Reinforcement learning encounters formidable challenges when tasked with intricate decision-making scenarios,primarily due to the expansive parameterized action spaces and the vastness of the corresponding policy land...Reinforcement learning encounters formidable challenges when tasked with intricate decision-making scenarios,primarily due to the expansive parameterized action spaces and the vastness of the corresponding policy landscapes.To surmount these difficulties,we devise a practical structured action graph model augmented by guiding policies that integrate trust region constraints.Based on this,we propose guided proximal policy optimization with structured action graph(GPPO-SAG),which has demonstrated pronounced efficacy in refining policy learning and enhancing performance across sophisticated tasks characterized by parameterized action spaces.Rigorous empirical evaluations of our model have been performed on comprehensive gaming platforms,including the entire suite of StarCraft II and Hearthstone,yielding exceptionally favorable outcomes.Our source code is at https://github.com/sachiel321/GPPO-SAG.展开更多
Background:Despite the promise shown by large language models(LLMs)for standardized tasks,their multidimensional performance in real-world oncology decision-making remains unevaluated.This study aims to introduce a fr...Background:Despite the promise shown by large language models(LLMs)for standardized tasks,their multidimensional performance in real-world oncology decision-making remains unevaluated.This study aims to introduce a framework for evaluating LLMs and physician decisions in challenging lung cancer cases.Methods:We curated 50 challenging lung cancer cases(25 local and 25 published)classified as complex,rare,or refractory.Blinded three-dimensional,five-point Likert evaluations(1–5 for comprehensiveness,specificity,and readability)compared standalone LLMs(DeepSeek R1,Claude 3.5,Gemini 1.5,and GPT-4o),physicians by experience level(junior,intermediate,and senior),and AI-assisted juniors;intergroup differences and augmentation effects were analyzed statistically.Results:Of 50 challenging cases(18 complex,17 rare,and 15 refractory)rated by three experts,DeepSeek R1 achieved scores of 3.95±0.33,3.71±0.53,and 4.26±0.18 for comprehensiveness,specificity,and readability,respectively,positioning it between intermediate(3.68,3.68,3.75)and senior(4.50,4.64,4.53)physicians.GPT-4o and Claude 3.5 reached intermediate physician–level comprehensiveness(3.76±0.39,3.60±0.39)but junior-to-intermediate physician–level specificity(3.39±0.39,3.39±0.49).All LLMs scored higher on rare cases than intermediate physicians but fell below junior physicians in refractory-case specificity.AIassisted junior physicians showed marked gains in rare cases,with comprehensiveness rising from 2.32 to 4.29(84.8%),specificity from 2.24 to 4.26(90.8%),and readability from 2.76 to 4.59(66.0%),while specificity declined by 3.2%(3.17 to 3.07)in refractory cases.Error analysis showed complementary strengths,with physicians demonstrating reasoning stability and LLMs excelling in knowledge updating and risk management.Conclusions:LLMs performed variably in clinical decision-making tasks depending on case type,performing better in rare cases and worse in refractory cases requiring longitudinal reasoning.Complementary strengths between LLMs and physicians support case-and task-tailored human–AI collaboration.展开更多
Environmental problems are intensifying due to the rapid growth of the population,industry,and urban infrastructure.This expansion has resulted in increased air and water pollution,intensified urban heat island effect...Environmental problems are intensifying due to the rapid growth of the population,industry,and urban infrastructure.This expansion has resulted in increased air and water pollution,intensified urban heat island effects,and greater runoff from parks and other green spaces.Addressing these challenges requires prioritizing green infrastructure and other sustainable urban development strategies.This study introduces a novel Integrated Decision Support System that combines Pythagorean Fuzzy Sets with the Advanced Alternative Ranking Order Method allowing for Two-Step Normalization(AAROM-TN),enhanced by a dual weighting strategy.The weighting approach integrates the Criteria Importance Through Intercriteria Correlation(CRITIC)method with the Criteria Importance through Means and Standard Deviation(CIMAS)technique.The originality of the proposed framework lies in its ability to objectively quantify criteria importance using CRITIC,incorporate decision-makers’preferences through CIMAS,and capture the uncertainty and hesitation inherent in human judgment via Pythagorean Fuzzy Sets.A case study evaluating green infrastructure alternatives in metropolitan regions demonstrates the applicability and effectiveness of the framework.A sensitivity analysis is conducted to examine how variations in criteria weights affect the rankings and to evaluate the robustness of the results.Furthermore,a comparative analysis highlights the practical and financial implications of each alternative by assessing their respective strengths and weaknesses.展开更多
With the rapid development of artificial intelligence,intelligent air combat maneuver decision-making(ACMD)has garnered global attention.Although deep reinforcement learning provides a promising approach to ACMD,exist...With the rapid development of artificial intelligence,intelligent air combat maneuver decision-making(ACMD)has garnered global attention.Although deep reinforcement learning provides a promising approach to ACMD,existing methods often suffer from rigid reward functions and limited adaptability to evolving adversarial strategies.Moreover,most research assumes open airspace,overlooking the influence of potential obstacles.In this paper,we address one-on-one within-visual-range ACMD in obstructed environments,and propose an improved Soft Actor-Critic(SAC)algorithm trained under a curriculum self-play framework.A maneuver strategy mirroring inference module is integrated to estimate each other's likely positions when visual obstruction occurs.By leveraging curriculum learning to guide progressive experience accumulation and self-play for adversarial evolution,our method enhances both training efficiency and tactical diversity.We further integrate an attention mechanism that dynamically adjusts the weights of sub-rewards,enabling the learned policy to adapt to rapidly changing air combat situations.Numerical simulations demonstrate that our enhanced SAC converges more quickly and achieves higher win rates than other baseline methods.An animation is available at bilibili.com/video/BV1BHVszHE98 for better illustration.展开更多
With the increasing complexity of industrial automation,planetary gearboxes play a vital role in largescale equipment transmission systems,directly impacting operational efficiency and safety.Traditional maintenance s...With the increasing complexity of industrial automation,planetary gearboxes play a vital role in largescale equipment transmission systems,directly impacting operational efficiency and safety.Traditional maintenance strategies often struggle to accurately predict the degradation process of equipment,leading to excessive maintenance costs or potential failure risks.However,existing prediction methods based on statistical models are difficult to adapt to nonlinear degradation processes.To address these challenges,this study proposes a novel condition-based maintenance framework for planetary gearboxes.A comprehensive full-lifecycle degradation experiment was conducted to collect raw vibration signals,which were then processed using a temporal convolutional network autoencoder with multi-scale perception capability to extract deep temporal degradation features,enabling the collaborative extraction of longperiod meshing frequencies and short-term impact features from the vibration signals.Kernel principal component analysis was employed to fuse and normalize these features,enhancing the characterization of degradation progression.A nonlinear Wiener process was used to model the degradation trajectory,with a threshold decay function introduced to dynamically adjust maintenance strategies,and model parameters optimized through maximum likelihood estimation.Meanwhile,the maintenance strategy was optimized to minimize costs per unit time,determining the optimal maintenance timing and preventive maintenance threshold.The comprehensive indicator of degradation trends extracted by this method reaches 0.756,which is 41.2%higher than that of traditional time-domain features;the dynamic threshold strategy reduces the maintenance cost per unit time to 55.56,which is 8.9%better than that of the static threshold optimization.Experimental results demonstrate significant reductions in maintenance costs while enhancing system reliability and safety.This study realizes the organic integration of deep learning and reliability theory in the maintenance of planetary gearboxes,provides an interpretable solution for the predictive maintenance of complex mechanical systems,and promotes the development of condition-based maintenance strategies for planetary gearboxes.展开更多
