Objective:To assess the effectiveness of simulation-based learning regarding the management of post-COVID complications in terms of knowledge,clinical decision-making ability,and self-efficacy among nursing students.M...Objective:To assess the effectiveness of simulation-based learning regarding the management of post-COVID complications in terms of knowledge,clinical decision-making ability,and self-efficacy among nursing students.Methods:This was a quasi-experimental study conducted among 1152nd-year nursing students.The participants were selected by a simple random sampling technique.The participants were divided into an experimental(n=56)and a comparison group(n=59)by a random table method.Data were analyzed using descriptive and inferential statistics with SPSS version 20.Results:There were significant differences in mean post-test knowledge scores(P=0.03)and mean post-test self-efficacy scores(P=0.001)between the experimental and the comparison groups while the difference in mean post-test clinical decision-making ability scores between the two groups was non-significant(P=0.07).A positive correlation was found between knowledge and clinical decision-making ability in pre-test(P=0.03)and in post-test(P<0.001)and a non-significant correlation was found between pre-test knowledge and self-efficacy score(P=0.52)among the experimental group.Conclusions:Simulation-based learning regarding the management of post-COVID complications is effective among nursing students.Simulation labs should be established in health care settings where simulation training can be provided for updating the knowledge,clinical decision-making ability,and self-efficacy of nursing personnel during program installment and continuous nursing education.展开更多
This study examined the effects of design thinking pedagogy on undergraduates’career decision-making selfefficacy and employability in career education.Using a quasi-experimental design,Chinese college students(N=93)...This study examined the effects of design thinking pedagogy on undergraduates’career decision-making selfefficacy and employability in career education.Using a quasi-experimental design,Chinese college students(N=93)were participants in two wings.The experimental group(n=47)received the design thinking pedagogy,while the control group(n=46)followed the regularly teacher-centered method.The students completed the career decision-making self-efficacy scale and employability scale before and after the intervention.Independent samples t-test results showed that design thinking pedagogy significantly improves students’career decision-making self-efficacy and employability.The ANCOVA results showed that the pretest scores of career decision-making self-efficacy and employability had no significant association with the experimental intervention.There was no interaction between the treatment and pretest scores.It would seem that experimental design thinking pedagogy implemented in career guidance courses has little effect compared to the usual course presentation.Nonetheless,prospects for the implementation of design thinking-guided learning activities to support interdisciplinary learning for improved higher education and career development outcomes need further exploration.展开更多
The critical role of patient-reported outcome measures(PROMs)in enhancing clinical decision-making and promoting patient-centered care has gained a profound significance in scientific research.PROMs encapsulate a pati...The critical role of patient-reported outcome measures(PROMs)in enhancing clinical decision-making and promoting patient-centered care has gained a profound significance in scientific research.PROMs encapsulate a patient's health status directly from their perspective,encompassing various domains such as symptom severity,functional status,and overall quality of life.By integrating PROMs into routine clinical practice and research,healthcare providers can achieve a more nuanced understanding of patient experiences and tailor treatments accordingly.The deployment of PROMs supports dynamic patient-provider interactions,fostering better patient engagement and adherence to tre-atment plans.Moreover,PROMs are pivotal in clinical settings for monitoring disease progression and treatment efficacy,particularly in chronic and mental health conditions.However,challenges in implementing PROMs include data collection and management,integration into existing health systems,and acceptance by patients and providers.Overcoming these barriers necessitates technological advancements,policy development,and continuous education to enhance the acceptability and effectiveness of PROMs.The paper concludes with recommendations for future research and policy-making aimed at optimizing the use and impact of PROMs across healthcare settings.展开更多
To solve problems of poor security guarantee and insufficient training efficiency in the conventional reinforcement learning methods for decision-making,this study proposes a hybrid framework to combine deep reinforce...To solve problems of poor security guarantee and insufficient training efficiency in the conventional reinforcement learning methods for decision-making,this study proposes a hybrid framework to combine deep reinforcement learning with rule-based decision-making methods.A risk assessment model for lane-change maneuvers considering uncertain predictions of surrounding vehicles is established as a safety filter to improve learning efficiency while correcting dangerous actions for safety enhancement.On this basis,a Risk-fused DDQN is constructed utilizing the model-based risk assessment and supervision mechanism.The proposed reinforcement learning algorithm sets up a separate experience buffer for dangerous trials and punishes such actions,which is shown to improve the sampling efficiency and training outcomes.Compared with conventional DDQN methods,the proposed algorithm improves the convergence value of cumulated reward by 7.6%and 2.2%in the two constructed scenarios in the simulation study and reduces the number of training episodes by 52.2%and 66.8%respectively.The success rate of lane change is improved by 57.3%while the time headway is increased at least by 16.5%in real vehicle tests,which confirms the higher training efficiency,scenario adaptability,and security of the proposed Risk-fused DDQN.展开更多
This study constructs a reflective feedback model based on a pedagogical agent(PA)and explores its impact on students’problem-solving ability and cognitive load.A quasi-experimental design was used in the study,with ...This study constructs a reflective feedback model based on a pedagogical agent(PA)and explores its impact on students’problem-solving ability and cognitive load.A quasi-experimental design was used in the study,with 84 students from a middle school selected as the research subjects(44 in the experimental group and 40 in the control group).The experimental group used the reflective feedback model,while the control group used the factual feedback model.The results show that,compared with factual feedback,the reflective feedback model based on the pedagogical agent significantly improves students’problem-solving ability,especially at the action and thinking levels.In addition,this model effectively reduces students’cognitive load,especially in terms of internal and external load.展开更多
Construction engineering and management(CEM)has become increasingly complicated with the increasing size of engineering projects under different construction environments,motivating the digital transformation of CEM.T...Construction engineering and management(CEM)has become increasingly complicated with the increasing size of engineering projects under different construction environments,motivating the digital transformation of CEM.To contribute to a better understanding of the state of the art of smart techniques for engineering projects,this paper provides a comprehensive review of multi-criteria decision-making(MCDM)techniques,intelligent techniques,and their applications in CEM.First,a comprehensive framework detailing smart technologies for construction projects is developed.Next,the characteristics of CEM are summarized.A bibliometric review is then conducted to investigate the keywords,journals,and clusters related to the application of smart techniques in CEM during 2000-2022.Recent advancements in intelligent techniques are also discussed under the following six topics:①big data technology;②computer vision;③speech recognition;④natural language processing;⑤machine learning;and⑥knowledge representation,understanding,and reasoning.The applications of smart techniques are then illustrated via underground space exploitation.Finally,future research directions for the sustainable development of smart construction are highlighted.展开更多
