A technological convergence in hepatobiliary oncology: Evolving roles of smart surgical systems.

Response to M. Trengove & coll regarding "Attention is not all you need: the complicated case of ethically using large language models in healthcare and medicine".

during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (see The Effect of Open Access).

Generative artificial intelligence (GAI), represented by large language models, have the potential to transform health care and medical education. In particular, GAI's impact on higher education has the potential to change students' learning experience as well as faculty's teaching. However, concerns have been raised about ethical consideration and decreased reliability of the existing examinations. Furthermore, in medical education, curriculum reform is required to adapt to the revolutionary changes brought about by the integration of GAI into medical practice and research. This study analyzes the impact of GAI on medical education curricula and explores strategies for adaptation. The study was conducted in the context of faculty development at a medical school in Japan. A workshop involving faculty and students was organized, and participants were divided into groups to address two research questions: (1) How does GAI affect undergraduate medical education curricula? and (2) How should medical school curricula be reformed to address the impact of GAI? The strength, weakness, opportunity, and threat (SWOT) framework was used, and cross-SWOT matrix analysis was used to devise strategies. Further, 4 researchers conducted content analysis on the data generated during the workshop discussions. The data were collected from 8 groups comprising 55 participants. Further, 5 themes about the impact of GAI on medical education curricula emerged: improvement of teaching and learning, improved access to information, inhibition of existing learning processes, problems in GAI, and changes in physicians' professionality. Positive impacts included enhanced teaching and learning efficiency and improved access to information, whereas negative impacts included concerns about reduced independent thinking and the adaptability of existing assessment methods. Further, GAI was perceived to change the nature of physicians' expertise. Three themes emerged from the cross-SWOT analysis for curriculum reform: (1) learning about GAI, (2) learning with GAI, and (3) learning aside from GAI. Participants recommended incorporating GAI literacy, ethical considerations, and compliance into the curriculum. Learning with GAI involved improving learning efficiency, supporting information gathering and dissemination, and facilitating patient involvement. Learning aside from GAI emphasized maintaining GAI-free learning processes, fostering higher cognitive domains of learning, and introducing more communication exercises. This study highlights the profound impact of GAI on medical education curricula and provides insights into curriculum reform strategies. Participants recognized the need for GAI literacy, ethical education, and adaptive learning. Further, GAI was recognized as a tool that can enhance efficiency and involve patients in education. The study also suggests that medical education should focus on competencies that GAI hardly replaces, such as clinical experience and communication. Notably, involving both faculty and students in curriculum reform discussions fosters a sense of ownership and ensures broader perspectives are encompassed.

Big Data, Machine Learning, and Artificial Intelligence to Advance Cancer Care: Opportunities and Challenges

Precision, minimal invasiveness, digitalization, information technology and integrative medicine were considered as the future driving force of hepatobiliary surgery progress in the era of precision medicine, especially in the comprehensive management for patients with hepatobiliary (HB) tumors. Given the encouraging outcomes in the genomic technology-based precision treatment of cancers, we believe that a paradigm shift is emerging in the surgical management for HB tumors with cumulative practice in precision medicine. The current practice would be changed in: (1) the precision neoadjuvant therapy for unresectable HB tumors would come into practice to improve the long-term survival or increase the resec-tability; (2)precision management may become a first-line strategy to prevent the postoperative disease recurrence; (3)patients with recurrent intractable HB tumors could be conversed to the chronic status of surviving with tumor. Given the large population of HB tumors and current status of precision, the precision-based paradigm shift is inevitable in the surgical management for HB tumors. It’s therefore mandatory for the new generation of hepatobiliary surgeons to comprehend the concept and technology of precesion medicine into the current practice. We compose this article to emphasize the role of precision medicine in practice of surgical oncology for HB tumors Key words: Liver neoplasms; Cholangiocarcinoma; Surgical procedures, operative; Precision medicine

