Adaptive Design Association

Abstract Background Diagnostic decision support systems (DDSS) are increasingly deployed at scale, yet their diagnostic accuracy is insufficiently monitored once integrated into care. Traditional post-market surveillance relies on clinician review, which is costly, slow, and difficult to sustain. Large language models (LLMs) may offer a scalable and potentially automatable solution, but their performance in real-world monitoring remains unknown. Methods We conducted a diagnostic accuracy substudy within ESSENCE, a prospective evaluation of Ada Health’s DDSS integrated into Portugal’s largest private healthcare network. Clinical notes and ICD-10 diagnoses from 498 encounters were anonymised and classified using a filter–map–match framework. Manual clinician review served as the reference standard. We compared eligibility classification and condition mapping between clinicians and GPT-4.1 and GPT-5, and assessed diagnostic accuracy of two DDSS versions using both reference sets. Findings Manual review classified 385 of 498 encounters (77·3%) as eligible for diagnostic comparison. GPT-5 reproduced these classifications with 84·7% accuracy (κ=0·57), showing high sensitivity but only moderate specificity. Among 347 encounters judged eligible by both approaches, GPT-5 exactly matched clinician-assigned diagnoses in 93·6% and proposed clinically plausible alternatives in 3·5%. Diagnostic accuracy estimates based on manual versus GPT-5 mappings were statistically indistinguishable at Top-1 and Top-3 across the full analyzable sets, with one significant difference at Top-5. In the overlapping 346 cases, no statistical differences were observed. Across both reference sets, the experimental DDSS version outperformed the original only at the Top-5 threshold. Interpretation LLMs can reproduce clinician review of real-world diagnostic encounters with close agreement. While GPT-5 performed comparably to clinicians for condition mapping, the eligibility filtering step - deciding which encounters should enter the diagnostic-accuracy analysis - remains the main source of divergence and is the priority for improvement. Embedding such approaches into health systems could enable automated and continuous performance and safety monitoring and support regulatory compliance. Broader evaluations across diverse care settings are needed to establish generalisability and equity impact. Funding German Federal Ministry of Education and Research (NextGenerationEU, PATH project).

It is common to translate a programming language to an intermediate representation as part of interpreting or compiling a program written in the language. The question is what are the implications when we try to implement normally unsafe features, such as pointers into a heap with user-controlled deallocation, on top of a virtual machine based on an intermediate language that is inherently safe and provides no user-controlled deallocation. A similar question arises in the implementation of exceptions on top of a virtual machine that has no direct support for exceptions but has lightweight threading. This paper will describe how we are addressing these two challenges as part of building an Ada implementation on top of a parallel virtual machine, and evaluate the result.

Stratospheric ozone protects life on Earth from solar ultraviolet radiation, but the ozone layer is fragile. The Antarctic ozone hole has shown that humankind's release of certain chemicals into the atmosphere can deplete ozone essentially completely in a region where the destruction process is operative. Early detection of a future threat, especially one that might operate on a global scale as severely as that now operating in a layer over Antarctica each October, is crucial. Globally observing the stratosphere submillimeter-wavelength spectrum can give early (potentially earliest-possible) detection of threats to the ozone layer. Hundreds of chemical species – including radicals that can reveal new destruction processes before they cause noticeable depletion of ozone – have submillimeter spectral lines that are detectable and measurable at abundances that can threaten ozone. Spectral lines are resolved at all stratospheric heights, providing definitive identification. Chemical species in all global regions and at all stratospheric heights can be measured each 24-hour period, both day and night, including in the presence of dense volcanic aerosol and ice clouds. New solid-state technology is available for the stratosphere submillimeter spectrum to be observed from satellite at wavelengths down to 0.1 mm by both passive and active limb sounding. Using this technology, we present a Submillimeter Observatory for the Stratosphere (SOS) concept. SOS economically combines the most valuable features of passive and active measurements: vertical profile measurements of passive and ultra-high sensitivity of active. Active and passive measurements are time-shared, the passive system is the receiver for the active, eliminating the need for a separate receiver satellite. Active measurement vertical resolution is obtained from the measured spectral line shape, eliminating the need for a constellation of satellites. Instruments operate at ambient temperature, eliminating the need for detector cooling. Projected SOS detectability is given for 455 chemical species. Active measurement daily 10° latitude zonal mean precisions with 2 m antenna are projected capable of detecting 440 species down to ∼10⁻¹² relative abundances, and 220 species down to ∼10⁻¹⁵. Passive individual vertical profile measurements, made every 1.5° along the suborbital path with ∼2 km vertical resolution, have projected precision better than ∼10⁻⁹ relative abundance for 390 species. Passive daily 10° latitude zonal means with 5 km vertical resolution have projected precision capable of detecting 200 species down to ∼10⁻¹². The fundamental limit on detectability is the stratosphere's spectral clutter floor. The practical limit is likely to be set by the ability to calibrate out instrumental spectral artifacts.

This study was conducted to evaluate different rice straw management practices for wheat sowing for the years 2021-22 and 2022-23. This study includes four treatments Treatment 1: Burning of rice straw and stubbles followed by seed bed preparation by rotavator and broadcasting seed, Treatment 2: Use of rice straw chopper + MB Plough (1) + Rotavator (2) + Planking followed by drilling, Treatment 3: Use of rice straw chopper + Disc Harrow (1) + Rotavator (2) + Planking followed by drilling and Treatment 4: Use of zero tillage happy seeder. Among all these methods Treatment 2 performed higher in term of yield data for both years associated with higher cost of operation. Zero Tillage Happy Seeder performed at par with Treatment 2 in terms of yield data with minimum cost involved and single step wheat sowing process and excellent rice straw management option for wheat sowing in rice wheat cropping system.

