Generative Artificial Intelligence and Prompt Engineering: A Primer for Orthopaedic Surgeons.

¼ Generative artificial intelligence (AI), a rapidly evolving field, has the potential to revolutionize orthopedic care by enhancing diagnostic accuracy, treatment planning, and patient management through data-driven insights and personalized strategies.¼ Unlike traditional AI, generative AI has the potential to generate relevant information for orthopaedic surgeons when instructed through prompts, automating tasks such as literature reviews, streamlining workflows, predicting health outcomes, and improving patient interactions.¼ Prompt engineering is essential for crafting effective prompts for large language models (LLMs), ensuring accurate and reliable AI-generated outputs, and promoting ethical decision-making in clinical settings.¼ Orthopaedic surgeons can choose between various prompt types-including open-ended, focused, and choice-based prompts-to tailor AI responses for specific clinical tasks to enhance the precision and utility of generated information.¼ Understanding the limitations of LLMs, such as token limits, context windows, and hallucinations, is crucial for orthopaedic surgeons to effectively use generative AI while addressing ethical concerns related to bias, privacy, and accountability.

Management of distal cholangiocarcinoma with arterial involvement: Systematic review and case series on the role of neoadjuvant therapy.

BACKGROUND: The use of neoadjuvant therapy (NAT) in distal cholangiocarcinoma (dCCA) with regional arterial or extensive venous involvement, is not widely accepted and evidence is sparse. AIM: To synthesise evidence on NAT for dCCA and present the experience of a high-volume tertiary-centre managing dCCA with arterial involvement. METHODS: A systematic review was performed according to PRISMA guidance to identify all studies reporting outcomes of patients with dCCA who received NAT. All patients from 2017 to 2022 who were referred for NAT for dCCA at our centre were retrospectively collected from a prospectively maintained database. Baseline characteristics, NAT type, progression to surgery and oncological outcomes were collected. RESULTS: Twelve studies were included. The definition of "unresectable" locally advanced dCCA was heterogenous. Four studies reported outcomes for 9 patients who received NAT for dCCA with extensive vascular involvement. R0 resection rate ranged between 0 and 100% but without survival benefit in most cases. Remaining studies considered either NAT in resectable dCCA or inclusive with extrahepatic CCA. The presented case series includes 9 patients (median age 67, IQR 56-74 years, male:female 5:4) referred for NAT for borderline resectable or locally advanced disease. Three patients progressed to surgery and 2 were resected. One patient died at 14 months with evidence of recurrence at 6 months and the other died at 51 months following recurrence 6 months post-operatively. CONCLUSION: Evidence for benefit of NAT is limited. Consensus on criteria for uniform definition of resectability for dCCA is required. We propose using the established National-Comprehensive-Cancer-Network® criteria for pancreatic ductal adenocarcinoma.

Oral but Not Topical Sodium Bicarbonate Improves Repeated Sprint Performance During Simulated Soccer Match Play Exercise in Collegiate Athletes.

This study investigated the effect of oral and topical sodium bicarbonate (SB) on soccer-specific performance during simulated soccer exercise. In a block randomized, double-blind, crossover design, 10 collegiate male soccer players (stature: 181.7 ± 3.2 cm, body mass: 81.7 ± 10.5 kg) performed soccer-specific performance tests (countermovement jumps, Illinois agility, 8 × 25 m repeated sprints) throughout a 90-min soccer-specific aerobic field test (SAFT90) following 0.3 g/kg body mass SB in capsules (SB-ORAL), 0.9036 g/kg body mass PR Lotion (SB-LOTION), or placebo capsules and lotion (PLA). Soccer-specific performance tests were conducted pre-SAFT90, during half-time and post-SAFT90. Blood samples were analyzed for acid-base balance (pH; bicarbonate, HCO3-) and strong ions (sodium, Na+; potassium, K+). Average sprint times were quicker for SB-ORAL than PLA during half-time (3.7%; p = .049; g = .57) and post-SAFT90 (4.9%; p = .041; g = .66). SB-ORAL increased pH and HCO3- prewarm-up and during half-time (p < .05), and lowered K+ during half-time (p = .035) compared with PLA. SB-LOTION increased pH (p = .019) and lowered K+ (p = .012) during half-time compared with PLA. SB-LOTION increased Na+ postexercise compared with PLA (p = .008). Repeated sprint times during simulated soccer exercise improved for SB-ORAL, which might have been mechanistically underpinned by elevated blood buffering capacity and greater regulation of strong ion concentration. Consuming SB in capsules is a more effective strategy than topical SB application for improving blood buffering capacity and repeated sprint performance throughout competitive soccer matches.

