目的:系统评价培土生金中药联合西医常规疗法治疗支气管哮喘缓解期肺脾两虚证的疗效以及证据质量,为临床决策及疾病指南制订提供循证依据。方法:检索中国知网(CNKI)、万方数据库(Wangfang)、Pubmed、Web of Science等8大中英文数据库,由...目的:系统评价培土生金中药联合西医常规疗法治疗支气管哮喘缓解期肺脾两虚证的疗效以及证据质量,为临床决策及疾病指南制订提供循证依据。方法:检索中国知网(CNKI)、万方数据库(Wangfang)、Pubmed、Web of Science等8大中英文数据库,由2名研究者独立进行文献筛选、信息提取、偏倚风险评估及方法学质量评价,并对纳入研究的总有效率、中医证候积分、第一秒用力呼气容积(FEV1)、第一秒用力呼气容积/用力肺活量(FEV1/FVC)、哮喘控制测试(ACT)评分等结局指标进行Meta分析,最终依照GRADE评估证据质量。结果:共纳入14项研究,合计1263例患者。结果显示:(1)培土生金中药联合常规西医疗法可有效改善患者总有效率,降低患者中医证候积分,改善患者FEV1水平、FEV1/FVC及ACT评分。(2)总有效率证据质量较优,可信度高,其余指标证据质量较低,尚待更多高质量的研究支持以提升证据级别。结论:培土生金中药联合西医常规疗法治疗支气管哮喘缓解期肺脾两虚证优于单用西医常规治疗,且在总有效率上证据质量较高,具有一定的循证学意义。展开更多
Functionally graded cellular structures(FGCSs)have a multitude of applications to a wide range of industries.Utilising the ever-progressing technology of additive manufacturing(AM),FGCSs can be applied to control mate...Functionally graded cellular structures(FGCSs)have a multitude of applications to a wide range of industries.Utilising the ever-progressing technology of additive manufacturing(AM),FGCSs can be applied to control material grading and achieve the desired mechanical properties.The current study explores the design and optimisation of FGCSs for AM,with a focus on improving the compression and impact performance of below knee(BK)prosthetic limbs made of thermoplastic polyurethane(TPU).A multiscale research methodology integrating topology optimization(TO),finite element analysis(FEA),and design of experiments(Do E)was adopted to optimise lattice structures in terms of stiffness and lightweight properties.Two-unit cell designs were considered in the study:Schwarz P gyroid and body-centered cubic(BCC).Response surface methodology(RSM)was implemented to analyse the effect of minimum and maximum cell wall thickness,cell size,and unit cell type on the mechanical performance of TPU FGCS structures.The results indicated that a Schwarz P FGCS structure with cell size,minimum and maximum cell wall thickness of 6,0.9 and 2.8 mm,respectively,could be optimal for a compromise between performance and weight.In this optimized case,stiffness and volume fraction values of 684 N/mm and 0.64 were obtained,respectively.The study also presents a proof-of-concept design for a BK prosthetic damper,highlighting the potential of FGCSs to enhance patient comfort,reduce manufacturing costs,and enable personalised designs through 3D scanning and AM.The obtained results could be a step forward towards the incorporation of AM technologies in prosthetics,offering a pathway to lightweight,cost-effective,and functionally tailored solutions.展开更多
With the reform booming in teaching fields,the author carried out Graded English teaching in her teaching classroom and achieved favorable efficiency.In this paper,the author mainly discusses the specific grading of e...With the reform booming in teaching fields,the author carried out Graded English teaching in her teaching classroom and achieved favorable efficiency.In this paper,the author mainly discusses the specific grading of exercise after class in implementing graded teaching,taking for example Section A,Unit 6(Go for it! SB for Grade Eight,Volume A,by People's Education Press and Thomson Learning,2004,2nded).展开更多
With the reform booming in teaching fields,the author carried out Graded English teaching in her teaching classroom and achieved favorable efficiency.In this paper,the author mainly discusses the specific grading of t...With the reform booming in teaching fields,the author carried out Graded English teaching in her teaching classroom and achieved favorable efficiency.In this paper,the author mainly discusses the specific grading of teaching objectives in implementing graded teaching.展开更多
Purpose:To evaluate the effect of competency-based management in improving nurse and patient satisfaction.Methods:According to the competency-based management objectives and principles,821 nurses were classified into ...Purpose:To evaluate the effect of competency-based management in improving nurse and patient satisfaction.Methods:According to the competency-based management objectives and principles,821 nurses were classified into different levels based on clear nurse qualifications and post responsibilities.According to the different levels of nursing staff and training plans with different emphases,the goal was for the nursing staff to gradually achieve the corresponding level.Targeted training programs for different levels of nurses were formulated to enable nurses to gradually increase their competency levels.Results:After implementation of competency-based management,nurse job satisfaction and patient satisfaction increased significantly(P<0.01).Additionally,the reported nurse job burnout decreased(P<0.01).Conclusion:Competency-based management can promote nurses’enthusiasm,reduce job burnout,improve job satisfaction,as well as improve patient satisfaction.展开更多
