Direct Questions Research Articles

Iowa family physician’s reporting of elder abuse: 20-year follow-up

ABSTRACT The purpose of this project was to assess changes over 20 years, between family physicians perceived magnitude of elder mistreatment, physician knowledge of state laws, barriers to reporting suspected cases, and what is done in practice. Questionnaires were mailed to 1,080 physician members of the Iowa Academy of Family Physicians. Thirty-six percent of physicians returned the questionnaire. These respondents had a mean age of 51 years, were licensed for 19 years, and 51% were male. Twenty-nine percent of physicians ask their patients direct questions about elder abuse in 2022 compared to 14% in 2002. Identifying an elder abuse case was associated with asking direct questions about abuse and the belief that prompt action would be taken. Knowledge of elder abuse legislation was associated with reporting of all abuse cases, along with thinking there were clear definitions of abuse and that reporting benefits patients.

PATIENT AND CARE PARTNER QUESTIONS AND CLINICIAN RESPONSES DURING INITIAL OUTPATIENT PALLIATIVE CARE APPOINTMENTS

Abstract Person-centered palliative care (PC) requires person-centered communication. This study characterized questions asked by persons with neurologic illnesses and their care partners and PC clinicians’ responses. We analyzed audio recordings from 38 initial outpatient PC appointments to characterize questions stated by patients and care partners. Based on previous research, we identified two question types: direct questions (typically-phrased, stated to obtain or clarify information) and indirect questions (declarative statements, not phrased as a typical question, made with information seeking intent). We rated the completeness of clinicians’ responses on a 4-point scale ranging from 1 (completely addressed question and provided additional information) to 4 (no response). We also coded features of clinicians’ responses, including offers of support or action and unprompted recommendations. Patients and care partners asked both direct (n = 442; 79.6%) and indirect (n = 113; 20.4%) questions. More than 60% of all questions were about symptoms, treatment, and lifestyle issues. Clinicians responded to 90.9% of direct questions and 90.2% of indirect questions; their responses to both question types were similar in completeness (median = 1, mode = 1). Clinicians’ responses to direct questions included more offers of support or action compared to responses to indirect questions (17% v. 11%). Responses to indirect questions included more unprompted recommendations compared to responses to direct questions (21% v. 9%). Persons with neurologic illnesses and their care partners use different question types to obtain information during PC appointments. Implications include the need for clinician training to effectively respond to different question types and topics.

OLDER ADULTS’ ACCEPTANCE OF TELEGRACE: A HYBRID TELEHEALTH CARE MODEL

Abstract The VA Geriatric Resources for Assessment and Care of Elders (GRACE) at Veterans Health Indiana is an interdisciplinary, home-based program providing comprehensive geriatric assessment and ongoing care management for community-dwelling older Veterans’ experiencing geriatric syndromes. TeleGRACE is an extension of the GRACE program and delivers care via a hybrid, telehealth home visit. The TeleGRACE technician operates the audio-visual equipment in the patient’s home while the clinical dyad (GRACE nurse practitioner and social worker) conducts the assessment. The specific aim of this study was to evaluate patient acceptability of TeleGRACE. We conducted a mixed methods study which included Likert-scale ratings and open-ended interviews. Participants used a 5-point scale to indicate agreement (5) to disagreement (1) regarding the acceptability of program elements ratings including ease with technician and virtual dyads; access; and clinical telepresence. The sample included 12 Veterans (mean [M] age, 78.7 years; standard deviation [SD] 7.5) who completed both an initial and follow-up TeleGRACE visit. Veterans reported high agreement of TeleGRACE acceptability (M=4.9, SD=0.3). They agreed: TeleGRACE hybrid visits helped them get care that they could not access otherwise (M=4.7, SD=0.65), they were as well taken care of by TeleGRACE virtual clinicians as those met at in-person visits (M=4.8, SD=0.4), they could hear (M=4.8, SD=0.6) and see (M=5.0, SD=0) the clinical dyads through the video visits, and they were able to ask direct questions of the TeleGRACE clinical staff (M=5.0, SD=0). These results indicated that TeleGRACE’s key elements of a hybrid telehealth home visit were acceptable to older, community-dwelling Veterans.

