Background:We aimed to study physician attitudes toward ultrasound-guided procedures and possible improvements.We hypothesized that the usage of ultrasound in procedures may be limited by a high barrier of entry and t...Background:We aimed to study physician attitudes toward ultrasound-guided procedures and possible improvements.We hypothesized that the usage of ultrasound in procedures may be limited by a high barrier of entry and that most physicians would choose to adopt software that provides real-time image guidance if accessible.Methods:A voluntary,cross-sectional survey of physicians at a single site was conducted using a five-point Likert scale.Data analysis included both descriptive and inferential statistical analyses and stratified by categorical descriptors,including variables of formal training,years of experience,and specialty of practice.Results:One hundred sixteen physicians responded to the survey.The majority disagreed that there was a steep learning curve(57.5%)and that they need more time to identify structures under ultrasound(85.0%).Overall attitudes were mixed about the use of additional software to improve ease of use,but most(55.4%)had positive opinions toward the addition of real-time 3D reconstruction.Respondents without formal training were significantly more likely to agree that additional software would improve ease of ultrasound-guided procedures(p=0.0389).Radiologists were significantly more likely to perceive a steeper learning curve and less likely to advocate for supplemental software compared to emergency medicine physicians,surgeons,or anesthesiologists.Conclusions:Surveyed physicians demonstrated comfort with ultrasound-guided procedures and a mixed stance toward the use of additional software to assist with procedures.Those without formal training had significantly more positive attitudes toward the use of additional technology to augment ultrasound-guided procedures,suggesting a knowledge gap that may benefit from such technology.展开更多
Conventional empirical equations for estimating undrained shear strength(s_(u))from piezocone penetration test(CPTu)data,without incorporating soil physical properties,often lack the accuracy and robustness required f...Conventional empirical equations for estimating undrained shear strength(s_(u))from piezocone penetration test(CPTu)data,without incorporating soil physical properties,often lack the accuracy and robustness required for geotechnical site investigations.This study introduces a hybrid virus colony search(VCS)algorithm that integrates the standard VCS algorithm with a mutation-based search mechanism to develop high-performance XGBoost learning models to address this limitation.A dataset of 372 seismic CPTu and corresponding soil physical properties data from 26 geotechnical projects in Jiangs_(u)Province,China,was collected for model development.Comparative evaluations demonstrate that the proposed hybrid VCS-XGBoost model exhibits s_(u)perior performance compared to standard meta-heuristic algorithm-based XGBoost models.The res_(u)lts highlight that the consideration of soil physical properties significantly improves the predictive accuracy of s_(u),emphasizing the importance of considering additional soil information beyond CPTu data for accurate s_(u)estimation.展开更多
The flow shop scheduling problem is important for the manufacturing industry.Effective flow shop scheduling can bring great benefits to the industry.However,there are few types of research on Distributed Hybrid Flow S...The flow shop scheduling problem is important for the manufacturing industry.Effective flow shop scheduling can bring great benefits to the industry.However,there are few types of research on Distributed Hybrid Flow Shop Problems(DHFSP)by learning assisted meta-heuristics.This work addresses a DHFSP with minimizing the maximum completion time(Makespan).First,a mathematical model is developed for the concerned DHFSP.Second,four Q-learning-assisted meta-heuristics,e.g.,genetic algorithm(GA),artificial bee colony algorithm(ABC),particle swarm optimization(PSO),and differential evolution(DE),are proposed.According to the nature of DHFSP,six local search operations are designed for finding high-quality solutions in local space.Instead of randomselection,Q-learning assists meta-heuristics in choosing the appropriate local search operations during iterations.Finally,based on 60 cases,comprehensive numerical experiments are conducted to assess the effectiveness of the proposed algorithms.The experimental results and discussions prove that using Q-learning to select appropriate local search operations is more effective than the random strategy.To verify the competitiveness of the Q-learning assistedmeta-heuristics,they are compared with the improved iterated greedy algorithm(IIG),which is also for solving DHFSP.The Friedman test is executed on the results by five algorithms.It is concluded that the performance of four Q-learning-assisted meta-heuristics are better than IIG,and the Q-learning-assisted PSO shows the best competitiveness.展开更多
Background: Implementing invasive procedures is an important part of patient management by clinical nurses;however, there are gaps between nurses’ actual knowledge and skills and expected professional care capacity. ...Background: Implementing invasive procedures is an important part of patient management by clinical nurses;however, there are gaps between nurses’ actual knowledge and skills and expected professional care capacity. Purpose: This scoping review aimed to map the existing literature related to recent institution-provided educational programs for invasive procedures involving clinical nurses. This study seeks to understand the contents of educational programs and the methods for assessing educational effects. Methods: This scoping review was completed using the following four databases: PubMed (MEDLINE), Embase, Cochrane Library, and Emcare for the period 2000-2022. We included studies that used all forms of educational approaches (e.g., didactic lectures, hands-on training, or on-the-job training). This scoping review considered peer-reviewed publications published in English using quantitative, qualitative, or mixed approaches. A total of 83 studies underwent in the final analysis. Results and Conclusion: A combination of didactic lectures and hands-on training was provided as an educational program in most studies. Contrary to our prediction, educational interventions with advanced technologies such as VR are extremely rare, suggesting that the effectiveness of advanced technologies in learning invasive procedures should be examined to facilitate and retain educational effects more efficiently in future studies. Regarding the assessment of educational effects, nurses’ cognitive (i.e., theoretical knowledge about procedures), psychomotor (i.e., implementing procedures), and psychological aspects (e.g., confidence and self-efficacy in procedures) were evaluated using questionnaires and observational methods. While most studies used a one-group pretest-posttest design, the ratio of randomized controlled trials (RCT) was relatively low. Thus, an RCT design should be introduced in future studies to test the validity of the developed educational program more accurately.展开更多
