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GraphTreeMed: A Hybrid Graph-Tree RAG Architecture for Mission-Critical Medical Applications
Get PDFStudies within engineering management indicate that decision-making is often based on the cognitive processing of grouped and pictographic information clusters entangled with high-level pattern recognition. Similarly, graph-based retrieval-augmented generation (RAG) architectures substantially improve diagnostic accuracy and interpretability, while tree-structured systems reduce critical misses through hierarchical reasoning. However, existing solutions often lack a unified framework that seamlessly integrates these two paradigms to address the multifaceted demands of mission-critical healthcare settings. This proposal introduces GraphTreeMed, a novel hybrid RAG architecture designed to harness the complementary strengths of graph-based and tree-based retrieval mechanisms, thereby advancing the safety and efficacy of clinical decision support systems. Existing research on graph-based medical RAG has demonstrated up to 23% higher diagnostic accuracy over vector retrieval methods. GraphTreeMed employs structured knowledge graphs to model dynamic and non-linear relationships between symptoms, diseases, treatments, and patient demographics. Concurrently, it integrates the hierarchical design principles from tree-structured RAG, which has shown a 37% reduction in critical miss rates by implementing layered reasoning pathways. Combinedly, GraphTreeMed addresses ambiguous or overlapping symptom profiles, rapidly evolving patient data, and the need for precise, stepwise decision protocols in high-stakes environments like intensive care units. The proposed system includes three components. First, the Dynamic Graph-Tree Mapper translates graph entities (medical concepts and diagnostic codes) into corresponding tree nodes that capture hierarchical dependencies among possible diagnoses. Second, a Criticality-Aware Router leverages graph-based risk differentiation to select the suitable diagnostic or therapeutic pathway, tailoring its retrieval strategy to each patient’s severity level. Finally, a Compliance Verifier implements robust safety checks to minimize misinformation and reduce the likelihood of adverse events. Testing of GraphTreeMed is designed to be on Medical-RAGv2, a comprehensive benchmark of 15,000+ complex diagnostic cases, focusing on accuracy, coverage, and latency improvements. The results surpass current standards in critical-case retrieval recall and a 42% reduction in diagnostic errors during ICU triage simulations. The methodology includes HIPAA-compliant data masking, real-time consistency checks for knowledge alignment, and differential diagnosis consensus mechanisms
Populism, Media, and the End of Democracy
No full textLike Ancient Athens, post-democracy has come for modern democracies. Democratic institutions still exist and seem to function, but they are strained and sick with misuse, especially by populists, and the government increasingly behaves like oligarchy. Like Ancient Athens, there is now a post-modern marketplace of ideas and morality, which facilitates not truth but sophistry as the guiding light. If all ideas are equally legitimate, then so too are the words of a charismatic radical ethnonational populist.
Unlike Ancient Athens, today\u27s populism rides on the winds of mass and social media. Media companies seek profit, which requires engagement, which uses and means outrage, isolation, and radicalization, especially through personalized media, an exemplar of social disengagement.
This kind of radicalizing tool did not exist in Ancient Athens, yet democratically destructive populism still arose. While modern representative democracies are distinct from Athenian direct democracy, they are founded on similar principles, and per Plato\u27s fears, post-democratic populist movements may be endemic to democracy. Media does not cause democratic erosion, but the more technologically advanced it is, the more power post-democratic populism has to breach scale and institutional resilience
Counselor Education for Serving Individuals Seeking Mental Health Care after Perinatal Loss in the United States
No full textThere are approximately 3.6 million births yearly in the U.S., but the general fertility rate is declining (Hamilton et al., 2024). Miscarriage risk, pregnancy loss prior to 20-weeks gestation, is about 15% in known pregnancies, suggesting this number could be significantly higher given losses occur prior to confirmation testing (Quenby et al., 2021). Additionally, about 5.7 stillbirths occur per 1,000 births annually in the U.S. (Gandhi & Page, 2024), meaning there are about 20.5 thousand babies lost after 20-weeks gestation during birth every year. Ely & Driscoll (2023) reported 3.58 per 1,000 deaths occurred in the neonatal period (within 28 days of birth), and 2.02 per 1,000 deaths occurred in the postneonatal period (between 28 and 364 days after birth). These statistics highlight the prevalence of perinatal loss in the U.S. and the heightened likelihood of counselors working with individuals seeking mental health care after such losses.
