Evaluation of Rhinoplasty Information from ChatGPT, Gemini, and Claude for Readability and Accuracy.

OBJECTIVE: Assessment of the readability, accuracy, quality, and completeness of ChatGPT (Open AI, San Francisco, CA), Gemini (Google, Mountain View, CA), and Claude (Anthropic, San Francisco, CA) responses to common questions about rhinoplasty. METHODS: Ten questions commonly encountered in the senior author's (SPM) rhinoplasty practice were presented to ChatGPT-4, Gemini and Claude. Seven Facial Plastic and Reconstructive Surgeons with experience in rhinoplasty were asked to evaluate these responses for accuracy, quality, completeness, relevance, and use of medical jargon on a Likert scale. The responses were also evaluated using several readability indices. RESULTS: ChatGPT achieved significantly higher evaluator scores for accuracy, and overall quality but scored significantly lower on completeness compared to Gemini and Claude. All three chatbot responses to the ten questions were rated as neutral to incomplete. All three chatbots were found to use medical jargon and scored at a college reading level for readability scores. CONCLUSIONS: Rhinoplasty surgeons should be aware that the medical information found on chatbot platforms is incomplete and still needs to be scrutinized for accuracy. However, the technology does have potential for use in healthcare education by training it on evidence-based recommendations and improving readability. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Influence of acute heat mitigation strategies on core temperature, heart rate and aerobic performance in females: A systematic literature review.

This review examined the effect of acute heat mitigation strategies on physiological strain and exercise performance in females exercising in the heat. Three databases were searched for original research with an acute heat mitigation (intervention) and control strategy in active females and reporting core temperature, heart rate and/or aerobic exercise performance/capacity with ≥ 24°C wet bulb globe temperature. Hedges' g effect sizes were calculated to evaluate outcomes. Thirteen studies (n = 118) were included. Most studies that applied an acute heat mitigation strategy to females did not reduce thermal (9/10) or cardiovascular (6/6) strain or improve exercise performance/capacity (8/10). The most effective strategies for attenuating thermal strain were pre-cooling with ice-slurry (effect size = -2.2 [95% CI, -3.2, -1.1]) and ice-vests (-1.9 [-2.7, -1.1]), and pre- and per-cooling with an ice-vest (-1.8 [-2.9, -0.7]). Only pre-cooling with an ice-vest improved running performance (-1.8 [-2.9, -0.7]; ~0.43 min) whilst sodium hyperhydration improved cycling capacity at 70% V O2peak (0.8 [0.0, 1.6]; ~20.1 min). There is currently limited research on acute heat mitigation strategies in females, so the evidence for the efficacy is scarce. Some studies show beneficial effects with ice-slurry, ice-vests and sodium hyperhydration, which can guide future research to support female exercise performance in the heat.

An Overview of Traditional and Novel Tools to Assess Diet.

Effective dietary interventions are vital for combating morbidity and mortality, necessitating reliable assessment tools. This article explores diverse dietary assessment methods, emphasizing their complexities and applications. Food Frequency Questionnaires (FFQs) offer insights into dietary habits over specified periods but require validation for target populations. Traditional Food Records provide detailed insights but are labor-intensive and prone to underreporting. Technology-based and technology-assisted records offer efficient alternatives, leveraging mobile apps and wearable sensors, albeit with access and privacy concerns. 24 hour Dietary Recall (24HR) methods capture detailed intake within a day, with traditional and technology-assisted approaches strengthening population studies. The Automated Multi-Pass Method (AMPM) and technology-assisted ASA24 represent traditional and contemporary 24HR methodologies, respectively, both yielding comprehensive dietary data. In conclusion, dietary assessments are crucial for understanding dietary patterns and health implications. Integration of novel technologies streamlines data collection and analysis, enhancing researchers' ability to accurately gauge short- and long-term dietary impacts. Proper utilization of these tools empowers researchers to make informed decisions regarding dietary interventions and public health initiatives.

Postoperative Pain and Perioperative Antibiotic Management in Functional Rhinoplasty.

Post-rhinoplasty pain control should use a multimodal regimen. Evidence suggests decreasing routine prescriptions of narcotics is reasonable for most individuals, and acetaminophen and nonsteroidal antiinflammatory drug combinations may be equivalent to as-needed opioids for postsurgical pain management. Preoperative pain counseling is important to set post-rhinoplasty pain expectations and reduce opioid use. A single intravenous dose of prophylactic antibiotics before incision is sufficient for most cases of functional rhinoplasty. Additional considerations are given to complex revision cases, use of allogenic grafts or implants, external osteotomies, or patients with immunosuppression or at risk of endocarditis.

