Expert consensus on difficulty assessment of endodontic therapy

Endodontic diseases are a kind of chronic infectious oral disease. Common endodontic treatment concepts are based on the removal of inflamed or necrotic pulp tissue and the replacement by gutta-percha. However, it is very essential for endodontic treatment to debride the root canal system and prevent the root canal system from bacterial reinfection after root canal therapy(RCT). Recent research, encompassing bacterial etiology and advanced imaging techniques, contributes to our understanding of the root canal system’s anatomy intricacies and the technique sensitivity of RCT. Success in RCT hinges on factors like patients, infection severity, root canal anatomy, and treatment techniques. Therefore, improving disease management is a key issue to combat endodontic diseases and cure periapical lesions. The clinical difficulty assessment system of RCT is established based on patient conditions, tooth conditions, root canal configuration, and root canal needing retreatment, and emphasizes pre-treatment risk assessment for optimal outcomes. The findings suggest that the presence of risk factors may correlate with the challenge of achieving the high standard required for RCT. These insights contribute not only to improve education but also aid practitioners in treatment planning and referral decision-making within the field of endodontics.

IMPACT de la déprivation sociale sur les difficultés psychosociales au décours d’un cancer pédiatrique:uneétude prospective IMPACT of the Social Deprivation on Psychosocial Difficulties of Pediatric Cancer Survivors:A Prospective Study

The posttreatment period is a key part of the management of pediatric cancer.During this time,school and psychological difficulties have been described in childhood cancer survivors(CCS)and can be prognostic for the success of social reintegration.This study estimated the influence of the household’s socioeconomic status(SES)on these psychosocial difficulties.This study is based on a prospective multicentric database and focused on children who received a psychosocial evaluation during their follow-up from 2013 to 2020.We retrieved data on school and psychological difficulties.Household SES was estimated by a social deprivation score.Data from1003 patients were analyzed.School difficulties were noted in 22%of CCS.A greater social deprivation was significantly associated with school difficulty.Tumor relapse,treatment with hematopoietic stem cell transplantation,and central nervous system(CNS)tumors remained significant risk factors.In the subgroup of CNS tumors,school difficulties were increased and associated with greater social deprivation.Psychological difficulties were not associated with the deprivation score.There is a link between SES and school difficulties in CCS.Further investigations should be carried out for children with CNS tumors,which is the population of the greatest concern.

Construction of a nomogram model to predict technical difficulty in performing laparoscopic sphincter-preserving radical resection for rectal cancer

BACKGROUND Colorectal surgeons are well aware that performing surgery for rectal cancer becomes more challenging in obese patients with narrow and deep pelvic cavities.Therefore,it is essential for colorectal surgeons to have a comprehensive understanding of pelvic structure prior to surgery and anticipate potential surgical difficulties.AIM To evaluate predictive parameters for technical challenges encountered during laparoscopic radical sphincter-preserving surgery for rectal cancer.METHODS We retrospectively gathered data from 162 consecutive patients who underwent laparoscopic radical sphincterpreserving surgery for rectal cancer.Three-dimensional reconstruction of pelvic bone and soft tissue parameters was conducted using computed tomography(CT)scans.Operative difficulty was categorized as either high or low,and multivariate logistic regression analysis was employed to identify predictors of operative difficulty,ultimately creating a nomogram.RESULTS Out of 162 patients,21(13.0%)were classified in the high surgical difficulty group,while 141(87.0%)were in the low surgical difficulty group.Multivariate logistic regression analysis showed that the surgical approach using laparoscopic intersphincteric dissection,intraoperative preventive ostomy,and the sacrococcygeal distance were independent risk factors for highly difficult laparoscopic radical sphincter-sparing surgery for rectal cancer(P<0.05).Conversely,the anterior-posterior diameter of pelvic inlet/sacrococcygeal distance was identified as a protective factor(P<0.05).A nomogram was subsequently constructed,demonstrating good predictive accuracy(C-index=0.834).CONCLUSION The surgical approach,intraoperative preventive ostomy,the sacrococcygeal distance,and the anterior-posterior diameter of pelvic inlet/sacrococcygeal distance could help to predict the difficulty of laparoscopic radical sphincter-preserving surgery.