Counselors have the ethical professional responsibility to practice only within their competence boundaries and must monitor and improve their effectiveness, when necessary (ACA, 2014). Medical research surrounding perinatal loss is abundant, but study is sparse on mental health challenges and counseling competencies for this population. These individuals often experience severe distress, such as anxiety, depression, grief, and post-traumatic stress disorder (Karaahmet & Bilgiç, 2024; Quenby et al., 2021). Therapeutic interventions can aid in grief adaptation and reduce mental health symptoms (Karaahmet & Bilgiç, 2024). Although, there are about 1 million professionals in the U.S. behavioral health workforce, only around 9 thousand are perinatal mental health certified and of these only 2.6 thousand specialize in perinatal loss and/or grief/bereavement (National Center for Health Workforce, 2024; PSI, 2024). The Council for Accreditation of Counseling and Related Educational Programs requires programs to address the “effects of crises, disasters, stress, grief, and trauma across the lifespan,” but this is only briefly mentioned in a subsection of the accreditation standards (CACREP, 2024). Grief education is rarely prioritized in counseling programs. There is a shortage of mental health providers, and there is a need to increase educational opportunities for counseling professionals serving populations who have lost a baby at various stages of gestation and infancy.
Due to cultural norms of silence and societal taboos, there is misinformation and minimization of the impact that results from perinatal loss (Rogers et al., 2019). The purpose of this advocacy project was to increase counselors’ awareness and provide considerations for counseling populations through perinatal loss. Through reviewing literature and conversing with members in the community, recommendations are offered. Counselors should approach clients with empathy, asking specific questions and repairing empathic failures. Counselors can be knowledgeable of support resources in their areas, as well as establish both in-person and telehealth groups that meet at least biweekly to increase access to care. Careful consideration should be given to group admission criteria, as some are restricted to only non-pregnant parental figures. Counselors could also expand accepted payment options, offering sliding-scale and pro bono services for uninsured individuals. Furthermore, counselors should engage in ongoing training and consultation
Three Particle Interactions from Quantum Chromodynamics
No full textThree-body physics is important in measuring physical properties of exotic hadrons, which mostly decays into three or more particles under strong interactions. To realize these states using the fundamental theory of strong interactions, Quantum Chromodynamics (QCD), we use a tool called Lattice QCD. LQCD is a systematically improvable numerical technique that solves non-perturbative QCD by putting quarks and gluons on a discretized space-time lattice. Due to the finite volume nature of this method, we can\u27t have asymptotic states, thus no scattering information. But we can map the finite volume results from LQCD to constrain physical dynamical quantities. The path to extracting three-body scattering information is a bit more complicated because on top this mapping, one needs to solve three-body integral equations to get the scattering amplitude. My work focuses on solving the three-body integral equations and extracting dynamical quantities of three-body systems. In this talk, I will present our techniques of studying three-body scattering from Lattice QCD
Case of Acute Encephalopathy Associated with Montelukast
No full textIntroduction:
Montelukast is a leukotriene receptor antagonist that is sometimes used off-label to treat chronic obstructive pulmonary disease (COPD). Although many studies have explored possible associations between montelukast and neuropsychiatric adverse events including mood disorders, suicidality, and anxiety disorders; few have investigated a specific association between montelukast and acute encephalopathy in the hospital setting.
Case:
A 59-year-old female with an extensive medical history including morbid obesity, diabetes, chronic pain, and COPD presented to the emergency department with worsening back pain, right leg pain, and paresthesias. Magnetic resonance imaging revealed spinal osteomyelitis with psoas abscess and epidural abscess. The patient was admitted and underwent drainage of the psoas abscess on hospital day 3. She was placed on long-term antibiotics for epidural abscess and bacteremia.
On hospital day 19, she had new onset of encephalopathy with fluctuating confusion, hallucinations, and speech difficulties. At that time, no severe derangements were noted on complete blood count or comprehensive metabolic panel. Serum levels of thiamine, folate, cobalamin, methylmalonic acid, copper, zinc, and thyrotropin were unrevealing. Computed tomography of the head showed no acute findings, and urine culture yielded no growth. Her encephalopathy was thought to be multifactorial in the setting of prolonged hospital stay, treatment for bacteremia and epidural abscess, and possible drug-related toxicity. The patient’s baclofen dosage was decreased from 20 mg to 10 mg three times daily; however, her mental status continued to fluctuate during the next few weeks.
On hospital day 41, her home dose of 10 mg montelukast was held to assess any impact on her mental status. Over the next few days, her mentation improved. She was able to communicate clearly, and no further episodes of agitation were reported by nursing staff. Consequently, the decision was made to discontinue the montelukast on hospital day 48. The improvement in her cognition was sustained even though other medical factors continued to fluctuate.
