Stand-alone Strategies Research Articles

Interventions addressing routine childhood immunization and its behavioral and social drivers.

Despite the advances in vaccination, there are still several challenges in reaching millions of children in low- and middle-income countries (LMICs). In this review, we present an extensive summary of the various strategies used for improving routine immunization in LMICs to aid program implementers in designing vaccination interventions. Experimental and quasi-experimental impact evaluations conducted in LMICs evaluating the effectiveness of interventions in improving routine immunization of children aged 0-5 years or the intermediate outcomes were included from 3ie's review of systematic reviews. Some additional impact evaluation studies published in recent years in select LMICs with large number of unvaccinated children were also included. Studies were coded to identify interventions and the barriers in the study context using the intervention framework developed in 3ie's Evidence Gap Map and the WHO's Behavioral and Social Drivers (BeSD) of vaccination framework, respectively. Qualitative analysis of the content was conducted to analyze the intervention strategies and the vaccination barriers that they addressed. One hundred and forty-two impact evaluations were included to summarize the interventions. To address attitudinal and knowledge related barriers to vaccination and to motivate caregivers, sensitization and educational programs, media campaigns, and monetary or non-monetary incentives to caregivers, that may or may not be conditional upon certain health behaviors, have been used across contexts. To improve knowledge of vaccination, its place, time, and schedule, automated voice messages and written or pictorial messages have been used as standalone or multicomponent strategies. Interventions used to improve service quality included training and education of health workers and providing monetary or non-monetary perks to them or sending reminders to them on different aspects of provision of vaccination services. Interventions like effective planning or outreach activities, follow-up of children, tracking of children that have missed vaccinations, pay-for-performance schemes and health system strengthening have also been used to improve service access and quality. Interventions aimed at mobilizing and collaborating with the community to impact social norms, attitudes, and empower communities to make health decisions have also been widely implemented.

The dangers of having only one pandemic exit strategy

BackgroundWhen it comes to pandemic response, preparation can be the key. Between 2020 and 2024, the fast-paced development of COVID-19—often compounded by pubic policies’ failures to reflect the latest reality and the public’s divergent reactions to the pandemic and the policies—means that society should prepare for exit strategies that can reflect the reality of the pandemic and the interests of the people. Yet oftentimes societies only have one exit strategy with limited scope. This paper investigates the dangers of having only one pandemic exit strategy for pandemics like COVID-19. MethodsAnalyses were based on a review of the literature on COVID-19 exit strategies and our own research. The PubMed literature search focused on two concepts—“COVID-19″ and “exit strategy”—and was limited to peer-reviewed papers published between 2020 and 2024 in English. ResultsA total of 31 articles were included in the final review. Analyses showed that existing studies on COVID-19 exit strategies often focused on using the modelling method to gauge one exit strategy. Exit strategies were often discussed in the context of implementing, easing, or lifting specific pharmaceutical or non-pharmaceutical interventions. Staged and country-wide coordinated exit strategies were also discussed in the literature, both of which were often deemed as comparatively rigorous options compared to single or stand-alone exit strategies. Drawing on the overall development of COVID-19 and our own research, we presented and discussed the importance of having multiple exit strategies that are considerate of all possible pandemic trajectories, diverse interests of the public, and the communication challenges officials might face in introducing or implementing pandemic policies. ConclusionThis paper underscored the importance of having multiple exit strategies for societies to prepare for pandemics. The insights of this study can help inform health policies so that they can more comprehensively and compassionately protect the needs and wants of the “public” in public health, particularly in grave times like COVID-19.

Fast-track interventions for HIV and AIDS epidemic control among key populations: A rapid review.

