搜索结果：European clinical respiratory journal

The AEFishBIT tri-axial accelerometer was externally attached to the operculum to assess the divergent activity and respiratory patterns of two marine farmed fish, the gilthead sea bream (Sparus aurata) and European sea bass (Dicentrarchus labrax). Analysis of raw data from exercised fish highlighted the large amplitude of operculum aperture and body tail movements in European sea bass, which were overall more stable at low-medium exercise intensity levels. Cosinor analysis in free-swimming fish (on-board data processing) highlighted a pronounced daily rhythmicity of locomotor activity and respiratory frequency in both gilthead sea bream and European sea bass. Acrophases of activity and respiration were coupled in gilthead sea bream, acting feeding time (once daily at 11:00 h) as a main synchronizing factor. By contrast, locomotor activity and respiratory frequency were out of phase in European sea bass with activity acrophase on early morning and respiration acrophase on the afternoon. The daily range of activity and respiration variation was also higher in European sea bass, probably as part of the adaptation of this fish species to act as a fast swimming predator. In any case, l

Deep learning techniques have shown promising results in the automatic classification of respiratory sounds. However, accurately distinguishing these sounds in real-world noisy conditions remains challenging for clinical deployment. In addition, predicting signals with only background noise may reduce user trust in the system. This study explores the feasibility and effectiveness of incorporating a deep learning-based audio enhancement step into automatic respiratory sound classification systems to improve robustness and clinical applicability. We conducted extensive experiments using various audio enhancement model architectures, including time-domain and time-frequency-domain approaches, combined with multiple classification models to evaluate the module's effectiveness. The classification performance was compared against the noise injection data augmentation method. These experiments were carried out on two datasets: the ICBHI respiratory sound dataset and the FABS dataset. Furthermore, a physician validation study assessed the system's clinical utility. Integrating the audio enhancement module resulted in a 21.9% increase in the ICBHI classification score and a 4.1% improvement

The competency of any intelligent agent is bounded by its formal account of the world in which it operates. Clinical AI lacks such an account. Existing frameworks address evaluation, regulation, or system design in isolation, without a shared model of the clinical world to connect them. We introduce the Clinical World Model, a framework that formalizes care as a tripartite interaction among Patient, Provider, and Ecosystem. To formalize how any agent, whether human or artificial, transforms information into clinical action, we develop parallel decision-making architectures for providers, patients, and AI agents, grounded in validated principles of clinical cognition. The Clinical AI Skill-Mix operationalizes competency through eight dimensions. Five define the clinical competency space (condition, phase, care setting, provider role, and task) and three specify how AI engages human reasoning (assigned authority, agent facing, and anchoring layer). The combinatorial product of these dimensions yields a space of billions of distinct competency coordinates. A central structural implication is that validation within one coordinate provides minimal evidence for performance in another, re

We introduce SoftTiger, a clinical large language model (CLaM) designed as a foundation model for healthcare workflows. The narrative and unstructured nature of clinical notes is a major obstacle for healthcare intelligentization. We address a critical problem of structuring clinical notes into clinical data, according to international interoperability standards. We collect and annotate data for three subtasks, namely, international patient summary, clinical impression and medical encounter. We then supervised fine-tuned a state-of-the-art LLM using public and credentialed clinical data. The training is orchestrated in a way that the target model can first support basic clinical tasks such as abbreviation expansion and temporal information extraction, and then learn to perform more complex downstream clinical tasks. Moreover, we address several modeling challenges in the healthcare context, e.g., extra long context window. Our blind pairwise evaluation shows that SoftTiger outperforms other popular open-source models and GPT-3.5, comparable to Gemini-pro, with a mild gap from GPT-4. We believe that LLMs may become a step-stone towards healthcare digitalization and democratization.

