Thursday, July 06, 2023

HOSPITALS KILL

Kenyan hospital visits linked to increased exposure to antibiotic-resistant bacteria


Peer-Reviewed Publication

WASHINGTON STATE UNIVERSITY




PULLMAN, Wash. -- Kenyan patients who spend more than three days in the nation’s hospitals are more likely to harbor a form of bacteria resistant to one of the most widely used antibiotic classes, according to a recent study led by Washington State University.

The research team found that 66% of hospitalized patients were colonized with bacteria resistant to third-generation cephalosporins, compared to 49% among community residents. Third-generation cephalosporins are typically used for serious infections, and resistance to these antibiotics leaves limited options for treating patients with some bacterial infections.

The study, published in the Clinical Infectious Diseases journal, was part of a pair of projects in Kenya and a third in Guatemala to determine the prevalence of antibiotic-resistant bacteria. The research also aimed to identify risk factors for colonization with bacteria resistant to important and frequently used classes of antibiotics, including third-generation cephalosporins.

“These bacteria can cause untreatable infections,” said Sylvia Omulo, an assistant professor at WSU’s Paul G. Allen School for Global Health who led the studies in Kenya. “We have to use surveillance to make sure we understand what causes these bacteria to colonize and, later, resist certain antibiotics.”

By examining health records of Kenyan hospital patients who were colonized with cephalosporin-resistant bacteria, researchers identified three risk factors associated with colonization. Those risk factors included hospitalization for more than three days at 132% increased risk, intubation at 73% and a positive HIV status at 70%.

A person colonized with the bacteria may show no symptoms of an infection; however, the germs are present and growing in their body, and the individual may be at increased risk of a more dangerous infection from something as simple as a minor medical procedure or sickness from common bacteria like E. coli and Klebsiella. The germs can unknowingly be spread through person-to-person contact or contaminated surfaces.

While resistance is often associated with improper antibiotic use, that does not appear to be a primary contributing factor for cephalosporin-resistant bacteria in either Kenya or Guatemala. 

The Guatemala study, led by WSU Allen School assistant professor Brooke Ramay, was interrupted by the COVID-19 pandemic and resulted in data being collected during two time periods. Reported antibiotic use in the community declined three-fold between the pre- and post-periods, but the prevalence of cephalosporin-resistant bacteria remained steady, with colonization found in 67% of hospital patients and 46% of community subjects.

“If antibiotic use locally in the community was a major risk factor, we'd expect some change over the course of the year,” said WSU Regents Professor Douglas Call, corresponding author for the three publications.

 

In a Kenyan study of communities, the likelihood of colonization with cephalosporin-resistant bacteria rose by 12% with increasing visits to hospitals and clinics, and individuals who kept poultry were 57% more likely to have the resistant bacteria. Previous and ongoing work in both countries also highlights the role of bacterial transmission due to poor sanitation and hygiene.

What is not clear is if contact with the health care system is a source of transmission or if people seeking care are more likely to harbor these bacteria.

“We know if you're interacting with the health care system, you're more likely to carry these bugs, but we don't know why yet,” Call said. “To sort out the cause from the effect, we need to track the same people over time and record how their colonization status changes with different behaviors. Studies to do this are being set up for the coming year.”

The research was completed in collaboration with the Centers for Disease Control and Prevention, University del Valle de Guatemala, University of Nairobi and the Kenya Medical Research Institute. The work was funded by the CDC and is part of the broader Antimicrobial Resistance in Communities and Hospitals (ARCH) study partnership, which has research projects in six countries. The most recent findings from WSU and other institutions involved in the ARCH study were published in a special supplement of the Clinical Infectious Diseases journal.

Factors associated with learning disabilities and autism led to requests for euthanasia and assisted suicide in the Netherlands, study finds


A Kingston University, London study found reasons for chosing euthanasia and assisted suicide included feelings of loneliness and a struggle to form friendships

Peer-Reviewed Publication

KINGSTON UNIVERSITY




A Kingston University, London study found several people with learning disabilities and autism in the Netherlands chose to die legally through euthanasia and assisted suicide due to feeling unable to cope with the world, changes around them or because they struggled to form friendships.

There were almost 60,000 cases of euthanasia and physician-assisted suicide between 2012 and 2021 in the Netherlands. More than 900 case reports were recorded on an online, searchable database. This form of dying is legal in the country provided six due care criteria are met, one of which is that the patient’s suffering is unbearable, with no prospect of improvement.

Study lead and Professor of Intellectual Disability and Palliative Care at Kingston University Irene Tuffrey-Wijne and colleagues examined the database to understand the situations where people with learning disabilities or autism spectrum disorders had been granted requests for euthanasia or assisted suicide, and the main causes of suffering that led to the request.

