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To limit global warming to below 2 °C by 2100, CO2removal from the atmosphere will be necessary. One promising method for achieving CO2removal at scale is ocean alkalinity enhancement (OAE), but there are challenges with incomplete air–sea CO2equilibration, which reduces the efficiency of carbon removal. Here, we present global maps of OAE efficiency, and assess the seasonal variation in efficiency. We find that the equilibration kinetics have two characteristic timescales: rapid surface equilibration followed by a slower second phase, which represents the re-emergence of excess alkalinity that was initially subducted. These kinetics vary considerably with latitude and the season of alkalinity release, which are critical factors for determining the placement of potential OAE deployments. Additionally, we quantify the spatial and temporal scales of the induced CO2uptake, which helps identify the requirements for modelling OAE in regional ocean models.

Type 1 diabetes results from the autoimmune destruction of pancreatic insulin-producing β-cells, primarily targeted by autoreactive T cells that recognize insulin B9–23 peptides as antigens. Using drift tube ion mobility spectrometry-mass spectrometry, transmission electron microscopy, and two-dimensional infrared spectroscopy, we characterized mouse insulin 1 B9–23 (Ins1 B9–23), insulin 2 B9–23 (Ins2 B9–23), along with two of their mutants, Ins2 B9–23 Y16A and Ins2 B9–23 C19S. Our findings indicate that Ins1 B9–23 and the Ins2 Y16A mutant exhibit rapid fibril formation, whereas Ins2 B9–23 and the Ins2 C19S mutant show slower fibrillization and a structural rearrangement from globular protofibrils to fibrillar aggregates. These differences in aggregation behaviors also manifest in interactions with (−)epigallocatechin gallate (EGCG), a canonical amyloid inhibitor. EGCG effectively disrupts the fibrils formed by Ins1 B9–23 and the Y16A mutant. However, it proves ineffective in preventing fibril formation of Ins2 B9–23 and the C19S mutant. These results establish a strong correlation between the aggregation behaviors of these peptides and their divergent effects on anti-islet autoimmunity.

Severely ill patients with COVID-19 are challenging to sedate and often require high-dose sedation and analgesic regimens. Ketamine can be an effective adjunct to facilitate sedation of critically ill patients but its effects on sedation level and inflammation in COVID-19 patients have not been studied. This retrospective, observational cohort study evaluated the effect of ketamine infusions on inflammatory biomarkers and clinical outcomes in mechanically ventilated patients with SARS-CoV-2 infection. A total of 186 patients were identified (47 received ketamine, 139 did not). Patients who received ketamine were significantly younger than those who did not (mean (standard deviation) 59.2 (14.2) years versus 66.3 (14.4) years; P= 0.004), but there was no statistically significant difference in body mass index (P= 0.25) or sex distribution (P= 0.91) between groups. Mechanically ventilated patients who received ketamine infusions had a statistically significant reduction in Richmond Agitation-Sedation Scale score (–3.0 versus –2.0, P < 0.001). Regarding inflammatory biomarkers, ketamine was associated with a reduction in ferritin (P= 0.02) and lactate (P= 0.01), but no such association was observed for C-reactive protein (P= 0.27), lactate dehydrogenase (P= 0.64) or interleukin-6 (P= 0.87). No significant association was observed between ketamine administration and mortality (odds ratio 0.971; 95% confidence interval 0.501 to 1.882; P= 0.93). Ketamine infusion was associated with improved sedation depth in mechanically ventilated COVID-19 patients and provided a modest anti-inflammatory benefit but did not confer benefit with respect to mortality or intensive care unit length of stay.

Narrative counseling, narrative interviewing, or storytelling is a therapeutic approach to treating individuals with mental health conditions that is client-led. The approach can also employ the power of recall to reconstruct one’s story and oneself through reframing. In this article, we explore the possibility of employing narrative counseling in vocational rehabilitation settings, with immigrants with disabilities experiencing grief through loss and migration. Autonomy, cultural relevance, and trauma-informed care present the rationale for consideration and further exploration of narrative counseling in vocational rehabilitation research, teaching, and practice.

Research can inform policies on substance use/substance use disorders (SU/SUDs), yet there is limited experimental investigation into strategies for optimizing policymakers’ engagement with SU/SUD research. This study tested the use of narratives to boost policymakers’ research engagement.

