Accurate drought assessment demands thoughtful consideration of drought definition first of all.Drought is commonly defined as a prolonged period of below-average precipitation leading to water shortages that impact e...Accurate drought assessment demands thoughtful consideration of drought definition first of all.Drought is commonly defined as a prolonged period of below-average precipitation leading to water shortages that impact ecosystems,agriculture,and human societies.However,meteorologists,hydrologists,and agronomists often use different criteria to define drought,depending on their specific focus areas.For example,hydrologists define drought according to water deficits in some components of the hydrological cycle(such as precipitation,soil moisture,river flow,and groundwater)or its impacts on the level of services provided to public water supply,irrigation,or hydropower demands(Tate and Gustard,2000).Differences in drought definitions may result in great uncertainties in drought assessment(Satoh et al.,2021).We cannot expect the existence of any workable generalized objective definition of drought(Lloyd-Hughes,2014).展开更多
Background and Objective The development of modern palliative care in China began in the 1980s and is currently in an accelerating phase.However,inconsistencies in terminology and concepts have hindered policy-making,...Background and Objective The development of modern palliative care in China began in the 1980s and is currently in an accelerating phase.However,inconsistencies in terminology and concepts have hindered policy-making,clinical practice,and academic research.The Terminology of Clinical Medicine(2023 edition)has determined huan-he-yi-liao(缓和医疗)and an-ning-liao-hu(安宁疗护)as the formal terms of"palliative care"and"hospice care",respectively.To align with these terms,this study aims to establish expert consensus definitions tailored to the Chinese context.Methods We systematically retrieved and collected domestic and international literature and policy documents related to the definition of palliative care,then deconstructed and analyzed the relevant conceptual elements of these definitions.Core expert panel built the initial recommended definition upon the conceptual elements and consensus definition of palliative care by the International Association for Hospice and Palliative Care(IAHPC)through two rounds of online discussions.After nomination and selection,61 professionals in the field of palliative care in China were invited to participate in the consensus expert group.Two rounds of Delphi consultation were conducted among the consensus experts,who were asked to score their agreement using Likert scale to the items in the initial recommended definition and the definition statements of palliative care and hospice care.Agreement rate of over 80%was considered as reaching consensus for each items.The core expert panel revised the items and the statements of recommended definitions based on the results from Delphi surveys.The final recommended definitions were formulated after feedback from patient and public involvement(PPI)group members.Results The response rates for the first and second round of Delphi surveys were 83.6%and 100.0%,respectively.The agreement rates of the items and statements of the recommended definitions exceeded 90%.Accordingly,the definitions based on Chinese expert consensus are recommended.Palliative care is an active holistic approach aimed at patients of all ages suffering from life-threatening illness and their families and caregivers.It seeks to improve their quality of life by preventing,assessing,and relieving physical,psychological,social,and spiritual suffering.Hospice care is an integral part of palliative care,focusing on holistic care for patients at the end of life and their families and caregivers.Its goal is to help patients to maintain dignity and achieve a good death by alleviating physical,psychological,social,and spiritual distress without intentionally hastening or postponing death,meanwhile improve the quality of life for families and caregivers.Conclusions This study has established the Chinese expert consensus definitions of palliative care and hospice care in China,as well as the relationship between the two.The definitions highlight the holistic nature of palliative care,providing a foundation for discipline development,clinical practice,and public communication.展开更多
BACKGROUND Fever of unknown origin(FUO)remains a diagnostic challenge and was originally defined in 1961.Its classic criteria include fever≥38.3°C(≥101°F)on multiple occasions,fever lasting three weeks or ...BACKGROUND Fever of unknown origin(FUO)remains a diagnostic challenge and was originally defined in 1961.Its classic criteria include fever≥38.3°C(≥101°F)on multiple occasions,fever lasting three weeks or longer,and a diagnosis after one week of inpatient evaluation.However,these criteria may not fully encompass the varied clinical presentations seen in resource-limited settings such as India.The adaptation of FUO definitions to local healthcare contexts is crucial for enhancing diagnostic accuracy and optimizing patient outcomes.AIM To investigate the applicability of revised FUO criteria in a tertiary care setting in India.METHODS This longitudinal-exploratory study at All India Institute of Medical Sciences Rishikesh(January 2018–December 2022)analyzed 228 adult patients with fever≥99.1°F lasting over three days.Patients diagnosed within three days of admission were excluded.Data were collected retrospectively and prospectively using predefined FUO definitions based on durations of nondiagnosis(3-21 days,>21 days),temperature ranges(99.1°F-100.9°F,≥101°F),and hospitalization durations(3-7 days,>7 days).Descriptive statistics and comparative tests(Fisher's exact test,χ2 test)evaluated outcomes across definitions.RESULTS Among the proposed FUO definitions,Definition B(fever lasting 3-21 days,temperatures between 99.1°F-100.9°F,hospitalization>7 days)predominated(40.8%),while only 2.2%met the classical criteria.Notably,36.5%of Definition B patients remained undiagnosed after 7-10 days,despite 94%undergoing diagnostic workups within 21 days.Infection emerged as the leading etiology across definitions,without significant variation in outcomes or mortality during hospitalization(χ2=27.937,P=0.142).CONCLUSION Adapting FUO criteria to local contexts improves diagnostic accuracy and treatment.Definition B(40.8%prevalence)showed practical utility,with higher mortality in patients discharged on empirical'Anti-tuberculosis therapy'.展开更多
