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
BACKGROUND:To promote the shared decision-making(SDM)between patients and doctors in pediatric outpatient departments,this study was designed to validate artificial intelligence(AI)-initiated medical tests for childre...BACKGROUND:To promote the shared decision-making(SDM)between patients and doctors in pediatric outpatient departments,this study was designed to validate artificial intelligence(AI)-initiated medical tests for children with fever.METHODS:We designed an AI model,named Xiaoyi,to suggest necessary tests for a febrile child before visiting a pediatric outpatient clinic.We calculated the sensitivity,specificity,and F1 score to evaluate the efficacy of Xiaoyi’s recommendations.The patients were divided into the rejection and acceptance groups.Then we analyzed the rejected examination items in order to obtain the corresponding reasons.RESULTS:We recruited a total of 11,867 children with fever who had used Xiaoyi in outpatient clinics.The recommended examinations given by Xiaoyi for 10,636(89.6%)patients were qualified.The average F1 score reached 0.94.A total of 58.4%of the patients accepted Xiaoyi’s suggestions(acceptance group),and 41.6%refused(rejection group).Imaging examinations were rejected by most patients(46.7%).The tests being time-consuming were rejected by 2,133 patients(43.2%),including rejecting pathogen studies in 1,347 patients(68.5%)and image studies in 732 patients(31.8%).The difficulty of sampling was the main reason for rejecting routine tests(41.9%).CONCLUSION:Our model has high accuracy and acceptability in recommending medical tests to febrile pediatric patients,and is worth promoting in facilitating SDM.展开更多
For the explosive development of emerging diagnostic and therapeutic technologies brought by the advancement of precision medicine strategy, shared decision-making could improve the quality of clinical decision-making...For the explosive development of emerging diagnostic and therapeutic technologies brought by the advancement of precision medicine strategy, shared decision-making could improve the quality of clinical decision-making and promote the transformation of clinical research evidence in TCM. Paying attention to patients＇ narrative needs and strengthening medical humanistic concerns could improve clinical outcome and patient satisfaction. We described the origins and development of evidence-based medicine, narrative medicine and shared decision-making, and analyzed the existing problems in TCM clinical decision-making. Further, we put forward the model of shared decision-making between clinicians and patients under the guidance of narrative evidence-based medicine concepts and methods.展开更多
Shared decision-making has been described as allowing patients to gain more control over their life situation and feel less helpless. The aim of this systematic review was to describe the involvement of older patients...Shared decision-making has been described as allowing patients to gain more control over their life situation and feel less helpless. The aim of this systematic review was to describe the involvement of older patients in shared decision-making in community settings. In accordance with the systematic review method, a total of 2468 abstracts were read, after which nine quantitative studies were included. A qualitative thematic analysis was performed and two themes emerged;increased understanding of self-management and a desire to strengthen one’s position in relationship with professionals, both of which were essential for empowering older patients to participate in shared decision-making. Older patients’ shared decision-making was seen as a struggle to maintain their autonomy in different areas of everyday life. Emotional and psychological problems made their position more difficult. In order to empower them in relationships with healthcare professionals, older patients require more knowledge (self-efficacy) and information about their illness, which could strengthen their position in the decision-making process. They also need a greater awareness of decisional conflicts that may arise. Age, gender and health status influence older patients’ chance of being respected and taken seriously in relationship with professionals.展开更多
BACKGROUND There is a lack of studies and educational programs focused on biosimilars and shared decision-making among patients diagnosed with various rheumatic diseases.AIM To improve knowledge and awareness of biosi...BACKGROUND There is a lack of studies and educational programs focused on biosimilars and shared decision-making among patients diagnosed with various rheumatic diseases.AIM To improve knowledge and awareness of biosimilars and shared decision-making among patients attending rheumatology practices in Colorado as well as to assess a rheumatology patient’s interest in discussing biosimilars as well as shared decision-making with others(e.g.,medical professionals,family members,friends).METHODS Our goal was to work with 80 rheumatology teams in Colorado.We developed and distributed 2000 multi-page brochures to each participating office and later conducted an online anonymous survey.RESULTS There were a total of 49(2.5%)rheumatology patients who responded to our survey.After reading our educational booklet,many survey respondents