Efficient scaling of large language models with mixture of experts and 3D analog in-memory computing.

Large language models (LLMs), with their remarkable generative capacities, have greatly impacted a range of fields, but they face scalability challenges due to their large parameter counts, which result in high costs for training and inference. The trend of increasing model sizes is exacerbating these challenges, particularly in terms of memory footprint, latency and energy consumption. Here we explore the deployment of 'mixture of experts' (MoEs) networks-networks that use conditional computing to keep computational demands low despite having many parameters-on three-dimensional (3D) non-volatile memory (NVM)-based analog in-memory computing (AIMC) hardware.

Delayed atorvastatin delivery promotes recovery after experimental spinal cord injury.

Spinal cord injury (SCI) significantly alters gene expression, potentially impeding functional recovery. This study investigated the effects of atorvastatin, a widely prescribed cholesterol-lowering drug, on gene expression and functional recovery in a chronic murine SCI model. Female C57BL/6J mice underwent moderate 0.

A 2D detector array for relative dosimetry and beam steering for FLASH radiotherapy with electrons.

Background: FLASH radiotherapy is an emerging treatment modality using ultra-high dose rate beams. Much effort has been made to develop suitable dosimeters for reference dosimetry, yet the spatial beam characteristics must also be characterized to enable computerized treatment planning, as well as quality control and service of a treatment delivery device. In conventional radiation therapy, this is commonly achieved by beam profile scans in a water phantom using a point detector.

Marginally outer trapped tubes in de Sitter spacetime.

We prove two results which are relevant for constructing marginally outer trapped tubes (MOTTs) in de Sitter spacetime. The first one (Theorem 1) holds more generally, namely for spacetimes satisfying the null convergence condition and containing a timelike conformal Killing vector with a "temporal function". We show that all marginally outer trapped surfaces (MOTSs) in such a spacetime are unstable.

Gender Differences in Clinical Performance Assessment of Internal Medicine Residents: A Longitudinal Analysis of the Influence of Faculty and Trainee Gender.

Purpose: Competency-based medical education relies on equitable assessment. This study examined the influence of faculty and trainee gender on assessments of internal medicine (IM) resident performance over time.

Method: A longitudinal analysis of clinical performance assessments from 7 U.

Perceptions and Behaviors of Nurses and Physicians During Bedside Rounds in Medical-Surgical Units.

Background: Communication and collaboration among health care professionals during bedside rounds improve patient outcomes and nurses' and physicians' satisfaction.

Objectives: To determine barriers to nurse-physician communication during bedside rounds and identify opportunities to improve nurse-physician collaboration at an academic medical center.

Methods: A survey with Likert-scale and open-ended questions regarding professional attitudes toward nurse-physician communication was administered to 220 nurses and physicians in medical-surgical units to assess perceptions of participation in bedside rounds.

Risk management during times of health uncertainty in Spain: A qualitative analysis of ethical challenges.

The study examines the reflections of various experts in risk management when asked about uncertainty generated by a health threat and the response to such a threat: what criteria should guide action when potential harm is anticipated, but not known with certainty? The objective of the research is to obtain a holistic perspective of ethical conflicts in risk management, based on experts' accounts within the Spanish territory. A qualitative study was conducted through semi-structured interviews with 27 experts from various fields related to health risk management and its ethical implications, following the grounded theory method. The method includes theory generation through an inductive approach, based on the identified categories.

Structures and Processes of Grading Committees in Internal Medicine Clerkships: Results of a National Survey.

Purpose: Clerkship grades are important in the residency selection process but can be influenced by individual bias and grading tendencies. Although clinical competency committees are standard in graduate medical education, in undergraduate medical education, they have not gained widespread traction. This study describes structures and processes of grading committees in internal medicine (IM) clerkships and strategies used to mitigate grading bias.

The Healthcare Improvement and Innovation in Quality (THINQ) Collaborative: A Novel Quality Improvement Training Program for Undergraduate and Postgraduate Students.

