Faculty Bibliography

BACKGROUND/UNASSIGNED:Teamwork and communication are critical to reducing medical error, particularly in complex surgical procedures such as vascularized composite allotransplantation (VCA). Although cadaveric rehearsals are used to prepare for VCA, their effect on team development and operative outcomes remains unstudied. We therefore sought to evaluate the evolution of teamwork and its impact on operative outcomes in preparation for the first successful combined full-face and bilateral hand transplant. METHODS/UNASSIGNED:Cadaveric rehearsals were conducted in preparation for a combined full-face and bilateral hand transplant. As a quality improvement effort, teams followed surgical checklists and were assessed for teamwork using the Clinical Teamwork Scale (CTS) and the Oxford Non-Technical Skills (NOTECHS) tool. Face- and hand-specific scores and dissection times were recorded at each rehearsal to guide debriefings and refine subsequent sessions until transplantation. RESULTS/UNASSIGNED:= 0.004). CONCLUSIONS/UNASSIGNED:Teamwork and dissection time significantly improved during 11 cadaveric rehearsals, culminating in the first successful face and bilateral hand transplant. A comprehensive, team-based approach is essential to the success of VCA.

In recent years, the Permo-Triassic rocks of Kashmir have attracted considerable attention due to their intriguing preservation of fossil assemblages and relatively continuous sedimentary sequences, offering key insights into the end-Permian mass extinction event and subsequent biotic recovery. Among these, the Mandakpal section on the southern limb of the Vihi Syncline has remained comparatively understudied, despite its rich fossil assemblages and apparently continuous Permo-Triassic sequence, similar to the well-studied Guryul Ravine. In this study, the Mandakpal section is re-investigated through detailed fieldwork, lithological characterization, and fossil sampling. Multiple fossiliferous horizons were identified, including beds rich in productid brachiopods and pectinid bivalves. Notably, a partially preserved Meckel's cartilage of a chondrichthyan fish, possibly representing an eugeneodontiform, is documented from the Upper Permian limestone and shale beds of the Zewan Formation. This represents the first non-dental chondrichthyan fossil record from the Permian of Kashmir, highlighting the exceptional preservation potential of these rocks. In addition, the occurrence of Ophiceras ammonoid beds and the bivalve Claraia in the overlying strata confirms the presence of the earliest Triassic (Scythian) at Mandakpal, marking a clear Permo-Triassic transition within the section. The Mandakpal section represents an important locality for regional biostratigraphic correlation, documenting vertebrate fossils, and can contribute to future research aimed at more precise demarcation of the Permian-Triassic boundary in the Tethyan belt, thereby refining our understanding of biotic turn over and environmental disruptions during earth's most severe extinction event.

OBJECTIVES:Increased cancer survival has led to a growing population of geriatric patients with cancer. The post-acute rehabilitation outcomes of these patients are poorly understood. This study aimed to investigate whether cancer status is associated with functional outcomes, new institutionalization, and mortality in Australian geriatric rehabilitation patients. DESIGN:Observational longitudinal REStORing health of acutely unwell adulTs (RESORT) cohort. SETTING AND PARTICIPANTS:Geriatric rehabilitation patients in a tertiary hospital in Australia. METHODS:Patients were allocated to "no," "past," and "active" cancer status groups. Function was measured at geriatric rehabilitation admission and discharge using Katz Activities of Daily Living (ADL) and Lawton-Brody Instrumental ADL (IADL) scores. Logistic regression and Cox regression were performed to investigate the association between functional change with new institutionalization and 1-year mortality, respectively. RESULTS:Of 1890 patients, 77.7% had "no," 13.3% had "past," and 9.0% had "active" cancer. ADL and IADL scores improved in all groups, with no significant difference between groups in functional outcomes or new institutionalization. Compared with "no" cancer (2.9%), a significantly higher proportion of "active" (8.2%) and "past" (6.0%) cancer patients died during the hospital admission, P < .001. Active cancer was associated with higher 3- and 12-month mortality (20% and 40.6%). ADL and IADL improvement were significantly associated with reduced risk of 12-month mortality in "no" and "active" groups, and lower incidence of institutionalization in all groups. CONCLUSIONS AND IMPLICATIONS:Although inpatient mortality is higher in active cancer patients, older adults with active cancer who survive until inpatient geriatric rehabilitation discharge achieve similar functional gains and rates of discharge to the community. Functional improvement is of prognostic value in active cancer patients.

