Accuracy and consistency of online large language model-based artificial intelligence chat platforms in answering patients' questions about heart failure.

BACKGROUND: Heart failure (HF) is a prevalent condition associated with significant morbidity. Patients may have questions that they feel embarrassed to ask or will face delays awaiting responses from their healthcare providers which may impact their health behavior. We aimed to investigate the potential of large language model (LLM) based artificial intelligence (AI) chat platforms in complementing the delivery of patient-centered care. METHODS: Using online patient forums and physician experience, we created 30 questions related to diagnosis, management and prognosis of HF. The questions were posed to two LLM-based AI chat platforms (OpenAI's ChatGPT-3.5 and Google's Bard). Each set of answers was evaluated by two HF experts, independently and blinded to each other, for accuracy (adequacy of content) and consistency of content. RESULTS: ChatGPT provided mostly appropriate answers (27/30, 90%) and showed a high degree of consistency (93%). Bard provided a similar content in its answers and thus was evaluated only for adequacy (23/30, 77%). The two HF experts' grades were concordant in 83% and 67% of the questions for ChatGPT and Bard, respectively. CONCLUSION: LLM-based AI chat platforms demonstrate potential in improving HF education and empowering patients, however, these platforms currently suffer from issues related to factual errors and difficulty with more contemporary recommendations. This inaccurate information may pose serious and life-threatening implications for patients that should be considered and addressed in future research.

Biosimilars production in Africa opportunities & challenges.

The healthcare systems of African nations heavily rely on importing and repackaging biological medicine. More than 70% of the pharmaceutical products consumed in Africa are imported. The localization of biosimilar production can have a positive impact on the availability and cost of these products by reducing the expenses for African governments and making essential healthcare products more accessible to the population. However, it is evident that the developing countries, particularly African nations, face various obstacles and difficulties in localizing biosimilar production. These challenges encompass development, manufacturing, evaluation, and registration processes. In this review, we will highlight the significant hurdles and achievements encountered during the localization process of biosimilars.

Advances in clinical applications of bioceramics in the new regenerative medicine era.

In this editorial, we comment on the hard and soft tissue applications of different ceramic-based scaffolds prepared by different mechanisms such as 3D printing, sol-gel, and electrospinning. The new concept of regenerative medicine relies on biomaterials that can trigger in situ tissue regeneration and stem cell recruitment at the defect site. A large percentage of these biomaterials is ceramic-based as they provide the essential requirements of biomaterial principles such as tailored multisize porosity, antibacterial properties, and angiogenic properties. All these previously mentioned properties put bioceramics on top of the hierarchy of biomaterials utilized to stimulate tissue regeneration in soft and hard tissue wounds. Multiple clinical applications registered the use of these materials in triggering soft tissue regeneration in healthy and diabetic patients such as bioactive glass nanofibers. The results were promising and opened new frontiers for utilizing these materials on a larger scale. The same results were mentioned when using different forms and formulas of bioceramics in hard defect regeneration. Some bioceramics were used in combination with other polymers and biological scaffolds to improve their regenerative and mechanical properties. All this progress will enable a larger scale of patients to receive such services with ease and decrease the financial burden on the government.

Online monitoring of protein refolding in inclusion body processing using intrinsic fluorescence.

Inclusion bodies (IBs) are protein aggregates formed as a result of overexpression of recombinant protein in E. coli. The formation of IBs is a valuable strategy of recombinant protein production despite the need for additional processing steps, i.e., isolation, solubilization and refolding. Industrial process development of protein refolding is a labor-intensive task based largely on empirical approaches rather than knowledge-driven strategies. A prerequisite for knowledge-driven process development is a reliable monitoring strategy. This work explores the potential of intrinsic tryptophan and tyrosine fluorescence for real-time and in situ monitoring of protein refolding. In contrast to commonly established process analytical technology (PAT), this technique showed high sensitivity with reproducible measurements for protein concentrations down to 0.01 g L - 1 . The change of protein conformation during refolding is reflected as a shift in the position of the maxima of the tryptophan and tyrosine fluorescence spectra as well as change in the signal intensity. The shift in the peak position, expressed as average emission wavelength of a spectrum, was correlated to the amount of folding intermediates whereas the intensity integral correlates to the extent of aggregation. These correlations were implemented as an observation function into a mechanistic model. The versatility and transferability of the technique were demonstrated on the refolding of three different proteins with varying structural complexity. The technique was also successfully applied to detect the effect of additives and process mode on the refolding process efficiency. Thus, the methodology presented poses a generic and reliable PAT tool enabling real-time process monitoring of protein refolding.

