Levels of evidence and grades of recommendation supporting European society for medical oncology clinical practice guidelines

Background:The European Society for Medical Oncology(ESMO)guidelines are among the most comprehensive and widely used clinical practice guidelines(CPGs)globally.However,the level of scientific evidence supporting ESMO CPG recommendations has not been systematically investigated.This study assessed ESMO CPG levels of evidence(LOE)and grades of recommendations(GOR),as well as their trends over time across various cancer settings.Methods:We manually extracted every recommendation with the Infectious Diseases Society of America(IDSA)classification from each CPG.We examined the distribution of LOE and GOR in all available ESMO CPG guidelines across different topics and cancer types.Results:Among the 1,823 recommendations in the current CPG,30%were classified as LOEⅠ,and 43%were classified as GOR A.Overall,there was a slight decrease in LOEⅠ(−2%)and an increase in the proportion of GOR A(+1%)in the current CPG compared to previous versions.The proportion of GOR A recommendations based on higher levels of evidence such as randomized trials(LOEⅠ–Ⅱ)shows a decrease(71%vs.63%,p=0.009)while recommendations based on lower levels of evidence(LOEⅢ–Ⅴ)show an increase(29%vs.37%,p=0.01)between previous and current version.In the current versions,the highest proportion of LOEⅠ(42%)was found in recommendations related to pharmacotherapy,while the highest proportion of GOR A recommendations was found in the areas of pathology(50%)and diagnostic(50%)recommendations.Significant variability in LOEⅠand GOR A recommendations and their changes over time was observed across different cancer types.Conclusion:One-third of the current ESMO CPG recommendations are supported by the highest level of evidence.More well-designed randomized clinical trials are needed to increase the proportion of LOEⅠand GOR A recommendations,ultimately leading to improved outcomes for cancer patients.

Parametric resonance of axially functionally graded pipes conveying pulsating fluid

Based on the generalized Hamilton's principle,the nonlinear governing equation of an axially functionally graded(AFG)pipe is established.The non-trivial equilibrium configuration is superposed by the modal functions of a simply supported beam.Via the direct multi-scale method,the response and stability boundary to the pulsating fluid velocity are solved analytically and verified by the differential quadrature element method(DQEM).The influence of Young's modulus gradient on the parametric resonance is investigated in the subcritical and supercritical regions.In general,the pipe in the supercritical region is more sensitive to the pulsating excitation.The nonlinearity changes from hard to soft,and the non-trivial equilibrium configuration introduces more frequency components to the vibration.Besides,the increasing Young's modulus gradient improves the critical pulsating flow velocity of the parametric resonance,and further enhances the stability of the system.In addition,when the temperature increases along the axial direction,reducing the gradient parameter can enhance the response asymmetry.This work further complements the theoretical analysis of pipes conveying pulsating fluid.

Dynamic Characteristics of Functionally Graded Timoshenko Beams by Improved Differential Quadrature Method

This study proposes an effective method to enhance the accuracy of the Differential Quadrature Method(DQM)for calculating the dynamic characteristics of functionally graded beams by improving the form of discrete node distribution.Firstly,based on the first-order shear deformation theory,the governing equation of free vibration of a functionally graded beam is transformed into the eigenvalue problem of ordinary differential equations with respect to beam axial displacement,transverse displacement,and cross-sectional rotation angle by considering the effects of shear deformation and rotational inertia of the beam cross-section.Then,ignoring the shear deformation of the beam section and only considering the effect of the rotational inertia of the section,the governing equation of the beam is transformed into the eigenvalue problem of ordinary differential equations with respect to beam transverse displacement.Based on the differential quadrature method theory,the eigenvalue problem of ordinary differential equations is transformed into the eigenvalue problem of standard generalized algebraic equations.Finally,the first several natural frequencies of the beam can be calculated.The feasibility and accuracy of the improved DQM are verified using the finite element method(FEM)and combined with the results of relevant literature.

