ChatGPT's performance before and after teaching in mass casualty incident triage.

Since its initial launching, ChatGPT has gained significant attention from the media, with many claiming that ChatGPT's arrival is a transformative milestone in the advancement of the AI revolution. Our aim was to assess the performance of ChatGPT before and after teaching the triage of mass casualty incidents by utilizing a validated questionnaire specifically designed for such scenarios. In addition, we compared the triage performance between ChatGPT and medical students. Our cross-sectional study employed a mixed-methods analysis to assess the performance of ChatGPT in mass casualty incident triage, pre- and post-teaching of Simple Triage And Rapid Treatment (START) triage. After teaching the START triage algorithm, ChatGPT scored an overall triage accuracy of 80%, with only 20% of cases being over-triaged. The mean accuracy of medical students on the same questionnaire yielded 64.3%. Qualitative analysis on pre-determined themes on 'walking-wounded', 'respiration', 'perfusion', and 'mental status' on ChatGPT showed similar performance in pre- and post-teaching of START triage. Additional themes on 'disclaimer', 'prediction', 'management plan', and 'assumption' were identified during the thematic analysis. ChatGPT exhibited promising results in effectively responding to mass casualty incident questionnaires. Nevertheless, additional research is necessary to ensure its safety and efficacy before clinical implementation.

Effects of mass casualty incidents on anxiety, depression and PTSD among doctors and nurses: a systematic review protocol.

INTRODUCTION: Both doctors and nurses showed a greater risk of being exposed to different mental health conditions following mass casualties. This systematic review aims to synthesise the existing evidence on the prevalence of anxiety, depression and post-traumatic stress disorder and their associated risk factors among doctors and nurses following mass casualty incidents. METHODS AND ANALYSIS: Seven electronic databases (PubMed, PsycINFO, MEDLINE Ovid, Embase, CINAHL, Web of Science and Nursing & Allied Health database) will be searched from 2010 to 2022 with peer-reviewed articles in English language using the predefined keywords. Two reviewers will independently screen the titles and abstracts, as well as review the full texts using the eligibility criteria, then extract data independently. The National Institutes of Health Quality Assessment Tools (NIH-QAT) for quantitative studies, the Critical Appraisal Skills Programme (CASP) Checklist for qualitative studies and the Mixed-Methods Appraisal Tool (MMAT) for mixed-method studies will be used to measure the quality appraisal of eligible studies. A third reviewer will resolve the discrepancies when the two reviewers cannot reach an agreement in any step. The result from the eligible studies will be described following narrative synthesis with the key characteristics and findings of the included studies, and meta-analysis will be performed, if applicable. ETHICS AND DISSEMINATION: This systematic review deals with existing published studies without any personally identifiable information of participants. Therefore, ethical approval from the research committee is not required. Findings from this review will be disseminated in peer-reviewed journals and presented at relevant international conferences. PROSPERO REGISTRATION NUMBER: CRD42023412852.

Availability and use of personal protective equipment in low- and middle-income countries during the COVID-19 pandemic.

BACKGROUND: Availability and appropriate use of personal protective equipment (PPE) is of particular importance in Low and Middle-Income countries (LMICs) where disease outbreaks other than COVID-19 are frequent and health workers are scarce. This study assesses the availability of necessary PPE items during the COVID-19 pandemic at health facilities in seven LMICs. METHODS: Data were collected using a rapid-cycle survey among 1554 health facilities in seven LMICs via phone-based surveys between August 2020 and December 2021. We gathered data on the availability of World Health Organization (WHO)-recommended PPE items and the use of items when examining patients suspected to be infected with COVID-19. We further investigated the implementation of service adaptation measures in a severe shortage of PPE. RESULTS: There were major deficiencies in PPE availability at health facilities. Almost 3 out of 10 health facilities reported a stock-out of medical masks on the survey day. Forty-six percent of facilities did not have respirator masks, and 16% did not have any gloves. We show that only 43% of health facilities had sufficient PPE to comply with WHO guidelines. Even when all items were available, healthcare workers treating COVID-19 suspected patients were reported to wear all the recommended equipment in only 61% of health facilities. We did not find a statistically significant difference in implementing service adaptation measures between facilities experiencing a severe shortage or not. CONCLUSION: After more than a year into the COVID-19 pandemic, the overall availability of PPE remained low in our sample of low and middle-income countries. Although essential, the availability of PPE did not guarantee the proper use of the equipment. The lack of PPE availability and improper use of available PPE enable preventable COVID-19 transmission in health facilities, leading to greater morbidity and mortality and risking the continuity of service delivery by healthcare workers.