Evaluation and Management of Lateral Wall Insufficiency.

Successful treatment of nasal airway obstruction depends on accurate diagnosis of the underlying etiology. Lateral wall insufficiency (LWI) is a common cause of obstructed nasal breathing and should be recognized and treated accordingly by the rhinoplasty surgeon. LWI refers to dynamic collapse of the lateral nasal sidewalls at the internal (zone 1) and external (zone 2) nasal valves. This article serves as an overview of the important aspects in evaluation and management of LWI.

Stage IC grade 1 endometrioid adenocarcinoma of the ovary: assessment of post-operative chemotherapy de-escalation.

OBJECTIVE: Given limited real-world practice data evaluating the National Comprehensive Cancer Network clinical practice guidelines for possible post-operative chemotherapy omission as a treatment option for patients with stage IC grade 1 endometrioid ovarian carcinoma, this population-based study examined the association between post-operative chemotherapy and overall survival in this tumor group. METHODS: The National Cancer Institute's Surveillance, Epidemiology, and End Results program was retrospectively queried. The study population was 1207 patients with stage IC grade 1-3 endometrioid ovarian carcinoma who received primary cancer-directed surgery from 2007 to 2020. Overall survival was assessed with multivariable Cox proportional hazard regression model. RESULTS: The median age was 52, 54, and 55 years for grade 1, 2, and 3 groups, respectively (p=0.02). Grade 1 and 2 tumors were more common than grade 3 tumors (n=508 (42.1%), n=493 (40.8%), and n=206 (17.1%), respectively). Chemotherapy use rate for grade 1 tumors was lower compared with grade 2-3 tumors (67.9%, 76.5%, and 78.6%, respectively, p<0.001). When nodal evaluation was performed for grade 1 tumors, among patients who did not receive post-operative chemotherapy and among those who did, 5-year overall survival rate exceeded 90% (93.3% and 96.0%, respectively), with statistically non-significant hazard estimates (adjusted hazard ratio (aHR) 1.54, 95% CI 0.63 to 3.73). In contrast, post-operative chemotherapy omission for patients who did not undergo nodal evaluation was associated with decreased overall survival (5-year rates 82.3% vs 96.0%, aHR 5.41, 95% CI 1.95 to 15.06). Results were similar for node-evaluated grade 2 tumors (5-year overall survival rates, 94.6% and 94.4% for node-evaluated post-operative chemotherapy omission and administration, respectively), but not in grade 3 tumors. CONCLUSION: The results of this population-based study may partially support the current clinical practice guidelines for post-operative chemotherapy omission as a possible option for patients with stage IC grade 1 endometrioid adenocarcinoma of the ovary for those who had lymph node evaluation. Observed data were also supportive for node-evaluated grade 2 tumors, warranting further evaluation.

Myocarditis, Myositis, and Myasthenia Gravis Overlap Syndrome Associated with Immune Checkpoint Inhibitors: A Systematic Review.

Immune checkpoint inhibitors (ICIs) have significantly transformed cancer treatment, but their use is linked to immune-related adverse events (irAEs), including the rare ICI-associated myocarditis, myositis, and myasthenia gravis (MMM) overlap syndrome. This systematic review aims to highlight MMM's clinical implications in emergency departments. PubMed and Embase were searched using a specific search strategy. Reports were eligible for inclusion if all three conditions were present and associated with the use of an ICI. Data were extracted by independent reviewers using the Rayyan web application for systematic reviews. Descriptive statistics and qualitative synthesis were used to summarize demographic, clinical, and treatment data for the reported cases. Among 50 cases, predominantly associated with melanoma, lung cancer, and renal cancer, the in-hospital mortality rate was 38.0%. The most commonly presenting symptoms were ptosis (58%), dyspnea (48%), diplopia (42%), or myalgia (36%). The median time from ICI initiation to MMM presentation was 21 days (interquartile range: 15-28 days). Corticosteroids were the primary treatment for the irAEs. MMM, a rare but potentially fatal complication of ICI therapy, requires prompt recognition in emergency settings. Corticosteroids should be initiated if suspected, without waiting for confirmation. Multidisciplinary collaboration is vital for diagnosis and treatment planning. Research on MMM's link to specific cancers and ICIs is imperative for better risk assessment and interventions.

AOP Report: An Upstream Network for Reduced Androgen Signaling Leading to Altered Gene Expression of Androgen Receptor-Responsive Genes in Target Tissues.

