Surgeons have dealt with the negative effects of misinformation from “Dr. Google” since patients started using search engines to seek out medical information. With the advent of natural language ...processing software such as ChatGPT, patients may have a seemingly real conversation with artificial intelligence software. However, ChatGPT provides misinformation in response to medical questions and responds at the reading level of a college freshman, whereas the U.S. National Institute of Health recommends medical information be written at a 6th-grade level. The flaw of ChatGPT is that it recycles information from the Internet. It is “artificially intelligent” because of its ability to mimic natural language, not because of its ability to understand and synthesize content. It fails to understand nuance or critically analyze new inputs. Ultimately, these skills require human intelligence, whereas ChatGPT provides responses that are exactly what you might expect—artificial.
Antibiotics that affect the ribosome Lambert, T
Revue scientifique et technique (International Office of Epizootics),
04/2012, Volume:
31, Issue:
1
Journal Article
Peer reviewed
The ribosome is a major bacterial target for antibiotics. Drugs inhibit ribosome function either by interfering in messenger RNA translation or by blocking the formation of peptide bonds at the ...peptidyl transferase centre. These effects are the consequence of the binding of drugs to the ribosomal subunits. Various mechanisms, including enzymatic detoxification, target alteration (ribosomal rRNAs and ribosomal proteins) and reduced accumulation (impermeability and efflux) are involved in bacterial resistance to protein synthesis inhibitors. The fact that some positions in rRNA participate in the binding of antibiotics belonging to distinct families explains why bacteria have developed mechanisms that can lead to cross-resistance.
The Kardia Band (KB) is a novel technology that enables patients to record a rhythm strip using an Apple Watch (Apple, Cupertino, California). The band is paired with an app providing automated ...detection of atrial fibrillation (AF).
The purpose of this study was to examine whether the KB could accurately differentiate sinus rhythm (SR) from AF compared with physician-interpreted 12-lead electrocardiograms (ECGs) and KB recordings.
Consecutive patients with AF presenting for cardioversion (CV) were enrolled. Patients underwent pre-CV ECG along with a KB recording. If CV was performed, a post-CV ECG was obtained along with a KB recording. The KB interpretations were compared to physician-reviewed ECGs. The KB recordings were reviewed by blinded electrophysiologists and compared to ECG interpretations. Sensitivity, specificity, and K coefficient were measured.
A total of 100 patients were enrolled (age 68 ± 11 years). Eight patients did not undergo CV as they were found to be in SR. There were 169 simultaneous ECG and KB recordings. Fifty-seven were noninterpretable by the KB. Compared with ECG, the KB interpreted AF with 93% sensitivity, 84% specificity, and a K coefficient of 0.77. Physician interpretation of KB recordings demonstrated 99% sensitivity, 83% specificity, and a K coefficient of 0.83. Of the 57 noninterpretable KB recordings, interpreting electrophysiologists diagnosed AF with 100% sensitivity, 80% specificity, and a K coefficient of 0.74. Among 113 cases where KB and physician readings of the same recording were interpretable, agreement was excellent (K coefficient = 0.88).
The KB algorithm for AF detection supported by physician review can accurately differentiate AF from SR. This technology can help screen patients prior to elective CV and avoid unnecessary procedures.
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To evaluate how both annual surgeon and facility volume affect the cost and outcomes of anterior cruciate ligament reconstruction surgery. We also aimed to identify trends in how surgeon caseload ...predicts graft selection.
The 2014 State Ambulatory and Surgical Database from Florida was used. Every case with Current Procedural Terminology code 29888 (“Arthroscopic anterior cruciate ligament reconstruction”) was selected. Surgeon and facility identifiers were used to separate high- and low-volume groups, defined as >25 cases for surgeons and >125 cases for facilities. Univariate analysis was performed for patient demographics and surgical characteristics. Multivariate analysis was performed on significant factors to determine how these variables impact cost and odds of allograft usage, postoperative admission, and meniscal repair.
There were 7905 cases performed between January 1, 2014, and December 31, 2014 after excluding same-year revisions. High-volume surgeons had $6155 lower total charges, were 1.949 times more likely to use an autograft, and had 54.5% lower odds of postoperative admission (all P < .001). They were also 1.196 times more likely to perform a meniscal repair (P = .017). In patients younger than 18, low-volume surgeons were 3.7 times more likely to use an allograft (P < .001). Concomitant multiligamentous procedures were also performed at greater rates in the high-volume group. Postoperative admission added $18,698, and allografts added $9174 (both P < .001).
We found that high-volume surgeons were more likely to perform a meniscal repair and less likely to have their patients admitted postoperatively, which was the second largest cost driver of anterior cruciate ligament reconstruction. They were also significantly less likely to use an allograft, especially in patients younger than the age of 18 years. High-volume surgeons had lower costs despite greater rates of concomitant procedures.
III, retrospective cohort study.
A history of assessment in medical education Schuwirth, Lambert W. T.; van der Vleuten, Cees P. M.