This study examined the extent of disaster preparedness in Australian hospitals, seeking to identify opportunities for improvement. Insufficient preparation can lead to mortality/morbidity in post-disaster scenarios. Early identification of resolvable shortcomings in preparing for events is an important goal.

We combine liquid chromatography coupled with ion mobility spectrometry–mass spectrometry to elucidate how short exposure to corticosterone (Cort) alters the output of mouse pancreatic islet hormones. The workflow enables the robust separation of mouse insulin 1 (Ins1) and insulin 2 (Ins2) and the detection of major islet hormones in a homogenate equivalent to 100–150 islet cells. We show that Ins2 has a unique structure and is degraded much faster than Ins1. Further investigation indicates that Ins2 may populate both T and R states, whereas Ins1 may not. The assemblies of Ins1’s B-chain also introduce more structural heterogeneity than Ins2. Collectively, these features account for their unique degradation profiles, the diabetes risk associated with Ins1, and the protective effect of Ins2. In the same experiments, we observe that the ratio of amylin to Ins1 increased significantly in Cort-treated mice (15:1) compared to the control mice (42:1), correlating well with β-cell proliferation observed in immunoassays on the same animal model. We observe no increase in intact full-length insulin levels but more of the truncated forms, indicating that enzymatic activity is accelerated. Our data provide a molecular basis for reduced insulin action induced by Cort and connections between insulin turnover and insulin resistance.

Net-zero greenhouse gas (GHG) emissions targets are driving interest in opportunities for biomass-based negative emissions and bioenergy, including from marine sources such as seaweed. Yet the biophysical and economic limits to farming seaweed at scales relevant to the global carbon budget have not been assessed in detail. We use coupled seaweed growth and technoeconomic models to estimate the costs of global seaweed production and related climate benefits, systematically testing the relative importance of model parameters. Under our most optimistic assumptions, sinking farmed seaweed to the deep sea to sequester a gigaton of CO2per year costs as little as US$480 per tCO2on average, while using farmed seaweed for products that avoid a gigaton of CO2-equivalent GHG emissions annually could return a profit of $50 per tCO2-eq. However, these costs depend on low farming costs, high seaweed yields, and assumptions that almost all carbon in seaweed is removed from the atmosphere (that is, competition between phytoplankton and seaweed is negligible) and that seaweed products can displace products with substantial embodied non-CO2GHG emissions. Moreover, the gigaton-scale climate benefits we model would require farming very large areas (>90,000 km2)—a >30-fold increase in the area currently farmed. Our results therefore suggest that seaweed-based climate benefits may be feasible, but targeted research and demonstrations are needed to further reduce economic and biophysical uncertainties.

Understanding obstacles to preventive care is crucial for medical providers. This study examined the association between various types of barriers and reporting of routine gynecological care.

ABSTRACTWe present the first Bayesian 14C modeling based on AMS ages from stratified sediments representing continuous occupation across the Early Bronze III/IV interface in the Southern Levant. This new high-precision modeling incorporates 12 calibrated AMS ages from Khirbat Iskandar Area C using OxCal 4.4.4 and the IntCal 20 calibration curve to specify the EB III/IV transition at or slightly before 2500 cal BCE. Our results contribute to the continuing emergence of a high chronology for the Levantine Early Bronze Age, which shifts the end of EB III 200–300 years earlier than the traditional time frame and increases the length of EB IV to about 500 years. Data from Khirbat Iskandar also help direct greater attention to the importance of sedentary communities through EB IV, in contrast to the traditional emphasis on non-sedentary pastoral encampments and cemeteries. Modeling of AMS data from Khirbat Iskandar bolsters the ongoing revision of Early Bronze Age Levantine chronology and its growing interpretive independence from Egyptian history and contributes particularly to re-examination of the EB III/IV nexus in the Southern Levant.