Contemporary Themes in Dietary Intake in Rugby Union Players: A Narrative Review.

Rugby union is an intermittent team sport with variability in body composition and match-play demands between positions which requires careful consideration for individual dietary requirements. While previous reviews have detailed the macronutrient intake in rugby players, none have discussed the further determinants of dietary intake in this population. Therefore, the purpose of the current review was to summarise the current evidence detailing dietary intake in rugby union players, report on contemporary nutritional research themes, and provide recommendations for athletes, nutritionists, and other stakeholders. In total, eighteen articles report on dietary intake in rugby players, with only one of these detailing dietary intake in female athletes. Recent studies have reported on both protein and carbohydrate periodisation practices in rugby union players; however, there is currently limited evidence as to the influence of these on performance, recovery, and well-being. Factors influencing eating patterns, the impact of sports nutritionists on dietary intake, and food consumption in catered and non-catered environments has been explored in isolated studies. Nutrition knowledge levels in rugby players have been reported in several studies; however, the influence this has on dietary intake in rugby players is unknown. Collectively, despite new contemporary themes emerging in the literature concerning dietary intake in rugby players, the studies are isolated; as such, there is limited scope to the translatability of information due to heterogeneity in sex, level of play, and location of participants. Given this, future research should aim to build upon the themes identified in this review in combination to support practitioners working within their specific environments. This will subsequently build towards the generation of rugby-specific recommendations.

Neither an Individualised Nor a Standardised Sodium Bicarbonate Strategy Improved Performance in High-Intensity Repeated Swimming, or a Subsequent 200 m Swimming Time Trial in Highly Trained Female Swimmers.

Inconsistent swimming performances are often observed following sodium bicarbonate (NaHCO3) ingestion, possibly because the time taken to reach peak blood buffering capacity is highly variable between individuals. Personalising NaHCO3 ingestion based on time-to-peak blood bicarbonate (HCO3-) could be a solution; however, this strategy is yet to be explored in swimming, or adequately compared to standardised NaHCO3 approaches. Therefore, six highly trained female swimmers ingested 0.3 g·kg BM-1 NaHCO3 in capsules to pre-determine their individual time-to-peak blood HCO3-. They then participated in three experimental trials, consisting of a 6 × 75 m repeated sprint swimming test, followed by a 200 m maximal time trial effort after 30 min active recovery. These experiments were conducted consuming a supplement at three different timings: individualised NaHCO3 (IND: 105-195 min pre-exercise); standardised NaHCO3 (STND: 150 min pre-exercise); and placebo (PLA: 90 min pre-exercise). Both NaHCO3 strategies produced similar increases in blood HCO3- prior to exercise (IND: +6.8 vs. STND: +6.1 mmol·L-1, p < 0.05 vs. PLA) and fully recovered blood HCO3- during active recovery (IND: +6.0 vs. STND: +6.3 mmol·L-1 vs. PLA, p < 0.05). However, there were no improvements in the mean 75 m swimming time (IND: 48.2 ± 4.8 vs. STND: 48.9 ± 5.8 vs. PLA: 49.1 ± 5.1 s, p = 0.302) nor 200 m maximal swimming (IND: 133.6 ± 5.0 vs. STND: 133.6 ± 4.7 vs. PLA: 133.3 ± 4.4 s, p = 0.746). Regardless of the ingestion strategy, NaHCO3 does not appear to improve exercise performance in highly trained female swimmers.

Harnessing the Power of Generative Artificial Intelligence in Pathology Education.