Targeted interventions for key populations remain critical for realisation of epidemic control for human immunodeficiency virus (HIV) infection because of the causal relationship between HIV infection in the general population and among key population groups. To consolidate evidence on the fast-track interventions towards achieving HIV epidemic control among key populations. A rapid scoping review was conducted using the methodological framework by Arksey and O' Malley. The Population, Intervention, Context and Outcome (PICO) framework was used to identify relevant studies using key words with Boolean operators in electronic data bases, namely CINHAL, Web of Science, Psych Info and Sabinet. Studies were extracted using a modified data extraction tool, and results were presented narratively. A total of 19 articles were included in this review. Most articles were primary studies (n = 17), while another involved the review of existing literature and policies (n = 2) and routinely collected data (n = 1). Most studies were conducted in the United States of America (n = 6), while another were conducted in China, Kenya, Botswana, South Africa and Mozambique. All studies revealed findings on tested interventions to achieve HIV epidemic control among key populations. Effective interventions for HIV epidemic control were stand-alone behavioural preventive interventions, stand-alone biomedical preventive strategies and combination prevention approaches. Furthermore, the findings suggest that effective activities to achieve HIV epidemic control among key populations should be centred around prevention.Contribution: The findings of this study have policy and practice implications for high HIV burden settings such as South Africa in terms of interventions to facilitate realisation of the Joint United Nations Programme on HIV/AIDS (UNAIDS) 95-95-95 targets, thereby contributing to HIV epidemic control.

Collective Action and Intra-Group Conflict: An Experiment

ABSTRACT In many situations, two rivals find themselves facing a common threat necessitating cooperation. Such alliances are uneasy as the parties anticipate eventually competing against each other in the future. Recent theoretical work shows that both standalone and joint contribution strategies, as well as a hybrid of the two, can emerge in equilibrium where the former strategy is characterized by one of the rivals contributing enough to eliminate the common threat, while the latter is characterized by rivals providing half the necessary effort to eliminate the common threat. Using a controlled laboratory experiment, we show that player behavior is best described by the hybrid strategy. However, none of these predictions closely describes the observed behavior, which is better described as following a proportionate rule.

A Comparison of Local Failure and Necrosis Following Different Radiosurgery Strategies for Large Brain Metastases

Large brain metastases (LBMs) are associated with poor local control with single-fraction stereotactic radiosurgery (SRS) alone. Various alternative strategies have been developed, including fractionated SRS (FSRS) and staged SRS (SSRS) for intact LBMs, and resection with postoperative-SRS (postop-SRS) or preoperative-SRS (preop-SRS) for operable LBMs. The objective of this study is to compare local failure (LF) and radiation necrosis (RN) outcomes among these four management strategies to determine the optimal treatment paradigm. Consecutive patients diagnosed with LBM (≥2 cm in maximum dimension) between July 2017 and January 2022 and treated with one of the aforementioned strategies at a single tertiary institution were evaluated. All immobilization, target contouring, margins, dose- and prescription selection followed pre-defined institutional guidelines. Primary endpoints included LF, symptomatic RN, or a composite endpoint of these two variables. Gray's test was used to compare the cumulative incidence of the LF and the composite endpoint, with death as a competing risk. A total of 234 LBMs in 188 consecutive patients met the inclusion criteria. The median age was 65 years (range: 31-98), the median KPS was 80 (range: 50-100), and 58% were female. The most common primary tumors were lung (48%) and breast cancer (17%). The median maximum tumor diameter was 3.0 cm (range: 2.0-5.6). 47 (20%) lesions were treated with FSRS, 66 (28%) with SSRS, 74 (32%) with postop-SRS, and 47 (20%) with preop-SRS. With a median follow-up of 12 months, 22 (9%) LF and 11 (5%) RN events occurred. The 6-month and 1-year cumulative incidences of LF for the entire cohort were 5% (95% CI: 3%-9%) and 8% (95% CI: 5%-12%), respectively. The 6-month and 1-year LF rates were 4% (95% CI: 1%-13%) and 8% (95% CI: 3%-20%) for FSRS; 8% (95% CI: 3%-20%) and 8% (95% CI: 3%-20%) for SSRS; 7% (95% CI: 3%-15%) and 8% (95% CI: 3%-16%) for postop-SRS; 0 and 7% (95% CI: 2%-20%) for preop-SRS (p>0.05). The 1-year OS rates were favorable in resected patients (61% for postop-SRS and 82% for preop-SRS) compared to SRS alone strategies (45% for FSRS and 56% for SSRS) (p = 0.004). Similarly, RN events were significantly lower in resected patients treated with either bimodality approach (0 for postop-SRS and 4% for preop-SRS) than SRS standalone strategies (9% for FSRS and 8% SSRS) (p = 0.024). At 12 months, the cumulative probabilities of the composite endpoint were 13% (95% CI: 5%-25%) for FSRS, 15% (95% CI: 7%-25%) for SSRS, 9% (95% CI: 3%-17%) for postop-SRS, and 12% (95% CI: 4%-24%) for preop-SRS and not significantly different between the groups. For medically operable patients with surgically resectable LBMs, a strategy of surgery and SRS, regardless of timing, is associated with favorable local control and reduced risk for RN. For unresected patients, either SSRS or FSRS is associated with similar local control, but slightly higher RN risk. Prospective comparative evaluation is warranted.

