nkhani

Large Language Model (LLM) imatha kulemba zolemba zokopa kutengera mawu achangu, kupambana mayeso aluso, ndikulemba zambiri zachifundo komanso zachifundo. Komabe, kuwonjezera pa zoopsa zodziwika bwino za nthano zopeka, zofooka, ndi zowona zolakwika mu LLM, nkhani zina zomwe sizinathetsedwe pang'onopang'ono zikuyamba kuyang'ana, monga zitsanzo za AI zomwe zimakhala ndi "zosankha zaumunthu" zomwe zingathe kukhala ndi tsankho pakupanga ndi kugwiritsa ntchito kwawo, ndipo ngakhale LLM ikasiya kupanga zomwe zilimo ndikuchotsa zotsatira zovulaza momveka bwino, "makhalidwe a LLM" akhoza kutsikabe.

Zitsanzo zosawerengeka zikuwonetsa momwe deta yomwe imagwiritsidwa ntchito pophunzitsa mitundu ya AI imayika zikhalidwe zapayekha komanso pagulu, zomwe zitha kukhazikika mkati mwachitsanzocho. Zitsanzozi zimaphatikizapo kugwiritsa ntchito mitundu ingapo, kuphatikiza kutanthauzira kokha kwa X-ray pachifuwa, gulu la matenda apakhungu, komanso kupanga zisankho motsatana ndi kugawika kwa zida zamankhwala. Monga tanenera m'nkhani yaposachedwa m'magazini athu, maphunziro okondera atha kukulitsa ndi kuwulula zikhalidwe ndi kukondera komwe kulipo pakati pa anthu. M'malo mwake, kafukufuku wasonyezanso kuti AI ingagwiritsidwe ntchito kuchepetsa kukondera. Mwachitsanzo, ochita kafukufuku adagwiritsa ntchito zitsanzo zakuya zophunzirira mafilimu a X-ray a mawondo ndipo adapeza zinthu zomwe zinaphonya zizindikiro zowawa (zolembedwa ndi radiologists) mkati mwa mawondo a mawondo, motero kuchepetsa kusiyana kosadziwika kwa ululu pakati pa odwala akuda ndi oyera.

Ngakhale kuti anthu ambiri akuzindikira kukondera mu zitsanzo za AI, makamaka pokhudzana ndi deta yophunzitsira, mfundo zina zambiri zolowera za makhalidwe aumunthu sizimapatsidwa chisamaliro chokwanira pakupanga ndi kutumizira zitsanzo za AI. AI yachipatala posachedwapa yapeza zotsatira zochititsa chidwi, koma kwakukulukulu, sichinaganizire momveka bwino za makhalidwe aumunthu ndi kugwirizana kwawo ndi kuwunika kwa chiopsezo ndi kulingalira kwapang'onopang'ono, komanso sikunapangidwe.

Kuti mumvetsetse malingaliro osamveka awa, yerekezerani kuti ndinu katswiri wa endocrinologist yemwe akuyenera kupereka mankhwala ophatikizika a kukula kwa munthu kwa mwana wazaka 8 yemwe ali pansi pa 3 peresenti ya usinkhu wake. Mnyamatayo amalimbikitsa kukula kwa timadzi tating'onoting'ono tating'onoting'ono ta 2 ng/mL (reference value,> 10 ng/mL, mtengo wotchulidwa m'maiko ambiri kunja kwa United States ndi> 7 ng/mL), ndipo jini yake yopangira ma hormoni yakukula kwamunthu yazindikira masinthidwe osowa osasinthika. Timakhulupirira kuti kugwiritsa ntchito mankhwala a hormone ya kukula kwaumunthu ndi zoonekeratu komanso zosatsutsika muzochitika zachipatalazi.

Kugwiritsiridwa ntchito kwa chithandizo cha hormone ya kukula kwaumunthu muzochitika zotsatirazi kungayambitse mikangano: msinkhu wa mnyamata wa zaka 14 wakhala nthawi zonse mu 10 peresenti ya anzawo, ndipo nsonga ya kukula kwa hormone pambuyo pa kukondoweza ndi 8 ng / mL. Palibe odziwika ntchito masinthidwe kuti zingakhudze kutalika, kapena zifukwa zina zodziwika za msinkhu waufupi, ndi zaka mafupa ake ndi zaka 15 (ie palibe kuchedwa chitukuko). Gawo lokhalo la mkanganowo ndi chifukwa cha kusiyana kwa zomwe akatswiri amapeza potengera kafukufuku wambiri wokhudzana ndi kukula kwa timadzi tating'onoting'ono tomwe timagwiritsidwa ntchito pozindikira kuperewera kwa timadzi tating'onoting'ono tomwe timakulitsa. Mkangano wochuluka umachokera ku phindu la phindu la kugwiritsa ntchito mankhwala a hormone ya kukula kwa anthu kuchokera kwa odwala, makolo odwala, ogwira ntchito zachipatala, makampani opanga mankhwala, ndi olipira. Ma endocrinologists a ana amatha kuyeza zovuta zoyipa zomwe zimadza chifukwa cha jakisoni wa tsiku ndi tsiku wa kukula kwa hormone kwa zaka 2 ndikuthekera kwapang'onopang'ono kukula kwa thupi la munthu wamkulu poyerekeza ndi pano. Anyamata angakhulupirire kuti ngakhale kutalika kwawo kungangowonjezeka ndi 2 cm, ndi bwino jekeseni kukula kwa hormone, koma wolipira ndi kampani ya mankhwala akhoza kukhala ndi malingaliro osiyanasiyana.