Recent advances in genomic sequencing have improved the accessibility of reproductive genetic carrier screening (RGCS). As awareness and interest grows, non-genetic health care professionals are increasingly offering RGCS to consumers. We conducted a qualitative interview study informed by behaviour change theory to identify influences on health care professionals considered as ‘early adopters’ offering RGCS through Mackenzie’s Mission, an Australian national research study investigating the implementation of free RGCS to couple’s preconception or in early pregnancy. Interviews were deductively analysed using the Theoretical Domains Framework to examine barriers and enabling factors. In total, we interviewed 31 health care professionals, who were primarily general practitioners (n= 23) offering RGCS through Mackenzie’s Mission. Upon analysis, 15 barriers and 44 enablers to implementation were identified and categorised across three health care professional target behaviours 1. Engaging with RGCS, 2. Identifying eligible patients, and 3. Offering RGCS. Whilst all Theoretical Domains Framework domains were present, barriers were predominantly categorised as ‘Environmental Context and Resources’ e.g., lack of time, followed by ‘Knowledge’ e.g., lack of understanding about genetics and ‘Beliefs about Capabilities’ e.g., concern about giving high risk results to patients. Although health care professionals expressed a preference for offering RGCS through a comprehensive and supported model of care, such as Mackenzie’s Mission, barriers remain. By understanding what drives current health care professionals’ behaviour towards offering RGCS, behaviour change theory provides an avenue to direct future efforts based on evidence and improve service delivery.

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BACKGROUNDIn the early months of the COVID-19 pandemic, health care decision-makers in North Carolina needed information about the available health workforce in order to conduct workforce surge planning and to anticipate concerns about professional or geographic workforce shortages.METHODDescriptive and cartographic analyses were conducted using licensure data held by the North Carolina Health Professions Data System to assess the supply of respiratory therapists, nurses, and critical care physicians in North Carolina. Licensure data were merged with population data and numbers of intensive care unit (ICU) beds drawn from the Centers for Medicare and Medicaid Services (CMS) Healthcare Cost Report Information System (HCRIS).RESULTSThe pandemic highlighted how critical data infrastructure is to public health infrastructure. Respiratory therapists and acute care, emergency, and critical care nurses were diffused broadly throughout the state, with higher concentrations in urban areas. Critical care physicians were primarily based in areas with academic health centers.LIMITATIONSData were unavailable to capture the rapid changes in supply due to clinicians reentering or exiting the workforce. County-level analyses did not reflect individual, facility-level supply, which was needed to plan organizational responses.CONCLUSIONSHealth care decision-makers in North Carolina were able to access information about the supply of clinicians critical to caring for COVID-19 patients due to the state’s long-standing investments in health workforce data infrastructure. Ability to respond was made easier due to strong working relationships between the University of North Carolina at Chapel Hill Cecil G. Sheps Center for Health Services Research, the North Carolina Area Health Education Centers Program, the health professional licensure boards, and state government health care agencies.

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Beyond a narrow focus on cost and outcomes, robust evidence of what is valued in genomic medicine is scarce. We gathered views on value from key stakeholders (clinical genomic staff, operational genomic staff and community representatives) in relation to three testing contexts (General Healthcare, Acute Care and Neurodevelopmental Conditions). We conducted an iterative focus group in three stages over a week using a multiphase mixed methods study, i.e. quantitative ratings and qualitative discussion. For each testing context, the characteristics of genomic testing were generated and ranked by the group using a co-productive approach. Up to 17 characteristics were identified in one scenario with several characteristics featuring in all three testing contexts. The likelihood of getting an answerwas consistently reported as most highly valued, followed by the potential for the test to impact on clinical management(or wellbeing/healthfor Neurodevelopmental Conditions). Risk of discriminationdid not feature highly across the different settings (and not at all in Acute Care). While costwas an issue in the general health setting, it was one of the least-valued characteristics in the other two testing contexts. In conclusion, co-producing an understanding of what is valued in different testing contexts, and identifying the areas of differences or commonalities, is important to maximise value provision and inform future policy to ensure that clinical genomic services meet the needs of the community and service providers.

In epidemiologic studies of health effects of air pollution, measurements or models are used to estimate exposure. Exposure estimates have errors that propagate to effect estimates in exposure-response models. We critically evaluate how types of exposure measurement error influenced bias and precision of effect estimates to understand conditions affecting interpretation of exposure-response models for epidemiologic studies of exposure to PM2.5, NO2, and SO2. We reviewed available literature on exposure measurement error for time-series and long-term exposure epidemiology studies. For time-series studies, time–activity error (daily exposure concentration did not account for variation in exposure due to time–activity during a day) and nonambient (indoor) sources negatively biased the effect estimates and increased standard error, so uncertainty grew with increasing bias while underestimating the true health effect in these studies. Spatial error (deviation between true exposure concentration at an individual’s location and concentration at a receptor) was ascribed to negatively biased effect estimates in most cases. Positive bias occurred for spatially variable pollutants when the variance of error correlated with the exposure estimate. For long-term exposure studies, most spatial errors did not bias the effect estimate. For both time-series and long-term exposure studies reviewed, large uncertainties were observed when exposure concentration was modeled with low spatial and temporal resolution for a spatially variable pollutant.

