Hasil untuk "Internal medicine"

S. Benjamens, Pranavsingh Dhunnoo, B. Meskó

At the beginning of the artificial intelligence (AI)/machine learning (ML) era, the expectations are high, and experts foresee that AI/ML shows potential for diagnosing, managing and treating a wide variety of medical conditions. However, the obstacles for implementation of AI/ML in daily clinical practice are numerous, especially regarding the regulation of these technologies. Therefore, we provide an insight into the currently available AI/ML-based medical devices and algorithms that have been approved by the US Food & Drugs Administration (FDA). We aimed to raise awareness of the importance of regulatory bodies, clearly stating whether a medical device is AI/ML based or not. Cross-checking and validating all approvals, we identified 64 AI/ML based, FDA approved medical devices and algorithms. Out of those, only 29 (45%) mentioned any AI/ML-related expressions in the official FDA announcement. The majority (85.9%) was approved by the FDA with a 510(k) clearance, while 8 (12.5%) received de novo pathway clearance and one (1.6%) premarket approval (PMA) clearance. Most of these technologies, notably 30 (46.9%), 16 (25.0%), and 10 (15.6%) were developed for the fields of Radiology, Cardiology and Internal Medicine/General Practice respectively. We have launched the first comprehensive and open access database of strictly AI/ML-based medical technologies that have been approved by the FDA. The database will be constantly updated.

L. Mokkink, C. Terwee, D.walaa badawy et al.

E. Von Elm, D. Altman, M. Egger et al.

Much biomedical research is observational. The reporting of such research is often inadequate, which hampers the assessment of its strengths and weaknesses and of a study's generalisability. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Initiative developed recommendations on what should be included in an accurate and complete report of an observational study. We defined the scope of the recommendations to cover three main study designs: cohort, case-control, and cross-sectional studies. We convened a 2-day workshop in September 2004, with methodologists, researchers, and journal editors to draft a checklist of items. This list was subsequently revised during several meetings of the coordinating group and in e-mail discussions with the larger group of STROBE contributors, taking into account empirical evidence and methodological considerations. The workshop and the subsequent iterative process of consultation and revision resulted in a checklist of 22 items (the STROBE Statement) that relate to the title, abstract, introduction, methods, results, and discussion sections of articles. 18 items are common to all three study designs and four are specific for cohort, case-control, or cross-sectional studies. A detailed Explanation and Elaboration document is published separately and is freely available on the Web sites of PLoS Medicine, Annals of Internal Medicine, and Epidemiology. We hope that the STROBE Statement will contribute to improving the quality of reporting of observational studies.