Due to the numerous variables to take into account as well as the inherent ambiguity and uncertainty,evaluating educational institutions can be difficult.The concept of a possibility Pythagorean fuzzy hypersoft set(pP...Due to the numerous variables to take into account as well as the inherent ambiguity and uncertainty,evaluating educational institutions can be difficult.The concept of a possibility Pythagorean fuzzy hypersoft set(pPyFHSS)is more flexible in this regard than other theoretical fuzzy set-like models,even though some attempts have been made in the literature to address such uncertainties.This study investigates the elementary notions of pPyFHSS including its set-theoretic operations union,intersection,complement,OR-and AND-operations.Some results related to these operations are also modified for pPyFHSS.Additionally,the similarity measures between pPyFHSSs are formulated with the assistance of numerical examples and results.Lastly,an intelligent decision-assisted mechanism is developed with the proposal of a robust algorithm based on similarity measures for solving multi-attribute decision-making(MADM)problems.A case study that helps the decision-makers assess the best educational institution is discussed to validate the suggested system.The algorithmic results are compared with the most pertinent model to evaluate the adaptability of pPyFHSS,as it generalizes the classical possibility fuzzy set-like theoretical models.Similarly,while considering significant evaluating factors,the flexibility of pPyFHSS is observed through structural comparison.展开更多
The critical role of patient-reported outcome measures(PROMs)in enhancing clinical decision-making and promoting patient-centered care has gained a profound significance in scientific research.PROMs encapsulate a pati...The critical role of patient-reported outcome measures(PROMs)in enhancing clinical decision-making and promoting patient-centered care has gained a profound significance in scientific research.PROMs encapsulate a patient's health status directly from their perspective,encompassing various domains such as symptom severity,functional status,and overall quality of life.By integrating PROMs into routine clinical practice and research,healthcare providers can achieve a more nuanced understanding of patient experiences and tailor treatments accordingly.The deployment of PROMs supports dynamic patient-provider interactions,fostering better patient engagement and adherence to tre-atment plans.Moreover,PROMs are pivotal in clinical settings for monitoring disease progression and treatment efficacy,particularly in chronic and mental health conditions.However,challenges in implementing PROMs include data collection and management,integration into existing health systems,and acceptance by patients and providers.Overcoming these barriers necessitates technological advancements,policy development,and continuous education to enhance the acceptability and effectiveness of PROMs.The paper concludes with recommendations for future research and policy-making aimed at optimizing the use and impact of PROMs across healthcare settings.展开更多
To solve problems of poor security guarantee and insufficient training efficiency in the conventional reinforcement learning methods for decision-making,this study proposes a hybrid framework to combine deep reinforce...To solve problems of poor security guarantee and insufficient training efficiency in the conventional reinforcement learning methods for decision-making,this study proposes a hybrid framework to combine deep reinforcement learning with rule-based decision-making methods.A risk assessment model for lane-change maneuvers considering uncertain predictions of surrounding vehicles is established as a safety filter to improve learning efficiency while correcting dangerous actions for safety enhancement.On this basis,a Risk-fused DDQN is constructed utilizing the model-based risk assessment and supervision mechanism.The proposed reinforcement learning algorithm sets up a separate experience buffer for dangerous trials and punishes such actions,which is shown to improve the sampling efficiency and training outcomes.Compared with conventional DDQN methods,the proposed algorithm improves the convergence value of cumulated reward by 7.6%and 2.2%in the two constructed scenarios in the simulation study and reduces the number of training episodes by 52.2%and 66.8%respectively.The success rate of lane change is improved by 57.3%while the time headway is increased at least by 16.5%in real vehicle tests,which confirms the higher training efficiency,scenario adaptability,and security of the proposed Risk-fused DDQN.展开更多
A novel model termed a bipolar complex fuzzy N-soft set(BCFN-SS)is initiated for tackling information that involves positive and negative aspects,the second dimension,and parameterised grading simultaneously.The theor...A novel model termed a bipolar complex fuzzy N-soft set(BCFN-SS)is initiated for tackling information that involves positive and negative aspects,the second dimension,and parameterised grading simultaneously.The theory of BCFN-SS is the generalisation of two various theories,that is,bipolar complex fuzzy(BCF)and N-SS.The invented model of BCFN-SS helps decision-makers to cope with the genuine-life dilemmas containing BCF information along with parameterised grading at the same time.Further,various algebraic operations,including the usual type of union,intersection,complements,and a few others types,are invented.Certain primary operational laws for BCFNSS are also invented.Moreover,a technique for order preference by similarity to the ideal solution(TOPSIS)approach is devised in the setting of BCFN-SS for managing strategic decision-making(DM)dilemmas containing BCFN-SS information.Keeping in mind the usefulness and benefits of the TOPSIS approach,two various types of TOPSIS approaches in the environment of BCFN-SS are devised and then a numerical example for exposing the usefulness of the devised TOPSIS approach is interpreted.To disclose the prominence and benefits of the devised work,the devised approaches with numerous prevailing work are compared.展开更多
The decision-making under complex urban environment become one of the key issues that restricts the rapid development of the autonomous vehicles. The difficulty in making timely and accurate decisions like human being...The decision-making under complex urban environment become one of the key issues that restricts the rapid development of the autonomous vehicles. The difficulty in making timely and accurate decisions like human beings under highly dynamic traffic environment is a major challenge for autonomous driving. Car-following has been regarded as the simplest but essential driving behavior among driving tasks and has received extensive attention from researchers around the world. This work addresses this problem and proposes a novel method RSAN(rough-set artificial neural network) to learn the decisions from excellent human drivers. A virtual urban traffic environment was built by Pre Scan and driving simulation was conducted to obtain a broad set of relevant data such as experienced drivers' behavior data and surrounding vehicles' motion data. Then, rough set was used to preprocess these data to extract the key influential factors on decision and reduce the impact of uncertain data and noise data. And the car-following decision was learned by neural network in which key factor was the input and acceleration was the output. The result shows the better convergence speed and the better decision accuracy of RSAN than ANN. Findings of this work contributes to the empirical understanding of driver's decision-making process and it provides a theoretical basis for the study of car-following decision-making under complex and dynamic environment.展开更多
Accurate medical diagnosis,which involves identifying diseases based on patient symptoms,is often hindered by uncertainties in data interpretation and retrieval.Advanced fuzzy set theories have emerged as effective to...Accurate medical diagnosis,which involves identifying diseases based on patient symptoms,is often hindered by uncertainties in data interpretation and retrieval.Advanced fuzzy set theories have emerged as effective tools to address these challenges.In this paper,new mathematical approaches for handling uncertainty in medical diagnosis are introduced using q-rung orthopair fuzzy sets(q-ROFS)and interval-valued q-rung orthopair fuzzy sets(IVq-ROFS).Three aggregation operators are proposed in our methodologies:the q-ROF weighted averaging(q-ROFWA),the q-ROF weighted geometric(q-ROFWG),and the q-ROF weighted neutrality averaging(qROFWNA),which enhance decision-making under uncertainty.These operators are paired with ranking methods such as the similarity measure,score function,and inverse score function to improve the accuracy of disease identification.Additionally,the impact of varying q-rung values is explored through a sensitivity analysis,extending the analysis beyond the typical maximum value of 3.The Basic Uncertain Information(BUI)method is employed to simulate expert opinions,and aggregation operators are used to combine these opinions in a group decisionmaking context.Our results provide a comprehensive comparison of methodologies,highlighting their strengths and limitations in diagnosing diseases based on uncertain patient data.展开更多