Hitting the bullseye: Accurately measuring willingness to pay for innovations with open and closed direct questions

Knowledge of a customer’s willingness to pay (WTP) at early stages of product development is key to the success of innovations. However, since innovative products do not exist yet, only the hypothetical WTP can be surveyed, inducing a measurement bias. Unfortunately, little is known about the factors that induce this bias and how it differs depending on the method utilized in measuring WTP. We address this gap by focusing on direct methods to survey hypothetical WTP. Based on anchoring theory and the corresponding psychological mechanisms for open questions as well as closed questions, we conducted two experiments, each comprised of a survey and a field study. The experiments differ regarding the product category and the product’s degree of innovativeness. Our results show that open questions are less accurate in estimating real WTP than closed questions. Further, our research offers insights into moderating factors that influence the efficacy of open and closed questions. For example, for customers with a very high product category knowledge, open questions are applicable, while closed questions result in higher accuracy when accounting for the customers’ cognitive abilities.

Generative AI for corpus approaches to discourse studies: A critical evaluation of ChatGPT

This paper explores the potential of generative artificial intelligence technology, specifically ChatGPT, for advancing corpus approaches to discourse studies. The contribution of artificial intelligence technologies to linguistics research has been transformational, both in the contexts of corpus linguistics and discourse analysis. However, shortcomings in the efficacy of such technologies for conducting automated qualitative analysis have limited their utility for corpus approaches to discourse studies. Acknowledging that new technologies in data analysis can replace and supplement existing approaches, and in view of the potential affordances of ChatGPT for automated qualitative analysis, this paper presents three replication case studies designed to investigate the applicability of ChatGPT for supporting automated qualitative analysis within studies using corpus approaches to discourse analysis.The findings indicate that, generally, ChatGPT performs reasonably well when semantically categorising keywords; however, as the categorisation is based on decontextualised keywords, the categories can appear quite generic, limiting the value of such an approach for analysing corpora representing specialised genres and/or contexts. For concordance analysis, ChatGPT performs poorly, as the results include false inferences about the concordance lines and, at times, modifications of the input data. Finally, for function-to-form analysis, ChatGPT also performs poorly, as it fails to identify and analyse direct and indirect questions. Overall, the results raise questions about the affordances of ChatGPT for supporting automated qualitative analysis within corpus approaches to discourse studies, signalling issues of repeatability and replicability, ethical challenges surrounding data integrity, and the challenges associated with using non-deterministic technology for empirical linguistic research.

THE ROLE OF PROSODY IN THE IMPLEMENTATION OF THE STRATEGY OF DIRECT QUESTIONING IN THE DETECTIVE’S SPEECH IN FILM DISCOURSE

The article reports on the results of experimental phonetic research aimed at identifying the prosodic characteristics of utterances manifesting the strategy of direct questioning. To unveil the prosody of direct questioning, utterances used by a police detective and an amateur detective in detective film discourse have been analysed. It has been established that tone frequency, or melodic component of prosody, is helpful in differentiating of the communicative tactics, since it has turned out to be the most varied component according to the results of auditory analysis. The results of the instrumental analysis of the police detective’s speech and the amateur detective’s speech have shown that the widest frequency range marks the communicative tactic of clarification in the police detective’s speech, and the communicative tactic of a demand to speak to the point / interruption in the amateur detective’s speech. The narrowest frequency range is characteristic of the communicative tactic of a direct questioning in the police detective’s speech and the tactic of clarification in the amateur detective’s speech. On the whole, the frequency range of the utterances manifesting communicative tactics in the amateur detective’s speech has turned out to be wider compared to those in the police detective’s speech. The analysis of the localization of the frequency maxima in different parts of sense-groups uttered by both detectives has shown that the localization fluctuations of the frequency maxima are insignificant and denote expressive coloring of the most important lexemes in the speech of both detectives.

