Prior Versions Research Articles

ChatGPT Solving Complex Kidney Transplant Cases: A Comparative Study With Human Respondents.

ChatGPT has shown the ability to answer clinical questions in general medicine but may be constrained by the specialized nature of kidney transplantation. Thus, it is important to explore how ChatGPT can be used in kidney transplantation and how its knowledge compares to human respondents. We prompted ChatGPT versions 3.5, 4, and 4 Visual (4V) with 12 multiple-choice questions related to six kidney transplant cases from 2013 to 2015 American Society of Nephrology (ASN) fellowship program quizzes. We compared the performance of ChatGPT with US nephrology fellowship program directors, nephrology fellows, and the audience of the ASN's annual Kidney Week meeting. Overall, ChatGPT 4V correctly answered 10 out of 12 questions, showing a performance level comparable to nephrology fellows (group majority correctly answered 9 of 12 questions) and training program directors (11 of 12). This surpassed ChatGPT 4 (7 of 12 correct) and 3.5 (5 of 12). All three ChatGPT versions failed to correctly answer questions where the consensus among human respondents was low. Each iterative version of ChatGPT performed better than the prior version, with version 4V achieving performance on par with nephrology fellows and training program directors. While it shows promise in understanding and answering kidney transplantation questions, ChatGPT should be seen as a complementary tool to human expertise rather than a replacement.

Clinical guideline highlight for the hospitalist: Diagnosis and management of acute bacterial arthritis in children.

Clinical Practice Guideline by the Pediatric Infectious Diseases Society (PIDS) and the Infectious Diseases Society of America (IDSA): 2023 Guideline on Diagnosis and Management of Acute Bacterial Arthritis RELEASE DATE: January 1, 2024 PRIOR VERSION(S): n/a DEVELOPER: Pediatric Infectious Diseases Society (PIDS), Infectious Diseases Society of America (IDSA) FUNDING SOURCE: PIDS and IDSA TARGET POPULATION: Children with suspected or confirmed acute bacterial arthritis.

Heartmate 3 Left Ventricular Assist Device Bend Relief Disconnection Causing Laceration of the Outflow Graft.

As technology in mechanical circulatory support continues to advance, so does the utilization of durable left ventricular assist devices (LVADs). We present the first reported case of HeartMate 3 (HM3) LVAD bend relief disconnection causing laceration of the outflow graft. Our patient is a 34 year old male with end-stage heart failure status post-HM3 implantation with recent debridement of a driveline infection who presented with weakness and sanguineous drainage 5 days after an episode of heavy lifting associated with a palpable substernal pop. During the initial evaluation, he experienced sudden massive decompression of a left chest hematoma through a thoracotomy incision with exsanguinating hemorrhage and an abrupt drop in LVAD flow. An emergent anterolateral thoracotomy was performed where it was discovered that the bend relief was disconnected and had lacerated the outflow graft. The graft was repaired and the ring was removed using a diamond blade rotary saw. He was discharged home and made a full recovery. Mechanical device malfunction has been documented in several prior versions of durable LVADS. Although there have been reported cases in the Heartmate 2, this is the first reported case of a HM3 bend relief disconnection and resultant laceration of the outflow graft.

Performance of ChatGPT-3.5 and ChatGPT-4 on the European Board of Urology (EBU) exams: a comparative analysis.