We performed this study to investigate pathological upgrading from biopsy to prostatectomy and clinicopathological factors associated with grade group(GG)upgrading in patients with International Society of Urological ...We performed this study to investigate pathological upgrading from biopsy to prostatectomy and clinicopathological factors associated with grade group(GG)upgrading in patients with International Society of Urological Pathology(ISUP)GG 1 and 2 prostate cancer(PCa)in a Chinese cohort.We included patients diagnosed with PCa with ISUP GG 1 and 2 at biopsy,who underwent RP at our institution.Pre-and postoperative clinical variables were examined.Univariate and multivariate logistic regression analyses were conducted to identify independent factors associated with GG upgrading.Patients in GG upgraded group had higher total prostatespecific antigen(tPSA;median:14.43 ng ml^(−1) vs 10.52 ng ml^(−1),P=0.001)and PSA density(PSAD;median:0.45 ng ml^(−2) vs 0.27 ng ml^(−2),P<0.001)than those in GG nonupgraded group.Patients in upgraded group had a higher ratio for Prostate ImagingReporting and Data System(PI-RADS)score>3(86.4%vs 67.9%,P<0.001).Those with GG 1 in biopsy were more likely to experience GG upgrading after RP than those with GG 2(71 vs 54,P=0.016).Independent preoperative factors predicting GG upgrading were PI-RADS score>3(odds ratio[OR]:2.471,95%confidence interval[CI]:1.132–5.393;P=0.023),higher PSAD(P=0.001),and GG in biopsy(OR:0.241,95%CI:0.123–0.471;P<0.001).The histopathological analyses of RP specimens revealed that perineural invasion(PNI;OR:1.839,95%CI:1.027–3.490;P=0.041)was identified as an independent factor associated with GG upgrading.Our results revealed that GG in the biopsy,PSAD,PI-RADS score>3,and PNI were independent factors of GG upgrading.These factors should be considered for patients with ISUP grade≤2 PCa.展开更多
The SHIFT-G technology of inverse catalyst loading is used to optimize the catalyst grading in the residue hydrotreating unit. The results, taken from pilot tests and commercial units, have showed that the optimized c...The SHIFT-G technology of inverse catalyst loading is used to optimize the catalyst grading in the residue hydrotreating unit. The results, taken from pilot tests and commercial units, have showed that the optimized catalyst grading system can reasonably distribute the reaction load, effectively improve the prop- erties of hydrotreated products, prolong the operating cycle and promote economic benefits.展开更多
Object:To determine the extent and impact of upgrading and downgrading among men who underwent radical prostatectomy(RP)according to new grade groupings and to identify predictors of upgrading from biopsy grade Group ...Object:To determine the extent and impact of upgrading and downgrading among men who underwent radical prostatectomy(RP)according to new grade groupings and to identify predictors of upgrading from biopsy grade Group Ⅰ and Ⅱ,and downgrading to grade Group I,in a community setting.Methods:Study participants included 2279 men with non-metastatic prostate cancer diagnosed 2006-2015 who underwent prostatectomy,from the multi-institutional South Australia Prostate Cancer Clinical Outcomes Collaborative registry.Extent of up-or down-grading was assessed by comparing biopsy and prostatectomy grade groupings.Risk of biochemical recurrence(BCR)with upgrading was assessed using multivariable competing risk regression.Binomial logistic regression was used to identify pre-treatment predictors of upgrading from grade Groups Ⅰ and Ⅱ,and risk group reclassification among men with low risk disease.Results:Upgrading occurred in 35%of cases,while downgrading occurred in 13%of cases.Sixty percent with grade Group I disease were upgraded following prostatectomy.Upgrading from grade Group I was associated with greater risk of BCR compared with concordant grading(Hazard ratio:3.1,95%confidence interval:1.7-6.0).Older age,higher prostate-specific antigen levels(PSA),fewer biopsy cores,higher number of positive cores and more recent diagnosis predicted upgrading from grade Group Ⅰ,while higher PSA and clinical stage predicted upgrading from grade Group Ⅱ.No clinical risk factors for reclassification were identified.Conclusion:Biopsy sampling errors may play an important role in upgrading from grade Group I.Improved clinical assessment of grade is needed to encourage greater uptake of active surveillance.展开更多
