dogs. We distinguish between different types of this trauma. This disease is commonly encountered in young and skeletally immature animals. In the past, dogs with tibial tuberosity avulsion fractures were not treated, which resulted in chronic lameness. At present, various therapeutic methods are available for managing this disease. The aim of this article was to present the therapeutic protocols for managing tibial tuberosity avulsion fractures in dogs. The present article reviews the data regarding the treatment of tibial tuberosity avulsion fractures in dogs. Many veterinarians are reluctant to use conservative methods in the treatment of tibial tuberosity avulsion fractures due to the uncertain outcome and possible fracture progression. There are many surgical treatment options, but Kirschner wires with a tension band are the surgical method of choice for managing the problem. This article also contains a detailed description of the surgical procedure with the recommended method. The manuscript additionally touches on rehabilitation and conservative treatment of tibial tuberosity avulsion fractures.

SARS-CoV-2 Virus-like Particles (VLPs) Specifically Detect Humoral Immune Reactions in an ELISA-Based Platform.

A key in controlling the SARS-CoV-2 pandemic is the assessment of the immune status of the population. We explored the utility of SARS-CoV-2 virus-like particles (VLPs) as antigens to detect specific humoral immune reactions in an enzyme-linked immunosorbent assay (ELISA). For this purpose, SARS-CoV-2 VLPs were produced from an engineered cell line and characterized by Western blot, ELISA, and nanoparticle tracking analysis. Subsequently, we collected 42 serum samples from before the pandemic (2014), 89 samples from healthy subjects, and 38 samples from vaccinated subjects. Seventeen samples were collected less than three weeks after infection, and forty-four samples more than three weeks after infection. All serum samples were characterized for their reactivity with VLPs and the SARS-CoV-2 N- and S-protein. Finally, we compared the performance of the VLP-based ELISA with a certified in vitro diagnostic device (IVD). In the applied set of samples, we determined a sensitivity of 95.5% and a specificity of 100% for the certified IVD. There were seven samples with an uncertain outcome. Our VLP-ELISA demonstrated a superior performance, with a sensitivity of 97.5%, a specificity of 100%, and only three uncertain outcomes. This result warrants further research to develop a certified IVD based on SARS-CoV-2 VLPs as an antigen.

ОСОБЕННОСТИ РАСЩЕПЛЕНИЯ АЛЬВЕОЛЯРНОГО ГРЕБНЯ ПРИ ОДНОМОМЕНТНОЙ ИМПЛАНТАЦИИ (клинический случай)

The widespread use of dental implants for the restoration of missing teeth has expanded the possibilities of treatment for both patients and dentists. After tooth extraction, the jaw bones decrease significantly in volume over time (atrophy). During the first year, 25% of bone tissue is lost in the area of the removed tooth, and in the next 2–3 years, bone tissue is reduced by 50% of the original volume. After the implants are installed, the loss of bone tissue stops. The increasing use of implants also necessitates both new studies of implant designs, materials, and technologies for the use of dental implants. Such research has increased dramatically over the past two decades and is expected to expand. The scientific literature we have studied shows that the success of dental implants largely depends on the quality and quantity of available bone in the recipient site. However, this may be disrupted or unavailable due to bone diseases, trauma, periodontal disease, etc., which, in turn, requires additional manipulations with the bone.
 Subject. Professional and psychological capabilities of a doctor to work effectively in a situation of uncertain outcome of a surgical operation.
 The relevance of this study is due to the need to prevent complications of implantation surgery in the professional activity of a dentist-surgeon in conditions of insufficient thickness of the alveolar process. The need for this study was also dictated by the needs of patients using implantological systems in maintaining the quality of life.
 The aim is to study the installation and preservation of the implant with insufficient thickness of the alveolar process.
 Methodology. A retrospective study of patients with insufficient thickness of the alveolar process who underwent implantation treatment was conducted. Patients were included in the study if they had one or more implants without clinical signs of implant mobility.
 Results. The patient was treated with surgical tactics with insufficient thickness of the alveolar process; antibacterial therapy; chemical decontamination and the imposition of an allogeneic graft.
 Conclusions. Bone expansion using a piezoscalpel is a reliable and relatively safe way to expand narrow ridges. The method of expansion of the bone ridge allows to obtain the optimal thickness of the bone for implantation of the implant. The expansion of atrophic rollers with the use of piezoscalpel is a technique that does not require bone collection, reducing the time of surgery and postoperative morbidity, which leads to a reduction in the duration of rehabilitation.

