Evaluation Criteria Research Articles

Career intervention program to promote academic adjustment and success in higher education

IntroductionThe transition to higher education can be challenging for many students, requiring developing skills and strategies to help them overcome various challenges. Adjustment to university is a multifaceted process involving several dimensions. Given the difficulty that a significant percentage of students face in this process, the lack of adaptation to higher education has been widely studied, as it is often associated with academic failure and dropping out of school. To mitigate these risks, career interventions have emerged as an essential support, helping students to develop personal resources such as resilience, time management, and decision-making capacity. The aim here is to present a career intervention program focused on promoting the adjustment and academic success of first-year undergraduate or integrated master’s students and evaluating the participants’ feedback on this intervention.MethodologyThis intervention program aimed to provide students with an opportunity to reflect on their adjustment process to the University, identifying possible areas of vulnerability, providing personalized feedback, and proposing modules of learning and personal and academic development that would favor the adjustment and academic success process. Additionally, it aimed to organize, systematize, and make known the support structures existing at the University to which students can resort in possible situations of psychosocial vulnerability and support for academic and career development. This intervention was based on and used a computer platform developed within the framework of the SUnStar project. The intervention took place over 6 weeks using the Teams platform and consisted of three modules, with module two divided into different sessions and topics. Seventy-four university students participated in the intervention, 56 (75.7%) of whom were female. A questionnaire with four Likert-type questions was designed to evaluate the sessions by the students.ResultsThe session “Pursuing my UMinho Career: Institutional Support Structures” consistently received the highest ratings across multiple evaluation criteria. In contrast, the “Social Networks and Cooperation” session received the lowest, although all sessions were rated above the average response point. The results are discussed regarding their relevance in an academic context and their implications for future interventions with this target group.

What is wrong with the international business tax system?

Abstract Despite wave after wave of reform, the existing international business tax system remains poor. This article evaluates the system against five standard evaluative criteria: economic efficiency, robustness to profit shifting, fairness, ease of administration, and incentive compatibility, and concludes that it performs poorly on all five. The article argues that the root cause of this poor performance is the underlying fundamental structure of the system, in particular its origin basis and the separate entity approach.

Safety and Efficacy of Toripalimab in Patients with Cholangiocarcinoma: An Open-Label, Phase 1 Study

Introduction This was the first phase 1 study conducted in the United States. It consisted of dose-escalation (part A) and multiple indication-specific cohort expansion (part B), investigating the safety and preliminary efficacy of toripalimab (anti–programmed cell death-1 inhibitor) in patients with advanced malignancies. Methods Patients with advanced malignancies that progressed after treatment with at least one prior line of standard systemic therapy, including the patients with advanced/recurrent cholangiocarcinoma (CCA), received toripalimab 240 mg every 3 weeks in part B. The primary endpoint was safety assessment. Efficacy endpoints included objective response rate (ORR), disease control rate (DCR), duration of response (DoR), progression-free survival (PFS) as assessed by the investigators according to Response Evaluation Criteria in Solid Tumors (version 1.1) and overall survival (OS). Results In part B, 166 patients, including the 42 patients with CCA, were enrolled and received toripalimab. Among the 166 patients, treatment-emergent adverse events (TEAEs) of any grade occurred in 158 (95.2%) patients, and 97 (58.4%) patients experienced TEAEs of Grade 3 or greater. The most common TEAE was fatigue (42.2%). Seven (4.2%) patients experienced TEAEs with a fatal outcome, none of which were identified by investigators as related to toripalimab. Investigator-assessed immune-related adverse events (irAE) of Grade 3 or higher occurred in 7 (4.2%) patients. In the CCA cohort, with the median follow-up of 4.4 months, the ORR and DCR were 4.8% (95% CI: 0.58, 16.16) and 40.5% (95% CI: 25.63, 56.72), respectively; median DoR was 7.8 (range 4.4+ to 7.8) months; median PFS was 2.1 (95% CI: 1.91, 3.88) months; median OS was not estimable. Conclusions Toripalimab had manageable side effects in patients with refractory cholangiocarcinoma and exhibited preliminary evidence of anti-tumor activity. However, further information regarding biomarkers is needed. ClinicalTrials.gov ID: NCT03474640

Identification of off-site construction disputes: technical, managerial and external dispute causes