Introduction: The essential problems in providing quality and safety services to patients, rapid changes in health care settings as well as information technology require educational revision. Competency-based curricu...Introduction: The essential problems in providing quality and safety services to patients, rapid changes in health care settings as well as information technology require educational revision. Competency-based curriculum focuses on set of skills that students should achieve. This study reviewed characteristics of competency-based curriculum in psychiatric nursing. Methods: A literature review about a competency-based curriculum in psychiatric mental health nursing was carried out by searching databases including Iran Medex, Iran Doc, and Pub Med with key words such as competency-based education, competency-based curriculum, and competency-based curriculum in psychiatric mental health nursing. No time limitation was considered. Results: Results revealed that over 30 literatures have been done about nursing curriculum, but just several studies were done regarding competency-based curriculum and just a few about competency-based curriculum in psychiatric mental health nursing. Conclusion: Competency-based curriculum development is one of the essential steps to facilitate teaching-learning process. The revision of curriculum may decrease theory-practice gap and pave the way for graduates to have essential competences for their roles.展开更多
It is important to transform knowledge-based learning to competency-based learning.This paper describes the exploration and practice of“programming and algorithm foundation”curriculum reform for competency-based lea...It is important to transform knowledge-based learning to competency-based learning.This paper describes the exploration and practice of“programming and algorithm foundation”curriculum reform for competency-based learning.In order to cultivate students’ability of high-level program development,the intelligent learning system of“MOOC/SPOC+icoding online experiment and programming ability test Platform+Rain Classroom”is established.In the case of limited class hours,we make full use of online resources to build a student-centered method to internalize knowledge and ability.We guide students to complete the basic knowledge module of MOOC or SPOC,and complete the programming experiment on icoding platform.According to the feedback of learning outcome,teachers use offline classroom and rain classroom to sort out the key and difficult points,expanding the depth and breadth of the curriculum,and stimulate students’enthusiasm to participate in the curriculum.展开更多
An increasing number of graded readers thus come out for pedagogical purposes. However, the reliability of text-grading for graded readers remains questionable. Whether they show linguistic difference across levels ne...An increasing number of graded readers thus come out for pedagogical purposes. However, the reliability of text-grading for graded readers remains questionable. Whether they show linguistic difference across levels needs further research given a shifted emphasis on multidimensional features. The study used Co-Metrix to give an assessment on graded readers’text-grading both under unidimensional and multidimensional indices, providing a testimony to publishers’original design and to the feasibility against the new trend. It indicated that across-grade difference only partly corresponded with publishers’text-grading rationale that focused on surface features. But it made no sense in linguistics at a deeper level since no overall difference was found. Therefore, the reassessment and design of graded readers were suggested to take account of multidimensional features for across-grade difference.展开更多
目的:基于推荐分级的评估、制订和评价系统(grading of recommendations assessment,development and e valuation,GRADE)与整合证据链法(integrated evidence chain-based efficacy evaluation of traditional Chinese medicine,i EC-E...目的:基于推荐分级的评估、制订和评价系统(grading of recommendations assessment,development and e valuation,GRADE)与整合证据链法(integrated evidence chain-based efficacy evaluation of traditional Chinese medicine,i EC-Eff),评价电针治疗痛风性关节炎(gouty arthritis,GA)的证据质量。方法:计算机检索PubMed、Web of Science、Cochrane Library、Embase、中国知网、中文科技期刊数据库、万方医学期刊数据库、中国生物医学文献数据库等数据库,检索时限为建库至2025年4月,纳入电针治疗GA的随机对照试验(randomized controlled trial,RCT)、实验研究及临床经验文献,采用Cochrane偏倚风险工具以及针刺临床试验干预措施报告标准(standards for reportlng interventions in clinical trials of acupuncture,STRICTA)评估RCT质量,采用Stata 18软件进行Meta分析,采用GRADE工具对结局指标进行证据质量评级,通过i EC-Eff整合多维度证据。结果:GRADE评价中,单一电针干预血尿酸、疼痛视觉模拟评分(visual analogue scale,VAS)等指标证据为C级(低质量证据),针药结合降低血尿酸、改善炎症指标C反应蛋白(C-reactive protein,CRP)和红细胞沉降率(erythrocyte sedimentation reaction,ESR)为B级(中等质量证据),细胞因子等指标证据为C级(低质量证据)。i EC-Eff评价中,临床经验证据为B级,实验研究证据为A级,临床试验证据为B级,综合评定为BAB(中级证据)。GRADE与i EC-Eff评价体系差异源于前者对研究设计严谨性要求高,后者契合中医药整体模式。电针联合西药在降尿酸、抗炎方面具有优势,但需高质量RCT验证。结论:电针治疗GA可以改善关节红肿热痛症状、降低血尿酸水平、减轻关节炎症反应(如ESR、CRP等指标)等,证据质量较高,具有较好的临床应用前景。GRADE与i EC-Eff在电针治疗GA的证据评价方面各有优势,未来需将二者结合起来优化中医药疗效评价体系,推动电针治疗GA的循证医学证据积累与国际化认可。展开更多
