Gray Zone Research Articles

Comparison of the ability of short time low PEEP challenge and mini fluid challenge to predict fluid responsiveness in patients undergoing open pancreaticoduodenectomy: an observational cohort study.

The mini-fluid challenge (MFC), which assesses the change in stroke volume index (SVI) following the administration of 100 mL of crystalloids, and the short-time low positive end-expiratory pressure (PEEP) challenge (SLPC), which evaluates the temporary reduction in SVI due to a PEEP increment, are two functional hemodynamic tests used to predict fluid responsiveness in the operating room. However, SLPC has not been assessed in patients undergoing abdominal surgery, and there is no study comparing these two methods during laparotomy. Therefore, we aimed to compare the SLPC and MFC in patients undergoing open pancreaticoduodenectomy. All patients received a standard hemodynamic management. The study protocol evaluated the percentage change in SVI following the application of an additional 5 cmH2O PEEP (SVIΔ%-SLPC) and the infusion of 100 mL crystalloid (SVIΔ%-MFC). Challenges that resulted in an increase of more than 15% in SVI after the 500 ml of fluid loading were classified as positive challenges (PC). Areas under the receiver operating characteristics curves (ROC AUCs) were used for the comparison of the methods. Thirty-three patients completed the study with 94 challenges. Fifty-five (58.5%) of them were PCs. The ROC AUC of SVIΔ%-MFC was observed to be significantly higher than that of SVIΔ%-SLPC (0.97 vs. 0.64, p < 0.001). The best cut-off value for SVIΔ%-MFC was 5.6%. If we had stopped the bolus fluid administration when SVIΔ%-MFC ≤ 5% was observed (lower limit of the gray zone), we would have postponed the fluid loading in 35 (89.7%) of 39 negative challenges. The amount of fluid deferred would have corresponded to up to 40% of the total fluid given. SVIΔ%-MFC predicts fluid responsiveness with high diagnostic performance and is better than SVIΔ%-SLPC in patients undergoing open pancreatoduodenectomy. Additionally, the use of SVIΔ%-MFC has the potential to defer up to 40% of the total fluid given. gov: NCT05419570.

P‐234: Late‐News Poster: A Data‐Centric Approach to Minimize Defect Leakage in an AI‐based Automated Surface Inspection System for Display Manufacturing Process

This study advances Surface Inspection (SI) in display panel manufacturing using a data‐centric approach, addressing high gray zone rates and data discrepancies. We employed a data flywheel method with dual labeling to improve dataset quality. Results show expanded automated coverage and enhanced classification, reducing defect leakage, demonstrating AI's impact in smart manufacturing processes.

Analisis Model Altman Z”-Score Sebagai Prediksi Kebangkrutan

The retail business is a great opportunity for Indonesia because some people earn income from selling retail goods, but in recent years retail companies in Indonesia have experienced a slowdown, impacting many large and well-known retail outlets in Indonesia that have begun to stop their business for various reasons. Increasingly sophisticated technological developments such as the emergence of e-commerce that is more attractive to buyers because of the ease of transacting at a much more affordable price is one of the reasons. This study aims to analyze the prediction of potential bankruptcy in retail subsector companies on the Indonesia Stock Exchange for the 2018-2021 period by applying the Altman Z"-Score model. Sampling using purposive sampling techniques with samples of five retail companies listed on the IDX for the 2018-2021 period with a total of The sample is 5 companies, namely GLOB, HERO, MKN, MPPA and TRIO. This research uses a type of descriptive research using quantitative methods. Based on the results of research the Altman Z "-Score method categorizes companies in three categories, namely not bankrupt (safe zone) with a cut off value of Z" &gt; 2.60; prone (gray zone) with a cut off value of 1.10 &lt; Z'' &lt; 2.60 and bankrupt (distress zone) with a cut off value of Z" &lt; 1.10, which means that the company in the HERO category is in the gray zone or it could be said that the company is in a vulnerable condition. This is indicated by a Z"-Score value of 1.10 &lt; Z "&lt; 2.60. MKNT is in the distress zone position, the company shows a decreasing and negative Z"-Score value, namely Z"-Score &lt; 1.10, which means the company is in a state of bankruptcy, the Z" value. -The score is decreasing and negative, namely the Z"-Score value &lt; 1.10 which means the company is in a state of bankruptcy. Based on these results, the Z"-Score value is &lt; 1.10 which means the company is in a bankrupt position. So suggestions for a) company managers who have a Z"-Score &lt; 1.10 are expected to optimize the e-commerce platform as an alternative to cut working capital costs, land rental costs and cut other escalating costs and for investors it can be a consideration in taking investment decisions to minimize losses by utilizing Altman Z"-Score analysis.

