3.1. Indications and contraindications

The main role for TACE is reserved for patients with stage B disease based on the Barcelona Clinic Liver Cancer (BCLC) staging system. Stage B disease is defined as patients with large, multinodular disease with good functional status and a Child-Pugh A-B score. Other indications would include downstaging patient's tumor burden to allow for transplantation.

Absolute contraindications would be reserved for patients with poorly compensated advanced liver disease since TACE may exacerbate patient's symptoms and increase risks of progression into liver failure. Other absolute contraindications include refractory bleeding diathesis, large metastatic disease burden outside the liver, active infection, main, right and left portal vein thrombosis as well as refractory encephalopathy.

#### 3.2. Management

decreased recurrence rates with RFA, 9%, compared to MWA, 19% [14]. A review of multiple studies demonstrate overall comparable rates for MWA and RFA in terms of overall survival

A study by Wang compared cryoablation to RFA in patients with HCC lesions less than or equal to 4 cm. Results demonstrated significantly lower local tumor progression rates with cryoablation, 5.6%, compared to RFA, 10% [15]. For lesions larger than 3 cm, the difference became more apparent with progression rates of 7.7% for cryoablation and 18.2% for RFA. The recurrence free survival and overall survival rates were not significantly different between

In patients with metastatic CRC, RFA was shown to have a complete response rate of 91–97% [16]. In patients with five or fewer lesions less than 5 cm, the 5-year survival rate was between 24 and 44% [17]. For patients who had complete tumor ablation, 98% did not require further surgical resection either due to remaining disease free or developing disease progression [18].

Transarterial chemoembolization (TACE) is the most commonly performed procedure by interventional radiologists for treatment of unresectable hepatic malignancies. Nearly half of all HCC patients receive TACE at some point in their disease course [19]. Multiple techniques

The theory behind TACE relies on the liver's dual blood supply as hepatic tumors derive their blood supply mainly from the hepatic artery while normal hepatic parenchyma is predominantly supplied by the portal vein. Percutaneous access to the arterial system is obtained via femoral or radial artery catheterization. Imaging is performed to assess for variant anatomy, portal vein patency, and tumoral blood supply. Angiograms were performed, however in recent years, Cone Beam Computed Tomography (CBCT) has played an important role during locoregional therapies and is recommended as standard of care during chemoembolization [20]. Once the feeding arteries to the tumor are identified, they are selectively catheterized and chemoembolization is performed. Chemoembolization can be achieved by bland embolization, conventional trans-arterial chemoembolization (cTACE) or with drug-eluting embolic trans-

cTACE consists of administering chemotherapeutic agent(s) combined with an ethiodized oil emulsion followed by an embolic agent i.e. Gelfoam, or microspheres. Historically, doxorubicin, cisplatin, and mitomycin C in combination were used for cTACE, however due to shortage of some of the drugs, the regimens changed. Neither drug alone or any combination of these agents have shown to be statistically superior [17, 18]. Currently in the United States and Europe, doxorubicin is used in the majority of cases while miriplatin and cisplatin are used in Japan [21]. Lipiodol is an ethiodized oil that is commonly used for cTACE and has been considered the standard of care. The thick consistency allows it act as an embolic agent, which travels further into the microvascular than microspheres. In addition, lipiodol is radio-opaque and it

and local recurrence.

54 Medical Imaging and Image-Guided Interventions

cryoablation and RFA [15].

3. Transarterial chemoembolization

arterial chemoembolization (DEE-TACE).

have been used for TACE over the past few decades.

TACE is commonly performed under moderate sedation. Pre-procedural hydration may be performed to decrease risk of contrast/chemotherapy-induced nephropathy. Pre-operative antibiotics are only given for patients with high risk for infection such as disrupted biliary drainage pathways.

Patients are usually admitted overnight post-procedure to monitor for potential complications. Most often, patients develop minor symptoms that can be managed medically such as postembolization syndrome. This self-limiting syndrome is comprised of abdominal pain, fever, and nausea and usually occurs within the first 72 h post-procedure. This can be seen in up to 80% of patients. Post-procedural transaminitis is more frequent with cTACE compared to DEE-TACE.

Patients are typically discharged the next day. The criteria for discharge include appropriate pain control, ambulation, adequate urine production, and tolerating PO intake. TACE may be repeated for tumor control. Multiple treatments are often required until either the MRI shows greater than 90% tumor necrosis, the patient is downstaged, there is a lack of tumor response after at least two treatments, or the development of disease progression or a contraindication to treatment.

