Assessing the decision quality of artificial intelligence and oncologists of different experience in different regions in breast cancer treatment.

Background: AI-based clinical decision support system (CDSS) has important prospects in overcoming the current informational challenges that cancer diseases faced, promoting the homogeneous development of standardized treatment among different geographical regions, and reforming the medical model. However, there are still a lack of relevant indicators to comprehensively assess its decision-making quality and clinical impact, which greatly limits the development of its clinical research and clinical application. This study aims to develop and application an assessment system that can comprehensively assess the decision-making quality and clinical impacts of physicians and CDSS. Methods: Enrolled adjuvant treatment decision stage early breast cancer cases were randomly assigned to different decision-making physician panels (each panel consisted of three different seniority physicians in different grades hospitals), each physician made an independent "Initial Decision" and then reviewed the CDSS report online and made a "Final Decision". In addition, the CDSS and guideline expert groups independently review all cases and generate "CDSS Recommendations" and "Guideline Recommendations" respectively. Based on the design framework, a multi-level multi-indicator system including "Decision Concordance", "Calibrated Concordance", " Decision Concordance with High-level Physician", "Consensus Rate", "Decision Stability", "Guideline Conformity", and "Calibrated Conformity" were constructed. Results: 531 cases containing 2124 decision points were enrolled; 27 different seniority physicians from 10 different grades hospitals have generated 6372 decision opinions before and after referring to the "CDSS Recommendations" report respectively. Overall, the calibrated decision concordance was significantly higher for CDSS and provincial-senior physicians (80.9%) than other physicians. At the same time, CDSS has a higher " decision concordance with high-level physician" (76.3%-91.5%) than all physicians. The CDSS had significantly higher guideline conformity than all decision-making physicians and less internal variation, with an overall guideline conformity variance of 17.5% (97.5% vs. 80.0%), a standard deviation variance of 6.6% (1.3% vs. 7.9%), and a mean difference variance of 7.8% (1.5% vs. 9.3%). In addition, provincial-middle seniority physicians had the highest decision stability (54.5%). The overall consensus rate among physicians was 64.2%. Conclusions: There are significant internal variation in the standardization treatment level of different seniority physicians in different geographical regions in the adjuvant treatment of early breast cancer. CDSS has a higher standardization treatment level than all physicians and has the potential to provide immediate decision support to physicians and have a positive impact on standardizing physicians' treatment behaviors.

Sustainable recovery of titanium from secondary resources: A review.

The exploitation and utilization of secondary resources have the social benefits of saving resources, reducing pollution, and reducing production costs. Currently, less than 20% of titanium secondary resources can be recycled, and there are few reviews on titanium secondary resources recovery, which cannot fully reveal the technical information and progress of titanium secondary resources recovery. This work presents the current global distribution of titanium resources and market supply and demand, then focuses on an overview of technical studies on titanium extraction from different titanium-bearing secondary slags. The following types of titanium secondary resources are mainly available: sponge titanium production, the production of titanium ingot, titanium dioxide production, red mud, titanium-bearing blast furnace slag, spent SCR catalyst, and lithium titanate waste. The various methods of secondary resource recovery are compared, including the advantages and disadvantages, and the future development direction of the titanium recycling process is pointed out. On the one hand, recycling companies can classify and recover each type of residual waste according to its characteristics. On the other hand, solvent extraction technology can be the direction of attention due to the increased requirement for the purity of recovered materials. Meanwhile, the attention to lithium titanate waste recycling should also be enhanced.

N-heterocyclic carbene organocatalysts for dehydrogenative coupling of silanes and hydroxyl compounds.

Go organic! N-Heterocyclic carbene (NHC) 1,3-diisopropyl-4,5-dimethylimidazol-2-ylidene (IiPr) has been found to be an efficient and selective catalyst for the dehydrogenative coupling of a wide range of silanes and hydroxyl groups to form SiO bonds under mild and solvent-free conditions. Mechanistic studies indicated that the activation of hydroxyl groups by the NHC is the most plausible initial step for the process.