Background:Multiparametric magnetic resonance imaging(mpMRI)has significantly advanced prostate cancer(PCa)detection,yet decisions on invasive biopsy with moderate prostate imaging reporting and data system(PI-RADS)sc...Background:Multiparametric magnetic resonance imaging(mpMRI)has significantly advanced prostate cancer(PCa)detection,yet decisions on invasive biopsy with moderate prostate imaging reporting and data system(PI-RADS)scores remain ambiguous.Methods:To explore the decision-making capacity of Generative Pretrained Transformer-4(GPT-4)for automated prostate biopsy recommendations,we included 2299 individuals who underwent prostate biopsy from 2018 to 2023 in 3 large medical centers,with available mpMRI before biopsy and documented clinical-histopathological records.GPT-4 generated structured reports with given prompts.The performance of GPT-4 was quantified using confusion matrices,and sensitivity,specificity,as well as area under the curve were calculated.Multiple artificial evaluation procedures were conducted.Wilcoxon’s rank sum test,Fisher’s exact test,and Kruskal-Wallis tests were used for comparisons.Results:Utilizing the largest sample size in the Chinese population,patients with moderate PI-RADS scores(scores 3 and 4)accounted for 39.7%(912/2299),defined as the subset-of-interest(SOI).The detection rates of clinically significant PCa corresponding to PI-RADS scores 2-5 were 9.4%,27.3%,49.2%,and 80.1%,respectively.Nearly 47.5%(433/912)of SOI patients were histopathologically proven to have undergone unnecessary prostate biopsies.With the assistance of GPT-4,20.8%(190/912)of the SOI population could avoid unnecessary biopsies,and it performed even better[28.8%(118/410)]in the most heterogeneous subgroup of PI-RADS score 3.More than 90.0%of GPT-4-generated reports were comprehensive and easy to understand,but less satisfied with the accuracy(82.8%).GPT-4 also demonstrated cognitive potential for handling complex problems.Additionally,the Chain of Thought method enabled us to better understand the decision-making logic behind GPT-4.Eventually,we developed a ProstAIGuide platform to facilitate accessibility for both doctors and patients.Conclusions:This multi-center study highlights the clinical utility of GPT-4 for prostate biopsy decision-making and advances our understanding of the latest artificial intelligence implementation in various medical scenarios.展开更多
Based on an analysis of the role of industrial control and optimization technologies in the Industrial Revolution,as well as the current situation and existing problems of operational decision-making(ODM)for industria...Based on an analysis of the role of industrial control and optimization technologies in the Industrial Revolution,as well as the current situation and existing problems of operational decision-making(ODM)for industrial process,this paper introduces the concept of intelligent ODM in industrial process,shapes its future directions,and highlights key technical challenges.By the tight conjoining of and coordination between industrial artificial intelligence(AI)with industrial control and optimization technologies,as well as the Industrial Internet with industrial computer management and control systems,an intelligent operational optimization decision-making methodology is proposed for complex industrial process.The intelligent ODM methodology and its successful application demonstrate that the tight conjoining of and coordination between next-generation information technologies with industrial control and optimization technologies will promote the development of industrial intelligent ODM.Finally,main research directions and ideas are outlined for realizing intelligent ODM in industrial process.展开更多
Complex systems,such as infrastructure networks,industrial plants and jet engines,are of paramount importance to modern societies.However,these systems are subject to a variety of different threats.Novel research focu...Complex systems,such as infrastructure networks,industrial plants and jet engines,are of paramount importance to modern societies.However,these systems are subject to a variety of different threats.Novel research focuses not only on monitoring and improving the robustness and reliability of systems,but also on their recoverability from adverse events.The concept of resilience encompasses precisely these aspects.However,efficient resilience analysis for the modern systems of our societies is becoming more and more challenging.Due to their increasing complexity,system components frequently exhibit significant complexity of their own,requiring them to be modeled as systems,i.e.,subsystems.Therefore,efficient resilience analysis approaches are needed to address this emerging challenge.This work presents an efficient resilience decision-making procedure for complex and substructured systems.A novel methodology is derived by bringing together two methods from the fields of reliability analysis and modern resilience assessment.A resilience decision-making framework and the concept of survival signature are extended and merged,providing an efficient approach for quantifying the resilience of complex,large and substructured systems subject to monetary restrictions.The new approach combines both of the advantageous characteristics of its two original components:A direct comparison between various resilience-enhancing options from a multidimensional search space,leading to an optimal trade-off with respect to the system resilience and a significant reduction of the computational effort due to the separation property of the survival signature,once a subsystem structure has been computed,any possible characterization of the probabilistic part can be validated with no need to recompute the structure.The developed methods are applied to the functional model of a multistage high-speed axial compressor and two substructured systems of increasing complexity,providing accurate results and demonstrating efficiency and general applicability.展开更多
BACKGROUND Understanding a patient's clinical status and setting priorities for their care are two aspects of the constantly changing process of clinical decision-making.One analytical technique that can be helpfu...BACKGROUND Understanding a patient's clinical status and setting priorities for their care are two aspects of the constantly changing process of clinical decision-making.One analytical technique that can be helpful in uncertain situations is clinical judgment.Clinicians must deal with contradictory information,lack of time to make decisions,and long-term factors when emergencies occur.AIM To examine the ethical issues healthcare professionals faced during the coronavirus disease 2019(COVID-19)pandemic and the factors affecting clinical decision-making.METHODS This pilot study,which means it was a preliminary investigation to gather information and test the feasibility of a larger investigation was conducted over 6 months and we invited responses from clinicians worldwide who managed patients with COVID-19.The survey focused on topics related to their professional roles and personal relationships.We examined five core areas influencing critical care decision-making:Patients'personal factors,family-related factors,informed consent,communication and media,and hospital administrative policies on clinical decision-making.The collected data were analyzed using the χ^(2) test for categorical variables.RESULTS A total of 102 clinicians from 23 specialties and 17 countries responded to the survey.Age was a significant factor in treatment planning(n=88)and ventilator access(n=78).Sex had no bearing on how decisions were made.Most doctors reported maintaining patient confidentiality regarding privacy and informed consent.Approximately 50%of clinicians reported a moderate influence of clinical work,with many citing it as one of the most important factors affecting their health and relationships.Clinicians from developing countries had a significantly higher score for considering a patient's financial status when creating a treatment plan than their counterparts from developed countries.Regarding personal experiences,some respondents noted that treatment plans and preferences changed from wave to wave,and that there was a rapid turnover of studies and evidence.Hospital and government policies also played a role in critical decision-making.Rather than assessing the appropriateness of treatment,some doctors observed that hospital policies regarding medications were driven by patient demand.CONCLUSION Factors other than medical considerations frequently affect management choices.The disparity in treatment choices,became more apparent during the pandemic.We highlight the difficulties and contradictions between moral standards and the realities physicians encountered during this medical emergency.False information,large patient populations,and limited resources caused problems for clinicians.These factors impacted decision-making,which,in turn,affected patient care and healthcare staff well-being.展开更多