#### 3.3. Complications

There are varying criteria in determining patients who are at high risk for post-TACE liver failure. High-risk patients include a total bilirubin greater than 2 mg/dL, INR greater than 1.5, MELD score greater than 15, Child C disease, portal venous thrombosis, thrombocytopenia, or the presence of ascites. While many of these criteria have excluded patients in the past, advancements in technology has led to selective and superselective chemoembolization allowing a number of these patients to be treated. Non-selective chemoembolization can damage surrounding healthy hepatic parenchyma leading patients to decompensated liver failure, especially those with poor hepatic reserve. With selective and superselective techniques, there is increased sparing of viable tissue. Many articles have exhibited TACE being safely performed in high-risk patients. One study demonstrated the rate of selective TACErelated irreversible liver failure to be 3% compared to 20% in nonselective cases [23]. Other studies showed TACE to be safe and effective in patients with portal venous thrombosis, especially in those with hepatic reserve and collateral circulation [24]. Kothary et al. analyzed 65 high-risk TACE procedures which showed a procedure-related morbidity rate of 10.8% and a 30-day mortality rate of 7.7% [25]. Yoon et al. observed a procedure-related morbidity rate of 2% and a 30-day mortality rate of 1% in 96 high-risk patients [26]. Overall, the general consensus seems to be on a case-to-case basis in which baseline hepatic function, hepatic reserve, and overall tumor burden are commonly taken into account.

TACE in patients with unresectable HCC (odds ratio 0.54, 95% CI 0.33–89, P = 0.015 and odds

Liver Directed Therapies

57

http://dx.doi.org/10.5772/intechopen.75163

Several studies have compared DEE-TACE versus cTACE versus bland TACE. The PRECI-SION V study was a prospective randomized study analyzing cTACE versus DEE-TACE. The study did not meet its primary endpoint of superior response rate with DEE-TACE but did show DEE-TACE is better tolerated [32]. One major criticism is that the study used 300–500 μ beads, which are considered large for this application. However other randomized controlled trials also compared cTACE versus DEE-TACE including Golfieri et al. This study on 177 patients did not show any statistical difference in terms of local or overall tumor response with 2 year follow-up but demonstrated reduced post procedural pain with DEE-TACE [33]. Meta-

Interestingly, a randomized trial of 101 patients treated with TAE using microspheres alone versus TACE using doxorubicin-eluting microspheres found no difference in the response to

A recent meta-analysis of randomized controlled trials pertaining to 5700 patients concluded that none of the transcatheter chemoembolization options as stand-alone were superior to transarterial bland embolization. The authors added that the conclusions are based on large information size of moderate quality based on data from 3 randomized controlled trials (RCT) of TAE versus best

The SPACE trial, a randomized, double-blinded, phase II trial, compared Sorafenib with DEB-TACE versus DEB-TACE alone (placebo) in the treatment of intermediate stage HCC. The study did not show improvement in time to progression nor overall survival between the two

Radioembolization, also known as selective internal radiation therapy (SIRT), consists of administering either glass or resin microspheres loaded with radioactive isotope, yttrium-90 (Y-90). Y-90 is a pure better emitter with a half-life of 64.1 h and a mean tissue penetration of 2–3 mm. Radioembolization is currently not part of the standard treatment guidelines. However, promising clinical research has driven its growing use in the management of hepatic malignancies. A multidisciplinary team consisting of surgeons, interventional radiologist, hepatologists, oncologists, and radiation oncologists determines if a patient is a candidate for Y-90 radioembolization. The Barcelona Clinic Liver Cancer (BCLC) and Eastern Cooperative Oncology Group (ECOG) scoring systems are taken into account in the decision process. The microspheres used today are either glass and resin microspheres. Glass microspheres, or TheraSpheres, is FDA approved for the treatment of unresectable HCC. Resin microspheres, or SIR-Spheres, is premarket approved by the FDA for the treatment of hepatic metastases from colorectal cancer in combination with floxuridine. Glass microspheres carry a higher activity load, thus requiring decreased volumes and number of spheres, compared to resin microspheres for the same dose [37]. Since resin

treatment (primary endpoint) and no difference in overall survival [34].

supportive care, 4 RCT of TAE versus TACE and 2 TAE versus DEB-TACE [35].

ratio 0.53, 95% CI 0.32–0.89, P = 0.017) [31].

analysis on the topic has had equivocal results.

groups [36].

