Exploring the Possible Use of AI Chatbots in Public Health Education: Feasibility Study

Background: Artificial intelligence (AI) is a rapidly developing field with the potential to transform various aspects of health care and public health, including medical training. During the “Hygiene and Public Health” course for fifth-year medical students, a practical training session was conducted on vaccination using AI chatbots as an educational supportive tool. Before receiving specific training on vaccination, the students were given a web-based test extracted from the Italian National Medical Residency Test. After completing the test, a critical correction of each question was performed assisted by AI chatbots. Objective: The main aim of this study was to identify whether AI chatbots can be considered educational support tools for training in public health. The secondary objective was to assess the performance of different AI chatbots on complex multiple-choice medical questions in the Italian language. Methods: A test composed of 15 multiple-choice questions on vaccination was extracted from the Italian National Medical Residency Test using targeted keywords and administered to medical students via Google Forms and to different AI chatbot models (Bing Chat, ChatGPT, Chatsonic, Google Bard, and YouChat). The correction of the test was conducted in the classroom, focusing on the critical evaluation of the explanations provided by the chatbot. A Mann-Whitney U test was conducted to compare the performances of medical students and AI chatbots. Student feedback was collected anonymously at the end of the training experience. Results: In total, 36 medical students and 5 AI chatbot models completed the test. The students achieved an average score of 8.22 (SD 2.65) out of 15, while the AI chatbots scored an average of 12.22 (SD 2.77). The results indicated a statistically significant difference in performance between the 2 groups (U=49.5, P<.001), with a large effect size (r=0.69). When divided by question type (direct, scenario-based, and negative), significant differences were observed in direct (P<.001) and scenario-based (P<.001) questions, but not in negative questions (P=.48). The students reported a high level of satisfaction (7.9/10) with the educational experience, expressing a strong desire to repeat the experience (7.6/10). Conclusions: This study demonstrated the efficacy of AI chatbots in answering complex medical questions related to vaccination and providing valuable educational support. Their performance significantly surpassed that of medical students in direct and scenario-based questions. The responsible and critical use of AI chatbots can enhance medical education, making it an essential aspect to integrate into the educational system

Increased risk of acquisition of New Delhi metallo-beta-lactamase-producing carbapenem-resistant enterobacterales (Ndm-cre) among a cohort of covid-19 patients in a teaching hospital in Tuscany, Italy

We describe the epidemiology of New Delhi Metallo-Beta-Lactamase-Producing Carbapenem-Resistant Enterobacterales (NDM-CRE) colonization/infection in a cohort of COVID-19 patients in an Italian teaching hospital. These patients had an increased risk of NDM-CRE acquisition versus the usual patients (75.9 vs. 25.3 cases/10,000 patient days). The co-infection significantly increased the duration of hospital stay (32.9 vs. 15.8 days)

Basaltic Plinian eruptions at Las Sierras-Masaya volcano driven by cool storage of crystal-rich magmas

Although rare, basaltic Plinian eruptions represent a considerable volcanic hazard. The low viscosity of crystal-poor basaltic magma inhibits magma fragmentation; however, Las Sierras-Masaya volcano, Nicaragua, has produced multiple basaltic Plinian eruptions. Here, we quantify the geochemistry and volatile concentrations of melt inclusions in samples of the Fontana Lapilli and Masaya Triple Layer eruptions to constrain pre-eruptive conditions. Combining thermometry and geochemical modelling, we show that magma cooled to similar to 1000 degrees C prior to eruption, crystallising a mush that was erupted and preserved in scoriae. We use these data in a numerical conduit model, which finds that conditions most conducive to Plinian eruptions are a pre-eruptive temperature <1100 degrees C and a total crystal content >30 vol.%. Cooling, crystal-rich, large-volume basaltic magma bodies may be hazardous due to their potential to erupt with Plinian magnitude. Rapid ascent rates mean there may only be some minutes between eruption triggering and Plinian activity at Masaya

Preparedness and response to the covid-19 emergency: Experience from the teaching hospital of Pisa, Italy

In Italy, the coronavirus disease 2019 (COVID-19) emergency took hold in Lombardy and Veneto at the end of February 2020 and spread unevenly among the other regions in the following weeks. In Tuscany, the progressive increase of hospitalized COVID-19 patients required the set-up of a regional task force to prepare for and effectively respond to the emergency. In this case report, we aim to describe the key elements that have been identified and implemented in our center, a 1082-bed hospital located in the Pisa district, to rapidly respond to the COVID-19 outbreak in order to guarantee safety of patients and healthcare workers

Amyloid deposits and fibrosis on left ventricular endomyocardial biopsy correlate with extracellular volume in cardiac amyloidosis

BACKGROUND: The relative contribution of amyloid and fibrosis to extracellular volume expansion in cardiac amyloidosis (CA) has never been defined. METHODS AND RESULTS: We included all patients diagnosed with amyloid light-chain (AL) or transthyretin cardiac amyloidosis at a tertiary referral center between 2014 to 2020 and undergoing a left ventricular endomyocardial biopsy. Patients (n=37) were more often men (92%), with a median age of 72 years (interquartile range, 68–81). Lambda-positive AL was found in 14 of 19 AL cases (38%) and kappa-positive AL in 5 of 19 (14%), while transthyretin was detected in the other 18 cases (48%). Amyloid deposits accounted for 15% of tissue sample area (10%–30%), without significant differences between AL and transthyretin amyloidosis. All patients displayed myocardial fibrosis, with a median extent of 15% of tissue samples (10%–23%; range, 5%–60%), in the absence of spatial overlap with amyloid deposits. Interstitial fibrosis was often associated with mild and focal subendocardial fibrosis. The extent of fibrosis or the combination of amyloidosis and fibrosis did not differ significantly between transthyretin amyloidosis and AL subgroups. In 20 patients with myocardial T1 mapping at cardiac magnetic resonance, the combined amyloid and fibrosis extent displayed a modest correlation with extracellular volume (r=0.661, P=0.001). The combined amyloid and fibrosis extent correlated with high-sensitivity troponin T (P=0.035) and N-terminal pro-B-type natriuretic peptide (P=0.002) serum levels. CONCLUSIONS: Extracellular spaces in cardiac amyloidosis are enlarged to a similar extent by amyloid deposits and fibrotic tissue. Their combination can better explain the increased extracellular volume at cardiac magnetic resonance and circulating biomarkers than amyloid extent alone

