主题语境:好人好事篇幅:343词建议用时:7分钟.1 Last August,I came across my best friend whom I hadn't seen for several years.We attended a friend's wedding in Germany(neither of us live there).Her flight home was...主题语境:好人好事篇幅:343词建议用时:7分钟.1 Last August,I came across my best friend whom I hadn't seen for several years.We attended a friend's wedding in Germany(neither of us live there).Her flight home was several hours before mine so I went with her to the airport to see her off and then had to hang around Frankfurt airport about an entire day waiting for my own flight.展开更多
AIM:To assess the effect of the coronavirus disease 2019(COVID-19)pandemic on the wait times and severity of surgical glaucoma cases in a single tertiary referral center in Quebec,Canada.METHODS:Preoperative severity ...AIM:To assess the effect of the coronavirus disease 2019(COVID-19)pandemic on the wait times and severity of surgical glaucoma cases in a single tertiary referral center in Quebec,Canada.METHODS:Preoperative severity data included mean visual field(VF)deficit,intraocular pressure(IOP),the number of topical glaucoma medication classes,and preoperative best corrected visual acuity(BCVA).The times from referral to procedure(referral time)and from listing date to procedure(waitlisting time)were calculated.RESULTS:This retrospective cohort study involved 181 eyes of patients undergoing glaucoma surgery from March 1 to June 30,2019(pre-pandemic period),and 201 eyes in the same timeframe in 2021(pandemic period)at Saint-Sacrement Hospital in Quebec City.There was no significant difference in the severity data of surgical glaucoma across both periods(VF deficit:P=0.48;IOP:P=0.14;BCVA:P=0.24;topical medication classes:P=0.27).The number of patients referred with oral glaucoma medication increased slightly from 45 to 70 in 2019 and 2021 respectively(P=0.08).Delay data were also comparable.Mean referral time was 122±120d in 2019 versus 144±136d in 2021(P=0.09),whereas waitlisting time before the pandemic was 43±44.5 versus 39±41.8d in 2021(P=0.13).CONCLUSION:Despite North America’s strictest pandemic restrictions,limited negative impact is observed on waitlisting delays and the severity of glaucoma cases presenting at our center.A larger subset of patients is treated with oral medications indicating a possible increase in advanced glaucoma.展开更多
1.Introduction Hepatocellular carcinoma(HCC)is the most common primary malignancy of the liver.HCC is the sixth most frequently diagnosed cancer and the third leading cause of cancer-relatedmortality worldwide.[1]Part...1.Introduction Hepatocellular carcinoma(HCC)is the most common primary malignancy of the liver.HCC is the sixth most frequently diagnosed cancer and the third leading cause of cancer-relatedmortality worldwide.[1]Partial hepatectomy is recommended for patients with early stage HCC.[2]A large proportion of patients with HCC inChina are diagnosed in the intermediate to advanced HCC stages,rendering them ineligible for hepatectomy due to aspects such as liver dysfunction,insufficient residual liver volume,or surgical technique.展开更多
The treatment of locally advanced rectal cancer(LARC)has evolved significantly over the past century,driven by a deeper understanding of tumor biology,technological advancements,and multidisciplinary approaches.This a...The treatment of locally advanced rectal cancer(LARC)has evolved significantly over the past century,driven by a deeper understanding of tumor biology,technological advancements,and multidisciplinary approaches.This article reviews the historical progression of LARC management,emphasizing the latest breakthroughs that are reshaping treatment paradigms.Key developments include the watch and wait strategy for patients achieving a complete clinical response after neoadjuvant therapy,the emergence of total neoadjuvant therapy as a standard approach,and the adoption of minimally invasive surgical techniques,such as transanal endoscopic microsurgery.Watch and wait may reduce treatment-related morbidity and help preserve anorectal function,but it requires rigorous patient selection and close long-term surveillance to ensure oncologic safety.Additionally,the role of targeted therapies and immunotherapy is gaining prominence,offering new opportunities for personalized treatment.These innovations aim to improve oncological outcomes while minimizing morbidity and preserving organ function,ultimately enhancing patients’quality of life.Despite these advancements,challenges remain in optimizing patient selection,refining treatment strategies,and ensuring long-term safety and efficacy.A multidisciplinary approach involving surgeons,oncologists,and radiation specialists is crucial to tailoring therapies to individual patient profiles.As research continues,integrating novel therapeutic strategies will be key to further improving survival rates and reducing treatment-related morbidity in LARC patients.展开更多
