With the increasing adoption of artificial intelligence (AI) in various domains, including healthcare, there is growing acceptance and interest in consulting AI models to provide medical information and advice. This study aimed to evaluate the accuracy of ChatGPT’s responses to practice quiz questions designed for otolaryngology board certification and decipher potential performance disparities across different otolaryngology subspecialties.A dataset covering 15 otolaryngology subspecialties was collected from an online learning platform funded by the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery, designed for board certification examination preparation. These questions were entered into ChatGPT, with its responses being analyzed for accuracy and variance in performance.n = 1475) were answered correctly by ChatGPT. An in-depth analysis of question style revealed that single-choice questions were associated with a significantly higher rate (p < 0.001) of correct responses  compared to multiple-choice questions . Stratified by question categories, ChatGPT yielded the highest rate of correct responses  in the field of allergology, whereas 7 out of 10 questions  on legal otolaryngology aspects were answered incorrectly.The dataset included 2576 questions (479 multiple-choice and 2097 single-choice), of which 57% (The study reveals ChatGPT’s potential as a supplementary tool for otolaryngology board certification preparation. However, its propensity for errors in certain otolaryngology areas calls for further refinement. Future research should address these limitations to improve ChatGPT’s educational use. An approach, with expert collaboration, is recommended for the reliable and accurate integration of such AI models. Artificial intelligence (AI) refers to the technology that aims to develop algorithms and computer systems capable of performing tasks that typically require human intelligence . TherefoRecently, ChatGPT, an interactive chatbot, has emerged as a revolutionary language-based AI model. Powered by the state-of-the-art GPT-4 language model and advanced deep learning techniques, ChatGPT is able to generate human-like responses across a broad spectrum of topics, covering both medical and non-medical domains.As the popularity of ChatGPT continues to grow, an increasing number of users turn to this AI model for medical advice. Albeit previous studies have reported on ChatGPT’s ability to provide medical information –11, annoThis study aims to evaluate the accuracy of ChatGPT’s responses to practice questions for the German otolaryngology board certification and delineate differences in performance across distinct subspecialties within this medical discipline. Our findings may contribute to the broader puzzle of understanding and utilizing AI and ChatGPT to advance medical education and improve clinical decision-making.https://hno.keelearning.de/), which offers quiz-style questions to prepare for the German otolaryngology board certification. The platform is funded by the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery, and encompasses a comprehensive range of 15 distinct otolaryngology subspecialties. These subspecialties include allergology, audiology, ENT tumors, face and neck, inner ear and skull base, larynx, middle ear, oral cavity and pharynx, nose and sinuses, phoniatrics, salivary glands, sleep medicine, vestibular system, and legal aspects. To ensure the validity of the study, any image-based questions were excluded from the analysis. A total of 2576 questions were included and categorized by question style into multiple-choice (479 questions) and single-choice (2097 questions). Prior to the start of the study, official permission to use the questions for research purposes was obtained from the copyright holder.We used the question database of an online learning platform (https://chat.openai.com). It is important to note that the questions were entered into the AI system only once during the testing process. To account for variations in question formats, two distinct prompts were employed when asking ChatGPT to respond to quiz-style questions with four options.The testing of the AI model was conducted by C.C.H. and M.A. between May 5th and May 7th, 2023, by manually inputting the questions into the most recent version of ChatGPT (May 3rd version) on the respective website ((A) “Please answer the following question. Note that only one option is correct:For single-choice style questions, the following prompt was used:Option AOption BOption COption D”Single-choice question(B) “Please answer the following question. Note that several options may be correct:For questions in the multiple-choice format, we included the following prompt:Option AOption BOption COption D”Multiple-choice questionSubsequently, the responses generated by ChatGPT were evaluated to determine their accuracy, i.e., whether they matched the answers provided by the online study platform. For multiple-choice style questions, a response was considered correct only if all four options were accurately identified as either correct or false Figs.  and 2. Tp value of ≤ 0.05 was deemed to indicate statistical significance.Differences between question style and categories were determined using Pearson’s chi-square test. The statistical analysis was conducted with SPSS Statistics 25  and a two-tailed Of the 2576 questions submitted to ChatGPT, 1475 questions (57%) were answered correctly, and 1101 questions (43%) were answered incorrectly, regardless of question style or category.p < 0.001) was noted between both question styles.ChatGPT answered a total of 2097 single-choice style questions, of which 1313 questions (63%) were answered correctly, and 784 questions (37%) were answered incorrectly. By contrast, out of the 479 multiple-choice style questions, ChatGPT answered 162 questions (34%) correctly and 317 questions (66%) falsely. A statistically significant difference , face and neck , ENT tumors , sleep medicine , vestibular system , salivary glands , phoniatrics , larynx , inner ear and skull base , audiology , nose and sinuses , middle ear , oral cavity and pharynx , and legal aspects , with a p value of < 0.001 indicating statistically significant differences between the categories (Figs. When investigating question categories for the different otolaryngology subspecialties, the correct versus incorrect response rates, listed in descending order, were as follows: allergology (Language-based AI models, such as ChatGPT, are of increasing popularity due to their ability to maintain context and engage in coherent conversations. ChatGPT has been trained using deep learning techniques and a large amount of text data from online sources up until September 2021. Notably, its performance continues to improve through ongoing user interaction and reinforcement learning. In this study, we demonstrated the applicability of ChatGPT in the field of otolaryngology by evaluating its performance in answering quiz-style questions specifically designed for the German otolaryngology board certification examination.Prior to the public release of ChatGPT, several studies analyzed the potential of AI models in answering medical licensing exam questions. For example, Jin et al. noted an accuracy rate of only 37% when evaluating a dataset comprising 12,723 questions from Chinese medical licensing exams .Reaching beyond the boundaries of one-dimensional question-answering tasks, ChatGPT pushed the traditional boundaries of one-dimensional question-answering tasks and, therefore, represents a significant leap forward in web-based remote knowledge access with broad practicality for both medical laymen and experts. Gilson et al. demonstrated that ChatGPT performs comparably or even surpasses previous models when confronted with questions of similar difficulty and content . These fA major strength of our study lies in the extensive dataset of 2576 quiz questions, including both single-choice and multiple-choice formats, across 15 distinct otolaryngology subspecialties. These questions, initially designed for the German board certification examination, are characterized by a higher level of difficulty compared to typical otolaryngology questions in medical licensure examinations.Despite the complex nature of the questions, ChatGPT was able to answer more than half of all questions correctly. Of note, specifically in single-choice questions, ChatGPT was most successful, with over 60% rate of correct answers. In contrast, multiple-choice questions appeared to be a greater hurdle for ChatGPT: only one third of this question type could be answered correctly. This finding of a significant difference in performance between question formats is consistent with results reported by Huh, who highlighted ChatGPT’s inherent difficulty in accurately answering multiple-choice questions . These oIn addition, our analysis included an examination of ChatGPT’s performance across diverse otolaryngology subspecialties, revealing marked variations in the rates of correct responses. For instance, ChatGPT yielded the highest rate of correct answers in the field of allergology, whereas less than 3 in 10 questions regarding legal aspects were answered correctly by ChatGPT. These significant disparities in performance across subspecialties could be attributed to the varying availability and quality of training data for each category. It is important to consider that the question category “legal aspects”, which referred to German medical law, presented a challenge for ChatGPT due to its reliance on a potentially more limited literature database. In contrast, otolaryngology subspecialties with greater rates of correct ChatGPT responses may have benefited from more extensive data sources and a broader pool of retrievable information. Moreover, categories associated with high correct/false response ratios, such as allergology, are likely to be topics for which ChatGPT users frequently seek medical advice. This underscores the potential for continuous improvement through regular user interaction, thereby broadening the model’s armamentarium while sharpening its accuracy.In a recent study investigating the response accuracy of otolaryngology residents utilizing the same database but incorporating image-based questions, the results revealed a 65% correct answer rate . SimilarAs an educational resource, the performance of ChatGPT indicated potential efficacy in offering educational assistance in specific subspecialties and question formats. Nevertheless, the study also underscored aspects that need improvement. Notably, ChatGPT delivered a considerable number of incorrect responses within specific otolaryngology subdomains, rendering it unreliable as the sole resource for residents preparing for otolaryngology board examination.In addition to the complexity of its usage, concerns have been raised about the potential misuse of AI tools like ChatGPT to cheat or gain unfair advantages during medical examination tests. It is important to clarify that our study aimed to evaluate the effectiveness of ChatGPT as a tool for test preparation, not to encourage its use during the actual examination process.Our results revealed that, given its limitations and inconsistent performance across different subspecialties and question formats, ChatGPT does not currently provide a significant unfair advantage to test-takers. This conclusion, however, might not remain static as AI models like ChatGPT continue to evolve. The progression of these models, driven by improved training data and increasingly sophisticated algorithms, heralds the arrival of more accurate language models capable of generating contextually relevant responses. This development, in turn, presents fresh ethical dilemmas regarding their application in educational settings.Despite these challenges, the key takeaway is the importance of integrating ChatGPT into a wider learning strategy. This approach should supplement AI-based learning with traditional educational methods such as textbooks, lectures, and one-on-one sessions with subject matter experts. This combination ultimately ensures a well-rounded learning experience, while also mitigating potential reliability and ethical issues associated with the sole use of AI tools for educational purposes.When interpreting the results and drawing conclusions, the study’s inherent limitations must be considered. The use of a single online learning platform that incorporates a mononational question database exclusively focused on a specific subfield of medicine limits the generalizability and transferability of our results to other medical disciplines. In addition, the absence of implementing the session clearing process before each question in our study has the potential to significantly impact the accuracy of the responses provided by ChatGPT, as this process aims to remove biases or influences from prior questions. Future investigations are needed to explore potential improvements in the rates of correctly answered questions by employing a well-defined question database within a longitudinal study design. Such an approach would offer valuable insights into ChatGPT’s capacity to learn and improve over time through continuous user interaction.The study’s findings underscore the potential of AI language models like ChatGPT as a supplemental educational tool for otolaryngology knowledge mining and board certification preparation. However, the study also identified areas for improvement, as ChatGPT provided false answers to a substantial proportion of questions in specific otolaryngology subdomains. This highlights the need for further refinement and validation of the model. Future research should focus on addressing the limitations identified in our study to improve the efficacy of ChatGPT as an educational tool in broader educational contexts. The integration of AI language models should be approached with caution and in close cooperation with human experts to ensure their reliability and accuracy.


