ChatGPT for assessment writing.

What is the educational challenge?Medical schools invest significant resources into the creation of multiple-choice items for assessments. This process is costly and requires faculty training. Recently ChatGPT has been used in various areas to improve content creation efficiency, and it has otherwise been used to answer USMLE-style assessment items.What are the proposed solutions?We proposed the use of ChatGPT to create initial drafts of multiple-choice items.What are the potential benefits to a wider global audience?The use of ChatGPT to generate assessment items can decrease resources required, allowing for the creation of more items, and freeing-up faculty time to perform higher level assessment activities. ChatGPT is also able to consistently produce items using a standard format while adhering to item writing guidelines, which can be very challenging for faculty teams.What are the next steps?We plan to pilot ChatGPT drafted questions and compare item statistics for those written by ChatGPT with those written by our content experts. We also plan to further identify the types of questions that ChatGPT is most appropriate for, and incorporate media into assessment items (e.g. images, videos).

Validation of the English version of the Autism-Spectrum Quotient in an English-speaking Singaporean sample.

The Autism-Spectrum Quotient (AQ) measures the degree of autistic traits in clinical and non-clinical samples and has been validated in various countries and languages. However, the AQ has not been validated in Singapore, an Asian country whose population speaks predominantly English. Although previous validation studies have examined the distribution of scores, internal consistency, test-retest reliability and construct, convergent and discriminant validities in Asian countries using translated versions of the AQ and generally shown a suitable structure of the AQ, other studies testing cultural differences of the AQ have provided inconsistent results about whether differences exist in scores between Western and Asian samples. Additionally, while prior literature has consistently documented sex differences in AQ scores, findings about the relationship between personality traits and friendship quality with autistic traits have been mixed. The aim of the current study was to validate the psychometric properties of the original English AQ in a non-clinical Singaporean sample and compare their mean AQ scores to previous Western samples. In this study, psychometric properties of the original English AQ were assessed in 113 Singaporean adults (47M/66F; Mean age = 37.78; SD = 14.52) with no clinical diagnoses. They completed the AQ, the Friendship Questionnaire (FQ) and the short Big Five Inventory, with a subsample completing the AQ twice within three to six months. Results showed that AQ scores were normally distributed and the AQ had satisfactory internal consistency and test-retest reliability and it demonstrated construct, convergent and discriminant validities. Higher AQ scores were related to lower friendship quality and extraversion and higher neuroticism. The mean AQ scores of the Singaporean sample did not differ to that reported in original British sample. Together, present findings showed the original English AQ to be reliable for measuring the degree of autistic traits in a non-clinical Singaporean sample, producing comparable AQ scores and showing the same relationships to other social and personality measures and the same sex differences as has been reported in English samples. This supports the use of the AQ in Singapore for clinical and research purposes and suggests that the measurement of autistic traits in some Asian cultures is comparable to that reported in Western cultures.

Neurogenesis-dependent antidepressant-like activity of Hericium erinaceus in an animal model of depression.

BACKGROUND: Depression is a severe neuropsychiatric disorder that affects more than 264 million people worldwide. The efficacy of conventional antidepressants are barely adequate and many have side effects. Hericium erinaceus (HE) is a medicinal mushroom that has been reported to have therapeutic potential for treating depression. METHODS: Animals subjected to chronic restraint stress were given 4 weeks HE treatment. Animals were then screened for anxiety and depressive-like behaviours. Gene and protein assays, as well as histological analysis were performed to probe the role of neurogenesis in mediating the therapeutic effect of HE. Temozolomide was administered to validate the neurogenesis-dependent mechanism of HE. RESULTS: The results showed that 4 weeks of HE treatment ameliorated depressive-like behaviours in mice subjected to 14 days of restraint stress. Further molecular assays demonstrated the 4-week HE treatment elevated the expression of several neurogenesis-related genes and proteins, including doublecortin, nestin, synaptophysin, brain-derived neurotrophic factor (BDNF), tropomyosin receptor kinase B (TrkB), phosphorylated extracellular signal-regulated kinase, and phosphorylated cAMP response element-binding protein (pCREB). Increased bromodeoxyuridine-positive cells were also observed in the dentate gyrus of the hippocampus, indicating enhanced neurogenesis. Neurogenesis blocker temozolomide completely abolished the antidepressant-like effects of HE, confirming a neurogenesis-dependent mechanism. Moreover, HE induced anti-neuroinflammatory effects through reducing astrocyte activation in the hippocampus, which was also abolished with temozolomide administration. CONCLUSION: HE exerts antidepressant effects by promoting neurogenesis and reducing neuroinflammation through enhancing the BDNF-TrkB-CREB signalling pathway.

