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OBJECTIVE: To identify and quantify ability bias in generative artificial intelligence large language model chatbots, specifically OpenAI's ChatGPT and Google's Gemini. DESIGN: Observational study of language usage in generative artificial intelligence models. SETTING: Investigation-only browser profile restricted to ChatGPT and Gemini. PARTICIPANTS: Each chatbot generated 60 descriptions of people prompted without specified functional status, 30 descriptions of people with a disability, 30 descriptions of patients with a disability, and 30 descriptions of athletes with a disability (nâ¯=â¯300). MAIN OUTCOME MEASURE: Generated descriptions produced by the models were parsed into words that were linguistically analyzed into favorable qualities or limiting qualities. RESULTS: Both large language models significantly underestimated disability in a population of people, and linguistic analysis showed that people, patients, and athletes with a disability were generated as having significantly fewer favorable qualities and significantly more limitations when compared to people without a disability in both ChatGPT and Gemini. CONCLUSION: Generative artificial intelligence chatbots demonstrate quantifiable ability bias and often exclude people with disabilities in their responses. Ethical use of these generative large language model chatbots in medical systems should recognize this limitation, and further consideration should be taken in developing equitable artificial intelligence technologies.
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Introduction: This is a case of a 30-year-old male with no prior medical conditions presented to the emergency department for presumed seizures after ingesting 900 mg of caffeine via pre-workout drinks and pills. Case Presentation: The patient was described as having nearly 15 min of generalized seizure activity observed by emergency medical service, requiring midazolam. A head computerized tomography (CT) demonstrated a possible thrombus, and further, CT angiography and CT perfusion confirmed a basilar artery occlusion. He was treated with tissue plasminogen activator and underwent thrombectomy achieving TICI grade 3 in the left posterior cerebral artery and TICI grade 2b in the superior cerebellar artery. Unfortunately, the patient experienced a hemorrhagic conversion leading to an incomplete locked-in syndrome. Conclusion: This case report suggests a novel association between energy drinks and caffeine supplements as potential etiologies for rapid onset on cerebrovascular incidents.
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BACKGROUND: High sensitivity troponin assays have become widespread for emergency department evaluation of acute chest pain. We assessed if a high sensitivity troponin under the 99th percentile upper reference limit drawn at 6 h or greater from symptom onset could safely rule out acute coronary syndrome in patients who did not meet the rapid rule-out strategy. METHODS: We conducted a multicenter retrospective study examining emergency department patients with chest pain who did not meet rapid-rule out criteria and were admitted for further evaluation. Among these admitted patients, we assessed the rate of clinically relevant adverse cardiac events (death, cardiac or respiratory arrest, STEMI, or life-threatening arrhythmia) and NSTEMI in patients with high sensitivity troponin less than the 99th percentile value obtained after at least 6 h of chest pain. RESULTS: Out of 1187 patients admitted, we found 30 clinically relevant adverse cardiac events, all of which occurred in patients admitted for another compelling reason or ischemic ECG. 36 patients had an NSTEMI, of which 33 were identified with high sensitivity troponin greater than 99th percentile upper reference limit within 6 h of chest pain onset. This left 0 clinically relevant adverse cardiac events and 3 NSTEMI among the 429 patients with high sensitivity troponin less than the 99th percentile at 6 h and nonischemic ECG and no other compelling reason for admission. CONCLUSION: This study assessed patients with chest pain with high sensitivity troponin values between 3 ng/L and the 99th percentile upper reference limit after 6 h of chest pain and found that they have a low rate of clinically relevant adverse cardiac events and NSTEMI.