E. Von Elm, D. G. Altman, M. Egger et al.

D. Lederer, S. Bell, R. Branson et al.

Control of Confounding and Reporting of Results in Causal Inference Studies Guidance for Authors fromEditors of Respiratory, Sleep, andCritical Care Journals David J. Lederer*, Scott C. Bell*, Richard D. Branson*, James D. Chalmers*, Rachel Marshall*, David M. Maslove*, David E. Ost*, Naresh M. Punjabi*, Michael Schatz*, Alan R. Smyth*, Paul W. Stewart*, Samy Suissa*, Alex A. Adjei, Cezmi A. Akdis, Élie Azoulay, Jan Bakker, Zuhair K. Ballas, Philip G. Bardin, Esther Barreiro, Rinaldo Bellomo, Jonathan A. Bernstein, Vito Brusasco, Timothy G. Buchman, Sudhansu Chokroverty, Nancy A. Collop, James D. Crapo, Dominic A. Fitzgerald, Lauren Hale, Nicholas Hart, Felix J. Herth, Theodore J. Iwashyna, Gisli Jenkins, Martin Kolb, Guy B. Marks, Peter Mazzone, J. Randall Moorman, ThomasM.Murphy, Terry L. Noah, Paul Reynolds, Dieter Riemann, Richard E. Russell, Aziz Sheikh, Giovanni Sotgiu, Erik R. Swenson, Rhonda Szczesniak, Ronald Szymusiak, Jean-Louis Teboul, and Jean-Louis Vincent Department of Medicine and Department of Epidemiology, Columbia University Irving Medical Center, New York, New York; Editor-inChief, Annals of the American Thoracic Society; Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, Queensland, Australia; Editor-in-Chief, Journal of Cystic Fibrosis; Department of Surgery, University of Cincinnati, Cincinnati, Ohio; Editor-in-Chief, Respiratory Care; University of Dundee, Dundee, Scotland; Deputy Chief Editor, European Respiratory Journal; London, England; Deputy Editor, The Lancet Respiratory Medicine; Department of Medicine, Queen’s University, Kingston, Ontario, Canada; Associate Editor for Data Science, Critical Care Medicine; Department of Pulmonary Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas; Editor-in-Chief, Journal of Bronchology and Interventional Pulmonology; Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland; Deputy Editor-in-Chief, SLEEP; Department of Allergy, Kaiser Permanente Medical Center, San Diego, California; Editor-in-Chief, The Journal of Allergy & Clinical Immunology: In Practice; Division of Child Health, Obstetrics, and Gynecology, University of Nottingham, Nottingham, England; Joint Editor-in-Chief, Thorax; Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina; Associate Editor, Pediatric Pulmonology; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada; Advisor, COPD: Journal of Chronic Obstructive Pulmonary Disease; Department of Oncology, Mayo Clinic, Rochester, Minnesota; Editor-in-Chief, Journal of Thoracic Oncology; Swiss Institute of Allergy and Asthma Research, University of Zurich, Davos, Switzerland; Editor-in-Chief, Allergy; St. Louis Hospital, University of Paris, Paris, France; Editor-in-Chief, Intensive Care Medicine; Department of Medicine, Columbia University Irving Medical Center, and Division of Pulmonary, Critical Care, and Sleep, NYU Langone Health, New York, New York; Department of Intensive Care Adults, Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Intensive Care, Pontificia Universidad Católica de Chile, Santiago, Chile; Editor-in-Chief, Journal of Critical Care; Department of Internal Medicine, University of Iowa and the Iowa City Veterans Affairs Medical Center, Iowa City, Iowa; Editor-in-Chief, The Journal of Allergy and Clinical Immunology; Monash Lung and Sleep, Monash Hospital and University, Melbourne, Victoria, Australia; Co-Editor-in-Chief, Respirology; Pulmonology Department, Muscle and Lung Cancer Research Group, Research Institute of Hospital del Mar and Centro de Investigación Biomédica en Red Enfermedades Respiratorias Instituto de Salud Carlos III, Barcelona, Spain; Editor-in-Chief, Archivos de Bronconeumologia; Department of Intensive Care Medicine, Austin Hospital and University of Melbourne, Melbourne, Victoria, Australia; Editor-in-Chief, Critical Care & Resuscitation; Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio; Editor-in-Chief, Journal of Asthma; Department of Internal Medicine, University of Genoa, Genoa, Italy; Editor-in-Chief, COPD: Journal of Chronic Obstructive Pulmonary Disease; Department of Surgery, Department of Anesthesiology, and Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, Georgia; Editor-in-Chief,Critical CareMedicine; JFKNewJersey Neuroscience Institute, HackensackMeridian Health–JFKMedical Center, Edison, New Jersey; Editor-in-Chief, Sleep Medicine; Department of Medicine and Department of Neurology, Emory University School of Medicine, Atlanta, Georgia; Editor-in-Chief, Journal of Clinical Sleep Medicine; Department of Medicine, National Jewish Hospital, Denver, Colorado; Editor-in-Chief, Journal of the COPD Foundation; The Children’s Hospital at Westmead, Sydney Medical School, University of

