Neoadjuvant treatment of rectal cancer: Where we are and where we are going

Locally advanced rectal cancer requires a multidisciplinary approach based on total neoadjuvant treatment with radiotherapy(RT)and chemotherapy(ChT),followed by deferred surgery.Currently,alternatives to the standard total neoadjuvant therapy(TNT)are being explored,such as new ChT regimens or the introduction of immunotherapy.With standard TNT,up to a third of patients may achieve a complete pathological response(CPR),potentially avoiding surgery.However,as of now,we lack predictive markers of response that would allow us to define criteria for a conservative organ strategy.The presence of muta-tions,genes,or new imaging tests is helping to define these criteria.An example of this is the diffusion coefficient in the diffusion-weighted sequence of magnetic resonance imaging and the integration of this imaging technique into RT treatment.This allows for the monitoring of the evolution of this coefficient over successive RT sessions,helping to determine which patients will achieve CPR or those who may require intensification of neoadjuvant therapy.

Effect of Extending Voluntary Waiting Period on Health of Holstein Friesian Dairy Cows

The aim of this of this experimental study to investigate the effect of 3 voluntary waiting periods (VWP) on health of dairy cows. A total of 100 lactations of 100 Holstein Friesian cows with high milk production (average 9.442 ± 620 kg) were randomly (based on the ear tags digits of cows) distributed to 1 to 3 experimental groups with VWP of 50 (VWPG50;n = 32), 100 (VWPG100;n = 34) or 150 days (VWPG150;n = 34). Observations relating to diseases of the cows were made by the farm veterinarian and research personnel. Were defined eight disease: puerperal fever, retained fetal membranes, displaced abomasum, metritis, clinical ketosis, clinical mastitis, ovarian cysts, and claw diseases. The experimental days (ED) were from 4 days in milk (DIM) to 100 days after the next calving. The experiment was managed at Dairy Research Farm ?imnic-Craiova January 2018 to December 2022. A clear set of clinical signs were used to define a case at the diseases without the need for laboratory confirmation. Values of Lactational incidence risk (LIR) median postpartum days at diagnosis and pairwise comparison of proportion between VWPs were calculated. LIR for puerperal fiver, retained fetal membranes, displaced abomasum, clinical ketosis, clinical mastitis, ovarian cysts and claw disease were 4;5;2;8;8;and 4% respectively. Numerically, cows with VWP of 100 and150 days had more disease cases compared with VWP of 50 days. The differences between experimental groups of cows regarding proportions of cows with disease cases were not statistically significant. Any of the eight disorders reported in this study was analyzed independently to other health problems. For all enrolled cows (n = 100) VWP was extended until 100 or 150 days postpartum with no effect on the lactational incidence risk for the eight disorders analyzed.

Reexamining Positivity of Thinking in Waiting for Godot Through Camus’s Absurdism

Absurdity originated from French existentialism,and Martin Esslin,in categorizing Waiting for Godot as a theater of the absurd,ignores the positive aspects of Camus’s absurdism and regards that as an existential tragedy of mankind.However,the author Samuel Beckett himself did not approve of such a definition,believing that Esslin’s definition of theater of the absurd was too judgmental and pessimistic.Through the imagery of boots,ropes,hats and baggage in Waiting for Godot,Beckett reveals the rootlessness,constraint and agony of the minds of people born into absurdity in the early 20th century.The luck of Lucky is Beckett’s use of irony:people who have lost the ability to think for themselves escape the absurdity and dystopia of life and descend to slaves.Gogo and Didi,who are waiting and expecting,and thinking in the midst of absurdity,represent“Godot”,the symbol of hope.Their endurance in waiting,akin to Camus’s Sisyphus,underscores a form of existential defiance that challenges the notion of absolute pessimism in absurdist literature.