Linking 24-h Movement Behavior Guidelines to Cognitive Difficulties,Internalizing and Externalizing Problems in Preterm Youth

Background:Given the heightened risk of developmental challenges associated with preterm birth,it is crucial to explore interventions that may ameliorate potential adverse outcomes.This study aimed to examine whether meeting the 24-h movement behavior(24-HMB)guidelines,which include recommendations on physical activity(PA),screen time(ST),and sleep(SL),is related to indicators of cognitive difficulties,internalizing problems(e.g.,depression and anxiety),and externalizing problems(e.g.,difficulties in making friends and arguing)in a sample of preterm youth(children and adolescents born preterm).Methods:In this cross-sectional study,data from 3410 preterm youth(aged 6 to 17 years)were included for data analyses.Multivariable logistic regression was used to investigate associations between meeting the 24-HMB guidelines and the above-mentioned health outcomes,while controlling for sociodemographic and health-related factors.Results:The prevalence of meeting 24-HMB guidelines varied across independent and integrated components of the 24-HMB guidelines.Meeting the ST guideline alone(p<0.05)and integrated guidelines(i.e.,ST+SL and ST+SL+PA)were associated with fewer cognitive difficulties and reduced internalizing and externalizing problems(p<0.05).Specifically,meeting the SL guideline alone and integrated guidelines(i.e.,SL+ST)were associated with lower odds of depression and anxiety(p<0.01).Additionally,meeting independent,and integrated(PA and/or ST)guidelines were associated with less pronounced difficulties in making friends and arguing(p<0.05).Meeting 24-HMB guidelines in an isolated and integrated manner are linked to better cognitive performance and fewer internalizing and externalizing problems in preterm youth.Conclusion:Results suggest that advocating for the implementation of the 24-HMB guidelines may reduce cognitive challenges and behavioral issues,which is of high relevance for improving public health.Future longitudinal studies in preterm youth should investigate how modifying specific 24-HMB behaviors,especially ST,influence cognitive difficulties,internalizing and externalizing problems in this vulnerable population.

Development of a novel difficulty scoring system for laparoscopic liver resection procedure in patients with intrahepatic duct stones

BACKGROUND For intrahepatic duct(IHD)stones,laparoscopic liver resection(LLR)is currently a reliable treatment.However,the current LLR difficulty scoring system(DSS)is only available for patients with hepatocellular carcinoma.AIM To explore the development of a DSS for IHD stone patients with LLR and the validation of its reliability.METHODS We used clinical data from 80 patients who received LLR for IHD stones.Forty-six of these patients were used in multiple linear regression to construct a scoring system.Another 34 patients from different centers were used as external validation.The completeness of our DSS was then evaluated in patients with varying degrees of surgical difficulty based on documented surgical outcomes in the study group of patients.RESULTS The following five predictors were ultimately included and scored by calculating the weighted contribution of each factor to the prediction of operative time in the training cohort:Location of stones,number of stones≥3,stones located in the bile ducts of several grades,previous biliary surgery less than twice,distal bile duct atrophy.Subsequently,the data set was validated using a DSS developed from the variables.The following variables were identified as statistically significant in external validation:Operative time,blood loss,intraoperative transfusion,postoperative alanine aminotransferase,and Clavien-Dindo grading≥3.These variables demonstrated statistically significant differences in patients with three or more grades.CONCLUSION Patients with IHD stones have varying degrees of surgical difficulty,and the newly developed DSS can be validated with external data to effectively predict risks and complications after LLR surgery.