Incidental asymptomatic gallstone disease(AGD)is prevalent,but its management remains contentious.Old-fashioned conservative care is under scrutiny today with precision medicine and artificial intelligence(AI)on the h...Incidental asymptomatic gallstone disease(AGD)is prevalent,but its management remains contentious.Old-fashioned conservative care is under scrutiny today with precision medicine and artificial intelligence(AI)on the horizon.Unlike previous overviews,this review primarily focuses on clinical outcomes,surgical decision-making,and the integration of genomics,predictive analytics,and precision tools into AGD management.We emphasise how AI-based models and precision diagnostics enable tailored recommendations,preventing unnecessary cholecystectomy in low-risk patients while requiring early elective surgery in high-risk subgroups(e.g.,single large stones,polyps,endemic cancer areas).We also compare cost-effectiveness,surgical safety,and quality of life(QoL)measures within this precision strategy.Our vision is to overcome the binary"operate or observe"model by leveraging technology-enabled forecasting and collaborative decision-making to deliver future-proof care for AGD.The terminology of asymptomatic gallstones was used more meticulously in the era of open cholecystectomy,when neither the diagnostic tools nor the concept of minimal access surgery were available.After careful consideration of the evidence on natural history,risk of surgery,QoL,and cost,we recommend that clinicians utilise shared decision-making and present information regarding cholecystectomy as an intervention option to all patients with asymptomatic gallstones.展开更多
Delay tolerant wireless sensor networks(DTWSN)is a class of wireless network that finds its deployment in those application scenarios which demand for high packet delivery ratio while maintaining minimal overhead in o...Delay tolerant wireless sensor networks(DTWSN)is a class of wireless network that finds its deployment in those application scenarios which demand for high packet delivery ratio while maintaining minimal overhead in order to prolong network lifetime;owing to resource-constrained nature of sensors.The fundamental requirement of any network is routing a packet from its source to destination.Performance of a routing algorithm depends on the number of network parameters utilized by that routing protocol.In the recent years,various routing protocol has been developed for the delay tolerant networks(DTN).A routing protocol known as spray and wait(SnW)is one of the most widely used routing algorithms for DTN.In this paper,we study the SnW routing protocol and propose a modified version of it referred to as Pentago SnW which is based on pentagonal number series.Comparison to binary SnW shows promising results through simulation using real-life scenarios of cars and pedestrians randomly moving on a map.展开更多
Federated learning combined with edge computing has greatly facilitated transportation in real-time applications such as intelligent traffic sys-tems.However,synchronous federated learning is in-efficient in terms of ...Federated learning combined with edge computing has greatly facilitated transportation in real-time applications such as intelligent traffic sys-tems.However,synchronous federated learning is in-efficient in terms of time and convergence speed,mak-ing it unsuitable for high real-time requirements.To address these issues,this paper proposes an Adap-tive Waiting time Asynchronous Federated Learn-ing(AWTAFL)based on Dueling Double Deep Q-Network(D3QN).The server dynamically adjusts the waiting time using the D3QN algorithm based on the current task progress and energy consumption,aim-ing to accelerate convergence and save energy.Addi-tionally,this paper presents a new federated learning global aggregation scheme,where the central server performs weighted aggregation based on the freshness and contribution of client parameters.Experimen-tal simulations demonstrate that the proposed algo-rithm significantly reduces the convergence time while ensuring model quality and effectively reducing en-ergy consumption in asynchronous federated learning.Furthermore,the improved global aggregation update method enhances training stability and reduces oscil-lations in the global model convergence.展开更多
针对基于社区的机会网络路由算法存在的消息无序发送和过期消息管理效率不高等难题,提出一种基于高效缓存管理机制的可靠消息传输机会网络路由算法RMTEB(Reliable Message Transmission Routing Algorithm for Opportunistic Networks B...针对基于社区的机会网络路由算法存在的消息无序发送和过期消息管理效率不高等难题,提出一种基于高效缓存管理机制的可靠消息传输机会网络路由算法RMTEB(Reliable Message Transmission Routing Algorithm for Opportunistic Networks Based on Efficient Buffer Management Mechanism)。引入Spray and Wait机制,设计消息传输策略,对消息发送顺序、缓存清除机制以及消息转发机制进行优化,以确保携带消息节点在有限通信时间内向邻居节点转发更多的消息,节点相遇后,判断缓存中过期消息的目标节点是否为当前邻居节点,是则将消息发送给对方,否则删除;通过调整发送给目标节点为邻居节点的消息顺序,优先发送生存期剩余时间小的消息,显著提高消息传输效率,降低传输时延。仿真结果表明,RMTEB算法在传输成功率、平均端到端时延、路由开销比率和平均存储时间等方面均优于经典的Prophet routing算法及其改进算法Social Groups Based Routing(SGBR)。展开更多
