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Objectives/Goals: Magnetic resonance imaging (MRI) reports are stored as unstructured text in the electronic health record (EHR), rendering the data inaccessible. Large language models (LLM) are a new tool for analyzing and generating unstructured text. We aimed to evaluate how well an LLM extracts data from MRI reports compared to manually abstracted data. Methods/Study Population: The University of California, San Francisco has deployed a HIPAA-compliant internal LLM tool utilizing GPT-4 technology and approved for PHI use. We developed a detailed prompt instructing the LLM to extract data elements from prostate MRI reports and to output the results in a structured, computer-readable format. A data pipeline was built using the OpenAI Application Programming Interface (API) to automatically extract distinct data elements from the MRI report that are important in prostate cancer care. Each prompt was executed five times and data were compared with the modal responses to determine variability of responses. Accuracy was also assessed. Results/Anticipated Results: Across 424 prostate MRI reports, GPT-4 response accuracy was consistently above 95% for most parameters. Individual field accuracies were 98.3% (96.3–99.3%) for PSA density, 97.4% (95.4–98.7%) for extracapsular extension, 98.1% (96.3–99.2%) for TNM Stage, had an overall median of 98.1% (96.3–99.2%), a mean of 97.2% (95.2–98.3%), and a range of 99.8% (98.7–100.0%) to 87.7% (84.2–90.7%). Response variability over five repeated runs ranged from 0.14% to 3.61%, differed based on the data element extracted (p Discussion/Significance of Impact: GPT-4 was highly accurate in extracting data points from prostate cancer MRI reports with low upfront programming requirements. This represents an effective tool to expedite medical data extraction for clinical and research use cases.
A least squares method is presented for fitting a given matrix A to another given matrix B under choice of an unknown rotation, an unknown translation, and an unknown central dilation. The procedure may be useful to investigators who wish to compare results obtained with nonmetric scaling techniques across samples or who wish to compare such results with those obtained by conventional factor analytic techniques on the same sample.
Over the past 20 years, collaboration has become an essential aspect of archaeological practice in North America. In paying increased attention to the voices of descendant and local communities, archaeologists have become aware of the persistent injustices these often marginalized groups face. Building on growing calls for a responsive and engaged cultural heritage praxis, this forum article brings together a group of Native and non-Native scholars working at the nexus of history, ethnography, archaeology, and law in order to grapple with the role of archaeology in advancing social justice. Contributors to this article touch on a diverse range of critical issues facing Indigenous communities in the United States, including heritage law, decolonization, foodways, community-based participatory research, and pedagogy. Uniting these commentaries is a shared emphasis on research practices that promote Indigenous sovereignty and self-determination. In drawing these case studies together, we articulate a sovereignty-based model of social justice that facilitates Indigenous control over cultural heritage in ways that address their contemporary needs and goals.
Effective nutrition policies require timely, accurate individual dietary consumption data; collection of such information has been hampered by cost and complexity of dietary surveys and lag in producing results. The objective of this work was to assess accuracy and cost-effectiveness of a streamlined, tablet-based dietary data collection platform for 24-hour individual dietary recalls (24HR) administered using INDDEX24 platform v. a pen-and-paper interview(PAPI) questionnaire, with weighed food record (WFR) as a benchmark. This cross-sectional comparative study included women 18–49 years old from rural Burkina Faso (n 116 INDDEX24; n 115 PAPI). A WFR was conducted; the following day, a 24HR was administered by different interviewers. Food consumption data were converted into nutrient intakes. Validity of 24HR estimates of nutrient and food group consumption was based on comparison with WFR using equivalence tests (group level) and percentages of participants within ranges of percentage error (individual level). Both modalities performed comparably estimating consumption of macro- and micronutrients, food groups and quantities (modalities’ divergence from WFR not significantly different). Accuracy of both modalities was acceptable (equivalence to WFR significant at P < 0·05) at group level for macronutrients, less so for micronutrients and individual-level consumption (percentage within ±20 % for WFR, 17–45 % for macronutrients, 5–17 % for micronutrients). INDDEX24 was more cost-effective than PAPI based on superior accuracy of a composite nutrient intake measure (but not gram amount or item count) due to lower time and personnel costs. INDDEX24 for 24HR dietary surveys linked to dietary reference data shows comparable accuracy to PAPI at lower cost.
