ChatGPT sits the DFPH exam: large language model performance and potential to support public health learning.

BACKGROUND: Artificial intelligence-based large language models, like ChatGPT, have been rapidly assessed for both risks and potential in health-related assessment and learning. However, their applications in public health professional exams have not yet been studied. We evaluated the performance of ChatGPT in part of the Faculty of Public Health's Diplomat exam (DFPH). METHODS: ChatGPT was provided with a bank of 119 publicly available DFPH question parts from past papers. Its performance was assessed by two active DFPH examiners. The degree of insight and level of understanding apparently displayed by ChatGPT was also assessed. RESULTS: ChatGPT passed 3 of 4 papers, surpassing the current pass rate. It performed best on questions relating to research methods. Its answers had a high floor. Examiners identified ChatGPT answers with 73.6% accuracy and human answers with 28.6% accuracy. ChatGPT provided a mean of 3.6 unique insights per question and appeared to demonstrate a required level of learning on 71.4% of occasions. CONCLUSIONS: Large language models have rapidly increasing potential as a learning tool in public health education. However, their factual fallibility and the difficulty of distinguishing their responses from that of humans pose potential threats to teaching and learning.

Changing trends in a decade of vascular radiology-the impact of technical developments of non-invasive techniques on vascular imaging.

OBJECTIVES: This review aims to establish the impact on conventional angiography and endovascular intervention of contrast-enhanced magnetic resonance angiography (CE-MRA) and contrast-enhanced computed tomography angiography (CE-CTA) on a background of evolving technology, changing clinical requirements and resulting clinical repercussions. METHODS: The angiographic and interventional caseload was prospectively recorded between 1997 and 2010, along with the CE-MRA and CE-CTA caseload. Waiting times and the marginal cost analyses for 2001 and 2009 were also prospectively established. RESULTS: Conventional diagnostic angiographies declined from a peak of 847 to 121 per year while endovascular interventions continue in similar numbers. CE-MRA increased from effectively none initially to 620 per year while CE-CTA has currently risen to 396 per year. Total diagnostic study numbers have increased but at reduced cost. Various influences are clear, including on-site modality availability, capability and accuracy along with impact of new therapies, research studies and adverse events. CONCLUSIONS: Vascular imaging has undergone a metamorphosis in little over a decade because of CE-MRA and CE-CTA. With waiting times significantly reduced since the start of the study and the cost-effectiveness of both CE-MRA and CE-CTA as primary diagnostic investigations established, further development of these services is inevitable. MAIN MESSAGES: • The availability of CE-MRA and CE-CTA has reduced the need for conventional angiography. • Both waiting times and the marginal cost analyses for CE-MRA and CE-CTA have reduced. • The impact of new therapies, research studies (e.g. ASTRAL) and adverse events is illustrated.

Imaging in endovascular therapy: our future.

The endovascular therapist now has many modern imaging techniques available to plan and execute treatment, whereas in the past vascular surgeons relied mostly on clinical examination and arteriography. Advances in computer technology have enabled fast acquisition and processing of the large amounts of digital data essential to capture the dynamic information from fast-flowing blood at high resolution. Functional imaging has begun to play a role in predicting stability of progressive vascular disease and the need for and risks of intervention. Computing power now affords the interventionist the ability to handle imaging data in powerful 3-dimensional programs and electronically "in-lay" a variety of devices to plan complex endovascular procedures from the familiar platform of a laptop. In four major clinical areas, carotid intervention, peripheral intervention, endoluminal grafting, and cardiac imaging, we review the latest advances and changes with an eye toward how we should best be using imaging in our patients undergoing endovascular treatment...now and into the future.

Virtual histology intravascular ultrasound in carotid interventions.

PURPOSE: To report early clinical experience with virtual histology intravascular ultrasound (VH IVUS) in carotid endoluminal repair. TECHNIQUE: A 2.9-F, 20-MHz catheter that utilizes computer software to demonstrate the histological components of arteriosclerotic plaque was evaluated during carotid angioplasty and stenting. VH IVUS images were created following a pullback through the carotid stenosis and produced a color-coded map of the different histological constituents of the disease (dark green: fibrous, yellow/green: fibrofatty, white: calcified, and red: necrotic lipid core plaque). CONCLUSION: VH IVUS produces a color-coded map of the different histological components of artery plaque. It has the potential to predict how the plaque is likely to behave at the moment of endoluminal treatment.

