Nevin Manimala

JMIR Med Educ. 2024 Nov 6;10:e63430. doi: 10.2196/63430.

ABSTRACT

BACKGROUND: Recent studies, including those by the National Board of Medical Examiners, have highlighted the remarkable capabilities of recent large language models (LLMs) such as ChatGPT in passing the United States Medical Licensing Examination (USMLE). However, there is a gap in detailed analysis of LLM performance in specific medical content areas, thus limiting an assessment of their potential utility in medical education.

OBJECTIVE: This study aimed to assess and compare the accuracy of successive ChatGPT versions (GPT-3.5, GPT-4, and GPT-4 Omni) in USMLE disciplines, clinical clerkships, and the clinical skills of diagnostics and management.

METHODS: This study used 750 clinical vignette-based multiple-choice questions to characterize the performance of successive ChatGPT versions (ChatGPT 3.5 [GPT-3.5], ChatGPT 4 [GPT-4], and ChatGPT 4 Omni [GPT-4o]) across USMLE disciplines, clinical clerkships, and in clinical skills (diagnostics and management). Accuracy was assessed using a standardized protocol, with statistical analyses conducted to compare the models’ performances.

RESULTS: GPT-4o achieved the highest accuracy across 750 multiple-choice questions at 90.4%, outperforming GPT-4 and GPT-3.5, which scored 81.1% and 60.0%, respectively. GPT-4o’s highest performances were in social sciences (95.5%), behavioral and neuroscience (94.2%), and pharmacology (93.2%). In clinical skills, GPT-4o’s diagnostic accuracy was 92.7% and management accuracy was 88.8%, significantly higher than its predecessors. Notably, both GPT-4o and GPT-4 significantly outperformed the medical student average accuracy of 59.3% (95% CI 58.3-60.3).

CONCLUSIONS: GPT-4o’s performance in USMLE disciplines, clinical clerkships, and clinical skills indicates substantial improvements over its predecessors, suggesting significant potential for the use of this technology as an educational aid for medical students. These findings underscore the need for careful consideration when integrating LLMs into medical education, emphasizing the importance of structured curricula to guide their appropriate use and the need for ongoing critical analyses to ensure their reliability and effectiveness.

PMID:39504445 | DOI:10.2196/63430

J Craniofac Surg. 2024 Nov 6. doi: 10.1097/SCS.0000000000010766. Online ahead of print.

ABSTRACT

To our knowledge, there has not been a review article summarizing the current evidence with regard to perinatal risk factors, and our aim is to perform a systematic review and meta-analysis of the evidence of perinatal risk factors in single suture craniosynostosis to inform our practice and identify any need for further research in this area. Our target population was pediatric single-suture craniosynostosis patients, and the intervention was perinatal risk factors. The comparison group was an age and sex-matched control group without craniosynostosis and the outcome we investigated was presence of single suture craniosynostosis. The literature search was done using OVID MEDLINE, Pubmed, and Embase databases from 1946 to 2023. A PRISMA flowchart was created, and statistical analysis was performed using RevMan pooled odds ratios, and 95% CIs were used to combine results from individual studies. Our initial search identified 625 abstracts and these were narrowed down to 16 articles, which were included in the final selection for the review. Out of these, 13 were used for the quantitative meta-analysis. Our meta-analysis showed a possible association between craniosynostosis and the following perinatal risk factors; presence of maternal thyroid disease, maternal age greater than 29, paternal age greater than 29, maternal smoking, gestational age above 37 weeks, and maternal underweight (BMI<18.5). Further prospective studies are warranted to investigate definite associations. The next step is to set up a multicenter prospective study among a craniofacial unit network.

PMID:39504409 | DOI:10.1097/SCS.0000000000010766

J Craniofac Surg. 2024 Nov 6. doi: 10.1097/SCS.0000000000010841. Online ahead of print.