identified the correct answer in most questions focused on biosimilars or shared decision-making.Our survey results suggest that patients attending rheumatology practices in Colorado are generally not involved in discussions with their providers regarding treatment plans or options.The improvement in scores after reading our educational materials was statistically significant for biosimilars and shared decision-making.CONCLUSION Overall,the level of knowledge and awareness of biosimilars and shared decisionmaking among patients attending rheumatology practices in Colorado was low.More educational programs as well as follow up trainings to measure changes in knowledge and awareness regarding biosimilars and shared decision-making among patients attending rheumatology practices are recommended.展开更多
The rapid progress of research into inflammatory bowel disease(IBD)has resulted in increasingly more treatment options.Different options have different advantages and disadvantages,and the preferences of patients may ...The rapid progress of research into inflammatory bowel disease(IBD)has resulted in increasingly more treatment options.Different options have different advantages and disadvantages,and the preferences of patients may also differ.If patients can be invited to the formulation of medical decision-making,their compliance and satisfaction would be improved,thus possibly achieving better therapeutic results.The present review aims to summarize the current literature on shared decision-making(SDM)in the management of IBD,with the goal of promoting the application of SDM.展开更多
Background: In paternalistic models, healthcare providers’ responsibility is to decide what is best for patients. The main concern is that such models fail to respect patient autonomy and do not promote patient respo...Background: In paternalistic models, healthcare providers’ responsibility is to decide what is best for patients. The main concern is that such models fail to respect patient autonomy and do not promote patient responsibility. Aim: To evaluate mental healthcare team members’ perceptions of their own role in encouraging elderly persons to participate in shared decision-making after implementation of the CCM. The CCM is not an explanatory theory, but an evidence-based guideline and synthesis of best available evidence. Methods: Data were collected from two teams that took part in a focus group interview, and the transcript was analysed by means of qualitative thematic analysis. Results: One overall theme emerged—Preventing the violation of human dignity based on three themes, namely, Changing understanding and attitudes, Increasing depressed elderly persons’ autonomy and Clarifying the mental healthcare team coordinator’s role and responsibility. The results of this study reveal that until recently, paternalism has been the dominant decision-making model within healthcare, without any apparent consideration of the patient perspective. Community mental healthcare can be improved by shared decision-making in which team members initiate a dialogue focusing on patient participation to prevent the violation of human dignity. However, in order to determine how best to empower the patient, team members need expert knowledge and intuition.展开更多
In order to carry out comprehensive decision-making of multi-class shared parking measures within a region, a bilevel model assisting decision-making is proposed. The upper level selects parkers＇ average satisfaction...In order to carry out comprehensive decision-making of multi-class shared parking measures within a region, a bilevel model assisting decision-making is proposed. The upper level selects parkers＇ average satisfaction and the violation rate during peak hours as indices in object function, and sets probability distribution models describing dynamic parking demand of each site, the feasibility of shared parking scenarios and occupancy requirements during peak hours of each parking lot as restrictions. The simulation model in the lower level sets up rules to assign each parker in the random parking demand series to the proper parking lot. An iterative method is proposed to confirm the state of each parking lot at the start of formal simulations. Besides, two patterns linking initialization and formal simulation are presented to acquire multiple solutions. The results of the numerical examples indicate the effectiveness of the model and solution methods.展开更多
On February 5, the Dialogue on Building a China-Laos Community with a Shared Future, themed “Focusing on the ‘Action Plan,’ Creating a Better Future Together,” took place in Vientiane, Laos.The opening ceremony fe...On February 5, the Dialogue on Building a China-Laos Community with a Shared Future, themed “Focusing on the ‘Action Plan,’ Creating a Better Future Together,” took place in Vientiane, Laos.The opening ceremony featured speeches by several distinguished vips including Fang Hong, Chinese ambassador to Laos, Daosavanh Kheugmixai, vice president of the Lao National Academy of Politics and Public Administration, Yu Yunquan, vice president of the China International Communications Group (CICG),Sakhon Phommalat, deputy head of the Propaganda and Training Board of the Lao People’s Revolutionary Party (LPRP) Central Committee, Sun Jisheng, vice president of China Foreign Affairs University (CFAU),and Vadthuninyom Duangmala,president of the Diplomatic Academy of Laos.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
