Objective:This cross-sectional study assessed the methodological quality of systematic reviews(SRs)of Chinese herbal medicine(CHM)published in Chinese between Jan 2021 and Sep 2022.Methods:Chinese language CHM SRs wer...Objective:This cross-sectional study assessed the methodological quality of systematic reviews(SRs)of Chinese herbal medicine(CHM)published in Chinese between Jan 2021 and Sep 2022.Methods:Chinese language CHM SRs were identified through literature searches across 3 international and 4 Chinese databases.Methodological quality was appraised using A MeaSurement Tool to Assess systematic Reviews 2.Logistic regressions were used to explore associations between bibliographical characteristics and quality.Results:Analyses of methodological quality found that among the 213 sampled SRs,69.5%were of critically low quality,30.5%were of low quality,and none achieved high or moderate quality.Common shortcomings included the failure to identify the studies excluded from the analysis,failure to disclose funding sources,and limited evaluation of the potential impact of bias on conclusions.Logistic regressions revealed that SRs led by corresponding authors affiliated with universities or academic institutions tended to be of lower quality than SRs led by authors affiliated with hospitals or clinical facilities.Conclusion:Recent Chinese language CHM SRs exhibited limited methodological quality,making them unlikely to support the development of clinical practice guidelines.Urgent initiatives are needed to enhance training for researchers,peer-reviewers and editors involved in the preparation and publication of SRs.Adoption of Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines in Chinese language journals is crucial to improve the relevance of SRs for Chinese medicine development.Addressing deficiencies in methodology and reporting is essential for promoting evidence-based practices and informed clinical decisions in Chinese medicine.展开更多
Background:Methodological issues and challenges hinder the high-quality development of acupuncture clinical studies.Objective:To systematically summarize the methodological issues,challenges,and recommendations in acu...Background:Methodological issues and challenges hinder the high-quality development of acupuncture clinical studies.Objective:To systematically summarize the methodological issues,challenges,and recommendations in acupuncture clinical research using the participant,intervention,comparison,outcome,and study design(PICOS)framework to generate a comprehensive list of methodological questions and recommendations.Methods:We searched seven databases for articles on the methodological aspects of clinical acupuncture research from their inception to March 24,2023.Two researchers independently screened the titles,ab-stracts,and full text of each article.Data extraction and analyses were performed for the eligible studies.Finally,the methodological challenges and recommendations for acupuncture clinical studies are listed,and the frequency of methodological challenges is displayed in a sunburst chart.Results:A total of 226 studies were included in the review,most of which originated in China(173,77%),followed by the United States(25,11%)and the United Kingdom(12,5%).Clinical research on acupuncture faces methodological challenges that span the five elements of the PICOS framework.The most frequently mentioned issues were related to comparison,followed by study design and interven-tions.If further categorized,the establishment of the control group is undoubtedly the most concerning issue for researchers.Conclusion:This review provides a comprehensive overview of the challenges and recommendations for each aspect of the PICOS framework in clinical acupuncture research.展开更多
BACKGROUND Systematic reviews(SRs)synthesize and evaluate data,mainly from randomized trials,which then guides the development of clinical recommendations in evidence-based medicine.However,the data and methodological...BACKGROUND Systematic reviews(SRs)synthesize and evaluate data,mainly from randomized trials,which then guides the development of clinical recommendations in evidence-based medicine.However,the data and methodological information in the included papers can often be lacking or unclear,and reviewers usually need to contact the authors of included studies for clarifications.Contacting authors is recommended,but it is unclear how often SR teams do it,or what the level of response is.AIM To investigate how often reviewers undertake contact with the authors of included randomized controlled trials(RCTs)for clarification on data and risk of bias concerns,to explore the factors that influence whether SR authors contact or do not contact the authors,and the content and level of responses.METHODS We conducted a systematic electronic database search in MEDLINE using the search string“(systematic review)”AND“(RCT OR randomized OR trial)”for articles published between 1 January 2024 and 19 February 2024,without language restrictions.Screening and data extraction was done independently by two reviewers,and conflicts resolved by a senior author.Contact authors of included SRs were contacted for clarifications.RESULTS Of the 329 included SRs,38%(n=125)explicitly mentioned contact with the authors of included studies.The remaining 62%(n=204)did not.We attempted contact with all SR teams for clarifications and received 90 responses(19.4%).Of the 50 respondents who did not explicitly mention contact in their SRs,25(50%)replied that they did make contact.We received a total of 64 responses on the level and content of information sought.The mean±SD contacts SR teams made were 10(10),replies received 5(6.7),and response waiting time 10.1(28.3)weeks.Resources,time,poor previous experience,perceived likelihood of poor response and bias concerns were reported as barriers to attempting contact.CONCLUSION The majority of SRs published in 2024 did not confirm seeking clarifying or missing information from primary study authors.However,SR teams reported that 50%of contacted primary authors respond.Additional research can clarify this rate of response and establish methods to increase the integration of this core methodological element in SRs.展开更多
Urban transportation systems are facing severe challenges due to the rapid growth of the urban population,especially in China.Suspended monorail system(SMS),as a sky rail transportation form,can effectively alleviate ...Urban transportation systems are facing severe challenges due to the rapid growth of the urban population,especially in China.Suspended monorail system(SMS),as a sky rail transportation form,can effectively alleviate urban traffic congestion due to its independent right-of-way and minimal ground footprint.However,the SMS possesses a special traveling system with unique vehicle structure and bridge configuration,which results in significant differences in both the mechanisms and dynamics problems associated with train–bridge interaction(TBI)when contrasted with those of traditional railway systems.Therefore,a thorough understanding of the SMS dynamics is essential for ensuring the operational safety of the system.This article presents a state-of-the-art review of the TBI modeling methodologies,critical dynamic features,field tests,and practice of the SMS in China.Firstly,the development history,technical features,and potential dynamics problems of the SMS are briefly described,followed by the mechanical characteristics and mechanisms of the train–bridge interactive systems.Then,the modeling methodology of the fundamental elements in the suspended monorail TBI is systematically reviewed,including the suspended train subsystem,bridge subsystem,train–bridge interaction relationships,system excitations,and solution method.Further,the typical dynamic features of the TBI under various operational scenarios are elaborated,including different train speeds,a variety of line sections,and a natural wind environment.Finally,the first new energy-based SMS test line in the world is systematically introduced,including the composition and functionality of the system,the details of the conducted field tests,and the measured results of the typical dynamic responses.At the end of the paper,both the guidance on further improvement of the SMS and future research topics are proposed.展开更多