New classifications of B-cell neoplasms: a comparison of 5th WHO and International Consensus classifications.

In 2024, the World Health Organization (WHO) launched a new classification of lymphoid neoplasms, a revision of the previously used Revised 4th Edition of their classification (WHO-4R). However, this means that two classifications are now in simultaneous use: the 5th Edition of the WHO classification (WHO-5) and the International Consensus Classification (ICC). Instead of a comprehensive review of each disease entity, as already described elsewhere, this review focuses on revisions made in both the WHO-5 and ICC from WHO-4R and discrepancies between them regarding B-cell neoplasms. Similarities include cutaneous marginal zone lymphoma, cold agglutinin disease, non-primary effusion lymphoma-type effusion-based lymphoma, and gray zone lymphoma. Differences include plasma cell neoplasms, high-grade B-cell lymphoma (double hit lymphoma), follicular lymphoma, LPD with immune deficiency and dysregulation, extranodal large B-cell lymphoma, transformations of indolent B-cell lymphomas, and diffuse large B-cell lymphoma, not otherwise specified. Understanding the similarities and differences between the two latest classifications will aid daily diagnostic practice and future research on lymphoid neoplasms.

Serum (-2)proPSA/freePSAratio, (-2)proPSA/freePSA density, prostate health index, and prostate health index density as clues to reveal postoperative clinically significant prostate cancer in men with prostate-specific antigen 2-10 ng/mL.

There is a strong clinical need to fill the gap of identifying clinically significant prostate cancer (csPCa) in men with prostate-specific antigen(PSA) gray zone values. Promising, but not definitive results have been obtained using PSA derivatives such as prostate health index (PHI) and PHI density (PHID) and the percentage (-2)proPSA/free PSA(%p2PSA/fPSA). Thus, this study aimed to compare the diagnostic value of PHI, PHID, %proPSA/fPSA, and (-2)proPSA/freePSA density (-2pPSA/fPSAD) for csPCa in the patients with PSAwithin 2-10 ng/mL. Serum samples and clinicopathological features were prospectively collected from 142 patients who underwent robot-assisted radical prostatectomy between September 2021 and December 2023. According to the inclusion criteria, the patients with total PSA within 2 and 10 ng/mL and negative or suspicious digital rectal examination were enrolled. We used two different classifications for csPCa: 1) patients with Gleason score (GS) ≥ 7(4 + 3) and 2) patients with GS ≥ 7(3 + 4). The receiver operating characteristic curves and the area under the curve (AUC)values were used to assess the diagnostic performance. Of the 142 men included, 116 (82%) patients were diagnosed with csPCa as GS ≥ 3 + 4 and 107 (75%) defined as csPCa as GS ≥ 7(4 + 3), respectively. We found that p2PSA/fPSA, p2PSA/fPSAD, PHI, and PHID were significantly higher in csPCa classified as GS ≥ 7(3 + 4) as well as GS ≥ 7(4 + 3), with p-values 0.027, 0.054, 0.0016, and 0.0027, respectively. AUCs of the analyzed variables were higher when used to predict csPCa as GS ≥ 6 compared to csPCa as GS ≥7(4 + 3), with an AUC equal, respectively, to 0.679 (95% CI: 0.571-0.786), 0.685 (95% CI: 0.571-0.799), 0.737 (95% CI: 0.639-0.836), and 0.736 (95% CI: 0.630-0.841) in the first subgroup and with an AUC equal, respectively, to 0.653 (95% CI: 0.552-0.754), 0.665 (95% CI: 0.560-0.770), 0.668 (95% CI: 0.568-0.769), and 0.670 (95% CI: 0.567-0.773) in the second, respectively. Both PHID and p2PSA/fPSADallowed improvement in the diagnostic accuracy with respect to PHI and p2PSA/fPSA ratio, however the differences were not statistically significant (p = 0.409, 0.180 for csPCa as G ≥ Gleason grade (GG) 2 and 0.558 and 0.087 for csPCa as G ≥ GG3, respectively). We found that PHI, PHID, p2PSA/fPSA ratio, and p2PSA/fPSADshowed higher sensitivity, specificity, and positive predictive valuewhen used to predict csPCa as GG ≥ 2, whereas negative predictive valueof all four parameters was higher when used to predict GG ≥ 3. In men with a PSA level between 2 and 10 ng/mL, PHI and PHID, p2PSA/fPSA, and p2PSA/fPSAD showed good diagnostic performance for postoperative csPCa. However, PHID and p2PSA/fPSAD had a small advantage over PHI which needs to be further investigated for the reduction of unnecessary surgical interventions. This finding suggests that it could be a promising biomarker for making the treatment-decision strategy.