It is known that there exist obivious differences between the two most commonly used definitions of fractional derivatives-Riemann-Liouville(R-L)definition and Caputo definition.The multiple definitions of fractional ...It is known that there exist obivious differences between the two most commonly used definitions of fractional derivatives-Riemann-Liouville(R-L)definition and Caputo definition.The multiple definitions of fractional derivatives in fractional calculus have hindered the application of fractional calculus in rheology.In this paper,we clarify that the R-L definition and Caputo definition are both rheologically imperfect with the help of mechanical analogues of the fractional element model(Scott-Blair model).We also clarify that to make them perfect rheologically,the lower terminals of both definitions should be put to∞.We further prove that the R-L definition with lower terminal a→∞and the Caputo definition with lower terminal a→∞are equivalent in the differentiation of functions that are smooth enough and functions that have finite number of singular points.Thus we can define the fractional derivatives in rheology as the R-L derivatives with lower terminal a→∞(or,equivalently,the Caputo derivatives with lower terminal a→∞)not only for steady-state processes,but also for transient processes.Based on the above definition,the problems of composition rules of fractional operators and the initial conditions for fractional differential equations are discussed,respectively.As an example we study a fractional oscillator with Scott-Blair model and give an exact solution of this equation under given initial conditions.展开更多
During the last two decades fractional calculus has been increasingly applied to physics,especially to rheology.It is well known that there are obivious differences between Riemann-Liouville(R-L)definition and Caputo ...During the last two decades fractional calculus has been increasingly applied to physics,especially to rheology.It is well known that there are obivious differences between Riemann-Liouville(R-L)definition and Caputo definition,which are the two most commonly used definitions of fractional derivatives.The multiple definitions of fractional derivatives have hindered the application of fractional calculus in rheology.In this paper,we clarify that the R-L definition and Caputo definition are both Theologically unreasonable with the help of the mechanical analogues of the fractional element model.We also find that to make them more reasonable Theologically,the lower terminals of both definitions should be put to—∞.We further prove that the R-L definition with lower terminal—∞and the Caputo definition with lower terminal—∞are equivalent in the differentiation of functions that are smooth enough and functions that have finite number of singular points.Thus we can define the fractional derivatives in rheology as the R-L derivatives with lower terminal—∞(or,equivalently,the Caputo derivatives with lower terminal—∞)not only for steady-state processes,but also for transient processes.展开更多
BACKGROUND Sessile serrated adenomas(SSAs)are important premalignant lesions that are difficult to detect during colonoscopy due to poor definition,concealment by mucous caps,and flat appearance.High definition(HD)col...BACKGROUND Sessile serrated adenomas(SSAs)are important premalignant lesions that are difficult to detect during colonoscopy due to poor definition,concealment by mucous caps,and flat appearance.High definition(HD)colonoscopy may uniquely aid in the detection of these inconspicuous lesions compared to standard definition(SD)colonoscopes.In the absence of existing clinical guidelines to obligate the use of HD colonoscopy for colorectal cancer screening in average-risk patients,demonstrating the benefit of HD colonoscopy on SSA detection rate(SSADR)may help strengthen the evidence to recommend its use in all settings.AIM To evaluate the benefit of HD colonoscopy compared to SD colonoscopy on SSADR in average-risk patients undergoing screening colonoscopy.METHODS Data from screening colonoscopies for patients aged 50-76 years two years before and two years after the transition from SD colonoscopy to HD colonoscopy at our large,academic teaching center were collected.Patients with symptoms of colorectal disease,positive occult blood test,history of colon polyps,cancer,polyposis syndrome,inflammatory bowel disease or family history of colon cancer or polyps were excluded.Patients whose endoscopists did not perform colonoscopies both before and after scope definition change were also excluded.Differences in individual endoscopist SSADR,average SSADR,and overall SSADR with SD colonoscopy vs HD colonoscopy were also evaluated for significance.RESULTS A total of 3657 colonoscopies met eligibility criteria with 2012 colonoscopies from the SD colonoscopy period and 1645 colonoscopies from the HD colonoscopy period from a pool of 11 endoscopists.Statistically significant improvements of 2.30%in mean SSADR and 2.53%in overall SSADR were noted with HD colonoscopy(P=0.00028 and P=0.00849,respectively).On the individual level,three endoscopists experienced statistically significant benefit with HD colonoscopy(+5.74%,P=0.0056;+4.50%,P=0.0278;+4.84%,P=0.03486).CONCLUSION Our study suggests that HD colonoscopy statistically significantly improves sessile serrated adenoma detection rate in the screening of average risk patients during screening colonoscopy.By improving the detection and removal of these lesions,adoption of HD colonoscopy may reduce the significant premalignant burden of sessile serrated adenomas.展开更多
Glacial lakes are not only the important refresh water resources in alpine region, but also act as a trigger of many glacial hazards such as glacial lake outburst flood (GLOF) and debris flow. Therefore, glacial lak...Glacial lakes are not only the important refresh water resources in alpine region, but also act as a trigger of many glacial hazards such as glacial lake outburst flood (GLOF) and debris flow. Therefore, glacial lakes play an important role on the cryosphere, climate change and alpine hazards. In this paper, the issues of glacial lake were systematically discussed, then from the view of glacial lake inventory and glacial lake hazards study, the glacial lake was defined as natural water mainly supplied by modern glacial meltwater or formed in glacier moraine's depression. Furthermore, a complete classification system of glacial lake was proposed based on its formation mechanism, topographic feature and geographical position. Glacial lakes were classified as 6 classes and 8 subclasses, i.e., glacial erosion lake (including cirque lake, gla- cial valley lake and other glacial erosion lake), moraine-dammed lake (including end mo- raine-dammed lake, lateral moraine-dammed lake and moraine thaw lake), ice-blocked lake (including advancing glacier-blocked lake and other glacier-blocked lake), supraglacial lake, subglacial lake and other glacial lake. Meanwhile, some corresponding features exhibiting on remote sensing image and quantitative indices for identifying different glacial lake types were proposed in order to build a universal and operational classification system of glacial lake.展开更多