Background Early embryo development plays a pivotal role in determining pregnancy outcomes,postnatal development,and lifelong health.Therefore,the strategic selection of functional nutrients to enhance embryo developm...Background Early embryo development plays a pivotal role in determining pregnancy outcomes,postnatal development,and lifelong health.Therefore,the strategic selection of functional nutrients to enhance embryo development is of paramount importance.In this study,we established a stable porcine trophectoderm cell line expressing dual fluorescent reporter genes driven by the CDX2 and TEAD4 gene promoter segments using lentiviral transfection.Results Three amino acid metabolites—kynurenic acid,taurine,and tryptamine—met the minimum z-score criteria of 2.0 for both luciferase and Renilla luciferase activities and were initially identified as potential metabolites for embryo development,with their beneficial effects validated by qPCR.Given that the identified metabolites are closely related to methionine,arginine,and tryptophan,we selected these three amino acids,using lysine as a standard,and employed response surface methodology combined with our high-throughput screening cell model to efficiently screen and optimize amino acid combination conducive to early embryo development.The optimized candidate amino acid system included lysine(1.87 mmol/L),methionine(0.82 mmol/L),tryptophan(0.23 mmol/L),and arginine(3 mmol/L),with the ratio of 1:0.43:0.12:1.60.In vitro experiments confirmed that this amino acid system enhances the expression of key genes involved in early embryonic development and improves in vitro embryo adhesion.Transcriptomic analysis of blastocysts suggested that candidate amino acid system enhances early embryo development by regulating early embryonic cell cycle and differentiation,as well as improving nutrient absorption.Furthermore,based on response surface methodology,400 sows were used to verify this amino acid system,substituting arginine with the more cost-effective N-carbamoyl glutamate(NCG),a precursor of arginine.The optimal dietary amino acid requirement was predicted to be 0.71%lysine,0.32%methionine,0.22%tryptophan,and 0.10%NCG for sows during early gestation.The optimized amino acid system ratio of the feed,derived from the peripheral release of essential amino acids,was found to be 1:0.45:0.13,which is largely consistent with the results obtained from the cell model optimization.Subsequently,we furtherly verified that this optimal dietary amino acid system significantly increased total litter size,live litter size and litter weight in sows.Conclusions In summary,we successfully established a dual-fluorescent high-throughput screening cell model for the efficient identification of potential nutrients that would promote embryo development and implantation.This innovative approach overcomes the limitations of traditional amino acid nutrition studies in sows,providing a more effective model for enhancing reproductive outcomes.展开更多
Chinese medicine,with its rich historical roots and holistic approach,has been a fundamental aspect of healthcare in East Asia and is now gaining global recognition.Founded on centuries of empirical knowledge and phil...Chinese medicine,with its rich historical roots and holistic approach,has been a fundamental aspect of healthcare in East Asia and is now gaining global recognition.Founded on centuries of empirical knowledge and philosophical insight,Chinese medicine draws heavily from classical texts to guide its practices in herbal medicine and acupuncture.Despite its cultural and historical significance,integrating Chinese medicine into global healthcare systems presents challenges,notably the need for evidence-based practices to enhance credibility,ensure patient safety,and foster broader acceptance within the medical community.This paper explores how Chinese medicine can adopt evidence-based practices by incorporating principles of Western medicine into its research methodologies.It reviews the origins and philosophical foundations of Chinese medicine,examining its reliance on classical texts and empirical methods.The paper also highlights the differences between the personalised approach of Chinese medicine,which tailors treatments to individual needs,and the standardised protocols typical of Western medicine.Additionally,it addresses methodological challenges in Chinese medicine research,such as inconsistent diagnostic criteria and insufficient design rigour.To bridge these gaps,innovative research methodologies that respect the unique variability of Chinese medicine are needed.By adopting evidence-based practices and rigorous scientific validation,Chinese medicine can enhance its legitimacy and facilitate its integration into the global healthcare landscape.展开更多
Objective: This study assessed the methodological quality of systematic reviews/meta-analysis of the effectiveness of probiotics against irritable bowel syndrome (IBS) using the accepted methodological quality assessm...Objective: This study assessed the methodological quality of systematic reviews/meta-analysis of the effectiveness of probiotics against irritable bowel syndrome (IBS) using the accepted methodological quality assessment scale AMSTAR and explored the factors that influenced the quality of methodology. It was designed to provide a reference for future research and systematic reviews/metaanalysis. Methods: The methodological quality of existing systematic reviews/meta-analysis was evaluated using the AMSTAR scale. Influencing factors of methodological quality were statistically analyzed using RevMan 5.3 software. The included systematic reviews/metaanalysis must include the following characteristics:(1) methods using systematic evaluation/meta-analysis,(2) probiotic intervention, and (3) language limitation to Chinese and English. Results: The AMSTAR score was 5-9 (7.42 ± 1.22), and the quality is above average. The factors affecting the methodological quality are the number of authors and whether they cooperate with the institution. Conclusions: Studies have shown that current systematic reviews/meta-analysis of the effectiveness of probiotics on IBS does not fully comply with methodological quality standards, and therefore the methodological quality of research in this area needs to be strengthened. To better clarify how probiotics affect IBS, future systematic reviews and meta-analyses should not only follow methodological quality standards but also include more effective outcome measures, and they should focus more on the discussion of research results. We look forward to the development of higher-quality randomized controlled trials in the future.展开更多
In the State of Santa Catarina, Brazil, especially in the Itajai valley, there are records of accidents and disasters mainly associated to landslides and floods, which have caused significant damages and losses, inclu...In the State of Santa Catarina, Brazil, especially in the Itajai valley, there are records of accidents and disasters mainly associated to landslides and floods, which have caused significant damages and losses, including human lives. In order to make the coexistence with such natural disasters possible, most particularly with floods, a integration is required among the technical, political, environmental, and human knowledge. Measures that encompass integrated actions for the entire river basin, with the help from an updated technical cadastre and tools, such as the GIS, allow the development of planning tools that might effectively help the people to live with the water, or else to cope with floods in a more appropriate manner. This paper attempts to propose a methodology for urban flood control, based on the integration among the several public entities involved in the flood control, along with the CTM （Multipurpose Technical Cadastre） and GIS tool. In order to solve or minimize the problems, the model proposed here aims at promoting a balance between the agents involved, and enables to rank the degrees of importance assigned to the different needs, thus allowing to eliminate or to improve those areas and processes that are duplicated or superimposed.展开更多
Background:Stroke is not only high in morbidity and mortality but also poses a great burden of disease and it is also the most reported disease in Chinese medicine systematic reviews.Therefore,the quality of such evid...Background:Stroke is not only high in morbidity and mortality but also poses a great burden of disease and it is also the most reported disease in Chinese medicine systematic reviews.Therefore,the quality of such evidence couldn’t be ignored.This study aims to use a measurement tool to assess systematic reviews(AMSTAR)to assess the methodological qualities of SR/Meta-analyses of Chinese medicine on stroke.Methods:Systematic searching of seven electronic databases and PROSPERO registration platform was carried out.Two researchers separately selected studies,extracted bibliographical characteristics and scored every included study independently after training.Total score and the proportion of each item completion were explored in different subgroup comparisons.Spearman rank correlation and multivariable logistic regression were used to measure the association between bibliographical characteristics and total score or each item.Results:Total average score of AMSTAR 1.0 checklists of 234 systematic reviews/Meta-analyses was 4.47(95%CI 4.27–4.68)and the qualities were unsatisfied especially in terms of priori setting(2.14%),grey literature inclusion(5.13%),providing a list of excluded studies(2.14%)and conflict of interest(0.00%).No improvement was found in 3 years even after the publication of AMSTAR.Chinese or nonregistered systematic reviews/Meta-analyses showed even worse methodological qualities(P<0.01).Positive correlation was found between individual items and number of pages,number of authors,research questions,languages or Meta-analyse separately(P<0.05).Conclusion:The methodological qualities of systematic reviews/Meta-analyses of Chinese medicine on stroke are poor especially Chinese studies,non-registered studies,brief studies and studies without Meta-analyse or cooperation.There is no obvious improvement over these years even after the publication of AMSTAR tool,so it is urgent to promote the use of AMSTAR or develop other efficient methods to control the quantity and monitor the quality in future.展开更多