Active bystandership by youth in the digital era: Microintervention strategies for responding to social media-based microaggressions and cyberbullying.

Microaggressions are intentional or unintentional slights, insults, invalidations, and offensive behaviors that communicate hostile or derogatory messages to minoritized populations. When microaggressions cross over to social media, they can be considered a form of cyberbullying, which occurs over digital devices and harms, threatens, undermines, or socially excludes others. Microaggressions and cyberbullying have adverse mental health outcomes for racial and cultural minority youth, and there is an urgent need for practical strategies youth can use online to interrupt and disarm negative and harmful social media content. We used a multimethod approach to critically appraise and adapt Sue et al.'s (2019) microinterventions framework for use on social media with youth bystanders. Our analysis found high compatibility between microinterventions and youth bystander research, supporting transferability to social media for use with youth. Relevant adaptations include incorporating strategies that promote cognitive appraisal, cognitive empathy, education via social media, and use of social media features for external support. Using a social media microaggression example for each of the four microinterventions, we provide concrete tactics and example social media posts that youth can use when they come across insulting or offensive commentary online. The resulting framework offers a promising set of theory and research-informed strategies ready for further testing and refinement. When validated and refined, these microinterventions could be used as stand-alone strategies and/or incorporated into existing cyberbullying prevention or media literacy programs. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Climate response to off-equatorial stratospheric sulfur injections in three Earth system models – Part 1: Experimental protocols and surface changes

Abstract. There is now substantial literature on climate model studies of equatorial or tropical stratospheric SO2 injections that aim to counteract the surface warming produced by rising concentrations of greenhouse gases. Here we present the results from the first systematic intercomparison of climate responses in three Earth system models wherein the injection of SO2 occurs at different latitudes in the lower stratosphere: CESM2-WACCM6, UKESM1.0 and GISS-E2.1-G. The first two use a modal aerosol microphysics scheme, while two versions of GISS-E2.1-G use a bulk aerosol (One-Moment Aerosol, OMA) and a two-moment (Multiconfiguration Aerosol TRacker of mIXing state, MATRIX) microphysics approach, respectively. Our aim in this work is to determine commonalities and differences between the climate model responses in terms of the distribution of the optically reflective sulfate aerosols produced from the oxidation of SO2 and in terms of the surface response to the resulting reduction in solar radiation. A focus on understanding the contribution of characteristics of models transport alongside their microphysical and chemical schemes, and on evaluating the resulting stratospheric responses in different models, is given in the companion paper (Bednarz et al., 2023). The goal of this exercise is not to evaluate these single-point injection simulations as stand-alone proposed strategies to counteract global warming; instead we determine sources and areas of agreement and uncertainty in the simulated responses and, ultimately, the possibility of designing a comprehensive intervention strategy capable of managing multiple simultaneous climate goals through the combination of different injection locations. We find large disagreements between GISS-E2.1-G and the CESM2-WACCM6 and UKESM1.0 models regarding the magnitude of cooling per unit of aerosol optical depth (AOD) produced, which varies from 4.7 K per unit of AOD in CESM2-WACCM6 to 16.7 K in the GISS-E2.1-G version with two-moment aerosol microphysics. By normalizing the results with the global mean response in each of the models and thus assuming that the amount of SO2 injected is a free parameter that can be managed independently, we highlight some commonalities in the overall distributions of the aerosols, in the inter-hemispheric surface temperature response and in shifts to the Intertropical Convergence Zone, as well as some areas of disagreement, such as the extent of the aerosol confinement in the equatorial region and the efficiency of the transport to polar latitudes. In conclusion, we demonstrate that it is possible to use these simulations to produce more comprehensive injection strategies in multiple climate models. However, large differences in the injection magnitudes can be expected, potentially increasing inter-model spreads in some stratospheric quantities (such as aerosol distribution) while reducing the spread in the surface response in terms of temperature and precipitation; furthermore, the selection of the injection locations may be dependent on the models' specific stratospheric transport.