Purpose This study aims to critically examine the socio-technical, economic and governance challenges emerging at the intersection of Generative artificial intelligence (AI) and Urban AI. By foregrounding the metaphor of “the moon and the ghetto” (Nelson, 1977, 2011), the issue invites contributions that interrogate the gap between technological capability and institutional justice. The purpose is to foster a multidisciplinary dialogue–spanning applied economics, public policy, AI ethics and urban governance – that can inform trustworthy, inclusive and democratically grounded AI practices. Contributors are encouraged to explore not just what GenAI can do, but for whom, how and with what consequences. Design/methodology/approach This study draws upon interdisciplinary literature from public policy, innovation studies, digital governance and urban sociology to frame the emerging governance challenges of Generative AI and Urban AI. It builds a conceptual foundation by synthesizing insights from comparative city case studies, innovation systems theory and normative policy frameworks. The approach is interpretive and exploratory, aiming to situate AI technologies within broader institutional, geopolitical and socio-economic contexts. The study invites contributions that adopt empirical, theoretical or practice-based methodologies addressing the governance of GenAI in cities and regions. Findings This study identifies a critical gap between the rapid technological advancements in Generative AI and the institutional readiness of public governance systems – particularly in urban contexts. It finds that current policy frameworks often prioritize efficiency and innovationism over democratic legitimacy, civic trust and inclusive design. Drawing on comparative global city experiences, it highlights the risk of reinforcing power asymmetries without robust accountability mechanisms. The analysis suggests that trustworthy AI is not a purely technical attribute but a political and institutional achievement, requiring participatory governance architectures and innovation systems grounded in public value and civic engagement. Research limitations/implications As an editorial introduction, this study does not present original empirical data but synthesizes key theoretical frameworks, case studies and policy debates to guide future research. Its analytical scope is conceptual and comparative, offering a foundation for submissions that further investigate Generative and Urban AI through empirical, normative and practice-based lenses. The limitations lie in its broad coverage and reliance on secondary sources. Nonetheless, it provides an agenda-setting contribution by highlighting the urgent need for interdisciplinary research into how AI reshapes public governance, institutional legitimacy and urban democratic futures. Practical implications This editorial offers a structured framework for policymakers, urban planners, technologists and public administrators to critically assess the governance of Generative and Urban AI systems. By highlighting international case studies and conceptual tools – such as public algorithmic infrastructures, civic trust frameworks and anticipatory governance – the article underscores the importance of institutional design, regulatory foresight and civic engagement. It invites practitioners to shift from techno-solutionist approaches toward inclusive, democratic and place-based AI governance. The reflections aim to support the development of trustworthy AI policies that are grounded in legitimacy, accountability and societal needs, particularly in urban and regional contexts. Social implications The editorial underscores that Generative and Urban AI systems are not socially neutral but carry significant implications for equity, representation and democratic legitimacy. These technologies risk reinforcing existing social hierarchies and systemic biases if not governed inclusively. This study calls for reimagining trust not as a technical feature but as a relational, contested dynamic between institutions and citizens. It encourages submissions that examine how AI reshapes the urban social contract, affects marginalized communities and challenges existing civic infrastructures. The goal is to promote AI governance frameworks that are pluralistic, just and reflective of diverse societal values and lived experiences. Originality/value This editorial offers a timely and conceptually grounded intervention into the emerging field of Urban AI and Generative AI governance. By framing the challenges through Richard R. Nelson’s metaphor of The Moon and the Ghetto, this study foregrounds the gap between technical capabilities and enduring societal injustices. The contribution lies in its interdisciplinary synthesis – bridging innovation systems, AI ethics, public policy and urban governance. It introduces a critical framework for assessing “trustworthy AI” not as a technical goal but as a democratic achievement and encourages research that is policy-relevant, equity-oriented and attuned to the institutional realities of AI in cities.