4. Radioembolization

Non-target embolization can occur due to reflux of chemoembolic agents or failure to recognize the arterial anatomy supplying non-hepatic structures. This can lead to gastrointestinal ulceration/perforation, pancreatitis, cholecystitis, pneumonitis, or skin burns.

Hepatic abscess formation is rare in patients with unaltered anatomy. However, patients with post-surgical or disrupted anatomy of the biliary tree are at increased risk due to colonization of the biliary tree from enteric flora. One study showed 6 out of 7 patients with a prior bilioenteric anastomosis formed hepatic abscesses even after receiving standard broad spectrum prophylactic antibiotics [27]. Another study showed no formation of hepatic abscess in four patients with prior bilioenteric anastomosis when adding an aggressive bowel preparation [28]. In addition, gas formation within embolized hepatic tumors may occur postprocedurally which may lead to the misdiagnosis of a hepatic abscess.

Vascular complications are uncommon but include access site hematomas, pseudoaneurysms, or arteriovenous fistulas.

Other rare complications include sepsis, biliary strictures, variceal bleeding, renal failure, or chemotherapy-related toxicities such as alopecia, anemia, or myelosuppression.

#### 3.4. Results

Multiple studies have shown TACE to increase overall survival when compared to conservative management. A randomized control trial by Llovet et al. was terminated early as it demonstrated the one-year and two-year survival rates for chemoembolization to be 82 and 63% compared to 63 and 27% for supportive care [29]. Another randomized trial by Lo et al. showed the one-year and two-year survival rates for chemoembolization to be 57 and 31% compared to 32 and 11% for supportive care [30]. Two meta-analyses of randomized controlled trials by Camma et al. and Llovet et al. showed a significant decrease in 2 year mortality with TACE in patients with unresectable HCC (odds ratio 0.54, 95% CI 0.33–89, P = 0.015 and odds ratio 0.53, 95% CI 0.32–0.89, P = 0.017) [31].

Several studies have compared DEE-TACE versus cTACE versus bland TACE. The PRECI-SION V study was a prospective randomized study analyzing cTACE versus DEE-TACE. The study did not meet its primary endpoint of superior response rate with DEE-TACE but did show DEE-TACE is better tolerated [32]. One major criticism is that the study used 300–500 μ beads, which are considered large for this application. However other randomized controlled trials also compared cTACE versus DEE-TACE including Golfieri et al. This study on 177 patients did not show any statistical difference in terms of local or overall tumor response with 2 year follow-up but demonstrated reduced post procedural pain with DEE-TACE [33]. Metaanalysis on the topic has had equivocal results.

Interestingly, a randomized trial of 101 patients treated with TAE using microspheres alone versus TACE using doxorubicin-eluting microspheres found no difference in the response to treatment (primary endpoint) and no difference in overall survival [34].

A recent meta-analysis of randomized controlled trials pertaining to 5700 patients concluded that none of the transcatheter chemoembolization options as stand-alone were superior to transarterial bland embolization. The authors added that the conclusions are based on large information size of moderate quality based on data from 3 randomized controlled trials (RCT) of TAE versus best supportive care, 4 RCT of TAE versus TACE and 2 TAE versus DEB-TACE [35].

The SPACE trial, a randomized, double-blinded, phase II trial, compared Sorafenib with DEB-TACE versus DEB-TACE alone (placebo) in the treatment of intermediate stage HCC. The study did not show improvement in time to progression nor overall survival between the two groups [36].


*3.2. Construction and Verification of Models*

Based on 22 principal factors, 24 regression models of six PM2.5 relative indicators were carried out for four pollution levels, which included principal factors that significantly influenced PM2.5. Regression models of six PM2.5 relative indicators at the overall pollution level passed the test of significance (Table 2). However, the principal factors included in the six models were different, indicating the complex impacts of different principal factors on the range, duration, and rate of PM2.5 increase or decrease. The number of principal factors included in the regression model was 3~11. The more principal factors were included in the regression model, the adj\_*R*2 value was relatively higher. In these models, P3, P4, P13, and P17 were the four principal factors that appeared more frequently, indicating their significant effects on the increase/decrease in PM2.5. Overall, these principal factors can explain approximately 60.6~81.3% of the PM2.5 reduction indicators but only approximately 23.2~67.9% of the PM2.5 increase indicators.