Discussion:
Encephalopathy is a term that describes the clinical syndrome of altered mental status resulting from brain dysfunction. The causes of acute encephalopathy are numerous and include both systemic and primary neurologic conditions. In the case of our patient, there were many factors, including medications, medical conditions, and length of hospital stay, that may have contributed to her encephalopathy. However, the temporal relationship between cessation of montelukast and improvement of her mentation suggests a possible association between this medication and the patient’s symptoms.
The United States Food and Drug Administration issued a safety advisory in 2008 and a boxed warning in 2020 due to reports of neuropsychiatric adverse events in patients taking montelukast, and many studies over the past 15 years have investigated this association. Some have suggested that montelukast is linked to mood, anxiety, and sleep disorders, and that this association may be greater in children than in adults.
Conclusion:
In this case report, we present a hospitalized patient with acute encephalopathy whose mentation improved after discontinuation of montelukast. Further research is needed to explore the potential association between montelukast and acute encephalopathy, particularly in adults
Effect of Brd4 Inhibition on the Expression of Pro-Fibrotic Markers
No full textEffect of Brd4 Inhibition on the Expression of Pro-Fibrotic Markers
Ryan Washington, Jennifer Zhou
Eastern Virginia Medical School
INTRODUCTION: Idiopathic Pulmonary Fibrosis (IPF) is a chronic lung disease characterized by excessive scarring of lung tissues. 80,380 Americans are affected by IPF today. The likelihood of developing the disease increases as getting older. IPF patients have increased activated fibroblasts compared to healthy people. Inhibition of Brd4, a transcription factor that regulates the transformation of fibroblasts into myofibroblasts has been proposed as a way to slow the progression of IPF. In this study, we utilized two Brd4 inhibitors, dBET6 and A1874, to test the effects of Brd4 inhibition on fibroblast activation.
METHODS: IMR90 cells were cultured in a 6-well plate in 2 mL of DMEM media in each well. The cells were incubated in serum-free media overnight to arrest them in G0. 24 hours later, the dishes were subdivided into 2 control wells, 2 wells that contained TGF-B, one well containing TGF-B and dBET6, and one well containing TGF-B and A1874. The plates were incubated for 24 hrs, then protein was extracted. Afterwards, Western blot Analysis was conducted to detect differences in protein expression.
RESULTS: We observed an increase in the expression of pro-fibrotic markers in the cells treated with TGF-B with or without inhibitors when compared to control. The cells treated with TGF-β and dBET6 showed lower levels of profibrotic markers (α-SMA and Col3A1) expression compared to the control. However, the cells that were treated with TGF-β /A1874 showed no detectable difference.
CONCLUSION: In this study, we demonstrated that dBET6 decreases the expression of proteins associated with fibrosis in IMR90 cells induced by profibrotic cytokine TGF-β. These results suggest that dBET6 may play a protective role in the pathogenesis of IPF. In the future, further studies are needed to confirm the results in IPF patient samples
The Role of IgA in Atherosclerosis
No full textINTRODUCTION: Atherosclerosis is a disease primarily characterized by the build-up of fatty lesions in large and medium-sized vessels, chronic inflammation, dyslipidemia, and obesity. Immune systems from all lineages, especially B cell subsets, play a complex role in the development of plaque formation during atherosclerosis. Innate response activator and follicular B cells are known to be pro-atherogenic whereas, B1 cells, and marginal zone B cells show protective functions in atherosclerosis. B1 cells produce immunoglobulin A (IgA) Abs that are crucial for mucosal immunity. Gut microbiota plays an important role in shaping the immune system at all stages of life. IgA Abs are involved in maintaining intestinal homeostasis and have the ability to mediate gut protective immunity. Interestingly, studies have shown a close relation between altered gut microbiota and the presence of bacterial populations within atherosclerotic plaques. However, the role of IgA in atherogenesis development is still largely unknown. In this study, we investigate the role of IgA in developing atherosclerosis and associated changes in gut health that accompany plaque progression.
METHODS: IgA-deficient low-density lipoprotein–deficient receptor (IgA-/-Ldlr-/-) and control Ldlr-/- male mice were fed a high-fat diet (HFD) for 17 weeks to induce hyperlipidemia and the development of atherosclerotic lesions. Plasma cholesterol levels and lesion formation in the aorta and the brachiocephalic artery (BCA) were measured. Single-cell suspensions from different tissues were collected and analyzed with Spectral Flow to assess immune cell distribution and activation. The hearts were collected and stained with MOVAT to assess plaque size and stability phenotype. Guts were collected and stained with specific Abs to measure gut health and inflammatory status. Immunoglobulin levels in plasma were detected using ELISA.
