A study of generative large language model for medical research and healthcare.

There are enormous enthusiasm and concerns in applying large language models (LLMs) to healthcare. Yet current assumptions are based on general-purpose LLMs such as ChatGPT, which are not developed for medical use. This study develops a generative clinical LLM, GatorTronGPT, using 277 billion words of text including (1) 82 billion words of clinical text from 126 clinical departments and approximately 2 million patients at the University of Florida Health and (2) 195 billion words of diverse general English text. We train GatorTronGPT using a GPT-3 architecture with up to 20 billion parameters and evaluate its utility for biomedical natural language processing (NLP) and healthcare text generation. GatorTronGPT improves biomedical natural language processing. We apply GatorTronGPT to generate 20 billion words of synthetic text. Synthetic NLP models trained using synthetic text generated by GatorTronGPT outperform models trained using real-world clinical text. Physicians' Turing test using 1 (worst) to 9 (best) scale shows that there are no significant differences in linguistic readability (p = 0.22; 6.57 of GatorTronGPT compared with 6.93 of human) and clinical relevance (p = 0.91; 7.0 of GatorTronGPT compared with 6.97 of human) and that physicians cannot differentiate them (p < 0.001). This study provides insights into the opportunities and challenges of LLMs for medical research and healthcare.

A large language model for electronic health records.

There is an increasing interest in developing artificial intelligence (AI) systems to process and interpret electronic health records (EHRs). Natural language processing (NLP) powered by pretrained language models is the key technology for medical AI systems utilizing clinical narratives. However, there are few clinical language models, the largest of which trained in the clinical domain is comparatively small at 110 million parameters (compared with billions of parameters in the general domain). It is not clear how large clinical language models with billions of parameters can help medical AI systems utilize unstructured EHRs. In this study, we develop from scratch a large clinical language model-GatorTron-using >90 billion words of text (including >82 billion words of de-identified clinical text) and systematically evaluate it on five clinical NLP tasks including clinical concept extraction, medical relation extraction, semantic textual similarity, natural language inference (NLI), and medical question answering (MQA). We examine how (1) scaling up the number of parameters and (2) scaling up the size of the training data could benefit these NLP tasks. GatorTron models scale up the clinical language model from 110 million to 8.9 billion parameters and improve five clinical NLP tasks (e.g., 9.6% and 9.5% improvement in accuracy for NLI and MQA), which can be applied to medical AI systems to improve healthcare delivery. The GatorTron models are publicly available at: https://catalog.ngc.nvidia.com/orgs/nvidia/teams/clara/models/gatortron_og .

Oncolytic Viruses: Treatment and Implications for Patients With Gliomas
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BACKGROUND: Oncolytic viral therapies are increasingly being explored for the treatment of diverse cancer types, most notably melanoma. However, advances in the treatment of high-grade gliomas, and specifically glioblastoma multiforme (GBM), are the result of novel oncolytic viral therapies. Delta-24-RGD is one such therapy that has demonstrated promising results in phase 1 trials.
. OBJECTIVES: The objective of this article is to provide an overview of Delta-24-RGD, highlighting considerations for nurses in diverse clinical, research, and advanced practice roles.
. METHODS: A high-level overview of the pathophysiology of the Delta-24-RGD virus as it relates to GBM is presented. A case study is used to illustrate the course of care for a patient receiving this therapy.
. FINDINGS: Delta-24-RGD has demonstrated remarkable clinical efficacy in the near to complete regression of GBM activity. Nurses may increasingly be caring for patients who are undergoing such therapy or have received it in the past. Understanding the mechanism of action, safe-handling implications, and expected patient care needs and treatment sequelae is important.

Translational Science for Energy and Beyond.

A clear challenge for the coming decades is decreasing the carbon intensity of the global energy supply while simultaneously accommodating a rapid worldwide increase in power demand. Meeting this challenge of providing abundant, clean energy undoubtedly requires synergistic efforts between basic and applied researchers in the chemical sciences to develop and deploy new technologies. Among the available options, solar energy is one of the promising targets because of the high abundance of solar photons over much of the globe. Similarly, decarbonization of the global energy supply will require clean sources of hydrogen to use as reducing equivalents for fuel and chemical feedstocks. In this report, we discuss the importance of translational research-defined as work that explicitly targets basic discovery as well as technology development-in the context of photovoltaics and solar fuels. We focus on three representative research programs encompassing translational research in government, industry, and academia. We then discuss more broadly the benefits and challenges of translational research models and offer recommendations for research programs that address societal challenges in the energy sector and beyond.

Public health human resources: a comparative analysis of policy documents in two Canadian provinces.

