Effect Of Different Sequences Research Articles

Increasing goals of care conversations in primary care: Study protocol for a cluster randomized, pragmatic, sequential multiple assignment randomized trial

BackgroundGoals of care conversations explore seriously ill patients' values to guide medical decision making and often inform decisions about life sustaining treatments. Ideally, conversations occur before a health crisis between patients and clinicians in the outpatient setting. In the United States Veterans Affairs (VA) healthcare system, most conversations still occur in the inpatient setting. Strategies are needed to improve implementation of outpatient, primary care goals of care conversations. MethodsWe plan a cluster randomized (clinician-level) sequential, multiple assignment randomized trial to evaluate the effectiveness of patient implementation strategies on the outcome of goals of care conversation documentation when delivered in combination with clinician implementation strategies. Across three VA healthcare system sites, we will enroll primary care clinicians with low rates of goals of care conversations and their patients with serious medical illness in the top 10th percentile of risk of hospitalization or death. We will compare the effectiveness of sequences of implementation strategies and explore how patient and site factors modify implementation strategy effects. Finally, we will conduct a mixed-methods evaluation to understand implementation strategy success or failure. The design includes two key innovations: (1) strategies that target both clinicians and patients and (2) sequential strategies with increased intensity for non-responders. ConclusionThis study aims to determine the effect of different sequences and combinations of implementation strategies on primary care documentation of goals of care conversations. Study partners, including the VA National Center for Ethics in Health Care and Office of Primary Care, can consider policies based on study findings.

The effect of different sequences of biological crusts on soil physicochemical properties in dry land

The effect of different sequences of biological crusts on soil physicochemical properties in dry land

Evaluating the Effect of Different Sequences of Biological Crusts on Loess Derived Soil Biophysiological Properties in the Semi-arid Regions of Northern Iran

Evaluating the Effect of Different Sequences of Biological Crusts on Loess Derived Soil Biophysiological Properties in the Semi-arid Regions of Northern Iran

MRI View of Rehabilitation Methods to Relieve Anterior Cruciate Ligament Injury in Dancers.

In order to solve the problem of the difference in the diagnostic effect of different sequences of magnetic resonance imaging (MRI) examinations for anterior and posterior cruciate ligament injuries, the author proposes an MRI rehabilitation method to relieve anterior cruciate ligament injury in dancers. This method retrospectively analyzed the clinical data of 60 patients with knee anterior and posterior cruciate ligament injuries in our hospital, and all patients were diagnosed with knee anterior and posterior cruciate ligament injuries. All patients underwent MRI 3D sequence and 2D sequence examination successively to compare anatomical measurements. This study aimed at comparing the measurements of the posterior cruciate ligament (PCL) and anterior cruciate ligament (ACL) between the two examination sequences; comparing the diagnosis; comparing the grading and judgment of the anterior and posterior cruciate ligament injuries of the knee joint between the two inspection sequences; and comparing the diagnostic coincidence rates of the two examination sequences in the complete tear of the anterior and posterior cruciate ligaments of the knee. Experimental results show that, in terms of PCL and ACL, the angle, thickness, and length of two-dimensional MRI examination were significantly different from those of MRI examination and anatomical measurement (P < 0.05); for PCL and ACL, the angle, thickness, and length of 3D MRI were not significantly different from anatomical measurements (P > 0.05). The diagnostic accuracy of 2D MRI was 83.33%, which was lower than 95.00% of 3D MRI (P < 0.05). There was no significant difference in the grading of anterior and posterior cruciate ligament injuries between the two examination sequences (P > 0.05). The diagnostic coincidence rates of 3D MRI and 2D MRI for complete tear of the anterior and posterior cruciate ligaments were 95.55% and 80.00%, respectively (P < 0.05). In conclusion, three-dimensional MRI examination can obtain higher diagnostic value for patients with knee joint anterior and posterior cruciate ligament injury.

Artificial Intelligence Algorithm-Based MRI for Differentiation Diagnosis of Prostate Cancer.

