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临床诊断思维 (临床诊断思维 / 临床推理 (Clinical Diagnostic Reasoning) — 医生『怎么想病』的元学科:从症状/体征/检查到诊断结论的认知操作系统,从业者(临床医生/住院医/规培生,尤其全科/急诊/大内科等以未分化主诉为生的科室)、医学生与医学教育者、诊断安全与质量改进研究者、以及做医疗 AI 辅助诊断产品的人的视角。覆盖: (a) 第一性张力 — **直觉模式识别 (System 1: illness scripts 疾病脚本 / pattern recognition / gestalt, 『资深人一眼认出 aunt Minnie』) ⇄ 分析性推理 (System 2: hypothetico-deductive 假设演绎 / Bayesian 概率更新)** 的 dual-process 双过程理论 (Kahneman→Croskerry/Norman 谱系), 资深≠更会分析而是『脚本库更大+校准更好』; 更深层论战 — **『认知去偏可教 (Croskerry: bias awareness / cognitive forcing strategies / diagnostic timeout) ⇄ 偏倚标签是马后炮、知识结构才是主因 (Norman/Sherbino/Monteiro: debiasing 干预 transfer 证据弱, bias 是 hindsight 标签)』** — 本行最核心学术对垒; 『概率思维 (验前概率 × 似然比 → 验后概率, Pauker-Kassirer test/treatment threshold 阈值模型) ⇄ 穷尽式排查 (rule-out everything / 防御性医疗 / VOMIT)』; 『临床 gestalt ⇄ 结构化临床决策规则 (Wells/PERC/HEART)』; 『诊断简约 Occam's razor ⇄ Hickam's dictum (病人可以同时得 N 个病)』; 『床旁体格检查复兴 (Verghese Stanford 25 / McGee 循证体检) ⇄ 影像检验替代床旁』; (b) 方法论正典 — illness script theory (Schmidt/Boshuizen: enabling conditions/fault/consequences 三段结构), problem representation + semantic qualifiers 问题表征与语义限定词 (Bowen NEJM 2006, 把病人翻成 one-liner), hypothetico-deductive model (Elstein 1978《Medical Problem Solving》: 早期假设生成+定向检验), Bayesian 工具箱 (sensitivity/specificity/LR/Fagan nomogram/SnNout-SpPin), threshold model (Pauker-Kassirer NEJM 1975/1980), 认知偏倚分类学 (anchoring/premature closure/availability/confirmation/base-rate neglect/search satisficing/diagnostic momentum — Croskerry 偏倚清单), 去偏与元认知策略 (diagnostic timeout/cognitive forcing/Ely checklist/calibration), schema-based reasoning (Clinical Problem Solvers schemas: 按 pivot 症状走分支), reflective practice 结构化反思 (Mamede/Schmidt), 诊断错误科学 (NAM 2015 报告定义 / Newman-Toker Big Three / Hardeep Singh e-triggers / SAFER Dx 框架); (c) 行业结构与角色 — 医学生→实习/住院医 (晨会 morning report/查房被 pimping/汇报训练)→主治 attending→master clinician (NEJM CPC discussant/晨会大师如 Dhaliwal); 配套生态: 医学教育者 (clinical reasoning curriculum + 评估: script concordance test/key features exam/OSCE), 诊断安全研究者 (SIDM/AHRQ), 诊断辅助与 CDS 工具开发者 (DDx generator/AI); (d) 核心工作流 — 数据采集 (病史为王 + 循证体检 + 针对性检验影像) → 问题表征 (one-liner + semantic qualifiers) → 鉴别诊断生成 (schema / 解剖定位法 / VINDICATE-M 病因筛, 按『常见可能 × 致命不能漏 can't-miss』双轴排序) → 假设定向检验 (按 LR 选检查 / 阈值决策) → working diagnosis + 安全网 (red flags 交代 / test of time / test of treatment) → 反馈校准 (follow-up / M&M / diagnostic timeout); 教学工作流: 晨会渐进披露汇报 / CPC / SNAPPS / one-minute preceptor / virtual morning report; AI 增强工作流 (2023-2026: LLM 鉴别诊断头脑风暴 / OpenEvidence 检索 / ambient scribe 释放认知带宽 + 自动化偏倚 guardrails); (e) 产出物 — one-liner, problem list, prioritized DDx, assessment & plan (按问题分层), 晨会/CPC 汇报, M&M 复盘, 诊断不确定性沟通 (『最可能是 X, 但出现 Y 红旗立刻回来』); (f) 教育与评估 — script concordance test / key feature exam / EPA / 里程碑; 中国语境: 人卫《诊断学》教材 / 执业医师考试 / 规培结业临床思维考核; (g) 争议/批判 — debiasing 之争 (Croskerry vs Norman-Sherbino『knowledge is the cure』, 去偏 RCT 效果弱 / bias 标签不可证伪), 诊断错误率数字之争 (『10-15%』经典估计 / Newman-Toker 79.5 万美国年严重伤害外推方法被质疑 / 尸检符合率), dual-process 二分被批过度简化 (连续谱 / 难以实证分离), 决策规则 vs gestalt (资深 gestalt 常不输 Wells 类规则 / 算法厌恶), vignette 研究外推性 + context/case specificity (推理高度内容绑定不可通用迁移 [Norman/Eva] — 对『教推理通用课』产业的根本批判), AI 辅助诊断 2023-2026 (GPT-4 在 NEJM CPC/vignette 追平或超医生 [Kanjee 2023 JAMA / Goh 2024 JAMA Netw Open『AI alone > physician+AI』悖论] / Google AMIE / OpenEvidence 爆发 vs 自动化偏倚 / 去技能化 / 真实环境验证缺失), 防御性医疗与过度检查 (incidentaloma 瀑布 / VOMIT), 体检衰亡之争, pimping 教学法争议; (h) 流派/思想谱系 — 决策科学/Bayesian 派 (Ledley-Lusted 1959 → Elstein/Kassirer/Sox/Pauker/Eddy → Brush) vs 认知心理/双过程派 (Kahneman-Tversky → Croskerry/Graber) vs 教育认知派 (Schmidt/Boshuizen illness scripts → Norman/Eva/Mamede/Durning 情境认知) vs 诊断安全/系统派 (NAM 2015 / Newman-Toker / Hardeep Singh / Graber-SIDM: 错误=系统×认知共因) vs 床旁临床派 (Osler 传统 → Tierney aphorisms / Verghese / McGee / Dhaliwal / Saint: 病史体检为王 + 刻意练习) vs AI/计算派 (INTERNIST-1/DXplain 专家系统 → Isabel → LLM 世代 Rodman/Topol)。不含: 具体专科治疗方案与手术决策深度 (足踝外科/种植牙等另有 skill), 中医辨证 (另有 skill), EBM 文献批判性评价方法学 (相关但本 skill 聚焦诊断推理本身), 护理诊断体系 (NANDA), 影像/病理知觉型读片训练 (相邻但独立), 精神科 DSM 结构化访谈细节, 医患沟通技巧全集 (只覆盖诊断不确定性沟通), 患者自查/自我诊断指

