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This study mainly focuses on the risk assessment of public–private partnership (PPP) projects. Evaluating the risks of PPP projects precisely is critical to their successful implementation. However, the traditional approaches often lack mechanisms in manipulating imprecise and vague information, and they need auxiliary information or pre-assumptions (e.g., preset fuzzy membership functions). To solve this problem, an integrated method for evaluating risks in public–private partnership projects is proposed. This method is based on the strength of the group analytic hierarchy process (GAHP), rough set theory, and cloud model theory. The proposed approach integrates the strength of rough set theory in coping with vagueness of the information from experts’ assessments without much pre-assumptions, the advantage of cloud model theory in investigating the randomness of experts’ judgments, and the merit of the AHP method in evaluation under multiple criteria and complex situation. Finally, an application in a PPP project in Wuhu, China, is provided to show the feasibility and effectiveness of the proposed method. The proposed approach is effective in modeling hierarchy assessment as well as dealing with vagueness and randomness, and it can help managers to make reasonable and effective decisions in risk management.

Background Artificial intelligence (AI) assistance has been considered as a promising way to improve colonoscopic polyp detection, but there are limited prospective studies on real‐time use of AI systems. Methods We conducted a prospective, multicenter, randomized controlled trial of patients undergoing colonoscopy at six centers. Eligible patients were randomly assigned to conventional colonoscopy (control group) or AI‐assisted colonoscopy (AI group). AI assistance was our newly developed AI system for real‐time colonoscopic polyp detection. Primary outcome is polyp detection rate (PDR). Secondary outcomes include polyps per positive patient (PPP), polyps per colonoscopy (PPC), and non‐first polyps per colonoscopy (PPC‐Plus). Results A total of 2352 patients were included in the final analysis. Compared with the control, AI group did not show significant increment in PDR (38.8% vs. 36.2%, p = 0.183), but its PPC‐Plus was significantly higher (0.5 vs. 0.4, p, Artificial intelligence (AI) assistance plays a limited role in overall polyp detection. AI system increases detection of easily missed polyps, including non‐first polyps, diminutive and flat polyps. The impact is greater for male operators, longer withdrawal time, and elderly obese patients.

Background/Aim This study aimed to investigate the clinical significance of changes in vitamin D [25(OH)D] levels and vitamin D receptor (VDR) mRNA expression in colorectal adenoma development. Methods Plasma concentrations of 25(OH)D and mRNA expression of VDR in tissues were determined by enzyme‐linked immunosorbent assay (ELISA) and real‐time fluorescence quantitative polymerase chain reaction (RT‐qPCR), respectively. In addition, the concentration of plasma 25(OH)D and levels of VDR mRNA in tissues were compared among healthy individuals and adenoma and adenocarcinoma patients. Results Vitamin D receptor expression in colorectal adenocarcinoma tissues was significantly lower than that in para‐cancerous tissues that were >5 cm away from malignant tumor sites (p, The levels of 25(OH)D and VDR mRNA expression might be associated with the development of colorectal adenoma and the progression to adenocarcinoma.

In this study, glue-pressed engineered honeycomb bamboo (GPEHB) was prepared, and the dependence of the compressive properties of the produced GPEHB on the load–slenderness ratio, longitudi...

Concerning the problem that the existing face recognition algorithm fails to exhibit good robustness when dealing with multi-view mixed face data, a multi-view face recognition method based on low-rank features and auxiliary dictionary is proposed. The method is designed to select low-rank decomposition models with two different regular terms and complete the feature extraction process respectively, and reduce the difference of same people faces in different views. The obtained low-rank feature can enhance the discriminating information of different types of faces in the same view, and remove the influence of common parts on the recognition effect. Then, using the external data to learn auxiliary dictionary which can simulate view variable and a residual ratio comparison model based on the minimum residual and the secondary minimum residual is designed. Finally, the final classification results are determined based on the results of auxiliary dictionary learning and residual ratio comparison. Experiments on the multi-view face database CMU-PIE with or without auxiliary dictionary show that the improved method can obtain low-rank face discrimination information and eliminate the gesture interference effectively. The proposed face recognition algorithm has more efficient recognition rate and robustness in the experimental environment of multi-view mixed data.

On the basis of overall mechanical structure of existing lower limb exoskeleton robot, a key ankle joint protecting component of ankle joint mechanism is improved and designed. According to person's steps, the dimension and the model of the protecting component are specified by using SolidWorks, and the person's two kinds of gestures are determined. The concept of forces' balance in the plane is derived from a principle of zero moment point balance. The correctness of forces' balance in the plane is verified in the force analysis of an ankle joint. It puts forward the necessity of security design after wearing the component. The finite element analysis and mesh refinement of the component is finished by using ANSYS. Calculating and contrasting through the simulation analysis and check-theories, the test data were obtained by using static analysis method with a constant force, and adopting the transient analysis method with an instantaneous moment. The design and material of the component are demonstrated safety, which provided a mechanics research reference for other joints' key components.

