Large Rate Research Articles

Patients with symptomatic cholelithiasis at a safety net hospital: Early surgeon involvement matters.

Gallstones are a common diagnosis in the United States; though many patients remain asymptomatic, others develop symptoms. Standard of care for symptomatic cholelithiasis is cholecystectomy, but many do not undergo surgery. The purpose of this study is to identify factors that influence receipt of cholecystectomy for symptomatic cholelithiasis at a safety net hospital. This is a retrospective study performed at a large, academic, tertiary care and safety net state hospital. Patients who presented with symptomatic cholelithiasis were included. Same admission cholecystectomy and elective outpatient cholecystectomy were considered success/standard of care, and readmission cholecystectomy or no cholecystectomy were considered failures/not standard of care. Of 376 patients, a substantial minority were Spanish speaking, and almost half had public insurance. 23.7% were successfully treated, and 76.3% had failure in management. A larger number of patients in the group that had successful treatment had surgery consultation, 67.4%. Only 28.5% of patients saw a surgeon as an outpatient within 30days of their visit. On multivariable analysis, patients who were provided a surgery consultation were more likely to receive standard of care. Age, sex, language, smoking status, lack of insurance, and alcohol use were not associated. Surgery consultation during presentation for symptomatic cholelithiasis was associated with receipt of same admission, or outpatient elective cholecystectomy, or successful management. There should be a low threshold to involve a surgeon for symptomatic cholelithiasis.

The Effect of Geographical Factors on the Foreign Policy of Qatar during 2014-2016

Objectives:Qatar is a small country that showed an important role in the local, regional, and international levels. Several geographical factors such as location, area, shape, and regional water have affected Qatar’s foreign affairs policy. Therefore, this study aims at illustrating the role of geographical factors in the country’s foreign affairs policy. What makes the study significant is that it is the first study which focuses on this topic in Qatar. Methods: The study has used to analysis the Foreign polices decisions two methods (i.e. Dwisha, 1977) (Dawisha) framework throughout the study. Results: The study revealed that some geographical factors had recently benefited Qatar during the forced siege by some GCC countries. Also, the political crises made Qatar depends mainly in its foreign affairs policy on the given energy resources alongside with a wide range of foreign relationships network with the effective countries in the international policy. This, enabled Qatar to overcome on the lack of space and population in order to enhance its economy to be out of the dominance of some GCC countries. Conclusions: Finally, the study approved that Qatar had inter-relation foreign network that positioned Qatar politically among countries, organizations, institutions comparing with large states. Keywords: Qatar’s geopolitics, Foreign policy, geographical factors, Qatar Siege, Gulf Cooperation Council (GCC).

Solving mystery with the Meissner state in La3Ni2O7-δ

Recently, zero resistance state in highly compressed La3Ni2O7-δ has been observed. However, all attempts of many research groups to detect the Meissner state in the La3Ni2O7-δ have been failed. To explain this puzzle, an exotic superconducting state (for instance, filamentary superconductivity) in the La3Ni2O7-δ has been supposed. Here, I extracted temperature dependent self-field critical current, Ic(sf,T), dataset from current-voltage curves and performed the Ic(sf,T) analysis. As a result, I found that highly compressed La3Ni2O7-δ to exhibits d-wave superconductivity with the gap-to-transition temperature ratio 2Δ(0)/(kBTc) = =4.0 ± 0.3, a very large ground state London penetration depth, λ(0, P = 16.6 GPa) = 6.0 μm, and a very high Ginzburg-Landau parameter k(0, P = 16.6 GPa) = 1500. This implies that the ground state lower critical field Bc1(0, P = 16.6 GPa) = 34 μT is of the same order as the Earth’s magnetic field. Based on this, to detect the Meissner state in the La3Ni2O7-δ becomes a very challenging task. I can hypothesize that the magnetic flux trap effect recently proposed to eliminate the diamond anvil cell (DAC) background in experiments on magnetic properties of the superconducting hydrides can also apply in studies of magnetic properties in the La3Ni2O7-δ superconductor.

