AIM:To investigate decisional conflict among patients diagnosed with primary angle-closure suspect(PACS)or primary angle-closure(PAC)who are considering laser peripheral iridotomy(LPI)treatment.METHODS:A total of 111 ...AIM:To investigate decisional conflict among patients diagnosed with primary angle-closure suspect(PACS)or primary angle-closure(PAC)who are considering laser peripheral iridotomy(LPI)treatment.METHODS:A total of 111 individuals diagnosed with PACS or PAC were selected through convenient sampling from March 2023 to December 2023.These participants then completed a general information questionnaire and the Decision Conflict Scale.Data analysis was performed using multiple linear regression to reveal factors influencing decisional conflict.RESULTS:The mean Decisional Conflict Score among patients with PACS or PAC was 48.58±10.01,with 99.1%of these individuals reporting experiencing decisional conflict.Multiple linear regression analysis revealed that females(P=0.002)and patients with a shorter duration of the disease(P=0.006)had higher levels of decisional conflict.Additionally,patients diagnosed during medical visits(P=0.049),those who refused LPI treatment(P=0.032),and individuals facing significant economic burdens related to medical expenses(P=0.005)exhibited higher levels of decisional conflict.Furthermore,patients who preferred to make medical decisions independently(P=0.023)and those who favored involving family members in decisionmaking(P=0.005)experienced increased levels of decisional conflict.CONCLUSION:Patients with PACS or PAC who undergo LPI treatment often encounter significant decisional conflict.Healthcare professionals should thoroughly assess a range of factors that influence this conflict,including gender,duration of disease,method of diagnosis acquisition,LPI treatment,economic burden of medical expenses,and patient preferences regarding medical decision-making.By considering these variables,tailored decision support can be developed to address individual patient needs,ultimately reducing decisional conflict and optimizing the quality of decisions made regarding treatment options.展开更多
Chronic hepatitis B and C together with alcoholic and non-alcoholic fatty liver diseases represent the major causes of progressive liver disease that can eventually evolve into cirrhosis and its end-stage complication...Chronic hepatitis B and C together with alcoholic and non-alcoholic fatty liver diseases represent the major causes of progressive liver disease that can eventually evolve into cirrhosis and its end-stage complications,including decompensation,bleeding and liver cancer.Formation and accumulation of fibrosis in the liver is the common pathway that leads to an evolutive liver disease.Precise definition of liver fibrosis stage is essential for management of the patient in clinical practice since the presence of bridging fibrosis represents a strong indication for antiviral therapy for chronic viral hepatitis,while cirrhosis requires a specif ic follow-up including screening for esophageal varices and hepatocellular carcinoma.Liver biopsy has always represented the standard of reference for assessment of hepatic fibrosis but it has some limitations being invasive,costly and prone to sampling errors.Recently,blood markers and instrumental methods have been proposed for the non-invasive assessment of liver fibrosis.However,there are still some doubts as to their implementation in clinical practice and a real consensus on how and when to use them is not still available.This is due to an unsatisfactory accuracy for some of them,and to an incomplete validation for others.Some studies suggest that performance of non-invasive methods for liver fibrosis assessment may increase when they are combined.Combination algorithms of non-invasive methods for assessing liver fibrosis may represent a rational and reliable approach to implement non-invasive assessment of liver fibrosis in clinical practice and to reduce rather than abolish liver biopsies.展开更多
The thalamus and central dopamine signaling have been shown to play important roles in high-level cognitive processes including impulsivity. However, little is known about the role of dopamine receptors in the thalamu...The thalamus and central dopamine signaling have been shown to play important roles in high-level cognitive processes including impulsivity. However, little is known about the role of dopamine receptors in the thalamus in decisional impulsivity. In the present study,rats were tested using a delay discounting task and divided into three groups： high impulsivity（HI）, medium impulsivity（MI）, and low impulsivity（LI）. Subsequent in vivo voxel-based magnetic resonance imaging revealed that the HI rats displayed a markedly reduced density of gray matter in the lateral thalamus compared with the LI rats. In the MI rats, the dopamine D1 receptor antagonist SCH23390 or the D2 receptor antagonist eticlopride was microinjected into the lateral thalamus. SCH23390 significantly decreased their choice of a large, delayed reward and increased their omission of lever presses. In contrast,eticlopride increased the choice of a large, delayed reward but had no effect on the omissions. Together, our results indicate that the lateral thalamus is involved in decisional impulsivity, and dopamine D1 and D2 receptors in the lateral thalamus have distinct effects on decisional impulsive behaviors in rats. These results provide a new insightinto the dopamine signaling in the lateral thalamus in decisional impulsivity.展开更多
BACKGROUND The interest in shared decision making has increased considerably over the last couple of decades.Decision aids(DAs)can help in shared decision making.Especially when there is more than one reasonable optio...BACKGROUND The interest in shared decision making has increased considerably over the last couple of decades.Decision aids(DAs)can help in shared decision making.Especially when there is more than one reasonable option and outcomes between treatments are comparable.AIM To investigate if the use of DAs decreases decisional conflict in patients when choosing treatment for knee or hip osteoarthritis(OA).METHODS In this multi-center unblinded randomized controlled trial of patients with knee or hip OA were included from four secondary and tertiary referral centers.Onehundred-thirty-one patients who consulted an orthopedic surgeon for the first time with knee or hip OA were included between December 2014 and January 2016.After the first consultation,patients were randomly assigned by a computer to the control group which was treated according to standard care,or to the intervention group which was treated with standard care and provided with a DA.After the first consultation,patients were asked to complete questionnaires about decisional conflict(DCS),satisfaction,anxiety(PASS-20),gained knowledge,stage of decision making and preferred treatment.Follow-up was carried out after 26 wk and evaluated decisional conflict,satisfaction,anxiety,health outcomes(HOOS/KOOS),quality of life(EQ5D)and chosen treatment.RESULTS After the first consultation,patients in the intervention group(mean DCS:25 out of 100,SD:13)had significantly(P value:0.00)less decisional conflict compared to patients in the control group(mean DCS:39 out of 100,SD 11).The mean satisfaction score for the given information(7.6 out of 10,SD:1.8 vs 8.6 out of 10,SD:1.1)(P value:0.00),mean satisfaction score with the physician(8.3 out of 10,SD:1.7 vs 8.9 out of 10,SD:0.9)(P value:0.01)and the mean knowledge score(3.3 out of 4,SD:0.9 vs 3.7 out of,SD:0.6)(P value:0.01)were all significantly higher in the intervention group.At 26-wk follow-up,only 75 of 131 patients(57%)were available for analysis.This sample is too small for meaningful analysis.CONCLUSION Providing patients with an additional DA may have a positive effect on decisional conflict after the first consultation.Due to loss to follow-up we are unsure if this effect remains over time.展开更多