BACKGROUND Online surveys can align with youth’s increased use of the internet and can be a mechanism for expanding youth participation in research.This is particularly important during the coronavirus disease 2019(C...BACKGROUND Online surveys can align with youth’s increased use of the internet and can be a mechanism for expanding youth participation in research.This is particularly important during the coronavirus disease 2019(COVID-19)pandemic,when inperson interactions are limited.However,the advantages and drawbacks of online systems used for research need to be carefully considered before utilizing such methodologies.AIM To describe and discuss the strengths and limitations of an online system developed to recruit adolescent girls for a sexual health research study and conduct a three-month follow up survey.METHODS This methodology paper examines the use of an online system to recruit and follow participants three months after their medical visit to evaluate a mobile sexual and reproductive health application,Health-E You/Salud iTuTM,for adolescent girls attending school-based health centers(SBHCs)across the United States.SBHC staff gave adolescent girls a web link to an online eligibility and consent survey.Participants were then asked to complete two online surveys(baseline and 3-month follow-up).Surveys,reminders,and incentives to complete them were distributed through short message service(SMS)text messages.Upon completing each survey,participants were also sent an email with a link to an electronic gift card as a thank-you for their participation.Barriers to implementing this system were discussed with clinicians and staff at each participating SBHC.RESULTS This online recruitment and retention system enabled participant recruitment at 26 different SBHCs in seven states across the United States.Between September 2021 and June 2022,415 adolescent girls were screened using the Qualtrics online survey platform,and 182 were eligible to participate.Of those eligible,78.0%(n=142)completed the baseline survey.Participants were racially,geographically,and linguistically diverse.Most of the participants(89.4%)were non-White,and 40.8%spoke Spanish.A total of 62.0%(n=88)completed the 3-month follow-up survey.Limitations of this system included reliance on internet access(via Wi-Fi or cell service),which was not universally available or reliable.In addition,an individual unrelated to the study obtained the survey link,filled out multiple surveys,and received multiple gift cards before the research team discovered and stopped this activity.As a result,additional security protocols were instituted.CONCLUSION Online systems for health research can increase the reach and diversity of study participants,reduce costs for research personnel time and travel,allow for continued study operation when in-person visits are limited(such as during the COVID-19 pandemic),and connect youth with research using technology.However,there are challenges and limitations to online systems,which include limited internet access,intermittent internet connection,data security concerns,and the potential for fraudulent users.These challenges should be considered prior to using online systems for research.展开更多
Aims:This study aims to investigate the methodological quality of the systematic reviews of music therapy for Alzheimer’s Disease in the past five years,and to explore their compliance with each AMSTAR(A Measure Tool...Aims:This study aims to investigate the methodological quality of the systematic reviews of music therapy for Alzheimer’s Disease in the past five years,and to explore their compliance with each AMSTAR(A Measure Tool to Assess Systematic Reviews)item.Based on the above,this study is intended to facilitate the evidence transformation of music therapy in Alzheimer's Disease.Method:Cochrane Library,Web of Science,Embase and PubMed were searched from 2017-2021,to obtain the systematic reviews of music therapy among Alzheimer’s Disease.We used the AMSTAR,to evaluate their methodological quality.Additionally,their compliance with 16 AMSTAR items was investigated.Results:12 systematic reviews were included in this study.The methodological quality of 10 articles was“very low”,1 article was“low”,and 1 article was“high”.The 12 systematic reviews had 25%to 100%compliance with 16 AMSTAR items.Conclusion:The methodological quality of systematic reviews of music therapy among Alzheimer’s Disease in the recent five years is not high,and needs to be further improved.Future research should continue to explore the factors that affect their methodological quality,to promote the transformation of evidence-based evidence.展开更多
Background:The purported ergogenic and health effects of probiotics have been a topic of great intrigue among researchers,practitioners,and the lay public alike.There has also been an increased research focus within t...Background:The purported ergogenic and health effects of probiotics have been a topic of great intrigue among researchers,practitioners,and the lay public alike.There has also been an increased research focus within the realm of sports science and exercise medicine on the athletic gut microbiota.However,compared to other ergogenic aids and dietary supplements,probiotics present unique study challenges.The objectives of this systematic scoping review were to identify and characterize study methodologies of randomized controlled trials investigating supplementation with probiotics in athletes and physically active individuals.Methods:Four databases(MEDLINE,CINAHL,Cochrane CENTRAL,and Cochrane Database of Systematic Reviews)were searched for randomized controlled studies involving healthy athletes or physically active individuals.An intervention with probiotics and inclusion of a control and/or placebo group were essential.Only peer-reviewed articles in English were considered,and there were no date restrictions.Results were extracted and presented in tabular form to detail study protocols,characteristics,and outcomes.Bias in randomized controlled trials was determined with the RoB 2.0 tool.Results:A total of 45 studies were included in the review,with 35 using a parallel group design and 10 using a cross-over design.Approximately half the studies used a single probiotic and the other half a multi-strain preparation.The probiotic dose ranged from 2×10^(8)to 1×10^(11)colony forming units daily,and the length of intervention was between 7 and 150 days.Fewer than half the studies directly assessed gastrointestinal symptoms,gut permeability,or the gut microbiota.The sex ratio of participants was heavily weighted toward males,and only 3 studies exclusively investigated females.Low-level adverse events were reported in only 2 studies,although the methodology of reporting varied widely.The risk of bias was generally low,although details on randomization were lacking in some studies.Conclusion:There is a substantial body of research on the effects of prob iotic supplementation in healthy athletes and physically active individuals.Considerable heterogeneity in probiotic selection and dosage as well as outcome measures has made clinical and mechanistic interpretation challenging for both health care practitioners and researchers.Attention to issues of randomization of participants,treatments and interventions,selection of outcomes,demographics,and reporting of adverse events will facilitate more trustworthy interpretation of probiotic study results and inform evidence-based guidelines.展开更多
