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Un altro «romanzo del Novecento»: il middlebrow italiano dal «neorealismo narrativo» alla letteratura contemporanea
No full textIn questo saggio riapro il dibattito sul romanzo middlebrow italiano. Parto dalla ricezione del ciclo L’amica geniale di Elena Ferrante, mostrando come la critica letteraria italiana ripeta il giudizio negativo sul romanzo middlebrow che ne avevano dato Umberto Eco e Gian Carlo Ferretti negli anni Sessanta e Settanta. Nel ricostruire quel dibattito letterario, dimostro poi come la polemica contro la «narrativa neorealista» sia l’episodio italiano di una battle of the brows transnazionale, che vede in Italia l’affermarsi dell’idea modernista del «romanzo del Novecento». Per andare oltre l’orizzonte tracciato da Eco e Ferretti propongo una concezione diversa del middlebrow che permette di identificare un altro «romanzo del Novecento». Analizzo infine La ragazza di Bube di Carlo Cassola, che è uno dei romanzi al centro di quella polemica ed è uno dei modelli del romanzo middlebrow italiano, che è riemerso nella letteratura contemporanea grazie al successo di opere come L’amica geniale.
In this article, I reopen the debate on Italian middlebrow fiction. I discuss the reception of The Neapolitan Novels Quartet by Elena Ferrante, showing how Italian literary critics still echo the negative conception of the middlebrow put forward by Umberto Eco and Gian Carlo Ferretti in the 1960s and 1970s. Reassessing that literary debate, I argue that the controversy around Neorealist fiction must be read as an episode of a transnational “battle of the brows”, which ends up in Italy with the assertion of the modernist conception of the «romanzo del Novecento». To overcome this negative conception of the middlebrow, I propose a new way of theorising the middlebrow that allows for the acknowledgment of an alternative «romanzo del Novecento». I then analyse La ragazza di Bube by Carlo Cassola, which was at the epicentre of the controversy and offers a blueprint for Italian middlebrow fiction – which has now resurfaced thanks to the success of literary works such as The Neapolitan Novels
Using causal inference to test systems with hidden and interacting variables: an evaluative case study
No full textSoftware systems with large parameter spaces, nondeterminism and high computational cost are challenging to test. Recently, software testing techniques based on causal inference have been successfully applied to systems that exhibit such characteristics, including scientific models and autonomous driving systems. One significant limitation is that these are restricted to test properties where all of the variables involved can be observed and where there are no interactions between variables. In practice, this is rarely guaranteed; the logging infrastructure may not be available to record all of the necessary runtime variable values, and it can often be the case that an output of the system can be affected by complex interactions between variables. To address this, we leverage two additional concepts from causal inference, namely effect modification and instrumental variable methods. We build these concepts into an existing causal testing tool and conduct an evaluative case study which uses the concepts to test three system-level requirements of CARLA, a high-fidelity driving simulator widely used in autonomous vehicle development and testing. The results show that we can obtain reliable test outcomes without requiring large amounts of highly controlled test data or instrumentation of the code, even when variables interact with each other and are not recorded in the test data
The investment and valuation nexus: exploring the perceptions of Nigerian real estate valuation professionals
Get PDFPurpose: Despite the importance of investment fundamentals in determining commercial property value, there is a knowledge gap in terms of how investment factors are integrated into the valuation process in developing markets, particularly in Africa. This study investigates how property valuers in Nigeria perceive the investment-valuation nexus, and how this influences their valuation processes and output.
Design/Methodology/Approach: Semi-structured interviews were deployed to 14 professional property valuers across Nigeria. The discussion from the interview transcripts was subjected to thematic and content analysis using the K-mean clustering learning algorithm and Latent Dirichlet Allocation topic modelling.
Findings: Key findings indicate that valuers consider a range of investment factors, including market conditions, location, and property features. However, the study highlights a potential gap in the consideration of cash flow analysis and tenant-related factors. The findings suggest that a more comprehensive approach to valuation is necessary to enhance the accuracy and reliability of property valuations in Nigeria.