BACKGROUND Despite the emerging knowledge about colorectal anastomotic leakage(CAL)through the increasing number of clinical and experimental studies, there is no generally accepted definition of CAL. Because of the w...BACKGROUND Despite the emerging knowledge about colorectal anastomotic leakage(CAL)through the increasing number of clinical and experimental studies, there is no generally accepted definition of CAL. Because of the wide variety of definitions used in literature, comparison of study outcomes and quality of care is complicated.AIM To reach consensus on the definition of CAL using a modified Delphi method.METHODS The RAND/UCLA appropriateness method was used. The expert panel consisted of international colorectal surgeons and researchers who had published three or more articles about CAL. The consensus process consisted of two online distributed questionnaires and a third round with a recommendation. In the questionnaires participants were asked to rate the appropriateness of statements using a 1-9 Likert scale. Consensus was defined as a panel median between 1-3 or 7-9 without disagreement. In the final round a recommendation was formed regarding the definition of CAL and the expert panel was asked if they agreed or disagreed.RESULTSTwenty-three authors participated in the first round and twenty-one finished the second round. After two rounds consensus was reached on 37 items(80%) in nine different categories. The International Study Group of Rectal Cancer definition is the most frequently advised general definition by our panel. Consensus was reached regarding the clinical symptoms of CAL, which serum markers contributes to the suspicion of CAL, which radiological and perioperative findings should be considered as CAL, which grading system is appropriate and if there should be a range of postoperative days in the definition. Eventually, 19 experts completed all three rounds of which 16(84%) agreed with our final recommendations for the definition of CAL.CONCLUSION A consensus-based recommendation for the definition of CAL was formed using our modified Delphi method that can be widely incorporated in the field.展开更多
In nature, to realize the smooth motion for different speeds, the continuous gait transition is usually required for the quadrupeds. Thus, the gait simulation of quadrupeds is a requisite step to obtain the stable and...In nature, to realize the smooth motion for different speeds, the continuous gait transition is usually required for the quadrupeds. Thus, the gait simulation of quadrupeds is a requisite step to obtain the stable and energy-efficient gait for the walking machines. In this paper, the definitions of the two gait parameters, phasic difference and duty factor are presented, which can determine the gait of the quadrupeds. Then, several typical gaits of the quadrupeds are analyzed such that the seven standard gaits and corresponding parameters are summarized. Additionally, the variance law of the two parameters, which determine the relationship of gait transition, is analyzed. Furthermore, the quadruped gait derivative spectrum (QGDS) is proposed and the gait definition of the quadrupeds is presented. To minimize the power consumption, the choice criterion of gait, the optimal gait in terms of the motion speed, duty factory, and power consumption for the walking machines, is developed. Last, the continuous variance of the gait is implemented by the simulation of the gait transition from walk to trot, which evaluate the choice criterion and transition of gait.展开更多
AIM To determine the level of consensus on the definition of colorectal anastomotic leakage(CAL)among Dutch and Chinese colorectal surgeons.METHODS Dutch and Chinese colorectal surgeons were asked to partake in an onl...AIM To determine the level of consensus on the definition of colorectal anastomotic leakage(CAL)among Dutch and Chinese colorectal surgeons.METHODS Dutch and Chinese colorectal surgeons were asked to partake in an online questionnaire.Consensus in the online questionnaire was defined as>80%agreement between respondents on various statements regarding a general definition of CAL,and regarding clinical and radiological diagnosis of the complication.RESULTS Fifty-nine Dutch and 202 Chinese dedicated colorectal surgeons participated in the online survey.Consensus was found on only one of the proposed elements of a general definition of CAL in both countries:‘extravasation of contrast medium after rectal enema on a CT scan'.Another two were found relevant according to Dutch surgeons:‘necrosis of the anastomosis found during reoperation',and‘a radiological collection treated with percutaneous drainage'.No consensus was found for all other proposed elements that may be included in a general definition.CONCLUSION There is no universally accepted definition of CAL in the Netherlands and China.Diagnosis of CAL based on clinical manifestations remains a point of discussion in both countries.Dutch surgeons are more likely to report‘subclinical'leaks as CAL,which partly explains the higher reported Dutch CAL rates.展开更多
While the incidence of gastric cancer(GC)in general has decreased worldwide in recent decades,the incidence of diffuse cancer historically comprising poorly cohesive cells-GC(PCC-GC)and including signet ring cell canc...While the incidence of gastric cancer(GC)in general has decreased worldwide in recent decades,the incidence of diffuse cancer historically comprising poorly cohesive cells-GC(PCC-GC)and including signet ring cell cancer is rising.Literature concerning PCC-GC is scarce and unclear,mostly due to a large variety of historically used definitions and classifications.Compared to other histological subtypes of GC,PCC-GC is nevertheless characterized by a distinct set of epidemiological,histological and clinical features which require a specific diagnostic and therapeutic approach.The aim of this review was to provide an update on the definition,classification and therapeutic strategies of PCC-GC.We focus on the updated histological definition of PCC-GC,along with its implications on future treatment strategies and study design.Also,specific considerations in the diagnostic management are discussed.Finally,the impact of some recent developments in the therapeutic management of GC in general such as the recently validated taxane-based regimens(5-Fluorouracil,leucovorin,oxaliplatin and docetaxel),the use of hyperthermic intraperitoneal chemotherapy as well as pressurized intraperitoneal aerosol chemotherapy and targeted therapy have been reviewed in depth for their relative importance for PCC-GC in particular.展开更多
Pseudocapacitive materials generally offer both high capacitance and high rate capability, which has stimulated great efforts in developing the materials system and related energy storage devices. In recent years, how...Pseudocapacitive materials generally offer both high capacitance and high rate capability, which has stimulated great efforts in developing the materials system and related energy storage devices. In recent years, however, with the extensive use of nanomaterials in batteries, fast redox kinetics comparable to pseudocapacitive have been achieved in many kinds of battery materials due to the much shortened ion diffusion lengths and highly exposed surface/interface as a result of nanosize effect. Consequently, the terms"pseudocapacitive materials" and "battery materials" are becoming more and more confusing. In this review, different opinions on the definition of pseudocapacitive materials and the evolution of the definitions as well as the resulting confusion will be firstly reviewed. Then, to accurately distinguish pseudocapacitive and battery materials, method with the consideration of both the electrochemical signatures(CVs and GCD) and quantitative kinetics analysis as a supplement is proposed. Finally, we end this review by discussing the possible device configurations of asymmetric supercapacitors and hybrid supercapacitors. The present review will help understanding the differences between pseudocapacitive materials and battery materials, and thus avoiding the definition confusion.展开更多
