Background: Localized pancreatic cancer, including resectable (R), borderline resectable (BR) and locally advanced unresectable disease (LAU), is considered in clinical guidelines for diverse treatment options based o...Background: Localized pancreatic cancer, including resectable (R), borderline resectable (BR) and locally advanced unresectable disease (LAU), is considered in clinical guidelines for diverse treatment options based on clinical trials in selected populations. Hence, exploring with real world evidence (RWE) clinicians’ preferences for treatment options and their results seems pertinent. Methods: In a set of consecutive patients with localized pancreatic cancer assisted in a third level hospital from January 2013 to December 2022, medical records, symptoms, diagnostic process, distribution between subtypes, and treatment plans, with safety and efficacy results, were assessed. Results: A total of 152 patients with localized disease were included (43.4% R, 21.0% BR, 33.6% LAU). The population characteristics exemplified differences between daily practice and clinical trials. Tumor location and symptoms were as expected. Treatment plan was conditioned by PS or comorbidities in 23.0% of patients. In patients with R disease, surgery followed by different adjuvant chemotherapy (CT) regimes was the antineoplastic treatment of choice (64.8%) with efficacy results (OS 37.5 months;95% CI 18.4 - 56.7), in the range of contemporary standards. The common use of neoadjuvant CT for BR disease (94.4%), with surgery in 50% of them, and its results (OS 30.8 months;95% CI 10.5 - 51.2) reflected current controversies of treatment recommendations and evolution in this scenario. Paliative CT with or without radiotherapy was the standard specific treatment in LAU disease (95.1%) with survival results (PFS: 10.8 months;95% CI 8.8 - 12.7. OS: 20.3 months;95% CI 13.5 - 27.2) that justify the distinct character and the specific study of this entity. Conclusion: RWE for localized pancreatic cancer aroused from the analysis of this population confirms the distinct nature of patients assisted in daily practice, as well as mirrors the complexity of decision making in clinical assumptions in which achieving stronger evidence should be paramount.展开更多
Hydrogen is the new age alternative energy source to combat energy demand and climate change.Storage of hydrogen is vital for a nation’s growth.Works of literature provide different methods for storing the produced h...Hydrogen is the new age alternative energy source to combat energy demand and climate change.Storage of hydrogen is vital for a nation’s growth.Works of literature provide different methods for storing the produced hydrogen,and the rational selection of a viable method is crucial for promoting sustainability and green practices.Typically,hydrogen storage is associated with diverse sustainable and circular economy(SCE)criteria.As a result,the authors consider the situation a multi-criteria decision-making(MCDM)problem.Studies infer that previous models for hydrogen storage method(HSM)selection(i)do not consider preferences in the natural language form;(ii)weights of experts are not methodically determined;(iii)hesitation of experts during criteria weight assessment is not effectively explored;and(iv)three-stage solution of a suitable selection of HSM is unexplored.Driven by these gaps,in this paper,authors put forward a new integrated framework,which considers double hierarchy linguistic information for rating,criteria importance through inter-criteria correlation(CRITIC)for expert weight calculation,evidence-based Bayesian method for criteria weight estimation,and combined compromise solution(CoCoSo)for ranking HSMs.The applicability of the developed framework is testified by using a case example of HSM selection in India.Sensitivity and comparative analysis reveal the merits and limitations of the developed framework.展开更多
In the novel“A Clean,Well-lighted Place”,Hemingway tells the story of two waiters in a Spanish caféjust before closing time,talking about an old man who drank heavily in the caféevery night and lived a wea...In the novel“A Clean,Well-lighted Place”,Hemingway tells the story of two waiters in a Spanish caféjust before closing time,talking about an old man who drank heavily in the caféevery night and lived a wealthy life but still wants to commit suicide.Using the iceberg principle,Hemingway purposely omits the plot,characterization of the story,and uses symbolism and repetition to describe people’s different attitudes facing the spiritual emptiness after the war,breaking the readers’expectations,and inspiring them to explore the meaning of individual life.Therefore,based on Wolfgang Iser and Zhu Liyuan’s appealing structure theory,this paper will analyze the appealing structure in“A Clean,Well-lighted Place”at three levels:meaning construction,rhetorical techniques,and thoughts and themes.It is hoped that readers can find a new way to interpret the short story,better understand the author’s creative ideas and dig deeper into the connotation of the work.展开更多