The rapid increase in prostate cancer (PCa) patients is similar to that of benign prostatic hyperplasia (BPH) patients, but the treatments are quite different. In this research, magnetic resonance imaging (MRI) images under the weighted low-rank matrix restoration algorithm (RLRE) were utilized to differentiate PCa from BPH. The diagnostic effects of different sequences of MRI images were evaluated to provide a more effective examination method for the clinical differential diagnosis of PCa and BPH. 150 patients with suspected PCa were taken as the research objects. Pathological examination revealed that 137 patients had PCa and 13 patients had BPH. The pathological results were the gold standard and were compared with the MRI results of different sequences. Therefore, the accuracy of the MRI results was evaluated. The results showed that with the rise of Gaussian noise, the peak signal-to-noise ratio (PSNR) and structural similarity (SSIM) of all three algorithms gradually decreased, but the PSNR and SSIM of the RLRE algorithm were always higher than those of the RL and BM3D algorithms (P < 0.05). The sensitivity (97.08%), specificity (92.31%), accuracy (96.67%), and consistency (0.678) of the dynamic contrast enhancement (DCE) sequence were higher than those of the plain scan (86.13%, 69.23%, 84.67%, and 0.469, respectively). In conclusion, the RLRE algorithm could promote the resolution of MRI images and improve the display effect. DCE could better differentiate PCa from BPH, had great clinical application value, and was worthy of clinical promotion.

A Computational Model of Context-Dependent Encodings During Category Learning.

Although current exemplar models of category learning are flexible and can capture how different features are emphasized for different categories, they still lack the flexibility to adapt to local changes in category learning, such as the effect of different sequences of study. In this paper, we introduce a new model of category learning, the Sequential Attention Theory Model (SAT‐M), in which the encoding of each presented item is influenced not only by its category assignment (global context) as in other exemplar models, but also by how its properties relate to the properties of temporally neighboring items (local context). By fitting SAT‐M to data from experiments comparing category learning with different sequences of trials (interleaved vs. blocked), we demonstrate that SAT‐M captures the effect of local context and predicts when interleaved or blocked training will result in better testing performance across three different studies. Comparatively, ALCOVE, SUSTAIN, and a version of SAT‐M without locally adaptive encoding provided poor fits to the results. Moreover, we evaluated the direct prediction of the model that different sequences of training change what learners encode and determined that the best‐fit encoding parameter values match learners’ looking times during training.

Acute Teaching Method of College Physical Skills Based on Mobile Intelligent Terminal

Mobile technology can make lessons of physical skills for the students to prepare them more vibrant. Its multicultural, consolidated, and communicative characteristics contribute to the improving teaching performance, excitement of learners, reformation of learning, and a basic idea of teaching mode. The challenge facing college physical education professionals is emotionally labile students, repetition of their education, and the lack of appropriate technology, resources, school violence, and behavioral issues. Because of the high levels of bullying experienced by students with learning and attention difficulties, misbehavior and absence are more likely to occur. The school environment and negative emotions can both aggravate academic difficulties. The proposed methodology involves evaluating student’s physical training based on big data analysis (ESPT-BDA) to compensate voluntary sport behavior by neglecting its unwanted attitude or values and solving the problem of uniform learning to meet the student’s requirements. Repetition helps hone a talent by putting it to use repeatedly. The interval at which a skill is performed is another critical component of repetition. Using spaced repetition as a learning strategy involves gradually increasing the time between repetitions of the same piece of knowledge. The regulating intelligent control framework is used to compute an effective method of directing the insufficient and improper system to achieve a specific objective in an uncertain context. A convolution neural network is implemented to automatically detect vital physical activity characteristics without a need for human monitoring. Various experiment’s findings demonstrate the effect of different sequences up to 96.51% properly classified test data and improve evaluation of intelligent control framework, intelligent practicing intensity control 94.3%.