CONTEXT.­: Generative artificial intelligence (AI) technologies are rapidly transforming numerous fields, including pathology, and hold significant potential to revolutionize educational approaches. OBJECTIVE.­: To explore the application of generative AI, particularly large language models and multimodal tools, for enhancing pathology education. We describe their potential to create personalized learning experiences, streamline content development, expand access to educational resources, and support both learners and educators throughout the training and practice continuum. DATA SOURCES.­: We draw on insights from existing literature on AI in education and the collective expertise of the coauthors within this rapidly evolving field. Case studies highlight practical applications of large language models, demonstrating both the potential benefits and unique challenges associated with implementing these technologies in pathology education. CONCLUSIONS.­: Generative AI presents a powerful tool kit for enriching pathology education, offering opportunities for greater engagement, accessibility, and personalization. Careful consideration of ethical implications, potential risks, and appropriate mitigation strategies is essential for the responsible and effective integration of these technologies. Future success lies in fostering collaborative development between AI experts and medical educators, prioritizing ongoing human oversight and transparency to ensure that generative AI augments, rather than supplants, the vital role of educators in pathology training and practice.

Losartan alters osteoblast differentiation and increases bone mass through inhibition of TGFB signalling in vitro and in an OIM mouse model.

Excessive production of Transforming Growth Factor ß (TGFß) is commonly associated with dominant and recessive forms of OI. Previous reports have indicated that administration of TGFß-targeted antibodies maybe of potential therapeutic benefit to OI patients. However, direct targeting of TGFß is likely to cause multiple adverse effects including simulation of autoimmunity. In the current study we use patient-derived normal and OI fibroblasts, osteoblasts and OIM mouse models to determine the effects of Losartan, an angiotensin II receptor type 1 (AT1) antagonist, on TGFß signalling and bone morphology in OI. In OIM mice bred on a mixed background administration of 0.6 g/L losartan for 4 weeks was associated with a significant reduction in TGFß from 79.2 g/L in the control to 60.0 ng/ml following losartan (p < 0.05), reduced osteoclast activity as measured by CTX from 275.9 ng/ml in the control to 157.2 ng/ml following 0.6 g/L of losartan (p < 0.05) and increased cortical bone thickness (P < 0.001). Furthermore in OIM mice bred on a C57BL/6 background 0.6 g/L losartan increased trabecular bone volume in the tibiae (P < 0.05) and the vertebrae (P < 0.01), increased cortical bone thickness (P < 0.001) reduced the trabecular pattern factor (P < 0.01 and P < 0.001 for the tibiae and vertebrae respectively), reduced osteoclast (P < 0.05) and osteoblast (P < 0.01) numbers as well as reducing the area of bone covered by these cell types. Interestingly, losartan did not affect immune cells infiltrating into bone, nor did this drug alter TGFß signalling in normal or OI fibroblasts. Instead, losartan reduced SMAD2 phosphorylation in osteoblasts, inhibiting their ability to differentiate. Our data suggest that losartan may be an effective treatment for the bone-associated dysmorphia displayed in OI whilst minimising potential adverse immune cell-related effects.

The Effects of a Novel Sodium Bicarbonate Ingestion System on Repeated 4 km Cycling Time Trial Performance in Well-Trained Male Cyclists.

BACKGROUND: A novel sodium bicarbonate (SB) product has come to market named the "Bicarb System" (M-SB; Maurten AB, Gothenburg, Sweden). It claims to minimise gastrointestinal (GI) discomfort whilst still improving exercise performance. AIM: To investigate the effects of M-SB ingestion on repeated 4 km cycling time trials (TT1 and TT2) in well-trained male cyclists. METHODS: The study recruited ten well-trained cyclists (maximal oxygen uptake ( V ˙ O 2 max ): 67 ± 4 ml kg-1 min-1 BM; peak power output (PPO) at V ˙ O 2 max : 423 ± 21 W) to take part in this randomised, crossover and double-blinded study. Following one visit to determine V ˙ O 2 max , participants completed a second visit to identify individual time to peak blood bicarbonate (HCO3-) (ITTP) in a rested state. Visit three was a familiarisation trial mimicking the experimental procedures. Visits four to seven consisted of completing 2 × 4 km cycling TTs separated by 45 min passive recovery, following one of either: 0.3 g kg-1 BM M-SB, 0.21 g kg-1 BM sodium chloride (placebo; PLA) in vegetarian capsules (size 00), or a control trial (CON). Supplements (M-SB or placebo) were ingested pre-exercise at their respective ITTP. RESULTS: Performance in TT1 was faster in the M-SB condition compared with TT1 in CON (- 5.1 s; p = 0.004) and PLA (- 3.5 s; p < 0.001). In TT2, performance was also significantly faster in the M-SB condition compared with CON (- 4.4 s; p = 0.018) or PLA (- 4.1 s; p = 0.002). Total aggregated GI symptoms were generally low and not significantly different between PLA and the M-SB conditions for a range of symptoms. CONCLUSIONS: The ingestion of M-SB improves repeated 4 km cycling TT performance and the recovery of acid-base balance between bouts, whilst causing minimal GI discomfort.

