Barriers and facilitators to engagement with artificial intelligence (AI)-based chatbots for sexual and reproductive health advice: a qualitative analysis.

Background The emergence of artificial intelligence (AI) provides opportunities for demand management of sexual and reproductive health services. Conversational agents/chatbots are increasingly common, although little is known about how this technology could aid services. This study aimed to identify barriers and facilitators for engagement with sexual health chatbots to advise service developers and related health professionals. Methods In January-June 2020, we conducted face-to-face, semi-structured and online interviews to explore views on sexual health chatbots. Participants were asked to interact with a chatbot, offering advice on sexually transmitted infections (STIs) and relevant services. Participants were UK-based and recruited via social media. Data were recorded, transcribed verbatim and analysed thematically. Results Forty participants (aged 18-50 years; 64% women, 77% heterosexual, 58% white) took part. Many thought chatbots could aid sex education, providing useful information about STIs and sign-posting to sexual health services in a convenient, anonymous and non-judgemental way. Some compared chatbots to health professionals or Internet search engines and perceived this technology as inferior, offering constrained content and interactivity, limiting disclosure of personal information, trust and perceived accuracy of chatbot responses. Conclusions Despite mixed attitudes towards chatbots, this technology was seen as useful for anonymous sex education but less suitable for matters requiring empathy. Chatbots may increase access to clinical services but their effectiveness and safety need to be established. Future research should identify which chatbots designs and functions lead to optimal engagement with this innovation.

Contribution of local rarity and climatic suitability to local extinction and colonization varies with species traits.

Changes in species distributions through local extinction and colonization events are a major consequence of climate change. The mechanisms underlying these processes, however, are yet to be fully understood. We investigate the effects of climatic suitability and local rarity on local extinction and colonization of British birds. We test the hypothesis that local extinction and colonization on decadal scales are driven by both climatic suitability and the prevalence of the species within an area and that the balance between these two is affected by species traits. We use spatially explicit conditional autoregressive models to determine the effect size of local rarity and climatic suitability (extracted from climate envelope models) on local extinction and colonization events. We then use phylogenetically constrained, generalized least-square models to estimate the association of extinction and colonization predictors with body mass, clutch size and national range of each species. Both local rarity and climatic suitability of an area contributed to local extinctions and colonizations, but the importance of these predictors varied between species. This interspecific variation was explained, in part, by species traits, in particular national range, which influenced the importance of local rarity and climatic suitability to both local extinction and colonization. These results further our knowledge of the mechanisms underlying changes in species occupancy due to climate change. This can inform predictive models as well as contribute to more focussed avian conservation efforts.

Achieving health equity through conversational AI: A roadmap for design and implementation of inclusive chatbots in healthcare.

BACKGROUND: The rapid evolution of conversational and generative artificial intelligence (AI) has led to the increased deployment of AI tools in healthcare settings. While these conversational AI tools promise efficiency and expanded access to healthcare services, there are growing concerns ethically, practically and in terms of inclusivity. This study aimed to identify activities which reduce bias in conversational AI and make their designs and implementation more equitable. METHODS: A qualitative research approach was employed to develop an analytical framework based on the content analysis of 17 guidelines about AI use in clinical settings. A stakeholder consultation was subsequently conducted with a total of 33 ethnically diverse community members, AI designers, industry experts and relevant health professionals to further develop a roadmap for equitable design and implementation of conversational AI in healthcare. Framework analysis was conducted on the interview data. RESULTS: A 10-stage roadmap was developed to outline activities relevant to equitable conversational AI design and implementation phases: 1) Conception and planning, 2) Diversity and collaboration, 3) Preliminary research, 4) Co-production, 5) Safety measures, 6) Preliminary testing, 7) Healthcare integration, 8) Service evaluation and auditing, 9) Maintenance, and 10) Termination. DISCUSSION: We have made specific recommendations to increase conversational AI's equity as part of healthcare services. These emphasise the importance of a collaborative approach and the involvement of patient groups in navigating the rapid evolution of conversational AI technologies. Further research must assess the impact of recommended activities on chatbots' fairness and their ability to reduce health inequalities.