Background:There was no consistent definition for heat wave worldwide,while a limited number of studies have compared the mortality effect of heat wave as defined differently.This paper aimed to provide epidemiologica...Background:There was no consistent definition for heat wave worldwide,while a limited number of studies have compared the mortality effect of heat wave as defined differently.This paper aimed to provide epidemiological evidence for policy makers to determine the most appropriate definition for local heat wave warning systems.Methods:We developed 45 heat wave definitions(HWs)combining temperature indicators and temperature thresholds with durations.We then assessed the impact of heat waves under various definitions on non-accidental mortality in hot season(May-September)in Wuhan,China during 2003-2010.Results:Heat waves defined by HW14(daily mean temperature≥99.0th percentile and duration≥3 days)had the best predictive ability in assessing the mortality effects of heat wave with the relative risk of 1.63(95%CI:1.43,1.89)for total mortality.The group-specific mortality risk using official heat wave definition of Chinese Meteorological Administration was much smaller than that using HW14.We also found that women,and the elderly(age≥65)were more susceptible to heat wave effects which were stronger and longer lasting.Conclusion:These findings suggest that region specific heat wave definitions are crucial and necessary for developing efficient local heat warning systems and for providing evidence for policy makers to protect the vulnerable population.展开更多
In this study, a group of indices were defined regarding intensity (P), area (S) and central position (λc, Фc) of the Aleutian low (AL) in the Northern Hemisphere in winter, using seasonal and monthly mean h...In this study, a group of indices were defined regarding intensity (P), area (S) and central position (λc, Фc) of the Aleutian low (AL) in the Northern Hemisphere in winter, using seasonal and monthly mean height field at 1000-hPa. These indices were calculated over 60 winter seasons from 1948/1949 to 2007/2008 using reanalysis data. Climatic and anomalous characteristics of the AL were analyzed based on these indices and relationships between the AL, and general circulations were explored using correlations between indicesP, λc, and Pacific SST, as well as Northern Hemisphere temperature and precipitation. The main results are these: (1) AL is the strongest in January, when the center shifts to the south and west of its climatological position, and it is the weakest in December when the center shifts to the north and east. (2) AL intensity (P) is negatively correlated with its longitude (λc): a deeper low occurs toward the east and a shallower low occurs toward the west. On a decadal scale, the AL has been persistently strong and has shifted eastward since the 1970s, but reversal signs have been observed in recent years. (3) The AL is stronger and is located toward the east during strong E1 Nifio winters and vice versa during strong La Nifia years; this tendency is particularly evident after 1975. The AL is also strongly correlated with SST in the North Pacific. It intensifies and moves eastward with negative SST anomalies, and it weakens and moves westward with positive SST anomalies. (4) Maps of significance correlation between AL intensity and Northern Hemisphere temperature and rainfall resemble the PNA teleconnection pattern in mid-latitudes in the North Pacific and across North America. The AL and the Mongolian High are two permanent atmospheric pressure systems adjacent to each other during boreal winter over the middle and high latitudes in the Northern Hemisphere, but their relationships with the E1 Nifio/La Nifia events and with temperature and precipitation in the Northern Hemisphere are significantly different.展开更多
The concept, definition, and diagnosis of amyotrophic lateral sclerosis(ALS) currently present some problems. This article systematically reviews the literature on the history, current concepts, definition, and diagno...The concept, definition, and diagnosis of amyotrophic lateral sclerosis(ALS) currently present some problems. This article systematically reviews the literature on the history, current concepts, definition, and diagnosis of ALS, and discloses the present problems based on the retrieved literature and the authors' clinical experience. The current concepts and definitions of ALS have not yet been unified or standardized in clinical practice, and are sometimes vague or inaccurate, which can cause difficulties for neurologists in the clinical treatment of ALS. The concept and definition of ALS need to be further ascertained, and the current diagnostic criteria for ALS require further development. The identification of effective and objective biomarkers may be a feasible method for the early and accurate diagnosis of ALS. Therefore, future research should focus on the identification of reliable biomarkers—especially neuroimaging biomarkers—through autopsy. Standardizing the concept and definition of ALS and formulating clear diagnostic criteria will largely avoid many uncertainties in the future clinical research and treatment of ALS, which will greatly benefit patients.展开更多
Car routing solutions are omnipresent and solutions for pedestrians also exist.Furthermore,public or commercial buildings are getting bigger and the complexity of their internal structure has increased.Consequently,th...Car routing solutions are omnipresent and solutions for pedestrians also exist.Furthermore,public or commercial buildings are getting bigger and the complexity of their internal structure has increased.Consequently,the need for indoor routing solutions has emerged.Some prototypes are available,but they still lack semantically-enriched modelling (e.g.,access constraints,labels,etc.) and are not suitable for providing user-adaptive length-optimal routing in complex buildings.Previous approaches consider simple rooms,concave rooms,and corridors,but important characteristics such as distinct areas in huge rooms and solid obstacles inside rooms are not considered at all,although such details can increase navigation accuracy.By formally defining a weighted indoor routing graph,it is possible to create a detailed and user-adaptive model for route computation.The defined graph also contains semantic information such as room labels,door accessibility constraints,etc.Furthermore,one-way paths inside buildings are considered,as well as three-dimensional building parts,e.g.,elevators or stairways.A hierarchical structure is also possible with the presented graph model.展开更多
基金supported by the National Natural Science Foundation of China(Grant No.42471027).