On the occasion of the 65th anniversary of the establishment of diplomatic relations between China and Laos,I wish to express,on behalf of the Embassy of the People's Republic of China in the Lao People's Demo...On the occasion of the 65th anniversary of the establishment of diplomatic relations between China and Laos,I wish to express,on behalf of the Embassy of the People's Republic of China in the Lao People's Democratic Republic,our sincere gratitude and highest respect to all friends and personages from various sectors in both countries who have long cared about and supported the development of our bilateral relations.展开更多
Fifty-five-year-old Shi Yizhong never imagined fireflies could become the foundation of a serious business.In 2022,Longshan Village in Huzhou’s Wuxing District collaborated with a young entrepreneurial team to create...Fifty-five-year-old Shi Yizhong never imagined fireflies could become the foundation of a serious business.In 2022,Longshan Village in Huzhou’s Wuxing District collaborated with a young entrepreneurial team to create a firefly campsite-a natural attraction where visitors can observe these glowing insects in a preserved habitat.The site quickly drew waves of tourists,who shared their experience online,recouping its initial investment in just two years.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
The year 2026 marks the 65th anniversary of the establishment of diplomatic relations between China and Laos.The bilateral relations are now at a new starting point where the past has been inherited and a course for t...The year 2026 marks the 65th anniversary of the establishment of diplomatic relations between China and Laos.The bilateral relations are now at a new starting point where the past has been inherited and a course for the future has been set.Looking back,China and Laos have weathered storms together and stood by each other.展开更多
As China and Laos mark the 65th anniversary of their diplomatic relations,the two socialist neighbors stand at a new historical starting point.From revolutionary comrades-in-arms to comprehensive strategic partners,Ch...As China and Laos mark the 65th anniversary of their diplomatic relations,the two socialist neighbors stand at a new historical starting point.From revolutionary comrades-in-arms to comprehensive strategic partners,China and Laos have steadily deepened their bond as"good neighbors,good friends,good comrades,and good partners."展开更多
As a Burundian doctoral student at Nanjing University,my personal journey is closely intertwined with China’s development in the new era and the deepening China-Africa partnership.Recently,my experiences have given m...As a Burundian doctoral student at Nanjing University,my personal journey is closely intertwined with China’s development in the new era and the deepening China-Africa partnership.Recently,my experiences have given me a deeper appreciation of the importance of people-to-people exchanges between China and Africa.展开更多
The year 2026 marks the 65th anniversary of diplomatic ties between China and Laos.During their meeting in Beijing in September 2025,Chinese President Xi Jinping and Lao President Thongloun Sisoulith stressed a need t...The year 2026 marks the 65th anniversary of diplomatic ties between China and Laos.During their meeting in Beijing in September 2025,Chinese President Xi Jinping and Lao President Thongloun Sisoulith stressed a need to advance the construction of the China Laos Economic Corridor and deliver more substantive results across all areas of cooperation.展开更多
Shared energy storage helps lower user investment costs and enhances energy efficiency,which is considered a pivotal driver in accelerating the green transition of energy sectors.In view of the increasing demand for h...Shared energy storage helps lower user investment costs and enhances energy efficiency,which is considered a pivotal driver in accelerating the green transition of energy sectors.In view of the increasing demand for hydrogen,this paper proposes a bi-level optimization of configurations and scheduling for combined cooling,heating,and power(CCHP)microgrid systems considering shared hybrid electric-hydrogen energy storage service.The upper-level model addresses the capacity allocation problem of energy storage stations,while the lower-level model optimizes the operational strategies for the multi-microgrid system(MMS).To resolve the complexity of the coupled bi-level problem,Karush-Kuhn-Tucker(KKT)conditions and the Big-M method are applied to reformulate it into a solvable mixed-integer linear programming(MILP)model,compatible with CPLEX.The economic viability and rationality of the proposed approach are verified through comparisons of three cases.Numerical results show that the proposed approach reduces user annual costs by 20.15%compared to MMS without additional energy storage equipment and achieves 100%renewable absorption.For operators,it yields 5.71 M CNY annual profit with 3.02-year payback.Compared to MMS with electricity sharing,it further cuts user costs by 3.84%,boosts operator profit by 60.71%,and shortens payback by 15.88%.展开更多
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.