Background: The differential utility of neurocognitive impulsivity and externalizing/ internalizing traits as putative endophenotypes for dependence on heroin vs. amphetamine is unclear. Objective: This exploratory study aims to determine: (1) whether neurocognitive impulsivity dimensions and externalizing/internalizing traits are correlated between siblings discordant for heroin and amphetamine dependence; and (2) which of these associations are common across substances and which are substance- specific. Methods: Pearson correlations between individuals with ‘pure’ heroin and amphetamine dependence and their unaffected biological siblings (n = 37 heroin sibling pairs; n = 30 amphetamine sibling pairs) were run on 10 neurocognitive measures, 6 externalizing measures, and 5 internalizing measures. Sibling pair effects were further examined using regression. Results: Siblings discordant for heroin dependence were significantly correlated on delay aversion on the Cambridge Gambling Task, risk-taking on the Balloon Analogue Risk Task, sensation seeking, and hopelessness. Siblings discordant for amphetamine dependence were significantly correlated on the quality of decision-making on the Cambridge Gambling Task, discriminability on the Immediate Memory Task, commission errors on the Go/No Go Task, trait impulsivity, ADHD and anxiety sensitivity. Conclusion: Dimensions of impulsivity and externalizing/internalizing traits appear to aggregate among siblings discordant for substance dependence. Risk-taking propensity, sensation seeking and hopelessness were specific for heroin sibling pairs. Motor/action impulsivity, trait impulsivity, and anxiety sensitivity were specific to amphetamine sibling pairs. Decisional/choice impulsivity was common across both heroin and amphetamine sibling pairs. These findings provide preliminary evidence for the utility of neurocognitive impulsivity and externalizing/ internalizing traits as candidate endophenotypes for substance dependence in general and for substance-specific dependencies.

In the tropical Pacific, weak ventilation and intense microbial respiration at depth give rise to a low dissolved oxygen (O2) environment that is thought to be ventilated primarily by the equatorial current system (ECS). The role of mesoscale eddies and vertical mixing as potential pathways of O2supply in this region, however, remains poorly known due to sparse observations and coarse model resolution. Using an eddy resolving simulation of ocean circulation and biogeochemistry, we assess the contribution of these processes to the O2budget balance and find that vertical mixing of O2, which is modulated by the surface wind speed and the vertical shear of the eddying currents, contributes substantially to the replenishment of O2in the upper equatorial Pacific thermocline, complementing the advective supply of O2by the ECS and meridional circulation at depth. These transport processes vary seasonally in conjunction with the wind: mixing of O2into the upper thermocline is strongest during boreal summer and fall when the vertical shear and eddy kinetic energy are intensified. The relationship between eddy activity and the downward mixing of O2arises from the modulation of equatorial turbulence by Tropical Instability Waves via their impacts on the vertical shear. This interaction of processes across scales sustains a local pathway of O2delivery into the equatorial Pacific interior and highlights the need for adequate observations and models of turbulent mixing and mesoscale processes for understanding and predicting the fate of the tropical Pacific O2content in a warmer and more stratified ocean. The eastern tropical Pacific interior is an O2deficient environment, due to intense O2consumption by microbial communities that is not vigorously replenished by ocean circulation at depth. In this study, we use a high resolution simulation of ocean circulation and biogeochemistry to understand the role of finer scale processes such as turbulence and eddies in injecting O2locally. We find that mixing due to turbulence along the equator supplies a key portion of O2into the ocean by exchanging waters between the well‐aerated mixed layer near the surface and the ocean's interior where O2falls precipitously with depth. We also find that this mixing varies considerably with the seasons. This annual cycle in mixing arises from the seasonal variability in wind stress and the passage of eddies, which amplify turbulence through their influence on the subsurface currents along the equator, and represents a previously unexplored but potentially important route of O2delivery into the ocean's interior. As the upper ocean warms and becomes less dense, the ocean's O2content is expected to decrease, and thus observing and accurately modeling these O2pathways will be crucial to monitoring how marine ecosystem habitats will shift in a warmer climate. Mesoscale‐resolving ocean biogeochemistry simulations show vertical mixing is a key source of oxygen to the equatorial Pacific thermoclineThe supply of oxygen by advection and vertical mixing is strongly seasonal and is driven by seasonal variability in the windThe vertical mixing of oxygen is modulated by the wind stress and mesoscale eddy impacts on equatorial shear‐driven turbulence Mesoscale‐resolving ocean biogeochemistry simulations show vertical mixing is a key source of oxygen to the equatorial Pacific thermocline The supply of oxygen by advection and vertical mixing is strongly seasonal and is driven by seasonal variability in the wind The vertical mixing of oxygen is modulated by the wind stress and mesoscale eddy impacts on equatorial shear‐driven turbulence

