This study investigates the accuracy and reliability of large language models (LLMs) in scoring writing tasks from the Advanced Placement (AP) Chinese Language and Culture Exam. Using generalizability theory, the research evaluates and compares score consistency (reliability) and alignment with human raters (accuracy) across two types of AP Chinese free-response writing tasks: story narration and email response. These essays were independently scored by two trained human raters and seven artificial intelligence (AI) raters. Each essay received four scores: one holistic score and three analytic scores corresponding to the domains of task completion, delivery, and language use. Results indicate that although human raters produced more reliable scores overall, LLMs demonstrated reasonable consistency under certain conditions, particularly for story narration tasks. Composite scoring that incorporates both human and AI raters enhanced score dependability and human–AI agreement, which supports that hybrid scoring models improve both reliability and accuracy in large-scale writing assessments.

PurposeAcute pancreatitis is a common disease with limited supportive treatments. Finding effective biomarkers is of great significance for early diagnosis and therapy, as well as to achieve better prognosis.Materials and MethodsThe core genes of AP were identified through bioinformatics and machine learning. The expression, clinical features, biological function and immunological effects of the characteristic gene were also evaluated. AP murine models were constructed to verify the results in vivo. Finally, Mendelian randomization studies were performed to determine the causal relationship between IL-18 and AP through genome-wide association studies.ResultsA total of 100 core genes were obtained, and IL18 was identified as the characteristic gene for AP. The expression of IL18 was increased in AP (p<0.001) with an AUC value of 0.917. And some immune responses were inhibited when IL18 is highly expressed. In addition, the OR for IL18 and AP was 0.908 (95% CI = 0.843–0.978, p=0.011) via inverse variance weighting (IVW).ConclusionElevated IL18 can be used to predict the clinical prognosis and immune responses in AP. Meanwhile, MR suggests that an increase in IL18 indicates a low risk of AP, implying that the course of AP often presents a self-limiting feature in clinic.

Most high school students in the United States will receive only minimal instruction in Black history. However, the College Board’s new Advanced Placement (AP) African American Studies (AAS) curriculum has made Black-centered curriculum accessible to more students. Using a Black critical theory (BlackCrit) framework, we used classroom assignments, interviews, and observational data from one West Coast school’s pilot AP African American Studies course to explore how students experience the teaching of Black history in the course versus their other courses. We found that the pilot AP AAS course, when taught by an experienced and passionate Black studies teacher, emerged as a meaningful educational experience that fostered pride in Black identity, resilience in the face of antiblackness and healing from the harm it causes, and a deeper understanding of the global Black diaspora. We conclude by discussing our findings and the implications of AP AAS as a healing educational intervention, particularly for Black students navigating antiblack educational systems.

Conventional manufacturing techniques for continuous carbon fiber-reinforced polymers (CFRP) rely on costly, geometry-specific molds, which substantially limit design flexibility. To overcome these constraints, this paper proposes a robot-based, multi-axis Fused Filament Fabrication (FFF) approach for the production of CFRP components of complex geometries. The setup enables advanced material placement so that support structures and internal cores can be avoided, thereby reducing process preparation effort, post-processing requirements, and overall manufacturing cost. As a case study, a tee pipe geometry is investigated. A dedicated slicing strategy is developed in which the main pipe and the branching section are fabricated sequentially. This approach requires precise cutting and controlled re-adhesion of the CFRP material, a critical capability for extending conventional neat-polymer FFF processes to the additive manufacturing of CFRP. Experimental validation demonstrated the feasibility of the process, highlighting the critical role of an innovative technique called nozzle ironing for surface preparation, as well as the challenges associated with fiber cutting mechanisms. While the final component achieved structural coherence, leakage testing revealed porosity at specific interface regions, suggesting directions for future hardware refinement and process optimization.