Corrigendum: State-of-the-art and novel approaches to mild solubilization of inclusion bodies.

[This corrects the article DOI: 10.3389/fbioe.2023.1249196.].

A novel automated peak frequency annotation algorithm for identifying deceleration zones and ventricular tachycardia ablation sites.

BACKGROUND: Current annotation of local fractionated signals during ventricular electroanatomic mapping (EAM) requires manual input subject to variability and error. OBJECTIVES: The purpose of this study was to evaluate a novel peak frequency (PF) annotation software for its ability to automatically detect late potentials (LPs) and local abnormal ventricular activity (LAVA), determine an optimal range for display, and assess its impact on isochronal late activation mapping (ILAM). METHODS: EAM data from 25 patients who underwent ventricular tachycardia (VT) ablation were retrospectively analyzed. Samplings of electrogram PFs from areas of normal bipolar voltage, areas of low voltage, and areas of low voltage with fractioned signals were performed. An optimal range of frequency display was identified from these patients and applied to a validation cohort of 10 prospective patients to assess high PF within scar as a predictor of VT ablation target sites, in particular deceleration zones (DZs) identified by ILAM, LP, and LAVA. RESULTS: Voltage and PF ranges of normal endocardial tissue varied widely. Using 220 Hz as a frequency cutoff value in areas of low bipolar voltage, areas of high fractionation were identified with sensitivity of 91% and specificity of 85% There was no significant reduction in targeted DZ surface areas, and colocalization with DZs was observed in all cases. Applied to the prospective cohort, PF predicted fractionated areas and DZ in 9 of 10 patients. CONCLUSION: A PF annotation algorithm with a cutoff of 220 Hz accurately identifies areas of fractioned signals and accurately predicts DZs during ILAM.

Influence of doping and solvent interactions on the electronic and capacitive properties of metal-supported graphene: A combined DFT and AIMD study.

Theoretical prediction of interfacial capacitance in graphene-based supercapacitors is crucial to accelerating materials' design and development cycles. However, there is currently a significant gap between ab initio predictions and experimental reports, particularly in the case of nitrogen-doped graphene. Analyses based on changes to the density of states of freestanding graphene upon doping do not account for the electronic interactions between the electrode, dopants, and substrates. The result is an overestimation of the doping-induced capacitance increase by up to two orders of magnitude. Moreover, it is unclear whether electrolyte and solvent interactions can further complicate matters by inducing changes to the band structure and, therefore, the capacitive properties of the electrode. A third complication lies in the fixed-band approximation, where materials are simulated without accounting for the influence of an external electrical field. In this work, we present an interfacial modeling and characterization procedure that leverages the combined strengths of ab-initio molecular dynamics, density functional theory, and microscopic polarization theory to produce reliable predictions of interfacial capacitance. The procedure is applied to two case studies of interest in supercapacitor design: (1) nitrogen-doped graphene on a Cu(111) substrate and (2) an interface between bulk water and Cu(111)-supported graphene at room temperature. Results show that water alters graphene's band structure from a semi-metallic to an n-doped-semiconducting character and that metallic substrates dominate the band structure of the electrode interface even in the presence of dopants. The water interface also shows an asymmetric capacitive response relative to the polarity of the applied field.

State-of-the-art and novel approaches to mild solubilization of inclusion bodies.

Throughout the twenty-first century, the view on inclusion bodies (IBs) has shifted from undesired by-products towards a targeted production strategy for recombinant proteins. Inclusion bodies can easily be separated from the crude extract after cell lysis and contain the product in high purity. However, additional solubilization and refolding steps are required in the processing of IBs to recover the native protein. These unit operations remain a highly empirical field of research in which processes are developed on a case-by-case basis using elaborate screening strategies. It has been shown that a reduction in denaturant concentration during protein solubilization can increase the subsequent refolding yield due to the preservation of correctly folded protein structures. Therefore, many novel solubilization techniques have been developed in the pursuit of mild solubilization conditions that avoid total protein denaturation. In this respect, ionic liquids have been investigated as promising agents, being able to solubilize amyloid-like aggregates and stabilize correctly folded protein structures at the same time. This review briefly summarizes the state-of-the-art of mild solubilization of IBs and highlights some challenges that prevent these novel techniques from being yet adopted in industry. We suggest mechanistic models based on the thermodynamics of protein unfolding with the aid of molecular dynamics simulations as a possible approach to solve these challenges in the future.