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In-process semantic search over text files or in-memory strings, using Gemini embeddings via the CF AI Gateway. Use when user wants fuzzy/conceptual search where exact-keyword grep would miss — "sessions discussing regulatory constraints", "code about retry logic", "notes mentioning burnout even if the word isn't there". Complements searching-codebases (regex/AST) and extracting-keywords (YAKE). Do NOT use when an exact string/regex match is what's wanted — grep/rg wins on speed and precision there.

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Implement semantic vector search with AgentDB for intelligent document retrieval, similarity matching, and context-aware querying. Use when building RAG systems, semantic search engines, or intelligent knowledge bases.

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SERP-based semantic topic clustering for content architecture planning. Groups keywords by actual Google SERP overlap (not text similarity), designs hub-and-spoke content clusters with internal link matrices, and generates interactive visualizations. Optionally executes content creation if claude-blog is installed. Use when user says "topic cluster", "content cluster", "semantic clustering", "pillar page", "hub and spoke", "content architecture", "keyword grouping", or "cluster plan".

日本語の概要は準備中です。原文の説明を表示しています。

Implement semantic vector search with AgentDB for intelligent document retrieval, similarity matching, and context-aware querying. Use when building RAG systems, semantic search engines, or intelligent knowledge bases.

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Find the papers that answer a research query in Firecrawl's research paper index — a corpus of paper abstracts whose largest share is biomedical and life-science literature (PubMed, bioRxiv, medRxiv), alongside arXiv preprints in CS, physics, and math — using semantic search, semantic and structural expansion, and in-body verification. Use this skill for literature-finding and paper-retrieval tasks of any kind, including clinical, biomedical, drug, gene, disease, and other life-science questions, whether the answer is a single paper or a full multi-paper set. The index is reached only through the `firecrawl_research_*` MCP tools or the `firecrawl research` CLI subcommands. Calling `firecrawl_search` with its `categories` option set to `["research"]` is a different feature — it filters ordinary web search to research-affiliated websites (the list includes PubMed, bioRxiv, medRxiv, arXiv, and publisher sites) and returns page results from them, without querying the paper records in this index.

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Find the papers that answer a research query in Firecrawl's research paper index — a corpus of paper abstracts whose largest share is biomedical and life-science literature (PubMed, bioRxiv, medRxiv), alongside arXiv preprints in CS, physics, and math — using semantic search, semantic and structural expansion, and in-body verification. Use this skill for literature-finding and paper-retrieval tasks of any kind, including clinical, biomedical, drug, gene, disease, and other life-science questions, whether the answer is a single paper or a full multi-paper set. The index is reached only through the `firecrawl_research_*` MCP tools or the `firecrawl research` CLI subcommands. Calling `firecrawl_search` with its `categories` option set to `["research"]` is a different feature — it filters ordinary web search to research-affiliated websites (the list includes PubMed, bioRxiv, medRxiv, arXiv, and publisher sites) and returns page results from them, without querying the paper records in this index.