Arrhythmic risk stratification in non-ischemic cardiomyopathy using cardiovascular magnetic resonance

Abstract Background Myocardial fibrosis (MF) is an essential component of the arrhythmic substrate for ventricular arrhythmias (VAs). Aims To determine whether total myocardial fibrosis (TF) and gray zone fibrosis (GZF), assessed using cardiovascular magnetic resonance, are better than LVEF in predicting ventricular arrhythmias in patients with non-ischemic cardiomyopathy (NICM). Methods and results Patients with NICM in a derivation cohort (n=866) and a validation cohort (n=848) underwent quantification of TF and GZF. The primary composite endpoint was sudden cardiac death (SCD) or VAs (ventricular fibrillation or sustained ventricular tachycardia). The primary endpoint was met by 52/866 (6.0%) patients in the derivation cohort (follow-up of 7.5 years [interquartile range, IQR] 5.2-9.3). In competing risk analyses, MF on visual assessment (MFVA) predicted the primary endpoint (hazard ratio [HR] 5.83, 95% confidence intervals [CI] 3.15-10.8). Quantified MF measures permitted categorization into 3 risk groups: a TF &amp;gt;0 ≤ 10 g was associated with an intermediate risk (HR: 4.03 [95% CI 1.99-8.16]) and a TF &amp;gt; 10g with the highest risk (HR: 9.17 [95% CI 4.64-18.1]) compared to no MFVA (lowest risk) (Figure). Similar trends were observed in the validation cohort. Categorization into 3 risk groups was achievable using TF or GZF in combination or in isolation. In contrast, LVEF&amp;lt;35% was a poor predictor of the primary endpoint (validation cohort HR:1.99, 95% CI 0.99-0.41). Conclusions MFVA is a strong predictor of SCD and VAs in NICM. TF and GZF mass added incremental value to MFVA. In contrast, LVEF was not useful in arrhythmic risk stratification.

FAST and Agile-the MASLD drift: Validation of Agile 3+, Agile 4 and FAST scores in 246 biopsy-proven NAFLD patients meeting MASLD criteria of prevalent caucasian origin.

MASLD is a prevalent chronic liver condition with substantial clinical implications. This study aimed to assess the effectiveness of three new, elastography-based, scoring systems for advanced fibrosis ≥F3 (Agile 3+), cirrhosis F4 (Agile 4), and fibrotic NASH: NASH + NAS ≥4 + F≥2 (FAST score), in a cohort of biopsy-proven NAFLD meeting MASLD criteria. Our secondary aim was to compare their diagnostic performances with those of other fibrosis prediction tools: LSM-VCTE alone, and common, easily available scores (FIB-4 or APRI). Single-center, retrospective study, on consecutive patients with baseline laboratory tests, liver biopsy, and reliable LSM-VCTE measurements. The discrimination between tests was evaluated by analyzing the AUROCs. Dual cut-off approaches were applied to rule-out and rule-in ≥F3, F4 and fibrotic NASH. We tested previously reported cut-off values and provided our best thresholds to achieve Se ≥85%, Se ≥90%, and Sp ≥90%, Sp ≥95%. Among 246 patients, 113 (45.9%) were women, and 75 (30.5%) presented diabetes. Agile 3+ and Agile 4 demonstrated excellent performance in identifying ≥F3 and F4, achieving AUROCs of 0.909 and 0.968, while the FAST score yielded acceptable results in distinguishing fibrotic NASH. When compared to FIB-4 and LSM-VCTE, both Agile 3+ and Agile 4 performed better than FIB-4 and had a similar performance to LSM-VCTE, but with higher diagnostic accuracy, hence reducing the grey zone. Agile 3+ and Agile 4 are reliable, non-invasive tests for identifying advanced fibrosis or cirrhosis in MASLD patients, while FAST score demonstrates moderate performance in identifying fibrotic NASH.