BackgroundNowadays, generative artificial intelligence (GAI) drives medical education toward enhanced intelligence, personalization, and interactivity. With its vast generative abilities and diverse applications, GAI redefines how educational resources are accessed, teaching methods are implemented, and assessments are conducted.ObjectiveThis study aimed to review the current applications of GAI in medical education; analyze its opportunities and challenges; identify its strengths and potential issues in educational methods, assessments, and resources; and capture GAI’s rapid evolution and multidimensional applications in medical education, thereby providing a theoretical foundation for future practice.MethodsThis scoping review used PubMed, Web of Science, and Scopus to analyze literature from January 2023 to October 2024, focusing on GAI applications in medical education. Following PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines, 5991 articles were retrieved, with 1304 duplicates removed. The 2-stage screening (title or abstract and full-text review) excluded 4564 articles and a supplementary search included 8 articles, yielding 131 studies for final synthesis. We included (1) studies addressing GAI’s applications, challenges, or future directions in medical education, (2) empirical research, systematic reviews, and meta-analyses, and (3) English-language articles. We excluded commentaries, editorials, viewpoints, perspectives, short reports, or communications with low levels of evidence, non-GAI technologies, and studies centered on other fields of medical education (eg, nursing). We integrated quantitative analysis of publication trends and Human Development Index (HDI) with thematic analysis of applications, technical limitations, and ethical implications.ResultsAnalysis of 131 articles revealed that 74.0% (n=97) originated from countries or regions with very high HDI, with the United States contributing the most (n=33); 14.5% (n=19) were from high HDI countries, 5.3% (n=7) from medium HDI countries, and 2.2% (n=3) from low HDI countries, with 3.8% (n=5) involving cross-HDI collaborations. ChatGPT was the most studied GAI model (n=119), followed by Gemini (n=22), Copilot (n=11), Claude (n=6), and LLaMA (n=4). Thematic analysis indicated that GAI applications in medical education mainly embody the diversification of educational methods, scientific evaluation of educational assessments, and dynamic optimization of educational resources. However, it also highlighted current limitations and potential future challenges, including insufficient scene adaptability, data quality and information bias, overreliance, and ethical controversies.ConclusionGAI application in medical education exhibits significant regional disparities in development, and model research statistics reflect researchers’ certain usage preferences. GAI holds potential for empowering medical education, but widespread adoption requires overcoming complex technical and ethical challenges. Grounded in symbiotic agency theory, we advocate establishing the resource-method-assessment tripartite model, developing specialized models and constructing an integrated system of general large language models incorporating specialized ones, promoting resource sharing, refining ethical governance, and building an educational ecosystem fostering human-machine symbiosis, enabling deep tech-humanism integration and advancing medical education toward greater efficiency and human-centeredness.

Can an Artificial Intelligence (AI) Be an Author on a Medical Paper?

Recent advances in artificial intelligence and machine learning for nonlinear relationship analysis and process control in drinking water treatment: A review

The rapid advancement of generative artificial intelligence (GAI) is poised to revolutionize medical education, clinical decision-making, and health care workflow. Despite considerable interest and a surfeit of newly available tools, medical educators largely lack both competencies and guidance on how to incorporate the new and rapidly evolving world of GAI into the core medical school curriculum and experiences of undergraduate medical education. This Scholarly Perspective highlights the need for medical schools to adapt to this new paradigm by implementing policies, governance, and curricula that address the ethical, technical, and pedagogical implications of GAI. The authors recommend creating policies for appropriate GAI use, designed to protect institutional and patient data, and provide students with clarity on the appropriate use of AI for education. The authors suggest that implementing GAI governance at institutions is crucial to create guiding principles on ethical and equitable GAI use and involving students as coinventors of local innovation. The authors argue that providing faculty and learners with tools and training for safe experimentation with GAI and defining competencies for students and faculty are essential. Curricula for GAI should focus on implications of clinical uses. The authors propose a set of new competencies for GAI that build on those already established for AI in general. Given how dynamic the world of GAI is and how quickly new innovations are changing longstanding practices of clinical medicine, it is imperative that the medical education community acts together to share best practices, gather data to assess the impact of GAI education, continuously update the expected competencies of medical students, and help students prepare for a career that will be continually changed by GAI.

