Tag recommendation: problem statement.
\\n\\n
IntechOpen was founded by scientists, for scientists, in order to make book publishing accessible around the globe. Over the last two decades, this has driven Open Access (OA) book publishing whilst levelling the playing field for global academics. Through our innovative publishing model and the support of the research community, we have now published over 5,700 Open Access books and are visited online by over three million academics every month. These researchers are increasingly working in broad technology-based subjects, driving multidisciplinary academic endeavours into human health, environment, and technology.
\\n\\nBy listening to our community, and in order to serve these rapidly growing areas which lie at the core of IntechOpen's expertise, we are launching a portfolio of Open Science journals:
\\n\\nAll three journals will publish under an Open Access model and embrace Open Science policies to help support the changing needs of academics in these fast-moving research areas. There will be direct links to preprint servers and data repositories, allowing full reproducibility and rapid dissemination of published papers to help accelerate the pace of research. Each journal has renowned Editors in Chief who will work alongside a global Editorial Board, delivering robust single-blind peer review. Supported by our internal editorial teams, this will ensure our authors will receive a quick, user-friendly, and personalised publishing experience.
\\n\\n"By launching our journals portfolio we are introducing new, dedicated homes for interdisciplinary technology-focused researchers to publish their work, whilst embracing Open Science and creating a unique global home for academics to disseminate their work. We are taking a leap toward Open Science continuing and expanding our fundamental commitment to openly sharing scientific research across the world, making it available for the benefit of all." Dr. Sara Uhac, IntechOpen CEO
\\n\\n"Our aim is to promote and create better science for a better world by increasing access to information and the latest scientific developments to all scientists, innovators, entrepreneurs and students and give them the opportunity to learn, observe and contribute to knowledge creation. Open Science promotes a swifter path from research to innovation to produce new products and services." Alex Lazinica, IntechOpen founder
\\n\\nIn conclusion, Natalia Reinic Babic, Head of Journal Publishing and Open Science at IntechOpen adds:
\\n\\n“On behalf of the journal team I’d like to thank all our Editors in Chief, Editorial Boards, internal supporting teams, and our scientific community for their continuous support in making this portfolio a reality - we couldn’t have done it without you! With your support in place, we are confident these journals will become as impactful and successful as our book publishing program and bring us closer to a more open (science) future.”
\\n\\nWe invite you to visit the journals homepage and learn more about the journal’s Editorial Boards, scope and vision as all three journals are now open for submissions.
\\n\\nFeel free to share this news on social media and help us mark this memorable moment!
\\n\\n\\n"}]',published:!0,mainMedia:{caption:"",originalUrl:"/media/original/237"}},components:[{type:"htmlEditorComponent",content:'
After years of being acknowledged as the world's leading publisher of Open Access books, today, we are proud to announce we’ve successfully launched a portfolio of Open Science journals covering rapidly expanding areas of interdisciplinary research.
\n\n\n\nIntechOpen was founded by scientists, for scientists, in order to make book publishing accessible around the globe. Over the last two decades, this has driven Open Access (OA) book publishing whilst levelling the playing field for global academics. Through our innovative publishing model and the support of the research community, we have now published over 5,700 Open Access books and are visited online by over three million academics every month. These researchers are increasingly working in broad technology-based subjects, driving multidisciplinary academic endeavours into human health, environment, and technology.
\n\nBy listening to our community, and in order to serve these rapidly growing areas which lie at the core of IntechOpen's expertise, we are launching a portfolio of Open Science journals:
\n\nAll three journals will publish under an Open Access model and embrace Open Science policies to help support the changing needs of academics in these fast-moving research areas. There will be direct links to preprint servers and data repositories, allowing full reproducibility and rapid dissemination of published papers to help accelerate the pace of research. Each journal has renowned Editors in Chief who will work alongside a global Editorial Board, delivering robust single-blind peer review. Supported by our internal editorial teams, this will ensure our authors will receive a quick, user-friendly, and personalised publishing experience.
\n\n"By launching our journals portfolio we are introducing new, dedicated homes for interdisciplinary technology-focused researchers to publish their work, whilst embracing Open Science and creating a unique global home for academics to disseminate their work. We are taking a leap toward Open Science continuing and expanding our fundamental commitment to openly sharing scientific research across the world, making it available for the benefit of all." Dr. Sara Uhac, IntechOpen CEO
\n\n"Our aim is to promote and create better science for a better world by increasing access to information and the latest scientific developments to all scientists, innovators, entrepreneurs and students and give them the opportunity to learn, observe and contribute to knowledge creation. Open Science promotes a swifter path from research to innovation to produce new products and services." Alex Lazinica, IntechOpen founder
\n\nIn conclusion, Natalia Reinic Babic, Head of Journal Publishing and Open Science at IntechOpen adds:
\n\n“On behalf of the journal team I’d like to thank all our Editors in Chief, Editorial Boards, internal supporting teams, and our scientific community for their continuous support in making this portfolio a reality - we couldn’t have done it without you! With your support in place, we are confident these journals will become as impactful and successful as our book publishing program and bring us closer to a more open (science) future.”
\n\nWe invite you to visit the journals homepage and learn more about the journal’s Editorial Boards, scope and vision as all three journals are now open for submissions.
\n\nFeel free to share this news on social media and help us mark this memorable moment!
