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The integration of Artificial Intelligence (AI) into medicine has progressed from discriminative models to Generative AI (GenAI), which can synthesize novel content. For orthopaedic surgeons, scientific publication remains a vital marker of academic success but is often constrained by clinical workload. This review proposes a structured, practical framework to help orthopaedists effectively harness AI tools, transitioning from opaque, "black box" generation to grounded, verifiable research assistance through Retrieval-Augmented Generation (RAG). A PubMed search was conducted to explore the application of GenAI in the context of orthopaedic scientific research. An interactive review with experts in GenAI was also conducted, from which the proposed structure was developed. From this synthesis, a three-phase workflow is proposed: (1) Evidence selection using semantic discovery systems to identify and map relevant literature beyond keyword matching; (2) Data extraction and synthesis employing RAG-based systems to anchor AI responses to verified PDF sources, thereby minimizing hallucinations; and (3) Drafting and refining using Large Language Models (LLMs) for structured composition, linguistic clarity, and iterative manuscript improvement. The workflow integrates platform features to enhance efficiency, accuracy, and accessibility in orthopaedic research. When applied within a controlled, evidence-grounded environment, these systems can automate literature synthesis, expedite data extraction, and assist with scientific writing, while preserving authorial intent and accountability. However, challenges remain. Risks include algorithmic bias, "hallucinations", privacy concerns, and ethical issues related to authorship. Despite these limitations, AI represents a paradigm shift in orthopaedic scholarship, functioning as a cognitive exoskeleton that augments rather than replaces human expertise. With vigilant human oversight and adherence to journal ethics, orthopaedic surgeons can leverage AI to enhance research productivity, reproducibility, and quality while upholding the highest standards of scientific integrity.

Dislocation remains a common complication after total hip arthroplasty (THA). While higher annual surgical volume has been associated with lower dislocation rates, the influence of surgeon experience is poorly understood. We evaluated whether early-career surgeons have higher rates of dislocation compared to experienced-career surgeons and whether enabling technology, specifically computer navigation (CN) or robotic assistance (RA), mitigates this risk. A retrospective review of 5,516 consecutive primary THAs was performed at a single academic institution between June 1, 2018, and November 1, 2024. Patients were &#x2265; 18 years, had primary osteoarthritis, and underwent posterior approach (PA) or direct anterior approach (DAA) THA. Surgeons were categorized as early-career (n = 6) or experienced-career (n = 4) based on having fewer or more than five years in practice, respectively. Demographics, history of lumbar spinal fusion, use of enabling technology, surgical variables, and postoperative dislocations and revisions were collected from the electronic medical record and telephone follow-up. Multivariate logistic regressions were performed to identify factors associated with dislocation. Dislocation was more common after PA compared to DAA THA (1.7 versus 0.5%, P < 0.001). Experience did not affect the DAA dislocation rate (early-career 0.2 versus experienced-career 0.6%, P = 0.311). For manual PA THA, early-career surgeons had a higher dislocation rate than experienced-career surgeons (4.5 versus 1.2%, P < 0.001). Early-career surgeons using RA for PA THA had a dislocation rate comparable to experienced-career surgeons using manual technique (0.3 versus 1.2%, P = 0.240) and to DAA THA (P > 0.999). On multivariate analysis, RA was protective against dislocation for early-career surgeons (odds ratio 0.08, 95% confidence interval 0.004 to 0.42, P = 0.001). Early-career surgeons had a higher dislocation rate after manual PA THA compared to experienced-career surgeons. Use of RA reduced PA dislocation risk to levels comparable to those of experienced-career surgeons and those performing DAA THA.

This AM Last Page provides a visual depiction of how to best implement successful hybrid learning practices in academic -medicine using the Community of Inquiry conceptual framework.