Aim Evidence of the lungs being a target organ of diabetes-related pathophysiology is increasing, and decreased pulmonary function increases the risk of diabetes after adjusting for demographic and metabolic factors. This systematic review and meta-analysis evaluates the bidirectional relationship between diabetes and pulmonary function. Methods MEDLINE, Embase, The Cochrane Library and Web of Science databases were searched, and all studies describing this bidirectional relationship were identified. Two reviewers independently extracted study characteristics and assessed the risk of bias. Results A total of 93 studies were included in the meta-analysis. The pooled weighted mean difference (WMD) between diabetes patients and non-diabetic participants for forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) were −5.65% and −5.91%, respectively, of predicted values. Diabetes-related microvascular complications and poor glycaemic control were associated with poorer pulmonary function in those with diabetes. In addition, diabetes was associated with a restrictive spirometry pattern (RSP) in both cross-sectional studies [odds ratio (OR): 2.88, 95% confidence interval (CI): 2.18–3.81, I2 = 0.0%] and prospective cohort studies [hazard ratio (HR): 1.57, 95% CI: 1.04–2.36]. In five longitudinal studies, the conclusions were inconsistent as to whether or not diabetes accelerates pulmonary function decline. However, every 10% decrease in baseline predicted FVC value was associated with a 13% higher risk of incident diabetes (HR: 1.13, 95% CI: 1.09–1.17, I2 = 0.0%). Conclusion There is a bidirectional relationship between diabetes and pulmonary function. However, further investigations into whether dynamic changes in glycaemic levels before and shortly after diabetes onset mediate the deleterious effects on pulmonary function, or vice versa, are now required.

Lending was of importance in finance of Song Dynasty, and the government constituted strict laws and regulations to control the risk. Those measures had made great contribution to the sustainable financial market by maximizing the strengths of lending and lessening the loss of individuals and instability of society caused by bad loans. Nevertheless, there were many problems in the policy implementation that the officials violated the law and discipline. Thus, coordination should be made between soft constraint and hard constraint, which needs conditions to support (mainly the advance in scientific technology).

With the expansion of the scale of intelligent power distribution network and the complexity of power grid structure, the amount of data in power system increases rapidly, and the power equipment are faced with new challenges. Based on the principle of big data and data mining analysis, this paper proposes a method based on random matrix theory and clustering algorithm to evaluate the running state of electric energy meter. Specifically, time series data of various indicators is characterized by real-time separation window technology. Based on the random matrix theory, the random matrix based analysis model is constructed to calculate and analyze the statistical timing characteristics in real time. The proposed method has good robustness, reliability and timeliness, which provides a new idea for the application research of power grid detection technology.

Diabetic retinopathy is the most common eye complication of diabetes and one of the major causes of human blindness. The main causes of visual impairment are diabetic macular edema and proliferative diabetic retinopathy. From the perspective of endocrinologists, for patients with diabetic retinopathy, systemic treatments, including the control of blood glucose and blood lipids, are equally important as local treatment for the treatment of lesions that have occurred and prevention of visual impairment from occurring. Patients who need early intervention in diabetic retinopathy patients should be retained in the endocrinology department, and high-risk patients should be referred to the ophthalmology department, particularly those who need to be diagnosed and screened for severe non-proliferative retinopathy. This is a key issue to be solved. Through integration of the latest advances in epidemiological studies and clinical experiences, regular diabetic retinopathy screening, and intervention against risk factors, it is possible to prevent the occurrence of diabetic retinopathy. This chapter can help us understand how endocrinology and ophthalmology should work together to achieve the goal that the patients who need early intervention (not yet with diabetic retinopathy) stay in the endocrinology department for control of blood sugar, while high-risk patients (with diabetic retinopathy that may impact visual acuity) are referred to the ophthalmology department. Let’s work together to improve the quality of life of patients by preventing or reducing the occurrence of visual impairment.

In this work we successfully integrated the split-gate SuperFlash® ESF1 cell into our 130nm BCD (Bipolar-CMOS-DMOS) platform for automotive applications. The platform enhances the modularity of flash macro in addition to logic devices, high performance power devices up to 85V as well as complimentary analog devices such as a BJT, MIM and Poly Resistor. Besides maintaining BCD device performance, the embedded flash operating temperature range from - 40°C to 170°C, programmability, chip erase & read access time well meet the specifications. Endurance cycling of up to 20k cycles and data retention of over 20 years well satisfy AECQ-100 Automotive Grade 0 requirements.

