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Background: Large language models such as GPT-4 (Generative Pre-trained Transformer 4) are being increasingly used in medicine and medical education. However, these models are prone to "hallucinations" (ie, outputs that seem convincing while being factually incorrect). It is currently unknown how these errors by large language models relate to the different cognitive levels defined in Bloom's taxonomy. Objective: This study aims to explore how GPT-4 performs in terms of Bloom's taxonomy using psychosomatic medicine exam questions. Methods: We used a large data set of psychosomatic medicine multiple-choice questions (N=307) with real-world results derived from medical school exams. GPT-4 answered the multiple-choice questions using 2 distinct prompt versions: detailed and short. The answers were analyzed using a quantitative approach and a qualitative approach. Focusing on incorrectly answered questions, we categorized reasoning errors according to the hierarchical framework of Bloom's taxonomy. Results: GPT-4's performance in answering exam questions yielded a high success rate: 93% (284/307) for the detailed prompt and 91% (278/307) for the short prompt. Questions answered correctly by GPT-4 had a statistically significant higher difficulty than questions answered incorrectly (P =.002 for the detailed prompt and P <.001 for the short prompt). Independent of the prompt, GPT-4's lowest exam performance was 78.9% (15/19), thereby always surpassing the "pass" threshold. Our qualitative analysis of incorrect answers, based on Bloom's taxonomy, showed that errors were primarily in the "remember" (29/68) and "understand" (23/68) cognitive levels; specific issues arose in recalling details, understanding conceptual relationships, and adhering to standardized guidelines. Conclusions: GPT-4 demonstrated a remarkable success rate when confronted with psychosomatic medicine multiple-choice exam questions, aligning with previous findings. When evaluated through Bloom's taxonomy, our data revealed that GPT-4 occasionally ignored specific facts (remember), provided illogical reasoning (understand), or failed to apply concepts to a new situation (apply). These errors, which were confidently presented, could be attributed to inherent model biases and the tendency to generate outputs that maximize likelihood. [ABSTRACT FROM AUTHOR]

Background: Virtual reality (VR)–based simulation is being increasingly used to train medical students in emergency medicine. However, because the usefulness of VR may depend on various factors, the best practices for implementing this technology in the medical school curriculum are yet to be determined. Objective: The overall objective of our study was to assess the perceptions of a large cohort of students toward VR-based training and to identify the associations between these attitudes and individual factors, such as gender and age. Methods: The authors implemented a voluntary, VR-based teaching session in the emergency medicine course at the Medical Faculty in Tübingen, Germany. Fourth-year medical students were invited to participate on a voluntary basis. Afterward, we asked the students about their perceptions, collected data on individual factors, and assessed the test scores achieved by them in the VR-based assessment scenarios. We used ordinal regression analysis and linear mixed-effects analysis to detect the impact of individual factors on the questionnaire answers. Results: A total of 129 students participated in our study (mean age 24.7, SD 2.9 years; n=51, 39.8% male; n=77, 60.2% female). No student had previously used VR for learning, and only 4.7% (n=6) of the students had prior experience with VR. Most of the students agreed that VR can convey complex issues quickly (n=117, 91%), that VR is a useful addition to mannequin-based courses (n=114, 88%) or could even replace them (n=93, 72%), and that VR simulations should also be used for examinations (n=103, 80%). However, female students showed significantly less agreement with these statements. Most students perceived the VR scenario as realistic (n=69, 53%) and intuitive (n=62, 48%), with a relatively lower agreement for the latter among female respondents. We found high agreement among all participants (n=88, 69%) for immersion but strong disagreement (n=69, 54%) for empathy with the virtual patient. Only 3% (n=4) of the students felt confident regarding the medical content. Responses for the linguistic aspects of the scenario were largely mixed; however, most of the students were confident with the English language (not native) scenarios and disagreed that the scenario should be offered in their native language (female students agreed more strongly than male students). Most of the students would not have felt confident with the scenarios in a real-world context (n=69, 53%). Although physical symptoms during VR sessions were reported by 16% (n=21) of the respondents, this did not lead to the termination of the simulation. The regression analysis revealed that the final test scores were not influenced by gender, age, or prior experience in emergency medicine or with virtual reality. Conclusions: In this study, we observed a strong positive attitude in medical students toward VR-based teaching and assessment. However, this positivity was comparatively lower among female students, potentially indicating that gender differences need to be addressed when VR is implemented in the curriculum. Interestingly, gender, age, or prior experience did not influence the final test scores. Furthermore, confidence regarding the medical content was low, which suggests that the students may need further training in emergency medicine. [ABSTRACT FROM AUTHOR]