Due to the numerous variables to take into account as well as the inherent ambiguity and uncertainty,evaluating educational institutions can be difficult.The concept of a possibility Pythagorean fuzzy hypersoft set(pP...Due to the numerous variables to take into account as well as the inherent ambiguity and uncertainty,evaluating educational institutions can be difficult.The concept of a possibility Pythagorean fuzzy hypersoft set(pPyFHSS)is more flexible in this regard than other theoretical fuzzy set-like models,even though some attempts have been made in the literature to address such uncertainties.This study investigates the elementary notions of pPyFHSS including its set-theoretic operations union,intersection,complement,OR-and AND-operations.Some results related to these operations are also modified for pPyFHSS.Additionally,the similarity measures between pPyFHSSs are formulated with the assistance of numerical examples and results.Lastly,an intelligent decision-assisted mechanism is developed with the proposal of a robust algorithm based on similarity measures for solving multi-attribute decision-making(MADM)problems.A case study that helps the decision-makers assess the best educational institution is discussed to validate the suggested system.The algorithmic results are compared with the most pertinent model to evaluate the adaptability of pPyFHSS,as it generalizes the classical possibility fuzzy set-like theoretical models.Similarly,while considering significant evaluating factors,the flexibility of pPyFHSS is observed through structural comparison.展开更多
Accurate medical diagnosis,which involves identifying diseases based on patient symptoms,is often hindered by uncertainties in data interpretation and retrieval.Advanced fuzzy set theories have emerged as effective to...Accurate medical diagnosis,which involves identifying diseases based on patient symptoms,is often hindered by uncertainties in data interpretation and retrieval.Advanced fuzzy set theories have emerged as effective tools to address these challenges.In this paper,new mathematical approaches for handling uncertainty in medical diagnosis are introduced using q-rung orthopair fuzzy sets(q-ROFS)and interval-valued q-rung orthopair fuzzy sets(IVq-ROFS).Three aggregation operators are proposed in our methodologies:the q-ROF weighted averaging(q-ROFWA),the q-ROF weighted geometric(q-ROFWG),and the q-ROF weighted neutrality averaging(qROFWNA),which enhance decision-making under uncertainty.These operators are paired with ranking methods such as the similarity measure,score function,and inverse score function to improve the accuracy of disease identification.Additionally,the impact of varying q-rung values is explored through a sensitivity analysis,extending the analysis beyond the typical maximum value of 3.The Basic Uncertain Information(BUI)method is employed to simulate expert opinions,and aggregation operators are used to combine these opinions in a group decisionmaking context.Our results provide a comprehensive comparison of methodologies,highlighting their strengths and limitations in diagnosing diseases based on uncertain patient data.展开更多
BACKGROUND Understanding a patient's clinical status and setting priorities for their care are two aspects of the constantly changing process of clinical decision-making.One analytical technique that can be helpfu...BACKGROUND Understanding a patient's clinical status and setting priorities for their care are two aspects of the constantly changing process of clinical decision-making.One analytical technique that can be helpful in uncertain situations is clinical judgment.Clinicians must deal with contradictory information,lack of time to make decisions,and long-term factors when emergencies occur.AIM To examine the ethical issues healthcare professionals faced during the coronavirus disease 2019(COVID-19)pandemic and the factors affecting clinical decision-making.METHODS This pilot study,which means it was a preliminary investigation to gather information and test the feasibility of a larger investigation was conducted over 6 months and we invited responses from clinicians worldwide who managed patients with COVID-19.The survey focused on topics related to their professional roles and personal relationships.We examined five core areas influencing critical care decision-making:Patients'personal factors,family-related factors,informed consent,communication and media,and hospital administrative policies on clinical decision-making.The collected data were analyzed using the χ^(2) test for categorical variables.RESULTS A total of 102 clinicians from 23 specialties and 17 countries responded to the survey.Age was a significant factor in treatment planning(n=88)and ventilator access(n=78).Sex had no bearing on how decisions were made.Most doctors reported maintaining patient confidentiality regarding privacy and informed consent.Approximately 50%of clinicians reported a moderate influence of clinical work,with many citing it as one of the most important factors affecting their health and relationships.Clinicians from developing countries had a significantly higher score for considering a patient's financial status when creating a treatment plan than their counterparts from developed countries.Regarding personal experiences,some respondents noted that treatment plans and preferences changed from wave to wave,and that there was a rapid turnover of studies and evidence.Hospital and government policies also played a role in critical decision-making.Rather than assessing the appropriateness of treatment,some doctors observed that hospital policies regarding medications were driven by patient demand.CONCLUSION Factors other than medical considerations frequently affect management choices.The disparity in treatment choices,became more apparent during the pandemic.We highlight the difficulties and contradictions between moral standards and the realities physicians encountered during this medical emergency.False information,large patient populations,and limited resources caused problems for clinicians.These factors impacted decision-making,which,in turn,affected patient care and healthcare staff well-being.展开更多
Twenty short-statured maize inbred lines were collected from CIMMYT India and Mexico through the Plant Breeding Division, Bangladesh Agricultural Research Institute (BARI), Gazipur. The experiment was conducted from N...Twenty short-statured maize inbred lines were collected from CIMMYT India and Mexico through the Plant Breeding Division, Bangladesh Agricultural Research Institute (BARI), Gazipur. The experiment was conducted from November 2020 to April 2021 in three different agroecological regions such as BARI, Gazipur, RARS Barisal and RARS Rangpur. Seven inbred lines were selected on the basis of genetic diversity and per se performance and they were crossed separately in a 7 × 7 half diallel fashion, producing 21F1 hybrids in 2019 which were evaluated at three locations. However, variances due to GCA were much higher in magnitude than SCA for all the characters indicating preponderance of additive gene effects on the inheritance of these characters. Two parents viz., P3 (CML33) and P4 (CML41) were good general combiners and two crosses viz., P4 × P5 (CML41 × CML31) and P5 × P7 (CML31 × CML124) expressed significant positive SCA effects coupled with significant positive heterosis for grain yield and for most of the yield contributing characters over the two commercial check varieties BHM 9 and NK40. Four crosses: P1 × P5 (CML116 × CML31), P1 × P6 (CML116 × CML32), P2 × P6 (CML72 × CML32) and P3 × P4 (CML33 × CML41), exhibited significant and negative SCA effects for both plant and ear height which were desirable for short stature. Genotypes x location interaction was also significant for maximum characters, suggesting that genotypes interacted significantly in different environments.展开更多
