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Drawing inspiration from the sitcom Ho Preso un Granchio created by the young patients of the Youth Project at the Istituto Nazionale dei Tumori in Milan, this paper discusses how the depiction of cancer in film and television has changed over the years: specifically, how in 50 years society has gone from being unable to even pronounce the word "cancer" to being able to laugh about it, much like they did, telling their own stories with self-irony and even black humor.These reflections are the result of meetings held with the Youth Project patients, who for this initiative reinvented themselves as authors, screenwriters, actors, and assistant directors.This article serves as a reminder that film and television are a mass art form that acts as a mirror of our society, but at the same time can profoundly influence the collective imagination and the ways we express ourselves and think. Like other art forms, cinema can play an important role in narrating the illness of cancer, but it can also be used to support the disease journey of oncology patients, as in the creative laboratories of the Youth Project, where art becomes the tool to offer young patients a way to open up and tell their stories, their fears, and their hopes.

Cervical cancer is the second leading cause of cancer-related death among women in Mexico, accounting for approximately 4,500 deaths annually. The Mexican Social Security Institute (IMSS), which provides mandatory social security and healthcare for formal-sector workers, currently relies on conventional cervical cytology for early detection. To explore alternatives, a workplace-based pilot program introducing human papillomavirus (HPV) self-sampling was implemented. This study compares the effectiveness and feasibility of HPV self-sampling with the existing cytology program, aiming to inform future screening strategies. A prospective analysis of the cost-saving impact was conducted from the IMSS institutional financing perspective, including healthcare program costs and IMSS-financed disability leave and pension payments. A two-module Markov model separately simulated clinical pathways for detection, diagnosis, and treatment under each screening strategy, and the natural progression of HPV infection and cervical intraepithelial neoplasia. Model inputs were derived from the HPV self-sampling pilot and complementary literature. Costs are reported in 2024 USD and both costs and outcomes are discounted at 3% annually. Both programs were evaluated by simulating a cohort of 100,000 women over a 10 year period. The HPV self-sampling strategy was less costly and more effective than cytology. In the modeled cohort, HPV screening prevented 812 cervical cancer cases at a total cost of 39.7 million USD, resulting in a cost of 48,896 USD per cancer case prevented. In contrast, the cytology program prevented 651 cases at a cost of 99.9 million USD, yielding 153,559 USD per case prevented. HPV self-sampling demonstrated a 61% increase in the detection of high-grade cervical lesions and was less costly and more effective than cytology. The reduction in disability leaves and associated social security expenditures further amplifies its economic value for an institution like IMSS. These findings highlight the potential benefits of increasing screening coverage and implementing workplace-based HPV screening.

Since agriculture sustains most Cambodian households, food safety in the aquaculture and poultry sectors is a public health priority. This study investigates food safety practices and compliance with legal provisions through interviews with 20 participants across four provinces (Battambang, Siem Reap, Kampong Speu, and Takeo). The findings revealed critical deficiencies in hygiene, veterinary medical product management, and traceability. In addition to a detailed qualitative thematic analysis, Structural Equation Modelling identified veterinary drug control (&#x3b2; = 0.670, p < 0.001) and hygiene practices (&#x3b2; = 0.395, p < 0.001) as significant predictors of farm safety. While knowledge positively correlates with these practices, operational challenges negatively impact compliance (&#x3b2; = -0.466 and -0.497, p < 0.005). Notably, fish farmers reported using human medications (e.g., paracetamol) and often neglecting withdrawal periods due to limited VMP access and insufficient knowhow. While acknowledging the pilot-scale sample size, the findings of our modelling complement our qualitative analysis and provide a foundational model for future research. These findings suggest that farmer knowledge and systemic barriers are the primary drivers of food safety outcomes. The study highlights the urgent need for targeted training in good practices and responsible VMP use. Future research should explore scalable interventions to enhance regulatory compliance among smallholder farmers.