In the transformative era of artificial intelligence, its integration into various spheres, especially healthcare, has been promising. The objective of this study was to analyze the performance of ChatGPT, as open-source Large Language Model (LLM), in its different versions on the recent European Board of Urology (EBU) in-service assessment questions. We asked multiple choice questions of the official EBU test books to ChatGPT-3.5 and ChatGPT-4 for the following exams: exam 1 (2017-2018), exam 2 (2019-2020) and exam 3 (2021-2022). Exams were passed with ≥60% correct answers. ChatGPT-4 provided significantly more correct answers in all exams compared to the prior version 3.5 (exam 1: ChatGPT-3.5 64.3% vs. ChatGPT-4 81.6%; exam 2: 64.5% vs. 80.5%; exam 3: 56% vs. 77%, p < 0.001, respectively). Test exam 3 was the only exam ChatGPT-3.5 did not pass. Within the different subtopics, there were no significant differences of provided correct answers by ChatGPT-3.5. Concerning ChatGPT-4, the percentage in test exam 3 was significantly decreased in the subtopics Incontinence (exam 1: 81.6% vs. exam 3: 53.6%; p = 0.026) and Transplantation (exam 1: 77.8% vs. exam 3: 0%; p = 0.020). Our findings indicate that ChatGPT, especially ChatGPT-4, has the general ability to answer complex medical questions and might pass FEBU exams. Nevertheless, there is still the indispensable need for human validation of LLM answers, especially concerning health care issues.

Clinical guideline highlights for the hospitalist: International consensus criteria for pediatric sepsis and septic shock.

International Consensus Criteria for Pediatric Sepsis and Septic Shock RELEASE DATE: January 21, 2024 PRIOR VERSION(S): International Pediatric Sepsis Consensus Conference: Definitions for Sepsis and Organ Dysfunction in Pediatrics (2005) DEVELOPER: Society of Critical Care Medicine FUNDING SOURCE: Society of Critical Care Medicine (grant R01HD105939 from the National Institute of Child Health and Human Development) TARGET POPULATION: Children with sepsis and septic shock.

Words Can Hurt: A Taxonomy of Verbally Pressured Sexual Exploitation in the SES-V

ABSTRACT This article describes the development of the Verbally Pressured Sexual Exploitation module of the Sexual Experiences Survey (SES)-Victimization (introduced by Koss et al., 2024). This module assesses the use of verbal or nonphysical, paraverbal pressure to obtain sexual acts without freely given permission. An interdisciplinary team of seven sexual exploitation researchers collaborated to create this module, with consultation from the full 15 member SES-V revision collaboration team. In this paper, we describe our process for developing this module. We briefly review empirical literature and theoretical frameworks (e.g., rape scripts, normative sexual scripts, intersectionality, and sex-positivity) that informed this work. Summary tables compare the SES-V items to verbal pressure items in prior versions of the SES and to other existing measures of violence. The comprehensive taxonomy developed herein includes six domains of Verbally Pressured sexual exploitation across 11 item stems. The components of the taxonomy include: positive verbal pressure, neutral verbal pressure, negative verbal pressure, substance-related pressure, postural violence, and threats to critical resources. The paper concludes with suggestions for future research, with priority on intersectional research that can illuminate the phenomenology and contexts of sexual exploitation against marginalized groups.

Quantifying Criminal Sexual Acts: The Illegal Sexual Exploitation Module of the Revised Sexual Experiences Survey-Victimization (SES-V) Measure

ABSTRACT Since the initial development of the Sexual Experiences Survey (SES) four decades ago, the SES has been designed to measure a range of forms of sexual exploitation, including acts that are coercive but not legally sanctioned as well as acts that legally qualify as crimes. That feature was retained in the revised Sexual Experiences Survey-Victimization (SES-V) measure. This article reviews the theoretical and empirical literature that guided the development of the Illegal Sexual Exploitation module of the SES-V, which measures experiences of nonconsensual exploitation resulting in sexual contact and which is designed to correspond to legal definitions across multiple jurisdictions. This article addresses research and applied contexts in which the distinction between legal and illegal sexual exploitation is important and the challenges and limitations involved in writing survey items that correspond to legal definitions. It also discusses revisions made to the items that make up the Illegal Sexual Exploitation module of the SES-V as compared to the illegal items in prior versions of the SES, including a new operationalization of non-consent and an expansion of the sexual acts and exploitative tactics that are included. Finally, the article discusses directions for future research on the Illegal Sexual Exploitation module of the SES-V.

Clinical guideline highlights for the hospitalist: Management of COVID-19.