They found 39 cases that involved people with either learning disabilities or autism spectrum disorder, or in some cases, both. Of these, 19 were male and 20 were female, with 18 of the 39 under the age of 50.

Published in the BJPsych Open Journal, the study found a majority, around two-thirds, chose that path solely, or mostly, due to characteristics associated with their condition, such as anxiety, loneliness and not feeling they had a place in society.  In eight of the 39 cases the reasons for the individual’s suffering were exclusively related to the learning disability or autism, with people feeling unable to cope with the world, changes around them and a struggle to make friendships and connections.

The research team said the findings highlighted a need for an international philosophical and ethical debate around criteria for euthanasia and assisted suicide and how to deal with such requests from vulnerable patient groups.

Within the study, a further eight said their autism or learning disability made it hard to cope with non-life-threatening physical illness or decline, while the same number stated their condition combined with psychiatric problems like anxiety and loneliness was their reason for wanting to die. Of the 39 cases, causes of suffering that led people to asked for help to die included loneliness (77 per cent of cases), a dependence on others (62 per cent), a lack of resilience or coping strategies (56 per cent) and a lack of flexibility and difficulty adapting to change (44 per cent).

Finally, in a third of the cases, doctors noted explicitly that the individual’s learning disabilities or autism were not treatable and that this was a key consideration in their assessment that there was no prospect of improvement and therefore an assisted death was the only remaining option for the patient.

Commenting on the findings, Professor Tuffrey-Wijne said that alongside the need for a wider debate on the ethics of dealing with requests from vulnerable groups, the research also highlighted the importance of investing in highly individualised support services around the world. “What these individuals needed was a society where they felt they belonged, with people around them who not just accept and accommodate, but welcome their unique ways of being,” she said.

“There is no doubt some people feel helpless, suffer deeply and profoundly and the support needed is complex but hopefully there can be a culture shift and a big investment in services that are significantly under-resourced.”

In addition to this work, Professor Tuffrey-Wijne gave oral evidence at a government health and social care select committee about an assisted dying and suicide inquiry earlier this month.

AI unleashes a Pandora's box: ChatGPT generates convincingly fake scientific article


Researchers demonstrate how AI can generate seemingly authentic scientific articles, prompting ethical concerns in the scientific community

Peer-Reviewed Publication

JMIR PUBLICATIONS

AI-generated image, in response to the request "pandoras box opened with a physician standing next to it. Oil painting Henry Matisse style 

IMAGE: AI-GENERATED IMAGE, IN RESPONSE TO THE REQUEST "PANDORAS BOX OPENED WITH A PHYSICIAN STANDING NEXT TO IT. OIL PAINTING HENRY MATISSE STYLE", (GENERATOR: DALL-E2/OPENAI, MARCH 9, 2023, REQUESTOR: MARTIN MÁJOVSKÝ). view more 

CREDIT: CREATED WITH DALL-E2, AN AI SYSTEM BY OPENAI; COPYRIGHT: N/A (AI-GENERATED IMAGE);



A new study published in the Journal of Medical Internet Research on May 31, 2023, by Dr Martin Májovský and colleagues has revealed that artificial intelligence (AI) language models such as ChatGPT (Chat Generative Pre-trained Transformer) can generate fraudulent scientific articles that appear remarkably authentic. This discovery raises critical concerns about the integrity of scientific research and the trustworthiness of published papers.

Researchers from Charles University, Czech Republic, aimed to investigate the capabilities of current AI language models in creating high-quality fraudulent medical articles. The team used the popular AI chatbot ChatGPT, which runs on the GPT-3 language model developed by OpenAI, to generate a completely fabricated scientific article in the field of neurosurgery. Questions and prompts were refined as ChatGPT generated responses, allowing the quality of the output to be iteratively improved.

The results of this proof-of-concept study were striking—the AI language model successfully produced a fraudulent article that closely resembled a genuine scientific paper in terms of word usage, sentence structure, and overall composition. The article included standard sections such as an abstract, introduction, methods, results, and discussion, as well as tables and other data. Surprisingly, the entire process of article creation took just 1 hour without any special training of the human user.

While the AI-generated article appeared sophisticated and flawless, upon closer examination expert readers were able to identify semantic inaccuracies and errors particularly in the references—some references were incorrect, while others were non-existent. This underscores the need for increased vigilance and enhanced detection methods to combat the potential misuse of AI in scientific research.