Series samples of Bi-2223 were added with different weight percentages  of graphene nanoparticles. The samples’ phase formations and crystal structures were characterized via X-ray diffraction (XRD), while the superconducting critical temperatures, Tc, were investigated using alternating current susceptibility (ACS). The XRD showed that a high-Tc phase, Bi-2223, and a small low-Tc phase, Bi-2212, dominated the samples. The volume fraction of the Bi-2223 phase increased for the sample with x = 0.3 wt.% and 0.5 wt.% of graphene and slightly reduced at x = 1.0 wt.%. The ACS showed that the onset critical temperature, Tc-onset, phase lock-in temperature, Tcj, and coupling peak temperature, TP, decreased when graphene was added to the samples. The susceptibility–temperature (χ′-T) and (χ″-T) curves of each sample, where χ′ and χ″ are the real and imaginary parts of the susceptibility, respectively, were obtained. The critical temperature of the pure sample was also measured.The effects of graphene addition on the phase formation and superconducting properties of (Bi The current fabrication technique has succeeded in producing Bi-2223 wires with Jc as high as 7.4 × 104 A/cm2 at 77.3 K and a self-magnetic field [6 A/cm2 at 70 K [Jc had reached 2.5 × 105 A/cm2 [Ic, must be improved to enhance the Jc. One approach that has been broadly accepted is the addition or substitution of various elements into the BSCCO system. Numerous studies have shown that nanoparticles can be easily integrated and spread widely among the grains in the BSCCO system because of their small size. Promising outcomes on the properties of the Bi-2223 system, such as high cT phase formation, improved intergrain connectivity, flux pinning ability, and critical current density, Jc, were achieved when nanosized dopants were integrated [BSCCO is a class of high-temperature superconductors (HTS) that has been widely investigated and applied in engineering, medical equipment, mining, and transport systems. In 2004, high-performance and long-length Bi-2223 HTS wires were successfully commercialized and well-received in the market ,7,8,9,10ic field  for Bi-2 at 70 K . Magneto05 A/cm2 . To extetegrated ,18,19,202 [Jc), and reducing the average grain diameter.Graphene, a two-dimensional crystalline carbon material, has been used in many applications, especially electronics, due to its outstanding electrical, mechanical, and chemical properties ,22. Grap2 ,35,36, a2 . However2 . UndoubtJc) of Bi-2223 superconductors in future studies. In this paper, we report on the effect of the critical temperature, Tc; the critical current density, Jc; and the structural and morphological properties of bulk Bi1.6Pb0.4Sr2Ca2Cu3Oy when graphene nanoparticles are integrated into the superconductors using the co-precipitation method.Recent studies have found that single-phase Bi-2223 superconductors are usually challenging to synthesize because of the complexity of the reaction during phase formation. The co-precipitation method, a wet chemical technique, can often be considered a viable solution for addressing this issue. This is because powders generated through this method possess a reduced grain size, increased purity, and greater homogeneity than those produced using the solid-state method ,44,45,461.6Pb0.4Sr2Ca2Cu3Oy was carried out via the co-precipitation method using bismuth(III) acetate (CH3COO)3Bi (99%), lead(II) acetate (CH3COO)2Pb·3H2O (99%), strontium acetate (CH3COO)2Sr·0.5H2O (98%), calcium acetate (CH3COO)2Ca·XH2O (97%), and copper(II) acetate (CH3COO)2Cu·H2O (98–102%). All chemicals were purchased from Alfa Aesar and used without further purification. The powders were weighed and mixed in a 2:2:2:3 stoichiometric ratio and were dissolved in 500 mL acetate acid and labeled as solution A. Adding lead, Pb, into the BSCCO composition is able to effectively increase the volume fraction of the Bi-2223 phase [2H2O4·2H2O (99.5–102.5%) in a solution of distilled water:propane-2-ol (1:1.5) to obtain a concentration of 0.5 M. Solution A was stirred at 400 rpm at a temperature of 80 °C, while solution B was stirred at 400 rpm without heating. They were then soaked in an ice bath to achieve a temperature range of 0 °C to 2 °C. Solutions A and B were mixed until a uniform milky blue suspension was obtained. The blue suspension slurry was filtered, dried on a hot plate at 80 °C for 12 h, and ground into powder. The powder was initially calcined in an alumina boat at 730 °C for 12 h to obtain a good texture.The preparation of Bi23 phase . SolutioJc of the samples was determined using a four-point probe (4PP) with a 12 K closed-cycle He Cryostat system.The calcined powders were ground and subjected to another calcination process at 850 °C for 24 h. The initial powder underwent a regrinding process and was combined with graphene sheets obtained from Nanostructured and Amorphous Materials, Inc. in Houston, TX, USA, with an average diameter ranging from 0.5 to 3 µm and a thickness between 0.55 to 1.2 nm. Different weight percentages of graphene sheets were added: 0.0 wt.%, 0.3 wt.%, 0.5 wt.%, and 1.0 wt.%. Subsequently, the mixture was pressed into pellets weighing 1.0 g each using hydraulic press under 5 tons of pressure. The pellets were sintered in a tube furnace at 850 °C for 48 h at a heating rate of 2 °C/min and cooling rate of 1 °C/min. X-ray diffraction (XRD) patterns of the samples were recorded using an X-ray diffraction diffractometer  with CuKα radiation. The thermal material’s stability was monitored using a thermogravimetric analyzer , and the measurement of AC magnetic susceptibility as a function of temperature was obtained using an AC Susceptometer (CryoBIND). The morphology and elemental analysis were analyzed using field emission scanning electron microscopy . The 2(C2O4)3, Pb(C2O4), Sr(C2O4), Ca(C2O4), and Cu(C2O4) contribute to the formation of dehydrated oxalate. The second phase occured between 200.10 °C and 508.82 °C, resulting in a weight loss of 33.54%. This weight reduction is primarily caused by the decomposition of Bi2(C2O4)3 into Bi2O3, Pb(C2O4) into PbO, Sr(C2O4) into SrCO3, Ca(C2O4) into CaCO3, and Cu(C2O4) into CuO. Previous studies have also reported similar findings regarding the thermal decomposition of individual oxalates of Bi, Sr, Ca, and Cu. However, for rare earth acetate, the decomposition typically occurs within the temperature range of approximately 200 to 300 °C [3 to CaO and SrCO3 to SrO. These results are consistent with that of similar investigations [Thermogravimetric analysis (TGA) and differential thermogravimetry (DTG) curves versus temperature for pure Bi-2223 samples were obtained immediately after the co-precipitation process had been performed and before the sintering process was carried out. The TGA curve of Bi-2223 displayed in o 300 °C . The thiigations . Figure igations ,50. At tigations .θ when the amount of graphene nanoparticles increased in the sample. However, some minor peaks belonging to Bi-2212 (ICSD: 98-003-0405) were also observed in all XRD patterns at 2θ ≈ 31.16°, 35.45°, 41.24°, and 47.46°, which indicate the presence of a secondary phase. Unfortunately, no graphene-related peak appears in the XRD results due to the small amount of graphene added. Previous studies have found that the main graphene peak appears around 2θ equal to 9.86° [I is the peak intensity of the phases. a = b = 3.826 Å and c = 37.104 Å. All the graphene-added samples given in Jc [L is the crystallite size, K equal to 0.9 is a dimensionless shape factor, sizeB is the line broadening at half the maximum intensity (FWHM), λ equal to 1.5406 Å is the X-ray wavelength for Cu Kα radiation, and θ is the Bragg angle. εC is the lattice strain. By plotting hklβ cosθ against 4sinθ, the intercept (Kλ/L) of the plot represents the crystallite size and the gradient represents the lattice strain (εC) of the samples [The patterns of XRD for Bi-2223 samples integrated with the graphene nanoparticles of 0, 0.3, 0.5, and 1.0 wt.