Effect of Mouth Opening Training Stick Combined with Oral Massage on Mouth Opening Difficulty in Head and Neck Cancer Patients after Treatment

Objective: To study the application effect of mouth-opening training sticks combined with oral massage on patients with mouth-opening difficulty after treatment for head and neck cancer. Methods: Using convenient sampling, 60 patients with mouth-opening difficulty after treatment for head and neck cancer admitted to the Oncology Department from February 2022 to October 2023 were selected for a 2-week exercise and nursing program. The patients were divided into a control group (February 1, 2022 to November 30, 2022) and an observation group (December 1, 2022 to October 31, 2023), with 30 patients in each group. The control group underwent routine mouth-opening functional exercises combined with cork for oral support training, while the observation group underwent routine mouth-opening functional exercises combined with oral massage and mouth-opening training sticks for oral support training. The mouth-opening degree, mouth-opening difficulty level, comfort level, compliance, and quality of life were observed in both groups. Results: Before the intervention, there were no statistically significant differences in mouth-opening degree and mouth-opening difficulty level between the two groups (P > 0.05). After the intervention, the mouth-opening degree, mouth-opening difficulty level, oral comfort level, compliance, and QLICP-HN scores in the observation group were all better than those in the control group, with statistically significant differences (P < 0.05). Conclusion: The combination of mouth-opening training sticks and oral massage with mouth-opening functional exercises can effectively improve the degree of mouth-opening difficulty, enhance oral comfort, increase compliance with mouth-opening exercises, and improve quality of life.

Text Difficulty,Working Memory Capacity and Mind Wandering During Chinese EFL Learners’Reading

This experimental study investigated how text difficulty and different working memory capacity(WMC)affected Chinese EFL learners’reading comprehension and their tendency to engage in task-unrelated thoughts,that is,mind wandering(MW),in the course of reading.Sixty first-year university non-English majors participated in the study.A two-factor mixed experimental design of 2(text difficulty:difficult and simple)×2(WMC:high/large and low/small)was employed.Results revealed that 1)the main and interaction effects of WMC and text difficulty on voluntary MW were significant,whereas those on involuntary MW were not;2)while reading the easy texts,the involuntary MW of high-WMC individuals was less frequent than that of low-WMC ones,whereas while reading the difficult ones,the direct relationship between WMC and involuntary MW was not found;and that 3)high-WMC individuals had a lower overall rate of MW and better reading performance than low-WMC individuals did,but with increasing text difficulty,their rates of overall MW and voluntary MW were getting higher and higher,and the reading performance was getting lower and lower.These results lend support to WM theory and have pedagogical implications for the instruction of L2 reading.

Ableism and (Neo)Racism in School Placement Processes in Quebec: School Personnel Interpretations of Immigrant Student Difficulties - A Secondary Publication

The school placement processes of students from immigrant backgrounds considered to be in“difficulty”is an international concern at the intersection of works relating to special education and those concerning the school experiences of students from immigrant backgrounds or racialized groups.The research problem of this article concerns the identification of these students as disabled or as having adjustment or learning difficulties.From a perspective anchored in Disability Critical Race Studies,this ethnographic study documents different interpretations of perceived difficulties made by school actors with regard to seven primary school students from immigrant backgrounds.Five interpretation types are presented:(1)medicalization by dismissal of cultural markers,(2)medicalization by professional constraint,(3)medicalization by cultural deficit,(4)precautionary wait,and(5)cultural differentialism.Our results help to shed light on the special education overrepresentation phenomenon regarding these students and to understand how ableism and(neo)racism contribute to it.

Teachers’ Perceptions of the Challenges and Strategies in Supporting Students with Reading Difficulties

The purpose of this study is to determine the teacher’s perceptions of the challenges and strategies in supporting students with reading difficulties.This study used qualitative method of research and descriptive approach as its research design,in addition to a set of structured interview questions administered through Google Forms to gather data from elementary teachers of Taal Central School,located at Taal Batangas.These structured interview questions were carefully designed to cover various dimensions of the study,including the types of challenges perceived by teachers,strategies employed,and possible solutions for addressing the problems encountered in the process of supporting students with reading difficulties.The results revealed that teachers faced several challenges when teaching students with reading difficulties such as emotional and motivational issues/factors,lack of resources or teaching aids,deficits in knowledge and skills,and problems with student engagement and participation.This study also showed common approaches utilized by the teachers in supporting students with reading difficulties,which were fostering a positive and supportive environment,adopting individualized and multifaceted approaches,and utilizing effective teaching tools and strategies.Lastly,teachers also concluded varied solutions in addressing the challenges perceived in teaching students with reading difficulties towards fostering reading proficiency.These include developing peer support,use of positive reinforcement,and parental involvement.Moreover,specialized resources,professional development for teachers,and specific teaching strategies are also highlighted as crucial components.By integrating these approaches,teachers concluded that it can create a supportive and effective learning environment tailored to the needs of students with reading difficulties.

