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AI skill development is essential in health professions education (HPE), yet this type of faculty development is complex to design and implement. While competency frameworks and AI education programs are emerging, many faculty developers are themselves still building AI literacy and confidence, and practical guidance for how to design a faculty development program on AI that is accessible, skill-oriented, and responsive to rapid technological change remains limited. Although webinars and workshops can only do so much, a well-planned faculty development program can provide a great introduction to AI, alleviate fears, and inspire participants to keep growing and learning. Drawing on our experience designing and hosting the AAMC GEA AI Skill-Building Webinar Series and the current literature in AI, this article offers twelve practical tips for faculty developers who are creating AI-focused learning opportunities for everyone involved in HPE. These tips will help readers create robust AI skill-building sessions that move participants beyond awareness of AI and shift their perspectives toward applied, reflective, and responsible use of AI in HPE.

Abstract Topic Benign Disease: Eosinophilic Esophagitis Background Active inflammation in eosinophilic esophagitis (EoE) disrupts the mucosal barrier, leading to dilated intercellular spaces and decreased transepithelial electrical resistance. Mucosal impedance (MI) has been used to assess mucosal integrity in EoE. We evaluated whether baseline MI measured by high-resolution impedance manometry (HRIM) distinguishes active and inactive EoE. Methods We retrospectively reviewed data from patients with EoE who underwent endoscopic esophageal biopsies within three months of HRIM from 2018-2026 at our tertiary referral center and had no treatment changes between studies. We excluded patients with a history of foregut surgery, erosive esophagitis, or Barrett’s esophagus. Demographics, endoscopy and pathology results were collected by chart review. Active EoE was histologically defined as ≥15 eosinophils per high-power field. Esophageal baseline MI was measured in the 30-second landmark period for the whole esophagus (from 2 cm above LES to 2 cm below UES), distal esophagus (from 2–7 cm above LES), and mid/proximal esophagus (from 10 cm above LES to 2 cm below UES). Mann–Whitney U or T tests were used for comparisons . Optimal MI thresholds were identified by Youden index with 10,000 bootstrap validations, and interrater reliability was assessed using two-way mixed effects intraclass correlation coefficients. Results Seventy-three patients were included: 37 (51%) female, median age 52 years, median BMI 27.2 kg/m2. Fifty-seven patients (78%) had atopic history, including seasonal allergies (38, 52%), asthma (31, 42%), eczema (21, 29%), and food allergies (19, 26%). Thirty-nine patients (53%) were receiving proton pump inhibitors, 25 (34%) were not on EoE therapy, 5 (6.8%) were on swallowed topical steroids, 3 (4.1%) were on dupilumab, and 1 (1.4%) was on an elimination diet. Esophageal strictures were present in 23 patients (32%), and 45 (62%) had active EoE. Baseline MI measurement showed high interrater reliability (n=50, 2 raters; intraclass correlation coefficient 0.937–0.963, p<0.001). Basal mean and minimal impedance were significantly lower in active EoE across all segments, greatest in the distal esophagus (all p<0.05; Figure 1). ROC analysis showed high discrimination of distal mean MI, with a cutoff ≤1.91 kΩ (AUC=0.837, sensitivity 67.9%, specificity 86.7%, Youden 0.545; Figure 2). Conclusion Baseline mucosal impedance during HRIM distinguishes active from inactive EoE, with strongest discrimination in the distal esophagus, supporting MI as a potential, minimally-invasive physiologic marker of mucosal inflammation and disease activity. Clinically, MI may serve as an adjunct tool in dysphagia evaluation, prompting EoE-directed biopsy when abnormal, aiding management in biopsy–symptom discordance, and potentially supporting disease monitoring in selected patients. Larger prospective studies are warranted.