Use of stepwise lung recruitment maneuver to predict fluid responsiveness under lung protective ventilation in the operating room

Recent research has revealed that hemodynamic changes caused by lung recruitment maneuvers (LRM) with continuous positive airway pressure can be used to identify fluid responders. We investigated the usefulness of stepwise LRM with increasing positive end-expiratory pressure and constant driving pressure for predicting fluid responsiveness in patients under lung protective ventilation (LPV). Forty-one patients under LPV were enrolled when PPV values were in a priori considered gray zone (4% to 17%). The FloTrac-Vigileo device measured stroke volume variation (SVV) and stroke volume (SV), while the patient monitor measured pulse pressure variation (PPV) before and at the end of stepwise LRM and before and 5 min after fluid challenge (6 ml/kg). Fluid responsiveness was defined as a ≥ 15% increase in the SV or SV index. Seventeen were fluid responders. The areas under the curve for the augmented values of PPV and SVV, as well as the decrease in SV by stepwise LRM to identify fluid responders, were 0.76 (95% confidence interval, 0.61–0.88), 0.78 (0.62–0.89), and 0.69 (0.53–0.82), respectively. The optimal cut-offs for the augmented values of PPV and SVV were > 18% and > 13%, respectively. Stepwise LRM -generated augmented PPV and SVV predicted fluid responsiveness under LPV.

Perception-Dominant Control Types for Human/Machine Systems

We explore a novel approach to complex domain modelling by emphasising primitives based on perception. The usual approach either focuses on actors or cognition associated with tokens that convey information. In related research, we have examined using effects and/or outcomes as primitives, and influences as the generator of those outcomes via categoric functors. That approach (influences, effects) has advantages: it leverages what is known and supports the expanded logics we use, where we want to anticipate and engineer possible futures. But it has weaknesses when placed in a dynamic human-machine system where what is perceived or assumed matters more than what is known. The work reported here builds on previous advances in type specification and reasoning to ‘move the primitives forward’ more toward situation encounter and away from situation understanding. The goal is in the context of shared human-machine systems where: • reaction times are shorter than the traditional ingestion/comprehension/response loop can support; • situations that are too complex or dynamic for current comprehension by any means; • there simply is insufficient knowledge about governing situations for the comprehension model to support action; and/or, • the many machine/human and system/system interfaces that are incapable of conveying the needed insights; that is, the communication channels choke the information or influence flows. While the approach is motivated by the above unfriendly conditions, we expect significant benefits. We will explore these but engineer toward a federated decision paradigm where decisions by local human, machine or synthesis are not whole-situation-aware, but that collectively ‘swarm’ locally across the larger system to be more effective, ‘wiser’ than a convention paradigm may produce. The supposed implementation strategy will be through extending an existing ‘playbooks as code’ project whose goals are to advise on local action by modelling and gaming complex system dynamics. A sponsoring context is ‘grey zone’ competition that avoids armed conflict, but that can segue to a mixed system course of action advisory. The general context is a costly ‘blue swan’ risk in large commercial and government enterprises. The method will focus on patterns and relationships in synthetic categories used to model type transitions within topological models of system influence. One may say this is applied intuitionistic type theory, following mechanisms generally described by synthetic differential geometry. In this context, the motivating supposition of this study is that information-carrying influence channels are best modelled in our challenging domain as perceived types rather than understood types.