The document is a reply by authors Anne Herrmann-Werner et al. to a commentary on evaluating GPT-4's cognitive functions using the Bloom Taxonomy. The authors clarify the use of the term "difficulty" in their research and discuss GPT-4's approach to memory tasks. They highlight the complexity of assessing artificial intelligence and emphasize the importance of ongoing research into AI's cognitive processes. The authors appreciate the critique and stress the need for continued dialogue on this topic. [Extracted from the article]

Considerable attention has been paid in recent years to the history of Bohemian exiles in Saxony and Lusatia. However, it has remained unnoticed that in Lusatia the Bohemians, most of whom spoke only Czech, in some cases encountered a Sorbian population, the majority of whom spoke only Sorbian. This study therefore investigates the particular relationships and encounters between Lusatian Sorbs and Bohemian exiles. Attention is given to places of encounter such as family, work and church, as well as to the Moravian Church. In the latter attempts were made, especially in view of the lack of suitable leaders who could speak Czech or Sorbian, to make use of synergies between the two nations in congregational work. The idea of founding a Moravian settlement for Sorbs and Bohemians came to nothing, but countless people moved between the Sorbian and Czech congregational work in Kleinwelka, Niesky and Berlin. A further focus of the article is on people who played important intermediary roles, such as the Bohemian-Sorbian-German pastor Georg Petermann, who generated relationships between Bohemians and Sorbs. For example, while working in Upper Lusatia Petermann developed a seminary in Klix for future Sorbian ministers in about 1740, gathered a Bohemian congregation and attracted other Bohemian pastors to come to Sorbian Lusatia. [ABSTRACT FROM AUTHOR]

Questing ticks were sampled monthly over a period of 11 months from February, 2011 to December, 2011 at 13 sites in southern Germany using the flagging method. The ticks were identified to species, gender, and stadium. Although both I. ricinus and D. reticulatus were sampled, this study concentrated on I. ricinus, since it was the most abundant tick to be found. Additional weather data (air and soil temperature, relative air humidity, precipitation, sunshine duration) were recorded on each sampling site and the local vegetation described. A total of 14, 394 ticks was collected (7,862 larvae, 5,568 nymphs, 964 adults) and their activity was recorded in order to determine the seasonal activity pattern over different periods of the year. In contrast to the widely accepted pattern of a bimodal seasonal activity in moderate areas with a dominant peak in spring and a minor peak in autumn, a unimodal activity pattern was found for all development stages on six of the 12 sampling sites. Tick abundance was compared to weather variables. Tick host-seeking activity was found to be significantly dependent on the temperature at ground level, precipitation, and sunshine duration as well as relative air humidity. Adult ticks showed a positive correlation with the duration of sunshine, whereas nymphs were mostly unaffected by this phenomenon. [ABSTRACT FROM AUTHOR]

Abstract: The hard tick Ixodes ricinus is the most common tick in Central Europe and plays an important role as a vector of several pathogens. In the complex life cycles of these pathogens, the role of wild animals as natural reservoirs has been discussed. The aims of this study were to investigate the role of roe deer (Capreolus capreolus) as a potential reservoir host for Babesia spp., Anaplasma phagocytophilum, and Rickettsia spp. Therefore, we explored the differences in the infection rates of roe deer and engorged and questing ticks with these pathogens from a single forest site with special attention to coinfection. Blood, spleen, and skin samples of a total of 95 roe deer individuals were screened by molecular methods for these pathogens from September 2010 to January 2012 in the ‘Angelberger Forst’ (Bavaria, Germany). Moreover, 331 engorged ticks from 44 roe deer individuals and 199 host-seeking ticks from the same area were screened. Altogether, the following prevalence rates and a high diversity of species were detected for the respective pathogens in individual animals and ticks: (i) Babesia spp.: roe deer, 89.5%; engorged ticks, 7.3%; questing ticks: adults, 2.5%, nymphs, 3.3%. Sequencing revealed B. venatorum, B. capreoli, and B. microti. (ii) A. phagocytophilum: roe deer 98.9%; engorged ticks, 86.1%; questing ticks: adults, 8.9%, nymphs, 0.8%. (iii) Rickettsia spp.: roe deer, 0%; engorged ticks, 16.6%; questing ticks: adults, 13.9%, nymphs, 17.5%. Sequencing revealed R. helvetica. Furthermore, several coinfections were detected in both roe deer and ticks. The high prevalence rates of B. capreoli and A. phagocytophilum in roe deer support their role as reservoir hosts for these pathogens, but no evidence for a role of roe deer in the life cycle of R. helvetica could be provided. [Copyright &y& Elsevier]

