Low dose computed tomography (LDCT) plays a critical role in screening individuals for lung cancer. To better understand why its utilization remains poor, we analyzed the geospatial distribution of lung cancer screening programs in Florida to determine whether the distribution of these programs aligns with populations at greatest risk. Accredited programs offering LDCT were identified from public databases maintained by the American College of Radiology. Age-adjusted incidence and mortality for lung cancer were retrieved from the Florida Cancer Data System and Florida Department of Health. County-level demographic features were retrieved from the 2022 U.S. Census and Florida Department of Health. Univariate Pearson correlations and Kruskal-Wallis analyses revealed that screening programs in Florida are more likely to be located in counties with greater population density and a greater proportion of college-educated residents, physicians per capita and residents with private insurance. In contrast, the number of facilities correlated inversely with the proportion of current smokers, white residents, and lung cancer incidence and mortality. In multivariate analyses, only smoking remained significantly associated with disease-specific incidence or mortality. No association between outcomes with the number of facilities in each county was identified. In conclusion, these findings indicate that the geographic distribution of certified screening programs in Florida does not align with lung cancer burden. Moving forward, strategies to address this mismatch may be helpful for improving the early detection of lung cancer.

Clinical guidelines are essential for evidence-based oncology care but are often long, complex, and difficult to navigate. We developed a multiagent artificial intelligence (AI) system to accurately retrieve and interpret guideline content in response to guideline-based clinical questions. We included 34 ASCO guidelines published between January 2021 and December 2024. Using a multiagent framework, we assigned distinct roles to AI agents: a Coordinator Agent selected the relevant guideline, specialized Tumor Board Agents extracted information from text, tables, and figures, and a Reviewer Agent synthesized a final answer. A total of 100 open-ended questions were created on the basis of the guideline content. The system's performance was compared with GPT-4o, Claude 3.7, Gemini 2.5 flash, DeepSeek-R1, and the ASCO Guidelines Assistant. The multi-agent system achieved (94% [95% CI, 89.3 to 98.7]) accuracy in selecting the correct guidelines and (90% [95% CI, 84.1 to 95.9]) accuracy in answering questions. This significantly outperformed GPT-4o (48%), Claude 3.7 (49%), Gemini 2.5 (50%), DeepSeek-R1 (58%), and the ASCO Guidelines Assistant (67%, all P < .01, McNemar's test). Most errors were due to incorrect guideline selection or misinterpretation; no hallucinated answers were observed. Removing the Coordinator Agent reduced accuracy to 40%, and excluding tables and figures reduced accuracy to 51%. By assigning specialized tasks to AI agents and incorporating visual elements from clinical guidelines, our system outperformed existing tools in accurately answering oncology questions. This pilot study, limited to ASCO guidelines, may improve access to guideline-based care.

Objective To assess the effect of an iatrogenic gastroschisis on fetal pulmonary growth in an animal model of congenital left-sided diaphragmatic hernia (CDH). Methods Eighteen time-dated ewes were studied: Group I: healthy controls (H); Group II: CDH controls (untreated) (CDH); Group III: CDH and iatrogenic gastroschisis (CDH+GS). CDH was created in Groups II and III at a mean gestational age of 85 days as previously described. In Group III, a gastroschisis was created concomitantly with the creation of the CDH. A silo was placed around the intestines during the creation of the gastroschisis. Outcome variables included the lung-to-body weight ratio (LBWR) in unfixed and fixed lungs, as well as histological right and left radial alveolar counts (RAC), as previously described. Results One animal miscarried, leaving 17 for analysis. One ewe had a twin gestation of which one fetus died in the womb after CDH creation, and the co-twin was used as a healthy control, leaving 17 fetuses for analysis. In six of the 8 ewes with CDH+GS, the silo prevented the intestines from protruding outside the abdomen. However, the CDH was confirmed in all 8 fetuses. Therefore, 6 fetuses with a failed gastroschisis but with a persistent CDH were crossed over to Group II (CDH), while the other two were kept in Group III. In three subsequent ewes, the silo was not placed during the creation of the gastroschisis (CDH+GS without silo). This resulted in 4 fetuses in Group I (H), 8 fetuses in Group II (CDH), and 5 fetuses in Group III (CDH+GS). The LBWR was significantly smaller in Group II, compared to the other two groups. There was no difference in the LBWR between groups I and III. In Group III, the LBWR in the fixed lungs was significantly higher than in Group II, and had a tendency to be significantly different in the unfixed lung (p = 0.057). The right and left RAC were significantly smaller in Group II compared to groups I and III, whereas they were not different between groups I and III. The RAC in Group III was significantly higher in Group III compared to Group II. The intestine of two CDH+GS fetuses was analyzed and showed fibrous tissue with chronic inflammation. Conclusion Gastroschisis prevents the development of pulmonary hypoplasia in an ovine model of CDH. Further studies are warranted to confirm these findings.