2023 IDSA Guidelines on the Treatment and Management of Patients with COVID-19 RELEASE DATE: 06/26/2023 PRIOR VERSION (S): 2021 DEVELOPER: Infectious Diseases Society of America FUNDING SOURCE: Infectious Diseases Society of America TARGET POPULATION: Patients with COVID-19 Infection.

Estimated Effectiveness of the BNT162b2 XBB Vaccine Against COVID-19

Data describing the early additional protection afforded by the recently recommended BNT162b2 XBB vaccine (Pfizer-BioNTech; 2023-2024 formulation) are limited. To estimate the association between receipt of the BNT162b2 XBB vaccine and medically attended COVID-19 outcomes among US adults 18 years and older. This test-negative case-control study was performed to estimate the effectiveness of the BNT162b2 XBB vaccine against COVID-19-associated hospitalization and emergency department (ED) or urgent care (UC) encounters among adults in the Kaiser Permanente Southern California health system between October 10, 2023, and December 10, 2023. Cases were those presenting with an acute respiratory illness and who had a positive SARS-CoV-2 polymerase chain reaction test; controls had an acute respiratory illness but tested negative for SARS-CoV-2. The primary exposure was receipt of the BNT162b2 XBB vaccine compared with not receiving an XBB vaccine of any kind, regardless of prior COVID-19 vaccination or SARS-CoV-2 infection history. Receipt of prior (non-XBB) versions of COVID-19 vaccines was also compared with being unvaccinated to estimate remaining protection from older vaccines. Analyses for cases and controls were conducted separately for COVID-19 hospital admissions and ED/UC encounters. Adjusted odds ratios and 95% CIs were estimated from multivariable logistic regression models that were adjusted for patient demographic and clinical characteristics. Estimation of vaccine effectiveness was calculated as 1 - odds ratio × 100%. Among 2854 cases and 15 345 controls (median [IQR] age, 56 [37-72] years; 10 658 [58.6%] female), adjusted estimation of effectiveness of the BNT162b2 XBB vaccine received a median of 34 days prior vs not having received an XBB vaccine of any kind was 62% (95% CI, 32%-79%) against COVID-19 hospitalization and 58% (95% CI, 48%-67%) for ED/UC visits. Compared with being unvaccinated, those who had received only older versions of COVID-19 vaccines did not show statistically significant reduced risk of COVID-19 outcomes, including hospital admission. Findings of this case-control study reaffirm current recommendations for broad age-based use of annually updated COVID-19 vaccines given that (1) the BNT162b2 XBB vaccine provided statistically significant additional protection against a range of COVID-19 outcomes and (2) older versions of COVID-19 vaccines offered little, if any, long-term protection, including against hospital admission, regardless of the number or type of prior doses received.

Clinical guideline highlights for the hospitalist: GOLD COPD update 2024.

Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease (2024 Report) RELEASE DATE: December 4, 2023 PRIOR VERSIONS: Initial report was released in 2001 with major revisions in 2006, 2011, 2017, and 2023. This 2024 release is an update to the 2023 major revision DEVELOPER: Global Initiative for Chronic Obstructive Lung Disease (GOLD) FUNDING SOURCE: GOLD TARGET POPULATION: Adults with a diagnosis of or at risk for COPD.

Porcospino Flex: A Bio-Inspired Single-Track Robot with a 3D-Printed, Flexible, Compliant Vertebral Column

This paper is focused on the design and development of the Porcospino Flex, a single-track robot inspired by nature and featuring a meta-material structure. In the earlier version of the Porcospino, the main body was composed of a chain of vertebrae and two end sections linked by flexible joints, but the excessive use of materials in 3D printing and the resulting weight of the robot posed challenges, ultimately leading to a decrease in its overall efficiency and performance. The Porcospino Flex is manufactured through the fused deposition modeling process using acrylonitrile butadiene styrene and thermoplastic polyurethane, featuring a singular meta-material structure vertebral column. The adoption of a lattice structure in the main body of the Porcospino Flex leads to a substantial increase in performance, reducing its weight from 4200 g to 3600 g. Furthermore, the decrease in weight leads to a reduction in material usage and waste, making a substantial contribution to the sustainability of the robot. The discussion focuses on the testing results of the Porcospino Flex prototype, highlighting the enhancements observed compared to its prior version.