Background: Prenatal diagnosis is the process of evaluating the presence of disease or potential disease in the fetus, this enables families to be better prepared before the birth of the baby. There are non-invasive p...Background: Prenatal diagnosis is the process of evaluating the presence of disease or potential disease in the fetus, this enables families to be better prepared before the birth of the baby. There are non-invasive prenatal diagnosis procedures and invasive prenatal diagnosis procedures. The invasive prenatal diagnosis procedures are CVS (chorionic villus sampling) and amniocentesis. The American College of Obstetricians and Gynecologists states that invasive diagnostic testing should be available to all women, regardless of age or risk. Objective: To determine the indications, outcome and results of diagnostic invasive prenatal procedures. Study setting: The obstetrics and Gynecology Department in Salmaniya Medical Complex in Kingdom of Bahrain. Study design: Retrospective descriptive study. Study subjects and Methods: This retrospective descriptive study was conducted on 175 pregnant women who underwent invasive prenatal procedures (CVS and amniocentesis) between January 2013 and December 2018 at SMC in Kingdom of Bahrain. All medical records of the participants were reviewed and entered the study. According to the implemented procedures, medical records were categorized into two chorionic villus sampling (CVS) and amniocentesis groups. The study subject will include indications of the procedures which are advanced maternal age, hematological disorders, genetic disorders, metabolic disorders, abnormal structural findings in fetal ultrasound and previous child with aneuploidy. In addition, the study will address the complications, outcome and results of procedures. Results: About half of our indications of the procedures were due to hematological disorders (47.6%) followed by abnormal structural findings in fetal ultrasound (30.1%) then genetic disorders (15.7%), metabolic disorders (4.8%) and advanced maternal age (1.8%). Regarding complications of the procedure;threatened miscarriage or loss of pregnancy within 3 weeks was (2.3%), amniotic fluid leakage (0.7%), abdominal cramps (0.7%) and Insufficient or contaminated sample (6.2%). Regarding outcome of the pregnancy, our results showed that the loss of pregnancy was (4.8%), intrauterine fetal death or still birth was (13.9%), live birth was (63.9%), preterm delivery was (7.8%), preterm premature rupture of membrane (PPROM) was (1.8%), limbs reduction was (0.0%). Termination of pregnancy outside the country was (7.8%) of chorionic villus sampling and amniocentesis. Conclusion: CVS and amniocentesis are useful outpatient procedures to detect diagnosis or to assess whether a patient is at increased risk of having an affected fetus and that will minimize the psychological impact on the patient and to provide a proper antenatal care to the pregnant women by her obstetrician and follow up to the baby by pediatrician. In this study it was observed that most of the patients who underwent the procedure were couples either carrier or affected to sickle cell disease or Beta thalassemia.展开更多
This paper primarily concerns the effective coordination of the procedures and methods employed in open pit mining operations under the background of river management.The central objective of this study is to identify...This paper primarily concerns the effective coordination of the procedures and methods employed in open pit mining operations under the background of river management.The central objective of this study is to identify a viable approach for ensuring rational and efficient development of open pit mineral resources while simultaneously protecting and restoring the ecological environment of the river.This approach should facilitate the realization of a harmonious symbiosis between mining and river management.The intricate mutual influence relationship between river management and open pit mining is first analyzed in depth,which provides a solid foundation for the subsequent coordination strategy development.In light of the aforementioned considerations,a set of coordination procedures for open pit mining based on river management conditions is proposed.These procedures emphasize the integration of river protection into the overall layout of mining at the planning stage.The implementation of scientific mining schemes,accompanied by rigorous control of the scope and depth of mining operations,has proven to be an effective means of reducing the impact of mining activities on river environments.This approach has also facilitated the achievement of a balance and coordination between mining and river management.展开更多