In presynaptic nerve terminals, the endocytic apparatus rapidly restores synaptic vesicles after neurotransmitter release. Many endocytic proteins localize to the periactive zone, a loosely defined area adjacent to active zones. A prevailing model posits that recruitment of these endocytic proteins to the periactive zone is activity-dependent. We here show that periactive zone targeting of endocytic proteins is largely independent of active zone machinery and synaptic activity. At mouse hippocampal synapses and Drosophila neuromuscular junctions, pharmacological or genetic silencing resulted in unchanged or increased levels of endocytic proteins including Dynamin, Amphiphysin, Nervous Wreck, Endophilin A, Dap160/Intersectin, PIPK1γ and AP-180. Similarly, disruption of active zone assembly via genetic ablation of active zone scaffolds at each synapse did not impair the localization of endocytic proteins. Overall, our work indicates that endocytic proteins are constitutively deployed to the periactive zone and supports the existence of independent assembly pathways for active zones and periactive zones.

We present ReXVQA, the largest and most comprehensive benchmark for visual question answering (VQA) in chest radiology, comprising 694,841 questions paired with 160,000 chest X-rays studies across training, validation, and test sets. Unlike prior efforts that rely heavily on template based queries, ReXVQA introduces a diverse and clinically authentic task suite reflecting five core radiological reasoning skills: presence assessment, location analysis, negation detection, differential diagnosis, and geometric reasoning. We evaluate eight state-of-the-art multimodal large language models, including MedGemma-4Bit, Qwen2.5-VL, Janus-Pro-7B, and Eagle2-9B. The best-performing model (MedGemma) achieves 83.24% overall accuracy. To bridge the gap between AI performance and clinical expertise, we conducted a comprehensive human reader study involving 3 senior radiology residents on 200 randomly sampled cases. Our evaluation demonstrates that MedGemma achieved superior performance (83.84% accuracy) compared to human readers (best radiology resident: 77.27%), representing a significant milestone where AI performance exceeds human evaluation on chest X-ray interpretation. The reader study reveals distinct performance patterns between AI models and radiology residents, with strong inter-reader agreement among the human readers while showing more variable agreement patterns between human readers and AI models. ReXVQA establishes a new standard for evaluating generalist radiological AI systems, offering public leaderboards, fine-grained evaluation splits, structured explanations, and category-level breakdowns. This benchmark lays the foundation for next-generation AI systems capable of mimicking expert-level clinical reasoning beyond narrow pathology classification.Dataset: https://hf.co/datasets/rajpurkarlab/ReXVQA; Supplementary Material: https://github.com/monk1337/PSB-Conference-2025/blob/main/Appendix.pdf.

OBJECTIVE:This study was undertaken to develop and validate a deep survival model (EEGSurvNet) that analyzes routine electroencephalography (EEG) to predict individual seizure risk over time, comparing its performance to traditional clinical predictors such as interictal epileptiform discharges (IEDs). METHODS:We conducted a retrospective cohort study including 1014 consecutive routine EEGs from 994 patients recorded at a tertiary epilepsy center. We developed EEGSurvNet, a deep learning model that predicts time to next seizure over a 2-year horizon from a single EEG. Model performance was evaluated on a temporally shifted testing set of 135 EEGs from 115 patients using time-dependent area under the receiver operating characteristic curve (AUROC), AUROC integrated over 2 years (iAUROC), and C-index. We compared the deep survival model to a clinical Cox model incorporating standard risk factors as well as a random model based on baseline seizure risk. RESULTS:EEGSurvNet achieved a 2-year iAUROC of .69 (95% confidence interval [CI] = .64-.73) and C-index of .66 (95% CI = .60-.73), outperforming both clinical and random models. Performance was highest in the first months following EEG, peaking at 2 months (AUROC = .80). Combining EEGSurvNet with clinical predictors further improved performances (iAUROC = .70, C = .69). Notably, the model showed superior discrimination on EEGs without IEDs (iAUROC = .78 vs. .53). Model interpretation revealed that the temporal-occipital regions and 6-15-Hz frequencies contributed most to risk prediction. SIGNIFICANCE/CONCLUSIONS:EEGSurvNet demonstrates that deep learning can extract prognostic information from routine EEG beyond visible epileptiform abnormalities, potentially improving patient counseling and treatment decisions. Future prospective studies are needed to validate these findings and assess their clinical impact.