基金This study was supported by the Science and Technology Innovation-Biomedical Supporting Program of Shanghai Science and Technology Committee(19441904400)Program for artificial intelligence innovation and development of Shanghai Municipal Commission of Economy and Informatization(2020-RGZN-02048).
文摘BACKGROUND:To promote the shared decision-making(SDM)between patients and doctors in pediatric outpatient departments,this study was designed to validate artificial intelligence(AI)-initiated medical tests for children with fever.METHODS:We designed an AI model,named Xiaoyi,to suggest necessary tests for a febrile child before visiting a pediatric outpatient clinic.We calculated the sensitivity,specificity,and F1 score to evaluate the efficacy of Xiaoyi’s recommendations.The patients were divided into the rejection and acceptance groups.Then we analyzed the rejected examination items in order to obtain the corresponding reasons.RESULTS:We recruited a total of 11,867 children with fever who had used Xiaoyi in outpatient clinics.The recommended examinations given by Xiaoyi for 10,636(89.6%)patients were qualified.The average F1 score reached 0.94.A total of 58.4%of the patients accepted Xiaoyi’s suggestions(acceptance group),and 41.6%refused(rejection group).Imaging examinations were rejected by most patients(46.7%).The tests being time-consuming were rejected by 2,133 patients(43.2%),including rejecting pathogen studies in 1,347 patients(68.5%)and image studies in 732 patients(31.8%).The difficulty of sampling was the main reason for rejecting routine tests(41.9%).CONCLUSION:Our model has high accuracy and acceptability in recommending medical tests to febrile pediatric patients,and is worth promoting in facilitating SDM.
文摘For the explosive development of emerging diagnostic and therapeutic technologies brought by the advancement of precision medicine strategy, shared decision-making could improve the quality of clinical decision-making and promote the transformation of clinical research evidence in TCM. Paying attention to patients＇ narrative needs and strengthening medical humanistic concerns could improve clinical outcome and patient satisfaction. We described the origins and development of evidence-based medicine, narrative medicine and shared decision-making, and analyzed the existing problems in TCM clinical decision-making. Further, we put forward the model of shared decision-making between clinicians and patients under the guidance of narrative evidence-based medicine concepts and methods.
文摘Shared decision-making has been described as allowing patients to gain more control over their life situation and feel less helpless. The aim of this systematic review was to describe the involvement of older patients in shared decision-making in community settings. In accordance with the systematic review method, a total of 2468 abstracts were read, after which nine quantitative studies were included. A qualitative thematic analysis was performed and two themes emerged;increased understanding of self-management and a desire to strengthen one’s position in relationship with professionals, both of which were essential for empowering older patients to participate in shared decision-making. Older patients’ shared decision-making was seen as a struggle to maintain their autonomy in different areas of everyday life. Emotional and psychological problems made their position more difficult. In order to empower them in relationships with healthcare professionals, older patients require more knowledge (self-efficacy) and information about their illness, which could strengthen their position in the decision-making process. They also need a greater awareness of decisional conflicts that may arise. Age, gender and health status influence older patients’ chance of being respected and taken seriously in relationship with professionals.
