Hasil untuk "Internal medicine"

T. Barlam, S. Cosgrove, L. Abbo et al.

T. Shanafelt, S. Boone, Litjen L J Tan et al.

R. Loeser, S. Goldring, C. Scanzello et al.

Kalpana Gupta, Thomas M. Hooton, K. G. Naber et al.

A. Bosquet, A. Medjkane, Dorit Voitel-Warneke et al.

D. Moher, A. Liberati, J. Tetzlaff et al.

Editor's Note: PTJ 's Editorial Board has adopted PRISMA to help PTJ better communicate research to physical therapists. For more, read Chris Maher's [editorial][1] starting on page 870. Membership of the PRISMA Group is provided in the Acknowledgments . This article has been reprinted with permission from the Annals of Internal Medicine from Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. Ann Intern Med . Available at: . The authors jointly hold copyright of this article. This article has also been published in PLoS Medicine , BMJ , Journal of Clinical Epidemiology , and Open Medicine . Copyright © 2009 Moher et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. [1]: http://www.ptjournal.org/cgi/content/full/89/9/870

Tobias Pincock

F. Taylor, C. Toh, K. Hoots et al.

Jinning Zhang, Jie Song, Wenhui Tu et al.

Current medical retrieval-augmented generation (RAG) approaches overlook evidence-based medicine (EBM) principles, leading to two key gaps: (1) the lack of PICO alignment between queries and retrieved evidence, and (2) the absence of evidence hierarchy considerations during reranking. We present SR-RAG, an EBM-adapted GraphRAG framework that integrates the PICO framework into knowledge graph construction and retrieval, and proposes Bayesian Evidence Tier Reranking (BETR) to calibrate ranking scores by evidence grade without predefined weights. Validated in sports rehabilitation, we release a knowledge graph (357,844 nodes, 371,226 edges) and a benchmark of 1,637 QA pairs. SR-RAG achieves 0.812 evidence recall@10, 0.830 nugget coverage, 0.819 answer faithfulness, 0.882 semantic similarity, and 0.788 PICOT match accuracy, substantially outperforming five baselines. Five expert clinicians rated the system 4.66--4.84 on a 5-point Likert scale, and system rankings are preserved on a human-verified gold subset (n=80).

Qi Zhang, Wencui Yang, Lina Tan et al.

Proton therapy, by leveraging its unique physical characteristic of the Bragg peak, enables high-precision dose delivery to the tumor target while effectively protecting surrounding normal tissues, and has become an important representative of advanced radiotherapy. This review aims to systematically summarize key technological breakthroughs in recent years that have driven the progress of proton therapy, including compact superconducting accelerators, pencil beam scanning (PBS), image-guided proton therapy (IGPT), and the transformative ultra-high dose rate FLASH radiotherapy, while highlighting the role of artificial intelligence (AI) in advancing proton therapy toward real-time adaptive precision radiotherapy. The article also explores the global distribution and development status of proton centers, with a specific analysis of China’s notable advancements as an emerging market in center construction, equipment localization, and the treatment of characteristic local tumor types. Moving forward, it is essential to continue promoting technological integration and innovation, strengthen high-quality clinical research, and develop a more accessible, intelligent, and personalized proton therapy system to achieve broader clinical application and patient benefit.

Amama Mahmood, Bokyung Kim, Honghao Zhao et al.

The sleep diary is a widely used clinical tool for understanding and treating sleep disorders in Behavioral Sleep Medicine (BSM); however, low patient compliance and limited capture of contextual information constrain its effectiveness and leave specialists with an incomplete picture of patients' sleep-related behaviors. In this work, we explore conversational agents (CAs) as an alternative to traditional diary methods by designing a voice-based sleep diary and a specialist-facing analytics tool, and using them as design probes to understand how CAs might support BSM more broadly. Our multi-stage study with specialists comprised: (1) interviews to identify shortcomings of current text-based diaries, (2) iterative co-design of the conversational diary and analytics tool, and (3) focus groups to examine broader opportunities for CAs in BSM. This work offers empirical insights into how specialists envision CAs in clinical care and outlines design implications for integrating them into existing self-report practices and behavioral interventions.