Timatengera creatinine based eGFR monga chitsanzo, chomwe ndi chizindikiro chogwiritsidwa ntchito kwambiri cha aimpso pozindikira ndikuwonetsa matenda osachiritsika a impso, kukhazikitsa kuyika impso kapena zoperekera, ndikuwunika njira zochepetsera komanso zotsutsana ndi mankhwala ambiri omwe amaperekedwa ndi dokotala. EGFR ndi njira yosavuta yowerengera yomwe imagwiritsidwa ntchito poyerekezera kuchuluka kwa kusefera kwa glomerular (mGFR), yomwe ndi mulingo wolozera, koma njira yowunika ndiyovuta. Kuwongolera uku sikungaganizidwe ngati mtundu wa AI, koma kukuwonetsa mfundo zambiri zamakhalidwe aumunthu ndi kulingalira kwanzeru.

Cholowa choyamba cha mfundo zaumunthu kulowa mu eGFR ndikusankha deta yofananira. Mzere woyambirira womwe umagwiritsidwa ntchito popanga fomula ya eGFR nthawi zambiri imakhala ya anthu akuda ndi oyera, ndipo kugwirizana kwake ndi mitundu ina yambiri sikudziwika bwino. Mfundo zotsatila za makhalidwe aumunthu mu ndondomekoyi zikuphatikizapo: kusankha kulondola kwa mGFR monga cholinga chachikulu chowunika ntchito ya impso, ndi mlingo wotani wovomerezeka wa kulondola, momwe mungayesere kulondola, ndi kugwiritsa ntchito eGFR monga poyambira kuyambitsa zisankho zachipatala (monga kudziwa mikhalidwe yoika impso kapena kupereka mankhwala). Pomaliza, posankha zomwe zili munjira yolowera, zikhalidwe zaumunthu zidzalowanso m'njirayi.

Mwachitsanzo, chaka cha 2021 chisanafike, malangizo akuwonetsa kusintha kwa creatinine mu fomula ya eGFR kutengera zaka za wodwala, jenda, ndi mtundu (omwe amangodziwika kuti ndi anthu akuda kapena osakhala akuda). Kusintha kotengera mtundu ndicholinga chofuna kuwongolera kulondola kwa chilinganizo cha mGFR, koma mu 2020, zipatala zazikulu zidayamba kukayikira kugwiritsa ntchito eGFR yotengera mtundu, kutchula zifukwa monga kuchedwetsa kuyenerera kwa wodwala kuti amuike ndi kuthamangitsa mpikisano ngati lingaliro lachilengedwe. Kafukufuku wasonyeza kuti kupanga zitsanzo za eGFR malinga ndi mtundu wamtunduwu kungakhale ndi zotsatira zozama komanso zosiyana pa zolondola ndi zotsatira zachipatala; Chifukwa chake, kuyang'ana kwambiri pakulondola kapena kuyang'ana gawo lina lazotsatira kumawonetsa kugamula kwa phindu ndipo kungabise kupanga zisankho mowonekera. Pomaliza, gulu la ogwira ntchito m'dzikolo lidapereka njira yatsopano yomwe idakonzedwanso popanda kuganizira zamtundu kuti zigwirizane ndi momwe magwiridwe antchito ndi chilungamo. Chitsanzochi chikuwonetsa kuti ngakhale njira yosavuta yachipatala imakhala ndi mfundo zambiri zolowa muzofunikira zaumunthu.