BACKGROUND: Amidst concerns regarding the capacity of the public health system to respond rapidly and appropriately to threats such as pandemics and terrorism, along with changing population health needs, governments have focused on strengthening public health systems. A key factor in a robust public health system is its workforce. As part of a nationally funded study of public health renewal in Canada, a policy analysis was conducted to compare public health human resources-relevant documents in two Canadian provinces, British Columbia (BC) and Ontario (ON), as they each implement public health renewal activities. METHODS: A content analysis of policy and planning documents from government and public health-related organizations was conducted by a research team comprised of academics and government decision-makers. Documents published between 2003 and 2011 were accessed (BC = 27; ON = 20); documents were either publicly available or internal to government and excerpted with permission. Documentary texts were deductively coded using a coding template developed by the researchers based on key health human resources concepts derived from two national policy documents. RESULTS: Documents in both provinces highlighted the importance of public health human resources planning and policies; this was particularly evident in early post-SARS documents. Key thematic areas of public health human resources identified were: education, training, and competencies; capacity; supply; intersectoral collaboration; leadership; public health planning context; and priority populations. Policy documents in both provinces discussed the importance of an educated, competent public health workforce with the appropriate skills and competencies for the effective and efficient delivery of public health services. CONCLUSION: This policy analysis identified progressive work on public health human resources policy and planning with early documents providing an inventory of issues to be addressed and later documents providing evidence of beginning policy development and implementation. While many similarities exist between the provinces, the context distinctive to each province has influenced and shaped how they have focused their public health human resources policies.

A cross-sectional study examining factors related to critical thinking in nursing.

The purpose of this study was to examine critical thinking skills among registered nurses who work in a military hospital. Sixty-five nurses were administered the Health Sciences Reasoning Test to obtain scores in inductive reasoning, deductive reasoning, interpretation, analysis, and evaluation skills. Results showed no significant association between critical thinking skills and years of experience; however, differences were identified among racial/ethnic groups. It is hoped that findings from this study create a platform for dialogue among staff development nurses who are best situated to develop strategies that address these issues.

Shoulder dystocia and postpartum hemorrhage simulations: student confidence in managing these complications.

INTRODUCTION: Simulation is an effective teaching strategy for educating health professionals. However, little is known about the effectiveness of simulations in midwifery education. The purpose of this project was to determine whether the use of high-fidelity simulations for the obstetric emergencies of shoulder dystocia and postpartum hemorrhage increases student confidence in managing these complications. METHODS: The participants were registered nurses enrolled in a graduate midwifery education program in the Southeastern United States. Student confidence in learning to manage shoulder dystocia and postpartum hemorrhage was studied in 2 groups of students. The control group (n = 10) received standard teaching methods consisting of discussion, watching a video, and low-fidelity teaching methods. The intervention group (n = 18) received a high-fidelity simulation learning experience. Student confidence was measured before and after each learning experience using a validated, 8-item, Likert-type scale. RESULTS: In the control group, student confidence did not significantly increase after a classroom discussion or low-fidelity simulation experience. Student confidence increased significantly (P < .01) after the high-fidelity simulation learning experiences. When the differences between the pretest and posttest scores were compared for the control and intervention groups, there was a moderate effect size (0.54) for the intervention group for the shoulder dystocia simulations and a large effect size (1.68) for the postpartum hemorrhage simulations. CONCLUSION: High-fidelity simulations for shoulder dystocia and postpartum hemorrhage significantly increased student confidence in managing these complications.

Reflections on the journey: six short stories.

One of the goals of the 2011 International Year of Chemistry is to celebrate the contributions of women to science. A question that has been frequently asked in this regard is... Why is it necessary to highlight women in the "age of equality"? The reasons are varied but the facts are that many women scientists worked in obscurity throughout the 19th and even well into the 20th century, sometimes publishing anonymously to be heard. This celebration of Women in Science is one way to recognize both the resiliency and passion of these women. As part of this celebration, Chemistry Central Journal's Thematic Series of "Women in Chemistry" includes this article describing the path several women took as they pursued chemistry careers spanning the latter part of the 20th century and into the early 21st century. Sharon Haynie, Nancy Jones, Cheryl Martin, Paula Olsiewski, Mary Roberts and Amber Hinkle each have unique story of their personal journey from childhood to adulthood. As you read these stories, listen generously, and feel free to share your own stories, comments and thoughts.

Bendamustine: a novel cytotoxic agent for hematologic malignancies.

A significant need exists for effective and well-tolerated treatments for patients with hematologic malignancies. Bendamustine hydrochloride is a novel cytotoxic agent that possesses alkylator and purine-like structural groups, which may confer a unique mechanism of action. Bendamustine recently was approved by the U. S. Food and Drug Administration for the treatment of chronic lymphocytic leukemia (CLL) and currently is being used in clinical trials for a number of hematologic and solid tumors. Bendamustine has demonstrated promising clinical activity in patients with hematologic malignancies and has manageable toxicities when administered as monotherapy or in combination with other agents. In clinical trials, nausea, fatigue, vomiting, fever, diarrhea, constipation, and headache were the most commonly reported nonhematologic side effects. Reversible myelosuppression also was reported. Nurses need to understand the efficacy and safety profiles of bendamustine to educate patients and their families about its use and expected side effects. Knowledge of specific measures for preventing and managing associated side effects and dose modifications is integral to the provision of optimal care.