Abstract: This study aimed to provide up-to-date information on the dynamics of tick infestations on foxes in Thuringia, as the most recent information available was published in 1997. Fox carcasses that had been sent to the Thuringian State Authority for Food Safety and Consumer Protection (Thüringer Landesamt für Lebensmittelsicherheit und Verbraucherschutz – TLLV), between January 1st and December 31st, 2009, were examined for the presence of ticks. All ticks collected were stored at −20°C before being identified and classified according to their developmental stage and sex. Out of a total of 1286 foxes examined, 989 (76.9%) were infested with ticks. A total of 13,227 ticks were collected from the foxes. The stage most frequently found was the larva (48.1%), followed by the adult (34.1%), and the nymphal stage (17.8%). Regarding the adult stage, Ixodes ricinus was the most frequent tick species detected (82.2%), followed by I. canisuga (10.8%) and I. hexagonus (6.7%). Dermacentor reticulatus ticks were very rare (0.3%). With regard to nymphs, I. canisuga and I. hexagonus were the most frequent tick species found, and this was also assumed for the larval stage. The results indicate the occurrence of tick infestations in foxes throughout the year, mainly by I. ricinus, I. canisuga, and I. hexagonus, with seasonal variations. Foxes were infested by I. ricinus ticks significantly more frequently from April to September. This applied to all tick developmental stages, but especially to adults. In contrast to I. ricinus, the infestation of foxes with I. canisuga and I. hexagonus was significantly higher from January to March and from October to December, especially with the immature developmental stages. [Copyright &y& Elsevier]

A report from the first Historians' Congress of Latvia, held in Riga, Latvia on September 16 and 17, 2011 is presented. The goal of this meeting was to determine research priorities for historical scientists working in Latvia, as well as presenting projects on Latvian history, and identifying the importance of history for Latvian national identity. The need for digitization of historical sources is discussed, as are the lingering effects of Soviet occupation, and the need for increased funds.

Abstract: Previous studies have shown that public parks provide extraordinary habitats for ticks and tick-borne pathogens. Therefore, the aim of this study was to investigate the tick abundance (ticks/100m2) in urban areas and the prevalence of Anaplasma phagocytophilum. Collection of ticks was performed by the flagging method in selected Bavarian public parks in a 2-year survey. DNA from 30 ticks of each developmental stage, sampling site and month was extracted and screened by specific real-time PCR for A. phagocytophilum. Selected positive samples were further genetically differentiated by nested PCR, targeting the 16S rRNA gene. A total of 13,403 Ixodes ricinus were collected with an average tick abundance of 15–53 ticks/100m2 in 2009 and 15–35 ticks/100m2 in 2010, depending on the sampling site. DNA of A. phagocytophilum was detected in 11.6% (n =146) and 8.5% (n =50) of adult females, 13.3% (n =164) and 9.2% (n =51) of adult males as well as 5% (n =60) and 3.9% (n =29) of nymphs for 2009 (n =3685) and 2010 (n =1884), respectively. 16S rRNA gene analysis revealed 6 different genetic variants, 2 of which were 100% identical to known sequences in humans. The results give strong evidence that the occurrence of A. phagocytophilum in I. ricinus is highly variable in different habitat types due to geographical, climatic, and biological factors as well as different genetic variants of A. phagocytophilum circulated in ticks with a noticeable habitat and host tropism. [Copyright &y& Elsevier]