Clinical Camel: An Open Expert-Level Medical Language Model with Dialogue-Based Knowledge Encoding

We present Clinical Camel, an open large language model (LLM) explicitly tailored for clinical research. Fine-tuned from LLaMA-2 using QLoRA, Clinical Camel achieves state-of-the-art performance across medical benchmarks among openly available medical LLMs. Leveraging efficient single-GPU training, Clinical Camel surpasses GPT-3.5 in five-shot evaluations on all assessed benchmarks, including 64.3% on the USMLE Sample Exam (compared to 58.5% for GPT-3.5), 77.9% on PubMedQA (compared to 60.2%), 60.7% on MedQA (compared to 53.6%), and 54.2% on MedMCQA (compared to 51.0%). In addition to these benchmarks, Clinical Camel demonstrates its broader capabilities, such as synthesizing plausible clinical notes. This work introduces dialogue-based knowledge encoding, a novel method to synthesize conversational data from dense medical texts. While benchmark results are encouraging, extensive and rigorous human evaluation across diverse clinical scenarios is imperative to ascertain safety before implementation. By openly sharing Clinical Camel, we hope to foster transparent and collaborative research, working towards the safe integration of LLMs within the healthcare domain. Significant challenges concerning reliability, bias, and the potential for outdated knowledge persist. Nonetheless, the transparency provided by an open approach reinforces the scientific rigor essential for future clinical applications.Comment: for model weights, see https://huggingface.co/wanglab

HPLC Method Validation for Simultaneous Determination of Three Mycotoxins from Corn Seeds

A new HPLC optimized method for simultaneous determination of some mycotoxins by separation and using a Dionex UltiMate3000 modular system, with multichannel UV detector was developed and validated. The method optimization was performed to determine simultaneously, several relevant mycotoxins from corn seeds that were stored over 8 months. The mycotoxins selected for quantification were: aflatoxin B1, ochratoxin A and zearalenone. They were selected due to their high concentration in the fodder. For the development stages of the HPLC method, it was introduced an internal standard to have accurate results. Taking into account that the analytes should be extracted from the complex matrix they reside, an extraction procedure was performed, using organic solvents, and the selection after repeated tests demonstrated the best capacity for ethyl acetate. The recovery is about 60–70 % after the extraction process also there is a good preconcentration (×2.5) of the analytes and the internal standard for their quantification. The limit of quantification (LOQ) obtained by chromatographic parameters optimization, for aflatoxin B1 and ochratoxin A were about 3–5 μg kg–1 and 14.4 μg kg–1 for zearalenone of raw biological material, making these values lower than those accepted by the actual normatives and regulations. (doi: 10.5562/cca1788

Medical students’ challenges and suggestions regarding research training: a synthesis of comments from a cross-sectional survey

Background: We previously reported on a cross-sectional study of students from the Michael G. DeGroote School of Medicine at McMaster University that found most respondents wanted more opportunities to participate in research. Students provided additional comments that we synthesized to enrich the findings of our quantitative analysis.   Methods: From our previously administered 13-item, online questionnaire, run across three campuses in Ontario, Canada, 498 of 618 medical students completed our survey and 360 (72%) provided optional written comments, which we synthesized using thematic analysis in this current study.  Results: Major themes that emerged were: (1) Active student participation to identify research opportunities and interested mentors are needed; (2) Types of research involvement; (3) Uncertainty whether research training translates into useable skills; (4) Desire for a formalized research curriculum and centralization of research opportunities across campuses.  Conclusion: Programs should stress to interested students the importance of actively looking for research opportunities and consider both large and small-group educational sessions

WangLab at MEDIQA-Chat 2023: Clinical Note Generation from Doctor-Patient Conversations using Large Language Models

This paper describes our submission to the MEDIQA-Chat 2023 shared task for automatic clinical note generation from doctor-patient conversations. We report results for two approaches: the first fine-tunes a pre-trained language model (PLM) on the shared task data, and the second uses few-shot in-context learning (ICL) with a large language model (LLM). Both achieve high performance as measured by automatic metrics (e.g. ROUGE, BERTScore) and ranked second and first, respectively, of all submissions to the shared task. Expert human scrutiny indicates that notes generated via the ICL-based approach with GPT-4 are preferred about as often as human-written notes, making it a promising path toward automated note generation from doctor-patient conversations.Comment: Camera-ready submission to ClinicalNLP @ ACL 202

A missing high-spin molecule in the family of cyano-bridged heptanuclear heterometal complexes, [(LCuII)6FeIII(CN)6]3+, and its CoIII and CrIII analogues, accompanied in the crystal by a novel octameric water cluster