Introduction: Studies have shown Emergency Department (ED) crowding contributes to reduced quality of patient care, delays in starting treatments, and increased number of patients leaving without being seen. This anal...Introduction: Studies have shown Emergency Department (ED) crowding contributes to reduced quality of patient care, delays in starting treatments, and increased number of patients leaving without being seen. This analysis shows how to theoretically and optimally align staffing to demand. Methods: The ED value stream was identified and mapped. Patients were stratified into three resource-driven care flow cells based on the severity indices. Time observations were conducted for each of the key care team members and the manual cycle times and service rate were calculated and stratified by severity indices. Using X32 Healthcare’s Online Staffing Optimization (OSO) tool, staffing inefficiencies were identified and an optimal schedule was created for each provider group. Results: Lower Severity Indices (higher acuity patient) led to longer times for providers, nurses, patient care assistants, and clerks. The patient length of stay varied from under one hour to over five hours. The flow of patients varied considerably over the 24 hours’ period but was similar by day of the week. Using flow data, we showed that we needed more nurses, more care team members during peak times of patient flow. Eight hour shifts would allow better flexibility. We showed that the additional salary hours added to the budget would be made up for by increased revenue recognized by decreasing the number of patients who leave without being seen. Conclusion: If implemented, these changes will improve ED flow by using lean tools and principles, ultimately leading to timeliness of care, reduced waits, and improved patient experience.展开更多
Shoppers,crowding into the West End of Londonyesterday for the start of sales,answered demands fromthe police to use public transportation rather than theircars.They also decided not to invite danger,after thebursting...Shoppers,crowding into the West End of Londonyesterday for the start of sales,answered demands fromthe police to use public transportation rather than theircars.They also decided not to invite danger,after thebursting of a bomb in the West End on Christmasevening,by not waiting in line outside the shops.“Iwould have been very worried of what they had.”saidMr Harry Weblin,manager of Liberty’s.Last night the police,which operated a big actionincluding special searches outside the main shops,spoke highly of the common sense of the展开更多
上期的第二个话题“跳槽”是目前普遍存在的现象,对此人们看法不一。有些人认为这在国外并非什么新鲜事,中国人也开始这样做说明人们的思想解放了.打破了过去那种在一个单位干一辈子的传统观念.这是社会的进步。也有人把“跳槽”看做是...上期的第二个话题“跳槽”是目前普遍存在的现象,对此人们看法不一。有些人认为这在国外并非什么新鲜事,中国人也开始这样做说明人们的思想解放了.打破了过去那种在一个单位干一辈子的传统观念.这是社会的进步。也有人把“跳槽”看做是人的私欲膨胀,是对金钱和物质利益的过分追求,不利于一个企业或部门的发展,不应提倡。考生如同意后一种观点就可以说:“I don’t think it is reasonable for aperson to change his(her)job frequently.A展开更多
Teacher questioning strategy is one of popular teaching method in teaching practice.The teachers and students of college English course II was taken as investigate objects in this study.This study will focus on the pr...Teacher questioning strategy is one of popular teaching method in teaching practice.The teachers and students of college English course II was taken as investigate objects in this study.This study will focus on the problems of questioning frequency,questioning types,questioning strategies,waiting time and students’response to deeply study this situation.Through the data collection and analysis,the researcher hopes the study will deeply reveal the real situation of teacher questioning usage in Honghe University.Some referential suggestions will be offered to the college English teachers for their future teaching.展开更多
As an important representative of the Theatre of Absurd, in his masterpiece Waiting for Godot, Beckett deserted the traditional dramatic form and adopted a new one that shows us the fragmentary characters and the absu...As an important representative of the Theatre of Absurd, in his masterpiece Waiting for Godot, Beckett deserted the traditional dramatic form and adopted a new one that shows us the fragmentary characters and the absurdity of the modern society. This paper demonstrates his artful creation of the language form from the following three aspects: The use of repetition, use of silence and pause and short sentences.展开更多
文摘主题语境:好人好事篇幅:343词建议用时:7分钟.1 Last August,I came across my best friend whom I hadn't seen for several years.We attended a friend's wedding in Germany(neither of us live there).Her flight home was several hours before mine so I went with her to the airport to see her off and then had to hang around Frankfurt airport about an entire day waiting for my own flight.