Dengue transmission in Indonesia is shaped by interacting climatic, environmental, and socio-demographic factors, yet most forecasting systems remain static and vulnerable to data shifts. There is a critical need for adaptive, data-driven early-warning frameworks that integrate multiple predictor domains while preventing methodological biases such as information leakage. This study aimed to develop a Random Forest (RF)-based predictive model embedded within an Agile System Development workflow to forecast monthly dengue case counts in Yogyakarta. Monthly dengue case counts from five districts (2017-2022) were modeled using multi-domain predictors. All preprocessing steps-including imputation, standardization, correlation screening, VIF diagnostics, and Negative Binomial GLM-based feature screening-were performed exclusively on the 2017-2021 training subset, with parameters applied unchanged to the 2022 test set. The GLM served solely as a leakage-free exploratory screening tool. A Random Forest model was trained using optimized hyperparameters (500 trees, max depth 10) and evaluated through temporal testing. Model reliability was assessed using calibration curves, prediction-interval metrics, and a one-month early-warning classification evaluated with sensitivity, specificity, PPV, and NPV. The RF model achieved strong predictive performance (R&#xb2; = 0.86; RMSE&#x2009;=&#x2009;5.72), exceeding the GLM benchmark (R&#xb2; = 0.64). Rainfall lag-1, temperature, and humidity emerged as dominant predictors, complemented by built-up area and population density. Calibration indicated good agreement across routine transmission ranges, with reduced reliability during outbreak peaks. The early-warning component demonstrated high sensitivity (0.82) and strong negative predictive value (0.86), supporting its use as a decision-support indicator of elevated transmission risk. The proposed Agile-AI framework demonstrates the potential to deliver accurate dengue risk predictions with interpretable uncertainty estimates within a flexible, multi-domain early-warning architecture. While external validation and further refinement are required, the framework offers a scalable foundation for adaptive dengue surveillance and targeted vector-control decision support in dynamic tropical settings.

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Hepatitis B virus (HBV) coinfection worsens HIV care outcomes and liver disease risk, but genotype-specific data in the World Health Organization (WHO) Africa Region is limited. To address this gap, we assessed HBV genotype distribution and genotype-specific clinical features in a cohort of people living with HIV (PLHIV) in Maputo City, Mozambique. This was a sub-analysis of a prospective cohort study that included newly diagnosed, HIV/HBV coinfected patients who were enrolled from May 2021 to November 2023. DNA extraction and partial-genome nested PCR with Sanger sequencing was performed on plasma samples. HBV genotypes were assigned by BLASTn, Geno2pheno, HBVdb, and NCBI-HBV, and phylogeny was inferred with MAFFT-based alignments and maximum likelihood-based phylogenetics. Clinical/laboratory data (Hepatitis B e antigen, HBV viral load, aspartate aminotransferase, alanine aminotransferase, CD4+ T cell count, HIV viral load) were recorded. Fibrosis was estimated using the AST-Platelet Ratio Index (APRI) score and WHO thresholds. R was applied for statistical analyses. Group comparisons used Pearson's chi-squared or Fisher's exact and Wilcoxon rank sum tests (complete-case analysis). Of 1,106 newly diagnosed ART-na&#xef;ve PLHIV, 81 (7.3%) were hepatitis B surface antigen (HBsAg)-positive and genotyping was successful in 55 (68%). Among HBV genotyped patients, the median age was 33.0 years (IQR 30.0, 39.0), 37 (67.3%) were male, 46 (83.6%) had HBV genotype A (subgenotype A1) and 9 (16.4%) genotype E. Median AST, ALT, and APRI scores tended to be higher in genotype E than subgenotype A1 cases, although differences were not statistically significant (AST 71.9 vs. 37.9 U/L; IQR 26.0-118.0 vs. 29.0-98.1; ALT 36.5 vs. 32.6 U/L; IQR 20.4-63.0 vs. 20.2-57.7; APRI 1.3 vs. 0.5; IQR 0.3-1.8 vs. 0.3-1.3). HBV DNA&#x2009;>&#x2009;2,000 IU/mL occurred in 52.2% of subgenotype A1 and 55.6% of genotype E cases. Most cases were HBeAg-negative (A1: 36/46, 78.3%; E: 6/9, 66.7%). HBV subgenotype A1 and genotype E are prevalent among HIV/HBV coinfected patients in Maputo, often with high HBV DNA levels and evidence of liver injury. Routine HBV screening, simple fibrosis assessment and further research are recommended.

