University of Louisville Physicians

The single biggest problem in communication is the illusion that it has taken place. — George Bernard Shaw (who might have been a ferocious peer reviewer with legendary comment threads.)1 Welcome Aboard the S.S. JACMP and Encounter the Culture JACMP was not spawned from the academic ether. It evolved, as many things do—like volcanos, river beds, or acerbity—from a global imperative: a place to communicate work that is practical, principled, and patient-first. Management is doing things right; leadership is doing the right things. (emphasis mine). — Peter Drucker4 Ann Michael: Editorial independence at its core means that a publisher may never tell an Editor in Chief (EIC) what he or she can or cannot publish in the journal. The EIC is the arbiter of what content is suitable for the journal, based on its mission and goals. For article, accept/reject decisions this is relatively straightforward. The publisher also has a remit. The publisher is charged with the financial health of the journal. Sales and licensing, marketing, branding, distribution, and new product development are often the purview of the publisher. But the lines are never crystal clear. For example, new product development often requires the collaboration of publishing and editorial to define a product or service that is both viable in the market and valuable to the user community. — The Scholarly Kitchen—Ask the Chefs: What is Editorial Independence and How Does It Impact Publishing?5 While some of our papers are very fashionable with a plethora of citations and downloads, the JACMP is not here to impress university ranking committees or engage in academic robot wars. Our mission is precise: serve clinical physicists and the patients they attend. And to do that well, editors need autonomy—not a micromanaging boardroom, not 3 a.m. obsessive-emails, and definitely not political horse-trading. This is not a quaint editorial request—it is codified ethics, per COPE,6 ICMJE,7 and AAPM's own policy scripture (see AP-139-A8). Your ego is writing checks your manuscript can't cash. — Not Top Gun (but maybe celebrity reviewer #2 commenting before their morning coffee.)10 Your Ego Is Not Your Amigo (And Might Be Desk Rejected) Peer review is not Mortal Kombat.12 It is collaborative inventiveness and serves a purpose: It is more like karaoke or modern dance—you are supposed to dance with the reviewer and sing your way to a better paper, so do it with some rhythm and refinement. Like Gene Kelly: Remember, “Singing in the Rain13” is the key to benefiting our patients and may be helpful for advancing your career. “All scientists agree—when you censor the ones who don't.” — Jacobus MacFarlane (and perhaps that one post-doc who makes everyone slightly nervous but is usually right.)15 Some Parting Thoughts From a Departing Editor I have seen the JACMP rise from little more than a Man of La Mancha impossible dream to a trusted, international voice in clinical physics. As I hand over the reins, I have this admonition: Respect the codified ethics, Protect journal independence and Preserve the JACMP culture History is not only written by the Great People. Sometimes it is rewritten by visionary clinical physicists, idealists who venerate open access, and after midnight authors who take risks and change the world. — Possibly you, next time you hit “Submit”.16 Michael Mills was responsible for conceptualization, content, investigation, writing, reviewing, and editing. The author is grateful to Tim Solberg and Susan Richardson for their feedback on this editorial, for their stewardship of the JACMP over many years, and for their steadfast commitment to editorial independence. The author reports no relevant conflicts of interest related to this work. The author is the editor-in-chief for the JACMP and is compensated by the AAPM for this service. ChatGPT 5.0 was used in the grammar review and proofreading of this editorial.

This full-length research study compares first-year engineering student performance on a summative programming assignment before and after integrating Generative AI (GenAI) into the assignment. The code-writing capabilities of GenAI technology can potentially help introductory engineering students with programming. However, the limitations of GenAI, especially its tendency to produce hallucinations, might confuse and/or overwhelm novice programmers. Using a quasi-experimental design, we compared student performance on a final programming project from two consecutive years: one without GenAI support (2022) and one with a guided GenAI integration (2023). The assignment was such that GenAI tools were not likely to complete it correctly solely from the written instructions, and thus students were required to think critically about both programming and GenAI to develop a successful program. Student-submitted programs were evaluated in terms of program accuracy, communication, and functionality using a scoring rubric. It was anticipated that GenAI would improve program functionality, but unknown whether it would have the same positive impact on accuracy and communication based on its limitations. Results revealed a significant overall improvement in programming outcomes from 2022 to 2023, with significantly higher scores for accuracy and communication observed for the with-GenAI group than the without-GenAI group. Functionality scores remained consistently high (at ceiling). These findings suggest that a guided GenAI integration can enhance novice student programming outcomes despite its limitations. GenAI tools are expected to become increasingly valuable for introductory engineering programming instruction and for programming as a field.

