Crowdsourcing with Enhanced Data Quality Assurance: An Efficient Approach to Mitigate Resource Scarcity Challenges in Training Large Language Models for Healthcare.

Large Language Models (LLMs) have demonstrated immense potential in artificial intelligence across various domains, including healthcare. However, their efficacy is hindered by the need for high-quality labeled data, which is often expensive and time-consuming to create, particularly in low-resource domains like healthcare. To address these challenges, we propose a crowdsourcing (CS) framework enriched with quality control measures at the pre-, real-time-, and post-data gathering stages. Our study evaluated the effectiveness of enhancing data quality through its impact on LLMs (Bio-BERT) for predicting autism-related symptoms. The results show that real-time quality control improves data quality by 19% compared to pre-quality control. Fine-tuning Bio-BERT using crowdsourced data generally increased recall compared to the Bio-BERT baseline but lowered precision. Our findings highlighted the potential of crowdsourcing and quality control in resource-constrained environments and offered insights into optimizing healthcare LLMs for informed decision-making and improved patient care.

Utilizing Large Language Models to Generate Synthetic Data to Increase the Performance of BERT-Based Neural Networks.

An important problem impacting healthcare is the lack of available experts. Machine learning (ML) models may help resolve this by aiding in screening and diagnosing patients. However, creating large, representative datasets to train models is expensive. We evaluated large language models (LLMs) for data creation. Using Autism Spectrum Disorders (ASD), we prompted GPT-3.5 and GPT-4 to generate 4,200 synthetic examples of behaviors to augment existing medical observations. Our goal is to label behaviors corresponding to autism criteria and improve model accuracy with synthetic training data. We used a BERT classifier pretrained on biomedical literature to assess differences in performance between models. A random sample (N=140) from the LLM-generated data was also evaluated by a clinician and found to contain 83% correct behavioral example-label pairs. Augmenting the dataset increased recall by 13% but decreased precision by 16%. Future work will investigate how different synthetic data characteristics affect ML outcomes.

African American mothers' perceptions of infant body size are prospectively associated with infant growth and BMI.

OBJECTIVES: The effect of mothers' perceptions of infant body size on infant growth and later BMI is poorly understood. We aimed to assess whether maternal perceptions were associated with infant BMI and weight gain and to identify factors that may influence maternal perceptions. METHODS: We analyzed data from a prospective, longitudinal study of pregnant African American women living with healthy weight (BMI < 25 kg/m2 ) or obesity (BMI ≥ 30 kg/m2 ). We collected sociodemographic, feeding mode, perceived stress, depression, and food insecurity information. The African American Infant Body Habitus Scale assessed maternal perceptions of infant body size at age 6 months. A "maternal satisfaction with infant body size" score was derived. Infant BMI z-scores (BMIZ) were calculated at 6 and 24 months. RESULTS: Maternal perception and satisfaction scores did not differ between obese (n = 148) and healthy weight (n = 132) groups. Perception of infant size at 6 months was positively associated with infant BMIZ at 6 and 24 months. A positive association of maternal satisfaction scores with change in infant BMIZ from 6 to 24 months indicated that BMIZ changed less for infants whose mothers preferred them to be smaller at 6 months. Perception and satisfaction scores were not associated with feeding variables, maternal stress, depression, socioeconomic status, or food security status. CONCLUSION: Mothers' perceptions of and satisfaction with infant size correlated with current and later infant BMI. However, mother's perceptions were not associated with maternal weight status or other factors explored for their potential to impact maternal perceptions. Further work is needed to elucidate factors linking maternal perception/satisfaction and infant growth.

Esophageal remodeling in eosinophilic esophagitis: Relationships to luminal captured biomarkers of inflammation and periostin.