日本語の概要は準備中です。原文の説明を表示しています。

Implement semantic vector search with AgentDB for intelligent document retrieval, similarity matching, and context-aware querying. Use when building RAG systems, semantic search engines, or intelligent knowledge bases.

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Use when searching academic papers, looking up citations, finding authors, or getting paper recommendations using the Semantic Scholar API. Triggers on queries about research papers, academic search, citation analysis, or literature discovery.

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Use when the user asks for a literature review, academic deep dive, research report, state-of-the-art survey, topic scoping, comparative analysis of methods/papers, grant background, or any request that needs multi-source scholarly evidence with citations. Also trigger proactively when a user question clearly requires academic grounding (e.g. "what's known about X", "compare approach A vs B in the literature", "summarize the field of Y"). Runs an 8-phase (Phase 0..7), script-driven research workflow across 7 federated sources (OpenAlex, arXiv, Crossref, PubMed, DBLP, bioRxiv, Exa) with optional Semantic Scholar / Brave MCP enrichment, with deduplication, transparent ranking, dual-backend citation chasing (OpenAlex + Semantic Scholar), self-critique, and structured report output with verifiable citations.

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Design a color palette with semantic tokens for a brand or product. Use when asked to "design a color palette", "what colors should we use", or "define semantic color tokens".

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Expert guide for AI FinOps, dynamic model routing (LiteLLM, Portkey, RouteLLM), cost optimization, budget enforcement, semantic caching, and latency-based fallback architectures / Panduan ahli untuk AI FinOps, routing model dinamis, optimasi biaya, penegakan anggaran, semantic caching, dan arsitektur fallback berbasis latensi.

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Define semantic type detectors in detectors.js for auto-detecting column data meaning

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Semantic HTML5, SEO basics, alt text, progressive enhancement and SPA concerns. Use when building web UI, reviewing markup or optimising for search.

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Use when parallel agents in a convoy or across git worktrees hit a write conflict on shared state — a git tree, a config, or a shared document — and you must decide whether the conflict is semantically real. Classifies each conflicting hunk as independent (keep both), redundant (pick one), or a genuine clash (escalate), instead of blind locks, abort-and-retry, or escalate-everything. Sits ABOVE refinery-merge and NEVER blind auto-merges: it wraps an LLM judgment, defaults to escalate on any uncertainty, and unconditionally escalates any hunk touching .planning/, config, credentials, or safety-critical paths. Backed by CoAgent (arxiv 2606.15376v1). Triggers on write conflicts between parallel agents on shared repo state.

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Implement semantic vector search with AgentDB for intelligent document retrieval, similarity matching, and context-aware querying. Use when building RAG systems, semantic search engines, or intelligent knowledge bases.

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Compatibility router for semantic skill tightening. Delegate goal recovery, authority, semantic conservation, evaluation contracts, and instruction optimization to Skill Lapidary rather than duplicating that system in Plugin Creator.

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Semantic code understanding with IDE-like symbol operations. Use when: (1) Large codebase analysis (>50 files), (2) Symbol-level operations (find, rename, refactor), (3) Cross-file reference tracking, (4) Project memory and session persistence, (5) Multi-language semantic navigation. Triggers: "find symbol", "rename function", "find references", "symbol overview", "project memory". IMPORTANT: Prioritize Serena's symbolic tools over file-based grep/read for code exploration.

日本語の概要は準備中です。原文の説明を表示しています。

Implement semantic vector search with AgentDB for intelligent document retrieval, similarity matching, and context-aware querying. Use when building RAG systems, semantic search engines, or intelligent knowledge bases.

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Use when navigating or refactoring code with a language server - choosing between semantic (LSP), exact-text (rg), and fuzzy/semantic search; anchoring LSP calls by position; gating degraded results; and disclosing tool substitutions, in any language.

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Semantic search over global agent memory. Use to retrieve previously learned patterns, decisions, gotchas, and workarounds. Prevents stale-context errors across long sessions and multi-agent pipelines.

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Semantic code search using Phase 1 vector embeddings and Phase 2 hybrid search.

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Build or refine UI color systems, warmth, semantic color, and color-based hierarchy in designs that are too gray, monochromatic, or missing color meaning. Use when the user mentions dull colors, gray UI, missing warmth, weak semantic color, or a need for stronger color hierarchy.

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Apply semantic versioning (SemVer 2.0.0) to determine the correct version bump based on change analysis. Covers major/minor/patch classification, pre-release identifiers, build metadata, and breaking change detection. Use when preparing a new release to determine the correct version number, after merging changes before tagging, evaluating whether a change constitutes a breaking change, adding pre-release identifiers, or resolving disagreement about what version bump is appropriate.

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