Comparing ChatGPT and a Single Anesthesiologist's Responses to Common Patient Questions: An Exploratory Cross-Sectional Survey of a Panel of Anesthesiologists.

Increased patient access to electronic medical records and resources has resulted in higher volumes of health-related questions posed to clinical staff, while physicians' rising clinical workloads have resulted in less time for comprehensive, thoughtful responses to patient questions. Artificial intelligence chatbots powered by large language models (LLMs) such as ChatGPT could help anesthesiologists efficiently respond to electronic patient inquiries, but their ability to do so is unclear. A cross-sectional exploratory survey-based study comprised of 100 anesthesia-related patient question/response sets based on two fictitious simple clinical scenarios was performed. Each question was answered by an independent board-certified anesthesiologist and ChatGPT (GPT-3.5 model, August 3, 2023 version). The responses were randomized and evaluated via survey by three blinded board-certified anesthesiologists for various quality and empathy measures. On a 5-point Likert scale, ChatGPT received similar overall quality ratings (4.2 vs. 4.1, p = .81) and significantly higher overall empathy ratings (3.7 vs. 3.4, p < .01) compared to the anesthesiologist. ChatGPT underperformed the anesthesiologist regarding rate of responses in agreement with scientific consensus (96.6% vs. 99.3%, p = .02) and possibility of harm (4.7% vs. 1.7%, p = .04), but performed similarly in other measures (percentage of responses with inappropriate/incorrect information (5.7% vs. 2.7%, p = .07) and missing information (10.0% vs. 7.0%, p = .19)). In conclusion, LLMs show great potential in healthcare, but additional improvement is needed to decrease the risk of patient harm and reduce the need for close physician oversight. Further research with more complex clinical scenarios, clinicians, and live patients is necessary to validate their role in healthcare.

Precision Anesthesia in 2050.

Over the last few decades, the field of anesthesia has advanced far beyond its humble beginnings. Today's anesthetics are better and safer than ever, thanks to innovations in drugs, monitors, equipment, and patient safety.1-4 At the same time, we remain limited by our herd approach to medicine. Each of our patients is unique, but health care today is based on a one-size-fits-all approach, while our patients grow older and more medically complex every year. By 2050, we believe that precision medicine will play a central role across all medical specialties, including anesthesia. In addition, we expect that health care and consumer technology will continually evolve to improve and simplify the interactions between patients, providers, and the health care system. As demonstrated by 2 hypothetical patient experiences, these advancements will enable more efficient and safe care, earlier and more accurate diagnoses, and truly personalized treatment plans.

Bald eagle mercury exposure varies with region and site elevation in New York, USA.

Freshwater fish in several regions of New York State (NYS) are known to contain concentrations of mercury (Hg) associated with negative health effects in wildlife and humans. We collected blood and breast feathers from bald eagle (Haliaeetus leucocephalus) nestlings throughout NYS, with an emphasis on the Catskill region to determine their exposure to Hg. We assessed whether habitat type (lake or river), region (Delaware-Catskill region vs. rest of NY) or sample site elevation influenced Hg concentrations in bald eagle breast feathers using ANCOVA. The model was significant and accounted for 41% of the variability in log10 breast feather Hg concentrations. Mercury concentrations in nestling breast feathers were significantly greater in the Delaware-Catskill Region (geometric mean: 14.5 µg/g dw) than in the rest of NY (7.4 µg/g, dw), and greater at nests located at higher elevations. Habitat type (river vs. lake) did not have a significant influence on breast feather Hg concentrations. Geometric mean blood Hg concentrations were significantly greater in Catskill nestlings (0.78 µg/g ww) than in those from the rest of NY (0.32 µg/g). Mercury concentrations in nestling breast feathers and especially blood samples from the Delaware-Catskill region were generally greater than those reported for most populations sampled elsewhere, including areas associated with significant Hg pollution problems. Bald eagles can serve as valuable Hg bioindicators in aquatic ecosystems of NYS, particularly given their broad statewide distribution and their tendency to nest across all major watersheds and different habitat types.

Conducting a team-based multi-sited focused ethnography in primary care.