Sören von der Gracht, Eddie Nijholt, Bob Rink

The analysis of network dynamics is oftentimes restricted to networks with one-dimensional internal dynamics. Here, we show how symmetry explains the relation between behavior of systems with one-dimensional internal dynamics and with higher dimensional internal dynamics, when the network topology is the same. Fundamental networks of homogeneous coupled cell systems (B. Rink, J. Sanders. Coupled Cell Networks and Their Hidden Symmetries. SIAM J. Math. Anal. 46.2 (2014)) can be expressed in terms of monoid representations, which uniquely decompose into indecomposable subrepresentations. In the high-dimensional internal dynamics case, these subrepresentations are isomorphic to multiple copies of those one computes in the one-dimensional case. We describe the implications of this observation on steady state and Hopf bifurcations in $l$-parameter families of network vector fields. The main results are that (1) generic one-parameter steady state bifurcations are qualitatively independent of the dimension of the internal dynamics and that, (2) in order to observe all generic $l$-parameter bifurcations that may occur for internal dynamics of any dimension, the internal dynamics has to be at least $l$-dimensional for steady state bifurcations and $2l$-dimensional for Hopf bifurcations. Furthermore, we illustrate how additional structure in the network can be exploited to obtain understanding beyond qualitative statements about the collective dynamics. One-parameter steady state bifurcations in feedforward networks exhibit an unusual amplification in the asymptotic growth rates of individual cells, when these are one-dimensional (S. von der Gracht, E. Nijholt, B. Rink. Amplified steady state bifurcations in feedforward networks. Nonlinearity 35.4 (2022)). We prove that (3) the same cells exhibit this amplifying effect with the same growth rates when the internal dynamics is high-dimensional.

Martin Preiß

Large Language Models (LLMs) have succeeded in a variety of natural language processing tasks [Zha+25]. However, they have notable limitations. LLMs tend to generate hallucinations, a seemingly plausible yet factually unsupported output [Hua+24], which have serious real-world consequences [Kay23; Rum+24]. Recent work has shown that probing-based classifiers that utilize LLMs' internal representations can detect hallucinations [AM23; Bei+24; Bur+24; DYT24; Ji+24; SMZ24; Su+24]. This approach, since it does not involve model training, can enhance reliability without significantly increasing computational costs. Building upon this approach, this thesis proposed novel methods for hallucination detection using LLM internal representations and evaluated them across three benchmarks: TruthfulQA, HaluEval, and ReFact. Specifically, a new architecture that dynamically weights and combines internal LLM layers was developed to improve hallucination detection performance. Throughout extensive experiments, two key findings were obtained: First, the proposed approach was shown to achieve superior performance compared to traditional probing methods, though generalization across benchmarks and LLMs remains challenging. Second, these generalization limitations were demonstrated to be mitigated through cross-benchmark training and parameter freezing. While not consistently improving, both techniques yielded better performance on individual benchmarks and reduced performance degradation when transferred to other benchmarks. These findings open new avenues for improving LLM reliability through internal representation analysis.

Evan S. Ross, Lance C. Visser, Lalida Tantisuwat et al.

ABSTRACT Background The effects of general anesthesia (GA) on less flow‐dependent (velocity ratio, velocity time integral [VTI] ratio and indexed pulmonary valve area [iPVA]) and flow‐dependent (mean [PVmeanPG] and maximum pressure gradient [PVmaxPG]) indices of severity of pulmonary stenosis (PS) are unclear. Objectives Determine the effects of GA on indices of severity of PS in dogs undergoing an interventional procedure (IP). Determine the reproducibility of indices of severity of PS. Animals Thirty‐nine dogs with PS. Methods Prospective cross‐sectional study. Five repeated echocardiograms were performed over 3 days. Day 1: two echocardiograms were performed by 2 different operators. Day 2: echocardiograms were performed before and after GA but before IP. Day 3: an echocardiogram was performed after the IP. Results After GA, median (IQR) cardiac index (2.1 [1.6–2.6] L/min/m2), PVmeanPG (45.0 [26.0–55.2] mmHg), PVmaxPG (76.6 [46.6–100.3] mmHg) were decreased (p ≤0.001) compared to before GA (2.8 [2.2–3.0] L/min/m2, 55.9 [47.6–73.1] mmHg, 96.1 [81.6–127.0] mmHg, respectively). There were no differences (p ≥0.35) in velocity ratio, VTI ratio, or iPVA after GA. Intra‐operator and inter‐operator coefficients of variation (95% CI) were highest for iPVA (13.8% [10.4–18.4] and 13.5% [11.0–18.4], respectively) and lowest for velocity ratio (9.2% [7.7–12.3] and 9.3% [7.7–12.4], respectively). Conclusions and Clinical Importance PVmeanPG and PVmaxPG might be misleading in states of reduced flow. An integrative assessment of severity of PS that includes less flow‐dependent indices is recommended. Reproducibility of indices of severity of PS should be considered when re‐evaluating dogs with PS.