This study’s findings emphasize the importance of developing ethical guidelines and best practices for the use of AI language models in genuine scientific writing and research. Models like ChatGPT have the potential to enhance the efficiency and accuracy of document creation, result analysis, and language editing. By using these tools with care and responsibility, researchers can harness their power while minimizing the risk of misuse or abuse.

In a commentary on Dr Májovský’s article, published here, Dr Pedro Ballester discusses the need to prioritize the reproducibility and visibility of scientific works, as they serve as essential safeguards against the flourishing of fraudulent research.

As AI continues to advance, it becomes crucial for the scientific community to verify the accuracy and authenticity of content generated by these tools and to implement mechanisms for detecting and preventing fraud and misconduct. While both articles agree that there needs to be a better way to verify the accuracy and authenticity of AI-generated content, how this could be achieved is less clear. “We should at least declare the extent to which AI has assisted the writing and analysis of a paper,” suggests Dr Ballester as a starting point. Another possible solution proposed by Majovsky and colleagues is making the submission of data sets mandatory.

The article “Artificial Intelligence Can Generate Fraudulent but Authentic-Looking Scientific Medical Articles: Pandora's Box Has Been Opened” was published by JMIR Publications in its flagship title, the Journal of Medical Internet Research and can be accessed here.

Please cite as:

Májovský M, Černý M, Kasal M, Komarc M, Netuka D Artificial Intelligence Can Generate Fraudulent but Authentic-Looking Scientific Medical Articles: Pandora’s Box Has Been Opened J Med Internet Res 2023;25:e46924 

URL: https://www.jmir.org/2023/1/e46924/

doi: 10.2196/46924


 

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About JMIR Publications

JMIR Publications is a leading, born-digital, open access publisher of 30+ academic journals and other innovative scientific communication products that focus on the intersection of health, and technology. Its flagship journal, the Journal of Medical Internet Research, is the leading digital health journal globally in content breadth and visibility, and is the largest journal in the medical informatics field.

To learn more about JMIR Publications, please visit jmirpublications.com or connect with us via TwitterLinkedInYouTubeFacebook, and Instagram.

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The content of this communication is licensed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, published by JMIR Publications, is properly cited.

Researchers find hidden micro-stressors in routine driving


University of Houston and Texas A&M Transportation Institute use affective computing to gain unique insights into the driver condition

Peer-Reviewed Publication

UNIVERSITY OF HOUSTON

Ioannis Pavlidis 

IMAGE: IOANNIS PAVLIDIS, ECKHARD-PFEIFFER DISTINGUISHED PROFESSOR OF COMPUTER SCIENCE AT THE UNIVERSITY OF HOUSTON view more 

CREDIT: UNIVERSITY OF HOUSTON



Commuters around the world dream of ideal driving conditions every day, but they rarely get them. The traffic is often heavy and gets worse when the weather turns sour. Light traffic and good weather are usually perceived as factors for a stress-free commute. Alas, researchers from the University of Houston and the Texas A&M Transportation Institute found that even under such ideal conditions, daily driving is stressful to many people, and for intriguing reasons.

In a study published in the journal IEEE Transactions on Affective Computing, researchers report that people with a predisposition to anxiety exhibit a significantly higher heart rate when they drive as opposed to those who are not predisposed to anxiety. Anxious drivers had a heart rate about five beats per minute higher than non-anxious drivers, under similar conditions.

The study’s researchers also found drivers’ heart rate increased significantly with car speed. Drivers moving at 65 mph had a heart rate of about four beats per minute higher than drivers moving at 25 mph, under similar conditions. In both cases, the observed cardiovascular activation was linked to sympathetic activation, that is, to stress responses.

“These are substantial numbers that we would have never guessed”, said Ioannis Pavlidis, Eckhard-Pfeiffer Distinguished Professor of Computer Science, who led the University of Houston group. “Anxious people who commute at highway speeds experience, on average, heart rate elevation of nine beats per minute; this is every day for an hour or more, which is the typical commuting time in this country. It is an unexpected stressor that is hard to ignore because of its substantial effect and its repetitive nature.”

Both Mike Manser, senior research scientist and Robert Wunderlich, director of the Center for Transportation Safety with the Texas A&M group, emphasized that the reported stress effect was measured under good weather and light traffic, that is, ideal commuting conditions. “This sizeable stress effect stands to grow even bigger, as the conditions get worse”, they said.

The researchers conducted the driving study with a new affective computing method they call NUBI, short for Naturalistic and UBIquitous. The researchers said they recruited volunteers from Texas, where most people commute daily, the weather is usually good and traffic conditions are ideal in mid-size cities. All the volunteers were young (mean age 27), healthy and experienced drivers.