Note: \*\*\*, \*\*, and \* indicate that the factors passed the test of significance at 1%, 5%, and 10%, respectively, and the numbers in brackets indicate the regression coefficient and standardization coefficient, respectively.

PM2.5 indicator regression models at different pollution levels also passed the test of significance (Table S6). First, although there were great differences in the principal factors included in the different models, some principal factors had a high frequency and great impacts on PM2.5. However, these principal factors varied based on pollution levels. For example, P3, P1, and P16 were important principal factors affecting the relative indicators of PM2.5 at slight, moderate, and heavy pollution levels, respectively. Second, the explanation degree of these principal factors for different PM2.5 indicators showed a similar trend at different pollution levels. The explanation degree of Cin was higher than that of Cin', and Δtin was generally between them. The explanation degree of Cde was lower than that of Cde', and Δtde was often in between. Nonetheless, the explanations of these principal factors for PM2.5 increase and decrease indicators were different. At the slight pollution level, these principal factors explained relatively more (approximately 52~81%) of the PM2.5 decrease indicators and less (approximately 16~49%) of the PM2.5 increase indicators.  At the heavy pollution level, the difference in the explanation of PM2.5 increase and decrease indicators by principal factors narrowed, focusing on 60~75%.

The prediction accuracy of the verification neighborhood samples was calculated for validation. Figure 4 shows the comparison between the predicted value and the actual value of PM2.5 indicators. Generally, the predicted value and actual value of each PM2.5 indicator were similar. There were individual samples with great differences between the predicted value and the actual value, which were mainly at heavy pollution, followed by moderate pollution. Furthermore, the accuracy of different PM2.5 indicators of five verification samples was compared through the RE value via Equation (3). At the overall pollution level, the RE of the six PM2.5 indicators of each verification sample was mostly less than 10%. The prediction error of different verification samples had great randomness. The maximum prediction error was Cin (33.3%) of sample HZ4, and the minimum was Δtde in WH4, whose RE was 0.3%. At different pollution levels, the trend of prediction error of verification samples increased with the increase in pollution level, and the prediction error of each verification sample varied greatly.

**Figure 4.** Validation for regression models of six PM2.5 indicators at the different pollution levels. (**a**) Cin; (**b**) Δtin; (**c**) Cin'; (**d**) Cde; (**e**) Δtde; (**f**) Cde'.

The prediction error was relatively low at the overall pollution level because more days of data (24 days) were used for testing. With the increase in pollution level, the number of days used for verification was less, which is vulnerable to accidental or sudden factors outside the built environment, resulting in an increase in prediction error. Based on these models, although the short-term prediction error is unstable, it can still achieve high prediction accuracy for the long-term PM2.5 change trend of the block. Therefore, it has high application value.

Data with fewer days used in the analysis usually lead to a lower R2 and a greater RE. In this study, due to the limited number of heavy pollution days, only 3 days of data were used for analysis at this pollution level. However, 4-day PM2.5 data and 3-day data monitored by instruments were used to analyze the effects of urban lake wetlands, neighboring urban greenery, and plant communities on PM2.5, respectively [42,43]. There may be some accidental factors influencing the results by limited data, but it is enough for analysis.


Compared with the control values (p<0.05)

## Compared in Group I post op. 1th and 24th hours values (p<0.05). Fig. 2. Changes in Insulin values when compared to Groups

(Figure 2).

Fig. 1. Changes in Glucose values when compared to Groups

Levobupivacaine or Bupivacaine on Hemodynami Stress Response and Postoperative Pain 215

There was no statistically significant difference between the groups in the 1st and 24th hour measurements of the insulin values (p>0.05). In Group I, the postoperative 1st and 24th hour values were different and the 24th hour values were higher (p<0.05). In Group III, the postoperative values in the first and 24th hours were higher than the control values (p<0.05)

The postoperative cortisol values at 1 hour differed between the groups and were highest in Group III (p<0.05). The intra-group comparison of the cortisol values revealed higher measurements one hour after the operation relative to the control values (p<0.05). The 24th

\* p< 0.05 Compared with Group I and Group II

(Mean ± SD)

Table 2. Mean doses of drugs used in the operation and recovery times.

There was no statistically significant difference between the groups with respect to requirement for atropine and ephedrine (p>0.05). One, two and nine patients received additional muscle relaxant administration in Group I, II and III respectively. There was a statistically significant difference between the groups with respect to the requirement of muscle relaxant (p=0.002), which was higher in Group III relative to Groups I and II.