Reduction in kidney function decline and risk of severe clinical events in agalsidase beta-treated Fabry disease patients: a matched analysis from the Fabry Registry.

Background: Patients with Fabry disease (FD, α-galactosidase A deficiency or absence) accumulate glycosphingolipids, leading to progressive dysfunction of kidneys, heart and nervous system. Generalizable real-world outcomes following agalsidase beta treatment initiation outside trials are limited. We investigated the associations of long-term agalsidase beta treatment with estimated glomerular filtration rate (eGFR) changes over time and the risk of developing a composite clinical event in a matched analysis of treated and untreated patients with FD. Methods: Agalsidase beta-treated adult patients (aged ≥16 years) from the Fabry Registry and adult untreated patients from a natural history cohort were matched 1:1 and X:X (with one occurrence and multiple occurrences of each untreated patient, respectively) by sex, phenotype, age and (for eGFR slope analysis) baseline eGFR. Outcomes included eGFR slope over 5 years and composite clinical event risk (cardiovascular, cerebrovascular or renal event, or death) over 10+ years. As a surrogate indicator of therapeutic response in paediatric patients, the percentage experiencing normalization in plasma globotriaosylceramide (GL-3) from treatment initiation was assessed in patients aged 2 to <16 years. Results: Overall, eGFR slopes for 1:1-matched untreated and treated adult patients [122 pairs (72.1% male)] were -3.19 and -1.47 mL/min/1.73 m2/year, respectively (reduction in rate of decline = 53.9%, P = .007), and for X:X-matched [122 untreated/950 treated (59.4% male)] were -3.29 and -1.56 mL/min/1.73 m2/year, respectively (reduction in rate of decline = 52.6%, P < .001). Agalsidase beta treatment was associated with lower risk of clinical events, with hazard ratios of 0.41 (P = .003) and 0.67 (P = .008) for 1:1-matched and X:X-matched analyses, respectively. Plasma GL-3 declined markedly in paediatric patients and normalized in most within 6 months of treatment initiation. Conclusion: Agalsidase beta treatment preserves kidney function and delays progression to severe clinical events among adult patients with FD. Plasma GL-3 levels analysed in paediatric patients showed normalization of elevated pre-treatment levels in most patients.

Enhancing exercise performance and recovery through sodium bicarbonate supplementation: introducing the ingestion recovery framework.

Sodium bicarbonate (SB) supplementation is an ergogenic strategy for athletes competing in high-intensity exercise, but the efficacy of SB for accelerating recovery from exercise and thus improving performance during repeated bouts of exercise is not fully understood. In a similar fashion to using SB as a pre-exercise buffer, it is possible accelerated restoration of blood pH and bicarbonate following an exercise bout mechanistically underpins the use of SB as a recovery aid. Physiological mechanisms contributing to beneficial effects for SB during repeated bout exercise could be more far-reaching however, as alterations in strong ion difference (SID) and attenuated cellular stress response might also contribute to accelerated recovery from exercise. From inspection of existing literature, ingestion of 0.3 g kg-1 body mass SB ~60-90 min pre-exercise seems to be the most common dosage strategy, but there is evidence emerging for the potential application of post-exercise supplementation timing, gradual SB doses throughout a competition day, or even ingestion during exercise. Based on this review of literature, an SB ingestion recovery framework is proposed to guide athletes and practitioners on the use of SB to enhance performance for multiple bouts of exercise.

