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Previous research has shown that individual decision making is often characterized by inertia—that is, a tendency for decision makers to choose options that maintain the status quo. In this study, I conduct a laboratory experiment to investigate two potential determinants of inertia in uncertain environments: (i) regret aversion and (ii) ambiguity-driven indecisiveness. I use a between-subjects design with varying conditions to identify the effects of these two mechanisms on choice behavior. In each condition, participants choose between two simple real gambles, one of which is the status quo option. The findings indicate that regret aversion and ambiguity-driven indecisiveness are equally important determinants of inertia, which in turn plays a major role in individual decision making.

Resumen Según la evidencia científica, la trombosis venosa profunda (TVP) se trata con anticoagulación, variando el tiempo según la causa. Ocasionalmente aparecen recidivas en la misma localización, siendo el síndrome de May-Thurner o síndrome de Cockett una de las causas, debido a la compresión del sistema venoso ilio-cava entre los cuerpos vertebrales y el sistema arterial. El tratamiento varía respecto al resto de causas de TVP: aunque la anticoagulación debe mantenerse el mismo tiempo, en estos casos está recomendada la trombectomía, con o sin la colocación destentvenoso para evitar la recidiva. No existe consenso en la literatura respecto a la indicación o no de antiagregación tras el periodo de anticoagulación. Presentamos un caso de síndrome de May-Thurner tratado con trombectomía y colocación destentvenoso, que resultó un manejo óptimo de la enfermedad. Abstract According to scientific evidence, deep venous thrombosis (DVT) is treated with anticoagulation therapy, involving different periods of time depending on the cause. Occasionally, recurrences appear in the same location, with May-Thurner syndrome or Cockett syndrome as one reason, due to compression of the ilio-cava venous system between the vertebral bodies and the arterial system. In these cases, anticoagulation therapy must be maintained during the same time as in the rest of DVT, but as opposed to them, thrombectomy is recommended, with or without the implant of a venous stent in order to avoid recurrence. There is no consensus in the literature regarding the indication of antiaggregation therapy after the anticoagulation therapy period. We present a case of May-Thurner syndrome treated with thrombectomy and the implant of a venous stent, which yielded an optimum management of the disease.

OBJECTIVE There are variable reports of risk of concordance for progression to islet autoantibodies and type 1 diabetes in identical twins after one twin is diagnosed. We examined development of positive autoantibodies and type 1 diabetes and the effects of genetic factors and common environment on autoantibody positivity in identical twins, nonidentical twins, and full siblings. RESEARCH DESIGN AND METHODS Subjects from the TrialNet Pathway to Prevention Study (N = 48,026) were screened from 2004 to 2015 for islet autoantibodies (GAD antibody [GADA], insulinoma-associated antigen 2 [IA-2A], and autoantibodies against insulin [IAA]). Of these subjects, 17,226 (157 identical twins, 283 nonidentical twins, and 16,786 full siblings) were followed for autoantibody positivity or type 1 diabetes for a median of 2.1 years. RESULTS At screening, identical twins were more likely to have positive GADA, IA-2A, and IAA than nonidentical twins or full siblings (all P < 0.0001). Younger age, male sex, and genetic factors were significant factors for expression of IA-2A, IAA, one or more positive autoantibodies, and two or more positive autoantibodies (all P ≤ 0.03). Initially autoantibody-positive identical twins had a 69% risk of diabetes by 3 years compared with 1.5% for initially autoantibody-negative identical twins. In nonidentical twins, type 1 diabetes risk by 3 years was 72% for initially multiple autoantibody–positive, 13% for single autoantibody–positive, and 0% for initially autoantibody-negative nonidentical twins. Full siblings had a 3-year type 1 diabetes risk of 47% for multiple autoantibody–positive, 12% for single autoantibody–positive, and 0.5% for initially autoantibody-negative subjects. CONCLUSIONS Risk of type 1 diabetes at 3 years is high for initially multiple and single autoantibody–positive identical twins and multiple autoantibody–positive nonidentical twins. Genetic predisposition, age, and male sex are significant risk factors for development of positive autoantibodies in twins.

Resumen Según la evidencia científica, la trombosis venosa profunda (TVP) se trata con anticoagulación, variando el tiempo según la causa. Ocasionalmente aparecen recidivas en la misma localización, siendo el síndrome de May-Thurner o síndrome de Cockett una de las causas, debido a la compresión del sistema venoso ilio-cava entre los cuerpos vertebrales y el sistema arterial. El tratamiento varía respecto al resto de causas de TVP: aunque la anticoagulación debe mantenerse el mismo tiempo, en estos casos está recomendada la trombectomía, con o sin la colocación destentvenoso para evitar la recidiva. No existe consenso en la literatura respecto a la indicación o no de antiagregación tras el periodo de anticoagulación. Presentamos un caso de síndrome de May-Thurner tratado con trombectomía y colocación destentvenoso, que resultó un manejo óptimo de la enfermedad.

