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Abstract BackgroundThis research explores the capabilities of ChatGPT-4 in passing the American Board of Family Medicine (ABFM) Certification Examination. Addressing a gap in existing literature, where earlier artificial intelligence (AI) models showed limitations in medical board examinations, this study evaluates the enhanced features and potential of ChatGPT-4, especially in document analysis and information synthesis. ObjectiveThe primary goal is to assess whether ChatGPT-4, when provided with extensive preparation resources and when using sophisticated data analysis, can achieve a score equal to or above the passing threshold for the Family Medicine Board Examinations. MethodsIn this study, ChatGPT-4 was embedded in a specialized subenvironment, “AI Family Medicine Board Exam Taker,” designed to closely mimic the conditions of the ABFM Certification Examination. This subenvironment enabled the AI to access and analyze a range of relevant study materials, including a primary medical textbook and supplementary web-based resources. The AI was presented with a series of ABFM-type examination questions, reflecting the breadth and complexity typical of the examination. Emphasis was placed on assessing the AI’s ability to interpret and respond to these questions accurately, leveraging its advanced data processing and analysis capabilities within this controlled subenvironment. ResultsIn our study, ChatGPT-4’s performance was quantitatively assessed on 300 practice ABFM examination questions. The AI achieved a correct response rate of 88.67% (95% CI 85.08%-92.25%) for the Custom Robot version and 87.33% (95% CI 83.57%-91.10%) for the Regular version. Statistical analysis, including the McNemar test (PP ConclusionsThe study demonstrates that ChatGPT-4, particularly when equipped with specialized preparation and when operating in a tailored subenvironment, shows promising potential in handling the intricacies of medical board examinations. While its performance is comparable with the expected standards for passing the ABFM Certification Examination, further enhancements in AI technology and tailored training methods could push these capabilities to new heights. This exploration opens avenues for integrating AI tools such as ChatGPT-4 in medical education and assessment, emphasizing the importance of continuous advancement and specialized training in medical applications of AI.

Cohesion measure launched from the Family Adaptability and Cohesion Evaluation Scale (FACES) is a well-known instrument to assess family functioning. It is essential to perform a measurement equivalence test of cohesion targeting racially diverse families. The web-based self-administered survey was performed and 291 college/university students’ responses in Ohio were collected (Whites = 37.5%, Hispanics = 23%, Asians = 23%, and Blacks = 16.5%). This study explicated measurement equivalence for family cohesion structure (balanced cohesion, disengagement, enmeshed). The multiple group analysis was performed to investigate whether parameters in the measurement models of the “cohesion sub-structures (balanced cohesion, disengagement, enmeshed; 7 items of each)” were equivalent across the four racial groups. While “balanced cohesion” and “disengagement” structures showed measurement invariance across the groups, the “enmeshed” structure showed significant measurement variance across the groups. Two-items, “Family members feel pressured to spend most free time together” and “We feel too connected to each other” were inadequate for Hispanics’ enmeshment. One-item, “Family members have little need for friends outside the family” was inadequate to explain enmeshment of Blacks and Asians. Professionals should be aware of possible misinterpretations of results from the cohesion measure of FACES IV when they particularly assess the enmeshment status of racially diverse families with closer attention to cross-cultural comparability.

Introduction Smartwatches have become ubiquitous for tracking health metrics. These data sets hold substantial potential for enhancing healthcare and public health initiatives; it may be used to track chronic health conditions, detect previously undiagnosed health conditions and better understand public health trends. By first understanding the factors influencing one’s continuous use of the device, it will be advantageous to assess factors that may influence a person’s willingness to share their individual data sets. This study seeks to comprehensively understand the factors influencing the continued use of these devices and people’s willingness to share the health data they generate.Methods and analysis A two-section online survey of smartwatch users over the age of 18 will be conducted (n ≥200). The first section, based on the expectation-confirmation model, will assess factors influencing continued use of smartwatches while the second section will assess willingness to share the health data generated from these devices. Survey data will be analysed descriptively and based on structural equation modelling.Subsequently, six focus groups will be conducted to further understand the issues raised in the survey. Each focus group (n=6) will consist of three smartwatch users: a general practitioner, a public health specialist and an IT specialist. Young smartwatch users (aged 18–44) will be included in three of the focus groups and middle-aged smartwatch users (aged 45–64) will be included in the other three groups. This is to enhance comparison of opinions based on age groups. Data from the focus groups will be analysed using the microinterlocutor approach and an executive summary.After the focus group, participants will complete a brief survey to indicate any changes in their opinions resulting from the discussion.Ethics and dissemination The results of this study will be disseminated through publication in a peer-reviewed journal, and all associated data will be deposited in a relevant, publicly accessible data repository to ensure transparency and facilitate future research endeavours.This study was approved by the Social Research Ethic Committee (SREC), University College Cork—SREC/SOM/21062023/2.