Reactive atmospheric halogens destroy tropospheric ozone (O3), an air pollutant and greenhouse gas. The primary source of natural halogens is emissions from marine phytoplankton and algae, as well as abiotic sources from ocean and tropospheric chemistry, but how their fluxes will change under climate warming, and the resulting impacts on O3, are not well known. Here, we use an Earth system model to estimate that natural halogens deplete approximately 13% of tropospheric O3in the present-day climate. Despite increased levels of natural halogens through the twenty-first century, this fraction remains stable due to compensation from hemispheric, regional and vertical heterogeneity in tropospheric O3loss. Notably, this halogen-driven O3buffering is projected to be greatest over polluted and populated regions, due mainly to iodine chemistry, with important implications for air quality.

We present airborne observations of the vertical gradient of atmospheric oxygen (δ(O2/N2)) and carbon dioxide (CO2) through the atmospheric boundary layer (BL) over the Drake Passage region of the Southern Ocean, during the O2/N2Ratio and CO2Airborne Southern Ocean Study, from 15 January to 29 February 2016. Gradients were predominately anticorrelated, with excesses of δ(O2/N2) and depletions of CO2found within the boundary layer, relative to a mean reference height of 1.7 km. Through analysis of the molar ratio of the gradients (GR), the behavior of other trace gases measured in situ, and modeling experiments with the Community Earth System Model, we found that the main driver of gradients was air‐sea exchange of O2and CO2driven by biological processes, more so than solubility effects. An exception to this was in the eastern Drake Passage, where positive GRs were occasionally observed, likely due to the dominance of thermal forcing on the air‐sea flux of both species. GRs were more spatially consistent than the magnitudes of the gradients, suggesting that GRs can provide integrated process constraints over broad spatial scales. Based on the model simulation within a domain bounded by 45°S, 75°S, 100°W, and 45°W, we show that the sampling density of the campaign was such that the observed mean GR (± standard error), −4.0± 0.8 mol O2per mol CO2, was a reasonable proxy for both the mean GR and the mean molar ratio of air‐sea fluxes of O2and CO2during the O2/N2Ratio and CO2Airborne Southern Ocean Study. Using an aircraft, we measured changes in atmospheric oxygen and carbon dioxide over the surface of the Southern Ocean. We show that these changes can be used to estimate the relative amounts of oxygen and carbon dioxide that the Southern Ocean exchanges in summer. We present atmospheric boundary layer gradients of oxygen and carbon dioxide over the Southern OceanGradients are driven primarily by air‐sea fluxes due to biological productionThe ratio of these gradients can be used to approximate the flux ratio of the study region

Nephrogenic diabetes insipidus (NDI) is a rare inherited disorder most often caused by mutations in the arginine-vasopressin receptors or aquaporin channels, which subsequently impairs the water reabsorption in the kidney. This case report describes a 15-year-old female diagnosed with NDI after an acute gastroenteritis and multiple fluid boluses leading to intractable emesis. Gene testing reveals our patient is compound heterozygous for novel AQP2gene mutations with a cytosine-to-thymine substitution at nucleotide position 277 and adenine-to-cytosine substitution at nucleotide position 659. Therefore, we report a novel AQP2gene mutation in an adolescent patient which is outside the common age for diagnosis.

For patients with chronic, life-limiting illnesses, admission to the intensive care unit (ICU) near the end of life might not improve patient outcomes or be consistent with patient and family values, goals, and preferences. In this context, advance care planning and palliative care interventions designed to clarify patients' values, goals, and preferences have the potential to reduce provision of high-intensity interventions that are unwanted or non-beneficial. In this Series paper, we have assessed interventions that are effective at helping patients with chronic, life-limiting illnesses to avoid an unwanted ICU admission. The evidence found was largely from observational studies, with considerable heterogeneity in populations, methods, and types of interventions. Results from randomised trials of interventions to improve communication about goals of care are scarce, of variable quality, and mixed. Although observational studies show that advance care planning and palliative care interventions are associated with a reduced number of ICU admissions at the end of life, causality has not been well established. Using the available evidence we suggest recommendations to help to avoid ICU admission when it does not align with patient and family values, goals, and preferences and conclude with future directions for research.