DUKUNGAN SUAMI BERPENGARUH TERHADAP TINGKAT KECEMASAN IBU HAMIL TRIMESTER III

Anxiety is a feeling of restlessness, nervousness or anxiety about something with uncertain outcome that may accompany, influence or cause depression. Anxiety will have a negative impact on pregnant women starting from pregnancy, childbirth and the fetus. At the time of delivery can cause weakened uterine contractions, in the fetus can cause growth retardation. These effects can be harmful to both mother and fetus. This is due to poor family support for pregnant women, one of which is the husband. It is necessary to have husband's assistance in dealing with childbirth to overcome anxiety in the third trimester. With the husband's assistance given to the mother-to-be, the mother feels calmer and has a strong mentality to face childbirth. This study aims to determine the effect of husband's support on anxiety levels in third trimester pregnant women. The research method used is quantitative using a cross sectional design with a population of 106 pregnant women and a sample of 84 respondents. The results showed that the respondents who had insufficient family support were 22 (26.2%) and experienced anxiety disorders as many as 20 respondents, pregnant women who had sufficient family support were 39 (46.4%) respondents and experienced anxiety disorders as many as 38 respondents, while respondents who have good family support are 23 respondents (27.4%) and have anxiety disorders as many as 19 respondents with p value <0.05, which is 0.03. It can be concluded that husband's support can affect the third trimester pregnancy anxiety.

Decision-making about gene therapy in transfusion dependent thalassemia

BackgroundHematopoietic stem cell transplantation (HSCT) is a treatment option with curative intent for patients with transfusion dependent thalassemia (TDT) but its application is limited by the lack of suitable donors and acceptability due to the related morbidity/mortality. Transplantation of autologous genetically modified hematopoietic cells, gene therapy (GT) is emerging as a promising treatment option for TDT as it eliminates graft versus host disease (GVHD) and need for immunosuppression. Early results of GT suggest that many, but not all patients achieve transfusion independence after the procedure. There is little information about the acceptability of GT in patients with TDT. We sought to examine patient/family knowledge about GT in TDT and to examine factors that influence decision-making about this therapy.MethodsParents of children with TDT and adults with TDT were who provided informed consent underwent semi-structured interviews to understand patient/family knowledge and decision-making regarding GT in TDT. Transcribed interviews were coded and the data was examined for emerging themes using a combination of thematic and content analysis.ResultsTwenty-five study participants with mean age of 38Y (17—52Y) including eight adults living with TDT, and 17 parents of children with TDT underwent semi-structured qualitative interviews. Participant responses coalesced around broad themes related to knowledge of GT, motivating/deterring factors and outcomes. Study participants expressed a desire for ‘cure’ from thalassemia including transfusion independence, chelation reduction and improved quality of life as motivators for considering GT. Insufficient knowledge about the process, long-term outcomes, safety, and side effects as well as the potential for death/failure of the procedure were deterrents for the consideration GT. Reduction in frequency of transfusions, even without elimination of transfusions was an acceptable outcome of GT for most participants. Participant choice for preferred treatment modality was split between indefinitely continuing transfusions which was familiar to them versus GT which was unfamiliar, and with an uncertain outcome. None of the participants had a matched sibling donor; alternate donor HSCT was the least preferred option in this group.ConclusionThere is tempered excitement about GT in patients/families with TDT with a general willingness to accept transfusions reduction as the outcome.