PurposeWhile off-site construction (OSC) offers a promising solution to many problems plaguing traditional construction (e.g. low productivity, waste and safety risks), a lack of standards and knowledge about OSC, especially regarding disputes, hinders its wider adoption. This study aims to address this gap by identifying and analyzing the importance levels of technical, managerial and external disputes specific to OSC projects.Design/methodology/approachThree steps methodology was employed in the study. Focus group discussion (FGD) technique was used to identification and finalize dispute causes found from literature and collect data for the next step. In the study, two multi-criteria decision-making MCDM (methods) [a hybrid approach-Pythagorean fuzzy analytic hierarchy process (AHP) and fuzzy Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS)] were employed. While Pythagorean fuzzy AHP was used to calculate the weights of criteria, fuzzy TOPSIS analysis was used to calculate the weights of main and sub-dispute causes. Instead of using the classical AHP method, the Pythagorean fuzzy AHP method was employed due to its superiority in capturing the inherent uncertainty and ambiguity of decision-makers, giving flexibility to decision-makers with linguistic variables instead of expecting exact evaluation scores and flexibility in the integration with other methods. During the analysis of the weights of the main and sub-dispute causes, the fuzzy TOPSIS method was preferred. The fuzzy TOPSIS method involves a quicker and more straightforward decision-making process. Also, the fuzzy TOPSIS method allows the consideration of numerous alternatives and evaluation criteria and uncertainty in the decision-making process.FindingsThe analysis reveals that technical disputes pose the biggest challenge in off-site construction compared to managerial or external disputes. Specifically, “late completion, delivery and installation of components” emerged as the most significant technical dispute. Within managerial disputes, “poor planning and management of the project” ranked highest, while “the complexity of legal expressions” was the most prominent external dispute factor.Originality/valueIn the literature, three studies offer some insight on OSC disputes by analyzing the litigation cases. Nonetheless, the results can be misleading, because some disputes can be resolved before the litigation process. Therefore, the study findings can aid in foreseeing technical, managerial and external factors and in generating robust OSC contracts by considering these issues.

Diagnostic performance of microRNAs for predicting response to transarterial chemoembolization in hepatocellular carcinoma: a meta-analysis

PurposeTo provide a detailed pooled analysis of the diagnostic accuracy of microRNAs (miRNAs) in predicting the response to transarterial chemoembolization (TACE) in hepatocellular carcinoma (HCC).MethodsA comprehensive literature search was conducted across PubMed, Embase, Cochrane Library, and Web of Science to identify studies assessing the diagnostic performance of miRNAs in predicting TACE response in HCC. Two independent reviewers performed quality assessment and data extraction using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and the area under the summary receiver operating characteristic (SROC) curve were calculated using a bivariate random-effects model. Subgroup analyses and meta-regression were performed to explore potential sources of heterogeneity, including sample size, response criteria, specimen source, response evaluation methods, TACE efficacy interval window, and geographical location.ResultsSeven studies, comprising 320 HCC responders and 187 non-responders, were included in this meta-analysis. The miRNAs studied included miR-373, miR-210, miR-4492, miR-1271, miR-214, miR-133b, and miR-335. The pooled sensitivity of miRNAs in predicting recurrence after TACE was 0.79 [95% CI: 0.72-0.84], and the pooled specificity was 0.82 [95% CI: 0.74-0.88]. The DOR was 17 [95% CI: 9-33], and the pooled area under the SROC curve (AUC) was 0.85 [95% CI: 0.81-0.88], indicating excellent diagnostic accuracy. Subgroup analyses revealed significant differences in diagnostic performance based on response criteria and geographical location. Meta-regression did not identify any significant sources of interstudy heterogeneity.ConclusionMiRNAs show promise as diagnostic tools for predicting TACE response in HCC patients. However, their clinical application requires further validation in larger cohorts. Future research should focus on standardizing RNA extraction methods, selecting consistent endogenous controls, and adopting uniform response evaluation criteria to improve reliability and reduce variability.

Conditional Generative Models for Synthetic Tabular Data: Applications for Precision Medicine and Diverse Representations.

