Real-time multicenter semantic segmentation for laparoscopic gastrectomy: development, external validation and operating room deployment of an AI navigation system.

Girls impacted by the juvenile legal system experience disproportionately high sexual and reproductive health (SRH) risks, including early sexual initiation, elevated rates of sexually transmitted infections (STIs), and unintended pregnancy (). These risks extend beyond youth currently confined to girls who are court-involved but non-incarcerated (CINI), those with prior juvenile legal system involvement, and those who are justice-exposed through family incarceration, reflecting shared structural vulnerabilities and barriers to care. Moreover, these girls have unique SRH needs compared to their counterparts who are not system-impacted, yet they often face limited access to SRH care in community settings (). Multiple factors exacerbate their SRH risks, including high rates of childhood trauma, abuse, poverty, and family instability. These intersect with increased rates of substance use, psychiatric disorders, social stigma, and marginalization from health care services (). Additionally, STI rates among CINI girls have been reported to range from 3% to 45%, depending on demographic and contextual factors (). Rates of chlamydia and gonorrhea among girls in juvenile detention are 5–7 times higher than in their non-detained counterparts (). Moreover, one in three girls in detention has experienced pregnancy (; ), compared to 13.1 per 1,000 U.S. adolescent girls aged 15–19 (). While girls in detention often receive at least some SRH services, CINI girls and girls with prior personal carceral involvement living in the community share many of the same SRH risks but may receive none at all when in community settings (). Further, girls with indirect carceral exposure through family or household member incarceration are at heightened risk of carceral involvement and poor SRH outcomes (). These sexual health concerns, compounded by limited access to sexual healthcare, underscore the need for targeted, developmentally aligned, and trauma-informed SRH education that addresses the specific needs of CINI girls and girls with prior carceral exposure, including personal or household exposure.