文摘AIM:To assess the effect of the coronavirus disease 2019(COVID-19)pandemic on the wait times and severity of surgical glaucoma cases in a single tertiary referral center in Quebec,Canada.METHODS:Preoperative severity data included mean visual field(VF)deficit,intraocular pressure(IOP),the number of topical glaucoma medication classes,and preoperative best corrected visual acuity(BCVA).The times from referral to procedure(referral time)and from listing date to procedure(waitlisting time)were calculated.RESULTS:This retrospective cohort study involved 181 eyes of patients undergoing glaucoma surgery from March 1 to June 30,2019(pre-pandemic period),and 201 eyes in the same timeframe in 2021(pandemic period)at Saint-Sacrement Hospital in Quebec City.There was no significant difference in the severity data of surgical glaucoma across both periods(VF deficit:P=0.48;IOP:P=0.14;BCVA:P=0.24;topical medication classes:P=0.27).The number of patients referred with oral glaucoma medication increased slightly from 45 to 70 in 2019 and 2021 respectively(P=0.08).Delay data were also comparable.Mean referral time was 122±120d in 2019 versus 144±136d in 2021(P=0.09),whereas waitlisting time before the pandemic was 43±44.5 versus 39±41.8d in 2021(P=0.13).CONCLUSION:Despite North America’s strictest pandemic restrictions,limited negative impact is observed on waitlisting delays and the severity of glaucoma cases presenting at our center.A larger subset of patients is treated with oral medications indicating a possible increase in advanced glaucoma.
文摘1.Introduction Hepatocellular carcinoma(HCC)is the most common primary malignancy of the liver.HCC is the sixth most frequently diagnosed cancer and the third leading cause of cancer-relatedmortality worldwide.[1]Partial hepatectomy is recommended for patients with early stage HCC.[2]A large proportion of patients with HCC inChina are diagnosed in the intermediate to advanced HCC stages,rendering them ineligible for hepatectomy due to aspects such as liver dysfunction,insufficient residual liver volume,or surgical technique.
文摘The treatment of locally advanced rectal cancer(LARC)has evolved significantly over the past century,driven by a deeper understanding of tumor biology,technological advancements,and multidisciplinary approaches.This article reviews the historical progression of LARC management,emphasizing the latest breakthroughs that are reshaping treatment paradigms.Key developments include the watch and wait strategy for patients achieving a complete clinical response after neoadjuvant therapy,the emergence of total neoadjuvant therapy as a standard approach,and the adoption of minimally invasive surgical techniques,such as transanal endoscopic microsurgery.Watch and wait may reduce treatment-related morbidity and help preserve anorectal function,but it requires rigorous patient selection and close long-term surveillance to ensure oncologic safety.Additionally,the role of targeted therapies and immunotherapy is gaining prominence,offering new opportunities for personalized treatment.These innovations aim to improve oncological outcomes while minimizing morbidity and preserving organ function,ultimately enhancing patients’quality of life.Despite these advancements,challenges remain in optimizing patient selection,refining treatment strategies,and ensuring long-term safety and efficacy.A multidisciplinary approach involving surgeons,oncologists,and radiation specialists is crucial to tailoring therapies to individual patient profiles.As research continues,integrating novel therapeutic strategies will be key to further improving survival rates and reducing treatment-related morbidity in LARC patients.