Background There are significant clinical, policy and societal concerns about the impact on young people (YP), from admission to psychiatric wards far from home. However, research evidence is scarce.Aims To investigate the impact of at-distance admissions to general adolescent units, from the perspectives of YP, parents/carers and healthcare professionals (HCPs) including service commissioners, to inform clinical practice, service development and policy.Method Semistructured interviews with purposive samples of YP aged 13–17 years (n=28) and parents/carers (n=19) across five large regions in England, and a national sample of HCPs (n=51), were analysed using a framework approach.Results There was considerable agreement between YP, parents/carers and HCPs on the challenges of at-distance admissions. YP and parents/carers had limited or no involvement in decision-making processes around admission and highlighted a lack of available information about individual units. Being far from home posed challenges with maintaining home contact and practical/financial challenges for families visiting. HCPs struggled with ensuring continuity of care, particularly around maintaining access to local clinical teams and educational support. However, some YP perceived separation from their local environment as beneficial because it removed them from unhelpful environments. At-distance admissions provided respite for some families struggling to support their child.Conclusions At-distance admissions lead to additional distress, uncertainty, compromised continuity of care and educational, financial and other practical difficulties, some of which could be better mitigated. For a minority, there are some benefits from such admissions.Clinical implications Standardised online information, accessible prior to admission, is needed for all Child and Adolescent Mental Health Services units. Additional practical and financial burden placed on families needs greater recognition and consideration of potential sources of support. Policy changes should incorporate findings that at-distance or adult ward admissions may be preferable in certain circumstances.

Background The increasing prevalence and acuity of mental disorders among children and adolescents have placed pressure on services, including inpatient care, and resulted in young people being admitted at-distance or to adult wards. Little empirical research has investigated such admissions.Objective To determine the incidence, clinical characteristics and 6-month outcomes of patients aged 13–17 years old admitted at-distance (>50 miles from home or out of region) to general adolescent psychiatric wards or to adult psychiatric wards.Methods Surveillance over 13 months (February 2021–February 2022) using the Child and Adolescent Psychiatry Surveillance System including baseline and 6-month follow-up questionnaires.Findings Data were collected about 290 admissions (follow-up rate 99% (288 of 290); sample were 73% female, mean age 15.8 years). The estimated adjusted yearly incidence of at-distance admission was 13.7–16.9 per 100 000 young people 13–17 years old. 38% were admitted >100 miles from home and 8% >200 miles. The most common diagnoses at referral were depression (34%) and autism spectrum disorder (20%); other common referral concerns included suicide risk (80%), emotional dysregulation (53%) and psychotic symptoms (22%). Over two-fifths (41%) waited ≥1 week for a bed, with 55% waiting in general hospital settings. At 6-month follow-up, 20% were still in hospital, the majority in at-distance placements.Conclusions At-distance and adult ward admissions for patients aged

Objective: Standard nerve excitability testing (NET) predominantly assesses Aα- and Aβ-fiber function, but a method examining small afferents would be of great interest in pain studies. Here, we examined the properties of a novel perception threshold tracking (PTT) method that preferentially activates Aδ-fibers using weak currents delivered by a novel multipin electrode and compared its reliability with NET. Methods: Eighteen healthy subjects (mean age:34.06 ± 2.0) were examined three times with motor and sensory NET and PTT in morning and afternoon sessions on the same day (intra-day reliability) and after a week (inter-day reliability). NET was performed on the median nerve, while PTT stimuli were delivered through a multipin electrode located on the forearm. During PTT, subjects indicated stimulus perception via a button press and the intensity of the current was automatically increased or decreased accordingly by Qtrac software. This allowed changes in the perception threshold to be tracked during strength-duration time constant (SDTC) and threshold electrotonus protocols. Results: The coefficient of variation (CoV) and interclass coefficient of variation (ICC) showed good–excellent reliability for most NET parameters. PTT showed poor reliability for both SDTC and threshold electrotonus parameters. There was a significant correlation between large (sensory NET) and small (PTT) fiber SDTC when all sessions were pooled (r = 0.29, p = 0.03). Conclusions: Threshold tracking technique can be applied directly to small fibers via a psychophysical readout, but with the current technique, the reliability is poor. Significance: Further studies are needed to examine whether Aβ-fiber SDTC may be a surrogate biomarker for peripheral nociceptive signalling.

