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.

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.

不同性能水平下600 MPa级高强钢筋混凝土柱位移角限值研究

基于性能抗震设计思想的600 MPa级高强钢筋混凝土柱位移角限值研究,对于推广高强钢筋混凝土柱的应用至关重要。通过17根HTRB630高强钢筋混凝土柱试件和3根HRB400钢筋混凝土柱试件的拟静力试验研究了其抗震性能。与HRB400钢筋混凝土柱相比,HTRB630高强钢筋混凝土柱的滞回曲线的形状没有发生明显改变,试件具有较好的承载能力和延性。将基于Kunnath损伤模型计算的损伤指数与试验中测量的损伤指数范围进行了比较,结果表明,Kunnath损伤模型可以准确计算HTRB630高强钢筋混凝土柱的损伤指标。根据HTRB630高强钢筋混凝土柱的破坏特点,以屈服点、峰值点和极限点作为高强钢筋混凝土柱的性能水平控制点。基于性能抗震设计的思想,将600 MPa级高强钢筋混凝土柱的性能水平划分为5个性能水平,即正常使用、暂时使用、修复后使用、生命安全和接近倒塌性能水平。结合参考文献中600 MPa级高强钢筋混凝土柱的试验数据,对65个600 MPa级高强钢筋混凝土柱各特征点的位移角进行了相对频率统计分析,得到了600 MPa级高强钢筋混凝土柱在暂时使用、修复后使用和接近倒塌3个性能水平下具有超过90%安全保证率的位移角限值分别为1/150、1/80和1/60。

速度350km/h高速铁路长大下坡地段闭塞分区设置方法研究

通过分析长大下坡道闭塞分区长度对CTCS-3级和后备CTCS-2级列控系统的影响,指出二者对闭塞分区长度的需求完全相反,并针对CTCS-3级列控系统的行车许可回缩、速度突降等问题的产生原因进行分析。阐述坡度、闭塞分区长度与不同列控模式下列车运行速度、追踪间隔时间等要素之间的关系,制定闭塞分区设置的基本原则。检算典型坡度下闭塞分区长度设置的合理区间范围及相应追踪间隔时间,指出坡度超过-30‰后将无法兼顾不同列控等级下的运行速度。设计模拟退火算法,根据闭塞分区设置原则及闭塞分区取值规律,给出压缩求解空间、提高求解效率的方法。以郑万高速铁路长大下坡地段为例,对闭塞分区设置进行优化,在不考虑其他约束的前提下,与设计院优化方案相比,本求解优化方案在确保CTCS-3级控车模式下允许速度可达350 km/h的同时,将CTCS-2级控车模式下的允许速度提高30 km/h,追踪间隔时间压缩23 s。

天津某三甲综合医院国际人才引进实践

以天津某三甲综合医院海外优秀青年人才引进措施为案例,介绍了该医院的优秀青年科学基金项目(海外)的总体概况、目标要求、申报条件、资助情况、考核管理及实施成效等。认为应充分重视海外优秀青年人才引进工作,科学规划,构建综合性、国际化的人才引进管理体系;优化服务,为国际人才融入提供各项安置措施;双重保障,引入咨询津贴和科研资助双项激励;强化考核,建立国际特殊人才考评任务分解机制;闭环管理,全力构筑全链条科技人才发展生态。

国内针灸治疗焦虑障碍临床实验的GRADE证据评价

目的:GRADE系统评价单纯针灸治疗焦虑障碍临床实验的证据等级。方法:收集针灸治焦虑障碍临床研究随机对照文献,计算机检索万方数字化期刊群(1998—),CBM(1979—)、CNKI(1979—)和VIP(1989—),所有检索时间截至2016年2月15日,并手工检索广州中医药大学图书馆过刊资料库,统计学分析采用Rev Man5.2软件,证据质量评估采用GRADE profiler3.6软件。结果:本研究纳入14个随机对照试,结局指标为治疗3周的HAMA有效率、8周的HAMA评分、1个月及2个月后随访的HAMA评分、60 d的SAS有效率,证据质量均为非常低。其中治疗60 d的SAS有效率比较,差别有统计学意义,其余均无统计学意义。结局指标为治疗4、6周的HAMA有效率,4、5、6周的HAMA评分,4周的SAS评分,证据质量均为低级。其中治疗4、6周的HAMA评分比较,差别有统计学意义,其余均无统计学意义。结局指标为治疗后3、6个月后随访的HAMA评分,证据质量为中级,差别无统计学意义。结论:针灸治疗焦虑障碍的随机对照的证据质量总体偏低,需完善随机对照实验的设计及报告,以为临床及指南制定提供高级别的针灸治疗证据。