This study investigated the relationship between parental cognitive ability and child logical reasoning ability,and the role of academic expectation and family environment in that relationship.Based on the 2020 China ...This study investigated the relationship between parental cognitive ability and child logical reasoning ability,and the role of academic expectation and family environment in that relationship.Based on the 2020 China Family Panel Studies(CFPS)data,1491 children(girls ratio=53.78%;average grade=6.023 years,school grade standard deviation=1.825 years).Results following multiple regression model(OLS)show that the higher the parental cognitive ability,the higher the children’s logical reasoning ability.Secondly,parental academic expectation serves as a mediator between their cognitive ability and children’s logical reasoning ability for higher logical reasoning by children.Third,a possible family environment acts as a mediator in the relationship between parents’cognitive ability and children’s logical reasoning ability to be higher.We conclude from thesefindings that parents with high cognitive abilities can enhance their children’s logical reasoning skills not only by setting higher academic expectations,but also by cultivating a supportive family environment.Thesefindings imply a need for intervention to improve family quality of life to enhance children’s thinking abilities to optimize their academic learning.展开更多
Objectives This study aimed to clarify the relationship between the content of proxy decision-making made by families of patients with malignant brain tumors regarding treatment policies and daily care and the cues le...Objectives This study aimed to clarify the relationship between the content of proxy decision-making made by families of patients with malignant brain tumors regarding treatment policies and daily care and the cues leading to those decisions.Methods Semi-structured personal interviews were used to collect data.Seven family members of patients with malignant brain tumors were selected to participate in the study by purposive sampling method from June to August 2022 in the Patient Family Association of Japan.Responses were content analyzed to explore the relationship between the content of decisions regarding“treatment policies”and“daily care”and the cues influencing those decisions.Semi-structured interviews were analyzed by using thematic analysis.Results The contents of proxy decisions regarding“treatment policies”included implementation,interruption,and termination of initial treatments,free medical treatments,use of respirators,and end-of-life sedation and included six cues:treatment policies suggested by the primary physician,information and knowledge about the disease and treatment obtained by the family from limited resources,perceived life threat from symptom worsening,words and reactions from the patient regarding treatment,patient’s personality and way of life inferred from their treatment preferences,family’s thoughts and values hoping for better treatment for the patient.Decisions for“daily care”included meal content and methods,excretion,mobility,maintaining cleanliness,rehabilitation,continuation or resignation from work,treatment settings(outpatient or inpatient),and ways to spend time outside and included seven cues:words and thoughts from the patient about their way of life,patient’s reactions and life history inferred from their preferred way of living,things the patient can do to maintain daily life and roles,awareness of the increasing inability to do things in daily life,family’s underlying thoughts and values about how to spend the remaining time,approval from family members regarding the care setting,advice from medical professionals on living at home.Conclusions For“treatment policies,”guidelines from medical professionals were a key cue,while for“daily care,”the small signs from the patients in their daily lives served as cues for proxy decision-making.This may be due to the lack of information available to families and the limited time available for discussion with the patient.Families of patients with malignant brain tumors repeatedly use multiple cues to make proxy decision-making under high uncertainty.Therefore,nurses supporting proxy decision-making should assess the family’s situation and provide cues that facilitate informed and confident decisions.展开更多
Group living is widespread across diverse taxa,and the mechanisms underlying collective decision-making in contexts of variable role division are critical for understanding the dynamics of group stability.While studie...Group living is widespread across diverse taxa,and the mechanisms underlying collective decision-making in contexts of variable role division are critical for understanding the dynamics of group stability.While studies on collective behavior in small animals such as fish and insects are well-established,similar research on large wild animals remains challenging due to the limited availability of sufficient and systematic field data.Here,we aimed to explore the collective decision-making pattern and its sexual difference for the dimorphic Tibetan antelopes Pantholops hodgsonii(chiru)in Xizang Autonomous Region,China,by analyzing individual leadership distribution,as well as the joining process,considering factors such as calving stages and joining ranks.The distinct correlations of decision participants’ratio with group size and decision duration underscore the trade-off between accuracy and speed in decision-making.Male antelopes display a more democratic decision-making pattern,while females exhibit more prompt responses after calving at an early stage.This study uncovers a partially shared decision-making strategy among Tibetan antelopes,suggesting flexible self-organization in group decision processes aligned with animal life cycle progression.展开更多
BACKGROUND Mesalamine is the recommended first-line treatment for inducing and maintaining remission in mild-to-moderate ulcerative colitis(UC).However,adherence in real-world settings is frequently suboptimal.Encoura...BACKGROUND Mesalamine is the recommended first-line treatment for inducing and maintaining remission in mild-to-moderate ulcerative colitis(UC).However,adherence in real-world settings is frequently suboptimal.Encouraging collaborative patient-provider relationships may foster better adherence and patient outcomes.AIM To quantify the association between patient participation in treatment decisionmaking and adherence to oral mesalamine in UC.METHODS We conducted a 12-month,prospective,non-interventional cohort study at 113 gastroenterology practices in Germany.Eligible patients were aged≥18 years,had a confirmed UC diagnosis,had no prior mesalamine treatment,and provided informed consent.At the first visit,we collected data on demographics,clinical characteristics,patient preference for mesalamine formulation(tablets or granules),and disease knowledge.Self-reported adherence and disease activity were assessed at all visits.Correlation analyses and logistic regression were used to examine associations between adherence and various factors.RESULTS Of the 605 consecutively screened patients,520 were included in the study.The median age was 41 years(range:18-91),with a male-to-female ratio of 1.1:1.0.Approximately 75%of patients reported good adherence at each study visit.In correlation analyses,patient participation in treatment decision-making was significantly associated with better adherence across all visits(P=0.04).In the regression analysis at 12 months,this association was evident among patients who both preferred and received prolonged-release mesalamine granules(odds ratio=2.73,P=0.001).Patients reporting good adherence also experienced significant improvements in disease activity over 12 months(P<0.001).CONCLUSION Facilitating patient participation in treatment decisions and accommodating medication preferences may improve adherence to mesalamine.This may require additional effort but has the potential to improve long-term management of UC.展开更多