\n\n\n'}],latestNews:[{slug:"webinar-introduction-to-open-science-wednesday-18-may-1-pm-cest-20220518",title:"Webinar: Introduction to Open Science | Wednesday 18 May, 1 PM CEST"},{slug:"step-in-the-right-direction-intechopen-launches-a-portfolio-of-open-science-journals-20220414",title:"Step in the Right Direction: IntechOpen Launches a Portfolio of Open Science Journals"},{slug:"let-s-meet-at-london-book-fair-5-7-april-2022-olympia-london-20220321",title:"Let’s meet at London Book Fair, 5-7 April 2022, Olympia London"},{slug:"50-books-published-as-part-of-intechopen-and-knowledge-unlatched-ku-collaboration-20220316",title:"50 Books published as part of IntechOpen and Knowledge Unlatched (KU) Collaboration"},{slug:"intechopen-joins-the-united-nations-sustainable-development-goals-publishers-compact-20221702",title:"IntechOpen joins the United Nations Sustainable Development Goals Publishers Compact"},{slug:"intechopen-signs-exclusive-representation-agreement-with-lsr-libros-servicios-y-representaciones-s-a-de-c-v-20211123",title:"IntechOpen Signs Exclusive Representation Agreement with LSR Libros Servicios y Representaciones S.A. de C.V"},{slug:"intechopen-expands-partnership-with-research4life-20211110",title:"IntechOpen Expands Partnership with Research4Life"},{slug:"introducing-intechopen-book-series-a-new-publishing-format-for-oa-books-20210915",title:"Introducing IntechOpen Book Series - A New Publishing Format for OA Books"}]},book:{item:{type:"book",id:"92",leadTitle:null,fullTitle:"Stochastic Optimization - Seeing the Optimal for the Uncertain",title:"Stochastic Optimization",subtitle:"Seeing the Optimal for the Uncertain",reviewType:"peer-reviewed",abstract:"Stochastic Optimization Algorithms have become essential tools in solving a wide range of difficult and critical optimization problems. Such methods are able to find the optimum solution of a problem with uncertain elements or to algorithmically incorporate uncertainty to solve a deterministic problem. 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\r\n\tThe use of antibiotics in food animals is largely in practice for decades. Poultry, as well as animal producers, use sub-therapeutic levels of antimicrobials in feed to get maximum production. Furthermore, in serval countries, non-judicial use of antimicrobials while using for therapeutic purposes is also been observed. However, research has evidence that the use of antibiotics in food animals has many deleterious effects on the animals, the environment, and human beings. One of the prime examples of antimicrobials' side-effects is the development of antimicrobial resistance that results in a reduction of treatment options in human and animal medicine. Nowadays, scientists are looking for viable alternatives to antibiotics including prebiotics, probiotics, and synbiotics. Probiotics are live microorganisms that are helpful for digestion and health. They are also capable to reduce harmful bacteria in the gut when supplemented in the diet. Many available studies show that probiotic supplementation in poultry, fish, livestock, and pet animals led to improved production, health, immunity, and meat quality.
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Dr. Asghar Ali Kamboh completed his Ph.D. in Veterinary Science from Nanjing Agricultural University, China. He has published more than 100 research and review articles in national and international peer-reviewed journals. He is an editor/editorial board member of many scholarly journals in the area of animal health and production.",coeditorOneBiosketch:null,coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"225390",title:"Dr.",name:"Asghar Ali",middleName:null,surname:"Kamboh",slug:"asghar-ali-kamboh",fullName:"Asghar Ali Kamboh",profilePictureURL:"https://mts.intechopen.com/storage/users/225390/images/system/225390.jpeg",biography:"Dr. Asghar Ali Kamboh was born in Mehrabpur, Sindh, Pakistan. He completed his studies in Veterinary Medicine and Masters in Veterinary Microbiology in 2003 and 2007 respectively, with distinguished grades. In 2009, he was awarded an overseas scholarship by the Government of Pakistan and proceeded to China for doctoral studies. Currently, he is working as an Associate Professor in the Department of Veterinary Microbiology, Sindh Agriculture University, Tandojam. He has edited two books and published more than 100 research and review articles in national and international peer-reviewed journals. He has supervised/co-supervised more than 35 M.Phil students. He is also the author of many books and book chapters. 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Tagging has become a common feature available in these applications, consisting in associating freely created tags (keywords) to objects (e.g., videos, images, texts). In comparison with a fixed taxonomy, tags are simpler, cheaper, and a more natural way of organizing content. In fact, taxonomies with a controlled vocabulary do not suit the increasing and evolving Web 2.0 environment [1].
Moreover, various studies have demonstrated that, among other textual features such as title, description, and user comments, tags are the most effective to support information retrieval (IR) services such as search [2], automatic classification [3], and content recommendation [4].
The tagging process can benefit a lot from a tag recommendation service. This type of service supports users in the selection of some of the recommended tags or in the creation of new ones. With that in mind, tag recommendation benefits are not limited to the improvement of the user experience: there is a high potential of improving the quality of the generated tags by, for example, reducing the amount of misspellings and nondescriptive keywords. Thus, the quality of the IR services that rely on tags as data sources can be indirectly improved by tag recommendation. Other examples of the benefits that tag recommendation can bring to IR services include the direct application of the recommended tags in search [5] and on query expansion [6]. In search, the recommended tags can be exploited to measure the similarity between queries and documents, improving the quality of the retrieved documents. Query expansion, in turn, aims at suggesting more specific and unambiguous queries to the user, which also allows the achievement of better search results. Further examples include researcher profile summarization [7] and search result summarization [8].
Tag recommendation brings specific challenges that other kinds of recommendation services do not: in the tag domain, we are interested not only in matching the interests of the target user but also in describing, summarizing, and organizing Web content. Thus, the design of tag recommenders demands specific solutions which greatly differ from methods proposed for item recommendation tasks in general. For instance, text mining, knowledge extraction, and semantics play a substantial role in the tag domain. In sum, the recommendation effectiveness affects not only user satisfaction but also the performance of various IR services that rely on tags as data source.
The goal of this chapter is to present the concepts of tagging systems and to provide an overview of tag recommendation techniques, explaining the two main steps of these methods: the candidate tag generation and the candidate tag ranking.
The rest of this chapter is organized as follows. In Section 2, we define tags, objects, folksonomies, and other basic concepts related to tagging systems. In Section 3, we state the tag recommendation problem, while we explain the main tag candidate extraction and ranking techniques in Sections 4 and 5, respectively.
A Web 2.0
In particular,
Figure 1 illustrates a MovieLens page containing textual features assigned to an object (a movie, in this case).
A Web 2.0 page and some of its textual features.
Features commonly found in Web 2.0 pages. Friendship and subscription links are representative examples of social features. The set of tags a user assigned to objects in the applications is taken as one of the
The Web 2.0 tags, objects, and users form the basic structure of the
More formally, a folksonomy is defined as a relation
Examples of broad folksonomies include the online radio station LastFM (http://www.last.fm/) and the publication sharing application Bibsonomy (http://www.bibsonomy.org). The photo sharing site Flickr (http://www.flickr.com/) is an example of narrow folksonomy. While both broad and narrow folksonomies have common goals, a broad folksonomy can be further exploited to rank tags by their popularity and visualize the most important tags by means of tag clouds, which also provide an easy way to navigate the tags, objects, and users of a folksonomy.