动物实验是生物医学研究中的重要手段,是连接基础研究与临床试验的桥梁。动物实验的系统评价/Meta分析(systematic review/meta-analysis,SRs/MAs)是整合动物实验证据的重要手段,能够促进成果向临床研究转化,降低转化风险,并推动基础研...动物实验是生物医学研究中的重要手段,是连接基础研究与临床试验的桥梁。动物实验的系统评价/Meta分析(systematic review/meta-analysis,SRs/MAs)是整合动物实验证据的重要手段,能够促进成果向临床研究转化,降低转化风险,并推动基础研究的资源整合。随着证据推荐分级的评估、制订与评价(grading of recommendations assessment,development and evaluation,GRADE)方法的不断发展,其在动物实验SRs/MAs中的应用受到了越来越多的关注。本文首先阐述了GRADE方法在动物实验SRs/MAs中的应用原理及具体应用类型,包括定性描述的系统评价、Meta分析及网状Meta分析;接着深入分析了GRADE方法在实际应用中的误用情况,主要包括未正确进行证据体分级、证据体分级不当、误用于定性系统评价、升降级过程记录与结果不一致,以及误用于提供推荐意见;此外,还全面探讨了GRADE方法在动物实验SRs/MAs中的证据确信度升降级因素,包括偏倚风险、间接性、不一致性、不精确性和发表偏倚对证据降级的影响,以及大效应量和跨物种一致性对证据升级的作用;最后,针对上述问题提出了改进策略,包括进一步研究与优化GRADE方法在动物实验SRs/MAs中的应用细节、制定符合动物实验研究特点的SRs/MAs报告规范,以及加强研究人员在GRADE方法上的专业培训等。本文旨在通过提升动物实验SRs/MAs的证据质量,增强其在临床决策中的可靠性,促进动物实验研究成果更高效地转化为临床实践。展开更多
应用推荐分级的评估、制订和评价(grading of recommendations assessment,development and evaluation,GRADE)系统与中药有效性评价整合证据链法(integrated evidence chain-based effectiveness evaluation of traditional Chinese me...应用推荐分级的评估、制订和评价(grading of recommendations assessment,development and evaluation,GRADE)系统与中药有效性评价整合证据链法(integrated evidence chain-based effectiveness evaluation of traditional Chinese medicine,Eff-iEC)对指南或专家共识推荐频次较高的12种治疗骨质疏松症的常用中成药进行了证据评价。结果显示,仙灵骨葆胶囊/片根据GRADE系统评价为C级(低级证据),根据Eff-iEC体系评价为BA+B^(+)(中级证据);金天格胶囊根据GRADE系统评价为C级(低级证据),根据Eff-iEC体系评价为AA+B(高级证据);骨疏康颗粒/胶囊根据GRADE系统评价为C级(低级证据),根据Eff-iEC体系评价为BA+B^(+)(中级证据);左归丸根据GRADE系统评价为C级(低级证据),根据Eff-iEC体系评价为AA^(++)B^(+)(高级证据);强骨胶囊根据GRADE系统评价为D级(极低级证据),根据Eff-iEC体系评价为AA+B^(+)(高级证据);壮骨止痛胶囊根据GRADE系统评价为D级(极低级证据),根据Eff-iEC体系评价为BA+B(中级证据);金匮肾气丸根据GRADE系统评价为D级(极低级证据),根据Eff-iEC体系评价为AA+B(高级证据);全杜仲胶囊根据GRADE系统评价为D级(极低级证据),根据Eff-iEC体系评价为AD+B^(+)(低级证据);淫羊藿总黄酮胶囊根据GRADE系统评价为D级(极低级证据),根据Eff-iEC体系评价为AAB^(+)(高级证据);右归丸根据GRADE系统评价为D级(极低级证据),根据Eff-iEC体系评价为AA^(++)B^(+)(高级证据);芪骨胶囊根据GRADE系统评价为D级(极低级证据),根据Eff-iEC体系评价为BB^(+)B(中级证据);六味地黄丸根据GRADE系统评价为C级(低级证据),根据Eff-iEC体系评价为AA^(++)B^(+)(高级证据)。整体而言,Eff-iEC评价体系较GRADE系统能更全面地评价中医药的有效性证据,但仍有不够完善之处,制约其推广应用。在临床证据评价方面,Eff-iEC评价体系与GRADE系统均反映出当前中成药治疗骨质疏松症的临床研究质量普遍较低,未来尚需开展高质量临床试验,进一步验证临床疗效。展开更多
BACKGROUND Esophageal squamous cell carcinoma is a major histological subtype of esophageal cancer.Many molecular genetic changes are associated with its occurrence.Raman spectroscopy has become a new method for the e...BACKGROUND Esophageal squamous cell carcinoma is a major histological subtype of esophageal cancer.Many molecular genetic changes are associated with its occurrence.Raman spectroscopy has become a new method for the early diagnosis of tumors because it can reflect the structures of substances and their changes at the molecular level.AIM To detect alterations in Raman spectral information across different stages of esophageal neoplasia.METHODS Different grades of esophageal lesions were collected,and a total of 360 groups of Raman spectrum data were collected.A 1D-transformer network model was proposed to handle the task of classifying the spectral data of esophageal squamous cell carcinoma.In addition,a deep learning model was applied to visualize the Raman spectral data and interpret their molecular characteristics.RESULTS A comparison among Raman spectral data with different pathological grades and a visual analysis revealed that the Raman peaks with significant differences were concentrated mainly at 1095 cm^(-1)(DNA,symmetric PO,and stretching vibration),1132 cm^(-1)(cytochrome c),1171 cm^(-1)(acetoacetate),1216 cm^(-1)(amide III),and 1315 cm^(-1)(glycerol).A comparison among the training results of different models revealed that the 1Dtransformer network performed best.A 93.30%accuracy value,a 96.65%specificity value,a 93.30%sensitivity value,and a 93.17%F1 score were achieved.CONCLUSION Raman spectroscopy revealed significantly different waveforms for the different stages of esophageal neoplasia.The combination of Raman spectroscopy and deep learning methods could significantly improve the accuracy of classification.展开更多
The good combination of mechanical and wear properties for cemented carbides is crucial.In this work,the wear behavior of functionally graded cemented carbide(FGCC)and non-graded cemented carbide(CC),with CoNiFeCr mul...The good combination of mechanical and wear properties for cemented carbides is crucial.In this work,the wear behavior of functionally graded cemented carbide(FGCC)and non-graded cemented carbide(CC),with CoNiFeCr multi-principal-element alloy(MPEA)binder,has been investigated by performing sliding wear tests and composition characterization.The results showed that compared with CC,FGCC had higher hardness,stronger fracture toughness,better wear performance,and similar TRS.FGCCs exhibited lower wear rates(3.44×10^(−7)–6.95×10^(−6)mm^(3)/(N m))and coefficients of friction(COFs)(0.27–0.39)than CCs from RT to 600℃due to mitigation of multiple risks caused by binder removal,fragmentation and pull-out of WC grains,high-temperature oxidation and softening.In the low-temperature wear stage,the MPEA binder underwent dynamic recrystallization(DRX)and twinning deformation before removing from the surface.The binder removal caused dislocation pile-ups and stacking faults(SFs)to form