文摘Incidental asymptomatic gallstone disease(AGD)is prevalent,but its management remains contentious.Old-fashioned conservative care is under scrutiny today with precision medicine and artificial intelligence(AI)on the horizon.Unlike previous overviews,this review primarily focuses on clinical outcomes,surgical decision-making,and the integration of genomics,predictive analytics,and precision tools into AGD management.We emphasise how AI-based models and precision diagnostics enable tailored recommendations,preventing unnecessary cholecystectomy in low-risk patients while requiring early elective surgery in high-risk subgroups(e.g.,single large stones,polyps,endemic cancer areas).We also compare cost-effectiveness,surgical safety,and quality of life(QoL)measures within this precision strategy.Our vision is to overcome the binary"operate or observe"model by leveraging technology-enabled forecasting and collaborative decision-making to deliver future-proof care for AGD.The terminology of asymptomatic gallstones was used more meticulously in the era of open cholecystectomy,when neither the diagnostic tools nor the concept of minimal access surgery were available.After careful consideration of the evidence on natural history,risk of surgery,QoL,and cost,we recommend that clinicians utilise shared decision-making and present information regarding cholecystectomy as an intervention option to all patients with asymptomatic gallstones.
文摘Delay tolerant wireless sensor networks(DTWSN)is a class of wireless network that finds its deployment in those application scenarios which demand for high packet delivery ratio while maintaining minimal overhead in order to prolong network lifetime;owing to resource-constrained nature of sensors.The fundamental requirement of any network is routing a packet from its source to destination.Performance of a routing algorithm depends on the number of network parameters utilized by that routing protocol.In the recent years,various routing protocol has been developed for the delay tolerant networks(DTN).A routing protocol known as spray and wait(SnW)is one of the most widely used routing algorithms for DTN.In this paper,we study the SnW routing protocol and propose a modified version of it referred to as Pentago SnW which is based on pentagonal number series.Comparison to binary SnW shows promising results through simulation using real-life scenarios of cars and pedestrians randomly moving on a map.
基金supported by the National Natural Science Foundation of China(62371082)Guangxi Science and Technology Project(AB24010317)+1 种基金Science and Technology Project of Chongqing Education Commission(KJZD-K202400606)Natural Science Foundation of Chongqing(CSTB2023NSCQ-MSX0726,CSTB2023NSCQ-LZX0014).
文摘Federated learning combined with edge computing has greatly facilitated transportation in real-time applications such as intelligent traffic sys-tems.However,synchronous federated learning is in-efficient in terms of time and convergence speed,mak-ing it unsuitable for high real-time requirements.To address these issues,this paper proposes an Adap-tive Waiting time Asynchronous Federated Learn-ing(AWTAFL)based on Dueling Double Deep Q-Network(D3QN).The server dynamically adjusts the waiting time using the D3QN algorithm based on the current task progress and energy consumption,aim-ing to accelerate convergence and save energy.Addi-tionally,this paper presents a new federated learning global aggregation scheme,where the central server performs weighted aggregation based on the freshness and contribution of client parameters.Experimen-tal simulations demonstrate that the proposed algo-rithm significantly reduces the convergence time while ensuring model quality and effectively reducing en-ergy consumption in asynchronous federated learning.Furthermore,the improved global aggregation update method enhances training stability and reduces oscil-lations in the global model convergence.
基金the Australian large ARC grants No.DP0449535DP0559536 and DP0667060(澳大利亚ARC项目)+4 种基金the Key Project of National Natural Science Foundation of China under Grant No.60496327(国家自然科学基金重大项目)the National Natural Science Foundation of China under Grant No.60463003(国家自然科学基金)the Overseas-Returning High-level Talent Research Pro-gram of Human-Resource Ministry of China(人事部(2004-2005年度首批)海外高层次留学人才回国资助项目)the Innovation Project of Guangxi Graduate Education No.2006106020812M35(广西研究生教育创新计划资助项目).
