ChatGPT sits the DFPH exam: large language model performance and potential to support public health learning

Background Artificial intelligence-based large language models, like ChatGPT, have been rapidly assessed for both risks and potential in health-related assessment and learning. However, their applications in public health professional exams have not yet been studied. We evaluated the performance of ChatGPT in part of the Faculty of Public Health’s Diplomat exam (DFPH). Methods ChatGPT was provided with a bank of 119 publicly available DFPH question parts from past papers. Its performance was assessed by two active DFPH examiners. The degree of insight and level of understanding apparently displayed by ChatGPT was also assessed. Results ChatGPT passed 3 of 4 papers, surpassing the current pass rate. It performed best on questions relating to research methods. Its answers had a high floor. Examiners identified ChatGPT answers with 73.6% accuracy and human answers with 28.6% accuracy. ChatGPT provided a mean of 3.6 unique insights per question and appeared to demonstrate a required level of learning on 71.4% of occasions. Conclusions Large language models have rapidly increasing potential as a learning tool in public health education. However, their factual fallibility and the difficulty of distinguishing their responses from that of humans pose potential threats to teaching and learning

Control of nuclear beta-dystroglycan content is crucial for the maintenance of nuclear envelope integrity and function

β-Dystroglycan (β-DG) is a plasma membrane protein that has ability to target to the nuclear envelope (NE) to maintain nuclear architecture. Nevertheless, mechanisms controlling β-DG nuclear localization and the physiological consequences of a failure of trafficking are largely unknown. We show that β-DG has a nuclear export pathway in myoblasts that depends on the recognition of a nuclear export signal located in its transmembrane domain, by CRM1. Remarkably, NES mutations forced β-DG nuclear accumulation resulting in mislocalization and decreased levels of emerin and lamin B1 and disruption of various nuclear processes in which emerin (centrosome-nucleus linkage and β-catenin transcriptional activity) and lamin B1 (cell cycle progression and nucleoli structure) are critically involved. In addition to nuclear export, the lifespan of nuclear β-DG is restricted by its nuclear proteasomal degradation. Collectively our data show that control of nuclear β-DG content by the combination of CRM1 nuclear export and nuclear proteasome pathways is physiologically relevant to preserve proper NE structure and activity

Tocilizumab in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

Background: In this study, we aimed to evaluate the effects of tocilizumab in adult patients admitted to hospital with COVID-19 with both hypoxia and systemic inflammation. Methods: This randomised, controlled, open-label, platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing several possible treatments in patients hospitalised with COVID-19 in the UK. Those trial participants with hypoxia (oxygen saturation <92% on air or requiring oxygen therapy) and evidence of systemic inflammation (C-reactive protein ≥75 mg/L) were eligible for random assignment in a 1:1 ratio to usual standard of care alone versus usual standard of care plus tocilizumab at a dose of 400 mg–800 mg (depending on weight) given intravenously. A second dose could be given 12–24 h later if the patient's condition had not improved. The primary outcome was 28-day mortality, assessed in the intention-to-treat population. The trial is registered with ISRCTN (50189673) and ClinicalTrials.gov (NCT04381936). Findings: Between April 23, 2020, and Jan 24, 2021, 4116 adults of 21 550 patients enrolled into the RECOVERY trial were included in the assessment of tocilizumab, including 3385 (82%) patients receiving systemic corticosteroids. Overall, 621 (31%) of the 2022 patients allocated tocilizumab and 729 (35%) of the 2094 patients allocated to usual care died within 28 days (rate ratio 0·85; 95% CI 0·76–0·94; p=0·0028). Consistent results were seen in all prespecified subgroups of patients, including those receiving systemic corticosteroids. Patients allocated to tocilizumab were more likely to be discharged from hospital within 28 days (57% vs 50%; rate ratio 1·22; 1·12–1·33; p<0·0001). Among those not receiving invasive mechanical ventilation at baseline, patients allocated tocilizumab were less likely to reach the composite endpoint of invasive mechanical ventilation or death (35% vs 42%; risk ratio 0·84; 95% CI 0·77–0·92; p<0·0001). Interpretation: In hospitalised COVID-19 patients with hypoxia and systemic inflammation, tocilizumab improved survival and other clinical outcomes. These benefits were seen regardless of the amount of respiratory support and were additional to the benefits of systemic corticosteroids. Funding: UK Research and Innovation (Medical Research Council) and National Institute of Health Research