Practical Implications: The findings have significant implications for Nigeria and other emerging African markets considering the high volume of property investment capital received by the countries. With key investment fundamentals not being sufficiently captured in the valuation process in line with best practices, current valuation output may be omitting important factors thereby undermining their accuracy and reliability.
Originality: This study provides alternative perspectives on the investment-valuation relationship through the unique lenses of key stakeholders (valuers) in the context of developing countries. This context is important, given that these economies are usually perceived to be less sophisticated and often present significant challenges around standardisation and bias. Secondly, the study provides some insights into the heterogeneity associated with the valuation of assets in highly heterogeneous markets such as Nigeria. Thirdly, the study adopts the K-mean clustering learning algorithm and Latent Dirichlet Allocation topic modelling approaches which have previously not been applied to property valuation
Patient perspectives on the impact of appearance and weight changes attributed to systemic glucocorticoid treatment of rheumatic diseases
Get PDFObjective
To explore patients’ perspectives on the impact of appearance changes attributed to glucocorticoid treatment.
Methods
A secondary inductive thematic analysis was conducted of the ‘Steroid PRO’ semi-structured interviews with patients with rheumatic conditions receiving glucocorticoids in the UK, USA and Australia.
Results
Sixty patient interviews were analysed. Patient age was 26–84 years; 39 (65%) were female; and the patients had systemic vasculitis (n = 19), inflammatory arthritis (n = 14), crystal arthropathy (n = 2), connective tissue disorders (n = 16) or other/multiple (n = 9). In addition to participants expressing the need for more information and support, three over-arching themes were identified: (i) societal norms [‘I think my main concern, particularly being female, was the weight gain that the steroids had’ (female aged 26–30)]; these included real or perceived expectations to which participants felt pressure to conform, which were sustained through interactions with others; (ii) harms to mental health and sense of self [‘It makes you feel down. It makes you feel depressed. You don’t want to socialize because you’re not you’ (male aged 61–65)]; glucocorticoids were described as making participants ‘not look like’ themselves, associated with changes in mood and self-confidence; and (iii) burden of adjustments [‘I have a wardrobe right now that goes four different sizes’ (female aged 51–55)]; other adjustments related to diet, exercise, work, hobbies, activities of daily living and key life events.
Conclusion
Patients attribute a variety of impacts on their quality of life to glucocorticoid-related appearance changes. We suggest ways to meet patients’ needs for information and support, which can be developed through further work
At the far end of everything: a likely Ahrensburgian presence in the far north of the Isle of Skye, Scotland
Get PDFA Late Upper Paleolithic (LUP) site containing Ahrensburgian‐type stone tools has been discovered at South Cuidrach, Isle of Skye, Scotland. Together with a group of intertidal stone circular alignments also recently discovered on the island, this new evidence for the occupation of northern Scotland also represents the most northerly LUP site in Britain. The timing of the continental Ahrensburgian culture is closely linked to the later part of the Younger Dryas, also known regionally as the Loch Lomond Stadial (LLS), a cold period that saw a significant ice cap and glacier expansion across the mainland of western Scotland. Here, we examine the climatic, environmental and relative sea‐level contexts and reflect on the location of this site on an island to the north‐west of the Younger Dryas ice mass. South Cuidrach is situated on the north coast of Skye, lying around 25 km north‐west of the maximum known local extent of the Younger Dryas ice mass. Most of the lithic assemblage is made from locally available baked mudstone. The site has good access to coastal and riverine resources and readily available ochre, suggesting it was deliberately chosen. Together with the new stone alignments and several other nearby sites, this region now contains more evidence for the LUP than anywhere else in Scotland. The geography and Late Glacial environment of west Scotland comprised a volatile landscape of water, mountains and fluctuating glaciers and coastlines, a challenging area at the north‐westerly limit of the European landmass that was very different to the Ahrensburgian core territories in mainland Europe. We anticipate that by examining this new evidence within the various broad geographical and geomorphological conditions, there is significant potential for the discovery of further LUP locations both on and off‐shore in this region
Characterisation of HER2‐driven morphometric signature in breast cancer and prediction of risk of recurrence
Get PDFIntroduction
Human epidermal growth factor receptor 2-positive (HER2-positive) breast cancer (BC) is a heterogeneous disease. In this study, we hypothesised that the degree of HER2 oncogenic activity, and hence response to anti-HER2 therapy is translated into a morphological signature that can be of prognostic/predictive value.