ABSTRACT This qualitative study explores how structured learning logs appear to support reflective learning and research-skill development among Grade 12 students enrolled in AP Research course (Advanced Placement Research) in the United Arab Emirates. Twenty-one students (ages 17–18) completed weekly logs over two academic terms, and five participated in follow-up interviews. In this AP Research course, students undertook inquiry-based projects that included original research (e.g. small-scale surveys/interviews), systematic literature reviews, and basic data analysis tasks; learning logs were used to plan, monitor, and evaluate these specific activities. Content analysis identified recurring themes of metacognitive awareness, planning, accountability, time management, adaptability, and critical thinking, suggesting that learning logs may scaffold self-regulated learning behaviors. At the same time, their influence on sustained motivation was limited. Findings should be interpreted cautiously given the small sample size, single-site context, the graded nature of the logs (20% of course mark), and reliance on self-reported data. Implications include the need for explicit scaffolding and sustained, developmentally appropriate feedback to optimize reflective tools in secondary education.

We tested the a priori hypothesis that a ventilation rate of 20 breaths per minute (bpm) is noninferior to 10 and 5 bpm with respect to resuscitation outcomes and physiology following advanced airway placement in a porcine ventricular fibrillation (VF) cardiac arrest model. Twenty-four pigs underwent 4 minutes of untreated VF and 4 minutes of chest compressions without ventilation. Animals were randomized to 5, 10, or 20 bpm (n = 8 per group) for 4 minutes of asynchronous cardiopulmonary resuscitation (CPR), followed by defibrillation. The primary endpoint was achieving return of spontaneous circulation (ROSC); secondary endpoints included 24-hour survival, neurological scores (cerebral performance category), hemodynamic parameters, and respiratory/acid-base physiological parameters. For the primary endpoint, ROSC rates were comparable across groups: 6/8 (75%) in the 5 bpm group, 7/8 (87.5%) in the 10 bpm group, and 6/8 (75%) in the 20 bpm group ( P = 0.837). All animals that achieved ROSC survived for 24 hours with favorable neurological function (CPC 1-2). Notably, this high survival rate reflects the controlled experimental model (short no-flow time and healthy subjects), rather than direct human clinical outcomes. During CPR, intrathoracic pressure and hemodynamics were comparable across groups (all P > 0.05). During the ventilation stage, the 20 bpm group showed significantly better CO 2 clearance, with lower PaCO 2 than the 5 bpm group (mean difference: -12.88 mmHg, 38.50 ± 8.26 vs. 51.38 ± 15.41 mmHg, P = 0.022) and higher arterial pH than the 5 bpm group (mean difference: 0.15, 7.29 ± 0.12 vs. 7.14 ± 0.12, P = 0.001). At 1 hour post-ROSC, the 20 bpm group exhibited significantly higher diastolic blood pressure (mean difference: 26.26 mmHg, 97.83 ± 15.09 vs. 71.57 ± 14.86 mmHg, P = 0.002) and coronary perfusion pressure (CPP, mean difference: 27.96 mmHg, 90.67 ± 13.76 vs. 62.71 ± 18.84 mmHg, P = 0.001), as well as higher arterial pH (mean difference: 0.10, 7.37 ± 0.04 vs. 7.27 ± 0.04, P = 0.029) and smaller base deficit (mean difference: 6.77 mEq/L, -2.83 ± 2.32 vs. -9.60 ± 2.20 mEq/L, P = 0.001) compared with the 10 bpm group. Although peak airway pressure ( Ppeak ) was higher in the 20 bpm group compared with the 5 bpm group (mean difference: 4.75 cmH 2 O, 32.63 ± 3.16 cmH 2 O vs. 27.88 ± 1.81 cmH 2 O, P = 0.010), mean airway pressure ( Pmean ) did not differ significantly among groups ( P = 0.473). Ventilation at 20 bpm did not compromise ROSC, hemodynamics, or increases intrathoracic pressure compared with lower rates in the porcine VF model. Furthermore, 20 bpm facilitated superior acid-base balance and postresuscitation stability, providing a physiological basis for further investigation of moderate increases in the ventilation rate in specific, controlled clinical settings to optimize metabolic clearance.

Across differentiated course levels, teachers create distinct learning environments through their interactional dynamics, rule enforcement, and pedagogical techniques. In this study, I compared students’ experiences in “regular” classes with those geared toward “exceptional learners” in a large public high school. I found that teachers emphasized rigid rule enforcement and rote learning in regular classes while creating spaces characterized by flexibility, collaboration, and permissiveness in classes intended for exceptional learners. These patterns held both in classes intended for students perceived to have exceptional academic abilities (Advanced Placement classes) and in those perceived to have exceptional social needs (a grouping known as “the Block”). These findings show how labeling shapes the organization of work in schools, demonstrating the sociospatial dimensions of academic differentiation.