In order to solve the problem of applying super-tonnage prestressing force to the gate pier in the process of dam reinforcement, this paper presents a comparative study on the three groups of test specimens of prestressed counterbore self-locking anchor rod and unbonded prestressed anchor cable. T show: (a)both methods satisfy the needs of applying prestress, the experiment conducted on the gate pier that is to be renovated has tested the prestress loss of two schemes and the concrete stress in both free section and anchor section after applying the prestress. The results and counterbore self-locking anchor rod boasts shorter anchorage section and better applicability. (b) the anchorage sections of two schemes generate additional tensile stress, and the maximum additional tensile stress in the anchor rod features 54% less than that of anchor cable, smaller range of additional tensile stress and more reasonable stress state of concrete than that of anchor cable.

Aim: Substantial percentage of patients with T2D have asymptomatic Coronary Heart disease (CHD). To explore identification of PDR to asymptomatic CHD. We reported the baseline data from this IPAD reach group study, a China retrospective cohort study on clinical predictors of asymptomatic CHD in type 2 diabetes. Method: T2D individuals (211non-DR (NDR) and 140 proliferative DR (PDR)) from a national diabetes center in China. The area under the receiver operating characteristic curve (AUC) were created. Discrimination and reclassification were used to assess the value of addition of PDR to the base model. Results: Investigation included 211 NDR and 140 PDR. With the model estimating risk of asymptomatic CHD based on UKPDS engine, the AUC analysis improved from 0.583 (95% CI, 0.51-0.66) to 0.697 (95% CI, 0.641- 0.752) in the model without PDR and with PDR. The addition of PDR to a base model (8 traditional risk factors) to identify asymptomatic CHD increased the C statistic from 0.746 (95% CI, 0.681-0.811) to 0.762 (95% CI, 0.699-0.825; P=0.73). With the addition of PDR to the base model, there was a continuous net reclassification indexes (NRI) of 5.9% (95% CI, 1.4%-10.2%, p=0.017) for asymptomatic CHD. The absolute integrated discrimination index (IDI) was 0.004 (p= 0.02), with a relative IDI of 10.4%. Conclusions: The improvement in identification of asymptomatic CHD, compared with traditional risk factors, demonstrates that PDR could identify cardiovascular risk stratification in Chinese diabetic individuals. Follow-up of this cohort will provide reliable information on asymptomatic CHD risk. Disclosure J. Zhou: None. J. Yang: None.

Failure of insulated gate bipolar transistors (IGBTs) can make a serious impact on the entire rectification or inverter system. IGBTs are used in different practical applications, causing a large difference in the form of failure of its solder layer. Therefore, it is necessary to study the aging failure law of IGBT solder layer. Firstly, the improved IGBT dynamic model is used to build a three-phase rectifier circuit and correct its circuit power consumption error. Then constructing three-dimensional finite element model of IGBT and analyzing its chip temperature and solder layer stress distribution under electro-thermal-force multiphysics coupling. Finally, the randomly generated solder layer defects are used to investigate the effects of voids, cracks, etc. on solder layer failure, and the aging failure mechanism of the solder layer is obtained. The simulation results show that after the solder layer defect area ratio is higher than 15%, solder layer voids, cracks and shedding have a significant effect on chip junction temperature and solder layer stress. Among them, shedding and cracks have a greater influence on the stress of the solder layer.

Primary biliary cholangitis (PBC) is an autoimmune liver disease with a strong hereditary component. Here, we report a genome-wide association study that included 1,122 PBC cases and 4,036 controls of Han Chinese descent, with subsequent replication in a separate cohort of 907 PBC cases and 2,127 controls. Our results show genome-wide association of 14 PBC risk loci including previously identified 6p21 (HLA-DRA and DPB1), 17q12 (ORMDL3), 3q13.33 (CD80), 2q32.3 (STAT1/STAT4), 3q25.33 (IL12A), 4q24 (NF-κB) and 22q13.1 (RPL3/SYNGR1). We also identified variants in IL21, IL21R, CD28/CTLA4/ICOS, CD58, ARID3A and IL16 as novel PBC risk loci. These new findings and histochemical studies showing enhanced expression of IL21 and IL21R in PBC livers (particularly in the hepatic portal tracks) support a disease mechanism in which the deregulation of the IL21 signalling pathway, in addition to CD4 T-cell activation and T-cell co-stimulation are critical components in the development of PBC., Primary biliary cholangitis is an autoimmune liver disease. Here, the authors show that variants in interleukin genes which potentially deregulate their expression are associated with this condition, and suggest that the IL21 signalling pathway may have a role in disease aetiology.

