Large language models (LLMs) are increasingly used by the public to seek health information, including explanations of medical treatments and clinical trials. The objective of this study was to evaluate the completeness of LLM-generated informed consent information for clinical trials involving adolescent and young adult (AYA) patients with central nervous system (CNS) tumors, using U.S. Food and Drug Administration (FDA)–aligned consent requirements as the benchmark. We conducted a structured audit of five publicly available LLMs, ChatGPT 5.2, Claude Sonnet 4.5, Claude Haiku 4.5, Gemini (Fast), and Perplexity. Six standardized prompts were developed based on FDA informed consent requirements (21 CFR § 50.25), corresponding to key consent domains. Prompts were applied to five CNS tumor diagnoses prevalent in the AYA population. Responses were scored using an FDA-aligned checklist, with items coded as present or absent/unclear and summed to produce a consent completeness score. The sample included 25 LLM-generated informed consent responses evenly distributed across five cancer diagnoses. The median consent completeness score was 33 (interquartile range: 31–34), with scores ranging from 22 to 35, indicating variability in disclosure completeness. Completeness scores overlapped across cancer diagnoses, suggesting that variability was driven by response-level heterogeneity rather than clinical context. Domain-level completeness was generally high but showed modest variability across consent domains. Median scores were highest and most consistent for eligibility and procedures domains (median 6, IQR 6–6), while greater variability was observed in domains related to study purpose and practical details (median 5, IQR 4–5 and 5–6, respectively), contributing to overall heterogeneity in completeness. Publicly available LLMs variably and inconsistently include essential informed consent elements when responding to standardized clinical trial prompts. These findings suggest areas for further consideration regarding how general-purpose LLM-based tools are used in consent-related health communication.
Veterinary drug residues in animal-derived foods, including antimicrobials, anthelmintics, non-steroidal anti-inflammatory drugs, and hormonal agents, pose significant risks to food safety, human health, and antimicrobial resistance mitigation. Persistent contamination arises from interspecies pharmacokinetic variability, non-compliance with withdrawal periods, and inadequate analytical infrastructure, particularly in low- and middle-income countries. Established detection platforms such as liquid chromatography coupled with tandem mass spectrometry and enzyme-linked immunosorbent assays remain the foundation of regulatory monitoring, while emerging tools including CRISPR-Cas biosensors, nanomaterial-based electrochemical assays, and artificial intelligence assisted spectroscopic systems show promise but remain largely at the proof-of-concept or research stage and are not yet routinely applicable in regulatory enforcement. Thermal treatments, fermentation, and storage can modify drug stability, generate degradation products, and alter toxicological profiles, yet these transformations are rarely incorporated into surveillance strategies or Maximum Residue Limit determinations. This review synthesizes evidence across pharmacokinetic determinants, processing-induced residue transformations, analytical innovation, and international regulatory frameworks within a One Health and food safety risk assessment perspective. It argues that integrating processing-adjusted exposure data, harmonizing Maximum Residue Limit policies across jurisdictions, and strengthening analytical capacity in resource-limited settings are essential for equitable food safety governance and sustainable animal production systems.