Heterogeneous Ensemble Model to Optimize Software Effort Estimation Accuracy

The software industry has rapidly expanded, and software development is now essential to the success of many multinational corporations. The demand for complex software systems has also dramatically increased. Effective software development is essential, given the limitations of resources such as money, time, and labor. The cost and effort calculations affect the development process and client needs. Project failure was usually caused by errors in job estimating. Underestimating could have severe repercussions, if the project’s budget ends up being more than anticipated. Project overruns, on the other hand, can also have a detrimental impact on how successfully software projects are finished. Researchers and experts in the field of software are investigating ways to keep management and development productivity at high levels. However, a stand-alone estimation has not produced any noteworthy research results. Over the last decade, the standalone estimating models have revealed inadequacies. Literature suggests opting ensemble models, would yield better results as compared to standalone models. We have proposed a heterogeneous ensemble effort estimation (EEE) model in this research. The proposed model is comprises of standalone estimating models such as 1) Use Case Point, 2) Expert Judgment (EJ) and 3)Artificial neural network (ANN). Finally, using linear combination rules, the effort of each unique base model is combined. We applied our ensemble model on the benchmark dataset i.e. ISBSG using three different variations to avoid biasness. Furthermore, trained models were applied on industry use-cases for cross-validation. The findings of this study demonstrated that, in comparison to stand-alone estimate strategies, the ensemble technique gave better estimation results.

Bagged Pretested Portfolio Selection

This article exploits the idea of combining pretesting and bagging to choose between competing portfolio strategies. We propose an estimator for the portfolio weight vector, which optimally trades off Type I against Type II errors when choosing the best investment strategy. Furthermore, we accommodate the idea of bagging in the portfolio testing problem, which helps to avoid sharp thresholding and reduces turnover costs substantially. Our Bagged Pretested Portfolio Selection (BPPS) approach borrows from both the shrinkage and the forecast combination literature. The portfolio weights of our strategy are weighted averages of the portfolio weights from a set of stand-alone strategies. More specifically, the weights are generated from pseudo-out-of-sample portfolio pretesting, such that they reflect the probability that a given strategy will be overall best performing. The resulting strategy allows for a flexible and smooth switch between the underlying strategies and outperforms the corresponding stand-alone strategies. Besides yielding high point estimates of the portfolio performance measures, the BPPS approach performs exceptionally well in terms of precision and is robust against outliers resulting from the choice of the asset space.

Digital interventions for people with dementia and carers: effective, cost-effectiveand equitable?

Digital interventions for people with dementia and carers: effective, cost-effectiveand equitable?

Non-invasive oxygenation support in acutely hypoxemic COVID-19 patients admitted to the ICU: a multicenter observational retrospective study