Peningkatan Pemahaman Peserta Didik SMA IT Harapan Bunda Semarang Mengenai Merek Usaha

The budding entrepreneurship that many students are starting to do often does not have the right business brand. In fact, brands are the spirit of the business world so that it runs smoothly, especially for goods and/or services. One of the first things that novice entrepreneurs must do when starting their business is to design a brand that is appropriate and reflects the spirit of their business. Designing a business brand by combining the strongest characteristics of the business and making it attractive to target consumers is an invaluable added value. Therefore, it is necessary to increase legal understanding for prospective entrepreneurs when starting their business, especially in the field of branding. The goal to be achieved is: to provide an understanding of the importance of business branding. This service is carried out using direct lecture and question and answer methods, and evaluation is carried out by comparing the results of distributing pre-test and post-test questionnaires to increase student understanding.

The Use and Productivity of Visual Aids as Retrieval Support in Police Interviews of Preschool-Aged Victims of Abuse

Professional use of external retrieval cues, such as various types of visual aids, has been utilized in investigative interviews of children for decades based on the assumption that aids can facilitate children’s recollection of abusive incidents. Although analog studies and surveys have provided insight into various aspects of visual aid utilization, there is a scarcity of field studies that addresses the use of visual aids in large samples of authentic investigative interviews of preschool-aged children. In the present study, the use and productivity of visual aids were examined in 140 investigative interviews of 3- to 6-year-old children, all of whom disclosed abuse in cases that progressed to prosecution. The exploratory analyses focused on the overall use of visual aids, the types of questions posed along with visual aids when the interviewer directly asks questions regarding the investigated incident(s), and the extent to which the children provided forensically relevant information in response to questions used along with visual aids. It was found that visual aids were utilized to elicit information regarding the investigated incident(s) in 92% (n = 129) of the interviews, with emotion cards and drawing materials being the most common aids used. The highest proportion of questions asked alongside visual aids were directive (41.6%) and option-posing (37.3%) questions, followed by suggestive questions (17.9%), and a rather low proportion of open-ended invitations (3.2%). In addition to visual aids, open-ended invitations elicited the most forensically relevant information from the interviewees. The need for standardized guidelines and specialized training for the use of visual aids in investigative interviews of young children is discussed.

Comparison of three chatbots as an assistant for problem-solving in clinical laboratory.

Data generation in clinical settings is ongoing and perpetually increasing. Artificial intelligence (AI) software may help detect data-related errors or facilitate process management. The aim of the present study was to test the extent to which the frequently encountered pre-analytical, analytical, and postanalytical errors in clinical laboratories, and likely clinical diagnoses can be detected through the use of a chatbot. A total of 20 case scenarios, 20 multiple-choice, and 20 direct questions related to errors observed in pre-analytical, analytical, and postanalytical processes were developed in English. Difficulty assessment was performed for the 60 questions. Responses by 4 chatbots to the questions were scored in a blinded manner by 3 independent laboratory experts for accuracy, usefulness, and completeness. According to Chi-squared test, accuracy score of ChatGPT-3.5 (54.4 %) was significantly lower than CopyAI (86.7 %) (p=0.0269) and ChatGPT v4.0. (88.9 %) (p=0.0168), respectively in cases. In direct questions, there was no significant difference between ChatGPT-3.5 (67.8 %) and WriteSonic (69.4 %), ChatGPT v4.0. (78.9 %) and CopyAI (73.9 %) (p=0.914, p=0.433 and p=0.675, respectively) accuracy scores. CopyAI (90.6 %) presented significantly better performance compared to ChatGPT-3.5 (62.2 %) (p=0.036) in multiple choice questions. These applications presented considerable performance to find out the cases and reply to questions. In the future, the use of AI applications is likely to increase in clinical settings if trained and validated by technical and medical experts within a structural framework.

