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Evidence for a membrane defect in Alzheimer disease brain

To determine whether neurodegeneration in Alzheimer disease brain is associated with degradation of structural cell membrane molecules, we measured tissue levels of the major membrane phospholipids and their metabolites in three cortical areas from postmortem brains of Alzheimer disease patients and matched controls. Among phospholipids, there was a significant (P less than 0.05) decrease in phosphatidylcholine and phosphatidylethanolamine. There were significant (P less than 0.05) decreases in the initial phospholipid precursors choline and ethanolamine and increases in the phospholipid deacylation product glycerophosphocholine. The ratios of glycerophosphocholine to choline and glycerophosphoethanolamine to ethanolamine were significantly increased in all examined Alzheimer disease brain regions. The activity of the glycerophosphocholine-degrading enzyme glycerophosphocholine choline-phosphodiesterase was normal in Alzheimer disease brain. There was a near stoichiometric relationship between the decrease in phospholipids and the increase of phospholipid catabolites. These data are consistent with increased membrane phospholipid degradation in Alzheimer disease brain. Similar phospholipid abnormalities were not detected in brains of patients with Huntington disease, Parkinson disease, or Down syndrome. We conclude that the phospholipid abnormalities described here are not an epiphenomenon of neurodegeneration and that they may be specific for the pathomechanism of Alzheimer disease.

NASA Discipline Regulatory Physiology

Space Radiation Heart Disease Risk Estimates for Lunar and Mars Missions

The NASA Space Radiation Program performs research on the risks of late effects from space radiation for cancer, neurological disorders, cataracts, and heart disease. For mortality risks, an aggregate over all risks should be considered as well as projection of the life loss per radiation induced death. We report on a triple detriment life-table approach to combine cancer and heart disease risks. Epidemiology results show extensive heterogeneity between populations for distinct components of the overall heart disease risks including hypertension, ischaemic heart disease, stroke, and cerebrovascular diseases. We report on an update to our previous heart disease estimates for Heart disease (ICD9 390-429) and Stroke (ICD9 430-438), and other sub-groups using recent meta-analysis results for various exposed radiation cohorts to low LET radiation. Results for multiplicative and additive risk transfer models are considered using baseline rates for US males and female. Uncertainty analysis indicated heart mortality risks as low as zero, assuming a threshold dose for deterministic effects, and projections approaching one-third of the overall cancer risk. Medan life-loss per death estimates were significantly less than that of solid cancer and leukemias. Critical research questions to improve risks estimates for heart disease are distinctions in mechanisms at high doses (>2 Gy) and low to moderate doses (<2 Gy), and data and basic understanding of radiation doserate and quality effects, and individual sensitivity.

Cucinotta, Francis A.

Meeting Global Health Needs via Infectious Disease Forecasting: Development of a Reliable Data-Driven Framework

Infectious diseases (IDs) have a significant detrimental impact on global health. Timely and accurate ID forecasting can result in more informed implementation of control measures and prevention policies. To meet the operational decision-making needs of real-world circumstances, we aimed to build a standardized, reliable, and trustworthy ID forecasting pipeline and visualization dashboard that is generalizable across a wide range of modeling techniques, IDs, and global locations. We forecasted 6 diverse, zoonotic diseases (brucellosis, campylobacteriosis, Middle East respiratory syndrome, Q fever, tick-borne encephalitis, and tularemia) across 4 continents and 8 countries. We included a wide range of statistical, machine learning, and deep learning models (n=9) and trained them on a multitude of features (average n=2326) within the One Health landscape, including demography, landscape, climate, and socioeconomic factors. The pipeline and dashboard were created in consideration of crucial operational metrics—prediction accuracy, computational efficiency, spatiotemporal generalizability, uncertainty quantification, and interpretability—which are essential to strategic data-driven decisions. While no single best model was suitable for all disease, region, and country combinations, our ensemble technique selects the best-performing model for each given scenario to achieve the closest prediction. For new or emerging diseases in a region, the ensemble model can predict how the disease may behave in the new region using a pretrained model from a similar region with a history of that disease. The data visualization dashboard provides a clean interface of important analytical metrics, such as ID temporal patterns, forecasts, prediction uncertainties, and model feature importance across all geographic locations and disease combinations. As the need for real-time, operational ID forecasting capabilities increases, this standardized and automated platform for data collection, analysis, and reporting is a major step forward in enabling evidence-based public health decisions and policies for the prevention and mitigation of future ID outbreaks.