Introduction: Semantic search, which retrieves documents based on conceptual similarity rather than keyword matching, offers substantial advantages for retrieval of clinical information. However, deploying semantic search across entire health systems, comprising hundreds of millions of clinical notes, presents formidable engineering, cost, and governance challenges that have prevented adoption. Methods: We deployed a semantic search system at a large children's hospital indexing 166 million clinical notes (484 million vectors) from 1.68 million patients. The system uses instruction-tuned qwen3-embedding-0.6B embeddings, stores vectors in a managed database with storage-optimized indexing, maintains full-text metadata in a low-latency key-value store, and operates within a HIPAA-compliant governance framework. We evaluated the system through three experiments: optimization of embedding model and chunking strategy using a physician-authored benchmark dataset, characterization of full-scale performance (cost, latency, retrieval quality), and clinical utility assessment via comparison of chart abstraction efficiency across three tasks. Results: The system delivers sub-second query late

We introduce Clinical ModernBERT, a transformer based encoder pretrained on large scale biomedical literature, clinical notes, and medical ontologies, incorporating PubMed abstracts, MIMIC IV clinical data, and medical codes with their textual descriptions. Building on ModernBERT the current state of the art natural language text encoder featuring architectural upgrades such as rotary positional embeddings (RoPE), Flash Attention, and extended context length up to 8,192 tokens our model adapts these innovations specifically for biomedical and clinical domains. Clinical ModernBERT excels at producing semantically rich representations tailored for long context tasks. We validate this both by analyzing its pretrained weights and through empirical evaluation on a comprehensive suite of clinical NLP benchmarks.

We compare the network of aggregated journal-journal citation relations provided by the Journal Citation Reports (JCR) 2012 of the Science and Social Science Citation Indexes (SCI and SSCI) with similar data based on Scopus 2012. First, global maps were developed for the two sets separately; sets of documents can then be compared using overlays to both maps. Using fuzzy-string matching and ISSN numbers, we were able to match 10,524 journal names between the two sets; that is, 96.4% of the 10,936 journals contained in JCR or 51.2% of the 20,554 journals covered by Scopus. Network analysis was then pursued on the set of journals shared between the two databases and the two sets of unique journals. Citations among the shared journals are more comprehensively covered in JCR than Scopus, so the network in JCR is denser and more connected than in Scopus. The ranking of shared journals in terms of indegree (that is, numbers of citing journals) or total citations is similar in both databases overall (Spearman's \r{ho} > 0.97), but some individual journals rank very differently. Journals that are unique to Scopus seem to be less important--they are citing shared journals rather than bein

Empiric antibiotic prescribing in high-risk clinical contexts often requires decision making under conditions of incomplete information, where inappropriate coverage or unjustified escalation may compromise safety and antimicrobial stewardship. While clinical decision-support systems have been proposed to assist in this process, many approaches lack explicit governance and evaluation mechanisms defining scope, abstention conditions, recommendation permissibility, and expected system behavior. This work specifies a governance and evaluation framework for deterministic clinical decision-support systems operating under explicitly constrained scope. Deterministic behavior is adopted to ensure that identical inputs yield identical outputs, supporting transparency, auditability, and conservative decision support in high-risk prescribing contexts. The framework treats governance as a first-class design component, separating clinical decision logic from rule-based mechanisms that determine whether a recommendation may be issued. Explicit abstention, deterministic stewardship constraints, and exclusion rules are formalized as core constructs. The framework defines an evaluation methodology

Clinical AI development has traditionally followed a collaborative paradigm that depends on close interaction between clinicians and specialized AI teams. This paradigm imposes a practical challenge: clinicians must repeatedly communicate and refine their requirements with AI developers before those requirements can be translated into executable model development. This iterative process is time-consuming, and even after repeated discussion, misalignment may still exist because the two sides do not fully share each other's expertise. However, autonomous coding agents may change this paradigm, raising the possibility that clinicians could develop clinical AI models independently through natural-language interaction alone. In this study, we present such an autonomous prototype for clinician-driven clinical AI development. We evaluated the system on five clinical tasks spanning dermoscopic lesion classification, melanoma-versus-nevus triage, wrist-fracture detection (including a weakly supervised variant with only 5% bounding-box annotations), and debiased pneumothorax classification on chest radiographs. Across these settings, the system consistently developed models from clinician re

