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Lateral extra-articular tenodesis (LET) to augment anterior cruciate ligament reconstruction significantly reduces graft failure rates. Although there are many techniques for lateral extra-articular tenodesis, the modified Ellison technique provides numerous advantages as a distally fixed construct, including dynamic rotational stability, reducing the risk of lateral compartment overload, and eliminating femoral tunnel convergence. The addition of knotless anchor fixation provides a reproducible and efficient method for providing extra-articular stability to anterior cruciate ligament reconstruction without the need to alter postoperative rehabilitation protocols. We describe our preferred lateral extra-articular tenodesis technique utilizing the modified Ellison approach with both an all-suture knotless anchor and a hardbody knotless anchor to provide stable fixation while minimizing additional operative time during anterior cruciate ligament reconstruction.
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This article provides a structured summary of "Leadership in Focus: Lessons Learned from Women Leaders," a conference panel organized by the American Psychological Association (APA) Division 40's Society for Clinical Neuropsychology (SCN)'s Women in Neuropsychology (WIN) committee at APA's annual conference in 2025. This panel brought together four prolific women leaders in neuropsychology and associated fields, Kim Gorgens, PhD, ABPP, Paula Shear, PhD, Chriscelyn Tussey, PsyD, ABPP, and Sara Weisenbach, PhD, ABPP, to discuss major themes related to women's leadership in neuropsychology, including: (1) a historical view of women in leadership positions, (2) systemic barriers faced by women in leadership, and (3) strategies used as a woman in leadership. Erin Sullivan-Baca, PhD, ABPP, and Rachael L. Ellison, PhD, co-moderated this panel discussion. The panel session and this resulting paper aim to disseminate the panelists' wisdom around best practices in knowledge and strategies for promoting gender equity and supporting the advancement of women in leadership within neuropsychology. Common themes across panelists and topics included celebrating and recognizing the strengths of women's unique leadership style, reflecting on personal strengths, seeking out mentorship and sponsorship, engaging in professional organizations, and not overplanning or waiting until conditions are perfect to volunteer for leadership opportunities. Panelists concluded by acknowledging continued barriers to women in leadership while also providing a vision of hope for the future of women leaders in neuropsychology.
The quantity and bioavailability of iron (Fe) in commercial chicken eggs have been subject to ongoing debate. Understanding the chemical form of Fe in eggs, and how different laying conditions or cooking environments may alter chemical form is important to guide future studies of Fe bioavailability. To address these unanswered questions, this study aimed to accurately quantify and characterise Fe speciation (including haem and non-haem Fe) in egg yolk, albumen and whole eggs (mixed yolk and albumen), in both raw and cooked eggs. Eggs were obtained from four different hen housing systems: free-range, cage, barn and organic. Total Fe was measured using microwave plasma atomic emission spectrometry, and X-ray absorption near-edge structure spectroscopy was used to quantify the relative proportions of different chemical forms of Fe (Fe speciation). These analyses were conducted on raw albumen, yolk, and whole egg samples (combined yolk and albumen) from eggs produced across all housing systems, as well as on baked and boiled albumen, yolk, and whole egg samples from free-range eggs. Haem Fe was not detected by the analytical methods used, confirming that eggs are not a nutritionally relevant source of haem Fe. Mixing yolk and albumen alters Fe speciation, decreasing relative phosphate coordination of Fe and increasing Fe associated with protein carboxylate and chloride groups. Subsequent baking causes a significant reduction in carboxylate- and chloride-bound Fe, accompanied by an increase in sulfur-bound Fe. Boiling eggs was found to have minimal effects on Fe speciation. Despite contributing little Fe, albumen plays an important role in modulating Fe speciation, which may subsequently impact bioavailability. Cooking eggs changes the Fe speciation, particularly increasing the amount of Fe-S coordination, which should be taken into consideration for future study design when assessing Fe bioavailability.