60 APPLIED LIFE SCIENCES

Global Disease Outbreaks Associated with the 2015-2016 El Niño Event

Interannual climate variability patterns associated with the El Niño-Southern Oscillation phenomenon result in climate and environmental anomaly conditions in specific regions worldwide that directly favor outbreaks and/or amplification of variety of diseases of public health concern including chikungunya, hantavirus, Rift Valley fever, cholera, plague, and Zika. We analyzed patterns of some disease outbreaks during the strong 2015–2016 El Niño event in relation to climate anomalies derived from satellite measurements. Disease outbreaks in multiple El Niño-connected regions worldwide (including Southeast Asia, Tanzania, western US, and Brazil) followed shifts in rainfall, temperature, and vegetation in which both drought and flooding occurred in excess (14–81% precipitation departures from normal). These shifts favored ecological conditions appropriate for pathogens and their vectors to emerge and propagate clusters of diseases activity in these regions. Our analysis indicates that intensity of disease activity in some ENSO-teleconnected regions were approximately 2.5–28% higher during years with El Niño events than those without. Plague in Colorado and New Mexico as well as cholera in Tanzania were significantly associated with above normal rainfall (p < 0.05); while dengue in Brazil and southeast Asia were significantly associated with above normal land surface temperature (p < 0.05). Routine and ongoing global satellite monitoring of key climate variable anomalies calibrated to specific regions could identify regions at risk for emergence and propagation of disease vectors. Such information can provide sufficient lead-time for outbreak prevention and potentially reduce the burden and spread of ecologically coupled diseases.

El Nino

Natural Language Processing for Extracting Rich Disease Data Aligned To Satellite Meteorological Data

Global climate change is redefining our understanding of how diseases spread. In Sri Lanka, vector-borne diseases such as dengue fever, encephalitis, and leptospirosis historically surged during the monsoon seasons when temperatures were high enough for mosquito eggs to hatch. Unfortunately, due to rising temperatures and more erratic rainfall patterns, mosquito eggs can now hatch year-round and are increasingly unpredictable, leading to an alarmingly increasing number of hospitalizations and deaths. More data is needed to adapt our response to these diseases in an increasingly warmer world. In the contemporary landscape, a wealth of disease information is available, yet accessibility remains limited due to unstructured data formats such as PDFs. Therefore, converting unstructured disease reports into structured formats is necessary for effectively leveraging data. This paper introduces a comprehensive framework for collecting unstructured disease reports and transforming them into analyzable formats. By creating separate models tailored to each data format, we can ensure accuracy compared to general models. These straightforward models enhance accessibility and empower other researchers to use our tools. The returned structured data can then be harnessed for analysis, statistical purposes, and informing evidence-based public health interventions, thus facilitating more informed decision-making in healthcare. We deploy this framework to produce geospatial data for Sri Lanka and Brazil for many different conditions and align these data with satellite environmental data, providing for the first time a structured, aligned powerful dataset for disease modeling.

Open Source Open Science

Altered fractal dynamics of gait: reduced stride-interval correlations with aging and Huntington's disease

Fluctuations in the duration of the gait cycle (the stride interval) display fractal dynamics and long-range correlations in healthy young adults. We hypothesized that these stride-interval correlations would be altered by changes in neurological function associated with aging and certain disease states. To test this hypothesis, we compared the stride-interval time series of 1) healthy elderly subjects and young controls and of 2) subjects with Huntington's disease and healthy controls. Using detrended fluctuation analysis we computed alpha, a measure of the degree to which one stride interval is correlated with previous and subsequent intervals over different time scales. The scaling exponent alpha was significantly lower in elderly subjects compared with young subjects (elderly: 0.68 +/- 0.14; young: 0.87 +/- 0.15; P < 0.003). The scaling exponent alpha was also smaller in the subjects with Huntington's disease compared with disease-free controls (Huntington's disease: 0.60 +/- 0.24; controls: 0.88 +/-0.17; P < 0.005). Moreover, alpha was linearly related to degree of functional impairment in subjects with Huntington's disease (r = 0.78, P < 0.0005). These findings demonstrate that strike-interval fluctuations are more random (i.e., less correlated) in elderly subjects and in subjects with Huntington's disease. Abnormal alterations in the fractal properties of gait dynamics are apparently associated with changes in central nervous system control.