文摘BACKGROUND There is a lack of studies and educational programs focused on biosimilars and shared decision-making among patients diagnosed with various rheumatic diseases.AIM To improve knowledge and awareness of biosimilars and shared decision-making among patients attending rheumatology practices in Colorado as well as to assess a rheumatology patient’s interest in discussing biosimilars as well as shared decision-making with others(e.g.,medical professionals,family members,friends).METHODS Our goal was to work with 80 rheumatology teams in Colorado.We developed and distributed 2000 multi-page brochures to each participating office and later conducted an online anonymous survey.RESULTS There were a total of 49(2.5%)rheumatology patients who responded to our survey.After reading our educational booklet,many survey respondents identified the correct answer in most questions focused on biosimilars or shared decision-making.Our survey results suggest that patients attending rheumatology practices in Colorado are generally not involved in discussions with their providers regarding treatment plans or options.The improvement in scores after reading our educational materials was statistically significant for biosimilars and shared decision-making.CONCLUSION Overall,the level of knowledge and awareness of biosimilars and shared decisionmaking among patients attending rheumatology practices in Colorado was low.More educational programs as well as follow up trainings to measure changes in knowledge and awareness regarding biosimilars and shared decision-making among patients attending rheumatology practices are recommended.
基金Supported by Peking Union Medical College,No.2019zlgc0503.
文摘The rapid progress of research into inflammatory bowel disease(IBD)has resulted in increasingly more treatment options.Different options have different advantages and disadvantages,and the preferences of patients may also differ.If patients can be invited to the formulation of medical decision-making,their compliance and satisfaction would be improved,thus possibly achieving better therapeutic results.The present review aims to summarize the current literature on shared decision-making(SDM)in the management of IBD,with the goal of promoting the application of SDM.
文摘Background: In paternalistic models, healthcare providers’ responsibility is to decide what is best for patients. The main concern is that such models fail to respect patient autonomy and do not promote patient responsibility. Aim: To evaluate mental healthcare team members’ perceptions of their own role in encouraging elderly persons to participate in shared decision-making after implementation of the CCM. The CCM is not an explanatory theory, but an evidence-based guideline and synthesis of best available evidence. Methods: Data were collected from two teams that took part in a focus group interview, and the transcript was analysed by means of qualitative thematic analysis. Results: One overall theme emerged—Preventing the violation of human dignity based on three themes, namely, Changing understanding and attitudes, Increasing depressed elderly persons’ autonomy and Clarifying the mental healthcare team coordinator’s role and responsibility. The results of this study reveal that until recently, paternalism has been the dominant decision-making model within healthcare, without any apparent consideration of the patient perspective. Community mental healthcare can be improved by shared decision-making in which team members initiate a dialogue focusing on patient participation to prevent the violation of human dignity. However, in order to determine how best to empower the patient, team members need expert knowledge and intuition.
基金The Planning Program of Science and Technology of Ministry of Housing and Urban-Rural Development of China (No. 2010-K5-16)
文摘In order to carry out comprehensive decision-making of multi-class shared parking measures within a region, a bilevel model assisting decision-making is proposed. The upper level selects parkers＇ average satisfaction and the violation rate during peak hours as indices in object function, and sets probability distribution models describing dynamic parking demand of each site, the feasibility of shared parking scenarios and occupancy requirements during peak hours of each parking lot as restrictions. The simulation model in the lower level sets up rules to assign each parker in the random parking demand series to the proper parking lot. An iterative method is proposed to confirm the state of each parking lot at the start of formal simulations. Besides, two patterns linking initialization and formal simulation are presented to acquire multiple solutions. The results of the numerical examples indicate the effectiveness of the model and solution methods.