Examples of tagging datasets available online for experimentation include MovieLens and Bibsonomy snapshots (https://grouplens.org/datasets/movielens and http://www.kde.cs.uni-kassel.de/bibsonomy/dumps, respectively) and our LastFM, YouTube, and YahooVideo crawled data (https://figshare.com/articles/data_tar_gz/2067183).
As in [13], we define two tag recommendation tasks: the
On the other hand,
In more formal terms, the tag recommendation tasks are defined in [13] as:
“
Note that possibly there are no tags available in the target object, that is,
These definitions focus on relevance as the only objective to be maximized. However, other aspects of the problem, such as novelty and diversity, have been considered as important, in recommendation systems in general and also in the specific tag recommendation domain [14].
According to the traditional definition of relevance or accuracy, the relevance of each tag in a recommendation list is independent of the relevance of the other tags in the list. However, in the general recommendation context, given that a recommendation satisfied the user need, the usefulness of similar recommendations is arguable. This occurs in the tagging context when, for example, only synonyms or strongly similar words are provided as recommendations. To deal with these issues, concepts of novelty and diversity have been introduced.
In tag recommendation, the novelty of a tag has been defined from the perspective of its popularity in the application. In [14], tag novelty is calculated as the inverse of the frequency at which the tag is used in the collection. The rationale is that frequently used tags tend to be more “obvious” recommendations (if relevant), thus being of little use to improve the description of the target object. We note that, according to this definition, noisy terms such as typos may be considered highly novel. However, novelty and diversity must be considered jointly with relevance in order to provide effective tag recommendations. It is worth mentioning that this definition of novelty is closely related to tag
The
Table 1 summarizes the tag recommendation problem and its aspects.
Personalized | Object-centered | |
---|---|---|
Object | Pair object-user < | |
Tag recommendation: problem statement.
Tag recommendation methods can be divided in two steps: (1) the generation of a set of candidate tags and (2) the ranking of the candidate tags produced in step (1). In this section, we introduce the main techniques to tackle the first step, while in Section 5, we discuss methods to perform the second step.
The candidate tag generation depends on the data sources available in the target application. As summarized by [9], previous tag recommendation strategies have exploited as data sources: (1) the folksonomy (history of tag assignments); (2) textual features (other than tags), such as title, description, and user comments; (3) rich media content, that is, image, audio, or video; and (4) social features, such as friendship links in social networks and other interactions among users as illustrated in Section 2.
Based on these data sources, we can name three main groups of techniques to extract or generate candidate tags: (1) extraction of terms from the textual features associated with the target object, (2) tag co-occurrences with terms in these textual features (possibly including previously assigned tags) or other features (e.g., visual features for rich media content), and (3) tags extracted from neighbors, that is, objects that are similar to the target object or users that are similar to the target user. These three groups of techniques will be the subject of Sections 4.1–4.3, respectively.
The simplest strategy to extract candidate tags from a given text is to consider each (whitespace) separated word as a candidate, after removing punctuation and other special characters. After this, a basic post-processing step is to remove
“The tagging process can benefit a lot from a tag recommendation service.”
However, this simple strategy is only capable of generating single words as tags, although it is common to use expressions containing two or more words (e.g., “information systems,” “digital image processing”) as tags. Thus, alternative keyword extraction techniques first generate all word
A sliding window of size
The tagging process – tagging process can – process can benefit – can benefit a – benefit a lot – a lot from – lot from a – from a tag – a tag recommendation – tag recommendation service.
To filter out meaningless or uninformative candidate tags such as “benefit a lot” or “from a tag,” some authors, such as [7, 16] exploit a selection approach based on part-of-speech (PoS) labels, which captures the idea of keywords having a certain syntactic property. Besides that, this approach is based on empirical evidence obtained in training data. First, the most frequent PoS patterns of keywords that occur in a given training dataset are identified. For example, the three most frequent PoS patterns for keywords found in [15] are:
ADJECTIVE + NOUN (singular or plural)
NOUN + NOUN (both singular or plural)
ADJECTIVE + NOUN (plural)
Thus, only sequences of words that match the top-x (let us say, x = 50) most frequent patterns are selected as candidate tags. For the aforementioned example and considering n = 2 and x = 3, the selected candidate tags would be “tagging process,” “tag recommendation,” and “recommendation service”, all three of them matching the ADJECTIVE + NOUN pattern.
Unlike the PoS-based approach, which is a supervised, language-dependent approach that processes a training dataset, the
tagging process – benefit – tag recommendation service
After extracting candidate keywords, RAKE builds a graph of word co-occurrences, in which there is an edge between two words if they appeared in the same keyword. The score of each word
Another strong source of candidate tags is the history of tag assignments of the application (folksonomy). Tags that the target user frequently used in previous tagging events are good candidates to recommend for this user, especially in a personalized recommendation task. Still more interesting, we can exploit tag co-occurrences in these previous posts, recommending to an object
Tag co-occurrences are usually computed by exploiting association rules, which are employed in general to describe frequently co-occurring item sets. For tag recommendation, association rules assume the form
To recommend tags for an object
Another form of obtaining candidate tags that are external to the target object, besides exploiting co-occurrences, is extracting tags from the neighborhood of the target object
Thus, the neighborhood-based tag generation approaches exploit a graph in which the nodes correspond to objects or users, and there is an edge between two objects (or two users) if they are similar (e.g., share tags or other words in common). Alternatively, visual features extracted from image and video objects can be used to estimate content similarity [19, 20], although they may face scalability issues and a larger semantic gap [20].
To identify similar objects or users, each object (or user) is usually modeled as a bag of terms (extracted from the textual features of the object or from the vocabulary of the users). These terms receive a TFIDF weight, and a similarity measure such as the cosine of these term vector representations is exploited to estimate the similarity between objects or users [21].
After generating a set of candidate tags, it is necessary to rank them, showing the most relevant tags first, in order to provide effective tag recommendations. Some tag candidate generation strategies already provide a measure to estimate the candidate tag relevance, such as the degree/frequency ratio in RAKE, as defined in Section 4.1. In this section, we first discuss various tag quality attributes that can be used to estimate tag relevance (Section 5.1), isolated or combined with other attributes. Then, we discuss methods that can automatically combine various attributes exploiting a learning-to-rank approach (Section 5.2).
