Initial Inquiry Research Articles

Can ChatGPT reliably answer the most common patient questions regarding total shoulder arthroplasty?

BackgroundIncreasingly, patients are turning to artificial intelligence (AI) programs such as ChatGPT to answer medical questions either before or after consulting a physician. Although ChatGPT’s popularity implies its potential in improving patient education, concerns exist regarding the validity of the chatbot’s responses. Therefore, the objective of this study was to evaluate the quality and accuracy of ChatGPT’s answers to commonly asked patient questions surrounding total shoulder arthroplasty (TSA). MethodsEleven trusted healthcare websites were searched to compose a list of the 15 most frequently asked patient questions about TSA. Each question was posed to the ChatGPT user interface, with no follow-up questions or opportunity for clarification permitted. Individual response accuracy was graded by three board-certified orthopedic surgeons using an alphabetical grading system (i.e., A-F). Overall grades, descriptive analyses, and commentary were provided for each of the ChatGPT responses. ResultsOverall, ChatGPT received a cumulative grade of B-. The question responses surrounding general/preoperative and postoperative questions received a grade of B- and B-, respectively. ChatGPT’s responses adequately responded to patient questions with sound recommendations. However, the chatbot neglected recent research in its responses, resulting in recommendations that warrant professional clarification. The interface deferred specific questions to orthopedic surgeons in 8/15 questions, suggesting its awareness of its own limitations. Moreover, ChatGPT often went beyond the scope of the question after the first two sentences, and generally made errors when attempting to supplement its own response. ConclusionOverall, this is the first study to our knowledge to utilize AI to answer the most common patient questions surrounding TSA. ChatGPT achieved an overall grade of B-. Ultimately, while AI is an attractive tool for initial patient inquiries, at this time it cannot provide responses to TSA-specific questions that can substitute the knowledge of an orthopedic surgeon.

Examining Occupation Fields of Programs According to Artificial Intelligence: Anadolu University Open Education System Case

Anadolu University's Open Education System (OES) accommodates over one million students and has incorporated an AI-based Virtual Assistant for non-academic support since 2022. While OES offers abundant information about its programs on its website, there is a notable absence of support services providing job recommendations related to students' chosen programs. This gap in student support extends to the post-graduation phase, with the Virtual Assistant lacking a concept for guiding students in finding employment opportunities. Recognizing the need for comprehensive assistance, this study sought to leverage AI capabilities to offer job recommendations by extracting information from the objectives of 63 OES programs. The initial inquiry involved requesting AI-generated job recommendations based on the stated objectives of these programs. Subsequently, the Virtual Assistant was tasked with providing insights into the occupation fields associated with OES programs. Analysis of the AI's responses, along with the classification of occupations according to the International Standards of Classifications of Occupations (ISCO) and the International Standard Classification of Education (ISCED), forms the core of this study. Contrary to trends observed in most European countries, the predominant number of graduates in Türkiye emerges from business and management fields. However, the correlation between graduation rates and subsequent job placements appears suboptimal within the labor force and employment landscape. The study advocates for the integration of AI in offering job recommendations, incorporating graduation and employment rates. This approach enables students to seek guidance on suitable programs aligned with their skills, fostering a more informed decision-making process. The study underscores the potential for higher education institutes to share employment and labor force data.

Toxicity of New Psychoactive Substance (NPS): Threo-4-methylmethylphenidate (4-Mmph) – Prediction of toxicity using in silico methods