The Healthcare Improvement and Innovation in Quality (THINQ) Collaborative is a uniquely designed program that engages undergraduate and postgraduate students to participate in improving health care and addressing important clinical problems. In 9 years, over 120 THINQ Fellows have been trained in quality improvement (QI) frameworks and methodologies focusing on research skills, social justice, leadership development, and problem-solving. Program evaluation has included surveying current and former THINQ Fellows about their experiences with the program and its subsequent impact on their careers.

Circular food system approaches can support current European protein intake levels while reducing land use and greenhouse gas emissions.

Protein transition and circular food system transition are two proposed strategies for supporting food system sustainability. Here we model animal-sourced protein to plant-sourced protein ratios within a European circular food system, finding that maintaining the current animal-plant protein share while redesigning the system with circular principles resulted in the largest relative reduction of 44% in land use and 70% in greenhouse gas (GHG) emissions compared with the current food system. Shifting from a 60:40 to a 40:60 ratio of animal-sourced proteins to plant-sourced proteins yielded a 60% reduction in land use and an 81% GHG emission reduction, while supporting nutritionally adequate diets.

Microglial P2Y calcium signaling promotes phagocytosis and shapes neuroimmune responses in epileptogenesis.

Microglial calcium signaling is rare in a baseline state but strongly engaged during early epilepsy development. The mechanism(s) governing microglial calcium signaling are not known. By developing an in vivo uridine diphosphate (UDP) fluorescent sensor, GRAB, we discovered that UDP release is a conserved response to seizures and excitotoxicity across brain regions.

Database Integration Correlates Street Crossing Design Strategies With Pedestrian Injury.

Introduction: Transportation databases have limited data regarding injury severity of pedestrian versus automobile patients. To identify opportunities to reduce injury severity, transportation and trauma databases were integrated to examine the differences in pedestrian injury severity at street crossings that were signalized crossings (SCs) versus nonsignalized crossings (NSCs). It was hypothesized that trauma database integration would enhance safety analysis and pedestrians struck at NSC would have greater injury severity.

The Role of The Hospitalist in the Clinical Education of Medical Students.

Hospitalist clinician-educators frequently work with medical students at the clinical level, but many early career educators may lack an understanding of how to effectively promote student learning and growth. We explore the role of hospitalists working with medical students in the clinical environment as it pertains to three overarching domains - clinical skills, systems-based healthcare, and career mentorship.

Physician behaviors associated with increased physician and nurse communication during bedside interdisciplinary rounds.

Background: Effective team communication during interdisciplinary rounds (IDRs) is a hallmark of safe, efficient, patient-centered care. However, there is limited understanding of optimal IDR structures and procedures.

Objective: This study aimed to analyze direct observations of physician and nurse interactions during bedside IDR to identify behaviors associated with increased interprofessional communication.

Characterization of a diode dosimeter for UHDR FLASH radiotherapy.

Background: Ultra-high dose rate (UHDR) FLASH beams typically deliver dose at rates of  >40 Gy/sec. Characterization of these beams with respect to dose, mean dose rate, and dose per pulse requires dosimeters which exhibit high temporal resolution and fast readout capabilities.

Purpose: A diode EDGE Detector with a newly designed electrometer has been characterized for use in an UHDR electron beam and demonstrated appropriateness for UHDR FLASH radiotherapy dosimetry.

Circularity in Europe strengthens the sustainability of the global food system.

Redesigning the European food system on the basis of circularity principles could bring environmental benefits for Europe and the world. Here we deploy a biophysical optimization model to explore the effects of adopting three circularity scenarios in the European Union (EU)27 + UK. We calculate a potential reduction of 71% in agricultural land use and 29% per capita in agricultural greenhouse gas emissions, while producing enough healthy food within a self-sufficient European food system.

Pregnancy and infant outcomes by trimester of SARS-CoV-2 infection in pregnancy-SET-NET, 22 jurisdictions, January 25, 2020-December 31, 2020.

Objectives: We describe clinical characteristics, pregnancy, and infant outcomes in pregnant people with laboratory-confirmed SARS-CoV-2 infection by trimester of infection.

