To evaluate the response capabilities, in a public healthcare system otolaryngology job competition examination, of ChatGPT 3.5 and an internet-connected GPT-4 engine (Microsoft Copilot) with the real scores of otolaryngology specialists as the control group. In September 2023, 135 questions divided into theoretical and practical parts were input into ChatGPT 3.5 and an internet-connected GPT-4. The accuracy of AI responses was compared with the official results from otolaryngologists who took the exam, and statistical analysis was conducted using Stata 14.2. Copilot (GPT-4) outperformed ChatGPT 3.5. Copilot achieved a score of 88.5 points, while ChatGPT scored 60 points. Both AIs had discrepancies in their incorrect answers. Despite ChatGPT\'s proficiency, Copilot displayed superior performance, ranking as the second-best score among the 108 otolaryngologists who took the exam, while ChatGPT was placed 83rd. A chat powered by GPT-4 with internet access (Copilot) demonstrates superior performance in responding to multiple-choice medical questions compared to ChatGPT 3.5.

Demographics, social determinants of health, and family history documented in the unstructured text within the electronic health records are increasingly being studied to understand how this information can be utilized with the structured data to improve healthcare outcomes. After the GPT models were released, many studies have applied GPT models to extract this information from the narrative clinical notes. Different from the existing work, our research focuses on investigating the zero-shot learning on extracting this information together by providing minimum information to the GPT model. We utilize de-identified real-world clinical notes annotated for demographics, various social determinants, and family history information. Given that the GPT model might provide text different from the text in the original data, we explore two sets of evaluation metrics, including the traditional NER evaluation metrics and semantic similarity evaluation metrics, to completely understand the performance. Our results show that the GPT-3.5 method achieved an average of 0.975 F1 on demographics extraction, 0.615 F1 on social determinants extraction, and 0.722 F1 on family history extraction. We believe these results can be further improved through model fine-tuning or few-shots learning. Through the case studies, we also identified the limitations of the GPT models, which need to be addressed in future research.

BACKGROUND: In the United States, 1 in 5 adults currently serves as a family caregiver for an individual with a serious illness or disability. Unlike professional caregivers, family caregivers often assume this role without formal preparation or training. Thus, there is an urgent need to enhance the capacity of family caregivers to provide quality care. Leveraging technology as an educational tool or an adjunct to care is a promising approach that has the potential to enhance the learning and caregiving capabilities of family caregivers. Large language models (LLMs) can potentially be used as a foundation technology for supporting caregivers. An LLM can be categorized as a foundation model (FM), which is a large-scale model trained on a broad data set that can be adapted to a range of different domain tasks. Despite their potential, FMs have the critical weakness of \"hallucination,\" where the models generate information that can be misleading or inaccurate. Information reliability is essential when language models are deployed as front-line help tools for caregivers.
OBJECTIVE: This study aimed to (1) develop a reliable caregiving language model (CaLM) by using FMs and a caregiving knowledge base, (2) develop an accessible CaLM using a small FM that requires fewer computing resources, and (3) evaluate the model\'s performance compared with a large FM.
METHODS: We developed a CaLM using the retrieval augmented generation (RAG) framework combined with FM fine-tuning for improving the quality of FM answers by grounding the model on a caregiving knowledge base. The key components of the CaLM are the caregiving knowledge base, a fine-tuned FM, and a retriever module. We used 2 small FMs as candidates for the foundation of the CaLM (LLaMA [large language model Meta AI] 2 and Falcon with 7 billion parameters) and adopted a large FM (GPT-3.5 with an estimated 175 billion parameters) as a benchmark. We developed the caregiving knowledge base by gathering various types of documents from the internet. We focused on caregivers of individuals with Alzheimer disease and related dementias. We evaluated the models\' performances using the benchmark metrics commonly used in evaluating language models and their reliability for providing accurate references with their answers.
RESULTS: The RAG framework improved the performance of all FMs used in this study across all measures. As expected, the large FM performed better than the small FMs across all metrics. Interestingly, the small fine-tuned FMs with RAG performed significantly better than GPT 3.5 across all metrics. The fine-tuned LLaMA 2 with a small FM performed better than GPT 3.5 (even with RAG) in returning references with the answers.
CONCLUSIONS: The study shows that a reliable and accessible CaLM can be developed using small FMs with a knowledge base specific to the caregiving domain.