This study represents the first application of in silico methods to evaluate the toxicity of 4-methylphenidate (4-Mmph), a new psychoactive substance (NPS). Using advanced in silico toxicology tools, it was feasible to anticipate key aspects of 4-Mmph's toxicological profile, including acute toxicity (LD50), genotoxicity, cardiotoxicity, and possible endocrine disruption. The findings indicate significant acute toxicity with variability among species, a high potential for adverse effects in the gastrointestinal system and lungs, a low genotoxic potential, a significant likelihood of skin irritation, and a notable cardiotoxicity risk associated with hERG channel inhibition. Evaluation of endocrine disruption revealed a low likelihood that 4-Mmph interacts with the estrogen receptor alpha (ER-α), indicating minimal estrogenic activity. These insights, derived from in silico studies, play a crucial role in improving the comprehension of 4-Mmph in forensic and clinical toxicology. These initial toxicological inquiries establish the foundation for future investigations and help formulate risk assessment and management strategies regarding the use and abuse of NPS. This article is part of a larger project funded by the Polish Ministry of Education and Science, titled “Toxicovigilance, Poisoning Prevention, and First Aid in Poisoning with Xenobiotics of Current Clinical Importance in Poland” (Grant Number SKN/SP/570184/2023).

A CRITICAL ANALYSIS OF THE BISHOPS᾽ SIGNATURE SEQUENCE IN THE LETTER OF MOESIA SECUNDA IN ENCYCLIA, AD 457–458

This study investigates the principle guiding the order in which the hierarchs of Moesia Secunda signed the response epistle addressed to Emperor Leo I (r. 457– 474) during the religious investigation known as the Encyclia (AD 457–458). The analysis marks the first detailed examination of this topic since T. Schnitzler's initial inquiry, which suggested that the bishops’ signatures were arranged in descending order of their tenure in the episcopate. The investigation undertaken here confirms the thesis of the German researcher. Furthermore, the correlation of the data from Encyclia with those from the signing lists of the First Council of Ephesus (431) and those from the Notitiae Episcopatuum of the Church of Constantinople led to the conclusion that there was no hierarchy among the ordinary bishoprics of Moesia Secunda at least until AD 536. Until then, when the metropolitan see of Marcianopolis was vacant, the ecclesiastical leadership in the province was assumed by the bishop with the longest tenure in the episcopacy. It is possible that in AD 536, as part of the extensive ecclesiastical reorganization that took place in Moesia Secunda, the status of protothronos (‘πρωτόθρονος,’ the first-ranked ordinary bishopric) may have been introduced in the province. In such a case, the rank was most likely assigned to the see of Novae (now Svishtov, Bulgaria).

To Counsel or Not to Counsel: Physician Attitudes and Experiences with Do-It-Yourself (DIY) Fecal Microbiota Transplant (FMT)

Background In the early 2010s, a phenomenon known as do-it-yourself (DIY) fecal microbiota transplant (FMT) emerged as lay individuals began self-administering FMTs at home. Although prior research indicates that many individuals who perform DIY FMT have sought advice from healthcare providers, to date there has been no investigation of physicians’ experiences with DIY FMT. The objective of this qualitative study was to examine the attitudes of physicians who offer FMT regarding the practice of DIY FMT and to assess how they navigated the ethical challenges of patient requests for DIY FMT. Methods We recruited physicians listed on two patient-created online databases of FMT providers. All physicians who indicated having been approached for advice about DIY FMT were included in the study. Semi-structured interviews with physicians explored their attitudes toward and experiences with DIY FMT. Results Of 18 physicians interviewed, one reported having provided counsel in response to an initial patient inquiry about DIY FMT, 2 indicated they explicitly advised against DIY FMT and refused to provide advice, and 15 fell in a middle category of discouraging DIY FMT and discussing reasons why. Among the physicians in this third category, four reported that they had changed their approach to providing counsel in response to a patient telling them they were going to perform DIY FMT anyway. Conclusions Physicians in our study employed a wide range of strategies for promoting safety in the DIY FMT context, from explicitly advising against the procedure to the provision of guidance aimed at mitigating potential harms. While there has been increasing attention to the practices of DIY medicine, this study underscores the need for greater attention to the ethically complex situations that physicians face when patients request guidance for unapproved at-home treatments.