Tabular medical datasets, like electronic health records (EHRs), biobanks, and structured clinical trial data, are rich sources of information with the potential to advance precision medicine and optimize patient care. However, real-world medical datasets have limited patient diversity and cannot simulate hypothetical outcomes, both of which are necessary for equitable and effective medical research. Fueled by recent advancements in machine learning, generative models offer a promising solution to these data limitations by generating enhanced synthetic data. This review highlights the potential of conditional generative models (CGMs) to create patient-specific synthetic data for a variety of precision medicine applications. We survey CGM approaches that tackle two medical applications: correcting for data representation biases and simulating digital health twins. We additionally explore how the surveyed methods handle modeling tabular medical data and briefly discuss evaluation criteria. Finally, we summarize the technical, medical, and ethical challenges that must be addressed before CGMs can be effectively and safely deployed in the medical field.

LHB-YOLOv8: An Optimized YOLOv8 Network for Complex Background Drop Stone Detection

Real-time detection of rockfall on slopes is an essential part of a smart worksite. As a result, target detection techniques for rockfall detection have been rapidly developed. However, the complex geologic environment of slopes, special climatic conditions, and human factors pose significant challenges to this research. In this paper, we propose an enhanced high-speed slope rockfall detection method based on YOLOv8n. First, the LSKAttention mechanism is added to the backbone part to improve the model’s ability to balance the processing of global and local information, which enhances the model’s accuracy and generalization ability. Second, in order to ensuredetection accuracy for smaller targets, an enhanced detection head is added, and other detection heads of different sizes are combined to form a multi-scale feature fusion to improve the overall detection performance. Finally, a bidirectional feature pyramid network (BiFPN) is introduced in the neck to effectively reduce the parameters and computational complexity and improve the overall performance of rockfall detection. In addition we compare the LSKAttention mechanism with other attention mechanisms to verify the effectiveness of the improvements. Compared with the baseline model, our method improves the average accuracy mAP@0.5 by 4.8%. Moreover, the amount of parameters is reduced by 20.2%. Among the different evaluation criteria, the LHB-YOLOv8 method shows obvious advantages, making it suitable for engineering applications and the practical deployment of slope rockfall detection systems.

Fruquintinib Plus Sintilimab in Patients with Treatment-Naive and Previously Treated Advanced Renal Cell Carcinoma: Results from a Phase Ib/II Clinical Trial.

Antiangiogenic inhibitors plus immune checkpoint inhibitors have synergistic antitumor activity and have improved treatment outcomes in patients with renal cell carcinoma (RCC). We report the RCC cohort from a phase Ib/II study in Chinese patients evaluating the efficacy and safety of fruquintinib plus sintilimab in treating advanced clear cell RCC (ccRCC). Eligible patients had pathologically confirmed advanced ccRCC. Patients received fruquintinib 5 mg once daily, 2 weeks on/1 week off, plus sintilimab 200 mg every 3 weeks in 3-week cycles. The primary endpoint was investigator-assessed objective response rate (ORR) per Response Evaluation Criteria in Solid Tumors, version 1.1. By March 31, 2023, 42 patients (median age 58.9 years; 81.0% male) had been treated in the RCC cohort. Among treatment-naive patients (n = 22), confirmed ORR was 68.2% (95% confidence interval [CI] 45.1-86.1). The median progression-free survival (PFS) was not reached, and 18-month PFS ratewas 59.4%. Among previously treated patients (n = 20), the confirmed ORR was 60.0% (95% CI 36.1-80.9), and the median PFS was 15.9 (95% CI 5.4-19.3) months. All patients had adverse events related to study treatment, 52.4% of which were grade ≥ 3 in severity. Treatment-related adverse events with an incidence of ≥ 40% included proteinuria, hypothyroidism, hypercholesterolemia, hypertriglyceridemia, and hypoalbuminemia. Fruquintinib plus sintilimab demonstrated promising efficacy in advanced ccRCC and was well tolerated. A phase III study (FRUSICA-02) using this combination regimen in patients with previously treated advanced ccRCC is ongoing. The study was registered with ClinicalTrials.gov (NCT03903705).