UNASSIGNED: Previous studies evaluated the ability of large language models (LLMs) in medical disciplines; however, few have focused on image analysis, and none specifically on cardiovascular imaging or nuclear cardiology.
UNASSIGNED: This study assesses four LLMs - GPT-4, GPT-4 Turbo, GPT-4omni (GPT-4o) (Open AI), and Gemini (Google Inc.) - in responding to questions from the 2023 American Society of Nuclear Cardiology Board Preparation Exam, reflecting the scope of the Certification Board of Nuclear Cardiology (CBNC) examination.
UNASSIGNED: We used 168 questions: 141 text-only and 27 image-based, categorized into four sections mirroring the CBNC exam. Each LLM was presented with the same standardized prompt and applied to each section 30 times to account for stochasticity. Performance over six weeks was assessed for all models except GPT-4o. McNemar\'s test compared correct response proportions.
UNASSIGNED: GPT-4, Gemini, GPT4-Turbo, and GPT-4o correctly answered median percentiles of 56.8% (95% confidence interval 55.4% - 58.0%), 40.5% (39.9% - 42.9%), 60.7% (59.9% - 61.3%) and 63.1% (62.5 - 64.3%) of questions, respectively. GPT4o significantly outperformed other models (p=0.007 vs. GPT-4Turbo, p<0.001 vs. GPT-4 and Gemini). GPT-4o excelled on text-only questions compared to GPT-4, Gemini, and GPT-4 Turbo (p<0.001, p<0.001, and p=0.001), while Gemini performed worse on image-based questions (p<0.001 for all).
UNASSIGNED: GPT-4o demonstrated superior performance among the four LLMs, achieving scores likely within or just outside the range required to pass a test akin to the CBNC examination. Although improvements in medical image interpretation are needed, GPT-4o shows potential to support physicians in answering text-based clinical questions.

BACKGROUND: The rapid evolution of ChatGPT has generated substantial interest and led to extensive discussions in both public and academic domains, particularly in the context of medical education.
OBJECTIVE: This study aimed to evaluate ChatGPT\'s performance in a pulmonology examination through a comparative analysis with that of third-year medical students.
METHODS: In this cross-sectional study, we conducted a comparative analysis with 2 distinct groups. The first group comprised 244 third-year medical students who had previously taken our institution\'s 2020 pulmonology examination, which was conducted in French. The second group involved ChatGPT-3.5 in 2 separate sets of conversations: without contextualization (V1) and with contextualization (V2). In both V1 and V2, ChatGPT received the same set of questions administered to the students.
RESULTS: V1 demonstrated exceptional proficiency in radiology, microbiology, and thoracic surgery, surpassing the majority of medical students in these domains. However, it faced challenges in pathology, pharmacology, and clinical pneumology. In contrast, V2 consistently delivered more accurate responses across various question categories, regardless of the specialization. ChatGPT exhibited suboptimal performance in multiple choice questions compared to medical students. V2 excelled in responding to structured open-ended questions. Both ChatGPT conversations, particularly V2, outperformed students in addressing questions of low and intermediate difficulty. Interestingly, students showcased enhanced proficiency when confronted with highly challenging questions. V1 fell short of passing the examination. Conversely, V2 successfully achieved examination success, outperforming 139 (62.1%) medical students.
CONCLUSIONS: While ChatGPT has access to a comprehensive web-based data set, its performance closely mirrors that of an average medical student. Outcomes are influenced by question format, item complexity, and contextual nuances. The model faces challenges in medical contexts requiring information synthesis, advanced analytical aptitude, and clinical judgment, as well as in non-English language assessments and when confronted with data outside mainstream internet sources.