NASA Discipline Cardiopulmonary

Spatial metabolomics and lipidomics in kidney disease

Kidney disease is a global health issue that affects over 850 million people, and early detection is key to preventing severe disease and complications. Kidney diseases are associated with complex dysregulation of lipid metabolism. Spatial metabolomics through mass spectrometry imaging (MSI) enables spatial mapping of the lipids in tissue and includes a variety of techniques that can be used to image lipids. In the kidney MSI studies often seek to resolve individual functional tissue units such as glomeruli and proximal tubules. Several different MSI techniques such as matrix-assisted laser desorption/ionization and desorption electrospray ionization have been used to characterize lipids and small molecules in chronic kidney disease, acute kidney injury, genetic kidney disease, and cancer. In this review we provide several examples of how spatial metabolomics data can provide critical information concerning localization of changes in disease states. Additionally, when combined with pathology, measurements, transcriptomics, or proteomics, the metabolomic changes can illuminate underlying mechanisms and provide new clinical insights.

59 BASIC BIOLOGICAL SCIENCES

A deep generative model for deciphering cellular dynamics and in silico drug discovery in complex diseases

Human diseases are characterized by intricate cellular dynamics. Single-cell transcriptomics provides critical insights, yet a persistent gap remains in computational tools for detailed disease progression analysis and targeted in silico drug interventions. Here we introduce UNAGI, a deep generative neural network tailored to analyse time-series single-cell transcriptomic data. This tool captures the complex cellular dynamics underlying disease progression, enhancing drug perturbation modelling and screening. When applied to a dataset from patients with idiopathic pulmonary fibrosis, UNAGI learns disease-informed cell embeddings that sharpen our understanding of disease progression, leading to the identification of potential therapeutic drug candidates. Validation using proteomics reveals the accuracy of UNAGI’s cellular dynamics analysis, and the use of the fibrotic cocktail-treated human precision-cut lung slices confirms UNAGI’s predictions that nifedipine, an antihypertensive drug, may have anti-fibrotic effects on human tissues. UNAGI’s versatility extends to other diseases, including COVID, demonstrating adaptability and confirming its broader applicability in decoding complex cellular dynamics beyond idiopathic pulmonary fibrosis, amplifying its use in the quest for therapeutic solutions across diverse pathological landscapes.

Neural Network

Biomarkers of exposure, sensitivity and disease

PURPOSE: This review is to evaluate the use of biomarkers as an indication of past exposure to radiation or other environmental insults, individual sensitivity and risk for the development of late occurring disease. OVERVIEW: Biomarkers can be subdivided depending on their applications. Markers of exposure and dose can be used to reconstruct and predict past accidental or occupational exposures when limited or no physical measurements were available. Markers of risk or susceptibility can help identify sensitivity individuals that are at increased risk for development of spontaneous disease and may help predict the increased risk in sensitive individuals associated with environmental or therapeutic radiation exposures. Markers of disease represent the initial cellular or molecular changes that occur during disease development. Each of these types of biomarkers serves a unique purpose. OUTLINE: This paper concentrates on biomarkers of dose and exposure and provides a brief review of biomarkers of sensitivity and disease. The review of biomarkers of dose and exposure will demonstrate the usefulness of biomarkers in evaluation of physical factors associated with radiation exposure, such as LET, doserate and dose distribution. It will also evaluate the use of biomarkers to establish relationships that exist between exposure parameters such as energy deposition, environmental concentration of radioactive materials, alpha traversals and dose. In addition, the importance of biological factors on the magnitude of the biomarker response will be reviewed. Some of the factors evaluated will be the influence of species, tissue, cell types and genetic background. The review will demonstrate that markers of sensitivity and disease often have little usefulness in dose-reconstruction and, by the same token, many markers of dose or exposure may not be applicable for prediction of sensitivity or risk.

