Chatbots, generative AI, and scholarly manuscripts: WAME recommendations on chatbots and generative artificial intelligence in relation to scholarly publications

This statement revises our earlier "WAME Recommendations on ChatGPT and Chatbots in Relation to Scholarly Publications" (January 20, 2023). The revision reflects the proliferation of chatbots and their expanding use in scholarly publishing over the last few months, as well as emerging concerns regarding lack of authenticity of content when using chatbots. These recommendations are intended to inform editors and help them develop policies for the use of chatbots in papers published in their journals. They aim to help authors and reviewers understand how best to attribute the use of chatbots in their work and to address the need for all journal editors to have access to manuscript screening tools. In this rapidly evolving field, we will continue to modify these recommendations as the software and its applications develop.

Esta declaración revisa las anteriores "Recomendaciones de WAME sobre ChatGPT y Chatbots en Relation to Scholarly Publications" (20 de enero de 2023). La revisión refleja la proliferación de chatbots y su creciente uso en las publicaciones académicas en los últimos meses, así como la preocupación por la falta de autenticidad de los contenidos cuando se utilizan chatbots. Estas recomendaciones pretenden informar a los editores y ayudarles a desarrollar políticas para el uso de chatbots en los artículos sometidos en sus revistas. Su objetivo es ayudar a autores y revisores a entender cuál es la mejor manera de atribuir el uso de chatbots en su trabajo y a la necesidad de que todos los editores de revistas tengan acceso a herramientas de selección de manuscritos. En este campo en rápida evolución, seguiremos modificando estas recomendaciones a medida que se desarrollen el software y sus aplicaciones.

Authors' reply.

We thank Dr Rupa V., Dr Nagoba B.S. and their colleagues for their comments on our editorial.1,2 Both the groups generally agree with our propositions, with Rupa and colleagues suggesting some changes. Credit for authorship is a balancing act between giving credit to all those who deserve it versus avoiding the scourge of ‘gift authorship’. Our editorial recommends credit to all the authors in order to encourage interdepartmental research and to prevent junior researchers from being denied their due which Nagoba and colleagues agree with. Any restriction in this context as suggested by Rupa and colleagues has a potential for harm—with credit being limited to the senior authors, who may be in a stronger position to influence their relative position in the authorship list. One wonders whether in India we have carried the ‘one size fits all’ approach too far in the name of ‘being objective’––and whether a subjective decision by a selection committee based on an individual’s actual contribution (e.g. the volume of work reported in a paper, the multidisciplinary nature of the work, and the expertise of a particular author) may be the way forward. We wish to reiterate that our editorial, written on behalf of the Indian Association of Medical Journal Editors, focused mainly on issues related to the publication process, and not on the criteria for faculty promotions, which is an entirely different debate. However, we emphasize that credit based on impact factor, as suggested by Rupa and colleagues, will pose a fresh set of challenges, given that the concept, application and the potential for manipulation of this measure have been the subject of widespread critique and debate in the literature.

The revised guidelines of the Medical Council of India for academic promotions: Need for a rethink.

Measuring academic achievements is never an easy task. This is particularly so when individuals are assessed for promotions in several fields with differing job descriptions. Assessment by peers is time-consuming and may be prone to bias; thus, objective criteria are required to minimize these concerns. The Medical Council of India (MCI) has laid down guidelines for appointments and promotions of teachers in medical institutions in India. Among the criteria used for promotions, publication of research is an essential requirement. Though the need for this requirement has been debated, it is believed that the quality of teaching improves when medical teachers are involved in research. Many countries have made it mandatory for their medical faculty to do research; some other countries incentivize the conduct and publication of research. Reports have also lamented that the physician–scientist might become an endangered species.1,2 Thus, linking publications with promotions might benefit both the individual and society. The flip side is that the time spent on research might take teachers away from teaching or clinical duties, particularly in under-staffed specialty departments. Further, the quality of research is likely to be poor when the resources and training in research are lacking.3 Poor quality may even discredit research as a professional activity. Insistence on a certain amount of published research to maintain teaching credentials may lead to the phenomenon of ‘publish or perish’.4 Finally, it is important to consider that biomedical research may, at times, be relevant to nonbiomedical journals and criteria for awarding credit to such publications should also be devised.

The revised guidelines of the Medical Council of India for academic promotions: need for a rethink.

Measuring academic achievements is never an easy task. This is particularly so when individuals are assessed for promotions in several fields with differing job descriptions. Assessment by peers is time-consuming and may be prone to bias; thus, objective criteria are required to minimise these concerns.