Action of the plant-based essential oil-derived compound Taxol for improvising drought tolerance in Eucalyptus by modulating the VIT1 channel protein: a cutting-edge computational approach.

Background: Drought poses a significant threat to the growth and survival of woody plants, especially Eucalyptus grandis, which is known for its slow and steady growth. Understanding the physiological and molecular responses of E. grandis to abiotic stress is essential for developing strategies to improve its drought resistance. This study focuses on the potential vulnerability of E. grandis during the initial months of root system proliferation and investigates the role of the essential oil-derived compound Taxol in enhancing its drought resistance. Methodology: A comprehensive analysis was performed on various aspects of E. grandis, including morphological features, photosynthetic rates, pigment concentrations, nitrogenous components, and lipid peroxidation. Furthermore, the study examined the accumulation of soluble carbohydrates, proline, and antioxidant enzymes as part of the tree's response to drought stress. Molecular docking and molecular dynamics simulations were conducted to determine the binding affinity of Taxol, an essential oil derived from Taxus brevifolia, with the VIT1 protein in E. grandis. Results: E. grandis displayed remarkable resilience to drought by accumulating vast reserves of soluble carbohydrates, proline, and antioxidant enzymes. The essential oil-derived compound Taxol exhibited a strong binding affinity with the VIT1 protein (-10.23 kcal/mol), suggesting its potential role in enhancing the tree's drought resistance. Conclusion: This study reveals the pivotal role of Taxol in augmenting the resilience of E. grandis against drought stress and improving its therapeutic oil properties. Emphasizing the tree's inherent tolerance during its susceptible early stages is crucial in promoting sustainable agriculture and forestry practices. The findings underscore the importance of advanced scientific research in uncovering the concealed capabilities of robust trees like E. grandis as we continue our pursuit of a sustainable future.

Family resilience and neighborhood factors affect the association between digital media use and mental health among children: does sleep mediate the association?

The associations between digital media use and mental well-being among children and adolescents have been inconclusive. We examined (i) the associations between digital media use and mental health outcomes, anxiety, depression, and ADHD, (ii) whether family resilience and neighborhood factors attenuate the associations, and (iii) whether sleep mediates these associations. We used the National Survey of Children's Health data from 2019 to 2020. A total of 45,989 children's (6-17 years) data were analyzed in this study. Multivariate logistic regression was used to assess the associations between digital media use and anxiety, depression, and ADHD. Path models and Paramed command in STATA were used to test the role of sleep as a mediator of these associations. The prevalence of heavy digital media users (who spent 4 or more hours per day) among the analytic sample was 30.52%, whereas anxiety was 13.81%, depression was 5.93%, and ADHD was 12.41%. Children in the heavy media user group had 63% increased odds of anxiety (95% CI: 1.32-2.01) and 99% increased odds of depression (95% CI: 1.35-2.94) after adjusting for sociodemographic factors, compared to the children in light media user group (who spent < 2 h per day), and these relations were significant at 0.01 level. However, family resilience and community factors significantly attenuated the effect of digital media use on anxiety and depression. Sleep did not mediate the associations between digital media use and anxiety or depression.   Conclusions: Family resilience and neighborhood factors protect against the harmful effects of digital media use. Further research is needed to examine the relationships of media contents, the presence of electronic devices in bedrooms, and sleep quality with mental health. What is Known: • Spending long hours on digital media may adversely affect children and adolescents' health and development. However, the mediating role of sleep in the association between digital media use and mental health outcomes is inconclusive. What is New: • Digital media use has detrimental effects on anxiety and depression. However, family resilience and neighborhood factors attenuated the association. The study highlights the importance of positive family functioning and neighborhood conditions reducing the harmful effects of digital media use.

Healthcare utilization and maternal and child mortality during the COVID-19 pandemic in 18 low- and middle-income countries: An interrupted time-series analysis with mathematical modeling of administrative data.