Non-NASA Center

Cardiac Repolarization Abnormalities and Potential Evidence for Loss of Cardiac Sodium Currents on ECGs of Patients with Chagas' Heart Disease

Some individuals with Chagas disease develop right precordial lead ST segment elevation in response to an ajmaline challenge test, and the prevalence of right bundle branch block (RBBB) is also high in Chagas disease. Because these same electrocardiographic abnormalities occur in the Brugada syndrome, which involves genetically defective cardiac sodium channels, acquired damage to cardiac sodium channels may also occur in Chagas disease. We studied several conventional and advanced resting 12-lead/derived Frank-lead ECG parameters in 34 patients with Chagas -related heart disease (mean age 39 14 years) and in 34 age-/gender-matched healthy controls. All ECG recordings were of 5-10 min duration, obtained in the supine position using high fidelity hardware/software (CardioSoft, Houston, TX). Even after excluding those Chagas patients who had resting BBBs, tachycardia and/or pathologic arrhythmia (n=8), significant differences remained in multiple conventional and advanced ECG parameters between the Chagas and control groups (n=26/group), especially in their respective QT interval variability indices, maximal spatial QRS-T angles and low frequency HRV powers (p=0.0006, p=0.0015 and p=0.0314 respectively). In relation to the issue of potential damage to cardiac sodium channels, the Chagas patients had: 1) greater than or equal to twice the incidence of resting ST segment elevation in leads V1-V3 (n=10/26 vs. n=5/26) and of both leftward (n=5/26 versus n=0/26) and rightward (n=7/26 versus n=3/26) QRS axis deviation than controls; 2) significantly increased filtered (40-250 Hz) QRS interval durations (92.1 8.5 versus 85.3 plus or minus 9.0 ms, p=0.022) versus controls; and 3) significantly decreased QT and especially JT interval durations versus controls (QT interval: 387.5 plus or minus 26.4 versus 408.9 plus or minus 34.6 ms, p=0.013; JT interval: 290.5 plus or minus 26.3 versus 314.8 plus or minus 31.3 ms; p=0.0029). Heart rates and Bazett-corrected QTc/JTc intervals were not significantly different between groups. Patients with Chagas heart disease have increased cardiac repolarization abnormalities, especially by advanced ECG. Moreover, as a group, they have decreased uncorrected JT and QT interval durations and increased filtered QRS interval durations (versus age/gender-matched controls), all suggesting a potential loss of cardiac sodium channel function that might be mediated, in part, by cardiac autonomic damage. Overall findings support Brugada et al's recent hypothesis that the pathway leading to sudden death may often be similar in Chagas' disease and Brugada syndrome i.e., damage to the sodium channel (infectious/immunologic/autonomic in Chagas' genetic in Brugada) with consequent loss of sodium currents may facilitate a phase II-reentry based arrhythmic substrate for ventricular fibrillation in both conditions. In general, JT interval-related results have been underreported in the Chagas literature.

Schlegel, T. T.

Accessing and Utilizing Remote Sensing Data for Vectorborne Infectious Diseases Surveillance and Modeling