Exploring the effects of strategy-focused instruction in writing skills of 4TH grade students

The improvement of writing skills is one of the aims of the educational system. The present study implemented strategy-focused instruction through the Cognitive Self-Regulation Instruction (CSRI) program which included three instructional components: Direct Teaching, Modelling, and Peer-Practice. The aim was to explore the short- and long-term effects of different sequences of the three CSRI instructional components on writing skills (reflected in greater Coherence, Structure and Quality of the text product). Six 4th grade primary education classes from three different schools (N = 126) were randomly allocated to the experimental conditions which differed in the order in which the instructional components were implemented: Direct Teaching, Peer-Practice, and Modelling (experimental condition 1, n = 47); or Modelling, Peer-Practice, and Direct Teaching (experimental condition 2, n = 36). A control condition (n = 43) was also included in which students received traditional instruction. Writing performance was measured through compare-contrast writing tasks. In addition, writing performance was assessed through the anchor text procedure (considering three variables: Coherence, Structure and Quality). Findings supported the effectiveness of strategy-focused instruction after four sessions of the CSRI program. Experimental conditions 1 and 2 showed a significant gain relative to the control condition and were equally effective for the improvement of writing skills over a short-term period. More specifically, the Peer-Practice component was associated with the largest gains in the 4th grade students’ writing skills.

Damage detection of cylindrical shells based on Sander's theory and model updating using incomplete modal data considering random noises

In this paper, a new system of damage detection equations for damage identification of cylindrical shells is developed based on classic finite element method, incomplete noisy modal data and model updating. Classic finite element technique in conjunction with Sander's thin shell theory is deployed in order to construct the finite element model of cylindrical shells and compute vibration data. To overcome the difficulty of incomplete data, “system equivalent reduction expansion process” (SEREP) method is applied to find a proper complete approximation of incomplete modal data. The proposed system is usually ill-posed due to noisy data and ill-conditioned system derived from the model updating process. To tackle this issue, a constraint as a regularization parameter is employed in model updating problem to differentiate potentially damaged elements and undamaged elements. This constraint is imposed on the model updating process by defining a Reduction Index (RI) and forcing severities of undamaged elements to tend to zero. Furthermore, the presented system is non-square and large depending on the number of structural unknowns. For these reasons, Biconjugate gradient (BCG) method along with an appropriate preconditioner are employed to solve the system of equations. Not only does the preconditioner stabilize the solution against numerical errors and inaccuracies caused by noisy data, but also it alters the system to a square one. Numerical studies are performed to demonstrate the efficiency of the presented method. Moreover, a statistical analysis is carried out to evaluate the effect of different sequences of random noises on the damage detection results. Findings show that the proposed method is capable of detecting the severities and sites of damages for cylindrical shells in the presence of noisy data.

Temporal patterns of seed germination in early spring-flowering temperate woodland geophytes are modified by warming

Understorey species in temperate deciduous woodlands such as wild daffodil (Narcissus pseudonarcissus) and common snowdrop (Galanthus nivalis) have complex dormancy: seeds that are shed in late spring require warm summer temperatures for embryo elongation and dormancy alleviation, but then cooler temperatures for germination in autumn. As seasons warm and tree canopies alter, how will different seasonal temperature sequences affect these complex dormancy responses? The effect of different sequences of warmer (+5 °C), current or cooler (-5 °C) seasons (summer to spring) on seed germination patterns over seven successive seasons were investigated, with all sequences combined factorially to determine the consequences of differential seasonal temperature change for the temporal pattern of germination (and so seedling recruitment). Little (<1 %, G. nivalis) or no (N. pseudonarcissus) seed germination occurred during the first summer in any treatment. Germination of N. pseudonarcissus in the first autumn was considerable and greatest at the average (15 °C) temperature, irrespective of the preceding summer temperature; germination was also substantial in winter after a warmer autumn. Germination in G. nivalis was greatest in the warmest first autumn and influenced by preceding summer temperature (average > warmer > cooler); the majority of seeds that germinated over the whole study did so during the two autumns but also in year 2's cooler summer after a warm spring. Warmer autumns and winters delay first autumn germination of N. pseudonarcissus to winter but advance it in G. nivalis; overall, warming will deplete the soil seed bank of these species, making annual seed influx increasingly important for recruitment and persistence. This study provides a comprehensive account of the effects of temperature changes in different seasons on seed germination in these early spring-flowering geophytes and consequently informs how these and other temperate woodland species with complex seed dormancy may respond to future climate change.