Tag quality attributes can be grouped into the following categories, based on the aspect they try to capture regarding the tag recommendation task [13]:
As mentioned in Section 4.2, tag recommenders select association rules in which antecedents are included in
where
Descriptive power attributes usually estimate the descriptive capacity of candidate tags based on statistics of their occurrence in the textual features of the target object. We [13] proposed the use of four of these attributes for tag recommendation. We start by defining the
The rationale behind
TF or
However, neither TS nor TF consider that some textual features may describe the content of the target object more accurately than others. For example, the title is usually the most representative textual feature of the object’s content [3]. Thus, we proposed in [13] two other attributes, which extend TF and TS, weighting a candidate tag based on the average descriptive powers of the textual features in which it appears.
To define these new attributes, we need first to automatically estimate the descriptive power of a textual feature Fi using the
where
Discriminative power attributes promote more infrequent terms as tags, since they may better
We note that the value 1 is added to both numerator and denominator, without harming the tag specificity estimation, to deal with the value 0 in the denominator, which occurs for new terms that do not appear as tags in the training data.
IFF may have privilege terms from other textual features that do not appear as tags in the training data or noisy terms such as typos. Nevertheless, this attribute can be combined with the other attributes into a function, using, for example, learning-to-rank algorithms. Thus, its relative weight can be adjusted in order to avoid negative impacts in tag recommendation effectiveness.
Considering that both too general and too specific or noisy terms may not be ideal tag recommendations, [2] propose the s
Another important aspect for tag recommendation is term predictability. Heymann et al. [22] measure this characteristic through the term’s
If a term occurs consistently with certain tags, it is more predictable, thus having lower entropy. Terms that occur indiscriminately with many other tags are less predictable, thus having higher entropy. Term entropy can be useful particularly for breaking ties, as it is better to recommend more “consistent” or less “confusing” terms.
Another predictability attribute, called
The user frequency (UF) attribute was used in [13, 18] in order to estimate the relevance of a candidate tag for a target user and thus provides personalized recommendations.
It is also common to exploit the temporal dynamics of tagging, particularly in user frequency-based tag attributes. From the observation that the temporal decay of the users’ word choices follows a power-law function, the authors in [23] integrate a time component that gives more weight to tags that have been used more recently.
Observing that recommendation is usually modeled as a ranking problem (i.e., we want to recommend the most relevant items first), learning-to-rank (L2R) techniques constitute an appropriate approach to tackle it. L2R-based methods are supervised approaches that automatically “learn” a ranking function from “previously seen” data known as training instances. Such training examples usually consist of candidate tags, their tag quality attribute values, and their relevance labels, which indicates their relevance levels. These labels can be assigned either manually or by exploiting previous tag assignments as ground truth. The objective of L2R approaches is to generate a model (function) that maps the tag quality attributes into a relevance score or rank.
More formally, for each candidate tag
Various L2R-based algorithms have been proposed for tag recommendation in the literature, including RankSVM, RankBoost, Genetic Programming, Random Forest (RF), Multiple Additive Regression Trees (MART), Lambda-MART, AdaRank, ListNet, Ranknet, and Coordinate Ascent. In [24] we can find a brief description of each of these algorithms and experimental results of the comparison of these methods using the RankLib tool (https://sourceforge.net/p/lemur/wiki/RankLib/). According to our results, RF, MART, and Lambda-MART are found to be the best performing strategies for the tag recommendation problem.
In [25], the author reviewed existing L2R algorithms in the context of document ranking, categorizing them into three approaches: pointwise, pairwise, and listwise. The
Finally, it is also worth mentioning that, instead of adopting an attribute engineering approach, exploiting various handcrafted attributes like those described in Section 4, some recent works focus on investigating techniques that can learn attribute interactions from raw data, such as deep learning and factorization machines (FM) [26, 27]. The most representative method of this group is pairwise interaction tensor factorization (PITF). In this method, the tensor (i.e., a “tridimensional matrix”) that models the pairwise interactions among users, items, and tags (i.e., the ranking preferences of the tags for each pair user object, which is obtained from the folksonomy relation data) is factored into lower-dimensional matrices to reduce noise [27]. The PITF model is learned from an adaption of the Bayesian personalized ranking (BPR) criterion. More recently, [26] exploit not only the folksonomy but also visual features of images, such as the objects appearing in the image, colors, shapes, or other visual aspects, into factorization machine models.
In this chapter, we have reviewed the main concepts related to tags and tag recommendation. There are various sources of data associated with Web 2.0 objects that can be used to extract and rank tags. Candidate tags can be extracted from the textual features associated with the target object using keyword extraction techniques, from mining co-occurrences with other tags, or other textual and content features, and from the neighborhood of the target object and/or target user. We also have briefly discussed various tag quality attributes that can be exploited to rank candidate tags. An effective way to combine these attributes is by means of learn-to-rank techniques, which can automatically “learn” tag recommendation functions from training examples.
Our research group is partially funded by Google, the Brazilian National Institute of Science and Technology for Web Research (MCT/CNPq/INCT Web Grant Number 573871/2008-6), and the authors’ individual grants from CNPq, CAPES, and FAPEMIG.
REAH is the eponysm for Respiratory Epithelial Adenomatoid Hamartoma. It is a relatively new diagnosis, only added to the World Health Organization classification of tumors in 2005 [1].
Wenig and Heffner were the first to describe it in 1995 in a series of 31 cases [2]. They described it as “a proliferation of glands lined by multi-layered ciliated respiratory epithelium, often with admixed mucocytes, arising in direct continuity with the surface epithelium, which invaginated downward into the submucosa.”
The lesion is usually diagnosed in middle-aged patients. Clinically it may manifest as a solitary lesion or in association with sinonasal polyposis. The former is far less common than the latter. The lesion takes its origin either in the olfactory cleft, the posterior septum, or the rhinopharynx [1, 2, 3, 4, 5] Because the incidence, clinical signs, imaging, modality of treatment, outcomes, and pathogenesis seem to be quiet different between these two clinical patterns, we call the first ones “REAHs” and the second ones “REAH-like.” This terminology is proposed by Jankowski [3, 5] and Hawley [4] as well.
The purpose of this paper is to remind the histopathological characteristics and differential diagnosis of REAHs/REAH-like lesions and to report two different cohorts of patients (one with REAHs and the other with REAH like lesions), treated in the ENT department of the CHU UCL Namur.