BACKGROUND: The Coronavirus Disease 2019 (COVID-19) pandemic has had wide-reaching direct and indirect impacts on population health. In low- and middle-income countries, these impacts can halt progress toward reducing maternal and child mortality. This study estimates changes in health services utilization during the pandemic and the associated consequences for maternal, neonatal, and child mortality. METHODS AND FINDINGS: Data on service utilization from January 2018 to June 2021 were extracted from health management information systems of 18 low- and lower-middle-income countries (Afghanistan, Bangladesh, Cameroon, Democratic Republic of the Congo (DRC), Ethiopia, Ghana, Guinea, Haiti, Kenya, Liberia, Madagascar, Malawi, Mali, Nigeria, Senegal, Sierra Leone, Somalia, and Uganda). An interrupted time-series design was used to estimate the percent change in the volumes of outpatient consultations and maternal and child health services delivered during the pandemic compared to projected volumes based on prepandemic trends. The Lives Saved Tool mathematical model was used to project the impact of the service utilization disruptions on child and maternal mortality. In addition, the estimated monthly disruptions were also correlated to the monthly number of COVID-19 deaths officially reported, time since the start of the pandemic, and relative severity of mobility restrictions. Across the 18 countries, we estimate an average decline in OPD volume of 13.1% and average declines of 2.6% to 4.6% for maternal and child services. We projected that decreases in essential health service utilization between March 2020 and June 2021 were associated with 113,962 excess deaths (110,686 children under 5, and 3,276 mothers), representing 3.6% and 1.5% increases in child and maternal mortality, respectively. This excess mortality is associated with the decline in utilization of the essential health services included in the analysis, but the utilization shortfalls vary substantially between countries, health services, and over time. The largest disruptions, associated with 27.5% of the excess deaths, occurred during the second quarter of 2020, regardless of whether countries reported the highest rate of COVID-19-related mortality during the same months. There is a significant relationship between the magnitude of service disruptions and the stringency of mobility restrictions. The study is limited by the extent to which administrative data, which varies in quality across countries, can accurately capture the changes in service coverage in the population. CONCLUSIONS: Declines in healthcare utilization during the COVID-19 pandemic amplified the pandemic's harmful impacts on health outcomes and threaten to reverse gains in reducing maternal and child mortality. As efforts and resource allocation toward prevention and treatment of COVID-19 continue, essential health services must be maintained, particularly in low- and middle-income countries.

Associations of forms of intimate partner violence with low birth weight in India: findings from a population-based Survey.

BACKGROUND: Many studies report a significant association between a lifetime measure of intimate partner violence (IPV) and low birth weight (LBW) in low-income and economically developed countries. However, it remains relatively unclear how different forms of IPV affect LBW in low-income countries. This study examines the associations of various forms of IPV with two measures of birth outcomes - LBW and birth weight in India. METHODS: This study used the National Family Health Survey (NFHS-4) 2015-2016 data of India. The analysis included 11,423 women aged 15-49 years. Using both logistic and linear regression analyses, we assessed the associations of various forms of IPV with binary and continuous measures of birth weight. The analysis controlled for several potential covariates. RESULTS: In fully-adjusted regression models, women who experienced any IPV, compared to those who had not experienced any IPV, were 1.19 times (95% CI: 1.02-1.37) as likely to give birth to an LBW baby. Compared to those who had not experienced any physical violence (PV), women who experienced any PV were 1.16 times (95% CI: 1.00-1.35) as likely to have an LBW baby. Moreover, compared to those who had not experienced any emotional violence (EV), women who experienced any EV were 1.29 times (95% CI: 1.06-1.56) as likely to have LBW babies. Linear regression analysis found that any IPV exposure was associated with a significant decrease in birth weight in the fully-adjusted model (b = -32.39; 95% CI: -63.39 to -1.73). Further, experience of any PV (b = -28.40; 95% CI: -60.13 to 3.36) and any EV (b = -51.69; 95% CI: -93.97 to -9.42) appear to be negatively associated with a continuous measure of birth weight. CONCLUSION: Findings have implications for public health policies and interventions that protect women from exposure to intimate partner violence for ensuring better maternal health and birth outcomes.

Parenting stress and family resilience affect the association of adverse childhood experiences with children's mental health and attention-deficit/hyperactivity disorder.