K. Weiss, P. Gergen, T. Hodgson

V. Wong, W. Chan, S. Chitturi et al.

E. Araki, A. Goto, Tatsuya Kondo et al.

Diabetes 2019 Eiichi Araki , Atsushi Goto, Tatsuya Kondo, Mitsuhiko Noda, Hiroshi Noto, Hideki Origasa, Haruhiko Osawa, Akihiko Taguchi, Yukio Tanizawa, Kazuyuki Tobe, Narihito Yoshioka Department of Metabolic Medicine, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan, Department of Health Data Science, Graduate School of Data Science, Yokohama City University, Yokohama, Japan, Department of Diabetes, Metabolism and Endocrinology, Kumamoto University Hospital, Kumamoto, Japan, Department of Diabetes, Metabolism and Endocrinology, Ichikawa Hospital,International University of Health and Welfare, Ichikawa, Japan, Division of Endocrinology and Metabolism, St. Luke’s International Hospital, Tokyo, Japan, Department of Biostatistics and Clinical Epidemiology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan, Department of Diabetes and Molecular Genetics, Ehime University Graduate School of Medicine, Toon, Japan, Department of Endocrinology, Metabolism, Hematological Science and Therapeutics, Graduate School of Medicine, Yamaguchi University, Ube, Japan, First Department of Internal Medicine, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan, and NTT Medical Center Sapporo, Sapporo, Japan

Mayuree Tangkiatkumjai, H. Boardman, D. Walker

Objectives To determine similarities and differences in the reasons for using or not using complementary and alternative medicine (CAM) amongst general and condition-specific populations, and amongst populations in each region of the globe. Methods A literature search was performed on Pubmed, ScienceDirect and EMBASE. Keywords: ‘herbal medicine’ OR ‘herbal and dietary supplement’ OR ‘complementary and alternative medicine’ AND ‘reason’ OR ‘attitude’. Quantitative or qualitative original articles in English, published between 2003 and 2018 were reviewed. Conference proceedings, pilot studies, protocols, letters, and reviews were excluded. Papers were appraised using valid tools and a ‘risk of bias’ assessment was also performed. Thematic analysis was conducted. Reasons were coded in each paper, then codes were grouped into categories. If several categories reported similar reasons, these were combined into a theme. Themes were then analysed using χ 2 tests to identify the main factors related to reasons for CAM usage. Results 231 publications were included. Reasons for CAM use amongst general and condition-specific populations were similar. The top three reasons for CAM use were: (1) having an expectation of benefits of CAM (84% of publications), (2) dissatisfaction with conventional medicine (37%) and (3) the perceived safety of CAM (37%). Internal health locus of control as an influencing factor was more likely to be reported in Western populations, whereas the social networks was a common factor amongst Asian populations ( p < 0.05). Affordability, easy access to CAM and tradition were significant factors amongst African populations ( p < 0.05). Negative attitudes towards CAM and satisfaction with conventional medicine (CM) were the main reasons for non-use ( p < 0.05). Conclusions Dissatisfaction with CM and positive attitudes toward CAM, motivate people to use CAM. In contrast, satisfaction with CM and negative attitudes towards CAM are the main reasons for non-use.

Harsh Rathva, Ojas Srivastava, Pruthwik Mishra

We introduce Embedded Safety-Aligned Intelligence (ESAI), a theoretical framework for multi-agent reinforcement learning that embeds alignment constraints directly into agents internal representations using differentiable internal alignment embeddings. Unlike external reward shaping or post-hoc safety constraints, internal alignment embeddings are learned latent variables that predict externalized harm through counterfactual reasoning and modulate policy updates toward harm reduction through attention and graph-based propagation. The ESAI framework integrates four mechanisms: differentiable counterfactual alignment penalties computed from soft reference distributions, alignment-weighted perceptual attention, Hebbian associative memory supporting temporal credit assignment, and similarity-weighted graph diffusion with bias mitigation controls. We analyze stability conditions for bounded internal embeddings under Lipschitz continuity and spectral constraints, discuss computational complexity, and examine theoretical properties including contraction behavior and fairness-performance tradeoffs. This work positions ESAI as a conceptual contribution to differentiable alignment mechanisms in multi-agent systems. We identify open theoretical questions regarding convergence guarantees, embedding dimensionality, and extension to high-dimensional environments. Empirical evaluation is left to future work.