Prediction systems are an important aspect of intelligent decisions.In engineering practice,the complex system structure and the external environment cause many uncertain factors in the model,which influence the model...Prediction systems are an important aspect of intelligent decisions.In engineering practice,the complex system structure and the external environment cause many uncertain factors in the model,which influence the modeling accuracy of the model.The belief rule base(BRB)can implement nonlinear modeling and express a variety of uncertain information,including fuzziness,ignorance,randomness,etc.However,the BRB system also has two main problems:Firstly,modeling methods based on expert knowledge make it difficult to guarantee the model’s accuracy.Secondly,interpretability is not considered in the optimization process of current research,resulting in the destruction of the interpretability of BRB.To balance the accuracy and interpretability of the model,a self-growth belief rule basewith interpretability constraints(SBRB-I)is proposed.The reasoning process of the SBRB-I model is based on the evidence reasoning(ER)approach.Moreover,the self-growth learning strategy ensures effective cooperation between the datadriven model and the expert system.A case study showed that the accuracy and interpretability of the model could be guaranteed.The SBRB-I model has good application prospects in prediction systems.展开更多
Objective: To search, evaluate and integrate the best domestic and foreign evidence on the preoperative pre-rehabilitation of lung cancer patients with COPD, and summarize the best evidence. Methods: Cochrane Library,...Objective: To search, evaluate and integrate the best domestic and foreign evidence on the preoperative pre-rehabilitation of lung cancer patients with COPD, and summarize the best evidence. Methods: Cochrane Library, BMJ Best Practice, JBI Center for International Cooperation in Evidence-Based Health Care Library, and Up to were searched by computer system Date, Embase, CINAHL, PubMed, Evidence-Based Health Care Center Database (JBI), American Guidenet, Global Guidenet, CNKI, CMBM, Wanfang, and VIP databases on preoperative pre-rehabilitation of patients with lung cancer and COPD. Literature screening and quality evaluation were conducted independently by two researchers, and evidence was extracted, summarized and summarized according to the theme. Results: A total of 13 kinds of literature were included, including 4 guidelines, 4 systematic reviews, 3 evidence summaries, and 2 expert consensus articles. This paper summarizes 44 best evidence on pre-rehabilitation of lung cancer patients with COPD, including 8 aspects: pre-rehabilitation content and principle, pre-rehabilitation assessment, exercise rehabilitation, nutrition management, psychological guidance, health education, multidisciplinary cooperation, quality control and follow-up. Conclusion: The best evidence of preoperative pre-rehabilitation for patients with lung cancer complicated with COPD is rich in content, and needs to be selected according to the characteristics of the hospital and the clinical environment. Some of the evidence still needs to be confirmed by higher-quality studies. .展开更多
Objective:Paid sick leave(PSL)laws mandate employers give workers paid time off when they are sick or injured.This current study aims to examine whether access to PSL is associated with healthcare utilization and heal...Objective:Paid sick leave(PSL)laws mandate employers give workers paid time off when they are sick or injured.This current study aims to examine whether access to PSL is associated with healthcare utilization and health outcomes and to summarize the types of utilization and outcomes which have been reported to be associated with PSL.Methods:We conducted a rapid evidence review.Our search of seven databases,including Medline,Embase,PsycINFO,Cochrane Library,CINAHL,Scopus,and JSTOR,on September 21,2020,identified 757 studies,30 of which were retained.Results:Previous evidence is mostly provided by cross-sectional studies with survey data.In this study,evidence suggests that PSL is significantly associated with some types of healthcare utilization and health outcomes.In terms of healthcare utilization,findings indicate PSL is associated with an increase in the use of some preventive sendees and a decrease in the use of emergency care;while findings are mixed regarding associations of PSL with health provider visits and the use of mammograms and pap smears.As for health outcomes,findings suggest PSL is associated with improved mental and self-rated health,decreased incidence of influenza-like illness,and lower occupational injuries and mortality rates.Conclusion:PSL may be an effective tool in improving some healthcare utilization and health outcomes.Future research could help identify mechanisms through which PSL access works and identify what policy components lead to better outcomes.展开更多