Efficacy and safety of gadodiamide (Gd-DTPA-BMA) in renal 3D-magnetic resonance angiography (MRA): a phase II study.

PURPOSE: To determine the most efficacious dose of gadodiamide for three-dimensional (3D) contrast-enhanced (CE) magnetic resonance angiography (MRA) of the renal arteries on a patient level based on the sensitivity in detecting the main hemodynamically relevant (> or =50% or occlusion) renal artery stenosis (RAS) using intra-arterial digital subtraction angiography (IA DSA) as the gold standard. MATERIALS AND METHODS: This prospective, randomized, double-blind, parallel-group, multicenter study included 273 patients referred to IA DSA for suspected RAS. Patients underwent 3D CE MRA after injection of 0.01, 0.05, 0.1, or 0.2mmol/kg of body weight gadodiamide (0.5mmol/ml). The images were assessed for location and degree of RAS by independent blinded readers (MRA: three readers, IA DSA: one reader). Hypothesis testing for a significant trend in sensitivity across dose groups was based on the one-sided Cochran-Armitage style trend test for each independent MRA reader. RESULTS: The lowest dose group (0.01mmol/kg) proved non-efficacious in detecting hemodynamically relevant (i.e., > or =50% or occlusion) RAS. A statistically significant dose trend (p<0.001) was shown for each of the three independent readers. Depending on reader, the sensitivity obtained with 0.05, 0.1, and 0.2mmol/kg was 63.9-86.1%, 75.8-91.4% and 80.6-90.6%, the specificity was 66.7-73.9%, 59.3-75.0%, and 59.3-75.0% and accuracy was 67.8-78.9%, 75.4-77.4%, and 76.3-81.0%, for the three dose groups, respectively. There were eight non-severe adverse events (AEs). Three serious AEs occurring in one patient were judged not related to gadodiamide by the on-site investigator. CONCLUSION: A significant dose trend between the four doses examined was observed. The lowest dose (0.01mmol/kg) differed significantly from those of the other three doses. Based on the analysis of the primary and secondary endpoints, 0.1mmol/kg gadodiamide appears to be the most suitable dose in diagnosing hemodynamically relevant RAS. The present study also demonstrated gadodiamide to be safe and well tolerated.

Primary progressive aphasia in a bilingual woman.

Multilingual aphasias are common because most people in the world know more than one language, but little is known of these syndromes except in patients who have had a stroke. We present a 76-year-old right-handed woman, fluent in English and Chinese, who developed anomia at age 70 and then progressed to aphasia. Functional neuroimaging disclosed mild left temporoparietal hypometabolism. Neurolinguistic testing was performed in both English and Chinese, representing a unique contribution to the literature. Results revealed conduction-like aphasia that was comparable in the two languages, although English was slightly better preserved. Primary progressive aphasia has disrupted 2 languages in a similar manner, suggesting their close neuroanatomic relationship in this case.

Endovascular significance of the external carotid artery in the treatment of cerebrovascular insufficiency.

PURPOSE: To present illustrative cases that demonstrate the feasibility and clinical benefits of endovascular treatment of external carotid artery (ECA) stenoses in patients with occluded internal carotid arteries (ICA). CASE REPORTS: Three patients with symptoms of cerebrovascular insufficiency and a stenosis of the ECA in the presence of occluded ICAs and diseased vertebral arteries were treated successfully by percutaneous stent or stent-graft implantation with and without cerebral protection. CONCLUSIONS: The ECAs play an important role in providing collateral blood supply to the brain through the many connections between branches of the ECA and cranial branches of the ICA and vertebral arteries. If these important pathways of collateral cerebral blood flow become diseased, ischemic symptoms become apparent. We recommend an endovascular procedure as a potential alternative to surgical endarterectomy of the ECA in patients with severe extracranial arterial disease.

Vascular imaging: an unparalleled decade.

Vascular imaging techniques, such as catheter angiography, ultrasound, computed tomography (CT), and magnetic resonance (MR), have all undergone unprecedented innovation and incredible technological leaps in the last 10 years. Ultrasound, CT, and MR have progressed in acquisition speed, resolution, and accuracy to the point that they have now supplanted the former mainstay, invasive catheter-based angiography, despite the advent of digitized angiographic image recording. This review explores the advantages and shortcomings of each technique and how they have changed the diagnosis and assessment of the cardiovascular system for endovascular intervention.