Qualitative evaluation of artificial intelligence-generated weight management diet plans.

Importance: The transformative potential of artificial intelligence (AI), particularly via large language models, is increasingly being manifested in healthcare. Dietary interventions are foundational to weight management efforts, but whether AI techniques are presently capable of generating clinically applicable diet plans has not been evaluated. Objective: Our study sought to evaluate the potential of personalized AI-generated weight-loss diet plans for clinical applications by employing a survey-based assessment conducted by experts in the fields of obesity medicine and clinical nutrition. Design setting and participants: We utilized ChatGPT (4.0) to create weight-loss diet plans and selected two control diet plans from tertiary medical centers for comparison. Dietitians, physicians, and nurse practitioners specializing in obesity medicine or nutrition were invited to provide feedback on the AI-generated plans. Each plan was assessed blindly based on its effectiveness, balanced-ness, comprehensiveness, flexibility, and applicability. Personalized plans for hypothetical patients with specific health conditions were also evaluated. Main outcomes and measures: The primary outcomes measured included the indistinguishability of the AI diet plan from human-created plans, and the potential of personalized AI-generated diet plans for real-world clinical applications. Results: Of 95 participants, 67 completed the survey and were included in the final analysis. No significant differences were found among the three weight-loss diet plans in any evaluation category. Among the 14 experts who believed that they could identify the AI plan, only five did so correctly. In an evaluation involving 57 experts, the AI-generated personalized weight-loss diet plan was assessed, with scores above neutral for all evaluation variables. Several limitations, of the AI-generated plans were highlighted, including conflicting dietary considerations, lack of affordability, and insufficient specificity in recommendations, such as exact portion sizes. These limitations suggest that refining inputs could enhance the quality and applicability of AI-generated diet plans. Conclusion: Despite certain limitations, our study highlights the potential of AI-generated diet plans for clinical applications. AI-generated dietary plans were frequently indistinguishable from diet plans widely used at major tertiary medical centers. Although further refinement and prospective studies are needed, these findings illustrate the potential of AI in advancing personalized weight-centric care.

An evolutionary perspective on genetic load in small, isolated populations as informed by whole genome resequencing and forward-time simulations.

Small populations are vulnerable to increased genetic load and drift that can lead to reductions in fitness and adaptive potential. By analyzing 66 individual whole genomes of Montezuma Quail (Cyrtonyx montezumae) from multiple populations, we illustrate how genetic load is dynamic over evolutionary time. We show that Montezuma Quail are evolving like a ring species, where the terminal extant populations from Arizona and Texas have been separated for ~16,500 years. The Texas populations have remained small but stable since the separation, whereas the Arizona population is much larger today but has been contracting for thousands of years. Most deleterious mutations across the genome are young and segregating privately in each population and a greater number of deleterious alleles are present in the larger population. Our data indicate that ancestral load is purged during strong bottlenecks, but the reduced efficiency of selection in small populations means that segregating deleterious mutations are more likely to rise in frequency over time. Forward-time simulations indicate that severe population declines in historically large populations is more detrimental to individual fitness, whereas long-term small populations are more at risk for reduced adaptive potential and population-level fitness. Our study highlights the intimate connections among evolutionary history, historical demography, genetic load, and evolutionary potential in wild populations.

El tratamiento de las demencias en el sistema de salud de Uruguay / Dementias: Treatment within Uruguayan Health System / Tratamento das demências no sistema de saúde do Uruguai