Objectives This study aimed to clarify the relationship between the content of proxy decision-making made by families of patients with malignant brain tumors regarding treatment policies and daily care and the cues le...Objectives This study aimed to clarify the relationship between the content of proxy decision-making made by families of patients with malignant brain tumors regarding treatment policies and daily care and the cues leading to those decisions.Methods Semi-structured personal interviews were used to collect data.Seven family members of patients with malignant brain tumors were selected to participate in the study by purposive sampling method from June to August 2022 in the Patient Family Association of Japan.Responses were content analyzed to explore the relationship between the content of decisions regarding“treatment policies”and“daily care”and the cues influencing those decisions.Semi-structured interviews were analyzed by using thematic analysis.Results The contents of proxy decisions regarding“treatment policies”included implementation,interruption,and termination of initial treatments,free medical treatments,use of respirators,and end-of-life sedation and included six cues:treatment policies suggested by the primary physician,information and knowledge about the disease and treatment obtained by the family from limited resources,perceived life threat from symptom worsening,words and reactions from the patient regarding treatment,patient’s personality and way of life inferred from their treatment preferences,family’s thoughts and values hoping for better treatment for the patient.Decisions for“daily care”included meal content and methods,excretion,mobility,maintaining cleanliness,rehabilitation,continuation or resignation from work,treatment settings(outpatient or inpatient),and ways to spend time outside and included seven cues:words and thoughts from the patient about their way of life,patient’s reactions and life history inferred from their preferred way of living,things the patient can do to maintain daily life and roles,awareness of the increasing inability to do things in daily life,family’s underlying thoughts and values about how to spend the remaining time,approval from family members regarding the care setting,advice from medical professionals on living at home.Conclusions For“treatment policies,”guidelines from medical professionals were a key cue,while for“daily care,”the small signs from the patients in their daily lives served as cues for proxy decision-making.This may be due to the lack of information available to families and the limited time available for discussion with the patient.Families of patients with malignant brain tumors repeatedly use multiple cues to make proxy decision-making under high uncertainty.Therefore,nurses supporting proxy decision-making should assess the family’s situation and provide cues that facilitate informed and confident decisions.展开更多
Group living is widespread across diverse taxa,and the mechanisms underlying collective decision-making in contexts of variable role division are critical for understanding the dynamics of group stability.While studie...Group living is widespread across diverse taxa,and the mechanisms underlying collective decision-making in contexts of variable role division are critical for understanding the dynamics of group stability.While studies on collective behavior in small animals such as fish and insects are well-established,similar research on large wild animals remains challenging due to the limited availability of sufficient and systematic field data.Here,we aimed to explore the collective decision-making pattern and its sexual difference for the dimorphic Tibetan antelopes Pantholops hodgsonii(chiru)in Xizang Autonomous Region,China,by analyzing individual leadership distribution,as well as the joining process,considering factors such as calving stages and joining ranks.The distinct correlations of decision participants’ratio with group size and decision duration underscore the trade-off between accuracy and speed in decision-making.Male antelopes display a more democratic decision-making pattern,while females exhibit more prompt responses after calving at an early stage.This study uncovers a partially shared decision-making strategy among Tibetan antelopes,suggesting flexible self-organization in group decision processes aligned with animal life cycle progression.展开更多
Accurately determining when and what to remanufacture is essential for maximizing the lifecycle value of industrial equipment.However,existing approaches face three significant limitations:(1)reliance on predefined ma...Accurately determining when and what to remanufacture is essential for maximizing the lifecycle value of industrial equipment.However,existing approaches face three significant limitations:(1)reliance on predefined mathematical models that often fail to capture equipment-specific degradation,(2)offline optimization methods that assume access to future data,and(3)the absence of component-level guidance.To address these challenges,we propose a data-driven framework for component-level decision-making.The framework leverages streaming sensor data to predict the remaining useful life(RUL)without relying on mathematical models,employs an online optimization algorithm suitable for practical settings,and,through remanufacturing simulations,provides guidance on which components should be replaced.In a case study on gas-insulated switchgear,the proposed framework achieved RUL prediction performance comparable to an oracle model in an online setting without relying on predefined mathematical models.Furthermore,by employing online optimization,it determined a remanufacturing timing close to the global optimum using only past and current data.In addition,unlike previous studies,the framework enables component-level decision-making,allowing for more detailed and actionable remanufacturing guidance in practical applications.展开更多
BACKGROUND Mesalamine is the recommended first-line treatment for inducing and maintaining remission in mild-to-moderate ulcerative colitis(UC).However,adherence in real-world settings is frequently suboptimal.Encoura...BACKGROUND Mesalamine is the recommended first-line treatment for inducing and maintaining remission in mild-to-moderate ulcerative colitis(UC).However,adherence in real-world settings is frequently suboptimal.Encouraging collaborative patient-provider relationships may foster better adherence and patient outcomes.AIM To quantify the association between patient participation in treatment decisionmaking and adherence to oral mesalamine in UC.METHODS We conducted a 12-month,prospective,non-interventional cohort study at 113 gastroenterology practices in Germany.Eligible patients were aged≥18 years,had a confirmed UC diagnosis,had no prior mesalamine treatment,and provided informed consent.At the first visit,we collected data on demographics,clinical characteristics,patient preference for mesalamine formulation(tablets or granules),and disease knowledge.Self-reported adherence and disease activity were assessed at all visits.Correlation analyses and logistic regression were used to examine associations between adherence and various factors.RESULTS Of the 605 consecutively screened patients,520 were included in the study.The median age was 41 years(range:18-91),with a male-to-female ratio of 1.1:1.0.Approximately 75%of patients reported good adherence at each study visit.In correlation analyses,patient participation in treatment decision-making was significantly associated with better adherence across all visits(P=0.04).In the regression analysis at 12 months,this association was evident among patients who both preferred and received prolonged-release mesalamine granules(odds ratio=2.73,P=0.001).Patients reporting good adherence also experienced significant improvements in disease activity over 12 months(P<0.001).CONCLUSION Facilitating patient participation in treatment decisions and accommodating medication preferences may improve adherence to mesalamine.This may require additional effort but has the potential to improve long-term management of UC.展开更多
基金supported by National Nature Science Foundation of China(Nos.62073324,6200629,61771471 and 91748131)in part by the InnoHK Project,China.
