Application of generative language models to orthopaedic practice.

OBJECTIVE: To explore whether large language models (LLMs) Generated Pre-trained Transformer (GPT)-3 and ChatGPT can write clinical letters and predict management plans for common orthopaedic scenarios. DESIGN: Fifteen scenarios were generated and ChatGPT and GPT-3 prompted to write clinical letters and separately generate management plans for identical scenarios with plans removed. MAIN OUTCOME MEASURES: Letters were assessed for readability using the Readable Tool. Accuracy of letters and management plans were assessed by three independent orthopaedic surgery clinicians. RESULTS: Both models generated complete letters for all scenarios after single prompting. Readability was compared using Flesch-Kincade Grade Level (ChatGPT: 8.77 (SD 0.918); GPT-3: 8.47 (SD 0.982)), Flesch Readability Ease (ChatGPT: 58.2 (SD 4.00); GPT-3: 59.3 (SD 6.98)), Simple Measure of Gobbledygook (SMOG) Index (ChatGPT: 11.6 (SD 0.755); GPT-3: 11.4 (SD 1.01)), and reach (ChatGPT: 81.2%; GPT-3: 80.3%). ChatGPT produced more accurate letters (8.7/10 (SD 0.60) vs 7.3/10 (SD 1.41), p=0.024) and management plans (7.9/10 (SD 0.63) vs 6.8/10 (SD 1.06), p<0.001) than GPT-3. However, both LLMs sometimes omitted key information or added additional guidance which was at worst inaccurate. CONCLUSIONS: This study shows that LLMs are effective for generation of clinical letters. With little prompting, they are readable and mostly accurate. However, they are not consistent, and include inappropriate omissions or insertions. Furthermore, management plans produced by LLMs are generic but often accurate. In the future, a healthcare specific language model trained on accurate and secure data could provide an excellent tool for increasing the efficiency of clinicians through summarisation of large volumes of data into a single clinical letter.

The impact of the introduction of selective screening in the UK on the epidemiology, presentation, and treatment outcomes of developmental dysplasia of the hip.

Aims: Developmental dysplasia of the hip (DDH) can be managed effectively with non-surgical interventions when diagnosed early. However, the likelihood of surgical intervention increases with a late presentation. Therefore, an effective screening programme is essential to prevent late diagnosis and reduce surgical morbidity in the population. Methods: We conducted a systematic review and meta-analysis of the epidemiological literature from the last 25 years in the UK. Articles were selected from databases searches using MEDLINE, EMBASE, OVID, and Cochrane; 13 papers met the inclusion criteria. Results: The incidence of DDH within the UK over the last 25 years is 7.3/1,000 live births with females making up 86% of the DDH population (odds ratio 6.14 (95% confidence interval 3.3 to 11.5); p < 0.001). The incidence of DDH significantly increased following the change in the Newborn and Infant Physical Examination (NIPE) guidance from 6.5/1,000 to 9.4/1,000 live births (p < 0.001). The rate of late presentation also increased following the changes to the NIPE guidance, rising from 0.7/1,000 to 1.2/1,000 live births (p < 0.001). However, despite this increase in late-presenting cases, there was no change in the rates of surgical intervention (0.8/1,000 live births; p = 0.940). Conclusion: The literature demonstrates that the implementation of a selective screening programme increased the incidence of DDH diagnosis in the UK while subsequently increasing the rates of late presentation and failing in its goal of reducing the rates of surgical intervention for DDH.

Chiral Spin-Chain Interfaces Exhibiting Event-Horizon Physics.

The interface between different quantum phases of matter can give rise to novel physics, such as exotic topological phases or nonunitary conformal field theories. Here we investigate the interface between two spin chains in different chiral phases. Surprisingly, the mean field theory approximation of this interacting composite system is given in terms of Dirac fermions in a curved space-time geometry. In particular, the interface between the two phases represents a black hole horizon. We demonstrate that this representation is faithful both analytically, by employing bosonization to obtain a Luttinger liquid model, and numerically, by employing matrix product state methods. A striking prediction from the black hole equivalence emerges when a quench, at one side of the interface between two opposite chiralities, causes the other side to thermalize with the Hawking temperature for a wide range of parameters and initial conditions.