Based on decisional Difiie-Hcllman problem, we propose a simpleproxy-protected signature scheme In the random oracle model, we also carry out the strict securityproof for the proposed scheme. The security of the propo...Based on decisional Difiie-Hcllman problem, we propose a simpleproxy-protected signature scheme In the random oracle model, we also carry out the strict securityproof for the proposed scheme. The security of the proposed scheme is not loosely related to thediscrete logarithm assumption hut tightly related to the decisional Diffie-Hellman assumption in therandom oracle model.展开更多
Evaluating Unmanned Aerial Vehicle(UAV)systems within a System-of-Systems(SoS)environment helps clarify their contribution to the overall combat capability and supports effectiveness-oriented system optimization.When ...Evaluating Unmanned Aerial Vehicle(UAV)systems within a System-of-Systems(SoS)environment helps clarify their contribution to the overall combat capability and supports effectiveness-oriented system optimization.When assessing decision systems in such an environment,cross-level modeling and simulation are required,which often face a trade-off between low modeling cost and high simulation accuracy,while the credibility of results remains challenging to ensure.To address these issues,this study proposes a hybrid-granularity Hardware-In-the-Loop(HIL)SoS environment construction method based on Graphical Evaluation and Review Technique(GERT).The method employs GERT to analyze the relationships between simulation systems,the System Under Test(SUT),and mission outcomes,thereby determining the required model precision for different systems.A dynamic resource allocation algorithm is applied to adjust model granularity on demand,ensuring high-fidelity simulation under constrained total cost.Additionally,GERT estimates the computational frequency and communication bandwidth requirements of the SUT,guiding hardware selection to enhance simulation credibility.A UAV maritime combat case study was conducted for validation.The results demonstrate that,compared to the flat modeling approach,the hybrid-granularity scenario based on GERT analysis achieves higher simulation accuracy with lower overall model complexity.The coefficient of variation in evaluation results significantly decreases in HIL simulations compared to virtual simulations,confirming improved credibility.Under the hybrid-granularity HIL scenario,the decision system was evaluated from an effectiveness perspective,identifying the most sensitive performance parameter.Subsequent targeted optimization led to an 11.90%improvement in effectiveness,validating the method's practical utility.展开更多
The global shift towards sustainable energy has intensified research into renewable sources,particularly wave energy.Pakistan,with its long coastline,holds significant potential for wave energy development.However,ide...The global shift towards sustainable energy has intensified research into renewable sources,particularly wave energy.Pakistan,with its long coastline,holds significant potential for wave energy development.However,identifying optimal locations for wave energy plants involves evaluating complex,multi-faceted criteria.This study employs a multi-criteria group decisionmaking(MCGDM)approach using single-valued neutrosophic numbers(SVNNs)to address both qualitative and quantitative uncertainties inherent in real-world scenarios.To enhance decision quality,we introduce two novel operators:the singlevalued neutrosophic prioritised averaging(SVNPAd)operator and the single-valued neutrosophic prioritised geometric(SVNPGd)operator,both incorporating priority degrees.These tools allow decision-makers to express preferences better and handle ambiguous data.The proposed model is validated through comparative analysis with prior studies and demonstrates improved robustness in site selection.Furthermore,we analyse how variations in priority degrees influence decision outcomes,enabling a more dynamic and tailored decision-making process.Our method contributes a more holistic and adaptive framework for selecting locations for wave energy projects,ultimately supporting informed investments in renewable energy infrastructure and improving energy access in underserved coastal regions.展开更多
Earthquakes are highly destructive spatio-temporal phenomena whose analysis is essential for disaster preparedness and risk mitigation.Modern seismological research produces vast volumes of heterogeneous data from sei...Earthquakes are highly destructive spatio-temporal phenomena whose analysis is essential for disaster preparedness and risk mitigation.Modern seismological research produces vast volumes of heterogeneous data from seismic networks,satellite observations,and geospatial repositories,creating the need for scalable infrastructures capable of integrating and analyzing such data to support intelligent decision-making.Data warehousing technologies provide a robust foundation for this purpose;however,existing earthquake-oriented data warehouses remain limited,often relying on simplified schemas,domain-specific analytics,or cataloguing efforts.This paper presents the design and implementation of a spatio-temporal data warehouse for seismic activity.The framework integrates spatial and temporal dimensions in a unified schema and introduces a novel array-based approach for managing many-to-many relationships between facts and dimensions without intermediate bridge tables.A comparative evaluation against a conventional bridge-table schema demonstrates that the array-based design improves fact-centric query performance,while the bridge-table schema remains advantageous for dimension-centric queries.To reconcile these trade-offs,a hybrid schema is proposed that retains both representations,ensuring balanced efficiency across heterogeneous workloads.The proposed framework demonstrates how spatio-temporal data warehousing can address schema complexity,improve query performance,and support multidimensional visualization.In doing so,it provides a foundation for integrating seismic analysis into broader big data-driven intelligent decision systems for disaster resilience,risk mitigation,and emergency management.展开更多
Eco-driving behaviors have been recommended around the world because the transport is a key factor of energy use and pollution emissions.Therefore,based on the driving decision model,this paper introduces three aspect...Eco-driving behaviors have been recommended around the world because the transport is a key factor of energy use and pollution emissions.Therefore,based on the driving decision model,this paper introduces three aspects of the driving decisions(strategic decision,tactical decision and operation decision)to analyze the economy of vehicle energy.The analytic hierarchy process(AHP)is used to assign the weight of the internal evaluation indexes,so as to form a complete assessment for drivers'eco-driving behaviors.The research result can not only quantitatively describe the energy-saving effect of drivers'decisions,but also put forward targeted driving suggestions to optimize drivers'eco-driving behaviors.This assessment model helps to clarify the potential of eco-driving on energy economy of transportation in a hierarchical way,and provides a valuable theoretical basis for the further promotion and application of eco-driving education.展开更多