Focused ethnography is an applied and pragmatic form of ethnography that explores a specific social phenomenon as it occurs in everyday life. Based on the literature a problem-focused research question is formulated before the data collection. The data generation process targets key informants and situations so that relevant results on the pre-defined topic can be obtained within a relatively short time-span. As part of a theory based evaluation of alternative forms of consultation (such as video, phone and email) in primary care we used the focused ethnographic method in a multisite study in general practice across the UK. To date there is a gap in the literature on using focused ethnography in healthcare research.The aim of the paper is to build on the various methodological approaches in health services research by presenting the challenges and benefits we encountered whilst conducing a focused ethnography in British primary care. Our considerations are clustered under three headings: constructing a shared understanding, dividing the tasks within the team, and the functioning of the focused ethnographers within the broader multi-disciplinary team.As a result of using this approach we experienced several advantages, like the ability to collect focused data in several settings simultaneously within in a short time-span. Also, the sharing of experiences and interpretations between the researchers contributed to a more holistic understanding of the research topic. However, mechanisms need to be in place to facilitate and synthesise the observations, guide the analysis, and to ensure that all researchers feel engaged. Reflection, trust and flexibility among the team members were crucial to successfully adopt a team focused ethnographic approach. When used for policy focussed applied healthcare research a team-based multi-sited focused ethnography can uncover practices and understandings that would not be apparent through surveys or interviews alone. If conducted with care, it can provide timely findings within the fast moving context of healthcare policy and research.

Maternal mood and neuroendocrine programming: effects of time of exposure and sex.

Adverse exposures that influence growth in prenatal and early postnatal periods are considered to influence vulnerability to chronic diseases via their effects on the neuroendocrine system. In humans, the assessment of the underlying mechanisms has been restricted. The present study aimed to investigate the effects of adverse early-life exposures, specifically maternal mood, on hypothlamic-pituitary-adrenal (HPA) axis, sympathetic nervous system (SNS) and parasympathetic nervous system (PNS) responses to an acute physiological stressor. In addition, we conducted a preliminary examination into whether these effects varied by time of exposure and sex. One hundred and thity-nine individuals (mean age 15.12 years) were recruited from the ALSPAC (Avon Longitudinal Study of Parents and Children) birth cohort. Participants underwent the CO(2) stress test and indices of the PNS, SNS and HPA axis were measured. Pre-existing data on demographic and psychosocial factors of the mothers during pregnancy (18 and 32 weeks) and postnatally (8 weeks and 8 months) were extracted, as were participants' clinical and demographic data at birth. Increases in both pre- and postnatal anxiety and depression were associated with greater SNS reactivity to the stressor and slower recovery, as well as blunted HPA axis responses. Programming effects on the SNS appeared to be restricted to male offspring only. No consistent relationships were evident for any of the measures of pre-stress function. We have found preliminary evidence that both pre- and postnatal maternal anxiety and depression have sustained programming effects on the SNS and HPA axis. Effects on the SNS were restricted to male offspring.

An investigation into the effects of social evaluation on cardiovascular and endocrine responses to the CO2 stress test in humans.

The present study examined whether social evaluation could heighten individuals' physiological responses to the CO(2) stress test, and the hypothalamic-pituitary-adrenal (HPA) response in particular. Twenty-five healthy volunteers undertook the CO(2) test under three conditions: (i) standard CO(2) protocol, (ii) standard CO(2) protocol conducted in front of a full-length mirror (mirror) and (iii) standard CO(2) protocol conducted in front of a video camera deemed to be transmitting live images of the procedure to investigators evaluating participant performance (video). Despite counterbalancing for task order, there were significant differences in anger and depression among the conditions. Repeated measures analysis of variances (ANOVAs), controlling for these mood indices, revealed that salivary cortisol, heart rate and systolic blood pressure responses to the CO(2) test were not affected by social evaluation (i.e. mirror or video). Although the data provide no evidence that endocrine and cardiovascular responses to the CO(2) test are affected by social evaluation, the potency of the social evaluation manipulation in this study is in question. Thus, further research is warranted which includes evidence of, or instructions suggesting negative social evaluation.

A preliminary investigation into whether attentional bias influences mood outcomes following emotional disclosure.

BACKGROUND: There is considerable interest in factors which may influence the efficacy of emotional disclosure. To date, a range of demographic and psychological variables have been considered. However, consideration has not yet been given to cognitive factors known to influence emotional processing such as attentional bias (AB). PURPOSE: We present the results from an exploratory study examining the role of AB in influencing mood outcomes following emotional disclosure. METHOD: Individuals with negative and avoidant ABs (i.e., individuals vigilant for and individuals avoidant of negative emotional material, respectively) were identified by asking 105 individuals to complete a standardized AB task. Individuals in the bottom quartile of AB scores were categorized as having a negative AB and individuals in the top quartile were categorized as having an avoidant AB. These participants (n = 38) completed the emotional disclosure intervention and mood was assessed at 1, 4, and 8 weeks post-intervention. RESULTS: Negative AB individuals showed greater improvements in depression, anger, fatigue, and total mood disturbance. These results were unrelated to alexithymia. CONCLUSION: These results provide preliminary support for the proposal that AB may influence the effects of emotional disclosure on mood.