工程类课程核心难点微视频辅助教学法探索与实践

工程类专业课兼具理论性和实践性的特点,而对工程现场过于生疏常常造成学生理解和学习的关键难点。该文提出一种基于“核心知识难点”和“微视频”的融合性教学方法,为克服这一难题、实现微时代高质量教学提供一条路径。分析该微视频辅助教学法的必要性、目标和建设路径,继而结合地下工程施工技术课程教学案例给出具体方法和效果分析,为应用核心难点微视频辅助教学法提供参考。

高校小额零星集中采购管理难点与对策研究——以复印、打印、印刷采购管理模式为切入点

随着我国综合国力的日益增强,政府对高等教育的支持力度不断加大,高校的办学规模逐步扩大,高校的小额零星采购总量逐年增加,这类采购具有金额小、业务量大的特点,增加了相关部门业务量和监管难度。文章通过解析复印、打印、印刷采购管理现状、存在的问题难点,探索定点采购、招租“二合一”模式、实施使用范围分类、建设电子卖场等措施,减轻了科研人员负担,释放了创新活力,调动了科研人员积极性。为优化科研管理、提升科研业绩、促进科研成果发挥提供了新的思路和方法。

算法支配下新业态从业者的生存之困与化解方法

目前,以数字算法为核心技术支撑的平台企业已成为我国吸纳各类新业态从业者的重要载体。研究显示,新业态从业者不仅在劳动收入、劳动时间、劳动强度、劳动安全等方面不同程度地受制于平台企业的“算法控制”,而且由于后者常常有意凭借算法技术优势模糊劳动雇佣关系,从业者普遍面临着合同签约率低、社会保障覆盖低、工伤保险认定和劳动维权难等一系列问题。与此同时,受“算法支配”的生存处境也对从业者的自我感知、情绪稳定性、社会心态等造成了不同程度的负面影响,从而引发了许多不容忽视的社会安全隐患。有效化解新业态从业者的生存之困,需要政府、平台企业、从业者三方共同努力,从加强制度保障、技术优化、提高从业群体组织化水平等方面入手,积极营造一个更公平、更包容、更可持续的平台经济发展环境。

萨提亚模式团体干预对家庭经济困难大学生自我接纳的提升作用

目的:探索萨提亚模式团体干预对家庭经济困难大学生自我接纳的提升作用。方法:采用方便取样的方法筛选自我接纳水平较低的家庭经济困难大学生实验组12人和对照组13人,对实验组进行为期8周、每周1次的萨提亚模式自我接纳团体干预,对照组不进行干预。采用实验组对照组前后测设计,使用自我接纳问卷(SAQ)在研究前后分别测量。结果:实验组大学生干预后自我接纳水平显著高于干预前(t=-4.36,P<0.01),对照组在前后两次测量中自我接纳水平差异无统计学意义(P>0.05);两组被试在干预前自我接纳水平一致(P>0.05),而干预后实验组被试自我接纳水平高于对照组(t=3.06,P<0.01)。结论:萨提亚模式自我接纳团体干预能有效改善家庭经济困难大学生的自我接纳水平。

新时期房地产企业融资困境及应对措施分析

随着经济的发展,房地产行业成为我国国民经济的支柱行业,因其具有项目建设周期长、资金需求量大等特点,科学合理的融资管理对房地产企业至关重要。然而,随着国家政策加强监管以及大量企业涌入房地产市场,越来越多的房地产企业目前面临许多融资相关难题。文章首先对房地产企业目前的融资特点和融资管理对房企的重要性进行介绍,之后深入分析了房地产企业目前的融资困境以及针对融资困境提出了相应的解决措施,以期能对面临相同融资问题的房地产企业有所启示。