摘要Accurate drought assessment demands thoughtful consideration of drought definition first of all.Drought is commonly defined as a prolonged period of below-average precipitation leading to water shortages that impact ecosystems,agriculture,and human societies.However,meteorologists,hydrologists,and agronomists often use different criteria to define drought,depending on their specific focus areas.For example,hydrologists define drought according to water deficits in some components of the hydrological cycle(such as precipitation,soil moisture,river flow,and groundwater)or its impacts on the level of services provided to public water supply,irrigation,or hydropower demands(Tate and Gustard,2000).Differences in drought definitions may result in great uncertainties in drought assessment(Satoh et al.,2021).We cannot expect the existence of any workable generalized objective definition of drought(Lloyd-Hughes,2014).
摘要Background and Objective The development of modern palliative care in China began in the 1980s and is currently in an accelerating phase.However,inconsistencies in terminology and concepts have hindered policy-making,clinical practice,and academic research.The Terminology of Clinical Medicine(2023 edition)has determined huan-he-yi-liao(缓和医疗)and an-ning-liao-hu(安宁疗护)as the formal terms of"palliative care"and"hospice care",respectively.To align with these terms,this study aims to establish expert consensus definitions tailored to the Chinese context.Methods We systematically retrieved and collected domestic and international literature and policy documents related to the definition of palliative care,then deconstructed and analyzed the relevant conceptual elements of these definitions.Core expert panel built the initial recommended definition upon the conceptual elements and consensus definition of palliative care by the International Association for Hospice and Palliative Care(IAHPC)through two rounds of online discussions.After nomination and selection,61 professionals in the field of palliative care in China were invited to participate in the consensus expert group.Two rounds of Delphi consultation were conducted among the consensus experts,who were asked to score their agreement using Likert scale to the items in the initial recommended definition and the definition statements of palliative care and hospice care.Agreement rate of over 80%was considered as reaching consensus for each items.The core expert panel revised the items and the statements of recommended definitions based on the results from Delphi surveys.The final recommended definitions were formulated after feedback from patient and public involvement(PPI)group members.Results The response rates for the first and second round of Delphi surveys were 83.6%and 100.0%,respectively.The agreement rates of the items and statements of the recommended definitions exceeded 90%.Accordingly,the definitions based on Chinese expert consensus are recommended.Palliative care is an active holistic approach aimed at patients of all ages suffering from life-threatening illness and their families and caregivers.It seeks to improve their quality of life by preventing,assessing,and relieving physical,psychological,social,and spiritual suffering.Hospice care is an integral part of palliative care,focusing on holistic care for patients at the end of life and their families and caregivers.Its goal is to help patients to maintain dignity and achieve a good death by alleviating physical,psychological,social,and spiritual distress without intentionally hastening or postponing death,meanwhile improve the quality of life for families and caregivers.Conclusions This study has established the Chinese expert consensus definitions of palliative care and hospice care in China,as well as the relationship between the two.The definitions highlight the holistic nature of palliative care,providing a foundation for discipline development,clinical practice,and public communication.
摘要BACKGROUND Fever of unknown origin(FUO)remains a diagnostic challenge and was originally defined in 1961.Its classic criteria include fever≥38.3°C(≥101°F)on multiple occasions,fever lasting three weeks or longer,and a diagnosis after one week of inpatient evaluation.However,these criteria may not fully encompass the varied clinical presentations seen in resource-limited settings such as India.The adaptation of FUO definitions to local healthcare contexts is crucial for enhancing diagnostic accuracy and optimizing patient outcomes.AIM To investigate the applicability of revised FUO criteria in a tertiary care setting in India.METHODS This longitudinal-exploratory study at All India Institute of Medical Sciences Rishikesh(January 2018–December 2022)analyzed 228 adult patients with fever≥99.1°F lasting over three days.Patients diagnosed within three days of admission were excluded.Data were collected retrospectively and prospectively using predefined FUO definitions based on durations of nondiagnosis(3-21 days,>21 days),temperature ranges(99.1°F-100.9°F,≥101°F),and hospitalization durations(3-7 days,>7 days).Descriptive statistics and comparative tests(Fisher's exact test,χ2 test)evaluated outcomes across definitions.RESULTS Among the proposed FUO definitions,Definition B(fever lasting 3-21 days,temperatures between 99.1°F-100.9°F,hospitalization>7 days)predominated(40.8%),while only 2.2%met the classical criteria.Notably,36.5%of Definition B patients remained undiagnosed after 7-10 days,despite 94%undergoing diagnostic workups within 21 days.Infection emerged as the leading etiology across definitions,without significant variation in outcomes or mortality during hospitalization(χ2=27.937,P=0.142).CONCLUSION Adapting FUO criteria to local contexts improves diagnostic accuracy and treatment.Definition B(40.8%prevalence)showed practical utility,with higher mortality in patients discharged on empirical'Anti-tuberculosis therapy'.
