A systematic review of pre-injury anxiety disorder and post-concussion outcomes in youth and young adult athletes.

Pre-injury anxiety disorder may be a risk factor for poor outcomes following sportsrelated concussion. A systematic review was performed to characterize the relationship between pre-injury anxiety disorder and post-concussion symptom presentation and recovery time after sports-related concussions among children, adolescents, and young adults. A PRISMA-compliant literature search was conducted in Ovid MEDLINE, PsycINFO, EMBASE, and Scopus for articles published up to 25 January 2024. The initial query yielded 1358 unique articles. Articles that analyzed the relationship between pre-injury anxiety disorder and post-concussion symptoms and recovery time were included. A final cohort of 11 articles was extracted, comprising a total of 8390 study participants, of whom 921 had a history of pre-injury anxiety disorder. Pre-injury anxiety disorder was associated with prolonged time to return to sports activity and an increased incidence of physical, emotional, cognitive, and sleep-related symptoms. While the results of this review suggest an association between pre-injury anxiety disorder and post-concussion symptoms and recovery time, future studies should be more stringent regarding standardized anxiety disorder definitions, longitudinal assessment of post-concussion symptoms, anxiety disorder subtypes, and anxiety treatment history.

Special Issue on Informatics Education: ChatGPT Performs Worse on USMLE-Style Ethics Questions Compared to Medical Knowledge Questions.

OBJECTIVES: The main objective of this study is to evaluate the ability of the Large Language Model ChatGPT to accurately answer USMLE board style medical ethics questions compared to medical knowledge based questions. This study has the additional objectives of comparing the overall accuracy of GPT-3.5 to GPT-4 and to assess the variability of responses given by each version. MATERIALS AND METHODS: Using AMBOSS, a third party USMLE Step Exam test prep service, we selected one group of 27 medical ethics questions and a second group of 27 medical knowledge questions matched on question difficulty for medical students. We ran 30 trials asking these questions on GPT-3.5 and GPT-4, and recorded the output. A random-effects linear probability regression model evaluated accuracy, and a Shannon entropy calculation evaluated response variation. RESULTS: Both versions of ChatGPT demonstrated a worse performance on medical ethics questions compared to medical knowledge questions. GPT-4 performed 18% points (P < 0.05) worse on medical ethics questions compared to medical knowledge questions and GPT-3.5 performed 7% points (P = 0.41) worse. GPT-4 outperformed GPT-3.5 by 22% points (P < 0.001) on medical ethics and 33% points (P < 0.001) on medical knowledge. GPT-4 also exhibited an overall lower Shannon entropy for medical ethics and medical knowledge questions (0.21 and 0.11, respectively) than GPT-3.5 (0.59 and 0.55) which indicates lower variability in response. CONCLUSION: Both versions of ChatGPT performed more poorly on medical ethics questions compared to medical knowledge questions. GPT-4 significantly outperformed GPT-3.5 on overall accuracy and exhibited a significantly lower response variability in answer choices. This underscores the need for ongoing assessment of ChatGPT versions for medical education. KEY WORDS: ChatGPT, Large Language Model, Artificial Intelligence, Medical Education, USMLE, Ethics.

A brain atlas for the camouflaging dwarf cuttlefish, Sepia bandensis.

The coleoid cephalopods (cuttlefish, octopus, and squid) are a group of soft-bodied marine mollusks that exhibit an array of interesting biological phenomena, including dynamic camouflage, complex social behaviors, prehensile regenerating arms, and large brains capable of learning, memory, and problem-solving.1,2,3,4,5,6,7,8,9,10 The dwarf cuttlefish, Sepia bandensis, is a promising model cephalopod species due to its small size, substantial egg production, short generation time, and dynamic social and camouflage behaviors.11 Cuttlefish dynamically camouflage to their surroundings by changing the color, pattern, and texture of their skin. Camouflage is optically driven and is achieved by expanding and contracting hundreds of thousands of pigment-filled saccules (chromatophores) in the skin, which are controlled by motor neurons emanating from the brain. We generated a dwarf cuttlefish brain atlas using magnetic resonance imaging (MRI), deep learning, and histology, and we built an interactive web tool (https://www.cuttlebase.org/) to host the data. Guided by observations in other cephalopods,12,13,14,15,16,17,18,19,20 we identified 32 brain lobes, including two large optic lobes (75% the total volume of the brain), chromatophore lobes whose motor neurons directly innervate the chromatophores of the color-changing skin, and a vertical lobe that has been implicated in learning and memory. The brain largely conforms to the anatomy observed in other Sepia species and provides a valuable tool for exploring the neural basis of behavior in the experimentally facile dwarf cuttlefish.