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Infarto do Miocárdio , Infarto do Miocárdio sem Supradesnível do Segmento ST , Humanos , Troponina I , Estudos Retrospectivos , Infarto do Miocárdio/diagnóstico , Biomarcadores , Dor no Peito/diagnóstico , Dor no Peito/etiologia , Troponina T , Sensibilidade e EspecificidadeRESUMO
OBJECTIVE: The purpose of this scoping review was to evaluate the current literature related to vocational outcomes among US service members and veterans with traumatic brain injury (TBI). METHODS: Seven research databases (Ovid MEDLINE, PsycINFO, EMBASE, CINAHL Plus, Cochrane Library, Scopus, and SPORTDiscus) were queried for human studies between the database inception and February, 2020. We included studies that focused on US service members and veterans who sustained a TBI and their vocational outcomes. Conference abstracts, systematic reviews, literature reviews, editorials, consensus reports, commentaries, dissertations, and qualitative studies were excluded. Two rounds of independent reviews were performed. Details of study design, intervention, and vocational outcomes were recorded. RESULTS: The search yielded 5667 articles; 48 articles met inclusion criteria. Forty-three studies were observational (90%), and 5 were randomized controlled trials. A majority of interventions were in the outpatient setting (71%). Interventions related to return to work and duty utilized physical therapy and occupational therapy to address cognitive skills and functional deficits and provide supportive employment. CONCLUSION: Community reintegration research among service members and veterans with brain injuries is underdeveloped. Because of heterogeneity of severity and smaller sample sizes, no consensus was reached on interventions that improve vocational outcomes. Evidence thus far suggests that future studies should incorporate an interdisciplinary team approach beyond physical therapy and occupational therapy, longer-term outcomes, and sample subgroups.
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Lesões Encefálicas Traumáticas , Lesões Encefálicas , Terapia Ocupacional , Veteranos , Humanos , Lesões Encefálicas/reabilitação , Modalidades de FisioterapiaRESUMO
INTRODUCTION: There has been controversy regarding whether headgear use in women's lacrosse will affect the rate of head and musculoskeletal injuries. The purpose of this study was to investigate the effect of mandated headgear use on the rate of head and musculoskeletal injuries in high school women's lacrosse. METHODS: This was a prospective cohort study of eight high school women's lacrosse teams and their game op-ponents who were mandated to wear F3137 headgear for the 2017 and 2018 seasons. Athletic trainers documented all injuries that occurred as a result of participation on the lacrosse teams. Injury rates in the headgear cohort were compared to a retrospective (control) cohort from the High School Reporting Information Online injury data reports. RESULTS: Over the study period, 17 total injuries were reported in the headgear cohort during 22,397 exposures for an injury rate of 0.76 injuries per 1,000 athlete-exposures. The headgear cohort demonstrated significant decreases in rates of in-game head and face injury (RR 0.141, 95% CI [0.004, 0.798]), in-game concussion (RR 0.152, 95% CI [0.004, 0.860]), and practice trunk and extremity injury (RR 0.239, 95% CI [0.049, 0.703]) when compared to the control cohort. CONCLUSION: Mandated use of headgear was shown to be effective at lowering the rate of head or face injury and concussions in women's lacrosse. Additionally, mandated headgear use was also shown to lower the rate of injury to body locations other than the head or face during practice. To our knowledge, this is the first study to demonstrate a decrease in injury rates associated with ASTM approved headgear in women's lacrosse.
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Traumatismos em Atletas , Concussão Encefálica , Dispositivos de Proteção da Cabeça , Sistema Musculoesquelético/lesões , Traumatismos em Atletas/epidemiologia , Traumatismos em Atletas/prevenção & controle , Fenômenos Biomecânicos , Concussão Encefálica/epidemiologia , Concussão Encefálica/etiologia , Concussão Encefálica/prevenção & controle , Feminino , Dispositivos de Proteção da Cabeça/normas , Dispositivos de Proteção da Cabeça/estatística & dados numéricos , Humanos , Incidência , Testes Mecânicos/métodos , Estudos Retrospectivos , Estados Unidos/epidemiologia , Adulto JovemRESUMO
OBJECTIVES: Some of the most pressing health problems are found in rural America. However, the surveillance needed to track and prevent disease in these regions is lacking. Our objective was to perform a comprehensive health survey of a single rural county to assess the validity of using emergency claims data to estimate rural disease prevalence at a sub-county level. DESIGN: We performed a cross-sectional study of chronic disease prevalence estimates using emergency department (ED) claims data versus mailed health surveys designed to capture a substantial proportion of residents in New York's rural Sullivan County. SETTING: Sullivan County, a rural county ranked second-to-last for health outcomes in New York State. PARTICIPANTS: Adult residents of Sullivan County aged 25 years and older who responded to the health survey in 2017-2018 or had at least one ED visit in 2011-2015. OUTCOME MEASURES: We compared age and gender-adjusted prevalence of hypertension, hyperlipidaemia, diabetes, cancer, asthma and chronic obstructive pulmonary disease/emphysema among nine sub-county areas. RESULTS: Our county-wide mailed survey obtained 6675 completed responses for a response rate of 30.4%. This sample represented more than 12% of the estimated 53 020 adults in Sullivan County. Using emergency claims data, we identified 34 576 adults from Sullivan County who visited an ED at least once during 2011-2015. At a sub-county level, prevalence estimates from mailed surveys and emergency claims data correlated especially well for diabetes (r=0.90) and asthma (r=0.85). Other conditions were not well correlated (range: 0.23-0.46). Using emergency claims data, we created more geographically detailed maps of disease prevalence using geocoded addresses. CONCLUSIONS: For select conditions, emergency claims data may be useful for tracking disease prevalence in rural areas and providing more geographically detailed estimates. For rural regions lacking robust health surveillance, emergency claims data can inform how to geographically target efforts to prevent chronic disease.