PURPOSE EA1181 (ClinicalTrials.gov identifier: NCT04266249 ) is a single-arm trial evaluating neoadjuvant taxane, trastuzumab, and pertuzumab (THP) in patients with clinical stage II/IIIa human epidermal growth factor receptor 2 (HER2)–positive breast cancer. This report focuses on the secondary end points of pathologic complete response (pCR) rates and associated factors. The primary end point—3-year recurrence-free survival among patients achieving a pCR (ypT0/Tis, ypN0)—will be reported when data mature. METHODS Patients received four cycles of trastuzumab and pertuzumab (HP) with either once per week paclitaxel (12 weeks) or docetaxel (every 3 weeks for four cycles), followed by surgery. Clinicopathologic characteristics were assessed in all patients. The HER2DX pCR score was determined using diagnostic biopsy samples in a representative subset. Logistic regression models identified factors associated with pCR. RESULTS A total of 2,175 patients were enrolled (781 HER2+/estrogen receptor‑negative [ER–]; 1,394 HER2+/ER+). Of 2,141 patients who initiated THP, the overall pCR rate was 43.8%: 63.7% in HER2+/ER– and 32.4% in HER2+/ER+ tumors. Higher pCR rates were observed in tumors that were ER-negative or low ER expressing, progesterone receptor-negative or low expressing, HER2 immunohistochemistry (IHC) 3+, and in patients treated with once per week paclitaxel. T3 disease was associated with a lower pCR rate in HER2+/ER– tumors; otherwise, tumor (T) and nodal (N) stage did not significantly affect pCR. Among 569 patients assessed for HER2DX pCR scores, a high score was independently associated with higher pCR rates, after adjustment for clinicopathologic variables. CONCLUSION Neoadjuvant THP achieved pCR in nearly two-thirds of patients with HER2+/ER– and one third with HER2+/ER+ breast cancer. Low hormone receptor expression, HER2 IHC 3+ status, once per week paclitaxel use, and a high HER2DX pCR score were independent predictors of pCR. These findings should help optimize risk stratification and treatment personalization for patients with HER2-positive breast cancer.

Background Transthyretin amyloid cardiomyopathy (ATTR‐CM) is a progressive, fatal disease associated with a substantial health care system burden. The aim of this study was to compare health care resource utilization and associated costs among individuals with ATTR‐CM, with non‐amyloid heart failure (HF), and without HF in the United States. Methods Optum's de‐identified Clinformatics Data Mart Database (January 2016 to September 2023) was used to identify patients with ATTR‐CM based on HF and/or cardiomyopathy claims within 2 years of the first ATTR diagnosis. Patients with ATTR‐CM were matched to patients with non‐amyloid HF (HF/cardiomyopathy without ATTR) and non‐HF controls using 1:1 propensity score matching. All‐cause and cardiovascular‐related hospitalizations and costs were compared during follow‐up. Results Each matched cohort included 4571 patients (mean age, 75.3–75.5 years; 56.0%–56.6% male; mean follow‐up: 2.9–3.2 years). The ATTR‐CM, non‐amyloid HF, and non‐HF cohorts had 3.3, 2.7, and 1.5 all‐cause hospitalizations per patient during follow‐up, respectively. Compared with non‐amyloid HF, patients with ATTR‐CM had a longer mean length of stay per hospitalization (all‐cause and cardiovascular‐related: 8.0 versus 7.5 days; P <0.001), more mean days hospitalized annually per patient (all‐cause: 10.6 versus 8.4; cardiovascular‐related: 10.5 versus 8.3 [both P <0.001]), and higher mean annual inpatient hospitalization costs per patient (all‐cause: $42 868 versus $36 061; cardiovascular‐related: $42 841 versus $36 027 [both P <0.001]). In ATTR‐CM subgroups, mean cardiovascular‐related length of stay and days hospitalized were higher among patients aged 46 to 64 years and 65 to 80 years (versus >80 years), Black patients (versus White patients), and patients in the Northeast or South US regions (versus West regions). Conclusions ATTR‐CM is associated with a higher health care resource utilization/cost burden than non‐amyloid HF and the general population.