The low egg production of goose greatly limits the development of the industry.China possesses the most abundant goose breeds resources.In this study,genome resequencing data of swan goose(Anser cygnoides)and domestic...The low egg production of goose greatly limits the development of the industry.China possesses the most abundant goose breeds resources.In this study,genome resequencing data of swan goose(Anser cygnoides)and domesticated high and low laying goose breeds(Anser cygnoides domestiation)were used to identify key genes related to egg laying ability in geese and verify their functions.Selective sweep analyses revealed 416 genes that were specifically selected during the domestication process from swan geese to high laying geese.Furthermore,SNPs and Indels markers were used in GWAS analyses between high and low laying breed geese.The results showed that RTCB,BPIFC,SYN3,SYNE1,VIP,and ESR1 may be related to the differences in laying ability of geese.Notably,only ESR1 was identified simultaneously by GWAS and selective sweep analysis.The genotype of Indelchr3:54429172,located downstream of ESR1,was confirmed to affect the expression of ESR1 in the ovarian stroma and showed significant correlation with body weight at first egg and laying frequency of geese.CCK-8,EdU,and flow cytometry confirmed that ESR1 can promote the apoptosis of goose pre-hierarchical follicles ganulosa cells(phGCs)and inhibit their proliferation.Combined with transcriptome data,it was found ESR1 involved in the function of goose phGCs may be related to MAPK and TGF-beta signaling pathways.Overall,our study used genomic information from different goose breeds to identify an indel located in the downstream of ESR1 associated with goose laying ability.The main pathways and biological processes of ESR1 involved in the regulation of goose laying ability were identified by cell biology and transcriptomics methods.These results are helpful to further understand the laying ability characteristics of goose and improve the egg production of geese.展开更多
Information plays a crucial role in guiding behavioral decisions during public health emergencies. Individuals communicate to acquire relevant knowledge about an epidemic, which influences their decisions to adopt pro...Information plays a crucial role in guiding behavioral decisions during public health emergencies. Individuals communicate to acquire relevant knowledge about an epidemic, which influences their decisions to adopt protective measures.However, whether to disseminate specific information is also a behavioral decision. In light of this understanding, we develop a coupled information–vaccination–epidemic model to depict these co-evolutionary dynamics in a three-layer network. Negative information dissemination and vaccination are treated as separate decision-making processes. We then examine the combined effects of herd and risk motives on information dissemination and vaccination decisions through the lens of game theory. The microscopic Markov chain approach(MMCA) is used to describe the dynamic process and to derive the epidemic threshold. Simulation results indicate that increasing the cost of negative information dissemination and providing timely clarification can effectively control the epidemic. Furthermore, a phenomenon of diminishing marginal utility is observed as the cost of dissemination increases, suggesting that authorities do not need to overinvest in suppressing negative information. Conversely, reducing the cost of vaccination and increasing vaccine efficacy emerge as more effective strategies for outbreak control. In addition, we find that the scale of the epidemic is greater when the herd motive dominates behavioral decision-making. In conclusion, this study provides a new perspective for understanding the complexity of epidemic spreading by starting with the construction of different behavioral decisions.展开更多
Decision-making of connected and automated vehicles(CAV)includes a sequence of driving maneuvers that improve safety and efficiency,characterized by complex scenarios,strong uncertainty,and high real-time requirements...Decision-making of connected and automated vehicles(CAV)includes a sequence of driving maneuvers that improve safety and efficiency,characterized by complex scenarios,strong uncertainty,and high real-time requirements.Deep reinforcement learning(DRL)exhibits excellent capability of real-time decision-making and adaptability to complex scenarios,and generalization abilities.However,it is arduous to guarantee complete driving safety and efficiency under the constraints of training samples and costs.This paper proposes a Mixture of Expert method(MoE)based on Soft Actor-Critic(SAC),where the upper-level discriminator dynamically decides whether to activate the lower-level DRL expert or the heuristic expert based on the features of the input state.To further enhance the performance of the DRL expert,a buffer zone is introduced in the reward function,preemptively applying penalties before insecure situations occur.In order to minimize collision and off-road rates,the Intelligent Driver Model(IDM)and Minimizing Overall Braking Induced by Lane changes(MOBIL)strategy are designed by heuristic experts.Finally,tested in typical simulation scenarios,MOE shows a 13.75%improvement in driving efficiency compared with the traditional DRL method with continuous action space.It ensures high safety with zero collision and zero off-road rates while maintaining high adaptability.展开更多
Bridge networks are essential components of civil infrastructure,supporting communities by delivering vital services and facilitating economic activities.However,bridges are vulnerable to natural disasters,particularl...Bridge networks are essential components of civil infrastructure,supporting communities by delivering vital services and facilitating economic activities.However,bridges are vulnerable to natural disasters,particularly earthquakes.To develop an effective disaster management strategy,it is critical to identify reliable,robust,and efficient indicators.In this regard,Life-Cycle Cost(LCC)and Resilience(R)serve as key indicators to assist decision-makers in selecting the most effective disaster risk reduction plans.This study proposes an innova-tive LCC-R optimization framework to identify the most optimal retrofit strategies for bridge networks facing hazardous events during their lifespan.The proposed framework employs both single-and multi-objective opti-mization techniques to identify retrofit strategies that maximize the R index while minimizing the LCC for the under-study bridge networks.The considered retrofit strategies include various options such as different mate-rials(steel,CFRP,and GFRP),thicknesses,arrangements,and timing of retrofitting actions.The first step in the proposed framework involves constructing fragility curves by performing a series of nonlinear time-history incre-mental dynamic analyses for each case.In the subsequent step,the seismic resilience surfaces are calculated using the obtained fragility curves and assuming a recovery function.Next,the LCC is evaluated according to the pro-posed formulation for multiple seismic occurrences,which incorporates the effects of complete and incomplete repair actions resulting from previous multiple seismic events.For optimization purposes,the Non-Dominated Sorting Genetic Algorithm II(NSGA-II)evolutionary algorithm efficiently identifies the Pareto front to represent the optimal set of solutions.The study presents the most effective retrofit strategies for an illustrative bridge network,providing a comprehensive discussion and insights into the resulting tactical approaches.The findings underscore that the methodologies employed lead to logical and actionable retrofit strategies,paving the way for enhanced resilience and cost-effectiveness in bridge network management against seismic hazards.展开更多
文摘Objective:To assess the effectiveness of simulation-based learning regarding the management of post-COVID complications in terms of knowledge,clinical decision-making ability,and self-efficacy among nursing students.Methods:This was a quasi-experimental study conducted among 1152nd-year nursing students.The participants were selected by a simple random sampling technique.The participants were divided into an experimental(n=56)and a comparison group(n=59)by a random table method.Data were analyzed using descriptive and inferential statistics with SPSS version 20.Results:There were significant differences in mean post-test knowledge scores(P=0.03)and mean post-test self-efficacy scores(P=0.001)between the experimental and the comparison groups while the difference in mean post-test clinical decision-making ability scores between the two groups was non-significant(P=0.07).A positive correlation was found between knowledge and clinical decision-making ability in pre-test(P=0.03)and in post-test(P<0.001)and a non-significant correlation was found between pre-test knowledge and self-efficacy score(P=0.52)among the experimental group.Conclusions:Simulation-based learning regarding the management of post-COVID complications is effective among nursing students.Simulation labs should be established in health care settings where simulation training can be provided for updating the knowledge,clinical decision-making ability,and self-efficacy of nursing personnel during program installment and continuous nursing education.