Background: The transmission of vectorborne infectious diseases is often influenced by environmental, meteorological and climatic parameters, because the vector life cycle depends on these factors. For example, the geophysical parameters relevant to malaria transmission include precipitation, surface temperature, humidity, elevation, and vegetation type. Because these parameters are routinely measured by satellites, remote sensing is an important technological tool for predicting, preventing, and containing a number of vectorborne infectious diseases, such as malaria, dengue, West Nile virus, etc. Methods: A variety of NASA remote sensing data can be used for modeling vectorborne infectious disease transmission. We will discuss both the well known and less known remote sensing data, including Landsat, AVHRR (Advanced Very High Resolution Radiometer), MODIS (Moderate Resolution Imaging Spectroradiometer), TRMM (Tropical Rainfall Measuring Mission), ASTER (Advanced Spaceborne Thermal Emission and Reflection Radiometer), EO-1 (Earth Observing One) ALI (Advanced Land Imager), and SIESIP (Seasonal to Interannual Earth Science Information Partner) dataset. Giovanni is a Web-based application developed by the NASA Goddard Earth Sciences Data and Information Services Center. It provides a simple and intuitive way to visualize, analyze, and access vast amounts of Earth science remote sensing data. After remote sensing data is obtained, a variety of techniques, including generalized linear models and artificial intelligence oriented methods, t 3 can be used to model the dependency of disease transmission on these parameters. Results: The processes of accessing, visualizing and utilizing precipitation data using Giovanni, and acquiring other data at additional websites are illustrated. Malaria incidence time series for some parts of Thailand and Indonesia are used to demonstrate that malaria incidences are reasonably well modeled with generalized linear models and artificial intelligence based techniques. Conclusions: Remote sensing data relevant to the transmission of vectorborne infectious diseases can be conveniently accessed at NASA and some other websites. These data are useful for vectorborne infectious disease surveillance and modeling.

Kiang, Richard

Peru Health & Air Quality: Land Use Change in the Rapidly Developing Peruvian Amazon and Implications on Zoonotic Disease Incidence

In the Madre de Dios region of the Peruvian Amazon, forests are being cleared for mining, timber harvesting, road construction, and hydroelectric dam development. These rapid land use changes are increasing human presence in previously sparsely populated areas, disrupting ecosystems and increasing the proximity of human settlement to zoonotic disease vectors. Dengue fever and leishmaniasis are two neglected tropical diseases which are prevalent in Madre de Dios and have been associated with urbanization and road construction. In partnership with the Peruvian Ministries of Health (MINSA) and the Environment (MINAM) and other in-country collaborators, our team examined Land Use Land Cover (LULC) correlations with reported dengue and leishmaniasis incidence in the Madre de Dios region to help partners understand the spatial relationship between land use change and zoonotic disease incidence. We created a LULC classification script using Google Earth Engine with Landsat 5 Thematic Mapper and Landsat 8 Operational Land Imager imagery to classify land cover in 2010, 2015, and 2020 and evaluate changes over this time period. We then used the quantified results of the LULC assessment in conjunction with reported disease cases to evaluate correlations between disease incidence and key land cover changes across Madre de Dios’s 11 districts. In the second term, the team will use these products to develop more detailed disease incidence risk maps and models. High risk areas will then be classified, using PeruSat-1 that allow for even higher resolution mapping at less than 3 meters. These products will allow the partners to understand hotspots of land cover change in Peru and the relationship with outbreaks to inform public health decision making and environmental policy.

Elizabeth Stapleton

Moving With Parasites: Relationships Between Animal Movement and Infectious Disease Across Systems and Scales

Animal movement patterns are important for ecological processes such as population dynamics and infectious disease transmission. Because animals move in response to environmental cues like temperature and precipitation, changes to the environment – whether they are seasonal, interannual, or long-term – can change these processes, leading to changes in population sizes or infectious disease prevalence across space and time. My work uses a combination of simulation modeling and data analysis at multiple spatial and temporal scales to understand the environment-movement-disease connection in diverse animal taxa and environments. In this seminar, I will highlight the diverse ways that the environment can influence infectious disease dynamics via changes to animal movement patterns, including through a global study of migration in ungulate populations, a study of American White Ibis adapting to urban environments in South Florida, and examples of avian influenza prevalence in wild waterfowl. Together, these examples highlight that understanding environment-movement interactions can help predict how infectious disease dynamics might change in the future, as changes to climate, land use, and habitats alter animal movement patterns.

Animal movement

A Multi-Region SEIR Model Incorporating Inter-County Mobility and Time-Dependent Transmission Dynamics: Application to COVID-19 Disease Outbreak Data in North Carolina.