Abstract Aim To describe the spectrum of parasagittal injury on MRI studies performed on children following severe perinatal term hypoxia–ischaemia, using a novel MRI grading system, and propose a new central pattern correlated with neuropathologic features. Methods MR scans of 297 patients with perinatal term hypoxia–ischaemia were evaluated for typical patterns of brain injury. A total of 83 patients that demonstrated the central/basal ganglia–thalamus and perirolandic pattern of injury were categorised according to the degree of severity. The perirolandic injury was graded by the degree of interhemispheric widening, paracentral lobule involvement and perirolandic cortex destruction leading to a tiered categorisation. Of these 83 patients, 19 had the most severe subtype of injury. A detailed analysis of the clinical data of a subset of 11 of these 19 patients was conducted. Results We demonstrated the mild subtype in 21/83(25%), the moderate subtype in 22/83(27%) and the severe subtype in 21/83(25%). A fourth pattern was identified in 19/83(23%) patients with a diamond-shaped expansion of the interhemispheric fissure, concomitant thalamic, putaminal, hippocampal and other smaller substrate involvement indicative of the most destructive subtype. Conclusions We propose a new MR grading system of injury at the parasagittal perirolandic region related to severe, sustained central perinatal term hypoxia–ischaemia. We also introduce a previously undescribed pattern of injury, the most severe form of this spectrum, seen especially after prolongation of the second stage of labour. This constellation of high metabolic substrate, targeted tissue destruction is consistently demonstrated by MRI, termed the massive paramedian injury pattern.

Summary: Protein coding genes were originally identified with sequence-based definitions that included a 100-codon cutoff to avoid annotating irrelevant open reading frames. However, many active proteins contain less than 100 amino acids. Indeed, functional genetics, ribosome profiling, and proteomic profiling have identified many short, translated open reading frames, including those with biologically active peptide products (microproteins). Yet, functions for most of these peptide products remain unknown. Because microproteins often act as key signals or fine-tune processes, animal development has already revealed functions for a handful of microproteins and provides an ideal context to uncover additional microprotein functions. However, many mRNAs during early development are maternally provided and hinder targeted mutagenesis approaches to characterize developmental microprotein functions. The recently established, RNA-targeting CRISPR-Cas13d system in zebrafish overcomes this barrier and produces potent knockdown of targeted mRNA, including maternally provided mRNA, and enables flexible, efficient interrogation of microprotein functions in animal development.

Genetic modification is one possible strategy to generate bananas (Musa spp.) with resistance to the soil-borne pathogen causing Fusarium wilt. The availability of banana root-specific promoters to target transgene expression to the sites of infection would be beneficial. We have assessed 18 promoter sequences derived from a range of plant species for their expression profiles in banana tissues to identify those with root-specific activity. Promoter sequences were isolated and fused to the β-glucuronidase (GUS) gene to assess their expression levels and tissue specificity in both banana and the model plant tobacco. Two heterologous promoters conferring high root expression levels in banana were identified, including a β‐glucosidase 1 (GLU1) promoter from maize and the RB7-type tonoplast intrinsic protein (TIP)-2 promoter from strawberry. Further, a novel Musa TIP2-2 promoter sequence was isolated and characterized which, when fused to the GUS gene, conferred very high GUS expression levels in banana roots. These promoters will expand the options for the control of gene expression in genetically modified bananas, providing a tool to develop plants with resistance not only to soil-borne diseases such as Fusarium wilt, but also for the improvement of other traits, such as nematode resistance, nutrition or abiotic stress resistance.

The use of antibodies in the treatment of lung diseases is of increasing interest especially as the search for COVID-19 therapies has unfolded. Historically, the use of antibody therapy was based on multiple targets including receptors involved in local hyper-reactivity in asthma, viruses and micro-organisms involved in a variety of pulmonary infectious disease. Generally, protein therapeutics pose challenges with respect to formulation and delivery to retain activity and assure therapy. The specificity of antibodies amplifies the need for attention to molecular integrity not only in formulation but also during aerosol delivery for pulmonary administration. Drug product development can be viewed from considerations of route of administration, dosage form, quality, and performance measures. Nebulizers and dry powder inhalers have been used to deliver protein therapeutics and each has its advantages that should be matched to the needs of the drug and the disease. This review offers insight into quality and performance barriers and the opportunities that arise from meeting them effectively.