Investigating how Explicit Contextual Cues Affect Predictive Sensorimotor Control in Autistic Adults

Research suggests that sensorimotor difficulties in autism could be reduced by providing individuals with explicit contextual information. To test this, we examined autistic visuomotor control during a virtual racquetball task, in which participants hit normal and unexpectedly-bouncy balls using a handheld controller. The probability of facing each type of ball was varied unpredictably over time. However, during cued trials, participants received explicit information about the likelihood of facing each uncertain outcome. When compared to neurotypical controls, autistic individuals displayed poorer task performance, atypical gaze profiles, and more restricted swing kinematics. These visuomotor patterns were not significantly affected by contextual cues, indicating that autistic people exhibit underlying differences in how prior information and environmental uncertainty are dynamically modulated during movement tasks.

Factors that influence owner consent for exploratory laparotomy in horses with colic in Australia and New Zealand.

Horse owners' motivators and barriers for consent to exploratory laparotomy are poorly understood. To (1) determine the proportion of Australian and New Zealand horse owners who would consent to exploratory laparotomy and (2) identify motivators and barriers for consent. Cross-sectional survey. A questionnaire was developed and distributed online. Descriptive statistics were calculated by tabulating respondents by their answers to whether they would consent to exploratory laparotomy. Univariate and multivariate analyses were used to identify variables associated with consenting to exploratory laparotomy. Two thousand two hundred horse owners participated with a 68.3% survey completion rate. Most were female (95.6%), and 18.7% stated they would consent to exploratory laparotomy, 55.2% would consider exploratory laparotomy and 26.1% would not consent to exploratory laparotomy being performed on their horse. Geographical location, intended use of the horse and perceptions regarding the cost and prognosis of exploratory laparotomy, as well as the previous experience of respondents significantly impacted the decision. Self-reported level of financial comfort, gender of respondents, number of horses owned and pre-existing relationship with nearest equine referral clinic did not impact the decision. Top motivators for exploratory laparotomy were high probability of survival, trust in hospital, emotional value of horse and the alternative being euthanasia. Top barriers for exploratory laparotomy were financial cost, uncertain outcome, welfare concern and age of the horse. Self-selection bias and acquiescence in responses. Most respondents indicated that they would consider or consent to exploratory laparotomy. Several factors for owners to decide for exploratory laparotomy could be identified. Improved owner education regarding the positively reported survival rates for exploratory laparotomy would be beneficial.

Extremely small and incredibly close: Gut microbes as modulators of inflammation and targets for therapeutic intervention

Chronic inflammation is a hallmark for a variety of disorders and is at least partially responsible for disease progression and poor patient health. In recent years, the microbiota inhabiting the human gut has been associated with not only intestinal inflammatory diseases but also those that affect the brain, liver, lungs, and joints. Despite a strong correlation between specific microbial signatures and inflammation, whether or not these microbes are disease markers or disease drivers is still a matter of debate. In this review, we discuss what is known about the molecular mechanisms by which the gut microbiota can modulate inflammation, both in the intestine and beyond. We identify the current gaps in our knowledge of biological mechanisms, discuss how these gaps have likely contributed to the uncertain outcome of fecal microbiota transplantation and probiotic clinical trials, and suggest how both mechanistic insight and -omics-based approaches can better inform study design and therapeutic intervention.