Monitoring was completely unobtrusive. For a week, every few seconds the drivers’ heart rate was monitored through their own Apple Watches, while their driving data was monitored through OBD II devices, popular with car insurance tracking programs. The volunteers also had to respond to daily psychometric questionnaires they received via text messages when they were not driving. Momentary weather and surrounding traffic data corresponding to the volunteers’ driving and heart rate data were extracted via open internet sources based on the drivers’ GPS signal. The researchers also monitored the volunteers during their non-driving hours to establish the uniqueness of any driving effects.

“Across the state, we were shadowing the participants’ real-lives moment by moment for a week,” Pavlidis said. “This is the beauty of a NUBI driving study – you can monitor participants hundreds of miles away and get insights into their natural driving and non-driving behaviors.”  

The resulting data set was huge, including 77 hours of driving and 915 hours of non-driving observations, expressed as nearly four million rows of multimodal information, which were analyzed with machine learning and statistical models.

The results of this study follow the results of an earlier study by the same researchers, who reported that certain people experience significant stress even in minute acceleration events, such as stop and go traffic. It appears there are cohorts in the population for which even trivial driving is stressful. These daily micro-stressors were not known or suspected thus far, because NUBI-style studies with unprecedented access to drivers’ internal and external state were not feasible until recently.

“Because driving is ingrained into people’s lives, even individuals who exhibit the said stress responses are not consciously aware of them. Nevertheless, the responses are there, they are substantial and their long-term implications are unknown,” said Pavlidis.  

For the short term, these micro-stressors appear to overload the drivers who experience them, because for similar itineraries, afflicted drivers consistently report being more tired than non-afflicted drivers, he added. Collectively, the study’s long- and short-term results have potential lifestyle, safety and insurance implications, the researchers noted.

Public support for militarily defending NATO allies

Peer-Reviewed Publication

PNAS NEXUS

Effect of Target Joining NATO 

IMAGE: EFFECT OF TARGET JOINING NATO, OVERALL AND BY SENDER COUNTRY. view more 

CREDIT: TOMZ ET AL.


Voters in North Atlantic Treaty Organization (NATO) member states are far more willing to militarily defend another country if the country joins NATO, versus if the same country does not join NATO, according to a study. To explore the possible consequences of expanding NATO membership, Michael Tomz and colleagues surveyed 14,000 voters in 13 NATO countries. Each survey participant was presented with a hypothetical Russian attack on one of four possible targets: Bosnia, Finland, Georgia, or Sweden—the four countries (other than Ukraine) furthest along in their bids for NATO accession at the time of the study. Whether or not the target had joined NATO prior to the attack was randomly varied. Participants were asked if their own country should defend the target country militarily. NATO membership boosted support for military defense from an average of 45% to 74% across the four targets. For Bosnia and Georgia, support nearly doubled between the non-member and member conditions. The benefits of joining NATO were smaller for Finland and Sweden, because most voters in NATO countries would defend Finland and Sweden even if those countries remained outside the alliance. Finally, willingness to defend new members of NATO depended critically on whether voters perceived the alliance as valuable for their own country. Anti-NATO rhetoric could, therefore, undermine the alliance by making voters less willing to defend alliance members, whereas pro-NATO rhetoric could enhance defense and deterrence. The results have significant implications for geopolitics and current debates about the expansion of NATO, according to the authors.

Internet searches for self-managed abortion after Roe v Wade overturned

Peer-Reviewed Publication

JAMA NETWORK

About The Study: This study used Google Trends data to estimate public interest in self-managed abortions and whether this interest differs depending on the legality of abortion in a state.

Authors: Sean D. Young, Ph.D., of the University of California, Irvine, is the corresponding author.

To access the embargoed study: Visit our For The Media website at this link https://media.jamanetwork.com/

(doi:10.1001/jamasurg.2023.2410)

Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, conflict of interest and financial disclosures, and funding and support.

Embed this link to provide your readers free access to the full-text article 

 https://jamanetwork.com/journals/jamasurgery/fullarticle/10.1001/jamasurg.2023.2410?guestAccessKey=325f7deb-2c36-4ddb-8a79-22839290a6aa&utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_content=tfl&utm_term=070523

BAN PALM OIL

Migrant orangutans learn which foods are good to eat by watching the locals


Migrants male orangutans ‘peer’ at role models to learn about new foods, especially those hard to process or rarely eaten


Peer-Reviewed Publication

FRONTIERS

Peering 

IMAGE: AN UNFLANGED MIGRANT ORANGUTAN MALE (ON THE LEFT SIDE) AND AN ADOLESCENT LOCAL ORANGUTAN FEMALE (ON THE RIGHT SIDE) ARE PEERING AT EACH OTHER. ORANGUTAN SPECIES: PONGO ABELII view more 

CREDIT: CAROLINE SCHUPPLI, SUAQ PROJECT, WWW.SUAQ.ORG




Orangutans are dependent on their mothers longer than any other non-human animal, nursing until they are at least six years old and living with her for up to three years more, learning how to find, choose, and process the exceedingly varied range of foods they eat. But how do orangutans that have left their mothers and now live far from their natal ranges, where the available foods may be very different, decide what to eat and figure out how to eat it? Now, an international team of authors has shown that in such cases, migrants follow the rule ‘observe, and do as the locals do’. The results are published in Frontiers in Ecology and Evolution.