The Giant Leap in the Development of Higher Engineering Education in China

Purpose This study discusses the development of higher engineering education and its future direction following the increased enrollment in higher education institutions in China. Design/Approach/Methods By compiling and analyzing corresponding policies and historical and statistical data, the large-scale expansion process and quality enhancement pathways of China's higher engineering education are summarized. Additionally, probable future development scenarios are identified based on the current situation. Findings Ever since the expansion of higher education enrollment in China, higher engineering education has experienced rapid expansion in scale and quality, leading China toward becoming a prolific global leader in this aspect. Through a series of national engineering educational reforms, such as “Engineering Program Accreditation,” “Outstanding Engineer Plan,” and “New Engineering Construction,” China has sought to improve the quality of engineering talent to “transition from a large state to a powerful state” in higher engineering education. Therefore, this development process can be considered a “golden age” of higher engineering education development in China. Going forward, China's higher engineering education should focus on continuous quality improvement, strengthen international exchanges and collaboration, and expansion into new engineering fields. Originality/Value This study systematically analyzes the large-scale expansion and quality enhancement routes of China's higher engineering education. By enhancing the understanding of such education, this study can serve as a reference for domestic and foreign engineering education researchers.

An Automated Penetration Testing Framework Based on Hierarchical Reinforcement Learning

Given the large action space and state space involved in penetration testing, reinforcement learning is widely applied to enhance testing efficiency. This paper proposes an automatic penetration testing scheme based on hierarchical reinforcement learning to reduce both action space and state space. The scheme includes a network intelligence responsible for specifying the penetration host and a host intelligence designated to perform penetration testing on the selected host. Specifically, within the network intelligence, an action-masking mechanism is adopted to shield unenabled actions, thereby reducing the explorable action space and improving the penetration testing efficiency. Additionally, the host intelligence employs an invalid discrimination mechanism, terminating testing after actions that do not alter system states, thereby preventing sudden increases in the number of neural network training steps for an action. An optimistic estimation mechanism is also introduced to select penetration strategies suited to various hosts, preventing training crashes due to value confusion between different hosts. Ablation experiments demonstrate that the host intelligence can learn different penetration strategies for varying penetration depths without significant fluctuations in training steps, and the network intelligence can coordinate with the host intelligence to perform network penetration steadily. This hierarchical reinforcement learning framework can detect network vulnerabilities more quickly and accurately, significantly reducing the cost of security policy updates.

Assessing the impact of the National Clean Air Programme in Uttar Pradesh's non-attainment cities: a prophet model time series analysis

BackgroundUttar Pradesh, India’s largest state, faces critical pollution levels, necessitating urgent action. The National Clean Air Programme (NCAP) targets a 40% reduction in particulate pollution by 2026. This study assesses the NCAP’s impact on 15 non-attainment cities in Uttar Pradesh using the Prophet forecasting model. MethodsMonthly data from 2016 to 2023 on AQI and PM10 concentrations were sourced from the Uttar Pradesh Pollution Control Board. Significant changes in mean AQI and PM10 levels from 2017 to 2023 were evaluated using the Friedman Test. Prophet models forecasted PM10 concentrations for 2025-26, with relative percentage changes calculated and model evaluation metrics assessed. FindingsMost cities exhibited unhealthy air quality. Jhansi had the lowest AQI (72·73) in 2023, classified as 'moderate' by WHO standards. Gorakhpur consistently showed 'poor' AQI levels, peaking at 249·31 in 2019. Western Uttar Pradesh cities such as Ghaziabad, Noida, and Moradabad had significant pollution burdens. Predictions showed Bareilly with over a 70% reduction in PM10 levels, Raebareli 58%, Moradabad 55%, Ghaziabad 48%, Agra around 41%, and Varanasi 40%, meeting NCAP targets. However, Gorakhpur and Prayagraj predicted increases in PM10 levels by 50% and 32%, respectively. Moradabad’s model showed the best performance with an R2 of 0·81, MAE of 17·27 μg/m3, and MAPE of 0·10. InterpretationForecasting PM10 concentrations in Uttar Pradesh's non-attainment cities offers policymakers substantial evidence to enhance current efforts. While existing measures are in place, our findings suggest that intensified provisions may be necessary for cities predicted to fall short of meeting program targets. The Prophet model's forecasts can pinpoint these at-risk areas, allowing for targeted interventions and regional adjustments to strategies. This approach will help promote sustainable development customized to each city's specific needs. FundingNo funding was issued for this research.