Path Forward: Materials Data Modernization for ASME Codes and Standards in the Artificial Intelligence Era

Abstract Development of the ASME Materials Properties Database was initiated in the early 2010s to support the ASME Codes and Standards. As information technologies advance at an accelerated pace with the artificial intelligence era on the horizon, the ASME Materials Properties Database must be further modernized from a database to a knowledgebase to ride the wave of digital information revolution and effectively support the ASME Codes and Standards in the new era. This paper is intended to provide an overview of the ASME Materials Properties Database and discuss a roadmap for its future development to facilitate understanding of and participation from different sectors of the Codes and Standards community. It first reviews the basic concepts of data, information, knowledge, database, and database system as well as the pros and cons in different types of data management and then discusses the path forward for a desired evolution of the database into a self-explanatory and machine-readable knowledgebase that is consistent with human cognitive processes for the Codes and Standards development and, furthermore, provides resources for data processing and analysis to reach an eventual goal of streamlining the Codes and Standards development from the initial inquiry, throughout data submission, analysis, …, to Codes and Standards rule establishment for final publication.

Celebrating the Birthday of AMPA Receptor Nanodomains: Illuminating the Nanoscale Organization of Excitatory Synapses with 10 Nanocandles.

A decade ago, in 2013, and over the course of 4 summer months, three separate observations were reported that each shed light independently on a new molecular organization that fundamentally reshaped our perception of excitatory synaptic transmission (Fukata et al., 2013; MacGillavry et al., 2013; Nair et al., 2013). This discovery unveiled an intricate arrangement of AMPA-type glutamate receptors and their principal scaffolding protein PSD-95, at synapses. This breakthrough was made possible, thanks to advanced super-resolution imaging techniques. It fundamentally changed our understanding of excitatory synaptic architecture and paved the way for a brand-new area of research. In this Progressions article, the primary investigators of the nanoscale organization of synapses have come together to chronicle the tale of their discovery. We recount the initial inquiry that prompted our research, the preceding studies that inspired our work, the technical obstacles that were encountered, and the breakthroughs that were made in the subsequent decade in the realm of nanoscale synaptic transmission. We review the new discoveries made possible by the democratization of super-resolution imaging techniques in the field of excitatory synaptic physiology and architecture, first by the extension to other glutamate receptors and to presynaptic proteins and then by the notion of trans-synaptic organization. After describing the organizational modifications occurring in various pathologies, we discuss briefly the latest technical developments made possible by super-resolution imaging and emerging concepts in synaptic physiology.

Metaheuristic optimized electrocardiography time-series anomaly classification with recurrent and long-short term neural networks

This study explores the realm of time series forecasting, focusing on the utilization of Recurrent Neural Networks (RNN) to detect abnormal cardiovascular rhythms in Electrocardiogram (ECG) signals. The principal objective is to optimize RNN performance by finely tuning hyperparameters, a complex task with known NP-hard complexity. To address this challenge, the study employs metaheuristic algorithms, specialized problem-solving techniques crafted for navigating intricate and non-deterministic optimization landscapes. Additionally, a refined algorithm is introduced to overcome limitations inherent in the original approach. This modified algorithm exhibits significant improvements, surpassing its predecessor in identifying anomalous cardiovascular rhythms within ECG signals. The most successful optimized model achieves an accuracy of 99.26%, outperforming models optimized by other contemporary metaheuristics assessed in the study. Further experimentation extends the initial inquiry by exploring the capabilities of Long Short-Term Memory (LSTM) models augmented by attention layers. In this extension, the best models demonstrate an accuracy of 99.83%, surpassing the original RNN models. These findings underscore the crucial importance of refining machine learning models and emphasize the potential for substantial advancements in healthcare through innovative algorithmic approaches.

Rescuing the profession we love: general practice training sector recommendations for improving the attractiveness of general practice training. A qualitative analysis.

