Grey Area Research Articles

“That grey area where no one can help”: The experience of younger people avoiding or leaving residential aged care who are not NDIS participants

AbstractLiving in residential aged care (RAC) can have deleterious effects on the health, well‐being and social participation of younger people (<65 years of age). This research examined the barriers and enablers to leaving or avoiding RAC for Australian younger people who are not National Disability Insurance Scheme (NDIS) participants. It reports on the findings from semi‐structured interviews with 16 younger people living in, or at risk of entering RAC and 12 family members. The research revealed that most participants were opposed to younger people living in RAC, and many of those who were already living in RAC were dissatisfied with their lives. However, some in RAC reported feeling satisfied, and expressed fear that their needs would not be met elsewhere. The barriers and enablers to leaving or avoiding RAC related to funding to access services, help to navigate funding and services, and the availability of services in rural and regional areas. To best support younger people, there is a need for increased funding for the services required to live outside RAC, and assistance to navigate funding and services. Initiatives that address hesitancy to move from RAC, and to build capacity to help younger people imagine life outside RAC are required.

Human Rights in Limbo: A Human Rights Analysis of Religious Freedom Protections in European Asylum Centres

Abstract This article examines the legal protections for religious freedom afforded to non- detained asylum seekers and refugees in European asylum centres, highlighting the gap between theoretical rights and practical implementation. Despite the fundamental right to freedom of religion or belief, asylum seekers often face coercion, verbal and physical attacks, and restrictions on their religious practices within these centres. The absence of regulations or guidelines exacerbates these problems, leaving operators in a legal grey area and the religious freedom rights of asylum seekers in limbo. The article also examines how the privatisation of refugee reception impacts human rights obligations and the dual nature of state responsibilities—both negative and positive—regarding religious freedom. It emphasises the necessity for the implementation of regulations and guidelines to guarantee the enforcement of religious freedom protections, with the objective of safeguarding the religious freedom rights of asylum seekers and refugees in European asylum centres.

War, art, and sanctions: social network analysis on the NACP’s databases of sanctioned Russian individuals and art collectors

AbstractUntil March 2024, Ukraine’s National Agency on Corruption Prevention (NACP) was tasked with maintaining databases of individuals sanctioned for their support of Russian military action in Ukraine and monitoring works of art owned by these individuals to prevent their being sold in violation of sanctions. The present study gathered data from the NACP’s War & Sanctions and War & Art databases through a combination of web scraping and API requests. These data were then examined using measures of network analysis (including degree centrality, eigenvector centrality, and clustering coefficient), which allowed the visualisation and statistical analysis of the network of Russian elite. This research is the first that has conducted scientific analysis on these datasets. Investigation determined that the social network of individuals in the upper strata of Russian society is vast and moderately centralised, with over a dozen clusters around influential Russian oligarchs, politicians, and celebrities. It also determined that art collectors have a more central role in this network than non-collectors of art. The network exhibits a clear presence of hubs and nodes with high degree centrality and a high degree-betweenness centrality correlation, indicating that information can flow quickly and efficiently. However, the network’s dependence on a few key individuals could constitute a vulnerability, with the extraction or isolation of these figures potentially disrupting the network’s function and coordination. This research also identified inconsistencies in the imposition of sanctions, creating grey areas that could allow the continued trade of cultural goods, potentially bypassing international restrictions.

Religious hydro-healing and medical hydrotherapy: Links, benefits, contrasts and challenges

here seems to be some recognition of the relevance of dihydrogen oxide (water) in many spheres. Among others, literature in poetry, religious texts and medical science, address the value of water in emotional, physical and psychological healings. To understudy how religion, spirituality and medical science connect and contrast in domesticating water for healing purposes, this article undertook literary research on religious and medical hydro-healings in Christianity, African and Native American traditional religions, and medical science. It presented links, benefits, challenges and contrasts between spiritual healing and medical water therapy as well as inter-religious connections. Based on the literature, the article discovered that spiritual hydro-healing is spiritual, instantaneous and non-scientific, but medical hydrotherapy is organic, naturopathic, gradual and scientific or logical. On the positive side, the article found that indigenous spiritual knowledge is a key motivating factor in the popularity of hydro-healing practices. Whereas, on the negative, it observed the danger of the grey areas of spiritual hydro-healings which include, but are not limited to, unethical practices, commercialisation of healing waters, addiction, river baptism mortality and the quest for instantaneous hydro-healing leading to health hazards and death.Contribution: The article concluded with an urgent call to stakeholders to pay attention to the hydro-healing practices that can compromise public health and safety.