Reliability and validity of PedsQL for Portuguese children aged 5–7 and 8–12 years

BACKGROUND: Pediatric Quality of Life Inventory (PedsQL) is a measure to assess health-related quality of life (HRQoL) in children and adolescents. It is formed by 23 items adapted to children age and includes a parent proxy report version. With four multidimensional subscales and three summary scores, it measures health as defined by WHO. The concepts measured by this instrument are ‘physical functioning’ (8 items), ‘emotional functioning’ (5 items), ‘social functioning’ (5 items) and ‘school functioning’ (5 items). It also measures a ‘total scale score’ (23 items), a ‘physical health summary score’ (8 items) and a ‘psychosocial health summary score’ (15 items). The aim of this paper is to present the main results of the cultural adaptation and validation of the PedsQL into European Portuguese. METHODS: The Portuguese version was the result of a forward-backward translation process, with a cognitive debriefing analysis, guaranteeing face validity and semantic equivalence. Children aged 5–7 and 8–12 were randomly selected and were asked to fill a socio-demographic data survey and the Portuguese versions of PedsQL and KINDL, another HRQoL measure for children and adolescents. They were divided into three groups, healthy children, children with type I diabetes and children with spina bifida. The reliability was tested for reproducibility (ICC) and internal consistency (Cronbach’s alpha). The construct validity (known-groups discriminant validity) was supported by differences between self-reports from healthy children and children with chronic conditions, and from children with chronic diseases and their parents. The criterion validity was tested after the correlations of the scores obtained by both children and adolescents HRQoL assessment instruments. RESULTS: A total of 179 children and 97 parents were recruited. PedsQL demonstrated good levels of reproducibility (r > 0.95 in all versions) and acceptable levels of internal consistency with Cronbach’s alpha at 0.70 on most scales. Concordance values between children’s and parents’ perceptions ranged between 0.36 and 0.78 and the correlations with KINDL questionnaire were excellent, supporting concurrent validity. CONCLUSIONS: The Portuguese version of the PedsQL demonstrated acceptable psychometric properties for future research and clinical practice for children aged 5–12

Microscale textural heterogeneity and tip-streaming instability in alkaline magmas: Evidence in tube pumices from Campi Flegrei, Italy

We present a textural investigation of compositionally homogeneous alkaline tube pumices from the plinian fallouts of the Agnano Monte Spina eruption (ca. 4.1 ka), Campi Flegrei, Italy. The pumice clasts present strong textural complexity from hand specimen to microscopic scale of inspection. The clasts are characterized by large vesicle tubes that extend up to several millimetres along the clast main axis. They also exhibit small and elongated vesicles arranged in stretched bands around textural domains of larger, sub-spherical vesicles associated with pyroxene, feldspar, and biotite phenocrysts. Clasts, vesicle tubes, vesicle deformation, major axes of pyroxene phenocrysts and crystals with size ≤100 μm align in the same direction. In addition, we observe chains of gradually smaller stretched vesicles likely generated from break-up of a larger parent vesicle (i.e., tip-streaming phenomenon). We use image analysis to quantify the heterogeneity of vesicle sizes and shapes. Then, we deduce the Capillary number (Ca) of the each single vesicle, which represents the ratio between the deforming viscous stress on a bubble and the restoring stress supplied by surface tension, and obtain the spatial distribution of Ca values within pumice clasts. As Ca depends on strain-rate and viscosity, the spatial distribution of Ca values provides us with a snapshot of the sub-millimetre scale variation in magma strain-rate and rheology before fragmentation. Ca in highly stretched vesicles is close to values (0.45 to 0.6) required for bubble-breakup induced by tip-streaming. Instead, low Ca values (0.3 to 0.45) are calculated for large sub-spherical vesicles mostly distributed around phenocrysts. We suggest that sub-millimetre heterogeneities in vesicle sizes and shapes recorded in tube pumices are caused by a combination of tip-streaming, heterogeneous bubble nucleation and second-boiling processes prior to fragmentation. The heterogeneous spatial distribution of Ca values may be the result of local micrometric shear localisation and consequent deformation upon break-up experienced by magma while ascending in the conduit. This deformation suggests that a variation of magma strain-rate and viscosity occurred before fragmentation at the clast microscale and this is likely to affect magma dynamics and fragmentation. Our results claim for future experimental and numerical modelling studies that investigate and consider the effect of such micrometric heterogeneities on magma rheology and flow condition variations inside volcanic conduits

Safety and efficacy of levosimendan in patients with cardiac amyloidosis

none5noNo abstract availablemixedAimo A.; Rapezzi C.; Arzilli C.; Vergaro G.; Emdin M.Aimo, A.; Rapezzi, C.; Arzilli, C.; Vergaro, G.; Emdin, M