To investigate the views of the general practice training sector about responding to recruitment challenges, with the aim of identifying effective initiatives and other solutions. Qualitative study; focus group discussion of recommendations from a medical educator workshop. An initial online appreciative enquiry workshop for medical educators followed by focus group discussions by a broader selection of people involved in general practitioner training (Royal Australian College of General Practitioners fellows, supervisors, practice managers, medical educators, registrars). Key overarching themes and major recommendations for increasing recruitment derived from focus group responses to workshop recommendations, based on qualitative descriptive analysis. The 26 medical educators at the workshop made four major recommendations: increase the number of student and junior doctor clinical placements in general practice; increase exposure of students and junior doctors to general practitioner teachers and educators; improve general practitioner trainee pay and entitlements; and improve the integration of general practice and hospital patient care and professional relationships. Thirty-four semi-structured focus group participants broadly supported the recommendations, provided that supervisors and training practices were adequately compensated for the effects on workloads, income, and patient care. Two overarching themes infused participant responses: "rescuing the profession we love" (reflecting participants' passion for general practice and their sense of threat), and "no idea what general practitioners do" (perceptions of being misunderstood and misrepresented by hospital-based practitioners). Clinicians, educators, and policy makers should work together to increase the number of high quality, adequately supported student and junior doctor placements in general practice, improve intra-professional relationships, and trial new models of general practitioner trainee payment and conditions.

Abstract PO2-06-03: Meta-Analysis of Clinical Characteristics and Outcomes in Breast Cancer Patients with Visceral Crisis

Abstract Background: Recent advancements in novel therapeutics have resulted in improved survival over the last decade for patients with metastatic breast cancer, but there remain subsets of patients who experience disproportionately poor outcomes. Patients with visceral crisis (VC), defined by the 5th ESO ESMO as the presence of visceral metastasis with severe organ compromise and/or rapid progression, are often excluded from clinical trials of novel therapeutics. This is despite patients with VC having poorer clinical outcomes and a lack of guidelines consensus on best therapeutic practices. Thus, we sought to better characterize this patient cohort via a meta-analysis to elucidate clinical characteristics and treatment options. Methods: We searched MEDLINE, Embase, Cochrane, Scopus and other sources, from each database's inception to March 2023. The search strategy was designed and conducted by an experienced librarian with input from the study's principal investigator. Controlled vocabulary supplemented with keywords was used to search for patients with breast cancer in visceral crisis. Outcomes of interest included mortality and progression at different time points. Meta-analysis was conducted using the random-effects model. Results: The studies matching our initial inquiry was 154. After evaluation for patient number, and VC related outcomes, 16 studies (12 abstract only) met initial criteria. After data extraction, 12 studies were excluded due to insufficient outcomes delineated by VC. The treatment period was 01/2008 until 01/2022. The mean age at diagnosis of VC was 53.9 with a total of 6404 patients, 6259 were hormone positive, 41 Her2 positive and 87 triple negative. The type of VC included 212 liver dysfunction, 84 respiratory dysfunction, 40 with bone marrow dysfunction, 4 with SVC syndrome, and 43 with meningeal disease (VC type is not reported in every study). The treatments were varied and included multiple platinum doublets, CDK4/6 with endocrine therapy, platinum with bevacizumab, endocrine monotherapy and Her-2 targeted agents. Unfortunately, the number of patients per treatment group or VC type is not enough for targeted outcome analysis. The proportion of patients who progressed at 1, 6, 12 and 18 months were 0.17, 0.64, 0.95 and 0.91 respectively (2 studies Yang et al and Funasaka et al). Mortality assessed as proportion who expired at 1, 6, 12 and 18 months at 0.07, 0.44, 0.64 and 0.77 respectively (3 studies Yang et al, Funasaka et al and Franzoi et al) and at 24 months 0.89 in 4 studies (Yang et al, Funasaka et al, Dawood et al and Franzoi et al) (Table 1). Conclusions In this systematic review, we clearly demonstrate a lack of clinical trial data available to demonstrate specific outcomes based on chemotherapy, visceral crisis type or targeted treatment. The prognosis, however, is consistently poor with mortality at 64 percent by 12 months. Thus, further studies are needed to guide best treatment strategies that address both the poor clinical outcomes and therapeutic toxicities for patients with VC. Clinical trial groups and regulatory bodies overseeing new drug development for breast cancer should consider specific arms for patients with VC, instead of targeted exclusion from trials, as this strategy has proven effective in expansion of therapeutics for other challenging breast cancer subtypes. Table 1 Table 1: Proportion of progression and mortality. Progression studies include Yang et al 2022, Funasaka et al 2021. Mortality studies at 1, 6 and 12 months Yang et al 2022, Funasaka et al 2021 and Franzoi et al 2021. Mortality studies at 24 months Yang et al 2022, Funasaka et al 2021, Franzoi et al 2021, Dawood et al 2021. Citation Format: Michael Auster, Raed Benkhadra, Sophia Lee, Tamarah Aldawoodi, Larry Prokop, Tarek Nayfeh, Paromita Datta, Kate Lathrop. Meta-Analysis of Clinical Characteristics and Outcomes in Breast Cancer Patients with Visceral Crisis [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-06-03.