“Is this good enough?” How often have you heard this from students? Despite using rubrics and mandated assessments, my students sought my approval as the ultimate judge of their work. Were my students grappling with issues of self-confidence about their art? Were the threads of creativity and emotional intelligence broken? Why were peer reviews such a painful process? No matter how much I tried, providing individual feedback or addressing the fundamental “is this good enough” question became an impossible feat with class sizes on average of 30+ students. Were my attempts at peer-to-peer feedback basic? During class critiques, I offered constructive feedback to every student. I offered so much commentary that I often did not leave space for student voice. After 20 years of teaching Photography in a Career Technical Education Program, Advanced Placement (AP) Art and Design, and a myriad of elective art classes at a high-performing Los Angeles County Office of Education high school, and attending district-run professional development, my teaching practice and student work were at a stalemate. Immersed in the Connected Arts Network (CAN), I critically analyzed my teaching practice through the lens of social-emotional learning and diversity, equity, and inclusion. In these sessions, I reflected on my teaching practice with tools specifically for arts educators. Referencing Gholdy Muhammad’s five pursuits (2023), how can I empower my students and give them agency, criticality, and joy? This paper outlines how being a part of CAN has helped me to successfully incorporate peer-to-peer feedback into my classroom pedagogy by focusing on social-emotional learning with my students.

Which comes first, the epinephrine or the endotracheal tube? Several observational studies have found an association between earlier epinephrine administration and survival in pediatric out-of-hospital cardiac arrest. The potential benefits of early placement of advanced airway management compared to bag valve mask ventilation are, however, unclear. On-scene resources may be limited during an out-of-hospital cardiac arrest, so prioritizing an advanced airway or epinephrine could impact other aspects of the resuscitation. In this retrospective observational study from the 2011–2015 Resuscitation Outcomes Consortium (ROC Epistry), Amagasa et al. used sophisticated trial emulation techniques to estimate the impact of the sequence of advanced airway placement vs. epinephrine administration on survival to discharge, neurologically intact survival, and return of spontaneous circulation (ROSC) [1]. They found in the adjusted analysis that (1) the airway sequence was not associated with survival to discharge, (2) epinephrine first was associated with increased odds of ROSC, but not survival to discharge, and (3) advanced airway placement first was associated with increased odds of neurologically intact survival. We commend the authors for their efforts to conduct extensive subgroup and sensitivity analyses to examine effect modifications and the robustness of their findings; however, associations between epinephrine or advanced airway management first with survival to discharge and ROSC were often inconsistent across subgroups, without plausible clinical explanations. Without an RCT comparing the order of epinephrine vs. airway management in pediatric OHCA, this may be the best available evidence on the timing of the advanced airway compared with epinephrine. This study used sophisticated propensity score methods to account for potential confounding variables and resuscitation time bias, and multiple imputation to address missing data. However, the results conflict with recent AHA guideline updates, which emphasize early epinephrine and de-emphasize early advanced airway management based on accumulating observational data [2]. The question is: should EMS medical directors and clinicians change practice to prioritize advanced airway management first, based on the results of this study? Several important limitations should temper enthusiasm to change existing clinical practice based on this analysis. Neurological outcomes were only available on a small subset of the patients. The analysis finding an association between advanced airway placement before epinephrine and improved neurological outcomes only included 13 cardiac arrest survivors. A basic fragility index calculation based on the crude analysis shows that only 2 patients would need to have different outcomes for the results to no longer be statistically significant. Though this does not apply to the adjusted analysis, it indicates that the association between advanced airway management first and improved neurological outcomes is tenuous. Also, inconsistent findings across subgroups undermine the applicability of the main results. The smaller sample size limits subgroup analyses, so it is generally more important to evaluate the consistency in the direction and magnitude of the associations rather than the statistical significance of effect modification. Further, only approximately half of the patients in the study were treated with advanced airways, and the authors could not control for site or the agency, which likely influence the decision to place an advanced airway. From a physiologic standpoint, the goal of all airway management is to provide effective oxygenation and ventilation. Bag-valve-mask ventilation is generally an effective short-term method for providing oxygenation and ventilation in pediatric patients. The benefits of advanced airways may only be realized when bag-valve-mask ventilation is ineffective due to the patient's anatomic characteristics or unsafe due to gastric regurgitation and potential aspiration. There may also be practical considerations in placing an advanced airway before transporting a cardiac arrest patient, since maintaining a good mask seal can be challenging when transporting a patient to a hospital. Based on this reasoning and the currently available evidence, we believe that starting with BVM and escalating to AAM as needed using clinical judgment is a reasonable approach for pediatric OHCA [3]. In addition, newer generation supraglottic airways provide another advanced airway option that has substantially increased in use since the ROC-Epistry era. Future clinical trial data, including the Pediatric Prehospital Airway Resuscitation Trial (Pedi-PART), will provide additional insights. Data sharing not applicable to this article as no datasets were generated or analysed during the current study.