CTI Integration in Contact Centers: A Comparative Analysis of Security, Scalability, and Challenges in Legacy vs. Cloud-Based Systems

AIM: Scope of this work aims to explore the integration of Computer Telephony Integration (CTI) in both legacy and cloud-based contact center systems, examining security challenges and integration methods for achieving robust Computer Telephony Integration implementations. Study Design: This study provides a comparative analysis of techniques, methodologies, and integration challenges associated with CTI in legacy on-premises systems and modern cloud-based solutions, with a particular focus on security considerations in both contexts. Place and Duration of Study: This study is based on a review of contact centers in retail versus mid-sized tech companies, focusing on solutions implemented between 2018 and 2024. Methodology: This study compares Computer Telephony Integration in both legacy and cloud-based contact center systems, focusing on integration processes, security concerns, scalability, challenges, and feature differences. It uses a combination of key evaluation criteria (covering core components, flexibility, security practices, and scalability), case studies, financial implications, and a feature comparison matrix to explore CTI integration in traditional on-premises environments versus modern cloud-based solutions. Security has been the primary concern, and this included encryption, authentication and compliance with regulations such as the General Data Protection Regulation (GDPR) and the Health Insurance Portability and Accountability Act (HIPAA). Results: The study found that cloud-based contact centers offer more flexible and scalable integration options, leveraging modern APIs, cloud-native services, and omnichannel support. Legacy systems, while reliable, face challenges in scalability and integration, requiring complex middleware and custom solutions. Security is a significant concern for both environments; however, cloud solutions are enhanced by regular updates, improved compliance standards, and centralized management. Data encryption, secure voice protocols, and authentication were identified as the foundation for security for all types of Computer Telephony Integrations in either category of systems. In addition, the study found that cloud-based systems are being accelerated as more flexible and economically viable solutions are being demanded. A unique contribution of this study is the development of a security-focused comparative framework for this integration in legacy and cloud-based contact centers. By analyzing security practices, scalability challenges, and integration methodologies, this study bridges a critical knowledge gap, offering practitioners a comprehensive guide to CTI decision-making. Conclusion: Computer Telephony Integration (CTI) plays a critical role in modern contact centers. While legacy systems continue to serve their purpose, cloud-based solutions offer superior flexibility, scalability, and security. Organizations must prioritize robust security practices when implementing them, regardless of the platform. Future research should focus on advancing AI-enhanced security frameworks to address evolving threats, evaluating hybrid CTI models that integrate legacy and cloud components, and testing the impact of real-time analytics on customer satisfaction. Such advancements will ensure data privacy, regulatory compliance, and the continuous improvement of customer engagement and operational efficiency.

Integrating ESG Criteria in Corporate Strategies: Determinants and Implications for Performance

This study explores the integration of Environmental, Social, and Governance (ESG) principles into corporate practices, focusing on the methodologies used for their evaluation and the factors influencing their adoption. Through a qualitative and comparative analysis of European and Saudi Arabian contexts, the research examines how companies align their strategies with ESG requirements in diverse regulatory and cultural environments. Data is drawn from established ESG rating agencies, corporate sustainability reports, and case studies, allowing for a thorough investigation of internal and external evaluation processes and their implications for ESG scores. The study identifies key challenges in ESG implementation, including ambiguities in definitions, resource disparities, sector-specific considerations, and resistance due to cost or unfavorable ratings. It also highlights the role of legal and regulatory frameworks, such as the ESG Disclosure Guidelines introduced by the Saudi Capital Market Authority and global standards like the Global Reporting Initiative (GRI), in shaping corporate ESG practices. Recommendations emphasize the need for standardized evaluation criteria, targeted support for smaller enterprises, and stronger legal frameworks to promote transparency and compliance. The findings contribute to a deeper understanding of ESG dynamics and provide actionable insights for advancing corporate sustainability on a global scale.

Large Language Models as Evaluators in Education: Verification of Feedback Consistency and Accuracy

The recent advancements in large language models (LLMs) have brought significant changes to the field of education, particularly in the generation and evaluation of feedback. LLMs are transforming education by streamlining tasks like content creation, feedback generation, and assessment, reducing teachers’ workload and improving online education efficiency. This study aimed to verify the consistency and reliability of LLMs as evaluators by conducting automated evaluations using various LLMs based on five educational evaluation criteria. The analysis revealed that while LLMs were capable of performing consistent evaluations under certain conditions, a lack of consistency was observed both among evaluators and across models for other criteria. Notably, low agreement among human evaluators correlated with reduced reliability in LLM evaluations. Furthermore, variations in evaluation results were influenced by factors such as prompt strategies and model architecture, highlighting the complexity of achieving reliable assessments using LLMs. These findings suggest that while LLMs have the potential to transform educational systems, careful selection and combination of models are essential to improve their consistency and align their performance with human evaluators in educational settings.