Associations of Adipokine Levels with Levels of Remnant Cholesterol: the Multi-Ethnic Study of Atherosclerosis (MESA).

Background: The metabolic syndrome phenotype of individuals with obesity is characterized by elevated levels of triglyceride (TG)-rich lipoproteins and remnant particles, which have been shown to be significantly atherogenic. Understanding the association between adipokines, endogenous hormones produced by adipose tissue, and remnant cholesterol (RC) would give insight into the link between obesity and atherosclerotic cardiovascular disease. Methods: We studied 1,791 MESA participants of an ancillary study on body composition who had adipokine levels measured (leptin, adiponectin, resistin) at either visit 2 or 3. RC was calculated as non-high density lipoprotein cholesterol minus low-density lipoprotein cholesterol (LDL-C), measured at the same visit as the adipokines, as well as subsequent visits 4 through 6. Multivariable-adjusted linear mixed effects models were used to assess the cross-sectional and longitudinal associations between adipokines and levels of RC. Results: Mean (SD) age was 64.5±9.6 years and for body mass index (BMI) was 29.9±5.0 kg/m2; 52.0% were women. In fully adjusted models that included BMI, LDL-C and lipid-lowering therapy, for each 1-unit increment in adiponectin, there was 14.4% (12.0, 16.8) lower RC. With each 1-unit increment in leptin and resistin, there was 4.5% (2.3, 6.6) and 5.1% (1.2, 9.2) higher RC, respectively. Lower adiponectin and higher leptin were also associated with longitudinal increases in RC levels over median follow-up of 5(4-8) years. Conclusions: Lower adiponectin and higher leptin levels were independently associated with higher levels of RC at baseline and longitudinal RC increase, even after accounting for BMI and LDL-C. CLINICAL PERSPECTIVE: What is new?: - Among individuals without history of cardiovascular disease, adiponectin is inversely associated with cross-sectional levels of remnant cholesterol, whereas leptin and resistin are directly associated.- Adiponectin had an inverse association with progression of remnant cholesterol levels over time.What are the clinical implications?: - Adiponectin levels were not associated with LDL-C levels but with levels of triglyceride-rich lipoproteins, particularly remnant cholesterol.-Incrementing adiponectin via lifestyle modification and/or pharmacological therapies (i.e. GLP-1 agonists) could be a mechanism to reduce remnant cholesterol levels and ultimately cardiovascular risk.

Success of embryo transfer of hybrid embryos in Old World camelids: A first study.

This is the first study to test the embryo transfer (ET) of hybrid embryos in Old World camelids and produces a live calf from a dromedary recipient. Hybrid embryos were collected from 7 dromedary and 10 Bactrian donors, with or without ovarian super-stimulation, and transferred to dromedary recipients. Pregnancy diagnosis was conducted on Day 10 post-ET by using the progesterone-ELISA test and trans-rectal ultrasonography at 1 and 2 months of gestation. The date of abortion, stillbirth, or normal calving for each pregnant recipient was recorded. Without ovarian super-stimulation, two and one recipients were pregnant at 10 days post-ET, from ♂ Bactrian X ♀ dromedary and ♂ dromedary X ♀ Bactrian, respectively. While at 2 months of gestation, only one recipient was diagnosed pregnant from ♂ Bactrian X ♀ dromedary. Response to ovarian super-stimulation was successful in all 4 of the tested dromedary donors and in 8 out of 10 Bactrian donors. Additionally, 4 super-stimulated Bactrian donors (40%) showed failure of ovulation. The number of super-stimulated developed follicles and recovered embryos was higher in dromedary donors compared to Bactrian donors. Ten and two recipients were diagnosed pregnant at 10 days post-ET for ♂ Bactrian X ♀ dromedary and ♂ dromedary X ♀ Bactrian, respectively. At 2 months of gestation, the number of pregnant recipients from ♂ Bactrian X ♀ dromedary was reduced to eight, while the two pregnant recipients from ♂ dromedary X ♀ Bactrian remained pregnant. Total early pregnancy loss at 2 months gestation for all transferred hybrid embryos, obtained with or without ovarian super-stimulation, was 4/15 (26.6%). One healthy male calf was born from a recipient, with a total gestation period of 383 days, that received an embryo from a Bactrian male and a dromedary donor. Stillbirth was observed in six cases after 10.5-12 months of gestation and three cases aborted between 7 and 9 months of gestation due to trypanosomiasis. In conclusion, ET of hybrid embryos in Old World camelids is successful. However, further studies are required to improve the outcome of this technology to be used for meat and milk production in camels.