Safety of Ketamine Sedation for Interventional Radiology Procedures: Experience in 900 Consecutive Patients.

As sociocultural attitudes in South Korea continue to evolve, the growing visibility of lesbian, gay, bisexual, transgender, and queer (LGBTQ+) individuals highlights an increasing need for medical education that addresses diversity, equity, and inclusion (DEI). In response to this need, Seoul National University College of Medicine (SNUCM) introduced an LGBTQ+ medicine curriculum in 2021. The curriculum aims to prepare future physicians to provide equitable and respectful care to LGBTQ+ patients and to promote improvements in LGBTQ+ health through an affirming clinical approach. The program consists of both required and elective components. A required one-hour session for second-year medical students covers essential terminology, the historical process of depathologizing LGBTQ+ identities, and core principles of non-discriminatory and inclusive clinical care. Students seeking more advanced training may enroll in a four-week elective course, which provides in-depth learning through direct engagement with LGBTQ+ community members and site visits to LGBTQ+-affirming clinical settings. In addition, a ten-week research course is available to interested second-year students. Highly motivated senior-year students may further participate in a five-week advanced clinical placement focused on clinical observation and seminar-based learning. Participants reported high satisfaction with the program and perceived meaningful improvements in their competence in providing LGBTQ+-affirming health care. Broader national implementation of similar curricula will require coordinated collaboration among medical schools and relevant professional and expert organizations to establish shared core educational content and regionally structured clinical clerkship programs. The experience at SNUCM demonstrates both the necessity and the practical feasibility of integrating DEI-focused education, including LGBTQ+ medicine. Such efforts are expected to support the development of physicians who are committed to health equity and capable of delivering high quality, person-centered care free from prejudice.

Disciplinary outcomes and science educational opportunities both shape student outcomes, with research suggesting that non-advanced science placement via academic tracking and exclusionary discipline both have negative associations with student outcomes, especially for marginalized students. Using a Quantitative Critical Race Theory (QuantCrit) approach, we examined the relationship between in-school-suspension (ISS) and advanced science placement, doing a comparative group analysis that analyzes heterogeneity in gender racial/ethnic subgroups. We found that for most student groups, placement in non-advanced coursework was associated with higher levels of ISS attendance. Drawing on our findings, we recommend culturally responsive science education to promote equity for marginalized students who experience systems of discrimination via tracking and exclusionary discipline.

ABSTRACT Broaching is a cognitive willingness or directedness to initiate a conversation on a topic that may be difficult or uneasy to discuss with all parties involved. Within the counseling context, broaching refers to the school counselor's or helping professional's effort to initiate or respond to issues related to race, ethnicity, and culture in the counseling process. Further, within the broaching framework, the counseling context is interpreted broadly, but it includes strong awareness and understanding of the dynamic interplay of race, ethnicity, gender, social class status, sexual orientation, religion, national origin, immigration status, ability/disability, and so forth, and how they individually and collectively shape beliefs, practices, value orientations, sociopolitical realities, and positionalities. Given the symbiotic relationship among race, ethnicity, and culture, this article emphasizes the social construction of race and class and how they work together to influence counseling/educational and non‐counseling/educational dynamics. Because Black students are disproportionately underrepresented in Gifted and Talented Education (GATE), Advanced Placement (AP), and International Baccalaureate (IB) programs, we highlight the effects of race and class in such programs, contributing to Blacks’ underrepresentation. We also include Boykin's Afro‐centric cultural styles framework and Cross’ racial identity theory to illustrate the additional layers to the broaching process.