BACKGROUND: Esophageal remodeling is a factor in disease progression and symptom severity for patients with eosinophilic esophagitis (EoE). Remodeling can begin early in children, resulting in stricture and food impaction. Detection of esophageal remodeling often depends on endoscopy and is appreciated only in its later stages. OBJECTIVE: We sought to determine whether luminal eosinophil-associated and remodeling proteins captured by the esophageal string test (EST) correlate with measures of esophageal remodeling and biomarkers of the epithelial-mesenchymal transition (EMT). METHODS: Patients with EoE (7-18 years old) were enrolled from 2 pediatric hospitals. Participants performed the EST and underwent endoscopy. Histology, distensibility measured by endoluminal functional lumen imaging probe, and symptoms were assessed. Protein quantitation by ELISA was performed on mucosal biopsy and EST samples. Tissue sections were evaluated for EMT. Outcome measures were summarized, and Spearman ρ was used to assess bivariate correlations. RESULTS: Forty patients (68% male) were enrolled (mean age, 12.5 years). Twenty-four (60%) had active disease (≥15 eosinophils per high-power field). EST-captured eotaxin-3, major basic protein 1, EDN, eosinophil peroxidase, and Charcot-Leyden crystal protein/galectin-10 showed significant correlations with peak eosinophils per high-power field (ρ 0.53-0.68, P < .001). Luminal proteins positively correlated with endoscopic features and markers of EMT, and negatively with esophageal distensibility. Periostin was captured by the EST and correlated with eosinophil density, basal zone hyperplasia, endoscopic appearance, and markers of EMT. CONCLUSION: Luminal markers of esophageal remodeling in addition to biomarkers of eosinophilic inflammation correlate with epithelial and functional remodeling in EoE.

A Culinary Medicine Elective for Clinically Experienced Medical Students: A Pilot Study.

Purpose: Culinary medicine, a combination of nutrition science and the culinary arts, is an emerging approach for teaching nutrition to medical students and improving their competence in counseling patients with diet-associated diseases. Data are, however, lacking on the impact of culinary medicine courses directed at clinically experienced students. This study reports initial outcomes of a pilot nutrition and culinary medicine course targeting 4th-year medical students. Methods: An elective course on culinary medicine was offered to 4th-year medical students at the Perelman School of Medicine, comprising seven disease-focused sessions, with a final capstone session. Students read primary literature for each session. Individual sessions consisted of culinary literacy, cooking, and a case discussion led by physicians and registered dietitians. In addition, students participated in a nutrition education initiative in a local high school. Students completed pre-and postcourse surveys that evaluated perceived nutrition knowledge and counseling skills and personal dietary choices, and included free-text options for qualitative comments. Results: Thirty-one 4th-year medical students participated in three offerings of the course in 2018 and 2019. There was strong student enthusiasm for the course as (1) all the available slots for each course offering were filled within 2 h of an e-mail announcement to the students; (2) student attendance was consistently very high; and (3) student feedback about the course was uniformly positive. Students reported significant increases in their confidence regarding (1) knowledge of pertinent nutrition information; (2) discussing nutrition with patients; and (3) ability to impact patient behavior through counseling (p < 0.001). Qualitative comments suggested that students were contemplating or implementing changes in their dietary habits and food choices. Conclusion: A culinary medicine course for clinically experienced medical students may improve perceived nutrition knowledge and increases confidence in counseling patients with diet-associated diseases.

Exclusion of an Azygos Vein Varix With a Covered Stent.

An azygos vein varix was incidentally discovered in a 26-year-old man. Owing to the potential risk of pulmonary emboli, we implanted a covered stent in the superior vena cava, effectively excluding the varix. Eighth months later, the varix was thrombosed and involuted. (Level of Difficulty: Advanced.).

Comparative Genomic Screen in Two Yeasts Reveals Conserved Pathways in the Response Network to Phenol Stress.

Living organisms encounter various perturbations, and response mechanisms to such perturbations are vital for species survival. Defective stress responses are implicated in many human diseases including cancer and neurodegenerative disorders. Phenol derivatives, naturally occurring and synthetic, display beneficial as well as detrimental effects. The phenol derivatives in this study, butylated hydroxyanisole (BHA), butylated hydroxytoluene (BHT), and bisphenol A (BPA), are widely used as food preservatives and industrial chemicals. Conflicting results have been reported regarding their biological activity and correlation with disease development; understanding the molecular basis of phenol action is a key step for addressing issues relevant to human health. This work presents the first comparative genomic analysis of the genetic networks for phenol stress response in an evolutionary context of two divergent yeasts, Schizosaccharomyces pombe and Saccharomyces cerevisiae Genomic screening of deletion strain libraries of the two yeasts identified genes required for cellular response to phenol stress, which are enriched in human orthologs. Functional analysis of these genes uncovered the major signaling pathways involved. The results provide a global view of the biological events constituting the defense process, including cell cycle arrest, DNA repair, phenol detoxification by V-ATPases, reactive oxygen species alleviation, and endoplasmic reticulum stress relief through ergosterol and the unfolded protein response, revealing novel roles for these cellular pathways.