Trauma surgery at a designated COVID-19-free site during the pandemic: a safe model and a possible way to restart routine elective surgery.

AIMS: Elective operating was halted during the COVID-19 pandemic to increase the capacity to provide care to an unprecedented volume of critically unwell patients. During the pandemic, the orthopaedic department at the Aneurin Bevan University Health Board restructured the trauma service, relocating semi-urgent ambulatory trauma operating to the isolated clean elective centre (St. Woolos' Hospital) from the main hospital receiving COVID-19 patients (Royal Gwent Hospital). This study presents our experience of providing semi-urgent trauma care in a COVID-19-free surgical unit as a safe way to treat trauma patients during the pandemic and a potential model for restarting an elective orthopaedic service. METHODS: All patients undergoing surgery during the COVID-19 pandemic at the orthopaedic surgical unit (OSU) in St. Woolos' Hospital from 23 March 2020 to 24 April 2020 were included. All patients that were operated on had a telephone follow-up two weeks after surgery to assess if they had experienced COVID-19 symptoms or had been tested for COVID-19. The nature of admission, operative details, and patient demographics were obtained from the health board's electronic record. Staff were assessed for sickness, self-isolation, and COVID-19 status. RESULTS: A total of 58 surgical procedures were undertaken at the OSU during the study period; 93% (n = 54) of patients completed the telephone follow-up. Open reduction and internal fixation of ankle and wrist fractures were the most common procedures. None of the patients nor members of their households had developed symptoms suggestive of COVID-19 or required testing. No staff members reported sick days or were advised by occupational health to undergo viral testing. CONCLUSION: This study provides optimism that orthopaedic patients planned for surgery can be protected from COVID-19 nosocomial transmission at separate COVID-19-free sites.Cite this article: Bone Joint Open 2020;1-6:302-308.

Bariatric surgery as a treatment for idiopathic intracranial hypertension: a systematic review.

BACKGROUND: Idiopathic intracranial hypertension (IIH) is a chronic neurologic disease that may result in persistent and debilitating symptoms that are refractory to conventional treatments. OBJECTIVES: The aim of this study was to systematically review the effect of bariatric weight reduction surgery as a treatment for IIH. METHODS: A comprehensive literature search was conducted using the following databases: MEDLINE, EMBASE, PubMed, Scopus, Web of Sciences, and the Cochrane Library. No restrictions were placed on these searches, including the date of publication. RESULTS: A total of 85 publications were identified, and after initial appraisal, 17 were included in the final review. Overall improvement in symptoms of IIH after bariatric surgery was observed in 60 of the 65 patients observed (92%). Postoperative lumbar puncture opening pressure was shown to decrease by an average of 18.9 cmH2O in the 12 patients who had this recorded. CONCLUSION: Bariatric surgery for weight loss is associated with alleviation of IIH symptoms and a reduction in intracranial pressure. Furthermore, an improvement was observed in patients where conventional treatments, including neurosurgery, were ineffective. Further prospective randomized studies with control groups and a larger number of participants are lacking within the published studies to date. There is, therefore, a strong rationale for the use of bariatric surgery in individuals with IIH for the effective treatment of this condition, as well as the efficacy of weight loss for various other obesity co-morbidities.

Asymmetries of influence: differential effects of body postures on perceptions of emotional facial expressions.