基金supported by Hanshan Normal University Research Initiation Program(QD2024214).
文摘This study examined the effects of design thinking pedagogy on undergraduates’career decision-making selfefficacy and employability in career education.Using a quasi-experimental design,Chinese college students(N=93)were participants in two wings.The experimental group(n=47)received the design thinking pedagogy,while the control group(n=46)followed the regularly teacher-centered method.The students completed the career decision-making self-efficacy scale and employability scale before and after the intervention.Independent samples t-test results showed that design thinking pedagogy significantly improves students’career decision-making self-efficacy and employability.The ANCOVA results showed that the pretest scores of career decision-making self-efficacy and employability had no significant association with the experimental intervention.There was no interaction between the treatment and pretest scores.It would seem that experimental design thinking pedagogy implemented in career guidance courses has little effect compared to the usual course presentation.Nonetheless,prospects for the implementation of design thinking-guided learning activities to support interdisciplinary learning for improved higher education and career development outcomes need further exploration.
文摘The critical role of patient-reported outcome measures(PROMs)in enhancing clinical decision-making and promoting patient-centered care has gained a profound significance in scientific research.PROMs encapsulate a patient's health status directly from their perspective,encompassing various domains such as symptom severity,functional status,and overall quality of life.By integrating PROMs into routine clinical practice and research,healthcare providers can achieve a more nuanced understanding of patient experiences and tailor treatments accordingly.The deployment of PROMs supports dynamic patient-provider interactions,fostering better patient engagement and adherence to tre-atment plans.Moreover,PROMs are pivotal in clinical settings for monitoring disease progression and treatment efficacy,particularly in chronic and mental health conditions.However,challenges in implementing PROMs include data collection and management,integration into existing health systems,and acceptance by patients and providers.Overcoming these barriers necessitates technological advancements,policy development,and continuous education to enhance the acceptability and effectiveness of PROMs.The paper concludes with recommendations for future research and policy-making aimed at optimizing the use and impact of PROMs across healthcare settings.
基金Supported by National Key Research and Development Program of China(Grant No.2022YFE0117100)National Science Foundation of China(Grant No.52102468,52325212)Fundamental Research Funds for the Central Universities。
文摘To solve problems of poor security guarantee and insufficient training efficiency in the conventional reinforcement learning methods for decision-making,this study proposes a hybrid framework to combine deep reinforcement learning with rule-based decision-making methods.A risk assessment model for lane-change maneuvers considering uncertain predictions of surrounding vehicles is established as a safety filter to improve learning efficiency while correcting dangerous actions for safety enhancement.On this basis,a Risk-fused DDQN is constructed utilizing the model-based risk assessment and supervision mechanism.The proposed reinforcement learning algorithm sets up a separate experience buffer for dangerous trials and punishes such actions,which is shown to improve the sampling efficiency and training outcomes.Compared with conventional DDQN methods,the proposed algorithm improves the convergence value of cumulated reward by 7.6%and 2.2%in the two constructed scenarios in the simulation study and reduces the number of training episodes by 52.2%and 66.8%respectively.The success rate of lane change is improved by 57.3%while the time headway is increased at least by 16.5%in real vehicle tests,which confirms the higher training efficiency,scenario adaptability,and security of the proposed Risk-fused DDQN.
基金023 Zhejiang Provincial Department of Education General Project:Research on an interdisciplinary teaching model to promote the development of computational thinking in the context of the new curriculum standards[Grant NO:Y202351596]Key Project of Zhejiang Provincial Education Science Planning:Research on an interdisciplinary teaching model to promote students’computational thinking from multiple analytical perspectives[Grant NO:2025SB103].
文摘This study constructs a reflective feedback model based on a pedagogical agent(PA)and explores its impact on students’problem-solving ability and cognitive load.A quasi-experimental design was used in the study,with 84 students from a middle school selected as the research subjects(44 in the experimental group and 40 in the control group).The experimental group used the reflective feedback model,while the control group used the factual feedback model.The results show that,compared with factual feedback,the reflective feedback model based on the pedagogical agent significantly improves students’problem-solving ability,especially at the action and thinking levels.In addition,this model effectively reduces students’cognitive load,especially in terms of internal and external load.
基金funded by the project of Guangdong Provincial Basic and Applied Basic Research Fund Committee(2022A1515240073)the Pearl River Talent Recruitment Program(2019CX01G338),Guangdong Province.
