Medinol (Israel)

BackgroundCognitive biases, systematic deviations from logical judgment, are well documented in clinical decision-making, particularly in clinical settings characterized by high decision load, limited time, and diagnostic uncertainty-such as critical care. Prior work demonstrated that large language models, particularly GPT-4, reproduce many of these biases, sometimes to a greater extent than human clinicians.MethodsWe tested whether the o1 model (o1-2024–12-17), a newly released AI system with enhanced reasoning capabilities, is susceptible to cognitive biases that commonly affect medical decision-making. Following the methodology established by Wang and Redelmeier [15], we used ten pairs of clinical scenarios, each designed to test a specific cognitive bias known to influence clinicians. Each scenario had two versions, differed by subtle modifications designed to trigger the bias (such as presenting mortality rates versus survival rates). The o1 model generated 90 independent clinical recommendations for each scenario version, totalling 1,800 responses. We measured cognitive bias as systematic differences in recommendation rates between the paired scenarios, which should not occur with unbiased reasoning. The o1 model's performance was compared against previously published results from both the GPT-4 model and historical human clinician studies.ResultsThe o1 model showed no measurable cognitive bias in seven of the ten vignettes. In two vignettes, the o1 model showed significant bias, but its absolute magnitude was lower than values previously reported for GPT-4 and human clinicians. In a single vignette, Occam’s razor, the o1 model exhibited consistent bias. Therefore, although overall bias appears less frequent overall with the reasoning model than with GPT-4, it was worse in one vignette. The model was more prone to bias in vignettes that included a gap-closing cue, seemingly resolving the clinical uncertainty. Across eight vignette versions, intra‑scenario agreement exceeded 94%, indicating lower decision variability than previously described with GPT‑4 and human clinicians.ConclusionReasoning models may reduce cognitive bias and random variation in judgment (i.e., “noise”). However, our findings caution that reasoning models are still not entirely immune to cognitive bias. These findings suggest that reasoning models may impart some benefits as decision-support tools in medicine, but they also imply a need to explore further the circumstances in which these tools may fail.Graphical Supplementary InformationThe online version contains supplementary material available at 10.1186/s13054-025-05591-5.

Japanese patients have shown improved outcomes after treatment with drug eluting stents compared with Western patients. Outcomes with the ridaforolimus-eluting EluNIR stent in Japanese patients are unknown. This was a multi-center trial in Japanese patients undergoing PCI with the ridaforolimus eluting EluNIR stent. A propensity-score matched analysis was performed with the EluNIR arm of the BIONICS trial. The matched cohort was compared with the Japanese patients for the primary endpoint of target lesion failure (TLF) in a non-inferiority study. 104 Japanese patients were compared with 410 matched patients from BIONICS. Baseline characteristics were similar except for more frequent multi-vessel disease in the BIONICS cohort. Post dilation was more likely in Japanese patients (90.4% vs. 64.6%, p < 0.001). TLF at 12months was met by 2 patients (1.9%) in the JNIR study compared with 5.3% in the BIONICS group (Pnoninf = 0.0028). Rates of MI (0% vs. 4.7%, p = 0.03), target vessel MI (0% vs. 3.7%, p = 0.04), MACE (1.0% vs. 6.2%, p = 0.03) and TVF (1.0% vs. 6.9%, p = 0.02) were all significantly lower among Japanese patients. Treatment of Japanese patients with the EluNIR stent is associated with very low rates of adverse events, significantly fewer than seen in the BIONICS trial.

ABSTRACTIntroduction: First-generation drug-eluting stents (DES) were developed and indeed proved their superiority compared to bare-metal stent in minimizing neo-intimal hyperplasia and in-stent restenosis (ISR), overall, reducing target vessel revascularization (TVR). Newer-generation DES are characterized by thinner struts, more biocompatible and either durable, biodegradable or polymer-free surfaces, better device profile and refined drug elution.Area covered: The EluNIRTM (Medinol, Tel Aviv, Israel) Ridaforolimus Eluting Coronary Stent System is a new DES with unique properties. In this review, we highlight the special characteristics of the stent and summarize relevant clinical data. The EluNIRTM was studied in two clinical trials, the NIREUS trial and the larger, pivotal, BIONICS trial. These trials collectively provide data on the safety, performance, and efficacy of the device.Expert commentary: The newly FDA-approved EluNIRTM stent features an elastomeric durable polymer which elutes a novel drug, Ridaforolimus. The stent has thin struts with variable widths and a delivery catheter with a spring tip. These characteristics may explain the good angiographic and clinical results of this stent, which were noninferior to the FDA-approved Medtronic ResoluteTM stent DES.

Auto restraint policies are becoming increasingly popular among urban planners and policy makers as a way of managing travel demand and traffic in city centers. Because urban access is considered crucial to the economic success of a downtown area, certain constituencies, such as business and retail, have historically been opposed to such policies. To address these concerns and design appropriate policies, it is important to understand how visitors to a city center are likely to respond to new policies. This paper presents a model for estimating the likely response to two potential auto restraint policies in the center of Tel Aviv, the largest metropolitan area in Israel: an increase in parking cost and the use of congestion pricing in the form of a cordon around the city center. The models are based on the responses of center visitors to a stated preference survey. The results show that for both workers and nonworkers, most drivers who respond to the policy will do so by changing their mode of travel, and, in the case of congestion pricing, by also changing the time of their trip. The minority will respond by changing their destination or canceling their trip. This is an encouraging result from a policy point of view because changing time or mode is considered a positive shift, whereas changing destination or canceling the trip is considered negative. The results indicate that auto restraint policies can be effective in reducing traffic congestion and air pollution in city centers without hampering their economic vitality.