In this paper, we combine with the requirements of clinical medicine professional certification to carry out reforms on the aspects of organic chemistry teaching contents, teaching methods, teaching content and evaluation of teaching effectiveness and teaching real research, and teaching staff construction with some certain success. Medical organic chemistry is a basic subject for student who majored in clinical specialty and provides the necessary basic knowledge of organic chemistry, basic theory and basic skills for medical students. The original pure chemical education makes students feel bored in organic chemistry class with weariness that chemistry knowledge is not very useful to his profession. In order to meet the clinical needs of the times and the assessment of professional certification, we not only introduce organic compounds react with each other outside of the structure, properties and matter, but also to highlight organic chemistry close contact with the medicine. Medical students are introduced to some of the related chemical application of knowledge with increased bio-organic chemistry of life, etc. We prune some content which is far away from medication to enhance penetration and clinical application of chemical knowledge for student, so that they could not only obtain some basic knowledge of chemistry, but also to grasp the chemical tools to explore highly specialized problems. For example: When we run into the study of enantiomers definition in Chapter" basic theory of the stereochemistry " , we focus on learning the differences

To evaluate the influence of different vitrectomy probe gauge sizes and their fluidics, under various vacuum settings, on tissue attraction.An apparatus was designed to model the retinal membrane during vitrectomy. A cantilever beam was constructed from a wire (diameter, 0.076 mm) with a latex strip (simulating ocular membranes) attached at a right angle to its tip. The beam was clamped vertically in a container of balanced salt solution. The port of the vitrectomy probe (20 gauge, 23 gauge, and enhanced 25 gauge) was aligned with the membrane. With the cutter off, the vacuum was increased until the membrane was attracted into the port. The aspiration flow rate was measured with a noninvasive flow meter. Attraction distance, vacuum pressure, and flow rate were recorded.For any given distance, the 20-gauge probe needed the lowest amount of vacuum and the highest aspiration flow, while the enhanced 25-gauge and 23-gauge probes needed larger vacuum and smaller aspiration flow rates to attract the membrane into the port.The sphere of influence on surrounding tissue was greatest with large-gauge vitrectomy probes. This laboratory model indicated that small-gauge probes could be used to target specific tissues while minimizing the effects on adjacent tissue structures.

The proliferation of glomerular mesangial cells (GMC) and secretion of the extracellular matrix (ECM) in rat with Thy-1 nephritis (Thy-1N) resembling human mesangioproliferative glomerulonephritis have been explored for many years; however, the molecular mechanisms of GMC proliferation and ECM production remain unclear. Our previous studies have demonstrated that the thrombospondin-1 (TSP-1) gene was involved in mediating rat GMC proliferation and ECM synthesis induced by sublytic C5b-9 in vitro. In the present study, the roles of the TSP-1 gene in GMC proliferation, ECM production, and urinary protein secretion in Thy-1N rats were determined by using TSP-1 small hairpin RNA, and the results revealed that silencing of the TSP-1 gene in rat renal tissues could diminish GMC proliferation (P < 0.01) and ECM secretion (P < 0.01) as well as urinary protein secretion (P < 0.05) in Thy-1N rats. Together, the current findings suggested that TSP-1 gene expression was required for GMC proliferation and ECM production in Thy-1N rats.

With the increasing scarcity of wood as a natural resource, bamboo has become a popular substitute for wood. The present work developed a high-strength original state multi-reorganization material (GPEHB), without the use of a hot press or traditional assembly. The original bamboo units were polygonized into outer contours and milled into finger-joints on each ending. The GPEHB was organized and assembled under an external press, using industrial adhesives. The mechanical properties and thermal insulation of GPEHB were characterized. Moreover, the overall GPEHB unit bending strength was 73.15 MPa, and the parallel-to-grain compression was 55.22 MPa (higher than that of Pinus sylvestris lumber, though less than that of glued laminated bamboo). The GPEHB unit overall density was 0.24 g/cm³, 76% lower than that of glued laminated bamboo, and 50% lower than Pinus sylvestris lumber. The compressive strength of GPEHB (7 units) was 170.5 kN, while the compressive strength of GPEHB for 14 units was 493.5 kN, which meet the requirements of GB 50005 (2003). The bending strength of GPEHB 7 units was 12 kN, while that of 14 units was 37 kN. The heat conductivity coefficient for GPEHB was 0.25 W/mK, which is better than concrete and steel. The GPEHB has taken full advantage of its honeycomb-structured material, which allows it to avoid stress concentration in the regular polygonal corners.