Regarding the MBP values, Group III had the highest values at 5, 10, 15, 30, 45 and 60 minutes of incision and after extubation (p<0.05).

The intra-group MBP values showed significant reductions relative to the control values during induction, 2, 5 minutes after intubation and 2, 5, 10, 15, 30, 45, 60 and 90 minutes after the surgical incision in Group 1; during induction, five minutes after the intubation, and 2, 5, 10, 15, 30, 45 and 60 minutes after the surgical incision in Group II; and during induction, 2, 5 minutes after the intubation and 2, 30 and 45 minutes after the surgical incision in Group 3 (p<0.05). While there was no statistically significant difference between the post-extubation MBP values and the control MBP values in Groups I and II (p>0.05), Group III exhibited a significant increase relative to the control value in Group III (p<0.013).

The HBR values were lower in Group III compared to Groups I and II in the 2nd and 5th minutes of intubation (p<0.05).

The intra-group HBR values showed significant reductions relative to the control values during induction, and 2, 5, 10, 15, 30, 45 and 60 minutes after the surgical incision in Group I; during induction, and 10, 15, 30, 45 and 60 minutes after the surgical incision in Group II; and during induction, five minutes after intubation, and 2, 5, 10, 45 and 60 minutes after the surgical incision in Group III (p<0.05).

Since the duration of surgery was below 100 minutes in all patients, there was no requirement for additional epidural local anesthetic administration and the follow-ups at 120 minutes could not be conducted (Table 1).

The mean control values for the parameters used to assess the response to surgical stress including glucose, insulin, cortisol and the CRP values were statistically similar between the three groups (p>0.05).

While the postoperative glucose values in the first and 24th hours were not significantly different, they were higher in Group III relative to Groups I and II (p>0.05). Regarding the intra-group comparison, the glucose values exhibited a significant increase relative to the control values one hour after the operation in all groups, and 24 hours after the operation in Groups I and III (p<0.05) (Figure 1).


**1. Introduction**

3

Since the conceptualization of bounded rationality by Herbert Simon (1947), management scholars started investigating how people—managers and entrepreneurs—really make decisions within (and for) organizations. Taking into considerations the effect on organizational choices (e.g., new product development, market entry, merger and/or acquisition of other entities) and related performance (in organizational, economic, and social terms), a series of trends have flourished within this pivotal research area. Nowadays, the main important are: the biasing or beneficial role of heuristics (i.e., cognitive shortcuts of human mind) (Kahneman 2003), the influence of socio-demographic characteristics and personality traits (see the derived Upper Echelons Theory; Hambrick and Mason 1984; Abatecola and Cristofaro 2020), the impact of affective states (e.g., emotions, mood, temperament), the intertwinement between cognitive and emotional factors, the co-determinant role of the (micro-, meso-, and macro-) environment in the formation of choices with person-, group-, firm-specific variables, and the biasing or beneficial impact of technologies on managers' and entrepreneurs' rationality.

The aim of the proposed Special Issue is to deeply investigate these trends in conceptual and/or empirical terms, trying to provide new insights on how managers and entrepreneurs make decisions within and for organizations. Research direction followed were: (a) The analysis of the differential role of affective states in managerial and entrepreneurial decisions (Baron 2008; Zhang and Cueto 2017), as the emotions are a driver for motivation regarding goals achievement, and impacts the nature of the decision (Cristofaro 2019); (b) differential cognitive schemas of managers and entrepreneurs (Forbes 1999; Cristofaro 2020); (c) the features of new technologies (e.g., big data analytics) that help or undermine decision-making processes (Sundberg and Larsson 2017); (d) dilemmas of organizational culture regarding the possibility of reducing the negative influences of cognitive traps (Hammond et al. 1998; Bazerman and Moore 2013); (e) heuristics conditions that are beneficial for managers and/or entrepreneurs during the organizational development processes; (f) the stronger or weaker impact of the personality of managers/entrepreneurs on decisions respect to their affective states (Armstrong et al. 2012), (g) the role of competences and experiences in the learning and decisions paths (Sousa et al. 2019; Sánchez-García et al. 2017); (g) which heuristics are beneficial for "take the plunge decisions" of entrepreneurs; (h) the differences in emotions in individual and group decisions; and (i) the impact of cognition and/or affective states of stakeholders on the one of managers and entrepreneurs (Hodgkinson and Sadler-Smith 2018).