文摘Construction engineering and management(CEM)has become increasingly complicated with the increasing size of engineering projects under different construction environments,motivating the digital transformation of CEM.To contribute to a better understanding of the state of the art of smart techniques for engineering projects,this paper provides a comprehensive review of multi-criteria decision-making(MCDM)techniques,intelligent techniques,and their applications in CEM.First,a comprehensive framework detailing smart technologies for construction projects is developed.Next,the characteristics of CEM are summarized.A bibliometric review is then conducted to investigate the keywords,journals,and clusters related to the application of smart techniques in CEM during 2000-2022.Recent advancements in intelligent techniques are also discussed under the following six topics:①big data technology;②computer vision;③speech recognition;④natural language processing;⑤machine learning;and⑥knowledge representation,understanding,and reasoning.The applications of smart techniques are then illustrated via underground space exploitation.Finally,future research directions for the sustainable development of smart construction are highlighted.
基金supported by the Deanship of Graduate Studies and Scientific Research at Qassim University(QU-APC-2024-9/1).
文摘Due to the numerous variables to take into account as well as the inherent ambiguity and uncertainty,evaluating educational institutions can be difficult.The concept of a possibility Pythagorean fuzzy hypersoft set(pPyFHSS)is more flexible in this regard than other theoretical fuzzy set-like models,even though some attempts have been made in the literature to address such uncertainties.This study investigates the elementary notions of pPyFHSS including its set-theoretic operations union,intersection,complement,OR-and AND-operations.Some results related to these operations are also modified for pPyFHSS.Additionally,the similarity measures between pPyFHSSs are formulated with the assistance of numerical examples and results.Lastly,an intelligent decision-assisted mechanism is developed with the proposal of a robust algorithm based on similarity measures for solving multi-attribute decision-making(MADM)problems.A case study that helps the decision-makers assess the best educational institution is discussed to validate the suggested system.The algorithmic results are compared with the most pertinent model to evaluate the adaptability of pPyFHSS,as it generalizes the classical possibility fuzzy set-like theoretical models.Similarly,while considering significant evaluating factors,the flexibility of pPyFHSS is observed through structural comparison.
文摘Accurate medical diagnosis,which involves identifying diseases based on patient symptoms,is often hindered by uncertainties in data interpretation and retrieval.Advanced fuzzy set theories have emerged as effective tools to address these challenges.In this paper,new mathematical approaches for handling uncertainty in medical diagnosis are introduced using q-rung orthopair fuzzy sets(q-ROFS)and interval-valued q-rung orthopair fuzzy sets(IVq-ROFS).Three aggregation operators are proposed in our methodologies:the q-ROF weighted averaging(q-ROFWA),the q-ROF weighted geometric(q-ROFWG),and the q-ROF weighted neutrality averaging(qROFWNA),which enhance decision-making under uncertainty.These operators are paired with ranking methods such as the similarity measure,score function,and inverse score function to improve the accuracy of disease identification.Additionally,the impact of varying q-rung values is explored through a sensitivity analysis,extending the analysis beyond the typical maximum value of 3.The Basic Uncertain Information(BUI)method is employed to simulate expert opinions,and aggregation operators are used to combine these opinions in a group decisionmaking context.Our results provide a comprehensive comparison of methodologies,highlighting their strengths and limitations in diagnosing diseases based on uncertain patient data.
文摘BACKGROUND Understanding a patient's clinical status and setting priorities for their care are two aspects of the constantly changing process of clinical decision-making.One analytical technique that can be helpful in uncertain situations is clinical judgment.Clinicians must deal with contradictory information,lack of time to make decisions,and long-term factors when emergencies occur.AIM To examine the ethical issues healthcare professionals faced during the coronavirus disease 2019(COVID-19)pandemic and the factors affecting clinical decision-making.METHODS This pilot study,which means it was a preliminary investigation to gather information and test the feasibility of a larger investigation was conducted over 6 months and we invited responses from clinicians worldwide who managed patients with COVID-19.The survey focused on topics related to their professional roles and personal relationships.We examined five core areas influencing critical care decision-making:Patients'personal factors,family-related factors,informed consent,communication and media,and hospital administrative policies on clinical decision-making.The collected data were analyzed using the χ^(2) test for categorical variables.RESULTS A total of 102 clinicians from 23 specialties and 17 countries responded to the survey.Age was a significant factor in treatment planning(n=88)and ventilator access(n=78).Sex had no bearing on how decisions were made.Most doctors reported maintaining patient confidentiality regarding privacy and informed consent.Approximately 50%of clinicians reported a moderate influence of clinical work,with many citing it as one of the most important factors affecting their health and relationships.Clinicians from developing countries had a significantly higher score for considering a patient's financial status when creating a treatment plan than their counterparts from developed countries.Regarding personal experiences,some respondents noted that treatment plans and preferences changed from wave to wave,and that there was a rapid turnover of studies and evidence.Hospital and government policies also played a role in critical decision-making.Rather than assessing the appropriateness of treatment,some doctors observed that hospital policies regarding medications were driven by patient demand.CONCLUSION Factors other than medical considerations frequently affect management choices.The disparity in treatment choices,became more apparent during the pandemic.We highlight the difficulties and contradictions between moral standards and the realities physicians encountered during this medical emergency.False information,large patient populations,and limited resources caused problems for clinicians.These factors impacted decision-making,which,in turn,affected patient care and healthcare staff well-being.
文摘Twenty short-statured maize inbred lines were collected from CIMMYT India and Mexico through the Plant Breeding Division, Bangladesh Agricultural Research Institute (BARI), Gazipur. The experiment was conducted from November 2020 to April 2021 in three different agroecological regions such as BARI, Gazipur, RARS Barisal and RARS Rangpur. Seven inbred lines were selected on the basis of genetic diversity and per se performance and they were crossed separately in a 7 × 7 half diallel fashion, producing 21F1 hybrids in 2019 which were evaluated at three locations. However, variances due to GCA were much higher in magnitude than SCA for all the characters indicating preponderance of additive gene effects on the inheritance of these characters. Two parents viz., P3 (CML33) and P4 (CML41) were good general combiners and two crosses viz., P4 × P5 (CML41 × CML31) and P5 × P7 (CML31 × CML124) expressed significant positive SCA effects coupled with significant positive heterosis for grain yield and for most of the yield contributing characters over the two commercial check varieties BHM 9 and NK40. Four crosses: P1 × P5 (CML116 × CML31), P1 × P6 (CML116 × CML32), P2 × P6 (CML72 × CML32) and P3 × P4 (CML33 × CML41), exhibited significant and negative SCA effects for both plant and ear height which were desirable for short stature. Genotypes x location interaction was also significant for maximum characters, suggesting that genotypes interacted significantly in different environments.