ABSTRACT

INTRODUCTION: Over the past decade, there has been an improvement in access to gender-affirming surgical care for the transgender population. Even with improvements, this population continues with a high level of inequity among access to specialized surgical care. While multiple studies have previously focused on trends among top and bottom surgery, this study provides trends specifically among facial gender affirmation surgery (FGAS) within the United States.

METHODS: The National Inpatient Sample (NIS) was utilized to identify patients who underwent FGAS from 2012 to 2019. The diagnostic codes for gender identity disorder and gender dysphoria were used to identify the desired patient population. CPT coding released in a medical policy for transgender care coverage was used to identify those who underwent FGAS. Frequency distributions from the patient population were analyzed to determine differences among characteristics.

RESULTS: In total, 660 patients underwent FGAS from 2012 to 2019. The incidence of FGAS has increased by 1433%. Geographically, FGAS was more likely to be performed in the West and Northeast geographical regions (P<0.0001). There was a statistically significant difference in hospital length of stay and the total number of charges when stratified by race (P<0.0001 and P=0.0003), hospital location (P<0.0001 and <0.0001), and insurance type (P<0.0001 and <0.0001). The largest cohort of patients paid out-of-pocket (P<0.0001).

CONCLUSIONS: FGAS is one of the fastest-growing GAS procedures. Currently, FGAS procedures are not equally distributed, with higher concentrations occurring among wealthier, white individuals in certain geographical regions. Future studies are warranted to understand further trends within FGAS.

PMID:39504406 | DOI:10.1097/SCS.0000000000010841

AIDS. 2024 Nov 6. doi: 10.1097/QAD.0000000000004054. Online ahead of print.

ABSTRACT

OBJECTIVE: The possible differences in comorbidity burden were examined between people with longstanding HIV infection and those with shorter HIV duration of the same calendar age.

DESIGN: We performed a single-centre retrospective cohort analysis comparing long-term HIV survivors (LTS) diagnosed with HIV before 1996 (pre-HAART), with an age-matched and gender-matched group diagnosed after 2006 [modern ART era (mART)].

METHODS: Demographic and outcome data up to 1 May 2023 were obtained from electronic health records as well as from digitalized paper charts. Nine comorbidity domains were defined to overlook the comorbidity burden as on 1 May 2023: cardiovascular, musculoskeletal, neurological, oncological, liver, pulmonary, renal, psychiatric/cognitive, and metabolic.

RESULTS: Eighty-eight LTS and 88 people diagnosed in the modern ART era were included in the analysis. Median age in both groups was 60 years. LTS had a higher mean number of comorbidity domains than controls (2.6 vs. 1.9; P = .001). In both LTS and mART groups, metabolic and cardiovascular comorbidity was most prevalent (metabolic 70.5 and 52.3%, respectively, cardiovascular 44.3 and 38.6%, respectively). When stratified according to age, the distribution of the number of comorbidities for LTS roughly resembled the 10 years older mART subgroup. In a multivariate analysis, total ART duration and age were found to be statistically significantly associated with the number of comorbidity domains.

CONCLUSION: Our analysis suggests that LTS have a higher comorbidity burden compared with people diagnosed in the modern ART era of similar calendar age.

PMID:39504387 | DOI:10.1097/QAD.0000000000004054

Eur J Emerg Med. 2024 Nov 5. doi: 10.1097/MEJ.0000000000001196. Online ahead of print.

ABSTRACT

BACKGROUND AND IMPORTANCE: Climate change is widely recognised as a critical public health challenge.

OBJECTIVE: The objective of this study was to assess the awareness, preparedness and mitigation plans for climate change threats.

DESIGN, SETTINGS AND PARTICIPANTS: A cross-sectional observational study targeting emergency medical societies in different countries was conducted between 15 February and 15 March 2024.

INTERVENTION OR EXPOSURE: The survey featured 16 closed questions on climate change awareness, preparedness and risks. Focus groups of 4-6 members were organised by country. Results were correlated to income levels, United Nations (UN) regional classification and the World Risk Index.