Hemispherotomy is an effective surgical option for children with drug-resistant epilepsy originating from a single hemisphere. This paper details the first experience using a navigated augmented reality (AR) system to guide a vertical parasagittal hemispherotomy by Delalande. Twelve consecutive patients with a median age of 6.5 years (range 1 to 17 years) underwent the procedure between 2022 and 2023. The patient pathologies included Rasmussen encephalitis, congenital cortical malformations, post-stroke epilepsy, post-inflammatory changes, and Sturge-Weber syndrome, Two of the patients had previously undergone an incomplete disconnection surgery elsewhere. The preoperative evaluation included clinical examinations, video EEG monitoring, and MRI scans. All surgeries used AR guidance in the microscopes field of view established by the neuronavigation system (Brainlab, Germany). Intraoperative AR guidance enhanced the visualization of anatomical structures, which was particularly helpful in cases of congenital malformations where pathological brain tissue narrowed the surgical corridor. Two patients (16.7
Background:In 2022, human immunodeficiency virus (HIV) affected 39 million globally, with Iran experiencing a concentrated epidemic. This study aimed to identify and prioritize critical HIV/AIDS research areas to address existing gaps in the Iranian context. Methods:Researchers at Isfahan University of Medical Sciences employed a three-phase approach between May 2018 and March 2023. The first phase involved developing an HIV research matrix tailored to international guidelines and the Iranian context. In the second phase, a systematic review of HIV-related studies in Iran was conducted following the PRISMA protocol to assess quality and relevance. The third phase utilized a three-round Delphi method to collect expert feedback, which was used to prioritize research areas based on their importance and feasibility. Results:A systematic review of 6,310 sources yielded 745 documents for full-text analysis. Key research domains identified included prevention, diagnosis, care and treatment, epidemiology, and co-infections. Quantitative analysis indicated that 23% of studies focused on co-infections, while ethical issues were addressed in only 0.04%. Qualitative assessment revealed that 54% of reviewed studies were of low quality. Subsequent expert consultation and multi-criteria decision analysis ranked laboratory research and co-infections as the highest priorities. Specific sub-areas identified included molecular epidemiology and interventions addressing stigma and discrimination. Despite being highly cost-effective and urgently needed, research on stigma-related interventions exhibited a significant gap. Conclusion:The study identified 11 main research areas and 60 sub-areas as priorities for HIV/AIDS research in Iran, highlighting the need for strategic funding and research planning. Ethical considerations and laboratory improvements are essential for enhancing public health outcomes and addressing emerging challenges in the HIV epidemic.
BACKGROUND:Current risk assessments of cardiovascular disease (CVD) outcomes attributable to transportation noise rely on estimates from the 2018 WHO Environmental Noise Guidelines. Since the publication of these guidelines, several studies have been conducted to determine the association between transportation noise sources and CVD; however, recent meta-analyses have not derived updated exposure-response functions. OBJECTIVE:We reviewed epidemiological evidence linking long-term exposure to road traffic, railway, and aircraft noise with non-fatal and fatal myocardial infarction, ischemic heart disease, stroke, and ischemic stroke, and derived exposure-response functions using the conventional and Burden of Proof (BoP) methodologies. METHODS:We systematically searched databases for cohort or case-control studies that determined the associations between non-fatal and/or fatal myocardial infarction, ischemic heart disease, stroke, and ischemic stroke and long-term exposure to road traffic, railway, aircraft noise in general populations. Exposure-response functions were generated using the conventional natural cubic splines and Burden of Proof Risk Function approaches. RESULTS:Twenty-six studies met our eligibility criteria. Road traffic noise was associated with 1% increase in the combined risk of stroke incidence and mortality (RR = 1.01, 95%CI: 1.00-1.02, p-value = 0.04), and with 5% increase under the BoP framework (RR = 1.05, 95%UI: 1.03-1.07). Railway noise was associated with 1% increase in myocardial infarction outcomes (RR = 1.01, 95%CI: 1.01-1.01, p-value < 0.0001), and with 16% increase under the BoP framework (RR = 1.16 95%UI: 1.07-1.26). Of the twelve risk-outcome pairs examined, five showed no evidence of association, four showed weak evidence, and the remainder lacked credible evidence or did not meet the BoP criteria. Compared with the natural splines approach, the BoP framework produced more plausible exposure-response curves. SIGNIFICANCE:This study adds to the existing literature by providing a comprehensive comparison of the association between long-term exposure to transportation noise sources and CVD outcomes using both conventional and BoP methodologies. IMPACT STATEMENT:This is the first study to apply the conventional meta-regression and Burden of Proof methodologies to systematically quantify and evaluate associations between long-term exposure to transportation noise sources (i.e., road traffic, railway, and aircraft) and combined risk of fatal and non-fatal cardiovascular disease outcomes, including myocardial infarction, ischemic heart disease, stroke, and ischemic stroke. The application of these two approaches to deriving exposure-response functions provides additional insights into the quantification of the burden of disease attributable to transportation noise. Our findings using the Burden of Proof framework on transportation noise and CVD outcomes advance the integration of an additional environmental risk factor and propose new risk-outcome pairs for potential inclusion in the Global Burden of Disease study.