Electronic medical information systems and timeliness of care in the emergency department: a scoping review

BackgroundAlthough many emergency department (ED) settings have implemented an electronic medical information system (EMIS) and EMIS tools in an effort to improve timeliness of care outcomes, there remains a paucity of scientific information on this topic. We therefore performed a scoping review to describe the range of EMIS interventions and their impacts on time-based outcomes in the ED.MethodsWe searched four bibliographic databases to identify potentially relevant records published after 2014 in English. Two reviewers assessed records for eligibility using a two-step screening process. We then extracted data on the type of EMIS, outcomes assessed, and reported results. Findings were summarized in tabular form and grouped by time-based outcome.ResultsTwenty-five studies met the eligibility criteria, with approximately half being retrospective studies. Interventions varied among studies; they generally included a new or updated EMIS, EMIS tools related to disease diagnosis and/or management, triage tools, or health information exchange platforms. Included studies compared interventions with relevant comparator groups, such as prior versions of an EMIS, absence of an EMIS, pen-and-paper documentation, and/or communication via telephone and fax. The most common outcomes reported were length of stay (n = 17 studies) and time to medication (n = 6 studies), followed by time to order, time to provider, and time from result to disposition. Reported effects of the interventions were generally inconsistent, showing either improvements, delays, or no change in examined outcomes.ConclusionsAdditional research is needed to determine how electronic medical information may be used in the ED to improve timeliness of care. Findings from this review can be used to inform future systematic reviews that evaluate the impact of these systems and tools on specific quality of care measures.

A harmonized public resource of deeply sequenced diverse human genomes.

Underrepresented populations are often excluded from genomic studies owing in part to a lack of resources supporting their analyses. The 1000 Genomes Project (1kGP) and Human Genome Diversity Project (HGDP), which have recently been sequenced to high coverage, are valuable genomic resources because of the global diversity they capture and their open data sharing policies. Here, we harmonized a high-quality set of 4094 whole genomes from 80 populations in the HGDP and 1kGP with data from the Genome Aggregation Database (gnomAD) and identified over 153 million high-quality SNVs, indels, and SVs. We performed a detailed ancestry analysis of this cohort, characterizing population structure and patterns of admixture across populations, analyzing site frequency spectra, and measuring variant counts at global and subcontinental levels. We also show substantial added value from this data set compared with the prior versions of the component resources, typically combined via liftOver and variant intersection; for example, we catalog millions of new genetic variants, mostly rare, compared with previous releases. In addition to unrestricted individual-level public release, we provide detailed tutorials for conducting many of the most common quality-control steps and analyses with these data in a scalable cloud-computing environment and publicly release this new phased joint callset for use as a haplotype resource in phasing and imputation pipelines. This jointly called reference panel will serve as a key resource to support research of diverse ancestry populations.

Hidden numbers, hidden people: Family violence among South Asian Australians

International research suggests that migrants face additional challenges that may heighten their risk of experiencing family violence (FV). South Asians are one of Australia’s fastest growing immigrant populations—yet relatively little is known about their experiences of FV. This study sought to address this research gap by ascertaining what could be gleaned about FV experiences of Australian South Asians the Australian Bureau of Statistic’s 2016 Personal Safety Survey (PSS). While prior versions of the PSS have been deemed non-representative of minority cultural groups, it remains the largest FV victimisation dataset in Australia, and undoubtedly would include information about South Asian Australians. Specifically this study examined the lifetime prevalence and 10-year incidence of most recent FV among South Asian-born (SAB) immigrants and compared these figures to Australian-born (AB) individuals. SAB Australians included in the PSS reported lower lifetime prevalence of intimate partner violence (IPV) and a lower 10-year incidence of at least one type of FV (IPV and/or non-partner FV) than AB Australians. The sampling approach of the PSS was shown to have substantial methodological limitations that reduced the utility of these findings. Specifically, the sampling of South Asian immigrants in Australia was not demographically representative nor was the sample size sufficient for meaningful analysis. The implications of these limitations and recommendations to address them in future population-level FV surveys are explored.