Non-invasive estimation of respiratory physiology using computational algorithms promises to be a valuable technique for future clinicians to detect detrimental changes in patient pathophysiology. However, few clinical algorithms used to non-invasively analyze lung physiology have undergone rigorous validation in a clinical setting, and are often validated either using mechanical devices, or with small clinical validation datasets using 2-8 patients. This work aims to improve this situation by first, establishing an open, and clinically validated dataset comprising data from both mechanical lungs and nearly 40,000 breaths from 18 intubated patients. Next, we use this data to evaluate 15 different algorithms that use the "single chamber" model of estimating respiratory compliance. We evaluate these algorithms under varying clinical scenarios patients typically experience during hospitalization. In particular, we explore algorithm performance under four different types of patient ventilator asynchrony. We also analyze algorithms under varying ventilation modes to benchmark algorithm performance and to determine if ventilation mode has any impact on the algorithm. Our approach yields

This study compares publication pattern dynamics in the social sciences and humanities in five European countries. Three are Central and Eastern European countries that share a similar cultural and political heritage (the Czech Republic, Slovakia, and Poland). The other two are Flanders (Belgium) and Norway, representing Western Europe and the Nordics, respectively. We analysed 449,409 publications from 2013-2016 and found that, despite persisting differences between the two groups of countries across all disciplines, publication patterns in the Central and Eastern European countries are becoming more similar to those in their Western and Nordic counterparts. Articles from the Central and Eastern European countries are increasingly published in journals indexed in Web of Science and also in journals with the highest citation impacts. There are, however, clear differences between social science and humanities disciplines, which need to be considered in research evaluation and science policy.

We evaluate the impact of large language model-based clinical decision support in live care. In partnership with Penda Health, a network of primary care clinics in Nairobi, Kenya, we studied AI Consult, a tool that serves as a safety net for clinicians by identifying potential documentation and clinical decision-making errors. AI Consult integrates into clinician workflows, activating only when needed and preserving clinician autonomy. We conducted a quality improvement study, comparing outcomes for 39,849 patient visits performed by clinicians with or without access to AI Consult across 15 clinics. Visits were rated by independent physicians to identify clinical errors. Clinicians with access to AI Consult made relatively fewer errors: 16% fewer diagnostic errors and 13% fewer treatment errors. In absolute terms, the introduction of AI Consult would avert diagnostic errors in 22,000 visits and treatment errors in 29,000 visits annually at Penda alone. In a survey of clinicians with AI Consult, all clinicians said that AI Consult improved the quality of care they delivered, with 75% saying the effect was "substantial". These results required a clinical workflow-aligned AI Consult i

Digital Twins hold great potential to personalize clinical patient care, provided the concept is translated to meet specific requirements emerging from established clinical workflows. We present a general and unspecialized Digital Twin design combining knowledge graphs and ensemble learning to reflect the entire patient's clinical journey and assist clinicians in their decision-making. Such a design is predictive, modular, evolving, informed, interpretable and explainable, thus opening broad clinical applications.

This paper is dedicated to the design and evaluation of the first AMR parser tailored for clinical notes. Our objective was to facilitate the precise transformation of the clinical notes into structured AMR expressions, thereby enhancing the interpretability and usability of clinical text data at scale. Leveraging the colon cancer dataset from the Temporal Histories of Your Medical Events (THYME) corpus, we adapted a state-of-the-art AMR parser utilizing continuous training. Our approach incorporates data augmentation techniques to enhance the accuracy of AMR structure predictions. Notably, through this learning strategy, our parser achieved an impressive F1 score of 88% on the THYME corpus's colon cancer dataset. Moreover, our research delved into the efficacy of data required for domain adaptation within the realm of clinical notes, presenting domain adaptation data requirements for AMR parsing. This exploration not only underscores the parser's robust performance but also highlights its potential in facilitating a deeper understanding of clinical narratives through structured semantic representations.