Grossly, REAH looks like a “polypoid fleshy to firm mass with areas of induration.” It is yellow or white [6]. It may have varying sizes (Figures 1–3).
Gross appearance of a REAH.
REAHs: The glandular proliferation arises in direct continuity with the surface epithelium with invagination downward into the submucosa. Clusters of seromucinous glands are seen.
REAHs: Occasionally the gland lumina are filled with mucinous or eosinophilic amorphous material. It often demonstrates periglandular stromal hyalinization, and there is often a mixed inflammatory infiltrate within the stroma.
The histologic picture is dominated by the presence of a glandular proliferation with a polypoid appearance. The proliferation starts from the surface epithelium and tends to be submucosal.
The glands are lined by ciliated respiratory epithelium originating from the surface respiratory epithelium. The glands are typically round to oval in shape and were small to medium in size with prominent dilation. Stromal tissue separates the glands. The epithelium may be cuboidal or flat, and mucinous gland metaplasia is often seen. Occasionally the gland lumina are filled with mucinous or eosinophilic amorphous material. It often demonstrates periglandular stromal hyalinization, and there is often a mixed inflammatory infiltrate within the stroma.
In the literature we can find another type of REAH called
The histological features are almost exactly the same as REAH, but COREAH has islands of immature hyaline cartilage interspersed throughout the lesion (Figures 4 and 5).
COREAH: Nasal chondromesenchymal hamartoma. Multiple tumor fragments with a mucosal surface and nodules of cartilage (in red).
Seromucinous hamartoma: The mass is covered by respiratory epithelium and is comprised of lobular or haphazard proliferations of small to large glands and ducts which are lined by a single layer of cuboidal or flattened epithelial cells.
Immunohistochemistry has not been used to an extensive degree in the diagnosis of REAH, and it is not absolutely necessary to use it to make the definitive diagnosis of it.
However, Ozolek et al. did an immunohistochemical study in which they examined the profile of REAH [11]. REAHs are positive for CK7, negative for CK20 and CDX-2, and positive for MIB1 and Ki67. p63 staining was seen in the basal cells of REAH, which had a low proliferation index. The use of Mindbomb 1 (MIB-1) is useful in distinguishing REAH from other neoplasms, since neoplasms tend to have a high proliferation index.
The differential diagnostic of REAHs concerns the inflammatory polyps, Schneiderian papillomas, seromucinous hamartoma, and low-grade non-intestinal adenocarcinoma.
Inflammatory polyps are certainly the most common lesions that are confused with REAHs.
The most notable clinical differences between REAHs and inflammatory polyps are the location and their gross appearance.
Inflammatory polyps are typically the clinical manifestation of a sinonasal polyposis. Nasal polyps are rarely isolated. They are multiple and bilateral and usually extrude from the middle and superior meati. They are rarely attached to the posterior septum. REAHs originate specifically from the olfactory cleft.
Nasal polyps are usually edematous and not indurated. On microscopy, both lesions can show fibroblastic and vascular proliferation, stromal edema, a mixed inflammatory cell infiltrate, and seromucinous gland proliferation. However, inflammatory polyps do not have florid adenomatoid proliferation and stromal hyalinization which, when present, favor REAHs (Figures 6–9).
Macroscopic and endoscopic view of a nasal polyp.
Endoscopic view: right and left nasal cavity: presence of nasal polyps in the middle and superior meati.
Inflammatory polyp with edematous inflammatory stroma and single-layered glands.
Inflammatory polyp showing inflammatory stroma without hyalinization.
This is the second important differential diagnosis of REAHs.
Schneiderian papillomas are benign epithelial neoplasms of the sinonasal tract. Their annual incidence ranges between 0.2 and 1.5/100,000 people per year.
They are classified in three types: exophytic/fungiform papilloma, endophytic/inverted papilloma, and oncocytic/cylindrical cell papilloma. The inverted type is the most common, accounting for nearly two thirds of the cases. We limit the description to this type.
It is mostly unilateral. It occurs mainly in adults during the fifth or sixth decade. There is a predilection for men.
Unlike inflammatory polyps and REAHs, inverted papillomas are considered true neoplasms. While REAHs tend to be located medial to the turbinate lamella, inverted papillomas have a predilection for the lateral wall of the nasal cavity or the paranasal cavities. Maxillary and ethmoid sinuses are the most common origins followed by the sphenoid and frontal sinuses. Even if inverted papillomas are benign histologic lesions, clinically they may be aggressive with a relatively strong potential for local destruction, high rate of recurrence (more or less 50%), and a risk of carcinomatous evolution. This transformation in squamous cell carcinoma can be synchrone or metachrone and more likely in case of recurrence. This malignant transformation has never been observed in the case of REAHs.
Human papilloma virus seems to be implicated in the pathogenesis of inverted papillomas. Chronic inflammation seems to be a favorizing factor in REAHs.
The treatment of inverted papilloma requires a more extensive and radical excision with a subperiosteal dissection and a drilling of the base of implantation. Endonasal medial maxillectomy is the golden standard for maxillary sinus origin. Recurrence is more likely in frontal sinus papillomatosis due to the localization and the difficulty to completely eradicate the lesion. The surgical treatment for REAHs is a complete excision without ethmoidectomy.
Grossly, inverted papilloma looks like a reddish-gray lobulated tumor, more firm than an inflammatory polyp, with a fairly characteristic “raspberry” aspect (Figure 10).
Endoscopic view of an inverted papilloma originating from the left maxillary sinus.
Histologically inverted papillomas have an endophytic growth pattern. There is an invagination of stratified squamous epithelium with an admixture of mucin containing cells and microcysts. The epithelium may be of squamous, transitional, or respiratory type. The endophytic growth of squamous epithelium is not seen in REAH. Transmigrating neutrophils and neutrophilic microabscesses may be seen. Occasional mitoses may be seen in the basal layer. Mild to moderate atypia may be seen. Edema or chronic inflammatory infiltrate is present in the stroma (Figures 11–13).
Low magnification: typical view of an IP: it shows an endophytic growth pattern consisting of markedly thickened squamous epithelial proliferation growing downward into the underlying connective tissue stroma to form large clefts, ribbons, and islands. Note the absence of mucoserous glands. Delicate basement membrane.