Production planning in autonomous and matrix-structured assembly systems: Effects of similarity of precedence graphs on order release sequencing

Autonomous, matrix-structured assembly systems (AMSAS) are discussed as a promising approach for dealing with current challenges as high product variance. For production planning in such systems, the so-called volume cycle concept is proposed, in which a fixed order volume per time unit is consolidated for assembly. Within this concept, a sequence must be defined in which orders of a volume cycle are released. In this work, we present the effects of different sequences for the order release based on the similarity of products’ precedence graphs and outline the performance benefit of production flow using discrete event simulation studies. It is shown that lower similarities of sequences enhance throughput times and capacity utilization. An approach for quantification of the similarity of an entire order sequence is proposed. The improvements obtained reveal the potential resulting from cluster-based production planning for AMSAS.

Role of basidiomycete fungi in the grapevine trunk disease esca

Phaeomoniella chlamydospora and wood‐rotting basidiomycete fungi, namely Fomitiporia spp., are known esca pathogens. However, the effect of their mixed infections and the sequence of infection on disease development is unclear. To determine the effects of single and co‐inoculations on symptoms, potted Vitis vinifera ‘Crimson Seedless’ was inoculated with P. chlamydospora either alone or in combination with one of four basidiomycetes: Coprinellus radians, Fomitiporia langloisii, F. polymorpha and the novel species Tropicoporus texanus. Basidiomycetes were isolated from vines with foliar symptoms of esca in California and Texas. In sequential co‐inoculations, the effects of different sequences of infection (P. chlamydospora first, basidiomycete 6 months later; and vice versa) were tested, compared to simultaneous co‐inoculations. Plants inoculated with P. chlamydospora either alone or in combination with a basidiomycete (in any sequence) did not differ significantly in the length of black‐streaking lesions. In plants inoculated only with a basidiomycete, the appearance of large brown lesions, coupled with the absence of this wood symptom from control plants, suggests that C. radians, F. langloisii and T. texanus are pathogenic. Foliar symptoms resembling those of esca in the field (marginal and/or interveinal scorching, combined with red and/or yellow discoloration) were statistically more frequent among plants inoculated with F. polymorpha or T. texanus, either simultaneously or following P. chlamydospora, compared to single inoculations. Sequential co‐inoculations of a basidiomycete before or after P. chlamydospora were associated with similar lesion lengths, suggesting that basidiomycetes may not require infection by P. chlamydospora in order to extensively colonize the wood.

Alteration of the intaglio surface of lithium disilicate glass-ceramic

Statement of problemClinical adjustment of a lithium disilicate glass-ceramic (LDGC) restoration may necessitate its return to the laboratory for additional firing. Evidence of how the intaglio surface should be re-etched after internal adjustment, or after refiring, is lacking. PurposeThe purpose of this in vitro study was to investigate the effects of different sequences of etching, refiring, diamond rotary instrument adjustment, airborne-particle abrasion, and re-etching on the microstructure and surface roughness of the intaglio surface of heat-pressed LDGCs. Material and methodsHeat-pressed LDGC specimens were ground with abrasive paper to produce a uniformly flat surface. The groups (n=3) were subjected to different combinations of etching, refiring, diamond rotary instrument adjustment, airborne-particle abrasion, and re-etching. X-ray diffraction was used to characterize the crystalline phases. Scanning electron microscopy and surface profilometry were used to characterize the microstructure and surface roughness. ResultsQualitative differences were observed in the surface texture of specimens etched for different periods. Excessive etching revealed more of the underlying lithium disilicate crystallites and caused surface pitting for the longest etching period studied. Refiring altered the surface condition but did not completely remove the texture created by the original etching. Diamond rotary instrument adjustment resulted in appreciable surface damage and a higher mean value of measured surface roughness (with or without re-etching) than the other groups. Airborne-particle abrasion caused embedding of particles in the specimen surface, likely corresponding to the abrasion media, although this process resulted in qualitatively less surface damage than diamond rotary instrument adjustment. ConclusionsExcessive etching, refiring, and adjustment by airborne-particle abrasion or diamond rotary instrument result in qualitative changes in surface condition. Adjustment by diamond rotary instrument results in appreciable surface damage.