% are shown in to 9.86° , 10° [27to 9.86° , 12.85° to 9.86° , 26.5°, to 9.86° . The numto 9.86° ,53:(1)Bien in Jc ,55. The en in Jc :(3)L=KλBTc-onset, can be attributed to the transition occurring within individual grains (intra-grain). On the other hand, the second decrease observed at the phase-locking temperature, Tcj, results from the superconducting coupling between the grains (inter-grain) [Tc-onset) and the critical temperature (Tcj), the superconducting grains are disconnected, making the system resistive. However, below Tcj, the grains become connected and are phase-locked, resulting in zero phase difference across the intragranular junctions. There is a definite transition for Tc-onset (χ′) to the lower temperature with increasing graphene addition. The decrease in Tc-onset can be attributed to the reduction in hole concentration resulting from oxygen deficiency in the CuO chain [Tcj. Prior work has indicated that the Bi-2212 low-Tc phase can affect the phase-locking, Tcj [r-grain) . In the uO chain . The fining, Tcj .Tp, corresponding to intergrain coupling. Notably, no secondary peak was observed near the critical temperature, Tc, indicating the absence of an intra-granular peak in any of the samples. This could indicate an excellent quality for the ceramic superconductor in all the samples where the coupling phase occurs immediately after the occurrence of superconducting inside the grain [Tp to lower temperatures with the introduction of graphene nanoparticles indicates the weakening of the grains and subsequently reducing the pinning force, while the Tp/Tc-onset ratio indicates a weak coupling between the grains. The value of Josephson’s current, Io, was calculated by using the Ambegaokar–Baratoff theory [The peak observed in the imaginary part χ″ represents the measure of dissipation in the samples. The imaginary part of the AC susceptibility (ACS) in all the samples exhibited a single peak at the coupling peak temperature, he grain . There cf theory ,61:(5)IOIo decreases with the increasing amount of graphene nanoparticles in the samples. This may be attributed to an increased presence of unreacted graphene nanoparticles at the boundaries between grains. As a consequence, the tunneling of Josephson’s current across the grains is decreased. In addition, the decreasing Io also implies that excess graphene nanoparticles may degrade the grain connectivity.V versus current, I, shown in Ic, of the samples measured at 40 K in a zero magnetic field. The transport critical current density, Jc, was calculated using the equation Jc = Ic/A [A is the cross-sectional area of the bar-shaped samples. The critical current density increase is observed for samples with 0.3 wt.% and 1.0 wt.% addition of graphene but not for the 0.5 wt.%, as shown in Jc is attributable to improvements in the connectivity of intergrain.The graph of voltage, c = Ic/A , where Aab-plane compared to other samples. The existence of graphene in Bi-2223 showed the different parts of the structure and distributed uniformly on the grain boundaries in great amounts. According to the analysis depicted in Tc). ab-plane. This observation coincides with the results from four-point probe measurements that the 1.0 wt.% also has the highest critical current density, Jc, as presented in ab-plane is blocked. This occurs due to the large surface area of basal-plane-faced GBs, which are formed by high aspect ratio grains. This configuration allows for a strong linkage of c-axis supercurrents. In contrast, the RS model proposes a different mechanism. It suggests that the ab-plane supercurrent path is primarily established through low-angle, strongly coupled, and obliquely intersecting GBs called small-angle, c-axis tilt (SCTILT) GBs. These GBs contribute to improving the texture of the samples. The presence of these well-defined supercurrent paths in both models improves the transport current occupancy of the Bi-2223 tape’s cross-section. As a result, the need to rely on intrinsically lower critical current density (Jc) c-axis paths between dominant ab-plane paths is reduced. Ultimately, this improved connectivity and transport current occupancy enhance the Jc of the Bi-2223 tapes [23 tapes ,68.Data presented in The information provided suggests that the elements of carbon were detected in all samples with a percentage range of 7.57% to 10.54%. The presence of graphene (C) in Bi-2223 was confirmed through elemental mapping using energy dispersive X-ray spectroscopy (EDX) as shown in 1.6Pb0.4Sr2Ca2Cu3Oy superconducting samples with the addition of graphene nanoparticles at weight percentages of 0.0, 0.3, 0.5, and 1.0 wt.% were successfully synthesized using the co-precipitation method. A variation in Tc and Jc values was observed due to the addition of graphene content in Bi-2223. Elemental analysis via EDX showed that stoichiometry ratio of Bi-2223 superconducting compounds were obtained. The XRD patterns exhibited the primary phase indexed to Bi-2223, corresponding to a tetragonal structure, and a second phase which belonged to Bi-2212. ACS measurements established that the onset critical temperature, Tc-onset; coupling peak temperature, Tp; and intergranular critical current density, Tcj, decreased with the increase in graphene nanoparticle addition. The decrease in the Josephson current, Io, with the increased addition of graphene was due to the degradation of samples’ grain connection due to the amount of unreacted graphene at the grain boundary increase in the samples. The sample with 1.0 wt.% of graphene produced the highest Jc of all the samples. SEM results proved that the microstructure for samples with 1.0 wt.% was the best aligned and the grain showed a much better formation of Bi-2223 superconductors. Based on these results, adding graphene nanoparticles to Bi-2223 samples could be able to improve the pinning center and hence enhanced the critical current density, Jc.Bi


Journal of the American Board of Dermatology. A qualitative analysis of the questions was conducted by two board-certified dermatologists, assessing accuracy, complexity, and clarity. Out of 40 questions generated, only 16 (40%) were deemed accurate and appropriate for ABD-AE study preparation. The remaining questions exhibited limitations, including low complexity, lack of clarity, and inaccuracies. The findings highlight the challenges faced by ChatGPT in understanding the domain-specific knowledge required in dermatology. Moreover, the model's inability to comprehend the context and generate high-quality distractor options, as well as the absence of image generation capabilities, further hinders its usefulness. The study emphasizes that while ChatGPT may aid in generating simple questions, it cannot replace the expertise of dermatologists and medical educators in developing high-quality, board-style questions that effectively evaluate candidates' knowledge and reasoning abilities.This article investigates the limitations of Chat Generative Pre-trained Transformer (ChatGPT), a language model developed by OpenAI, as a study tool in dermatology. The study utilized ChatPDF, an application that integrates PDF files with ChatGPT, to generate American Board of Dermatology Applied Exam (ABD-AE)-style questions from continuing medical education articles from the  Chat Generative Pre-trained Transformer (ChatGPT) is a language model developed by OpenAI  that has shown promise in various natural language processing (NLP) tasks, including medical education and multiple-choice question generation ,2. WithiJournal of the American Academy of Dermatology (JAAD) are considered high-yield review material for the ABD-AE. CME articles from the JAAD  were imported into ChatPDF [ChatPDF is an application that combines the ability to upload entire PDF files into a ChatGPT 3.5 portal. The continuing medical education (CME) articles from the  ChatPDF . It was A total of 40 questions were created using ChatPDF for the eight CME articles. After an independent review of the questions, it was found that out of 40 questions, 10 (25%) were of low complexity, 9 (22.5%) were vague or unclear, and 5 12.5%) were inaccurate  Pulmonary function tests and high-resolution chest computed tomography B) Skin biopsy and blood tests C) Electrocardiogram and echocardiogram D) Urinalysis and liver function tests; Answer: A." Furthermore, 12.5% of generated questions were incorrect or inaccurate, raising concerns about the reliability of artificial intelligence-generated questions. This study identified the limited domain-specific knowledge of ChatGPT as a major limitation as dermatology requires a deep understanding of skin anatomy, physiology, and pathology, which ChatGPT lacks. ChatGPT's inability to understand the context and generate high-quality distractor options, as well as its incapacity to generate images, further limits its usefulness. To address these limitations, future research should focus on developing domain-specific language models that possess deep knowledge of dermatology. By improving the model's understanding of skin-related concepts and its ability to generate contextually appropriate questions and distractors, it may become a more reliable and valuable tool for medical education and exam preparation in dermatology.Our study demonstrates that while ChatGPT shows promise as an educational tool in dermatology, its limitations must be acknowledged. Generating ABD-AE-style questions with sufficient accuracy, complexity, and clarity remains a challenge for ChatGPT. The model's inability to understand context and lack of domain-specific knowledge contribute to the generation of suboptimal questions. Future research efforts addressing these shortcomings might increase its utility in question generation for the ABD-AE. In conclusion, while ChatGPT may help generate simple questions, it cannot replace the expertise of dermatologists and medical educators in developing high-quality, board-style questions that accurately test a candidate's knowledge and reasoning abilities.