Scientific evidence develops bit by bit from case reports,case series;to larger casecontrol,case-cohort;and further escalate to randomized controlled trials.This echoed the importance of continue publishing World jour...Scientific evidence develops bit by bit from case reports,case series;to larger casecontrol,case-cohort;and further escalate to randomized controlled trials.This echoed the importance of continue publishing World journal of Clinical Cases,where novel and advancing discoveries start from a single case.In contrast,at the other end of the realm of evidence synthesis,systematic review and meta-analysis represent distinct yet interconnected processes.Butorphanol in epidural labor analgesia has long been studied since 1989,and with 70 publications from MEDLINE searches.However,there was no meta-analysis,nor any systematic review published so far.The latest in-press article published by Tang et al.on the protocol for the systematic review and meta-analysis on the safety and effectiveness of butorphanol in epidural labor analgesia is encouraging.We believe the findings of this study will be valuable for clinical practice as well as for future research.展开更多
Periodontitis is independently associated with numerous lifestyle diseases.Diabetic patients have approximately threefold increased odds of periodontitis,which in turn increases the risk of systemic inflammation.The s...Periodontitis is independently associated with numerous lifestyle diseases.Diabetic patients have approximately threefold increased odds of periodontitis,which in turn increases the risk of systemic inflammation.The study by Thazhe Poyil et al is an effort to establish the inflammatory link between diabetic retinopathy(DR)and periodontitis based on the periodontal inflamed surface area in diabetic patients with and without DR.To further advance the study,we suggest refining the eligibility criteria to explicitly state the clinical correlates of periodontitis and DR,larger sample size and improved sampling methodology,matching of baseline characteristics of the two groups,as well as improved statistical approach and interpretation of the study findings.Measurement of hemoglobin A1c(HbA1c)in studies comparing type 2 diabetes mellitus patients with DR of matched severity with and without periodontitis could provide a clearer picture of whether HbA1c level is indeed influenced by periodontitis.展开更多
Civil engineering works require the selection of soil-type materials and the assessment of their geomechanical characteristics. However, the lack of relevant geotechnical mapping to facilitate the prediction of granul...Civil engineering works require the selection of soil-type materials and the assessment of their geomechanical characteristics. However, the lack of relevant geotechnical mapping to facilitate the prediction of granular material zones for civil engineering works in Benin means that very costly and sometimes inconclusive prospecting has to be undertaken for each project. The aim of this study is to contribute to the availability of geotechnical mapping in Benin. For this purpose, and in order to capitalize on the data, the proposed methodological approach is based on the systematic and controlled recording of data produced by laboratories during geotechnical and geological surveys for road construction projects. To this end, a web platform called ROAD MAT has been designed for data recording. This platform has been tested using data from test results from sixteen boreholes drilled in the Mono department. These results show a predominance of soil class G2 and CBR class P2. The database is steadily expanding, and its use by stakeholders will make it possible to collect and centralize vital data to define benchmarks for greater control of geotechnical risks. This work therefore constitutes a blueprint for the development of geotechnical mapping in Benin.展开更多
Background:The sustainability of rural surgical and obstetrical facilities depends on their efficacy and quality of care,which are difficult to measure in a rural context.In an evaluation of rural practice,it is often...Background:The sustainability of rural surgical and obstetrical facilities depends on their efficacy and quality of care,which are difficult to measure in a rural context.In an evaluation of rural practice,it is often the case that the only comparators are larger referral facilities,for which facility‐level comparisons are difficult due to differences in population demographics,acuity of patients,and services offered.This publication outlines these limitations and highlights a best‐practice approach to making facility‐level comparisons using population‐level data,risk stratification,tests of noninfer-iority,and Firth logistic regression analysis.This includes an investigation of minimum sample‐size requirements through Monte Carlo power analysis in the context of low‐acuity rural surgical care.Methods:Monte Carlo power analysis was used to estimate the minimum sample size required to achieve a power of 0.8 for both logistic regression and Firth logistic regression models that compare the proportion of surgical adverse events against facility type,among other confounders.We provide guidelines for the implementation of a recommended methodology that uses risk stratification,Firth penalized logistic regression,and tests of noninferiority.Results:We illustrate limitations in facility‐level comparison of surgical quality among patients undergoing one of four index procedures including hernia repair,colonoscopy,appendectomy,and cesarean delivery.We identified minimum sample sizes for comparison of each index procedure that fluctuate depending on the level of risk stratification used.Conclusion:The availability of administrative data can provide an adequate sample size to allow for facility‐level comparisons in surgical quality,at the rural level and elsewhere.When they are made appropriately,these comparisons can be used to evaluate the efficacy of general practitioners and nurse practitioners in performing low‐acuity procedures.展开更多
This letter critically evaluates Jiang et al's article on the differentiation of benign and malignant liver lesions using Emax and platelet count.Despite notable findings,significant methodological and interpretat...This letter critically evaluates Jiang et al's article on the differentiation of benign and malignant liver lesions using Emax and platelet count.Despite notable findings,significant methodological and interpretative limitations are identified.The study lacks detailed assay conditions for Emax measurement,employs inadequate statistical methods without robust multivariate analysis,and does not provide clinically relevant threshold values.The nomogram's reliance on Emax as a major diagnostic contributor is questionable due to attenuation in hepatocellular carcinoma patients with cirrhosis.Moreover,the study's limitations,such as selection bias and confounding factors,are not adequately addressed.Future research should adopt more rigorous methodologies,including prospective studies with larger cohorts and standardized protocols for biomarker measurement,to enhance validity and clinical applicability.展开更多
The graded density impactor(GDI)dynamic loading technique is crucial for acquiring the dynamic physical property parameters of materials used in weapons.The accuracy and timeliness of GDI structural design are key to ...The graded density impactor(GDI)dynamic loading technique is crucial for acquiring the dynamic physical property parameters of materials used in weapons.The accuracy and timeliness of GDI structural design are key to achieving controllable stress-strain rate loading.In this study,we have,for the first time,combined one-dimensional fluid computational software with machine learning methods.We first elucidated the mechanisms by which GDI structures control stress and strain rates.Subsequently,we constructed a machine learning model to create a structure-property response surface.The results show that altering the loading velocity and interlayer thickness has a pronounced regulatory effect on stress and strain rates.In contrast,the impedance distribution index and target thickness have less significant effects on stress regulation,although there is a matching relationship between target thickness and interlayer thickness.Compared with traditional design methods,the machine learning approach offers a10^(4)—10^(5)times increase in efficiency and the potential to achieve a global optimum,holding promise for guiding the design of GDI.展开更多