Studies of Upper Cretaceous deposits in North America have provided invaluable insights into the continental ecosystems of this time. Theropod (Saurischia, Dinosauria) pedal phalanges are commonplace in these deposits but can be difficult to identify at a finer taxonomic resolution. This, in part, results from a lack of data regarding the individual, ontogenetic, and intraspecific variation that exists among theropod pedal phalanges, and potential differences in phalanx shape that distinguish individual families and species. In this study, we use elliptic Fourier analysis to quantify pedal phalanx shape in a sample of individuals of known species from multiple theropod families in multiple views. The resulting variables were analyzed using principal component analysis to identify patterns of (dis)similarity among different theropod taxa and between phalanx positions and, as such, provide insights into the phalanx shape variation that existed among North American theropods during the Late Cretaceous. This study finds that caenagnathids often possess more gracile pedal phalanges relative to other theropod taxa, particularly when viewed dorsally or ventrally (e.g., for digits II, III, and IV). Although tyrannosaurid and ornithomimid pedal phalanges are generally similar to one another, even in similarly sized individuals the former are found to be more robust in shape than the latter for certain phalanges (e.g., II-1, III-2, and III-3) in dorsal and ventral views. In some instances, the shape of the lateral, medial, and distal margins of tyrannosaurid pedal phalanges differ considerably from those of ornithomimids (e.g., IV-1 in dorsal/ventral view; II-1, III-4, IV-5 in lateral/medial view). The use of elliptic Fourier analysis here provides quantitative data on the variation present among Late Cretaceous theropod pedal phalanges and provides evidence that theropod taxa can be identified down to the family level based on pedal phalanx morphology. This greatly increases the potential utility of isolated theropod phalanges in biodiversity assessments of Cretaceous fossil assemblages, particularly those with a lack of well-preserved skeletal samples.

BACKGROUND:Telemedicine is a critical military medicine capability in austere, remote, and denied environments where prolonged casualty care and knowledge gaps exist. Despite significant military investment in telemedicine, the literature lacks detailed lessons from real-world cases. METHODS:U.S. Air Force Pararescue missions between 1 January 2010 and 31 December 2020 that included telemedicine consultation were reviewed. Participating flight surgeons (FS) and Pararescuemen (PJ) were interviewed, and available after-action reports were analyzed. Mission parameters, outcomes, and technical or human factors affecting communication were evaluated. RESULTS:Across 13 telemedicine consultations, the 28 patients experienced: cave entrapment (13), trauma (7), burns (4), and illness (4). Consultations were from PJ to FS (11), U.S. Coast Guard to FS (1), and FS to neurosurgery (1). Secondary consultations (7) were from FS to dental (1), dermatology, burn/critical care, orthopedics (2), pediatric anesthesiology, and thoracic surgery specialists. Missions used voice over mobile or satellite phone, text, and email. Recommendations commonly involved medication selection (6), advisement against mission launch (3), and burn care (2). Consultation effectiveness was impacted by unclear directions (3) and degraded communications (2). CONCLUSION/CONCLUSIONS:Telemedicine is valuable to PJs during complicated cases and rarely performed procedures, but cannot replace pre-deployment medical exposure and training. Rehearsals may optimize telemedicine, and training should focus on synchronizing a shared mental model of the patient using well-understood patient report and evaluation tools (ATMIST and MARCH PAWS). Telemedicine may reduce human error, give medics the confidence to take action, and limit the psychological impact of difficult care decisions.

PURPOSE: Cardiovascular (CV) toxicity is prevalent in cancer survivors due to shared risk factors, direct CV injury from cancer therapy (CT), and development/exacerbation of CV risk factors during treatment. Succinct guidance on the minimum standard of CV care required of cancer care providers (CCPs) can improve outcomes for survivors. This clinical practice statement (CPS) is aimed at CCPs focused on identification, prevention, and management of CVD in individuals with cancer. METHODS: The International Cardio-Oncology Society and Multinational Association of Supportive Care in Cancer identified members with expertise across oncology, cardiology, and cancer survivorship. Key questions/areas of practice recommendations related to CV risk and CVD were identified across the cancer trajectory.Working groups performed targeted literature reviews and consensus was reached for all recommendations. RESULTS: 5 over-arching clinical practice recommendations for CCPs were identified: (1) perform a CV risk assessment prior to starting CT (2) identify and facilitate CV-related care during CT; (3) ensure measures are taken to mitigate the risk of cancer therapy related CV toxicity (CTR-CVT) prior to and during CT; (4) monitor CV status and risk factors during therapy and refer to the appropriate health care provider if CV risk factors are uncontrolled or new signs/symptoms develop; and (5) re-assess CV risk following completion of CT (periodically for those with advanced disease on life long treatment) and develop a CV surveillance plan. CONCLUSIONS: CCPs play a pivotal role in identifying and addressing CTR-CVT. This CPS provides specific, succinct, and actionable behaviours that can be readily implemented in cancer care globally.