Immunohistochemistry: high power shows the epithelium to be composed of pseudostratified columnar cells/positivity of MIB1 in the basal cells.
Immunohistochemistry: high power/positivity of CK7.
Seromucinous hamartoma is another subtype of hamartoma, recently described. It is a benign lesion of the sinonasal tract as well, located in the posterior nasal cavity or rhinopharynx frequently associated to REAHs. Since its description in 1974 [12], only a small number of additional cases have been reported.
The lesion occurs equally in men and women. Patients are middle-aged to elderly (mean age 50–60) and have complaints with nasal obstruction or nosebleeds. Surgical excision is the treatment of choice. It is included in the differential diagnosis of low grade epithelial proliferations of the sinonasal tract. The differentiation with low-grade non-intestinal adenocarcinoma can be tricky.
Histologically, the mass looks like a benign lesion. Lobular or haphazard proliferations of small to large glands and ducts lined by a single layer of cuboidal or flattened epithelial cells are visualized. Eosinophilic secretions are often present within tubules. The surrounding stroma often contains a lymphoplasmocytic inflammatory infiltrate. Periglandular hyalinization can be observed. There are no features suggesting a malignancy. There are no nuclear atypia.
Seromucinous hamartomas are positive for CK7 and CK19 and negative for CK14 and CK20. The serous glands are usually S100 positive and negative for p63 and muscle-specific antigen.
Sinonasal adenocarcinoma is the third differential diagnosis for REAH. It accounts for approximately 20% of all sinonasal malignancies and is classified into intestinal and non-intestinal salivary and non-salivary types. Intestinal adenocarcinomas (also called ITAC) take their origin in the olfactory cleftl and then extend into the ethmoid sinus, the orbit, or the anterior cranial fossa. It is an occupational disease; they typically occur in woodworkers. They look like an irregular exophytic pink necrotic and friable mass bulging into the nasal cavity located between the nasal septum and the turbinate lamella.
On microscopy, papillary and colonic types are the most common architectures. Differentiating ITAC from REAH is usually not difficult as the cell types, high-grade features, and increased mitotic index are characteristics for ITAC. ITAC is positive for CK20 and MIB1 and negative for CK7 (Figure 14).
Intestinal-type adenocarcinoma: Immunohistochemistry—Positivity for CK20, CK7, and MIB1.
On the other hand, low-grade non-intestinal adenocarcinomas (LGSNAC) are less common and less invasive. There is no sex or racial predilection. There is no association with wood dust exposure. They have no tendency to give systemic metastasis. However, they have a potential for local invasion and destruction of tissue. Extensive surgery is recommended to be associated with radiotherapy in some cases.
Histologically, the mass originates from the surface epithelium and the seromucinous glands of the submucosa. It consists of glandular proliferations lined by cuboidal to columnar cells which are usually monomorphic and cytologically bland. It forms a diverse group of bland tubular and/or papillary tumors. Mitoses are rare. Necrosis, perineural invasion, and lymphovascular invasion are absent. The stroma contains an inflammatory infiltrate as in REAHs.
Immunohistochemistry shows the positivity for CK7 and S100 and negativity for CK20 and CDX2.
The main differential diagnosis is between LGSNAC and seromucinous hamartoma (Figure 15).
LGSNAC: Glandular proliferations lined by cuboidal to columnar cells which are usually monomorphic and cytologically bland.
This clinical presentation of REAHs is actually the less frequent.
Table 1 reports a cohort of eight cases diagnosed and treated in the ENT department of the CHU UCL Namur since 2008.
Patient | Gender | Side | Symptoms |
---|---|---|---|
Br, L. | Female | R/olfactory cleft | Asymptomatic dacryoscan; 2009 |
Sch, M. | Female | L/septal implantation | Unilateral nasal obstruction 2008 |
Van rent. M. | Female | X2/olfactory cleft | Bilateral nasal obstruction 2012 |
W. Jes. | Female Seromucinous hamartoma | R/sphenochoanal recess | Unilateral nasal obstruction 2012 |
B. Pat. | Female/COREAH | L/sphenochoanal recess | Unilateral nasal obstruction/nasal collapse 2019 |
H. C. | Female | L/olfactory cleft | Unilateral nasal obstruction 2019 |
Tr. M. | Female | R/olfactory cleft | Asymptomatic Ct finding 2019 |
N, A. | Male | X2 R > L | Allergic rhinitis; paucisymptomatic/nasal endoscopy/CT scan 2019 |
Reports our experience of REAHs.
There were seven women. The mean age was 65 years old. Ranges are 27 and 81.
There was one man: age 53 years old.
The lesions were unilateral in six patients (three left sided; three right sided) and bilateral in two.
Two patients were asymptomatic. REAH was diagnosed by nasal endoscopy and a sinus CT scanner performed for an assessment of epiphora, a case of nasal dysfunction and another one to rule out sinus disease associated to his allergic rhinitis.
The other patients complained with nasal obstruction and rhinorrhea.
REAHS originated from the olfactory cleft in six patients and from the anterior wall of the sphenoid sinus in two cases.
On nasal endoscopy the lesion looked fleshy, with no vascular component and no necrosis.
On imaging the lesion was solitary in the olfactory cleft. No chronic rhinosinusitis was present (Figure 16).
Comparison between CT scan and nasal endoscopy.
The MRI performed in three cases was not so helpful. There were no pathognomonic features whatever was the localization. In the literature, REAHs appear as a homogeneous mass with post-contrast enhancement on T1-weighted sequences as well as hyperintensity on T2-weighted images (Figure 17) [13].
MRI of a patient with bilateral REAHs: T1- and T2-weighted sequences.
The diagnosis of REAH was confirmed in all the cases by the pathologist.
In one case it was a COREAH, and in another case it was a seromucinous hamartoma. These two hamartomas were located in the posterior nasal fossa.
A biopsy was performed under local anesthesia in asymptomatic cases to make a formal diagnosis. For the other the diagnosis was made on the surgical specimen.
There was no clear etiologic factor that could have played a role in the development of REAH except in one patient suffering from allergic rhinitis. There was no concomitant chronic sinusitis, asthma, or aspirin intolerance.
Concerning the management, in two patients a wait and see attitude was proposed as the patient was not symptomatic. For the others an endoscopic resection of the lesion was performed under general anesthesia. The dissection was done in a subperiosteal plane. We have never drilled out the site of implantation. There was no need to do a full house ethmoidectomy.