Mediatization of School Shooting (Сolumbine) in Fan Literature

One of the most acute and poorly predicted social problems in modern educational institutions around the world and in Russia has become school shooting (armed mass attacks) with tragic consequences and a long-term subsequent media effect. Revenge, the will to power, the search for universal attention: what motivates school shooters and generates a chain of subsequent tragic attacks in educational institutions? To a large extent, this is determined not only by internal factors (mental, behavioral characteristics), but also by external influence, including informational ones. The study is devoted to the study of a underexplored segment of fan-literature about school shooting and its participants, posted on the Wattpat and Ficbook media resources, from the position of identifying the main gender, thematic and content characteristics that contribute to maintaining interest in school shooting, its glorification and mythologization. The characteristic of the specifics, forms and mechanisms of promoting the ideas of school shooting in the media environment is obtained by the example of communities of creators and readers of fanfiction. The study was carried out using the methodological capabilities of modern communication theories as well as using Data-Science. It has been revealed that through fan literature, the topic of school shooting has largely become legalized, expanded its audience, and became a “gray zone”, poorly controlled from the outside.

BRUGADA SYNDROME: NEWEST DATA ON RISK STRATIFICATION

Abstract Background Brugada Syndrome (BrS) is a rare genetically based channelopathy responsible for malignant arrhythmias and sudden cardiac death (SCD) in young adults. Objectives The aims was to evaluate prognostic indicators useful for accurate arrhythmic risk stratification in BrS by studying genetic, clinical, anamnestic, instrumental parameters, and those derived from electrophysiological study (EPS) and intracavitary mapping. Materials and Methods 209 patients with Brugada type 1 were recruited between 01/01/2018 and 01/10/2023. Results In the first study, predictive factors related to high arrhythmic risk from the data obtained for the total population of 209 Brugada patients enrolled in our case series include a positive history of cardiogenic syncope (p value 0.000041), having had a resuscitated cardiac arrest (p value 0.00025), presenting positive EPS for inducibility of ventricular tachycardia (p value 0.00032), having a family history of sudden cardiac death (p value &amp;lt; 0.00001), and presenting positive cardiac mapping and MRI for pathological alterations (both with p value &amp;gt; 0.00001). From the data obtained for the subset of 80 Brugada patients with ICD in our case series, predictive factors related to high arrhythmic risk are different from the previously analyzed population: presenting spontaneous type 1 ECG (p value 0.0015), having had a resuscitated cardiac arrest (p value 0.014028), having a family history of sudden cardiac death (p value &amp;lt; 0.00001), and presenting positive mapping, genetics, and cardiac MRI for pathological alterations. Positive EPS and syncope in this subset do not appear to be risk factors, unlike the population of all 209 enrolled patients. Conclusions Multiparametric scores, including the mentioned markers, have been introduced in clinical practice for a better approach in selection. However, new markers are needed to improve risk stratification in BrS patients, especially those in the so–called "gray zone" with intermediate risk. In the future, it will be evaluated through experimental models and genotype–phenotype integration whether such electrical heterogeneity is also associated with specific genetic or structural abnormalities and may represent a new therapeutic target for etiological treatment in BrS patients. In conclusion, there is an urgent need to develop new methods for risk stratification in Brugada syndrome that are sufficiently sensitive, specific, reproducible, and easy to apply.

Hepatocellular carcinoma among patients with chronic hepatitis B in the indeterminate phase.

Hepatitis B virus (HBV) infection is a dynamic disease where patients progress through several stages defined by HBV e-antigen (HBeAg) status, HBV-DNA levels and transaminase elevations, with antiviral therapy indicated only in specific stages. However, some patients cannot be classified into one of the stages and are said to fall into an 'indeterminate phase' or 'grey zone'. Exact definitions of the indeterminate phase vary from guideline to guideline as a result of different cut-off values for biomarker measurements. Data suggest that as many as 50% of HBV patients may be in an indeterminate phase and may not rapidly transition out of this phase. Clinical data that suggest these patients are at increased risk of hepatocellular carcinoma (HCC) are complemented by molecular evidence of integrations of HBV-DNA into the host genome, chromosomal translocations and immune activation despite liver enzymes that may suggest lack of inflammation. Antiviral therapy reduces these hepatocarcinogenic mechanisms and is reflected in a reduction of fibrosis and HCC risk. We review key data on patients in the indeterminate phase, with emphasis on HCC as an outcome. We take a holistic approach and link new biological data with clinical observations as well as examine the potential role of antiviral therapy in reducing HCC risk among patients in the indeterminate phase. With the availability of safe and effective oral antivirals, consideration must be given as to how much residual risk of HCC should be tolerated among patients in the indeterminate phase.