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Doença Crônica/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Vigilância em Saúde Pública/métodos , Saúde da População Rural , Adulto , Idoso , Idoso de 80 Anos ou mais , Asma/epidemiologia , Estudos Transversais , Diabetes Mellitus/epidemiologia , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , New York/epidemiologia , Prevalência , População Rural/estatística & dados numéricosRESUMO
BACKGROUND: The treatment of orbital compartment syndrome has a rich history rooted in surgery and emergency medicine. It is a rare but acute and vision-threatening condition that most commonly occurs secondary to facial trauma or as a postoperative complication, and was first recognized in 1950. Surgical techniques and medical management were developed and refined soon afterwards to eventually become the modern-day treatment, lateral canthotomy, and inferior cantholysis. OBJECTIVE: This article details the history of orbital compartment syndrome and the evolution of its treatment to the present day. DISCUSSION: Given the time-sensitive nature and acuity of orbital compartment syndrome, lateral canthotomy was adopted by emergency physicians who could perform it more quickly at the bedside. CONCLUSIONS: Lateral canthotomy is a procedure adopted by emergency physicians from the surgical literature. The history of its adoption is a representative example of how emergency medicine evolves as a field.
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Descompressão Cirúrgica/história , Medicina de Emergência/história , Aparelho Lacrimal/cirurgia , Descompressão Cirúrgica/métodos , Medicina de Emergência/métodos , Serviço Hospitalar de Emergência/organização & administração , História do Século XX , História do Século XXI , Humanos , Órbita/lesões , Órbita/cirurgiaRESUMO
BACKGROUND: Patellar tendon tears impart potentially debilitating sequelae among professional basketball athletes. HYPOTHESIS: Professional basketball athletes with patellar tendon tears have decreased return-to-play performance in seasons after injury compared with preinjury statistics. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Patellar tendon tears among National Basketball Association (NBA) athletes from the 1999-2000 to 2014-2015 seasons were identified. Player performance statistics for players who underwent operative patellar tendon repair were compared from 1 season before injury to 1 season after injury and 2 seasons before injury to 2 seasons after injury using the primary outcome of player efficiency rating (PER). Secondary performance outcomes were also analyzed. RESULTS: A total of 13 patellar tendon tears (10 complete, 3 partial) were identified among 12 NBA athletes. Three players (25%) did not return to play in the NBA. No significant differences were found in PER in comparisons of 1 season before and after injury (16.6 ± 1.5 vs 14.3 ± 1.7; P = .20) or in comparisons of 2 seasons before and after injury (15.8 ± 0.8 vs 6.3 ± 2.3; P = .49). Diminished performance outcomes were noted for total minutes played (2598 ± 100 vs 1695 ± 78; P = .01), games played (74.8 ± 1.9 vs 60.5 ± 1.4; P = .04), and minutes per game (34.8 ± 1.5 vs 28.2 ± 1.8; P = .02) in comparisons of 1 season before and after injury. Total minutes played per season (2491 ± 190 vs 799 ± 280; P = .045) decreased in comparisons of 2 seasons before and after injury. CONCLUSION: Patellar tendon tears were not associated with diminished efficiency-adjusted performance, as measured by PER, games played, minutes per game played, points per 36 minutes, and rebounds per 36 minutes. However, decreases in total minutes played were observed following patellar tendon tear. Orthopaedic surgeons may be better prepared to counsel basketball athlete patients with patellar tendon tear given these findings.