Sustainable Landfill Site Selection in Urban Areas: Case Study of Millenium City in India

Landfills remain the predominant approach to managing solid waste in urban settings due to their cost-effectiveness, particularly in developing nations. In this regard, landfill site selection is a serious issue in the urban planning process because of its implications for the economy, environment, ecology, and public health. Municipal Corporation Gurugram records indicate that the city alone generates solid waste of about 1100 metric tons per day. The city's growing urban population and rapid expansion as a commercial and financial center presented numerous waste management difficulties. Existing studies lack comprehensive integration of multi-criteria decision analysis and GIS technologies for landfill site selection in rapidly urbanizing cities like Gurugram. In the present study, multi-criteria decision analysis and GIS technologies are used to identify suitable sites for landfills, considering most environmental factors. With the rate of population and settlements increasing, it is suggested that the landfill site serve for at least 20 years. In accordance with the regulations outlined in the Solid Waste Management Rules of 2016, a meticulous process was undertaken to identify and prioritize the ten most crucial criteria for evaluation in prescribed methodologies. The study's conclusions could help municipal planners and waste management authorities create an effective solid waste management system that takes into account all possible advantages and disadvantages.

Harmonized technical standard test methods for quality evaluation of medical fluorescence endoscopic imaging systems

Fluorescence endoscopy technology utilizes a light source of a specific wavelength to excite the fluorescence signals of biological tissues. This capability is extremely valuable for the early detection and precise diagnosis of pathological changes. Identifying a suitable experimental approach and metric for objectively and quantitatively assessing the imaging quality of fluorescence endoscopy is imperative to enhance the image evaluation criteria of fluorescence imaging technology. In this study, we propose a new set of standards for fluorescence endoscopy technology to evaluate the optical performance and image quality of fluorescence imaging objectively and quantitatively. This comprehensive set of standards encompasses fluorescence test models and imaging quality assessment protocols to ensure that the performance of fluorescence endoscopy systems meets the required standards. In addition, it aims to enhance the accuracy and uniformity of the results by standardizing testing procedures. The formulation of pivotal metrics and testing methodologies is anticipated to facilitate direct quantitative comparisons of the performance of fluorescence endoscopy devices. This advancement is expected to foster the harmonization of clinical and preclinical evaluations using fluorescence endoscopy imaging systems, thereby improving diagnostic precision and efficiency.

Changes of the ecological environment status in villages under the background of traditional village preservation: a case study in Enshi Tujia and Miao Autonomous Prefecture

The preservation of Chinese traditional villages plays a crucial role in promoting the sustainable development of rural natural, cultural, and ecological environments. It is also a key strategy for achieving rural revitalization. Current research on traditional villages predominantly focuses on the realm of cultural landscapes, with an emphasis on preserving the cultural ecological value of these communities. In comparison, discussions on the quality of the ecological environment of villages from the perspectives of natural environment, economic environment, and the social organizational environment within regional development are relatively scarce. Our study employed GIS and RS technology and refers to the Technical Criterion for Ecosystem Status Evaluation. Several sub-indices of the ecological environment status, including the biological richness index, vegetation coverage index, water network density index, and land stress index, were selected to construct an ecological environment assessment model. This model was used to analyze the spatial–temporal changes in the ecological environment status of each county, county-level city, and traditional village within the jurisdiction of Enshi Tujia and Miao Autonomous Prefecture and its surrounding areas from 2010 to 2020. The study quantitatively evaluated the ecological environment status of each county, county-level city, and village in Enshi before and after the implementation of traditional village preservation policies. Through comparative analysis, the study revealed the impact of these policies on the natural ecological environment of the study area. The results indicated the following: (1) From 2010 to 2020, the ecological index (EI) values in the villages of Enshi Prefecture exhibited a similar trend to the EI values in the respective counties and county-level cities they are located in, although significant differences in magnitude of change were observed. (2) The EI values in the counties, county-level cities, and villages demonstrated greater variation in the latter five years of the decade (2015–2020) compared to the previous five years (2010–2015). (3) In 2020, the EI value of the villages experienced more significant changes compared to 2010, whereas the overall EI value of the counties and county-level cities showed less pronounced changes. The findings of this study suggest that the traditional village preservation policies implemented in Enshi Prefecture have both positive and negative impacts on the ecological environment of the surrounding areas of protected villages, and these impacts become increasingly evident over time. By comparing and analyzing the ecological changes in the surrounding areas of traditional villages in Enshi Prefecture with the overall ecological changes in the respective counties and county-level cities, our study employs quantitative analytical methods to delve into the impact of traditional village conservation policies on the natural ecological environment. It assesses the effects of policy implementation on the natural ecological environment of traditional villages, analyzing both the positive and negative impacts brought about by the execution of these policies, with the aim of effectively guiding the natural ecological conditions of traditional villages towards a more healthy trajectory of development.