Response Aggregation to Obtain Truthful Answers to Sensitive Questions: Estimating the Prevalence of Illegal Purchases of Prescription Drugs

This research proposes a simple, new technique to obtain truthful answers to sensitive, categorical questions. The paired response technique (PRT) asks participants to merely report the sum of the answers to two paired questions, one baseline and one sensitive, with the answers to each question known only to the participants. The technique then statistically infers the prevalence of the sensitive characteristic and its potential drivers from the association of the baseline question with other questions in the survey. Monte Carlo simulations demonstrate the performance of the PRT under varying conditions. A representative survey (n = 4,649) in the Netherlands about legal and illegal purchases of prescription drugs to enhance sexual performance reveals that 17.4% of the target population has purchased medication to enhance sexual performance at least once. In contrast, in a control group surveyed with direct questioning, only 5.1% admit having done so. The great majority of these individuals opt to purchase illegally. Two further empirical applications, respectively, in the United States and the United Kingdom, show that the PRT reduces cognitive and affective costs of survey participation compared with a state-of-the-art randomized response technique for categorical questions.

Outcome and Indication of Caesarean Section amongst Pregnant Women Experiencing Premature Rupture of Membranes

Premature rupture of membranes (PROM) is characterized by the spontaneous rupture of chorioamniotic membranes more than one hour before the onset of labor. This condition typically arises spontaneously in most cases, affecting a significant portion of pregnancies. Notably, PROM can also occur in full-term pregnancies. This cross-sectional follow-up study was conducted among pregnant women had premature rupture of membranes and experiencing Caesarean Section (CS) in the department of Obstetrics and Gynaecology of Dhaka National Medical College Hospital (DNMCH), Dhaka, Bangladesh during the period of March to August 2011. The main aim of the study was to find out the indication and outcome of pregnant women with PROM and completed CS. A total of 90 data were collected purposively from all pregnant women more than 28 weeks of gestational age with PROM admitted in the Department of Obstetrics and Gynaecology, DNMCH, Dhaka for labour and underwent CS during study period. The data were collected using a semi-structured data sheet through direct questioning of the patients and physical examinations. Daily follow-ups were conducted until the patients were discharged, and data were also obtained from the clinical records of the patients. PROM patients encompassed all age groups, with ages ranging from 18 to 38 years. The overall educational level of the participants was low, with less than two-third (61.1%) belonging to the low socio-economic status. The average gestational age was 36.65 weeks, with 53.3% being primigravida, 45.6% being multigravida and grand multipara was 1 (1.11%). Only two had multiple pregnancies, and 11 respondents had experienced per vaginal bleeding. During previous gestations, 20 had a history of Caesarean section, 12 had experienced abortion, and 2 had previous cases of PROM. Nutritional deficits were found in 36.7% of patients, Pregnancy Induced Hypertension (PIH) in 35.6%, infections in 12.2%, and chronic hypertension in 5.6%. Four foetuses were in breech presentations, one had a single compound presentation, and two had a transverse or oblique lie. All the women were experiencing gushing of fluid per vagina, with one-fifth (20.0%) having meconium-stained and 12.2% blood-stained vaginal discharge. Attempts to prolong pregnancy were not very successful, with the longest duration being 75 hours. Caesarean sections had to be performed in all cases, with 34.4% within 24 hours and 41.2% within the next 24 hours. Elective caesarean sections following PROM were 28.9%. Indications for emergency caesarean section included a previous history of Caesarean section in 19 cases, foetal distress was found in 18 cases, failed induction in 7 cases, chorioamnionitis in 6 cases, foetal malpresentation was in 5 cases, and other reasons in 9 cases. More than one-third (35.56%) respondents had morbid condition to complicate the postpartum period. Among the complications, 21.11% suffered from wound infection; followed by puerperal sepsis 8.89% and postpartum haemorrhage 5.56%. At termination, all 92 foetuses were alive, but 6 babies had an Apgar score <7 at 5 minutes after delivery, 30.4% of babies had low birth weight and 73.9% were in good condition, whereas 26.1% were admitted in neonatal ward, and out of the admitted 7 died with neonatal sepsis being the primary cause of death. A better understanding of the diagnosis babies and management of PROM will enable obstetric care providers to optimize perinatal outcomes and minimize neonatal morbidity and mortality. Therefore, this study finds the indication and outcome of caesarean section in pregnant women experiencing PROM. Bangladesh Med J. 2022 May; 51(2): 45-53

Loneliness and cognitive function in older adults: Longitudinal analysis in 15 countries.