基金supported by the National Natural Science Foundation of China(10972117)
摘要It is known that there exist obivious differences between the two most commonly used definitions of fractional derivatives-Riemann-Liouville(R-L)definition and Caputo definition.The multiple definitions of fractional derivatives in fractional calculus have hindered the application of fractional calculus in rheology.In this paper,we clarify that the R-L definition and Caputo definition are both rheologically imperfect with the help of mechanical analogues of the fractional element model(Scott-Blair model).We also clarify that to make them perfect rheologically,the lower terminals of both definitions should be put to∞.We further prove that the R-L definition with lower terminal a→∞and the Caputo definition with lower terminal a→∞are equivalent in the differentiation of functions that are smooth enough and functions that have finite number of singular points.Thus we can define the fractional derivatives in rheology as the R-L derivatives with lower terminal a→∞(or,equivalently,the Caputo derivatives with lower terminal a→∞)not only for steady-state processes,but also for transient processes.Based on the above definition,the problems of composition rules of fractional operators and the initial conditions for fractional differential equations are discussed,respectively.As an example we study a fractional oscillator with Scott-Blair model and give an exact solution of this equation under given initial conditions.
基金supported by NSFC under the grant number 10972117
摘要During the last two decades fractional calculus has been increasingly applied to physics,especially to rheology.It is well known that there are obivious differences between Riemann-Liouville(R-L)definition and Caputo definition,which are the two most commonly used definitions of fractional derivatives.The multiple definitions of fractional derivatives have hindered the application of fractional calculus in rheology.In this paper,we clarify that the R-L definition and Caputo definition are both Theologically unreasonable with the help of the mechanical analogues of the fractional element model.We also find that to make them more reasonable Theologically,the lower terminals of both definitions should be put to—∞.We further prove that the R-L definition with lower terminal—∞and the Caputo definition with lower terminal—∞are equivalent in the differentiation of functions that are smooth enough and functions that have finite number of singular points.Thus we can define the fractional derivatives in rheology as the R-L derivatives with lower terminal—∞(or,equivalently,the Caputo derivatives with lower terminal—∞)not only for steady-state processes,but also for transient processes.
摘要BACKGROUND Sessile serrated adenomas(SSAs)are important premalignant lesions that are difficult to detect during colonoscopy due to poor definition,concealment by mucous caps,and flat appearance.High definition(HD)colonoscopy may uniquely aid in the detection of these inconspicuous lesions compared to standard definition(SD)colonoscopes.In the absence of existing clinical guidelines to obligate the use of HD colonoscopy for colorectal cancer screening in average-risk patients,demonstrating the benefit of HD colonoscopy on SSA detection rate(SSADR)may help strengthen the evidence to recommend its use in all settings.AIM To evaluate the benefit of HD colonoscopy compared to SD colonoscopy on SSADR in average-risk patients undergoing screening colonoscopy.METHODS Data from screening colonoscopies for patients aged 50-76 years two years before and two years after the transition from SD colonoscopy to HD colonoscopy at our large,academic teaching center were collected.Patients with symptoms of colorectal disease,positive occult blood test,history of colon polyps,cancer,polyposis syndrome,inflammatory bowel disease or family history of colon cancer or polyps were excluded.Patients whose endoscopists did not perform colonoscopies both before and after scope definition change were also excluded.Differences in individual endoscopist SSADR,average SSADR,and overall SSADR with SD colonoscopy vs HD colonoscopy were also evaluated for significance.RESULTS A total of 3657 colonoscopies met eligibility criteria with 2012 colonoscopies from the SD colonoscopy period and 1645 colonoscopies from the HD colonoscopy period from a pool of 11 endoscopists.Statistically significant improvements of 2.30%in mean SSADR and 2.53%in overall SSADR were noted with HD colonoscopy(P=0.00028 and P=0.00849,respectively).On the individual level,three endoscopists experienced statistically significant benefit with HD colonoscopy(+5.74%,P=0.0056;+4.50%,P=0.0278;+4.84%,P=0.03486).CONCLUSION Our study suggests that HD colonoscopy statistically significantly improves sessile serrated adenoma detection rate in the screening of average risk patients during screening colonoscopy.By improving the detection and removal of these lesions,adoption of HD colonoscopy may reduce the significant premalignant burden of sessile serrated adenomas.
基金National Natural Science Foundation of China,No.41261016,No.41561016Opening Foundation Projection of State Key Laboratory of Cryosphere Sciences,CAS,No.SKLCS-OP-2016-10+1 种基金Youth Scholar Scientific Capability Promoting Project of Northwest Normal University,No.NWNU-LKQN-14-4Geological Survey Project of China Geological Survey,No.DD2016034206
摘要Glacial lakes are not only the important refresh water resources in alpine region, but also act as a trigger of many glacial hazards such as glacial lake outburst flood (GLOF) and debris flow. Therefore, glacial lakes play an important role on the cryosphere, climate change and alpine hazards. In this paper, the issues of glacial lake were systematically discussed, then from the view of glacial lake inventory and glacial lake hazards study, the glacial lake was defined as natural water mainly supplied by modern glacial meltwater or formed in glacier moraine's depression. Furthermore, a complete classification system of glacial lake was proposed based on its formation mechanism, topographic feature and geographical position. Glacial lakes were classified as 6 classes and 8 subclasses, i.e., glacial erosion lake (including cirque lake, gla- cial valley lake and other glacial erosion lake), moraine-dammed lake (including end mo- raine-dammed lake, lateral moraine-dammed lake and moraine thaw lake), ice-blocked lake (including advancing glacier-blocked lake and other glacier-blocked lake), supraglacial lake, subglacial lake and other glacial lake. Meanwhile, some corresponding features exhibiting on remote sensing image and quantitative indices for identifying different glacial lake types were proposed in order to build a universal and operational classification system of glacial lake.