A ternary early-strengthening agent consisting of calcium formate+triethanolamine+lithium sulfate was compounded with quercetin to shorten the setting time of cementitious materials while ensuring their early strength...A ternary early-strengthening agent consisting of calcium formate+triethanolamine+lithium sulfate was compounded with quercetin to shorten the setting time of cementitious materials while ensuring their early strength.The optimum ratio of the three early-strengthening agents was determined as 0.5%calcium formate+0.04%triethanolamine+0.4%lithium sulfate by response surface methodology.The effects of the ternary early-strengthening agent composed of calcium formate+triethanolamine(TEA)+lithium sulfate on cementitious pore sealing materials under the synergistic effect of quercetin were studied by means of the performance tests of compressive strength,fluidity,and setting time,and the microstructural characterizations of X-ray powder diffractometer(XRD),thermogravimetry(TG-DSC)and scanning electron microscopy(SEM).The study shows that the synergistic effect of ternary early-strengthening agent and quercetin forms a multi-performance composite admixture for cementitious materials.The best performance was obtained with the compounding scheme of 0.5%calcium formate+0.04%triethanolamine+0.4%lithium sulfate ternary early-strengthening agent and 0.05%quercetin.The compressive strength of 1,3,7,and 28 d are 94.8%,39.8%,42%,and 28%higher than those of the blank group,respectively.The initial time and final setting time are 41 and 57 minutes,respectively.According to the microscopic analysis,the network and fibrous C-S-H gels generated by ternary early-strengthening agents are attached to the surface promoted by quercetin,which forms skeleton support while thickening and solidifying the cement slurry,which enhances the early compressive strength of the cement-based materials.展开更多
基金supported by Chinese Medicine Development Fund of the Hong Kong SAR(No.21B2/018A)。
文摘Objective:This cross-sectional study assessed the methodological quality of systematic reviews(SRs)of Chinese herbal medicine(CHM)published in Chinese between Jan 2021 and Sep 2022.Methods:Chinese language CHM SRs were identified through literature searches across 3 international and 4 Chinese databases.Methodological quality was appraised using A MeaSurement Tool to Assess systematic Reviews 2.Logistic regressions were used to explore associations between bibliographical characteristics and quality.Results:Analyses of methodological quality found that among the 213 sampled SRs,69.5%were of critically low quality,30.5%were of low quality,and none achieved high or moderate quality.Common shortcomings included the failure to identify the studies excluded from the analysis,failure to disclose funding sources,and limited evaluation of the potential impact of bias on conclusions.Logistic regressions revealed that SRs led by corresponding authors affiliated with universities or academic institutions tended to be of lower quality than SRs led by authors affiliated with hospitals or clinical facilities.Conclusion:Recent Chinese language CHM SRs exhibited limited methodological quality,making them unlikely to support the development of clinical practice guidelines.Urgent initiatives are needed to enhance training for researchers,peer-reviewers and editors involved in the preparation and publication of SRs.Adoption of Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines in Chinese language journals is crucial to improve the relevance of SRs for Chinese medicine development.Addressing deficiencies in methodology and reporting is essential for promoting evidence-based practices and informed clinical decisions in Chinese medicine.
基金Supported by National Natural Science Foundation of China:81973968,82274660China Center for Evidence Based Traditional Chinese Medicine:2020YJSZX-1.
文摘Background:Methodological issues and challenges hinder the high-quality development of acupuncture clinical studies.Objective:To systematically summarize the methodological issues,challenges,and recommendations in acupuncture clinical research using the participant,intervention,comparison,outcome,and study design(PICOS)framework to generate a comprehensive list of methodological questions and recommendations.Methods:We searched seven databases for articles on the methodological aspects of clinical acupuncture research from their inception to March 24,2023.Two researchers independently screened the titles,ab-stracts,and full text of each article.Data extraction and analyses were performed for the eligible studies.Finally,the methodological challenges and recommendations for acupuncture clinical studies are listed,and the frequency of methodological challenges is displayed in a sunburst chart.Results:A total of 226 studies were included in the review,most of which originated in China(173,77%),followed by the United States(25,11%)and the United Kingdom(12,5%).Clinical research on acupuncture faces methodological challenges that span the five elements of the PICOS framework.The most frequently mentioned issues were related to comparison,followed by study design and interven-tions.If further categorized,the establishment of the control group is undoubtedly the most concerning issue for researchers.Conclusion:This review provides a comprehensive overview of the challenges and recommendations for each aspect of the PICOS framework in clinical acupuncture research.
文摘BACKGROUND Systematic reviews(SRs)synthesize and evaluate data,mainly from randomized trials,which then guides the development of clinical recommendations in evidence-based medicine.However,the data and methodological information in the included papers can often be lacking or unclear,and reviewers usually need to contact the authors of included studies for clarifications.Contacting authors is recommended,but it is unclear how often SR teams do it,or what the level of response is.AIM To investigate how often reviewers undertake contact with the authors of included randomized controlled trials(RCTs)for clarification on data and risk of bias concerns,to explore the factors that influence whether SR authors contact or do not contact the authors,and the content and level of responses.METHODS We conducted a systematic electronic database search in MEDLINE using the search string“(systematic review)”AND“(RCT OR randomized OR trial)”for articles published between 1 January 2024 and 19 February 2024,without language restrictions.Screening and data extraction was done independently by two reviewers,and conflicts resolved by a senior author.Contact authors of included SRs were contacted for clarifications.RESULTS Of the 329 included SRs,38%(n=125)explicitly mentioned contact with the authors of included studies.The remaining 62%(n=204)did not.We attempted contact with all SR teams for clarifications and received 90 responses(19.4%).Of the 50 respondents who did not explicitly mention contact in their SRs,25(50%)replied that they did make contact.We received a total of 64 responses on the level and content of information sought.The mean±SD contacts SR teams made were 10(10),replies received 5(6.7),and response waiting time 10.1(28.3)weeks.Resources,time,poor previous experience,perceived likelihood of poor response and bias concerns were reported as barriers to attempting contact.CONCLUSION The majority of SRs published in 2024 did not confirm seeking clarifying or missing information from primary study authors.However,SR teams reported that 50%of contacted primary authors respond.Additional research can clarify this rate of response and establish methods to increase the integration of this core methodological element in SRs.
基金supported by the National Natural Science Foundation of China(Grant Nos.52202483,52108476,and 52388102)。
文摘Urban transportation systems are facing severe challenges due to the rapid growth of the urban population,especially in China.Suspended monorail system(SMS),as a sky rail transportation form,can effectively alleviate urban traffic congestion due to its independent right-of-way and minimal ground footprint.However,the SMS possesses a special traveling system with unique vehicle structure and bridge configuration,which results in significant differences in both the mechanisms and dynamics problems associated with train–bridge interaction(TBI)when contrasted with those of traditional railway systems.Therefore,a thorough understanding of the SMS dynamics is essential for ensuring the operational safety of the system.This article presents a state-of-the-art review of the TBI modeling methodologies,critical dynamic features,field tests,and practice of the SMS in China.Firstly,the development history,technical features,and potential dynamics problems of the SMS are briefly described,followed by the mechanical characteristics and mechanisms of the train–bridge interactive systems.Then,the modeling methodology of the fundamental elements in the suspended monorail TBI is systematically reviewed,including the suspended train subsystem,bridge subsystem,train–bridge interaction relationships,system excitations,and solution method.Further,the typical dynamic features of the TBI under various operational scenarios are elaborated,including different train speeds,a variety of line sections,and a natural wind environment.Finally,the first new energy-based SMS test line in the world is systematically introduced,including the composition and functionality of the system,the details of the conducted field tests,and the measured results of the typical dynamic responses.At the end of the paper,both the guidance on further improvement of the SMS and future research topics are proposed.