Numerical Analysis of Permeability of Functionally Graded Scaffolds

In this work,we numerically study the hydrodynamic permeability of new-generation artificial porous materials used as scaffolds for cell growth in a perfusion bioreactor.We consider two popular solid matrix designs based on triply periodic minimal surfaces,the Schwarz P(primitive)and D(diamond)surfaces,which enable the creation of materials with controlled porosity gradients.The latter property is crucial for regulating the shear stress field in the pores of the scaffold,which makes it possible to control the intensity of cell growth.The permeability of functionally graded materials is studied within the framework of both a microscopic approach based on the Navier-Stokes equation and an averaged description of the liquid filtration through a porous medium based on the equations of the Darcy or Forchheimer models.We calculate the permeability coefficients for both types of solid matrices formed by Schwarz surfaces,study their properties concerning forward and reverse fluid flows,and determine the ranges of Reynolds number for which the description within the Darcy or Forchheimer model is applicable.Finally,we obtain a shear stress field that varies along the sample,demonstrating the ability to tune spatially the rate of tissue growth.

A Hybrid Level Set Optimization Design Method of Functionally Graded Cellular Structures Considering Connectivity

With the continuous advancement in topology optimization and additive manufacturing(AM)technology,the capability to fabricate functionally graded materials and intricate cellular structures with spatially varying microstructures has grown significantly.However,a critical challenge is encountered in the design of these structures–the absence of robust interface connections between adjacent microstructures,potentially resulting in diminished efficiency or macroscopic failure.A Hybrid Level Set Method(HLSM)is proposed,specifically designed to enhance connectivity among non-uniform microstructures,contributing to the design of functionally graded cellular structures.The HLSM introduces a pioneering algorithm for effectively blending heterogeneous microstructure interfaces.Initially,an interpolation algorithm is presented to construct transition microstructures seamlessly connected on both sides.Subsequently,the algorithm enables the morphing of non-uniform unit cells to seamlessly adapt to interconnected adjacent microstructures.The method,seamlessly integrated into a multi-scale topology optimization framework using the level set method,exhibits its efficacy through numerical examples,showcasing its prowess in optimizing 2D and 3D functionally graded materials(FGM)and multi-scale topology optimization.In essence,the pressing issue of interface connections in complex structure design is not only addressed but also a robust methodology is introduced,substantiated by numerical evidence,advancing optimization capabilities in the realm of functionally graded materials and cellular structures.

Exact solution for thermal vibration of multi-directional functionally graded porous plates submerged in fluid medium

An analytical method for analyzing the thermal vibration of multi-directional functionally graded porous rectangular plates in fluid media with novel porosity patterns is developed in this study.Mechanical properties of MFG porous plates change according to the length,width,and thickness directions for various materials and the porosity distribution which can be widely applied in many fields of engineering and defence technology.Especially,new porous rules that depend on spatial coordinates and grading indexes are proposed in the present work.Applying Hamilton's principle and the refined higher-order shear deformation plate theory,the governing equation of motion of an MFG porous rectangular plate in a fluid medium(the fluid-plate system)is obtained.The fluid velocity potential is derived from the boundary conditions of the fluid-plate system and is used to compute the extra mass.The GalerkinVlasov solution is used to solve and give natural frequencies of MFG porous plates with various boundary conditions in a fluid medium.The validity and reliability of the suggested method are confirmed by comparing numerical results of the present work with those from available works in the literature.The effects of different parameters on the thermal vibration response of MFG porous rectangular plates are studied in detail.These findings demonstrate that the behavior of the structure within a liquid medium differs significantly from that within a vacuum medium.Thereby,they offer appropriate operational approaches for the structure when employed in various mediums.

Transfer matrix method for free and forced vibrations of multi-level functionally graded material stepped beams with different boundary conditions

Functionally graded materials(FGMs)are a novel class of composite materials that have attracted significant attention in the field of engineering due to their unique mechanical properties.This study aims to explore the dynamic behaviors of an FGM stepped beam with different boundary conditions based on an efficient solving method.Under the assumptions of the Euler-Bernoulli beam theory,the governing differential equations of an individual FGM beam are derived with Hamilton’s principle and decoupled via the separation-of-variable approach.Then,the free and forced vibrations of the FGM stepped beam are solved with the transfer matrix method(TMM).Two models,i.e.,a three-level FGM stepped beam and a five-level FGM stepped beam,are considered,and their natural frequencies and mode shapes are presented.To demonstrate the validity of the method in this paper,the simulation results by ABAQUS are also given.On this basis,the detailed parametric analyses on the frequencies and dynamic responses of the three-level FGM stepped beam are carried out.The results show the accuracy and efficiency of the TMM.

