Hasil untuk "Internal medicine"

Vohn Jacquez, Zachary Phan, Zachary Taebel et al.

Internal waves, or waves that propagate within a stratified fluid, may break and cause mixing. While each individual mixing event may be small, collectively, internal wave breaking drive processes in the ocean that are critical to understanding the maritime climate and biosphere. In this paper we show how to set up an experiment, suitable for an undergraduate-level lab, that illustrates a common generation and breaking mechanism in the ocean. In particular, we show how the process changes in response to a non dimensional parameter, the buoyancy Reynolds number, that can be easily varied. This parameter highlights the role of viscous vs. inertial/buoyancy forces. We outline our methods of creating a linear stratification, injecting energy with a forced topography, and analyzing the resulting dynamics with Background Oriented Schlieren and energy spectra from a conductivity probe. By altering our forcing to accommodate three values of the buoyancy Reynolds, three distinct internal wave regimes can be observed: no turbulence, slight turbulence, and extreme turbulence. Our methods aim to increase the accessibility to studying these internal waves in future experimental work, ocean modeling, and math and physics undergraduate learning.

Fei Bai, Zhipeng Chen, Chuan Hao et al.

Recently, reinforcement learning~(RL) has become an important approach for improving the capabilities of large language models~(LLMs). In particular, reinforcement learning from verifiable rewards~(RLVR) has emerged as a promising paradigm for reasoning tasks. However, existing RL-based training still remains only a rough approximation to human learning. Human learners leverage both external and internal experience to guide exploration and gradually internalize useful trajectories into stable knowledge. Motivated by this gap, we ask: how can LLMs better utilize and internalize experience during RLVR training? To answer this question, we propose \textbf{D}ual \textbf{G}uidance \textbf{O}ptimization~(\textbf{DGO}), a unified framework that leverages \emph{external} and \emph{internal experience} to improve training effectiveness. Specifically, DGO first constructs an experience bank from previously explored trajectories. The policy then performs exploration under the joint guidance of the experience bank and the model's internal knowledge. The resulting trajectories are further used to refine the experience bank and optimize model parameters, forming a closed loop of experience utilization and internalization. Experiments show that DGO consistently outperforms baseline methods, suggesting that better utilization and internalization of experience lead to more effective reasoning.

Min Jae Kang, Min Jae Kang, Roopa Kanakatti Shankar et al.

PurposeSkeletal abnormalities are common in Turner Syndrome (TS), yet data on objective radiographic markers are limited. We aimed to establish normative reference ranges for phalangeal length ratios and assess their utility in detecting skeletal abnormalities in TS.MethodsWe analyzed 4,082 female bone age X-rays (<18 years) from the Radiological Society of North America (RSNA) database after quality screening and outlier exclusion as a reference cohort. Phalangeal length ratios—4th to 3rd metacarpal (4:3 MC), 5th to 3rd metacarpal (5:3 MC), and 5th to 3rd middle phalanx (5:3 MP)—were measured and compared in 81 TS patients seen at a single center. Additional skeletal features such as SHOX deficiency-related signs and brachydactyly type A3 (BDA3) were assessed.ResultsIn reference subjects, 4:3 MC and 5:3 MC ratios remained stable across most age groups, while the 5:3 MP ratio increased with age. TS patients showed a significantly lower 4:3 MC and 5:3 MP ratios (P < 0.001, P = 0.002, respectively) compared to ones from reference subjects. A low 4:3 MC ratio (<–2 SD) was seen in 27.2% of TS patients. The 4:3 MC ratio correlated with height percentile (r = 0.27, P = 0.02). BDA3 was more prevalent in TS compared to reference subjects (13.6% vs. 2.1%, P < 0.001) and associated with low MC ratios.ConclusionNormative reference ranges for phalangeal length ratios were established and differences in 4:3 and 5:3 MP ratios in patients with TS were identified compared to the reference group. Further studies with larger TS cohorts are needed to confirm the clinical utility of these radiographic biomarkers.

Andreas Waldis, Vagrant Gautam, Anne Lauscher et al.