Bicarbonate transport and extracellular carbonic anhydrase in marine diatoms.

In this article, we present new laboratory results examining the relative importance of HCO(-)(3) transport and extracellular carbonic anhydrase (eCA) in 17 marine diatom species. We observed significant variability in both HCO(-)(3) transport and eCA expression across a range of diatom species with different cell morphologies. All species we examined took up HCO(-)(3) through a direct transport mechanism, with the fraction of HCO(-)(3) transport ranging from 40 to 95% of total C uptake. eCA expression also varied significantly, with catalytic enhancement factors ranging approximately 10-fold among species. There was a significant positive correlation between HCO(-)(3) transport and eCA expression among the test species. However, neither HCO(-)(3) transport nor eCA expression was significantly correlated to cell growth rates or surface area to volume ratios. We did observe weak positive trends between the ratio of C demand:supply and HCO(-)(3) utilization/eCA expression, but these were not statistically significant. We are thus unable to provide a mechanistic explanation for the apparent variability in HCO(-)(3) transport and eCA expression in marine diatoms. This variability may, nonetheless, have important implications for the physiological ecology of oceanic diatoms.

Osteoporosis--diagnosis and treatment in a general practice population.

BACKGROUND: Osteoporosis may be underdiagnosed and undertreated. General practitioners are best placed to redress this. METHODS: The research group invited all GPs in Bendigo (Victoria) (60) to attend an educational evening about osteoporosis, and also to engage in subsequent research involving data extraction from their electronic medical records for 2003. Twenty-three GPs accepted the invitation to participate. The research group calculated the proportion of patients with osteoporosis recorded as a diagnosis in their medical record, and compared them with national prevalence estimates based on radiological diagnosis. RESULTS: The research group assessed 29 356 patient records of the 23 participating GPs, identifying 593 cases of osteoporosis. In patients aged over 59 years, osteoporosis was diagnosed in 12.6% of women and 3.8% of men. Of identified cases, 53.4% were prescribed antiresorptive drugs. DISCUSSION: The occurrence of a diagnosis of osteoporosis was well below radiologically estimated prevalence. Implementation of learning opportunities designed to improve GP recognition and treatment of osteoporosis could be beneficial. Electronic medical records can provide useful research data with privacy protected.

Topology of the outer membrane usher PapC determined by site-directed fluorescence labeling.

In contrast to typical membrane proteins that span the lipid bilayer via transmembrane alpha-helices, bacterial outer membrane proteins adopt a beta-barrel architecture composed of antiparallel transmembrane beta-strands. The topology of outer membrane proteins is difficult to predict accurately using computer algorithms, and topology mapping protocols commonly used for alpha-helical membrane proteins do not work for beta-barrel proteins. We present here the topology of the PapC usher, an outer membrane protein required for assembly and secretion of P pili by the chaperone/usher pathway in uropathogenic Escherichia coli. An initial attempt to map PapC topology by insertion of protease cleavage sites was largely unsuccessful due to lack of cleavage at most sites and the requirement to disrupt the outer membrane to identify periplasmic sites. We therefore adapted a site-directed fluorescence labeling technique to permit topology mapping of outer membrane proteins using small molecule probes in intact bacteria. Using this method, we demonstrated that PapC has the potential to encode up to 32 transmembrane beta-strands. Based on experimental evidence, we propose that the usher consists of an N-terminal beta-barrel domain comprised of 26 beta-strands and that a distinct C-terminal domain is not inserted into the membrane but is located instead within the lumen of the N-terminal beta-barrel similar to the plug domains encoded by the outer membrane iron-siderophore uptake proteins.

The theory of critical thinking of nursing.

Critical thinking is a thought process used by nurses for clinical decision-making. This descriptive correlational study focused on the relationships among critical thinking, decision-making, and clinical nursing expertise during a clinical simulation. A midrange theory, developed from Benner (1) and Paul (2), states that as novice nurses become experts and develop clinical expertise through experience and the acquisition of knowledge, critical thinking is developed and used for clinical decision-making. > A convenience sample of 149 nursing students, graduate nurses, and expert nurses was selected for the study. Critical thinking was measured with the Elements of Thought Instrument (ETI) and a decision score was calculated. Critical thinking and decision-making increased with the level of clinical expertise. Related demographics included college credits taken, years in nursing practice, and grade point average. The findings were consistent with the midrange Theory of Critical Thinking of Nurses.