基金supported by National Natural Science Foundation of China (32172747 and 32425052)
文摘Background Early embryo development plays a pivotal role in determining pregnancy outcomes,postnatal development,and lifelong health.Therefore,the strategic selection of functional nutrients to enhance embryo development is of paramount importance.In this study,we established a stable porcine trophectoderm cell line expressing dual fluorescent reporter genes driven by the CDX2 and TEAD4 gene promoter segments using lentiviral transfection.Results Three amino acid metabolites—kynurenic acid,taurine,and tryptamine—met the minimum z-score criteria of 2.0 for both luciferase and Renilla luciferase activities and were initially identified as potential metabolites for embryo development,with their beneficial effects validated by qPCR.Given that the identified metabolites are closely related to methionine,arginine,and tryptophan,we selected these three amino acids,using lysine as a standard,and employed response surface methodology combined with our high-throughput screening cell model to efficiently screen and optimize amino acid combination conducive to early embryo development.The optimized candidate amino acid system included lysine(1.87 mmol/L),methionine(0.82 mmol/L),tryptophan(0.23 mmol/L),and arginine(3 mmol/L),with the ratio of 1:0.43:0.12:1.60.In vitro experiments confirmed that this amino acid system enhances the expression of key genes involved in early embryonic development and improves in vitro embryo adhesion.Transcriptomic analysis of blastocysts suggested that candidate amino acid system enhances early embryo development by regulating early embryonic cell cycle and differentiation,as well as improving nutrient absorption.Furthermore,based on response surface methodology,400 sows were used to verify this amino acid system,substituting arginine with the more cost-effective N-carbamoyl glutamate(NCG),a precursor of arginine.The optimal dietary amino acid requirement was predicted to be 0.71%lysine,0.32%methionine,0.22%tryptophan,and 0.10%NCG for sows during early gestation.The optimized amino acid system ratio of the feed,derived from the peripheral release of essential amino acids,was found to be 1:0.45:0.13,which is largely consistent with the results obtained from the cell model optimization.Subsequently,we furtherly verified that this optimal dietary amino acid system significantly increased total litter size,live litter size and litter weight in sows.Conclusions In summary,we successfully established a dual-fluorescent high-throughput screening cell model for the efficient identification of potential nutrients that would promote embryo development and implantation.This innovative approach overcomes the limitations of traditional amino acid nutrition studies in sows,providing a more effective model for enhancing reproductive outcomes.
文摘Chinese medicine,with its rich historical roots and holistic approach,has been a fundamental aspect of healthcare in East Asia and is now gaining global recognition.Founded on centuries of empirical knowledge and philosophical insight,Chinese medicine draws heavily from classical texts to guide its practices in herbal medicine and acupuncture.Despite its cultural and historical significance,integrating Chinese medicine into global healthcare systems presents challenges,notably the need for evidence-based practices to enhance credibility,ensure patient safety,and foster broader acceptance within the medical community.This paper explores how Chinese medicine can adopt evidence-based practices by incorporating principles of Western medicine into its research methodologies.It reviews the origins and philosophical foundations of Chinese medicine,examining its reliance on classical texts and empirical methods.The paper also highlights the differences between the personalised approach of Chinese medicine,which tailors treatments to individual needs,and the standardised protocols typical of Western medicine.Additionally,it addresses methodological challenges in Chinese medicine research,such as inconsistent diagnostic criteria and insufficient design rigour.To bridge these gaps,innovative research methodologies that respect the unique variability of Chinese medicine are needed.By adopting evidence-based practices and rigorous scientific validation,Chinese medicine can enhance its legitimacy and facilitate its integration into the global healthcare landscape.
文摘Objective: This study assessed the methodological quality of systematic reviews/meta-analysis of the effectiveness of probiotics against irritable bowel syndrome (IBS) using the accepted methodological quality assessment scale AMSTAR and explored the factors that influenced the quality of methodology. It was designed to provide a reference for future research and systematic reviews/metaanalysis. Methods: The methodological quality of existing systematic reviews/meta-analysis was evaluated using the AMSTAR scale. Influencing factors of methodological quality were statistically analyzed using RevMan 5.3 software. The included systematic reviews/metaanalysis must include the following characteristics:(1) methods using systematic evaluation/meta-analysis,(2) probiotic intervention, and (3) language limitation to Chinese and English. Results: The AMSTAR score was 5-9 (7.42 ± 1.22), and the quality is above average. The factors affecting the methodological quality are the number of authors and whether they cooperate with the institution. Conclusions: Studies have shown that current systematic reviews/meta-analysis of the effectiveness of probiotics on IBS does not fully comply with methodological quality standards, and therefore the methodological quality of research in this area needs to be strengthened. To better clarify how probiotics affect IBS, future systematic reviews and meta-analyses should not only follow methodological quality standards but also include more effective outcome measures, and they should focus more on the discussion of research results. We look forward to the development of higher-quality randomized controlled trials in the future.
文摘In the State of Santa Catarina, Brazil, especially in the Itajai valley, there are records of accidents and disasters mainly associated to landslides and floods, which have caused significant damages and losses, including human lives. In order to make the coexistence with such natural disasters possible, most particularly with floods, a integration is required among the technical, political, environmental, and human knowledge. Measures that encompass integrated actions for the entire river basin, with the help from an updated technical cadastre and tools, such as the GIS, allow the development of planning tools that might effectively help the people to live with the water, or else to cope with floods in a more appropriate manner. This paper attempts to propose a methodology for urban flood control, based on the integration among the several public entities involved in the flood control, along with the CTM （Multipurpose Technical Cadastre） and GIS tool. In order to solve or minimize the problems, the model proposed here aims at promoting a balance between the agents involved, and enables to rank the degrees of importance assigned to the different needs, thus allowing to eliminate or to improve those areas and processes that are duplicated or superimposed.
基金the National Natural Science Funding(81904055)of China.
文摘Background:Stroke is not only high in morbidity and mortality but also poses a great burden of disease and it is also the most reported disease in Chinese medicine systematic reviews.Therefore,the quality of such evidence couldn’t be ignored.This study aims to use a measurement tool to assess systematic reviews(AMSTAR)to assess the methodological qualities of SR/Meta-analyses of Chinese medicine on stroke.Methods:Systematic searching of seven electronic databases and PROSPERO registration platform was carried out.Two researchers separately selected studies,extracted bibliographical characteristics and scored every included study independently after training.Total score and the proportion of each item completion were explored in different subgroup comparisons.Spearman rank correlation and multivariable logistic regression were used to measure the association between bibliographical characteristics and total score or each item.Results:Total average score of AMSTAR 1.0 checklists of 234 systematic reviews/Meta-analyses was 4.47(95%CI 4.27–4.68)and the qualities were unsatisfied especially in terms of priori setting(2.14%),grey literature inclusion(5.13%),providing a list of excluded studies(2.14%)and conflict of interest(0.00%).No improvement was found in 3 years even after the publication of AMSTAR.Chinese or nonregistered systematic reviews/Meta-analyses showed even worse methodological qualities(P<0.01).Positive correlation was found between individual items and number of pages,number of authors,research questions,languages or Meta-analyse separately(P<0.05).Conclusion:The methodological qualities of systematic reviews/Meta-analyses of Chinese medicine on stroke are poor especially Chinese studies,non-registered studies,brief studies and studies without Meta-analyse or cooperation.There is no obvious improvement over these years even after the publication of AMSTAR tool,so it is urgent to promote the use of AMSTAR or develop other efficient methods to control the quantity and monitor the quality in future.