The Revised Guidelines Of The Medical Council Of India For Academic Promotions -Need for a rethink-

This editorial is being published simultaneously in the Indian Heart Journal, Indian Journal of Anaesthesia, Indian Journal of Gastroenterology, Indian Journal of Medical Ethics, Indian Journal of Medical Microbiology, Indian Journal of Occupational and Environmental Medicine, Indian Journal of Pathology and Microbiology, Indian Journal of Pharmacology, Indian Journal of Physiology and Pharmacology, Indian Journal of Urology, Indian Pediatrics, International Journal of Health Research & Medicolegal Practice, Journal of Anaesthesiology Clinical Pharmacology, Journal of Ayurveda and Integrative Medicine, Journal of Clinical and Scientific Research, Journal of Conservative Dentistry, Journal of Family Medicine and Primary Care, Journal of Indian Academy of Forensic Medicine, Journal of Mahatma Gandhi Institute of Medical Sciences, Journal of Postgraduate Medicine, National Journal of Integrated Research in Medicine, and The National Medical Journal of India. It may also be published in forthcoming issues of other journals. This editorial is not endorsed by all members of the IAMJE.[Aggarwal R NJIRM 2015; 6(6): 1-5]

Effect of Inclusion of Hepatitis B Vaccine in Childhood Immunization Program in India: A Retrospective Cohort Study.

Objective: To assess the effectiveness of hepatitis B immunization program in a field setting in India. Design: Serological survey of retrospective cohorts of children, vaccinated or not vaccinated with hepatitis B vaccine. Setting: Rural field areas of five districts in Andhra Pradesh state, where childhood hepatitis B immunization began in 2003. Participants: Children aged 5-11 years who had received HB immunization (n=2674; 1357 boys) or not received such immunization (n=2350; 1236 boys). Main Outcome Measures: Serum HBsAg, anti-HBc and anti- HBs (quantitative) using automated enzyme-immunoassays in the year 2010. Results: Anti-HBs positivity was higher among immunized than in unimmunized children (53% vs.18%; P<0.001), and anti-HBc positivity was lower (1.1% vs 10.8%: P<0.01). HBsAg positivity was low in both the groups (0.15% and 0.17%; P=0.855). Anti- HBs positivity rate declined with increasing age. Conclusions: Administration of hepatitis B vaccine as part of Universal immunization program led to anti-HBs in a large proportion of children and a reduction in anti-HBc positivity, a marker of hepatatis B virus infection. These data provide evidence supporting efficacy of hepatitis B immunization program in an Indian field setting, justifying the decision to include it in the universal immunization program.

N-acetyltransferase and cytochrome P450 2E1 gene polymorphisms and susceptibility to antituberculosis drug hepatotoxicity in an Indian population.

Background. Antituberculosis drug hepatotoxicity (ATDH) is common in India. Isoniazid, a constituent of most antituberculosis drug regimens, is metabolized by N-acetyltransferase (NAT2) and cytochrome P450 2E1 (CYP2E1) enzymes. We therefore studied the association of some single-nucleotide polymorphisms (SNPs) in these enzyme genes with ATDH. Methods. Allelic and genotypic frequencies at three SNP loci in the NAT2 gene (rs1799929, rs1799930 and rs1799931) and one locus (rs2031920) in the CYP2E1 gene were studied using restriction fragment length polymorphism in 33 patients who developed ATDH following an isoniazidcontaining antituberculosis drug regimen and 173 healthy blood donors. After confirming adherence of the control data to the Hardy–Weinberg equilibrium model, genotype and allele frequencies in the two groups were compared. Results. For SNP rs1799930 in the NAT2 gene, 7 (21%), 21 (64%) and 5 (15%) patients, and 93 (54%), 62 (36%) and 18 (10%) controls had GG, GA and AA genotypes, respectively (p=0.003; odds ratio [OR] for GA v. GG=4.50 [95% CI 1.80–11.22] and for AA v. GG=3.69 [1.05–12.93]). Allele frequency for G nucleotides for this SNP was 0.53 among patients and 0.72 among controls (OR 2.24 [1.31–3.84], p=0.007). The allele and genotype frequencies of the other NAT2 SNPs and the CYP2E1 SNP showed no significant difference between cases and controls. All the 33 patients and 151 (87%) of 173 controls had mutant allele at one or more of the three NAT2 SNP loci (p=0.03). The presence of two or more mutant alleles, a marker of slow acetylator status, was more frequent in patients (23/33 [70%]) than in controls (73/173 [42%]; OR 3.23 [95% CI 1.45–7.19], p=0.004). Conclusion. In India, the risk of ATDH is increased in persons with ‘A’ allele at SNP rs1799930 in the NAT2 gene, but is not associated with rs2031920 polymorphism in the CYP2E1 gene.

Spectrum of malabsorption syndrome among adults & factors differentiating celiac disease & tropical malabsorption.