BackgroundNon-invasive oxygenation strategies have a prominent role in the treatment of acute hypoxemic respiratory failure during the coronavirus disease 2019 (COVID-19). While the efficacy of these therapies has been studied in hospitalized patients with COVID-19, the clinical outcomes associated with oxygen masks, high-flow oxygen therapy by nasal cannula and non-invasive mechanical ventilation in critically ill intensive care unit (ICU) patients remain unclear.MethodsIn this retrospective study, we used the best of nine covariate balancing algorithms on all baseline covariates in critically ill COVID-19 patients supported with > 10 L of supplemental oxygen at one of the 26 participating ICUs in Catalonia, Spain, between March 14 and April 15, 2020.ResultsOf the 1093 non-invasively oxygenated patients at ICU admission treated with one of the three stand-alone non-invasive oxygenation strategies, 897 (82%) required endotracheal intubation and 310 (28%) died during the ICU stay. High-flow oxygen therapy by nasal cannula (n = 439) and non-invasive mechanical ventilation (n = 101) were associated with a lower rate of endotracheal intubation (70% and 88%, respectively) than oxygen masks (n = 553 and 91% intubated), p < 0.001. Compared to oxygen masks, high-flow oxygen therapy by nasal cannula was associated with lower ICU mortality (hazard ratio 0.75 [95% CI 0.58–0.98), and the hazard ratio for ICU mortality was 1.21 [95% CI 0.80–1.83] for non-invasive mechanical ventilation.ConclusionIn critically ill COVID-19 ICU patients and, in the absence of conclusive data, high-flow oxygen therapy by nasal cannula may be the approach of choice as the primary non-invasive oxygenation support strategy.

Validation of a German and English Version of the Revised Art-of-Living Inventory

Abstract. It is an important goal for many people to achieve happiness or well-being. Research has shown the effects of various stand-alone strategies to increase well-being. However, it is unclear whether multiple strategies can enhance happiness. Art-of-living is defined as a combination of the most important strategies that lead to well-being. Based on philosophical theory and empirical studies, 11 strategy components have been identified. A basic questionnaire, the Art-of-Living Inventory (AOLI), which aims to measure these strategies, was validated in a German-speaking sample ( n = 1,302) and an English-speaking sample ( n = 2,166). Results confirmed the hypothesized factor structure which comprised 11 dimensions and at least weak measurement invariance. Further analyses demonstrated good internal consistency, retest reliability and convergent, and discriminant validity with respect to different indicators of well-being and the validation measures. Multiple regressions indicated that a combination of multiple components was significantly better at predicting well-being than even the best single component. Moreover, when compared to personality, art-of-living was demonstrated to have additional and distinct effects on well-being. In sum, the AOLI has promising measurement characteristics and may be applied in research studies to better understand well-being and in intervention studies aimed at enhancing well-being.

Integrated Renewable Energy Management System for Reduced Hydrogen Consumption using Fuel Cell

The hybrid energy sources and their behavior may be controlled by monitoring and sensing with the help of a single or multiple control strategies incorporated in the energy management system. Utilization of the battery state of charge (SOC) and reduction in the consumption of hydrogen are the main objectives of battery and fuel cell (FC) based renewable hybrid power systems. The lifespan of the hydrogen storage as well as battery may be improved while improving the cost reduction benefits using these parameters. These objectives are achieved by designing an integrated energy management system (IEMS). A battery, supercapacitor (SC), proton-exchange membrane fuel cell (PEMFC) and Photovoltaic (PV) cell are combined to provide the required power to a predetermined load to form a renewable hybrid power system (RHPS). During daylight, PV is the master power source in RHPS. During the shading or night time, FC is the secondary power source. When high load power is required, the FC is supported by the battery. Load fast change or load transient operation is performed by the SC. Maximum SOC value and minimum hydrogen consumption value is obtained simultaneously based on predetermined functions that aids in switching between the state machine control, frequency decoupling and fuzzy logic based integrated strategies in the proposed energy management model. When compared to the stand-alone strategies, the integrated model achieves increased SOC and reduced hydrogen consumption. When maximum value of PV power is attained, the surplus power is displayed at the load. The battery is charged using this surplus power. The stand-alone strategies and integrated strategy results are compared. The attainment of the goal of IEMS is confirmed from this comparison.

Cervical Cancer Screening: Comparison of Conventional Pap Smear Test, Liquid-Based Cytology, and Human Papillomavirus Testing as Stand-alone or Cotesting Strategies.