基金Supported by the Dutch Research Council(NWO)research programme Vidi project,No.91719343。
摘要BACKGROUND Despite the emerging knowledge about colorectal anastomotic leakage(CAL)through the increasing number of clinical and experimental studies, there is no generally accepted definition of CAL. Because of the wide variety of definitions used in literature, comparison of study outcomes and quality of care is complicated.AIM To reach consensus on the definition of CAL using a modified Delphi method.METHODS The RAND/UCLA appropriateness method was used. The expert panel consisted of international colorectal surgeons and researchers who had published three or more articles about CAL. The consensus process consisted of two online distributed questionnaires and a third round with a recommendation. In the questionnaires participants were asked to rate the appropriateness of statements using a 1-9 Likert scale. Consensus was defined as a panel median between 1-3 or 7-9 without disagreement. In the final round a recommendation was formed regarding the definition of CAL and the expert panel was asked if they agreed or disagreed.RESULTSTwenty-three authors participated in the first round and twenty-one finished the second round. After two rounds consensus was reached on 37 items(80%) in nine different categories. The International Study Group of Rectal Cancer definition is the most frequently advised general definition by our panel. Consensus was reached regarding the clinical symptoms of CAL, which serum markers contributes to the suspicion of CAL, which radiological and perioperative findings should be considered as CAL, which grading system is appropriate and if there should be a range of postoperative days in the definition. Eventually, 19 experts completed all three rounds of which 16(84%) agreed with our final recommendations for the definition of CAL.CONCLUSION A consensus-based recommendation for the definition of CAL was formed using our modified Delphi method that can be widely incorporated in the field.
摘要In nature, to realize the smooth motion for different speeds, the continuous gait transition is usually required for the quadrupeds. Thus, the gait simulation of quadrupeds is a requisite step to obtain the stable and energy-efficient gait for the walking machines. In this paper, the definitions of the two gait parameters, phasic difference and duty factor are presented, which can determine the gait of the quadrupeds. Then, several typical gaits of the quadrupeds are analyzed such that the seven standard gaits and corresponding parameters are summarized. Additionally, the variance law of the two parameters, which determine the relationship of gait transition, is analyzed. Furthermore, the quadruped gait derivative spectrum (QGDS) is proposed and the gait definition of the quadrupeds is presented. To minimize the power consumption, the choice criterion of gait, the optimal gait in terms of the motion speed, duty factory, and power consumption for the walking machines, is developed. Last, the continuous variance of the gait is implemented by the simulation of the gait transition from walk to trot, which evaluate the choice criterion and transition of gait.
摘要AIM To determine the level of consensus on the definition of colorectal anastomotic leakage(CAL)among Dutch and Chinese colorectal surgeons.METHODS Dutch and Chinese colorectal surgeons were asked to partake in an online questionnaire.Consensus in the online questionnaire was defined as>80%agreement between respondents on various statements regarding a general definition of CAL,and regarding clinical and radiological diagnosis of the complication.RESULTS Fifty-nine Dutch and 202 Chinese dedicated colorectal surgeons participated in the online survey.Consensus was found on only one of the proposed elements of a general definition of CAL in both countries:‘extravasation of contrast medium after rectal enema on a CT scan'.Another two were found relevant according to Dutch surgeons:‘necrosis of the anastomosis found during reoperation',and‘a radiological collection treated with percutaneous drainage'.No consensus was found for all other proposed elements that may be included in a general definition.CONCLUSION There is no universally accepted definition of CAL in the Netherlands and China.Diagnosis of CAL based on clinical manifestations remains a point of discussion in both countries.Dutch surgeons are more likely to report‘subclinical'leaks as CAL,which partly explains the higher reported Dutch CAL rates.
摘要While the incidence of gastric cancer(GC)in general has decreased worldwide in recent decades,the incidence of diffuse cancer historically comprising poorly cohesive cells-GC(PCC-GC)and including signet ring cell cancer is rising.Literature concerning PCC-GC is scarce and unclear,mostly due to a large variety of historically used definitions and classifications.Compared to other histological subtypes of GC,PCC-GC is nevertheless characterized by a distinct set of epidemiological,histological and clinical features which require a specific diagnostic and therapeutic approach.The aim of this review was to provide an update on the definition,classification and therapeutic strategies of PCC-GC.We focus on the updated histological definition of PCC-GC,along with its implications on future treatment strategies and study design.Also,specific considerations in the diagnostic management are discussed.Finally,the impact of some recent developments in the therapeutic management of GC in general such as the recently validated taxane-based regimens(5-Fluorouracil,leucovorin,oxaliplatin and docetaxel),the use of hyperthermic intraperitoneal chemotherapy as well as pressurized intraperitoneal aerosol chemotherapy and targeted therapy have been reviewed in depth for their relative importance for PCC-GC in particular.
基金supported by grants from the National Natural Science Foundation of China(Grant Nos.51672205,51872104 and 21673169)the National Key R&D Program of China(Grant No.2016YFA0202602)+1 种基金the Research Start-Up Fund from Wuhan University of Technologythe Fundamental Research Funds for the Central Universities(WUT:2016IVA083,2017IB005,185220011)
摘要Pseudocapacitive materials generally offer both high capacitance and high rate capability, which has stimulated great efforts in developing the materials system and related energy storage devices. In recent years, however, with the extensive use of nanomaterials in batteries, fast redox kinetics comparable to pseudocapacitive have been achieved in many kinds of battery materials due to the much shortened ion diffusion lengths and highly exposed surface/interface as a result of nanosize effect. Consequently, the terms"pseudocapacitive materials" and "battery materials" are becoming more and more confusing. In this review, different opinions on the definition of pseudocapacitive materials and the evolution of the definitions as well as the resulting confusion will be firstly reviewed. Then, to accurately distinguish pseudocapacitive and battery materials, method with the consideration of both the electrochemical signatures(CVs and GCD) and quantitative kinetics analysis as a supplement is proposed. Finally, we end this review by discussing the possible device configurations of asymmetric supercapacitors and hybrid supercapacitors. The present review will help understanding the differences between pseudocapacitive materials and battery materials, and thus avoiding the definition confusion.