Offshore high-grade limemud resources of west coast of India:Economic potential and industrial applications

Limestone is one of the essential raw materials in the cement,paint,steel,ceramic,glass,chemical,pharmaceutical,paper,and fertilizer industries.In India,only 8%of the limestone resources are placed under the reserve category,of which 97%is of cement grade.Thus,India depends on imports to bridge the demand‐supply gap of steel,blast furnace,and chemical‐grade limestone.Efforts of Geological Survey of India(GSI)to locate alternate sources for limestone led to the discovery of enormous quantities of carbonate minerals called limemud from the continental shelf margin of the west coast of India.GSI carried out systematic studies to explore the nature of the disposition,quality,quantity,and suitability of the offshore limemud for various industrial applications.A preliminary estimate of resources using high‐resolution subbottom profiling and sediment core sample studies established the occurrence of more than 172 billion tonnes of high‐grade(The content of CaCO3 is greater than 80 wt%)limemud in 0.4–28.0m thick stratified sediment layers spread over an area of 18000 km2.Chemical,physical,mineralogical,beneficiation,and agglomeration studies found the offshore limemud as a potential replacement for limestone in the cement,filler,blast furnace,steel melting shop,lime production,paint,and Grade‐I steel industries.An assessment of mining and transportation costs indicates that the offshore limemud(USD 5–6/ton)is more cost‐effective than that imported from other countries(USD16‐18/ton).With several advantageous factors like low impurity,mode of occurrence in overburden‐free stratified form,fine‐grained slurry nature,and shallow water depth,sustainable mining of offshore limemud could be a future reality with controllable technological,economic,and environmental challenges.

Free vibration and buckling analysis of polymeric composite beams reinforced by functionally graded bamboo fbers

Natural fibers have been extensively researched as reinforcement materials in polymers on account of their environmental and economic advantages in comparison with synthetic fibers in the recent years.Bamboo fibers are renowned for their good mechanical properties,abundance,and short cycle growth.As beams are one of the fundamental structural components and are susceptible to mechanical loads in engineering applications,this paper performs a study on the free vibration and buckling responses of bamboo fiber reinforced composite(BFRC)beams on the elastic foundation.Three different functionally graded(FG)layouts and a uniform one are the considered distributions for unidirectional long bamboo fibers across the thickness.The elastic properties of the composite are determined with the law of mixture.Employing Hamilton’s principle,the governing equations of motion are obtained.The generalized differential quadrature method(GDQM)is then applied to the equations to obtain the results.The achieved outcomes exhibit that the natural frequency and buckling load values vary as the fiber volume fractions and distributions,elastic foundation stiffness values,and boundary conditions(BCs)and slenderness ratio of the beam change.Furthermore,a comparative study is conducted between the derived analysis outcomes for BFRC and homogenous polymer beams to examine the effectiveness of bamboo fibers as reinforcement materials,demonstrating the significant enhancements in both vibration and buckling responses,with the exception of natural frequencies for cantilever beams on the Pasternak foundation with the FG-◇fiber distribution.Eventually,the obtained analysis results of BFRC beams are also compared with those for carbon nanotube reinforced composite(CNTRC)beams found in the literature,indicating that the buckling loads and natural frequencies of BFRC beams are lower than those of CNTRC beams.