Current screening tools for harmful alcohol consumption have fallen out of step with recent guidance on the health risks of alcohol. To address this gap, the Canadian Research Initiative in Substance Matters updated the screening recommendations for high-risk drinking and alcohol use disorder (AUD) in the 2023 national clinical practice guideline. Following a systematic review of literature published between Jan. 1, 2013, and Feb. 24, 2023, that examined screening tools for high-risk drinking and AUD, the updated recommendations were developed by a multidisciplinary national committee, which included people with lived and living experience. We scored the recommendations and certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation tool. We used the Appraisal of Guidelines for Research and Evaluation II instrument and the Guidelines International Network's principles for disclosure of interests and management of conflicts to ensure the update met international standards for transparency, high quality, and methodological rigour. Acknowledging that time constraints are the most commonly reported barrier to universal alcohol screening, we developed 5 recommendations involving a simple screening method, to identify and address both unhealthy alcohol consumption and more serious problems related to alcohol. The recommendations include asking all patients about alcohol consumption and providing educational support to all those who drink above Canada's Guidance on Alcohol and Health's low-risk threshold. We propose a simple screening algorithm to optimize and tailor further intervention, including when to assess for possible AUD. The revised screening recommendations represent a timesaving and pragmatic approach intended to be a resource for universal screening for alcohol risks and problems. The recommendations streamline the process of identifying and addressing the health needs of those who consume alcohol in a hazardous way or may have more serious problems related to alcohol.

The tobacco industry has incorporated strategies like greenwashing (i.e. a marketing tactic that utilizes false or unverified claims to mislead consumers about a business's environmental practices and impact) within cigarette advertisements. Despite regulation to limit greenwashing, research found continued employment of greenwashing tactics. Understanding the magnitude and extent of greenwashing strategies used by the industry is helpful given the emergence of these alternative tactics and the association between greenwashing advertising and consumer inaccurate risk perceptions. We conducted a descriptive content analysis of 2102 cigarette ads that ran January 2019-December 2023 in the US and identified 487 ads (23.2%) that had at least one greenwashing feature. We further characterized the nature of the greenwashing tactics present via text, imagery, or audio cues in the ads, using a developed codebook. Ads were independently double-coded, with discrepancies reconciled by team deliberation. Over 90% of the sample of ads came from 4 brands: Hestia, Natural American Spirit, Winston and Marlboro. Social media were predominant for ad identification. Hestia ads predominantly featured the descriptors 'naked' (74.6%) and 'wild' (63.9%), and flora imagery (67.3%). Natural American Spirit ads frequently used descriptors such as 'different' (50.9%) and 'simple' (41.1%), and over half (58.9%) featured flora imagery. Winston ads used the term 'tobacco and water' (45.0%) and depicted the great outdoors (47.0%). Marlboro ads commonly used great outdoors imagery (92.7%) and eco-related sweepstakes (41.5%). Greenwashing continues to be used in cigarette advertising, including the use of tactics associated with inaccurate modified risk perceptions. If further studies strengthen the evidence, regulations to limit greenwashing in tobacco advertising may be justified.

Calvin Avant is partnering with residents, researchers, and activists to reduce environmental hazards in their communities.

Event-based vision sensors (EVSs) provide unique frequency analysis opportunities due to their event data output and high temporal resolution. Anomaly detection methods used in hyperspectral analysis can be used on the event frequency spectra to detect targets. However, the introduction of a strong, flickering interfering source can reduce the EVS sensitivity and obscure targets of interest. Previous work presented a method showing that targets could still be detected through an overwhelming source using frequency analysis, background suppression, and statistical filtering. This paper extends that research and compares the ability of five different eigenanalysis anomaly detection methods (principal component background suppression (PCBS) with peak threshold detection, Mahalanobis distance (MD) detector, complementary subspace detector (CSD), Reed-Xiaoli (RX) detector, and subspace Reed-Xiaoli (SSRX) detector) to detect targets in a high noise environment. The PCBS, MD, and CSD detectors performed well and were able to detect the targets through the overwhelming source. The PCBS detector had the best performance at low false-alarm rates (a > 400% detection probability increase at a false-alarm probability of 10-5). While the MD and CSD detectors had the best detection at higher false-alarm probabilities (approximately 7 &#xd7; 10-2), the MD detector had a sub-second execution time. Depending on the application, the PCBS or MD detector are the best choice out of these five methods to detect targets in this type of high noise environment.