This study aims to evaluate the directionality of the association between loneliness and cognitive performance in older adults, accounting for confounding factors. Data were from 55,662 adults aged ≥ 50 years who participated in Waves 5-8 of the Survey of Health, Ageing and Retirement in Europe (SHARE). Loneliness was assessed with the Three-Item Loneliness Scale (TILS) and with a one-item direct question. Cognitive performance was assessed with four measures: verbal fluency, numeracy, immediate recall, and delayed recall. Age, sex, geographical area, educational attainment, partnership status, depressive symptoms, and previous chronic diseases at baseline were used as covariates. We analyzed the associations with three-wave random intercept cross-lagged panel models (RI-CLPM) and conducted age-stratified analysis among those younger versus older than 65 years. Full information maximum likelihood estimators were used to handle missing values in Waves 6-8 in the main analyses. We also conducted additional sensitivity analyses stratified by retirement status (retired vs. not) at baseline. At the within-person level, loneliness and cognitive performance were not associated with each other among those aged 50-64 years in the main time-lagged analysis. Among those aged ≥ 65 years, loneliness was associated with lower cognitive performance in the next wave in all four cognitive domains. In addition, lower verbal fluency predicted greater loneliness in the next waves among this age group. Similar patterns were found independently of retirement status at baseline. These results suggest that loneliness is a psychosocial risk factor for cognitive decline among older adults (≥ 65 years). (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Support for Vladimir Putin in Russia's neighbors: Survey evidence from an endorsement experiment in six post-Soviet countries

The Russian invasion of Ukraine on February 24, 2022 has again drawn attention to the geopolitical aims of President Vladimir Putin in the states of the former Soviet Union, the ‘Near Abroad’. While Putin's actions have been widely condemned in the West, the reaction among the former Soviet states has been more mixed. Using representative national surveys from late 2019 - early 2020, the article reports the results of an endorsement experiment to gage the support that Putin had in six countries of the former Soviet space (Ukraine, Moldova, Kazakhstan, Belarus, Georgia and Armenia). Direct questioning about Putin revealed that half of the 8420 respondents said that they had ‘no trust at all’ though views varied a lot by country. Given the sensitivity around perceptions of Putin, an endorsement experiment elicits more accurate results. Five expectations of who supports Putin are tested in models with socio-demographic controls. Respondents with more close-minded personalities show significantly more support for Vladimir Putin, our key test. People who are skeptical of scientific expertise and those with traditional views (measured by a question about patriarchal dominance in marriages) are also more likely to support Putin. In contrast, support for Putin is not significantly greater by those who subscribe to conspiracy theories, and by those with little interest in politics. Country level results are generally in line with the results of the overall model, but demonstrate some interesting variation. Vladimir Putin overall has higher trust and support in Belarus, Armenia, and Kazakhstan than in Ukraine, Georgia, and Moldova but the respondents in all countries behave in a manner consistent with their personal traits in endorsing or opposing Putin's positions.

Do the Ultrasonographic Measures of Midurethral Sling Location Relate With Surgical Outcomes?

The proper placement of a midurethral sling (MUS) is the key factor for a successful surgical outcome. This study aimed to evaluate the relationship of perineal ultrasonographic measures of the tape location with subjective and objective outcomes after MUS surgery at midterm follow-up of women. The tape percentile (TP; total urethral length/bladder neck tape distance×100) and urethra tape distance (UTD; the shortest distance from the longitudinal smooth muscle complex of the urethra to the midpoint of the tape) were correlated with midterm surgical success. Patient satisfaction measured with the visual analog scale (VAS) was considered as the primary outcome. The presence of stress urinary incontinence on direct questioning, the Urinary Distress Inventory 6 (UDI-6) scores, findings of the cough stress test, free uroflowmetry, postvoid residual volume, and single-cycle voiding ambulatory urodynamic monitoring (AUM) were the other outcomes. Seventy-eight women were evaluated at a mean follow-up of 4.4 ±3.3 years. Women who were highly satisfied (VAS ≥ 8) had a significantly higher TP (64.7% vs 50.8%, P < 0.001) and lower UTD (3.6 vs 4.5 mm, P = 0.018). Irritative, stress, and obstructive scores at UDI-6 increased as the tape was located closer to the bladder neck (P < 0.001, P < 0.001 and P = 0.044, respectively), and stress symptoms decreased with a tape closer to the urethra (P < 0.001). Women with detrusor overactivity at AUM were found to have a lower TP (P < 0.001). The perineal ultrasonographic evaluation of tape location with UTD and TP seems to be well correlated with the women's midterm MUS surgical outcomes.