Regional variation in routes to diagnosis of cholangiocarcinoma in England from 2006 to 2017

BACKGROUND Incidence of cholangiocarcinoma(CCA)is rising,with overall prognosis remaining very poor.Reasons for the high mortality of CCA include its late presentation in most patients,when curative options are no longer feasible,and poor response to systemic therapies for advanced disease.Late presentation presents a large barrier to improving outcomes and is often associated with diagnosis via mergency presentation(EP).Earlier diagnoses may be made by Two Week Wait(TWW)referrals through General practitioner(GP).We hypothesise that TWW referrals and EP routes to diagnosis differ across regions in England.AIM To investigate routes to diagnosis of CCA over time,regional variation and influencing factors.METHODS We linked patient records from the National Cancer Registration Dataset to Hospital Episode Statistics,Cancer Waiting Times and Cancer Screening Programme datasets to define routes to diagnosis and certain patient characteristics for patients diagnosed 2006-2017 in England.We used linear probability models to investigate geographic variation by assessing the proportions of patients diagnosed via TWW referral or EP across Cancer Alliances in England,adjusting for potential confounders.Correlation between the proportion of people diagnosed by TWW referral and EP was investigated with Spearman’s correlation coefficient.RESULTS Of 23632 patients diagnosed between 2006-2017 in England,the most common route to diagnosis was EP(49.6%).Non-TWW GP referrals accounted for 20.5%of diagnosis routes,13.8%were diagnosed by TWW referral,and the remainder 16.2%were diagnosed via an‘other’or Unknown route.The proportion diagnosed via a TWW referral doubled between 2006-2017 rising from 9.9%to 19.8%,conversely EP diagnosis route declined,falling from 51.3%to 46.0%.Statistically significant variation in both the TWW referral and EP proportions was found across Cancer Alliances.Age,presence of comorbidity and underlying liver disease were independently associated with both a lower proportion of patients diagnosed via TWW referral,and a higher proportion diagnosed by EP after adjusting for other potential confounders.CONCLUSION There is significant geographic and socio-demographic variation in routes to diagnosis of CCA in England.Knowledge sharing of best practice may improve diagnostic pathways and reduce unwarranted variation.

LSTM Based Spectrum Prediction for Real-Time Spectrum Access for IoT Applications

In the Internet of Things(IoT)scenario,many devices will communi-cate in the presence of the cellular network;the chances of availability of spec-trum will be very scary given the presence of large numbers of mobile users and large amounts of applications.Spectrum prediction is very encouraging for high traffic next-generation wireless networks,where devices/machines which are part of the Cognitive Radio Network(CRN)can predict the spectrum state prior to transmission to save their limited energy by avoiding unnecessarily sen-sing radio spectrum.Long short-term memory(LSTM)is employed to simulta-neously predict the Radio Spectrum State(RSS)for two-time slots,thereby allowing the secondary node to use the prediction result to transmit its information to achieve lower waiting time hence,enhanced performance capacity.A frame-work of spectral transmission based on the LSTM prediction is formulated,named as positive prediction and sensing-based spectrum access.The proposed scheme provides an average maximum waiting time gain of 2.88 ms.The proposed scheme provides 0.096 bps more capacity than a conventional energy detector.

Probability Distributions Arising in Connection with the Inspection Paradox for the Poisson Process

The Inspection Paradox refers to the fact that in a Renewal Process, the length of the interarrival period which contains a fixed time is stochastically larger than the length of a typical interarrival period. To provide a more complete understanding of this phenomenon, conditioning arguments are used to obtain the distributions and moments of the lengths of the interarrival periods other than the one containing this fixed time for the case of the time-homogeneous Poisson Process. Distributions of the waiting times for events that occur both before and after this fixed time are derived. This provides a fairly complete probabilistic analysis of the Inspection Paradox.

Probability Distributions Arising in Connection with the Inspection Paradox for Bernoulli Trials

In renewal theory, the Inspection Paradox refers to the fact that an interarrival period in a renewal process which contains a fixed inspection time tends to be longer than one for the corresponding uninspected process. We focus on the paradox for Bernoulli trials. Probability distributions and moments for the lengths of the interarrival periods are derived for the inspected process, and we compare them to those for the uninspected case.