Globe-LFMC 2.0, an enhanced and updated dataset for live fuel moisture content research.

Globe-LFMC 2.0, an updated version of Globe-LFMC, is a comprehensive dataset of over 280,000 Live Fuel Moisture Content (LFMC) measurements. These measurements were gathered through field campaigns conducted in 15 countries spanning 47 years. In contrast to its prior version, Globe-LFMC 2.0 incorporates over 120,000 additional data entries, introduces more than 800 new sampling sites, and comprises LFMC values obtained from samples collected until the calendar year 2023. Each entry within the dataset provides essential information, including date, geographical coordinates, plant species, functional type, and, where available, topographical details. Moreover, the dataset encompasses insights into the sampling and weighing procedures, as well as information about land cover type and meteorological conditions at the time and location of each sampling event. Globe-LFMC 2.0 can facilitate advanced LFMC research, supporting studies on wildfire behaviour, physiological traits, ecological dynamics, and land surface modelling, whether remote sensing-based or otherwise. This dataset represents a valuable resource for researchers exploring the diverse LFMC aspects, contributing to the broader field of environmental and ecological research.

Clinical guideline highlights for the hospitalist: Evaluation, management, and prevention of cow's milk allergy.

An ESPGHAN position paper on the diagnosis, management and prevention of cow's milk allergy RELEASE DATE: Journal of Pediatric Gastroenterology and Nutrition, July 26, 2023 PRIOR VERSION: 2012 DEVELOPER: ESPGHAN (European Society of Paediatric Gastroenterology, Hepatology and Nutrition), NASPGHAN (North American Society of Pediatric Gastroenterology, Hepatology and Nutrition) FUNDING SOURCE: ESPGHAN TARGET POPULATION: Infants and young children with suspected cow's milk allergy.

Clinical guideline highlights for the hospitalist: Diagnosis and treatment of diabetes-related foot infections.

IWGDF/IDSA Guidelines on the Diagnosis and Treatment of Diabetes-related Foot Infections RELEASE DATE: October 2, 2023 PRIOR VERSION: March 16, 2020 DEVELOPER: IWGDF Editorial Board FUNDING SOURCE: International Working Group on the Diabetic Foot (IWGDF), Infectious Diseases Society of America (IDSA) TARGET POPULATION: Adults with suspected or confirmed diabetes-related foot infections.

Development of a weather robust microphone configuration for sonic boom measurments

This paper discusses ongoing development and testing of ground-based, weather-robust microphone measurement systems in conjunction with preparation for community testing of NASA's X-59 low-boom aircraft. Prior efforts [Anderson et al., Proc. Mtgs. Acoust. 42, 040005 (2022)] resulted in the refinement of a ground-plate setup by investigating varied windscreen and plate diameter and thickness. The most recent goal has been to make the setup more compact and easier to manufacture. This paper discusses the results of additional tests performed on updated designs meant to find the balance between compactness and performance. Anechoic chamber testing was performed to show ground plate and windscreen performance and to compared results against prior versions. Outdoor tests included measurements during different wind conditions and over different ground surfaces to examine low-frequency wind noise reduction and ground impedance effects. Results discussed during the presentation suggest the new design strikes an acceptable compromise between compactness, manufacturing ease and robustness, and performance. [Work supported by NASA Langley Research Center through Analytical Mechanics Associates]

