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The intricacies of air traffic departure scheduling, especially when numerous flights are delayed, frequently impede the implementation of automated decision-making for scheduling. To surmount this obstacle, a mathematical model is proposed, and a dynamic simulation framework is designed to tackle the scheduling dilemma. An optimization control strategy is based on adaptive dynamic programming (ADP), focusing on minimizing the cumulative delay time for a cohort of delayed aircraft amidst congestion. This technique harnesses an approximation of the dynamic programming value function, augmented by reinforcement learning to enhance the approximation and alleviate the computational complexity as the number of flights increases. Comparative analyses with alternative approaches, including the branch and bound algorithm for static conditions and the first-come, first-served (FCFS) algorithm for routine scenarios, are conducted. Moreover, perturbation simulations of ADP parameters validate the method's robustness and efficacy. ADP, when integrated with reinforcement learning, demonstrates time efficiency and reliability, positioning it as a viable solution for decision-making in departure management systems. [ABSTRACT FROM AUTHOR]

Aims: To examine whether sublingual microcirculation can be used as an effective and noninvasive method for assessing cardiovascular, kidney, and metabolic risks in patients with type 2 diabetes mellitus (T2DM). Materials and Methods: This cross‐sectional observational study enrolled 186 patients with T2DM. All patients were evaluated using the Framingham General Cardiovascular Risk Score (FGCRS) and cardiovascular‐kidney‐metabolic (CKM) syndrome stage. Side‐stream dark‐field microscopy was used for sublingual microcirculation, including total and perfused vessel density (TVD and PVD). Multiple machine‐learning prediction models have been developed for CKM risk and stage assessment in T2DM patients. Receiver operating characteristic (ROC) curves were generated to determine cutoff points. Results: Compared to patients with T2DM, diabetic patients with subclinical atherosclerosis (SA) had a greater CV risk, as measured by the FGCRS, accompanied by markedly decreased microcirculation perfusion. Microcirculatory parameters (TVD and PVD), including carotid intima–media thickness (IMT), brachial‐ankle pulse wave velocity (ba‐PWV), and FGCRS, were closely associated with SA incidence. Microcirculatory parameters, Index (DMSA screen), and cut‐off points were used to screen for SA in patients with T2DM. Furthermore, a new set of four factors identified through machine learning showed optimal sensitivity and specificity for detecting CKM risk in patients with T2DM. Decreased microcirculatory perfusion served as a useful early marker for CKM syndrome risk stratification in patients with T2DM without SA. Conclusions: Sublingual microcirculatory dysfunction is closely correlated with the risk of SA and CKM risk in T2DM patients. Sublingual microcirculation could be a novel tool for assessing the CKM syndrome stage in patients with T2DM. [ABSTRACT FROM AUTHOR]

Aim: To investigate the relationship between thyroid function and weight regain in patients with obesity after metabolic surgery. Methods: This retrospective study enrolled 162 patients who underwent metabolic surgery. Correlations between decreases in thyroid hormone levels and changes in weight, waist circumference (WC) and the Chinese visceral adiposity index (CVAI) were assessed. Binary logistic regression and receiver operating characteristic (ROC) curves were used to identify predictors and clinically useful cut‐off values, respectively. Results: The levels of thyroid‐stimulating hormone (TSH) and free triiodothyronine (FT3) decreased markedly at 1 year after surgery, as did weight, body mass index (BMI), triglycerides, total cholesterol, high‐density lipoprotein cholesterol, low‐density lipoprotein cholesterol, WC and CVAI. Decreases in TSH and FT3 after metabolic surgery were associated with changes in weight, BMI and CVAI. Binary logistic regression and ROC curve analyses confirmed that decreases in TSH can predict good weight loss after metabolic surgery to some extent. Finally, binary logistic regression and ROC curve analyses confirmed that changes in TSH can predict weight regain after metabolic surgery. Conclusions: Changes in TSH and FT3 after metabolic surgery were correlated with changes in weight and CVAI. Changes in thyroid hormones can predict weight regain in patients with obesity who underwent metabolic surgery. [ABSTRACT FROM AUTHOR]

As the number of foreign patients and the frequency of international academic exchanges increase, English proficiency has become increasingly essential for Chinese nurses in the treatment and nursing processes, clinical academic exchanges, and ongoing education. However, the overall English proficiency of Chinese nurses is generally inadequate, greatly depending on the English that they acquire during their nursing education. This study aims to explore the challenges encountered by Chinese EFL (English as a Foreign Language) nursing students in the process of learning Nursing English, along with the effective self-regulated learning strategies they adopt to overcome these challenges. Data were collected from nine Chinese EFL nursing students through their reflective journals and thematic analysis was applied. Data analysis revealed the variety of challenges EFL nursing students encountered, including language-related challenges, which are linguistic difficulties that relate to Nursing English learning itself, such as Nursing English vocabulary and terminology, English-to-English translation, limited listening comprehension, and the gap between textbook knowledge and its practical application; learner-related challenges, which are difficulties that affect students' emotional, affective, and mental state, primarily caused by uncertainty about the significance of Nursing English, the unexpected difficulty of Nursing English, and failing quizzes; and context-related challenges, which are difficulties relate to social, cultural, and educational context, such as insufficient learning resources, a lack of language environment, and peer pressure. To surmount these challenges, the participants adopted diverse self-regulated learning strategies, including setting goals, previewing in advance and reviewing in time, utilizing word roots, prefixes, and suffixes to facilitate vocabulary learning, repeating, practicing with sounds and writing systems, translating, highlighting and using imagery to overcome language-related challenges; believing in the usefulness and significance of Nursing English, keeping a growth mindset, enjoying Nursing English learning and teacher support and maintaining grit in learning Nursing English to overcome learner-related challenges; and integrating resources, creating supportive language environments and seeking assistance from teachers and cooperating with peers to overcome context-related challenges. Based on these findings, implications are drawn for Nursing English teachers, material designers, curriculum developers, and program designers. We suggest incorporating explicit strategy instruction into regular Nursing English education to enhance nursing students' self-regulated learning. [ABSTRACT FROM AUTHOR]