under high stress,resulting in fragmentation and pull-out of WC grains.The low-temperature wear was dominated by abrasive wear and adhesive wear,with a low wear rate and a high and unstable COF.In the high-temperature wear stage,initial pitting oxidation of WC grains generated many subgrain boundaries,reducing heat transfer and exacerbating oxidation,resulting in an oxide layer enriched with WO3,Mx Oy,and MWO4.High-temperature wear was dominated by oxidation wear and high-temperature softening,with a high wear rate and a low and smooth COF.The results from the present study do not only provide theoretical guidance for an understanding of the antiwear mechanism of WC-CoNiFeCr,but also a new approach for the preparation of cemented carbides with high wear resistance.展开更多
文摘目的:系统评价培土生金中药联合西医常规疗法治疗支气管哮喘缓解期肺脾两虚证的疗效以及证据质量,为临床决策及疾病指南制订提供循证依据。方法:检索中国知网(CNKI)、万方数据库(Wangfang)、Pubmed、Web of Science等8大中英文数据库,由2名研究者独立进行文献筛选、信息提取、偏倚风险评估及方法学质量评价,并对纳入研究的总有效率、中医证候积分、第一秒用力呼气容积(FEV1)、第一秒用力呼气容积/用力肺活量(FEV1/FVC)、哮喘控制测试(ACT)评分等结局指标进行Meta分析,最终依照GRADE评估证据质量。结果:共纳入14项研究,合计1263例患者。结果显示:(1)培土生金中药联合常规西医疗法可有效改善患者总有效率,降低患者中医证候积分,改善患者FEV1水平、FEV1/FVC及ACT评分。(2)总有效率证据质量较优,可信度高,其余指标证据质量较低,尚待更多高质量的研究支持以提升证据级别。结论:培土生金中药联合西医常规疗法治疗支气管哮喘缓解期肺脾两虚证优于单用西医常规治疗,且在总有效率上证据质量较高,具有一定的循证学意义。
基金financially supported and funded by the Deanship of Scientific Research at Imam Mohammad Ibn Saud Islamic University(IMSIU)(No.IMSIU-DDRSP2503)。
文摘Functionally graded cellular structures(FGCSs)have a multitude of applications to a wide range of industries.Utilising the ever-progressing technology of additive manufacturing(AM),FGCSs can be applied to control material grading and achieve the desired mechanical properties.The current study explores the design and optimisation of FGCSs for AM,with a focus on improving the compression and impact performance of below knee(BK)prosthetic limbs made of thermoplastic polyurethane(TPU).A multiscale research methodology integrating topology optimization(TO),finite element analysis(FEA),and design of experiments(Do E)was adopted to optimise lattice structures in terms of stiffness and lightweight properties.Two-unit cell designs were considered in the study:Schwarz P gyroid and body-centered cubic(BCC).Response surface methodology(RSM)was implemented to analyse the effect of minimum and maximum cell wall thickness,cell size,and unit cell type on the mechanical performance of TPU FGCS structures.The results indicated that a Schwarz P FGCS structure with cell size,minimum and maximum cell wall thickness of 6,0.9 and 2.8 mm,respectively,could be optimal for a compromise between performance and weight.In this optimized case,stiffness and volume fraction values of 684 N/mm and 0.64 were obtained,respectively.The study also presents a proof-of-concept design for a BK prosthetic damper,highlighting the potential of FGCSs to enhance patient comfort,reduce manufacturing costs,and enable personalised designs through 3D scanning and AM.The obtained results could be a step forward towards the incorporation of AM technologies in prosthetics,offering a pathway to lightweight,cost-effective,and functionally tailored solutions.
文摘With the reform booming in teaching fields,the author carried out Graded English teaching in her teaching classroom and achieved favorable efficiency.In this paper,the author mainly discusses the specific grading of exercise after class in implementing graded teaching,taking for example Section A,Unit 6(Go for it! SB for Grade Eight,Volume A,by People's Education Press and Thomson Learning,2004,2nded).
文摘With the reform booming in teaching fields,the author carried out Graded English teaching in her teaching classroom and achieved favorable efficiency.In this paper,the author mainly discusses the specific grading of teaching objectives in implementing graded teaching.
基金funded by a grant from the Liaocheng Science and Technology Development Plans(No.2012-193).
文摘Purpose:To evaluate the effect of competency-based management in improving nurse and patient satisfaction.Methods:According to the competency-based management objectives and principles,821 nurses were classified into different levels based on clear nurse qualifications and post responsibilities.According to the different levels of nursing staff and training plans with different emphases,the goal was for the nursing staff to gradually achieve the corresponding level.Targeted training programs for different levels of nurses were formulated to enable nurses to gradually increase their competency levels.Results:After implementation of competency-based management,nurse job satisfaction and patient satisfaction increased significantly(P<0.01).Additionally,the reported nurse job burnout decreased(P<0.01).Conclusion:Competency-based management can promote nurses’enthusiasm,reduce job burnout,improve job satisfaction,as well as improve patient satisfaction.