Persisting cognitive symptoms following SARS-CoV-2 infection (Long COVID) has become an increasingly common referral for neuropsychological evaluation. This study examined performance validity test (PVT) failure rates among adults referred for evaluation due to Long COVID cognitive complaints after mild SARS-CoV-2 disease severity. Data from 57 demographically diverse outpatients (72% female; Mage = 44.23; Meducation = 15.39 years) consecutively referred for a focused neuropsychological evaluation due to Long COVID cognitive symptoms were analyzed. The neuropsychological test battery included one freestanding (Test of Memory Malingering-Trial 1) and four embedded PVTs (Reliable Digit Span; California Verbal Learning Test-Brief Form Forced Choice; Brief Visuospatial Memory Test-Revised Recognition Discriminability; Stroop Color and Word Test-Word Reading T-Score), as well as a 11 neuropsychological test scores assessing the major domains of cognition, which were used to compute an overall neuropsychological test battery mean composite score. Individual PVT failure rates ranged from 4% to 18%. Overall, 67% passed all PVTs, 24% failed one PVT, and 9% failed ≥ 2 PVTs. Patients failing two or more PVTs had an overall neuropsychological test battery mean performance that was significantly lower than the group failing one or zero PVTs and 1.0 standard deviations below the population mean. Patients with zero PVT failures also outperformed those with one PVT failure by 0.5 standard deviations. Nonsignificant differences in COVID disease characteristics emerged between groups. The majority of patients (67%) passed all PVTs, with 24% of patients failing one PVT and 9% failing ≥ 2 PVTs. Future research is warranted to understand implications of a single freestanding PVT failure in this population, and to establish base rates of invalidity in Long COVID and among those with more severe initial COVID infection necessitating hospitalization and/or medical intervention. Such practices ensure accurate diagnosis, guide treatment, and improve the reliability of research on the cognitive sequelae of COVID-19.
We present a Q-learning framework for optimizing chemotherapy dosing schedules in a stochastic finite-cell model of tumor evolution under drug-induced selection. The tumor consists of three competing subpopulations: a chemosensitive lineage, S, and two single-drug-resistant lineages, R_{1} and R_{2}, each resistant to one of two cytotoxic agents, C_{1} and C_{2}. Drug administration is formulated as a discrete action space in a finite-state Markov process, where the state is defined by the composition (S,R_{1},R_{2}) constrained by a fixed population size N. Tumor volume evolves according to a separate growth equation, with expansion rate proportional to the difference between the population-averaged fitness and a fixed microenvironmental baseline. Using Q-learning, we derive optimal dosing policies that balance therapeutic pressure with the evolutionary dynamics of resistance. The reward function is engineered to promote long-term coexistence among subpopulations, thereby delaying fixation of resistance by penalizing population imbalance. We analyze the structure of the optimal policies to (i) infer dominant evolutionary trajectories under treatment, (ii) quantify robustness to partial observability of both initial conditions and state updates, and (iii) construct simplified, symmetry-informed heuristics that approximate the full learned policy. Our results highlight the potential of model-free adaptive control strategies to steer tumor evolution away from drug resistance in the presence of biological stochasticity and information constraints.