We introduce aligned probing, a novel interpretability framework that aligns the behavior of language models (LMs), based on their outputs, and their internal representations (internals). Using this framework, we examine over 20 OLMo, Llama, and Mistral models, bridging behavioral and internal perspectives for toxicity for the first time. Our results show that LMs strongly encode information about the toxicity level of inputs and subsequent outputs, particularly in lower layers. Focusing on how unique LMs differ offers both correlative and causal evidence that they generate less toxic output when strongly encoding information about the input toxicity. We also highlight the heterogeneity of toxicity, as model behavior and internals vary across unique attributes such as Threat. Finally, four case studies analyzing detoxification, multi-prompt evaluations, model quantization, and pre-training dynamics underline the practical impact of aligned probing with further concrete insights. Our findings contribute to a more holistic understanding of LMs, both within and beyond the context of toxicity.

Mohammad Ibrahim Qani

Language serves as a foundation of cultural identity, deeply entangled with the social and historical contexts of a community. This paper examines the ineffectiveness of interference by alien words within a culture. Drawing on sociolinguistic theories and case studies from diverse linguistic environments, it is argued that the forced introduction or adoption of foreign lexicon often fails to achieve its intended socio-cultural objectives. Instead, indigenous languages demonstrate resilience, adapting to or resisting external influences through unique strategies. The effectiveness of this research highlights the futility of attempting to impose linguistic uniformity and underscores the importance of understanding local cultural dynamics in preserving linguistic heritage. This pure language understanding directly relates to translation knowledge where linguists and translators need to work and research to eradicate misunderstanding. Misunderstandings mostly appear in non-equivalent words because there are different local and internal words like food, garment, cultural and traditional words, and others in every notion. Truly, most of these words do not have an equivalent in the target language and these words need to be worked and find their equivalent in the target language to fully understand both languages. The purpose of this research is to introduce the challenges and ineffectiveness of cultural influences in different notions where people do not see the facts of cultural enrichment. However, some of these ineffectiveness have been clearly mentioned in this research but some effective ways have also been dictated.

Tony Shaska

We introduce a graded formulation of internal symbolic computation for transformers. The hidden space is endowed with a grading $V=\bigoplus_{g\in G}V_g$, and symbolic operations are realized as typed block maps (morphisms) $φ_{h\leftarrow g}:V_g\to V_h$ that are activated selectively by a differentiable routing policy. A self-supervised \emph{graded utility functional}, defined as the loss reduction induced by a candidate morphism, governs activation and yields sparse, interpretable behavior. We develop the algebraic and geometric foundations: an internal model category whose objects are homogeneous components and whose morphisms are admissible grade transitions; adjoint pairs encoding typed round trips; and information-geometric interpretations in terms of KL gain, mirror descent with Bregman divergences, and Fisher natural gradients. Methodologically, we specify a utility--aware routing mechanism and objective that remain fully end-to-end differentiable. Analytic case studies and lightweight sanity checks illustrate selective morphic activation on hybrid symbolic-linguistic tasks. The framework unifies symbolic computation, geometry, and self--supervised learning within the \emph{graded transformer} formalism \cite{sh-89,sh-95}, while subsuming prior external-tool paradigms (e.g., Toolformer \cite{toolformer2023}) as a special case via functorial internalization.

Marta Rosado-Fernández, Elisenda Climent, Mercè Fernández-Miró et al.

Purpose: It has been previously described that some women with type 1 diabetes (T1D) may experience changes in glucose levels in relation to their menstrual cycle. However, whether an advanced hybrid closed-loop system (AHCL) can mitigate these cycle-dependent changes is yet to be determined. Methods: This study is a prospective analysis of a cohort of premenopausal women with T1D with spontaneous menstrual cycles who are users of an AHCL system 780G Medtronic^®. Three consecutive cycles were analyzed for each patient, and each cycle was divided into three phases (menstrual, luteal, and rest of cycle phase). Results: Fifteen subjects were included. Mean age was 38 ± 7.6 years, HbA1c was 7.12 ± 0.7%, and diabetes duration was 21 ± 13.7 years. Mean glucose was higher in the luteal phase compared to the menstrual period (<i>p</i> = 0.029 luteal vs. menstrual) and the rest of the cycle (<i>p</i> = 0.018 luteal vs. rest of cycle). The time in range (TIR) was lower in the luteal phase compared to the rest of cycle phase (<i>p</i> = 0.015 luteal vs. rest of cycle). The time below range (TBR) was significantly higher in the menstrual compared to the luteal phase (<i>p</i> = 0.007 luteal vs. menstrual). Daily insulin requirements were higher in luteal phase compared to rest of cycle (<i>p</i> = 0.017 luteal vs. rest of cycle). Conclusions: A higher mean glucose and lower TIR, despite a higher total insulin dose, was observed in the luteal phase. A higher TBR was observed in the menstrual phase. However, AHCL with 780G Medtronic^® achieves a TIR of almost 70% in all cycle phases.