Three isostructural cyano-bridged heptanuclear complexes, [{CuII(saldmen)(H2O)}6{MIII(CN)6}](ClO4)3$\cdotp$8H2O (M = FeIII 2; CoIII, 3; CrIII 4), have been obtained by reacting the binuclear copper(II) complex, [Cu2(saldmen)2(mu-H2O)(H2O)2](ClO4)2$\cdotp$2H2O 1, with K3[Co(CN)6], K4[Fe(CN)6], and, respectively, K3[Cr(CN)6] (Hsaldmen is the Schiff base resulted from the condensation of salicylaldehyde with N,N-dimethylethylenediamine). A unique octameric water cluster, with bicyclo[2,2,2]octane-like structure, is sandwiched between the heptanuclear cations in 2, 3 and 4. The cryomagnetic investigations of compounds 2 and 4 reveal ferromagnetic couplings of the central FeIII or CrIII ions with the CuII ions (JCuFe = +0.87 cm-1, JCuCr = +30.4 cm-1). The intramolecular Cu-Cu exchange interaction in 3, across the diamagnetic cobalt(III) ion, is -0.3 cm-1. The solid-state1H-NMR spectra of compounds 2 and 3 have been investigated

Correction to: Two years later: Is the SARS-CoV-2 pandemic still having an impact on emergency surgery? An international cross-sectional survey among WSES members

Background: The SARS-CoV-2 pandemic is still ongoing and a major challenge for health care services worldwide. In the first WSES COVID-19 emergency surgery survey, a strong negative impact on emergency surgery (ES) had been described already early in the pandemic situation. However, the knowledge is limited about current effects of the pandemic on patient flow through emergency rooms, daily routine and decision making in ES as well as their changes over time during the last two pandemic years. This second WSES COVID-19 emergency surgery survey investigates the impact of the SARS-CoV-2 pandemic on ES during the course of the pandemic. Methods: A web survey had been distributed to medical specialists in ES during a four-week period from January 2022, investigating the impact of the pandemic on patients and septic diseases both requiring ES, structural problems due to the pandemic and time-to-intervention in ES routine. Results: 367 collaborators from 59 countries responded to the survey. The majority indicated that the pandemic still significantly impacts on treatment and outcome of surgical emergency patients (83.1% and 78.5%, respectively). As reasons, the collaborators reported decreased case load in ES (44.7%), but patients presenting with more prolonged and severe diseases, especially concerning perforated appendicitis (62.1%) and diverticulitis (57.5%). Otherwise, approximately 50% of the participants still observe a delay in time-to-intervention in ES compared with the situation before the pandemic. Relevant causes leading to enlarged time-to-intervention in ES during the pandemic are persistent problems with in-hospital logistics, lacks in medical staff as well as operating room and intensive care capacities during the pandemic. This leads not only to the need for triage or transferring of ES patients to other hospitals, reported by 64.0% and 48.8% of the collaborators, respectively, but also to paradigm shifts in treatment modalities to non-operative approaches reported by 67.3% of the participants, especially in uncomplicated appendicitis, cholecystitis and multiple-recurrent diverticulitis. Conclusions: The SARS-CoV-2 pandemic still significantly impacts on care and outcome of patients in ES. Well-known problems with in-hospital logistics are not sufficiently resolved by now; however, medical staff shortages and reduced capacities have been dramatically aggravated over last two pandemic years

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Temperature changes during cortical bone drilling with a newly designed step drill and an internally cooled drill

PURPOSE: Bone drilling causes an increase in bone temperature, and a temperature above 47°C is critical because it causes thermal bone necrosis. Thermal osteonecrosis is common with the drill diameter of ≥4.5 mm without cooling. The aim of this study was to determine the increase of bone temperature during drilling using newly contructed two-step and internally cooled drills. ----- METHODS: An experiment was set up according to a central composite design. An internally cooled drill (3.4 mm and 4.5 mm) and a two-step drill (2.5/3.4 and 3.4/4.5 mm) were used in combination with feed rates of (0.02, 0.04, 0.10, 0.16 and 0.18 mm/rev) and cutting speeds (1.18, 10.68, 33.61, 56.55 and 66.05 m/min) with and without cooling with water of 24°C. Bone temperatures were measured with thermocouples. Drilling was performed on pig diaphyses with a three-axis mini milling machine. ----- RESULTS: Bone temperatures in all combinations of parameters with internal cooling were below the critical 47°C (p=0.05). The highest temperatures were detected using a 4.5-mm drill (40.5°C). A statistically significant effect other than cooling was found with the drill diameter and feed. A drill diameter of 3.4 mm with internal cooling developed a maximum temperature of 38.5°C and without cooling 46.3°C. For the same conditions a drill with diameter of 4.5 mm reached temperatures of 40.5°C and 55.7°C, respectively. The effect of feed rate is inversely proportional to the increase in bone temperature. With the feed rate 0.16 mm/rev, temperature was below critical even using the 4.5-mm drill (46.4°C, p=0.05). Using the 3.4-mm drill all temperatures were below critical (46.2°C, p=0.05). The two-step drill compared to a standard drill with the same diameter did not show statistical differences in maximum bone temperatures for all combinations of parameters (p=0.05). ----- CONCLUSIONS: A two-step drill does not have any advantages over a standard twist drill of the same diameter. An internally cooled drill causes a significantly smaller increase of bone temperature during drilling with water of 24°C. An internally cooled drill is currently the 'ideal' drill for traumatology/orthopaedics because it produces the smallest increase in bone drilling temperature. If internal cooling is used the regulation of other drilling parameters is of no importance