Respiratory motion limits the accuracy and precision of abdominal percutaneous procedures. In this paper, respiratory motion is compensated robotically using motion estimation models. Additionally, a teleoperated insertion is performed using proximity-based haptic feedback to guide physicians during insertion, enabling a radiation-free remote insertion for the end-user. The study has been validated using a robotic liver phantom, and five insertions were performed. The resulting motion estimation errors were below 3 mm for all directions of motion, and the overall resulting 3D insertion errors were 2.60, 7.75, and 2.86 mm for the superior-inferior, lateral, and anterior-posterior directions of motion, respectively. The proposed approach is expected to minimize the chances of inaccurate treatment or diagnosis due to respiratory-induced motion and reduce radiation exposure.

Bioinformatics platforms have significantly changed clinical diagnostics by facilitating the analysis of genomic data, thereby advancing personalized medicine and improving patient care. This study examines the integration, usage patterns, challenges, and impact of the Galaxy platform within clinical diagnostics laboratories. We employed a convergent parallel mixed-methods design, collecting quantitative survey data and qualitative insights from structured interviews with fifteen participants across various clinical roles. The findings indicate a wide adoption of Galaxy, with participants expressing high satisfaction due to its user-friendly interface and notable improvements in workflow efficiency and diagnostic accuracy. Challenges such as data security and training needs were also identified, highlighting the platform's role in simplifying complex data analysis tasks. This study contributes to understanding the transformative potential of Galaxy in clinical practice and offers recommendations for optimizing its integration and functionality. These insights are crucial for advancing clinical diagnostics and enhancing patient outcomes.

Predatory journals are Open Access journals of highly questionable scientific quality. Such journals pretend to use peer review for quality assurance, and spam academics with requests for submissions, in order to collect author payments. In recent years predatory journals have received a lot of negative media. While much has been said about the harm that such journals cause to academic publishing in general, an overlooked aspect is how much articles in such journals are actually read and in particular cited, that is if they have any significant impact on the research in their fields. Other studies have already demonstrated that only some of the articles in predatory journals contain faulty and directly harmful results, while a lot of the articles present mediocre and poorly reported studies. We studied citation statistics over a five-year period in Google Scholar for 250 random articles published in such journals in 2014, and found an average of 2,6 citations per article and that 60 % of the articles had no citations at all. For comparison a random sample of articles published in the approximately 25,000 peer reviewed journals included in the Scopus index had an average of 18,1 cit

Specialised pre-trained language models are becoming more frequent in NLP since they can potentially outperform models trained on generic texts. BioBERT and BioClinicalBERT are two examples of such models that have shown promise in medical NLP tasks. Many of these models are overparametrised and resource-intensive, but thanks to techniques like Knowledge Distillation (KD), it is possible to create smaller versions that perform almost as well as their larger counterparts. In this work, we specifically focus on development of compact language models for processing clinical texts (i.e. progress notes, discharge summaries etc). We developed a number of efficient lightweight clinical transformers using knowledge distillation and continual learning, with the number of parameters ranging from 15 million to 65 million. These models performed comparably to larger models such as BioBERT and ClinicalBioBERT and significantly outperformed other compact models trained on general or biomedical data. Our extensive evaluation was done across several standard datasets and covered a wide range of clinical text-mining tasks, including Natural Language Inference, Relation Extraction, Named Entity Reco

Clinical trials are critical in advancing medical treatments but often suffer from immense time and financial burden. Advances in statistical methodologies and artificial intelligence (AI) present opportunities to address these inefficiencies. Here we introduce Prognostic Covariate-Adjusted Mixed Models for Repeated Measures (PROCOVA-MMRM) as an advantageous combination of prognostic covariate adjustment (PROCOVA) and Mixed Models for Repeated Measures (MMRM). PROCOVA-MMRM utilizes time-matched prognostic scores generated from AI models to enhance the precision of treatment effect estimators for longitudinal continuous outcomes, enabling reductions in sample size and enrollment times. We first provide a description of the background and implementation of PROCOVA-MMRM, followed by two case study reanalyses where we compare the performance of PROCOVA-MMRM versus the unadjusted MMRM. These reanalyses demonstrate significant improvements in statistical power and precision in clinical indications with unmet medical need, specifically Alzheimer's Disease (AD) and Amyotrophic Lateral Sclerosis (ALS). We also explore the potential for sample size reduction with the prospective implementati