Grey areas in restorative dentistry: introduction

Grey areas in restorative dentistry: introduction

Grey areas in restorative dentistry: part 1. what are the aims of treatment?

Every dental practitioner makes decisions about how to manage the various clinical and ethical challenges that patients present. There is a need to balance the demands of the patient with the ethical requirements of the profession and the moral position of the practitioner. It is essential to establish with the patient, before any treatment is carried out, what outcomes are required so that a mutually agreed care plan can be drawn up and acted upon. This article explores the clinical and moral and ethical challenges that can arise in the patient–practitioner relationship. CPD/Clinical Relevance: All practitioners will be faced with the issues raised in this article.

Sphingosine 1-phosphate receptor subtype 1 (S1P1) activity in the course of Alzheimer's disease

Some specific lipid molecules in the brain act as signaling molecules, neurotransmitters, or neuromodulators, by binding to specific G protein-coupled receptors (GPCR) for neurolipids. One such receptor, sphingosine 1-phosphate receptor subtype 1 (S1P1), is coupled to Gi/o proteins and is involved in cell proliferation, growth, and neuroprotection. S1P1 constitutes an interesting target for neurodegenerative diseases like multiple sclerosis and Alzheimer's disease (AD), in which changes in the sphingolipid metabolism have been observed. This study analyzes S1P1 receptor-mediated activity in healthy brains and during AD progression using postmortem samples from controls and patients at different Braak's stages. Additionally, the distribution of S1P1 receptor activity in human brains is compared to that in commonly used rodent models, rats and mice, through functional autoradiography, measuring [35S]GTPγS binding stimulated by the S1P1 receptor selective agonist CYM-5442 to obtain the distribution of functional activity of S1P1 receptors.S1P1 receptor-mediated activity, along with that of the cannabinoid CB1 receptor, is one of the highest recorded for any GPCR in many gray matter areas of the brain, reaching maximum values in the cerebellar cortex, specific areas of the hippocampus and the basal forebrain. S1P1 signaling is crucial in areas that regulate learning, memory, motor control, and nociception, such as the basal forebrain and basal ganglia. In AD, S1P1 receptor activity is increased in the inner layers of the frontal cortex and underlying cortical white matter at early stages, but decreases in the hippocampus in advanced stages, indicating ongoing brain impairment. Importantly, we identified significant correlations between S1P1 receptor activity and Braak stages, suggesting that S1P1 receptor dysfunction is associated to disease progression, particularly in memory-related regions. The S1P signaling via S1P1 receptor is a promising neurological target due to its role in key neurophysiological functions and its potential to modify the progression of neurodegenerative diseases. Finally, rats are suggested as a preferred experimental model for studying S1P1 receptor-mediated responses in the human brain.

Genotype and corticosteroid treatment are distinctively associated with gray matter characteristics in patients with Duchenne muscular dystrophy

This study investigated if structural variation in specific gray matter areas is associated with corticosteroid treatment or genotype, and if cerebral morphological variations are related to neuropsychological and behavioral outcomes.The CAT12 toolbox in SPM was used for MRI segmentations, assessing subcortical structures, cortical thickness, gyrification, and sulci depths for DMD patients (n=40; 9-18 years) and age-matched controls (n=40). Comparisons were made between DMD vs. controls, daily vs. intermittent corticosteroid treatment (n=20 each), and Dp140+ vs. Dp140- gene mutations (n=15 vs. 25). MANCOVA, CAT12 3D statistics and Pearson correlations were conducted.DMD patients showed differences in volumes of distinct subcortical structures, left hemisphere cortical thickness, and gyrification in multiple brain areas compared with healthy controls. The daily treated DMD group exhibited differences in subcortical volumes and different patterns of cortical thickness, sulci depth, and gyrification compared to the intermittent treated DMD group. DMD Dp140+ patients displayed altered gyrification and sulci depth compared to DMD Dp140- patients. Finally, we found correlations between neurobehavioral outcomes and brain areas that showed differences in cortical morphology associated with corticosteroid treatment.Both genotype and corticosteroid treatment are associated with variations in subcortical volumes and cortical morphology, albeit in different ways. Corticosteroid treatment appears to have a more profound association with differences in gray matter characteristics of brain regions that are associated with functional outcomes.