Parliamentary acceptability of EU military deployments in member states: beyond rubber-stamping?

ABSTRACT This article examines national parliamentary debates in 13 EU member states of eight CSDP military deployments underway between 2016 and 2021. It reviews discussions about whether, and why, to send troops on EU missions and operations, and the extent to which these debates differ from expectations in the literature derived from involvement in NATO operations. The survey includes small states, which have been previously excluded from such analysis. Drawing on a dataset of 411 statements by national parliamentarians from across Europe, the article employs eight discursive frames to understand how MPs articulate their acceptance (or not) of CSDP deployments. We supplement this with detailed data on national troop contributions. We find that CSDP debates in national parliaments resemble those of ‘high-salience’ deployments when considering frame usage and party position. We present limited evidence supporting the claim that small states frame deployment debates similarly to large states.

Neoliberalism in question: The Philippines' nurse education and labour export as liberal neo‐statist development agenda

AbstractMany scholars have used neoliberalism as an analytical framework to examine the Philippines' labour export policy. While neoliberalism entails a retreat of the state in favour of market reforms, evidence shows that state intervention of the market becomes larger and stronger over time. This paper utilises liberal neo‐statism as an alternative framework to understand the Philippines' nurse labour export by explaining that the state's role is larger than and goes beyond labour brokerage. Following the historical institutionalism approach, we show the significant timing, sequence, and path dependence that affect the emergence of institutions that govern the Philippines' nurse labour export. Our paper reveals how specific policies and regulations in labour export are tucked within the disguise of market reforms, but which are manifest within a larger state's control. These policies serve as the state's apparatus for remittance generation and protection of migrant labour rights and welfare.

Mechanical‐performance deterioration of RC segment of shield tunnel under high corrosion degree and the transformation of eccentric‐failure mode

AbstractReinforcement corrosion in shield tunnel segments has an important impact on the structure's bearing capacity and failure mode. Generally, a shield tunnel structure is under small eccentric compression, but if the reinforcement corrosion develops sufficiently, then a transition occurs from small to large eccentric load state, thereby lowering the structural bearing capacity and endangering the safety of tunnel operation. In the study reported here, based on the compressive bending load characteristics of the shield lining structure, corrosion test columns with small eccentric loading were designed to simulate the actual force state of the tunnel lining, and the whole evolution process of their mid‐span strain, ultimate bearing capacity, and cracks under different corrosion degrees was analyzed. With increasing corrosion, the bearing capacity, concrete strain, and depth of the compressive zone of a test column decrease more and more rapidly, and at the maximum corrosion degree of 68.32%, the maximum reduction of bearing capacity is 53.23%. The tests show that the failure mode of a test column with high corrosion degree (≥46.25%) is transformed from small to large eccentric failure. Based on theoretical analysis of the normal section bearing capacity of reinforced concrete flexural members, a theoretical method is proposed for calculating the critical corrosion degree for the tunnel lining structure to transform from small to large eccentric failure. The theoretical calculation method is verified against finite‐element calculations, and the present research results offer theoretical support for the durability design and safety evaluation of shield tunnel lining structures.

Проблемы традиционной культуры коренных малочисленных народов юга Дальнего Востока России и роли государства в этих процессах (XX–начало XXI века)

During the XX-XXI centuries, aboriginal ethnic groups turned from independent ethnic formations into constituent parts of a large multinational state, with a fundamentally different spiritual dominant, a different social structure and type of economy. The changes affected both traditional material and spiritual culture. In the process of these changes, the concepts themselves were transformed, the lines between tradition and reality began to blur, since the latter is in constant dynamics. We made an attempt to assess the role of the state in the ongoing processes, as well as to compare the situation with the indigenous minorities in neighboring China, and note general trends. The study identifies the role of the main factors that influenced global transformations in the field of spiritual and material development of the Primorye Territrory, as well as outlines a somewhat new understanding of the problem of preserving ethnic identity.