An artificial neural network for pollution evaluation is introduced in this paper which contributes to design an expert system for flashover predicting. The network measures four parameters (peak impulse current, maximum low-frequency current, humidity and voltage) which reflect the insulating property of an insulator and outputs the pollution level. After enough of training, the outputs of the network show great agreement with the experiment results. However, accuracy of the network is influenced by the training sample.

Purpose To theorize the effect of Schlemm canal (SC) and/or collector channel (CC) dilation combined with a trabecular bypass on intraocular pressure (IOP) in eyes with primary open angle glaucoma. Methods The elliptic shaped SC is dilated in conjunction with a trabecular bypass and its expanded height is largest at the bypass and linearly deceases to the nondilated height over the dilated circumferential length. The CC dilation is modeled with a reduced outflow resistance of second order polynomial over the same dilated length. Equations governing the pressure and circumferential flow in SC are solved numerically for both the unidirectional and bidirectional bypasses. The reduced IOP is deduced from the solution. Results IOP is reduced substantially with moderate SC dilation from the normal height of 20 microm to 40 to 50 microm at the bypass; additional IOP reduction diminishes with further dilation. SC dilation is more effective for eyes with smaller SC. CC dilation also lower IOP significantly. With the trabecular bypass alone, the elevated IOP in primary open angle glaucoma is expected to drop to the mid-to-high teens. IOP can be further reduced by another 3 to 6 mm Hg with moderate SC and CC dilation. The circumferential length of dilated SC affects the efficacy of IOP reduction. In theory, the dilation of SC with a trabecular bypass is analogous to a partial trabeculotomy in terms of IOP reduction. Conclusions In theory, a moderate dilation of SC and CC in conjunction with a trabecular bypass reduces the IOP to the low-to-mid teens.

Purpose To introduce a hypothesis that theorizes the effect of a trabecular bypass, a channel created through the trabecular meshwork, on the facility of outflow and the intraocular pressure (IOP). Methods Equations that govern the pressure and circumferential flow in Schlemm's canal are established, based on the linear relationships between pressure drop and flow, the balance of flows in the canal, and a uniform leaking structure of collector channels. Two types of bypasses permitting either unidirectional or bidirectional flow are incorporated through boundary conditions to solve the equations and to derive the facility of outflow and the reduced IOP. Results In normal healthy eyes, the facility of outflow increases by 13% and 26% in the presence of a unidirectional and bidirectional bypass, respectively. The circumferential flow is significant only in the immediate quadrant to the bypass. The elevated IOP due to the abnormally high resistance in trabecular meshwork in open angle glaucoma is substantially reduced with a single bypass. Mean physiological level of IOP is attained if the bidirectional bypass is placed; slightly higher IOP is attained if a unidirectional bypass is placed. In either case, the higher the baseline IOP, the greater the reduction. The effectiveness of the bypass on IOP reduction is related to the resistances in the canal and the collector channels. Multiple bypasses can be used to further reduce the IOP. Conclusion It is theoretically demonstrated that a single patent trabecular bypass can enhance the facility of outflow and reduce the IOP to physiological levels.

To determine the effect on intraocular pressure (IOP) of bypassing the trabecular meshwork in cultured human anterior segments.Prospective laboratory investigation using normal human eyes obtained at autopsy.Anterior segments from 21 eyes were placed in perfusion culture, and trabecular bypass stents were inserted through the trabecular meshwork, with the lumen of the tube opening into Schlemm's canal. Eyes received from one to four stents, placed equidistant apart. In eyes receiving one or two stents, additional stents were later added to a maximum of four per eye.Intraocular pressure was lowered after placement of a single stent, from 21.4 +/- 3.8 mm Hg to 12.4 +/- 4.2 (P.001). This corresponded to an 84% increase in facility of outflow. Eyes receiving more than one stent had final IOP of 11.9 +/- 3.7 mm Hg. Nine eyes had sequential addition of stents, and seven of these had a further decrease of IOP (13.6 +/- 4.1 to 10.0 +/- 4.3; P = .02). Excision of the entire meshwork, between stents, dropped IOP to 6.3 +/- 3.2 mm Hg, indicating some residual meshwork or canal resistance remained even after placement of three stents.Bypass of the trabecular meshwork lowers IOP in cultured human anterior segments. One stent produced the greatest change in pressure. The sequential addition of more stents further lowered pressure in seven of nine eyes. This technique holds promise as a new clinical surgery for glaucoma.