Adverse outcome pathways (AOPs) can aid with chemical risk assessment by providing plausible links between chemical activity at the molecular level and effect outcomes in intact organisms. Because AOPs can be used to infer causality between upstream and downstream events in toxicological pathways, the AOP framework can also facilitate increased uptake of alternative methods and new approach methodologies to help inform hazard identification. However, a prevailing challenge is the limited number of fully developed and endorsed AOPs, primarily due to the substantial amount of work required by AOP developers and reviewers. Consequently, a more pragmatic approach to AOP development has been proposed where smaller units of knowledge are developed and reviewed independent of full AOPs. In this context, we have developed an upstream network comprising key events (KEs) and KE relationships related to decreased androgen signaling, converging at a nodal KE that can branch out to numerous adverse outcomes (AOs) relevant to androgen-sensitive toxicological pathways. Androgen signaling represents an extensively studied pathway for endocrine disruption. It is linked to numerous disease outcomes and can be affected by many different endocrine-disrupting chemicals. Still, pathways related to disrupted androgen signaling remain underrepresented in the AOP-wiki, and endorsed AOPs are lacking. Given the pivotal role of androgen signaling in development and function across vertebrate taxa and life stages of both sexes, this upstream AOP network serves as a foundational element for developing numerous AOPs. By connecting the upstream network with various downstream AOs, encompassing different species, it can also facilitate cross-species extrapolations for hazard and risk assessment of chemicals. Environ Toxicol Chem 2024;00:1-9. © 2024 The Author(s). Environmental Toxicology and Chemistry published by Wiley Periodicals LLC on behalf of SETAC.

Put the Vanc Down, Flip It and Reverse It: Comparison of Vancomycin and Daptomycin Health Care Utilization and Cost in Outpatient Parenteral Antimicrobial Therapy.

Vancomycin and daptomycin are frequently used in outpatient parenteral antimicrobial therapy (OPAT). We analyze health care utilization and cost to the health care system for vancomycin vs daptomycin in the outpatient setting and find that vancomycin results in significantly higher health care utilization and similar cost per course compared with daptomycin in OPAT.

Methodology for developing data-rich Key Event Relationships for Adverse Outcome Pathways exemplified by linking decreased androgen receptor activity with decreased anogenital distance.

The Adverse Outcome Pathway (AOP) framework has gained widespread acceptance in toxicological disciplines as a tool for aiding chemical hazard assessment. Despite increased activity in AOP development, progress towards a high volume of fully endorsed AOPs has been slow, partly due to the challenging task of constructing complete AOPs according to the AOP Developer's Handbook. To facilitate greater uptake of new knowledge units onto the open-source AOP-wiki platform, a pragmatic approach was recently proposed. This approach involves considering Key Event Relationships (KERs) for individual development through systematic approaches, as they represent essential units of knowledge from which causality can be inferred; from low complexity test data to adverse outcomes in intact organisms. However, more broadly adopted harmonized methodologies for KER development would be desirable. Using the AOP Developer's Handbook as a guide, a KER linking 'decreased androgen receptor (AR) activity' with 'reduced anogenital distance (AGD)' was developed to demonstrate a methodology applicable for future developments of KERs requiring systematic literature retrieval approaches.

Outcomes of Micropulse Transscleral Cyclophotocoagulation in Uveitic Glaucoma.

PURPOSE: To report a case series of patients with uveitic glaucoma who were treated with micropulse transscleral cyclophotocoagulation (mpCPC). METHODS: This retrospective case series consists of patients from the University of Colorado Sue Anschutz-Rodgers Eye Center from 2015 to 2020 who were diagnosed with uveitic glaucoma. Information collected includes demographic data, type of uveitis, glaucoma severity, and prior glaucoma surgeries. Pre- and postoperative best corrected visual acuity, intraocular pressure (IOP), glaucoma medications, degree of inflammation, and uveitis therapies were included up to 36 months postoperatively. Surgical success was defined as an IOP reduction of 30% with achievement of IOP goal using the same number of glaucoma medications or less at 6 months or 1 year. Uveitis success was defined as the absence of persistent anterior uveitis at 3 months. RESULTS: Six patients and seven eyes with uveitic glaucoma underwent mpCPC. Types of uveitis included idiopathic anterior uveitis, HLA-B27-associated anterior uveitis, varicella zoster virus anterior uveitis, juvenile idiopathic arthritis-associated chronic anterior uveitis, lichen planus-associated intermediate uveitis, and sarcoidosis-associated panuveitis. Two of six eyes (33.3%) at 6 months and three of five eyes (60%) at 1 year achieved surgical success. Around 6 months postoperatively, two out of seven eyes (28.6%) required Ahmed glaucoma valve placement (n = 1) or repeat mpCPC (n = 1). One eye (14.3%) required phacoemulsification with goniotomy followed by an Ahmed glaucoma valve 18 months after mpCPC. There were no cases of persistent anterior uveitis, hypotony, or phthisis after mpCPC in this cohort. CONCLUSIONS: Micropulse transscleral cyclophotocoagulation may safely reduce intraocular pressure in some patients with uveitic glaucoma without exacerbation of intraocular inflammation. Multiple treatments may be required to achieve longer-term success.