Methods
We developed a HER2-driven signature based on a set of morphometric features identified through digital image analysis and visual assessment in a sizable cohort of BC patients. HER2-enriched molecular sub-type (HER2-E) was used for validation, and pathway enrichment analysis was performed to assess HER2 pathway activity in the signature-positive cases. The predictive utility of this signature was evaluated in post-adjuvant HER2-positive BC patients.
Results
A total of 57 morphometric features were evaluated; of them, 22 features were significantly associated with HER2 positivity. HER2 IHC score 3+/oestrogen receptor-negative tumours were significantly associated with HER2-related morphometric features compared to other HER2 classes including HER2 IHC 2+ with gene amplification, and they showed the least intra-tumour morphological heterogeneity. Tumours displaying HER2-driven morphometric signature showed the strongest association with PAM50 HER2-E sub-type and were enriched with ERBB signalling pathway compared to signature-negative cases. BC patients with positive HER2 morphometric signature showed prolonged distant metastasis-free survival post-adjuvant anti-HER2 therapy (p = 0.007). The clinico-morphometric prognostic index demonstrated an 87% accuracy in predicting recurrence risk.
Conclusion
Our findings underscore the strong prognostic and predictive correlation between HER2 histo-morphometric features and response to targeted anti-HER2 therapy
Global sea-level rise in the early Holocene revealed from North Sea peats
Get PDFRates of relative sea-level rise during the final stage of the last deglaciation, the early Holocene, are key to understanding future ice melt and sea-level change under a warming climate1. Data about these rates are scarce2, and this limits insight into the relative contributions of the North American and Antarctic ice sheets to global sea-level rise during the early Holocene. Here we present an early Holocene sea-level curve based on 88 sea-level data points (13.7–6.2 thousand years ago (ka)) from the North Sea (Doggerland3,4). After removing the pattern of regional glacial isostatic adjustment caused by the melting of the Eurasian Ice Sheet, the residual sea-level signal highlights two phases of accelerated sea-level rise. Meltwater sourced from the North American and Antarctic ice sheets drove these two phases, peaking around 10.3 ka and 8.3 ka with rates between 8 mm yr−1 and 9 mm yr−1. Our results also show that global mean sea-level rise between 11 ka and 3 ka amounted to 37.7 m (2σ range, 29.3–42.2 m), reconciling the mismatch that existed between estimates of global mean sea-level rise based on ice-sheet reconstructions and previously limited early Holocene sea-level data. With its broad spatiotemporal coverage, the North Sea dataset provides critical constraints on the patterns and rates of the late-stage deglaciation of the North American and Antarctic ice sheets, improving our understanding of the Earth-system response to climate change
SMALL: open surgery versus minimally invasive vacuum-assisted excision for small screen-detected breast cancer—protocol for a phase III randomised multicentre trial
Get PDFIntroduction
Mammographic screening identifies many women with small breast cancers with favourable biological features, which have an excellent prognosis. Some of these may never have become clinically apparent without screening and are commonly described as ‘overdiagnosed’ cancers. Despite this, all patients with screen-detected cancers are currently treated with surgical excision and sentinel lymph node biopsy, although this may represent overtreatment. There is, therefore, a need for less invasive approaches to reduce treatment burden for patients while maintaining current excellent oncological outcomes. Vacuum-assisted excision (VAE) may represent such an alternative treatment approach, and the SMALL (Open Surgery versus Minimally invasive-vacuum Assisted excision for smaLL screen-detected breast cancer) trial aims to investigate the use of VAE for the safe de-escalation of surgical treatment for such excellent prognosis invasive breast cancers.
Methods
SMALL is a prospective, multicentre, randomised phase III trial of VAE versus surgery in patients with small, biologically favourable screen-detected invasive breast cancer. SMALL has an innovative hybrid design with coprimary endpoints. These include a randomised non-inferiority comparison of surgical re-excision rates following initial treatment, and a single-arm analysis of local recurrence at 5 years following VAE. Secondary outcomes include complication rates, overall survival, quality of life and a health economic analysis. The trial includes a QuinteT Recruitment Intervention to support recruitment.