Combined Optimal Dispatch of Thermal Power Generators and Energy Storage Considering Thermal Power Deep Peak Clipping and Wind Energy Emission Grading Punishment

Peak load and wind energy emission pressure rise more as wind energy penetration keeps growing,which affects the stabilization of the PS(power system).This paper suggests integrated optimal dispatching of thermal power generators and BESS(battery energy storage system)taking wind energy emission grading punishment and deep peak clipping into consideration.Firstly,in order to minimize wind abandonment,a hierarchical wind abandonment penalty strategy based on fuzzy control is designed and introduced,and the optimal grid-connected power of wind energy is determined as a result of minimizing the peak cutting cost of the system.Secondly,considering BESS and thermal power,the management approach of BESS-assisted virtual peak clipping of thermal power generators is aimed at reducing the degree of deep peak clipping of thermal power generators and optimizing the output of thermal power generators and the charging and discharging power of BESS.Finally,Give an example of how this strategy has been effective in reducing abandonment rates by 0.66% and 7.46% individually for different wind penetration programs,and the daily average can reduce the peak clipping power output of thermal power generators by 42.97 and 72.31 MWh and enhances the effect and economy of system peak clipping.

The interplay mechanism between IDH mutation, MGMT-promoter methylation, and PRMT5 activity in the progression of grade 4 astrocytoma: unraveling the complex triad theory

Background:The dysregulation of Isocitrate dehydrogenase(IDH)and the subsequent production of 2-Hydroxyglutrate(2HG)may alter the expression of epigenetic proteins in Grade 4 astrocytoma.The interplay mechanism between IDH,O-6-methylguanine-DNA methyltransferase(MGMT)-promoter methylation,and protein methyltransferase proteins-5(PRMT5)activity,with tumor progression has never been described.Methods:A retrospective cohort of 34 patients with G4 astrocytoma is classified into IDH-mutant and IDH-wildtype tumors.Both groups were tested for MGMT-promoter methylation and PRMT5 through methylation-specific and gene expression PCR analysis.Inter-cohort statistical significance was evaluated.Results:Both IDH-mutant WHO grade 4 astrocytomas(n=22,64.7%)and IDH-wildtype glioblastomas(n=12,35.3%)had upregulated PRMT5 gene expression except in one case.Out of the 22 IDH-mutant tumors,10(45.5%)tumors showed MGMT-promoter methylation and 12(54.5%)tumors had unmethylated MGMT.All IDH-wildtype tumors had unmethylated MGMT.There was a statistically significant relationship between MGMT-promoter methylation and IDH in G4 astrocytoma(p-value=0.006).Statistically significant differences in progression-free survival(PFS)were also observed among all G4 astrocytomas that expressed PRMT5 and received either temozolomide(TMZ)or TMZ plus other chemotherapies,regardless of their IDH or MGMT-methylation status(p-value=0.0014).Specifically,IDH-mutant tumors that had upregulated PRMT5 activity and MGMT-promoter methylation,who received only TMZ,have exhibited longer PFS.Conclusions:The relationship between PRMT5,MGMT-promoter,and IDH is not tridirectional.However,accumulation of D2-hydroxyglutarate(2-HG),which partially activates 2-OG-dependent deoxygenase,may not affect their activities.In IDH-wildtype glioblastomas,the 2HG-2OG pathway is typically inactive,leading to PRMT5 upregulation.TMZ alone,compared to TMZ-plus,can increase PFS in upregulated PRMT5 tumors.Thus,using a PRMT5 inhibitor in G4 astrocytomas may help in tumor regression.

Functionally graded structure of a nitride-strengthened Mg_(2)Si-based hybrid composite

The ex-situ incorporation of the secondary SiC reinforcement,along with the in-situ incorporation of the tertiary and quaternary Mg_(3)N_(2) and Si_(3)N_(4) phases,in the primary matrix of Mg_(2)Si is employed in order to provide ultimate wear resistance based on the laser-irradiation-induced inclusion of N_(2) gas during laser powder bed fusion.This is substantialized based on both the thermal diffusion-and chemical reactionbased metallurgy of the Mg_(2)Si–SiC/nitride hybrid composite.This study also proposes a functional platform for systematically modulating a functionally graded structure and modeling build-direction-dependent architectonics during additive manufacturing.This strategy enables the development of a compositional gradient from the center to the edge of each melt pool of the Mg_(2)Si–SiC/nitride hybrid composite.Consequently,the coefficient of friction of the hybrid composite exhibits a 309.3%decrease to–1.67 compared to–0.54 for the conventional nonreinforced Mg_(2)Si structure,while the tensile strength exhibits a 171.3%increase to 831.5 MPa compared to 485.3 MPa for the conventional structure.This outstanding mechanical behavior is due to the(1)the complementary and synergistic reinforcement effects of the SiC and nitride compounds,each of which possesses an intrinsically high hardness,and(2)the strong adhesion of these compounds to the Mg_(2)Si matrix despite their small sizes and low concentrations.