This study aimed to introduce a modified Byars staged procedure and investigate its application value in patients with severe hypospadias.We retrospectively analyzed the clinical data of patients with severe hypospadi...This study aimed to introduce a modified Byars staged procedure and investigate its application value in patients with severe hypospadias.We retrospectively analyzed the clinical data of patients with severe hypospadias admitted to the First Affiliated Hospital of Sun Yat-sen University(Guangzhou,China)between October 2012 and October 2022.In total,31 patients underwent the conventional Byars procedure(conventional group),and 45 patients underwent the modified Byars staged procedure(modified group).Our modified strategy was built upon the standard Byars procedure by incorporating glansplasty during the first stage and employing a Y-shaped flap in conjunction with a glandular tunnel for urethroplasty during the second stage.Notably,there were no statistically significant differences in the preoperative baseline characteristics,duration of surgery,amount of blood loss,or occurrence of postoperative complications,including urethral fistula,stricture and diverticulum,or penile curvature,between the conventional and modified groups.However,there was a significantly lower incidence of coronal sulcus fistula(0 vs 16.1%,P=0.02)and glans dehiscence(0 vs 12.9%,P=0.02)in the surgical group than that in the conventional group.In addition,the modified group exhibited a notably greater rate of normotopic urethral opening(100.0%vs 83.9%,P=0.01)and a higher mean score on the Hypospadias Objective Penile Evaluation(HOPE;mean±standard error of mean:8.6±0.2 vs 7.9±0.3,P=0.02)than did the conventional group.In conclusion,the modified Byars staged procedure significantly reduced the risks of glans dehiscence and coronal sulcus fistula.Consequently,it offers a promising approach for achieving favorable penile esthetics,thereby providing a reliable therapeutic option for severe hypospadias.展开更多
BACKGROUND In open heart surgery requiring cardiopulmonary bypass(CPB),ventricular fibrillation(VF)is common,but refractory recurrent VF is uncommon but perilous.CASE SUMMARY This article reports a 58-year-old male pa...BACKGROUND In open heart surgery requiring cardiopulmonary bypass(CPB),ventricular fibrillation(VF)is common,but refractory recurrent VF is uncommon but perilous.CASE SUMMARY This article reports a 58-year-old male patient with an ascending aortic aneurysm who presented for a Bentall procedure and subsequently experienced multiple occurrences of unexplained VF after weaning from CPB.The recurrent episodes of VF in this case were felt to be related to coronary insufficiency after reconstruction of the aortic root.Coronary artery bypass grafting(CABG)of the proximal right coronary artery and the left anterior descending artery successfully resolved VF.Finally,this patient was safely transferred to the postoperative intensive care unit,and was discharged successfully after subsequent supportive treatment.CONCLUSION In aortic root replacement,coronary insufficiency is a potential cause of VF episodes and should be considered in the differential diagnosis.CABG is the sole effective treatment for VF caused by coronary insufficiency.展开更多
Peroral endoscopic myotomy(POEM)has revolutionized the treatment of upper gastrointestinal tract motility disorders,particularly achalasia.This editorial explores the efficacy,safety,and challenges of POEM,emphasizing...Peroral endoscopic myotomy(POEM)has revolutionized the treatment of upper gastrointestinal tract motility disorders,particularly achalasia.This editorial explores the efficacy,safety,and challenges of POEM,emphasizing its role as a primary treatment with excellent long-term outcomes and minimal adverse events.The evolution of POEM underscores the need for precision in myotomy techniques and the importance of interdisciplinary collaboration,especially regar-ding anesthetic considerations.Despite significant advances,challenges remain in standardizing safety protocols and managing complications.As POEM appli-cations expand,precision endoscopy continues to enhance therapeutic outcomes,promising a transformative impact on gastrointestinal motility disorder manage-ment.展开更多
Practical jurisprudence is a completely new proposition in legal education and research.The introduction of the concept of“practical jurisprudence”in the teaching of the Civil Procedure Law of the People’s Republic...Practical jurisprudence is a completely new proposition in legal education and research.The introduction of the concept of“practical jurisprudence”in the teaching of the Civil Procedure Law of the People’s Republic of China(the“Civil Procedure Law”)is a major innovation in terms of values and methodology.Practical jurisprudence focuses more on practical issues,Chinese characteristics,and major needs,while strengthening the practical nature of the Civil Procedure Law.China’s traditional education system for juris masters(for non-law graduates)(“non-law JMs”)emphasizes the development of foundational legal theoretical knowledge.However,it has not fully achieved its goal of cultivating interdisciplinary and practical legal professionals.Therefore,the traditional education system for the Civil Procedure Law needs reconstruction and supplementation through the practical jurisprudence teaching system in the following areas:(a)System composition:The focus should be on the eight tertiary subsystems under the two secondary subsystems—“the knowledge teaching system and the practical teaching system”of practical jurisprudence in the Civil Procedure Law,as well as the management of their interrelationships.(b)Credit structure:The proportion of credits for“practical teaching and training”should be increased.(c)Practical ability requirements:Legal professionals should be cultivated according to the standards for juris masters(for law graduates)as stipulated by the Law of the People’s Republic of China on Academic Degrees.(d)Practice evaluation:“Formalization of the evaluations,”“homogeneity of the evaluators,”and“reliance on written formats”should be avoided.展开更多
Dear Editor,We report a relatively safe and effective triple procedure for traumatic aphakia,glaucoma,and mydriasis.Blunt eye trauma can lead to various anterior-and posterior-segment conditions[1],that often occur si...Dear Editor,We report a relatively safe and effective triple procedure for traumatic aphakia,glaucoma,and mydriasis.Blunt eye trauma can lead to various anterior-and posterior-segment conditions[1],that often occur simultaneously.Closed-globe injuries can damage one or more ocular structures.展开更多