PURPOSEThe global pediatric oncology clinical research landscape, particularly in Central and South America, Africa, and Asia, which bear the highest burden of global childhood cancer cases, is less characterized in the literature. Review of how existing pediatric cancer clinical trial groups internationally have been formed and how their research goals have been pursued is critical for building global collaborative research and data-sharing efforts, in line with the WHO Global Initiative for Childhood Cancer.METHODSA narrative literature review of collaborative groups performing pediatric cancer clinical research in each continent was conducted. An inventory of research groups was assembled and reviewed by current pediatric cancer regional and continental leaders. Each group was narratively described with identification of common structural and research themes among consortia.RESULTSThere is wide variability in the structure, history, and goals of pediatric cancer clinical trial collaborative groups internationally. Several continental regions have longstanding endogenously-formed clinical trial groups that have developed and published numerous adapted treatment regimens to improve outcomes, whereas other regions have consortia focused on developing foundational database registry infrastructure supported by large multinational organizations or twinning relationships.CONCLUSIONThere cannot be a one-size-fits-all approach to increasing collaboration between international pediatric cancer clinical trial groups, as this requires a nuanced understanding of local stakeholders and resources necessary to form partnerships. Needs assessments, performed either by local consortia or in conjunction with international partners, have generated productive clinical trial infrastructure. To achieve the goals of the Global Initiative for Childhood Cancer, global partnerships must be sufficiently granular to account for the distinct needs of each collaborating group and should incorporate grassroots approaches, robust twinning relationships, and implementation science.

Abstract Effective conservation requires accurate data on population genetic diversity, inbreeding, and genetic structure. Increasingly, scientists are adopting genetic non‐invasive sampling (gNIS) as a cost‐effective population‐wide genetic monitoring approach. gNIS has, however, known limitations which may impact the accuracy of downstream genetic analyses. Here, using high‐quality single nucleotide polymorphism (SNP) data from blood/tissue sampling of a free‐ranging koala population (n = 430), we investigated how the reduced SNP panel size and call rate typical of genetic non‐invasive samples (derived from experimental and field trials) impacts the accuracy of genetic measures, and also the effect of sampling intensity on these measures. We found that gNIS at small sample sizes (14% of population) can provide accurate population diversity measures, but slightly underestimated population inbreeding coefficients. Accurate measures of internal relatedness required at least 33% of the population to be sampled. Accurate geographic and genetic spatial autocorrelation analysis requires between 28% and 51% of the population to be sampled. We show that gNIS at low sample sizes can provide a powerful tool to aid conservation decision‐making and provide recommendations for researchers looking to apply these techniques to free‐ranging systems.

The 45th Annual Scientific Meeting of the Nutrition Society of Australia was held virtually from 2–3 December 2021. The theme of the meeting was Nutrition: Opportunities for Nutrition Science in a New Era. Abstracts were submitted from 13 countries. A total of 326 registrants attended the conference, and 134 papers were presented consisting of 6 plenary, 54 oral and 74 poster presentations. This issue presents the proceedings of this meeting in the form of abstracts for papers presented at the conference.

The population relationship between coefficient alpha and scale reliability is studied in the widely used setting of unidimensional multicomponent measuring instruments. It is demonstrated that for any set of component loadings on the common factor, regardless of the extent of their inequality, the discrepancy between alpha and reliability can be arbitrarily small in any considered population and hence practically ignorable. In addition, the set of parameter values where this discrepancy is negligible is shown to possess the same dimensionality as that of the underlying model parameter space. The article contributes to the measurement and related literature by pointing out that (a) approximate or strict loading identity is not a necessary condition for the utility of alpha as a trustworthy index of scale reliability, and (b) coefficient alpha can be a dependable reliability measure with any extent of inequality in the component loadings.

Purpose: The purpose of this paper is to understand the role of perplexity in young players' experiences within an educational videogame and how reflective thinking can help them to get out of perplexing scenarios. Design/methodology/approach: We used a constructivist grounded theory approach and the lenses of Dewey's conceptualization of perplexity and reflective thinking to examine young players' in-game experiences. Findings: We find that perplexity in gameplay is an experience that occurs when players encounter uncertainty about where to go or what to do next in the game. Findings reveal that while playing an educational game players engaged in two forms of perplexity--exploration-based and puzzle-based. Additionally, we unpack how players overcome these perplexing scenarios by reflecting on the information provided in the game. Research limitations/implications: While in a state of perplexity, reflecting on the in-game information aids players to think and make meaning, thus supporting learning. We provide suggestions for how to better utilize perplexity as an in-game design mechanism to encourage young players to reflect on in-game information. Originality/value: This empirical study is original in its context of studying the phenomenon of perplexity in videogames and young players' in-game reflection experiences.