Lixue Qiao, Hao Li, Keyu Yin et al.

BackgroundThere is a potential bidirectional pathogenicity between thyroid and breast cancers. The association between sex hormones and two types of malignant tumors has emerged as a topic of intense academic debate in recent years. However, the role of sex hormone metabolism-related genes in thyroid cancer still needs to be further explored.MethodsWe obtained thyroid and breast cancer transcriptome data from the TCGA database and sex hormone metabolism-related gene sets from the MSigDB database, thus screening for sex hormone metabolism-related genes linked to the two malignant tumors. Univariate cox regression analysis was used for the screening of disease-free survival (DFS)-associated genes. The TCGA-THCA patients were classified as two categories via a consistent clustering algorithm, and the differential genes between the two categories were subsequently screened. A sex hormone metabolism-related prognostic model (TBSMRPM) of thyroid cancer versus breast cancer consisting of 10 genes was developed by Cox regression analyses and least absolute shrinkage with selection operator (LASSO) cox regression analysis. Finally, we performed clinicopathological subgroup analyses to analyze the correlation between TBSMRPM and clinical characteristics, immune infiltration, tumor mutation burden (TMB), and chemosensitivity, and verified the expression of TBSMRPM signature genes by qRT-PCR.ResultsWe identified 2 clusters correlated with sex hormone metabolism, and screened 10 prognostic differential genes related to thyroid cancer, breast cancer and sex hormone metabolism. After establishing the two risk groups for thyroid cancer originated from TBSMRPM, the results showed that the high-risk group exhibited the shorter DFS (P&lt;0.05). In further clinical stratification analysis, immune infiltration analysis, TMB and drug sensitivity analysis, the two TBSMRPM groups showed significant differences. The qRT-PCR results showed that C2CD4A, CERS1, MMP9, SLC5A1, HORMAD2 were highly expressed in the IHH4, KTC-1, and TPC-1 cell lines, while SLITRK2, ARHGEF37, PLP1, RNF223, and F3 were lowly expressed.ConclusionThe TBSMRPM established in this study has a certain value for the prognosis of thyroid cancer and contributes to refine clinicians’ treatment protocols.

Michael J. Domanski, MD, Colin O. Wu, PhD, Xin Tian, PhD et al.

Background: In prior studies of cumulative risk factor exposure, self-identified race was independently associated with incident cardiovascular disease (CVD). A recent study suggests clinical, demographic, and socioeconomic factors explain racial differences. We used propensity score matching to study race as an independent incident CVD risk factor. Objectives: The purpose of this study was to assess race as an independent risk factor for incident CVD. Methods: We analyzed CARDIA (Coronary Artery Risk Development in Young Adults) study data using propensity score matching of White and Black women, and, separately, White and Black men, with respect to known CVD risk factors. Results: Black men (n = 487), compared to White men (n = 487), had higher risk of CVD (HR: 2.30; 95% CI: 1.36-3.89; P = 0.0014), stroke (HR: 5.00; 95% CI: 1.45-17.3; P = 0.0047), and congestive heart failure (CHF) (HR: 3.60; 95% CI: 1.34-9.70; P = 0.0067). Black women (n = 640), compared to White women (n = 640), had higher CVD risk (HR: 2.36; 95% CI: 1.17-4.78; P = 0.014) and stroke risk (HR: 2.80; 95% CI: 1.01-7.77; P = 0.039) and borderline significantly higher CHF risk (HR: 3.50; 95% CI: 0.73-16.9; P = 0.096). Risk of coronary heart disease did not differ significantly by race in either sex. Multivariable analyses showed racial differences in the associations of multiple risk factors with incident CVD events independent of other known CVD risk factors. Conclusions: Propensity score matching analyses demonstrate that race is an independent risk factor for incident CVD and its components, CHF, and stroke. Multivariable analyses suggest racial differences in Black vs White risk factor impact as the possible cause. Reasons for these differences remain to be explored.