某三甲医院特需门诊在线预约探索及应用

目的:为了提升大型三甲医院稀缺专家的利用效率,提高门诊住院转化率,提升患者满意度,上海某三甲医院胸外科实行特需门诊在线预约项目并评估其应用效果。方法:比较上海某三甲医院胸外科应用特需门诊在线预约项目前后,特需门诊量、患者平均就诊时长、直接收治入院人数、门诊住院转化率等指标,并随机抽样调查患者满意度。结果:自2020年12月至2022年8月,共计6 905人次提交预约申请,通过1 853人次(26.8%),其中男性、高龄、自费患者通过比例显著高于女性、年轻、医保患者(P均<0.01)。实行该项目后,门诊量显著降低(P<0.000 1),而平均就诊时长、直接收治入院人数、门诊住院转化率均显著提高(P均<0.05)。电话随访结果表明,预约通过和未通过患者满意度没有显著差别(P=0.138),总体满意度均高于90%。结论:在大型三甲医院实行特需门诊在线预约项目,能够有效改善患者就医体验和满意度,大幅提高收治效率,初步实现诊疗分级。

河套灌区向日葵菌核病发生等级预报

根据2000—2021年河套地区向日葵菌核病中心菌株的出现期、始盛期和发生程度和同期的气象资料,分析了向日葵菌核病发生周期和程度与气象条件的相关性,并建立了相应的预测方程。结果表明,温度和湿度是影响菌核病发生的关键因素。降水量、平均风速和日照时数对菌核病的发生时间和程度也有重要影响。通过逐步回归建立3个预测模型,均通过0.01水平的显著性检验。历史数据拟合效果较好,2021年的测试结果较好,2022年投入实际业务运行。

指向学业质量标准的考生表现评价研究——以2023年天津市普通高中学业水平等级性考试生物学试题为例

以《普通高中生物学课程标准(2017年版2020年修订)》中的学业质量水平为依据,构建学业质量水平评价框架和试卷结构分析表,分析2023年天津市普通高中学业水平等级性考试生物学试卷考查内容与课程标准和教材内容的一致性,以及考生在几个核心素养要求上的作答表现。结合研究结果,提出要帮助学生构建知识网络,形成完整的知识体系;要推进生物学实验教学多样化设计;要以具体情境为载体,发展科学思维的同时渗透社会责任等教学改进建议。

基于AS-OCT图像的核性白内障多级排序分类算法研究

目的探讨基于眼前节光学相干断层扫描(AS-OCT)图像的核性白内障智能辅助分级算法对白内障分级的诊断价值。方法采用诊断试验研究方法,收集2020年11月至2021年9月间同济大学附属第十人民医院电子病例系统中核性白内障患者939例1608眼的AS-OCT图像资料,所有资料均符合临床阅片清晰度要求。其中男398例664眼,女541例944眼,年龄18~94岁,平均年龄(65.7±18.6)岁。由3名经验丰富的临床医生基于晶状体混浊分类系统(LOCSⅢ分级系统),对所收集的AS-OCT图像进行1~6级人工标注。构建一种基于多级排序的全局-局部白内障分级算法,该算法包含5个基本的二元分类全局-局部网络(GL-Net),每个GL-Net聚合白内障核区域、原始图像等多尺度信息进行核性白内障分级。基于消融实验和模型对比试验,采用准确率、精确率、灵敏度、F1指标及Kappa系数对模型性能进行评价,且所有结果均通过五折交叉验证。结果模型在核性白内障数据集上的准确率、精确率、灵敏度、F1、Kappa分别为87.81%、88.88%、88.33%、88.51%、85.22%。消融实验结果表明,ResNet18结合局部特征和全局特征进行多级排序分类,模型在准确率、精确率、灵敏度、F1、Kappa指标上均有提升。与ResNet34、VGG16、Ranking-CNN、MRF-Net模型比较,本研究模型各性能指标均有提升。结论基于深度学习的AS-OCT核性白内障图像多级排序分类算法对白内障分级具有较高的准确度,有望辅助提高眼科医生对核性白内障的诊断精度以及效率。