Teaching Legal Englishfor Law Studentsin China:Difficultiesand Solutions

Teaching legal English for law students in China is difficult.For one thing,many Chinese law students have trouble moreor less in learning English,because the English language is not their mother tongue.For another,legal English differs a great dealfrom everyday English in many respects,including terminology,phrasing,linguistic structure,and linguistic conventions,whichmakes legal English teaching for law students in China by far harder.To solve difficulties undermining teaching legal English forlaw students in China,the author of this paper holds that in his or her actual legal English teaching,the teacher should boost lawstudents basic English teaching,expose them to cases study of specialized legal English terminology and linguistic structures andconventions.

The Effect of Topic Familiarity and Linguistic Difficulty on EFL Listening Comprehension

As a highly integrative and demanding receptive skill,listening comprehension presents a challenge to both learners and researchers.The study reported in this paper is listening comprehension objective-factor research.Manipulating topic factors,the study investigated the effect of topic familiarity and linguistic difficulty on EFL(English as a foreign language)listening comprehension of learners at different proficiency levels.

基于综合难度模型的新高考数学试题评析——以2021—2024年新高考Ⅰ卷、Ⅱ卷为例

根据高考数学试题的命题立意,对现有数学高考试题综合难度模型进行调整,从背景因素、是否含参、运算水平、推理能力、知识含量、思维方向、认知水平、新颖水平等8个因素,对2021—2024年新高考Ⅰ卷、Ⅱ卷数学试题的整体难度、知识主题难度、数学题型难度展开分析。结果表明:近4年新高考数学试题综合难度基本稳定,新高考Ⅰ卷难度略高于Ⅱ卷;在知识主题上,函数难度略高于几何与代数,大幅高于概率与统计,预备知识难度最低;解答题难于多选题,填空题次之,单选题最易。基于此,建议进一步强化试题情境创设,更好地贯彻落实基于情境活动的命题要求;聚焦新颖试题形式,着力发展学生的创新意识与综合素质;重视知识融合考查,整合学科知识主题,实现知识模块的交汇关联。

电信网络诈骗犯罪打击治理效能研究

随着人类社会科学技术的一次次飞跃,新兴技术在给社会发展和人们生产生活带来机遇的同时,也滋生了电信网络诈骗犯罪演变迭代的土壤。不法分子借助网络信息技术不断翻新诈骗手段。现阶段,电信网络诈骗犯罪已呈现出犯罪团伙职业化、涉案群体年轻化、作案手段多样化、诈骗方式精准化、侵害对象广泛化等特点。公安机关打击治理电信网络诈骗犯罪力度不断加强,但在实践中还面临着线索追查困难、犯罪藏匿隐蔽、行业监管不力、宣传防范不佳等难点。由此,为了进一步提升电信网络诈骗犯罪打击治理效能,公安机关通过组建专业化队伍、建立协同办案机制、强化数据赋能打击质效、增强群众安全防范意识等路径,实现对电信网络诈骗犯罪“打、防、管、控、宣”的综合治理,切实保护人民群众财产安全。

提升环境监测质量管理水平的有效路径

本文以某公司环境监测项目为例,分析提升环境监测质量管理水平的有效路径。首先解析了环境监测难点,包括环境监测工作内容多、环境污染覆盖面广、环境问题处理复杂等方面。然后归纳了项目环境监测质量管理措施,提出了相关的环境监测质量控制方案,最终圆满解决环境监测问题,达到预期的环境监测效果,希望为有关监测技术人员提供帮助。

荣威i5发动机启动困难分析

随着排放法规的日益严苛,发动机电控技术不断优化,越来越多的传感器和电控系统被应用于发动机上,因此对于发动机电路故障的诊断与排除提出了更高的要求。文章将以荣威i5发动机启动困难故障为例,深入解析其曲轴位置传感器的结构、工作原理以及检测方法,本研究同时适用于名爵3、名爵5及其他使用同款博世曲轴位置传感器的车型,以期能够为相关车主和维修人员提供维修的参考意见。