Ethics and dissemination
Ethical approval was obtained from the Office for Research Ethics (Northern Ireland) for all UK sites. Results will be submitted for publication in a peer-reviewed journal, presented, shared with patient partners and with relevant professional organisations to inform future guideline development for the management of screen-detected breast cancer.
Trial registration number
ISRCTN12240119
Cost-effectiveness of de-escalated molecular subtype dependent use of neoadjuvant chemotherapy in patients with muscle-invasive bladder cancer in a Swedish setting
Get PDFBackground: Guidelines recommend neoadjuvant chemotherapy (NAC) and radical cystectomy (RC) for muscle-invasive bladder cancer (MIBC). Current recommendations do not consider genomic profiles, although the Basal/Squamous (Ba/Sq) subtype is less likely to respond to NAC compared to Urothelial-like (Uro) and Genomically Unstable (GU) subtypes. The aim of this study is to perform cost-effectiveness analyses of a de-escalated use of NAC in patients with Ba/Sq tumors and MIBC.
Methods: A cost-effectiveness analysis was performed using a decision analytic Markov model using a healthcare provider perspective. Treatment and prognosis probabilities originated from the Bladder Cancer Data Base, Sweden (BladderBaSe) 2.0. Information on molecular subtype and outcomes was retrieved from published studies, and quality-adjusted life year (QALY) data were obtained from the iROC trial. Costs were collected from the regional healthcare registers in Sweden, utility values were obtained from the literature, and outcomes are presented as incremental cost-effectiveness ratio (ICER). Scenario analyses, along with several one-way and probabilistic sensitivity analyses were performed to capture uncertainties.
Results: At a 5-year time horizon, the model predicts that molecular subtype-based treatment has an ICER of 4,964 Euro/QALY (66,766 Swedish Krona/QALY), which is deemed cost-effective in the Swedish setting. At €7,427 (100,000 SEK) willingness-to-pay threshold, the molecular subtype-based treatment has a 65% probability of being cost-effective. The results were not sensitive to uncertainty analyses.
Conclusion: Molecular subtype-based treatment of MIBC, i.e., refraining from administering NAC to patients with Ba/Sq tumors, is cost-effective compared to the current treatment practices in Sweden
Development of a patient-reported outcome measure for gastrointestinal recovery after surgery (PRO-diGI)
Get PDFBackground
After major abdominal surgery, patients may experience significant gastrointestinal dysfunction, including postoperative ileus. Many clinical tools are used to measure this dysfunction, but there is no patient-reported outcome measure (PROM) specific to this group. The aim of this study was to develop a new PROM for this common condition.
Methods
A four-stage approach was undertaken. Stage 1 used semi-structured interviews with 29 patients to explore experiences of gastrointestinal recovery and develop a draft questionnaire. Stage 2 solicited feedback from 18 patients and 15 clinical experts on the face validity of the proposed tool using the Questionnaire on Questionnaires (QQ-10). Stage 3 recruited 297 patients to complete the questionnaire. Principal component analysis reduced the items and identified the domain structure. Test-retest reliability and a pilot assessment of responsiveness were assessed in stage 4 in a sample of 100 patients and in a sample of 68 patients respectively.
Results
The interviews generated 26 subthemes across gastrointestinal recovery and general well-being. An initial questionnaire containing 44 items was developed. The QQ-10 demonstrated high value and low burden, supporting face validity. Tests to reduce the items and identify the domain structure resulted in a 15-item questionnaire across four domains (nausea, eating, well-being, and bowels). Test-retest reliability showed intraclass correlation coefficient values ≥0.7 for all domains. Pilot responsiveness was demonstrated through differences in pre- and post-surgical scores.
Conclusion
PRO-diGI is a PROM for gastrointestinal dysfunction after major abdominal surgery that shows good psychometric properties and demonstrates face validity, reliability, and responsiveness. This now needs external validation to facilitate broader implementation
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