Size-dependent thermomechanical vibration characteristics of rotating pre-twisted functionally graded shear deformable microbeams

A three-dimensional(3D)thermomechanical vibration model is developed for rotating pre-twisted functionally graded(FG)microbeams according to the refined shear deformation theory(RSDT)and the modified couple stress theory(MCST).The material properties are assumed to follow a power-law distribution along the chordwise direction.The model introduces one axial stretching variable and four transverse deflection variables including two pure bending components and two pure shear ones.The complex modal analysis and assumed mode methods are used to solve the governing equations of motion under different boundary conditions(BCs).Several examples are presented to verify the effectiveness of the developed model.By coupling the slenderness ratio,gradient index,rotation speed,and size effect with the pre-twisted angle,the effects of these factors on the thermomechanical vibration of the microbeam with different BCs are investigated.It is found that with the increase in the pre-twisted angle,the critical slenderness ratio and gradient index corresponding to the thermal instability of the microbeam increase,while the critical material length scale parameter(MLSP)and rotation speed decrease.The sensitivity of the fundamental frequency to temperature increases with the increasing slenderness ratio and gradient index,and decreases with the other increasing parameters.Moreover,the size effect can suppress the dynamic stiffening effect and enhance the Coriolis effect.Finally,the mode transition is quantitatively demonstrated by a modal assurance criterion(MAC).

Teachers’Perception for Evaluation of the Primary School Students With Final Grade

The most difficult and delicate part of the learning process is assessment.Assessment is difficult because during his/her accomplishment the teacher has to consider not only the acquisition of knowledge from students,but also the overall degree of development of their competencies.It is delicate,because through assessment we can influence the emotional side of students and their“willingness”to learn.Despite these facts,teachers need to evaluate students during the learning process.The purpose of the research is to find out what is the perception of teachers about the level of evaluation of students with final grade.The overall results showed that 89%of teachers agree,9%of them have a neutral attitude,and 2%do not agree that the evaluation of students with a final grade is done taking into account many aspects and using many methods,the overall average of the results,M=4.36.Based on the empirical results,it was found that teachers who have completed assessment training have a more positive approach to student assessment,as the average score is higher than teachers who have not completed assessment training.From the qualitative results it was understood that the Teachers did not encounter any difficulties during the assessment of the students.

Sound Transmission Loss Analysis of a Double Plate-Acoustic Cavity Coupling System with In-Plane Functionally Graded Materials

In this paper, the isogeometric analysis (IGA) is employed to develop an acoustic radiation model for a double plate-acoustic cavity coupling system, with a focus on analyzing the sound transmission loss (STL). The functionally graded (FG) plate exhibits a different material properties in-plane, and the power-law rule is adopted as the governing principle for material mixing. To validate the harmonic response and demonstrate the accuracy and convergence of the isogeometric modeling, ANASYS is utilized to compare with numerical examples. A plane wave serves as the acoustic excitation, and the Rayleigh integral is applied to discretize the radiated plate. The STL results are compared with the literature, confirming the reliability of the coupling system. Finally, the investigation is conducted to study impact of cavity depth and power-law parameter on the STL.

Application Analysis of Nursing Students'Grades in Course Relevance Based on Association Rule Mining Algorithm Apriori

By analyzing the correlation between courses in students’grades,we can provide a decision-making basis for the revision of courses and syllabi,rationally optimize courses,and further improve teaching effects.With the help of IBM SPSS Modeler data mining software,this paper uses Apriori algorithm for association rule mining to conduct an in-depth analysis of the grades of nursing students in Shandong College of Traditional Chinese Medicine,and to explore the correlation between professional basic courses and professional core courses.Lastly,according to the detailed analysis of the mining results,valuable curriculum information will be found from the actual teaching data.