Non-uniform environmental conditioning has established substantial energy-saving and conditioning effects in residential buildings, however, few studies on the technology applied in greenhouses have been conducted. Semi-enclosed greenhouse development is hindered by energy consumption. To better apply non-uniform environmental conditioning technology in greenhouses, it is necessary to investigate the non-uniform characteristics of field environment parameters. Therefore, spatial and temporal measurements of indoor temperature and relative humidity in a Venlo-type greenhouse in Yangling, China, were conducted on June 5–11, 2022. Temperature and humidity sensors were arranged in the greenhouse at 4.5 m intervals, in the canopy, cultivation, center, and root areas. Temperature and humidity measurement points on the greenhouse walls were selected. The measurement results showed large fluctuations in the indoor temperature and relative humidity over time. The difference between indoor and outdoor average temperatures ranged from -5–10 °C and temperatures unsuitable for tomato growth were identified, although some passive conditioning methods such as ventilation and water spraying were employed, which indicates the necessity of active heating and cooling. Based on the measured data, the nonuniformity coefficients of temperature and relative humidity in different directions in the greenhouse were calculated. A larger non-uniformity in the vertical direction was found compared to that in the horizontal direction. These results suggest the possibility of non-uniform environmental conditioning. A rough estimation of the energy consumption by the two different condition modes, namely zone-specific and overall conditioning, was made. A huge energy saving of 69.6 % by the zone-specific conditioning mode was revealed compared to the overall conditioning. This implies a huge advantage in energy efficiency by non-unform environmental conditioning technologies applied in greenhouses. The study provides useful data for understanding non-uniform environments in greenhouses and the application of non-uniform environmental conditioning technologies. Some studies show that agricultural carbon emissions account for 16–17 % of the total carbon emissions in China, which is higher than the global average of 13.5 %, and is still growing at an average annual rate of 5 % [The concentration of carbon dioxide  to use cleaner and more durable energy at the energy end; (2) to lower energy requirements through more precise and rational distribution of energy at the control end; and (3) to adapt the energy supply to energy requirements in the greenhouse. Among them, the control of greenhouse environmental parameters is crucial for improving yield and energy use efficiency, and the greenhouse environmental control system directly determines the environmental parameters in the greenhouse . Many rentration ,14, lighntration  and so fntration .Different non-uniform regulation modes have been studied in residential and public buildings, especially in large-space buildings, including displacement ,20, stra22.12 supplemental gas, planting, harvesting, light supplemental, fertilization, and automatic control systems, and other environmental control equipment. No cooling equipment was installed and the temperature conditioning relied on the mist spray system. The planting area in the greenhouse was divided into two blocks and substrate-cultivated tomatoes were planted in these two blocks, as shown in The greenhouse used in this experiment was a Venlo-type multi-span glass greenhouse, as shown in In the greenhouse, each system was operated by staff and the Hoogendoor system . Each morning at approximately 08:00 h, the staff activated the shed operation, greenhouse control system, sensor system to measure greenhouse temperature and humidity, carbon dioxide, and light measurements as well as automatic control of the greenhouse, such as opening the lee window, circulation fan and fresh air unit, and greenhouse temperature control and dehumidification. Greenhouses are divided into southern and northern regions, which are divided into a number of districts, and manual operation is based on more detailed regulations for different regions of the environment. During the whole test period, the roof windows of the greenhouse, the mist spray system and the circulation fan system remained open to condition indoor air temperature as shown in 2.2The experiments were conducted from June 5–11, 2022, and data from 08:00–18:00 h in typical summer weather were selected for analysis. Considering the layout of the crops grown in the greenhouse, the sensors were arranged according to As shown in As the north and east sides of the greenhouse are neighbors to other indoor zones, and the south and west sides are adjacent to outdoor air, it is necessary to record the differences in different boundaries. A total of eight sensors arranged in two layers, one at the middle height of the cultivation area and one at 1.5 m above the canopy, were placed on the four sidewalls of the greenhouses, as shown in 2 concentration, were measured by a weather station installed outdoors, which was placed in an open area 20 m northwest of the greenhouse.In addition to temperature, humidity was also monitored. Six points were arranged in the greenhouse for wind speed and direction measurements, and each point was divided into two layers, as shown in 33.1After the operational activation of the greenhouse, the indoor environmental control system, including the spraying system, circulating fan, and skylight, was activated, so that the temperature inside the greenhouse increased and humidity decreased, reaching the maximum/minimum value at around 14:00 h. Subsequently, the outdoor temperature decreased, and humidity increased, displaying the same trend in the greenhouse. This indicates that after 14:00 h, the environment inside the greenhouse was influenced more by outdoor factors. The changes in the temperature and humidity in the middle and lower indoor layers were minimal, and there was a distinct stratification phenomenon between the upper and lower layers. The stratification may be attributed to the blocking effect of crops on light and airflow. During the data measurement, there was no obvious difference in the temperature and humidity variation under different weather conditions, which indicates that the weather has little effect on the indoor environment in the greenhouse.3.23.3X is the non-uniform coefficient, smaller X indicates better homogeneity, n is the number of measurement points, Based on the measured data, non-uniform coefficients were calculated to characterize the non-uniformity of the indoor environment in the greenhouse according to Eq. Comparing 3.4Q is the required cooling or heating energy, kJ, a negative value represents heating and a positive value represents cooling; ρ is the density of air, 1.29 kg/m3; V is the volume of the space requiring environmental conditioning; cp is the specific heat capacity of air, 1.01 kJ/(kg•K), Tactual is the measured temperature over time in different layer zones in the greenhouse, K; Tdesired is the corresponding required temperature for the growth period of the crop, In this study, tomato in the fruiting period was the cultivated crop and the desired temperature range was 24–28 °C. Hence, 28 °C was set as the desired cooling temperature and 24 °C was set as the desired heating temperature. During this period, the total energy consumption should be the sum of the heating and cooling energy consumption.With the assumption that only sensible heat is extracted from the greenhouse for simplification, the energy consumption for environmental conditioning to the temperature and humidity required by the crops can be estimated based on the measured actual temperature in the greenhouse using Eq. Based on Eq. Using Eqs. 4In this study, by exploring the stratification phenomena of environmental parameters, including temperature and relative humidity inside the greenhouse and analyzing the non-uniform variation of the greenhouse field environment, it was found that the trends of temperature and relative humidity changes in the greenhouse were contrasting, and relative humidity often decreased when the temperature rose. Compared with the high layer at a height of 4.5 m in the greenhouse, the middle and lower layers of the cultivation area displayed small and stable fluctuations in temperature and humidity, whereas the upper layer of the cultivation area displayed a similar trend of temperature and humidity changes as that of the higher layer at a height of 4.5 m. The cloudy weather conditions had little effect on the temperature and relative humidity in the greenhouse but affected the greenhouse walls more significantly. The east wall of the greenhouse displayed the largest temperature and humidity variation due to the longest exposure to sunlight, and the stratification of temperature and humidity on the west wall was more distinct due to shadows created by crops, while the temperature and humidity of the other walls were consistent.2 and crop growth are two more unique and important issue in greenhouses, however, they were not investigated in our study, resulting in short measurement time and less data volume. These issues need to be further considered in our further research to increase crop production.After analysis of measured temperature and humidity, it was found that the non-uniformity in summer in the vertical direction was larger than that in the horizontal direction. This may be caused by the uneven regulation of the environmental control equipment in the greenhouse and buffer shading by the crop. Based on this phenomenon, cultivation zone-specific environmental conditioning was proposed in concept, and the energy-saving potential for the conditioning mode was estimated and compared with that of the overall environmental conditioning. It was found that the energy consumption for the measurement period could be reduced by 69.9 % compared with that of the traditional environmental conditioning mode. Thus, it can be preliminarily concluded that zone-specific environmental conditioning is a promising energy-efficient technique for application in greenhouses. Further research on technology development details of the principle of non-uniform thermal environmental formation is necessary. In addition, in contrast to indoor environmental conditioning in residential buildings, COShaanxi Key Research and Development Program, China (2022ZDLNY03-02), Shaanxi Provincial Technology Innovation Guidance Special Fund, China (2021QFY08-02), and the Scientific & Technological Innovative Research Team of Shaanxi Province, China.This research was financially supported by the Data included in article/supp. Material/referenced the in article.Xianpeng Sun: Writing – original draft, Validation, Project administration, Investigation, Formal analysis, Data curation. Jinhong He: Writing – original draft, Validation, Software, Formal analysis. Chuanzhen Li: Writing – original draft, Resources, Investigation, Data curation. Yangda Chen: Project administration, Methodology, Formal analysis, Data curation. Runjie Li: Writing – review & editing, Writing – original draft, Resources, Methodology. Ziteng Wang: Supervision, Resources, Methodology. Weijun Wu: Project administration, Methodology, Investigation. Yapeng Li: Supervision, Software, Conceptualization. Xuxin Guo: Visualization, Software, Resources. Xinke Wang: Writing – review & editing, Resources, Funding acquisition, Conceptualization.The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.