基金supported by scientific research fund of Jiangxi Provincial Social Sciences“14th Five-Year Plan”(No.23SH05).
文摘This study investigated the relationship between parental cognitive ability and child logical reasoning ability,and the role of academic expectation and family environment in that relationship.Based on the 2020 China Family Panel Studies(CFPS)data,1491 children(girls ratio=53.78%;average grade=6.023 years,school grade standard deviation=1.825 years).Results following multiple regression model(OLS)show that the higher the parental cognitive ability,the higher the children’s logical reasoning ability.Secondly,parental academic expectation serves as a mediator between their cognitive ability and children’s logical reasoning ability for higher logical reasoning by children.Third,a possible family environment acts as a mediator in the relationship between parents’cognitive ability and children’s logical reasoning ability to be higher.We conclude from thesefindings that parents with high cognitive abilities can enhance their children’s logical reasoning skills not only by setting higher academic expectations,but also by cultivating a supportive family environment.Thesefindings imply a need for intervention to improve family quality of life to enhance children’s thinking abilities to optimize their academic learning.
文摘Objectives This study aimed to clarify the relationship between the content of proxy decision-making made by families of patients with malignant brain tumors regarding treatment policies and daily care and the cues leading to those decisions.Methods Semi-structured personal interviews were used to collect data.Seven family members of patients with malignant brain tumors were selected to participate in the study by purposive sampling method from June to August 2022 in the Patient Family Association of Japan.Responses were content analyzed to explore the relationship between the content of decisions regarding“treatment policies”and“daily care”and the cues influencing those decisions.Semi-structured interviews were analyzed by using thematic analysis.Results The contents of proxy decisions regarding“treatment policies”included implementation,interruption,and termination of initial treatments,free medical treatments,use of respirators,and end-of-life sedation and included six cues:treatment policies suggested by the primary physician,information and knowledge about the disease and treatment obtained by the family from limited resources,perceived life threat from symptom worsening,words and reactions from the patient regarding treatment,patient’s personality and way of life inferred from their treatment preferences,family’s thoughts and values hoping for better treatment for the patient.Decisions for“daily care”included meal content and methods,excretion,mobility,maintaining cleanliness,rehabilitation,continuation or resignation from work,treatment settings(outpatient or inpatient),and ways to spend time outside and included seven cues:words and thoughts from the patient about their way of life,patient’s reactions and life history inferred from their preferred way of living,things the patient can do to maintain daily life and roles,awareness of the increasing inability to do things in daily life,family’s underlying thoughts and values about how to spend the remaining time,approval from family members regarding the care setting,advice from medical professionals on living at home.Conclusions For“treatment policies,”guidelines from medical professionals were a key cue,while for“daily care,”the small signs from the patients in their daily lives served as cues for proxy decision-making.This may be due to the lack of information available to families and the limited time available for discussion with the patient.Families of patients with malignant brain tumors repeatedly use multiple cues to make proxy decision-making under high uncertainty.Therefore,nurses supporting proxy decision-making should assess the family’s situation and provide cues that facilitate informed and confident decisions.
基金supported by the National Natural Science Foundation of China(Grant no.32101237)the China Postdoctoral Science Foundation(Grant no.2021M691522)+1 种基金the National Key Research and Development Program(Grant no.2022YFC3202104)the Tibet Major Science and Technology Project(Grant no.XZ201901-GA-06).
文摘Group living is widespread across diverse taxa,and the mechanisms underlying collective decision-making in contexts of variable role division are critical for understanding the dynamics of group stability.While studies on collective behavior in small animals such as fish and insects are well-established,similar research on large wild animals remains challenging due to the limited availability of sufficient and systematic field data.Here,we aimed to explore the collective decision-making pattern and its sexual difference for the dimorphic Tibetan antelopes Pantholops hodgsonii(chiru)in Xizang Autonomous Region,China,by analyzing individual leadership distribution,as well as the joining process,considering factors such as calving stages and joining ranks.The distinct correlations of decision participants’ratio with group size and decision duration underscore the trade-off between accuracy and speed in decision-making.Male antelopes display a more democratic decision-making pattern,while females exhibit more prompt responses after calving at an early stage.This study uncovers a partially shared decision-making strategy among Tibetan antelopes,suggesting flexible self-organization in group decision processes aligned with animal life cycle progression.
文摘BACKGROUND Mesalamine is the recommended first-line treatment for inducing and maintaining remission in mild-to-moderate ulcerative colitis(UC).However,adherence in real-world settings is frequently suboptimal.Encouraging collaborative patient-provider relationships may foster better adherence and patient outcomes.AIM To quantify the association between patient participation in treatment decisionmaking and adherence to oral mesalamine in UC.METHODS We conducted a 12-month,prospective,non-interventional cohort study at 113 gastroenterology practices in Germany.Eligible patients were aged≥18 years,had a confirmed UC diagnosis,had no prior mesalamine treatment,and provided informed consent.At the first visit,we collected data on demographics,clinical characteristics,patient preference for mesalamine formulation(tablets or granules),and disease knowledge.Self-reported adherence and disease activity were assessed at all visits.Correlation analyses and logistic regression were used to examine associations between adherence and various factors.RESULTS Of the 605 consecutively screened patients,520 were included in the study.The median age was 41 years(range:18-91),with a male-to-female ratio of 1.1:1.0.Approximately 75%of patients reported good adherence at each study visit.In correlation analyses,patient participation in treatment decision-making was significantly associated with better adherence across all visits(P=0.04).In the regression analysis at 12 months,this association was evident among patients who both preferred and received prolonged-release mesalamine granules(odds ratio=2.73,P=0.001).Patients reporting good adherence also experienced significant improvements in disease activity over 12 months(P<0.001).CONCLUSION Facilitating patient participation in treatment decisions and accommodating medication preferences may improve adherence to mesalamine.This may require additional effort but has the potential to improve long-term management of UC.