文摘We performed this study to investigate pathological upgrading from biopsy to prostatectomy and clinicopathological factors associated with grade group(GG)upgrading in patients with International Society of Urological Pathology(ISUP)GG 1 and 2 prostate cancer(PCa)in a Chinese cohort.We included patients diagnosed with PCa with ISUP GG 1 and 2 at biopsy,who underwent RP at our institution.Pre-and postoperative clinical variables were examined.Univariate and multivariate logistic regression analyses were conducted to identify independent factors associated with GG upgrading.Patients in GG upgraded group had higher total prostatespecific antigen(tPSA;median:14.43 ng ml^(−1) vs 10.52 ng ml^(−1),P=0.001)and PSA density(PSAD;median:0.45 ng ml^(−2) vs 0.27 ng ml^(−2),P<0.001)than those in GG nonupgraded group.Patients in upgraded group had a higher ratio for Prostate ImagingReporting and Data System(PI-RADS)score>3(86.4%vs 67.9%,P<0.001).Those with GG 1 in biopsy were more likely to experience GG upgrading after RP than those with GG 2(71 vs 54,P=0.016).Independent preoperative factors predicting GG upgrading were PI-RADS score>3(odds ratio[OR]:2.471,95%confidence interval[CI]:1.132–5.393;P=0.023),higher PSAD(P=0.001),and GG in biopsy(OR:0.241,95%CI:0.123–0.471;P<0.001).The histopathological analyses of RP specimens revealed that perineural invasion(PNI;OR:1.839,95%CI:1.027–3.490;P=0.041)was identified as an independent factor associated with GG upgrading.Our results revealed that GG in the biopsy,PSAD,PI-RADS score>3,and PNI were independent factors of GG upgrading.These factors should be considered for patients with ISUP grade≤2 PCa.
文摘The SHIFT-G technology of inverse catalyst loading is used to optimize the catalyst grading in the residue hydrotreating unit. The results, taken from pilot tests and commercial units, have showed that the optimized catalyst grading system can reasonably distribute the reaction load, effectively improve the prop- erties of hydrotreated products, prolong the operating cycle and promote economic benefits.
基金This project was funded by the Movember Foundation as part of their Australian and New Zealand prostate cancer outcomes registry initiative(PCOR-ANZ)which aims to develop a binational clinical registry for outcomes monitoring and research to inform practice and improve outcomes for men with prostate cancer.Dr.Beckmann is supported by an NHMRC Early Career Researcher Fellowship.
文摘Object:To determine the extent and impact of upgrading and downgrading among men who underwent radical prostatectomy(RP)according to new grade groupings and to identify predictors of upgrading from biopsy grade Group Ⅰ and Ⅱ,and downgrading to grade Group I,in a community setting.Methods:Study participants included 2279 men with non-metastatic prostate cancer diagnosed 2006-2015 who underwent prostatectomy,from the multi-institutional South Australia Prostate Cancer Clinical Outcomes Collaborative registry.Extent of up-or down-grading was assessed by comparing biopsy and prostatectomy grade groupings.Risk of biochemical recurrence(BCR)with upgrading was assessed using multivariable competing risk regression.Binomial logistic regression was used to identify pre-treatment predictors of upgrading from grade Groups Ⅰ and Ⅱ,and risk group reclassification among men with low risk disease.Results:Upgrading occurred in 35%of cases,while downgrading occurred in 13%of cases.Sixty percent with grade Group I disease were upgraded following prostatectomy.Upgrading from grade Group I was associated with greater risk of BCR compared with concordant grading(Hazard ratio:3.1,95%confidence interval:1.7-6.0).Older age,higher prostate-specific antigen levels(PSA),fewer biopsy cores,higher number of positive cores and more recent diagnosis predicted upgrading from grade Group Ⅰ,while higher PSA and clinical stage predicted upgrading from grade Group Ⅱ.No clinical risk factors for reclassification were identified.Conclusion:Biopsy sampling errors may play an important role in upgrading from grade Group I.Improved clinical assessment of grade is needed to encourage greater uptake of active surveillance.
文摘Introduction: The essential problems in providing quality and safety services to patients, rapid changes in health care settings as well as information technology require educational revision. Competency-based curriculum focuses on set of skills that students should achieve. This study reviewed characteristics of competency-based curriculum in psychiatric nursing. Methods: A literature review about a competency-based curriculum in psychiatric mental health nursing was carried out by searching databases including Iran Medex, Iran Doc, and Pub Med with key words such as competency-based education, competency-based curriculum, and competency-based curriculum in psychiatric mental health nursing. No time limitation was considered. Results: Results revealed that over 30 literatures have been done about nursing curriculum, but just several studies were done regarding competency-based curriculum and just a few about competency-based curriculum in psychiatric mental health nursing. Conclusion: Competency-based curriculum development is one of the essential steps to facilitate teaching-learning process. The revision of curriculum may decrease theory-practice gap and pave the way for graduates to have essential competences for their roles.
基金This work is supported by Online and Offline Hybrid Curriculum Reform Project of UESTC in 2020 under Grant 2020HHKC0029by Project Based Curriculum for Freshmen of UESTC in 2020 under Grant 2020PBLF044by Online and Offline Hybrid Teaching Reform Project of CMOOC in 2019 under Grant B190201.