An Overview on the Management of Atrophic Acne Scars: The Role of Trifarotene as an Adjunct.

Acne vulgaris is a common, often chronic inflammatory disease that can affect all ages and skin tones. Beyond acute lesions, the sequelae of acne - specifically scarring and dyspigmentation - can be long-lasting, challenging to treat and have substantial psychosocial impact on affected individuals. For acne scarring, treatment modalities include topical, physical, and laser and light therapies, with combination approaches typically yielding optimal outcomes. Trifarotene is a novel fourth generation retinoid with targeted action towards retinoid acid receptor gamma (RAR-γ), the most common isotype found in the epidermis, that has previously been approved for the management of moderate-to-severe facial and truncal acne in individuals over the age of 12 years. Recently, data on trifarotene supports its application in acne scarring. Herein, we provide a succinct review on various treatments for acne scarring and explore how trifarotene and its mechanism of action present an additional topical approach to target atrophic acne scarring.

Bcl-2 Up-Regulation Mediates Taxane Resistance Downstream of APC Loss.

Triple-negative breast cancer (TNBC) patients are treated with traditional chemotherapy, such as the taxane class of drugs. One such drug, paclitaxel (PTX), can be effective in treating TNBC; however, many tumors will develop drug resistance, which can lead to recurrence. In order to improve patient outcomes and survival, there lies a critical need to understand the mechanism behind drug resistance. Our lab made the novel observation that decreased expression of the Adenomatous Polyposis Coli (APC) tumor suppressor using shRNA caused PTX resistance in the human TNBC cell line MDA-MB-157. In cells lacking APC, induction of apoptosis by PTX was decreased, which was measured through cleaved caspase 3 and annexin/PI staining. The current study demonstrates that CRISPR-mediated APC knockout in two other TNBC lines, MDA-MB-231 and SUM159, leads to PTX resistance. In addition, the cellular consequences and molecular mechanisms behind APC-mediated PTX response have been investigated through analysis of the BCL-2 family of proteins. We found a significant increase in the tumor-initiating cell population and increased expression of the pro-survival family member Bcl-2, which is widely known for its oncogenic behavior. ABT-199 (Venetoclax), is a BH3 mimetic that specifically targets Bcl-2. ABT-199 has been used as a single or combination therapy in multiple hematologic malignancies and has shown promise in multiple subtypes of breast cancer. To address the hypothesis that APC-induced Bcl-2 increase is responsible for PTX resistance, we combined treatment of PTX and ABT-199. This combination treatment of CRISPR-mediated APC knockout MDA-MB-231 cells resulted in alterations in apoptosis, suggesting that Bcl-2 inhibition restores PTX sensitivity in APC knockout breast cancer cells. Our studies are the first to show that Bcl-2 functional inhibition restores PTX sensitivity in APC mutant breast cancer cells. These studies are critical to advance better treatment regimens in patients with TNBC.

Surgical complications in combined rhinoplasty and endoscopic sinus surgery.

KEY POINTS: Complications in combined surgery are equivalent to ESS but are higher than rhinoplasty alone. The most common complications are pneumonia, stroke, and epistaxis. Rhinoplasty surgeries with graft use have a higher risk of complications.

Testing the model of judicial stress using a COVID-era survey of U.S. federal court personnel.

Non-judicial court personnel, critical to a well-functioning justice system, experience overloaded dockets and the responsibility of making significant decisions, contributing to cognitive stress. Understanding and mitigating their stress is essential for maintaining judicial efficiency. We adapted Miller and Richardson's Model of Judicial Stress to assess stress in a broad sample of non-judicial court personnel (n = 122), including judges, lawyers, and administrative staff. Participants responded to surveys about their stress levels, job performance, and health; they also completed cognitive performance tasks. The findings indicated that stress negatively affected employee outcomes including cognitive performance, job performance, job satisfaction, and health outcomes. Notably, perceived job performance had declined compared to the previous year, suggesting that the pandemic was an additional significant stressor. Based on the data, the Model of Judicial Stress is also applicable to other types of courtroom personnel, underlining its relevance across various judicial roles.