Following Efron (2014), we propose an algorithm for estimating treatment effects for use by researchers employing a regression-discontinuity (RD) design. This algorithm generates a set of estimates of the treatment effect from bootstrapped samples, wherein the polynomial-selection algorithm developed by Pei, Lee, Card, and Weber (2021) is applied to each sample, the average of these RD treatment effect (RDTE) estimates is computed and serves as the overall estimate of the RDTE. Effectively, this procedure estimates a set of plausible RD estimates and weights the estimates by their likelihood of being the best estimate to form a weighted-average estimate. We discuss why this procedure may lower the estimate’s root mean squared error (RMSE). In simulation results, we show that this better performance is achieved, yielding up to a 5% reduction in RMSE relative to PLCW’s method and a 16% reduction in RMSE relative to Calonico, Cattaneo, and Titiunik’s (2014) method for bandwidth selection (with default settings).

Pinatubo erupted during the first decadal survey of ocean biogeochemistry, embedding its climate fingerprint into foundational ocean biogeochemical observations and complicating the interpretation of long‐term biogeochemical change. Here, we quantify the influence of the Pinatubo climate perturbation on externally forced decadal and multi‐decadal changes in key ocean biogeochemical quantities using a large ensemble simulation of the Community Earth System Model designed to isolate the effects of Pinatubo, which cleanly captures the ocean biogeochemical response to the eruption. We find increased uptake of apparent oxygen utilization and preindustrial carbon over 1993–2003. Nearly 100% of the forced response in these quantities are attributable to Pinatubo. The eruption caused enhanced ventilation of the North Atlantic, as evidenced by deep ocean chlorofluorocarbon changes that appear 10–15 years after the eruption. Our results help contextualize observed change and contribute to improved constraints on uncertainty in the global carbon budget and ocean deoxygenation. Oceanographers' understanding of ocean properties comes from research cruises that take scientific measurements in the same locations every ten years. However, the first of these research cruises were deployed just after a large volcanic eruption in 1991 called Pinatubo. The eruption cooled the planet for several years, including the upper ocean. Here, we investigate how this eruption affected ocean properties using two collections of simulations of the Community Earth System Model which is a mathematical representation of the Earth system. The first collection of simulations shows the response to the eruption, while the second collection shows how ocean properties would have changed if there had been no eruption. The difference thus tell us the influence of the eruption on ocean properties. We find an increase of oxygen and preindustrial carbon over 1993–2003 due to Pinatubo, as well as an increase of ventilation of the North Atlantic that appears years after the eruption. Using a large ensemble model, we quantify the impact of Pinatubo on observed, externally forced decadal changes in ocean biogeochemistryNearly 100% of forced changes in apparent oxygen utilization and preindustrial carbon over 1993–2003 are attributable to PinatuboImpacts of Pinatubo last several decades, affecting interpretation of anthropogenic changes from physical and biogeochemical observations Using a large ensemble model, we quantify the impact of Pinatubo on observed, externally forced decadal changes in ocean biogeochemistry Nearly 100% of forced changes in apparent oxygen utilization and preindustrial carbon over 1993–2003 are attributable to Pinatubo Impacts of Pinatubo last several decades, affecting interpretation of anthropogenic changes from physical and biogeochemical observations

Families living with mitochondrial diseases (MD) often endure prolonged diagnostic journeys and invasive testing, yet many remain without a molecular diagnosis. The Australian Genomics Mitochondrial flagship, comprising clinicians, diagnostic, and research scientists, conducted a prospective national study to identify the diagnostic utility of singleton genomic sequencing using blood samples.

Zone 2 flexor tendon repair has been historically associated with poor outcomes, mainly due to stiffness. In an effort to minimize adhesions, accommodate flexor digitorum profundus and flexor digitorum superficialis bulk, and prevent bowstringing, we have developed a novel approach to flexor tendon repair that relies on aggressive flexor tendon pulley release and pulley reconstruction with acellular dermal matrix. This technique leverages the antiadhesive properties and high tensile strength of acellular dermal matrix to maximize gliding and prevent bowstringing. Here we describe the details of our technique and illustrate a case where this technique was employed.