文摘Background: Localized pancreatic cancer, including resectable (R), borderline resectable (BR) and locally advanced unresectable disease (LAU), is considered in clinical guidelines for diverse treatment options based on clinical trials in selected populations. Hence, exploring with real world evidence (RWE) clinicians’ preferences for treatment options and their results seems pertinent. Methods: In a set of consecutive patients with localized pancreatic cancer assisted in a third level hospital from January 2013 to December 2022, medical records, symptoms, diagnostic process, distribution between subtypes, and treatment plans, with safety and efficacy results, were assessed. Results: A total of 152 patients with localized disease were included (43.4% R, 21.0% BR, 33.6% LAU). The population characteristics exemplified differences between daily practice and clinical trials. Tumor location and symptoms were as expected. Treatment plan was conditioned by PS or comorbidities in 23.0% of patients. In patients with R disease, surgery followed by different adjuvant chemotherapy (CT) regimes was the antineoplastic treatment of choice (64.8%) with efficacy results (OS 37.5 months;95% CI 18.4 - 56.7), in the range of contemporary standards. The common use of neoadjuvant CT for BR disease (94.4%), with surgery in 50% of them, and its results (OS 30.8 months;95% CI 10.5 - 51.2) reflected current controversies of treatment recommendations and evolution in this scenario. Paliative CT with or without radiotherapy was the standard specific treatment in LAU disease (95.1%) with survival results (PFS: 10.8 months;95% CI 8.8 - 12.7. OS: 20.3 months;95% CI 13.5 - 27.2) that justify the distinct character and the specific study of this entity. Conclusion: RWE for localized pancreatic cancer aroused from the analysis of this population confirms the distinct nature of patients assisted in daily practice, as well as mirrors the complexity of decision making in clinical assumptions in which achieving stronger evidence should be paramount.
文摘Hydrogen is the new age alternative energy source to combat energy demand and climate change.Storage of hydrogen is vital for a nation’s growth.Works of literature provide different methods for storing the produced hydrogen,and the rational selection of a viable method is crucial for promoting sustainability and green practices.Typically,hydrogen storage is associated with diverse sustainable and circular economy(SCE)criteria.As a result,the authors consider the situation a multi-criteria decision-making(MCDM)problem.Studies infer that previous models for hydrogen storage method(HSM)selection(i)do not consider preferences in the natural language form;(ii)weights of experts are not methodically determined;(iii)hesitation of experts during criteria weight assessment is not effectively explored;and(iv)three-stage solution of a suitable selection of HSM is unexplored.Driven by these gaps,in this paper,authors put forward a new integrated framework,which considers double hierarchy linguistic information for rating,criteria importance through inter-criteria correlation(CRITIC)for expert weight calculation,evidence-based Bayesian method for criteria weight estimation,and combined compromise solution(CoCoSo)for ranking HSMs.The applicability of the developed framework is testified by using a case example of HSM selection in India.Sensitivity and comparative analysis reveal the merits and limitations of the developed framework.
文摘In the novel“A Clean,Well-lighted Place”,Hemingway tells the story of two waiters in a Spanish caféjust before closing time,talking about an old man who drank heavily in the caféevery night and lived a wealthy life but still wants to commit suicide.Using the iceberg principle,Hemingway purposely omits the plot,characterization of the story,and uses symbolism and repetition to describe people’s different attitudes facing the spiritual emptiness after the war,breaking the readers’expectations,and inspiring them to explore the meaning of individual life.Therefore,based on Wolfgang Iser and Zhu Liyuan’s appealing structure theory,this paper will analyze the appealing structure in“A Clean,Well-lighted Place”at three levels:meaning construction,rhetorical techniques,and thoughts and themes.It is hoped that readers can find a new way to interpret the short story,better understand the author’s creative ideas and dig deeper into the connotation of the work.