Classical infectious disease compartmental models typically do not incorporate spatial heterogeneity or mobility. We develop a multi-region susceptible-exposed-infected-recovered (SEIR) model in which disease dynamics are coupled via inter-region mobility and the transmission rate is both region and time dependent. We calibrate the model using rolling averages of daily COVID-19 data in all 100 North Carolina counties. Mobility parameters are prescribed using daily inter-county commuter data. The number of transmission rate parameters is substantially reduced by hypothesizing that the dynamics correlate with county-level population density. Parameter estimation is carried out using several objective functions with error terms at different scales. An additive combination of least squares error at the county-level and the state-level, along with a quadratic transmission rate polynomial, yields the lowest overall error at both spatial scales. The calibrated model is used to simulate regional effects of perturbing disease transmission rates in adjacent counties and to illustrate effects of the state’s mobility infrastructure on disease dynamics and spread for a new disease outbreak.

COVID-19 modeling

NASA’s NextGen Remote Sensing Instruments Have Arrived: Data Products For Studying Disease Vectors

Remote sensing can be used to measure, evaluate or estimate both the environment (state functions) and interfaces (processfunctions) defining vector habitats. The products of remote sensing can be integrated directly into the epidemiological equationsto significantly enhance our understanding of disease vector’s life cycles and habitats. The next generation of NASA’s remotesensing instruments which have become recently operational will provide a significant enhancement in our ability to studydisease vector’s life cycles and habitats. These instruments are on the International Space Station (ISS) and includeECOSTRESS, DESIS, and GEDI. ECOSTRESS is a 5 channel, thermal IR instrument with 70 m resolution and approximately1-5 day repeat cycle of day/night pairs. DESIS jointly developed by German Aerospace Center and Teledyne Brown Engineeringis a hyperspectral sensor system of 235 channels and 30 m resolution. DESIS data is only being acquired on demand. GEDI is ahigh-resolution laser ranger used for observing Earth’s forests and topography. NASA’s current ISS instrument configuration provides measurements of the critical environmental measures of environmentalstate functions important to vector & disease life cycles. Remote sensing data provide a spatial context and time series oflandscape scale process functions represented by land use mapping and measurements of ecological functions. Global publichealth is entering a new information age through the use of spatial models of disease vector/host ecologies driven by the use ofremotely sensed data to measure environmental and structural factors critical in determining disease vector habitats. In 2018, NASA initiated a new study for the Surface Biology and Geology (SBG) Designated Observable, identified in the 2018National Academies’ Decadal Survey entitled, “Thriving on Our Changing Planet: A Decadal Strategy for Earth Observationfrom Space.” (https://www.nap.edu/catalog/24938/thriving-on-our-changing-planet-a-decadal-strategy-for-earth) . The SBG isplanned to collect global remote sensing measurements using a hyperspectral spectrometer and multispectral thermal data. Thesedata sets will provide a significant enhancement in our ability to study disease vector’s life cycles and habitats globally. The 3sensors on the ISS provide precursor data to prepare the community for the application of future SBG data toward diseasestudies.

Disease Vectors

A Thermodynamic Paradigm for Studying Disease Vector’s Habitats & Life Cycles Using NASA’s NextGen Remote Sensing Instruments

Global public health is entering a new informational age through the use of spatial models of disease vector/host ecologies driven by the use of remotely sensed data to measure environmental and structural factors critical in determining disease vector habitats, distributions, life cycles, and host interactions. The vector habitat microclimates can be quantified in terms of the surface energy budget measured by satellites. The epidemiological equations (processes) can be adapted and modified to explicitly incorporate environmental factors and interfaces required by a specific disease and its vector/host cycle. Remote sensing can be used to measure or evaluate or estimate both environment (state functions) and interface (process functions). Remote sensing can be used to measure or evaluate or estimate both environment (state functions) and interface (process functions) defining vector habitats. The products of remote sensing can be integrated directly into the epidemiological equations to significantly enhance our understanding of disease vector’s life cycles and habitats. The next generation of NASA’s remote sensing instruments recently operational will provide a significant enhancement in our ability to study disease vector’s life cycles and habitats. Three new instruments have become operational on the International Space Station (ISS) In June 2018, ECOSTRESS (The ECOsystem Spaceborne Thermal Radiometer Experiment on Space Station), a five channel, thermal IR instrument with 70 m resolution and approximately 4-5 day repeat cycle of day/night pairs along with DESISa hyperspectral sensor system 235 channels (between 400 and 1000 nanometers), 30 m resolution, and data only being acquired on demand. In November 2018. GEDI (Global Ecosystem Dynamics Investigation). GEDI is a high-resolution laser ranging of Earth’s forests and topography. These instruments set the stage for NASA’s new global designated observables set of remote sensing measurements collecting hyperspectral and multispectral thermal data called SBG (Surface Biology Geology). The SBG is currently in the planning stage. The availability and use of level 1-4 data products generated from these ISS instruments will be discussed.