Performance Evaluation of RC Structures using Next- Generation Performance-Based Seismic Assessment Procedures

Seismic forces have wreaked havoc on buildings around the world, resulting in both property damage and human deaths. Reinforced concrete structures under cyclic loading cannot be predicted using current methods, according to relevant design codes. Code-based seismic design procedures have been replaced by performance-based design procedures (PBSD). PBSD describes a building's overall performance by taking into account its structural and non-structural performance categories. Immediate occupancy, life safety, and collapse prevention are the three types of damage that can be encountered in a construction site. They are ranked based on the amount of damage, downtime, and casualties they inflict. Although these procedures can detect damage, they are unable to assign a numerical value to the seriousness of the damage. The use of damage indices, which are based on structural and response-based parameters, has been proposed by many researchers in the past. The objective of current research is an attempt to summarise all of these efforts and identify grey areas for further investigation. Numerical approaches to integrate structural damages with various PBSD performance levels have been proposed.

Double edged tech: navigating the public health and legal challenges of digital twin technology

Abstract This research addresses the legal challenges posed by the implementation of digital twin technology in public health. Digital twins are advanced computational models which aim to replicate human organ functions and biological processes. Their goal is to enable the simulation of the entire human body and to personalize the outputs with individual patient’s health data. Digital twin technology promises to bridge gap between personalized medicine and precision public health. This research is based on a comprehensive review of the current European and Swiss legal frameworks for medical devices and data protection that apply to digital twin technology. Within these frameworks, digital twins are in a grey area, as they are only considered as medical device software when applied to individuals. They also incorporate artificial intelligence, machine learning, and data analytics, which are already a source of legal concern in a healthcare setting, but their effective use in public health raises additional issues. Preliminary findings suggest significant shortcomings in the legal frameworks regarding data privacy, and the potential for increased surveillance by health insurance systems, which could lead to human rights violations. The public health application of digital twins would require global data analysis of sensitive personal information, raising further questions about the secure storage, transmission, and processing of this data. The study concludes that current legal frameworks must be future proofed to manage the complexities introduced by digital twins in public health. In particular, it suggests that regulatory oversight of medical devices needs to be significantly improved in order to safely harness the potential of digital twin technologies for public health. Finally, the new European Union health data space and the forthcoming EU AI act will also play important roles in the implementation of digital twin technologies. Key messages • Applying digital twin technology in public health faces considerable challenges, particularly the issues around data privacy, potential discrimination, and increased surveillance. • We need to adapt and strengthen existing legal frameworks to effectively manage the complexities introduced by digital twins, ensuring that these technologies can be safely used for public health.

Analisis Tingkat Kebangkrutan pada PT Patra Trading Jakarta

This research aims to determine the prediction of the bankruptcy level of PT. Patra Trading uses financial report data from 2021 to 2023. The method used in this research is Quantitative Descriptive non-Statistical. This research uses secondary data originating from the company PT Patra Trading in the form of the company's annual financial report. The population used is a subsidiary of PT Pertamina Patra Niaga. The sampling technique used in this research is Purposive Sampling for taking samples from the population based on certain criteria. The benchmarks for this bankruptcy prediction analysis consist of several ratios; (1) working capital to total asset; (2) rentaint to total asset; (3) profit before interest and tax to total assets; (4) book value equity to book value liquiditas; (5) profit before tax on current liabilities; (6) sales to total assets: (7) return of assets; (8) debt ratio; (9) current ratio. The results of the analysis using the Altman Z-Score, Springate, Zmijewski, Grover model on PT Patra Trading, provide different research results, where two of them say that PT Patra Trading is in the healthy category, namely in the Zmijewski model the final figure for this model is below 0 and the Grover model final figure is above 0.001. The Springate model says that PT. Patra Trading is still in the bankruptcy category where the final figure is below the standard, namely 0.862. Finally using the Altman Z Score model at PT. Patra Trading is in the gray area.