A. V. Lakeyev

Necessary and sufficient conditions for the internal stability of formations whose dynamics are obtained is determined by linear differential equations.

Niels van der Weide

Internal language theorems are fundamental in categorical logic, since they express an equivalence between syntax and semantics. One of such theorems was proven by Clairambault and Dybjer, who corrected the result originally by Seely. More specifically, they constructed a biequivalence between the bicategory of locally Cartesian closed categories and the bicategory of democratic categories with families with extensional identity types, $\sum$-types, and $\prod$-types. This theorem expresses that the internal language of locally Cartesian closed categories is extensional Martin-Löf type theory with dependent sums and products. In this paper, we study the theorem by Clairambault and Dybjer for univalent categories, and we extend it to various classes of toposes, among which are $\prod$-pretoposes, elementary toposes, and elementary toposes with a universe. The results in this paper have been formalized using the proof assistant Rocq and the UniMath library.

Takashi Kodama, Hirokazu Kiyomaru, Yin Jou Huang et al.

Humans pay careful attention to the interlocutor's internal state in dialogues. For example, in recommendation dialogues, we make recommendations while estimating the seeker's internal state, such as his/her level of knowledge and interest. Since there are no existing annotated resources for the analysis, we constructed RecMind, a Japanese movie recommendation dialogue dataset with annotations of the seeker's internal state at the entity level. Each entity has a subjective label annotated by the seeker and an objective label annotated by the recommender. RecMind also features engaging dialogues with long seeker's utterances, enabling a detailed analysis of the seeker's internal state. Our analysis based on RecMind reveals that entities that the seeker has no knowledge about but has an interest in contribute to recommendation success. We also propose a response generation framework that explicitly considers the seeker's internal state, utilizing the chain-of-thought prompting. The human evaluation results show that our proposed method outperforms the baseline method in both consistency and the success of recommendations.

Gabriel Rotsen Fortes Aguiar, Geraldo Bezerra da Silva Júnior, Janaína de Almeida Mota Ramalho et al.

Abstract Arboviruses are endemic in several countries and represent a worrying public health problem. The most important of these diseases is dengue fever, whose numbers continue to rise and have reached millions of annual cases in Brazil since the last decade. Other arboviruses of public health concern are chikungunya and Zika, both of which have caused recent epidemics, and yellow fever, which has also caused epidemic outbreaks in our country. Like most infectious diseases, arboviruses have the potential to affect the kidneys through several mechanisms. These include the direct action of the viruses, systemic inflammation, hemorrhagic phenomena and other complications, in addition to the toxicity of the drugs used in treatment. In this review article, the epidemiological aspects of the main arboviruses in Brazil and other countries where these diseases are endemic, clinical aspects and the main laboratory changes found, including changes in renal function, are addressed. It also describes how arboviruses behave in kidney transplant patients. The pathophysiological mechanisms of kidney injury associated with arboviruses are described and finally the recommended treatment for each disease and recommendations for kidney support in this context are given.

Yi-Yuan Ge, Yan-Quan Lai, Ai-Ping Ju et al.

Objective The α-globin fusion gene between the HBA2 and HBAP1 genes, is clinically important in thalassemia screening because this fusion gene can cause severe hemoglobin (Hb) H disease when combined with α0 -thalassemia (α0 -thal). In this study, we evaluate the red blood cell parameters of α-thalassemia fusion gene in southern China.Method Study samples suspected of α-thalassemia fusion gene were collected and confirmed by PCR-sequencing from one medical lab center in southern China. Their genotypes and phenotypes were analyzed.Results A total of 266 cases of α-thalassemia fusion gene were confirmed in our lab from 2017 to 2023, most of them were from Hainan province (169 cases) and Huadu district of Guangzhou (21 cases), the nationality of 143 cases from Hainan was identified, with 71.3% (102/143) being from the Li minority. The Hb, MCV, MCH for αα/(αα)fusion in adult males were 143.5±11.83g/L, 81.51±4.39 fl, and 26.26±1.29 pg, respectively; and in females, they were 126.69±12.89 g/L, 80.10±4.05 fl, 25.8±2.04 pg, respectively. All 12 cases (αα) Fusion/ --SEA showed anemia with decreased Hb, MCV and MCH.Conclusion The carriers of α-globin fusion gene heterozygotes are clinically silent and exhibit an α+ phenotype. Individuals with (αα)Fusion/--SEA show apparent anemia. This α-globin fusion gene is relatively common in southern China, specifically among the Li minority of Hainan province. Therefore, it should be taken into account for genetic counseling purposes.