Some countries have implemented stand-alone human papillomavirus (HPV) testing while others consider cotesting for cervical cancer screening. We compared both strategies within a population-based study. The MARZY cohort study was conducted in Germany. Randomly selected women from population registries aged ≥30 years (n = 5,275) were invited to screening with Pap smear, liquid-based cytology (LBC, ThinPrep), and HPV testing (Hybrid Capture2, HC2). Screen-positive participants [ASC-US+ or high-risk HC2 (hrHC2)] and a random 5% sample of screen-negatives were referred to colposcopy. Post hoc HPV genotyping was conducted by GP5+/6+ PCR-EIA with reverse line blotting. Sensitivity, specificity (adjusted for verification bias), and potential harms, including number of colposcopies needed to detect 1 precancerous lesion (NNC), were calculated. In 2,627 screened women, cytological sensitivities (Pap, LBC: 47%) were lower than HC2 (95%) and PCR (79%) for CIN2+. Cotesting demonstrated higher sensitivities (HC2 cotesting: 99%; PCR cotesting: 84%), but at the cost of lower specificities (92%-95%) compared with HPV stand-alone (HC2: 95%; PCR: 94%) and cytology (97% or 99%). Cotesting versus HPV stand-alone showed equivalent relative sensitivity [HC2: 1.06, 95% confidence interval (CI), 1.00-1.21; PCR: 1.07, 95% CI, 1.00-1.27]. Relative specificity of Pap cotesting with either HPV test was inferior to stand-alone HPV. LBC cotesting demonstrated equivalent specificity (both tests: 0.99, 95% CI, 0.99-1.00). NNC was highest for Pap cotesting. Cotesting offers no benefit in detection over stand-alone HPV testing, resulting in more false positive results and colposcopy referrals. HPV stand-alone screening offers a better balance of benefits and harms than cotesting.See related commentary by Wentzensen and Clarke, p. 432.

Entrepreneurial ecosystems in an interconnected world: emergence, governance and digitalization

Achieving and sustaining growth depends on the effective work of multiple and interconnected actors—such as e.g. governments, the private sector, society, universities, entrepreneurs and many others—who build an ecosystem, i.e. a social and economic environment for innovative and entrepreneurial endeavors. The underlying idea is that firms do not just compete with each other through well-developed stand-alone strategies to achieve advantages over their rivals, uniquely relying on their own resources, knowledge, and capabilities, but rather base their business models on shared resources, network externalities, knowledge spill-overs, local endowments, and governmental support. This introductory article offers a wide array of topics, methods and fields of application within the field of entrepreneurial ecosystems as well as a theorizing about potential fruitful future areas of research within the field, concentrating on legitimation and identification processes in ecosystems, possibly culminating towards a meta-identity of the ecosystem.

Hot Potatoes: Overreaction to Extreme Negative Returns

Although it is well established that investors are willing to accept a negative premium for lottery-like stocks, it is puzzling that the opposite effect is not observed in stocks experiencing large daily losses. We find that stocks that experience large negative daily returns (MIN) also display large positive daily returns (MAX); therefore the MIN effect is subdued. Once stocks ranked as high-MAX within MIN deciles are removed, we find that MIN positively predicts future stock returns. More importantly, a strategy that buys pure high-MIN stocks and shorts pure high-MAX stocks generates superior returns compared to stand-alone MAX and/or MIN strategies.

Walkable Cities: Revitalization, Vibrancy, and Sustainable Consumption by Carlos J. L. Balsas