Workplace mental health promotion in a large state organization: Perceived needs, expected effects, neglected side effects

Background Work ability and mental health in the workplace is increasingly promoted in terms of workplace health management. In order to select suitable interventions at work in a concrete context, employees and managers of a large state organization (science and development sector) were asked about perceived needs, desired effects and possible side effects of health promotion interventions. Methods 13 semi-structured interviews with managers and three focus group interviews with employees (N = 20) were conducted in autumn 2020 by a behavior therapist in training. The evaluation was carried out by a qualitative content analysis of the interview transcripts according to a deductive procedure and was checked by two independent raters. Results Most frequently, need was expressed for individual case counselling by a health expert due to the diversity of work-related problems. Managers would like to see more health-related leadership training, and a review of the various communication channels of their organization. Expected positive effects are increased self-efficacy, higher person-job-fits and reduced absenteeism. Side effects were mentioned, such as confusion of health management activities with therapy, or sensitization effects when speaking too much about mental health in mentally healthy teams. Lack of competence with the topic of mental health was mentioned as a reason for non-participation in mental health promotion activities. Conclusions The role of managers in relation to mental health needs to be more defined. Side effects related to mental health activities should be considered in evaluations. Selection of health interventions should depend on the concrete needs of the organization.

AI Policies, Equity, and Morality and the Implications for Faculty in Higher Education

Artificial intelligence (AI) is transforming higher education. While universities have generally touted technological advancements as part of the fabric of their learning environments, the challenges to equitable outcomes for faculty and students related to the use of AI are under-recognized. There is scant work on the equity and morality of university AI policies and the implications for faculty within higher education institutions. While significant attention has been paid to the effect of tools like ChatGPT on student writing and academic integrity, less attention has been paid to how rapidly emerging AI policies affect other aspects of faculty work, and in potentially inequitable ways. This article considers AI policies at three large state universities to examine what policies are provided to faculty and their impacts, including instructional support for students, faculty research, and patents. Findings suggest that institutions vary greatly in terms of faculty guidance and far more work is needed to provide clear policies and resources regarding ethical AI for faculty. We discuss the implications, including challenges and opportunities for higher education institutions, and provide recommendations for moving forward as new technology continues to evolve.

Remote implementation of hidden or partially unknown quantum operators using optimal resources: a generalized view

Two protocols are proposed for two closely linked but different variants of remote implementation of quantum operators of specific forms The first protocol is designed for the remote implementation of the single qubit hidden quantum operator, whereas the second one is designed for the remote implementation of the partially unknown single qubit quantum operator. In both cases two-qubit maximally entangled state, which is entangled in the spatial degree of freedom is used. The quantum resources used here are optimal and easy to realize and maintain in comparison to the multi-partite or multi-mode entangled states used in earlier works. The impact of photon loss due to interaction with the environment is analyzed for both the schemes. The proposed protocols are also generalized to their controlled, bidirectional, cyclic, controlled cyclic, and controlled bidirectional versions and it is shown that either Bell state alone or products of Bell states will be sufficient to perform these tasks with some additional classical communications in the controlled cases only. This is in sharp contrast to the earlier proposals that require large entangled states. In addition, it’s noted that remote implementation of hidden or partially unknown operators involving multiple controllers and/or multiple players who jointly apply the desired operator(s) would require quantum channels more complex than the Bell states and their products. Explicit forms of such quantum channels are also provided.

Innovation bundles and platforms – a qualitative analysis of health system responses to the COVID-19 pandemic

BackgroundHealth systems underwent substantial changes to respond to COVID-19. Learning from the successes and failures of health system COVID-19 responses may help us understand how future health service responses can be designed to be both effective and sustainable. This study aims to identify the role that innovation played in crafting health service responses during the COVID-19 pandemic.MethodsSemi-structured interviews were conducted online, exploring 19 health professionals’ experiences in responding to COVID-19 in a large State health system in Australia. The data were collected from April to September 2022 and analysed utilising constant comparative analysis. The degree of innovation in health service responses was assessed by comparing them to pre-pandemic services using 5 categories adopted from the IMPISCO (Investigators, Methods, Population, Intervention, Setting, Comparators and Outcomes) framework, which classifies interventional fidelity as: 1/ Identical: No differences are found between health services; 2/ Substitution with alternatives that perform the same function, 3/ In-class replacement with elements that delivers roughly the same functionality, 4/ Augmentation with new functions, 5/ Creation of new elements. Services were decomposed into bundles and fidelity labels were assigned to individual bundle elements.ResultsNew services were typically created by reconfiguring existing ones rather than being created de novo. The presence of pre-existing infrastructure (foundational technologies) was seen as critical in mounting fast health service responses. Absence of infrastructure was associated with delays and impaired system responses.ConclusionsThe need to reconfigure rapidly and use infrastructure to support this suggests we reconceive health services as a platform (a general-purpose service upon which other elements can be added for specific functions), where a common core service (such as a primary care practice) can be extended by adding specialised functions using mediators which facilitate the connection (such as virtual service capabilities). Innovation can be costly and time consuming in crises, and during the COVID-19 pandemic, innovations were typically patched together from pre-existing services. The notion of platforms seems a promising way to prepare the health system for future shocks.