ABSTRACT Objective Weight loss is frequently considered a cardinal presenting symptom for patients with Zenker diverticulum (ZD). We hypothesized that weight loss in patients with cricopharyngeal muscle dysfunction (CPMD), with or without diverticula, was associated with the length of symptoms and size of diverticulum. Methods Prospective, multicenter observational study of CPMD patients with and without diverticula reporting unintentional weight loss (+WL) or no weight loss (−WL) prior to enrollment in the Prospective Outcomes of Cricopharyngeal Hypertonicity (POuCH) database. Complications and symptom response using a patient reported outcome measure, the Eating Assessment Tool (EAT‐10), were compared. Results Of 427 patients, 101 (23.6%) were +WL. Median weight loss was 14 pounds (interquartile range [IQR] 10–25). +WL cohort had a mean age of 71.5 (standard deviation [SD] 11.5) vs. 67.9 in −WL (SD 11.6, p = 0.007). Mean preoperative EAT‐10 score was 24.7 in +WL (SD 9.7) and 14.8 in −WL (SD 8.8, p < 0.0001). Higher preoperative weight loss was associated with higher preoperative EAT‐10 ( p < 0.0001, Spearman's ρ = 0.43). Size of diverticulum was associated with WL ( p = 0.003), but weight loss was highest in both large diverticula and CP bars. Duration of symptoms was not associated with weight loss ( p = 0.30). Postoperative complications in +WL and −WL patients were similar ( p = 0.78). Conclusion Unintentional weight loss is common with ZD. Patients with worse dysphagia are more likely to have more weight loss. Weight loss does not increase with the size of the diverticulum or length of symptoms. Surgery has a similar safety profile with greater improvement in dysphagia in patients reporting weight loss. Level of Evidence 3.

Introduction: COVID-19, in addition to its direct detrimental respiratory infection, is associated with multiple systemic complications involving different organs, including the liver. COVID-19 has been associated with liver injury through multiple mechanisms, including direct viral effects on liver cells, immune-mediated injury, cytokine-driven inflammation, ischemic hepatitis, microvascular thrombosis, and sepsis-related multiorgan dysfunction. Acute liver failure (ALF) is the acute form of liver damage, which has a high mortality, and recovery is dependent on various factors. We studied the effect of COVID-19 on clinical outcomes such as mortality, length of stay, and need for non-invasive and invasive ventilation in patients with acute liver failure. Methods: We performed a retrospective cohort analysis using the Nationwide Inpatient Sample (NIS) database from 2020 to 2022. Adult patients admitted to the hospital with acute liver failure were divided into 2 groups based on their COVID-19 infection status. We analyzed differences in mortality, length of stay, need for non-invasive and invasive ventilation, acute kidney injury, need for renal replacement therapy, and total charges to evaluate the effects on outcomes, and the results were then adjusted for demographic and hospital factors. Results: Of 633,155 patients with acute liver failure, 66,785 had concurrent COVID-19 infection, while 566,370 did not. Patients with concurrent COVID-19 infection had significantly higher in-hospital mortality (63.9% vs. 36.0%) and greater utilization of noninvasive ventilation (14.9% vs. 6.4%), invasive mechanical ventilation (68.9% vs. 41.7%), higher incidence of acute kidney injury (81.4% vs. 70.3%) and higher need for renal replacement therapy (26.8% vs. 16.9%). They also experienced longer hospital stays (17.1 vs. 10.7 days) and higher total charges ($345,072 vs. $221,268). The findings were statistically significant after adjusting for demographics and clinical factors. Conclusions: Patients hospitalized with acute liver failure and concurrent COVID-19 infection experienced worse clinical outcomes, including higher in-hospital mortality, greater need for ventilatory support and renal replacement therapy, and higher hospital resource utilization. Notably, COVID-19 was independently associated with worse outcomes even among patients with fewer baseline comorbidities. These findings underscore the importance of early recognition of COVID-19 in patients presenting with acute liver failure, as well as prompt, multidisciplinary management to optimize clinical outcomes.