Preceptors are essential partners in pharmacy education, supporting experiential learning that represents approximately 25-33% of pharmacy curricula and a substantial portion of residency training experiences. Effective interactions between preceptors and learners are essential for learner success; however, many preceptors lack formal training in providing support and addressing learners' holistic needs, including professional development and well-being. The Joint Commission of Pharmacy Practitioners' Pharmacists' Patient Care Process (PPCP), updated in 2025, offers a standardized approach to patient care delivery in any setting. This manuscript proposes a novel. Preceptor-Learner Care Process (PLCP), adapted from the PPCP framework, as a standardized, structured, and repeatable framework to guide the preceptor-learner relationship in experiential education and to support intentional learner development. The PLCP provides preceptors a systematic approach to collect, assess, plan, implement, and follow-up on learner-specific challenges or opportunities. This framework integrates clinical skills, professionalism, communication, emotional intelligence, and situational and self-awareness enabling preceptors to provide consistent and individualized approaches to learner-specific development.

Lurbinectedin in combination with irinotecan showed synergistic antitumor activity in preclinical studies. A phase I/II trial (NCT02611024) evaluated this combination in patients with advanced solid tumors. The phase II stage evaluated the antitumor activity of the recommended dose (RD) (lurbinectedin 2.0&#xa0;mg/m2 on Day (D)1 plus irinotecan 75&#xa0;mg/m2 on D1 and D8 q3wk with primary granulocyte colony-stimulating factor prophylaxis) in five tumor-specific cohorts. This pooled analysis describes the safety profile of this combination from 233 patients with different advanced solid tumors treated at the RD. Adverse events (AEs) and laboratory abnormalities were graded using NCI-CTCAE v.4. The most frequent AEs (any grade) related to treatment were fatigue (71% of patients/25% of cycles), diarrhea (62%/17%), nausea (59%/18%), vomiting (35%/7%) and decreased appetite (32%/6%); the most common grade&#x2009;&#x2265;&#x2009;3 AEs were fatigue (14%/2%), diarrhea (14%/2%) and febrile neutropenia (9%/1%). The most common grade&#x2009;&#x2265;&#x2009;3 laboratory abnormality regardless of relationship was neutropenia (53%). The rate of discontinuation due to treatment-related AEs was 3% (n&#x2009;=&#x2009;7 patients). There was one treatment-related death (0.4%) involving a 63-year-old male patient (0.4%) diagnosed with metastatic NEN who died due to grade 5 staphylococcal bacteremia. In conclusion, this pooled analysis shows a predictable and manageable safety profile for lurbinectedin in combination with irinotecan in patients with advanced solid tumors, with myelosuppression, fatigue and gastrointestinal disorders being the main toxicities observed.Trial code: ClinicalTrials.gov identifier: NCT02611024.

Improper storage and disposal of unused and expired medications in households pose significant environmental and public health risks. A cross-sectional study was conducted in November 2025 among 427 consecutively selected women visiting the outpatient pharmacy of Banadir Hospital to assess storage and disposal practices of unused and expired medications. Data were analyzed using descriptive statistics, while associations between socio-demographic characteristics and medication storage and disposal practices were assessed using the chi-square test and interpreted with Cram&#xe9;r's V. Most respondents reported storing unused medications at home (97%), mainly for emergency situations, while more than one-third also kept expired medications at home (34%). Nearly all participants did not read storage instructions on medication labels (98%), and most did not check expiration dates before purchasing (70%) or using medications (74%). Disposal practices were inappropriate in most cases, with over 90% reporting disposal in household trash. These findings indicate that improper medication storage and disposal practices are highly prevalent in this setting. Public awareness programs and the establishment of a national drug take-back system are needed to reduce environmental contamination, prevent medication misuse, and improve public health safety.