Activating mutations in BRAF disrupt the hypothalamo-pituitary axis leading to hypopituitarism in mice and humans.

Germline mutations in BRAF and other components of the MAPK pathway are associated with the congenital syndromes collectively known as RASopathies. Here, we report the association of Septo-Optic Dysplasia (SOD) including hypopituitarism and Cardio-Facio-Cutaneous (CFC) syndrome in patients harbouring mutations in BRAF. Phosphoproteomic analyses demonstrate that these genetic variants are gain-of-function mutations leading to activation of the MAPK pathway. Activation of the MAPK pathway by conditional expression of the BrafV600E/+ allele, or the knock-in BrafQ241R/+ allele (corresponding to the most frequent human CFC-causing mutation, BRAF p.Q257R), leads to abnormal cell lineage determination and terminal differentiation of hormone-producing cells, causing hypopituitarism. Expression of the BrafV600E/+ allele in embryonic pituitary progenitors leads to an increased expression of cell cycle inhibitors, cell growth arrest and apoptosis, but not tumour formation. Our findings show a critical role of BRAF in hypothalamo-pituitary-axis development both in mouse and human and implicate mutations found in RASopathies as a cause of endocrine deficiencies in humans.

Voluntarily Postponing Testing Is Associated with Lower Performance on the Pediatric Board Certifying Examinations.

OBJECTIVE: To investigate whether postponing certification testing, either voluntarily or involuntarily, affects a candidate's performance on pediatric certifying examinations. STUDY DESIGN: Both general pediatrics (GP) and pediatric subspecialty (PS) examination candidates were included in the study. Candidates were classified into 3 groups based on time since the completion of training: no delay (<12 months), short delay (12-24 months), and long delay (≥24 months). Examination scores and pass rates in the first GP and PS certifying examinations were compared to assess between-group differences. RESULTS: Significant differences in scores and pass rates were found for GP candidates who voluntarily waited 1 year or longer to take the certifying examination. Similarly, PS candidates who opted not to take the first examination available had significantly lower scores and pass rates. However, no significant difference was found for PS candidates who had to wait to take their examination owing to the Board's offered examination schedule. CONCLUSION: Candidates who postpone taking the certifying examination are less likely to pass the examination. The longer a candidate elects to wait to take the examination, the less likely he or she is to pass. The availability of the PS examinations once every 2 years does not affect pass rates and scores, as long as PS candidates take the first available examinations after completing fellowship.

Do Genetic Susceptibility Variants Associate with Disease Severity in Early Active Rheumatoid Arthritis?