A Study on the Correlation Between LIWC Word Categories and Chinese Composition Writing Performance of Fourth,Fifth,and Sixth Grade Students

This study focuses on the analysis of the Chinese composition writing performance of fourth,fifth,and sixth grade students in 16 selected schools in Longhua District,Shenzhen during the spring semester of 2023.Using LIWC(Linguistic Inquiry and Word Count)as a text analysis tool,the study explores the impact of LIWC categories on writing performance which is scaled by score.The results show that the simple LIWC word categories have a significant positive influence on the composition scores of lower-grade students;while complex LIWC word categories have a significant negative influence on the composition scores of lower-grade students but a significant positive influence on the composition scores of higher-grade students.Process word categories have a positive influence on the composition scores of all three grades,but the impact of complex process word categories increases as the grade level rises.

Reading Loss in Arabic Language During COVID-19 in the UAE and Proposed Solutions:The Perspectives of Primary-Grade Arabic Language Teachers

The COVID-19 pandemic caused significant disruptions in the field of education worldwide,including in the United Arab Emirates.Teachers and students had to adapt to remote learning and virtual classrooms,leading to various challenges in maintaining educational standards.The sudden transition to remote teaching could have a negative impact on students’reading abilities,especially in the Arabic language.To gain insight into the unique challenges encountered by Arabic language teachers in the UAE,a survey was conducted to explore their assessment of teaching quality,student-teacher interaction,and learning outcomes amidst the COVID-19 pandemic.The results of the survey revealed a significant decline of student reading abilities and identified several major issues in online Arabic language teaching.These issues included limited interaction between students and teachers,challenges in monitoring students’class participation and performance,and challenges in effectively assessing students’reading skills.The results also demonstrated some other challenges faced by Arabic language teachers,including a lack of preparedness,a lack of subscription to relevant platforms,and a lack of resources for online learning.Several solutions to these challenges are proposed,including reevaluating the balance between depth and breadth in the curriculum,integrating language skills into the curriculum more effectively,providing more comprehensive teacher professional development,implementing student grouping strategies,utilizing retired and expert teachers in specific content areas,allocating time for interventions,and improving support from both teachers and parents to ensure the quality of online learning.

热敏灸治疗颈型颈椎病的Meta分析及GRADE证据等级评价

目的系统评价热敏灸及其综合疗法用于颈型颈椎病的临床效果,为热敏灸治疗颈型颈椎病提供更好的证据来源。方法收集国内外各大数据库热敏灸及其综合疗法用于颈型颈椎病的随机对照试验(RCT),通过Revman 5.3软件进行Meta分析,按照GRADE标准对结局指标进行证据质量评价。结果纳入9篇文献共855例患者,Meta分析结果提示:热敏灸及其综合疗法组在提高总有效率(RR=1.19,P<0.01)和治愈率(RR=1.73,P<0.01)、降低视觉模拟量表(VAS)评分(SMD=-0.73,P<0.01)、简化McGill疼痛问卷(SF-MPQ)评分(SMD=-1.28,P<0.05)以及NPQ颈痛量表评分(SMD=-0.81,P<0.05)方面都优于对照组;GRADE证据等级评价提示:前三者为低质量证据,后二者为极低质量证据。结论热敏灸及其综合疗法用于颈型颈椎病在提高临床效果、镇痛以及改善患者生活质量方面更具优势。

Brief Discussion on Specific Grading of Exercises after Class In Implementing Grade English Teaching

With the reform booming in teaching fields,the author carried out Graded English teaching in her teaching classroom and achieved favorable efficiency.In this paper,the author mainly discusses the specific grading of exercise after class in implementing graded teaching,taking for example Section A,Unit 6(Go for it! SB for Grade Eight,Volume A,by People's Education Press and Thomson Learning,2004,2nded).