Until now we have had no recurrence (Figure 18).
Illustration of a case with bilateral REAHs: pre- and postop imaging.
This is the second clinical pattern of REAHs, and certainly this is the most common type.
Table 2 reports a cohort of 16 patients diagnosed with such a pattern during the past 18 months.
Patient | Sex | Disease/surgery |
---|---|---|
S. Jac. | M | Asthma/rev surgery: REAH-like X2/draf III |
Fris. JL | M | Polypose XZ/revision ethmoidectomy/REAH: chronic otitis media |
Ros. G | M | Recurrent NP/asthma: REAHs/rev ethmoidectomy |
Hub. S. | M | Sever NP/complete ethmoidectomy |
L.; Th. | M | Asthma: seromucous otitis media/revision surgery/REAH |
Br. Cl. | M | Aspirin intolerance; asthma/recurrence |
De Ras.Ge. | M | Nasal polyposis and asthma /previous surgery |
Bran. Ar | M | Revison surgery for massive polyposis |
De pl. Ph | M | Nasal polyposis operated 3 times/no asthma |
Hou. Adr. | M | Recurrentpolyposis/rev ethmoidectomy |
Aig; Ph. | M | Recurrentpolyposis/allergic rhinitis/aspirin intolerance/:metabisulfite intolerance |
Mas. Cl | F | Revision surgery/asthma/aspirin intolerance |
Corl. W. | M | Primary severe nasal polyposis: no asthma: operated in 2013/REAHs |
Tri. Fr. | M | Ethmoidectomy 10 y ago/nasal polyposis/ REAHs |
V. Mo | F | Nasal polyposis /asthma/previous FESS/REAHs X2 |
Cohort of patients with REAH-like lesions.
The series includes 13 men and 2 women. The mean average is about 63 years old.
The majority of the patients are in the fifth and sixth decades.
All the patients suffer from a nasal polyposis. In two cases it was a massive primary polyposis. The other patients have a nasal polyposis operated in the past. The REAHs were diagnosed at the revision surgery.
Eight patients have concomitant asthma. Two patients have aspirin intolerance.
Two patients have allergic rhinitis.
Chronic inflammation plays a role in the development of REAHs in this clinical pattern.
REAHs are located in the olfactory cleft. Their macroscopic aspect is different than usual nasal polyps extruding from the ethmoid sinus. They are more fleshy and firm. There is no necrosis.
As the following pictures show, it is extremely difficult to differentiate with the fibroscopy REAHs and inflammatory polyps in case of recurrent nasal polyposis. The histologic examination of the surgical specimens is mandatory for this differentiation (Figure 19).
Comparison of the nasal endoscopy and the histological pattern. The inflammation in the stroma is much more important than in pure REAHs.
CT imaging findings are described in only a limited number of studies [1, 4, 5, 14]. Lima et al. [5], Hawley et al. [4], and Lee et al. (51 cases) [14] conclude that REAHs cause widening of the olfactory cleft more than 10 mm but generally do not cause bone erosion.
All the paranasal sinus cavities can be opaque as illustrated by the following pictures (Figures 20–22):
CT showing a severe nasal polyposis; widening of the olfactory cleft raises suspicion of REAHs.
Patient with REAHs in the olfactory cleft. She had a standard ethmoidectomy for nasal polyposis. We observe REAHs in the olfactory cleft. Correlation between CT scan and nasal endoscopy.
Typical CT scan showing the opacity of both olfactory clefts caused by REAHs.
Some patients have a long-standing disease; REAHs develop after the surgery with time. Some of them are attached to the anterior and superior portion of the nasal septum and cause blockage of the frontal sinus pathway or even thinning and erosion of the nasal bones.
Figure 23 show such an exceptional evolution.
Same patient with thinning and erosion of the nasal bones (arrows) and opacity of both frontal sinuses.
MRI can be of some help to rule out other lesions such as encephalocele, olfactory neuroblastoma, or glioma.
The management of REAHs associated with nasal polyposis must be discussed case by case.
A complete sphenoethmoidectomy is usually necessary to manage the recurrent nasal polyposis.
For the REAHs, debulking or better exenteration of the olfactory cleft must be considered. But we know that it can be tricky and risky for the skull base with a risk of CSF leak if the surgery is too aggressive. Resection of the REAHs is usually more bloody than during a polypectomy.
In the case of frontal opacity caused by REAHs attached to the anterior and superior septa, a Draf III procedure must be considered.
After surgery medical treatment of the nasal polyposis and asthma remains absolutely necessary to prevent or delay as much as possible recurrences.
REAHs and REAH-like lesions are relatively new clinical entities. Despite numerous publications they are still underdiagnosed. These lesions are located in the olfactory clefts. They can be isolated or in association with nasal polyposis typically in the case of recurrence after FESS.
The clinicians and pathologists must know these lesions. They are usually benign, but in some cases they are associated to frontal sinus blockage and widening of the nasal vault; loss of smell is common. The differential diagnosis includes diseases with more severe morbidities such as inverted papilloma, seromucinous hamartomas, and low-grade non-intestinal adenocarcinoma.
Histological examination of all the surgical specimens is necessary.
The treatment is dictated by the disease.
The extent of the surgery depends on the type and size of the REAHs and the associated disease.
It consists of a limited polypectomy or a complete exenteration of the olfactory cleft associated or not to a full house ethmoidectomy and even a Draf III procedure.
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\\n\\nIntechOpen’s co-founders, both scientists themselves, created the company while undertaking research in robotics at Vienna University. Their goal was to spread research freely “for scientists, by scientists’ to the rest of the world via the Open Access publishing model. The company soon became a signatory of the Budapest Initiative, which currently has more than 1000 supporting organizations worldwide, ranging from universities to funders.