A single center comparative study of two single use digital flexible ureteroscopy in the management of renal stones less than 2 cm.

PURPOSE: For renal stones < 2 cm, guidelines recommend the use of retrograde intrarenal surgery as a first line treatment option. Many available single use flexible ureteroscopy were found. We aim to compare the effectiveness of two single use flexible ureteroscopy; Pusen Uscope 3011 versus LithoVue in the management of renal stones less than 2 cm. METHODS: Our study prospectively included 60 patients equally divided in to two groups: Pusen group and LithoVue group during the period from June 2020 to June 2021. The included patients were above 18 years old. Perioperative details as operative time, fluoroscopy time, hospital stay, and complications were recorded. Stone free rate was assessed. Base purchase cost was also compared. RESULTS: There was no statistically significant difference between the two groups regarding age, gender, and body mass index (BMI), stones size, side, number and location. The perioperative evaluation and outcome had no statistically significant differences between the two groups regarding the operative time, hospital stay, access sheath use, and stone free rate or radiation exposure. Among all cases, we had 49 cases (81.6%) with no postoperative complications (21 cases for Pusen group and 28 cases for LithoVue group). The incidence of postoperative complications was significantly higher among Pusen group than LithoVue group (p = 0.02). Initial purchase cost for both FURS had no significant difference (P = 0.86). CONCLUSION: RIRS can be performed effectively with Pusen 3011 and LithoVue single use flexible ureteroscopy in patients diagnosed with renal calculi < 2 cm with superior outcomes with LithoVue.

Ultrasound-guided lumbar erector spinae plane block versus caudal block for postoperative analgesia in pediatric hip and proximal femur surgery: a randomized controlled study.

BACKGROUND: According to previous research, 20% of infants experience prolonged postsurgical pain 6-12 months after major surgery, which is linked to functional impairment and a lower quality of life. The aim of our study is to evaluate whether the analgesic effect of the erector spinae plane block (ESPB) is superior to that of caudal epidural anesthesia (CEA) in pediatric patients undergoing hip or proximal femoral surgeries. METHODS: Seventy-six children ranging in age from 1 to 7 years scheduled for hip or proximal femur surgery were randomly assigned to receive either a unilateral ultrasound-guided ESPB or CEA with bupivacaine 0.25% at a dose of 0.5 ml/kg. The primary outcome was the Face, Legs, Activity, Cry, and Consolability (FLACC) scale 2 h postoperatively. The secondary outcomes were pain scores every 15 min for the first hour and then at 6, 12, and 24 h postoperatively; the block failure rate; time to perform a successful block; and time to first rescue analgesia. RESULTS: The FLACC score 2 h post¬operatively was not superior in the ESPB group compared to the CEA group; indeed, it was significantly higher in the ESPB group at 15 and 30 min post-operation (P = 0.005, 0.004, respectively). Additionally, the time to first rescue analgesia was prolonged in the CEA group (P < 0.001). The time to perform a successful block was comparable between the groups. CONCLUSIONS: The analgesic effect of the ESPB was not superior to that of CEA in pediatric patients undergoing hip and proximal femur surgery.

A prospective, randomized comparison of standard prone position versus flank-free modified supine position in percutaneous nephrolithotomy: A single-center initial experience.

Background: Percutaneous nephrolithotomy (PCNL) is the first choice for treatment of large renal stone >2 cm. The prone position is the classical position preferred by most surgeons. Aiming to improve patient anesthesia and surgery-related inconveniences of the prone position, Valdivia et al., 1987, described the performance of PCNL with the patient in the supine position. Hence, we aimed to study the safety and efficacy of flank-free modified supine position in PCNL compared to the standard prone position. Patients and Methods: This is a prospective randomized study for 60 patients with large renal stones planned for PCNL operation during the period from November 2017 to May 2019. Patients were divided into two groups (30 patients each group): Group A - patients underwent PCNL in the prone position and Group B - patients underwent PCNL in the modified flank supine position. Patients' demographics, stone size, Hounsfield unit with intraoperative details as fluoroscopy time, operative time, and complications were recorded. Postoperatively, need for or not to blood transfusions, hospital stay, stone-free status, and postoperative complications were assessed. Results: There was no statistically significant difference between the prone and supine positions regarding stone size (4 cm vs. 4.5 cm, P = 0.16), Hounsfield unit (940 HU vs. 955 HU, P = 0.78), body mass index (31.2 kg/m2 vs. 32.5 kg/m2, P = 0.49), fluoroscopy time (6.9 min vs. 7.3 min, P = 0.5), operative time (89.5 min vs. 90.4 min, P = 0.9), residual stones (10% vs. 20%, P = 0.8), and hospital stay (45.6 h vs. 48.6 h, P = 0.5). Fever occurred in 3.3% of cases in each group and urine leakage observed in one patient with prone position. No blood transfusion was needed in both the groups. Conclusions: PCNL in the modified supine position proved to be a safe and effective choice compared to the prone position for adult patients with large renal calculi.