Lumped parameter model for computing the minimum pressure during mechanical heart valve closure.

The cavitation inception threshold of mechanical heart valves has been shown to be highly variable. This is in part due to the random distribution of the initial and final conditions that characterize leaflet closure. While numerous hypotheses exist explaining the mechanisms of inception, no consistent scaling laws have been developed to describe this phenomenon due to the complex nature of these dynamic conditions. Thus in order to isolate and assess the impact of these varied conditions and mechanisms on inception, a system of ordinary differential equations is developed to describe each system component and solved numerically to predict the minimum pressure generated during valve closure. In addition, an experiment was conducted in a mock circulatory loop using an optically transparent size 29 bileaflet valve over a range of conditions to calibrate and validate this model under physiological conditions. High-speed video and high-response pressure measurements were obtained simultaneously to characterize the relationship between the valve motion, fluid motion, and negative pressure transients during closure. The simulation model was calibrated using data from a single closure cycle and then compared to other experimental flow conditions and to results found in the literature. The simulation showed good agreement with the closing dynamics and with the minimum pressure trends in the current experiment. Additionally, the simulation suggests that the variability observed experimentally (when using dP/dt alone as the primary measure of cavitation inception) is predictable. Overall, results from the current form of this lumped parameter model indicate that it is a good engineering assessment tool.

Dietary mercury exposure and bioaccumulation in amphibian larvae inhabiting Carolina bay wetlands.

Inorganic mercury and methylmercury concentrations were measured both in guts and remaining carcasses of southern leopard frog (Rana sphenocephala) larvae from 10 Carolina bay wetlands in South Carolina, USA. Significant variation among bays in methylmercury and inorganic mercury concentrations existed both in guts and carcasses. There was a moderate negative correlation between dissolved organic carbon concentration in bays and mean inorganic mercury concentrations in guts. There was also a weak positive correlation between pH in bays and mean methylmercury concentrations in carcasses. The ratio of methylmercury to inorganic mercury decreased with increasing total mercury concentration in guts and in larvae, but the rate of decrease was highly variable among bays. Ratios of concentrations in carcasses to concentrations in guts were inversely related to gut concentration. Mercury concentrations in carcasses in some bays were within the range of concentrations at which adverse effects have been observed in laboratory studies of R. sphenocephala.

Influence of methylmercury from tributary streams on mercury levels in Savannah River Asiatic clams.

Average methylmercury levels in five Savannah River tributary streams, sampled 11 times over 2 years (0.170 ng/l), were nearly twice as high as in the Savannah River (0.085 ng/l). Total mercury levels in the tributaries (2.98 ng/l) did not differ significantly from the river (2.59 ng/l). All of the tributaries drained extensive wetlands that would be expected to support comparatively high rates of methylation. Mercury concentrations in Asiatic clams (Corbicula fluminea) collected from the discharge plumes of Savannah River tributaries (average of 0.044 microg/g wet weight) were significantly (P<0.001) higher than in Asiatic clams collected from the Savannah River upstream from the tributary mouths (average of 0.017 microg/g wet weight). These results indicate that streams draining wetlands into coastal plain rivers can create localized areas of elevated methylmercury with resulting increases in the mercury levels of river biota.

Maternal sexuality during first pregnancy and after childbirth.

Information about sexual activity, enjoyment and libido was obtained at intervals from 119 primiparous women during a longitudinal survey of maternal emotional health in pregnancy and for a year after delivery. Most subjects described some reduction in the frequency of sexual intercourse and a diminution of libido and sexual enjoyment during pregnancy; this was most marked in the third trimester. After delivery, about a third of subjects had resumed intercourse by six weeks and nearly everyone had done so by three months. Nevertheless, 77% and 57% of the women were having intercourse less often at three and 12 months after delivery respectively, in comparison with the month before they became pregnant. Selected variables were examined for relationship with a low, or reduced frequency of intercourse and with a lack of enjoyment. Significant associations were found with aspects of maternal personality and childhood relationships, marital conflict, maternal depression, previous miscarriages, difficulties in conceiving and fears of harming the fetus. Nausea and vomiting during pregnancy, the mode of delivery and related obstetric and medical variables, breast-feeding and characteristics of the baby, did not appear to significantly influence maternal sexuality.