Controlled Fabrication of Wafer-Scale, Flexible Ag-TiO2 Nanoparticle-Film Hybrid Surface-Enhanced Raman Scattering Substrates for Sub-Micrometer Plastics Detection.

As an important trace molecular detection technique, surface-enhanced Raman scattering (SERS) has been extensively investigated, while the realization of simple, low-cost, and controllable fabrication of wafer-scale, flexible SERS-active substrates remains challenging. Here, we report a facile, low-cost strategy for fabricating wafer-scale SERS substrates based on Ag-TiO2 nanoparticle-film hybrids by combining dip-coating and UV light array photo-deposition. The results show that a centimeter-scale Ag nanoparticle (AgNP) film (~20 cm × 20 cm) could be uniformly photo-deposited on both non-flexible and flexible TiO2 substrates, with a relative standard deviation in particle size of only 5.63%. The large-scale AgNP/TiO2 hybrids working as SERS substrates show high sensitivity and good uniformity at both the micron and wafer levels, as evidenced by scanning electron microscopy and Raman measurements. In situ bending and tensile experiments demonstrate that the as-prepared flexible AgNP/TiO2 SERS substrate is mechanically robust, exhibiting stable SERS activity even in a large bending state as well as after more than 200 tensile cycles. Moreover, the flexible AgNP/TiO2 SERS substrates show excellent performance in detecting sub-micrometer-sized plastics (≤1 μm) and low-concentration organic pollutants on complex surfaces. Overall, this study provides a simple path toward wafer-scale, flexible SERS substrate fabrication, which is a big step for practical applications of the SERS technique.

An Overview Of Deep Deterministic Policy Gradient Algorithm And Applications

This research summarizes the major developments of the Deep Deterministic Policy Gradient (DDPG) in reinforcement learning Motivated by the ideas, of Deep Q-networks, DDPG has proven capable of confronting more complex problems involving continuous action spaces. The core of DDPG lies in its actor-critic architecture, which enables the learning of highly competitive policies. By leveraging neural network function approximations, it can efficiently operate in large state and action spaces. DDPG has found practical applications across various real-world domains. However, like many model-free reinforcement learning methods, DDPG still faces the challenge of requiring a large number of training steps.

Prevalence and correlates of disordered eating at a large state university before and after the onset of the COVID-19 pandemic

BackgroundEmerging adulthood is a transitory period in which disordered eating (DE) manifests; collecting data on the prevalence of DE among this population as well as demographic and behavioral correlates are important public health goals.MethodsData from an annual survey of undergraduate students at a large state university from 2019 to 2022 were analyzed, allowing researchers to compare prevalence and correlates before and after the onset of the COVID-19 pandemic using two brief screeners: the SCOFF and Eating Disorder Screener for Primary Care (ESP). We hypothesized that rates of DE would be greater after the onset of COVID-19 as compared to before. We also hypothesized that those identifying as women, reporting higher alcohol or drug use, and contemplating suicide would have greater odds of reporting symptoms consistent with DE.ResultsDE was significantly lower in pre-pandemic years compared to pandemic years: ESP pre = 38.01%(n = 704), pandemic = 48.79%(n = 645), p < 0.001; SCOFF pre = 22.82%(n = 422), pandemic = 31.46%(n = 414), p < 0.001. Logistic regressions showed women and students who contemplated suicide reported significantly greater DE, regardless of screener or time period. Inconsistent relationships were found between DE and current substance use.ConclusionThese findings may inform targeted interventions for those most vulnerable to disordered eating.