Windy W. Alonso, Sara E. Bills, Scott W. Lundgren et al.

Abstract Aims Most adults with stable heart failure are safe to exercise at a moderate intensity for 150 min/week. Regular participation in exercise may improve outcomes in adults with heart failure with preserved ejection fraction (HFpEF). Few adults with HFpEF initiate and sustain long‐term exercise. To promote exercise adherence in adults with HFpEF, we developed the Heart Failure Exercise and Resistance Training (HEART) Camp Connect intervention that is tested in this clinical trial. This trial tests our central hypothesis that theory‐informed coaching strategies delivered virtually will promote long‐term adherence to exercise in adults with HFpEF and drive clinically meaningful, and cost‐effective improvements in physiological and patient‐reported outcomes. Our aims are to (a) evaluate the effects of virtual and in‐person exercise and coaching on long‐term adherence, (b) determine a benchmark of minutes of moderate intensity exercise associated with health status as related to key biobehavioural outcomes, (c) examine behaviour change theory‐defined constructs as mediators of exercise adherence and (d) evaluate intervention costs. Methods This 18 month, three‐group, repeated measures randomized controlled trial is enrolling 300 adults with HFpEF. Participants are randomized to enhanced usual care (EUC), virtual coaching, or in‐person coaching. Our intervention applies coaching strategies, informed by behaviour change theories, in one‐on‐one and group settings weekly for 12 months. Our objective is to compare the effects of each delivery method to the other and EUC on exercise adherence (defined as ≥ 120 min of moderate intensity exercise/week) at 12 months (primary endpoint) and 18 months (sustainability endpoint). Secondary outcomes include minutes of moderate intensity exercise needed to drive minimal clinically important differences in health status, biomarkers, patient‐reported symptoms and cost. Behaviour change theory‐defined constructs (e.g., self‐efficacy and outcome expectations) will be tested as mediators of exercise adherence. Results We expect that virtual coaching is equally as efficacious and more cost effective at promoting exercise adherence as in‐person coaching. Effects on exercise adherence may be mediated by theory‐defined constructs. We also expect to identify a threshold for minutes of moderate intensity exercise to potentially serve as an adherence benchmark in adults with HFpEF, one that may differ from the 120 min of exercise in our current definition. Conclusions These findings could shift the paradigm of exercise coaching in HF towards virtual delivery and increase the generalizability and reach of exercise training. This is especially important for adults with HFpEF as they are excluded from Medicare reimbursement for traditional cardiopulmonary rehabilitation.

Una Tonkovic, Marko Bogicevic, Aarish Manzar et al.

Hemolytic uremic syndrome (HUS), a thrombotic microangiopathy primarily affecting the kidneys, can also involve the central nervous system (CNS), often leading to significant morbidity and mortality. Neurologic manifestations are among the most severe extra-renal complications, particularly in children and during outbreaks of Shiga toxin-producing Escherichia coli (STEC)-associated HUS (typical (tHUS)). This review explores the clinical spectrum, pathophysiology, diagnostic workup, and age-specific outcomes of neurologic involvement in both typical (tHUS) and atypical (aHUS). Neurologic complications occur in up to 11% of pediatric and over 40% of adult STEC-HUS cases in outbreak settings. Presentations include seizures, encephalopathy, focal deficits, movement disorders, and posterior reversible encephalopathy syndrome (PRES). Magnetic resonance imaging (MRI) commonly reveals basal ganglia or parieto-occipital lesions, though subtle or delayed findings may occur. Laboratory workup typically confirms microangiopathic hemolytic anemia (MAHA), thrombocytopenia, and kidney damage, with additional markers of inflammation or metabolic dysregulation. Eculizumab is the first-line treatment for aHUS with CNS involvement, while its utility in STEC-HUS remains uncertain. Although many children recover fully, those with early CNS involvement are at greater risk of developing epilepsy, cognitive delays, or fine motor deficits. Adults may experience lingering neurocognitive symptoms despite apparent clinical recovery. Differences in presentation and imaging findings between age groups emphasize the need for tailored diagnostic and therapeutic strategies. Comprehensive neurorehabilitation and long-term follow-up are crucial for identifying residual deficits. Continued research into predictive biomarkers, neuroprotective interventions, and standardized treatment protocols is needed for improving outcomes in HUS patients with neurological complications.