Whistleblowing in the travel industry: A research in the context of idealism and affective commitment

Whistleblowing is a topic that rarely garners attention in tourism, particularly within the travel industry. This research, delves into external whistleblowing in relation to idealism and affective organizational commitment. The study aims to examine how affective commitment and idealism influence the attitudes of travel agency employees towards external whistleblowing. Employing a quantitative approach, the study investigated these variables using data from 433 travel agency employees in Turkey. The findings indicate that these employees hold unfavourable opinions regarding external whistleblowing. Affective commitment and idealism are demonstrated to significantly impact attitudes towards external whistleblowing. Moreover, the data suggests that idealism does not moderate the correlation between affective commitment and external whistleblowing. This research represents one of the initial inquiries into whistleblowing within the travel industry. Typically, the effectiveness of organisational behaviours, such as affective commitment and external whistleblowing, may depend on the structural aspects of entrepreneurship, as well as the costs and benefits of such actions, rather than solely on the ethical orientation of individuals. The perception and reporting of unethical practices are heavily influenced by community culture, and Turkish culture, in particular, tends to foster a negative mindset towards reporting unethical behaviour externally.

Development of a supportive care framework for breast cancer survivor's unmet needs: A modified Delphi study.

To establish a supportive care framework for addressing unmet needs among breast cancer survivors, providing practical guidance for healthcare providers to assess and manage these needs, ultimately enhancing the health outcomes and quality of life of breast cancer survivors. We conducted a two-round Delphi survey to gather expert opinions regarding the unmet needs supportive care framework for breast cancer survivors. Initial framework identification and inquiry questionnaire creation was achieved via literature search and expert group discussions, which included 15 experts from nursing practice, clinical medicine, nursing management and nursing education was conducted using a Delphi survey. To establish consensus, a two-round Delphi poll was done, using criteria based on the mean (≥4.0), coefficient of variation (CV < 0.25) and percentage for entire score (≥20%). Experts reached a consensus, leading to six care modules, and 28 care entries: Tumour Detection Support (three care entries), Management of Complications of Antitumor Therapy (seven care entries), Healthy Lifestyle Management (five care entries), Sexual and Fertility Support (four care entries), Psychosocial Support (four care entries) and Resource and Linkage Support (five care entries). To address breast cancer survivors' unmet needs, a supportive framework was developed to actively enhance their health outcomes. However, further refinement and feasibility testing using mobile devices or artificial intelligence are required. This pioneering framework prioritises addressing unmet needs and equips healthcare providers to assess and manage these needs effectively, facilitating the implementation of programs aimed at improving the well-being of breast cancer survivors. This study was guided by a modified guideline for the Conducting and Reporting of Delphi Studies (CREDES) (Palliative Medicine, 31(8), 684, 2017). No Patient or Public Contribution. The Delphi study methodology does not require registration.

The Use of Psychotherapy for Refractory Irritable Bowel Syndrome: A Systematic Review.