The goal of this study was to determine the spatiotemporal characteristics of mangrove distribution and fragmentation patterns from 1988 through 2019 in Dongzhaigang.Land cover datasets were generated for Dongzhaigang...The goal of this study was to determine the spatiotemporal characteristics of mangrove distribution and fragmentation patterns from 1988 through 2019 in Dongzhaigang.Land cover datasets were generated for Dongzhaigang for multiple years via a decision tree method based on a classification and regression tree(CART)algorithm using Landsat time series images.Spatiotemporal transform and fragmentation patterns of mangrove distribution were separately assessed with a transfer matrix of land cover types and a landscape pattern index.The classification method combined with multi-band images showed good accuracy,with overall accuracy higher than 90%.Mangrove areas in 1988,1999,2009,and 2019 were 2050,1875,1818,and 1750 ha,respectively,with decreases mainly due to conversion to aquaculture ponds and farmland.A mangrove growth index(MGI)was proposed,reflecting the water-mangrove relationship,showing positive mangrove growth from 1988–2009 and negative growth from 2009–2019.Study results indicated anthropogenic factors play a leading role in the extent and scale of mangrove effects over the past 30 years.According to the analysis results,corresponding management and protection measures are proposed to provide reference for the sustainable development of Dongzhaigang Mangrove Wetland ecosystem.展开更多
With the expanding applications of unmanned aerial vehicles(UAVs),precise flight evaluation has emerged as a critical enabler for efficient path planning,directly impacting operational performance and safety.Tradition...With the expanding applications of unmanned aerial vehicles(UAVs),precise flight evaluation has emerged as a critical enabler for efficient path planning,directly impacting operational performance and safety.Traditional path planning algorithms typically combine Dubins curves with local optimization to minimize trajectory length under 3D spatial constraints.However,these methods often overlook the correlation between pilot control quality and UAV flight dynamics,limiting their adaptability in complex scenarios.In this paper,we propose an intelligent flight evaluation model specifically designed to enhancemulti-waypoint trajectory optimization algorithms.Our model leverages a decision tree to integrate attitude parameters and trajectory matching metrics,establishing a quantitative link between pilot control quality and UAV flight states.Experimental results demonstrate that the proposed model not only accurately assesses pilot performance across diverse skill levels but also improves the optimality of generated trajectories.When integrated with our path planning algorithm,it efficiently produces optimal trajectories while strictly adhering to UAV flight constraints.This integrated framework highlights significant potential for real-time UAV training,performance assessment,and adaptive mission planning applications.展开更多
The Double Take column looks at a single topic from an African and Chinese perspective.This month,we discuss how to understand the growing emphasis on emotional returns among young people.Emotional value has emerged a...The Double Take column looks at a single topic from an African and Chinese perspective.This month,we discuss how to understand the growing emphasis on emotional returns among young people.Emotional value has emerged as a central force shaping youth decision-making across work,consumption,relationships and lifestyle choices.Unlike traditional economic rationality that prioritises income and material security,emotional value focuses on how choices make individuals feel and how they align with personal meaning.This shift is particularly evident in rapidly transforming societies such as China and Ghana,where economic restructuring,globalisation and social change have reshaped pathways to adulthood.展开更多
Delayed wound healing following radical gastrectomy remains an important yet underappreciated complication that prolongs hospitalization,increases costs,and undermines patient recovery.In An et al’s recent study,the ...Delayed wound healing following radical gastrectomy remains an important yet underappreciated complication that prolongs hospitalization,increases costs,and undermines patient recovery.In An et al’s recent study,the authors present a machine learning-based risk prediction approach using routinely available clinical and laboratory parameters.Among the evaluated algorithms,a decision tree model demonstrated excellent discrimination,achieving an area under the curve of 0.951 in the validation set and notably identifying all true cases of delayed wound healing at the Youden index threshold.The inclusion of variables such as drainage duration,preoperative white blood cell and neutrophil counts,alongside age and sex,highlights the pragmatic appeal of the model for early postoperative monitoring.Nevertheless,several aspects warrant critical reflection,including the reliance on a postoperative variable(drainage duration),internal validation only,and certain reporting inconsistencies.This letter underscores both the promise and the limitations of adopting interpretable machine learning models in perioperative care.We advocate for transparent reporting,external validation,and careful consideration of clinically actionable timepoints before integration into practice.Ultimately,this work represents a valuable step toward precision risk stratification in gastric cancer surgery,and sets the stage for multicenter,prospective evaluations.展开更多
Hesitation analysis plays a crucial role in decision-making processes by capturing the intermediary position between supportive and opposing information.This study introduces a refined approach to addressing uncertain...Hesitation analysis plays a crucial role in decision-making processes by capturing the intermediary position between supportive and opposing information.This study introduces a refined approach to addressing uncertainty in decision-making,employing existing measures used in decision problems.Building on information theory,the Kullback–Leibler(KL)divergence is extended to incorporate additional insights,specifically by applying temporal data,as illustrated by time series data fromtwo datasets(e.g.,affirmative and dissent information).Cumulative hesitation provides quantifiable insights into the decision-making process.Accordingly,a modified KL divergence,which incorporates historical trends,is proposed,enabling dynamic updates using conditional probability.The efficacy of this enhanced KL divergence is validated through a case study predicting Korean election outcomes.Immediate and historical data are processed using direct hesitation calculations and accumulated temporal information.The computational example demonstrates that the proposed KL divergence yields favorable results compared to existing methods.展开更多
Mortality prediction in respiratory health is challenging,especially when using large-scale clinical datasets composed primarily of categorical variables.Traditional digital twin(DT)frameworks often rely on longi-tudi...Mortality prediction in respiratory health is challenging,especially when using large-scale clinical datasets composed primarily of categorical variables.Traditional digital twin(DT)frameworks often rely on longi-tudinal or sensor-based data,which are not always available in public health contexts.In this article,we propose a novel proto-DT framework for mortality prediction in respiratory health using a large-scale categorical biomedical dataset.This dataset contains 415,711 severe acute respiratory infection cases from the Brazilian Unified Health System,including both COVID-19 and non-COVID-19 patients.Four classification models—extreme gradient boosting(XGBoost),logistic regression,random forest,and a deep neural network(DNN)—are trained using cost-sensitive learning to address class imbalance.The models are evaluated using accuracy,precision,recall,F1-score,and area under the curve(AUC)related to the receiver operating characteristic(ROC).The framework supports simulated interventions by modifying selected inputs and recalculating predicted mortality.Additionally,we incorporate multiple correspondence analysis and K-means clustering to explore model sensitivity.A Python library has been developed to ensure reproducibility.All models achieve AUC-ROC values near or above 0.85.XGBoost yields the highest accuracy(0.84),while the DNN achieves the highest recall(0.81).Scenario-based simulations reveal how key clinical factors,such as intensive care unit admission and oxygen support,affect predicted outcomes.The proposed proto-DT framework demonstrates the feasibility of mortality prediction and intervention simulation using categorical data alone.This framework provides a foundation for data-driven explainable DTs in public health,even in the absence of time-series data.展开更多