基金Supported by a Patient-Centered Outcomes Research Institute(PCORI)Dissemination and Implementation Award,No.DI-2020C2-20372.
文摘BACKGROUND Online surveys can align with youth’s increased use of the internet and can be a mechanism for expanding youth participation in research.This is particularly important during the coronavirus disease 2019(COVID-19)pandemic,when inperson interactions are limited.However,the advantages and drawbacks of online systems used for research need to be carefully considered before utilizing such methodologies.AIM To describe and discuss the strengths and limitations of an online system developed to recruit adolescent girls for a sexual health research study and conduct a three-month follow up survey.METHODS This methodology paper examines the use of an online system to recruit and follow participants three months after their medical visit to evaluate a mobile sexual and reproductive health application,Health-E You/Salud iTuTM,for adolescent girls attending school-based health centers(SBHCs)across the United States.SBHC staff gave adolescent girls a web link to an online eligibility and consent survey.Participants were then asked to complete two online surveys(baseline and 3-month follow-up).Surveys,reminders,and incentives to complete them were distributed through short message service(SMS)text messages.Upon completing each survey,participants were also sent an email with a link to an electronic gift card as a thank-you for their participation.Barriers to implementing this system were discussed with clinicians and staff at each participating SBHC.RESULTS This online recruitment and retention system enabled participant recruitment at 26 different SBHCs in seven states across the United States.Between September 2021 and June 2022,415 adolescent girls were screened using the Qualtrics online survey platform,and 182 were eligible to participate.Of those eligible,78.0%(n=142)completed the baseline survey.Participants were racially,geographically,and linguistically diverse.Most of the participants(89.4%)were non-White,and 40.8%spoke Spanish.A total of 62.0%(n=88)completed the 3-month follow-up survey.Limitations of this system included reliance on internet access(via Wi-Fi or cell service),which was not universally available or reliable.In addition,an individual unrelated to the study obtained the survey link,filled out multiple surveys,and received multiple gift cards before the research team discovered and stopped this activity.As a result,additional security protocols were instituted.CONCLUSION Online systems for health research can increase the reach and diversity of study participants,reduce costs for research personnel time and travel,allow for continued study operation when in-person visits are limited(such as during the COVID-19 pandemic),and connect youth with research using technology.However,there are challenges and limitations to online systems,which include limited internet access,intermittent internet connection,data security concerns,and the potential for fraudulent users.These challenges should be considered prior to using online systems for research.
基金supported by National Natural Science Foundation of China(No.81603565)Tianjin University of Traditional Chinese Medicine Postgraduate Research Innovation Project(YJSKC-20201032).
文摘Aims:This study aims to investigate the methodological quality of the systematic reviews of music therapy for Alzheimer’s Disease in the past five years,and to explore their compliance with each AMSTAR(A Measure Tool to Assess Systematic Reviews)item.Based on the above,this study is intended to facilitate the evidence transformation of music therapy in Alzheimer's Disease.Method:Cochrane Library,Web of Science,Embase and PubMed were searched from 2017-2021,to obtain the systematic reviews of music therapy among Alzheimer’s Disease.We used the AMSTAR,to evaluate their methodological quality.Additionally,their compliance with 16 AMSTAR items was investigated.Results:12 systematic reviews were included in this study.The methodological quality of 10 articles was“very low”,1 article was“low”,and 1 article was“high”.The 12 systematic reviews had 25%to 100%compliance with 16 AMSTAR items.Conclusion:The methodological quality of systematic reviews of music therapy among Alzheimer’s Disease in the recent five years is not high,and needs to be further improved.Future research should continue to explore the factors that affect their methodological quality,to promote the transformation of evidence-based evidence.
文摘Background:The purported ergogenic and health effects of probiotics have been a topic of great intrigue among researchers,practitioners,and the lay public alike.There has also been an increased research focus within the realm of sports science and exercise medicine on the athletic gut microbiota.However,compared to other ergogenic aids and dietary supplements,probiotics present unique study challenges.The objectives of this systematic scoping review were to identify and characterize study methodologies of randomized controlled trials investigating supplementation with probiotics in athletes and physically active individuals.Methods:Four databases(MEDLINE,CINAHL,Cochrane CENTRAL,and Cochrane Database of Systematic Reviews)were searched for randomized controlled studies involving healthy athletes or physically active individuals.An intervention with probiotics and inclusion of a control and/or placebo group were essential.Only peer-reviewed articles in English were considered,and there were no date restrictions.Results were extracted and presented in tabular form to detail study protocols,characteristics,and outcomes.Bias in randomized controlled trials was determined with the RoB 2.0 tool.Results:A total of 45 studies were included in the review,with 35 using a parallel group design and 10 using a cross-over design.Approximately half the studies used a single probiotic and the other half a multi-strain preparation.The probiotic dose ranged from 2×10^(8)to 1×10^(11)colony forming units daily,and the length of intervention was between 7 and 150 days.Fewer than half the studies directly assessed gastrointestinal symptoms,gut permeability,or the gut microbiota.The sex ratio of participants was heavily weighted toward males,and only 3 studies exclusively investigated females.Low-level adverse events were reported in only 2 studies,although the methodology of reporting varied widely.The risk of bias was generally low,although details on randomization were lacking in some studies.Conclusion:There is a substantial body of research on the effects of prob iotic supplementation in healthy athletes and physically active individuals.Considerable heterogeneity in probiotic selection and dosage as well as outcome measures has made clinical and mechanistic interpretation challenging for both health care practitioners and researchers.Attention to issues of randomization of participants,treatments and interventions,selection of outcomes,demographics,and reporting of adverse events will facilitate more trustworthy interpretation of probiotic study results and inform evidence-based guidelines.
文摘Scientific evidence develops bit by bit from case reports,case series;to larger casecontrol,case-cohort;and further escalate to randomized controlled trials.This echoed the importance of continue publishing World journal of Clinical Cases,where novel and advancing discoveries start from a single case.In contrast,at the other end of the realm of evidence synthesis,systematic review and meta-analysis represent distinct yet interconnected processes.Butorphanol in epidural labor analgesia has long been studied since 1989,and with 70 publications from MEDLINE searches.However,there was no meta-analysis,nor any systematic review published so far.The latest in-press article published by Tang et al.on the protocol for the systematic review and meta-analysis on the safety and effectiveness of butorphanol in epidural labor analgesia is encouraging.We believe the findings of this study will be valuable for clinical practice as well as for future research.