基金This work was supported in part by the Postdoctoral Science Foundation of China under Grant No.2020M683736in part by the Natural Science Foundation of Heilongjiang Province of China under Grant No.LH2021F038+2 种基金in part by the innovation practice project of college students in Heilongjiang Province under Grant Nos.202010231009,202110231024,and 202110231155in part by the basic scientific research business expenses scientific research projects of provincial universities in Heilongjiang Province Grant Nos.XJGZ2021001in part by the Education and teaching reform program of 2021 in Heilongjiang Province under Grant No.SJGY20210457.
文摘Prediction systems are an important aspect of intelligent decisions.In engineering practice,the complex system structure and the external environment cause many uncertain factors in the model,which influence the modeling accuracy of the model.The belief rule base(BRB)can implement nonlinear modeling and express a variety of uncertain information,including fuzziness,ignorance,randomness,etc.However,the BRB system also has two main problems:Firstly,modeling methods based on expert knowledge make it difficult to guarantee the model’s accuracy.Secondly,interpretability is not considered in the optimization process of current research,resulting in the destruction of the interpretability of BRB.To balance the accuracy and interpretability of the model,a self-growth belief rule basewith interpretability constraints(SBRB-I)is proposed.The reasoning process of the SBRB-I model is based on the evidence reasoning(ER)approach.Moreover,the self-growth learning strategy ensures effective cooperation between the datadriven model and the expert system.A case study showed that the accuracy and interpretability of the model could be guaranteed.The SBRB-I model has good application prospects in prediction systems.
文摘Objective: To search, evaluate and integrate the best domestic and foreign evidence on the preoperative pre-rehabilitation of lung cancer patients with COPD, and summarize the best evidence. Methods: Cochrane Library, BMJ Best Practice, JBI Center for International Cooperation in Evidence-Based Health Care Library, and Up to were searched by computer system Date, Embase, CINAHL, PubMed, Evidence-Based Health Care Center Database (JBI), American Guidenet, Global Guidenet, CNKI, CMBM, Wanfang, and VIP databases on preoperative pre-rehabilitation of patients with lung cancer and COPD. Literature screening and quality evaluation were conducted independently by two researchers, and evidence was extracted, summarized and summarized according to the theme. Results: A total of 13 kinds of literature were included, including 4 guidelines, 4 systematic reviews, 3 evidence summaries, and 2 expert consensus articles. This paper summarizes 44 best evidence on pre-rehabilitation of lung cancer patients with COPD, including 8 aspects: pre-rehabilitation content and principle, pre-rehabilitation assessment, exercise rehabilitation, nutrition management, psychological guidance, health education, multidisciplinary cooperation, quality control and follow-up. Conclusion: The best evidence of preoperative pre-rehabilitation for patients with lung cancer complicated with COPD is rich in content, and needs to be selected according to the characteristics of the hospital and the clinical environment. Some of the evidence still needs to be confirmed by higher-quality studies. .
文摘Objective:Paid sick leave(PSL)laws mandate employers give workers paid time off when they are sick or injured.This current study aims to examine whether access to PSL is associated with healthcare utilization and health outcomes and to summarize the types of utilization and outcomes which have been reported to be associated with PSL.Methods:We conducted a rapid evidence review.Our search of seven databases,including Medline,Embase,PsycINFO,Cochrane Library,CINAHL,Scopus,and JSTOR,on September 21,2020,identified 757 studies,30 of which were retained.Results:Previous evidence is mostly provided by cross-sectional studies with survey data.In this study,evidence suggests that PSL is significantly associated with some types of healthcare utilization and health outcomes.In terms of healthcare utilization,findings indicate PSL is associated with an increase in the use of some preventive sendees and a decrease in the use of emergency care;while findings are mixed regarding associations of PSL with health provider visits and the use of mammograms and pap smears.As for health outcomes,findings suggest PSL is associated with improved mental and self-rated health,decreased incidence of influenza-like illness,and lower occupational injuries and mortality rates.Conclusion:PSL may be an effective tool in improving some healthcare utilization and health outcomes.Future research could help identify mechanisms through which PSL access works and identify what policy components lead to better outcomes.