摘要Background:There was no consistent definition for heat wave worldwide,while a limited number of studies have compared the mortality effect of heat wave as defined differently.This paper aimed to provide epidemiological evidence for policy makers to determine the most appropriate definition for local heat wave warning systems.Methods:We developed 45 heat wave definitions(HWs)combining temperature indicators and temperature thresholds with durations.We then assessed the impact of heat waves under various definitions on non-accidental mortality in hot season(May-September)in Wuhan,China during 2003-2010.Results:Heat waves defined by HW14(daily mean temperature≥99.0th percentile and duration≥3 days)had the best predictive ability in assessing the mortality effects of heat wave with the relative risk of 1.63(95%CI:1.43,1.89)for total mortality.The group-specific mortality risk using official heat wave definition of Chinese Meteorological Administration was much smaller than that using HW14.We also found that women,and the elderly(age≥65)were more susceptible to heat wave effects which were stronger and longer lasting.Conclusion:These findings suggest that region specific heat wave definitions are crucial and necessary for developing efficient local heat warning systems and for providing evidence for policy makers to protect the vulnerable population.
基金supported by National Key Technology Research and Development Program (Grant No. 2007BAC29B02)the National Basic Research Program of China’s 973 Program (Grant Nos.2010CB950502 and 2010CB428904)the project funded by the Priority Academic Program Development of Jiangsu Higher Education Institutions (PAPD)
摘要In this study, a group of indices were defined regarding intensity (P), area (S) and central position (λc, Фc) of the Aleutian low (AL) in the Northern Hemisphere in winter, using seasonal and monthly mean height field at 1000-hPa. These indices were calculated over 60 winter seasons from 1948/1949 to 2007/2008 using reanalysis data. Climatic and anomalous characteristics of the AL were analyzed based on these indices and relationships between the AL, and general circulations were explored using correlations between indicesP, λc, and Pacific SST, as well as Northern Hemisphere temperature and precipitation. The main results are these: (1) AL is the strongest in January, when the center shifts to the south and west of its climatological position, and it is the weakest in December when the center shifts to the north and east. (2) AL intensity (P) is negatively correlated with its longitude (λc): a deeper low occurs toward the east and a shallower low occurs toward the west. On a decadal scale, the AL has been persistently strong and has shifted eastward since the 1970s, but reversal signs have been observed in recent years. (3) The AL is stronger and is located toward the east during strong E1 Nifio winters and vice versa during strong La Nifia years; this tendency is particularly evident after 1975. The AL is also strongly correlated with SST in the North Pacific. It intensifies and moves eastward with negative SST anomalies, and it weakens and moves westward with positive SST anomalies. (4) Maps of significance correlation between AL intensity and Northern Hemisphere temperature and rainfall resemble the PNA teleconnection pattern in mid-latitudes in the North Pacific and across North America. The AL and the Mongolian High are two permanent atmospheric pressure systems adjacent to each other during boreal winter over the middle and high latitudes in the Northern Hemisphere, but their relationships with the E1 Nifio/La Nifia events and with temperature and precipitation in the Northern Hemisphere are significantly different.
基金supported by the National Natural Science Foundation of China,No.30560042,81160161 and 81360198(all to RSX)grants from the Education Department of Jiangxi Province,No.GJJ13198 and GJJ170021(both to RSX)+3 种基金grants from Jiangxi Provincial Department of Science and Technology,No.2014-47,20142BBG70062,and 20171BAB215022(all to RSX)a grant from Health and Family Planning Commission of Jiangxi Province,No.20181019(to RSX)a grant from Jiangxi Provincial Department of Science and Technology Gan Po Elite 555,No.2015108(to RSX)the Innovation Fund Designated for Graduate Students of Jiangxi Province,No.YC2016-B027 and YC2015-S097(both to RSX)。
摘要The concept, definition, and diagnosis of amyotrophic lateral sclerosis(ALS) currently present some problems. This article systematically reviews the literature on the history, current concepts, definition, and diagnosis of ALS, and discloses the present problems based on the retrieved literature and the authors' clinical experience. The current concepts and definitions of ALS have not yet been unified or standardized in clinical practice, and are sometimes vague or inaccurate, which can cause difficulties for neurologists in the clinical treatment of ALS. The concept and definition of ALS need to be further ascertained, and the current diagnostic criteria for ALS require further development. The identification of effective and objective biomarkers may be a feasible method for the early and accurate diagnosis of ALS. Therefore, future research should focus on the identification of reliable biomarkers—especially neuroimaging biomarkers—through autopsy. Standardizing the concept and definition of ALS and formulating clear diagnostic criteria will largely avoid many uncertainties in the future clinical research and treatment of ALS, which will greatly benefit patients.
基金the Chair of GIScience,University of Heidelberg and the Klaus-Tschira Foundation (KTS) Heidelberg
摘要Car routing solutions are omnipresent and solutions for pedestrians also exist.Furthermore,public or commercial buildings are getting bigger and the complexity of their internal structure has increased.Consequently,the need for indoor routing solutions has emerged.Some prototypes are available,but they still lack semantically-enriched modelling (e.g.,access constraints,labels,etc.) and are not suitable for providing user-adaptive length-optimal routing in complex buildings.Previous approaches consider simple rooms,concave rooms,and corridors,but important characteristics such as distinct areas in huge rooms and solid obstacles inside rooms are not considered at all,although such details can increase navigation accuracy.By formally defining a weighted indoor routing graph,it is possible to create a detailed and user-adaptive model for route computation.The defined graph also contains semantic information such as room labels,door accessibility constraints,etc.Furthermore,one-way paths inside buildings are considered,as well as three-dimensional building parts,e.g.,elevators or stairways.A hierarchical structure is also possible with the presented graph model.