Abstract Background Diagnosis and risk stratification in rare hematologic malignancies such as myeloproliferative neoplasms (MPNs) – polycythemia vera (PV), essential thrombocythemia (ET), and myelofibrosis (MF) – require expert review of longitudinal, heterogeneous clinical records. This process is cognitively demanding, inconsistently applied, and difficult to scale beyond tertiary centers. No automated phenotyping workflow currently exists for hematologic malignancies. Methods A HIPAA-compliant large language model (LLM) framework for phenotyping MPN was developed to integrate (i) rule-based retrieval of bone marrow biopsy reports, clinical notes, and structured laboratory results from the electronic health record (EHR); (ii) zero-shot extraction of diagnostic and prognostic variables from unstructured text using GPT-4 Turbo; (iii) a clinician-informed source-prioritization algorithm to reconcile conflicting multi-source data; (iv) WHO/ICC-criteria–based diagnostic classification; and (v) NCCN-based risk stratification using the conventional risk model for PV, IPSET-thrombosis for ET, and DIPSS, DIPSS-plus, and MIPSS70/MIPSS70+ v2 for MF. Patients were identified via MPN-related ICD-9/10 codes; cases met 2017 WHO criteria or had a hematologist-documented diagnosis, and controls did not. The cohort was split into a prompt-development set (n = 60) and a held-out test set (n = 450; 75 cases and 75 controls per disease). Ground truth was established by independent dual-clinician chart review with consensus adjudication. LLM performance was evaluated against the ground truth: variable-level extraction using accuracy, F1 score, and Cohen’s kappa; patient-level diagnostic classification using sensitivity, specificity, and Cohen’s kappa; and prognostic risk stratification (among confirmed cases) using accuracy, weighted F1 score, and quadratic-weighted Cohen’s kappa. Wilson 95% confidence intervals (CIs) were used for proportions and bootstrap 95% CIs with 500 resamples for F1 scores. Results The held-out test set included 450 patients (PV: 150; ET: 150; MF: 150) with pathology reports and structured laboratory results, and 172 patients (PV: 52; ET: 55; MF: 65) with clinical notes. From pathology reports, overall variable extraction accuracy and F1 score were 99% (95% CI, 98–100) and 1.00 (0.99–1.00) for PV, 100% (99–100) and 0.99 (0.96–1.00) for ET, and 100% (99–100) and 0.99 (0.97–1.00) for MF. From clinical notes, overall accuracy and F1 score were 96% (91–100) and 0.94 (0.85–1.00) for PV, 100% (100–100) and 1.00 (1.00–1.00) for ET, and 100% (99–100) and 0.98 (0.95–1.00) for MF. Diagnostic sensitivity was 100% (95% CI, 95.1–100.0) for PV, ET, and MF; specificity was 98.7% (92.8–99.8) for PV and 100% (95.1–100.0) for both ET and MF, with Cohen’s kappa of 0.99 for PV and 1.00 for ET and MF. Risk stratification accuracy was 100% with weighted F1 score of 1.00 and quadratic-weighted Cohen’s kappa of 1.00 across all three diseases. A pre-specified source-ablation analysis showed that pathology reports alone were sufficient for diagnosis (sensitivity 98.7% for PV, 100% for ET, 96.0% for MF; specificity 100% across all three subtypes) but inadequate for prognostication (accuracy 69.3% for PV, 93.3% for ET, 77.3% for MF). Adding clinical notes to pathology reports recovered full prognostic accuracy of 100% across all three diseases. Conclusions This first-in-class automated framework achieved expert-level performance for MPN diagnosis and risk stratification from real-world EHR data, establishing a foundation for scalable, standardized phenotyping in rare hematologic malignancies. Prospective, multi-site validation is warranted before clinical deployment.

Exercise and physical activity are recognized as essential tools to optimize fitness and longevity, improve overall health, and reduce the risk of cardiovascular disease and other major comorbidities. However, there are inherent risks associated with participation in sports and exercise, regardless of the level of competition or skill required. As such, there is a need for cardiologists to understand the unique aspects of competitive and recreational athletics, as well as sport and exercise science, as it relates to overall heart health and cardiovascular risk. In this article, we provide an overview of the essential aspects of sports and exercise cardiology. We describe the roles and responsibilities of a sports and exercise cardiologist as a member of a comprehensive team of experts who provide care of athletes at all levels of sport, emphasize the importance of risk stratification and prevention of sudden cardiac arrest, the role of exercise for maintaining and optimizing overall health in the general population, describe the growing field of sports electrophysiology and also discuss unique aspects of sports cardiology applied to environmental health and care of the tactical athlete. Knowledge gaps and directions for future clinical and research investigation are reviewed.