BACKGROUND Recently,the identification of cell apoptosis induced by natural products has become research hotspot and frontier in the biopharmaceutical and food industries under the umbrella of global green development...BACKGROUND Recently,the identification of cell apoptosis induced by natural products has become research hotspot and frontier in the biopharmaceutical and food industries under the umbrella of global green development worldwide.Traditionally,cell apoptosis is identified using morphological,biochemical,and cell cycle experiments,which is time consuming,and experimental materials are not from the same group,and it is very hard to ensure the identity and veracity of results of former and latter experiments.AIM To establish a selective,instant,and practical protocol to identify cell apoptosis induced by natural products.METHODS A one transient cell processing procedure(OTCPP)was used to detect human colorectal cancer LoVo cell apoptosis after treatment with Pinus massoniana bark extract(PMBE)at the morphological,biochemical,and cell cycle levels.The methods used included treatment with DNA gel electrophoresis,fluorescence microscopy,and flow cytometry.RESULTS In PMBE-treated LoVo cells,we observed a DNA ladder on gel electrophoresis and fluorescence microscopy revealed"nuclear shrinkage,chromatin condensation or fragmentation".In addition,flow cytometry showed an"obvious apoptosis curve".Thus OTCPP achieved synchronous detection of the morphology,biochemistry,cell cycle,and the DNA content of the cells.CONCLUSION OTCPP can quickly identify apoptosis and measure the apoptosis rate,thereby unifying qualitative and quantitative analysis.展开更多
In this study,we searched for dispersed repeats(DRs)in the rice(Oryza sativa)genome using the iterative procedure(IP)method.The results revealed that the O.sativa genome contained 79 DR families,comprising 992739 DNA ...In this study,we searched for dispersed repeats(DRs)in the rice(Oryza sativa)genome using the iterative procedure(IP)method.The results revealed that the O.sativa genome contained 79 DR families,comprising 992739 DNA repeats,of which 496762 and 495977 were identified on the forward and reverse DNA strands,respectively.The detected DRs were,on average,374 bp in length and occupied 66.4%of the O.sativa genome.Totally 61%of DRs,identified by the IP method,overlapped with previously annotated dispersed repeats(ADRs)detected using the Extensive De Novo TE Annotator(EDTA)pipeline.展开更多
Objective: To evaluate the procedures and timing of operation as well as long-term postoperative effect of congenital choledochal cysts (CCC) in adults. Methods: The procedures and timing of operation, effective rate,...Objective: To evaluate the procedures and timing of operation as well as long-term postoperative effect of congenital choledochal cysts (CCC) in adults. Methods: The procedures and timing of operation, effective rate, re-operation rate and incidence of car- cinoma after operation for 70 adult patients with CCC from January 1980 to June 1999 were analyzed retrospectively. Results: The re-operation rate of external drainage was 86% (6/7). The effective rate of internal drain- age was significantly lower than that of cyst resection (3/10 vs 45/49, X^2=20. 94, P<0.001). The re-op- eration rate and incidence of carcinoma of internal drainage were higher than those of cyst resection (5/ 10 vs 3/49, X^2=13. 64, P<0. 001 and 3/10 vs 3/49, X^2=5. 18, P<0. 025). The reoperation rate of e- mergency surgery was higher than that of selective operation (8/10 vs 6/56, X^2=24. 37, P<0.001). Conclusions: External drainage should be the first- aid measure and the therapy of choice on emergency basis. Internal drainage should never be attempted. Cyst resection with Roux-en-Y hepaticojejunostomy is recommended as the treatment of choice in selective operation.展开更多
In order to promote efficient communication between nurses in Beijing hospitals and foreign patients, EOP (English for Occupational Purposes) courses specifically for nurses are demanded. This paper introduces the mai...In order to promote efficient communication between nurses in Beijing hospitals and foreign patients, EOP (English for Occupational Purposes) courses specifically for nurses are demanded. This paper introduces the main procedures for setting up an EOP course for nurses in Beijing.展开更多
Two procedures were compared for extraction and clean-up of 20organophosphorus and 19 pyrethroid pesticides in sediment to identify the more effective procedurefor groups of pesticides or individual compounds. In Proc...Two procedures were compared for extraction and clean-up of 20organophosphorus and 19 pyrethroid pesticides in sediment to identify the more effective procedurefor groups of pesticides or individual compounds. In Procedure I, methanol/water and n-hexane wereused for extraction, and 1:10 (v/v) dichloromethane in n-hexane and acetone were used as eluents foreluting the analyte through the cartridge, with one evaporating steps on a rotary evaporator andtwo eluting steps on the cartridge. n-hexane/acetone (2:1, v/v) was used for extraction and elutionin Procedure II with one evaporating step on a rotary evaporator and one eluting step on thecartridge. All extractions were performed under an ultrasonic bath and gas chromatography and massspectrometry were utilized for measurements. Procedure II was developed as a rapid, timesaving, lesscostly and safer substitute for Procedure I which was an old method. Procedure II was moreeffective for almost all the organophosphorus pesticides tested and 11of the 19 pyrethroidpesticides, while Procedure I was more appropriate for analysis of 5 pyrethroid pesticides. However,recoveries of most pyrethroid pesticides were fairly low. Thus, further studies should focus onadjustment and formulation of solvents for more efficient extraction and clean-up of pyrethroidpesticides from sediment samples.展开更多
Endoscopic retrograde cholangiopancreatography(ERCP) is one of the most frequently used image-guided procedures in gastrointestinal endoscopy. Post-ERCP pancreatitis is an important concern, and prophylaxis, cannulati...Endoscopic retrograde cholangiopancreatography(ERCP) is one of the most frequently used image-guided procedures in gastrointestinal endoscopy. Post-ERCP pancreatitis is an important concern, and prophylaxis, cannulation and other related technical procedures have been well documented by endoscopists. In addition, medical radiation exposure is of great concern in the general population because of its rapidly increasing frequency and its potential carcinogenic effects. International organizations and radiological societies have established diagnostic reference levels, which guide proper radiation use and serve as global standards for all procedures that use ionizing radiation. However, data on gastrointestinal fluoroscopic procedures are still lacking because the demand for these procedures has recently increased. In this review, we present the current status of quality indicators for ERCP and the methods for measuring radiation exposure in the clinical setting as the next quality indicator for ERCP. To reduce radiation exposure, knowledge of its adverse effects and the procedures for proper measurement and protection are essential. Additionally, further studies on the factors that affect radiation exposure, exposure management and diagnostic reference levels are necessary. Then, we can discuss how to manage medical radiation use inthese complex fluoroscopic procedures. This knowledge will help us to protect not only patients but also endoscopists and medical staff in the fluoroscopy unit.展开更多