文摘针对基于社区的机会网络路由算法存在的消息无序发送和过期消息管理效率不高等难题,提出一种基于高效缓存管理机制的可靠消息传输机会网络路由算法RMTEB(Reliable Message Transmission Routing Algorithm for Opportunistic Networks Based on Efficient Buffer Management Mechanism)。引入Spray and Wait机制,设计消息传输策略,对消息发送顺序、缓存清除机制以及消息转发机制进行优化,以确保携带消息节点在有限通信时间内向邻居节点转发更多的消息,节点相遇后,判断缓存中过期消息的目标节点是否为当前邻居节点,是则将消息发送给对方,否则删除;通过调整发送给目标节点为邻居节点的消息顺序,优先发送生存期剩余时间小的消息,显著提高消息传输效率,降低传输时延。仿真结果表明,RMTEB算法在传输成功率、平均端到端时延、路由开销比率和平均存储时间等方面均优于经典的Prophet routing算法及其改进算法Social Groups Based Routing(SGBR)。
文摘Introduction: Studies have shown Emergency Department (ED) crowding contributes to reduced quality of patient care, delays in starting treatments, and increased number of patients leaving without being seen. This analysis shows how to theoretically and optimally align staffing to demand. Methods: The ED value stream was identified and mapped. Patients were stratified into three resource-driven care flow cells based on the severity indices. Time observations were conducted for each of the key care team members and the manual cycle times and service rate were calculated and stratified by severity indices. Using X32 Healthcare’s Online Staffing Optimization (OSO) tool, staffing inefficiencies were identified and an optimal schedule was created for each provider group. Results: Lower Severity Indices (higher acuity patient) led to longer times for providers, nurses, patient care assistants, and clerks. The patient length of stay varied from under one hour to over five hours. The flow of patients varied considerably over the 24 hours’ period but was similar by day of the week. Using flow data, we showed that we needed more nurses, more care team members during peak times of patient flow. Eight hour shifts would allow better flexibility. We showed that the additional salary hours added to the budget would be made up for by increased revenue recognized by decreasing the number of patients who leave without being seen. Conclusion: If implemented, these changes will improve ED flow by using lean tools and principles, ultimately leading to timeliness of care, reduced waits, and improved patient experience.
文摘Shoppers,crowding into the West End of Londonyesterday for the start of sales,answered demands fromthe police to use public transportation rather than theircars.They also decided not to invite danger,after thebursting of a bomb in the West End on Christmasevening,by not waiting in line outside the shops.“Iwould have been very worried of what they had.”saidMr Harry Weblin,manager of Liberty’s.Last night the police,which operated a big actionincluding special searches outside the main shops,spoke highly of the common sense of the
文摘上期的第二个话题“跳槽”是目前普遍存在的现象,对此人们看法不一。有些人认为这在国外并非什么新鲜事,中国人也开始这样做说明人们的思想解放了.打破了过去那种在一个单位干一辈子的传统观念.这是社会的进步。也有人把“跳槽”看做是人的私欲膨胀,是对金钱和物质利益的过分追求,不利于一个企业或部门的发展,不应提倡。考生如同意后一种观点就可以说:“I don’t think it is reasonable for aperson to change his(her)job frequently.A
文摘Teacher questioning strategy is one of popular teaching method in teaching practice.The teachers and students of college English course II was taken as investigate objects in this study.This study will focus on the problems of questioning frequency,questioning types,questioning strategies,waiting time and students’response to deeply study this situation.Through the data collection and analysis,the researcher hopes the study will deeply reveal the real situation of teacher questioning usage in Honghe University.Some referential suggestions will be offered to the college English teachers for their future teaching.
文摘As an important representative of the Theatre of Absurd, in his masterpiece Waiting for Godot, Beckett deserted the traditional dramatic form and adopted a new one that shows us the fragmentary characters and the absurdity of the modern society. This paper demonstrates his artful creation of the language form from the following three aspects: The use of repetition, use of silence and pause and short sentences.
