College of Central Florida

The timing of surgical nerve repair plays a pivotal role in optimizing functional recovery following peripheral nerve injury. This chapter will explore the physiologic basis of nerve regeneration, the impact of timing on axonal sprouting and target organ reinnervation, and the clinical factors influencing the decision between acute and delayed intervention. Emphasis will be placed on injury characteristics, associated trauma, patient comorbidities, and the reconstructive ladder. This chapter will provide surgeons with guidance on the timing of nerve repair, the utility of nerve grafts, and important considerations for acute and delayed repair. We will include injuries involving the hand and upper extremity, the brachial plexus, and nerve injuries with concomitant bone or vascular injury. Our evidence-based outline will hopefully reiterate important principles of nerve repair to help guide real-world practice.

29 Background: Colorectal cancer (CRC) remains as a leading cause of cancer-related morbidity as well as mortality worldwide. Effective screening strategies are needed for early detection of CRC and also for its precursors in the form of advanced neoplasia (AN). Fecal immunochemical testing (FIT) is widely used for non-invasive screening, but its diagnostic accuracy for CRC and especially advanced neoplasia (AN) remains variable across studies. Methods: We conducted a systematic review and meta-analysis in accordance with PRISMA guidelines. PubMed, Embase, and Cochrane Library were searched from inception to July 2025 for studies comparing FIT against colonoscopy in average-risk, asymptomatic adults aged >50 years. After deduplication, 231 articles were screened, of which 11 met eligibility criteria. Data were extracted into 2×2 tables and pooled using a bivariate random-effects model to estimate sensitivity, specificity, likelihood ratios, and diagnostic odds ratio (DOR) with 95% confidence intervals. Study quality was appraised using the QUADAS-2 tool. Results: Across 11 Studies, FIT detected CRC with a pooled sensitivity of 0.74 (95% CI, 0.63–0.83) and specificity of 0.93 (95% CI, 0.88–0.96), corresponding to a positive likelihood ratio (LR+) of 10.10 and DOR of 36.54. For CRC+AN , sensitivity fell to 0.29 (95% CI, 0.23–0.37) with specificity of 0.94 (95% CI, 0.91–0.97). These findings indicate strong ability to confirm CRC when FIT is positive but limited capacity to exclude advanced neoplasia. Assay threshold reduction improved sensitivity at the expense of specificity, while increasing threshold improved specificity, but more AN cases were missed. Conclusions: FIT demonstrates high specificity but only moderate sensitivity for detecting CRC, which supports its role in population based screening and functioning as an effective triage tool that reduces unnecessary colonoscopies. Nonetheless, because of single-sample FIT’s low sensitivity in detecting AN carries the risk of under-detecting AN. Strategies such as repeated annual testing/ multiple-sample FITs, or integration with validated clinical risk models may enhance diagnostic yield. Overall, FIT remains a cornerstone of CRC screening but its limited sensitivity for precancerous lesions underscores the need for optimization, with screening programs required to balance improved detection yield against increased colonoscopy demand. Outcomes CRC only CRC + AN Sensitivity (95% CI) 0.74 (0.63–0.83) 0.29 (0.23–0.37) Specificity (95% CI) 0.93 (0.88–0.96) 0.94 (0.91–0.97) LR+ (95% CI) 10.10 (6.48–15.72) 5.15 (3.86–6.89) LR– (95% CI) 0.28 (0.19–0.41) 0.75 (0.70–0.81) DOR (95% CI) 36.54 (21.34–62.57) 6.87 (5.27–8.95)

Artificial intelligence (AI) is rapidly transforming the social, economic, and political fabric of urban life. As cities adopt AI technologies for governance, planning, and service delivery, urban sociologists face new challenges in understanding how these systems reshape power relations, access to resources, and civic participation. This paper critically examines the sociological impacts of AI in urban contexts, focusing on seven key domains: predictive governance, labor and economic restructuring, smart city planning, housing and gentrification, the digital divide, civic engagement, and environmental justice. Drawing on recent scholarship, we explore how AI-driven systems both reflect and reinforce existing urban inequalities, particularly along racial, class, and geographic lines. We argue that while AI offers potential for more efficient and responsive urban management, it also risks deepening exclusion, eroding privacy, and marginalizing vulnerable populations. Through a sociotechnical lens, we highlight the need for equity-centered approaches to AI deployment in cities, emphasizing transparency, accountability, and inclusive design. Ultimately, this paper contributes to a growing body of urban sociology literature that interrogates the algorithmic turn in city life and calls for a reimagining of urban futures grounded in justice and democratic participation.

Gastroesophageal cancer (GEC) represents a global health burden, with rising incidence and high mortality. Despite advancements in early detection and systemic therapies, outcomes remain poor, especially in advanced stages. Management requires a multidisciplinary, multimodal approach that integrates surgery, chemotherapy, radiotherapy, targeted agents, and immunotherapy, tailored by tumor histology, location, and molecular profile. For localized disease, perioperative chemotherapy or chemoradiotherapy is standard, with adjuvant immunotherapy now emerging in selected high-risk cases. In metastatic or unresectable settings, systemic therapy forms the backbone of treatment, with biomarker-driven regimens targeting HER2, PD-L1, MSI-H/dMMR, and CLDN18.2, offering improved outcomes. Novel agents and combinations, including bispecific antibodies, FGFR2 inhibitors, and immunotherapy-based strategies, are actively being explored in clinical trials. This review provides a comprehensive overview of the evolving therapeutic landscape of GEC. It emphasizes the growing role of precision medicine and the integration of emerging clinical data into practice.