Depression is expensive to treat, but providing ineffective treatment is more expensive. Such is the case for many patients who do not respond to antidepressant medication.
Aims
To assess the cost-effectiveness of cognitive–behavioural therapy (CBT) plus usual care for primary care patients with treatment-resistant depression compared with usual care alone.
Method
Economic evaluation at 12 months alongside a randomised controlled trial. Cost-effectiveness assessed using a cost-consequences framework comparing cost to the health and social care provider, patients and society, with a range of outcomes. Cost-utility analysis comparing health and social care costs with quality-adjusted life-years (QALYs).
Results
The mean cost of CBT per participant was £910. The difference in QALY gain between the groups was 0.057, equivalent to 21 days a year of good health. The incremental cost-effectiveness ratio was £14 911 (representing a 74% probability of the intervention being cost-effective at the National Institute of Health and Care Excellence threshold of £20 000 per QALY). Loss of earnings and productivity costs were substantial but there was no evidence of a difference between intervention and control groups.
Conclusions
The addition of CBT to usual care is cost-effective in patients who have not responded to antidepressants. Primary care physicians should therefore be encouraged to refer such individuals for CBT.
The potential for mountain pine beetle, Dendroctonus ponderosae Hopkins (Coleoptera: Curculionidae: Scolytinae), to expand its historical range in North America from west of the continental divide into the eastern boreal forest was assessed on the basis of analyses of the effects of climate and weather on brood development and survival, and key aspects of the interaction of mountain pine beetle with its hosts and associated organisms. Variation in climate suitability and high host susceptibility in the boreal forest create a finite risk of establishment and local persistence of low-level mountain pine beetle populations outside their historical range. Eventually, these populations could become widespread and cause epidemic infestations, creating an ecological pathway eastward through the boreal forest. Such infestations would reduce the commercial value of forests and impose an additional disturbance on native ecological systems.
In early twentieth-century Suzhou, business and state leaders deployed female prostitution to foster commerce despite its controversial nature and sometime illegality. This political-economic policy variously pitted prostitutes and madams, police, commercial interests and social reformers against one another as tensions between gender reform and economic growth played out in urban development. This article analyses these conflicts to highlight the actions of prostitutes and the prerogatives of male desire in Suzhou's spatial and economic transformation.
IUCN (The World Conservation Union) published its first Action Plan more than a decade ago (Oates 1986). Many taxon-specific Specialist Groups working under the auspices of the IUCN Species Survival Commission (SSC) have since produced such documents, some of which are now in their second editions (e.g. Reeves and Leatherwood 1994). As we know only too well ourselves, Action Plans take a great deal of time and effort to compile, but what evidence is there to show that they are effective in achieving their prime objective of increasing the amount and quality of work that gets done to save threatened species from extinction?
Rapid progress in the definition of tumour antigens, and improved immunisation methods, bring effective cancer vaccines within reach. In this wide-ranging survey, clinicians and scientists at the forefront of these developments review therapeutic cancer vaccine strategies against a variety of diseases and molecular targets. Intended for an interdisciplinary readership, chapters cover the rationale, development and implementation of vaccines in human cancers generally, and with specific reference to cancer of the cervix, breast, colon, bladder, and prostate, and to melanoma and lymphoma. Target identification, delivery vectors and clinical trial design are reviewed, and the book begins and ends with lucid overviews from the editors, including the most recent developments. Encapsulating recent scientific progress and the likely clinical potential of cancer vaccines, this book provides an essential introduction and guide for oncologists, immunologists and indeed all clinicians treating cancer patients.
There is increasing evidence for the role of activated microglia in the neurotoxic pathways of Alzheimer's disease (AD). Amyloid-β1-42 is a potent activator of microglia (Benveniste et al., 2001), causing them to release pro-inflammatory cytokines including IL-6, IL-1β, TNF-α among others. A peripheral blood marker reflecting CNS inflammatory processes would be useful for treatment development, but the search for such an in vivo marker has been elusive. Peripheral blood and CSF levels of pro-inflammatory cytokines do not consistently differ in AD and controls (reviewed in Rosenberg, 2005). Both microglia and peripheral blood mononuclear cells (PBMCs) release pro-inflammatory cytokines when exposed to immunologic stimuli including lipopolysaccharide (LPS) and phytohemagglutinin (PHA). There are recent data suggesting that PBMCs from AD patients release more cytokines in this paradigm than normal controls (Reale et al., 2004).