Retrospective validation of automatic sleep analysis with grey areas model for human-in-the-loop scoring approach.

State-of-the-art automatic sleep staging methods have demonstrated comparable reliability and superior time efficiency to manual sleep staging. However, fully automatic black-box solutions are difficult to adapt into clinical workflow due to the lack of transparency in decision-making processes. Transparency would be crucial for interaction between automatic methods and the work of sleep experts, i.e., in human-in-the-loop applications. To address these challenges, we propose an automatic sleep staging model (aSAGA) that effectively utilises both electroencephalography and electro-oculography channels while incorporating transparency of uncertainty in the decision-making process. We validated the model through extensive retrospective testing using a range of datasets, including open-access, clinical, and research-driven sources. Our channel-wise ensemble model, trained on both electroencephalography and electro-oculography signals, demonstrated robustness and the ability to generalise across various types of sleep recordings, including novel self-applied home polysomnography. Additionally, we compared model uncertainty with human uncertainty in sleep staging and studied various uncertainty mapping metrics to identify ambiguous regions, or "grey areas", that may require manual re-evaluation. The validation of this grey area concept revealed its potential to enhance sleep staging accuracy and to highlight regions in the recordings where sleep experts may struggle to reach a consensus. In conclusion, this study provides a technical basis and understanding of automatic sleep staging uncertainty. Our approach has the potential to improve the integration of automatic sleep staging into clinical practice; however, further studies are needed to test the model prospectively in real-world clinical settings and human-in-the-loop scoring applications.

A wall-modeled large-eddy simulation of the unsteady flow in a water-jet pump based on the turbulent length scales

Non-zonal hybrid Reynolds-averaged Navier-Stokes (RANS) and large-eddy simulation (LES) are commonly used for predicting unsteady flows in pumps. However, these hybrid methods often face challenges in the transition between the RANS and LES regions, known as the “grey area” problem. In this study, a pure LES approach, coupled with wall modeling to eliminate this issue, was employed to simulate unsteady flow in a water-jet pump (WJP). A grid generation method, based on turbulent length scales derived from a precursor RANS calculation, was developed to address the complexities of grid design in wall-modeled large-eddy simulations (WMLESs) for complex geometries. Initially, the accuracy of the wall model was validated in the fully developed channel flow. The grid generation method and the accuracy of WMLES in predicting unsteady fluctuations were validated using the flow over a flat strut with an asymmetrically beveled trailing edge. The predicted fluctuation spectra at monitored points showed strong agreement with experimental data. The grid generation method was then applied to WMLES of flow in a WJP, where experimental measurements of the pump head rise and torque were accurately calculated by the numerical simulations. The results from three different grid resolutions were compared with experimental data, revealing significant changes in the predicted mean and transient fields as the grid was refined. The grid based on the turbulent length scales reproduced both the hydrodynamics and transient vortices with high accuracy and detailed resolution. These comparisons demonstrated that pure LES with wall modeling effectively predicts the mean and fluctuating characteristics of high Reynolds number flows with reasonable computational cost. The turbulent length scale-based WMLES enhance the fidelity of computational tools for simulating pump flows.

Pendaftaran Merek yang Memiliki Persamaan pada Pokoknya pada Kelas Berbeda dalam Perspektif Peraturan Perundang-Undangan

Simply said, a brand is any kind of distinctive symbol or name used in commercial contexts. There is still some gray area in Indonesia's trademark recording rules when it comes to the idea of basically identical trademarks and how to register ones that are quite similar to others in various classifications. From a legislative standpoint, this study intends to explore the notion of fundamental similarities in brands and its restrictions. It will also evaluate the recording of substantially similar trademarks in various classes in Indonesia. Using the framework of UU No 20 of 2016 concerning Marks and Geographical Indications, the study approach employed is normative legal research, which looks at the recording of trademarks in various classes that are basically comparable. Because the idea of similarity in essence is subjective and open to different interpretations by different people, the study's findings reveal that trademark recording requirements are vague on the issue. Nevertheless, while looking at statutory requirements, it is possible to register marks that are essentially similar to existing marks under UU No. 20 of 2016, provided that the marks are in a separate class.