Machine learning parameterization of the multi-scale Kain–Fritsch (MSKF) convection scheme and stable simulation coupled in the Weather Research and Forecasting (WRF) model using WRF–ML v1.0

Abstract. Warm-sector heavy rainfall along the south China coast poses significant forecasting challenges due to its localized nature and prolonged duration. To improve the prediction of such high-impact weather events, high-resolution numerical weather prediction (NWP) models are increasingly used to more accurately represent topographic effects. However, as these models' grid spacing approaches the scale of convective processes, they enter a “gray zone”, where the models struggle to fully resolve the turbulent eddies within the atmospheric boundary layer, necessitating partial parameterization. The appropriateness of applying convection parameterization (CP) schemes within this gray zone remains controversial. To address this, scale-aware CP schemes have been developed to improve the representation of convective transport. Among these, the multi-scale Kain–Fritsch (MSKF) scheme enhances the traditional Kain–Fritsch (KF) scheme, incorporating modifications that facilitate its effective application at spatial resolutions as high as 2 km. In recent years, there has been an increase in the application of machine learning (ML) models across various domains of atmospheric sciences, including efforts to replace conventional physical parameterizations with ML models. This work introduces a multi-output bidirectional long short-term memory (Bi-LSTM) model intended to replace the scale-aware MSKF CP scheme. This multi-output Bi-LSTM model is capable of simultaneously predicting the convection trigger while also modeling the associated convective tendencies and precipitation rates with a high performance. Data for training and testing the model are generated using the Weather Research and Forecast (WRF) model over south China at a horizontal resolution of 5 km. Furthermore, this work evaluates the performance of the WRF model coupled with the ML-based CP scheme against simulations with the traditional MSKF scheme. The results demonstrate that the Bi-LSTM model can achieve high accuracy, indicating the promising potential of ML models to substitute the MSKF scheme in the gray zone.

Robustness and classification capabilities of MRI radiomic features in identifying carotid plaque vulnerability.

To assess how radiomic features may be combined with plaque morphological and compositional features identified by multi-contrast MRI to improve upon conventional risk assessment models in determining culprit carotid artery lesions. Fifty-five patients (mean age: 62.6; 35 males) with bilateral carotid stenosis who experienced transient ischaemic attack (TIA) or stroke were included from the CARE-II multi-centre carotid imaging trial (ClinicalTrials.gov Identifier: NCT02017756). They underwent MRI within 2 weeks of the event. Classification capability in distinguishing culprit lesions was assessed by machine learning. Repeatability and reproducibility of the results were investigated by assessing the robustness of the radiomic features. Radiomics combined with a relatively conventional plaque morphological and compositional metric-based model provided incremental value over a conventional model alone (area under curve [AUC], 0.819 ± 0.002 vs 0.689 ± 0.019, respectively, P = .014). The radiomic model alone also provided value over the conventional model (AUC, 0.805 ± 0.003 vs 0.689 ± 0.019, respectively, P = .031). T2-weighted imaging-based radiomic features had consistently higher robustness and classification capabilities compared with T1-weighted images. Higher-dimensional radiomic features outperformed first-order features. Grey Level Co-occurrence Matrix, Grey Level Dependence Matrix, and Grey Level Size Zone Matrix sub-types were particularly useful in identifying textures which could detect vulnerable lesions. The combination of MRI-based radiomic features and lesion morphological and compositional parameters provided added value to the reference-standard risk assessment for carotid atherosclerosis. This may improve future risk stratification for individuals at risk of major adverse ischaemic cerebrovascular events. The clinical relevance of this work is that it addresses the need for a more comprehensive method of risk assessment for patients at risk of ischaemic stroke, beyond conventional stenosis measurement. This paper shows that in the case of carotid stroke, high-dimensional radiomics features can improve classification capabilities compared with stenosis measurement alone.