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

Background: Many patients with COVID-19 have been treated with plasma containing anti-SARS-CoV-2 antibodies. We aimed to evaluate the safety and efficacy of convalescent plasma therapy in patients admitted to hospital with COVID-19. Methods: This randomised, controlled, open-label, platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]) is assessing several possible treatments in patients hospitalised with COVID-19 in the UK. The trial is underway at 177 NHS hospitals from across the UK. Eligible and consenting patients were randomly assigned (1:1) to receive either usual care alone (usual care group) or usual care plus high-titre convalescent plasma (convalescent plasma group). The primary outcome was 28-day mortality, analysed on an intention-to-treat basis. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936. Findings: Between May 28, 2020, and Jan 15, 2021, 11558 (71%) of 16287 patients enrolled in RECOVERY were eligible to receive convalescent plasma and were assigned to either the convalescent plasma group or the usual care group. There was no significant difference in 28-day mortality between the two groups: 1399 (24%) of 5795 patients in the convalescent plasma group and 1408 (24%) of 5763 patients in the usual care group died within 28 days (rate ratio 1·00, 95% CI 0·93–1·07; p=0·95). The 28-day mortality rate ratio was similar in all prespecified subgroups of patients, including in those patients without detectable SARS-CoV-2 antibodies at randomisation. Allocation to convalescent plasma had no significant effect on the proportion of patients discharged from hospital within 28 days (3832 [66%] patients in the convalescent plasma group vs 3822 [66%] patients in the usual care group; rate ratio 0·99, 95% CI 0·94–1·03; p=0·57). Among those not on invasive mechanical ventilation at randomisation, there was no significant difference in the proportion of patients meeting the composite endpoint of progression to invasive mechanical ventilation or death (1568 [29%] of 5493 patients in the convalescent plasma group vs 1568 [29%] of 5448 patients in the usual care group; rate ratio 0·99, 95% CI 0·93–1·05; p=0·79). Interpretation: In patients hospitalised with COVID-19, high-titre convalescent plasma did not improve survival or other prespecified clinical outcomes. Funding: UK Research and Innovation (Medical Research Council) and National Institute of Health Research

Indução do estro no pós-parto em vacas primíparas Holandês-Zebu Induction of estrus in the postpartum of Holstein-Zebu heifers through norgestomet

Avaliou-se o efeito do peso corporal no início do tratamento com progestágeno sobre as características reprodutivas de vacas mestiças Holandês-Zebu no pós-parto. Foram utilizadas 64 vacas, divididas em quatro grupos: GI - vacas com peso corporal entre 390-458kg e submetidas a tratamento hormonal com norgestomet, GII - vacas com peso corporal entre 464-562kg e submetidas a tratamento hormonal com norgestomet, GIII - vacas com peso corporal entre 374-451kg (controle) e GIV - vacas com peso corporal entre 452-545kg (controle). Os animais do grupo II manifestaram o primeiro estro no pós-parto mais cedo que os demais (64,4 dias - GII vs. 109,4-GI; 143,2-GIII e 105,1-GIV dias), e apresentaram menor período de serviço (94,6 dias vs. 125,5; 160,9 e 131,0 dias, na mesma ordem de citação anterior). Quanto às taxas de manifestação de estro e de gestação final, não se verificaram diferenças (P>0,05) entre os tratamentos. Os animais do GII apresentaram o menor período de serviço e os do GIII, o maior (94,6 vs. 160,9). Não houve influência do tratamento hormonal nem do peso corporal sobre a produção de leite e duração da lactação. O uso do implante de progestágeno nos animais que apresentaram maiores peso e condição corporal no início do tratamento respondeu por menor intervalo entre o parto e o primeiro estro. O uso do progestágeno em animais mais leves esteve associado ao retorno mais rápido à atividade ovariana cíclica no pós-parto.<br>The experiment was carried out to evaluate the effect of two ranges of body weight and norgestomet treatment on the reproductive parameters of postpartum crossbred Holstein-zebu cows. Sixty four primiparous cows were randomly allocated to four treatments 40 days after calving: group I - cows with body weight ranging from 390 to 458kg and norgestomet treated; group II - cows with body weight ranging from 464 to 562kg and norgestomet treated; group III - cows with body weight ranging from 390 to 458kg (control); and group IV - cows with body weight ranging from 464 to 562kg (control). Progestagen auricular implants were mantained during 10 days and the cows were mated to bulls submitted to breeding soundness evaluation. Animals from treatment II showed estrus earlier than animals of the others treatments (II: 64.4; I: 109.4; III: 143.2 and IV: 105.1 days; P<0.05), and shorter open days (II: 94.6; I: 125.5; III: 160.9 and IV: 131.0 days; P<0.05). Estrus and pregnance rates did not differ between treatments (P>0.05). The hormonal treatment and the body weight did not affect the total and daily milk yield, and length of lactation (P>0.05). Progestagen treated, heavier and better body condition scored animals had shorter open days, and returned to postpartum ovarian ciclicity faster than lighter animals