OBJECTIVE: Genetic variants affect both the development and severity of rheumatoid arthritis (RA). Recent studies have expanded the number of RA susceptibility variants. We tested the hypothesis that these associated with disease severity in a clinical trial cohort of patients with early, active RA. METHODS: We evaluated 524 patients with RA enrolled in the Combination Anti-Rheumatic Drugs in Early RA (CARDERA) trials. We tested validated susceptibility variants - 69 single-nucleotide polymorphisms (SNP), 15 HLA-DRB1 alleles, and amino acid polymorphisms in 6 HLA molecule positions - for their associations with progression in Larsen scoring, 28-joint Disease Activity Scores, and Health Assessment Questionnaire (HAQ) scores over 2 years using linear mixed-effects and latent growth curve models. RESULTS: HLA variants were associated with joint destruction. The *04:01 SNP (rs660895, p = 0.0003), *04:01 allele (p = 0.0002), and HLA-DRß1 amino acids histidine at position 13 (p = 0.0005) and valine at position 11 (p = 0.0012) significantly associated with radiological progression. This association was only significant in anticitrullinated protein antibody (ACPA)-positive patients, suggesting that while their effects were not mediated by ACPA, they only predicted joint damage in ACPA-positive RA. Non-HLA variants did not associate with radiograph damage (assessed individually and cumulatively as a weighted genetic risk score). Two SNP - rs11889341 (STAT4, p = 0.0001) and rs653178 (SH2B3-PTPN11, p = 0.0004) - associated with HAQ scores over 6-24 months. CONCLUSION: HLA susceptibility variants play an important role in determining radiological progression in early, active ACPA-positive RA. Genome-wide and HLA-wide analyses across large populations are required to better characterize the genetic architecture of radiological progression in RA.

Predicting the risk of rheumatoid arthritis and its age of onset through modelling genetic risk variants with smoking.

The improved characterisation of risk factors for rheumatoid arthritis (RA) suggests they could be combined to identify individuals at increased disease risks in whom preventive strategies may be evaluated. We aimed to develop an RA prediction model capable of generating clinically relevant predictive data and to determine if it better predicted younger onset RA (YORA). Our novel modelling approach combined odds ratios for 15 four-digit/10 two-digit HLA-DRB1 alleles, 31 single nucleotide polymorphisms (SNPs) and ever-smoking status in males to determine risk using computer simulation and confidence interval based risk categorisation. Only males were evaluated in our models incorporating smoking as ever-smoking is a significant risk factor for RA in men but not women. We developed multiple models to evaluate each risk factor's impact on prediction. Each model's ability to discriminate anti-citrullinated protein antibody (ACPA)-positive RA from controls was evaluated in two cohorts: Wellcome Trust Case Control Consortium (WTCCC: 1,516 cases; 1,647 controls); UK RA Genetics Group Consortium (UKRAGG: 2,623 cases; 1,500 controls). HLA and smoking provided strongest prediction with good discrimination evidenced by an HLA-smoking model area under the curve (AUC) value of 0.813 in both WTCCC and UKRAGG. SNPs provided minimal prediction (AUC 0.660 WTCCC/0.617 UKRAGG). Whilst high individual risks were identified, with some cases having estimated lifetime risks of 86%, only a minority overall had substantially increased odds for RA. High risks from the HLA model were associated with YORA (P<0.0001); ever-smoking associated with older onset disease. This latter finding suggests smoking's impact on RA risk manifests later in life. Our modelling demonstrates that combining risk factors provides clinically informative RA prediction; additionally HLA and smoking status can be used to predict the risk of younger and older onset RA, respectively.

The protective effect of alcohol on developing rheumatoid arthritis: a systematic review and meta-analysis.