文摘Reinforcement learning encounters formidable challenges when tasked with intricate decision-making scenarios,primarily due to the expansive parameterized action spaces and the vastness of the corresponding policy landscapes.To surmount these difficulties,we devise a practical structured action graph model augmented by guiding policies that integrate trust region constraints.Based on this,we propose guided proximal policy optimization with structured action graph(GPPO-SAG),which has demonstrated pronounced efficacy in refining policy learning and enhancing performance across sophisticated tasks characterized by parameterized action spaces.Rigorous empirical evaluations of our model have been performed on comprehensive gaming platforms,including the entire suite of StarCraft II and Hearthstone,yielding exceptionally favorable outcomes.Our source code is at https://github.com/sachiel321/GPPO-SAG.
文摘Background:Despite the promise shown by large language models(LLMs)for standardized tasks,their multidimensional performance in real-world oncology decision-making remains unevaluated.This study aims to introduce a framework for evaluating LLMs and physician decisions in challenging lung cancer cases.Methods:We curated 50 challenging lung cancer cases(25 local and 25 published)classified as complex,rare,or refractory.Blinded three-dimensional,five-point Likert evaluations(1–5 for comprehensiveness,specificity,and readability)compared standalone LLMs(DeepSeek R1,Claude 3.5,Gemini 1.5,and GPT-4o),physicians by experience level(junior,intermediate,and senior),and AI-assisted juniors;intergroup differences and augmentation effects were analyzed statistically.Results:Of 50 challenging cases(18 complex,17 rare,and 15 refractory)rated by three experts,DeepSeek R1 achieved scores of 3.95±0.33,3.71±0.53,and 4.26±0.18 for comprehensiveness,specificity,and readability,respectively,positioning it between intermediate(3.68,3.68,3.75)and senior(4.50,4.64,4.53)physicians.GPT-4o and Claude 3.5 reached intermediate physician–level comprehensiveness(3.76±0.39,3.60±0.39)but junior-to-intermediate physician–level specificity(3.39±0.39,3.39±0.49).All LLMs scored higher on rare cases than intermediate physicians but fell below junior physicians in refractory-case specificity.AIassisted junior physicians showed marked gains in rare cases,with comprehensiveness rising from 2.32 to 4.29(84.8%),specificity from 2.24 to 4.26(90.8%),and readability from 2.76 to 4.59(66.0%),while specificity declined by 3.2%(3.17 to 3.07)in refractory cases.Error analysis showed complementary strengths,with physicians demonstrating reasoning stability and LLMs excelling in knowledge updating and risk management.Conclusions:LLMs performed variably in clinical decision-making tasks depending on case type,performing better in rare cases and worse in refractory cases requiring longitudinal reasoning.Complementary strengths between LLMs and physicians support case-and task-tailored human–AI collaboration.
基金supported by the Princess Nourah bint Abdulrahman University Researchers Supporting Project number(PNURSP2026R259)Princess Nourah bint Abdulrahman University,Riyadh,Saudi Arabia.Ashit Kumar Dutta would like to thank AlMaarefa University for supporting this research under project number MHIRSP2025017.
文摘Environmental problems are intensifying due to the rapid growth of the population,industry,and urban infrastructure.This expansion has resulted in increased air and water pollution,intensified urban heat island effects,and greater runoff from parks and other green spaces.Addressing these challenges requires prioritizing green infrastructure and other sustainable urban development strategies.This study introduces a novel Integrated Decision Support System that combines Pythagorean Fuzzy Sets with the Advanced Alternative Ranking Order Method allowing for Two-Step Normalization(AAROM-TN),enhanced by a dual weighting strategy.The weighting approach integrates the Criteria Importance Through Intercriteria Correlation(CRITIC)method with the Criteria Importance through Means and Standard Deviation(CIMAS)technique.The originality of the proposed framework lies in its ability to objectively quantify criteria importance using CRITIC,incorporate decision-makers’preferences through CIMAS,and capture the uncertainty and hesitation inherent in human judgment via Pythagorean Fuzzy Sets.A case study evaluating green infrastructure alternatives in metropolitan regions demonstrates the applicability and effectiveness of the framework.A sensitivity analysis is conducted to examine how variations in criteria weights affect the rankings and to evaluate the robustness of the results.Furthermore,a comparative analysis highlights the practical and financial implications of each alternative by assessing their respective strengths and weaknesses.
基金support of the National Key Research and Development Plan(No.2021YFB3302501)the financial support of the National Science Foundation of China(No.12161076)the financial support of the Fundamental Research Funds for the Central Universities(No.DUT25GF207).
文摘With the rapid development of artificial intelligence,intelligent air combat maneuver decision-making(ACMD)has garnered global attention.Although deep reinforcement learning provides a promising approach to ACMD,existing methods often suffer from rigid reward functions and limited adaptability to evolving adversarial strategies.Moreover,most research assumes open airspace,overlooking the influence of potential obstacles.In this paper,we address one-on-one within-visual-range ACMD in obstructed environments,and propose an improved Soft Actor-Critic(SAC)algorithm trained under a curriculum self-play framework.A maneuver strategy mirroring inference module is integrated to estimate each other's likely positions when visual obstruction occurs.By leveraging curriculum learning to guide progressive experience accumulation and self-play for adversarial evolution,our method enhances both training efficiency and tactical diversity.We further integrate an attention mechanism that dynamically adjusts the weights of sub-rewards,enabling the learned policy to adapt to rapidly changing air combat situations.Numerical simulations demonstrate that our enhanced SAC converges more quickly and achieves higher win rates than other baseline methods.An animation is available at bilibili.com/video/BV1BHVszHE98 for better illustration.
基金funded by scientific research projects under Grant JY2024B011.
文摘With the increasing complexity of industrial automation,planetary gearboxes play a vital role in largescale equipment transmission systems,directly impacting operational efficiency and safety.Traditional maintenance strategies often struggle to accurately predict the degradation process of equipment,leading to excessive maintenance costs or potential failure risks.However,existing prediction methods based on statistical models are difficult to adapt to nonlinear degradation processes.To address these challenges,this study proposes a novel condition-based maintenance framework for planetary gearboxes.A comprehensive full-lifecycle degradation experiment was conducted to collect raw vibration signals,which were then processed using a temporal convolutional network autoencoder with multi-scale perception capability to extract deep temporal degradation features,enabling the collaborative extraction of longperiod meshing frequencies and short-term impact features from the vibration signals.Kernel principal component analysis was employed to fuse and normalize these features,enhancing the characterization of degradation progression.A nonlinear Wiener process was used to model the degradation trajectory,with a threshold decay function introduced to dynamically adjust maintenance strategies,and model parameters optimized through maximum likelihood estimation.Meanwhile,the maintenance strategy was optimized to minimize costs per unit time,determining the optimal maintenance timing and preventive maintenance threshold.The comprehensive indicator of degradation trends extracted by this method reaches 0.756,which is 41.2%higher than that of traditional time-domain features;the dynamic threshold strategy reduces the maintenance cost per unit time to 55.56,which is 8.9%better than that of the static threshold optimization.Experimental results demonstrate significant reductions in maintenance costs while enhancing system reliability and safety.This study realizes the organic integration of deep learning and reliability theory in the maintenance of planetary gearboxes,provides an interpretable solution for the predictive maintenance of complex mechanical systems,and promotes the development of condition-based maintenance strategies for planetary gearboxes.