Conceptual Complexity About Return Migration of Refugees/Asylum Seekers

Return migration is one of the complex categories of migration, which becomes even more complicated in the context of refugees’ return to their country of origin. A plethora of terms is used to describe the return of refugees/asylum seekers, having strong political and policy relevance. To unpack the features and drivers of conceptual complexity, I propose three interrelated arguments. The first is that labelling – the choice of one concept over another – in return migration often depends on who uses the term (e.g. scholars, policymakers, practitioners, migrants) and in which part of the world. The second argument is that return, similar to binaries in other areas of migration, is often associated with binaries, such as voluntary and forced return. Despite policy categories that reiterate the ‘voluntary’ character of return, the actual practices rarely confirm that return is voluntary and often remain in grey areas, as the emerging literature on bordering practices shows. The third argument is that there are multiple levels at which labelling and binaries are constructed in relation to each other. The identifiable scales include the academic level, the policy level and the migrants themselves.

The Gray Area of Sarcoidosis and Tuberculosis: A Diagnostic Enigma

The Gray Area of Sarcoidosis and Tuberculosis: A Diagnostic Enigma

Adenoma, Hamartoma, or Something Else? Unique Diagnostic Challenges in Mixed Epithelial-Mesenchymal Lesions of the Gastrointestinal Tract

Abstract Introduction/Objective Mixed epithelial-mesenchymal lesions (MEMLs) are well-known in the gynecologic tract and, to a lesser extent, in the lungs and kidneys. However, the literature is mostly lacking in the GI tract. These cases pose significant diagnostic challenge when encountered upon, as there are many pitfalls and gray areas exist in characterization. Amongst other entities, hamartomas can account for a portion of these cases. Herein, we present a unique case of MEML identified in duodenum, which was reported as a hamartoma. Methods/Case Report A 59-year-old male presented with persistent upper GI bleeding requiring multiple transfusions. Initial upper GI endoscopy revealed an oozing ulcer as part of a 30 mm polyp in the second portion of duodenum opposite to ampulla. Epinephrine was injected for homeostasis. After repeat endoscopy failed to completely resect the lesion, the patient underwent exploratory laparotomy with resection of the 2nd portion of duodenum. The sections showed a submucosal proliferation of epithelial and mesenchymal elements. The epithelial component consisted of bland-appearing foveolar type mucinous glands, partly showing cystic dilation, while the mesenchymal component consisted of lymphovascular and neural structures as well as a population of small round cells that showed patchy SMA immunolabeling and low Ki67 proliferation index. The case was reported as hamartoma, however, a Brunner’s gland cyst and pericytic tumors (i.e. glomus tumor) were also considered. While the histologic features did not suggest malignancy, the patient had been followed-up closely for 6 months. Recurrence or malignant transformation was not reported. Results (if a Case Study enter NA) NA Conclusion MEMLs in the GI tract are always challenging to diagnose due to their rarity, unknown etiology and natural history, and lack of established risk factors. Furthermore, mesenchymal component is often difficult to characterize due to multiple differentiations and patchy/unrevealing immunohistochemistry. We report this unique case to enhance the awareness and recognition of MEMLS in the GI tract.

Navigating 'grey areas' and challenges during evaluation of transplant eligibility in specific myelofibrosis populations: a perspective on behalf of the Chronic Malignancies Working Party of the EBMT.