\\n\\nAt IntechOpen today, we are still as committed to working with organizations and people who care about scientific discovery, to putting the academic needs of the scientific community first, and to providing an Open Access environment where scientists can maximize their contribution to scientific advancement. By opening up access to the world’s scientific research articles and book chapters, we aim to facilitate greater opportunity for collaboration, scientific discovery and progress. We subscribe wholeheartedly to the Open Access definition:
\\n\\n“By “open access” to [peer-reviewed research literature], we mean its free availability on the public internet, permitting any users to read, download, copy, distribute, print, search, or link to the full texts of these articles, crawl them for indexing, pass them as data to software, or use them for any other lawful purpose, without financial, legal, or technical barriers other than those inseparable from gaining access to the internet itself. The only constraint on reproduction and distribution, and the only role for copyright in this domain, should be to give authors control over the integrity of their work and the right to be properly acknowledged and cited” (reference: http://www.budapestopenaccessinitiative.org)
\\n\\nOAI-PMH
\\n\\nAs a firm believer in the wider dissemination of knowledge, IntechOpen supports the Open Access Initiative Protocol for Metadata Harvesting (OAI-PMH Version 2.0). Read more
\\n\\nLicense
\\n\\nBook chapters published in edited volumes are distributed under the Creative Commons Attribution 3.0 Unported License (CC BY 3.0). IntechOpen upholds a very flexible Copyright Policy. There is no copyright transfer to the publisher and Authors retain exclusive copyright to their work. All Monographs/Compacts are distributed under the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0). Read more
\\n\\nPeer Review Policies
\\n\\nAll scientific works are Peer Reviewed prior to publishing. Read more
\\n\\nOA Publishing Fees
\\n\\nThe Open Access publishing model employed by IntechOpen eliminates subscription charges and pay-per-view fees, enabling readers to access research at no cost. In order to sustain operations and keep our publications freely accessible we levy an Open Access Publishing Fee for manuscripts, which helps us cover the costs of editorial work and the production of books. Read more
\\n\\nDigital Archiving Policy
\\n\\nIntechOpen is committed to ensuring the long-term preservation and the availability of all scholarly research we publish. We employ a variety of means to enable us to deliver on our commitments to the scientific community. Apart from preservation by the Croatian National Library (for publications prior to April 18, 2018) and the British Library (for publications after April 18, 2018), our entire catalogue is preserved in the CLOCKSS archive.
\\n\\nOpen Science is transparent and accessible knowledge that is shared and developed through collaborative networks.
\\n\\nOpen Science is about increased rigour, accountability, and reproducibility for research. It is based on the principles of inclusion, fairness, equity, and sharing, and ultimately seeks to change the way research is done, who is involved and how it is valued. It aims to make research more open to participation, review/refutation, improvement and (re)use for the world to benefit.
\\n\\nOpen Science refers to doing traditional science with more transparency involved at various stages, for example by openly sharing code and data. It implies a growing set of practices - within different disciplines - aiming at:
\\n\\nWe aim at improving the quality and availability of scholarly communication by promoting and practicing:
\\n\\n\\n"}]'},components:[{type:"htmlEditorComponent",content:'
The Open Access publishing movement started in the early 2000s when academic leaders from around the world participated in the formation of the Budapest Initiative. They developed recommendations for an Open Access publishing process, “which has worked for the past decade to provide the public with unrestricted, free access to scholarly research—much of which is publicly funded. Making the research publicly available to everyone—free of charge and without most copyright and licensing restrictions—will accelerate scientific research efforts and allow authors to reach a larger number of readers” (reference: http://www.budapestopenaccessinitiative.org)
\n\nIntechOpen’s co-founders, both scientists themselves, created the company while undertaking research in robotics at Vienna University. Their goal was to spread research freely “for scientists, by scientists’ to the rest of the world via the Open Access publishing model. The company soon became a signatory of the Budapest Initiative, which currently has more than 1000 supporting organizations worldwide, ranging from universities to funders.
\n\nAt IntechOpen today, we are still as committed to working with organizations and people who care about scientific discovery, to putting the academic needs of the scientific community first, and to providing an Open Access environment where scientists can maximize their contribution to scientific advancement. By opening up access to the world’s scientific research articles and book chapters, we aim to facilitate greater opportunity for collaboration, scientific discovery and progress. We subscribe wholeheartedly to the Open Access definition:
\n\n“By “open access” to [peer-reviewed research literature], we mean its free availability on the public internet, permitting any users to read, download, copy, distribute, print, search, or link to the full texts of these articles, crawl them for indexing, pass them as data to software, or use them for any other lawful purpose, without financial, legal, or technical barriers other than those inseparable from gaining access to the internet itself. The only constraint on reproduction and distribution, and the only role for copyright in this domain, should be to give authors control over the integrity of their work and the right to be properly acknowledged and cited” (reference: http://www.budapestopenaccessinitiative.org)
\n\nOAI-PMH
\n\nAs a firm believer in the wider dissemination of knowledge, IntechOpen supports the Open Access Initiative Protocol for Metadata Harvesting (OAI-PMH Version 2.0). Read more
\n\nLicense
\n\nBook chapters published in edited volumes are distributed under the Creative Commons Attribution 3.0 Unported License (CC BY 3.0). IntechOpen upholds a very flexible Copyright Policy. There is no copyright transfer to the publisher and Authors retain exclusive copyright to their work. All Monographs/Compacts are distributed under the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0). Read more
\n\nPeer Review Policies
\n\nAll scientific works are Peer Reviewed prior to publishing. Read more
\n\nOA Publishing Fees
\n\nThe Open Access publishing model employed by IntechOpen eliminates subscription charges and pay-per-view fees, enabling readers to access research at no cost. In order to sustain operations and keep our publications freely accessible we levy an Open Access Publishing Fee for manuscripts, which helps us cover the costs of editorial work and the production of books. Read more
\n\nDigital Archiving Policy
\n\nIntechOpen is committed to ensuring the long-term preservation and the availability of all scholarly research we publish. We employ a variety of means to enable us to deliver on our commitments to the scientific community. Apart from preservation by the Croatian National Library (for publications prior to April 18, 2018) and the British Library (for publications after April 18, 2018), our entire catalogue is preserved in the CLOCKSS archive.
\n\nOpen Science is transparent and accessible knowledge that is shared and developed through collaborative networks.
\n\nOpen Science is about increased rigour, accountability, and reproducibility for research. It is based on the principles of inclusion, fairness, equity, and sharing, and ultimately seeks to change the way research is done, who is involved and how it is valued. It aims to make research more open to participation, review/refutation, improvement and (re)use for the world to benefit.
\n\nOpen Science refers to doing traditional science with more transparency involved at various stages, for example by openly sharing code and data. It implies a growing set of practices - within different disciplines - aiming at:
\n\nWe aim at improving the quality and availability of scholarly communication by promoting and practicing:
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