Stigma toward people with substance use disorders (SUD) remains a major barrier to care. There have been multiple calls to action to address SUD stigma in healthcare settings and other reviews have clarified the need for more rigorous effectiveness research. In addition to attention to effectiveness research, there is a need to attend to the implementation strategies used to deliver SUD stigma reduction interventions. Delineating discrete implementation strategies that have been used to address stigma will support future research efforts to arrive at the most optimal interventions to address SUD stigma. We searched three databases and extracted data to identify interventions tested to reduce SUD stigma. We used the adapted Expert Recommendations for Implementing Change (ERIC) taxonomy to characterize the discrete implementation strategies used to support the adoption, implementation, sustainment, and scale-up (or spread) of each intervention. This scoping review synthesized 108 peer-reviewed studies reporting on interventions which to address SUD stigma among healthcare professionals. Most interventions were implemented in training environments, including higher education and continuing education settings, and focused on providing basic education on SUD broadly or opioid use disorder. Within interventions, educational and training implementation strategies were most prominent with 74% of studies using educational meetings and 39% distributing training materials. Far fewer studies used implementation strategies that used experiential approaches such interactive assistance, simulation, case-based learning, or contact with people with lived experience. Most studies (73%) reported reductions in stigmatizing attitudes, most often immediately post-intervention, though the need for higher study quality was notable. Existing stigma-reduction interventions are overwhelmingly education-focused and primarily implemented in academic settings, with limited use of strategies that promote reflective learning, contact-based engagement, or organizational change. Future work should employ more rigorous designs that systematically test implementation strategies to create packaged SUD stigma reduction interventions optimized for effectiveness and implementation.

Air pollution has been linked to impaired cognitive outcomes and lower academic performance in children. The Children's Health and Air Pollution Study (CHAPS) is a longitudinal cohort study following children who live in the Fresno metropolitan area of California, where air pollution is notoriously high. In this study, we investigated the relationship between estimated concentrations of three high-priority air pollutants (PM2.5, NO2, and O3) at the home and school and multiple years of standardized test scores from children in the CHAPS cohort. We analyzed data from 97 children between ages 8 to 13 who had reported at least three years of standardized testing between 2015 and 2022. To model the relationship between pollution and testing performance over multiple time points, we ran six mixed effects linear regression models differentiated by pollutant (PM2.5, NO2, and O3), and standardized tests (English Language Arts or math). Math standardized test scores were negatively associated with O3 and PM2.5, but not NO2. A one part per billion (ppb) increase in O3 was associated with a 0.078 (95% CI: -0.145 to -0.010) standard deviation decrease in test scores and a one microgram per meter cubed (&#x3bc;g/m3) increase in PM2.5 was associated with a -0.074 standard deviation decrease in test score (95% CI: -0.120 to -0.032). There was a weak negative association between English Language Arts and both O3 and PM2.5, however, the confidence intervals for these associations overlapped the null. The association between O3 and math scores was eliminated after adjusting for PM2.5, and may have resulted from collinearity between O3 and PM2.5 rather than a unique association between O3 and math scores. This association between air pollutant exposure at home and school and student standardized test scores emphasizes the possible neurocognitive impact of air pollution on a measure available for nearly all California children.