HPLC Method for Better Separation of THC Isomers to Ensure Safety and Compliance in the Hemp Market.

The 2018 Farm Bill dictates that delta-9-tetrahydrocannabinol (Δ9-THC) concentrations must not exceed 0.3% in hemp and hemp-derived products in order to be "compliant." This narrow margin of error necessitates very precise testing methods throughout every facet of the hemp industry. Though gas chromatography has become the industry's gold standard, many hemp laboratories still use high-performance liquid chromatography (HPLC) to quantify cannabinoids, and thus there exists a need for HPLC methods that can separate delta-8-tetrahydrocannabinol (Δ8-THC) and Δ9-THC-a notoriously difficult task. This article details one such method, while simultaneously acknowledging the inevitable limits of using HPLC to separate cannabinoids. The method was also used to test Δ8-THC samples that were marketed as compliant, and it was found that all of the samples contained well over 0.3% Δ9-THC. The use of refined testing methodologies is crucial for hemp companies to ensure compliance, prevent adverse health effects, and provide consumers with accurate cannabinoid profiles of the products that they purchase.

NowIKnowMyABCD: A global resource hub for researchers using data from the ABCD Study.

The Adolescent Brain and Cognitive Development (ABCD) Study, involving over 11,000 youth and their families, is a groundbreaking project examining various factors impacting brain and cognitive development. Despite yielding hundreds of publications and counting, the ABCD Study has lacked a centralized help platform to assist researchers in navigating and analyzing the extensive ABCD dataset. To support the ABCD research community, we created NowIKnowMyABCD, the first centralized documentation and communication resource publicly available to researchers using ABCD Study data. It consists of two core elements: a user-focused website and a moderated discussion board. The website serves as a repository for ABCD-related resources, tutorials, and a live feed of relevant updates and queries sourced from social media websites. The discussion board offers a platform for researchers to seek guidance, troubleshoot issues, and engage with peers. Our aim is for NowIKnowMyABCD to grow with participation from the ABCD research community, fostering transparency, collaboration, and adherence to open science principles.

Visual looming is a primitive for human emotion.

The neural computations for looming detection are strikingly similar across species. In mammals, information about approaching threats is conveyed from the retina to the midbrain superior colliculus, where approach variables are computed to enable defensive behavior. Although neuroscientific theories posit that midbrain representations contribute to emotion through connectivity with distributed brain systems, it remains unknown whether a computational system for looming detection can predict both defensive behavior and phenomenal experience in humans. Here, we show that a shallow convolutional neural network based on the Drosophila visual system predicts defensive blinking to looming objects in infants and superior colliculus responses to optical expansion in adults. Further, the neural network's responses to naturalistic video clips predict self-reported emotion largely by way of subjective arousal. These findings illustrate how a simple neural network architecture optimized for a species-general task relevant for survival explains motor and experiential components of human emotion.

Current gaps in emergency medicine core content education for oncologic emergencies: A targeted needs assessment.

Objective: The core content of emergency medicine (EM) residency training includes the management of oncologic emergencies; however, documented knowledge gaps continue to exist in this subtopic. This study represents a targeted needs assessment as indicated by Step 2 of Kern's curriculum design to determine the specific training gaps to be addressed within the oncologic EM curriculum. Methods: A multi-institutional cross-sectional survey of oncologists (surgical and medical) and emergency physicians (attendings and residents) was conducted during 2023 at five institutions. The voluntary survey consisted of general and specialty-specific questions exploring gaps in oncologic emergency-specific training/education topics. Descriptive statistics reported responses as frequencies and percentages. Results: Of the 833 surveys sent across the five sites, 302 (36.3%) were accessed by link; of these, 271 (89.7%) surveys were completed. There were no differences in the responses between early and later respondents and no differences in the characteristics of respondents between sites. A vast majority of the oncologist and EM groups (91.2% and 83.0%, respectively) reported a belief that emergency physicians would benefit from additional oncologic emergency training. Our survey identified 16 important topics for inclusion in an oncologic EM curriculum, including five topics not present on the 2022 Model of Clinical Practice of Emergency Medicine. Conclusions: Based on this needs assessment, an oncologic EM curriculum should include the topics listed under oncologic emergencies in the 2022 Model of the Clinical Practice of Emergency Medicine along with our respondent-identified topics of radiation therapy adverse effects, stem cell transplant complications, and the management of cancer-specific postsurgical complications, pain, and common diseases in patients with cancer.