湖北省十堰市恒牙龋病患者伤残权重现状研究

目的了解湖北省十堰市恒牙龋病患者伤残权重(disability weight,DW)现状。方法对湖北医药学院附属东风口腔医院及其两家分门诊的恒牙龋病患者进行问卷调查,并选择恒牙龋痛作为后遗症进行研究,通过患者EQ-5D VAS自评及调查者赋值、专家赋值三种方式获取DW。采用Mann-Whitney U检验及Kruskal-Wallis H检验进行单因素分析、多元线性回归进行多因素分析。结果共220名患者参与调查,年龄多为21~35岁,女性和学生群体居多。患者EQ-5D VAS自评DW[0.300(0.200,0.500)]、调查者赋值DW[0.220(0.096,0.400)]、专家赋值DW[0.220(0.096,0.400)]。单因素分析显示,不同年龄、月收入、学历的患者其自评DW、调查者赋值DW、专家赋值DW差异均具有统计学意义。多因素分析显示年龄越大,DW越大,患者失能状况越严重;学历越高,月收入越高,DW越小,患者失能状况越轻(P<0.05)。结论湖北省十堰市不同赋值方法测算的恒牙龋病患者DW存在差异,年龄大、学历低、月收入低是影响恒牙龋病患者DW的危险因素,当地公共卫生政策制定时应关注该类人群。

低渗透油藏强化CO_(2)/水交替注入驱油效果实验研究

为了强化低渗透油藏CO_(2)/水交替注入(WAG)驱油效果,针对CO_(2)黏性指进问题,提出了锥形WAG驱和活性水WAG驱2种强化驱油效果的方式。通过非均质岩心驱替实验,对比分析了锥形水气比(5∶1~1∶1和1∶1~1∶5)与等比例(1∶1)注入时采出程度变化情况;基于泡沫性能和界面活性评价结果,优选了强化WAG驱用表面活性剂,通过非均质岩心驱替实验评价了活性水强化WAG效果。结果表明:采用锥形WAG驱替时采出程度高于等比例水气比驱替。优选了具有良好起泡性能和低界面张力的L1表面活性剂,L1表面活性剂浓度为0.5%时,泡沫强度达到中等强度,油水界面张力降至2.91×10^(-2) mN/m;L1表面活性剂浓度为0.4%时,高渗层采出程度提高了26.82%,以提高洗油效率作用为主;L1表面活性剂浓度为0.6%时,低渗层采出程度提高了21.48%,以泡沫调驱作用为主。该研究成果为实现低渗透油藏CO_(2)驱油高效开发有指导意义。

Orem自理模式下分级干预时肘管综合征患者的临床研究

目的 探讨奥瑞姆(Orem)自理模式下分级干预对肘管综合征患者的临床效果。方法 纳入2019年4月至2022年3月收治的肘管综合征患者80例,随机分为对照组和观察组,每组40例。对照组采用常规干预,观察组实施Orem自理模式下分级别干预方案,比较2组的干预效果。结果 观察组的功能恢复优良率为95.00%高于对照组的75.00%(P<0.05)。2组干预后的疼痛水平评分均低于干预前,且观察组低于对照组(P<0.05)。2组干预后的睡眠质量评分均低于干预前,观察组低于对照组(P<0.05)。观察组的并发症发生率为2.50%低于对照组的20.00%(P<0.05)。观察组护理满意度评分高于对照组(P<0.05)。结论 肘管综合征患者中实施Orem自理模式下分级干预,可促进患者功能恢复,减轻患者疼痛感,帮助患者改善睡眠质量和减少并发症,患者的护理满意度高。