BackgroundCow ghee is a pure and clean animal fat derived from milk and is often recognized as clarified butter. It is used in Ayurvedic medicine as an excellent base for preparing various formulations due to its ability to penetrate deep tissue and be easily absorbed. Cow ghee possesses antioxidant, antibacterial, anti-inflammatory, and antiseptic properties, making it beneficial for treating skin-associated problems. When applied externally, ointment bases are semisolid preparations for use on the skin or mucous membranes. They are classified into four categories: Hydrocarbon, Absorption, Water-removable, and Water-soluble. In this study, ointment bases were formulated and evaluated using cow ghee and selected conventional ones.Materials and MethodsOintment bases like Cetostearyl alcohol, stearic acid, glyceryl monostearate, soft white paraffin, soft yellow paraffin, paraffin wax, white beeswax, and wool fat were obtained from SD fine chem manufacturer Ltd., Mumbai. Cow ghee was obtained from the Go Vigyan, Anusandhan Kendra, Nagpur. The ointment bases were prepared using pharmacopeia procedures. Cow ghee was used as a base in the preparation of ointment bases with different concentrations than conventional bases. Stability testing was performed per International Conference on Harmonization(ICH) guidelines and various physicochemical parameters like color, appearance, odor, consistency, pH, Spreadability Extrudability, loss on drying, solubility, and washability.ResultsThe ointment bases formulated using cow ghee in combination with selected conventional ointment bases were found to be stable. They exhibited desirable characteristics like non-greasy, attractive appearance, and suitability for various medications and supporting substances. The cow ghee-based ointment bases also showed good spreadability, extrudability, and solubility, indicating their effectiveness as carriers for active components.ConclusionThe study demonstrates the potential of cow ghee as a natural ointment base for the preparation of various Ayurvedic formulations. The ointment bases formulated using cow ghee in combination with conventional ointment bases were stable and exhibited desirable physicochemical properties. Thus, using cow ghee as an ointment base can provide a cost-effective and easily accessible alternative for therapeutic use or as a carrier of active components. Cow gheeThe pure and clean animal fat derived from milk is treated as ghee and is often recognized as clarified butter. Cow ghee is used in long-standing Indian development itself. Cow ghee does not spoil longer because it does not include water. Cow ghee's purest form is thin, greasy, and devoid of water, lactose, and other milk particles. For the grounding of Ayurvedic medicines, cow ghee is viewed as an admirable base. Cow ghee is a perfect base for preparing ayurvedic dosage form because of its capacity to penetrate the deeper tissue, cross the cell membrane, and be easily absorbed. According to Ayurveda, ghee's efficiency and medicinal qualities improve as it ages and has a bitter flavor. Five to ten years older ghee is highly favored in several Ayurvedic formulas. Also, it describes cow ghee as an effective medium for delivering medications into the deeper layers of the body's tissue. Lipids are found in human cell membranes, and cow ghee has a highly lipophilic effect. This makes it easier for cow ghee to deliver the medicines to the desired cellular level .In Ayurveda, cow ghee is a natural ointment used in the preparations of medicines as an ointment base ,3. Cow gOintment basesWhen applied externally, the ointment is described as a semisolid preparation intended for use on the skin or mucous membranes. Ointment (semisolid) bases fall into four categories: Hydrocarbon, Absorption, Water removable, and water-soluble. No matter their specific functions, all ointment bases should possess particular qualities. These consist of A. Under distinctive use and storage circumstances, it is chemically and physically stable; B. Nonreactive and suitable for a variety of medications and supporting substances; C. Free from offensive odors; D. No irritating, nontoxic, or no sensitizing; E. Attractive, simple to use, and non-greasy; F. Until it is removed, it remains in contact with the skin ointment bases intended for therapeutic use or as a carrier of active components ,6.AimThe persistence of this work is to formulate and evaluate ointment bases using cow ghee in combination with selected conventional ointment bases.MaterialsThe ointment bases like Cetostearyl alcohol, stearic acid, glyceryl monostearate, soft white paraffin, soft yellow paraffin, paraffin wax, white beeswax, and wool fat were obtained from SD fine chem manufacturer Ltd, Mumbai. Cow ghee was obtained from the Go Vigyan, Anusandhan Kendra, Nagpur. Based on certain factors, a routine or Pharmacopoeia procedure was used to recognize and authenticate cow ghee. The parameters include solubility, pH, loss on drying, ash content, refractive index, specific gravity, saponification value, acid value, iodine value, moisture content, peroxide value, microbial load, zinc content, vitamin C content, heavy metal analysis3, All of the analytical-grade solvents used for titrations to estimate levels of free fatty acids and peroxide were purchased from Sigma Aldrich Pvt. Ltd. in Mumbai.Preparation of ointment baseIn this procedure, the base components were put in a melting pan at 70°C. After melting, the components were gently swirled while being kept at a temperature of 70°C for about 5 minutes, and then they were continuously cooled to a temperature of 40°C. After being mixed to a smooth consistency, ointments were kept at room temperature (25°C)6. Ointment bases were prepared using pharmacopeia procedures. Later a portion of the lipid is utilized in the procedure and is replaced with cow ghee and prepared ointment bases varying in the concentration of cow ghee.Cow ghee is used as a base in the ointment bases preparation having different concentrations with conventional bases like Cetostearyl alcohol, stearic acid, glyceryl monostearate, Paraffin wax, soft white paraffin and soft yellow paraffin, white beeswax, and wool fat. Cow ghee and conventional bases are heated separately, bestowing to the declining order of melting point, and mixed.Stability of ointment baseThe organoleptic characteristics were examined, and stability testing was performed per ICH guidelines. The stability of the formulation of ointment bases was evaluated regarding variations in physical and chemical factors expected to impact it. Various physicochemical parameters were carried out, like color, appearance, odor, consistency, pH, spreadability, extrudability, loss on drying, solubility, and washability 7.Color and appearanceThe ointment base was precisely weighed at 2 gm, put into the watch glasses, and evaluated visually by the naked eye by placing it against the white background.OdourAccurately weighed 2 gm of ointment base, was taken into watch glasses, and smelled.ConsistencySmooth, and no signs of greediness were found.pHA digital pH meter was used to measure the pH of the bases for ointments. For this, 100 ml of distilled water was used to dissolve 0.5 g of ointment base, and the pH of the mixture was measured.SpreadabilityThe spreadability was assessed by sandwiching extra samples between two slides that had been crushed to a uniform thickness by applying a specific weight for a specific time. Spreadability was determined by measuring the time needed to separate the two slides, and better spreadability is the outcome of separating two slides in less time.The following formula calculated the spreadability.S=M×L/TWhere S= SpreadabilityM= Weight tide to the upper slideL= Length of glass slideT= Time taken to separate the slidesExtrudabilityThe collapsible tube container was filled with the ointment base. The weight of the ointment base needed to extrude 0.5 cm of ointment base ribbon in 10 seconds was used to calculate the extrudability.SolubilitySoluble in boiling water, ether, chloroform, miscible with alcohol.WashabilityAfter applying an ointment base to the skin, the ease of washing with water was evaluated.Non-irritancy TestA prepared ointment base was applied to a human's skin, and the outcome was monitored.HomogeneityBoth the ointment base's visual appearance and tactile uniformity were evaluated. The ointment base's appearance was esteemed according to its color, pearlescence, and roughness.After FeelA predetermined amount of ointment base was pragmatic, and the amount of residue left after the application was evaluated for emollients and slipperiness.Stability StudyThe physical stability of prepared ointment bases was tested for 45 days at various temperatures, including 2°C, 25°C, and 37°C. Within four weeks, it was discovered that the ointment bases were physically stable at three different temperatures, namely 2°C, 25°C, and 37°C.Degradation of ProductUnder expedited sceneries, the ointment bases were checked for any degradation that might have happened throughout the research period.Chemical StabilityDue to the inclusion of ghee, ointment bases were assessed for the amount of free fatty acids they emitted, and lipid peroxide values were determined per Indian norms.As we know, cow ghee has various properties like antioxidant, anti-inflammatory, wound healing, etc., so in this study, it is used as an ointment base and other ointment bases and evaluated for its compatibility with other ointment bases. We conducted research combining various ghee concentrations with other bases Table  that givThe present study aims to verify the hypothesis that cow ghee provides the better formation of ointment bases with different traditional