Zhanglin Hou, Ziluo Zhang, Jun Li et al.

Using an underdamped active Ornstein-Uhlenbeck particle, we propose two information swimmer models having either external or internal feedback control and perform their numerical simulations. Depending on the velocity that is measured after every fixed time interval (measurement time), the friction coefficient is modified in the externally controlled model, whereas the persistence time for the activity is changed in the internally controlled one. In the steady state, both of these information swimmers acquire finite average velocities in the noisy environment, and the efficiency can be maximized by tuning the measurement time. The internally controlled swimmer can generally achieve a larger velocity and efficiency than the externally controlled one when the active fluctuation is large.

Markanday Sharma, Prateek Yadav, Srikrishna P. Panda

Diagnostic and interventional aspects of psychiatric care can be augmented by the use of digital health technologies. Recent studies have tried to explore the use of artificial intelligence-driven technologies in screening, diagnosing, and treating psychiatric disorders. This short communication presents a current perspective on using Artificial Intelligence in psychiatry.

P. García Piqueras, D. Vírseda González, K. Soledad Encalada Luna et al.

Ferdinand Evers, Ishita Modak, Soumya Bera

After a decade of many claims to the opposite, there now is a growing consensus that generic disordered quantum wires, e.g. the XXZ-Heisenberg chain, do not exhibit many-body localization (MBL) - at least not in a strict sense within a reasonable window of disorder values $W$. Specifically, computational studies of short wires exhibit an extremely slow but unmistakable flow of physical observables with increasing time and system size (``creep") that is consistently directed away from (strict) localization. Our work sheds fresh light on delocalization physics: Strong sample-to-sample fluctuations indicate the absence of a generic time scale, i.e. of a naive ``clock rate"; however, the concept of an ``internal clock" survives, at least in an ensemble sense. Specifically, we investigate the relaxation of the imbalance $\mathcal{I}(t)$ and its temporal fluctuations $\mathcal{F}(t)$, the entanglement and Renyi entropies, $\mathcal{S}_{\mathrm{e}}(t)$ and $ \mathcal{S}_2(t)$, in a 1D system of interacting disordered fermions. We observe that adopting $\mathcal{S}_{\mathrm{e}}(t), \mathcal{S}_2(t)$ as a measure for the internal time per sample reduces the sample-to-sample fluctuations but does not eliminate them. However, a (nearly) perfect collapse of the average $\overline{\mathcal{I}}(t)$ and $\overline{\mathcal{F}}(t)$ for different $W$ is obtained when plotted against $\overline{\mathcal{S}}_{\mathrm{e}}(t)$ or $\overline{\mathcal{S}}_2(t)$, indicating that the average entropy appropriately models the ensemble-averaged internal clock. We take the tendency for faster-than-logarithmic growth of $\overline{\mathcal{S}}_{\mathrm{e}}(t)$ together with smooth dependency on $W$ of all our observables within the entire simulation window as support for the cross-over scenario, discouraging an MBL transition within the traditional parametric window of computational studies.

Vincent Labarre, Nicolas Lanchon, Pierre-Philippe Cortet et al.

We present a new derivation of the kinetic equation for weak, non-hydrostatic internal gravity wave turbulence. The equation is equivalent to the one obtained by Caillol & Zeitlin (2000), but it takes a canonical form. We show that it conserves the energy without involving the resonance condition in frequency, and look for the isotropic part of the steady, scale invariant solutions. We provide a parametrization of the resonant manifold of non-hydrostatic internal gravity wave triadic interactions. This allows us to simplify the collision integral, and to evaluate the transfer coefficients of all triadic interactions. In the hydrostatic limit, our equation is equivalent to the Hamiltonian description of Lvov & Tabak (2001).

Cynthia Burman, Jamie Findlow, Helen S. Marshall et al.