Vocal cord paralysis (VCP) presents with unique challenges when managing airways, particularly during endotracheal intubation. This literature review explores the effects of unilateral and bilateral VCP on intubation technique, first-pass success, extubation safety, and perioperative airway planning. While video laryngoscopy (VL) is becoming increasingly favored for its superior airway visualization, it does not always confirm successful placement in patients with VCP. Complications such as airway edema, aspiration risk, and cuff misplacements are increased in this patient population, and they may be more vulnerable to post-extubation complications, especially without the use of steroid prophylaxis or intensive post-operative planning. A comparison of direct laryngoscopy (DL) versus VL in this patient population reveals a gap in the literature, emphasizing the need for more research in airway management in patients with VCP. This review combines current practices, clinical considerations for anesthesia providers, and identifies areas for further investigation.

Summary of background data: While many studies have assessed factors associated with prolonged length of stay (LOS) following spine surgery, a limited number of studies have large cohorts with granular individual patient-level data, and little is known about the association between prolonged LOS and functional recovery after spine surgery.Objective: We aim to identify factors associated with prolonged length of stay (LOS) and its impact on postoperative complications and functional recovery.Methods: The present study is a retrospective longitudinal observational cohort study. Patients (N=576) who underwent one- or two-level transforaminal lumbar interbody fusion (TLIF) were identified. LOS was measured in hours, and prolonged LOS was defined as greater than the 75th percentile (>85 hours). Demographic and surgical parameters, and in-hospital and post-discharge complications were collected. Patient-reported outcome measures (PROMs), including the Oswestry Disability Index (ODI) and Numeric Rating Scale (NRS) scores for back and leg pain, were collected preoperatively and at six weeks, three months, and one year postoperatively. Multiple logistic regression identified factors associated with prolonged LOS and post-discharge complications.Results: The mean LOS for the entire cohort was 75.0±50.1 hours, with 145 patients categorized as prolonged LOS (141.4±54.5 hours). Prolonged LOS was independently associated with older age (odds ratio (OR)=1.03, p=0.003), lower preoperative hemoglobin (OR=0.80, p=0.020), longer operative time (OR=1.01, p<0.001), and in-hospital complications (OR=11.09, p<0.001). Prolonged LOS was also associated with higher post-discharge complication rates, including 30-day readmission (14% versus 6%, p=0.004), surgical site infection (6% versus 1%, p=0.002), and deep vein thrombosis (DVT)/pulmonary embolism (PE) (3% versus 0%, p=0.001). As complications are known to prolong LOS, a sub-analysis of 205 patients with complete PROMs and no post-discharge complications was performed. In this sub-analysis, patients with prolonged LOS had significantly worse preoperative ODI (51.8 versus 48.5, p=0.025), back pain (7.1 versus 6.2, p=0.013), and leg pain (6.8 versus 5.9, p=0.035). Postoperatively, improvement in PROMs was worse in prolonged LOS patients at all time points.Conclusion: Prolonged LOS after one- or two-level TLIF was associated with older age, lower preoperative hemoglobin, longer operative time, and in-hospital complications. It was also associated with a higher risk of post-discharge complications and lower functional status.

Maternal morbidity and mortality in the United States are higher than peer countries. These adverse events disproportionally affect Black women. Rates of maternal morbidity and mortality among Black childbearing women in West Louisville, Kentucky are higher than rates in Kentucky and the United States. We conducted a quality improvement project to evaluate the effectiveness of adding doulas to the health care teams at the Norton downtown hospital to address health disparities and other challenges identified by Black childbearing women related to communication and health care system barriers. Three culturally congruent doulas were hired and integrated into the health care teams in one large health care organization. Participants in the doula program had lower no-show rates for postpartum visits compared with non-participants. No-show rates for prenatal visits were the same for both groups. Rates of diagnosed preeclampsia, hypertension, and chronic hypertension were similar among doula program participants and those who did not participate. Narrative data indicated that program participants and health professionals were generally pleased with the doula program and there was positive feedback from the community. Integrating culturally congruent doulas into the health care system maximized their impact to address health and other challenges experienced by Black childbearing women.