thermodynamics

Consistent performance of large language models in rare disease diagnosis across ten languages and 4917 cases

Background Large language models (LLMs) are increasingly used medicine for diverse applications including differential diagnostic support. The training data used to create LLMs such as the Generative Pretrained Transformer (GPT) predominantly consist of English-language texts, but LLMs could be used across the globe to support diagnostics if language barriers could be overcome. Initial pilot studies on the utility of LLMs for differential diagnosis in languages other than English have shown promise, but a large-scale assessment on the relative performance of these models in a variety of European and non-European languages on a comprehensive corpus of challenging rare-disease cases is lacking. Methods We created 4917 clinical vignettes using structured data captured with Human Phenotype Ontology (HPO) terms with the Global Alliance for Genomics and Health (GA4GH) Phenopacket Schema. These clinical vignettes span a total of 360 distinct genetic diseases with 2525 associated phenotypic features. We used translations of the Human Phenotype Ontology together with language-specific templates to generate prompts in English, Chinese, Czech, Dutch, French, German, Italian, Japanese, Spanish, and Turkish. We applied GPT-4o, version gpt-4o-2024-08-06, and the medically fine-tuned Meditron3-70B to the task of delivering a ranked differential diagnosis using a zero-shot prompt. An ontology-based approach with the Mondo disease ontology was used to map synonyms and to map disease subtypes to clinical diagnoses in order to automate evaluation of LLM responses. Findings For English, GPT-4o placed the correct diagnosis at the first rank 19.9% and within the top-3 ranks 27.0% of the time. In comparison, for the nine non-English languages tested here the correct diagnosis was placed at rank 1 between 16.9% and 20.6%, within top-3 between 25.4% and 28.6% of cases. The Meditron3 model placed the correct diagnosis within the first 3 ranks for 20.9% of cases in English and between 19.9% and 24.0% for the other nine languages. Interpretation The differential diagnostic performance of LLMs across a comprehensive corpus of rare-disease cases was largely consistent across the ten languages tested. This suggests that the utility of LLMs in clinical settings may extend to non-English clinical settings.

Artificial intelligence

Exploring Climate-Disease Connections in Geopolitical Versus Ecological Regions: The Case of West Nile Virus in the United States

Many infectious disease forecasting models in the United States (US) are built with data partitioned into geopolitical regions centered on human activity as opposed to regions defined by natural ecosystems; although useful for data collection and intervention, this has the potential to mask biological relationships between the environment and disease. We explored this concept by analyzing the correlations between climate and West Nile virus (WNV) case data aggregated to geopolitical and ecological regions. We compared correlations between minimum, maximum, and mean annual temperature; precipitation; and annual WNV neuroinvasive disease (WNND) case data from 2005 to 2019 when partitioned into (a) climate regions defined by the National Oceanic and Atmospheric Administration (NOAA) and (b) Level I ecoregions defined by the Environmental Protection Agency (EPA). We found that correlations between climate and WNND in NOAA climate regions and EPA ecoregions were often contradictory in both direction and magnitude, with EPA ecoregions more often supporting previously established biological hypotheses and environmental dynamics underlying vector-borne disease transmission. Using ecological regions to examine the relationships between climate and disease cases can enhance the predictive power of forecasts at various scales, motivating a conceptual shift in large-scale analyses from geopolitical frameworks to more ecologically meaningful regions.

60 APPLIED LIFE SCIENCES