Scaling up: Advanced Placement Incentive Program

American universities have long treated racial underrepresentation in academic programs as a problem to be solved at the point of admission. Race-conscious selection, whether explicit or concealed, rests on the assumption that disparities in outcomes reflect systemic exclusion and can be corrected by relaxing formal thresholds based on merit. With medicine as the focus, this essay challenges that assumption by shifting attention to earlier in the pipeline, where preparation and performance are first measured at scale. Advanced Placement (AP) exam participation and performance—such as in AP Chemistry—are early meritocratic filters, and we document persistent gaps in both. We trace these disparities along the “success sequence” to medicine and demonstrate how conclusions about underrepresentation depend entirely on the denominator chosen. Relative to the general population, Blacks are underrepresented among medical school graduates; relative to AP examinees, they are neither under nor overrepresented among medical school graduates; relative to top AP performers, they are strongly overrepresented among medical school graduates. The same data tell three different stories, only one of which respects the structure of a meritorious pipeline. We argue that treating disparity as prima facie evidence of discrimination obscures the real problem: unequal preparation. A post-progressive research agenda should abandon the reflex to equate disparity with racism and instead confront the upstream factors that shape academic readiness. If the aim is durable representation in medicine and other selective professions, lowering standards at the end mistakes symptoms for causes.

Objectives Injury mechanisms play a critical role in determining the need for advanced airway management during prehospital trauma care. While prior studies have examined airway interventions in the context of physiological compromise or specific clinical conditions, few have evaluated how airway device use varies across trauma mechanisms (e.g., falls, motor vehicle collisions). Understanding which injury types are most associated with airway placement, and which airway devices are most commonly used, can help emergency medical service (EMS) clinicians anticipate airway needs and inform trauma system preparedness. Methods We analyzed 2023 data from the National Emergency Medical Services Information System (NEMSIS) to evaluate 9-1-1 trauma activations with documented advanced airway device placement (endotracheal intubation [ETI], supraglottic airway [SGA], and cricothyrotomy [Cric]). Injury causes were categorized based on clinically relevant categories derived from the 20 most common ICD-10 trauma codes. Airway use was described by patient age, sex, urbanicity, incident location, EMS system response, scene, and transport times. Age-stratified airway use rates (per/1,000 trauma activations) were calculated for pediatric (≤15), adult (16–64), and geriatric (≥65) patients. Results Among 5,716,650 trauma activations in 2023, 18,628 (3.6 per/1,000) involved advanced airway placement: ETI-only (13,452; 72.2%), SGA-only (3,544; 19.0%), Cric-only (110; 0.6%), and multiple airways (1,522; 8.2%). Patients were primarily male (75.0%) with a median age of 48 years (IQR: 30–66), found in urban areas (81.2%), on street/highway (40.0%) locations, with over half experiencing out-of-hospital cardiac arrest (55.8%). Falls (29.0%) and motor vehicle collisions (MVCs) (21.0%) accounted for the largest frequency of airway placements, while firearm-related injuries (51.9/1,000) and motorcycle accidents (16.1/1,000) had the highest airway use rates across all age groups. Cricothyrotomy was most commonly performed in firearm-related trauma (39.1%). Among patients with scene and transport times <60 min, median scene and transport times differed across airway types. Conclusions Advanced airway placement occurred in approximately 4 of every 1,000 EMS trauma activations. While falls and MVCs were the most frequent injury types, firearm-related injuries and motorcycle accidents had the highest incidence of airway use. These findings highlight high-risk scenarios for airway intervention and may inform EMS training, triage, and airway preparedness strategies.