Study Design: We analyzed data from the Surveillance for Emerging Threats to Mothers and Babies Network and included people with infection in 2020, with known timing of infection and pregnancy outcome. Outcomes are described by trimester of infection.

The probe-format graphite calorimeter, Aerrow, for absolute dosimetry in ultrahigh pulse dose rate electron beams.

Purpose: The purpose of this investigation is to evaluate the use of a probe-format graphite calorimeter, Aerrow, as an absolute and relative dosimeter of high-energy pulse dose rate (UHPDR) electron beams for in-water reference and depth-dose-type measurements, respectively.

Methods: In this paper, the calorimeter system is used to investigate the potential influence of dose per pulses delivered up to 5.6 Gy, the number of pulses delivered per measurement, and its potential for relative measurement (depth-dose curve measurement).

Association of Gender and Race/Ethnicity with Internal Medicine In-Training Examination Performance in Graduate Medical Education.

Background: Disparities in objective assessments in graduate medical education such as the In-Training Examination (ITE) that disadvantage women and those self-identifying with race/ethnicities underrepresented in medicine (URiM) are of concern.

Objective: Examine ITE trends longitudinally across post-graduate year (PGY) with gender and race/ethnicity.

Design: Longitudinal analysis of resident ITE metrics at 7 internal medicine residency programs, 2014-2019.

Impact of a Palliative Care Nurse Practitioner in an Oncology Clinic: A Quality Improvement Effort.

Purpose: Guidelines support early integration of palliative care (PC) into standard oncology practice; however, little is known as to whether outcomes can be improved by modifying health care delivery in a real-world setting.

Methods: We report our 6-year experience of embedding a nurse practitioner in an oncology clinic (March 2014-March 2020) to integrate early, concurrent advance care planning and PC.

Results: Compared with patients with advanced cancer not enrolled in the palliative care nurse practitioner program, in March 2020, patients who are enrolled are more likely to have higher quality of PC (eg, goals of care note documentation [82% 15%; < .

Blocking Kallikrein 6 promotes developmental myelination.

Kallikrein related peptidase 6 (Klk6) is a secreted serine protease highly expressed in oligodendrocytes and implicated in demyelinating conditions. To gain insights into the significance of Klk6 to oligodendrocyte biology, we investigated the impact of global Klk6 gene knockout on CNS developmental myelination using the spinal cord of male and female mice as a model. Results demonstrate that constitutive loss of Klk6 expression accelerates oligodendrocyte differentiation developmentally, including increases in the expression of myelin proteins such as MBP, PLP and CNPase, in the number of CC-1+ mature oligodendrocytes, and myelin thickness by the end of the first postnatal week.

Performance Evaluation of the Quantitative Point-of-Care LumiraDx D-Dimer Test.

Introduction: Fibrin degradation product D-dimer can be a valuable indicator for venous thromboembolism (VTE). The use of D-dimer testing in primary care settings can be limited by restricted access to laboratory services. This performance evaluation compares a quantitative, point-of-care (POC) D-dimer assay (LumiraDx D-Dimer Test) with a reference laboratory-based D-dimer assay.

Critical Role of Astrocyte NAD Glycohydrolase in Myelin Injury and Regeneration.

Western-style diets cause disruptions in myelinating cells and astrocytes within the mouse CNS. Increased CD38 expression is present in the cuprizone and experimental autoimmune encephalomyelitis models of demyelination and CD38 is the main nicotinamide adenine dinucleotide (NAD)-depleting enzyme in the CNS. Altered NAD metabolism is linked to both high fat consumption and multiple sclerosis (MS).

Beam energy metrics for the acceptance and quality assurance of Halcyon linear accelerator.

Purpose: Establish and compare two metrics for monitoring beam energy changes in the Halcyon platform and evaluate the accuracy of these metrics across multiple Halcyon linacs.

Method: The first energy metric is derived from the diagonal normalized flatness (F ), which is defined as the ratio of the average measurements at a fixed off-axis equal distance along the open profiles in two diagonals to the measurement at the central axis with an ionization chamber array (ICA). The second energy metric comes from the area ratio (AR) of the quad wedge (QW) profiles measured with the QW on the top of the ICA.