文摘On February 5, the Dialogue on Building a China-Laos Community with a Shared Future, themed “Focusing on the ‘Action Plan,’ Creating a Better Future Together,” took place in Vientiane, Laos.The opening ceremony featured speeches by several distinguished vips including Fang Hong, Chinese ambassador to Laos, Daosavanh Kheugmixai, vice president of the Lao National Academy of Politics and Public Administration, Yu Yunquan, vice president of the China International Communications Group (CICG),Sakhon Phommalat, deputy head of the Propaganda and Training Board of the Lao People’s Revolutionary Party (LPRP) Central Committee, Sun Jisheng, vice president of China Foreign Affairs University (CFAU),and Vadthuninyom Duangmala,president of the Diplomatic Academy of Laos.
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.
文摘On the occasion of the 65th anniversary of the establishment of diplomatic relations between China and Laos,I wish to express,on behalf of the Embassy of the People's Republic of China in the Lao People's Democratic Republic,our sincere gratitude and highest respect to all friends and personages from various sectors in both countries who have long cared about and supported the development of our bilateral relations.
文摘Fifty-five-year-old Shi Yizhong never imagined fireflies could become the foundation of a serious business.In 2022,Longshan Village in Huzhou’s Wuxing District collaborated with a young entrepreneurial team to create a firefly campsite-a natural attraction where visitors can observe these glowing insects in a preserved habitat.The site quickly drew waves of tourists,who shared their experience online,recouping its initial investment in just two years.
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.
文摘The year 2026 marks the 65th anniversary of the establishment of diplomatic relations between China and Laos.The bilateral relations are now at a new starting point where the past has been inherited and a course for the future has been set.Looking back,China and Laos have weathered storms together and stood by each other.
文摘As China and Laos mark the 65th anniversary of their diplomatic relations,the two socialist neighbors stand at a new historical starting point.From revolutionary comrades-in-arms to comprehensive strategic partners,China and Laos have steadily deepened their bond as"good neighbors,good friends,good comrades,and good partners."
文摘As a Burundian doctoral student at Nanjing University,my personal journey is closely intertwined with China’s development in the new era and the deepening China-Africa partnership.Recently,my experiences have given me a deeper appreciation of the importance of people-to-people exchanges between China and Africa.
文摘The year 2026 marks the 65th anniversary of diplomatic ties between China and Laos.During their meeting in Beijing in September 2025,Chinese President Xi Jinping and Lao President Thongloun Sisoulith stressed a need to advance the construction of the China Laos Economic Corridor and deliver more substantive results across all areas of cooperation.
文摘Shared energy storage helps lower user investment costs and enhances energy efficiency,which is considered a pivotal driver in accelerating the green transition of energy sectors.In view of the increasing demand for hydrogen,this paper proposes a bi-level optimization of configurations and scheduling for combined cooling,heating,and power(CCHP)microgrid systems considering shared hybrid electric-hydrogen energy storage service.The upper-level model addresses the capacity allocation problem of energy storage stations,while the lower-level model optimizes the operational strategies for the multi-microgrid system(MMS).To resolve the complexity of the coupled bi-level problem,Karush-Kuhn-Tucker(KKT)conditions and the Big-M method are applied to reformulate it into a solvable mixed-integer linear programming(MILP)model,compatible with CPLEX.The economic viability and rationality of the proposed approach are verified through comparisons of three cases.Numerical results show that the proposed approach reduces user annual costs by 20.15%compared to MMS without additional energy storage equipment and achieves 100%renewable absorption.For operators,it yields 5.71 M CNY annual profit with 3.02-year payback.Compared to MMS with electricity sharing,it further cuts user costs by 3.84%,boosts operator profit by 60.71%,and shortens payback by 15.88%.