Neuroimaging is prevalent in psychiatric research, but there is limited evidence that it improves clinical outcomes. Functional connectivity neuroimaging was recently used to target individualized brain circuits with accelerated transcranial magnetic stimulation (aTMS), with rapid antidepressant effects and US Food and Drug Administration clearance, but the importance of connectivity-based targeting remains unclear. To estimate the effect size of connectivity- vs scalp-based targeting of aTMS for treatment-resistant depression. This randomized clinical trial comparing connectivity- to scalp-based aTMS treatment was conducted between July 2023 and March 2025 with the primary outcome assessed at 1 month posttreatment and follow-up every 3 months for 1 year. Participants, TMS technicians, and study physicians were blinded. The study took place at the Center for Brain Circuit Therapeutics at Mass General Brigham and Harvard Medical School in Boston, Massachusetts. Forty adults aged 22 to 80 years with a primary diagnosis of major depressive disorder with moderate to severe depression per Montgomery-Åsberg Depression Rating Scale (MADRS) score and moderate to severe treatment resistance per Maudsley Staging Method were included. Key exclusion criteria included contraindications to TMS or magnetic resonance imaging, primary psychiatric diagnoses other than major depressive disorder or anxiety disorders, recent rapid-acting antidepressant treatments, and significant neurological or substance use disorders. All participants underwent a 41-minute multiecho resting-state functional connectivity scan prior to aTMS, and half of them received treatment guided by these data. The connectivity-based target was defined as the left dorsolateral prefrontal cortex region with the greatest correlation to a published and publicly available convergent depression circuit. This circuit includes multiple brain regions linked to depression, including negative connectivity to the subgenual cingulate cortex. The scalp-based target was identified with the Beam F3 method. MADRS score 1 month after treatment, adjusted for baseline. In total, 40 participants (22 female [55%]; mean [SD] age, 45.7 [15.2] years) were randomized and treated. The median (IQR) MADRS score reduction was 24 (19-28) vs 18 (10-23) points with connectivity- vs scalp-based targeting, respectively (P = .02). Connectivity-based targeting had an effect size of 0.8 (Cohen d analog) and 95% CI of 0.26-1.54, with a number needed to scan of 5 individuals. Individualized targets were reproducible within an individual (4.47 mm split-half distance) and different between individuals (12.97 mm) (P < .001). In this randomized clinical trial, individualized, connectivity-based targeting of the convergent depression circuit enhanced the antidepressant effects of high-dose aTMS. These results could facilitate cost-effectiveness analyses and help to power a confirmatory efficacy trial. ClinicalTrials.gov Identifier: NCT05680727.
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Polylactide (PLA) is the world's top synthetic biopolymer and a major contributor to the circular plastic economy by virtue of its biodegradation and full biomineralization into benign end products. Nevertheless, efficient and complete degradation of PLA at its end of use remains constrained by the need for engineered industrial composting environments that operate at elevated temperatures and high humidity levels. In this work, PLA samples containing low levels of phthalic or 2-sulfobenzoic acid anhydride additives were prepared using industrially viable melt-processing. These blends retained mechanical properties nearly identical to that of neat PLA while exhibiting significantly accelerated hydrolytic degradation, achieving appreciable mass losses within one month at 50 °C in artificial seawater. Remarkably, even trace (0.01 wt %, 100 ppm) incorporation of 2-sulfobenzoic acid cyclic anhydride proved highly effective in promoting PLA hydrolysis even at temperatures below the glass transition temperature of the parent material. Furthermore, incorporation of 2-sulfobenzoic acid cyclic anhydride (0.1 wt %) enabled rapid biodegradation under composting conditions at 58 °C, achieving 90% within 11 days, surpassing that of neat PLA. Using anhydrides as strong acid-generating additives enables acceleration of PLA hydrolysis and biodegradation without compromising its other attractive properties, thereby opening a viable pathway toward realizing the full potential of PLA in a larger array of applications.
Wave-plasma interactions and energy transport are fundamental processes in stellar atmospheres, shaping elemental composition through the first ionization potential (FIP) and inverse FIP (IFIP) effects. Although stellar measurements provide global evidence of abundance anomalies, the Sun offers a unique local laboratory in which to resolve how these processes operate on small spatial and temporal scales. In this overview, we summarize the current state of knowledge of the IFIP effect, its observational signatures and the theoretical framework that underpins it. We then present new insights from a detailed case study of active region (AR) NOAA AR 11967, where combined Hinode/extreme-ultraviolet imaging spectrometer (EIS), IRIS, SDO/AIA and Fermi/GBM observations and IRIS2+ inversions indicate that torsional Alfvén waves generated below the chromospheric fractionation region can account for the highly localized IFIP effect plasma observed on the Sun. This analysis highlights the possible role of sub-chromospheric processes in the formation of the IFIP effect on the Sun and informs pathways for understanding similar mechanisms in the coronae of active M dwarfs. This article is part of the Theo Murphy meeting issue 'Solar atmospheric abundances in space and time'.