Seismic resilience(SR)has emerged as a critical focus in earthquake engineering to evaluate the ability of structures to endure,recover from,and adapt to seismic events.This study presents an entropy-based multicriter...Seismic resilience(SR)has emerged as a critical focus in earthquake engineering to evaluate the ability of structures to endure,recover from,and adapt to seismic events.This study presents an entropy-based multicriteria approach for selecting optimal intensity measures(IMs)to assess SR of structures.Eight representative IMs,derived from time histories and response spectrum are evaluated.Incremental dynamic analysis is con-ducted on a reinforced concrete structure,using engineering demand parameters such as the maximum interstory drift and floor acceleration to generate fragility curves via a probabilistic seismic demand model.The optimal IMs are identified through a multi-criteria decision-making process,with scores calculated using the entropy weight method to incorporate factors such as efficiency,proficiency,and uncertainty based on infor-mation entropy.An effective SR framework is derived from fragility results.The findings indicate that peak ground velocity and spectral IMs are the most effective,while energy-related IMs underestimate SR.The study highlights the importance of optimizing IMs for more accurate seismic resilience assessments.The proposed entropy-based multi-criteria approach is shown to be both reliable and effective for selecting optimal IMs in this context.展开更多
Embodied intelligent systems integrate perception,control,and decision-making within physical agents,and have become a cornerstone of modern aerospace,autonomous driving,and cooperative robotic applications.When opera...Embodied intelligent systems integrate perception,control,and decision-making within physical agents,and have become a cornerstone of modern aerospace,autonomous driving,and cooperative robotic applications.When operating in uncertain and dynamic environments,such systems must address challenges arising from incomplete sensing,unpredictable maneuvers,communication constraints,disturbances,and evolving network structures.展开更多
Intervention strategies to control non-point source nitrogen(N)and phosphorus(P)pollution in agriculture are expensive and there is a trade-off between engineering cost and treatment effectiveness.Implementing strateg...Intervention strategies to control non-point source nitrogen(N)and phosphorus(P)pollution in agriculture are expensive and there is a trade-off between engineering cost and treatment effectiveness.Implementing strategies often result in unsatisfactory outcomes and massive engineering costs when managing diffusive pollution in agricultural catchments.To address this issue,this paper proposes a robust,handy,catchment N&P decision support system(CNPDSS),an Android-based smartphone system integrated with a web-based geographic information system(GIS).The CNPDSS aims to provide artificial intelligence-driven decisions that minimize N&P loadings and engineering costs for mitigating pollution in agricultural catchments.It consists of four components:a general user interface(GUI),GIS,N&P pollution modeling(NPPM),and a DSS.The CNPDSS simplifies the GUI and integrates GIS modules to create a user-friendly interface,enabling non-professional users to operate the system easily through intuitive actions.The NPPM uses straightforward empirical models to predict N&P loadings,enhancing efficiency by avoiding excessive parameters.Taking into account the N&P movement pathway in the catchment,the DSS incorporates three control measures:source reduction in farmland(before migration stage),process retention by ecological ditch(midway transport stage),and down-end purification by constructed wetland(waterbody discharge stage),to formulate a comprehensive ternary controlling strategy.To optimize the cost-effectiveness of any proposed N&P control strategies for sub-catchments,a differential evolution algorithm(DEA)is employed in CNPDSS to carry out a dual-objective decision-making optimization computation.In this study,the CNPDSS is applied to a case study in an agricultural catchment in Central China to develop the most cost-effective ternary N&P control strategies that ensure the catchment water quality within Criterion Ⅲ of the Chinese Surface Water Quality Standard GB3838-2002 is met(total N concentration≤1.0 mg L^(-1)and total P concentration≤0.2 mg L^(-1)).Our results demonstrate that the CNPDSS is feasible and also possesses an adaptive design and flexible architecture to enable its generalization and extension to support strong hands-on applications in other catchments.展开更多
Objective To develop a clinical decision and prescription generation system(CDPGS)specifically for diarrhea in traditional Chinese medicine(TCM),utilizing a specialized large language model(LLM),Qwen-TCM-Dia,to standa...Objective To develop a clinical decision and prescription generation system(CDPGS)specifically for diarrhea in traditional Chinese medicine(TCM),utilizing a specialized large language model(LLM),Qwen-TCM-Dia,to standardize diagnostic processes and prescription generation.Methods Two primary datasets were constructed:an evaluation benchmark and a fine-tuning dataset consisting of fundamental diarrhea knowledge,medical records,and chain-ofthought(CoT)reasoning datasets.After an initial evaluation of 16 open-source LLMs across inference time,accuracy,and output quality,Qwen2.5 was selected as the base model due to its superior overall performance.We then employed a two-stage low-rank adaptation(LoRA)fine-tuning strategy,integrating continued pre-training on domain-specific knowledge with instruction fine-tuning using CoT-enriched medical records.This approach was designed to embed the clinical logic(symptoms→pathogenesis→therapeutic principles→prescriptions)into the model’s reasoning capabilities.The resulting fine-tuned model,specialized for TCM diarrhea,was designated as Qwen-TCM-Dia.Model performance was evaluated for disease diagnosis and syndrome type differentiation using accuracy,precision,recall,and F1-score.Furthermore,the quality of the generated prescriptions was compared with that of established open-source TCM LLMs.Results Qwen-TCM-Dia achieved peak performance compared to both the base Qwen2.5 model and five other open-source TCM LLMs.It achieved 97.05%accuracy and 91.48%F1-score in disease diagnosis,and 74.54%accuracy and 74.21%F1-score in syndrome type differentiation.Compared with existing open-source TCM LLMs(BianCang,HuangDi,LingDan,TCMLLM-PR,and ZhongJing),Qwen-TCM-Dia exhibited higher fidelity in reconstructing the“symptoms→pathogenesis→therapeutic principles→prescriptions”logic chain.It provided complete prescriptions,whereas other models often omitted dosages or generated mismatched prescriptions.Conclusion By integrating continued pre-training,CoT reasoning,and a two-stage fine-tuning strategy,this study establishes a CDPGS for diarrhea in TCM.The results demonstrate the synergistic effect of strengthening domain representation through pre-training and activating logical reasoning via CoT.This research not only provides critical technical support for the standardized diagnosis and treatment of diarrhea but also offers a scalable paradigm for the digital inheritance of expert TCM experience and the intelligent transformation of TCM.展开更多
基金Supported by Basic Scientific Research Projects of Wenzhou(No.Y20220155).