WAIT和WABT在连续重整装置运行中的指导性及其应用

通过浙江石化3.8 Mt/a连续重整装置开车后的运行情况观察,结合相关原理定义解释WAIT和WABT的意义和其在装置运行中所起的指导性作用,并将其反向应用于装置的日常生产,针对当前工况所出现的生产问题及波动给出一种日常优化调整思路。通过工艺优化,确定出合理且相对准确的反应温度从而降低反应所需苛刻度,继而确定当前工况下最优的催化剂活性降低催化剂成本,以及在反应温度、催化剂活性一定的情况下根据进料中硫和氯的含量确定出稳定的注硫量和注氯量从而降低助剂所需成本,最终综合性的调整使装置达到相对经济且稳定的状态下运行,对装置生产优化及能耗方面具备一定指导意义和作用。

幽默小故事

(一)Diner:Waiter,the portions seem to have got a lot smaller lately.Waiter:Sir,the restaurant has been enlarged,so they look smaller.That's all.食客:服务员,最近份量好像少了很多。服务员:先生,餐厅已经扩建了,所以看起来份量更小了。仅此而已。

马耳他的“豆包姐姐”

Jenise Spiteri,a snowboarder repre⁃senting Malta,has become the darling of Chinese social media for her love of red bean buns and Chinese food.The 29⁃year⁃old athlete put half of a red bean bun into her mouth while waiting for her score in the women􀆳s half pipe qualifiers.She placed 21st and missed out on a spot in the final,but she won the hearts of millions of people after the scene was broadcast live.

基于相对等待时间的代价敏感决策树

首先引入相对等待时间代价,将它与测试代价一起称为有形代价,利用单位有形代价中无形代价(即误分类代价)降低最多的原则选择分裂属性;然后结合序列测试策略和批量测试策略建立相对等待时间代价敏感决策树。实验结果显示,该方法无论在误分类代价的减少量上还是所需有形代价的数量上都优于存在的算法,并且实验地分析了建立代价敏感决策树考虑相对等待时间是必要的。

基于高效缓存管理机制的可靠消息传输机会网络路由算法

针对基于社区的机会网络路由算法存在的消息无序发送和过期消息管理效率不高等难题,提出一种基于高效缓存管理机制的可靠消息传输机会网络路由算法RMTEB(Reliable Message Transmission Routing Algorithm for Opportunistic Networks Based on Efficient Buffer Management Mechanism)。引入Spray and Wait机制,设计消息传输策略,对消息发送顺序、缓存清除机制以及消息转发机制进行优化,以确保携带消息节点在有限通信时间内向邻居节点转发更多的消息,节点相遇后,判断缓存中过期消息的目标节点是否为当前邻居节点,是则将消息发送给对方,否则删除;通过调整发送给目标节点为邻居节点的消息顺序,优先发送生存期剩余时间小的消息,显著提高消息传输效率,降低传输时延。仿真结果表明,RMTEB算法在传输成功率、平均端到端时延、路由开销比率和平均存储时间等方面均优于经典的Prophet routing算法及其改进算法Social Groups Based Routing(SGBR)。

Using Poisson Modeling and Queuing Theory to Optimize Staffing and Decrease Patient Wait Time in the Emergency Department

Introduction: Studies have shown Emergency Department (ED) crowding contributes to reduced quality of patient care, delays in starting treatments, and increased number of patients leaving without being seen. This analysis shows how to theoretically and optimally align staffing to demand. Methods: The ED value stream was identified and mapped. Patients were stratified into three resource-driven care flow cells based on the severity indices. Time observations were conducted for each of the key care team members and the manual cycle times and service rate were calculated and stratified by severity indices. Using X32 Healthcare’s Online Staffing Optimization (OSO) tool, staffing inefficiencies were identified and an optimal schedule was created for each provider group. Results: Lower Severity Indices (higher acuity patient) led to longer times for providers, nurses, patient care assistants, and clerks. The patient length of stay varied from under one hour to over five hours. The flow of patients varied considerably over the 24 hours’ period but was similar by day of the week. Using flow data, we showed that we needed more nurses, more care team members during peak times of patient flow. Eight hour shifts would allow better flexibility. We showed that the additional salary hours added to the budget would be made up for by increased revenue recognized by decreasing the number of patients who leave without being seen. Conclusion: If implemented, these changes will improve ED flow by using lean tools and principles, ultimately leading to timeliness of care, reduced waits, and improved patient experience.