Current scores that discriminate rupture status/rupture-associated morphology of aneurysm rupture rely on size being >7 mm, ignoring important morphological parameters. This study applies advanced statistical methods on historical patient data to identify morphological features associated with aneurysms rupture. Data from 429 aneurysms along with demographics and morphological data, collected by a blinded research assistant, were utilised to explore associations between morphology and demographic features and aneurysm ruptures. Associations between morphology and rupture status were assessed with generalised estimating equations clustered by patient. The relative importance of morphological and historical/demographic factors in predicting the risk of aneurysm rupture were investigated applying a selected machine learning techniques (random forest, neural network and support vector machine). Demographic characteristics were not statistically associated with risk of aneurysm rupture, but morphological characteristics (parent vessel diameter and aneurysm dome diameter) had significant associations with rupture. Accounting for only morphological parameters in predicting ruptured aneurysm, support vector machine was superior in detecting ruptured aneurysm compared to random forest (RF) and neural network. Considering morphological data together with patients' historical and demographic features, RF had the best performance with a substantial increase in the risk of rupture accuracy. In the latter model, age, aneurysm dome diameter, irregularity of shape, years of smoking and bottleneck factor were the most important variables in aneurysm rupture prediction. An aneurysm likely to rupture can be identified with a reasonable degree of certainty from a single scan using morphological characteristics alone although the accuracy of prediction increases significantly when other factors are included in the model. Larger studies to investigate this further are required.
The epithelial sodium channel governs sodium and fluid absorption in kidney, lung, and colon epithelia, but the molecular organization of native epithelial sodium channel complexes in vivo remains poorly defined. Low abundance and biochemical instability have limited direct analysis of epithelial sodium channel assembly, composition, and regulatory associations in native tissues. We generated a knock-in mouse in which the endogenous epithelial sodium channel γ subunit was fused to a fluorescent protein and affinity tag while preserving physiologic channel function. We validated channel activity in vivo using electrolyte measurements and pharmacologic inhibition, and assessed channel pharmacology by radioligand binding. Native epithelial sodium channel complexes were analyzed from lung, kidney, and colon using fluorescence-detection size-exclusion chromatography, single-molecule pull-down, fluorescent antibody fragments, and mass spectrometry. The tagged γ subunit preserved normal epithelial sodium channel function in vivo. Native epithelial sodium channel complexes directly isolated from lung, kidney, and colon, revealed marked tissue-to-tissue differences in channel abundance and apparent complex size. Dual-color fluorescence analyses distinguished fully assembled channels from broader γ-containing assemblies. Proteomic analysis identified regulatory proteins associated with γ-containing complexes, indicating that epithelial sodium channel exists in multiple assembly and regulatory states in vivo. Native epithelial sodium channel architecture is heterogeneous across epithelial tissues. Endogenous tagging enables direct molecular interrogation of epithelial sodium channel assembly and regulation in vivo.
Gene model for the ortholog of Protein tyrosine phosphatase 61F ( Ptp61F ) in the Drosophila ananassae May 2011 (Agencourt dana_caf1/DanaCAF1) Genome Assembly (GenBank Accession: GCA_000005115.1). This ortholog was characterized as part of a developing dataset to study the evolution of the Insulin/insulin-like growth factor signaling pathway (IIS) across the genus Drosophila using the Genomics Education Partnership gene annotation protocol for Course-based Undergraduate Research Experiences.