基金supported by the Deanship of Graduate Studies and Scientific Research at Qassim University(QU-APC-2024-9/1).
文摘Due to the numerous variables to take into account as well as the inherent ambiguity and uncertainty,evaluating educational institutions can be difficult.The concept of a possibility Pythagorean fuzzy hypersoft set(pPyFHSS)is more flexible in this regard than other theoretical fuzzy set-like models,even though some attempts have been made in the literature to address such uncertainties.This study investigates the elementary notions of pPyFHSS including its set-theoretic operations union,intersection,complement,OR-and AND-operations.Some results related to these operations are also modified for pPyFHSS.Additionally,the similarity measures between pPyFHSSs are formulated with the assistance of numerical examples and results.Lastly,an intelligent decision-assisted mechanism is developed with the proposal of a robust algorithm based on similarity measures for solving multi-attribute decision-making(MADM)problems.A case study that helps the decision-makers assess the best educational institution is discussed to validate the suggested system.The algorithmic results are compared with the most pertinent model to evaluate the adaptability of pPyFHSS,as it generalizes the classical possibility fuzzy set-like theoretical models.Similarly,while considering significant evaluating factors,the flexibility of pPyFHSS is observed through structural comparison.
文摘The critical role of patient-reported outcome measures(PROMs)in enhancing clinical decision-making and promoting patient-centered care has gained a profound significance in scientific research.PROMs encapsulate a patient's health status directly from their perspective,encompassing various domains such as symptom severity,functional status,and overall quality of life.By integrating PROMs into routine clinical practice and research,healthcare providers can achieve a more nuanced understanding of patient experiences and tailor treatments accordingly.The deployment of PROMs supports dynamic patient-provider interactions,fostering better patient engagement and adherence to tre-atment plans.Moreover,PROMs are pivotal in clinical settings for monitoring disease progression and treatment efficacy,particularly in chronic and mental health conditions.However,challenges in implementing PROMs include data collection and management,integration into existing health systems,and acceptance by patients and providers.Overcoming these barriers necessitates technological advancements,policy development,and continuous education to enhance the acceptability and effectiveness of PROMs.The paper concludes with recommendations for future research and policy-making aimed at optimizing the use and impact of PROMs across healthcare settings.
基金Supported by National Key Research and Development Program of China(Grant No.2022YFE0117100)National Science Foundation of China(Grant No.52102468,52325212)Fundamental Research Funds for the Central Universities。
文摘To solve problems of poor security guarantee and insufficient training efficiency in the conventional reinforcement learning methods for decision-making,this study proposes a hybrid framework to combine deep reinforcement learning with rule-based decision-making methods.A risk assessment model for lane-change maneuvers considering uncertain predictions of surrounding vehicles is established as a safety filter to improve learning efficiency while correcting dangerous actions for safety enhancement.On this basis,a Risk-fused DDQN is constructed utilizing the model-based risk assessment and supervision mechanism.The proposed reinforcement learning algorithm sets up a separate experience buffer for dangerous trials and punishes such actions,which is shown to improve the sampling efficiency and training outcomes.Compared with conventional DDQN methods,the proposed algorithm improves the convergence value of cumulated reward by 7.6%and 2.2%in the two constructed scenarios in the simulation study and reduces the number of training episodes by 52.2%and 66.8%respectively.The success rate of lane change is improved by 57.3%while the time headway is increased at least by 16.5%in real vehicle tests,which confirms the higher training efficiency,scenario adaptability,and security of the proposed Risk-fused DDQN.
文摘A novel model termed a bipolar complex fuzzy N-soft set(BCFN-SS)is initiated for tackling information that involves positive and negative aspects,the second dimension,and parameterised grading simultaneously.The theory of BCFN-SS is the generalisation of two various theories,that is,bipolar complex fuzzy(BCF)and N-SS.The invented model of BCFN-SS helps decision-makers to cope with the genuine-life dilemmas containing BCF information along with parameterised grading at the same time.Further,various algebraic operations,including the usual type of union,intersection,complements,and a few others types,are invented.Certain primary operational laws for BCFNSS are also invented.Moreover,a technique for order preference by similarity to the ideal solution(TOPSIS)approach is devised in the setting of BCFN-SS for managing strategic decision-making(DM)dilemmas containing BCFN-SS information.Keeping in mind the usefulness and benefits of the TOPSIS approach,two various types of TOPSIS approaches in the environment of BCFN-SS are devised and then a numerical example for exposing the usefulness of the devised TOPSIS approach is interpreted.To disclose the prominence and benefits of the devised work,the devised approaches with numerous prevailing work are compared.
基金Project(9142020013)support by the National Natural Science Foundation of China
文摘The decision-making under complex urban environment become one of the key issues that restricts the rapid development of the autonomous vehicles. The difficulty in making timely and accurate decisions like human beings under highly dynamic traffic environment is a major challenge for autonomous driving. Car-following has been regarded as the simplest but essential driving behavior among driving tasks and has received extensive attention from researchers around the world. This work addresses this problem and proposes a novel method RSAN(rough-set artificial neural network) to learn the decisions from excellent human drivers. A virtual urban traffic environment was built by Pre Scan and driving simulation was conducted to obtain a broad set of relevant data such as experienced drivers' behavior data and surrounding vehicles' motion data. Then, rough set was used to preprocess these data to extract the key influential factors on decision and reduce the impact of uncertain data and noise data. And the car-following decision was learned by neural network in which key factor was the input and acceleration was the output. The result shows the better convergence speed and the better decision accuracy of RSAN than ANN. Findings of this work contributes to the empirical understanding of driver's decision-making process and it provides a theoretical basis for the study of car-following decision-making under complex and dynamic environment.
文摘Accurate medical diagnosis,which involves identifying diseases based on patient symptoms,is often hindered by uncertainties in data interpretation and retrieval.Advanced fuzzy set theories have emerged as effective tools to address these challenges.In this paper,new mathematical approaches for handling uncertainty in medical diagnosis are introduced using q-rung orthopair fuzzy sets(q-ROFS)and interval-valued q-rung orthopair fuzzy sets(IVq-ROFS).Three aggregation operators are proposed in our methodologies:the q-ROF weighted averaging(q-ROFWA),the q-ROF weighted geometric(q-ROFWG),and the q-ROF weighted neutrality averaging(qROFWNA),which enhance decision-making under uncertainty.These operators are paired with ranking methods such as the similarity measure,score function,and inverse score function to improve the accuracy of disease identification.Additionally,the impact of varying q-rung values is explored through a sensitivity analysis,extending the analysis beyond the typical maximum value of 3.The Basic Uncertain Information(BUI)method is employed to simulate expert opinions,and aggregation operators are used to combine these opinions in a group decisionmaking context.Our results provide a comprehensive comparison of methodologies,highlighting their strengths and limitations in diagnosing diseases based on uncertain patient data.