Transarterial chemoembolisation combined with lenvatinib plus pembrolizumab versus dual placebo for unresectable, non-metastatic hepatocellular carcinoma (LEAP-012): a multicentre, randomised, double-blind, phase 3 study.

Transarterial chemoembolisation (TACE) is standard care for unresectable, non-metastatic hepatocellular carcinoma. We aimed to evaluate the addition of lenvatinib and pembrolizumab to TACE versus dual placebo plus TACE in patients with unresectable, non-metastatic hepatocellular carcinoma. In this multicentre, randomised, double-blind, phase 3 study (LEAP-012), patients were recruited from 137 global sites in 33 countries or regions. Eligible patients were age 18 years or older with unresectable, non-metastatic hepatocellular carcinoma not amenable to curative treatment, but with tumours amenable to TACE, Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1, and Child-Pugh class A disease. Eligible participants were randomly assigned (1:1), stratified by study site, α-fetoprotein level, ECOG performance status, albumin-bilirubin grade, and tumour burden, by a central interactive response system, to receive TACE and either oral lenvatinib (bodyweight ≥60 kg: 12 mg; bodyweight <60 kg: 8 mg; once daily) plus intravenous pembrolizumab (400 mg once every 6 weeks for up to 2 years) or matched dual placebo (oral and intravenous). Primary endpoints were progression-free survival (threshold one-sided p=0·025), per Response Evaluation Criteria in Solid Tumours version 1.1 (modified for the current study to allow for up to five target tumours in the liver and requiring new intrahepatic tumours to meet LI-RADS 5 criteria to be considered progressive disease) by blinded independent central review, and overall survival (threshold one-sided p=0·0012) in the intention-to-treat (ITT) population (ie, all participants randomly assigned to treatment). Safety was assessed in the as-treated population (ie, all participants who were randomly assigned and received at least one dose of any study treatment). Here, we report results from the first interim analysis (final analysis for progression-free survival). This study is registered with ClinicalTrials.gov, NCT04246177, and is active but not recruiting. Between May 22, 2020, and Jan 11, 2023, 847 patients were screened, of whom 480 (57%) were enrolled and randomly assigned to receive TACE plus lenvatinib plus pembrolizumab (n=237) or TACE plus dual placebo (n=243; ITT population). Median age was 66 years (IQR 58-73), 82 (17%) of 480 participants were female, 398 (83%) were male, 98 (20%) were White, 347 (72%) were Asian, four (1%) were Black or African American, and five (1%) were American Indian or Alaska Native. Median follow-up as of data cutoff (Jan 30, 2024) was 25·6 months (IQR 19·5-32·4). Median progression-free survival was 14·6 months (95% CI 12·6-16·7; 132 events [20 deaths and 112 progressions]) with lenvatinib plus pembrolizumab and 10·0 months (8·1-12·2; 154 events [eight deaths and 146 progressions]) with placebo (hazard ratio [HR] 0·66 [95% CI 0·51-0·84]; one-sided p=0·0002). 69 (29%) of 237 in the lenvatinib plus pembrolizumab group and 82 (34%) of 243 from the placebo group died, with a 24-month overall survival rate of 75% (95% CI 68-80) in the lenvatinib plus pembrolizumab group and 69% (62-74) in the placebo group (HR 0·80 [95% CI 0·57-1·11]; one-sided p=0·087). Grade 3 or worse treatment-related adverse events occurred in 169 (71%) of 237 participants in the lenvatinib plus pembrolizumab group and in 76 (32%) of 241 in the placebo group, the most common of which were hypertension (57 [24%] vs 18 [7%]) and platelet count decreased (27 [11%] vs 15 [6%]). Deaths due to treatment-related adverse events occurred in four (2%) participants in the lenvatinib plus pembrolizumab group (n=1 each due to hepatic failure, gastrointestinal haemorrhage, myositis, and immune-mediated hepatitis) and one (<1%) in the placebo group (due to brain stem haemorrhage). TACE plus lenvatinib plus pembrolizumab showed significant, clinically meaningful improvement in progression-free survival in patients with unresectable, non-metastatic hepatocellular carcinoma compared with TACE plus placebo. The numerical improvement in overall survival is encouraging, but longer follow-up is necessary. Merck Sharp & Dohme, a subsidiary of Merck & Co, Inc, Rahway, NJ, USA, and Eisai, Nutley, NJ, USA.

