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Objectives To evaluate the proficiency of a HIPAA-compliant version of GPT-4 in identifying actionable, incidental findings from unstructured radiology reports of Emergency Department patients. To assess appropriateness of artificial intelligence (AI)-generated, patient-facing summaries of these findings. Materials and Methods Radiology reports extracted from the electronic health record of a large academic medical center were manually reviewed to identify non-emergent, incidental findings with high likelihood of requiring follow-up, further sub-stratified as "definitely actionable" (DA) or "possibly actionable—clinical correlation" (PA-CC). Instruction prompts to GPT-4 were developed and iteratively optimized using a validation set of 50 reports. The optimized prompt was then applied to a test set of 430 unseen reports. GPT-4 performance was primarily graded on accuracy identifying either DA or PA-CC findings, then secondarily for DA findings alone. Outputs were reviewed for hallucinations. AI-generated patient-facing summaries were assessed for appropriateness via Likert scale. Results For the primary outcome (DA or PA-CC), GPT-4 achieved 99.3% recall, 73.6% precision, and 84.5% F-1. For the secondary outcome (DA only), GPT-4 demonstrated 95.2% recall, 77.3% precision, and 85.3% F-1. No findings were "hallucinated" outright. However, 2.8% of cases included generated text about recommendations that were inferred without specific reference. The majority of True Positive AI-generated summaries required no or minor revision. Conclusion GPT-4 demonstrates proficiency in detecting actionable, incidental findings after refined instruction prompting. AI-generated patient instructions were most often appropriate, but rarely included inferred recommendations. While this technology shows promise to augment diagnostics, active clinician oversight via "human-in-the-loop" workflows remains critical for clinical implementation. [ABSTRACT FROM AUTHOR]

Abstract Several donor-specific factors influence the functional recovery and long-term outcomes of liver grafts. This study investigated the association between donor fasting glucose (DFG) and recipient outcomes after living donor liver transplantation (LDLT) in 950 cases at a single center. Patients were divided into two groups: low-DFG (

Gender disparities in science and engineering majors in Chinese universities have received increasing attention from researchers and educators in China in recent years. Using data from a national survey of college students who graduated in 2005, this study documents gender disparities in enrollment and academic performance in science and engineering majors, and explores gender disparities in initial employment experiences of science and engineering graduates. It finds that females lag far behind males in enrollment in science and engineering majors overall. However, females actually are more represented than males in some majors such as mathematics and chemistry though the reverse is true for other science and engineering majors. Also, in science and engineering majors, females perform better than males in both general course grades and in English competency tests. Male science and engineering graduates have a clear advantage over their female counterparts in initial employment after graduation: they have a high employment rate, a higher starting salary, and are more likely to be employed in such jobs as business management and technical specialist. The male advantage in employment rate and starting salary persists even after controlling for other factors. (Contains 1 figure and 9 tables.)

Background: Robotic systems have the potential to significantly enhance the accuracy and outcomes of spinal surgery. Adopting this new technology requires an examination of its learning curve and influencing factors. This study analyzes the learning curve associated with using the Mazor X Stealth Edition system for pedicle screw placement and performs a matched-pair analysis to compare operative durations between robot-assisted and navigation-based surgeries, evaluating the efficiency of the robotic system. Methods: We collected retrospective operative data from patients who underwent robot-assisted pedicle screw placements between December 2020 and June 2024 and conducted a cumulative sum (CuSUM) analysis to assess the learning curve, focusing on the robotic system’s setup duration. Additionally, we compared a group of patients who underwent robot-assisted pedicle screw placements with a pair-matched group who underwent O-arm-based navigation-assisted pedicle screw placements. Results: There was a notable decrease in the robotic setup duration, with a significant shift in trend observed after the first 20 cases. While the initial setup time was 24 minutes, it reduced to 17 minutes in later cases, reflecting a marked improvement in efficiency as the surgeon gained more experience with the robot. Conclusion: Our findings indicate there were no added difficulties using the robotic system compared to the navigation system. Moreover, the learning curve for the robotic system can be quickly surmounted, and it offers clear advantages over previous systems, making it a valuable tool for pedicle screw application.

In the fast-growing market-oriented economy of Shenzhen, China, most employees have continued to participate in job-related education and training. We argue that as firms have acquired autonomy in their operations and individuals have gained the right to pursue their personal occupational aspirations, non-state-sponsored education and training systems for the working population have developed to respond to the demands from firms, as well as individuals. With survey data from 3,475 employees in seventy-six firms from Shenzhen, this study uses a multinomial model to examine patterns in employee participation in job-related education and training. There are basically four options open to employees: taking part in education and training provided by a firm to its own employees, enrolling in education and training offered by institutions outside the firm, availing themselves of both options simultaneously, or not participating. Our findings suggest that these four groups of employees vary in terms of their cultural and symbolic attributes, their individual socioeconomic attributes in relation to their workplace, and the economic attributes of their firm.