Understanding how different ecological and anthropogenic drivers shape community structure is a central goal in ecology, particularly in spatially heterogeneous and rapidly changing systems. Fishes contribute to many key ecosystem functions and services on coral reefs, and a variety of physical, biological, and anthropogenic factors influence their distributions, habitat use, and ecological roles. Although habitat complexity is consistently shown to be important for reef fish ecology, it is rarely fully represented in large-scale analyses. When included, it is often measured using coarse or one-dimensional metrics, and seldom evaluated alongside other known ecological drivers. Here, we use three-dimensional habitat and overlapping fish census data collected at 89 sites throughout the main Hawaiian Archipelago to determine the role habitat structure plays in fish community structure compared to traditionally hypothesized environmental and anthropogenic drivers. We examined the impact of habitat structure (rugosity, fractal dimension, and coral cover), environmental conditions (depth, temperature, chlorophyll a, and wave exposure), and anthropogenic pressures (sedimentation, effluent pollution, coastal development, tourism, and fishing pressure) on four community descriptors: biomass, species richness, abundance, and community composition; the latter based on fish body size, diet, grouping behavior, and position in water column. Rugosity was the dominant driver of all community descriptors but was closely followed by environmental variables. The composition of behavioral traits in fish communities were strongly shaped by habitat structure, reflecting patterns in habitat use and predator-prey dynamics. Where structural complexity was not the primary effect, environmental conditions, such as temperature, were more strongly associated, particularly with body size distributions. Our results show that degraded reef conditions (i.e., reduced rugosity and coral cover) support communities with lower biomass and limited traits, which likely translates to a narrower range of ecosystem functions and services. These findings illustrate how different dimensions of habitat structure, in combination with environmental gradients, filter community traits and influence ecological organization. We offer a framework for predicting how management actions that alter habitat structure may cascade through fish communities to affect ecosystem functions and services. Maintaining structural features of reef habitats may therefore be essential to supporting the functional diversity and resilience of coral reef communities.

Proposed treatment algorithms favor the use of upadacitinib in medically refractory Crohn's disease (CD) and ulcerative colitis (UC). There has not yet been data published regarding efficacy of prolonged induction in CD or the efficacy of re-escalation to induction dosing in patients with either CD or UC. The aim of this study was to evaluate the real-world efficacy and safety of prolonged and/or re-escalation upadacitinib therapy in patients with inflammatory bowel disease (IBD) and prior inadequate response to standard upadacitinib treatment. This was a retrospective, dual-center study of the efficacy of prolonged induction or re-escalation of upadacitinib in patients with IBD with prior inadequate response to standard upadacitinib treatment. Fifty-five patients met eligibility criteria. Thirty-nine (70.9%) persisted on upadacitinib therapy while 16 (29.1%) met the primary endpoint for upadacitinib failure. Of those that had comparative objective data, 62.5% had improvement in endoscopic activity, 100% had normalization of an elevated CRP, and 83.3% experienced a decrease in FCP by >50%. There were no new safety signals. Over two-thirds of patients met the primary endpoint of persistence on therapy without requiring surgery, steroids, or additional biologic/small molecule inhibitor during follow-up. In a subset of patients who had adequate baseline and follow up objective data, the majority of patients had improvement in mucosal healing, decrease by 50% in FCP, and normalization of CRP. This study shows promising results that prolonged upadacitinib induction or dose re-escalation may improve clinical outcomes in a medically refractory patient population.

The Pragmatic Assessment of Influenza Vaccine Effectiveness in the Department of Defense (PAIVED) study was a clinical trial of three influenza vaccines in military beneficiaries enrolled at 10 military treatment facilities over four influenza seasons (2018/19-2021/22). This secondary analysis aimed to assess the relationship between cigarette smoking and e-cigarette use and influenza-like illness (ILI) incidence and severity. Demographic information, including cigarette smoking and e-cigarette use, was collected at enrollment. ILIs were identified during the influenza season of enrollment using weekly surveys. ILI symptoms were reported using the inFLUenza Patient-Reported Outcome (FLU-PRO) instrument. The relationship between smoking status and risk of reporting an ILI was estimated using Poisson regression; ILI severity was compared by cigarette smoking and e-cigarette use using multivariable linear regression. Among 8,708 participants with cigarette smoking status, 4.3% were current smokers and 11.9% were former smokers. Current cigarette smokers reported higher respiratory domain scores (0.24 (95% CI: 0.07, 0.41)) than non-smokers; former cigarette smokers were at higher risk of reporting an ILI than non-smokers [rate ratio 1.11 (95% CI: 1.02, 1.20)] and reported ILI episodes that were on average 1.23&#x202f;days longer in duration (95% CI: 0.29, 2.17). Among 8,119 participants with e-cigarette use status, 3.9% were current users and 2.6% were former users. Current e-cigarette users reported more than one additional day with limited activity (1.14&#x202f;days, 95% CI: 0.10, 2.18) and 0.78 additional days with fever (95% CI, 0.20, 1.35); former e-cigarette users were at higher risk of reporting an ILI than nonusers [rate ratio 1.20 (95% CI, 1.04, 1.38)] and reported higher respiratory domain scores than non-users (0.27 (95% CI 0.08, 0.46)). We observed slightly higher ILI risk in former cigarette smokers and e-cigarette users, longer symptom duration in former cigarette smokers, and higher respiratory symptom scores in current cigarette smokers and former e-cigarette users compared to non-smokers/users. Findings in this secondary analysis are exploratory and hypothesis-generating; additional studies are needed to confirm the relationships reported here.