ABSTRACT Background Eosinophilic esophagitis is associated with epithelial barrier dysfunction. Epidemiologic studies suggest environmental factors promote disease pathogenesis. The common household detergent sodium dodecyl sulfate (SDS) induces epithelial barrier dysfunction and eosinophilic inflammation in mice. We hypothesized that acute SDS exposure would compromise the esophageal mucosal barrier in humans. Methods Healthy adults brushed with 2 g of an SDS‐containing toothpaste. Esophageal impedance was measured continuously pre‐/post‐toothbrushing to assess the effect of toothpaste on epithelial barrier function. SDS was measured in saliva using a methylene blue anionic substances assay. Participants completed 1‐h esophageal string tests (ESTs) pre‐/post‐toothbrushing and protein isolates from EST eluates from the proximal and distal esophagus were analyzed by tandem mass tag mass spectrometry. Results Ten of twelve subjects completed the clinical study. SDS in the initial expectorate measured immediately after toothbrushing varied markedly (median: 321.40 μg/mL; range: 169.90–1243.00 μg/mL) and was detectable in saliva in 80% of subjects (median: 9.55 μg/mL; range: 0–123.40 μg/mL) at 60 min post toothbrushing. Esophageal mucosal impedance decreased within 30 min of toothbrushing ( p < 0.01). Toothbrushing increased salivary viscosity and proteins associated with mucosal defense in EST eluates. The tight junction pathway was downregulated while the salivary secretion and complement and coagulation cascades pathways were upregulated in the proximal esophagus. Conclusion In healthy individuals, SDS remained detectable in saliva for a prolonged period after toothbrushing at concentrations previously shown to disrupt esophageal epithelial barrier function in vitro. Toothbrushing with an SDS‐containing toothpaste was associated with reduced esophageal mucosal impedance, altered salivary properties, and activated mucosal immune responses.

Aims Reverse shoulder arthroplasty (RSA) after prior rotator cuff repair (RCR) is commonly performed for recurrence of pain and arthritic progression; however, the influence of prior RCR timing and technique on outcomes of RSA has not been adequately explored. Our primary aim was to evaluate the relationship between the postoperative American Shoulder and Elbow Surgeons (ASES) score, whether prior RCR was performed open or arthroscopic, and the time interval between RSA and prior RCR. Secondary outcomes were forward elevation (FE) and external rotation (ER). Methods A prospectively collected single-institution shoulder arthroplasty database was queried to identify patients undergoing primary RSA after prior RCR between 2004 and 2022 for non-tumour and non-fracture indications with minimum two-year follow-up. We evaluated the relationship between the postoperative ASES score, FE, and ER stratified by prior RCR approach (open vs arthroscopic) and time between RSA and RCR. Multivariable analysis was used to adjust for potential confounders. Results We included 104 RSAs (99 patients) with a mean 8.8 years (SD 7.3) after RCR and a mean age of 68 years (SD 8.3). Prior RCR was performed arthroscopically in 40 RSAs (38%). Mean follow-up was 4.8 years (SD 2.8). On multivariable analysis, arthroscopic RCR was independently associated with a 13-point greater postoperative ASES score (p = 0.008), 14° greater forward elevation (p = 0.011), and 8° greater external rotation (p = 0.018) compared with open RCR. A ten-year increase in time between RCR and RSA was associated with a seven-point greater postoperative ASES score (p = 0.029) and 5° greater external rotation (p = 0.015). Conclusion A greater time interval between prior RCR and RSA, as well as arthroscopic techniques, is associated with improved outcomes after primary RSA in patients with prior RCR. Cite this article: Bone Joint J 2026;108-B(7):928–935.