First episode-psychosis: Short- and long-term outcomes and related features predicting the transition to schizophrenia

IntroductionThe occurrence of a first episode-psychosis in adolescents or young adults represents a difficult struggle with an uncertain and divergent outcome, since the clinician does not have at his disposal the clinical elements sufficient to predict these different disease trajectories.ObjectivesOur aims are to describe the socio-demographic, clinical characteristics and the short and long-term outcomes of a first episode-psychosis and to identify the predictive factors of the transition to schizophrenia.MethodsWe conducted a retrospective study about 117 patients hospitalized for a first episode-psychosis in the Psychiatric Department of Monastir (Tunisia). Sociodemographic and clinical features were collected using a pre-established form.ResultsFirst-episode psychosis affected young male subjects with low educational level. Stressors were present in 54.7%. An 8-week prodromal phase preceded the onset of the disorder in 59%. The disorder course included diagnosis of: Brief psychotic disorder (32.5%), schizophrenia (31.6%) and bipolar disorder (18.8%). The short-term outcome was characterized by a complete remission rate of 58.1% at 3 months and 37.6% at 6 months. The long-term outcome was marked by a high rate of lost to follow-up: 70.8% after 5 years. The transition to schizophrenia was linked to the presence of delirium of influence and the absence of favorable course at 3 months.ConclusionsOur results led to the identification of the profile of patients with a first episode-psychosis and the factors correlated with a diagnosis of schizophrenia. Indeed, the determination of risk factors would make it possible to adapt earlier the care.DisclosureNo significant relationships.

РЕТРОГРАДНЫЙ ПЕРИИМПЛАНТИТ (КЛИНИЧЕСКИЙ СЛУЧАЙ)

To date, implantation has become quite a massive operation in public institutions. In the last 10 years, the number of complications at the surgical stage of implantation has decreased to a minimum. Numerous experimental and clinical studies prove the success of osseointegration of implants, but nevertheless the possible negative consequences of such operations persist. The increasingly frequent use of titanium supports leads to the emergence of clinical situations related to both the characteristics of the human body and the individual characteristics of a specialist doctor. It is also necessary to take into account the psychological characteristics of the patient's behavior in the treatment of such complications.
 Subject. Professional and psychological capabilities of a doctor to work effectively in a situation of uncertain outcome of a surgical operation.
 The relevance of this study is due to the need to prevent complications of implantation surgery in the professional activity of a dentist-surgeon. The need for this study was also dictated by the needs of patients using implantological systems in maintaining the quality of life.
 The aim is to study the preservation of the implant in the event of apical peri-implantitis.
 Methodology. A retrospective study was conducted on the basis of the State Medical Institution with "SP No. 12" of patients who underwent implantation treatment. Patients were included in the study if they had one or more implants without clinical signs of implant mobility.
 Results. The patient was treated with surgical tactics to remove the formation in the area of the apical part of the implant; antibacterial therapy; mechanical curettage; chemical decontamination and the imposition of an allogeneic graft.
 Conclusions. Retrograde (apical) reimplantitis was successfully cured by surgical curettage and the use of bone substitutes, and all implants are still in place after an average follow-up period of 1.44 years.

Walter Bruno Gratzer (1932–2021): In his own words, as far as possible

Miranda Robertson commemorates the life, remarkable times and witty and erudite writing of protein chemist and biophysicist Walter Gratzer.

Assessment of listing and categorisation of animal diseases within the framework of the Animal Health Law (Regulation (EU) No 2016/429): antimicrobial-resistant Staphylococcus aureus in cattle and horses.

Staphylococcus aureus (S. aureus) was identified among the most relevant antimicrobial‐resistant (AMR) bacteria in the EU for cattle and horses in previous scientific opinions. Thus, it has been assessed according to the criteria of the Animal Health Law (AHL), in particular criteria of Article 7 on disease profile and impacts, Article 5 on its eligibility to be listed, Annex IV for its categorisation according to disease prevention and control rules as in Article 9, and Article 8 for listing animal species related to the bacterium. The assessment has been performed following a methodology previously published. The outcome is the median of the probability ranges provided by the experts, which indicates whether each criterion is fulfilled (lower bound ≥ 66%) or not (upper bound ≤ 33%), or whether there is uncertainty about fulfilment. Reasoning points are reported for criteria with uncertain outcome. According to the assessment here performed, it is uncertain whether AMR S. aureus can be considered eligible to be listed for Union intervention according to Article 5 of the AHL (60–90% probability). According to the criteria in Annex IV, for the purpose of categorisation related to the level of prevention and control as in Article 9 of the AHL, the AHAW Panel concluded that the bacterium does not meet the criteria in Sections 1, 2 and 4 (Categories A, B and D; 1–5%, 5–10% and 10–33% probability of meeting the criteria, respectively) and the AHAW Panel was uncertain whether it meets the criteria in Sections 3 and 5 (Categories C and E, 33–90% and 60–90% probability of meeting the criteria, respectively). The animal species to be listed for AMR S. aureus according to Article 8 criteria include mainly mammals, birds, reptiles and fish.