基金supported by the Beijing Key Clinical Specialty Project(20240930)the National Natural Science Foundation of China(NSFC 82373436)+7 种基金the Beijing Hospitals Authority’Youth Program(BHAYP,QML20230114)the Beijing Natural Science Foundation(BNSF Z200027)the Beijing Chaoyang Hospital Multi-disciplinary Team Program(CYDXK202204),the NSFC(62331001)the BNSF(Z200027)the NSFC(82202097)the BHAYP(QML20230113)the Training Fund for Open Projects at Clinical Institutes and Departments of Capital Medical University(CCMU2022ZKYXY010)the Beijing Scholars Program(No.[2015]160).
文摘Background:Multiparametric magnetic resonance imaging(mpMRI)has significantly advanced prostate cancer(PCa)detection,yet decisions on invasive biopsy with moderate prostate imaging reporting and data system(PI-RADS)scores remain ambiguous.Methods:To explore the decision-making capacity of Generative Pretrained Transformer-4(GPT-4)for automated prostate biopsy recommendations,we included 2299 individuals who underwent prostate biopsy from 2018 to 2023 in 3 large medical centers,with available mpMRI before biopsy and documented clinical-histopathological records.GPT-4 generated structured reports with given prompts.The performance of GPT-4 was quantified using confusion matrices,and sensitivity,specificity,as well as area under the curve were calculated.Multiple artificial evaluation procedures were conducted.Wilcoxon’s rank sum test,Fisher’s exact test,and Kruskal-Wallis tests were used for comparisons.Results:Utilizing the largest sample size in the Chinese population,patients with moderate PI-RADS scores(scores 3 and 4)accounted for 39.7%(912/2299),defined as the subset-of-interest(SOI).The detection rates of clinically significant PCa corresponding to PI-RADS scores 2-5 were 9.4%,27.3%,49.2%,and 80.1%,respectively.Nearly 47.5%(433/912)of SOI patients were histopathologically proven to have undergone unnecessary prostate biopsies.With the assistance of GPT-4,20.8%(190/912)of the SOI population could avoid unnecessary biopsies,and it performed even better[28.8%(118/410)]in the most heterogeneous subgroup of PI-RADS score 3.More than 90.0%of GPT-4-generated reports were comprehensive and easy to understand,but less satisfied with the accuracy(82.8%).GPT-4 also demonstrated cognitive potential for handling complex problems.Additionally,the Chain of Thought method enabled us to better understand the decision-making logic behind GPT-4.Eventually,we developed a ProstAIGuide platform to facilitate accessibility for both doctors and patients.Conclusions:This multi-center study highlights the clinical utility of GPT-4 for prostate biopsy decision-making and advances our understanding of the latest artificial intelligence implementation in various medical scenarios.
基金supported by the Research Program of the Liaoning Liaohe Laboratory(LLL23ZZ-05-012)China Academy of Engineering Institute of Land Cooperation Consulting Project(2023-DFZD-60-02)+3 种基金the Key Research and Development Program of Liaoning Province(2023JH26/10200011)the National Natural Science Foundation of China(61991404)the National Key Research and Development Program of China(2024YFB3309700)the Science and Technology Major Project 2024 of Liaoning Province(2024JH1/11700048).
文摘Based on an analysis of the role of industrial control and optimization technologies in the Industrial Revolution,as well as the current situation and existing problems of operational decision-making(ODM)for industrial process,this paper introduces the concept of intelligent ODM in industrial process,shapes its future directions,and highlights key technical challenges.By the tight conjoining of and coordination between industrial artificial intelligence(AI)with industrial control and optimization technologies,as well as the Industrial Internet with industrial computer management and control systems,an intelligent operational optimization decision-making methodology is proposed for complex industrial process.The intelligent ODM methodology and its successful application demonstrate that the tight conjoining of and coordination between next-generation information technologies with industrial control and optimization technologies will promote the development of industrial intelligent ODM.Finally,main research directions and ideas are outlined for realizing intelligent ODM in industrial process.
基金Funded by the Deutsche Forschungsgemeinschaft(DFG,German Research Foundation)SFB 871/3119193472 and SPP 2388501624329.
文摘Complex systems,such as infrastructure networks,industrial plants and jet engines,are of paramount importance to modern societies.However,these systems are subject to a variety of different threats.Novel research focuses not only on monitoring and improving the robustness and reliability of systems,but also on their recoverability from adverse events.The concept of resilience encompasses precisely these aspects.However,efficient resilience analysis for the modern systems of our societies is becoming more and more challenging.Due to their increasing complexity,system components frequently exhibit significant complexity of their own,requiring them to be modeled as systems,i.e.,subsystems.Therefore,efficient resilience analysis approaches are needed to address this emerging challenge.This work presents an efficient resilience decision-making procedure for complex and substructured systems.A novel methodology is derived by bringing together two methods from the fields of reliability analysis and modern resilience assessment.A resilience decision-making framework and the concept of survival signature are extended and merged,providing an efficient approach for quantifying the resilience of complex,large and substructured systems subject to monetary restrictions.The new approach combines both of the advantageous characteristics of its two original components:A direct comparison between various resilience-enhancing options from a multidimensional search space,leading to an optimal trade-off with respect to the system resilience and a significant reduction of the computational effort due to the separation property of the survival signature,once a subsystem structure has been computed,any possible characterization of the probabilistic part can be validated with no need to recompute the structure.The developed methods are applied to the functional model of a multistage high-speed axial compressor and two substructured systems of increasing complexity,providing accurate results and demonstrating efficiency and general applicability.
文摘BACKGROUND Understanding a patient's clinical status and setting priorities for their care are two aspects of the constantly changing process of clinical decision-making.One analytical technique that can be helpful in uncertain situations is clinical judgment.Clinicians must deal with contradictory information,lack of time to make decisions,and long-term factors when emergencies occur.AIM To examine the ethical issues healthcare professionals faced during the coronavirus disease 2019(COVID-19)pandemic and the factors affecting clinical decision-making.METHODS This pilot study,which means it was a preliminary investigation to gather information and test the feasibility of a larger investigation was conducted over 6 months and we invited responses from clinicians worldwide who managed patients with COVID-19.The survey focused on topics related to their professional roles and personal relationships.We examined five core areas influencing critical care decision-making:Patients'personal factors,family-related factors,informed consent,communication and media,and hospital administrative policies on clinical decision-making.The collected data were analyzed using the χ^(2) test for categorical variables.RESULTS A total of 102 clinicians from 23 specialties and 17 countries responded to the survey.Age was a significant factor in treatment planning(n=88)and ventilator access(n=78).Sex had no bearing on how decisions were made.Most doctors reported maintaining patient confidentiality regarding privacy and informed consent.Approximately 50%of clinicians reported a moderate influence of clinical work,with many citing it as one of the most important factors affecting their health and relationships.Clinicians from developing countries had a significantly higher score for considering a patient's financial status when creating a treatment plan than their counterparts from developed countries.Regarding personal experiences,some respondents noted that treatment plans and preferences changed from wave to wave,and that there was a rapid turnover of studies and evidence.Hospital and government policies also played a role in critical decision-making.Rather than assessing the appropriateness of treatment,some doctors observed that hospital policies regarding medications were driven by patient demand.CONCLUSION Factors other than medical considerations frequently affect management choices.The disparity in treatment choices,became more apparent during the pandemic.We highlight the difficulties and contradictions between moral standards and the realities physicians encountered during this medical emergency.False information,large patient populations,and limited resources caused problems for clinicians.These factors impacted decision-making,which,in turn,affected patient care and healthcare staff well-being.