**Citation:** Cristofaro, Matteo, Maria José Sousa, José Carlos Sanchéz-Garcia, and Aron Larsson.2021. Contextualized Behavior for Improving Managerial and Entrepreneurial Decision-Making. *Administrative Sciences* 11: 14. https://doi.org/10.3390/admsci 11010014

Academic Editor: Isabel-María Garcia-Sanchez Received: 7 February 2021 Accepted: 8 February 2021 Published: 10 February 2021

**Publisher's Note:** MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

**Copyright:** © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/).

### **2. Managerial and Entrepreneurial Decision Making: Emerging Issues**

The Special Issue of *Administrative Sciences* entitled "Managerial and entrepreneurial decision making: Emerging issues" received 16 submissions from March 2020 to October 2020. Among them, only 7 have been accepted to be published (acceptance rate 43%) after the one-blind peer-review process. Published manuscripts were considered having scientific soundness and originality, but, especially, leading to the advancement of managerial and entrepreneurial decision-making literature.

About the entrepreneurial decision-making process, the study of Arend (2020) entitled "Getting Nothing from Something: Unfulfilled Promises of Current Dominant Approaches to Entrepreneurial Decision-Making" makes a provokable debates on the value of two dominant models in the decision-making process in the entrepreneurial context: the creative school, and the logic of effectuation. In particular, departing from the weaknesses and failures of the of these two models, he then provides a series of alternative approaches for effectively studying the entrepreneurial decision-making. The first approach states that the origins of the resources are not identifiable; they are windfalls that occur at different stages of the process and with different possible effects. From this, the role that managers-entrepreneurs have in the identification of resources, as well as in their use, stands out. The second approach also considers heterogeneous factors as windfalls and explicitly recognizes that other companies are endowed with them as well, which should lead to progress through co-evolutionary action. This alternative provides more open roles for managers and more meaning for institutional policy purposes to support business decision-making. The third alternative they propose takes a different starting point. It is aimed at the premises of the formal theories that underlie the currently dominant approaches. Provided critiques offer the basis to identify spaces for improvement, to warn from applying prescriptions that rely on models' current weaknesses and flaws, and to outline the opportunities of three different alternative approaches in studying entrepreneurial decision-making.

As to extend the analysis of the entrepreneurial decision-making process, this was also investigated by a third party view, in particular, from the consultants' standpoint. Indeed, Nuijten et al. (2020), with their work entitled "Cognitive Biases in Critical Decisions Facing SME Entrepreneurs: An External Accountants' Perspective," examined biases in entrepreneurial decision-making from the perspective of SME accountants. To this aim, they conducted an empirical study by interviewing 14 accountants who can provide independent assessments of small medium enterprise (SME) decision-making regarding strategy, regulatory compliance, human resources, IT, and succession. Results show that the presence of a particular bias is highly dependent on decision domain as well as accountants showed four different approaches (warn, inform, intervene, and coach) when they encounter cognitive biases in entrepreneurial decision-making. In this study, therefore, the role of the context in which a decision is made emerges as pivotal because of the emergence of distinct biases. As to reduce the probability of falling in these biases, authors propose that accountants must intervene in highlighting the cognitive pitfalls to SME entrepreneurs as well as that extensive programs of feedback to combat biases should be implemented.

This conclusion is shared also by the work of Schettini et al. (2020) entitled "Enhancing Healthcare Decision-Making Process: Findings from Orthopaedic Field." In particular, they intended to analyze, through an interview-based explorative case study, whether and how cognitive biases occurring in "clinical reasoning" can affect orthopedists in decision-making regarding the follow-up after knee and hip arthroplasty. Results from the semi-structured face-to-face interviews conducted with three orthopedic surgeons attested the presence of four common biases (affect heuristic, anchoring, halo effect, saliency), and four others (groupthink, availability, overconfidence, confirmation) that come to light depending on the physicians' intrinsic working experience and/or working context (i.e., private or public hospital). From that, decision-making of physicians can be improved through the intervention of a third party that can evaluate the process according to the context in

which it is embedded. The amelioration of decision-making processes, therefore, may come through the involvement of a third party and practices of training and coaching.