基金supported by the China Agriculture Research System of MOF and MARA(CARS-42-4)School Cooperation Project of Ya’an(21SXHZ0028)the Key Technology Support Program of Sichuan Province,China(2021YFYZ0014),for the financial support。
文摘The low egg production of goose greatly limits the development of the industry.China possesses the most abundant goose breeds resources.In this study,genome resequencing data of swan goose(Anser cygnoides)and domesticated high and low laying goose breeds(Anser cygnoides domestiation)were used to identify key genes related to egg laying ability in geese and verify their functions.Selective sweep analyses revealed 416 genes that were specifically selected during the domestication process from swan geese to high laying geese.Furthermore,SNPs and Indels markers were used in GWAS analyses between high and low laying breed geese.The results showed that RTCB,BPIFC,SYN3,SYNE1,VIP,and ESR1 may be related to the differences in laying ability of geese.Notably,only ESR1 was identified simultaneously by GWAS and selective sweep analysis.The genotype of Indelchr3:54429172,located downstream of ESR1,was confirmed to affect the expression of ESR1 in the ovarian stroma and showed significant correlation with body weight at first egg and laying frequency of geese.CCK-8,EdU,and flow cytometry confirmed that ESR1 can promote the apoptosis of goose pre-hierarchical follicles ganulosa cells(phGCs)and inhibit their proliferation.Combined with transcriptome data,it was found ESR1 involved in the function of goose phGCs may be related to MAPK and TGF-beta signaling pathways.Overall,our study used genomic information from different goose breeds to identify an indel located in the downstream of ESR1 associated with goose laying ability.The main pathways and biological processes of ESR1 involved in the regulation of goose laying ability were identified by cell biology and transcriptomics methods.These results are helpful to further understand the laying ability characteristics of goose and improve the egg production of geese.
基金Project supported by the National Natural Science Foundation of China (Grant No. 72174121)the Program for Professor of Special Appointment (Eastern Scholar) at Shanghai Institutions of Higher Learning, and the Soft Science Research Project of Shanghai (Grant No. 22692112600)。
文摘Information plays a crucial role in guiding behavioral decisions during public health emergencies. Individuals communicate to acquire relevant knowledge about an epidemic, which influences their decisions to adopt protective measures.However, whether to disseminate specific information is also a behavioral decision. In light of this understanding, we develop a coupled information–vaccination–epidemic model to depict these co-evolutionary dynamics in a three-layer network. Negative information dissemination and vaccination are treated as separate decision-making processes. We then examine the combined effects of herd and risk motives on information dissemination and vaccination decisions through the lens of game theory. The microscopic Markov chain approach(MMCA) is used to describe the dynamic process and to derive the epidemic threshold. Simulation results indicate that increasing the cost of negative information dissemination and providing timely clarification can effectively control the epidemic. Furthermore, a phenomenon of diminishing marginal utility is observed as the cost of dissemination increases, suggesting that authorities do not need to overinvest in suppressing negative information. Conversely, reducing the cost of vaccination and increasing vaccine efficacy emerge as more effective strategies for outbreak control. In addition, we find that the scale of the epidemic is greater when the herd motive dominates behavioral decision-making. In conclusion, this study provides a new perspective for understanding the complexity of epidemic spreading by starting with the construction of different behavioral decisions.
基金Supported by National Key R&D Program of China(Grant No.2022YFB2503203)National Natural Science Foundation of China(Grant No.U1964206).
文摘Decision-making of connected and automated vehicles(CAV)includes a sequence of driving maneuvers that improve safety and efficiency,characterized by complex scenarios,strong uncertainty,and high real-time requirements.Deep reinforcement learning(DRL)exhibits excellent capability of real-time decision-making and adaptability to complex scenarios,and generalization abilities.However,it is arduous to guarantee complete driving safety and efficiency under the constraints of training samples and costs.This paper proposes a Mixture of Expert method(MoE)based on Soft Actor-Critic(SAC),where the upper-level discriminator dynamically decides whether to activate the lower-level DRL expert or the heuristic expert based on the features of the input state.To further enhance the performance of the DRL expert,a buffer zone is introduced in the reward function,preemptively applying penalties before insecure situations occur.In order to minimize collision and off-road rates,the Intelligent Driver Model(IDM)and Minimizing Overall Braking Induced by Lane changes(MOBIL)strategy are designed by heuristic experts.Finally,tested in typical simulation scenarios,MOE shows a 13.75%improvement in driving efficiency compared with the traditional DRL method with continuous action space.It ensures high safety with zero collision and zero off-road rates while maintaining high adaptability.
文摘Bridge networks are essential components of civil infrastructure,supporting communities by delivering vital services and facilitating economic activities.However,bridges are vulnerable to natural disasters,particularly earthquakes.To develop an effective disaster management strategy,it is critical to identify reliable,robust,and efficient indicators.In this regard,Life-Cycle Cost(LCC)and Resilience(R)serve as key indicators to assist decision-makers in selecting the most effective disaster risk reduction plans.This study proposes an innova-tive LCC-R optimization framework to identify the most optimal retrofit strategies for bridge networks facing hazardous events during their lifespan.The proposed framework employs both single-and multi-objective opti-mization techniques to identify retrofit strategies that maximize the R index while minimizing the LCC for the under-study bridge networks.The considered retrofit strategies include various options such as different mate-rials(steel,CFRP,and GFRP),thicknesses,arrangements,and timing of retrofitting actions.The first step in the proposed framework involves constructing fragility curves by performing a series of nonlinear time-history incre-mental dynamic analyses for each case.In the subsequent step,the seismic resilience surfaces are calculated using the obtained fragility curves and assuming a recovery function.Next,the LCC is evaluated according to the pro-posed formulation for multiple seismic occurrences,which incorporates the effects of complete and incomplete repair actions resulting from previous multiple seismic events.For optimization purposes,the Non-Dominated Sorting Genetic Algorithm II(NSGA-II)evolutionary algorithm efficiently identifies the Pareto front to represent the optimal set of solutions.The study presents the most effective retrofit strategies for an illustrative bridge network,providing a comprehensive discussion and insights into the resulting tactical approaches.The findings underscore that the methodologies employed lead to logical and actionable retrofit strategies,paving the way for enhanced resilience and cost-effectiveness in bridge network management against seismic hazards.