RESULTS: The IgA deficiency significantly reduced atherosclerosis in IgA-/-Ldlr-/- by 42.6% (6.5%, lesion size IgA-/-Ldlr-/- and control 11.4% lesion size Ldlr-/-, with SE ; pLdlr-/- mice (Grade 1: 22.22%, Grade 3: 77.77%) compared to IgA-/-Ldlr-/- mice (Grade 1: 22.2%, Grade 2: 44.4%, Grade 3: 33.3%). We detected an increased number of leukocytes in Ldlr-/- mice compared to the IgA-/-Ldlr-/- control mice in the omentum (by 61.4%) and carotids (by 71.7%) (pIgA-/-Ldlr-/- mice were substantially increased by 90.5% and 96.5%, respectively, compared to their Ldlr-/- counterparts. IgG2b plasma levels in HFD and chow fed IgA-/-Ldlr-/- mice were also increased by 18.0% and 39.4%, respectively, compared to their Ldlr-/- counterparts. IgM plasma levels in HFD fed IgA-/-Ldlr-/- mice were decreased by 10.9% compared to the Ldlr-/- mice, whereas increased by 39.8% in the chow fed IgA-/-Ldlr-/- mice. Further analysis of flow cytometry and histology data is underway.
CONCLUSION: Our data so far suggests IgA plays an unexpected pro-atherogenic role, likely by altering the local immune composition and reshaping the ability of B cells to produce other immunoglobulins. Future work will focus on identifying the mechanisms by which IgA-deficient B cells regulate plaque development and plaque stability
Racial Disparities in Cervical Cancer Prevalence in the South Atlantic Region: A Cross-Sectional Analysis
No full textBackground: Cervical cancer remains a public health issue, with notable differences in incidence and outcomes based on race and geographic region. Pap smear tests are a primary prevention method to prevent being diagnosed with cervical cancer. This study investigates the association between race and cervical cancer in the South Atlantic region which consists of Delaware, the District of Columbia, Florida, Georgia, Maryland, North Carolina, South Carolina, Virginia, and West Virginia.
Methods: This cross-sectional study used data from the Health Information National Trends Survey (HINTS). The final sample consisted of 6,252 participants in the age range of 21 or higher. Survey weights were included to ensure that the results represent the target population accurately. Race was self-reported and divided into five groups. Cervical Cancer was defined as individuals who have ever been diagnosed with cervical cancer. Univariate and multivariable logistic regression model were used to find Odds Ratio (OR) and 95% Confidence Interval (CI) while adjusting for covariates.
Results:Non-Hispanic White participants comprised 57.14% of individuals diagnosed with cervical cancer, compared to 71.15% of those without a cervical cancer diagnosis. In contrast, Non-Hispanic Black and Hispanic participants accounted for 15.87% and 14.29% of the cervical cancer group, respectively. Black (aOR: 1.72, 95% CI: 1.35–2.19), Hispanic (aOR: 1.92, 95% CI: 1.47–2.50), and Asian (aOR: 1.921 95% CI: 1.19–3.06) populations had higher adjusted odds of cervical cancer when compared to their white counterparts. Participants aged 50-56 (OR: 0.18, 95% CI: 0.10–0.31, p
Conclusion: The findings of this study underscore the pronounced racial disparities in cervical cancer prevalence within the South Atlantic region, highlighting the urgent need for targeted interventions to address existing health inequities. These results emphasize the necessity of implementing culturally and regionally tailored prevention strategies, including enhanced access to Pap smear screening and the development of public health initiatives aimed at mitigating cervical cancer disparities in the South Atlantic region
Generating Real-World Evidence in Early Alzheimer\u27s Disease: Considerations for Applying the Target Trial Emulation Framework to Study the Safety of Anti-Amyloid Therapies
Get PDFAnti-amyloid beta monoclonal antibodies (anti-Aβ mAbs) have received approval from the US Food and Drug Administration for the treatment of patients with mild cognitive impairment or mild dementia due to Alzheimer\u27s disease (collectively known as early AD) based on evidence from clinical trials. However, whether findings from these trials are generalizable to the real world is uncertain. We need reliable evidence on the real-world safety of these treatments to inform decision making for clinicians, patients, and caregivers. Using lecanemab as an exemplar, we outline the key considerations in designing and implementing an observational study on safety and utilization outcomes using established administrative healthcare claims data sources with the target trial emulation framework. The target trial emulation framework is a rigorous causal inference framework that minimizes common biases in observational studies. The approach proposed here can be applied to evaluation of additional mAbs as they become available