Hypertension is the leading contributor to premature death and disability in the world. Genetic susceptibility and high dietary salt (NaCl) consumption have long been considered to be the primary culprits but growing evidence indicates that low dietary potassium consumption has an equally important role. Although the underlying mechanisms are complex and multifactorial, the potassium switch signalling mechanism in the kidney distal convoluted tubule represents a crucial pathway with implications for preventing and treating hypertension. Comprising a Kir4.1 and Kir5.1 channel potassium-sensing mechanism, a WNK kinase-induced phosphorylation cascade, and the thiazide-diuretic-targeted sodium chloride co-transporter, the potassium switch orchestrates a physiological response in the distal nephron that maintains sodium-potassium balance over wide variations in dietary potassium intake. The potassium switch is ideally adapted for the low-salt, feast-and-famine diets of hunter-gatherers. However, low potassium consumption, which is common in high-sodium modern diets, promotes potassium conservation at the expense of increasing sodium reabsorption, exacerbating salt-sensitive hypertension and its associated cardiovascular complications. Here, we discuss current understanding of the potassium switch and how its role in kidney adaptation to the modern diet can contribute to hypertension.
While native mass spectrometry (native-MS) has been widely explored in academic laboratories, its practical role within biopharmaceutical research remains less clearly defined. In this perspective, we present an industry-driven view of how native-MS is currently applied, where it offers unique advantages over established analytical technologies, and where alternative methods remain more practical for routine characterization. Within biopharma workflows, characterization strategies traditionally rely on orthogonal techniques such as size-exclusion chromatography (SEC), ion-exchange chromatography (IEX), electrophoresis, light scattering, calorimetry, and denaturing liquid chromatography (LC) MS. Native-MS complements these methods by enabling direct assessment of intact molecular assemblies, including monoclonal antibodies (mAbs), multispecific antibodies, antibody-drug conjugates (ADCs), glycoproteins, and protein complexes. Applications include evaluation of higher-order assembly, ligand or cofactor binding, stoichiometry of target complexes, and heterogeneity that may be obscured under denaturing conditions. However, challenges related to throughput, sensitivity, automation, and accessibility have limited widespread adoption in industrial laboratories. Emerging developments, including chromatographic hyphenation, online buffer exchange (OBE), improved automation, and charge-detection MS (CDMS), are beginning to address these constraints. We argue that the future impact of native-MS in biopharma will depend on integrating these technological advances with platformed analytical workflows and software capable of supporting high-throughput characterization across therapeutic pipelines. We hope that the ideas raised in this article spur debate on when, how, and if native-MS would or should see increased adoption.
Strategies for tuning the optical properties of organic chromophores generally focus on shifting the edges of the spectrum: this might be red-shifting the longest absorbance band to improve solar absorbance, or blue-shifting of the highest energy emission band towards deep blue emission. In contrast, strategies to enhance molar absorptivity and control excited state rate constants are less obvious, with intermolecular excitons such as J-aggregates providing arguably the most powerful approach. Here, a homologous series of π-extended triptycenes is presented which reveal opportunities to control both aspects. These molecules have electronic spectra consisting of two distinct regimes, a low energy intramolecular charge transfer and a mid-spectral progression which has characteristics similar to that of a J-aggregate in several respects. This reveals that a homoconjugated framework can be utilised rationally to separate and independently control distinct regions of the electronic structure of the molecule, here leading to controllably amplified mid-spectrum absorbance intensities and high fluorescence quantum yields.