UNASSIGNED: This study evaluates the diagnostic accuracy of a multimodal large language model (LLM), ChatGPT-4, in recognizing glaucoma using color fundus photographs (CFPs) with a benchmark dataset and without prior training or fine tuning.
UNASSIGNED: The publicly accessible Retinal Fundus Glaucoma Challenge \"REFUGE\" dataset was utilized for analyses. The input data consisted of the entire 400 image testing set. The task involved classifying fundus images into either \'Likely Glaucomatous\' or \'Likely Non-Glaucomatous\'. We constructed a confusion matrix to visualize the results of predictions from ChatGPT-4, focusing on accuracy of binary classifications (glaucoma vs non-glaucoma).
UNASSIGNED: ChatGPT-4 demonstrated an accuracy of 90% with a 95% confidence interval (CI) of 87.06%-92.94%. The sensitivity was found to be 50% (95% CI: 34.51%-65.49%), while the specificity was 94.44% (95% CI: 92.08%-96.81%). The precision was recorded at 50% (95% CI: 34.51%-65.49%), and the F1 Score was 0.50.
UNASSIGNED: ChatGPT-4 achieved relatively high diagnostic accuracy without prior fine tuning on CFPs. Considering the scarcity of data in specialized medical fields, including ophthalmology, the use of advanced AI techniques, such as LLMs, might require less data for training compared to other forms of AI with potential savings in time and financial resources. It may also pave the way for the development of innovative tools to support specialized medical care, particularly those dependent on multimodal data for diagnosis and follow-up, irrespective of resource constraints.

Symbolic task planning is a widely used approach to enforce robot autonomy due to its ease of understanding and deployment in engineered robot architectures. However, techniques for symbolic task planning are difficult to scale in real-world, highly dynamic, human-robot collaboration scenarios because of the poor performance in planning domains where action effects may not be immediate, or when frequent re-planning is needed due to changed circumstances in the robot workspace. The validity of plans in the long term, plan length, and planning time could hinder the robot\'s efficiency and negatively affect the overall human-robot interaction\'s fluency. We present a framework, which we refer to as Teriyaki, specifically aimed at bridging the gap between symbolic task planning and machine learning approaches. The rationale is training Large Language Models (LLMs), namely GPT-3, into a neurosymbolic task planner compatible with the Planning Domain Definition Language (PDDL), and then leveraging its generative capabilities to overcome a number of limitations inherent to symbolic task planners. Potential benefits include (i) a better scalability in so far as the planning domain complexity increases, since LLMs\' response time linearly scales with the combined length of the input and the output, instead of super-linearly as in the case of symbolic task planners, and (ii) the ability to synthesize a plan action-by-action instead of end-to-end, and to make each action available for execution as soon as it is generated instead of waiting for the whole plan to be available, which in turn enables concurrent planning and execution. In the past year, significant efforts have been devoted by the research community to evaluate the overall cognitive capabilities of LLMs, with alternate successes. Instead, with Teriyaki we aim to providing an overall planning performance comparable to traditional planners in specific planning domains, while leveraging LLMs capabilities in other metrics, specifically those related to their short- and mid-term generative capabilities, which are used to build a look-ahead predictive planning model. Preliminary results in selected domains show that our method can: (i) solve 95.5% of problems in a test data set of 1,000 samples; (ii) produce plans up to 13.5% shorter than a traditional symbolic planner; (iii) reduce average overall waiting times for a plan availability by up to 61.4%.

The integration of artificial intelligence (AI), particularly deep learning models, has transformed the landscape of medical technology, especially in the field of diagnosis using imaging and physiological data. In otolaryngology, AI has shown promise in image classification for middle ear diseases. However, existing models often lack patient-specific data and clinical context, limiting their universal applicability. The emergence of GPT-4 Vision (GPT-4V) has enabled a multimodal diagnostic approach, integrating language processing with image analysis.
In this study, we investigated the effectiveness of GPT-4V in diagnosing middle ear diseases by integrating patient-specific data with otoscopic images of the tympanic membrane.
The design of this study was divided into two phases: (1) establishing a model with appropriate prompts and (2) validating the ability of the optimal prompt model to classify images. In total, 305 otoscopic images of 4 middle ear diseases (acute otitis media, middle ear cholesteatoma, chronic otitis media, and otitis media with effusion) were obtained from patients who visited Shinshu University or Jichi Medical University between April 2010 and December 2023. The optimized GPT-4V settings were established using prompts and patients\' data, and the model created with the optimal prompt was used to verify the diagnostic accuracy of GPT-4V on 190 images. To compare the diagnostic accuracy of GPT-4V with that of physicians, 30 clinicians completed a web-based questionnaire consisting of 190 images.
The multimodal AI approach achieved an accuracy of 82.1%, which is superior to that of certified pediatricians at 70.6%, but trailing behind that of otolaryngologists at more than 95%. The model\'s disease-specific accuracy rates were 89.2% for acute otitis media, 76.5% for chronic otitis media, 79.3% for middle ear cholesteatoma, and 85.7% for otitis media with effusion, which highlights the need for disease-specific optimization. Comparisons with physicians revealed promising results, suggesting the potential of GPT-4V to augment clinical decision-making.
Despite its advantages, challenges such as data privacy and ethical considerations must be addressed. Overall, this study underscores the potential of multimodal AI for enhancing diagnostic accuracy and improving patient care in otolaryngology. Further research is warranted to optimize and validate this approach in diverse clinical settings.