Precision orthodontics entails the use of personalized clinical, biological, social and environmental knowledge of each patient for deep individualized clinical phenotyping and diagnosis combined with the delivery of care using advanced customized devices, technologies and biologics. From its historical origins as a mechanotherapy and materials driven profession, the most recent advances in orthodontics in the past three decades have been propelled by technological innovations including volumetric and surface 3D imaging and printing, advances in software that facilitate the derivation of diagnostic details, enhanced personalization of treatment plans and fabrication of custom appliances. Still, the use of these diagnostic and therapeutic technologies is largely phenotype driven, focusing mainly on facial/skeletal morphology and tooth positions. Future advances in orthodontics will involve comprehensive understanding of an individual's biology through omics, a field of biology that involves large-scale rapid analyses of DNA, mRNA, proteins and other biological regulators from a cell, tissue or organism. Such understanding will define individual biological attributes that will impact diagnosis, treatment decisions, risk assessment and prognostics of therapy. Equally important are the advances in artificial intelligence (AI) and machine learning, and its applications in orthodontics. AI is already being used to perform validation of approaches for diagnostic purposes such as landmark identification, cephalometric tracings, diagnosis of pathologies and facial phenotyping from radiographs and/or photographs. Other areas for future discoveries and utilization of AI will include clinical decision support, precision orthodontics, payer decisions and risk prediction. The synergies between deep 3D phenotyping and advances in materials, omics and AI will propel the technological and omics era towards achieving the goal of delivering optimized and predictable precision orthodontics.

Computational Intelligence methods have replaced almost all real world applications with high accuracy within the given time period. Machine Learning approaches like classification, feature selection, feature extraction have solved many problems of different domain. They use different ML models implemented with suitable ML tool or combination of tools from NN (Neural Network), SVM (Support Vector Machine), DL (Deep Learning), ELM (Extreme Learning Machine). The model is used for training with known data along with ML algorithms (fuzzy logic, genetic algorithm) to optimize the accuracy for different medical issues for example gene expression and image segmentation for information extraction and disease diagnosis, health monitoring, disease treatment. Most of the medical problems are solved using recent advances in AI (Artificial Intelligence) technologies with the biomedical systems development (e.g., Knowledge based Decision Support Systems) and AI technologies with medical informatics science. AI based methods like machine learning algorithms implemented models are increasingly found in real life applications ex. healthcare, natural calamity detection and forecasting. There are the expert systems handled by experts for knowledge gain which is used in decision making applications. The ML models are found in different medical applications like disease diagnosis (ex. cancer prediction, diabetics disease prediction) and for treatment of diseases (ex. in diabetics disease the reduction in mean glucose concentration following intermittent gastric feeds). The feature selection ML method is used for EEG classification for detection of the severity of the disease in heart related diseases and for identification of genes in different disorder like autism disorder. The ML models are found in health record systems. There are other applications of ML approaches found in image segmentation, tissue extraction, image fragmentation for disease diagnosis (ex. lesion detection in breast cancer for malignancy) and then treatment of those diseases. ML models are found in mobile health treatment, treatment of psychology patients, treatment of dumb patients etc. Medical data handling is the vital part of health care systems for the development of AI systems which can again be solved by machine learning approaches. The ML approaches for medical issues have used ensemble methods or combinations of machine learning tools and machine learning algorithms to optimize the result with good accuracy value at a faster rate.