Nelson R. F. Braga, Yan F. Ferreira, William S. Cunha

Holographic models that consider classical vector fields in a 5-d background provide successful effective descriptions for heavy vector meson spectra. This holds both in the vacuum and in a thermal medium, like the quark gluon plasma. However, it is somehow mysterious the way that these phenomenological models work. In particular, what is the role of the fifth dimension and what is the relation between the holographic 5-d background and the physical (4-d) heavy mesons. Hadrons, in contrast to leptons, are composite particles with some internal structure, that depends on the energy at which they are observed. In this work, a static meson is represented by a heavy quark-antiquark pair with an interaction described by a Nambu Goto string living in the same 5-d background that provides field solutions leading to masses and decay constants of charmonium states. The interaction potential that shows up is linear for large distances with a string tension consistent with the effective Cornell potential. Introducing temperature $T$ in the background it is found, for the $J/ψ$ case, that there is a deconfining transition at some critical value of $T$. The results obtained indicate that the 5-d background is effectively representing the internal structure of the (static) charmonium (quasi) states.

Carlo Perricone, Andrea Castellucci, Giacomo Cafaro et al.

The treatment of patients with rheumatoid arthritis (RA) has dramatically changed in the past 30 years. Currently, numerous conventional, biologic, and targeted synthetic DMARDs have been licensed and used following recommendations provided by international and national scientific societies. However, the availability of biosimilars and the increasing necessity of savings impacted on the local/national prescription of these drugs. The information provided by data sheet of every single drug is a decisive factor on the choice of a certain treatment merged with the patient’s profile. Thus, our purpose was to construct a rational algorithm for the treatment strategy in RA according to costs and the product leaflet of the biologic and targeted-synthetic DMARDs currently licensed in Italy. We used the most recent available recommendations and then we performed a review of the literature considering all the factors that are known to influence drug safety/effectiveness. All these factors were considered in the context of the data sheets of currently available originators and biosimilars.

Nitchanant Kitcharanant, Prangmalee Leurcharusmee, Pichitchai Atthakomol et al.

Abstract Background Even with the great advancements in recent years in total knee arthroplasty (TKA), some patients continue to have persistent postsurgical pain (PPSP). The advantages of systemic corticosteroids in the perioperative context have been further supported by previously published trials. However, the impact of dexamethasone on the intensity of post-TKA PPSP is still unclear. We aimed to investigate its effect on the degree of PPSP and compare that with a placebo. Methods In this randomized, double-blind, placebo-controlled study, 48 patients undergoing unilateral TKA were given intravenous dexamethasone 10 mg or saline just before spinal anesthesia was induced, and they also received two additional doses of dexamethasone 10 mg or saline 24 and 48 h after surgery. A standardized, multimodal analgesic regimen was administered to each patient. The modified WOMAC pain scores at 12 weeks postoperative were the main outcome. The secondary outcomes included pain during a walk of five meters, pain during active knee flexion at 45 degrees, maximum pain at rest during the previous 24 h, nausea visual analogue scale values, and use of rescue opioid and antiemetic medications. Results There was no difference in modified WOMAC pain scores 12 weeks after surgery between patients who received and did not receive perioperative dexamethasone. At 24, 30, 48, 54, and 72 h following surgery, the dexamethasone group experienced considerably less pain during a five-meter walk and during 45 degrees active knee flexion (p < 0.01). At postoperative 0–24, 24–48, and 48–72 h, the dexamethasone group experienced less maximal pain at rest (p < 0.01). The dexamethasone group also had less visual analogue scale scores for nausea at 6, 24, 30, 48, and 54 h after surgery (p < 0.02). During the first 0–24 and 24–48 h, the dexamethasone group consumed fewer opioids and antiemetic medications (p < 0.01). All patients showed no signs of wound complications. Conclusions When compared to a placebo at 12 weeks after TKA, intravenous dexamethasone did not reduce PPSP. Nevertheless, early postoperative pain was relieved by perioperative intravenous dexamethasone, which also decreased the need for opioid and antiemetic medications and decreased postoperative nausea and vomiting. Trial registration NCT02760459.