Precipitation plays a crucial role from a social and economic perspective in Subtropical Argentina (STAr). Therefore, it renders the need for continuous and reliable precipitation records to develop serious climatological researches. However, precipitation records in this region are frequently inhomogeneous and scarce, which makes it necessary to deal with data filling methods. Choosing the best method to complete precipitation data series relies on rain gauge network density and on the complexity of orography, among other factors. Most comparative-method studies in the literature are focused on dense station networks while, contrastingly, the STAr's station network density is remarkably poor (between 10 and 1000 times lower). The research aims at assessing the performance of several interpolation methods in STAr. In this sense, the performance of a large number of interpolation methods was evaluated for dry and wet seasons, interpolating raw monthly data and their anomalies applied to different time-series subsets. In general, most methods performances improve when applied to anomalies in the seasonal time-series subset. Multiple Linear Regression (MLR) stands out as the method with the best performance for infilling precipitation records for most of the regions regardless of orography or season. Despite the bibliography invokes that kriging interpolation methods are the best ones, in this work the performance of kriging methods was similar to the one of the Inverse Distance Weighted method (IDW) and the Angular Distance Weighted method (ADW, the method used to generate CRU precipitation dataset).

Homogeneity is an important characteristic of time series that must be checked before doing any analysis. Breakpoints in meteorological time series are very commondue to climatic jumps caused by natural forcing and/or human activity but also, and mainly, produced by inhomogeneities which are erratic in nature. In this work,five breakpoint tests are analyzed to evaluate their performance in detecting breakpoints for different lengths of time series and intensity of breakpoint, among otherfeatures, through the realization of numerical experiments of sensitivity. These tests are: Student´s, Mann-Whitney, Buishand-R, Pettit and SNHT. The Student´s andMann-Whitney tests show high probability of false breakpoint detection and problems to reproduce the date when a breakpoint occurs. In addition, the Buishand-Rand Pettit are more efficient to reproduce the date of breakpoint when it occurs in the middle of a time series while the SNHT does it for breakpoints in its borders. Inthis sense, the Pettit, Buishand-R and SNHT tests show better performance than the Mann-Whitney and Student´s. Furthermore, an original methodology to detectmulti-breakpoints based on the aforementioned tests is applied to precipitation time series from sixty-two rain-gauge stations in subtropical Argentina. A breakpointaround 1976 is detected in the wet season (austral warm season), highly likely linked to the well-documented 1976/77 climate transition, by all the used tests and formost of the stations. To a lesser extent, another breakpoint occurred in the mid-1950´s. Other breakpoints are also detected in the early 1980s and the early 2000s,though in few stations and by one or two tests. For the breakpoints found in the mid-1950´s and in the early 1980´s, a strong relationship with two ENSO´s indices isfound which suggests that changes in long-term ENSO variability could be the cause of these breakpoints. Fil: Hurtado, Santiago Ignacio. Universidad Nacional de La Plata. Facultad de Ciencias Astronómicas y Geofísicas; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata; Argentina Fil: Zaninelli, Pablo Gabriel. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Centro de Investigaciones del Mar y la Atmósfera. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Centro de Investigaciones del Mar y la Atmósfera; Argentina. Universidad Nacional de La Plata. Facultad de Ciencias Astronómicas y Geofísicas; Argentina Fil: Agosta Scarel, Eduardo Andres. Universidad Nacional de La Plata. Facultad de Ciencias Astronómicas y Geofísicas; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata; Argentina