BONUS: the National Oncology Network for Students and Junior Doctors

Advances in artificial intelligence (AI) technologies, together with the availability of big data in society, creates uncertainties about how these developments will affect healthcare systems worldwide. Compassion is essential for high-quality healthcare and research shows how prosocial caring behaviors benefit human health and societies. However, the possible association between AI technologies and compassion is under conceptualized and underexplored. The aim of this scoping review is to provide a comprehensive depth and a balanced perspective of the emerging topic of AI technologies and compassion, to inform future research and practice. The review questions were: How is compassion discussed in relation to AI technologies in healthcare? How are AI technologies being used to enhance compassion in healthcare? What are the gaps in current knowledge and unexplored potential? What are the key areas where AI technologies could support compassion in healthcare? A systematic scoping review following five steps of Joanna Briggs Institute methodology. Presentation of the scoping review conforms with PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews). Eligibility criteria were defined according to 3 concept constructs (AI technologies, compassion, healthcare) developed from the literature and informed by medical subject headings (MeSH) and key words for the electronic searches. Sources of evidence were Web of Science and PubMed databases, articles published in English language 2011-2022. Articles were screened by title/abstract using inclusion/exclusion criteria. Data extracted (author, date of publication, type of article, aim/context of healthcare, key relevant findings, country) was charted using data tables. Thematic analysis used an inductive-deductive approach to generate code categories from the review questions and the data. A multidisciplinary team assessed themes for resonance and relevance to research and practice. Searches identified 3,124 articles. A total of 197 were included after screening. The number of articles has increased over 10 years (2011, n = 1 to 2021, n = 47 and from Jan-Aug 2022 n = 35 articles). Overarching themes related to the review questions were: (1) Developments and debates (7 themes) Concerns about AI ethics, healthcare jobs, and loss of empathy; Human-centered design of AI technologies for healthcare; Optimistic speculation AI technologies will address care gaps; Interrogation of what it means to be human and to care; Recognition of future potential for patient monitoring, virtual proximity, and access to healthcare; Calls for curricula development and healthcare professional education; Implementation of AI applications to enhance health and wellbeing of the healthcare workforce. (2) How AI technologies enhance compassion (10 themes) Empathetic awareness; Empathetic response and relational behavior; Communication skills; Health coaching; Therapeutic interventions; Moral development learning; Clinical knowledge and clinical assessment; Healthcare quality assessment; Therapeutic bond and therapeutic alliance; Providing health information and advice. (3) Gaps in knowledge (4 themes) Educational effectiveness of AI-assisted learning; Patient diversity and AI technologies; Implementation of AI technologies in education and practice settings; Safety and clinical effectiveness of AI technologies. (4) Key areas for development (3 themes) Enriching education, learning and clinical practice; Extending healing spaces; Enhancing healing relationships. There is an association between AI technologies and compassion in healthcare and interest in this association has grown internationally over the last decade. In a range of healthcare contexts, AI technologies are being used to enhance empathetic awareness; empathetic response and relational behavior; communication skills; health coaching; therapeutic interventions; moral development learning; clinical knowledge and clinical assessment; healthcare quality assessment; therapeutic bond and therapeutic alliance; and to provide health information and advice. The findings inform a reconceptualization of compassion as a human-AI system of intelligent caring comprising six elements: (1) Awareness of suffering (e.g., pain, distress, risk, disadvantage); (2) Understanding the suffering (significance, context, rights, responsibilities etc.); (3) Connecting with the suffering (e.g., verbal, physical, signs and symbols); (4) Making a judgment about the suffering (the need to act); (5) Responding with an intention to alleviate the suffering; (6) Attention to the effect and outcomes of the response. These elements can operate at an individual (human or machine) and collective systems level (healthcare organizations or systems) as a cyclical system to alleviate different types of suffering. New and novel approaches to human-AI intelligent caring could enrich education, learning, and clinical practice; extend healing spaces; and enhance healing relationships. In a complex adaptive system such as healthcare, human-AI intelligent caring will need to be implemented, not as an ideology, but through strategic choices, incentives, regulation, professional education, and training, as well as through joined up thinking about human-AI intelligent caring. Research funders can encourage research and development into the topic of AI technologies and compassion as a system of human-AI intelligent caring. Educators, technologists, and health professionals can inform themselves about the system of human-AI intelligent caring.

Purpose This conceptual paper examines what underlies decision-making in generative change processes to explore how generative artificial intelligence (GAI) might shape the future of organisational change. Design/methodology/approach This investigation draws on Snowden and Stanbridge's (2004) social complexity concept, Archer's (1995) morphogenetic/morphostatic explanatory methodology and Mackenzie and Bititci's (2023) social systems-based model for organisational change to explain how structure, culture and agency influence generative change processes in complex adaptive social systems. Findings Both human-based decision-making and machine-based decision-making have roles to play in generative change. This paper proposes that human reflexivity mediates ideas, whereas the material aspects of artificial intelligence (AI) and GAI mediate tasks. The former shapes the change interventions that take place and the latter contributes to their more effective execution. Practical implications In generative change processes, AI and GAI technologies should be focused on tasks that support human-based decision-making. Originality/value This paper explores decision-making in organisational change from a social complexity perspective and identifies the complementary roles of human reflexivity and AI and GAI materiality in delivering emergent outcomes.