The accuracy and speed with which emotional facial expressions are identified is influenced by body postures. Two influential models predict that these congruency effects will be largest when the emotion displayed in the face is similar to that displayed in the body: the emotional seed model and the dimensional model. These models differ in whether similarity is based on physical characteristics or underlying dimensions of valence and arousal. Using a 3-alternative forced-choice task in which stimuli were presented briefly (Exp 1a) or for an unlimited time (Exp 1b) we provide evidence that congruency effects are more complex than either model predicts; the effects are asymmetrical and cannot be accounted for by similarity alone. Fearful postures are especially influential when paired with facial expressions, but not when presented in a flanker task (Exp 2). We suggest refinements to each model that may account for our results and suggest that additional studies be conducted prior to drawing strong theoretical conclusions.

Wide eyes and drooping arms: adult-like congruency effects emerge early in the development of sensitivity to emotional faces and body postures.

Adults' and 8-year-old children's perception of emotional faces is disrupted when faces are presented in the context of incongruent body postures (e.g., when a sad face is displayed on a fearful body) if the two emotions are highly similar (e.g., sad/fear) but not if they are highly dissimilar (e.g., sad/happy). The current research investigated the emergence of this adult-like pattern. Using a sorting task, we identified the youngest age at which children could accurately sort isolated facial expressions and body postures and then measured whether their accuracy was impaired in the incongruent condition. Among the child participants, 6-year-olds showed congruency effects for sad/fear, but even 4-year-olds did not do so for sad/happy. Early emergence of this adult-like pattern is consistent with the dimensional and emotional seed models of emotion perception, although future research is needed to test the relative validity of these two models. Testing children with emotional faces presented in the context of body postures and background scenes is an important step toward understanding how they perceive emotions on a daily basis.

Architectural diversity and elastic networks in hydrogen-bonded host frameworks: from molecular jaws to cylinders.

Guest-free guanidinium organomonosulfonates (GMS) and their inclusion compounds display a variety of lamellar crystalline architectures distinguished by different "up-down" projections of the organomonosulfonate residues on either side of a two-dimensional (2D) hydrogen-bonding network of complementary guanidinium ions (G) and sulfonate moieties (S), the so-called GS sheet. Using a combinatorial library of 24 GMS hosts and 26 guest molecules, a total of 304 inclusion compounds out of a possible 624 possible host-guest combinations were realized, revealing a remarkable capacity of the GMS hosts to form inclusion compounds despite the facile formation of the corresponding guest-free compounds and the absence of "predestined" inclusion cavities like those in related guanidinium organodisulfonate host frameworks. The GS sheets in the inclusion compounds behave as "molecular jaws" in which organomonosulfonate groups projecting from opposing sheets clamp down on the guest molecules, forming ordered interdigitated arrays of the host organic groups and guests. Both the guest-free and inclusion compounds display a variety of architectures that reveal the structural integrity of two-dimensional GS sheet and the unique ability of these hosts to conform to the steric demands of the organic guests. Certain GMS host-guest combinations prompt formation of tubular inclusion compounds in which the GS sheet curls into cylinders with retention of the 2D GS network. The cylinders assemble into hexagonal arrays through interdigitation of the organosulfonate residues that project from their outer surfaces, crystallizing in high-symmetry trigonal or hexagonal space groups. This unique example of network curvature and structural isomerism between lamellar and cylindrical structures, with retention of supramolecular connectivity, is reminiscent of the phase behavior observed in surfactant microstructures and block copolymers. The large number of host-guest combinations explored here permits grouping of the inclusion compound architectures according to the shape of the guests and the relative volumes of the organomonosulfonate groups, enabling more reliable structure prediction for this class of compounds than for molecular crystals in general.

Lamellae-Nanotube Isomerism in Hydrogen-Bonded Host Frameworks.

Inclusion compounds based on a flexible hydrogen-bonded sheet of guanidinium ions and sulfonate moieties display lamellar and tubular architectures, depending on the guest and the organic substituent attached to the sulfonate. The observed single-crystal architectures resemble lamellar and hexagonal microstructures in block copolymers and surfactant assemblies.