OBJECTIVES: Our aim was to establish whether alcohol protects against RA development and to determine whether this effect is influenced by alcohol dose, duration and serological status through systematically reviewing the literature and undertaking a meta-analysis. METHODS: We searched Medline/EMBASE (1946 to July 2012) using the terms rheumatoid arthritis.mp or arthritis, rheumatoid/ and alcohol.mp or ethanol/. Manuscript bibliographies were reviewed. Observational studies were included that were case-control/cohort, examined the relationship between alcohol and RA risk and reported or allowed the calculation of effect size data [odds ratios (ORs)/relative risks (RRs) with 95% CIs] in drinkers vs non-drinkers. A random-effects model was used to estimate pooled ORs/RRs. Dose-risk relationships were evaluated by trend tests. RESULTS. Nine studies (from 893 articles) met our inclusion criteria, comprising six case-control (3564 cases; 8477 controls) and three cohort studies (444 RA cases; 84 421 individuals). A significant protective effect of alcohol on RA risk was observed-summary OR for RA in drinkers vs non-drinkers 0.78 (95% CI 0.63, 0.96). This effect was confined to ACPA-positive RA-summary OR 0.52 (95% CI 0.36, 0.76), with no significant risk reduction seen for ACPA-negative RA-summary OR 0.74 (95% CI 0.53, 1.05). Subgroup analysis by study design identified a significant relationship in case-control but not cohort studies. CONCLUSION: Alcohol intake is inversely associated with ACPA-positive RA, suggesting a protective effect. As this finding is confined to case-control studies further research is required with prospective cohort studies incorporating ACPA status to confirm this relationship.

Investigation of rheumatoid arthritis susceptibility genes identifies association of AFF3 and CD226 variants with response to anti-tumour necrosis factor treatment.

BACKGROUND: Anti-tumour necrosis factor (anti-TNF) therapy has proved to be highly successful in treating rheumatoid arthritis (RA), although 30-40% of patients have little or no response. The authors hypothesise that this may be genetically determined. In other complex diseases, susceptibility genes have been shown to influence treatment response. The aim of the current study was to investigate the association of markers within confirmed RA susceptibility loci with the response to anti-TNF treatment. METHODS: Eighteen single nucleotide polymorphisms (SNPs) mapping to 11 genetic loci were genotyped in 1012 patients with RA receiving treatment with etanercept, infliximab or adalimumab. Multivariate linear regression analyses were performed using the absolute change in 28 joint count disease activity score (DAS28) between baseline and 6-month follow-up as the outcome variable, adjusting for confounders. p Values <0.05 were considered statistically significant and associated markers were genotyped in an additional 322 samples. Analysis was performed in the combined cohort of 1334 subjects with RA treated with anti-TNF. RESULTS: In the combined analysis, SNPs mapping to AFF3 and CD226 had a statistically significant association with the response to anti-TNF treatment under an additive model. The G allele at rs10865035, mapping to AFF3, was associated with an improved response to anti-TNF treatment (coefficient -0.14 (95% CI -0.25 to -0.03), p=0.015). At the CD226 SNP rs763361, the C allele conferred reduced response to treatment (coefficient 0.11 (95% CI 0.00 to 0.22), p=0.048). CONCLUSION: These results suggest that AFF3 and CD226, two confirmed RA susceptibility genes, have an additional role in influencing the response to anti-TNF treatment.

Comparison of attitudes between Generation X and Baby Boomer veterinary faculty and residents.

Understanding the characteristics and preferences of the different generations in the veterinary workforce is important if we are to help optimize current and future veterinary schools and teaching hospitals. The purpose of this study was to compare the attitudes of different generations of veterinary faculty and those of faculty and house officers. A survey administered to faculty and house officers asked respondents to identify their level of agreement with a series of statements addressing work and lifestyle issues and feedback preferences. In addition, the survey included an open-ended question on non-monetary rewards for hard work. Thirty-eight of 48 faculty members (79%) and 45 of 54 house officers (83%) completed the survey. Among faculty, there were no significant differences between the Generation X and Baby Boomer subgroups or between genders. More faculty than house officers responded that delayed gratification is acceptable (p = 0.03) and that it is difficult to balance home and work life (p < 0.001). Compared to faculty, house officers preferred more frequent (p = 0.03) and critical (p = 0.02) feedback. The most common responses to the question on effective non-monetary rewards for hard work, from both faculty and house officers, were recognition and time off. No attitudinal differences were detected between generations within the faculty group, but a number of significant differences emerged between faculty and house officers. Increased awareness of the importance of balance and rewards for hard work, as well as modification of feedback styles, may be beneficial in teaching and mentoring current and future generations.