Reviewed by: Walkable Cities: Revitalization, Vibrancy, and Sustainable Consumption by Carlos J. L. Balsas Bradley Bereitschaft Carlos J. L. Balsas Walkable Cities: Revitalization, Vibrancy, and Sustainable Consumption. Albany, NY: State University of New York Press, 2019. xix + 238 pp. References and index. $32.95 paper (ISBN 978-1-4384-7628-5); $95.00 cloth (ISBN 978-1-4384-7627-8); $18.12 electronic (ISBN 978-1-4384-7629-2). In the early 1960s, as urban renewal schemes designed to prioritize the automobile and needlessly segregate land uses, took hold in the United States and elsewhere, the urban theorist and activist Jane Jacobs argued eloquently and persuasively against this new paradigm and in favor of what many now consider “traditional” urban planning and design. At the heart of this traditional way of building cities is a fine-grained mix of mutually-supportive land uses – residential, commercial, civic – that at reasonable urban densities, encourages people to walk and generally inhabit the public realm (i.e., sidewalks, plazas, parks, etc.). Shoppers, street vendors, residents, office workers, tourists, and shopkeepers all take part in a kind of “street ballet” that lends vitality, vibrancy, and safety to an urban neighborhood. In Walkable Cities Carlos Balsas focuses on the core element of Jacob’s street ballet: the retail businesses and enterprises that shape the economic viability and vitality of city centers around the world. Through a diverse set of case studies in Portugal, Spain, The United States, Mexico, and Brazil, Balsas shows how business owners, political leaders, and community groups have employed strategic and coordinated planning, public-private partnerships, and various place-making efforts to cope with internal and external stresses related to urban growth, globalization, [End Page 210] economic restructuring, and changing consumer preferences. Focusing mainly on solutions and adaptations utilizing commercial revitalization strategies, Balsas takes a unique and refreshing approach to distilling and addressing these complex issues through a series of myths and “reality checks.” Balsas suggests that one of the most widespread and substantial challenges city centers have had to contend with over the past century is suburbanization and the subsequent rise of new retail formats such as shopping malls, big box stores, and strip malls that are often capable of out-competing traditional urban retail stores in regard to price, convenience, and product selection. In the first chapter, however, Balsas rejects the notion that this increase in competition from suburban retail markets is the sole, or even primary, reason traditional retail in the city center has so frequently struggled. Instead, he suggests that retailers, in concert with municipal leaders and other stakeholders, should take responsibility for attracting customers by providing attractive urban spaces and unique retail experiences (a revitalization strategy the author refers to as commercial urbanism). As Balsas notes throughout the book, one of the critical differences between the retail environment of urban centers and those of the suburbs is that visitors “want to have a pleasant experience without necessarily having to shop” (p. 84). Indeed, one of the central themes of the book is that traditional urban centers, with their dense, human-scaled streetscapes can leverage the unique social and environmental experiences (i.e., diverse people, street vendors, smells and sounds, historic architecture) to not only attract customers but also differentiate themselves from suburban retail offerings. While Balsas extolls the virtues of walkable urban districts, he also warns against cities rushing to implement pedestrian-only zones given the failure of so many “pedestrian malls,” particularly in the United States. Drawing on case studies from Latin America and the Iberian Peninsula, Balsas suggests that these spaces can be highly successful, however it is critical that they are a part of an authentic “living neighborhood” rather than simply an urban re-imagination of a suburban mall. They also need strong pedestrian and transit connections with the surrounding urban tissue. The implication is that pedestrian districts are best not to be thought of as stand-alone revitalization strategies, but rather “upgrades” to existing commercial areas where much of the traffic is already on foot. Balsas again emphasizes the need for careful planning and cooperative management strategies to ensure the long-term maintenance and viability of pedestrian-only spaces. Even when successful, the...

Q-Learning-Based Coordinated Variable Speed Limit and Hard Shoulder Running Control Strategy to Reduce Travel Time at Freeway Corridor

To increase traffic mobility and safety, several types of active traffic management (ATM) strategies, such as variable speed limit (VSL), ramp metering, dynamic message signs, and hard shoulder running (HSR), are adopted in many countries. While all kinds of ATM strategies show promise in releasing traffic congestion, many studies indicate that stand-alone strategies have very limited capability. To remedy the defects of stand-alone strategies, cooperative ATM strategies have caught researchers’ attention and different combinations have been studied. In this paper, a coordinated VSL and HSR control strategy based on a reinforcement learning technique—Q-learning—is proposed. The proposed control strategy bridges up a direct connection between the traffic flow data and the ATM control strategies via intensive self-learning processes, thus reducing the need for human knowledge. A typical congested interstate highway, I-270 in Maryland, United States, was selected as the study area to evaluate the proposed strategy. A dynamic traffic assignment simulation model was introduced to calibrate the network with real-world data and was used to evaluate the regional impact of the proposed algorithm. Simulation results indicated that the proposed coordinated control could reduce corridor travel time by up to 27%. The performance of various control strategies were also compared. The results suggested that the proposed strategy outperformed the stand-alone control strategies and the traditional feedback-based VSL strategy in mitigating congestion and reducing travel time on the freeway corridor.