Above results are also in line with the work by Goldsby et al. (2020), who proposed a conceptual paper entitled "Under Pressure: Time Management, Self-Leadership, and the Nurse Manager." The work advances a model to help mitigating time pressure on nurse managers and their frontline nurses based on the research regarding time pressure, psychosocial care, time management, and self-leadership. In particular, by the use of the metatriangulation methodology, authors propose three metaconjectures. First, it is proposed that time pressure will impede good decision-making and detract from the provision of quality psychosocial care by nurse managers. Second, research on time management and self-leadership leads authors to conjecture that when practices in these two areas are successfully implemented, the negative effect of time pressure on decisions related to care can be reduced. Third, the proper application of time management and self-leadership practices moderates the relationship between time pressure and psychosocial care by nurse managers. They conclude that deliberate and persistent use of time management and self-leadership practices, stimulated by training and coaching, may reduce the dissatisfiers that drain time and energy on the unit and open up more opportunities to find the little fixes that add marginal time savings as well.

However, biases in decision-making processes are just an effect of inner antecedents of decision-makers (e.g., personality traits, affective states, etc.,) and, because of that, another effective strategy to prevent cognitive biases is to understand their link with these precursory factors. In this regard, the study by Cristofaro et al. (2020) entitled "The Influence of Core Self-Evaluations on Group Decision Making Processes: A Laboratory Experiment" deals with the consideration of the personal trait called Core Self-Evaluations (CSE)—thus, the evaluations that individuals make about others, the world, and themselves—in decisionmaking processes. In particular, CSE of respondents was investigated with regard to: (i) the duality intuitive vs. reflective thinking, (ii) the connection with the overconfidence bias, and (iii) decision-making performance. To this aim, 120 graduate students—divided into groups of four—took part in a simulation game and were asked to make decisions acting the role of General Manager of a small-sized manufacturing firm. Results show that an average level of CSE is preferable to balance intuitive and reflective thinking, as well as avoiding overconfidence bias and reaching the best performance possible. This work suggests that there is a huge misattribution in considering a high level of CSE as being beneficial for decision-making processes and consequent performance and, because of that, managers should be aware of the level of CSE of each individual composing groups as to reach effective results.

In parallel to the study of the contextual features and personal characteristics that can lead to advent of biases in decision-making processes, other studies have been more focused on the actions to be implemented for anticipating undesired decision outcomes. In this vein, the paper by Splichalova et al. (2020) entitled "Managerial Decision Making in Indicating a Disruption of Critical Infrastructure Element Resilience," proposed a conceptual model to preventively indicate a potential disruption of the critical infrastructure elements' resilience before the actual occurrence of the adverse event. They identify the lack of managerial tools for the purpose of providing process support to decision-making in the selection of indicators for resilience disruptions, and contributes with a discussion on the need to further address resilience disruptions in the protection of critical infrastructure. In particular, they propose a model that consists of eight interconnected steps, providing the assessor with comprehensive instructions for the indication of a possible disruption of the resilience of critical infrastructure elements. This enables the assessment of the current level of the element's resilience to disruptive events evaluated according to the available methods.

With the same rationale of Splichalova et al. (2020), the work by Brous and Janssen (2020) entitled "Trusted decision-making: Data governance for creating trust in data science decision outcomes" provided a thoughtful model to understand the role of data governance in creating trust in data science decision outcome. In particular, owing to the duality of technology lens and the adoption of two explanatory case studies in the asset management domain, authors are able to depict the interactions among the organization, decisionmakers, and technology. Propositions of the model establish that organizations with an established data governance capability are more likely to: (i) have a well-functioning data science capability, (ii) to generate trusted data science outcomes, (iii) to ensure that organizational conditions of data science are met, (iv) and manage organizational and process changes introduced by data science outcomes. In synthesis, data governance here emerges as a boundary condition for managing the organizational consequences of data science outcomes.


*2.4. Bone Metastatic Samples: 147, A153, PCSD13 and 1135*

Sampling for genomic analyses occurred at bone biopsy. Patients 147 and A153 had not yet had systemic therapy, while 1135 had CRPC, having commenced intermittent ADT for BCR 3 years postoperatively. PCSD13 presented with de novo metastatic disease manifesting as hip pain. Investigations revealed multiple bone metastases and an elevated PSA. Selected genomic events are summarized in Figure 6.

**Figure 6.** Summary of relevant genomic alterations for cases with metastatic disease at the time of sampling (cases 147, A153, PCSD13, 1135); Circos plots as per Figure 3.