文摘Objectives This study aimed to clarify the relationship between the content of proxy decision-making made by families of patients with malignant brain tumors regarding treatment policies and daily care and the cues leading to those decisions.Methods Semi-structured personal interviews were used to collect data.Seven family members of patients with malignant brain tumors were selected to participate in the study by purposive sampling method from June to August 2022 in the Patient Family Association of Japan.Responses were content analyzed to explore the relationship between the content of decisions regarding“treatment policies”and“daily care”and the cues influencing those decisions.Semi-structured interviews were analyzed by using thematic analysis.Results The contents of proxy decisions regarding“treatment policies”included implementation,interruption,and termination of initial treatments,free medical treatments,use of respirators,and end-of-life sedation and included six cues:treatment policies suggested by the primary physician,information and knowledge about the disease and treatment obtained by the family from limited resources,perceived life threat from symptom worsening,words and reactions from the patient regarding treatment,patient’s personality and way of life inferred from their treatment preferences,family’s thoughts and values hoping for better treatment for the patient.Decisions for“daily care”included meal content and methods,excretion,mobility,maintaining cleanliness,rehabilitation,continuation or resignation from work,treatment settings(outpatient or inpatient),and ways to spend time outside and included seven cues:words and thoughts from the patient about their way of life,patient’s reactions and life history inferred from their preferred way of living,things the patient can do to maintain daily life and roles,awareness of the increasing inability to do things in daily life,family’s underlying thoughts and values about how to spend the remaining time,approval from family members regarding the care setting,advice from medical professionals on living at home.Conclusions For“treatment policies,”guidelines from medical professionals were a key cue,while for“daily care,”the small signs from the patients in their daily lives served as cues for proxy decision-making.This may be due to the lack of information available to families and the limited time available for discussion with the patient.Families of patients with malignant brain tumors repeatedly use multiple cues to make proxy decision-making under high uncertainty.Therefore,nurses supporting proxy decision-making should assess the family’s situation and provide cues that facilitate informed and confident decisions.
基金supported by the National Natural Science Foundation of China(Grant no.32101237)the China Postdoctoral Science Foundation(Grant no.2021M691522)+1 种基金the National Key Research and Development Program(Grant no.2022YFC3202104)the Tibet Major Science and Technology Project(Grant no.XZ201901-GA-06).
文摘Group living is widespread across diverse taxa,and the mechanisms underlying collective decision-making in contexts of variable role division are critical for understanding the dynamics of group stability.While studies on collective behavior in small animals such as fish and insects are well-established,similar research on large wild animals remains challenging due to the limited availability of sufficient and systematic field data.Here,we aimed to explore the collective decision-making pattern and its sexual difference for the dimorphic Tibetan antelopes Pantholops hodgsonii(chiru)in Xizang Autonomous Region,China,by analyzing individual leadership distribution,as well as the joining process,considering factors such as calving stages and joining ranks.The distinct correlations of decision participants’ratio with group size and decision duration underscore the trade-off between accuracy and speed in decision-making.Male antelopes display a more democratic decision-making pattern,while females exhibit more prompt responses after calving at an early stage.This study uncovers a partially shared decision-making strategy among Tibetan antelopes,suggesting flexible self-organization in group decision processes aligned with animal life cycle progression.
基金supported by the Human Resources Development of the Korea Institute of Energy Technology Evaluation and Planning(KETEP)grant funded by the Korea government Ministry of Knowledge Economy(No.RS-2023-00244330)the National Research Foundation of Korea(NRF)grant funded by the Korea government(MSIT)(No.NRF RS-2023-00219052RS-2024-00352587)。
文摘Accurately determining when and what to remanufacture is essential for maximizing the lifecycle value of industrial equipment.However,existing approaches face three significant limitations:(1)reliance on predefined mathematical models that often fail to capture equipment-specific degradation,(2)offline optimization methods that assume access to future data,and(3)the absence of component-level guidance.To address these challenges,we propose a data-driven framework for component-level decision-making.The framework leverages streaming sensor data to predict the remaining useful life(RUL)without relying on mathematical models,employs an online optimization algorithm suitable for practical settings,and,through remanufacturing simulations,provides guidance on which components should be replaced.In a case study on gas-insulated switchgear,the proposed framework achieved RUL prediction performance comparable to an oracle model in an online setting without relying on predefined mathematical models.Furthermore,by employing online optimization,it determined a remanufacturing timing close to the global optimum using only past and current data.In addition,unlike previous studies,the framework enables component-level decision-making,allowing for more detailed and actionable remanufacturing guidance in practical applications.
文摘BACKGROUND Mesalamine is the recommended first-line treatment for inducing and maintaining remission in mild-to-moderate ulcerative colitis(UC).However,adherence in real-world settings is frequently suboptimal.Encouraging collaborative patient-provider relationships may foster better adherence and patient outcomes.AIM To quantify the association between patient participation in treatment decisionmaking and adherence to oral mesalamine in UC.METHODS We conducted a 12-month,prospective,non-interventional cohort study at 113 gastroenterology practices in Germany.Eligible patients were aged≥18 years,had a confirmed UC diagnosis,had no prior mesalamine treatment,and provided informed consent.At the first visit,we collected data on demographics,clinical characteristics,patient preference for mesalamine formulation(tablets or granules),and disease knowledge.Self-reported adherence and disease activity were assessed at all visits.Correlation analyses and logistic regression were used to examine associations between adherence and various factors.RESULTS Of the 605 consecutively screened patients,520 were included in the study.The median age was 41 years(range:18-91),with a male-to-female ratio of 1.1:1.0.Approximately 75%of patients reported good adherence at each study visit.In correlation analyses,patient participation in treatment decision-making was significantly associated with better adherence across all visits(P=0.04).In the regression analysis at 12 months,this association was evident among patients who both preferred and received prolonged-release mesalamine granules(odds ratio=2.73,P=0.001).Patients reporting good adherence also experienced significant improvements in disease activity over 12 months(P<0.001).CONCLUSION Facilitating patient participation in treatment decisions and accommodating medication preferences may improve adherence to mesalamine.This may require additional effort but has the potential to improve long-term management of UC.