移动Agent系统的一种分布式死锁检测方案

传统的分布式死锁解决方案不适合于实体在网络中自由移动的MAS系统.本文描述了一种移动Agent系统的分布式死锁算法,使用专职Agent从事死锁检测和解决.该方案的特点是地点参考、拓扑独立、容错、异步操作.文中建立了StochasticPetri Net模型,并使用仿真试验给出它和Diffusion Computation算法的性能比较.

A Day's Wait会话中的“it”误解的关联解读

关联理论认为人的交际模式应为明示-推理交际。如果交际双方之间存在着认知环境的差异势必会导致交际的失败。本文试图利用关联理论的三个关联观,即语境关联,个体关联和认知关联来解读海明威的短篇小说A Day's Wait会话中的“it”误解,认为小说中父子之间交流的失败和误解是他们关联性不同制造成的,对“it”误解的关联解读,可以更好地理解作者如何通过两个主人公父与子之间会话中“it”误解的巧妙设计,推进故事情节的发展,揭示出作者在刻画他的“准则英雄”形象时对死亡和勇敢的深刻理解,从而显示作者匠心独具的艺术家本色,体现出不凡的艺术成就。

阅读理解练与析

Shoppers,crowding into the West End of Londonyesterday for the start of sales,answered demands fromthe police to use public transportation rather than theircars.They also decided not to invite danger,after thebursting of a bomb in the West End on Christmasevening,by not waiting in line outside the shops.“Iwould have been very worried of what they had.”saidMr Harry Weblin,manager of Liberty’s.Last night the police,which operated a big actionincluding special searches outside the main shops,spoke highly of the common sense of the

英语自学日语考试指导(12)

上期的第二个话题“跳槽”是目前普遍存在的现象,对此人们看法不一。有些人认为这在国外并非什么新鲜事,中国人也开始这样做说明人们的思想解放了.打破了过去那种在一个单位干一辈子的传统观念.这是社会的进步。也有人把“跳槽”看做是人的私欲膨胀,是对金钱和物质利益的过分追求,不利于一个企业或部门的发展,不应提倡。考生如同意后一种观点就可以说:“I don’t think it is reasonable for aperson to change his(her)job frequently.A

汉译英训练(39) 钥匙

小女孩手中拿着一串钥匙,定定地站在门前的过道上。我下班回家时,小女孩站在过道上迎住了我。她仰着小脸蛋,定定地望着我,用童稚的声音问：＂叔叔,这钥匙是你和阿姨丢失的吗？我是在你家门前的过道上拾到的。＂小女孩的目光一片天真无邪。我仔细地看了那串钥匙,不错,这串钥匙平日是妻掌管的。妻不小心把它遗失在过道上,幸亏是楼上的小女孩拾到了,要是万一落入了＊窃贼1的手中,后果真不堪设想。

An Investigation of Teacher Questioning Strategies Usage in College English Course——A Case Study on Honghe University

Teacher questioning strategy is one of popular teaching method in teaching practice.The teachers and students of college English course II was taken as investigate objects in this study.This study will focus on the problems of questioning frequency,questioning types,questioning strategies,waiting time and students’response to deeply study this situation.Through the data collection and analysis,the researcher hopes the study will deeply reveal the real situation of teacher questioning usage in Honghe University.Some referential suggestions will be offered to the college English teachers for their future teaching.

An Analysis of Language in "Waiting for Godot"

As an important representative of the Theatre of Absurd, in his masterpiece Waiting for Godot, Beckett deserted the traditional dramatic form and adopted a new one that shows us the fragmentary characters and the absurdity of the modern society. This paper demonstrates his artful creation of the language form from the following three aspects: The use of repetition, use of silence and pause and short sentences.