Exploring the Potential of ChatGPT in Obstetrics and Gynecology of Undergraduate Medical Curriculum.

ChatGPT, the new bustle in the field of technology, is attracting millions of users worldwide with its impressive skills to perform multiple tasks in a way that mimics human conversation. We conducted this study at two levels with direct and case-based questions from Obstetrics and gynecology to assess the performance of ChatGPT in the medical field. Our results suggest that ChatGPT has a good comprehension of the subject. However, ChatGPT should be trained to include recent updates and improvements in terms of generating error-free and upgraded responses.

Peranan Sistem Absensi dalam Meningkatkan Disiplin Kerja pada Pegawai Fraksi DPRD Provinsi Sumatera Utara

The aim of this research is to improve discipline, especially in terms of attendance given to employees at the Gerindra Faction Office in North Sumatra. Using descriptive qualitative research. The data used comes from interviews with direct questions and answers to the parties involved in the research. The research data will determine the type of information system needed. Based on the research results, it is hoped that the presence of an attendance system will help employees improve work discipline and arrive at work on time, complete work more quickly and reduce the occurrence of social jealousy between fellow employees. One way to improve discipline in the workplace is to provide sanctions and warnings to employees who break the rules, which in turn makes employees more disciplined and better able to avoid subsequent violations. Thus, increasing monitoring of employee actions will lead to increased discipline and overall levels of productivity in the workplace.

An Ayurvedic Intervention for Subconjunctival Hemorrhage (SCH) Resulting in Early Alleviation of Disease — A Case Report

Introduction: Subconjunctival Hemorrhage (SCH) is a common condition of the eye that has distinct characteristic features, such as the acute appearance of a sharply circumscribed redness of bleeding underneath the conjunctiva in the absence of discharge, and inflammation in the affected areas, which is painless. We are now disclosing a case of subconjunctival bleeding caused by local minor trauma and eye rubbing. This case was unique as the healing time, which was usually 1 to 2 weeks, was reduced to 5 days after the intervention of ayurvedic formulations. Case Presentation: A 60-year-old man who had redness in his left eye for one day came to the OPD setting. Redness and inflammation were present, as shown by direct clinical questioning. Later, a clinical examination confirmed both symptoms. A subconjunctival hemorrhage was confirmed by the way the eye appeared. Conclusion: Subconjunctival hemorrhage may exhibit signs of other conditions that pose a risk to the eyes. To make a distinction between those causes and localized subconjunctival hemorrhage, a clinical assessment was necessary.

Is football coming out? Anti-gay attitudes, social desirability, and pluralistic ignorance in amateur and professional football

Past work consistently points to improved attitudes towards gay athletes and growing support for homosexuality, yet reports of a homophobic climate in amateur and professional football persist. Here, we explore two potential explanations for the prevalence of homophobia in football despite low levels of anti-gay attitudes: social desirability and pluralistic ignorance. We conduct an online survey among a football-affine and socio-demographically diverse sample in the UK. We find that anti-gay attitudes are rare. Importantly, estimates from a list experiment do not differ from the prevalence measured by direct questions, providing no evidence of social desirability. By contrast, second-order beliefs about anti-gay attitudes substantially and consistently exceed attitudes, pointing towards pluralistic ignorance as the most likely explanation. We conclude by emphasizing the need for transparent communication to reduce pluralistic ignorance and correct misperceptions among players, officials and supporters.

Exploring the Possible Use of AI Chatbots in Public Health Education: Feasibility Study.

