Background: The study compared the readability, grade level, understandability, actionability, and accuracy of standard patient educational material against artificial intelligence chatbot-derived patient educational material regarding cirrhosis. Methods: An identical standardized phrase was used to generate patient educational materials on cirrhosis from 4 large language model-derived chatbots (ChatGPT, DocsGPT, Google Bard, and Bing Chat), and the outputs were compared against a pre-existing human-derived educational material (Epic). Objective scores for readability and grade level were determined using Flesch-Kincaid and Simple Measure of Gobbledygook scoring systems. 14 patients/caregivers and 8 transplant hepatologists were blinded and independently scored the materials on understandability and actionability and indicated whether they believed the material was human or artificial intelligence-generated. Understandability and actionability were determined using the Patient Education Materials Assessment Tool for Printable Materials. Transplant hepatologists also provided medical accuracy scores. Results: Most educational materials scored similarly in readability and grade level but were above the desired sixth-grade reading level. All educational materials were deemed understandable by both groups, while only the human-derived educational material (Epic) was considered actionable by both groups. No significant difference in perceived actionability or understandability among the educational materials was identified. Both groups poorly identified which materials were human-derived versus artificial intelligence-derived. Conclusions: Chatbot-derived patient educational materials have comparable readability, grade level, understandability, and accuracy to human-derived materials. Readability, grade level, and actionability may be appropriate targets for improvement across educational materials on cirrhosis. Chatbot-derived patient educational materials show promise, and further studies should assess their usefulness in clinical practice. Export

Margin of stability (MOS) is considered a measure of mechanical gait stability. Due to broad application of treadmills in gait assessment experiments, we aimed to determine if walking on a treadmill vs. overground would affect MOS during three speed-matched conditions. Eight healthy young participants walked on a treadmill and overground at Slow, Preferred, and Fast speed-matched conditions. The mean and variability (standard deviation) of the MOS in anterior-posterior and mediolateral directions at heel contact were calculated. Anterior-posterior and mediolateral mean MOS values decreased with increased speed for both overground and treadmill; although mediolateral mean MOS was always wider on the treadmill compared to overground. Due to lack of optic flow and different proprioceptive inputs during treadmill walking, subjects may employ strategies to increase their lateral stability on treadmill compared to overground. Anterior-posterior MOS variability increased with speed overground, while it did not change on treadmill, which might be due to the fixed speed of treadmill. Whereas, lateral variability on both treadmill and overground was U-shaped. Walking at preferred speed was less variable (may be interpreted as more stable) laterally, compared to fast and slow speeds. Caution should be given when interpreting MOS between modes and speeds of walking. As sagittal plane walking is functionally unstable, this raises the consideration as to the meaningfulness of using MOS as a global measure of gait stability in this direction.

Purpose: Prefabricated arrays with a limited number of electrodes offer an opportunity to hasten the diagnosis of seizures; however, their accuracy to detect seizures is unknown. We examined the utility of two limited-montage EEG setups for the detection of nonconvulsive seizures. Methods: Thirty previously interpreted EEG segments with nonconvulsive seizures from 30 patients and 60 segments with background slowing or normal EEG from 60 patients were rendered in a bipolar “double banana” montage, a double distance “neonatal” montage, and a circumferential “hatband” montage. Experts reviewed 60 to 180 seconds long segments to determine whether seizures were present and if the EEG data provided were sufficient to make a decision on escalation of clinical care by ordering an additional EEG or prescribing anticonvulsants. The periodic patterns on the ictal-interictal continuum were specifically excluded for this analysis to keep the focus on definite electrographic seizures. Results: The sensitivities for seizure of the neonatal and hatband montages were 0.96 and 0.84, respectively, when compared with full montage EEG, whereas the specificities were 0.94 and 0.98, respectively. Appropriate escalation of care was suggested for 96% and 92% of occurrences of seizure patterns in neonatal and hatband montages, respectively. When compared with clinical EEG, the sensitivities of the neonatal and hatband montages for seizure diagnosis were 0.85 and 0.69, respectively. Conclusions: Nonconvulsive seizures were detected with high accuracy using the limited electrode array configuration in the neonatal and hatband montages. The sensitivity of the neonatal montage EEG in detecting seizures was superior to that of a hatband montage. These findings suggest that in some patients with nonconvulsive seizures, limited-montage EEG may allow to differentiate ictal and slow patterns.