Irritable bowel syndrome (IBS) is a common yet debilitating and chronic condition that consists of disturbances in bowel habits and abdominal pain that is frequently relieved with defecation. While the first line of treatment for IBS is pharmacological treatment, this has been shown to fail, leading to the patient being classified as having refractory IBS. The quality of life (QOL) of these patients is greatly hindered; in this case, there are rarely moments of relief. Additional modalities of treatment have been employed in classical cases of IBS, such as psychotherapy, and research has started to evaluate its effectiveness with refractory IBS. Both cognitive behavioral therapy (CBT) and gut-directed hypnotherapy (GDH) are effective in treating classical IBS as they restructure and bring a state of meditation to the patient, allowing them to work through the symptoms. The question is whether it remains successful in refractory cases. This systematic review was conducted with strict adherence to PRISMA guidelines with an initial inquiry resulting in 28,978 publications through PubMed, ScienceDirect, and ProQuest databases. Through automatic and manual screening processes, articles that were peer-reviewed experimental or observation publications done between 2003 and 2023 were included in this study, resulting in 21 publications. Across all studies evaluating CBT, it was consistently found to be successful in improving symptom severity and frequency, QOL, and extracolonic symptoms such as anxiety and depression. When broken down into delivery methods, minimal contact CBT was found to be just as, if not superior, to standard contact. Within this, telephone-delivered CBT was superior to web-delivered CBT. GDH and biofeedback therapy were found to also significantly improve all domains of IBS with no difference between them. Acceptance and commitment therapy were found only to improve associated symptoms. However, there was no significant improvement in their QOL, whereas integrative group therapy found no significant improvement in any domain. Because IBS is so common and crippling to those affected, its crucial to continuously improve QOL through advancement in treatment modalities. Further research should focus more on other modes of therapy as success has been shown in standard therapeutic techniques.

In Dialogue: Initial Steps Toward Inquiry, Meaning-Making, and Democracy

In Dialogue: Initial Steps Toward Inquiry, Meaning-Making, and Democracy

Government Health Expenditure and Policy for Public Health Outcomes: A Systematic Literature Review

INTRODUCTION: The level of good governance, the efficiency of the healthcare system, and socioeconomic vulnerabilities all affect public health outcomes. Despite potential gains in terms of health outcomes, public healthcare investment has been extremely low in low-income countries. By improving the consolidation of healthcare system performance, this study helps the government and policymakers improve the quality of life in developing countries. MATERIALS AND METHODS: This study aims to assess the government health expenditure and policy for public health outcomes. The research is based on a review of empirical studies and reports. The PubMed search engine was used to locate research publications on government health expenditure and policy for public health outcomes. The PubMed Open Database was applied to find the publications using the keywords “health expenditure” and “health policy”. All papers that were published from January 1, 2013, to January 31, 2024, were checked for the study. 121 research papers were discovered during the initial inquiry; five duplicate articles were eliminated, and 84 were irrelevant to the study. Finally, 25 research papers and reports were selected for evaluation with the study titled “ Government Health Expenditure and Policy for Public Health Outcomes: A Systematic Literature Review”. RESULTS: Raising the nation’s social health insurance (SHI) coverage does not guarantee universal health care (UHC) or improved financial security. Extremely few people in poverty have health insurance and attempts to give them coverage through exemptions and waivers have not had the intended effect. To prevent families from being ruined due to family health problems, an innovative insurance plan needs to be created. Supply-side strategies, or health infrastructure, are needed to expand access to high-quality medical treatment. CONCLUSIONS: The quality of life in developing nations is directly improved by the consolidation of healthcare system performance, suggesting that policymakers should step in and offer financial and political help through a variety of policy options. Curative and preventive care are provided by health systems, which can greatly enhance people’s health. Developing a robust health finance system has been a primary objective for numerous countries worldwide, as increased public spending on healthcare leads to better health outcomes and more effective healthcare services. Financial limitations are one of the largest barriers to obtaining high-quality healthcare. A national health insurance program increased public financing for healthcare, and the construction of community-based clinics in rural areas could all contribute to the nation’s transition to universal health care. Policymakers ought to pay greater attention to the quality of care since it significantly affects the amount of money that patients must pay out-of-pocket. Governments must develop new internal financing sources and devise strategies to refocus on health promotion and prevention.