Durvalumab with or without bevacizumab with transarterial chemoembolisation in hepatocellular carcinoma (EMERALD-1): a multiregional, randomised, double-blind, placebo-controlled, phase 3 study.

Transarterial chemoembolisation (TACE) is standard of care for patients with unresectable hepatocellular carcinoma that is amenable to embolisation; however, median progression-free survival is still approximately 7 months. We aimed to assess whether adding durvalumab, with or without bevacizumab, might improve progression-free survival. In this multiregional, randomised, double-blind, placebo-controlled, phase 3 study (EMERALD-1), adults aged 18 years or older with unresectable hepatocellular carcinoma amenable to embolisation, an Eastern Cooperative Oncology Group performance status of 0 or 1 at enrolment, and at least one measurable intrahepatic lesion per modified Response Evaluation Criteria in Solid Tumours (RECIST) were enrolled at 157 medical sites including research centres and general and specialist hospitals in 18 countries. Eligible patients were randomly assigned (1:1:1), stratified by TACE method, region, and portal vein invasion, using an interactive voice response or web response system, to TACE plus either durvalumab plus bevacizumab (1500 mg intravenous durvalumab once every 4 weeks, then 1120 mg durvalumab plus 15 mg/kg intravenous bevacizumab once every 3 weeks), durvalumab plus placebo (same regimen using placebo instead of bevacizumab), or placebo alone (same regimen using placebo instead of durvalumab and instead of bevacizumab). Participants, investigators, and those assessing outcomes were masked to treatment assignment until data analysis. The primary endpoint was progression-free survival, by blinded independent central review (BICR), and per RECIST version 1.1, with durvalumab plus bevacizumab versus placebo alone in the intention-to-treat population (ITT; ie, all participants assigned to treatment). Key secondary endpoints were progression-free survival by BICR per RECIST version 1.1 with durvalumab plus placebo versus placebo alone, overall survival, and time to deterioration in select patient-reported outcomes. Participants continue to be followed up for overall survival, and overall survival and patient-reported outcomes will be reported in a later publication. Safety was assessed in the safety analysis set, which included all participants assigned to treatment who received any study treatment (ie, any durvalumab, bevacizumab, or placebo) by treatment received. This study is registered with ClinicalTrials.gov, NCT03778957, and is closed to accrual. Between Nov 30, 2018, and July 19, 2021, 887 patients were screened, of whom 616 were randomly assigned to durvalumab plus bevacizumab (n=204), durvalumab plus placebo (n=207), or placebo alone (n=205; ITT population). Median age was 65·0 years (IQR 59·0-72·0), 135 (22%) of 616 participants were female, 481 (78%) were male, 375 (61%) were Asian, 176 (29%) were White, 22 (4%) were American Indian or Alaska Native, nine (1%) were Black or African American, one (<1%) was native Hawaiian or other Pacific Islander, and 33 (5%) were other races. As of data cutoff (Sept 11, 2023) median follow-up for progression-free survival was 27·9 months (95% CI 27·4-30·4), median progression-free survival was 15·0 months (95% CI 11·1-18·9) with durvalumab plus bevacizumab, 10·0 months (9·0-12·7) with durvalumab, and 8·2 months (6·9-11·1) with placebo. Progression-free survival hazard ratio was 0·77 (95% CI 0·61-0·98; two-sided p=0·032) for durvalumab plus bevacizumab versus placebo, and 0·94 (0·75-1·19; two-sided p=0·64) for durvalumab plus placebo versus placebo. The most common maximum grade 3-4 adverse events were hypertension in participants who received durvalumab and bevacizumab (nine [6%] of 154 participants), anaemia in participants who received durvalumab and placebo (ten [4%] of 232 participants), and post-embolisation syndrome in participants who received placebo alone (eight [4%] of 200 participants). Study treatment-related adverse events that led to death occurred in none of 154 participants who received durvalumab and bevacizumab, three (1%) of 232 who received durvalumab and placebo (n=1 for arterial haemorrhage, liver injury, and multiple organ dysfunction syndrome), and three (2%) of 200 who received placebo alone (n=1 for oesophageal varices haemorrhage, upper gastrointestinal haemorrhage, and dermatomyositis). Durvalumab plus bevacizumab plus TACE has the potential to set a new standard of care. With additional follow-up of the EMERALD-1 study, future analyses, including the final overall survival data and patient-reported outcomes, will help to further characterise the potential clinical benefits of durvalumab plus bevacizumab plus TACE in hepatocellular carcinoma amenable to embolisation. AstraZeneca.