Maksim V. Agarkov, Alexey A. Safuanov, Svetlana T. Evreeva et al.

We describe a case of 72-year-old patient with recurrent transient ischemic attacks in the right internal carotid artery (ICA) territory associated with uncontrolled hypertension. Duplex ultrasonography und carotid angiography showed a 60% stenosis with signs of a vulnerable plaque in the cervical segment, as well as a 90% stenosis in the cavernous segment of the right ICA. After further examination the patient was diagnosed with an 80% renal artery stenosis. First, the patient had a single-stage stenting for extracranial and intracranial stenoses of the right ICA, then left renal artery stenting. No intraoperative and postoperative complications were observed. These results show that this surgical treatment is minimally invasive, safe, and effective in symptomatic patients and may be considered for the disease.

Qiao He, Zhenglian Luo, Haiming Zou et al.

Abstract Background Mean platelet volume (MPV), as a marker of platelet activity, has been shown to be an efficient prognostic biomarker in several types of cancer. Using MPV, this study aimed to create and validate a prognostic nomogram to the overall survival in esophageal squamous cell carcinoma (ESCC) patients. Methods The nomogram was constructed and tested using data from a retrospective study of 1893 patients who were randomly assigned to the training and testing cohorts with a 7:3 randomization. In order to screen out the optimal predictors for overall survival (OS), we conducted the LASSO‐cox regression, univariate, and multivariate cox regression analyses. Subsequently, the predictive accuracy of the nomogram was validated in both the training and the testing cohorts. Finally, decision curve analysis (DCA) was used to confirm clinical validity. Results Age, MPV, nerve invasion, T stage, and N stage were found as independent prognostic variables for OS and were further developed into a nomogram. The nomogram's prediction accuracy for 1‐, 3‐, and 5‐year OS was 0.736, 0.749, 0.774, and 0.724, 0.719, 0.704 in the training and testing cohorts, respectively. Furthermore, DCA results indicated that nomograms outperformed the AJCC 8th and conventional T, N staging systems in both the training and testing cohorts. Conclusions The nomogram, in conjunction with MPV and standard clinicopathological markers, could improve the accuracy of prediction of OS in ESCC patients.

Fiorenza De Rose, Riccardo Ray Colciago, Sara Lucidi et al.

Background: We assessed the current practice concerning the axillary management of breast cancer (BC) patients undergoing upfront surgery among radiation oncologists (ROs) practising in Italy. Methods: An online survey via SurveyMonkey (including 21 questions) was distributed amongst ROs in Italy through personal contacts and the Italian Association for Radiotherapy and Clinical Oncology (AIRO) network from August to September 2022. We particularly focused on the emerging omission of axillary lymph node dissection (ALND) in the presence of 1–2 sentinel node-positive patients and the consequent change in the role of regional nodal irradiation (RNI). Results: A total of 101/195 (51% response rate) Italian Radiotherapy Cancer Care Centres answered the survey. With respect to patients with 1–2 sentinel node-positive, the relative proportion of respondents that offer patients ALND a) always, b) only in selected cases, and c) never was 37.6%, 60.4%, and 2.0%, respectively, with no significant geographical (North vs. Centre–South Italy; <i>p</i> = 0.92) or institutional (Academic vs. non-Academic; <i>p</i> = 0.49) differences. Radiation therapy indications varied widely in patients who did not undergo ALND. Among these, about a third of the respondents (17/56, 30.4%) stated that RNI was constantly performed. On the other hand, half of the respondents offered RNI in selected cases, stating that an unfavourable biologic tumour profile and extracapsular nodal extension were considered drivers of their decision. Conclusions: Results of the present survey show the variability of axillary management offered in clinical practice for BC patients undergoing conserving surgery upfront in Italy. Analysis of these attitudes may trigger the modification of some clinical approaches through multidisciplinary collaboration and create the background for future clinical investigations.