Investigates education and earnings for 3,709 residents of rural China. Education was significantly related to earnings; an additional year of schooling raised residents' earnings by 4.8 yuan monthly. The earnings effect was stronger for males and in economically advanced areas. Average private rate of return to education was 4.8%. Contains 26 references. (MLH)

Different methods should be used to determine the costs of institutional versus enterprise-based vocational training. Training costs are influenced by such factors as technology, teachers, program length, and scale of operation. Vocational education is generally more costly than academic education, and preemployment training costs more than does inservice. (SK)

In the 1980s, the Chinese government converted uppersecondary education to an equal mix of general and vocational/technical education. Although justified in economic terms, the development of vocational/technical education was actually prompted by a desire to reduce the social demand for higher education and use education as a social stratification device. (38 references) (MLH)

Purpose: Autologous arteriovenous fistulas (AVFs) are considered the gold standard for hemodialysis access, with outcomes largely dependent on the surgeon’s experience. Nevertheless, few studies have been conducted on the learning curve of junior vascular surgeons in AVF creation. This study aims to address this by examining the development of surgical skills among junior vascular surgeons. Materials and Methods : A retrospective analysis was conducted on 100 patients who underwent autologous AVF procedures performed by five junior surgeons between January 2018 and December 2023. To establish the cutoff number of cases for the learning curve, we examined the cubic spline curve using the hazard ratio for primary failure. Results : The cutoff number for operation cases was 15.33, and we divided the analysis into a pre-learning curve period (≤15 cases of AVF) and a post-learning curve period (>15 cases of AVF). The 1-year primary patency rate for AVF during the post-learning curve period was 84.0%, which was higher than the 65.5% rate observed during the pre-learning curve period. In a subgroup analysis based on AVF type, the radiocephalic fistula patient group demonstrated a significant increase in 1-year primary patency in the post-learning curve period compared to that in the pre-learning curve period (80.0% vs. 43.0%, log-rank P=0.033). In contrast, there was no significant difference in the primary patency rates between the post- and pre-learning curve periods in the brachiocephalic fistula patient group (90.0% vs. 89.2%, log-rank P=0.930). Conclusion : Junior vascular surgeons demonstrated improved primary AVF patency beyond the learning curve benchmark in 15 patients, with particularly notable enhancements in radiocephalic fistulas.

Abstract Death with a functioning graft is important cause of graft loss after kidney transplantation. However, little is known about factors predicting death with a functioning graft among kidney transplant recipients. In this study, we evaluated the association between post-transplant creatinine-cystatin C ratio and death with a functioning graft in 1592 kidney transplant recipients. We divided the patients into tertiles based on sex-specific creatinine-cystatin C ratio. Among the 1592 recipients, 39.5% were female, and 86.1% underwent living-donor kidney transplantation. The cut-off value for the lowest creatinine-cystatin C ratio tertile was 0.86 in males and 0.73 in females. The lowest tertile had a significantly lower 5-year patient survival rate and was independently associated with death with a functioning graft (adjusted hazard ratio 2.574, 95% confidence interval 1.339–4.950, P

A conventional melt quenching technique was used to successfully fabricate Mn2O3 -doped willemite glass-ceramics (Zn2SiO4:Mn3+) produced from the ZnO-SLS glasses. The results from XRD revealed that willemite crystallization is improved by increasing the sintering duration. It was revealed that, as the sintering duration progressed, the phase formation shifted from amorphous to α-Zn2SiO4 crystal. In addition, the structural growth of willemite phases can be seen using FTIR spectroscopy. The results of UV-Vis spectroscopy indicated that the intense absorption occurs in the UV zone, with wavelengths ranging from 250 nm to 400 nm, while the optical band gap showed a decreasing trend from 3.61 eV to 2.52 eV. These results perfectly established that Mn3+ dopant is potentially beneficial for producing willemite glass-ceramics for optoelectronic applications. [ABSTRACT FROM AUTHOR]

Abstract The clinical effects of tacrolimus (TAC) exposure on hepatocellular carcinoma (HCC) recurrence after liver transplantation (LT) remain unclear. In this retrospective single centric study, 512 patients who underwent LT for HCC were divided into four groups according to cumulative exposure to tacrolimus (CET) during 3 months after LT: conventional (n = 218), aggressive minimization (n = 32), minimization (n = 161), and high exposure (n = 101). Impact of CET on HCC recurrence and death were analyzed. Compared with the conventional group, the other three CET groups showed a similar risk of HCC recurrence. The aggressive minimization group showed a higher risk [hazard ratio (HR) 5.64, P

Abstract Purpose Unusual grafts, including extended left liver plus caudate lobe, right anterior section, and right posterior section grafts, are alternatives to left and right lobe grafts for living-donor liver transplantation. This study aimed to investigate unusual grafts from the perspectives of recipients and donors. Methods From 2016 to 2021, 497 patients received living-donor liver transplantation at Severance Hospital. Among them, 10 patients received unusual grafts. Three patients received extended left liver plus caudate lobe grafts, two patients received right anterior section grafts, and five patients received right posterior section grafts. Liver volumetrics and anatomy were analyzed for all recipients and donors. We collected data on laboratory examinations (alanine aminotransferase, total bilirubin, international normalized ratio), imaging studies, graft survival, and complications. A 1:2 ratio propensity-score matching method was used to reduce selection bias and balance variables between the unusual and conventional graft groups. Results The median of Model for End-stage Liver Disease score of unusual graft recipients was 13.5 (interquartile range 11.5–19.3) and that of graft–recipient weight ratio was 0.767 (0.7–0.9). ABO incompatibility was observed in four cases. The alanine aminotransferase level, total bilirubin level, and international normalized ratio decreased in both recipients and donors. Unusual and conventional grafts had similar survival rates (p = 0.492). The right and left subgroups did not differ from each counter-conventional subgroup (p = 0.339 and p = 0.695, respectively). The incidence of major complications was not significantly different between unusual and conventional graft recipients (p = 0.513). Wound seromas were reported by unusual graft donors; the complication ratio was similar to that in conventional graft donors (p = 0.169). Conclusion Although unusual grafts require a complex indication, they may show feasible surgical outcomes for recipients with an acceptable donor complication.