Safe colorectal cancer (CRC) resection depends on accurate preoperative understanding of mesenteric vascular anatomy, which is highly variable and poorly represented in existing datasets. We curated dual-phase contrast-enhanced abdominal CT (CECT) scans from 60 adults imaged over one year on a Siemens SOMATOM Force scanner (slice thickness 0.75&#x2009;mm). Arterial phases (25-30 s) and venous phases (55-60 s) were manually segmented in 3D Slicer by an experienced surgeon and verified by a senior colorectal surgeon; without inter-phase registration to preserve native characteristics. The resource includes 60 CECT studies (50 dual-phase, 10 venous only), each containing &#xa0;~700-900 axial slices. Deliverables comprise CECT volumes, per-structure 3D label masks for major mesenteric arteries and veins. Example figures of overlays and 3D masks are provided. Intended uses include vessel segmentation, vascular-aware surgical planning, and registration research. Limitations include single-institution acquisition, difficulty delineating small vessels <4&#x2009;mm, absence of inter-phase registration, and altered vascular anatomy from surgeries.

Background Obesity has been increasingly linked to structural alterations in the brain, particularly involving subcortical gray matter regions. This study aimed to investigate whether obesity is associated with measurable volumetric changes in key subcortical structures relative to normal-weight individuals. Methodology In this cross-sectional observational&#xa0;study, 46 healthy volunteers (25.07 &#xb1; 5.82 years old) were initially recruited, of whom 38 normal-weight men and eight obese men (body mass index greater than 30 kg/m&#xb2;) were included. High-resolution T1-weighted MRI scans were acquired and analyzed using both FreeSurfer's automated segmentation and manual segmentation via ITK-SNAP. Statistical comparisons were performed to determine volumetric differences between groups. Results Automated segmentation results revealed significantly larger gray matter volumes in the right amygdala and left thalamus among obese individuals, with near-significant increases observed in the bilateral hippocampus and putamen. Manual segmentation demonstrated significant enlargement of the amygdala and caudate in obese participants. Conclusions Collectively, these findings indicate that obesity is associated with subtle but consistent volumetric expansion in several subcortical regions. Further research is needed to clarify the mechanisms underlying these structural differences and their potential cognitive and behavioral implications.

Responsible adoption of artificial intelligence (AI) in cardiology remains uneven. We aimed to map knowledge, attitudes, beliefs and practices among cardiovascular professionals in France and to identify levers for implementation. We conducted a national multiprofessional survey across cardiovascular care from 4 December 2024 to 1 March 2025. Prespecified outcomes included regular use in practice, confidence in diagnostic outputs, performance expectations, training needs, and social influence. Seven hundred fifty-six professionals completed the survey (58.2% cardiologists, 24.3% allied-health professionals, 17.8% other professionals; median age 37 years; 46.7% women). AI use was reported as regular (&#x2265; weekly) by 23%, occasionally by 40%, and none by 37%; only 7.8% had formal AI training. Use concentrated on AI-assisted imaging (32%) and patient monitoring/management (18%). The most valued benefit was improved diagnostic accuracy (29%); leading concerns were algorithmic bias (29.9%) and data privacy (28.2%). Explainability increased confidence (among cardiologists, high confidence 64% in therapeutic contexts vs. 84% with explanations). In multivariable analyses, prior training (aOR 3.22, 95% CI 1.60-6.55), research involvement (2.94, 1.90-4.58), and male sex (1.64, 1.05-2.59) were associated with higher use, while age > 40 years was associated with lower use (0.62, 0.40-0.96). Allied-health professionals reported lower social influence and training needs. Adoption of AI in cardiology remains limited, and four levers emerged for responsible scale-up: Training (education), Explainability (transparent outputs), Integration (workflow embedding), and Accompaniment (peer support, evaluation). These priorities should guide education, governance, and procurement strategies.