2.4.1. Case 147: Biopsy Left Pubic Bone Corresponding to Sclerotic Region on Imaging

This case did not have any relevant somatic SNVs or WGS-identified SVs. SCNAs included gains in *BRAF, AHNAK* and *BRD4*.

It is unknown, yet unlikely, whether the copy number gain in *BRAF* would be sufficient to sensitize the patient to BRAF inhibition. The low level of relevant alterations in this case may explain his less aggressive disease course with a late clinical relapse (10 years post prostatectomy). The gains in *BRD4* and *AHNAK* may have contributed to metastasis formation: BRD4, part of the Bromodomain and Extraterminal (BET) protein family, regulates tumour cell migration and invasion through transcription of *AHNAK* [83]. Small molecule BRD4-selective degraders inhibit metastatic potential in PCa cell lines and a Phase I clinical trial of birabresib which included CRPC patients has been completed [84]. BRD4 is also involved in the non-homologous end joining (NHEJ) DDR pathway and higher protein levels from pre-treatment biopsies are associated with poor outcomes following radical radiotherapy in localized disease [85].


*4.3.4 Age*

Interaction between the advanced glycation end-products (AGE) with its receptor (RAGE) is known to have pro-inflammatory consequences. Pharmacological inhibition of RAGE signalling led to a significant decrease in retinal capillary degeneration and other early lesion of DR in animal models [29].


**Meet the editor**

Ricardo López-Ruiz, M.S., Ph.D., works as an Associate Professor in the Department of Computer Science and Systems Engineering, Faculty of Science, University of Zaragoza, Spain. He also serves as an Associate Researcher in Complex Systems at the School of Mathematics, University of Zaragoza. He also worked as a Lecturer in the University of Navarra, the Public University

of Navarra and the UNED of Calatayud. He completed his postdoc with Prof. Yves Pomeau at the École Normale Supérieure of Paris and with Prof. Gabriel Mindlin at the University of Buenos Aires. His areas of interest include statistical complexity and nonlinear models, chaotic maps and applications, multiagent systems, and econo-physics.

Contents

**Preface VII**

**Algorithms 3**

**Recognition 21**

Fonseca

**Section 3 Face Recognition 89**

Chih-Wei Lin

**Section 1 Speech Extraction and Recognition 1**

Chapter 1 **Some Commonly Used Speech Feature Extraction**

Chapter 2 **Convolutional Neural Networks for Raw Speech**

**Section 2 Acoustic and Learning Applications 41**

Vishal Passricha and Rajesh Kumar Aggarwal

**Scenarios for Urban Representation 43**

Ramirez and Jocelyn Pamela Garcia-Duran

Chapter 5 **Local Patterns for Face Recognition 91**

Sabur Ajibola Alim and Nahrul Khair Alang Rashid

Chapter 3 **Evaluation between Virtual Acoustic Model and Real Acoustic**

Chapter 4 **Formative E-Assessment of Schema Acquisition in the Human Lexicon as a Tool in Adaptive Online Instruction 69**

Josep Llorca, Héctor Zapata, Jesús Alba, Ernest Redondo and David

Guadalupe Elizabeth Morales-Martinez, Yanko Norberto Mezquita-Hoyos, Claudia Jaquelina Gonzalez-Trujillo, Ernesto Octavio Lopez-


*3.3. Mobile Application*

An Android mobile application was developed to gather the sensor data from the Microsoft Band and the BLE advertising data packets being broadcasted from the BLE beacons. During the system operation, the mobile device is paired with the Microsoft Band and receives the incoming sensor data stream. Furthermore, all BLE traffic the mobile device is in range of is being filtered, so only our beacon advertising data packets are being captured. Then, the respective beacon identifiers and the measured RSSI of each packet are stored. To filter out any unwanted data, the application firstly looks to see if the captured packet is structured in accordance to the iBeacon protocol by checking for the prefix (see Figure 3), and then, it will attempt to find the UUID being used by our beacons.

The application was designed with a modular approach, to allow it to be used with other wearable devices easily without the need to change the core program; thus granting the ability to integrate new wearable devices quickly and efficiently. During the data gathering phase of our experiments, a session is created for every participant. When performing a data capture, the activity about to be performed is selected from a drop down list. Then, during a data capture operated by the start/stop button on the application interface, sensor data from the smart watch and BLE advertising data from the beacons are collected simultaneously and stored locally before being sent to a server once the capture has finished.