Importance Type 1 diabetes requires major lifestyle changes and carries increased morbidity and mortality. Prevention or delay of diabetes would have major clinical effect. Objective To determine whether oral insulin delays onset of type 1 diabetes in autoantibody-positive relatives of patients with type 1 diabetes. Design, Setting, and Participants Between March 2, 2007, and December 21, 2015, relatives with at least 2 autoantibodies, including insulin autoantibodies and normal glucose tolerance, were enrolled in Canada, the United States, Australia, New Zealand, the United Kingdom, Italy, Sweden, Finland, and Germany. The main study group (n = 389) had first-phase insulin release on an intravenous glucose tolerance test that was higher than the threshold. The 55 patients in the secondary stratum 1 had an identical antibody profile as the main study group except they had first-phase insulin release that was lower than the threshold. Secondary strata 2 (n = 114) and strata 3 (n = 3) had different autoantibody profiles and first-phase insulin release threshold combinations. Follow-up continued through December 31, 2016. Interventions Randomization to receive 7.5 mg/d of oral insulin (n = 283) or placebo (n = 277), including participants in the main study group who received oral insulin (n = 203) or placebo (n = 186). Main Outcome and Measures The primary outcome was time to diabetes in the main study group. Significance was based on a 1-sided threshold of .05, and 1-sided 95% CIs are reported. Results Of a total of 560 randomized participants (median enrollment age, 8.2 years; interquartile range [IQR], 5.7-12.1 years; 170 boys [60%]; 90.7% white non-Hispanic; 57.6% with a sibling with type 1 diabetes), 550 completed the trial including 389 participants (median age, 8.4 years; 245 boys [63%]), 382 (96%) in the main study group. During a median follow-up of 2.7 years (IQR, 1.5-4.6 years) in the main study group, diabetes was diagnosed in 58 participants (28.5%) in the oral insulin group and 62 (33%) in the placebo group. Time to diabetes was not significantly different between the 2 groups (hazard ratio [HR], 0.87; 95% CI, 0-1.2;P = .21). In secondary stratum 1 (n = 55), diabetes was diagnosed in 13 participants (48.1%) in the oral insulin group and in 19 participants (70.3%) in the placebo group. The time to diabetes was significantly longer with oral insulin (HR, 0.45; 95% CI, 0-0.82;P = .006). The HR for time to diabetes for the between-group comparisons for the 116 participants in the other secondary stratum was 1.03 (95% CI, 0-2.11;P = .53) and for the entire cohort of 560 participants was 0.83 (95% CI, 0-1.07;P = .11), which were not significantly different. The most common adverse event was infection (n = 254), with 134 events in the oral insulin group and 120 events in the placebo group, but no significant study-related adverse events occurred. Conclusions and Relevance Among autoantibody-positive relatives of patients with type 1 diabetes, oral insulin at a dose of 7.5 mg/d, compared with placebo, did not delay or prevent the development of type 1 diabetes over 2.7 years. These findings do not support oral insulin as used in this study for diabetes prevention. Trial Registration clinicaltrials.gov Identifier:NCT00419562

Background KRAS is the most frequently mutated gene in pancreatic ductal adenocarcinoma (PDAC), but the mechanisms underlying the transcriptional response to oncogenic KRAS are still not fully understood. We aimed to uncover transcription factors that regulate the transcriptional response of oncogenic KRAS in pancreatic cancer and to understand their clinical relevance. Methods and Findings We applied a well-established network biology approach (master regulator analysis) to combine a transcriptional signature for oncogenic KRAS derived from a murine isogenic cell line with a coexpression network derived by integrating 560 human pancreatic cancer cases across seven studies. The datasets included the ICGC cohort (n = 242), the TCGA cohort (n = 178), and five smaller studies (n = 17, 25, 26, 36, and 36). 55 transcription factors were coexpressed with a significant number of genes in the transcriptional signature (gene set enrichment analysis [GSEA] p < 0.01). Community detection in the coexpression network identified 27 of the 55 transcription factors contributing to three major biological processes: Notch pathway, down-regulated Hedgehog/Wnt pathway, and cell cycle. The activities of these processes define three distinct subtypes of PDAC, which demonstrate differences in survival and mutational load as well as stromal and immune cell composition. The Hedgehog subgroup showed worst survival (hazard ratio 1.73, 95% CI 1.1 to 2.72, coxPH test p = 0.018) and the Notch subgroup the best (hazard ratio 0.62, 95% CI 0.42 to 0.93, coxPH test p = 0.019). The cell cycle subtype showed highest mutational burden (ANOVA p < 0.01) and the smallest amount of stromal admixture (ANOVA p < 2.2e–16). This study is limited by the information provided in published datasets, not all of which provide mutational profiles, survival data, or the specifics of treatment history. Conclusions Our results characterize the regulatory mechanisms underlying the transcriptional response to oncogenic KRAS and provide a framework to develop strategies for specific subtypes of this disease using current therapeutics and by identifying targets for new groups., Florian Markowetz and colleagues study transcriptional mechanisms influenced by mutated KRAS, which is common in pancreatic ductal adenocarcinomas, and possible implications for disease characteristics and prognosis., Author Summary Why Was This Study Done? Outcomes for patients diagnosed with pancreatic cancer are very poor because surgical approaches plus other current treatments are often inadequate to treat this disease. Previous efforts have been made to subtype the disease in an effort to identify more clinically relevant groups for tailored treatment. To improve on these “landscape” studies, we focussed on transcriptional changes induced by KRAS mutations to understand perturbed pathways and their effects on patients. What Did the Researchers Do and Find? We created a transcriptional signature of oncogenic KRAS in an isogenic mouse ductal cell line. We then combined this signature with a coexpression network derived from a large collection of pancreatic cancer cases and used a well-validated algorithm to identify the transcription factors (so-called master regulators) responsible for the signature. The master regulators clustered into three distinct biological groups (Notch, cell cycle, and Hedgehog) characterised by significant differences in clinical survival and mutational load as well as immune cell and stromal infiltration. What Do These Findings Mean? Our results provide evidence that distinct modes of transcriptional reprogramming occur following KRAS-mediated transformation This improved understanding of pancreatic cancer biology may provide novel prognostic and therapeutic opportunities to counter this devastating disease.