Assessment of listing and categorisation of animal diseases within the framework of the Animal Health Law (Regulation (EU) No 2016/429): antimicrobial-resistant Escherichia coli in dogs and cats, horses, swine, poultry, cattle, sheep and goats.

Escherichia coli (E. coli) was identified among the most relevant antimicrobial‐resistant (AMR) bacteria in the EU for dogs and cats, horses, swine, poultry, cattle, sheep and goats in previous scientific opinions. Thus, it has been assessed according to the criteria of the Animal Health Law (AHL), in particular criteria of Article 7 on disease profile and impacts, Article 5 on its eligibility to be listed, Annex IV for its categorisation according to disease prevention and control rules as in Article 9 and Article 8 for listing animal species related to the bacterium. The assessment has been performed following a methodology previously published. The outcome is the median of the probability ranges provided by the experts, which indicates whether each criterion is fulfilled (lower bound ≥ 66%) or not (upper bound ≤ 33%), or whether there is uncertainty about fulfilment. Reasoning points are reported for criteria with uncertain outcome. According to the assessment here performed, it is uncertain whether AMR E. coli can be considered eligible to be listed for Union intervention according to Article 5 of the AHL (33–66% probability). According to the criteria in Annex IV, for the purpose of categorisation related to the level of prevention and control as in Article 9 of the AHL, the AHAW Panel concluded that the bacterium does not meet the criteria in Sections 1, 2, 3 and 4 (Categories A, B, C and D; 0–5%, 5–10%, 10–33% and 10–33% probability of meeting the criteria, respectively) and the AHAW Panel was uncertain whether it meets the criteria in Section 5 (Category E, 33–66% probability of meeting the criteria). The animal species to be listed for AMR E. coli according to Article 8 criteria include mammals, birds, reptiles and fish.

Assessment of listing and categorisation of animal diseases within the framework of the Animal Health Law (Regulation (EU) No 2016/429): antimicrobial-resistant Pseudomonas aeruginosa in dogs and cats.

Pseudomonas aeruginosa (P. aeruginosa) was identified among the most relevant antimicrobial‐resistant (AMR) bacteria in the EU for dogs and cats in a previous scientific opinion. Thus, it has been assessed according to the criteria of the Animal Health Law (AHL), in particular criteria of Article 7 on disease profile and impacts, Article 5 on its eligibility to be listed, Annex IV for its categorisation according to disease prevention and control rules as in Article 9, and Article 8 for listing animal species related to the bacterium. The assessment has been performed following a methodology previously published. The outcome is the median of the probability ranges provided by the experts, which indicates whether each criterion is fulfilled (lower bound ≥ 66%) or not (upper bound ≤ 33%), or whether there is uncertainty about fulfilment. Reasoning points are reported for criteria with uncertain outcome. According to the assessment here performed, it is uncertain whether AMR P. aeruginosa can be considered eligible to be listed for Union intervention according to Article 5 of the AHL (33–90% probability). According to the criteria in Annex IV, for the purpose of categorisation related to the level of prevention and control as in Article 9 of the AHL, the AHAW Panel concluded that the bacterium does not meet the criteria in Sections 1, 2, 3 and 4 (Categories A, B, C and D; 0–5%, 1–5%, 5–33% and 5–33% probability of meeting the criteria, respectively) and the AHAW Panel was uncertain whether it meets the criteria in Section 5 (Category E, 33–90% probability of meeting the criteria). The animal species to be listed for AMR P. aeruginosa according to Article 8 criteria are mainly dogs and cats.