bases. Cow ghee used in conventional medicine is reported to have a beneficial effect on wound healing. Thus, we selected Cow as an ointment base for the ointment preparation with different traditional bases .Although cow ghee is a standard Ayurvedic remedy, its potential for use has yet to be thoroughly investigated due to its lower stability. Consequently, this research was carried out to examine the use of cow ghee as an ointment base in the topical dosage form. It might be utilized as a replacement for the current topical ointment base in the forthcoming. Combining cow ghee with herbal medications or phytoconstituents as a base with traditional ointment bases might produce an effective herbal formulation. In this research, we prepared ointment bases with cow ghee having different concentrations from conventional bases, and their stability was also measured. All the required ointment bases are procured, and a routine Pharmacopoeia procedure was used to recognize and authenticate it. Cetostearyl alcohol, stearic acid, glyceryl monostearate, soft white paraffin, soft yellow paraffin, paraffin wax, white beeswax, and wool fat are all ointment bases selected. Based on certain factors, a routine or Pharmacopoeia procedure was used to recognize and authenticate cow ghee .The parameters include solubility, pH, loss on drying, ash content, refractive index, specific gravity, saponification value, acid value, iodine value, moisture content, and peroxide value, which was performed for cow ghee . After tPrepared all formulations of ointment bases are tested for their physical and chemical stability by studying various parameters like color, odor, consistency, pH, spreadability, washability, non-irritancy, and stability study at multiple temperatures  . This aloC, 25oC, and 37oC. The findings from ointment base formulations F5, F6, F8, and F9 were superior in texture and spreadability to the other combination of formulated ointment bases. Also, these ointment bases formulation was chemically stable, and there were no significant changes in free fatty acid level value. It is possible to prepare ointment bases containing cow ghee as a base with conventional bases; the prepared ointment bases were physically and chemically stable for at least 45 days at various temperatures like 2


Music therapy has been found to be an effective intervention for persons with dementia (PWD) and their primary caregivers (PC), yet the implementation of musical strategies to improve daily care in the home environment requires further exploration. This study developed and examined a home-based music therapy (HBMT) work model that offers weekly joint music therapy sessions, and additional bi-weekly phone-counseling sessions with the PC. This was followed by an additional 12-week support period that included 3 therapy sessions and 3 phone counseling sessions once every other fortnight, so that the same type of session occurred at a frequency of once a month. Participants were five couples (PWD + spouse as PC) who live in their home. Findings based on the qualitative multiple case study research method showed the importance of the music therapist’s (MT) continuous support. The MT’s presence made it possible to address the needs of both spouses, separately and together, while maintaining the required balance. Moreover, the MT’s presence enabled better implementation of the musical strategies independently and this was maintained during the intervention and the support period. The number of persons with dementia (PWD) has increased parallel to the increase in life expectancy. Most live at home and are supported by a primary caregiver (PC) . SpousesMusic therapy has been found to be a positive and beneficial intervention for both PWD and for their spouses as PCs. In recent years, various studies engaged in developing musical strategies for PCs have been conducted so that they can employ these strategies independently and daily without the ongoing presence of a music therapist (MT) . These sThere is a large number of based-music interventions that are not conducted by a MT. However, studies in which the intervention included a MT’s presence indicate better implementation. A more extensive presence can be seen in Melhuish’s study  where a The purpose of the current study was to examine whether a work model that includes extensive support enables the independent implementation of music used in daily life and over time. Although the frequency of the support was gradually reduced to increase independence, we believe it is important to continue providing the couple with ongoing assistance.The current study employed principles of the qualitative multiple case study research method, which gathers a collection of specific cases and gleans insights using similarity or contrast . The stuThis study was approved by the ethics committee of the Department of Music at Bar-Ilan University (E.MUS.2018-7), and the PCs signed their consent to participate in the study together with their spouses. Pseudonyms were used, identifying details were omitted, and the remaining information was kept confidential.The participants were recruited through organizations in Israel that provide home services to PWD. An explanation about the proposed program was given to the study participants. Criteria for participation included: (1) An individual with a diagnosis of dementia who lives at home with a spouse as a PC. (2) The spouse expressed their willingness to be involved in therapy and/or to receive phone counseling. (3) The spouse had difficulty coping with caring for the PWD at home. (4) The participants spoke Hebrew or English.Five couples (a PWD + spouse as PC) participated in the study, ages 73–95. A diagnosis of dementia was given 3–7 years before the study began. Four spouses lived in assisted living and one couple lived at home. They were all assisted by a paid caregiver.According to the model, the MT met with each couple at their home over 26 weeks, including a follow-up period, as follows: The intervention of 10 joint weekly music therapy sessions with both spouses, and five phone counseling sessions, which were held concurrently with the caregiving spouse. This was followed by an additional 12-week support period that included three therapy sessions and three phone counseling sessions once every other fortnight, so that the same type of session occurred at a frequency of once a month. Approximately 4 weeks after the support period ended, a follow-up session was held. The intervention included singing, listening to music, dancing, or playing percussion instruments, according to the couple’s preferences. The musical strategies were personalized and tailored to each couple’s needs.All therapy sessions were recorded and transcribed. Transcriptions of the sessions included verbal and musical content and they enabled an inside look at what occurred in the intervention.All counseling sessions were recorded for documentation purposes. The talks were conducted in order to offer musical interventions and to examine whether these contributed to the daily care of the PWD. These sessions employed topics from the burden questionnaire (Zarit Burden Interview - ZBI)  for PCs Around a month after the intervention ended, a follow-up call was held with the spouse. This call examined whether the musical strategies had been implemented and how had the therapy impacted the daily life of the PWD and their spouse even after the intervention had ended.The journal included documentation of the treatment goals, preliminary planning of the therapy sessions, interpretation, feelings, and personal conclusions of the therapist-investigator that emerged during the intervention. Writing the journal led to an observation of the processes the therapist underwent with the clients and provided a necessary distance from the therapeutic process required as an investigator.The data was analyzed according to the cross-case synthesis method , which iFive main themes emerged from an analysis of the content of all the couples’ sessions and phone counseling.The study emphasized positive and joint musical work to facilitate moments of connection and quality time together for the couples. The joint therapy sessions contributed to strengthening the couple’s relationship, created a shared experience, and a break from the caregiver-care recipient roles that had been created as a result of the dementia.When Sophie and Mark sang the aria Habanera from Bizet’s opera Carmen together, it was easily possible to forget that Sophie had an advanced case of vascular dementia. In the therapy sessions the spouses sang songs together, Sophie as a soprano and Mark as a tenor-baritone. The restlessness and depression Sophie was coping with on a daily basis lessened and for the first time she was fit to participate in a joint activity with Mark. Mark had a huge smile on his face when Sophie joined him in song. Although it was without vocal warmup and sheet music, these were precious moments where he could put aside the heavy role of PC. They simply went back to being a couple, partners in a meaningful activity that gave them a sense of connection and enjoyment.During the therapy sessions it was suggested that the couple practice using music together to help them on a daily basis. The joint practice made it possible to involve the PWD in therapy, fine-tune the intervention, and increase the PWD’s degree of cooperation.Jonathan’s walking was very slow and stiff since he was living with advanced Alzheimer’s and Parkinson’s, making it difficult for him to move from one place to another. However, when his wife Yael learned to use rhythm in the therapy sessions to encourage walking, it became easier, both technically and emotionally. Together we