Resumen: La Organización Mundial de la Salud ha exhortado a los gobiernos del mundo a declarar la demencia como una prioridad de salud pública. Recientemente ha definido un plan de acción mundial sobre la respuesta de salud pública a la demencia 2017-2025. El objetivo del presente estudio es conocer la respuesta que da el sistema de salud de Uruguay en materia de tratamientos de la demencia, aportando al área de tratamientos y atención de dicho plan. Se diseña un estudio descriptivo e interpretativo basado en las trayectorias de atención, que utiliza métodos cuantitativos y cualitativos para estudiar dos poblaciones: familiares y médicos. Los principales resultados indican que el sistema de salud de Uruguay es accesible para las personas con demencia, pero da una respuesta muy limitada en cuanto a tratamientos, no cumpliendo con el estándar de calidad y buenas prácticas definido internacionalmente. El tratamiento brindado es exclusivamente farmacológico y no existe disponibilidad de tratamientos psicosociales dentro del propio sistema de salud. De esta forma, todos los aspectos de la enfermedad - cognitivos, afectivos, conductuales, de sufrimiento psíquico - son abordados de forma exclusivamente neuroquímica, lo que hace muy ineficiente al propio sistema. Las personas con demencia atendidas presentan un alto consumo de fármacos psicotrópicos, incluido algunos que están especialmente contraindicados por sus efectos secundarios. Se discuten estas estrategias de atención como parte de un dispositivo biopolítico y una perspectiva de enfermedad objetivo-natural, que implican un riesgo de iatrogenia. Finalmente, se realizan algunas recomendaciones para revertir esta situación y mejorar el sistema de salud.

Abstract: World Health Organization has called Governments to make dementia a public health priority. A global action plan on the public health response to dementia 2017-2025 has recently been defined. The aim of the present study is to know the response given by the Uruguayan health system regarding treatments for dementia, addressing to areas of this plan. A descriptive and interpretative study is designed based on care trajectories; it uses quantitative and qualitative methods to study two populations: family and doctors. The main results indicate that the health system of Uruguay is accessible to people with dementia, but it gives a very limited response in terms of treatments, not complying with the internationally defined standards of quality and good practice. The treatment provided is exclusively pharmacological and there is no availability for psychosocial treatments within the health system itself. In this way, all aspects of the disease - cognitive, affective, behavioral, psychic suffering, etc. - are dealt within an exclusively neurochemical way, which makes the system itself very inefficient. People treated for dementia show a high consumption of psychotropic drugs, including some that are especially contraindicated due to their side effects. These care strategies are discussed as part of a biopolitical device and a perspective of objective-natural disease, which imply a high risk of iatrogenesis. We conclude by making some recommendations to reverse this situation.

Resumo: A Organização Mundial da Saúde convidou os governos do mundo a declararem a demência como uma prioridade de saúde pública. Recentemente, definiu um plano de ação global sobre a resposta da saúde pública à demência 2017-2025. O objetivo deste estudo é conhecer a resposta do sistema de saúde uruguaio em termos de tratamentos da demência, contribuindo para a área de terapêuticas e cuidados desse plano. Este estudo, descritivo e interpretativo com base em trajetórias das assistência que utilizam métodos quantitativos e qualitativos, estudou duas populações: família e médicos. Os principais resultados indicam que o sistema de saúde do Uruguai é acessível para pessoas com demência, mas dá uma resposta muito limitada em termos de tratamentos, não cumprindo a qualidade internacional e o padrão das boas práticas. O que é fornecido é exclusivamente farmacológico e não há disponibilidade de tratamentos psicossociais dentro do próprio sistema de saúde. Desta forma, todos os aspetos da doença - sofrimento cognitivo, afetivo, comportamental, psíquico, etc. - são tratados de forma exclusivamente neuroquímica, tornando muito ineficiente o próprio sistema. As pessoas com demência tratadas apresentam alto consumo de drogas psicotrópicas, incluindo algumas que são especialmente contraindicadas devido aos efeitos colaterais. Essas estratégias de atenção são discutidas como parte de um dispositivo biopolítico e uma perspetiva de doença meta-natural, implicando um alto risco de iatrogenia; e fazendo algumas recomendações para reverter essa situação.

A prospective pilot study of ultrasound therapy effectiveness in refractory venous leg ulcers.