Peak Serum Chloride and Hyperchloremia in Patients Undergoing Cardiac Surgery Is Not Explained by Chloride-Rich Intravenous Fluid Alone: A Post-Hoc Analysis of the LICRA Trial

With the exception of 0.9% saline, little is known about factors that may contribute to increased serum chloride concentration (SCl-) in patients undergoing cardiac surgery. For the present study, the authors sought to characterize the association between administered chloride load from intravenous fluid and other perioperative variables, with peak perioperative SCl-. Secondary analysis of data from a previously published controlled clinical trial in which patients were assigned to a chloride-rich or chloride-limited perioperative fluid strategy (NCT02020538). Academic medical center. The study comprised 1,056 adult patients with normal preoperative SCl- undergoing cardiac surgery. None MEASUREMENTS AND MAIN RESULTS: Peak perioperative SCl- and hyperchloremia, defined as peak SCl- >110 mmol/L, were selected as co-primary endpoints. Regression modeling identified factors independently associated with these endpoints. Mean (standard deviation) peak perioperative SCl- was 114 (5) mmol/L, and hyperchloremia occurred in 824 (78.0%) of the cohort. In addition to administered volume of 0.9% saline, multivariate linear and logistic regression modeling consistently associated preoperative SCl- (regression coefficient 0.5; 95% confidence interval [CI] 0.4-0.6 mmol/L; odds ratio 1.60; 95% CI 1.41-1.82 per 1 mmol/L increase) and cardiopulmonary bypass duration (regression coefficient 0.1; 95% CI 0.1-0.2 mmol/L; odds ratio 1.12; 95% CI 1.06-1.19 per 10 minutes) with both co-primary outcomes. Multivariate modeling only explained approximately 50% of variability in peak SCl-. The present study's data identified an association for both 0.9% saline administration and other nonfluid variables with peak perioperative SCl- and hyperchloremia. Stand-alone strategies to limit administration of chloride-rich intravenous fluid may have limited ability to prevent hyperchloremia in this setting.

Strategic planning of the integrated urban wastewater system using adaptation pathways

Emerging threats such as climate change and urbanisation pose an unprecedented challenge to the integrated management of urban wastewater systems, which are expected to function in a reliable, resilient and sustainable manner regardless of future conditions. Traditional long term planning is rather limited in developing no-regret strategies that avoid maladaptive lock-ins in the near term and allow for flexibility in the long term. In this study, a novel adaptation pathways approach for urban wastewater management is developed in order to explore the compliance and adaptability potential of intervention strategies in a long term operational period, accounting for different future scenarios and multiple performance objectives in terms of reliability, resilience and sustainability. This multi-criteria multi-scenario approach implements a regret-based method to assess the relative performance of two types of adaptation strategies: (I) standalone strategies (i.e. green or grey strategies only); and (II) hybrid strategies (i.e. combined green and grey strategies). A number of adaptation thresholds (i.e. the points at which the current strategy can no longer meet defined objectives) are defined to identify compliant domains (i.e. periods of time in a future scenario when the performance of a strategy can meet the targets). The results obtained from a case study illustrate the trade-off between adapting to short term pressures and addressing long term challenges. Green strategies show the highest performance in simultaneously meeting near and long term needs, while grey strategies are found less adaptable to changing circumstances. In contrast, hybrid strategies are effective in delivering both short term compliance and long term adaptability. It is also shown that the proposed adaption pathways method can contribute to the identification of adaptation strategies that are developed as future conditions unfold, allowing for more flexibility and avoiding long term commitment to strategies that may cause maladaptation. This provides insights into the near term and long term planning of ensuring the reliability, resilience and sustainability of integrated urban drainage systems.