Artificial intelligence (AI) is a rapidly developing field with the potential to transform various aspects of health care and public health, including medical training. During the "Hygiene and Public Health" course for fifth-year medical students, a practical training session was conducted on vaccination using AI chatbots as an educational supportive tool. Before receiving specific training on vaccination, the students were given a web-based test extracted from the Italian National Medical Residency Test. After completing the test, a critical correction of each question was performed assisted by AI chatbots. The main aim of this study was to identify whether AI chatbots can be considered educational support tools for training in public health. The secondary objective was to assess the performance of different AI chatbots on complex multiple-choice medical questions in the Italian language. A test composed of 15 multiple-choice questions on vaccination was extracted from the Italian National Medical Residency Test using targeted keywords and administered to medical students via Google Forms and to different AI chatbot models (Bing Chat, ChatGPT, Chatsonic, Google Bard, and YouChat). The correction of the test was conducted in the classroom, focusing on the critical evaluation of the explanations provided by the chatbot. A Mann-Whitney U test was conducted to compare the performances of medical students and AI chatbots. Student feedback was collected anonymously at the end of the training experience. In total, 36 medical students and 5 AI chatbot models completed the test. The students achieved an average score of 8.22 (SD 2.65) out of 15, while the AI chatbots scored an average of 12.22 (SD 2.77). The results indicated a statistically significant difference in performance between the 2 groups (U=49.5, P<.001), with a large effect size (r=0.69). When divided by question type (direct, scenario-based, and negative), significant differences were observed in direct (P<.001) and scenario-based (P<.001) questions, but not in negative questions (P=.48). The students reported a high level of satisfaction (7.9/10) with the educational experience, expressing a strong desire to repeat the experience (7.6/10). This study demonstrated the efficacy of AI chatbots in answering complex medical questions related to vaccination and providing valuable educational support. Their performance significantly surpassed that of medical students in direct and scenario-based questions. The responsible and critical use of AI chatbots can enhance medical education, making it an essential aspect to integrate into the educational system.

Prevalence of subclinical pulmonary tuberculosis and its association with HIV in household contacts of index tuberculosis patients in two South African provinces: a secondary, cross-sectional analysis of a cluster-randomised trial

BackgroundPeople with subclinical tuberculosis (TB) have microbiological evidence of disease caused by Mycobacterium tuberculosis, but either do not have or do not report TB symptoms. The relationship between human immunodeficiency virus (HIV) and subclinical TB is not yet well understood. We estimated the prevalence of subclinical pulmonary TB in household contacts of index TB patients in two South African provinces, and how this differed by HIV status.MethodsThis was a cross-sectional, secondary analysis of baseline data from the intervention arm of a household cluster randomised trial. Prevalence of subclinical TB was measured as the number of household contacts aged ≥ 5 years who had positive sputum TB microscopy, culture or nucleic acid amplification test (Xpert MTB/Rif or Xpert Ultra) results on a single sputum specimen and who did not report current cough, fever, weight loss or night sweats on direct questioning. Regression analysis was used to calculate odds ratios (OR) and 95% confidence intervals (CI) for the association between HIV status and subclinical TB; adjusting for province, sex and age in household contacts; and HIV status in index patients.ResultsAmongst household contacts, microbiologically confirmed prevalent subclinical TB was over twice as common as symptomatic TB disease (48/2077, 2.3%, 95% CI 1.7–3.1% compared to 20/2077, 1.0%, 95% CI 0.6–1.5%). Subclinical TB prevalence was higher in people living with HIV (15/377, 4.0%, 95% CI 2.2–6.5%) compared to those who were HIV-negative (33/1696, 1.9%, 95% CI 1.3–2.7%; p = 0.018). In regression analysis, living with HIV (377/2077, 18.2%) was associated with a two-fold increase in prevalent subclinical TB with 95% confidence intervals consistent with no association through to a four-fold increase (adjusted OR 2.00, 95% CI 0.99–4.01, p = 0.052). Living with HIV was associated with a five-fold increase in prevalent symptomatic TB (adjusted OR 5.05, 95% CI 2.22–11.59, p < 0.001).ConclusionsMost (70.6%) pulmonary TB diagnosed in household contacts in this setting was subclinical. Living with HIV was likely associated with prevalent subclinical TB and was associated with prevalent symptomatic TB. Universal sputum testing with sensitive assays improves early TB diagnosis in subclinical household contacts.