Unraveling Synergistic Redox Interactions in Tetraphenylporphyrin-Polyluminol-Carbon Nanotube Composite for Capacitive Charge Storage.

Organic redox-active materials, combined with high-surface-area carbonaceous substrates, form sustainable and low-cost composites with greatly enhanced electrochemical charge storage capacities. The electrochemical capacitive behavior of a composite electrode containing tetraphenylporphyrin sulfonate (TPPS), Chemically polymerized luminol (CpLum), and carbon nanotubes (TPPS-CpLum-CNT) was studied and compared with individual TPPS-CNT and CpLum-CNT composites. The dual-layer TPPS-CpLum had a combined contribution to the electrochemical charge storage, which led to an increased volumetric capacitance over the bare CNT and individual TPPS-CNT and CpLum-CNT composites. The synergistic interactions in the composite enabled faster charge storage kinetics and great stability. Spectroscopic analyses revealed that TPPS and CpLum interact electronically through noncovalent π-π and van der Waals bonds, which facilitates the transfer of electrons during charge and discharge. The synergy in charge storage was confirmed by density functional theory computational analysis, which suggested favorable physisorption and interfacial electronic interactions for TPPS adsorbed to a CpLum-carbon substrate. The combined insights from experimental and computational characterizations show that superimposing redox-active organic layers can be an effective and sustainable approach to design and engineer the surface of carbonaceous materials for capacitive charge storage.

Video laryngoscope versus USB borescope-aided endotracheal intubation in adults with anticipated difficult airway: a prospective randomized controlled study.

BACKGROUND: Video laryngoscopes are approved equipment for difficult airway intubations. The borescope, which was introduced during the coronavirus disease 2019 (COVID-19) era, is placed over a direct laryngoscope blade to provide an economical video laryngoscope. In the current study, we investigated the use of an endotracheal tube mounted over a USB borescope versus a video laryngoscope in patients with suspected difficult airways. METHODS: After obtaining informed consent, 120 adult patients with suspected difficult airways undergoing elective surgery were included in this study. Patients were randomized into the USB borescope and video laryngoscope groups. The primary outcome was time to successful intubation. The secondary outcomes included hemodynamic changes, anesthetist's satisfaction, and the incidence of complications. RESULTS: Intubation time was comparable between the two groups (video laryngoscope: 30.63 s and borescope: 28.35 s; P = 0.166). However, the view was clearer (P = 0.026) and the incidence of fogging was lower (P = 0.015) with the video laryngoscope compared to the borescope. Conversely, anesthetist's satisfaction frequency was higher with the borescope than with the video laryngoscope (P < 0.001). CONCLUSIONS: The video laryngoscope provided a better view and less fogging with an intubation time that was comparable to that of the borescope; however, the higher cost of the video laryngoscope limits its availability. Therefore, the borescope is a low-cost, readily available device that can be used for intubating patients with potentially difficult airways.

Feasibility and efficacy of erector spinae plane block versus transversus abdominis plane block in laparoscopic bariatric surgery: a randomized comparative trial.

BACKGROUND: Overweight and obesity are growing public health concerns worldwide. Bariatric surgery is a modality of weight reduction; however, postoperative pain can increase the length of hospital stay, with all the associated consequences. While regional anesthesia is an available option, the feasibility of performing abdominal wall blocks on patients with obesity is questionable. METHODS: Sixty adult patients with a body mass index of 40-50 kg/m2 undergoing laparoscopic bariatric surgery were randomly assigned to receive either an ultrasound-guided transversus abdominis plane (TAP) or erector spinae plane (ESP) block. The primary outcome was the analgesic effect in the first 24 h postoperatively, assessed using the mean visual analog scale (VAS) score. Secondary outcomes were the time required for a successful block, incidence of complications, time to first rescue analgesia, time to flatus or stool passage, and total opioid consumption. RESULTS: The mean VAS score during the first 24 h was higher with the TAP block than with the ESP block (2.78 ± 0.34 vs. 2.32 ± 0.12, P < 0.001). Additionally, the time to first rescue analgesia was greater with the ESP block (P = 0.001) and the time required for a successful block was higher with the TAP block (P = 0.001). However, the incidence of complications, total opioid consumption, and other secondary outcomes was similar between the groups. CONCLUSIONS: Compared with the TAP block, the bilateral ESP block is a more feasible and effective method for intra- and postoperative analgesia in patients undergoing laparoscopic bariatric surgery.