Establishment of ICU Mortality Risk Prediction Models with Machine Learning Algorithm Using MIMIC-IV Database.

Objective: The mortality rate of critically ill patients in ICUs is relatively high. In order to evaluate patients’ mortality risk, different scoring systems are used to help clinicians assess prognosis in ICUs, such as the Acute Physiology and Chronic Health Evaluation III (APACHE III) and the Logistic Organ Dysfunction Score (LODS). In this research, we aimed to establish and compare multiple machine learning models with physiology subscores of APACHE III—namely, the Acute Physiology Score III (APS III)—and LODS scoring systems in order to obtain better performance for ICU mortality prediction. Methods: A total number of 67,748 patients from the Medical Information Database for Intensive Care (MIMIC-IV) were enrolled, including 7055 deceased patients, and the same number of surviving patients were selected by the random downsampling technique, for a total of 14,110 patients included in the study. The enrolled patients were randomly divided into a training dataset (n = 9877) and a validation dataset (n = 4233). Fivefold cross-validation and grid search procedures were used to find and evaluate the best hyperparameters in different machine learning models. Taking the subscores of LODS and the physiology subscores that are part of the APACHE III scoring systems as input variables, four machine learning methods of XGBoost, logistic regression, support vector machine, and decision tree were used to establish ICU mortality prediction models, with AUCs as metrics. AUCs, specificity, sensitivity, positive predictive value, negative predictive value, and calibration curves were used to find the best model. Results: For the prediction of mortality risk in ICU patients, the AUC of the XGBoost model was 0.918 (95%CI, 0.915–0.922), and the AUCs of logistic regression, SVM, and decision tree were 0.872 (95%CI, 0.867–0.877), 0.872 (95%CI, 0.867–0.877), and 0.852 (95%CI, 0.847–0.857), respectively. The calibration curves of logistic regression and support vector machine performed better than the other two models in the ranges 0–40% and 70%–100%, respectively, while XGBoost performed better in the range of 40–70%. Conclusions: The mortality risk of ICU patients can be better predicted by the characteristics of the Acute Physiology Score III and the Logistic Organ Dysfunction Score with XGBoost in terms of ROC curve, sensitivity, and specificity. The XGBoost model could assist clinicians in judging in-hospital outcome of critically ill patients, especially in patients with a more uncertain survival outcome.

Pupil dilation and response slowing distinguish deliberate explorative choices in the probabilistic learning task

This study examined whether pupil size and response time would distinguish directed exploration from random exploration and exploitation. Eighty-nine participants performed the two-choice probabilistic learning task while their pupil size and response time were continuously recorded. Using LMM analysis, we estimated differences in the pupil size and response time between the advantageous and disadvantageous choices as a function of learning success, i.e., whether or not a participant has learned the probabilistic contingency between choices and their outcomes. We proposed that before a true value of each choice became known to a decision-maker, both advantageous and disadvantageous choices represented a random exploration of the two options with an equally uncertain outcome, whereas the same choices after learning manifested exploitation and direct exploration strategies, respectively. We found that disadvantageous choices were associated with increases both in response time and pupil size, but only after the participants had learned the choice-reward contingencies. For the pupil size, this effect was strongly amplified for those disadvantageous choices that immediately followed gains as compared to losses in the preceding choice. Pupil size modulations were evident during the behavioral choice rather than during the pretrial baseline. These findings suggest that occasional disadvantageous choices, which violate the acquired internal utility model, represent directed exploration. This exploratory strategy shifts choice priorities in favor of information seeking and its autonomic and behavioral concomitants are mainly driven by the conflict between the behavioral plan of the intended exploratory choice and its strong alternative, which has already proven to be more rewarding.