Why Do ESG Rating Differences Affect Audit Fees?—Dual Intermediary Path Analysis Based on Operating Risk and Analyst Earnings Forecast Error

As environmental, social, and governance (ESG) issues become increasingly important, ESG ratings have become a significant factor influencing audit fees for businesses. However, ESG ratings are typically assessed by multiple agencies or rating firms and, due to differences in evaluation criteria, methodologies, and data sources, the ratings provided by different institutions may vary considerably. Therefore, research on the impact of discrepancies in ESG ratings on audit fees is of great significance. This paper examines this phenomenon by analyzing a sample of Chinese listed companies from 2015 to 2022, yielding 3056 observational values through various methodologies. The study employs two-way fixed effects methods. The findings indicate that discrepancies in ESG ratings significantly elevate enterprises’ audit expenses, with operating risk and analyst earnings forecast errors serving as intermediary factors. Additionally, media attention intensifies these effects by increasing corporate disclosure, intensifying regulatory pressure, and heightening reputational risks for the company, and the positive impact of ESG rating discrepancies on audit fees is more significant when the “Big 4” accounting firms are involved in the audit. The research offers insights for enterprises, auditors, and regulatory bodies, contributing to the enhanced implementation of the ESG concept and fostering sustainable enterprise development.

Generative AI in Higher Education: Challenges and Opportunities for Course Learning

Generative Artificial Intelligence (GenAI) is transforming course learning in higher education. This study, based on two rounds of action research in two college courses, reveals critical challenges in this transformation. Findings indicate that students' reliance on GenAI can hinder their autonomy, critical thinking, and affective-social learning, while also raising concerns about content accuracy, intellectual property rights, and privacy. Although teacher guidance partially mitigates these issues, enhanced strategies are crucial. This study provides practical implications for optimizing curriculum design, teaching methods, and evaluation criteria, emphasizing the need to incorporate ethics education and strengthen emotional-social guidance. Future research directions are suggested to address the challenges of GenAI and ensure educational quality and student development.

A Versatile Point Cloud Compressor Using Universal Multiscale Conditional Coding - Part I: Geometry.

A universal multiscale conditional coding framework, Unicorn, is proposed to compress the geometry and attribute of any given point cloud. Geometry compression is addressed in Part I of this paper, while attribute compression is discussed in Part II. We construct the multiscale sparse tensors of each voxelized point cloud frame and properly leverage lower-scale priors in the current and (previously processed) temporal reference frames to improve the conditional probability approximation or content-aware predictive reconstruction of geometry occupancy in compression. Unicorn is a versatile, learning-based solution capable of compressing static and dynamic point clouds with diverse source characteristics in both lossy and lossless modes. Following the same evaluation criteria, Unicorn significantly outperforms standard-compliant approaches like MPEG G-PCC, V-PCC, and other learning-based solutions, yielding state-of-the-art compression efficiency while presenting affordable complexity for practical implementations.

Response if the Three Mainstay Treatments for Chronic Inflammatory Demyelinating Polyradiculoneuropathy Are Ineffective or Insufficient

The effectiveness of chronic inflammatory demyelinating polyneuropathy (CIDP) treatment is difficult to evaluate based on disease characteristics and treatment methods. The first basic concept of CIDP treatment is "to prevent undertreatment due to inadequate treatment and not overlook patients who can be saved." The second concept is "to prevent overtreatment by unnecessary treatment and discontinue excessive therapy for patients." The evaluation of CIDP treatment requires a treatment period of at least six months. For CIDP pathology and nerve regeneration mechanisms, the response should be divided into four evaluation criteria; marked improvement, no effect, and insufficient effect (slight improvement or no change).