Poyerekeza ndi machitidwe azachipatala omwe ali ndi zizindikiro zochepa chabe, LLM ikhoza kukhala ndi mabiliyoni mpaka mazana mabiliyoni a magawo (zolemera zachitsanzo) kapena kuposerapo, zomwe zimapangitsa kuti zikhale zovuta kumvetsa. Chifukwa chomwe timati "zovuta kumvetsetsa" ndikuti m'ma LLM ambiri, njira yeniyeni yopezera mayankho kudzera mukufunsa siingathe kujambulidwa. Chiwerengero cha magawo a GPT-4 sichinalengezedwe pano; Kumbuyo kwake GPT-3 inali ndi magawo 175 biliyoni. Zochulukira sizikutanthauza mphamvu zamphamvu, monga zitsanzo zing'onozing'ono zomwe zimaphatikizapo maulendo owerengera (monga LLaMA [Large Language Model Meta AI] model series) kapena zitsanzo zomwe zimakonzedwa bwino kutengera maganizo a anthu zidzachita bwino kuposa zitsanzo zazikulu. Mwachitsanzo, malinga ndi oyesa anthu, mtundu wa InstrumentGPT (chitsanzo chokhala ndi magawo 1.3 biliyoni) umaposa GPT-3 pakukometsa zotsatira zotuluka.

Tsatanetsatane wamaphunziro a GPT-4 sizinafotokozedwebe, koma tsatanetsatane wamitundu yam'badwo yam'mbuyomu kuphatikiza GPT-3, InstrumentGPT, ndi ma LLM ena ambiri otsegula awululidwa. Masiku ano, mitundu yambiri ya AI imabwera ndi makadi achitsanzo; Zowunikira ndi chitetezo cha GPT-4 zasindikizidwa mu khadi yofananira yoperekedwa ndi kampani yopanga zitsanzo ya OpenAI. Kupanga kwa LLM kumatha kugawidwa m'magawo awiri: gawo loyambirira lophunzitsira komanso gawo lokonzekera bwino lomwe cholinga chake ndi kukhathamiritsa zotsatira zotuluka. Mu gawo lophunzitsira, chitsanzocho chimaperekedwa ndi gulu lalikulu kuphatikiza zolemba zoyambirira za intaneti kuti ziphunzitse kulosera mawu otsatirawa. Njira yowoneka ngati yophweka "yomaliza yokha" imapanga chitsanzo champhamvu, koma ikhoza kuyambitsa khalidwe loipa. Makhalidwe aumunthu adzalowa m'gawo la maphunziro asanayambe, kuphatikizapo kusankha zidziwitso za GPT-4 ndikusankha kuchotsa zinthu zosayenera monga zolaula kuchokera ku deta yophunzitsira. Ngakhale kuyesayesa uku, chitsanzo choyambirira sichingakhalebe chothandiza kapena chokhoza kukhala ndi zotsatira zoyipa. Mu gawo lotsatira la kukonza bwino, zizolowezi zambiri zothandiza komanso zopanda vuto zidzawonekera.

M'gawo lokonzekera bwino, machitidwe a zilankhulo nthawi zambiri amasinthidwa kwambiri mwa kuwongolera bwino ndi kuphunzira kulimbikitsa kutengera mayankho a anthu. Mu gawo loyang'aniridwa bwino, ogwira ntchito m'makontilakitala omwe alembedwa ntchito adzalemba zitsanzo zamayankhidwe a mawu ofulumira ndikuphunzitsa molunjika chitsanzocho. Mu gawo lophunzirira kulimbikitsa malinga ndi mayankho a anthu, owunikira anthu amasankha zotulukapo ngati zitsanzo zolowa. Kenaka gwiritsani ntchito zotsatira zofananitsa zomwe zili pamwambazi kuti muphunzire "chitsanzo cha mphotho" ndikupititsa patsogolo chitsanzocho pophunzira kulimbikitsa. Kutengapo gawo modabwitsa kwa anthu kungathe kuwongolera bwino zitsanzo zazikuluzikuluzi. Mwachitsanzo, mtundu wa InstrumentGPT unagwiritsa ntchito gulu la anthu pafupifupi 40 ogwira ntchito m'makontilakitala omwe adatengedwa kuchokera ku mawebusayiti a crowdsourcing ndipo adachita mayeso omwe cholinga chake chinali kusankha gulu la ofotokozera omwe ali ndi chidwi ndi zomwe magulu osiyanasiyana a anthu amakonda.

Monga zitsanzo ziwirizi, zomwe ndi njira yosavuta yachipatala [eGFR] ndi LLM yamphamvu [GPT-4], zikuwonetseratu, kupanga zisankho zaumunthu ndi makhalidwe aumunthu zimagwira ntchito yofunika kwambiri pakupanga zotsatira za zotsatira. Kodi mitundu ya AI iyi ingagwire odwala awo osiyanasiyana komanso madokotala? Momwe mungawongolere poyera kugwiritsa ntchito AI muzamankhwala? Monga tafotokozera m'munsimu, kuunikanso kwa zisankho zachipatala kungapereke njira yothetsera vutoli.