Semi-automatic classification of prostate cancer on multi-parametric MR imaging using a multi-channel 3D convolutional neural network.

To present a deep learning-based approach for semi-automatic prostate cancer classification based on multi-parametric magnetic resonance (MR) imaging using a 3D convolutional neural network (CNN). Two hundred patients with a total of 318 lesions for which histological correlation was available were analyzed. A novel CNN was designed, trained, and validated using different combinations of distinct MRI sequences as input (e.g., T2-weighted, apparent diffusion coefficient (ADC), diffusion-weighted images, and K-trans) and the effect of different sequences on the network's performance was tested and discussed. The particular choice of modeling approach was justified by testing all relevant data combinations. The model was trained and validated using eightfold cross-validation. In terms of detection of significant prostate cancer defined by biopsy results as the reference standard, the 3D CNN achieved an area under the curve (AUC) of the receiver operating characteristics ranging from 0.89 (88.6% and 90.0% for sensitivity and specificity respectively) to 0.91 (81.2% and 90.5% for sensitivity and specificity respectively) with an average AUC of 0.897 for the ADC, DWI, and K-trans input combination. The other combinations scored less in terms of overall performance and average AUC, where the difference in performance was significant with a p value of 0.02 when using T2w and K-trans; and 0.00025 when using T2w, ADC, and DWI. Prostate cancer classification performance is thus comparable to that reported for experienced radiologists using the prostate imaging reporting and data system (PI-RADS). Lesion size and largest diameter had no effect on the network's performance. The diagnostic performance of the 3D CNN in detecting clinically significant prostate cancer is characterized by a good AUC and sensitivity and high specificity. • Prostate cancer classification using a deep learning model is feasible and it allows direct processing of MR sequences without prior lesion segmentation. • Prostate cancer classification performance as measured by AUC is comparable to that of an experienced radiologist. • Perfusion MR images (K-trans), followed by DWI and ADC, have the highest effect on the overall performance; whereas T2w images show hardly any improvement.

Effects of different sequences of examples and problems on motivation and learning

Recent research has shown that example study only (EE) and example-problem pairs (EP) were more effective (i.e., higher test performance) and efficient (i.e., attained with less effort invested in learning and/or test tasks) than problem-example pairs (PE) and problem solving only (PP). We conducted two experiments to investigate how different example and problem-solving sequences would affect motivational (i.e., self-efficacy, perceived competence, and topic interest) and cognitive (i.e., effectiveness and efficiency) aspects of learning. In Experiment 1, 124 technical students learned a mathematical task with the help of EEEE, EPEP, PEPE, or PPPP and then completed a posttest. Students in the EEEE Condition showed higher posttest performance, self-efficacy, and perceived competence, attained with less effort investment, than students in the EPEP and PPPP Condition. Surprisingly, there were no differences between the EPEP and PEPE Condition on any of the outcome measures. We hypothesized that, because the tasks were relevant for technical students, starting with a problem might not have negatively affected their motivation. Therefore, we replicated the experiment with a different sample of 81 teacher training students. Experiment 2 showed an efficiency benefit of EEEE over EPEP, PEPE, and PPPP. However, only EEEE resulted in greater posttest performance, self-efficacy, and perceived competence than PPPP. We again did not find any differences between the EPEP and PEPE Condition. These results suggest that, at least when short training phases are used, studying examples (only) is more preferable than problem solving only for learning. Moreover, this study showed that example study (only) also enhances motivational aspects of learning whereas problem solving only does not positively affect students’ motivation at all.