文摘AIM:To investigate decisional conflict among patients diagnosed with primary angle-closure suspect(PACS)or primary angle-closure(PAC)who are considering laser peripheral iridotomy(LPI)treatment.METHODS:A total of 111 individuals diagnosed with PACS or PAC were selected through convenient sampling from March 2023 to December 2023.These participants then completed a general information questionnaire and the Decision Conflict Scale.Data analysis was performed using multiple linear regression to reveal factors influencing decisional conflict.RESULTS:The mean Decisional Conflict Score among patients with PACS or PAC was 48.58±10.01,with 99.1%of these individuals reporting experiencing decisional conflict.Multiple linear regression analysis revealed that females(P=0.002)and patients with a shorter duration of the disease(P=0.006)had higher levels of decisional conflict.Additionally,patients diagnosed during medical visits(P=0.049),those who refused LPI treatment(P=0.032),and individuals facing significant economic burdens related to medical expenses(P=0.005)exhibited higher levels of decisional conflict.Furthermore,patients who preferred to make medical decisions independently(P=0.023)and those who favored involving family members in decisionmaking(P=0.005)experienced increased levels of decisional conflict.CONCLUSION:Patients with PACS or PAC who undergo LPI treatment often encounter significant decisional conflict.Healthcare professionals should thoroughly assess a range of factors that influence this conflict,including gender,duration of disease,method of diagnosis acquisition,LPI treatment,economic burden of medical expenses,and patient preferences regarding medical decision-making.By considering these variables,tailored decision support can be developed to address individual patient needs,ultimately reducing decisional conflict and optimizing the quality of decisions made regarding treatment options.
基金Supported by An unrestricted grant from Roche-Italia
文摘Chronic hepatitis B and C together with alcoholic and non-alcoholic fatty liver diseases represent the major causes of progressive liver disease that can eventually evolve into cirrhosis and its end-stage complications,including decompensation,bleeding and liver cancer.Formation and accumulation of fibrosis in the liver is the common pathway that leads to an evolutive liver disease.Precise definition of liver fibrosis stage is essential for management of the patient in clinical practice since the presence of bridging fibrosis represents a strong indication for antiviral therapy for chronic viral hepatitis,while cirrhosis requires a specif ic follow-up including screening for esophageal varices and hepatocellular carcinoma.Liver biopsy has always represented the standard of reference for assessment of hepatic fibrosis but it has some limitations being invasive,costly and prone to sampling errors.Recently,blood markers and instrumental methods have been proposed for the non-invasive assessment of liver fibrosis.However,there are still some doubts as to their implementation in clinical practice and a real consensus on how and when to use them is not still available.This is due to an unsatisfactory accuracy for some of them,and to an incomplete validation for others.Some studies suggest that performance of non-invasive methods for liver fibrosis assessment may increase when they are combined.Combination algorithms of non-invasive methods for assessing liver fibrosis may represent a rational and reliable approach to implement non-invasive assessment of liver fibrosis in clinical practice and to reduce rather than abolish liver biopsies.
基金supported by the National Natural Science Foundation(81471353)the National Basic Research Program of China(2015CB553500)the Science Fund for Creative Research Groups from of National Natural Science Foundation of China(81521063)
文摘The thalamus and central dopamine signaling have been shown to play important roles in high-level cognitive processes including impulsivity. However, little is known about the role of dopamine receptors in the thalamus in decisional impulsivity. In the present study,rats were tested using a delay discounting task and divided into three groups： high impulsivity（HI）, medium impulsivity（MI）, and low impulsivity（LI）. Subsequent in vivo voxel-based magnetic resonance imaging revealed that the HI rats displayed a markedly reduced density of gray matter in the lateral thalamus compared with the LI rats. In the MI rats, the dopamine D1 receptor antagonist SCH23390 or the D2 receptor antagonist eticlopride was microinjected into the lateral thalamus. SCH23390 significantly decreased their choice of a large, delayed reward and increased their omission of lever presses. In contrast,eticlopride increased the choice of a large, delayed reward but had no effect on the omissions. Together, our results indicate that the lateral thalamus is involved in decisional impulsivity, and dopamine D1 and D2 receptors in the lateral thalamus have distinct effects on decisional impulsive behaviors in rats. These results provide a new insightinto the dopamine signaling in the lateral thalamus in decisional impulsivity.
文摘BACKGROUND The interest in shared decision making has increased considerably over the last couple of decades.Decision aids(DAs)can help in shared decision making.Especially when there is more than one reasonable option and outcomes between treatments are comparable.AIM To investigate if the use of DAs decreases decisional conflict in patients when choosing treatment for knee or hip osteoarthritis(OA).METHODS In this multi-center unblinded randomized controlled trial of patients with knee or hip OA were included from four secondary and tertiary referral centers.Onehundred-thirty-one patients who consulted an orthopedic surgeon for the first time with knee or hip OA were included between December 2014 and January 2016.After the first consultation,patients were randomly assigned by a computer to the control group which was treated according to standard care,or to the intervention group which was treated with standard care and provided with a DA.After the first consultation,patients were asked to complete questionnaires about decisional conflict(DCS),satisfaction,anxiety(PASS-20),gained knowledge,stage of decision making and preferred treatment.Follow-up was carried out after 26 wk and evaluated decisional conflict,satisfaction,anxiety,health outcomes(HOOS/KOOS),quality of life(EQ5D)and chosen treatment.RESULTS After the first consultation,patients in the intervention group(mean DCS:25 out of 100,SD:13)had significantly(P value:0.00)less decisional conflict compared to patients in the control group(mean DCS:39 out of 100,SD 11).The mean satisfaction score for the given information(7.6 out of 10,SD:1.8 vs 8.6 out of 10,SD:1.1)(P value:0.00),mean satisfaction score with the physician(8.3 out of 10,SD:1.7 vs 8.9 out of 10,SD:0.9)(P value:0.01)and the mean knowledge score(3.3 out of 4,SD:0.9 vs 3.7 out of,SD:0.6)(P value:0.01)were all significantly higher in the intervention group.At 26-wk follow-up,only 75 of 131 patients(57%)were available for analysis.This sample is too small for meaningful analysis.CONCLUSION Providing patients with an additional DA may have a positive effect on decisional conflict after the first consultation.Due to loss to follow-up we are unsure if this effect remains over time.