Academic health center (AHC) psychologists finding novel leadership pathways, both within and outside their AHCs, can provide valuable opportunities for professional enrichment and growth. In this manuscript, we describe how psychologists' training, experiences, and skills contribute to leadership success in traditionally medically-led organizations (MLOs). We also describe how four ACH pediatric psychologists, all at different career stages, found unique leadership roles within traditionally medically-led organizations (MLOs). For each leadership role example, we describe (1) how career stage, expertise, and values intersect with the leadership opportunity, (2) the psychologist's organizational context and leadership role structure, and (3) the psychologist's leadership contributions and collaborative strategies. We also provide concrete recommendations to other ACH psychologists who wish to explore leadership roles throughout their careers.

Four-corner fusion is a reliable surgical option for symptomatic scapholunate advanced collapse and scaphoid nonunion advanced collapse. There are multiple current techniques with potential complications, including nonunion, hardware failure, impingement, and cartilage disruption. Despite these potential complications, 4-corner fusion can result in good functional outcomes and patient satisfaction. We present a cartilage-sparing technique using snap-off compression pins for 4-corner fusion. Potential benefits of this technique include strong internal fixation and stable compression with implants that avoid dorsal surfaces and the radiolunate articulation.

Today's global wars are mostly asymmetrical waged in urban areas resulting in mass destruction and a heavy impact on civilian populations. The spectra of war injuries on survivors are extremely wide and may be quite disturbing. While most casualties in earlier wars were caused by bullet wounds, thermal injuries are at present an important feature of armed conflicts since thermobaric small shoulder-launched missiles and improvised explosive devices became the weapons of choice of non-state combatants. Craniofacial and brain traumatic injuries (BTIs) are also serious common injuries; they frequently result in long-term disability and psychological distress. The time is ripe now for us in the medical profession dedicated to saving lives, to act for stopping the madness of civilian targeting, and focus on planning a better future for the next generations with bright prospects of progress and creativity.

Patients undergoing metabolic bariatric surgery (MBS) have a high prevalence of obstructive sleep apnea (OSA), increasing the risk of postoperative respiratory complications. While tongue thickness has been linked to OSA severity, its role as a predictor of postoperative hypoxemia and other complications remains unclear. This study is the first to evaluate whether preoperative ultrasound-measured tongue thickness correlates with postoperative respiratory outcomes and complications in patients undergoing MBS. METHODS: This prospective observational cohort study included 119 adult patients undergoing robotic-assisted laparoscopic MBS. Preoperative point-of-care ultrasound was used to measure sagittal and coronal tongue thickness. Continuous postoperative monitoring was performed using the Masimo RAD-97™ system for up to 14h. Outcomes included desaturation events, respiratory and pulse events, and 30-day postoperative complications. Correlations between tongue thickness and clinical outcomes were analyzed and stratified by OSA status. Larger tongue dimensions were modestly associated with postoperative desaturation events. Significant time-dependent correlations were observed during the 0-6-h postoperative period (ρ = 0.15-0.34). Patients with OSA showed correlations with desaturations during the first 2h, while patients without OSA had associations during the 4-6-h window. There were no significant differences in tongue size for those with common 30-day complications (p > 0.05). Ultrasound-measured tongue thickness is associated with early postoperative oxygen desaturation in patients undergoing MBS, independent of OSA diagnosis. These findings suggest that tongue ultrasound may serve as a noninvasive tool for preoperative respiratory risk stratification. Further studies into comprehensive preoperative anatomical measurements to enhance risk stratification are warranted.

BackgroundAcute management of traumatic brain injury (TBI) presents several challenges in hospital resource planning. While early tracheostomy (trach) and percutaneous endoscopic gastrostomy (PEG) tube placement may improve patient outcomes, the optimal timing and selection criteria for these interventions remain unclear. This study evaluates the impact of PEG and trach timing on key clinical outcomes and applies one-step reinforcement learning (RL) to recommend intervention timing.MethodsThis retrospective cohort study included 263 adult intensive care unit inpatients (194 men, 69 women, age range 18–87), diagnosed with severe TBI requiring trach and/or PEG between 1 January 2016 and 31 December 2023, at a single academic institution. Key outcomes included ICU and hospital length of stay (LOS), complications, time to oral feeding/decannulation, readmission, and mortality. One-step temporal difference (TD) learning and Q-learning were used to predict the expected value of interventions and to recommend optimal timing based on patient states, respectively.ResultsEarly PEG and trach interventions were associated with significantly shorter ICU and hospital length of stay (LOS) and fewer complications. Delayed PEG placement, however, was associated with a 67% reduction in the odds of mortality (OR: 0.33, p = 0.033) compared to early placement, despite having more total complications. One-step RL suggested greater cumulative rewards with earlier intervention and successfully recommended the optimal day for PEG/trach intervention based on initial patient presentation.ConclusionEarly interventions are associated with improved outcomes; however, delaying PEG or trach placement may be advantageous in select situations to reduce mortality. RL techniques, such as TD and Q-learning, can aid in decision-making regarding interventions.