explored what was right for Jonathan: Whether to walk to the sounds of a marching tune, to the percussive sound of a regular and steady beat, or to a rhythmic count: left-right, or one-two. The practice was accompanied by laughter and enjoyment. Yael hummed a military march and humorously used military terms like: “Yes, sir” and saluted when Jonathan asked to go home for the weekend, and said “we are returning to base” when she guided him back to the couch, and “soldier at ease” when she helped him sit down. The practice became an experience, and Jonathan, whose speech was usually repetitive and meaningless, suddenly declared: “want a hug.” Jonathan’s involvement in the practice made him feel loved and equal and made the use of rhythm an inseparable part of the couple’s daily life.Concurrent to the joint therapy sessions, the PC spouse was individually addressed in a separate session, where topics that were inappropriate or impossible to discuss together could be raised and processed, giving this spouse an empathetic ear, understanding, and support. The support sessions made it possible for the spouse to share and ask for advice on the daily challenges common with dementia, to vent emotions, and to regain strength.Observing the spouse losing cognitive function and changing was intolerable for Tamar. Robbie was frustrated and depressed. Although music always played in their home, Tamar preferred to watch the musical activity rather than partake. The disconnection protected her. “I’ve lost a friend. I used to be able to consult and speak with him. Now I cannot,” Tamar shared for the first time, expressing the loneliness and pain she felt in living with her husband Robbie’s Alzheimer’s disease. We were already in the middle of the therapeutic process and Tamar felt safe to express these feelings out loud. She did not want to burden her children or close friends with these hard feelings. Outwardly, Tamar presented a strong and optimistic facade, kept busy, and was socially active. “But inside I’m a very sad person,” she expressed with honesty.The validation, understanding, and empathy she received for her feelings during the phone sessions helped her to process and come to terms with the dramatic turning point in their lives. The therapy sessions created an opportunity for Tamar to return to the joint sessions and to experience positive and pleasant quality time with her spouse in a non-threatening manner. Also, the sense of distress Tamar described at the onset of the intervention lessened after she was given an opportunity to grieve the loss of their couplehood.The phone support sessions were held with the PC spouse separately. However, topics that emerged during the calls made it possible to fine-tune the intervention in the therapy sessions and to suggest different ways of using music. In this way, the phone sessions went from theory to applied practice.Singing and listening to classic Israeli songs turned out to be extremely meaningful for Eliraz. “There’s hope!” Motti, her husband, declared whenever she responded verbally and coherently after a musical activity. Motti was elated because Eliraz was living with dementia and spent most of the day sitting in her wheelchair, barely able to speak and understand instructions. However, when Motti tried to recreate the success on his own, he encountered great difficulty. He was frustrated that Eliraz did not respond to music on a daily basis in the same way she did during the joint therapy sessions. A joint examination revealed that without musical support, Motti had a hard time producing song and tended to recite the words without a melody. Also, he tended to ask Eliraz questions about the background of the songs, which elicited frustration and distress in Eliraz. Joint practice in the therapy sessions helped Motti learn singing techniques and how to address Eliraz in order to elicit past memories. Toward the end of the intervention, Motti succeeded in using music effectively. His singing was good, and he managed to create moments of closeness and connection, which the couple sorely lacked.When the therapy sessions ended, the participants continued to receive support for an additional 3 months. During this period, therapy sessions and phone support sessions were conducted with each spouse once every other fortnight, so that the same type of session occurred at a frequency of once a month. This frequency of sessions and calls made it possible for the couples to gradually wean off the support while still providing a small amount of assistance. In this way, the couples were encouraged to continue using music independently without being left to cope on their own.Elizabeth did not believe that a day would come when she and Victor would once again stand face to face, hold hands, and sway to the sounds of Tango. Victor, who was living with advanced dementia and required long-term care, was uncommunicative most of the time. The musical activities during the therapy sessions were a shared couple activity and elicited in Victor rare coherent verbal responses, which surprised and pleased Elizabeth. The phone support that Elizabeth received helped her to use musical strategies also during the week. Together we examined the couple’s challenges and how music can assist. Thus, Elizabeth learned to sing and play music in order to stimulate Victor, who spent most of the day sitting passively in the armchair. However, the musical work required effort from Elizabeth. She stated that the therapy sessions and the phone counseling boosted her motivation and encouraged her to use music more often. Without support, it was harder. In the follow-up phone session, about a month after the intervention ended, Elizabeth said: “After I speak to you, I also use singing, now I use it less.”The current study examined whether a work model that included extensive support for a total period of 26 weeks enabled the independent implementation of music, used in daily life and over time for PWD and their PCs. The work model made it possible to address the needs of both spouses, separately and together, while maintaining the required balance. Moreover, the MT’s presence enabled better implementation of the musical strategies independently and this was maintained during the intervention and the support. The research literature shows that addressing the roles of the MT for PWD and their spouses presents two widespread approaches. In the first approach, the MT focuses on treating the PWD but does not address the PC. The dependence on the therapist is high and the use of music is preserved only during the therapy sessions . In the As can be seen in The MT’s primary role is to provide therapy The therapy is given jointly while addressing the couple as one unit, contrary to focusing on the PWD and providing separate support for the PC . StrengtThe MT’s second role is to provide separate counseling and support for the PC. The phone counseling provided a platform for discussing topics that could not have been raised in the joint sessions, for giving tools to cope with the daily challenges, and for fine-tuning the therapeutic intervention. This model is consistent with other studies that see the importance and significance of addressing the PC spouse, in order to enable them to continue to provide optimal care , 16.The MT’s third role is to enable the spouses to continue using music beyond the therapy session. In the current work model, musical strategies were given internally, as part of the joint therapy, which addressed the needs of both spouses. Musical strategies were also provided separately to the PC in a way that made it possible to fine-tune the therapeutic intervention and to practice during the session together with the MT. Unlike studies that include musical strategies conducted by the PC with limited guidance and support from the MT , in the The study findings indicated that the MT’s extensive support helped to implement the use of music in the daily lives of PWD and their spouses. This extensive support requires an inclusive solution of couple’s therapy, counseling for the PC, and providing musical strategies. This inclusive solution requires extensive training of MTs. Alongside the resources required to enable the ongoing presence of a MT, it is a model that: (1) Provides a therapeutic space for the couples. (2) Enables good implementation of musical strategies. (3) Provides a stable foundation that makes it possible to reduce the frequency of the sessions, which saves resources, yet still provides support in using music independently. This study examined a limited number of couples and additional studies are required to further validate and develop the work model. In addition, a longer follow-up period is needed to examine the sustainability of the couple’s use of musical strategies and to explore whether music has been integrated into their daily lives.The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.The studies involving humans were approved by Department of Music at Bar-Ilan University (E.MUS.2018-7). The studies were conducted in accordance with the local legislation and institutional requirements. Written informed consent for participation in this study was provided by the participants’ legal guardians/next of kin. Written informed consent was obtained from the individual(s) for the publication of any potentially identifiable images or data included in this article.MR, AD, and AG conceived of the study, participated in its design, and took part in drafting the manuscript. MR, the music therapist, was in charge of coordination, data collection and coding as part of her Ph.D dissertation. AD and AG supervised the work. All authors contributed to the article and approved the submitted version.