Integral Representations over Finite Limits for Quantum Amplitudes

We extend previous research to derive three additional M-1-dimensional integral representations over the interval [0,1]. The prior version covered the interval [0,∞]. This extension applies to products of M Slater orbitals, since they (and wave functions derived from them) appear in quantum transition amplitudes. It enables the magnitudes of coordinate vector differences (square roots of polynomials) |x1−x2|=x12−2x1x2cosθ+x22 to be shifted from disjoint products of functions into a single quadratic form, allowing for the completion of its square. The M-1-dimensional integral representations of M Slater orbitals that both this extension and the prior version introduce provide alternatives to Fourier transforms and are much more compact. The latter introduce a 3M-dimensional momentum integral for M products of Slater orbitals (in M separate denominators), followed in many cases by another set of M-1-dimensional integral representations to combine those denominators into one denominator having a single (momentum) quadratic form. The current and prior methods are also slightly more compact than Gaussian transforms that introduce an M-dimensional integral for products of M Slater orbitals while simultaneously moving them into a single (spatial) quadratic form in a common exponential. One may also use addition theorems for extracting the angular variables or even direct integration at times. Each method has its strengths and weaknesses. We found that these M-1-dimensional integral representations over the interval [0,1] are numerically stable, as was the prior version, having integrals running over the interval [0,∞], and one does not need to test for a sufficiently large upper integration limit as one does for the latter approach. For analytical reductions of integrals arising from any of the three, however, there is the possible drawback for large M of there being fewer tabled integrals over [0,1] than over [0,∞]. In particular, the results of both prior and current representations have integration variables residing within square roots asarguments of Macdonald functions. In a number of cases, these can be converted to Meijer G-functions whose arguments have the form (ax2+bx+c)/x, for which a single tabled integral exists for the integrals from running over the interval [0,∞] of the prior paper, and from which other forms can be found using the techniques given therein. This is not so for integral representations over the interval [0,1]. Finally, we introduce a fourth integral representation that is not easily generalizable to large M but may well provide a bridge for finding the requisite integrals for such Meijer G-functions over [0,1].

Performance of ChatGPT as an AI-assisted decision support tool in medicine: a proof-of-concept study for interpreting symptoms and management of common cardiac conditions (AMSTELHEART-2)

Background It is thought that ChatGPT, an advanced language model developed by OpenAI, may in the future serve as an AI-assisted decision support tool in medicine. Objective To evaluate the accuracy of ChatGPT’s recommendations on medical questions related to common cardiac symptoms or conditions. Methods We tested ChatGPT’s ability to address medical questions in two ways. First, we assessed its accuracy in correctly answering cardiovascular trivia questions (n = 50), based on quizzes for medical professionals. Second, we entered 20 clinical case vignettes on the ChatGPT platform and evaluated its accuracy compared to expert opinion and clinical course. Lastly, we compared the latest research version (v3.5; 27 September 2023) with a prior version (v3.5; 30 January 2023) to evaluate improvement over time. Results We found that ChatGPT latest version correctly answered 92% of the trivia questions, with slight variation in accuracy in the domains coronary artery disease (100%), pulmonary and venous thrombotic embolism (100%), atrial fibrillation (90%), heart failure (90%) and cardiovascular risk management (80%). In the 20 case vignettes, ChatGPT’s response matched in 17 (85%) of the cases with the actual advice given. Straightforward patient-to-physician questions were all answered correctly (10/10). In more complex cases, where physicians (general practitioners) asked other physicians (cardiologists) for assistance or decision support, ChatGPT was correct in 70% of cases, and otherwise provided incomplete, inconclusive, or inappropriate recommendations when compared with expert consultation. ChatGPT showed significant improvement over time; as the January version correctly answered 74% (vs 92%) of trivia questions (p = 0.031), and correctly answered a mere 50% of complex cases. Conclusions Our study suggests that ChatGPT has potential as an AI-assisted decision support tool in medicine, particularly for straightforward, low-complex medical questions, but further research is needed to fully evaluate its potential.