Testing Indonesia’s decisiveness: Vietnam’s continuous presence in the North Natuna Seas

In December 2022, Indonesia and Vietnam concluded the EEZ boundary lines that have been under negotiations for 12 years. Through this, it is expected that intrusions made by Vietnamese maritime constabulary forces into Indonesia’s North Natuna Seas can end. On the contrary, intrusions have risen in the first 8 months of 2023, indicating Vietnam’s intent to continue its maritime-based operations in the gray-zone areas of Indonesian waters. In making sense of this developing crisis, this article adopts secondary data from the Indonesia Open Justice Initiative between January 2023 and August 2023. In tracking the instances of intrusions, it utilizes an Automatic Identification System obtained from Marine Traffic. The analysis is made by framing the crisis under the maritime diplomatic framework, which concludes that Vietnam is persistent with its maritime diplomatic strategy of “paragunboat diplomacy” in showcasing effective occupancy in gray zone areas.

Integrity games: an online teaching tool on academic integrity for undergraduate students

In this paper, we introduce Integrity Games (https://integgame.eu/) – a freely available, gamified online teaching tool on academic integrity. In addition, we present results from a randomized controlled experiment measuring the learning outcomes from playing Integrity Games.Integrity Games engages students in reflections on realistic and relevant academic integrity issues that lie in the grey zone between good practice and misconduct. Thereby, it aims to 1) motivate students to learn more about academic integrity, 2) increase their awareness of the grey-zone issues, and 3) increase their awareness of misconduct. To achieve these aims, the tool presents four gamified cases that lead students through an engaging narrative.The experiment to measure learning outcomes was conducted in three European countries, and included N = 257 participants from across natural science, social science and the humanities. We show that the participants enjoyed playing Integrity Games, and that it increased their sensitivity to grey-zone issues and misconduct. However, the increases identified were similar to those achieved by the participants in the control group reading a non-gamified text.We end by discussing the value of gamification in online academic integrity training in light of these results.

Texture identification in liquid crystal-protein droplets using evaporative drying, generalized additive modeling, and K-means Clustering

Sessile drying droplets manifest distinct morphological patterns, encompassing diverse systems, viz., DNA, proteins, blood, and protein-liquid crystal (LC) complexes. This study employs an integrated methodology that combines drying droplet, image texture analysis (features from First Order Statistics, Gray Level Co-occurrence Matrix, Gray Level Run Length Matrix, Gray Level Size Zone Matrix, and Gray Level Dependence Matrix), and statistical data analysis (Generalized Additive Modeling and K-means clustering). It provides a comprehensive qualitative and quantitative exploration by examining LC-protein droplets at varying initial phosphate buffered concentrations (0x, 0.25x, 0.5x, 0.75x, and 1x) during the drying process under optical microscopy with crossed polarizing configuration. Notably, it unveils distinct LC-protein textures across three drying stages: initial, middle, and final. The Generalized Additive Modeling (GAM) reveals that all the features significantly contribute to differentiating LC-protein droplets. Integrating the K-means clustering method with GAM analysis elucidates how textures evolve through the three drying stages compared to the entire drying process. Notably, the final drying stage stands out with well-defined, non-overlapping clusters, supporting the visual observations of unique LC textures. Furthermore, this paper contributes valuable insights, showcasing the efficacy of drying droplets as a rapid and straightforward tool for characterizing and classifying dynamic LC textures.Graphical

Navigating the Grey Zone: Counselling for Late Preterm Antenatal Corticosteroids and the Impact of the 2023 SOGC Technical Update

Navigating the Grey Zone: Counselling for Late Preterm Antenatal Corticosteroids and the Impact of the 2023 SOGC Technical Update

The Gray Zone of Melanocytic Tumors - A Clinical Point of View.

The Gray Zone of Melanocytic Tumors - A Clinical Point of View.

Biologic Gray Zone of Melanocytic Tumors in Reality: Defining 'Non-Conventional' Melanocytic Tumors.

Biologic Gray Zone of Melanocytic Tumors in Reality: Defining 'Non-Conventional' Melanocytic Tumors.