Evaluation of the long-term effects of gastric inhibitory polypeptide-ovalbumin conjugates on insulin resistance, metabolic dysfunction, energy balance and cognition in high-fat-fed mice.

The effects of active immunisation with gastric inhibitory polypeptide (GIP) or (proline3)GIP-ovalbumin conjugates on insulin resistance, metabolic dysfunction, energy expenditure and cognition were examined in high-fat-fed mice. Normal mice were injected (subcutaneously) once every 14 d for 98 d with GIP-ovalbumin conjugates, with transfer to a high-fat diet on day 21. Active immunisation resulted in GIP antibody generation and significantly (P < 0·01 to P < 0·001) reduced circulating non-fasting plasma insulin concentrations compared to high-fat control mice from day 70 onwards. The glycaemic responses to intraperitoneal glucose or nutrient ingestion were significantly improved in all treated mice, with corresponding stimulated plasma insulin levels depressed compared to high-fat controls. These changes were associated with substantially (P < 0·001) improved glucose-lowering responses to exogenous insulin and decreases of muscle and fat TAG, pancreatic insulin, circulating total and LDL-cholesterol levels (P < 0·01 to P < 0·001). Treatment with GIP-ovalbumin conjugates was not associated with alterations in energy expenditure, indirect calorimetry or aspects of cognitive function. The observed changes were almost identical in GIP and (Pro3)GIP immunised mice and were independent of any effects on food intake or body weight. Further tests established that coupling of GIP peptides to ovalbumin abolished any intrinsic insulin-releasing or glucose-lowering activity. These results suggest that induction of GIP-neutralising antibodies with GIP-ovalbumin conjugates is an effective means of countering the metabolic abnormalities induced by high-fat feeding and does not adversely have an impact on a marker of cognition function or energy expenditure.

Chemical cholecystokinin receptor activation protects against obesity-diabetes in high fat fed mice and has sustainable beneficial effects in genetic ob/ob mice.

The current study has determined the ability of (pGlu-Gln)-CCK-8 to counter the development of diet-induced obesity-diabetes and examined persistence of beneficial metabolic effects in high fat and ob/ob mice, respectively. Twice daily injection of (pGlu-Gln)-CCK-8 in normal mice transferred to a high fat diet reduced energy intake (p < 0.001), body weight (p < 0.01), circulating insulin and LDL-cholesterol (p < 0.001) and improved insulin sensitivity (p < 0.001) as well as oral and intraperitoneal (p < 0.001) glucose tolerance. Energy intake, body weight, circulating insulin and glucose tolerance of (pGlu-Gln)-CCK-8 mice were similar to lean controls. In addition, (pGlu-Gln)-CCK-8 prevented the effect of high fat feeding on triacylglycerol accumulation in liver and muscle. Interestingly, (pGlu-Gln)-CCK-8 significantly (p < 0.001) elevated pancreatic glucagon content. Histological examination of the pancreata of (pGlu-Gln)-CCK-8 mice revealed no changes in islet number or size, but there was increased turnover of beta-cells with significantly (p < 0.001) increased numbers of peripherally located alpha-cells, co-expressing both glucagon and GLP-1. Beneficial metabolic effects were observed similarly in ob/ob mice treated twice daily with (pGlu-Gln)-CCK-8 for 18 days, including significantly reduced energy intake (p < 0.05), body weight (p < 0.05 to p < 0.01), circulating glucose (p < 0.05 to p < 0.01) and insulin (p < 0.05 to p < 0.001) and improved glucose tolerance (p < 0.05) and insulin sensitivity (p < 0.001). Notably, these beneficial effects were still evident 18 days following cessation of treatment. These studies emphasize the potential of (pGlu-Gln)-CCK-8 for the treatment of obesity-diabetes.