ChatGPT Exhibits Gender and Racial Biases in Acute Coronary Syndrome Management

Recent breakthroughs in large language models (LLMs) have led to their rapid dissemination and widespread use. One early application has been to medicine, where LLMs have been investigated to streamline clinical workflows and facilitate clinical analysis and decision-making. However, a leading barrier to the deployment of Artificial Intelligence (AI) and in particular LLMs has been concern for embedded gender and racial biases. Here, we evaluate whether a leading LLM, ChatGPT 3.5, exhibits gender and racial bias in clinical management of acute coronary syndrome (ACS). We find that specifying patients as female, African American, or Hispanic resulted in a decrease in guideline recommended medical management, diagnosis, and symptom management of ACS. Most notably, the largest disparities were seen in the recommendation of coronary angiography or stress testing for the diagnosis and further intervention of ACS and recommendation of high intensity statins. These disparities correlate with biases that have been observed clinically and have been implicated in the differential gender and racial morbidity and mortality outcomes of ACS and coronary artery disease. Furthermore, we find that the largest disparities are seen during unstable angina, where fewer explicit clinical guidelines exist. Finally, we find that through asking ChatGPT 3.5 to explain its reasoning prior to providing an answer, we are able to improve clinical accuracy and mitigate instances of gender and racial biases. This is among the first studies to demonstrate that the gender and racial biases that LLMs exhibit do in fact affect clinical management. Additionally, we demonstrate that existing strategies that improve LLM performance not only improve LLM performance in clinical management, but can also be used to mitigate gender and racial biases.Comment: 19 pages, 2 tables, 2 figure

Performance characteristics of three Brucella canis serological assays in the United States

Brucella canis is a zoonotic pathogen of dogs that poses diagnostic challenges. While direct detection of B. canis by PCR or culture is ideal, serologic diagnosis is necessary for identification of carrier animals and can support a clinical diagnosis of brucellosis. Prior to 2022, B. canis seroscreening in the United States was primarily performed using a commercially available rapid slide agglutination test. However, the kit was discontinued by the manufacturer in early 2022, leaving a gap in the availability of commercial B. canis seroassays. The goal of this study was to compare the performance of three B. canis serologic tests that are currently available: VMRD Brucella ovis ELISA, Bionote Anigen Rapid C.Brucella Ab immunochromatographic lateral flow assay, and VMRD B. canis indirect fluorescent antibody (IFA) assay. A panel of 56 banked serum specimens originally submitted to the Cornell University Animal Health Diagnostic Center (the study reference laboratory) for B. canis seroscreening was distributed to 12 testing laboratories. Each sample was run on three assays developed at the reference lab: rapid slide agglutination test with 2-mercaptoethanol (2-ME RSAT), agar gel immunodiffusion test using cytoplasmic antigen (AGID II), and Canine Brucella Multiplex. Five testing labs ran the ELISA, six ran the lateral flow, and six ran the IFA. When evaluated as a screening assay, we compared the assays to the 2ME-RSAT. The ELISA had the highest sensitivity (96.8, 95%CI 83.8–99.9) but the lowest specificity (79.3, 95%CI 57.9–92.9). The sensitivity of the lateral flow was 90.6% (95%CI 75–98%) and the IFA was 87.5% (95%CI 71–96.5). Specificity for the lateral flow was 95.8% (95%CI 78.9–99.9) and IFA was 97.5% (95%CI 67.6–97.3). When compared to AGID II and Canine Brucella Multiplex, the test assays were all highly sensitive, but specificity was <90%. Interrater reliability was highest for IFA (Κ = 0.92) and lowest for the lateral flow (Κ = 0.82). Serial testing of positive samples with a more specific test, such as AGID II, will continue to be necessary when using any of the three assays tested in this study

Increased lateral microtubule contact at the cell cortex is sufficient to drive mammalian spindle elongation

The spindle is a dynamic structure that changes its architecture and size in response to biochemical and physical cues. For example, a simple physical change, cell confinement, can trigger centrosome separation and increase spindle steady-state length at metaphase. How this occurs is not understood, and is the question we pose here. We find that metaphase and anaphase spindles elongate at the same rate when confined, suggesting that similar elongation forces can be generated independent of biochemical and spindle structural differences. Furthermore, this elongation does not require bipolar spindle architecture or dynamic microtubules. Rather, confinement increases numbers of astral microtubules laterally contacting the cortex, shifting contact geometry from “end-on” to “side-on.” Astral microtubules engage cortically anchored motors along their length, as demonstrated by outward sliding and buckling after ablation-mediated release from the centrosome. We show that dynein is required for confinement-induced spindle elongation, and both chemical and physical centrosome removal demonstrate that astral microtubules are required for such spindle elongation and its maintenance. Together the data suggest that promoting lateral cortex–microtubule contacts increases dynein-mediated force generation and is sufficient to drive spindle elongation. More broadly, changes in microtubule-to-cortex contact geometry could offer a mechanism for translating changes in cell shape into dramatic intracellular remodeling