Adolescent idiopathic scoliosis (AIS) affects 1-3% of children in the United States, with approximately 38,000 patients undergoing posterior spinal fusion (PSF) annually. The relationship between preoperative patient-reported outcomes, postoperative recovery, and long-term clinical significance remains unclear. This study assesses longitudinal changes in Scoliosis Research Society-22r (SRS-22r) scores. It evaluates clinical significance using the Minimum Clinically Important Difference (MCID) in AIS patients undergoing PSF. Retrospective study using prospectively collected data. A retrospective study was conducted using prospectively collected data on AIS patients who underwent PSF at a single academic institution between 2012 and 2022. Patient-reported outcomes were assessed using the SRS-22r questionnaire at preoperative, 6-month, 1-year, and&#x2009;&#x2265;&#x2009;2&#xa0;years postoperative time points. MCID threshold achievements were determined using anchor-based criteria from Bago et al. The percentage of patients achieving MCID and predictors of MCID achievement were analyzed using logistic regression. A total of 161 patients (mean age 15.26&#x2009;&#xb1;&#x2009;2.15&#xa0;years; 65.8% female) were included. At 1&#xa0;year, MCID achievement ranged from 30.1% (Self-Image) to 43.4% (Mental Health). By&#x2009;&#x2265;&#x2009;2&#xa0;years, MCID rates declined in Pain (25.9%) and Self-Image (22.8%) but increased in Function/Activity (44.1%). Lower preoperative SRS-22r scores consistently predicted MCID achievement across all domains. A documented mental-health history reduced the likelihood of Pain MCID at 1&#xa0;year, and larger postoperative Cobb angles independently decreased the odds of achieving Self-Image MCID at both follow-up points. Neighborhood opportunity (Child Opportunity Index) was not associated with outcomes. Sensitivity analyses demonstrated that complete-case&#x2009;&#x2265;&#x2009;2 year MCID rates were consistently bounded by best- and worst-case values and closely approximated LOCF estimates, supporting robustness despite attrition. Meaningful postoperative improvement after PSF varies substantially by SRS-22r domain. Pain and mental-health gains occurred early and stabilized, whereas function demonstrated ongoing recovery, and self-image improved rapidly and remained stable. MCID achievement was most likely in patients with greater preoperative symptom burden, while mental-health history and residual postoperative deformity diminished domain-specific improvements. The stability of MCID patterns across sensitivity analyses reinforces the reliability of long-term findings. These results highlight the importance of incorporating psychological assessment, expectation management, and attention to postoperative alignment into perioperative care for AIS patients.

Adaptive radiotherapy (ART) has been shown to improve geometric and dosimetric accuracy, with emerging evidence for clinical benefit, but it remains resource-intensive and lacks scalability. This limitation arises from multiple factors, including the complexity of current systems, the closed and proprietary nature of radiotherapy platforms, and the need for human oversight driven in part by clinical risk considerations. Historically, major advances in radiotherapy-from Intensity-Modulated Radiation Therapy (IMRT) and Image-Guided Radiation Therapy (IGRT) to Magnetic Resonance-guided Radiotherapy (MRgRT) and Deep Learning in Radiotherapy (DLinRT) (particularly for auto-contouring)-have thrived through open collaboration and transparency. The community can accelerate ART innovation by returning to this model. Open-source initiatives such as Computational Environment for Radiotherapy Research (CERR), Open Knowledge-based Planning (OpenKBP), and matRad demonstrate how shared tools and methods improve reproducibility and drive scientific progress. The next critical step is to develop collaborative, structured frameworks that enable safe, secure interaction between academic and vendor systems-safeguarding intellectual property while fostering co-development and validation. Through structured transparency and shared accountability, the radiotherapy field can transform automation from a closed, non-transparent architecture into a collective learning ecosystem, ultimately extending the life-saving benefits of ART to more patients worldwide through openness, trust, and collective innovation.

Motivational factors are widely recognized as central to students' engagement in cognitively demanding learning; however, the role of STEM career interest in the development of computational thinking during adolescence remains insufficiently understood. It is also unclear whether this association differs by gender. Grounded in Social Cognitive Career Theory, this study examined the association between STEM career interest and computational thinking among high school students and tested the moderating role of gender. Data were collected from 467 students (Mage = 16.05, SD&#x2009;=&#x2009;1.20; 57.2% female) enrolled in public science high schools in Diyarbak&#x131;r, T&#xfc;rkiye, using a descriptive correlational design. Participants completed the STEM Career Interest Scale and the Computational Thinking Skills Scale. Moderation analysis was conducted using PROCESS (Model 1) with 5,000 bootstrap resamples. STEM career interest was positively associated with computational thinking. Gender showed no significant main effect, and the interaction between STEM career interest and gender was not significant, indicating that the strength of this association was similar for female and male students. These findings suggest that, within academically selective STEM-focused environments, motivational orientations toward STEM are linked to computational thinking in comparable ways across genders. The results highlight the importance of supporting students' motivational engagement, alongside instructional practices, in fostering computational thinking during secondary education.