OUTCOME MEASURE AND ANALYSIS: The questions were ranked using a Likert-like scale from 0 to 9 (9 being the highest). Descriptive statistics used central tendency estimators, and inferential analysis used chi-square and Kruskal-Wallis tests, with the significance level set at P < 0.05.

RESULTS: Forty-two focus groups responded, representing 36 countries: 21 (50%) high-income, seven (16.7%) low-income, five (11.9%) lower middle-income and nine (21.4%) upper middle-income countries, representing 31 of the 22 UN regions. According to the World Risk Index, the respondent countries belonged to the different categories as follows: very low risk, 6 (14%); low risk, 8 (19%); medium risk, 5 (12%); high risk, 8 (19%) and very high risk, 14 (34%). The estimated impact of climate change on national health systems had a mean score of 6.75 (SD = 2.16), while on Emergency Medical Systems was 6.96 (SD = 2.05). Overall, assessment and preparedness measures were reported by just 21.4 and 37.6% of respondents, respectively. Analysis by income did not show significant differences, with the exception of food supply. The main differences in the analysis by region were the risks of extreme weather events, vector-borne diseases and wildfires, whereas the World Risk Index was food and chain of supplies. Education and integration of health services were indicated by all as the main mitigation actions.

CONCLUSION: Geographical position and country risk index influence risk perception among focus groups more than income economy, with vector-borne diseases, extreme weather events and food shortages being the threats with the most variability. The most important actions identified to mitigate Climate Change effects are educational and strategic plans.

PMID:39504385 | DOI:10.1097/MEJ.0000000000001196

Memory. 2024 Nov 6:1-19. doi: 10.1080/09658211.2024.2423812. Online ahead of print.

ABSTRACT

The relationship between sports expertise and working memory (WM) has garnered increasing attention in experimental research. However, no meta-analysis has compared WM performance between athletes and non-athletes. This study addresses this gap by comparing WM performance between these groups and investigating potential moderators. A comprehensive literature search identified 21 studies involving 1455 participants from seven databases, including PubMed, Embase, and ProQuest. Athletes primarily engaged in basketball, football, and fencing, while non-athletes included some identified as sedentary. The risk of bias assessment indicated low risk across most domains. Publication bias, assessed through a funnel plot and statistical tests, showed no significant evidence of bias. The forest plot, using a random effects model, revealed moderate heterogeneity. The overall effect size indicated a statistically significant, albeit small, advantage for athletes over non-athletes (Hedges’ g = 0.30), persisting across sports types and performance levels. Notably, this advantage was more pronounced when athletes were contrasted with a sedentary population (Hedges’ g = 0.63), compared to the analysis where the sedentary population was excluded from the non-athlete reference group (Hedges’ g = 0.15). Our findings indicate a consistent link between sports expertise and improved WM performance, while sedentary lifestyles appear to be associated with WM disadvantages.

PMID:39504358 | DOI:10.1080/09658211.2024.2423812

PLoS One. 2024 Nov 6;19(11):e0313173. doi: 10.1371/journal.pone.0313173. eCollection 2024.

ABSTRACT

A growing body of evidence suggests that questionable health behaviors- not following medical recommendations and resorting to non-evidence based treatments-are more frequent than previously thought, and that they seem to have strong psychological roots. We thus aimed to: 1) document the lifetime prevalence of intentional non-adherence to medical recommendations (iNAR) and use of traditional, complementary and alternative medicine (TCAM) in Serbia and 2) understand how they relate to ‘distal’ psychological factors-personality traits and thinking dispositions, and ‘proximal’ factors-a set of beliefs and cognitive biases under the term ‘irrational mindset’. In this preregistered cross-sectional study on a nationally representative sample (N = 1003), we observed high lifetime prevalence of iNAR (91.3%) and TCAM (99.2%). Irrational beliefs, especially magical health beliefs and medical conspiracy theories, were the strongest predictors of TCAM. They also mediated the relation between Disintegration/lower cognitive reflectiveness and TCAM. High Disintegration, and low Conscientiousness predicted iNAR directly, whilst negative experiences with the healthcare system facilitated both types of questionable health practices. The established psychological profile of people prone to questionable health behaviors and the fact they can be tracked to negative experiences with the system can be used to tailor public health communications.

