The PAUL procedure had no effect on medial compartment pressure in the congruent elbow. It may ameliorate increased medial compartment pressure in the incongruent elbow. This change does not result from a medial to lateral compartmental shift and deserves further investigation.

Despite much progress in training AI systems to imitate human language, building agents that use language to communicate intentionally with humans in interactive environments remains a major challenge. We introduce Cicero, the first AI agent to achieve human-level performance in Diplomacy , a strategy game involving both cooperation and competition that emphasizes natural language negotiation and tactical coordination between seven players. Cicero integrates a language model with planning and reinforcement learning algorithms by inferring players' beliefs and intentions from its conversations and generating dialogue in pursuit of its plans. Across 40 games of an anonymous online Diplomacy league, Cicero achieved more than double the average score of the human players and ranked in the top 10% of participants who played more than one game.

Background Briefing of the trauma team prior to patient arrival is unstructured in many centers. We surveyed trauma teams regarding agreement on patient care priorities, and evaluated the impact of a structured, physician-led briefing on concordance during simulated resuscitations. Methods Trauma nurses at our Level II center were surveyed, and participated in four resuscitation scenarios, randomized to “Briefed” or “Non-briefed.” For Non-briefed scenarios, nurses independently reviewed triage sheets with written information. Briefed scenarios had a structured, four-minute physician-led briefing reviewing triage sheets identical to Non-briefed scenarios. Teams included 3–4 nurses (subjects) and 2–4 confederates (physicians, respiratory therapists). Each team served as their own control group. Confederates were blinded to nurses’ Briefed or Non-briefed status. Immediately before, and at the midpoint of each scenario, nurses estimated patient morbidity and mortality and ranked the top 3 of 16 designated immediate care priorities. Briefed and Non-briefed groups’ responses were compared for: (1) Agreement using intraclass correlation coefficient (ICC), (2) Concordance with physicians’ responses using Fisher’s exact test, (3) Teamwork via T-NOTECHS ratings by nurses and physicians using t-test, (4) Time to complete clinical tasks using t-test. Results 38 nurses participated. 97% “agreed/strongly agreed” briefing is important, but only 46% agreed briefing was done well. Comparing Briefed versus Non-briefed scenarios, nurses’ estimation of morbidity and mortality in Briefed scenarios showed significantly greater agreement with each other and with physicians’ answers (p<0.01). Rank lists also better agreed with each other (ICC 0.64 vs 0.59) and with physicians’ answers in Briefed scenarios. T-NOTECHS Leadership ratings were significantly higher in Briefed scenarios (3.70 versus 3.39, p<.01). Time to completion of key clinical tasks was significantly faster for one of the Briefed scenarios. Conclusions Discordant perceptions of patient care goals was frequently observed. Structured, physician-led briefing appeared to improve interprofessional team concordance, leadership and task completion in simulated trauma resuscitations. Level of Evidence Level 3, Therapeutic / Care management

Background Trauma care requires coordinating an interprofessional team, with formative feedback on teamwork skills. We hypothesized nurses and surgeons have different perceptions regarding roles during resuscitation; that nurses’ teamwork self-assessment differs from experts’, and that video debriefing might improve accuracy of self-assessment. Methods Trauma nurses and surgeons were surveyed regarding resuscitation responsibilities. Subsequently, nurses joined interprofessional teams in simulated trauma resuscitations. Following each resuscitation, nurses and teamwork experts independently scored teamwork (T-NOTECHS). After video debriefing, nurses repeated T-NOTECHS self-assessment. Results Nurses and surgeons assumed significantly more responsibility by their own profession for 71% of resuscitation tasks. Nurses’ overall T-NOTECHS ratings were slightly higher than experts’. This was evident in all T-NOTECHS subdomains except “leadership,” but despite statistical significance the difference was small and clinically irrelevant. Video debriefing did not improve the accuracy of self-assessment. Conclusions Nurses and physicians demonstrated discordant perceptions of responsibilities. Nurses’ self-assessment of teamwork was statistically, but not clinically significantly, higher than experts’ in all domains except physician leadership.