Abstract Objective To evaluate the effect of Medicaid expansion under the Affordable Care Act (ACA) on total inpatient hospital charges among women with MDD, comparing Maryland, an expansion state with an All-Payer Model, and Florida, a non-expansion state. Methods We conducted a retrospective cohort study using the Maryland State Inpatient Database and the Florida State Inpatient Database. The study population included women aged 18–64 years admitted with a primary diagnosis of MDD. The study period was stratified into pre-ACA (2007–2009) and post-ACA (2018–2020) eras. Difference-in-differences models with robust standard errors, complemented by inverse probability-weighted regression adjustment (IPWRA), were employed to estimate policy effects on hospital charges. Models adjusted for age, race/ethnicity, insurance type, discharge quarter, comorbidities, and neighborhood income quartile. Results A total of 122,963 hospitalizations were analyzed. Pre-ACA, baseline charges in Maryland averaged $7,123 (95% CI, 6,878–7,369). Following the ACA, Maryland experienced a moderated increase of $3,108 (95% CI, 2,752–3,465; p<0.001). In contrast, Florida’s charges remained significantly higher, exceeding Maryland by $5,136 pre-ACA and $11,413 post-ACA (p<0.001 for both). Difference-in-differences estimates confirmed that Medicaid expansion in Maryland mitigated cost escalation, producing a net relative reduction of $3,445 (95% CI, −3,886 to −3,004; p<0.001). Stratified analyses demonstrated the greatest financial protection among self-pay and Medicaid patients. Conclusion Medicaid expansion was associated with significantly lower inpatient charges among women with MDD in Maryland compared to non-expansion Florida, and may reduce financial burden, advance equity, and improve hospital resource sustainability.

ABSTRACTBackgroundThe clinical utility of diagnostic neuroimaging for pediatric patients presenting to the emergency department (ED) for psychosis remains unclear. We sought to estimate the prevalence of and characteristics associated with clinically significant neuroimaging findings among pediatric patients presenting to the ED with symptoms of psychosis who had neuroimaging performed.MethodsThis retrospective cross‐sectional study included visits by patients 5 to < 18 years old presenting with symptoms of psychosis to 28 EDs affiliated with the Pediatric Emergency Medicine Collaborative Research Committee from 2016 to 2019 and had neuroimaging performed. We estimated the rate of clinically significant neuroimaging findings, defined as those resulting in further testing, treatment, or medical admission, overall and by imaging modality. Multivariable logistic regression models examined presenting features associated with clinically significant findings.ResultsClinically significant neuroimaging findings were identified in 5.4% (95% CI 4.2%, 6.9%) of 1118 ED visits (54% male, median [IQR] 14 [11–16] years old). Clinically significant findings occurred in 4.9% (34/699) of head computed tomography scans and 7.5% (45/604) of brain magnetic resonance imaging studies (p = 0.07). In a model that imputed missing data, no presenting features were associated with clinically significant neuroimaging findings. In a model that treated missing documentation as absence of the clinical feature, the adjusted odds of clinically significant neuroimaging findings were lower among ED visits by patients with suspected alcohol or substance use (aOR 0.38, 95% CI 0.16, 0.87).ConclusionAmong pediatric patients presenting to the ED with symptoms of psychosis who had neuroimaging obtained, approximately 1 in 20 had clinically significant findings. Suspected alcohol or substance use was associated with lower odds of clinically significant neuroimaging findings, although this finding was not consistent across modeling approaches. Prospective studies are needed to definitively evaluate the utility of neuroimaging among children and adolescents presenting to the ED with symptoms of psychosis.

Hepatocellular carcinoma (HCC) accounts for a portion of primary liver cancers worldwide, with hepatitis B virus (HBV) as a major risk factor. Spontaneous rupture of HCC is a rare but life-threatening event. It can be triggered by minor trauma or increased intra-abdominal pressure, necessitating a high index of suspicion in at-risk patients. A 74-year-old male with HBV presented as a level 2 trauma after a ground-level fall without obvious injuries. Initial evaluation revealeda negative extended focused assessment with sonography in trauma (eFAST). However, the patient subsequently developed hypotension unresponsive to crystalloids and worsening abdominal discomfort. Massive transfusion protocol was initiated, and a repeat FAST revealed free fluid. Emergency laparotomy identified a ruptured right hepatic mass with significant hemorrhage. Hemorrhage control was achieved via hepatic packing, the Pringle maneuver, and right hepatic artery ligation. Postoperatively, angiography with embolization was performed. On postoperative day three, a bile leak required endoscopic retrograde cholangiopancreatography (ERCP) with stent placement. His recovery was otherwise uneventful, and pathology confirmed poorly differentiated HCC. This case highlights the need for vigilance in trauma patients with risk factors for occult malignancy. The delayed hemorrhage from an undiagnosed HCC rupture emphasizes the role of serial reassessment, prompt surgical intervention, and adjunctive embolization. Trauma surgeons must recognize atypical hemorrhage presentations in at-risk patients. Timely imaging, multidisciplinary management, and early intervention are crucial to improving survival in spontaneous HCC rupture.