Some research results are given in this paper about burnthrough and hydrogen cracking with a flowing chamber and a loop. Many factors including plate thickness, running rate, heat input and so forth have been studied....Some research results are given in this paper about burnthrough and hydrogen cracking with a flowing chamber and a loop. Many factors including plate thickness, running rate, heat input and so forth have been studied. By experiments it can be found that occurrence of hydrogen cracking can be effectively reduced by properly increasing heat input and using the tempering bead technique.展开更多
文摘Background:We aimed to study physician attitudes toward ultrasound-guided procedures and possible improvements.We hypothesized that the usage of ultrasound in procedures may be limited by a high barrier of entry and that most physicians would choose to adopt software that provides real-time image guidance if accessible.Methods:A voluntary,cross-sectional survey of physicians at a single site was conducted using a five-point Likert scale.Data analysis included both descriptive and inferential statistical analyses and stratified by categorical descriptors,including variables of formal training,years of experience,and specialty of practice.Results:One hundred sixteen physicians responded to the survey.The majority disagreed that there was a steep learning curve(57.5%)and that they need more time to identify structures under ultrasound(85.0%).Overall attitudes were mixed about the use of additional software to improve ease of use,but most(55.4%)had positive opinions toward the addition of real-time 3D reconstruction.Respondents without formal training were significantly more likely to agree that additional software would improve ease of ultrasound-guided procedures(p=0.0389).Radiologists were significantly more likely to perceive a steeper learning curve and less likely to advocate for supplemental software compared to emergency medicine physicians,surgeons,or anesthesiologists.Conclusions:Surveyed physicians demonstrated comfort with ultrasound-guided procedures and a mixed stance toward the use of additional software to assist with procedures.Those without formal training had significantly more positive attitudes toward the use of additional technology to augment ultrasound-guided procedures,suggesting a knowledge gap that may benefit from such technology.
基金funded by the National Science Fund for Distinguished Young Scholars(Grant No.42225206)the National Key R&D Program of China(Grant No.2020YFC1807200)the National Natural Science Foundation of China(Grant No.42072299).
文摘Conventional empirical equations for estimating undrained shear strength(s_(u))from piezocone penetration test(CPTu)data,without incorporating soil physical properties,often lack the accuracy and robustness required for geotechnical site investigations.This study introduces a hybrid virus colony search(VCS)algorithm that integrates the standard VCS algorithm with a mutation-based search mechanism to develop high-performance XGBoost learning models to address this limitation.A dataset of 372 seismic CPTu and corresponding soil physical properties data from 26 geotechnical projects in Jiangs_(u)Province,China,was collected for model development.Comparative evaluations demonstrate that the proposed hybrid VCS-XGBoost model exhibits s_(u)perior performance compared to standard meta-heuristic algorithm-based XGBoost models.The res_(u)lts highlight that the consideration of soil physical properties significantly improves the predictive accuracy of s_(u),emphasizing the importance of considering additional soil information beyond CPTu data for accurate s_(u)estimation.
基金partially supported by the Guangdong Basic and Applied Basic Research Foundation(2023A1515011531)the National Natural Science Foundation of China under Grant 62173356+2 种基金the Science and Technology Development Fund(FDCT),Macao SAR,under Grant 0019/2021/AZhuhai Industry-University-Research Project with Hongkong and Macao under Grant ZH22017002210014PWCthe Key Technologies for Scheduling and Optimization of Complex Distributed Manufacturing Systems(22JR10KA007).
文摘The flow shop scheduling problem is important for the manufacturing industry.Effective flow shop scheduling can bring great benefits to the industry.However,there are few types of research on Distributed Hybrid Flow Shop Problems(DHFSP)by learning assisted meta-heuristics.This work addresses a DHFSP with minimizing the maximum completion time(Makespan).First,a mathematical model is developed for the concerned DHFSP.Second,four Q-learning-assisted meta-heuristics,e.g.,genetic algorithm(GA),artificial bee colony algorithm(ABC),particle swarm optimization(PSO),and differential evolution(DE),are proposed.According to the nature of DHFSP,six local search operations are designed for finding high-quality solutions in local space.Instead of randomselection,Q-learning assists meta-heuristics in choosing the appropriate local search operations during iterations.Finally,based on 60 cases,comprehensive numerical experiments are conducted to assess the effectiveness of the proposed algorithms.The experimental results and discussions prove that using Q-learning to select appropriate local search operations is more effective than the random strategy.To verify the competitiveness of the Q-learning assistedmeta-heuristics,they are compared with the improved iterated greedy algorithm(IIG),which is also for solving DHFSP.The Friedman test is executed on the results by five algorithms.It is concluded that the performance of four Q-learning-assisted meta-heuristics are better than IIG,and the Q-learning-assisted PSO shows the best competitiveness.