Aims: Soils in Ghana's coastal savanna are typically poor in phosphorus (P), which has an impact on crop growth and productivity. The majority of West African phosphate rock formations are not reactive; therefore, their direct applications do not facilitate easy P availability to crops. Co-composting organic waste with phosphate rock and using phosphorus-solubilizing microorganisms is the new paradigm adopted by scientists in response to the lack of P availability (PSMs). The goals of this study were to (1) assess the effect of Aspergillus niger in P dissolution in phosphate rock during composting with citrus waste (CW) and rice straw (RS) and (2) to evaluate the effect of phosphor-compost on growth, dry matter yield and P uptake of maize.
 Methodology: Preparation of compost took place at University of Ghana Forest and Horticulture Research Center, Okumaning Camp close to Kade. Citrus waste and rice straw were used as feed stock. Each composting pile contained a mixture of urea, Togo phosphate rock, and feedstock in a 1:3:24 weight-to-weight ratio.
 Results: According to the findings, citrus waste feedstock was superior to rice straw in dissolving the P in rock phosphate. In a pot experiment, the phospho-composts were assessed using maize (Zea mays) as the test crop.

Leveraging top charts in over 60 countries in the year 2017-2021 from the world's largest streaming platform Spotify, I characterize music consumption patterns by constructing a global network of music diffusion between issuing countries and consuming countries. I adopt Hofstede's Cultural Dimensions theory to explain the underlying mechanism of music diffusion. In particular, I find that cultural differences between countries are negatively correlated with music diffusion. Further investigation using network analysis suggests that the music diffusion is asymmetric across countries: music issued by countries in the central positions of the network exerts more influence than those from other countries in the peripheral positions. Moreover, using clustering analysis, I demonstrate that the similarity of music tastes between countries in terms of acoustic features is positively correlated with their cultural similarity. Through my findings, I identify the important role of national culture in alternatively explaining music diffusion beyond the existing beliefs of common language and geographic proximity, which may shed light on music production and promotion in the streaming music era.

An endowment fund serves as a permanent source of capital to support a specific mission. It has, in the case of a university, dual goals of providing current financial support to the university and preserving long-term purchasing power to ensure that support continues in perpetuity. This article explores a methodology for constructing strategic asset allocation for endowment funds in the context of these competing long-term investment goals. <b>TOPICS:</b>Foundations &amp; endowments, portfolio construction <b>Key Findings</b> ▪ In constructing a strategic asset allocation for an endowment, a traditional mean-variance optimization framework alone does not provide sufficient context to generate comprehensive forward-looking analysis. However, adding additional measures such as maximizing the probability of achieving investment goals or minimizing relevant downside distress measures over the long term can improve the analysis. ▪ A typical endowment’s asset allocation, with an equity orientation and tilt toward alternative asset classes, nearly maximizes the probability of achieving the dual long-term investment goals of meeting a spending rate target while preserving real capital, as well as minimizes endowment-specific downside risk measures. ▪ Optimal portfolio choices are dependent on underlying return expectations across asset classes. Although expected returns are typically the highest for private investments, there are limits to investing in private asset classes, including an endowment’s liquidity requirements and ability to access the best-performing managers.

There is a need to develop techniques for conversion of carbon dioxide to useful products such as formaldehyde, formic acid, methanol, and hydrocarbons. Carbon dioxide can be converted into these products using either photochemically, electrochemically, thermochemical or hydrogenation by bacteria. Formate is of interest due to the possibility of being used in liquid fuel cells, as an additive in pyrolysis vapors and as a precursor for biological fuels. In this work, conversion of carbon dioxide to formic acid under acidic conditions and formate under basic or neutral conditions was accomplished through photoreduction using an inexpensive setup consisting of titanium dioxide, metal phthalocyanines and inexpensive incandescent sources. The yield of formic acid based on anion chromatography was 1.54%. This work also discusses and presents a true quantum yield determined using chemical actinometry which was near 2.0%. Detailed studies of the photoreduction process showed that the amount of sensitizer, light intensity and pH affect the amount of formate generated.

In an aim to improve first-time NCLEX-RN pass rates, some nursing programs have instituted high-stakes testing. This literature review investigated nursing faculty understanding of and student experiences with high-stakes testing. High-stakes testing is an assessment used to make decisions about student progression or completion of a nursing program. The literature revealed both negative and positive consequences associated with high-stakes testing. Literature from state boards of nursing and professional nursing organizations was also reviewed for recommendations.

Depression and AnxietyVolume 34, Issue 5 p. 390-390 ADAA President's Letter President's Letter May 2017 Journal Karen Lynn Cassiday PhD, ACT, Karen Lynn Cassiday PhD, ACT President, ADAASearch for more papers by this author Karen Lynn Cassiday PhD, ACT, Karen Lynn Cassiday PhD, ACT President, ADAASearch for more papers by this author First published: 27 April 2017 https://doi.org/10.1002/da.22630Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume34, Issue5FOCUS ON NEUROBIOLOGIC MECHANISMS IN PTSD AND DEPRESSIONMay 2017Pages 390-390 RelatedInformation