Inquiry ability of students to develop cognitive ability in learning hydrostatic pressure

This research aims to implement questions through problem stimuli regarding hydro static pressure based on inquiry investigations. This research is limited to conducting experiments because the focus of the study is analyzing the cognitive abilities of the questions tested on 106 junior high school students. This study uses a quantitative exploratory method that aims to improve the understanding that students go through for their initial inquiry and perspective abilities during the science learning process. Data collection was carried out using a test instrument in the form of description questions whose inquiry indicators had been developed referring to the National Research Council (NRC) indicators, plus a questionnaire to identify students’ perceptions as a secondary data source. The results showed that all stages of inquiry activities had a low percentage of 50.0%. The involvement of students has yet to be able to ask investigative questions in formulating problems to be a significant start, as well as predicting in hypothesising. So it affects the activities of designing experiments and analysing data. This causes scientific reasoning to be challenging to communicate. In comparison, student interest in science learning is only around 51.2%. This proves that the inquiry process aspects are tied to one another, and the role of students must be maximally fully involved in every stage. Teacher and technology support needs to be harmonised to optimise further research.

Diagnosis and Treatment of a Case of Maxillary Cleft in a Cat Associated with Pulmonary Emphysema

Maxillary cleft in cats often occurs due to high-altitude falls, resulting in trauma and pulmonary emphysema. Clinically, it is characterized by oral and nasal bleeding and is classified into congenital and acquired types, with its etiology being related to husbandry practices. This paper presents a case of maxillary cleft in a cat associated with pulmonary emphysema. After initial symptom observation and inquiry, a definitive diagnosis was made through clinical examination, laboratory tests, and X-ray imaging. Treatment involving medication and surgery was administered, followed by an evaluation of its effectiveness. Given the limited literature on this condition and its increasing incidence, this case contributes to the guidance of diagnosis and treatment for cats with maxillary cleft associated with pneumothorax.

The European Prevention of Alzheimer’s Dementia Programme: Summary outputs post Innovative Medicines Initiative Funding

AbstractBackgroundThe in 2015 initiated European Prevention of Alzheimer’s Dementia (EPAD) programme was funded by the Innovative Medicines Initiative (IMI), a European Union led programme that brought commercial, academic, and third sector organisations together. A key part of the project was the development of the EPAD Longitudinal Cohort Study (LCS) to test existing and develop new disease models regarding the pre‐dementia phases of Alzheimer’s disease (AD). After 2020, the maintenance of the EPAD Dataset and Biorepository was supported from multiple sources, including the Alzheimer’s Association and Gates Ventures. EPAD was the first dataset to be uploaded onto the AD Workbench, directly supporting the development of this key part of the Alzheimer’s Disease Data Initiative (ADDI).MethodEPAD‐LCS data is openly available on the AD workbench, with access being split into 3 domains: Data Only, Biological Samples (CSF, Blood, Saliva, and Urine), and (advanced) MRI data. Access to these data sets is monitored and reported on closely via the AD Workbench. More recently the NTK App developed by Roche Diagnostics has been embedded on the AD Workbench as a free‐to‐use app to ease data analysis from EPAD and other cohorts on the AD Workbench.ResultThe total number of requests for data will be presented grouped by research question domain, geographic location, and academic/commercial split. The outputs from these data requests in terms of academic publications will be presented with a summary of where these findings are pointing towards in terms of new insights in our understanding of preclinical and prodromal AD. Operational aspects will also be presented with regards speed of access from initial enquiry, through application to provision of data and samples.ConclusionThe EPAD‐LCS is a major pan‐European study which has generated vast amounts of data across a comprehensive range of biological, clinical, and epidemiological variables. Access to this data to generate new knowledge is free for anyone and we prioritised rapid access to a data environment that facilitates analysis. Combining the major programmes of EPAD, ADDI and the NTK App has been shown to achieve the core objective of knowledge generation which research participants expect.