Novel insights into the potential mechanisms underlying carbendazim-induced hepatorenal toxicity in rats.

Carbendazim (CBZ) is a common environmental pollutant that can contaminate food and water and severely damage human health. Some studies revealed the adverse effect of CBZ on different organs, but its detailed toxicity mechanism has not been elucidated yet. Thus, the present study aims to clarify the mechanisms of CBZ-induced hepatorenal toxicity in rats. Therefore, we partitioned 40 male Wistar rats into four groups (n = 10): a negative control group and three treatment groups, which received 100, 300, and 600 mg/kg of CBZ. All rats received the treatment daily by oral gavage. We collected blood and organ samples (liver and kidney) at 14 and 28 days postdosing. CBZ caused extensive pathological alterations in both the liver and kidneys, such as cellular degeneration and necrosis accompanied by severe inflammatory reactions in a dose- and time-dependent manner. All the CBZ-treated groups displayed strong tumor necrosis factor-α and nuclear factor-κB (NF-κB) immunopositivity. Additionally, CBZ dose-dependently elevated the alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, urea, and creatinine serum levels and reduced the serum albumin levels. Furthermore, CBZ-induced apoptosis, as indicated by the observed Bax gene upregulation and Bcl-2 gene downregulation in both organs. All these changes may be related to oxidative stress, as indicated by the increase in malondialdehyde levels and the decrease in total antioxidant capacity. Our results demonstrate that CBZ-induced dose- and time-dependent hepatorenal damage through oxidative stress, which activated both the NF-κB signaling pathway and Bcl-based programmed cell death.

Understanding Cardiology Practitioners' Interpretations of Electrocardiograms: An Eye-Tracking Study.

BACKGROUND: Visual expertise refers to advanced visual skills demonstrated when performing domain-specific visual tasks. Prior research has emphasized the fact that medical experts rely on such perceptual pattern-recognition skills when interpreting medical images, particularly in the field of electrocardiogram (ECG) interpretation. Analyzing and modeling cardiology practitioners' visual behavior across different levels of expertise in the health care sector is crucial. Namely, understanding such acquirable visual skills may help train less experienced clinicians to interpret ECGs accurately. OBJECTIVE: This study aims to quantify and analyze through the use of eye-tracking technology differences in the visual behavior and methodological practices for different expertise levels of cardiology practitioners such as medical students, cardiology nurses, technicians, fellows, and consultants when interpreting several types of ECGs. METHODS: A total of 63 participants with different levels of clinical expertise took part in an eye-tracking study that consisted of interpreting 10 ECGs with different cardiac abnormalities. A counterbalanced within-subjects design was used with one independent variable consisting of the expertise level of the cardiology practitioners and two dependent variables of eye-tracking metrics (fixations count and fixation revisitations). The eye movements data revealed by specific visual behaviors were analyzed according to the accuracy of interpretation and the frequency with which interpreters visited different parts/leads on a standard 12-lead ECG. In addition, the median and SD in the IQR for the fixations count and the mean and SD for the ECG lead revisitations were calculated. RESULTS: Accuracy of interpretation ranged between 98% among consultants, 87% among fellows, 70% among technicians, 63% among nurses, and finally 52% among medical students. The results of the eye fixations count, and eye fixation revisitations indicate that the less experienced cardiology practitioners need to interpret several ECG leads more carefully before making any decision. However, more experienced cardiology practitioners rely on their skills to recognize the visual signal patterns of different cardiac abnormalities, providing an accurate ECG interpretation. CONCLUSIONS: The results show that visual expertise for ECG interpretation is linked to the practitioner's role within the health care system and the number of years of practical experience interpreting ECGs. Cardiology practitioners focus on different ECG leads and different waveform abnormalities according to their role in the health care sector and their expertise levels.