“Here we show evidence that migrant orangutan males use observational social learning to learn new ecological knowledge from local individuals after dispersing to a new area,” said Julia Mörchen, a doctoral student at the Max Planck Institute for Evolutionary Anthropology and the University of Leipzig, in Germany, and the study’s lead author. “Our results suggest that migrant males not only learn where to find food and what to feed on from locals, but also continue to learn how to process these new foods.”

Mörchen and colleagues showed that migrant males learn this information through a behavior called ‘peering’: intensely observing for at least five seconds and from within two meters at a role model. Typically, peering orangutans faced the role model and showed signs of following his or her actions with head movements, indicating attentive interest.

Male orangutans migrate to another area after becoming independent, while females tend to settle close to their natal home range.

“What we don’t yet know is how far orangutan males disperse, or where they disperse to. But it’s possible to make informed guesses: genetic data and observations of orangutans crossing physical barriers such as rivers and mountains suggest long-distance dispersal, likely over tens of kilometers,” said Mörchen.

“This implies that during migration, males likely come across several habitat types and thus experience a variety of faunistic compositions, especially when crossing through habitats of different altitudes. Over evolutionary time, being able to quickly adapt to novel environments by attending to crucial information from locals, likely provided individuals with a survival advantage. As a result, this ability is likely ancestral in our hominin lineage, reaching back at least between 12 and 14 million years to the last common ancestor we share with orangutans.”

The authors analyzed 30 years of observations, collected by 157 trained observers, on 77 migrant adult males of the highly sociable Sumatran orangutan Pongo abelii at the Suaq Balimbing research station in Southwest Aceh, and 75 adult migrant males of the less sociable Bornean orangutan Pongo pygmaeus wurmbii at the Tuanan station in Central Kalimantan. They focused on every observation of peering behavior during 4,009 occasionswhen these males were within 50 meters of one or more neighbors, who could be adult females, juveniles, or adult males.

Peering by males was observed 534 times, occurring in 207 (5.2%) of these associations. In Suaq Balimbing, males most frequently peered at local females followed by at local juveniles, and least at adult males. In the less sociable population of Tuanan, the opposite held: males most frequently peered at adult males followed by immature orangutans, and least at adult females. Migrant males at Tuanan may lack opportunities to peer at local females, as females are known to avoid long associations with them in this population.

Migrant males then interacted more frequently with the peered-at food afterwards, putting into practice what they learned through peering.

“Our detailed analyses further showed that the migrant orangutan males in our study peered most frequently at food items that are difficult to process, or which are only rarely eaten by the locals: including foods that were only ever recorded to be eaten for a couple of minutes, throughout the whole study time,” said Dr Anja Widdig, a professor at the University of Leipzig and co-senior author of the study.  

“Interestingly, the peering rates of migrant males decreased after a couple of months in the new area, which implies that this is how long it takes them to learn about new foods,” added Dr Caroline Schuppli, a group leader at the Max Planck Institute of Animal Behavior in Konstanz, and co-senior author.

The authors cautioned that it’s still unknown how many times adult orangutans need to peer at a particular behavior to learn to master it. Observations suggest that depending on the complexity or novelty of the learned skill, adults may still use explorative behaviors on certain food items they first learned about through peering – possibly to figure out more details, strengthen and memorize the new information, or to compare the latter with previous knowledge.

An unflanged migrant orangutan male feeding on leaves from a tree fern, Akar Pakis Sarang Burung (Drynaria sparsisora). Orangutan species: Pongo abelii

CREDIT

Julia Mörchen, SUAQ Project, www.suaq.org

A flanged migrant orangutan male feeding on Rotan Tikus leaves (Flagellaria indica), Orangutan species: Pongo abelii

CREDIT

Guilhem Duvot, SUAQ Project, www.suaq.org

An unflanged migrant orangutan male feeding on Rotan Tikus leaves (Flagellaria indica) Orangutan species: Pongo abelii

CREDIT

Natascha Bartolotta, SUAQ Project, www.suaq.orgJOURNAL