文摘Based on decisional Difiie-Hcllman problem, we propose a simpleproxy-protected signature scheme In the random oracle model, we also carry out the strict securityproof for the proposed scheme. The security of the proposed scheme is not loosely related to thediscrete logarithm assumption hut tightly related to the decisional Diffie-Hellman assumption in therandom oracle model.
基金funded by Henan Key Laboratory of General Aviation Technology,grant number ZHKF-240202。
文摘Evaluating Unmanned Aerial Vehicle(UAV)systems within a System-of-Systems(SoS)environment helps clarify their contribution to the overall combat capability and supports effectiveness-oriented system optimization.When assessing decision systems in such an environment,cross-level modeling and simulation are required,which often face a trade-off between low modeling cost and high simulation accuracy,while the credibility of results remains challenging to ensure.To address these issues,this study proposes a hybrid-granularity Hardware-In-the-Loop(HIL)SoS environment construction method based on Graphical Evaluation and Review Technique(GERT).The method employs GERT to analyze the relationships between simulation systems,the System Under Test(SUT),and mission outcomes,thereby determining the required model precision for different systems.A dynamic resource allocation algorithm is applied to adjust model granularity on demand,ensuring high-fidelity simulation under constrained total cost.Additionally,GERT estimates the computational frequency and communication bandwidth requirements of the SUT,guiding hardware selection to enhance simulation credibility.A UAV maritime combat case study was conducted for validation.The results demonstrate that,compared to the flat modeling approach,the hybrid-granularity scenario based on GERT analysis achieves higher simulation accuracy with lower overall model complexity.The coefficient of variation in evaluation results significantly decreases in HIL simulations compared to virtual simulations,confirming improved credibility.Under the hybrid-granularity HIL scenario,the decision system was evaluated from an effectiveness perspective,identifying the most sensitive performance parameter.Subsequent targeted optimization led to an 11.90%improvement in effectiveness,validating the method's practical utility.
基金supported by Science foundation Ireland(22/NCF/DR/11309).
文摘The global shift towards sustainable energy has intensified research into renewable sources,particularly wave energy.Pakistan,with its long coastline,holds significant potential for wave energy development.However,identifying optimal locations for wave energy plants involves evaluating complex,multi-faceted criteria.This study employs a multi-criteria group decisionmaking(MCGDM)approach using single-valued neutrosophic numbers(SVNNs)to address both qualitative and quantitative uncertainties inherent in real-world scenarios.To enhance decision quality,we introduce two novel operators:the singlevalued neutrosophic prioritised averaging(SVNPAd)operator and the single-valued neutrosophic prioritised geometric(SVNPGd)operator,both incorporating priority degrees.These tools allow decision-makers to express preferences better and handle ambiguous data.The proposed model is validated through comparative analysis with prior studies and demonstrates improved robustness in site selection.Furthermore,we analyse how variations in priority degrees influence decision outcomes,enabling a more dynamic and tailored decision-making process.Our method contributes a more holistic and adaptive framework for selecting locations for wave energy projects,ultimately supporting informed investments in renewable energy infrastructure and improving energy access in underserved coastal regions.
文摘Earthquakes are highly destructive spatio-temporal phenomena whose analysis is essential for disaster preparedness and risk mitigation.Modern seismological research produces vast volumes of heterogeneous data from seismic networks,satellite observations,and geospatial repositories,creating the need for scalable infrastructures capable of integrating and analyzing such data to support intelligent decision-making.Data warehousing technologies provide a robust foundation for this purpose;however,existing earthquake-oriented data warehouses remain limited,often relying on simplified schemas,domain-specific analytics,or cataloguing efforts.This paper presents the design and implementation of a spatio-temporal data warehouse for seismic activity.The framework integrates spatial and temporal dimensions in a unified schema and introduces a novel array-based approach for managing many-to-many relationships between facts and dimensions without intermediate bridge tables.A comparative evaluation against a conventional bridge-table schema demonstrates that the array-based design improves fact-centric query performance,while the bridge-table schema remains advantageous for dimension-centric queries.To reconcile these trade-offs,a hybrid schema is proposed that retains both representations,ensuring balanced efficiency across heterogeneous workloads.The proposed framework demonstrates how spatio-temporal data warehousing can address schema complexity,improve query performance,and support multidimensional visualization.In doing so,it provides a foundation for integrating seismic analysis into broader big data-driven intelligent decision systems for disaster resilience,risk mitigation,and emergency management.
文摘Eco-driving behaviors have been recommended around the world because the transport is a key factor of energy use and pollution emissions.Therefore,based on the driving decision model,this paper introduces three aspects of the driving decisions(strategic decision,tactical decision and operation decision)to analyze the economy of vehicle energy.The analytic hierarchy process(AHP)is used to assign the weight of the internal evaluation indexes,so as to form a complete assessment for drivers'eco-driving behaviors.The research result can not only quantitatively describe the energy-saving effect of drivers'decisions,but also put forward targeted driving suggestions to optimize drivers'eco-driving behaviors.This assessment model helps to clarify the potential of eco-driving on energy economy of transportation in a hierarchical way,and provides a valuable theoretical basis for the further promotion and application of eco-driving education.
