Evaluation of GPT-3.5 and GPT-4 for supporting real-world information needs in healthcare delivery

Despite growing interest in using large language models (LLMs) in healthcare, current explorations do not assess the real-world utility and safety of LLMs in clinical settings. Our objective was to determine whether two LLMs can serve information needs submitted by physicians as questions to an informatics consultation service in a safe and concordant manner. Sixty six questions from an informatics consult service were submitted to GPT-3.5 and GPT-4 via simple prompts. 12 physicians assessed the LLM responses' possibility of patient harm and concordance with existing reports from an informatics consultation service. Physician assessments were summarized based on majority vote. For no questions did a majority of physicians deem either LLM response as harmful. For GPT-3.5, responses to 8 questions were concordant with the informatics consult report, 20 discordant, and 9 were unable to be assessed. There were 29 responses with no majority on "Agree", "Disagree", and "Unable to assess". For GPT-4, responses to 13 questions were concordant, 15 discordant, and 3 were unable to be assessed. There were 35 responses with no majority. Responses from both LLMs were largely devoid of overt harm, but less than 20% of the responses agreed with an answer from an informatics consultation service, responses contained hallucinated references, and physicians were divided on what constitutes harm. These results suggest that while general purpose LLMs are able to provide safe and credible responses, they often do not meet the specific information need of a given question. A definitive evaluation of the usefulness of LLMs in healthcare settings will likely require additional research on prompt engineering, calibration, and custom-tailoring of general purpose models.Comment: 27 pages including supplemental informatio

Community Strains of Methicillin-Resistant Staphylococcus aureus as Potential Cause of Healthcare-associated Infections, Uruguay, 2002–2004

Community-associated MRSA appears to be replacing healthcare-associated MRSA strain types in at least 1 facility and is a cause of healthcare-onset infections

Panorama atual e potencial de aplicação da abordagem dos serviços ecossistêmicos do solo no Brasil

Human pressure on ecosystems has undesirable impacts on human well-being. After the Millennium Project, much interdisciplinary research has been developed worldwide aiming to understand these impacts on ecosystem flows and processes, and to learn about the costs and the benefits of ecosystem services for production. Soil provides many ecosystem services, since its multi-functionality is the basis for food production, water filtration, nutrient cycling, and other goods essential to life. This article presents the main concepts and classifications of soil ecosystem services and of its functions; the indicators and the methods for assessment, modeling, and valuation of ecosystem services; some recent applications to assess and evaluate impacts of agricultural management practices on soil ecosystem services; as well as challenges and opportunities for research and for development of public policies related to agro-environmental sustainability in Brazil. Although the role of soil in supplying ecosystem services is yet undervalued, scientists are gradually recognizing soil processes and functions as fundamental to assess ecosystem services and the effects of land use and management on them. Interdisciplinary approaches to integrate science and public policies are necessary to build governance based on ecosystem services.A pressão humana sobre os serviços ecossistêmicos tem resultado em impactos indesejáveis sobre o bem-estar humano. Com o Projeto Millennium, várias pesquisas interdisciplinares têm sido desenvolvidas em todo o mundo com o objetivo de entender esses impactos sobre os fluxos e os processos dos ecossistemas e internalizar os custos e os benefícios dos serviços ecossistêmicos para a produção. O solo fornece muitos serviços ecossistêmicos, uma vez que sua multifuncionalidade é a base para a produção de alimentos, filtração de água, ciclagem de nutrientes e outros bens essenciais à vida. Este artigo apresenta os principais conceitos e classificações dos serviços ecossistêmicos do solo e de suas funções; os indicadores e os métodos de avaliação, modelagem e valoração dos serviços ecossistêmicos; algumas aplicações recentes para avaliar impactos de práticas de manejo agrícola sobre os serviços ecossistêmicos do solo; bem como os desafios e as oportunidades para a pesquisa e para o desenvolvimento de políticas públicas relacionadas à sustentabilidade agroambiental no Brasil. Apesar de o papel do solo para prestação de serviços ecossistêmicos ainda ser subestimado, os cientistas têm gradualmente reconhecido os processos e as funções do solo como fundamentais para avaliar os serviços ecossistêmicos e os efeitos do uso e manejo da terra sobre eles. Abordagens interdisciplinares que integrem ciência e políticas públicas são necessárias para construir uma governança com base em serviços ecossistêmicos

Free Gracilis Muscle Flap for Sarcoma Reconstruction: 19 Years of Clinical Experience

Background. Sarcoma treatment necessitates high-dose chemoradiation therapy and wide surgical margins that create wounds that are difficult to reconstruct. Many techniques have been developed to cover these defects, originating with muscle flaps such as the rectus abdominis and latissimus dorsi. The gracilis flap, which is best known in contemporary practice as a microneurovascular flap for functional reconstructions, is not usually considered a robust option for reconstruction after sarcoma extirpation. Methods. We reviewed records of 22 patients (9 women) at our institution who underwent reconstructive surgery after sarcoma extirpation using gracilis flaps for soft-tissue coverage from 1998 to 2017. Neurotized gracilis flaps were excluded. The mean patient age was 51 years (range, 18–85 years), and mean length of follow-up was 53 months (range, 9–156 months). Patients had 7 tumor types, with fibrosarcomas and undifferentiated tumors being most common. There were 23 defects (mean size, 118 cm2 (range, 54–200 cm2)). Defects were located most commonly in the foot and leg (n=9 each), upper extremity (n=4), and head and neck (n=1). The primary outcome was the flap success rate. Secondary outcomes were rates of major complications (unplanned reoperations, infections requiring intravenous antibiotics, and amputations); minor complications (superficial infections, partial skin-graft loss, partial flap necrosis, fluid collections treated in the office, and cosmetic reoperations); and sarcoma recurrence. Results. Twenty-one flaps (91%) survived. Six patients (27%) experienced a major complication, and 12 patients (54%) experienced a minor complication. There were 2 amputations, for a limb salvage rate of 91%. Conclusions. This series shows that the gracilis is well suited to covering large, compromised wounds across diverse anatomic features, which are the hallmark of sarcoma resections. The high rate of limb salvage and minimal donor-site morbidity further support the use of this flap as a first-line option for sarcoma reconstruction

Classificação digital de imagens de satélite de alta resolução espacial para o mapeamento de uso e cobertura da terra na área do complexo petroquímico do Rio de Janeiro

The mapping of the land use and cover in the area of the Petrochemical Complex of Rio de Janeiro (COMPERJ) is needed for identification and monitoring of environmental changes that are expected with its implementation. Then, this work aimed to select the best options of automatic classification to perform this mapping. The methodology involved the following steps: organization of the digital cartographic database, selection of better Quickbird satellite image to cover study area, digital image processing in software ENVI 4.5 and ArcGIS 9.3.1 from ESRI, verification of spectral patterns of mapped classes in field and preparation of the final map in scale 1: 15,000. Nine land use and cover classes were obtained and the results showed that the methodology adopted, supervised classification image using automatic classifiers pixel by pixel, was efficient for the separation of the main targets of interest, avoiding large scan job. However, it was found that the classification pixel by pixel, applied in high-resolution images, creates many isolated pixels and jagged edges due to the level of detail of these images. One solution to this problem would be to use programs that make image classification by regions and object-oriented. However, the cost of these programs is high. The verification work was essential to terrestrial confirmation of the mapped classes, which are often confused in the visual image as well as by the classifier used.Pages: 7340-734