文摘It is important to transform knowledge-based learning to competency-based learning.This paper describes the exploration and practice of“programming and algorithm foundation”curriculum reform for competency-based learning.In order to cultivate students’ability of high-level program development,the intelligent learning system of“MOOC/SPOC+icoding online experiment and programming ability test Platform+Rain Classroom”is established.In the case of limited class hours,we make full use of online resources to build a student-centered method to internalize knowledge and ability.We guide students to complete the basic knowledge module of MOOC or SPOC,and complete the programming experiment on icoding platform.According to the feedback of learning outcome,teachers use offline classroom and rain classroom to sort out the key and difficult points,expanding the depth and breadth of the curriculum,and stimulate students’enthusiasm to participate in the curriculum.
文摘An increasing number of graded readers thus come out for pedagogical purposes. However, the reliability of text-grading for graded readers remains questionable. Whether they show linguistic difference across levels needs further research given a shifted emphasis on multidimensional features. The study used Co-Metrix to give an assessment on graded readers’text-grading both under unidimensional and multidimensional indices, providing a testimony to publishers’original design and to the feasibility against the new trend. It indicated that across-grade difference only partly corresponded with publishers’text-grading rationale that focused on surface features. But it made no sense in linguistics at a deeper level since no overall difference was found. Therefore, the reassessment and design of graded readers were suggested to take account of multidimensional features for across-grade difference.
文摘目的:基于推荐分级的评估、制订和评价系统(grading of recommendations assessment,development and e valuation,GRADE)与整合证据链法(integrated evidence chain-based efficacy evaluation of traditional Chinese medicine,i EC-Eff),评价电针治疗痛风性关节炎(gouty arthritis,GA)的证据质量。方法:计算机检索PubMed、Web of Science、Cochrane Library、Embase、中国知网、中文科技期刊数据库、万方医学期刊数据库、中国生物医学文献数据库等数据库,检索时限为建库至2025年4月,纳入电针治疗GA的随机对照试验(randomized controlled trial,RCT)、实验研究及临床经验文献,采用Cochrane偏倚风险工具以及针刺临床试验干预措施报告标准(standards for reportlng interventions in clinical trials of acupuncture,STRICTA)评估RCT质量,采用Stata 18软件进行Meta分析,采用GRADE工具对结局指标进行证据质量评级,通过i EC-Eff整合多维度证据。结果:GRADE评价中,单一电针干预血尿酸、疼痛视觉模拟评分(visual analogue scale,VAS)等指标证据为C级(低质量证据),针药结合降低血尿酸、改善炎症指标C反应蛋白(C-reactive protein,CRP)和红细胞沉降率(erythrocyte sedimentation reaction,ESR)为B级(中等质量证据),细胞因子等指标证据为C级(低质量证据)。i EC-Eff评价中,临床经验证据为B级,实验研究证据为A级,临床试验证据为B级,综合评定为BAB(中级证据)。GRADE与i EC-Eff评价体系差异源于前者对研究设计严谨性要求高,后者契合中医药整体模式。电针联合西药在降尿酸、抗炎方面具有优势,但需高质量RCT验证。结论:电针治疗GA可以改善关节红肿热痛症状、降低血尿酸水平、减轻关节炎症反应(如ESR、CRP等指标)等,证据质量较高,具有较好的临床应用前景。GRADE与i EC-Eff在电针治疗GA的证据评价方面各有优势,未来需将二者结合起来优化中医药疗效评价体系,推动电针治疗GA的循证医学证据积累与国际化认可。
文摘动物实验是生物医学研究中的重要手段,是连接基础研究与临床试验的桥梁。动物实验的系统评价/Meta分析(systematic review/meta-analysis,SRs/MAs)是整合动物实验证据的重要手段,能够促进成果向临床研究转化,降低转化风险,并推动基础研究的资源整合。随着证据推荐分级的评估、制订与评价(grading of recommendations assessment,development and evaluation,GRADE)方法的不断发展,其在动物实验SRs/MAs中的应用受到了越来越多的关注。本文首先阐述了GRADE方法在动物实验SRs/MAs中的应用原理及具体应用类型,包括定性描述的系统评价、Meta分析及网状Meta分析;接着深入分析了GRADE方法在实际应用中的误用情况,主要包括未正确进行证据体分级、证据体分级不当、误用于定性系统评价、升降级过程记录与结果不一致,以及误用于提供推荐意见;此外,还全面探讨了GRADE方法在动物实验SRs/MAs中的证据确信度升降级因素,包括偏倚风险、间接性、不一致性、不精确性和发表偏倚对证据降级的影响,以及大效应量和跨物种一致性对证据升级的作用;最后,针对上述问题提出了改进策略,包括进一步研究与优化GRADE方法在动物实验SRs/MAs中的应用细节、制定符合动物实验研究特点的SRs/MAs报告规范,以及加强研究人员在GRADE方法上的专业培训等。本文旨在通过提升动物实验SRs/MAs的证据质量,增强其在临床决策中的可靠性,促进动物实验研究成果更高效地转化为临床实践。
文摘应用推荐分级的评估、制订和评价(grading of recommendations assessment,development and evaluation,GRADE)系统与中药有效性评价整合证据链法(integrated evidence chain-based effectiveness evaluation of traditional Chinese medicine,Eff-iEC)对指南或专家共识推荐频次较高的12种治疗骨质疏松症的常用中成药进行了证据评价。结果显示,仙灵骨葆胶囊/片根据GRADE系统评价为C级(低级证据),根据Eff-iEC体系评价为BA+B^(+)(中级证据);金天格胶囊根据GRADE系统评价为C级(低级证据),根据Eff-iEC体系评价为AA+B(高级证据);骨疏康颗粒/胶囊根据GRADE系统评价为C级(低级证据),根据Eff-iEC体系评价为BA+B^(+)(中级证据);左归丸根据GRADE系统评价为C级(低级证据),根据Eff-iEC体系评价为AA^(++)B^(+)(高级证据);强骨胶囊根据GRADE系统评价为D级(极低级证据),根据Eff-iEC体系评价为AA+B^(+)(高级证据);壮骨止痛胶囊根据GRADE系统评价为D级(极低级证据),根据Eff-iEC体系评价为BA+B(中级证据);金匮肾气丸根据GRADE系统评价为D级(极低级证据),根据Eff-iEC体系评价为AA+B(高级证据);全杜仲胶囊根据GRADE系统评价为D级(极低级证据),根据Eff-iEC体系评价为AD+B^(+)(低级证据);淫羊藿总黄酮胶囊根据GRADE系统评价为D级(极低级证据),根据Eff-iEC体系评价为AAB^(+)(高级证据);右归丸根据GRADE系统评价为D级(极低级证据),根据Eff-iEC体系评价为AA^(++)B^(+)(高级证据);芪骨胶囊根据GRADE系统评价为D级(极低级证据),根据Eff-iEC体系评价为BB^(+)B(中级证据);六味地黄丸根据GRADE系统评价为C级(低级证据),根据Eff-iEC体系评价为AA^(++)B^(+)(高级证据)。整体而言,Eff-iEC评价体系较GRADE系统能更全面地评价中医药的有效性证据,但仍有不够完善之处,制约其推广应用。在临床证据评价方面,Eff-iEC评价体系与GRADE系统均反映出当前中成药治疗骨质疏松症的临床研究质量普遍较低,未来尚需开展高质量临床试验,进一步验证临床疗效。