ABSTRACTIntroductionEndoscopic retrograde cholangiopancreatography (ERCP) is an essential procedure for the management of biliary diseases. Successful biliary cannulation is the first step. Advanced cannulation techniques, such as the double‐guidewire technique (DGW), precut techniques, and endoscopic ultrasound (EUS)‐guided rendezvous (RV), have been developed to improve cannulation success. However, comprehensive evaluations of a structured cannulation algorithm remain limited.AimsTo evaluate the status of biliary cannulation and associated adverse events (AEs) using a stepwise cannulation algorithm.MethodsA retrospective evaluation of 1,000 consecutive patients with a naïve papilla who underwent ERCP for biliary disease was performed between 2012 and 2022. Biliary cannulation was attempted using a stepwise algorithm, beginning with wire‐loaded cannulation (WLC), followed by DGW, precut techniques, and EUS‐RV. The primary endpoint was overall technical success; secondary endpoints included AEs, incidence of post‐ERCP pancreatitis (PEP), and risk factor analysis.ResultsInitial WLC achieved selective biliary cannulation in 69.2% of cases. Salvage techniques achieved high success rates: DGW (74.9%), precut techniques (77.6%), and EUS‐RV (97.0%). Overall, the final cannulation success rate was 97.8%. The overall AE rate was 7.5%, with PEP being the most common (6.1%). AEs were significantly more frequent in advanced cannulation techniques than WLC (13.3% vs. 5.2%, p < 0.001). Multivariate analysis identified advanced cannulation techniques, pancreatography, and metallic stent placement as independent factors increasing the risk of PEP.ConclusionA structured stepwise approach achieves very high biliary cannulation success in patients with a naïve papilla, though advanced cannulation techniques increase AE risk. Appropriate timing and positioning of EUS‐RV may further optimize safety and efficacy in biliary cannulation.

<h3>Abstract</h3> In this article, Ashley Pollitt and Susan Baglieri analyze an excerpt from a twelfth-grade advanced placement literature classroom discussion, during which students critically examine the absence and treatment of their disabled peers. Drawing on disability studies in education, they situate students9 observations within the historical context of disability segregation and illustrate how institutional practices, prevailing curricular omissions, and the organization of school spaces communicate to students powerful messages about belonging and difference. Pollitt and Baglieri demonstrate how a teacher-facilitated critical discussion can create conditions in which students may raise difficult questions about disability, and they offer information for educators interested in teaching about disability, recognizing disability identities and positionalities, and supporting students to take action against ableism. By foregrounding student perspectives and the complexity of school environments, the authors underscore the importance of deliberate, action-oriented approaches to teaching about disability in education as essential for creating more just and inclusive schools.

Automatic transport ventilators (ATVs) are a potential option for ventilating patients experiencing out-of-hospital cardiac arrest (OHCA); however, their tidal volume delivery performance at different pressure limits compared with that of manual ventilation remains unclear. This retrospective study with quasi-experimental before-after features included adult patients with nontraumatic OHCA with prehospital advanced airway in Hsinchu county, Taiwan, in 2023. Participants were categorized into three groups: Group 1 (ventilated by ATVs; pressure limit: 45 cmH2O), Group 2 (ventilated by ATVs; pressure limit: 60 cmH2O), and Group 3 [manual ventilation by bag-valve devices (BVDs)]. The inspiratory tidal volume measured using Zoll® X-series monitors after advanced airway placement in each group was compared using a linear mixed-effect model (LMM). The association between ventilation settings, delivered inspiratory tidal volume, and return of spontaneous circulation (ROSC) was investigated using logistic regression. Groups 1, 2, and 3 comprised 41 (23.0%), 80 (44.9%), and 57 (32.0%) patients with OHCA, respectively. In the post-hoc LMM analysis, Group 1 had a significantly higher tidal volume than Group 2 (adjusted difference: 66.84 mL, 95% confidence interval: 21.27-112.42, p = 0.012). However, no significant differences were found between Groups 1 and 3 or between Groups 2 and 3. No significant association was observed between different ventilation settings or delivered inspiratory tidal volume and prehospital ROSC or any ROSC following resuscitation. ATVs demonstrated comparable delivered inspiratory tidal volume to BVD ventilation in this exploratory retrospective cohort. Increasing the pressure limit of ATVs from 45 to 60 cmH2O did not increase delivered inspiratory tidal volume. The optimal pressure settings of ATVs, formal feasibility and implementation outcomes, and their effects on clinical outcomes remain unclear and require prospective validation.

A Matter of Survival: Building Better Connections Between High School and College Geography