基金financially supported by the National Natural Science Foundation of China(Nos.U2244225 and 42020104005)the Ministry of Education of China(111 Project)the Fundamental Research Funds for the Central Universities,China University of Geosciences(Wuhan)and China Geological Survey(No.DD20211391)。
文摘The goal of this study was to determine the spatiotemporal characteristics of mangrove distribution and fragmentation patterns from 1988 through 2019 in Dongzhaigang.Land cover datasets were generated for Dongzhaigang for multiple years via a decision tree method based on a classification and regression tree(CART)algorithm using Landsat time series images.Spatiotemporal transform and fragmentation patterns of mangrove distribution were separately assessed with a transfer matrix of land cover types and a landscape pattern index.The classification method combined with multi-band images showed good accuracy,with overall accuracy higher than 90%.Mangrove areas in 1988,1999,2009,and 2019 were 2050,1875,1818,and 1750 ha,respectively,with decreases mainly due to conversion to aquaculture ponds and farmland.A mangrove growth index(MGI)was proposed,reflecting the water-mangrove relationship,showing positive mangrove growth from 1988–2009 and negative growth from 2009–2019.Study results indicated anthropogenic factors play a leading role in the extent and scale of mangrove effects over the past 30 years.According to the analysis results,corresponding management and protection measures are proposed to provide reference for the sustainable development of Dongzhaigang Mangrove Wetland ecosystem.
基金funded in part by the Fundamental Research Funds for the Central Universities under Grant NS2023052in part by the Natural Science Foundation of Jiangsu Province of China under Grants No.BK20231439 and No.BK20222012.
文摘With the expanding applications of unmanned aerial vehicles(UAVs),precise flight evaluation has emerged as a critical enabler for efficient path planning,directly impacting operational performance and safety.Traditional path planning algorithms typically combine Dubins curves with local optimization to minimize trajectory length under 3D spatial constraints.However,these methods often overlook the correlation between pilot control quality and UAV flight dynamics,limiting their adaptability in complex scenarios.In this paper,we propose an intelligent flight evaluation model specifically designed to enhancemulti-waypoint trajectory optimization algorithms.Our model leverages a decision tree to integrate attitude parameters and trajectory matching metrics,establishing a quantitative link between pilot control quality and UAV flight states.Experimental results demonstrate that the proposed model not only accurately assesses pilot performance across diverse skill levels but also improves the optimality of generated trajectories.When integrated with our path planning algorithm,it efficiently produces optimal trajectories while strictly adhering to UAV flight constraints.This integrated framework highlights significant potential for real-time UAV training,performance assessment,and adaptive mission planning applications.
文摘The Double Take column looks at a single topic from an African and Chinese perspective.This month,we discuss how to understand the growing emphasis on emotional returns among young people.Emotional value has emerged as a central force shaping youth decision-making across work,consumption,relationships and lifestyle choices.Unlike traditional economic rationality that prioritises income and material security,emotional value focuses on how choices make individuals feel and how they align with personal meaning.This shift is particularly evident in rapidly transforming societies such as China and Ghana,where economic restructuring,globalisation and social change have reshaped pathways to adulthood.
文摘Delayed wound healing following radical gastrectomy remains an important yet underappreciated complication that prolongs hospitalization,increases costs,and undermines patient recovery.In An et al’s recent study,the authors present a machine learning-based risk prediction approach using routinely available clinical and laboratory parameters.Among the evaluated algorithms,a decision tree model demonstrated excellent discrimination,achieving an area under the curve of 0.951 in the validation set and notably identifying all true cases of delayed wound healing at the Youden index threshold.The inclusion of variables such as drainage duration,preoperative white blood cell and neutrophil counts,alongside age and sex,highlights the pragmatic appeal of the model for early postoperative monitoring.Nevertheless,several aspects warrant critical reflection,including the reliance on a postoperative variable(drainage duration),internal validation only,and certain reporting inconsistencies.This letter underscores both the promise and the limitations of adopting interpretable machine learning models in perioperative care.We advocate for transparent reporting,external validation,and careful consideration of clinically actionable timepoints before integration into practice.Ultimately,this work represents a valuable step toward precision risk stratification in gastric cancer surgery,and sets the stage for multicenter,prospective evaluations.
基金Uzbekistan to China International Science and Technology Innovation Cooperation:IL-8724053120-R11National Research Foundation of Korea:NRF-2025S1A5A2A01011466.
文摘Hesitation analysis plays a crucial role in decision-making processes by capturing the intermediary position between supportive and opposing information.This study introduces a refined approach to addressing uncertainty in decision-making,employing existing measures used in decision problems.Building on information theory,the Kullback–Leibler(KL)divergence is extended to incorporate additional insights,specifically by applying temporal data,as illustrated by time series data fromtwo datasets(e.g.,affirmative and dissent information).Cumulative hesitation provides quantifiable insights into the decision-making process.Accordingly,a modified KL divergence,which incorporates historical trends,is proposed,enabling dynamic updates using conditional probability.The efficacy of this enhanced KL divergence is validated through a case study predicting Korean election outcomes.Immediate and historical data are processed using direct hesitation calculations and accumulated temporal information.The computational example demonstrates that the proposed KL divergence yields favorable results compared to existing methods.
文摘Mortality prediction in respiratory health is challenging,especially when using large-scale clinical datasets composed primarily of categorical variables.Traditional digital twin(DT)frameworks often rely on longi-tudinal or sensor-based data,which are not always available in public health contexts.In this article,we propose a novel proto-DT framework for mortality prediction in respiratory health using a large-scale categorical biomedical dataset.This dataset contains 415,711 severe acute respiratory infection cases from the Brazilian Unified Health System,including both COVID-19 and non-COVID-19 patients.Four classification models—extreme gradient boosting(XGBoost),logistic regression,random forest,and a deep neural network(DNN)—are trained using cost-sensitive learning to address class imbalance.The models are evaluated using accuracy,precision,recall,F1-score,and area under the curve(AUC)related to the receiver operating characteristic(ROC).The framework supports simulated interventions by modifying selected inputs and recalculating predicted mortality.Additionally,we incorporate multiple correspondence analysis and K-means clustering to explore model sensitivity.A Python library has been developed to ensure reproducibility.All models achieve AUC-ROC values near or above 0.85.XGBoost yields the highest accuracy(0.84),while the DNN achieves the highest recall(0.81).Scenario-based simulations reveal how key clinical factors,such as intensive care unit admission and oxygen support,affect predicted outcomes.The proposed proto-DT framework demonstrates the feasibility of mortality prediction and intervention simulation using categorical data alone.This framework provides a foundation for data-driven explainable DTs in public health,even in the absence of time-series data.
基金partly supported by Engineering Partners Inter-national,LLC,Richfield,MN 55423(PC13803,482842-58309).
