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OBJECTIVE: Breast cancer has become one of the main diseases threatening women's health and lives. Ultrasound (US) is the first diagnostic option for several patients because of its non-radiation, convenient, and low-cost features. Conventional US combined with contrast-enhanced US (CEUS) has improved diagnostic accuracy, while due to the presence of numerous parameters, no international consensus on diagnostic criteria could be attained. Therefore, it is necessary to develop a reliable diagnostic model with the involvement of a few parameters while increasing the diagnostic accuracy. METHODS: Data from 265 patients, including conventional US, CEUS, and postoperative pathological results, were collected. 21 parameters from the conventional US and both qualitative and quantitative aspects of CEUS were analyzed through univariate and multivariate logistic regression analyses. Specific parameters with independent influential factors were identified. A nomogram was subsequently developed to visually represent the contribution and linear weighting of each parameter. The effectiveness of the new model was assessed through calibration curves and the Hosmer-Lemeshow goodness-of-fit test. RESULTS: Six independent influential factors for breast malignant tumors were identified, including homogeneous echo, lesion vascularity, enhancement mode, enhancement shape, nourishing vessels, and slope. The area under the curve (AUC) values in the training and test datasets were 0.933 and 0.860, respectively. The modified model exhibited satisfactory diagnostic accuracy and operability. CONCLUSION: The modified model, despite incorporating fewer parameters, maintained diagnostic accuracy. It is exhibited as a convenient, effective, and easily deployable model for diagnosing malignant breast nodules.
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While surface-enhanced Raman spectroscopy (SERS) has experienced substantial advancements since its discovery in the 1970s, it is an opportunity to celebrate achievements, consider ongoing endeavors, and anticipate the future trajectory of SERS. In this perspective, we encapsulate the latest breakthroughs in comprehending the electromagnetic enhancement mechanisms of SERS, and revisit CT mechanisms of semiconductors. We then summarize the strategies to improve sensitivity, selectivity, and reliability. After addressing experimental advancements, we comprehensively survey the progress on spectrum-structure correlation of SERS showcasing their important role in promoting SERS development. Finally, we anticipate forthcoming directions and opportunities, especially in deepening our insights into chemical or biological processes and establishing a clear spectrum-structure correlation.
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To analyze Taiwanese ecotourism with international standards, this research employed the social learning theory (SLT) to identify the determinants of Taiwanese community ecotourism with the international standards. This basic theory of social psychology comprehensively assays the interplays and interconnections among the three analytical perspectives (ecotourism tours, destinations, and accommodations), the four essential issues (management, social, cultural, and environment) of the Global Sustainable Tourism Council, the six assessed dimensions of ecotourism resolution from the WCC, and the twenty-nine assessed indexes of the KES ecotourism evaluations. It was then possible to comprehensively explore the sustainable determinants of Taiwanese ecotourism with the international standards through the FA of quantitative and qualitative analyses in combination with the highest research validity, reliability, representativeness, and accuracy. After analyzing the evaluated measurements, the empirical and valuable conclusions and findings are (1) these analytical perspectives, appraised attitudes, evaluated criteria, and sub-criteria positively advance Taiwanese ecotourism with the international standards (PITEEICIS); (2) the sustainable determinants of Taiwanese ecotourism with the international standards include the Support for Capacity Building of the Local Community (SCBLC), Cooperation with the Local Community (CLC), Supports for the Local Enterprises (SLE), Local Participation and Benefits Sharing Duties (LPBSD), Tourist Management (TM), and Responsible Tourist Behaviors Inducement (RTBI). Importantly, the majority of ecotourism industrialists and experts still focus on the economic benefits, such as supporting the local community and enterprises, rather than tourist behavior inducement to stimulate ecotourism participation in order to promote and advance the Taiwanese ecotourism to the international standards; (3) in order to promote Taiwanese ecotourism to the international conventions, the Taiwanese government and organizations in ecotourism should contribute toward the local welfare and create and design various training programs and courses to enhance local community's awareness and capability of ecotourism development in order to establish a complete system that stimulates the ongoing planning and decision making of local community participation and regularly monitors, records, and reflects their opinions, based on the area's history, culture, and natural attributes, to develop and sell sustainable local products by creating fair trade principles and valuable products.
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Conservación de los Recursos Naturales , Organizaciones , Humanos , Conservación de los Recursos Naturales/métodos , Reproducibilidad de los Resultados , Participación de la ComunidadRESUMEN
INTRODUCTION: One of the aims of health care reform in Montenegro is to strengthen primary care. An important step forward is the implementation of specialty training in family medicine (FM). The aim of this article is to evaluate the implementation of specialty training in family medicine in Montenegro, regarding the content, structure and methods, by the first generation of trainees and the coordinator of the training. METHODS: A questionnaire was sent by mail in July and August 2017 to all 26 eligible trainees who started specialty training in 2013. Twenty-two of the 26 trainees (84.6%) responded. The questionnaire consisted of closed and open-ended questions related to the evaluation of the training. A descriptive quantitative and qualitative analysis with predefined themes and a semi-structured interview with the coordinator were carried out. RESULTS: The process of training in FM was assessed positively by both trainees and the coordinator. The positive assessment included that the specialisation course offered modern design through modules and practice, and trainees both improved their existing knowledge and skills and acquired new ones necessary for everyday work. The coordinator emphasised the importance of the introduction of new teaching methods and formative assessment, the important role of mentors, and the involvement of Slovenian colleagues in the teaching process and supervision of the programme. CONCLUSIONS: The implementation of speciality training in FM in Montenegro was successful. Several assessment methods were used that can be further developed in individual structured feedback, which could stimulate the continual improvement of trainees' knowledge and competencies.