INTRODUCTION: Exposure to adverse childhood experience (ACE) has harmful consequences for children's health and well-being. However, it is less clear how different social processes may amplify or mitigate the effects of ACE on children's mental health. We examined how parenting stress mediates and family resilience moderates the associations of ACE with children's mental health and attention-deficit/hyperactivity disorder (ADHD) outcomes. METHODS: This secondary data analysis included 44,684 children aged 6-17 years from the 2016-17 National Survey of Children's Health (NSCH). Logistic regression with survey weights was used to account for the complex survey design and obtain odds ratios (OR) and 95% CI adjusted for sociodemographics. RESULTS: Overall, 7.3% of children had any mental health condition and 10.4% had ADHD. A higher ACE score (per 1-unit increase) was associated with a higher prevalence of any mental health condition (OR = 1.33, 95% CI: 1.27-1.40) and ADHD (OR = 1.21; 95% CI: 1.15-1.27) after adjustment for sociodemographics. Parenting stress mediated 57% of the total effect of ACE on any mental health condition and 60% of the total effect of ACE on ADHD diagnosis. The effect of ACE on mental health and ADHD outcomes was stronger among children with low levels of family resilience and connection index (FRCI) than among those with higher levels of FRCI. CONCLUSIONS: Parenting stress may be a potential mechanism through which ACE impacts a child's mental health and behavioral outcomes. Family resilience can lessen the impact of ACE on children's mental health and behavioral disorders.

Early termination of immune tolerance state of hepatitis B virus infection explains liver damage.

AIM: To assess an early termination of immune tolerance state of chronic hepatitis B virus infection in Bangladesh and its clinical significance. METHODS: From a series of 167 treatment-naive chronic hepatitis B patients aged between 12 to 20 years (mean ± SD; 17.5 ± 2.8 years), percutaneous liver biopsies of 89 patients who were all hepatitis B e antigen negative at presentation were done. Of them, 81 were included in the study. They had persistently normal or raised serum alanine aminotransferase (ALT) values. A precore mutation (PCM) study was accomplished in 8 patients who were randomly selected. RESULTS: Forty-four (53.7%) patients had significant necroinflammation (HAI-NI > 7), while significant fibrosis (HAI-F ≥ 3) was seen in 15 (18.5%) patients. Serum ALT (cut off 42 U/L) was raised in 29 (35.8%) patients, while low HBV DNA load (< 10(5) copies/mL) was observed in 57 (70.4%) patients. PCM was negative in all 8 patients. CONCLUSION: This study indicates that the current concept of age-related immune tolerance state of HBV infection deserves further analyses in different population groups.

Combination therapy with antiviral drugs and hepatitis B vaccine in incidentally-detected and asymptomatic chronic hepatitis virus B carriers at Bangladesh.

Abstract Asymptomatic chronic hepatitis B virus (HBV) carriers are at risk of developing complications of liver disease, but these patients are not recommended for treatment with antiviral drugs. In fact, antiviral drugs are ineffective in these patients in the immune tolerance phase, when they have inadequate levels of host immunity. We postulated that combination therapy of an immune modulator and antiviral drugs may have potential to help these patients. Twenty-five patients with incidentally-detected asymptomatic chronic HBV were immunized with hepatitis B vaccine (10 microg of hepatitis B surface antigen) intramuscularly five times (at 0, 1, 2, 6, and 12 mo) to induce HBV-specific immunity. The patients were also treated with lamivudine (100 mg) daily for 12 mo. The combination therapy was safe for all patients with asymptomatic chronic HBV, and no increases in alanine aminotransferase or liver damage were detected in any patient. Although all of the patients were expressing HBV DNA in their serum before treatment, HBV DNA became undetectable in 16 of 25 patients, and was reduced in 9 of 25 patients at the end of the combination therapy. Combination therapy with the antiviral agent lamivudine and an immune modulator (hepatitis B vaccine) represents a potential therapeutic option for the control of HBV without liver damage in asymptomatic chronic HBV carriers.

Effects of dissolved gases and pH on sonolysis of 2,4-dichlorophenol.

Ultrasonic degradation of 2,4-dichlorophenol (2,4-DCP) has been studied under oxygen, air, argon, and nitrogen in aqueous solutions for a liquid temperature of 20 degrees C at 489 kHz. The degradation rate increases significantly in the presence of O2, and argon, whereas it remains the lowest under nitrogen, for which a competitive reaction model has been proposed for its non-exponential decay. Experiments have been also performed at three different pHs, 11.0, 6.3, and 2.0. The significant degradation has been achieved at pH 6.3 under O2 (0.86 x 10(-3) s(-1)), which is 1.9 and 4 times higher than acidic (pH 2.0), and basic (pH 11.0) conditions, respectively. The degradation rates have decreased in the order O2 > Ar > air > N2 irrespective of pH.