Significant efforts have been made to effectively select myelofibrosis (MF) patients who can benefit from allogeneic hematopoietic cell transplantation (allo-HCT), the only current cure for MF. The recent EBMT/ELN 2024 recommendations offer valuable guidance for hematologists and transplant physicians. However, several grey areas remain in day-to-day clinical practice regarding the feasibility and optimal preparation for transplantation in patients with this disease. Effective spleen size reduction, often achieved with JAK inhibitors, appears crucial for transplant success. For resistant cases, switching JAK inhibitors, splenectomy, or spleen irradiation may be considered, taking into account patient profiles, treatment availability and center preferences. Managing splanchnic vein thromboses, portal, and pulmonary hypertension is critical as these conditions may affect transplant outcomes. Cytopenias, particularly transfusion-dependent anemia and thrombocytopenia, complicate treatment and impact on outcomes, though new drugs show promise. Comorbidities play a significant role and tools like the Hematopoietic Cell Transplantation-Comorbidity Index (HCT-CI) and frailty assessments are useful for evaluating transplant risks while allowing the implementation of corrective measures. Especially in low- and medium-income countries where access to novel therapies may be challenging, allo-HCT still represents an attractive therapeutic option for MF. Future directions include integrating new therapeutics into the transplant algorithm and leveraging artificial intelligence for more informed risk assessment, highlighting the need for tailored approaches to improve allo-HCT outcomes in such a setting.

An exploratory study on teachers’ perspective on applicability of neurolinguistic programming in developing language learning (at the high school level)

Neuro Linguistic Programming (NLP) is a fast-emerging set of tools and techniques for developing linguistic competencies among learners and teachers as well. NLP enables us to better understand the way our brain processes the words that we use and how that can impact our past, present and future. Learning second language offers high level of motivation and satisfaction to the learners. Similarly, teaching second language requires lots of planning and innovation in its application. In this context, NLP could be very helpful for teachers to improve their teaching skills, and similarly, it could facilitate learners to learn second language in a congenial environment. It could provide a roadmap for teachers to enhance the linguistic competence of their learners. On the other hand, it could enable the learners to identify their grey areas and provide solutions to work on their weaknesses. At this backdrop, the present paper attempts an exploratory study of teachers' perspective on the applicability of Neuro Linguistic Programming in developing Language Skills at the High School Level. / Keywords: neuro linguistic programming (NLP), second language (l2), teachers, learners, classroom, LSRW skills.

Hierarchical Classification of Factors Associated With Noninvasive Prenatal Testing Failures and Its Impact on Pregnancy Outcomes

Abstract Objective To conduct a hierarchical classification analysis of the nonreportable results of noninvasive prenatal testing in an attempt to reduce failure rates and provide pregnant women with accurate information to alleviate their anxiety. Methods In this study, 30,039 singleton pregnancies who underwent noninvasive prenatal testing in a single center from May 2019 to April 2022 were collected, and 811 samples with initial noninvasive prenatal testing failure were retrospectively analyzed. Grouping was based on the reasons for initial test failure; tracking the noninvasive prenatal testing results and prenatal diagnosis results (if any) of the “z-scores in the gray area” group and analyzing the possible influencing factors of the “low fetal fraction” group in the pre-experimental and experimental period by using one-way analysis of variance, Mann-Whitney U test, and χ2 test; and tracking the pregnancy outcomes of the test failures samples to analyze the risk of perinatal complications and adverse pregnancy outcomes of the different types of test failures. Results None of the samples' initial nonresults because of z-scores in the gray area were ultimately found to have chromosomal aneuploidy. However, pregnancy complications (P = 0.018) and a high likelihood of adverse pregnancy outcomes (P = 0.048) may still occur. Maternal gestational age (P < 0.001), body mass index (P < 0.001), library concentration (P < 0.001), and fetal gender (P < 0.001) were considered to be the associated factors for the initial low fetal fraction results. This may be associated with pregnancy complications (P < 0.001) and a high likelihood of adverse pregnancy outcomes (P = 0.034). The body mass index (P = 0.015) and time between draws (P = 0.001) were associated with the second test’s success. The incidence of low fetal fraction samples was more frequent with blood collection tubes of the G type than with the K type (P < 0.001). Conclusion Initial nonresults because of z-scores in the gray area did not imply an increased risk of aneuploidy, but vigilance is needed for an increased risk of pregnancy complications and adverse pregnancy outcomes. Because of the low fetal fraction, the initial absence of results may be related to the assay method, as well as the effect of blood collection tubes and the need to be alert to the risk of pregnancy complications and adverse pregnancy outcomes.