Kusanthula zisankho zachipatala sikudziwika kwa madokotala ambiri, koma kumatha kusiyanitsa pakati pa malingaliro otheka (chifukwa cha zotsatira zosatsimikizika zokhudzana ndi kupanga zisankho, monga ngati kupatsa munthu kukula kwa hormone muzochitika zotsutsana zachipatala zomwe zasonyezedwa mu Chithunzi 1) ndi zifukwa zoganizira (zotsatira zomwe zimakhudzidwa ndi zotsatirazi, zomwe mtengo wake umawerengedwa ngati "kuwonjezeka kwa 2" , kupatsa mphamvu ya 2 , kupatsa mphamvu kwa amuna pazosankha zovuta zamankhwala. Pofufuza zisankho, madokotala ayenera choyamba kudziwa zisankho zonse zomwe zingatheke ndi zomwe zingatheke zokhudzana ndi zotsatira zilizonse, ndiyeno amaphatikizapo chithandizo cha wodwalayo (kapena chipani china) chogwirizana ndi zotsatira zonse kuti asankhe njira yoyenera kwambiri. Choncho, kulondola kwa kusanthula zisankho kumadalira ngati zotsatira zake zimakhala zomveka, komanso ngati kuyeza kwazomwe zimagwiritsidwa ntchito ndi kuyerekezera kwa kuthekera kuli kolondola. Momwemo, njira iyi imathandiza kuonetsetsa kuti zisankho zimachokera ku umboni komanso zimagwirizana ndi zokonda za odwala, motero kuchepetsa kusiyana pakati pa deta ya zolinga ndi zikhalidwe zaumwini. Njirayi idayambika m'zachipatala zaka makumi angapo zapitazo ndipo idagwiritsidwa ntchito popanga zisankho za wodwala aliyense komanso kuwunika kwaumoyo wa anthu, monga kupereka malingaliro owunikira khansa yapakhungu kwa anthu wamba.

Pakuwunika zosankha zachipatala, njira zosiyanasiyana zapangidwa kuti zithandizire. Njira zambiri zachikhalidwe zimapeza phindu kuchokera kwa odwala payekha. Njira yosavuta ndiyo kugwiritsira ntchito mlingo wa mlingo, kumene odwala amayesa mlingo wawo wokonda zotsatira zinazake pa mlingo wa digito (monga mzere wozungulira kuchokera ku 1 mpaka 10), ndi zotsatira za thanzi labwino kwambiri (monga thanzi lathunthu ndi imfa) zomwe zili pamapeto onse awiri. Njira yosinthira nthawi ndi njira ina yomwe imagwiritsidwa ntchito kwambiri. Mwa njira iyi, odwala ayenera kusankha nthawi yathanzi yomwe akufuna kuwononga nthawi yomwe ali ndi thanzi labwino. Njira yodziwika bwino yotchova njuga ndi njira ina yomwe imagwiritsidwa ntchito pozindikira zofunikira. Mwa njira iyi, odwala amafunsidwa kuti ndi ziti mwazinthu ziwiri zomwe amakonda: mwina kukhala ndi zaka zingapo mu thanzi labwino ndi mwayi wapadera (p) (t), ndikukhala ndi chiopsezo cha imfa ndi mwayi wa 1-p; Onetsetsani kuti mukukhala zaka T pansi pa zovuta zaumoyo. Funsani odwala kangapo pa ma p-values ​​osiyanasiyana mpaka akuwonetsa kuti sakonda chilichonse, kotero kuti zofunikira zitha kuwerengedwa potengera mayankho a odwala.
Kuphatikiza pa njira zomwe zimagwiritsidwa ntchito pofuna kukopa zofuna za wodwala aliyense, njira zapangidwanso kuti zipeze zofunikira kwa odwala. Makamaka zokambirana zamagulu (kubweretsa odwala kuti akambirane zomwe zawachitikira) zitha kuthandiza kumvetsetsa momwe amawonera. Pofuna kuphatikizira bwino ntchito zamagulu, njira zosiyanasiyana zokambilana zamagulu zaperekedwa.
M'zochita, kukhazikitsidwa kwachindunji kwa zofunikira pazachipatala ndi njira yamankhwala kumatenga nthawi yambiri. Monga yankho, mafunso ofufuza nthawi zambiri amagawidwa kwa anthu osankhidwa mwachisawawa kuti apeze zofunikira pamlingo wa anthu. Zitsanzo zina ndi mafunso a EuroQol 5-dimensional, mawonekedwe a 6-dimensional utility utility short form, Health Utility Index, ndi Cancer Specific European Cancer Research and Treatment Organization Quality of Life Questionnaire Core 30 chida.