Eu ions’ chemi- and physisorption to both graphenes may lead to structural deformations, drop of symmetry of low-dimensional lattices, interlayer fusion, and mutual slides of TBG graphene fragments. The frontier bands in the valence region at the vicinity of the Fermi level of both spin-polarized 2D Eu/NPBG(AA) and Eu/TBG lattices clearly demonstrate flat dispersion laws caused by localized electronic states formed by TBG Moiré patterns, which could lead to strong electron correlations and the formation of exotic quantum phases.Advanced two-dimensional spin-polarized heterostructures based on twisted (TBG) and nanoporous (NPBG) bilayer graphenes doped with Eu ions were theoretically proposed and studied using Periodic Boundary Conditions Density Functional theory electronic structure calculations. The significant polarization of the electronic states at the Fermi level was discovered for both Eu/NPBG(AA) and Eu/TBG lattices.  Quantum phases ,2,3 are The connection between localized electronic states and electronic correlations is a fundamental concept in condensed matter physics and materials science ,9,10,11.In crystalline lattices which are characterized by flat electronic bands, the electronic states are typically highly localized in real space . This meThe unique physical properties of 2D bigraphenes (BGs)  make theAt particular magic angles with the largest one of around 1.05° , the Moic is a strongly correlated Mott insulator [c~0 K [c around 1.7 K with the formation of 2D superconducting quantum phase.Twisted bilayer graphene at magic angles and at higher temperatures Tnsulator , which ir [c~0 K , the inssp-metals, such as Li, Ca, and Al [Recently, it was shown that superlattices of potential bumps driven by folded holes in nanoporous bigraphene may induce visible spin polarization by breaking the balance between two graphene sublattices, thereby creating unpaired spins . Dai et , and Al . It coulThe spin polarization of graphene-based low-dimensional materials can be achieved by the creation of either complex heterostructures or defect lattices based on transition metal dichalcogenides/graphene  heterostHigh magnetoresistance in graphene was discovered in graphene coordinated to EuO and EuS surfaces . It was 2/Si substrate. There are two main options for its synthesis: the intercalation of Eu under the graphene sheet or the adsorption of Eu on top of the material [6 stoichiometry for single-layer graphene.Experimental data demonstrated that both EuS/graphene  and EuO/material ,47,48,49material . It is pmaterial ,52. At amaterial . As a reThe main goal of this investigation is theoretical design and the study of complex heterostructures based on nanoporous and twisted bigraphenes with either adsorbed or intercalated Europium ions using Density Functional Theory Periodic Boundary Conditions electronic structure calculations. It was shown that Eu-doping causes spin polarization with a different spatial localization of α and β spin states and fundamental alteration of their band structures with the formation of flat bands in the vicinity of the Fermi level, which may promote strong electronic correlations with the formation of quantum phases, which are promising for advanced spin- and quantum-related applications.k-point sampling was implemented, and the k-point mesh contained 3 × 3 × 1 k-points along with a, b, and c directions, respectively, being used for carbon-based media optimization. For all elements involved in the electronic structure calculations, PAW potentials were used. For carbon, 4 outer electrons, and for Eu, 8 outer electrons, were treated as valence electrons. For Eu, semi-core f-electrons were treated as core states despite being higher in energy than other valence states. For the density of states calculations, the 6 × 6 × 1 k-point mesh was used. A vacuum interval of 20 Å was set normal to the plane to avoid artificial interactions between adjacent unit cell images. In all calculations, the cut-off energy was equal to 600 eV. During the optimization procedure, the maximum force acting on atoms less than 0.001 eV/Å was used as a stopping criterion for structural minimization.The electronic structure calculations of low-dimensional crystalline lattices were performed using the Vienna Ab-initio Simulation Package (VASP) ,55,56 wia = b and γ = 120°, but during structural optimization, a drop of symmetry had been found for some of them. The unit cells of all heterostructures are presented in the Initial atomistic models of the heterostructures were developed using (i) AA and AB bigraphenes  with eitFor the sake of comparison, the optimization of the 2D atomic lattices of parent TBG-21 and both AA/NPBG and AB/NPBG was performed using the same PBC GGA-PBE + U PAW D3 approach. Structural optimization revealed small effects of DFT + U corrections on structure and electronic properties of all 2D lattices. The Parent TBG-21 lattice suffered small structural distortions constituting graphene fragments, which drastically increased with the Ei adsorption.xy direction. In both BG (AA) and BG (AB) cases the Eu interlayer led to the bending of the graphene fragments induced by repulsion with Eu ions.The PBE PBC atomic structure optimization of Eu/BG-AA and Eu/BG-AB experienced drastic cell distortion. In both cases, the lattice symmetry dropped from hexagonal to monoclinic with some slides of graphene fragments  along thh-BN, g-C3N4, g-C4N3, MoS2, and MoSe2 lattices [Topological stability of complex low-dimensial crystalline lattices with multiple non-equivalent sublattices is a key issue for the design and study of 2D periodic atomic lattices from both from theoretical  and expelattices ,68,69 malattices  the lattThe lattices of the graphene fragments of Eu/TBG demonstrated significant reconstruction during structural optimization, with the formation of corrugated carbon lattices formed by triangles, pentagons, hexagons, heptagons, octagons, and even nonagons . In partThe analysis of Total (TDOS) and Partial (PDOS) Density of Electronic States for Eu/BG a unequivf = 7.5 eV and Jf = 0.6 eV parameters [f-electrons. The results of DOS and band structure calculations  is similar to the shape of the second valence band for the β spin state (2b). This fact can indicate the correspondence of the −2a band to the 2b band, induced by the Eu coordination atop TBG since the DOS at the Fermi level is fully determined by the TBG fragment (The band structure of spin-polarized Eu/NPBG (AA) and Eu/TBG heterostructures are presented in fragment d. Tuninga) looks fairly similar to the first flat conduction band of the β spin state (1b), so the −1a band-to-1b band correspondence can occur. The flat nature of the band dispersion law for boundary CB and VB demonstrates their localized nature and the absence of chemical interactions between the states. In case of flat bands, the electronic transitions between VB and CB would not experience phonon relaxation, which could enhance the transition performance.The band shift could be identified in the case of the Eu/NPBG (AA) interface as well. The first flat valence band of the α spin state (−1The spin density distribution for Eu/NPBG (AA) and Eu/TBG are presented in In particular, for Eu/TBG, the spin density is fully localized at the TBG fragment c,d. NeitIn this study, the key Eu-doped low-dimensional 21.8° twisted bilayer graphene and both AA and AB nanoporous bigraphenes were theoretically proposed and studied using the PW PBC DFT approach. Based on electronic structure calculations, it was shown that Eu coordination on top of both the bigraphene and twisted bilayer graphene induces the glide of graphene fragments and drastic structural deformation for Eu/TBG. In accordance with the Topology Conservation Theorem, corrugated TBG graphene fragments form structural waves coupled with interlayer graphene fusion, which would stabilize the local structure and the long-order topology of 2D graphene lattice. The electronic structure calculations revealed that both Eu/NPBG (AA) and Eu/TBG are spin-polarized direct flat band semiconductors with a spin density mostly localized at graphene fragments. The localization of uncompensated spins highlights the leading role of carbon fragments in the spin polarization of the heterostructures. Heterostructure DOSes clearly demonstrate the similar distribution of electronic density of both valence and conductivity bands in the vicinity of the Fermi levels. The total density of states of the valence bands is mostly formed by carbon contributions, while conduction bands have some contributions to the Eu partial electronic states. The distinctive spin polarization and flat bands of the proposed graphene-based low-dimensional quantum materials may promote advanced spin- and quantum-related applications.


Report. A 49-year-old male presented with recurrent dyspnea on exertion, easy fatigue, and chest pain after several visits to different health facilities over 5 months. A diagnosis of pulmonary sarcoidosis was made after a series of laboratory and imaging investigations were done revealing bilateral reticonodular opacifications, noncaseating granulomata, elevated serum ACE and calcium levels consistent with sarcoidosis.  Sarcoidosis is a complex disease with nonspecific etiology and clinical presentation. Its diagnosis is often delayed due to the absence of a single specific investigation modality. A multidisciplinary approach is necessary for its diagnosis.  Sarcoidosis, although a rare presentation in our setting, may easily be overlooked or misdiagnosed if a holistic or multidisciplinary approach is not employed in its diagnosis. Nonspecificity of symptoms contributes to the delayed diagnosis. Sarcoidosis is a granulomatous disease that commonly affects the lungs, and its worldwide prevalence is estimated to be between 4 and 6 in 100,000  on accouData on the disease burden of sarcoidosis in Ghana is not readily available. However, a number of cases have been reported such as that by Bajantri et al. who reported on a 53-year-old woman with neurosarcoidosis  and two The elusiveness of the etiology makes the condition a subject of ongoing research . Severalα leading to massive macrophage activation. Other cells involved include monocytes and lymphocytes. Cytokines and chemokines also play a role in the pathogenesis of pulmonary sarcoidosis . In cases of steroid resistance, a weekly low-dose methotrexate therapy, azathioprine, infliximab, and leflunomide may be used , 20.The recommended period for follow-up is 6-12 months. Pulmonary function tests, especially vital capacity and chest X-ray, can be used to assess for resolution of symptoms or for progression of symptoms . It is aThe classification of sarcoidosis will depend on the outcome of the treatment. It is termed acute if the symptoms resolve between 2 and 5 years after the start of treatment. If symptoms persist after 5 years of treatment, it is termed chronic, and the classification of refractory sarcoidosis is used if symptoms worsen after the start of treatment .Delayed diagnosis is likely and seen in about 50% of cases on account of nonspecificity of the clinical signs and symptoms; however, a high index of suspicion should be entertained and a holistic multidisciplinary approach employed for its diagnosis in a low-resource setting.