Background & objectives: Aetiology of malabsorption syndrome (MAS) differs in tropical and temperate countries over time; clinical and laboratory parameters may differentiate between various causes. This study was undertaken to investigate the spectrum of MAS among Indian adults and to find out the features that may help to differentiate between TM and celiac disease. Methods: Causes of MAS, and factors differentiating tropical malabsorption (TM) from celiac disease (CD) were determined in 275 patients. Results: Using standard criteria, causes in 275 patients [age 37.5+13.2 yr, 170, (61.5%) male] were, TM 101 (37%), CD 53 (19%), small intestinal bacterial overgrowth 28 (10%), AIDS 15 (5.4%), giardiasis 13 (5%), hypogammaglobulinemia 12 (4%), intestinal tuberculosis 7 (2.5%), strongyloidiasis 6 (2%), immunoproliferative small intestinal disease 5 (2%), Crohn's disease 6 (2%), amyloidosis 4 (1.5%), intestinal lymphangiectasia 3 (1%) and unknown 22 (8%). On univariate analysis, patients with CD were younger than TM (30.6+12 vs. 39.3+12.6 yr, P<0.001), had lower body weight (41.3+11.8 vs. 49.9+11.2 kg, P<0.001), longer diarrhoea duration (median 36 inter-quartile range 17.8-120 vs. 24-months, 8-48, P<0.01), lower stool frequency (6/day, 5-8 vs. 8, 5-10, P<0.05), lower haemoglobin (9.4+3.2 vs. 10.4+2.7 g/dl, P<0.05), higher platelet count (2,58,000, range 1,35,500-3,23,500 vs. 1,60,000, 1,26,000-2,58,000/mm3, P<0.05), and more often had hepatomegaly (9/53, 17% vs. 4/101, 4%, P<0.01), and subtotal or partial villous atrophy (36/50, 72% vs. 28/87, 32%, P<0.001). Younger age (<35 yr), longer diarrhoea duration, higher platelet count and villous atrophy were significant on multivariate analysis. Interpretation & conclusions: TM and CD are common causes of MAS among Indian adults. Younger age (<35 yr), longer diarrhoea duration, higher platelet count and villous atrophy were found to be associated with CD.

Histological and immunohistochemical features in fatal acute fulminant hepatitis E.

Background: Hepatitis E is being increasingly recognized as an emerging infection in developed countries. Data on histological findings and nature of inflammatory cell infiltrate in liver in this disease are quite sparse. Aims: This study was planned to study the histological features and the type of inflammatory infiltrate in liver biopsies of patients with acute fulminant hepatitis E. Materials and Methods: We retrieved postmortem liver biopsies of 11 Indian patients with fulminant hepatitis E, and compared these with biopsies from seven patients with fulminant hepatitis B. Results : Biopsies from acute fulminant hepatitis E showed varying degrees of hepatocyte necrosis, mixed portal and lobular inflammation, accompanied by bile ductular proliferation, lymphocytic cholangitis, Kupffer cell prominence, cholestasis, apoptotic bodies, pseudo-rosette formation, steatosis, and presence of plasma cells in portal tracts. Interface hepatitis was more frequent in acute hepatitis B than in acute hepatitis E (100% vs 20%; P<0.05). These findings differ from those reported in cases with autochthonous hepatitis E in Europe. On immunohistochemistry, lymphocyte infiltrate consisted predominantly of CD3 + T cells in both hepatitis E and hepatitis B; these cells contained a predominant cytotoxic (CD8 + ) cell subpopulation in 81.8% of cases with hepatitis E and in 50% of cases with hepatitis B. Conclusion: Our findings suggest that histological changes in HEV infection may vary with geographical location because of prevalent HEV genotypes, and that CD8 + lymphocytes play a role in HEV-induced liver injury.

Effect of maternal education on choice of location for delivery among Indian women.

Background. Delivery in a healthcare facility is associated with better outcomes for both mother and child. However, in India, a large proportion of deliveries take place outside health facilities. We studied the effect of maternal education on the choice of location for delivery in the Indian population. Methods. Data from the National Family Health Survey 3 (NFHS-3) were used. The survey included women who were selected using a multi-stage (2-stage for urban areas and 3- stage for rural areas), stratified (based on demographic or social factors) sampling technique; the primary sampling units selected were proportional to population size, and the subsequent steps used simple random sampling. Effect of maternal education on the choice of place for delivery (home, public or private facility) was investigated through a multinomial logistic regression model. The model adjusted for several factors at individual, household and community level, the survey design effect and included sampling weights. Results. Of the 124 385 women aged 15–49 years included in the NFHS-3 dataset, 36 850 (29.6%) had had one or more childbirth during the past 5 years. A little more than half of all the deliveries were at home, and approximately a quarter each of the remaining deliveries were at public and private facilities, respectively. Maternal education was strongly and independently associated with the choice of location of delivery. For the choice sets of public facility versus home delivery and private facility versus home delivery, a clear dose–response relationship was apparent—higher maternal education was associated with a higher probability of delivery at a public or private health facility compared to home. Conclusion. Level of maternal education was a significant independent predictor of choice of location for childbirth among Indian women. Compared to cash incentives to increase facility-based delivery, improving maternal education may be a better way to achieve long term and sustained increase in facility deliveries in India.