Tony Lyons

The existence of internal geophysical waves of extreme form is confirmed and an explicit solution presented. The flow is confined to a layer lying above an eastward current while the mean horizontal flow of the solutions is westward, thus incorporating flow reversal in the fluid.

Luis Rodrigo Torres Neves, Frederico Brito

Recent advances in quantum thermodynamics have been focusing on ever more elementary systems of interest, approaching the limit of a single qubit, with correlations, strong coupling and non-equilibrium environments coming into play. Under such scenarios, it is clear that fundamental physical quantities must be revisited. This article questions whether a universal definition of internal energy for open quantum systems may be devised, setting limits on its possible properties. We argue that, for such a definition to be regarded as local, it should be implemented as a functional of the open system's reduced density operator and its time derivatives. Then we show that it should involve at least up to the second-order derivative, otherwise failing to recover the previously-known internal energy of the "universe". Possible implications of this general result are discussed.

Peter N-Jonaam Mahama, Amos Tiereyangn Kabo-Bah, Justine I. Blanford et al.

The current epidemiological transition makes us wonder how the parallel of infectious diseases (IDs) might be at the end of each passing year. Yet, the surveillance of these IDs continues to focus on high-profile diseases of public health importance without keeping track of the broad spectrum of the IDs we face. Here, we presented the prevalence of the broad spectrum of IDs in Ghana. Data from the annual reports on Gold Coast now Ghana, Global Infectious Diseases and Epidemiology Network (GIDEON), and the District Health Information Management System II (DHIMS2) databases were examined for records of ID prevalence in Ghana. Using the IDs from these databases, the paper assessed the epidemiological transition, pathogen-host interactions, spatiotemporal distribution, transmission routes, and their potential areas of impact in Ghana. The topmost ID recorded in health facilities in Ghana transitioned from yaws in the 1890s to malaria in the 1950s through 2020. We then presented the hosts of a pathogen and the pathogens of a host, the administrative districts where a pathogen was found, and the pathogens found in each district of Ghana. The highest modes of transmission routes were through direct contact for bacteria and airborne or droplet-borne for viral pathogens. From GIDEON, 226 IDs were identified as endemic or potentially endemic in Ghana, with 42% cited in peer-reviewed articles from 2000 to 2020. From the extent of risk of endemic or potentially endemic IDs, Ghana faces a high risk of ID burden that we should be mindful of their changing patterns and should keep track of the state of each of them.

Ralph Foorthuis

Compliance of organizations with internal and external norms is a highly relevant topic for both practitioners and academics nowadays. However, the substantive, elementary compliance tactics that organizations can use for achieving internal compliance have been described in a fragmented manner and in the literatures of distinct academic disciplines. Using a multidisciplinary structured literature review of 134 publications, this study offers three contributions. First, we present a typology of 45 compliance tactics, which constitutes a comprehensive and rich overview of elementary ways for bringing the organization into compliance. Secondly, we provide an overview of fundamental concepts in the theory of compliance, which forms the basis for the framework we developed for positioning compliance tactics and for analyzing or developing compliance strategies. Thirdly, we present insights for moving from compliance tactics to compliance strategies. In the process, and using the multidisciplinary literature review to take a bird's-eye view, we demonstrate that compliance strategies need to be regarded as a richer concept than perceived hitherto. We also show that opportunities for innovation exist.

Ernesto Horne, Jeremy Schmitt, Nelly Pustelnik et al.

The shear resulting from internal wave reflections can play a crucial role in the transport and resuspension of sediments in oceanic conditions. In particular, when these waves undergo a \textit{critical reflection} phenomenon, the reflected wave can produce a very large shear. Separating the reflected wave from the incident wave is a technical challenge since the two waves share the same temporal frequency. In our study, we present a series of experimental measurements of internal waves in \textit{critical reflection} configuration and we analyze them using the 2D-VMD-prox decomposition method. This decomposition method was adapted to specifically decompose waves in an internal wave critical reflection, showing an improvement in its performance with respect to preexisting internal wave decomposition methods. Being able to confidently isolate the reflected wave allowed us to compare our results to a viscous and non-linear model for critical reflection, that correctly describes the dependence of the shear rate produced in the boundary as a function of the experimental parameters.