文摘Seismic resilience(SR)has emerged as a critical focus in earthquake engineering to evaluate the ability of structures to endure,recover from,and adapt to seismic events.This study presents an entropy-based multicriteria approach for selecting optimal intensity measures(IMs)to assess SR of structures.Eight representative IMs,derived from time histories and response spectrum are evaluated.Incremental dynamic analysis is con-ducted on a reinforced concrete structure,using engineering demand parameters such as the maximum interstory drift and floor acceleration to generate fragility curves via a probabilistic seismic demand model.The optimal IMs are identified through a multi-criteria decision-making process,with scores calculated using the entropy weight method to incorporate factors such as efficiency,proficiency,and uncertainty based on infor-mation entropy.An effective SR framework is derived from fragility results.The findings indicate that peak ground velocity and spectral IMs are the most effective,while energy-related IMs underestimate SR.The study highlights the importance of optimizing IMs for more accurate seismic resilience assessments.The proposed entropy-based multi-criteria approach is shown to be both reliable and effective for selecting optimal IMs in this context.
文摘Embodied intelligent systems integrate perception,control,and decision-making within physical agents,and have become a cornerstone of modern aerospace,autonomous driving,and cooperative robotic applications.When operating in uncertain and dynamic environments,such systems must address challenges arising from incomplete sensing,unpredictable maneuvers,communication constraints,disturbances,and evolving network structures.
基金financially supported by the National Key Research and Development Program of China(2024YFD1700104 and 2022YFE0209200-03)the National Natural Science Foundation of China(42161144002 and 41977156)+3 种基金the Guangxi Natural Science Foundation,China(2022GXNSFBA035625)the Guangxi Technology Base and Talent Subject,China(Guike AD22035927)the Shandong Key Research and Development Project,China(2022TZXD0045)the State Key Laboratory of Earth System Numerical Modeling and Application,Institute of Atmospheric Physics,Chinese Academy of Sciences。
文摘Intervention strategies to control non-point source nitrogen(N)and phosphorus(P)pollution in agriculture are expensive and there is a trade-off between engineering cost and treatment effectiveness.Implementing strategies often result in unsatisfactory outcomes and massive engineering costs when managing diffusive pollution in agricultural catchments.To address this issue,this paper proposes a robust,handy,catchment N&P decision support system(CNPDSS),an Android-based smartphone system integrated with a web-based geographic information system(GIS).The CNPDSS aims to provide artificial intelligence-driven decisions that minimize N&P loadings and engineering costs for mitigating pollution in agricultural catchments.It consists of four components:a general user interface(GUI),GIS,N&P pollution modeling(NPPM),and a DSS.The CNPDSS simplifies the GUI and integrates GIS modules to create a user-friendly interface,enabling non-professional users to operate the system easily through intuitive actions.The NPPM uses straightforward empirical models to predict N&P loadings,enhancing efficiency by avoiding excessive parameters.Taking into account the N&P movement pathway in the catchment,the DSS incorporates three control measures:source reduction in farmland(before migration stage),process retention by ecological ditch(midway transport stage),and down-end purification by constructed wetland(waterbody discharge stage),to formulate a comprehensive ternary controlling strategy.To optimize the cost-effectiveness of any proposed N&P control strategies for sub-catchments,a differential evolution algorithm(DEA)is employed in CNPDSS to carry out a dual-objective decision-making optimization computation.In this study,the CNPDSS is applied to a case study in an agricultural catchment in Central China to develop the most cost-effective ternary N&P control strategies that ensure the catchment water quality within Criterion Ⅲ of the Chinese Surface Water Quality Standard GB3838-2002 is met(total N concentration≤1.0 mg L^(-1)and total P concentration≤0.2 mg L^(-1)).Our results demonstrate that the CNPDSS is feasible and also possesses an adaptive design and flexible architecture to enable its generalization and extension to support strong hands-on applications in other catchments.
基金National Key Research and Development Program of China(2024YFC3505400)Capital Clinical Project of Beijing Municipal Science&Technology Commission(Z221100007422092)Capital’s Funds for Health Improvement and Research(2024-1-2231).
文摘Objective To develop a clinical decision and prescription generation system(CDPGS)specifically for diarrhea in traditional Chinese medicine(TCM),utilizing a specialized large language model(LLM),Qwen-TCM-Dia,to standardize diagnostic processes and prescription generation.Methods Two primary datasets were constructed:an evaluation benchmark and a fine-tuning dataset consisting of fundamental diarrhea knowledge,medical records,and chain-ofthought(CoT)reasoning datasets.After an initial evaluation of 16 open-source LLMs across inference time,accuracy,and output quality,Qwen2.5 was selected as the base model due to its superior overall performance.We then employed a two-stage low-rank adaptation(LoRA)fine-tuning strategy,integrating continued pre-training on domain-specific knowledge with instruction fine-tuning using CoT-enriched medical records.This approach was designed to embed the clinical logic(symptoms→pathogenesis→therapeutic principles→prescriptions)into the model’s reasoning capabilities.The resulting fine-tuned model,specialized for TCM diarrhea,was designated as Qwen-TCM-Dia.Model performance was evaluated for disease diagnosis and syndrome type differentiation using accuracy,precision,recall,and F1-score.Furthermore,the quality of the generated prescriptions was compared with that of established open-source TCM LLMs.Results Qwen-TCM-Dia achieved peak performance compared to both the base Qwen2.5 model and five other open-source TCM LLMs.It achieved 97.05%accuracy and 91.48%F1-score in disease diagnosis,and 74.54%accuracy and 74.21%F1-score in syndrome type differentiation.Compared with existing open-source TCM LLMs(BianCang,HuangDi,LingDan,TCMLLM-PR,and ZhongJing),Qwen-TCM-Dia exhibited higher fidelity in reconstructing the“symptoms→pathogenesis→therapeutic principles→prescriptions”logic chain.It provided complete prescriptions,whereas other models often omitted dosages or generated mismatched prescriptions.Conclusion By integrating continued pre-training,CoT reasoning,and a two-stage fine-tuning strategy,this study establishes a CDPGS for diarrhea in TCM.The results demonstrate the synergistic effect of strengthening domain representation through pre-training and activating logical reasoning via CoT.This research not only provides critical technical support for the standardized diagnosis and treatment of diarrhea but also offers a scalable paradigm for the digital inheritance of expert TCM experience and the intelligent transformation of TCM.