某县级医院等级评审工作的实践与思考

等级评审是评价医院管理服务能力的重要手段。县级医院积极创建三级医院,既是政策引领和城乡需求,同时也是医院长远发展的需要。通过等级医院创建工作,实现以评促建、以评促改、评建并举、重在内涵的目标,将评审标准变成日常工作的行为准则,在实际行动中践行标准,在标准理解中指导实践,助推医院的高质量发展。本文阐述了仪征市人民医院在医院等级评审过程中的主要做法和取得的成效,为县级医院创建三级医院提供了参考借鉴。

智慧医疗背景下全椒县医院信息系统一体化建设研究

信息化是医疗卫生体制改革的重要任务,是医改成功逐步推进的重要保障。为高质量推进医院及县域医共体信息化建设,打造县域医疗卫生机构数据、资源及管理高效协同的信息化网络布局,全椒县人民医院坚持以政策为导向,以信息技术为支撑,以患者为中心,以医疗服务效率及质量双提升为目标的核心理念,探索构建县域一体化医疗信息系统,实现县域医疗机构“一张网”应用模式,带动县域医疗卫生信息化高效、协同发展。

Even low-grade inflammation impacts on small intestinal function

Independent of the cause and location,inflammation-even when minimal-has clear effects on gastrointestinal morphology and function.These result in altered digestion,absorption and barrier function.There is evidence of reduced villus height and crypt depth,increased permeability,as well as altered sugar and peptide absorption in the small intestine after induction of inflammation in experimental models,which is supported by some clinical data.Identification of inflammatory factors which may promote the process of gastrointestinal dysfunction as well as clinical research to verify experimental observations of inflammatory modulation of gastrointestinal function are required.Moreover,nutritional strategies to support functional restitution are needed.

Study on Optimal Strategy of Grade Transition in Industrial Fluidized Bed Gas-Phase Polyethylene Production Process

A model of grade transition is presented for a commercialized fluidized bed gas-phase polyethylene production process.The quantity of off-specification product and the time of grade transition can be minimized by the optimization of operating variables,such as polymerization temperature,the ratio of hydrogen to ethylene,the ratio of co-monomer to ethylene,feed rate of catalyst,and bed level.A new performance index,the ratio of melt flow(MFR),is included in the objective function,for restraining the sharp adjustment of operation variables and narrowing the distribution of molecular weight of the resion.It is recommended that catalyst feed rate and bed level are decreased in order to reduce the grade transition time and the quantity of off-specification product.This optimization problem is solved by an algorithm of sequential quadratic programming (SQP) in MATLAB. There is considerable difference between the forward transition and reverse transition of grade with regard to the operating variables due to the non-linearity of the system.The grade transition model is extended to a high space time yield(STY)Process with the so-called condensed model operation.In the end,an optimization strategy for multi-product transition is proposed with two-level optimization of the objective function J(x,u) on the the basis of the optimal grade transition model.A sequential transition of six commercial polyethylene grades in illustrated for an optimal multi-product operation.

Experimental study on preferential solution flow during dump leaching of low-grade ores

The phenomenon of preferential solution flow during dump leaching of low-grade ores was studied.The formative mechanism of preferential solution flow was investigated through analyzing the relationship between permeability and ore diameter,and the relationship between surface tension and ore diameter.The preferential solution flow happened within the fine ore area when the dump was unsaturated.And it could happen within the coarse ore area when the dump became saturated.The results of experiment show that the outflow of coarse ore area increases sharply with higher applied rate.The outflow of fine ore area is greater than that of coarse ore area when the applied rate is below 3.2 L/min,and the preferential solution flow happens in fine ore area.But the preferential solution flow happens in coarse ore area when the applied rate is higher than 3.2 L/min.The result of the experiment is consistent with the mechanism analyzing.

分次绝对clean模和分次level模

在任意分次环R上引入了分次绝对clean模和分次level模的概念,证明了(gr-FI∞,gr-F∞)和(gr-F∞,gr-FI∞)构成了分次R-模范畴中具有某种特殊性质的对偶对,其中gr-FI∞为由所有分次绝对clean模构成的子范畴,gr-F∞为由所有分次level模构成的子范畴.作为应用,证明了任意分次左R-模都有分次绝对clean覆盖和分次level预包络.