Mental health conditions account for 18% of years lived with disability worldwide. 1-in-6 adults are affected in England, with most mental health conditions beginning in childhood and adolescence. Mental distress and ill health are unequally distributed in the UK, with strong associations with wider determinants of health, and higher prevalence among systemically disadvantaged groups. Currently, there is a lack of evidence to inform effective and timely policymaking for primary prevention in the UK. In recognition of these challenges, a national Population Mental Health (PMH) Consortium was established, as part of Population Health Improvement UK (PHIUK). PHIUK is a national research network which works to transform health and reduce inequalities through change at the population level. Our aim is to establish an interdisciplinary PMH Consortium, focussing on upstream determinants and the prevention of risks and onset of mental health conditions through interdisciplinary stakeholder engagement, to create new opportunities for population-based improvement of mental health in the UK.The PMH Consortium brings together leading interdisciplinary representation in population mental health, spanning from sciences to the arts, across the UK. Membership includes six academic institutions, third sector organisations, lived experience expertise, and strong links with national bodies to ensure integrated cross-national and regional policy impact. The PMH Consortium comprises four cross-cutting platforms (Partners in policy, implementation, and lived experience; Data, linkages, and causal inference; Narrowing inequalities; Training and capacity building) and three challenge areas (Children and young people's mental health; Prevention of suicide and self-harm; Multiple long-term conditions) which are highly integrated and interdependent. The work will be underpinned by a Theory of Change across an initial four-year life cycle. This paper describes the aim, objectives, and approach of the PMH Consortium, as well as anticipated challenges and strengths. The goal of the PMH Consortium is to develop a model for population mental health research and policy translation that is both scalable and sustainable. It is critical to ensure continued impact and viability beyond the initial four years, contributing to the prevention of mental health conditions in the UK, with personal, economic, social, and health benefits.

Palliative care improves quality of life and reduces avoidable healthcare utilization for people with heart failure, yet referrals remain inconsistent and delayed. Clinical decision support offers a promising strategy to facilitate timely palliative care, but no tool currently exists to support palliative care decision-making specifically for this population. To identify clinician needs, contextual factors, and design requirements to inform the development of a clinical decision support tool to promote timely palliative care for hospitalized patients with heart failure. Guided by the User-Centered Framework for Implementation of Technology, we conducted a qualitative descriptive study using focus groups and interviews with referring clinicians (hospitalists and cardiologists) and palliative care clinicians across two hospitals in an academic health system. Rapid qualitative and content analysis were used to identify themes related to workflow, decision-making, and tool design. Twenty-five clinicians participated. Clinicians described workflow challenges, goals for earlier palliative care involvement, and barriers such as uncertainty about referral timing. Informational needs included prognostic indicators and healthcare utilization data. Clinicians reported limited experience with palliative-specific decision support and expressed strong dislike for interruptive alerts that disrupt workflow. Preferred features included objective markers of clinical deterioration, tailored recommendations based on clinical acuity, integration into existing workflows, and clear visuals. Clinicians identified critical informational, contextual, and design requirements for a clinical decision support tool to promote timely palliative care in heart failure. These findings directly inform tool design, workflow integration, and implementation strategies, and will guide future pilot testing and clinical evaluation.