文摘Background: Implementing invasive procedures is an important part of patient management by clinical nurses;however, there are gaps between nurses’ actual knowledge and skills and expected professional care capacity. Purpose: This scoping review aimed to map the existing literature related to recent institution-provided educational programs for invasive procedures involving clinical nurses. This study seeks to understand the contents of educational programs and the methods for assessing educational effects. Methods: This scoping review was completed using the following four databases: PubMed (MEDLINE), Embase, Cochrane Library, and Emcare for the period 2000-2022. We included studies that used all forms of educational approaches (e.g., didactic lectures, hands-on training, or on-the-job training). This scoping review considered peer-reviewed publications published in English using quantitative, qualitative, or mixed approaches. A total of 83 studies underwent in the final analysis. Results and Conclusion: A combination of didactic lectures and hands-on training was provided as an educational program in most studies. Contrary to our prediction, educational interventions with advanced technologies such as VR are extremely rare, suggesting that the effectiveness of advanced technologies in learning invasive procedures should be examined to facilitate and retain educational effects more efficiently in future studies. Regarding the assessment of educational effects, nurses’ cognitive (i.e., theoretical knowledge about procedures), psychomotor (i.e., implementing procedures), and psychological aspects (e.g., confidence and self-efficacy in procedures) were evaluated using questionnaires and observational methods. While most studies used a one-group pretest-posttest design, the ratio of randomized controlled trials (RCT) was relatively low. Thus, an RCT design should be introduced in future studies to test the validity of the developed educational program more accurately.
文摘Background: Prenatal diagnosis is the process of evaluating the presence of disease or potential disease in the fetus, this enables families to be better prepared before the birth of the baby. There are non-invasive prenatal diagnosis procedures and invasive prenatal diagnosis procedures. The invasive prenatal diagnosis procedures are CVS (chorionic villus sampling) and amniocentesis. The American College of Obstetricians and Gynecologists states that invasive diagnostic testing should be available to all women, regardless of age or risk. Objective: To determine the indications, outcome and results of diagnostic invasive prenatal procedures. Study setting: The obstetrics and Gynecology Department in Salmaniya Medical Complex in Kingdom of Bahrain. Study design: Retrospective descriptive study. Study subjects and Methods: This retrospective descriptive study was conducted on 175 pregnant women who underwent invasive prenatal procedures (CVS and amniocentesis) between January 2013 and December 2018 at SMC in Kingdom of Bahrain. All medical records of the participants were reviewed and entered the study. According to the implemented procedures, medical records were categorized into two chorionic villus sampling (CVS) and amniocentesis groups. The study subject will include indications of the procedures which are advanced maternal age, hematological disorders, genetic disorders, metabolic disorders, abnormal structural findings in fetal ultrasound and previous child with aneuploidy. In addition, the study will address the complications, outcome and results of procedures. Results: About half of our indications of the procedures were due to hematological disorders (47.6%) followed by abnormal structural findings in fetal ultrasound (30.1%) then genetic disorders (15.7%), metabolic disorders (4.8%) and advanced maternal age (1.8%). Regarding complications of the procedure;threatened miscarriage or loss of pregnancy within 3 weeks was (2.3%), amniotic fluid leakage (0.7%), abdominal cramps (0.7%) and Insufficient or contaminated sample (6.2%). Regarding outcome of the pregnancy, our results showed that the loss of pregnancy was (4.8%), intrauterine fetal death or still birth was (13.9%), live birth was (63.9%), preterm delivery was (7.8%), preterm premature rupture of membrane (PPROM) was (1.8%), limbs reduction was (0.0%). Termination of pregnancy outside the country was (7.8%) of chorionic villus sampling and amniocentesis. Conclusion: CVS and amniocentesis are useful outpatient procedures to detect diagnosis or to assess whether a patient is at increased risk of having an affected fetus and that will minimize the psychological impact on the patient and to provide a proper antenatal care to the pregnant women by her obstetrician and follow up to the baby by pediatrician. In this study it was observed that most of the patients who underwent the procedure were couples either carrier or affected to sickle cell disease or Beta thalassemia.
文摘This paper primarily concerns the effective coordination of the procedures and methods employed in open pit mining operations under the background of river management.The central objective of this study is to identify a viable approach for ensuring rational and efficient development of open pit mineral resources while simultaneously protecting and restoring the ecological environment of the river.This approach should facilitate the realization of a harmonious symbiosis between mining and river management.The intricate mutual influence relationship between river management and open pit mining is first analyzed in depth,which provides a solid foundation for the subsequent coordination strategy development.In light of the aforementioned considerations,a set of coordination procedures for open pit mining based on river management conditions is proposed.These procedures emphasize the integration of river protection into the overall layout of mining at the planning stage.The implementation of scientific mining schemes,accompanied by rigorous control of the scope and depth of mining operations,has proven to be an effective means of reducing the impact of mining activities on river environments.This approach has also facilitated the achievement of a balance and coordination between mining and river management.
基金supported by funding from the Medical Research Funding of Guangdong(No.A2022499 to QGX)the National Natural Science Foundation of China(No.82301796 to PL)the Guangdong Province Regional Joint Fund-Youth Fund Project of China(No.2022A1515111201 to PL).