Venous insufficiency is the most common cause of leg ulcers in the United States. Venous leg ulcers cost the health care system billions of dollars annually, and healing rates are less than 70% with standard of care; therefore, new therapies are needed to increase healing times and minimize associated costs. Non contact ultrasound therapy has been used to treat a variety of chronic wounds including venous leg ulcers, and it is thought that ultrasound has an effect on decreasing the bacterial count in wounds, although the exact mechanism of action of ultrasound is yet to be determined. We conducted an open labelled pilot study of 10 refractory venous ulcers of large size to determine the effect of non contact ultrasound on wound closure, bacterial counts, expression of inflammatory cytokines and pain reduction. We lacked a sham control group but we compared the baseline and end of treatment assessments and noted the differences. We found a significant reduction in wound area (P = 0·0039) over the 4-week treatment period. We also found a decline in individual and total bacterial counts; however, these differences were not significant. For all patients, there was also a trend toward reduced inflammatory cytokine expression compared with baseline levels; however, this reduction did not reach statistical significance. Interestingly, there was a correlation between healing and change in cytokine expression, which showed statistically significance for tumour necrosis factor (TNF)-αP = 0·0395, IL-1a P = 0·0351, IL-6 P = 0·0508, IL-8 P = 0·0990. Pain as measured by the visual analogue scale (VAS) was reduced from 4 at the baseline to 2·7 by the end of the study. In conclusion, we found that patients treated with ultrasound therapy and compression therapy show clinical improvement over the course of 4 weeks and had a decrease in inflammatory cytokines, bacterial counts and pain.

Tuning the excited-state dynamics of GFP-inspired imidazolone derivatives.

The excited-state dynamics of five derivatives of the GFP-chromophore, which differ by the position and nature of their substituents, has been investigated in solvents of various viscosity and polarity and in rigid media using femtosecond-resolved spectroscopy. In polar solvents of low viscosity, like acetonitrile or methanol, the fluorescence decays of all compounds are multiexponential, with average lifetimes of the order of a few picoseconds, whereas in rigid matrices (polymer films and low temperature glasses), they are single exponential with lifetimes of the order of a few nanoseconds and fluorescence quantum yields close to unity. Global analysis of the fluorescence decays recorded at several wavelengths and of the transient absorption spectra reveals the presence of several excited-state populations with slightly different fluorescence and absorption spectra and with distinct lifetimes. These populations are attributed to the existence of multiple ground-state conformers. From the analysis of the dependence of the excited-state dynamics on the solvent and on the nature of the substituents, it follows that the nonradiative deactivation of all these excited chromophores involves an intramolecular coordinate with large amplitude motion. However, depending on the solvent and substituent, additional channels, namely, inter- and intramolecular hydrogen bond assisted nonradiative deactivation, are operative. This allows tuning of the excited-state lifetime of the chromophore. Finally, an ultrafast photoinduced intramolecular charge transfer is observed in polar solvents with one derivative bearing a dimethylaminophenyl substituent.

Cosmeceuticals and natural products: wound healing.

Despite several technologic and strategic advances in the field, wound care has returned to the roots of medicine and embraced some of the remedies used millennia ago. Some of the many potentially beneficial natural products include the beta-glucans, honey, aloe, cocoa, and oak bark extracts. There has recently been a surge of interest for their possible roles in wound healing.

Digital and analog readout systems for fiber-optic strain sensors as applied to the monitoring of roller element bearing systems.

A rotating machinery test rig was instrumented with fiber Fabry-Perot interferometer strain sensors for condition monitoring of rolling element bearings. Strain variations produced by ball passes were observed and analyzed in the time and frequency domain. Wavelength division multiplexing was utilized to simultaneously monitor the sensors with analog and digital readout systems--analog for high bandwidth and digital for high dynamic range and the monitoring of multiple sensors. The effects of imbalance on the shaft, changes in rotational speed, effects on the rotor system, and detection of bearing defects were investigated. Frequency peaks observed in the bearing sensor spectra closely matched predicted values. Imbalance and rotational speed tests showed good agreement with expected trends, and bearing defects were successfully detected.