This article examines how medical secrecy, family silence, and nascent activism produce distinct spatial-cultural regimes that shape health outcomes, care pathways, and health inequities for intersex people in Chile. It contributes a spatial-analytic framework to medical anthropology debates on clinical secrecy, contested diagnostic nomenclature, and epistemic injustice in healthcare. Multi-sited reflexive ethnography was conducted in Chile between October 2020 and December 2023, primarily in Santiago. The study draws on 30 semi-structured interviews-14 with intersex individuals (aged 19-45), of whom one additionally provided a life history interview; 5 specialist physicians, 7 parents/guardians, 2 academic researchers, 1 government official, and 1 international activist-supplemented by approximately 340&#x202f;h of participant observation across virtual, institutional, domestic, and caf&#xe9;-based settings. Analysis followed a constructivist grounded theory approach. Medical institutions, families, and activist organizations produce distinct 'geographies of secrecy' that render intersex bodies selectively visible and impose specific health consequences: clinical spaces generate epistemic injustice through information hoarding and paternalistic consent practices; family spaces enforce silence that isolates individuals from diagnosis, community, and healthcare; activist spaces offer collective recognition while simultaneously producing new exclusions. The concept of 'calibrated disclosure' captures how intersex people strategically manage visibility across spatial contexts with direct implications for healthcare access and wellbeing. The article introduces 'embodied accountability' as a methodological principle for reflexive research with small, geographically concentrated marginalized communities. Findings highlight the need for healthcare systems to address not only clinical protocols but the spatial-institutional conditions that produce epistemic injustice and impede informed consent for intersex people.

Rare diseases affect small, dispersed populations and are often studied through multisite designs where equity-relevant demographic data are essential for inclusive recruitment and accurate interpretation. This study examined how sociodemographic variables are collected and reported in rare disease research and evaluated their alignment with the PROGRESS-Plus framework, which outlines Place of residence, Race/ethnicity/culture/language, Occupation, Gender/sex, Religion, Education, Socioeconomic status, social capital, and additional "Plus" factors such as age and disability status. A systematic review of peer-reviewed articles was conducted alongside an environmental scan of demographic instruments from governmental, health-system, academic, and rare disease organizations. Screening and extraction coded variables as reported, indirectly derivable, or not reported and compared them with established standards. Of 647 records identified, 37 met inclusion criteria. Reporting was dominated by age and sex, while most other equity-relevant variables including gender identity, sexual orientation, race/ethnicity, distinctions-based Indigenous identity, socioeconomic position, language, migration, disability/function, religion, occupation, and social capital, were inconsistently captured. Environmental scan instruments were more comprehensive, revealing a capture-to-reporting gap. Demographic reporting in rare disease research is heterogeneous and insufficient for equity-focused analyses. A concise, standards-aligned sociodemographic dataset is needed to improve transparency, comparability, and detection of inequities across rare disease populations.

Adolescence is a critical developmental period during which parenting practices interact with temperament and sociocultural context to shape mental health and adaptation. Most parenting models are derived from Western settings, with limited evidence from India. This simultaneous mixed methods study drew on cross sectional data from the Indian Consortium on Vulnerability to Externalizing Disorders and Addictions (cVEDA) cohort, including adolescents aged 12-17 years (parent report n&#x202f;=&#x202f;931; child report n&#x202f;=&#x202f;836). Exploratory factor analysis was conducted on parent and child versions of the Alabama Parenting Questionnaire. Qualitative data were obtained through in-depth interviews with 31 adolescents and their parents and analysed using thematic analysis. Findings were integrated at the interpretation stage. The original APQ structure did not replicate. Parent reports yielded three dimensions-Involvement/Positive Parenting, Poor Monitoring, and Corporal Punishment-while child reports yielded five, distinguishing father's and mother's involvement. Inconsistent disciplining did not emerge as a distinct construct. Qualitative findings indicated high involvement and behavioural and psychological control, largely driven by academic goals. Adolescents experienced these practices as both supportive and restrictive, with parental openness shaping communication. Contextual pressures, including resource constraints and urban stressors, contributed to a competency-control paradox. Parenting of adolescents in India must be understood within its relational and sociocultural ecology. While involvement and control function as primary supports, excessive control may constrain broader competency development. Integrating parent and adolescent perspectives is essential for culturally grounded research and intervention.