Introduction Invasive meningococcal disease (IMD) is a severe, life-threatening condition caused by infection with Neisseria meningitidis. Currently available vaccines offer protection against the five most common meningococcal disease-causing serogroups and include monovalent and quadrivalent conjugate vaccines (MenA, MenC, MenACWY vaccines) and outer membrane vesicle- and/or recombinant protein-based vaccines (MenB vaccines). Areas covered Country and regional immunization programs target populations susceptible to IMD and typically emphasize the highest-risk age groups (i.e., infants, adolescents/young adults, and the elderly); however, additional groups are also considered at an elevated risk and are the focus of the current review. Specific increased-risk groups include individuals with underlying immunocompromising medical conditions, university/college students, Indigenous people, laboratory workers, military personnel, men who have sex with men, and travelers to areas with hyperendemic IMD. This review compares established meningococcal vaccination recommendations for these vulnerable groups in Europe, the United States, Australia, New Zealand, Israel, Brazil, and Turkey. Expert opinion Recommendations should be standardized to cover all groups at increased risk of IMD.

Rachel E. Bosserman, Christopher W. Farnsworth, Caroline A. O’Neil et al.

Abstract Objective: To determine the prevalence of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) IgG nucleocapsid (N) antibodies among healthcare personnel (HCP) with no prior history of COVID-19 and to identify factors associated with seropositivity. Design: Prospective cohort study. Setting: An academic, tertiary-care hospital in St. Louis, Missouri. Participants: The study included 400 HCP aged ≥18 years who potentially worked with coronavirus disease 2019 (COVID-19) patients and had no known history of COVID-19; 309 of these HCP also completed a follow-up visit 70–160 days after enrollment. Enrollment visits took place between September and December 2020. Follow-up visits took place between December 2020 and April 2021. Methods: At each study visit, participants underwent SARS-CoV-2 IgG N-antibody testing using the Abbott SARS-CoV-2 IgG assay and completed a survey providing information about demographics, job characteristics, comorbidities, symptoms, and potential SARS-CoV-2 exposures. Results: Participants were predominately women (64%) and white (79%), with median age of 34.5 years (interquartile range [IQR], 30–45). Among the 400 HCP, 18 (4.5%) were seropositive for IgG N-antibodies at enrollment. Also, 34 (11.0%) of 309 were seropositive at follow-up. HCP who reported having a household contact with COVID-19 had greater likelihood of seropositivity at both enrollment and at follow-up. Conclusions: In this cohort of HCP during the first wave of the COVID-19 pandemic, ∼1 in 20 had serological evidence of prior, undocumented SARS-CoV-2 infection at enrollment. Having a household contact with COVID-19 was associated with seropositivity.

Christian Steidl, Robert Kridel, Michael Binkley et al.

Abstract Lymphoid cancers are among the most frequent cancers diagnosed in adolescents and young adults (AYA), ranging from approximately 30%–35% of cancer diagnoses in adolescent patients (age 10–19) to approximately 10% in patients aged 30–39 years. Moreover, the specific distribution of lymphoid cancer types varies by age with substantial shifts in the subtype distributions between pediatric, AYA, adult, and older adult patients. Currently, biology studies specific to AYA lymphomas are rare and therefore insight into age‐related pathogenesis is incomplete. This review focuses on the paradigmatic epidemiology and pathogenesis of select lymphomas, occurring in the AYA patient population. With the example of posttransplant lymphoproliferative disorders, nodular lymphocyte‐predominant Hodgkin lymphoma, follicular lymphoma (incl. pediatric‐type follicular lymphoma), and mediastinal lymphomas (incl. classic Hodgkin lymphoma, primary mediastinal large B cell lymphoma and mediastinal gray zone lymphoma), we here illustrate the current state‐of‐the‐art in lymphoma classification, recent molecular insights including genomics, and translational opportunities. To improve outcome and quality of life, international collaboration in consortia dedicated to AYA lymphoma is needed to overcome challenges related to siloed biospecimens and data collections as well as to develop studies designed specifically for this unique population.