UNASSIGNED: Large Language Models (LLMs) play a crucial role in clinical information processing, showcasing robust generalization across diverse language tasks. However, existing LLMs, despite their significance, lack optimization for clinical applications, presenting challenges in terms of illusions and interpretability. The Retrieval-Augmented Generation (RAG) model addresses these issues by providing sources for answer generation, thereby reducing errors. This study explores the application of RAG technology in clinical gastroenterology to enhance knowledge generation on gastrointestinal diseases.
UNASSIGNED: We fine-tuned the embedding model using a corpus consisting of 25 guidelines on gastrointestinal diseases. The fine-tuned model exhibited an 18% improvement in hit rate compared to its base model, gte-base-zh. Moreover, it outperformed OpenAI\'s Embedding model by 20%. Employing the RAG framework with the llama-index, we developed a Chinese gastroenterology chatbot named \"GastroBot,\" which significantly improves answer accuracy and contextual relevance, minimizing errors and the risk of disseminating misleading information.
UNASSIGNED: When evaluating GastroBot using the RAGAS framework, we observed a context recall rate of 95%. The faithfulness to the source, stands at 93.73%. The relevance of answers exhibits a strong correlation, reaching 92.28%. These findings highlight the effectiveness of GastroBot in providing accurate and contextually relevant information about gastrointestinal diseases. During manual assessment of GastroBot, in comparison with other models, our GastroBot model delivers a substantial amount of valuable knowledge while ensuring the completeness and consistency of the results.
UNASSIGNED: Research findings suggest that incorporating the RAG method into clinical gastroenterology can enhance the accuracy and reliability of large language models. Serving as a practical implementation of this method, GastroBot has demonstrated significant enhancements in contextual comprehension and response quality. Continued exploration and refinement of the model are poised to drive forward clinical information processing and decision support in the gastroenterology field.

Medical data have unique specificity and professionalism, requiring substantial domain expertise for their annotation. Precise data annotation is essential for anomaly-detection tasks, making the training process complex. Domain generalization (DG) is an important approach to enhancing medical image anomaly detection (AD). This paper introduces a novel multimodal anomaly-detection framework called MedicalCLIP. MedicalCLIP utilizes multimodal data in anomaly-detection tasks and establishes irregular constraints within modalities for images and text. The key to MedicalCLIP lies in learning intramodal detailed representations, which are combined with text semantic-guided cross-modal contrastive learning, allowing the model to focus on semantic information while capturing more detailed information, thus achieving more fine-grained anomaly detection. MedicalCLIP relies on GPT prompts to generate text, reducing the demand for professional descriptions of medical data. Text construction for medical data helps to improve the generalization ability of multimodal models for anomaly-detection tasks. Additionally, during the text-image contrast-enhancement process, the model\'s ability to select and extract information from image data is improved. Through hierarchical contrastive loss, fine-grained representations are achieved in the image-representation process. MedicalCLIP has been validated on various medical datasets, showing commendable domain generalization performance in medical-data anomaly detection. Improvements were observed in both anomaly classification and segmentation metrics. In the anomaly classification (AC) task involving brain data, the method demonstrated a 2.81 enhancement in performance over the best existing approach.