基金Supported by Beijing Hospitals Authority Youth Programme,No.QML20200505.
文摘BACKGROUND Esophageal squamous cell carcinoma is a major histological subtype of esophageal cancer.Many molecular genetic changes are associated with its occurrence.Raman spectroscopy has become a new method for the early diagnosis of tumors because it can reflect the structures of substances and their changes at the molecular level.AIM To detect alterations in Raman spectral information across different stages of esophageal neoplasia.METHODS Different grades of esophageal lesions were collected,and a total of 360 groups of Raman spectrum data were collected.A 1D-transformer network model was proposed to handle the task of classifying the spectral data of esophageal squamous cell carcinoma.In addition,a deep learning model was applied to visualize the Raman spectral data and interpret their molecular characteristics.RESULTS A comparison among Raman spectral data with different pathological grades and a visual analysis revealed that the Raman peaks with significant differences were concentrated mainly at 1095 cm^(-1)(DNA,symmetric PO,and stretching vibration),1132 cm^(-1)(cytochrome c),1171 cm^(-1)(acetoacetate),1216 cm^(-1)(amide III),and 1315 cm^(-1)(glycerol).A comparison among the training results of different models revealed that the 1Dtransformer network performed best.A 93.30%accuracy value,a 96.65%specificity value,a 93.30%sensitivity value,and a 93.17%F1 score were achieved.CONCLUSION Raman spectroscopy revealed significantly different waveforms for the different stages of esophageal neoplasia.The combination of Raman spectroscopy and deep learning methods could significantly improve the accuracy of classification.
基金financially supported by the National Key Research and Development Program of China(No.2021YFB3701800)Special funding support for the Yuelu Mountain National University Science and Technology City“Ranking the Top of the List”Research Project:(Tunnel Boring Machine High-performance Long-life Cutting Tools)the State Key Laboratory of Powder Metallurgy,Central South University,Changsha,China.
文摘The good combination of mechanical and wear properties for cemented carbides is crucial.In this work,the wear behavior of functionally graded cemented carbide(FGCC)and non-graded cemented carbide(CC),with CoNiFeCr multi-principal-element alloy(MPEA)binder,has been investigated by performing sliding wear tests and composition characterization.The results showed that compared with CC,FGCC had higher hardness,stronger fracture toughness,better wear performance,and similar TRS.FGCCs exhibited lower wear rates(3.44×10^(−7)–6.95×10^(−6)mm^(3)/(N m))and coefficients of friction(COFs)(0.27–0.39)than CCs from RT to 600℃due to mitigation of multiple risks caused by binder removal,fragmentation and pull-out of WC grains,high-temperature oxidation and softening.In the low-temperature wear stage,the MPEA binder underwent dynamic recrystallization(DRX)and twinning deformation before removing from the surface.The binder removal caused dislocation pile-ups and stacking faults(SFs)to form under high stress,resulting in fragmentation and pull-out of WC grains.The low-temperature wear was dominated by abrasive wear and adhesive wear,with a low wear rate and a high and unstable COF.In the high-temperature wear stage,initial pitting oxidation of WC grains generated many subgrain boundaries,reducing heat transfer and exacerbating oxidation,resulting in an oxide layer enriched with WO3,Mx Oy,and MWO4.High-temperature wear was dominated by oxidation wear and high-temperature softening,with a high wear rate and a low and smooth COF.The results from the present study do not only provide theoretical guidance for an understanding of the antiwear mechanism of WC-CoNiFeCr,but also a new approach for the preparation of cemented carbides with high wear resistance.