PMID:39504335 | DOI:10.1371/journal.pone.0313173

Chaos. 2024 Nov 1;34(11):113118. doi: 10.1063/5.0231126.

ABSTRACT

A deep understanding of non-smooth dynamics of vehicle systems, particularly with dry friction damping offer valuable insights into the design and optimization of railway vehicle systems, ultimately enhancing the safety and reliability of railway operations. In this paper, the two-parameter dynamics of a non-smooth railway wheelset system incorporating dry friction damping are investigated. The effect of the crucial parameters on the complexity of the evolution process is comprehensively exposed by identifying different dynamic responses in the two-parameter plane. In addition, the multistability and the various routes transition to chaos for the system are also discussed. It is found that dry friction induces highly complex dynamics in the system, encompassing a range of behaviors such as periodic, quasi-periodic, and chaotic motions. These intricate dynamics are a direct result of the interplay between multiple parameters, such as speed and damping coefficients, which are critical in determining the system’s stability and performance. The presence of multistability further complicates the system, resulting in unpredictable transitions between different motion states.

PMID:39504102 | DOI:10.1063/5.0231126

Chaos. 2024 Nov 1;34(11):113114. doi: 10.1063/5.0234573.

ABSTRACT

In this paper, we investigate the new generalized stochastic fractional potential-Korteweg-de Vries equation, which describes nonlinear optical solitons and photon propagation in circuits and multicomponent plasmas. Inspired by Kolmogorov-Arnold network and our earlier work, we enhance the improved bilinear neural network method by using a large number of activation functions instead of neurons. This method incorporates the concept of simulating more complicated activation functions with fewer parameters, with more diverse activation functions to generate more complex and rare analytical solutions. On this basis, constraints are introduced into the method, reducing a significant amount of computational workload. We also construct neural network architectures, such as “2-3-1,” “2-2-3-1,” “2-3-3-1,” and “2-3-2-1” using this method. Maple software is employed to obtain many exact analytical solutions by selecting appropriate parameters, such as the superposition of double-period lump solutions, lump-rogue wave solutions, and three interaction solutions. The results show that these solutions exhibit more complex waveforms than those obtained by conventional methods, which is of great significance for the electrical systems and multicomponent fluids to which the equation is applied. This novel method shows significant advantages when applied to fractional-order equations and is expected to be increasingly widely used in the study of nonlinear partial differential equations.

PMID:39504099 | DOI:10.1063/5.0234573

Epidemiol Serv Saude. 2024 Nov 1;33(spe2):e20231298. doi: 10.1590/S2237-96222024v33e20231298.especial2.en. eCollection 2024.

ABSTRACT

OBJECTIVE: To estimate vaccination coverage and analyze sociodemographic factors associated with non-vaccination in children born in 2017 and 2018 in the state capitals of Northeast Brazil.

METHODS: A household survey using cluster sampling was conducted from 2020-2022 to estimate vaccination coverage and hesitancy. Factors associated with non-vaccination were analyzed using logistic regression to calculate Odds Ratios (OR) and their Confidence Intervals (95%CI).

RESULTS: Natal was the capital with the lowest vaccination coverage, below 75.0% for most immunizers. Teresina had rates equal to or greater than 90.0% for all vaccines. Among those interviewed, 99.1% (95%CI 98.9;99.3) believe that vaccines are important for health; 95.4% (95%CI 95.0;95.8) trust immunobiologicals and 79.6% (95%CI% 78.8;80.3) are not afraid of reactions. Belonging to the highest socioeconomic stratum (adjusted OR: 1.34 – 95%CI 1.20;1.50) was as a factor associated with non-vaccination.

CONCLUSION: Low coverage highlights the need for a better understanding of regional specificities and social inequalities.

PMID:39504081 | DOI:10.1590/S2237-96222024v33e20231298.especial2.en