The effects of flood history on sediment transport in gravel-bed rivers

The transport of coarse sediment during floods often exhibits hysteresis patterns from changes in flow fields, channel geometry, bedforms, or sediment supply conditions. Flume experiments that simulate hydrographs tend to confirm that hysteresis is a consequence of the progressive organization of surface sediments in terms of grain protrusion, imbrication, orientation, and roughness. Hysteretic patterns are also highly dependent on the kind of sediment supply conditions, and the type of simulated hydrograph. A factor that has not been investigated extensively is the effect of the timing and sequencing of floods on bedload transport. Depending on its magnitude and duration, each flood leaves the channel bed in a different condition, which influences the bedload transport of the next event, representing the river bed's memory of past floods, which can determine future responses to natural disturbances. In this study, I investigated the effects of different sequences of events, i.e., the flood history, on sediment transport through a series of flume experiments that simulated three types of stepped and symmetrical hydrographs (ranging from short-duration/high-magnitude to long-duration/low-magnitude events) under sediment recirculation conditions. Hydrographs were simulated as a sequence of the same event, and with events in different sequences, in order to explore the effects of different antecedent conditions on sediment transport. The results show that a previous event decreases the rates of sediment transported by a certain hydrograph by around 40% if a high-magnitude event precedes another one and around 70% if a low-magnitude event precedes another event of similar magnitude. A low-magnitude event does not affect the rate of sediment transported by a subsequent high-magnitude flood, but a high-magnitude event reduces the sediment transported by a subsequent long-duration/low-magnitude event.

Effectiveness of sequences of classroom training for welfare recipients: what works best in West Germany?

ABSTRACTSequences of active labour market programmes (ALMPs) may be part of an intensified activation strategy targeting hard-to-place unemployed individuals. Such sequences are very common among welfare recipients in Germany, but most studies only evaluate either single ALMPs or unemployed individuals’ first ALMP. I analyse the effects of different sequences of classroom training for West German men and women on different labour market outcomes. Using rich administrative data and a dynamic causal model, I can control for dynamic selection problems that occur during a sequence. The results show that two classroom trainings are more effective than two periods of welfare receipt in helping welfare recipients find regular employment, especially among West German women. Moreover, immediately assigning individuals to classroom training is more effective than waiting and assigning them to classroom training in the second period. However, in some cases, avoiding participation in multiple programmes is preferable.Abbreviations: ALMP, active labour market programme; CIA, Conditional Independence Assumption; CSR, Common Support Requirement; DATET, dynamic average treatment effect on the treated; IEB, Integrated Employment Biographies; IPW, inverse probability weighting; LHG, UBII-Receipt History (Leistungshistorik Grundsicherung); MSB, mean standardized absolute bias; SUTVA, Stable Unit Treatment Value Assumption; UBII, unemployment benefit II; UBI, unemployment benefit I; WDCIA, Weak Dynamic Conditional Independence Assumption

What are the effects of different sequences of chemotherapy and radiotherapy in women with early breast cancer?

What are the effects of different sequences of chemotherapy and radiotherapy in women with early breast cancer?

Association of BCG, DTP, and measles containing vaccines with childhood mortality: systematic review

Objectives To evaluate the effects on non-specific and all cause mortality, in children under 5, of Bacillus Calmette-Guérin (BCG), diphtheria-tetanus-pertussis (DTP), and standard titre measles containing vaccines (MCV); to examine...

The Best. First. Anti-EGFR before anti-VEGF, in the first-line treatment of RAS wild-type metastatic colorectal cancer: from bench to bedside.

Since 2013, informative trials exploring the optimal use of available biologic agents in the first-line setting of metastatic colorectal cancer (mCRC) have been presented. These trials have opened a stimulating debate on the biological effect that first-line therapies may have on subsequent lines of treatment even long after the first-line progression. We reviewed available preclinical and clinical data on the effect of different sequences of the biological drugs approved for use in mCRC patients. The importance of molecular selection of patients based on RAS mutational status and toxicity and quality-of-life issues were also analyzed. Convincing evidence exists on the optimal therapeutic effect obtained by using anti-EGFR agents in first-line treatment before anti-VEGF agents. On the contrary, up-front anti-VEGF agents' use seems to determine biological changes that increase the risk of acquired resistance to subsequent EGFR inhibitors. This hypothesis is confirmed by the scarce evidence of EGFR inhibitor activity in second-line treatment. Such a therapeutic optimum is subject to a fine molecular selection based on RAS mutational status. There is accumulating evidence suggesting that, after precise and well-established molecular selection, anti-EGFR agents deliver their maximum efficacy in mCRC patients when given early in the treatment strategy. Their toxicity profile seems manageable under the supervision of experienced physicians. Large randomized trials prospectively confirming the impact of different sequencing strategies are eagerly awaited.