The Drosophila telomere is one of the best-studied examples of active transposable elements (TEs) benefitting, rather than harming, a host genome. All Drosophila species lack telomerase and most species instead have telomeres composed of head-to-tail arrays of specialized retrotransposons. These TEs ostensibly act as mutualists by elongating chromosome ends, but evidence from species closely related to Drosophila melanogaster suggests that telomeric transposons may also antagonize their host genome. Importantly, the limited number of Drosophila species characterized thus far has precluded our ability to delineate idiosyncrasies from universal evolutionary forces and genetic mechanisms that shape the history of these TEs. Here, we have surveyed long-read genome assemblies of over 100 species of Drosophila, identifying a total of 396 telomeric TE families. Our findings show that these telomere-specialized elements evolve dynamically and also undergo striking convergent evolution: the complete loss of telomeric TEs has occurred repeatedly across the genus while individual telomeric TE lineages have repeatedly lost one of their two protein-coding genes. These elements have also repeatedly undergone horizontal transfer between distantly related Drosophila lineages and have repeatedly captured host gene fragments that promote their selfish suppression of host TE-silencing systems. Furthermore, telomere specialization itself appears to have evolved convergently, as some non-telomeric families have gained the ability to target their insertions to telomeres. These results provide unprecedented resolution into the evolution of these unusual TEs and highlight several novel mechanisms by which they evolve in conflict both with each other and their host genome despite the essential telomere function they provide.
ObjectiveTo explore how primary and community-based healthcare professionals (HCPs) experience supporting adults with congenital heart disease (ACHD) in generalist healthcare settings.MethodsA qualitative interpretive study was conducted with 18 UK primary care HCPs, including general practitioners and advanced clinical practitioners. Semi-structured interviews were analysed using reflexive thematic analysis.ResultsAn overarching theme, balancing knowledge, care and constraint, captured how HCPs supported adults with ACHD while navigating uncertainty, relational responsibility and fragmented systems. Three interconnected themes were identified: navigating uncertainty, reflecting limited ACHD knowledge and infrequent exposure; sustaining relationships, highlighting the role of continuity and familiarity in maintaining care; and working around the system, describing how participants adapted to unclear pathways, inconsistent communication and organisational constraints. Despite limited condition-specific knowledge, participants described recognising concerns, coordinating care and sustaining continuity across fragmented services.ConclusionAs increasing numbers of adults with ACHD receive care beyond specialist centres, primary and community-based HCPs play a crucial role in recognising concerns, coordinating care and maintaining continuity. Participants' accounts highlight the often-unseen relational and coordinating work required to keep patients connected to appropriate care despite uncertainty and organisational constraints. Strengthening ACHD care therefore requires more than condition-specific education; it depends on healthcare systems that facilitate communication, collaboration and shared responsibility across specialist and generalist services.
Total Knee Arthroplasty is a common treatment for end-stage osteoarthritis with excellent long-term survival. However, aseptic loosening of the tibial component remains a concern and may be influenced by cementing technique. Radiostereometric analysis studies indicate that early tibial migration increases the risk for later loosening. There is no consensus regarding how the tibial component should be cemented. To compare surface cementation (SC) and full cementation (FC) of the tibial component with respect to migration, micromotion, and bonding strength and to assess correlation between cement thickness and implant movement. Using a composite tibia model, we compared SC (n = 5) with FC (n = 5) of the NexGen Stemmed Option tibial baseplate. Groups underwent 20,000 loading cycles at a maximal axial load of 1780 N at a 1 Hz rate. Migration and micromotion were measured with Linear Variable Differential Transformers. Bonding strength was assessed in a push-out test. Parametric statistics were used for group comparisons. Mean anterior migration was 0.7 µm (SD ± 0.8) for FC and -1.3 µm (±1.5) for SC (p = 0.03). Mean anterior micromotion was 1.1 µm (± 0.8) for FC and 12.3 µm (±7.2) for SC (p = 0.03). Posterior implant movement were similar between groups. The FC-group demonstrated higher mean bonding strength (7655 N ± 1613) compared with SC (4541 N ± 1202) (p = 0.009). Greater anterior cement thickness correlated with reduced micromotion (r = -0.7, p = 0.02). Full cementation resulted in greater anterior stability and bonding strength compared with surface cementation. These findings suggest that full cementation reduces initial movement for NexGen Stemmed Option tibial baseplates.