文摘Periodontitis is independently associated with numerous lifestyle diseases.Diabetic patients have approximately threefold increased odds of periodontitis,which in turn increases the risk of systemic inflammation.The study by Thazhe Poyil et al is an effort to establish the inflammatory link between diabetic retinopathy(DR)and periodontitis based on the periodontal inflamed surface area in diabetic patients with and without DR.To further advance the study,we suggest refining the eligibility criteria to explicitly state the clinical correlates of periodontitis and DR,larger sample size and improved sampling methodology,matching of baseline characteristics of the two groups,as well as improved statistical approach and interpretation of the study findings.Measurement of hemoglobin A1c(HbA1c)in studies comparing type 2 diabetes mellitus patients with DR of matched severity with and without periodontitis could provide a clearer picture of whether HbA1c level is indeed influenced by periodontitis.
文摘Civil engineering works require the selection of soil-type materials and the assessment of their geomechanical characteristics. However, the lack of relevant geotechnical mapping to facilitate the prediction of granular material zones for civil engineering works in Benin means that very costly and sometimes inconclusive prospecting has to be undertaken for each project. The aim of this study is to contribute to the availability of geotechnical mapping in Benin. For this purpose, and in order to capitalize on the data, the proposed methodological approach is based on the systematic and controlled recording of data produced by laboratories during geotechnical and geological surveys for road construction projects. To this end, a web platform called ROAD MAT has been designed for data recording. This platform has been tested using data from test results from sixteen boreholes drilled in the Mono department. These results show a predominance of soil class G2 and CBR class P2. The database is steadily expanding, and its use by stakeholders will make it possible to collect and centralize vital data to define benchmarks for greater control of geotechnical risks. This work therefore constitutes a blueprint for the development of geotechnical mapping in Benin.
基金Doctors of BC and the British Columbia Ministry of Health,Grant/Award Number:GR005415。
文摘Background:The sustainability of rural surgical and obstetrical facilities depends on their efficacy and quality of care,which are difficult to measure in a rural context.In an evaluation of rural practice,it is often the case that the only comparators are larger referral facilities,for which facility‐level comparisons are difficult due to differences in population demographics,acuity of patients,and services offered.This publication outlines these limitations and highlights a best‐practice approach to making facility‐level comparisons using population‐level data,risk stratification,tests of noninfer-iority,and Firth logistic regression analysis.This includes an investigation of minimum sample‐size requirements through Monte Carlo power analysis in the context of low‐acuity rural surgical care.Methods:Monte Carlo power analysis was used to estimate the minimum sample size required to achieve a power of 0.8 for both logistic regression and Firth logistic regression models that compare the proportion of surgical adverse events against facility type,among other confounders.We provide guidelines for the implementation of a recommended methodology that uses risk stratification,Firth penalized logistic regression,and tests of noninferiority.Results:We illustrate limitations in facility‐level comparison of surgical quality among patients undergoing one of four index procedures including hernia repair,colonoscopy,appendectomy,and cesarean delivery.We identified minimum sample sizes for comparison of each index procedure that fluctuate depending on the level of risk stratification used.Conclusion:The availability of administrative data can provide an adequate sample size to allow for facility‐level comparisons in surgical quality,at the rural level and elsewhere.When they are made appropriately,these comparisons can be used to evaluate the efficacy of general practitioners and nurse practitioners in performing low‐acuity procedures.
文摘This letter critically evaluates Jiang et al's article on the differentiation of benign and malignant liver lesions using Emax and platelet count.Despite notable findings,significant methodological and interpretative limitations are identified.The study lacks detailed assay conditions for Emax measurement,employs inadequate statistical methods without robust multivariate analysis,and does not provide clinically relevant threshold values.The nomogram's reliance on Emax as a major diagnostic contributor is questionable due to attenuation in hepatocellular carcinoma patients with cirrhosis.Moreover,the study's limitations,such as selection bias and confounding factors,are not adequately addressed.Future research should adopt more rigorous methodologies,including prospective studies with larger cohorts and standardized protocols for biomarker measurement,to enhance validity and clinical applicability.
基金supported by the Guangdong Major Project of Basic and Applied Basic Research(Grant No.2021B0301030001)the National Key Research and Development Program of China(Grant No.2021YFB3802300)the Foundation of National Key Laboratory of Shock Wave and Detonation Physics(Grant No.JCKYS2022212004)。
文摘The graded density impactor(GDI)dynamic loading technique is crucial for acquiring the dynamic physical property parameters of materials used in weapons.The accuracy and timeliness of GDI structural design are key to achieving controllable stress-strain rate loading.In this study,we have,for the first time,combined one-dimensional fluid computational software with machine learning methods.We first elucidated the mechanisms by which GDI structures control stress and strain rates.Subsequently,we constructed a machine learning model to create a structure-property response surface.The results show that altering the loading velocity and interlayer thickness has a pronounced regulatory effect on stress and strain rates.In contrast,the impedance distribution index and target thickness have less significant effects on stress regulation,although there is a matching relationship between target thickness and interlayer thickness.Compared with traditional design methods,the machine learning approach offers a10^(4)—10^(5)times increase in efficiency and the potential to achieve a global optimum,holding promise for guiding the design of GDI.
基金Funded by the Key Technologies Research and Development Program(No.2021YFC28000900)the National Natural Science Foundation of China(No.52374178)the Collaborative Innovation Project of Colleges and Universities of Anhui Province(No.GXXT-2020-057)。
文摘A ternary early-strengthening agent consisting of calcium formate+triethanolamine+lithium sulfate was compounded with quercetin to shorten the setting time of cementitious materials while ensuring their early strength.The optimum ratio of the three early-strengthening agents was determined as 0.5%calcium formate+0.04%triethanolamine+0.4%lithium sulfate by response surface methodology.The effects of the ternary early-strengthening agent composed of calcium formate+triethanolamine(TEA)+lithium sulfate on cementitious pore sealing materials under the synergistic effect of quercetin were studied by means of the performance tests of compressive strength,fluidity,and setting time,and the microstructural characterizations of X-ray powder diffractometer(XRD),thermogravimetry(TG-DSC)and scanning electron microscopy(SEM).The study shows that the synergistic effect of ternary early-strengthening agent and quercetin forms a multi-performance composite admixture for cementitious materials.The best performance was obtained with the compounding scheme of 0.5%calcium formate+0.04%triethanolamine+0.4%lithium sulfate ternary early-strengthening agent and 0.05%quercetin.The compressive strength of 1,3,7,and 28 d are 94.8%,39.8%,42%,and 28%higher than those of the blank group,respectively.The initial time and final setting time are 41 and 57 minutes,respectively.According to the microscopic analysis,the network and fibrous C-S-H gels generated by ternary early-strengthening agents are attached to the surface promoted by quercetin,which forms skeleton support while thickening and solidifying the cement slurry,which enhances the early compressive strength of the cement-based materials.