Impact of COVID-19 on dengue: a twofold challenge to public health in Sabah, Malaysia.

The dengue epidemic poses a significant public health challenge in Malaysia, and the concurrent presence of dengue and SARS-CoV-2 infections has further strained its healthcare system. Sabah, the second largest state in Malaysia, located in the northern part of Borneo Island, has been particularly hard-hit by both dengue and SARS-CoV-2 outbreaks. This study aims to analyze the status of dengue infections in Sabah over the past decade and understand the impact of the COVID-19 pandemic on dengue virus transmission. This study compared the annual dengue cases and associated deaths in Sabah from 2012 to 2022. Systematic data and information were collected from PubMed, the World Health Organization, the Centers for Disease Control and Prevention, and the official government reporting system of Malaysia. Dengue cases in Sabah increased overall with slight fluctuations over the years, marked by new outbreaks approximately every 3-5 years. The number of deaths did not consistently correlate with reported dengue cases. Early in the COVID-19 pandemic in 2020, dengue cases remained high; however, as COVID-19 cases surged, dengue cases experienced a significant decline. Conversely, from mid-2022, dengue cases surged in Sabah despite COVID-19 cases remaining relatively low and well-controlled. Particularly noteworthy is the 99% increase in dengue cases in Sabah, contrasting sharply with Malaysia's overall 36% decrease in 2022 compared to 2015 to 2019. Monitoring and prioritizing efforts to prevent COVID-19 and control dengue transmission is crucial. The dual challenges posed by these diseases offer valuable lessons that should be incorporated into future pandemic-preparedness strategies.

Current Trends and Pressing Issues of Solid Waste Management in Developing Countries with Special Reference to Pakistan

In South Asia, Pakistan ranks as the second largest state and stands sixth globally in terms of population. This research critically examines the solid waste management (SWM) system in Pakistan, employing a qualitative methodology to assess its effectiveness. The study begins with a broad overview of SWM issues in developing countries, focusing on Pakistan's specific challenges such as mismanagement, lack of innovative techniques, insufficient budget, and inadequate policies. It scrutinizes the SWM practices across all provinces, identifying open dumping, burning of solid waste, and industrial waste disposal in water streams as prevalent methods. These techniques are analyzed for their adverse impacts on human health and the environment, highlighting the urgent need for a more effective SWM system. The research underscores the importance of adopting sustainable practices and integrating comprehensive frameworks to improve SWM. By examining empirical data and employing a robust analytical framework, the study aims to provide actionable insights for policymakers and stakeholders to enhance the sustainability and effectiveness of SWM in Pakistan. The ultimate goal is to foster a system that aligns with global sustainability standards, ensuring better environmental and public health outcomes.

Examining peer review network dynamics in higher education visual communication courses using ERGM

Peer review plays a pivotal role in shaping collaborative learning environments and evaluating student engagement, but there is a lack of research on the relational dynamics that underlie the interactions between students during the peer review process, which is critical for understanding the effectiveness of peer review for students’ learning outcomes. Using explanatory sequential study design, this study’s objectives are to explore the dynamics of peer review as a feedback mechanism in higher education within a social network context, focusing on student interactions during the feedback process. Specifically, we applied dyadic-independent Exponential Random Graph Modeling (ERGM), along with mixed-methods design to analyze peer review interactions within a visual communication course at a large state university. We collected and analyzed two samples: a quantitative sample of 167 students for network analysis, drawn from 3082 peer reviews and rubric scores, and a qualitative sample of 136 students from post-course surveys that provided feedback on the peer review process and course methodologies. Our investigation revealed the inherently social network nature of peer review, shedding light on its significance in engaging students and assessing student engagement. Specifically, we examined the role of students’ performance levels, edge-based attributes derived from the visual peer review rubric, and language used in the feedback on the likelihood of forming peer review connections in the network. Our findings indicate that attributes derived from the visual peer review rubric significantly influence the likelihood of peer connections. On the other hand, students’ performance levels do not have any impact on the formation of peer connections. The findings highlight the importance of visual peer review activities in shaping peer connections in the classroom. Future studies will incorporate higher-order structures, such as transitivity and triadic closure, into our ERGM model to further enhance our understanding of peer review dynamics in educational settings.