文摘This study aimed to introduce a modified Byars staged procedure and investigate its application value in patients with severe hypospadias.We retrospectively analyzed the clinical data of patients with severe hypospadias admitted to the First Affiliated Hospital of Sun Yat-sen University(Guangzhou,China)between October 2012 and October 2022.In total,31 patients underwent the conventional Byars procedure(conventional group),and 45 patients underwent the modified Byars staged procedure(modified group).Our modified strategy was built upon the standard Byars procedure by incorporating glansplasty during the first stage and employing a Y-shaped flap in conjunction with a glandular tunnel for urethroplasty during the second stage.Notably,there were no statistically significant differences in the preoperative baseline characteristics,duration of surgery,amount of blood loss,or occurrence of postoperative complications,including urethral fistula,stricture and diverticulum,or penile curvature,between the conventional and modified groups.However,there was a significantly lower incidence of coronal sulcus fistula(0 vs 16.1%,P=0.02)and glans dehiscence(0 vs 12.9%,P=0.02)in the surgical group than that in the conventional group.In addition,the modified group exhibited a notably greater rate of normotopic urethral opening(100.0%vs 83.9%,P=0.01)and a higher mean score on the Hypospadias Objective Penile Evaluation(HOPE;mean±standard error of mean:8.6±0.2 vs 7.9±0.3,P=0.02)than did the conventional group.In conclusion,the modified Byars staged procedure significantly reduced the risks of glans dehiscence and coronal sulcus fistula.Consequently,it offers a promising approach for achieving favorable penile esthetics,thereby providing a reliable therapeutic option for severe hypospadias.
文摘BACKGROUND In open heart surgery requiring cardiopulmonary bypass(CPB),ventricular fibrillation(VF)is common,but refractory recurrent VF is uncommon but perilous.CASE SUMMARY This article reports a 58-year-old male patient with an ascending aortic aneurysm who presented for a Bentall procedure and subsequently experienced multiple occurrences of unexplained VF after weaning from CPB.The recurrent episodes of VF in this case were felt to be related to coronary insufficiency after reconstruction of the aortic root.Coronary artery bypass grafting(CABG)of the proximal right coronary artery and the left anterior descending artery successfully resolved VF.Finally,this patient was safely transferred to the postoperative intensive care unit,and was discharged successfully after subsequent supportive treatment.CONCLUSION In aortic root replacement,coronary insufficiency is a potential cause of VF episodes and should be considered in the differential diagnosis.CABG is the sole effective treatment for VF caused by coronary insufficiency.
文摘Peroral endoscopic myotomy(POEM)has revolutionized the treatment of upper gastrointestinal tract motility disorders,particularly achalasia.This editorial explores the efficacy,safety,and challenges of POEM,emphasizing its role as a primary treatment with excellent long-term outcomes and minimal adverse events.The evolution of POEM underscores the need for precision in myotomy techniques and the importance of interdisciplinary collaboration,especially regar-ding anesthetic considerations.Despite significant advances,challenges remain in standardizing safety protocols and managing complications.As POEM appli-cations expand,precision endoscopy continues to enhance therapeutic outcomes,promising a transformative impact on gastrointestinal motility disorder manage-ment.
文摘Practical jurisprudence is a completely new proposition in legal education and research.The introduction of the concept of“practical jurisprudence”in the teaching of the Civil Procedure Law of the People’s Republic of China(the“Civil Procedure Law”)is a major innovation in terms of values and methodology.Practical jurisprudence focuses more on practical issues,Chinese characteristics,and major needs,while strengthening the practical nature of the Civil Procedure Law.China’s traditional education system for juris masters(for non-law graduates)(“non-law JMs”)emphasizes the development of foundational legal theoretical knowledge.However,it has not fully achieved its goal of cultivating interdisciplinary and practical legal professionals.Therefore,the traditional education system for the Civil Procedure Law needs reconstruction and supplementation through the practical jurisprudence teaching system in the following areas:(a)System composition:The focus should be on the eight tertiary subsystems under the two secondary subsystems—“the knowledge teaching system and the practical teaching system”of practical jurisprudence in the Civil Procedure Law,as well as the management of their interrelationships.(b)Credit structure:The proportion of credits for“practical teaching and training”should be increased.(c)Practical ability requirements:Legal professionals should be cultivated according to the standards for juris masters(for law graduates)as stipulated by the Law of the People’s Republic of China on Academic Degrees.(d)Practice evaluation:“Formalization of the evaluations,”“homogeneity of the evaluators,”and“reliance on written formats”should be avoided.
文摘Dear Editor,We report a relatively safe and effective triple procedure for traumatic aphakia,glaucoma,and mydriasis.Blunt eye trauma can lead to various anterior-and posterior-segment conditions[1],that often occur simultaneously.Closed-globe injuries can damage one or more ocular structures.
基金Supported by 2023 Key R&D Projects of Tongji University,No.150029607160-24323Industrial Key Program Foundation of Guangdong Province:R&D of Natural Novel Anticancer Drugs,No.2004B10401033。
文摘BACKGROUND Recently,the identification of cell apoptosis induced by natural products has become research hotspot and frontier in the biopharmaceutical and food industries under the umbrella of global green development worldwide.Traditionally,cell apoptosis is identified using morphological,biochemical,and cell cycle experiments,which is time consuming,and experimental materials are not from the same group,and it is very hard to ensure the identity and veracity of results of former and latter experiments.AIM To establish a selective,instant,and practical protocol to identify cell apoptosis induced by natural products.METHODS A one transient cell processing procedure(OTCPP)was used to detect human colorectal cancer LoVo cell apoptosis after treatment with Pinus massoniana bark extract(PMBE)at the morphological,biochemical,and cell cycle levels.The methods used included treatment with DNA gel electrophoresis,fluorescence microscopy,and flow cytometry.RESULTS In PMBE-treated LoVo cells,we observed a DNA ladder on gel electrophoresis and fluorescence microscopy revealed"nuclear shrinkage,chromatin condensation or fragmentation".In addition,flow cytometry showed an"obvious apoptosis curve".Thus OTCPP achieved synchronous detection of the morphology,biochemistry,cell cycle,and the DNA content of the cells.CONCLUSION OTCPP can quickly identify apoptosis and measure the apoptosis rate,thereby unifying qualitative and quantitative analysis.