Advances in health sciences education,
12/2020, Volume:
25, Issue:
5
Journal Article
Peer reviewed
Open access
The way quality of assessment has been perceived and assured has changed considerably in the recent 5 decades. Originally, assessment was mainly seen as a measurement problem with the aim to tell ...people apart, the competent from the not competent. Logically, reproducibility or reliability and construct validity were seen as necessary and sufficient for assessment quality and the role of human judgement was minimised. Later, assessment moved back into the authentic workplace with various workplace-based assessment (WBA) methods. Although originally approached from the same measurement framework, WBA and other assessments gradually became assessment processes that included or embraced human judgement but based on good support and assessment expertise. Currently, assessment is treated as a whole system problem in which competence is evaluated from an integrated rather than a reductionist perspective. Current research therefore focuses on how to support and improve human judgement, how to triangulate assessment information meaningfully and how to construct fairness, credibility and defensibility from a systems perspective. But, given the rapid changes in society, education and healthcare, yet another evolution in our thinking about good assessment is likely to lurk around the corner.
Medical Education 2012: 46: 1028–1041
Context Longitudinal integrated clerkships (LICs) have been widely implemented in both rural and urban contexts, as is now evident in the wealth of studies ...published internationally. This narrative literature review aims to summarise current evidence regarding the outcomes of LICs for student, clinician and community stakeholders.
Methods Recent literature was examined for original research articles pertaining to outcomes of LICs.
Results Students in LICs achieve academic results equivalent to and in some cases better than those of their counterparts who receive clinical education in block rotations. Students in LICs are reported to have well‐developed patient‐centred communication skills, demonstrate understanding of the psychosocial contributions to medicine, and report more preparedness in higher‐order clinical and cognitive skills in comparison with students in traditional block rotations (TBRs). Students in LICs take on increased responsibility with patients and describe having more confidence in dealing with ethical dilemmas. Continuity of supervision reportedly facilitates incremental knowledge acquisition, and supervisors provide incrementally progressive feedback. Despite early disorientation regarding the organising of their learning, students feel well supported by the continuity of student–preceptor relationships and value the contributions made by these. Students in LICs living and working in rural areas are positively influenced towards primary care and rural career choices.
Discussion A sound body of knowledge in the field of LIC research suggests it is time to move beyond descriptive or exploratory research that is designed to justify this new educational approach by comparing academic results. As the attributes of LIC alumni are better understood, it is important to conduct explanatory research to develop a more complete understanding of these findings and a foundation for new theoretical frameworks that underpin educational change.
Conclusions Longitudinal integrated clerkships are now recognised as representing credible and effective pedagogical alternatives to TBRs in medical education.
Discuss ideas arising from this article at ‘discuss’
•Large data-set of CO2, CH4, and N2O in the surface waters of the Meuse River•Highest fluvial CO2, CH4, and N2O concentrations during low water•Highest fluvial CO2, CH4 and N2O concentrations in ...agriculture dominated catchments
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We report a data-set of CO2, CH4, and N2O concentrations in the surface waters of the Meuse river network in Belgium, obtained during four surveys covering 50 stations (summer 2013 and late winter 2013, 2014 and 2015), from yearly cycles in four rivers of variable size and catchment land cover, and from 111 groundwater samples. Surface waters of the Meuse river network were over-saturated in CO2, CH4, N2O with respect to atmospheric equilibrium, acting as sources of these greenhouse gases to the atmosphere, although the dissolved gases also showed marked seasonal and spatial variations. Seasonal variations were related to changes in freshwater discharge following the hydrological cycle, with highest concentrations of CO2, CH4, N2O during low water owing to a longer water residence time and lower currents (i.e. lower gas transfer velocities), both contributing to the accumulation of gases in the water column, combined with higher temperatures favourable to microbial processes. Inter-annual differences of discharge also led to differences in CH4 and N2O that were higher in years with prolonged low water periods. Spatial variations were mostly due to differences in land cover over the catchments, with systems dominated by agriculture (croplands and pastures) having higher CO2, CH4, N2O levels than forested systems. This seemed to be related to higher levels of dissolved and particulate organic matter, as well as dissolved inorganic nitrogen in agriculture dominated systems compared to forested ones. Groundwater had very low CH4 concentrations in the shallow and unconfined aquifers (mostly fractured limestones) of the Meuse basin, hence, should not contribute significantly to the high CH4 levels in surface riverine waters. Owing to high dissolved concentrations, groundwater could potentially transfer important quantities of CO2 and N2O to surface waters of the Meuse basin, although this hypothesis remains to be tested.
Abstract
We present the results of a multisite photometric observing campaign on the rapidly oscillating Ap (roAp) star 2MASS 16400299-0737293 (J1640; V = 12.7). We analyse photometric B data to show ...the star pulsates at a frequency of 151.93 d−1 (1758.45 μHz; P = 9.5 min) with a peak-to-peak amplitude of 20.68 mmag, making it one of the highest amplitude roAp stars. No further pulsation modes are detected. The stellar rotation period is measured at 3.674 7 ± 0.000 5 d, and we show that rotational modulation due to spots is in antiphase between broad-band and B observations. Analysis and modelling of the pulsation reveals this star to be pulsating in a distorted quadrupole mode, but with a strong spherically symmetric component. The pulsational phase variation in this star is suppressed, leading to the conclusion that the contribution of ℓ > 2 components dictate the shape of phase variations in roAp stars that pulsate in quadrupole modes. This is only the fourth time such a strong pulsation phase suppression has been observed, leading us to question the mechanisms at work in these stars. We classify J1640 as an A7 Vp SrEu(Cr) star through analysis of classification resolution spectra.
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