The Chance of FinTech to be a New General-Purpose Technology

FinTech has often been spoken about in highly promising terms, deemed to have a profound and potentially revolutionary effect. This has led to speculation and intrigue about whether this innovative form of technology might have the capability to influence an entire economy significantly. More than that, some even contend that it carries the potential to alter societies dramatically through its direct impact on both existing economic frameworks and social structures. Thus, a vital question has risen to the forefront: could FinTech indeed be seen as a general-purpose technology? Following the initial inquiry, a second question emerges, delving deeper into the overall impact of FinTech. The focus is on understanding how it influences things at an aggregate level and as a potential general-purpose technology. How does it affect aggregate economic welfare? The paper conducts an in-depth analysis using two distinctly different definitions and characteristics of general-purpose technologies. By leveraging these definitions, the document provides valuable insights into how FinTech aligns with the attributes of a general-purpose technology, effectively showcasing that it can indeed be typified as such. Despite the growing body of research on FinTech, no study thus far has examined the implications or influence it has on welfare. At an aggregate level, the research findings indicate that FinTech influences supply curves positively. In turn, this results in a noticeable uptick in both consumer and producer surplus, bolstering overall welfare. The examination thus reveals how FinTech is indeed a reckoning force in modern economics, and potentially a game-changer. Thus, its significance as a general-purpose technology and the value it brings to aggregate economic welfare cannot be underestimated.

Insurance Request and Approval Process for Proton Beam Therapy in Patients with Esophageal Cancer

Randomized data suggests proton beam therapy (PBT) reduces the risk and severity of toxicities when compared to IMRT in the neoadjuvant or definitive setting for esophageal cancer. As a critical barrier to access to PBT, we investigate our institutional experience with the prior authorization (PA) process for patients (pts) with esophageal cancer. One hundred and four (104) consecutive pts with esophageal cancer from 2016-2020 at one institution for whom PBT was recommended were analyzed. Data was collected from the customer relations management (CRM) database and electronic health record. Patient characteristics, tumor characteristics, treatment parameters, types of insurance, and clinical outcomes (OS, LF, DF) were recorded. Timepoints of the steps of the PA process included the PA team's initial inquiry, the initial decision, first through third appeals, and outcomes of each appeal (the third of which was regarded as the final decision). Rates of approval and successful appeal were calculated. Logistic and Cox regression models were used to evaluate whether insurance decisions were associated with clinical factors or clinical outcomes. Approval rates by Medicare (n = 68) and private insurance (n = 36) were 100 and 42% on initial request, at a median (range) 0 and 3 (0-15) days from inquiry to determination, respectively. All 21 pts initially denied coverage appealed the decision. Overall, denial was overturned in 48% of pts (median [range] time, 14 [7-36] days from initial inquiry [FIQ]), i.e., PBT was eventually approved for them. The remaining pts proceeded with self-pay or photon therapy. Upon first appeal, 14 pts were denied (median [range] time, 7 [1-26] days FIQ). Upon second appeal, 6 pts were denied (median [range] time, 18 [7-34] days FIQ). Finally, upon third appeal, 2 pts were denied and 1 patient was approved (median [range] time, 2 [20-39] days). Medicare insurance (P < .01) and possessing secondary insurance (P = .02) were found to be associated with increased likelihood of initial approval. Notably, a trend was found between clinical trial enrollment and decreased likelihood of initial approval. Neither initial nor final insurance decisions were found to be associated with OS, LF, or DF. Despite randomized data and policy efforts supporting the use of PBT in esophageal cancer, pts with private payers experience treatment delays and often eventual denial after appeal.