基金supported by the Russian Science Foundation,Russia(Grant No.24-24-00031).
文摘In this study,we searched for dispersed repeats(DRs)in the rice(Oryza sativa)genome using the iterative procedure(IP)method.The results revealed that the O.sativa genome contained 79 DR families,comprising 992739 DNA repeats,of which 496762 and 495977 were identified on the forward and reverse DNA strands,respectively.The detected DRs were,on average,374 bp in length and occupied 66.4%of the O.sativa genome.Totally 61%of DRs,identified by the IP method,overlapped with previously annotated dispersed repeats(ADRs)detected using the Extensive De Novo TE Annotator(EDTA)pipeline.
文摘Objective: To evaluate the procedures and timing of operation as well as long-term postoperative effect of congenital choledochal cysts (CCC) in adults. Methods: The procedures and timing of operation, effective rate, re-operation rate and incidence of car- cinoma after operation for 70 adult patients with CCC from January 1980 to June 1999 were analyzed retrospectively. Results: The re-operation rate of external drainage was 86% (6/7). The effective rate of internal drain- age was significantly lower than that of cyst resection (3/10 vs 45/49, X^2=20. 94, P<0.001). The re-op- eration rate and incidence of carcinoma of internal drainage were higher than those of cyst resection (5/ 10 vs 3/49, X^2=13. 64, P<0. 001 and 3/10 vs 3/49, X^2=5. 18, P<0. 025). The reoperation rate of e- mergency surgery was higher than that of selective operation (8/10 vs 6/56, X^2=24. 37, P<0.001). Conclusions: External drainage should be the first- aid measure and the therapy of choice on emergency basis. Internal drainage should never be attempted. Cyst resection with Roux-en-Y hepaticojejunostomy is recommended as the treatment of choice in selective operation.
文摘In order to promote efficient communication between nurses in Beijing hospitals and foreign patients, EOP (English for Occupational Purposes) courses specifically for nurses are demanded. This paper introduces the main procedures for setting up an EOP course for nurses in Beijing.
基金Project supported by the Outstanding Youth Fund of National Natural Science Foundation of China, the National Key Basic Research Support Foundation (NKBRSF) of China (No. 2002CB410805) and the Federal Ministry of Education and Research, Germany.
文摘Two procedures were compared for extraction and clean-up of 20organophosphorus and 19 pyrethroid pesticides in sediment to identify the more effective procedurefor groups of pesticides or individual compounds. In Procedure I, methanol/water and n-hexane wereused for extraction, and 1:10 (v/v) dichloromethane in n-hexane and acetone were used as eluents foreluting the analyte through the cartridge, with one evaporating steps on a rotary evaporator andtwo eluting steps on the cartridge. n-hexane/acetone (2:1, v/v) was used for extraction and elutionin Procedure II with one evaporating step on a rotary evaporator and one eluting step on thecartridge. All extractions were performed under an ultrasonic bath and gas chromatography and massspectrometry were utilized for measurements. Procedure II was developed as a rapid, timesaving, lesscostly and safer substitute for Procedure I which was an old method. Procedure II was moreeffective for almost all the organophosphorus pesticides tested and 11of the 19 pyrethroidpesticides, while Procedure I was more appropriate for analysis of 5 pyrethroid pesticides. However,recoveries of most pyrethroid pesticides were fairly low. Thus, further studies should focus onadjustment and formulation of solvents for more efficient extraction and clean-up of pyrethroidpesticides from sediment samples.
文摘Endoscopic retrograde cholangiopancreatography(ERCP) is one of the most frequently used image-guided procedures in gastrointestinal endoscopy. Post-ERCP pancreatitis is an important concern, and prophylaxis, cannulation and other related technical procedures have been well documented by endoscopists. In addition, medical radiation exposure is of great concern in the general population because of its rapidly increasing frequency and its potential carcinogenic effects. International organizations and radiological societies have established diagnostic reference levels, which guide proper radiation use and serve as global standards for all procedures that use ionizing radiation. However, data on gastrointestinal fluoroscopic procedures are still lacking because the demand for these procedures has recently increased. In this review, we present the current status of quality indicators for ERCP and the methods for measuring radiation exposure in the clinical setting as the next quality indicator for ERCP. To reduce radiation exposure, knowledge of its adverse effects and the procedures for proper measurement and protection are essential. Additionally, further studies on the factors that affect radiation exposure, exposure management and diagnostic reference levels are necessary. Then, we can discuss how to manage medical radiation use inthese complex fluoroscopic procedures. This knowledge will help us to protect not only patients but also endoscopists and medical staff in the fluoroscopy unit.
文摘Some research results are given in this paper about burnthrough and hydrogen cracking with a flowing chamber and a loop. Many factors including plate thickness, running rate, heat input and so forth have been studied. By experiments it can be found that occurrence of hydrogen cracking can be effectively reduced by properly increasing heat input and using the tempering bead technique.