Effects of Dietary Nitrate Supplementation on High-Intensity Cycling Sprint Performance in Recreationally Active Adults: A Systematic Review and Meta-Analysis.

This systematic review and meta-analysis investigated the influence of dietary nitrate supplementation on performance metrics during cycling sprint exercise according to the PRISMA guidelines. Searches were conducted on MEDLINE, PubMed, ScienceDirect, Scopus, and SPORTDiscus databases up to September 2023. Inclusion criteria were healthy recreationally active men and women who consumed nitrate-rich and nitrate-deficient beetroot juice to assess performance outcomes of mean power, peak power, time-to-peak power, and minimum power during 30-s cycling sprints. Risk of bias was assessed using the Cochrane Risk of Bias 2 and TESTEX tools and funnel plots. A random effects model was performed on six studies and showed that dietary nitrate had significant effects on time-to-peak power (SMD: -0.66, 95% CI: -1.127 to -0.192, p = 0.006) but not on mean power, peak power, or minimum power. Subgroup analysis revealed that an acute low nitrate dose improved time-to-peak power (SMD: -0.977, 95% CI: -1.524 to -0.430, p < 0.001) but not after a multiday moderate nitrate dose (SMD: -0.177, 95% CI: -0.619 to -0.264, p = 0.431). These data suggest that acute nitrate supplementation can benefit time-to-peak power during 30-s cycling sprints, but due to the limited availability of data and heterogeneity in methodology, these results should be interpreted with caution. There was insufficient data on women to analyze sex-based differences. Future studies are required to provide insight on how supplementation regimen and population impact the effects of dietary nitrate for enhancing cycling sprint performance.

Grasp Posture Variability Leads to Greater Ipsilateral Sensorimotor Beta Activation During Simulated Prosthesis Use.

Motor behaviour using upper-extremity prostheses of different levels is greatly variable, leading to challenges interpreting ideal rehabilitation strategies. Elucidating the underlying neural control mechanisms driving variability benefits our understanding of adaptation after limb loss. In this follow-up study, non-amputated participants completed simple and complex reach-to-grasp motor tasks using a body-powered transradial or partial-hand prosthesis simulator. We hypothesised that under complex task constraints, individuals employing variable grasp postures will show greater sensorimotor beta activation compared to individuals relying on uniform grasping, and activation will occur later in variable compared to uniform graspers. In the simple task, partial-hand variable and transradial users showed increased neural activation from the early to late phase of the reach, predominantly in the hemisphere ipsilateral to device use. In the complex task, only partial-hand variable graspers showed a significant increase in neural activation of the sensorimotor cortex from the early to the late phase of the reach. These results suggest that grasp variability may be a crucial component in the mechanism of neural adaptation to prosthesis use, and may be mediated by device level and task complexity, with implications for rehabilitation after amputation.

A Phanerozoic gridded dataset for palaeogeographic reconstructions.

Global Plate Models are widely used in the Earth Sciences to reconstruct the past geographic position of geological and palaeontological samples. However, the application of Global Plate Models to retrieve 'palaeocoordinates' is not trivial. Different Global Plate Models exist which vary in their complexity, spatiotemporal coverage, reference frame, and intended use. Consequently, careful consideration of which models are appropriate for any given research question is required. Here, we document and provide access to reconstruction datasets for five Global Plate Models in the palaeomagnetic reference frame. These datasets provide 'true' palaeolatitudes for three discrete global grids reconstructed at one-million-year intervals throughout the Phanerozoic (540-0 Ma), offering three key benefits for the Earth Science community: (1) allow users to look up palaeocoordinates for their samples (e.g. fossil occurrences) through simple indexing without having to learn additional software packages; (2) provide palaeocoordinates which have been generated consistently with thorough documentation; (3) provide static files which preserve model output and which can be used to evaluate palaeogeographic differences between Global Plate Models.

Let's talk about sex: instructor views and hesitancies related to sex and gender in the biology classroom.

There is much current debate in the US regarding how sex and gender are approached in science and medical classrooms. There does not seem to be sufficient consensus around why it must be taught and how it should be implemented. State-enacted restrictions to both education and healthcare in recent years demonstrate the relevance and importance of sex and gender in the college classroom, not only including but especially in the biology classroom. Given the areas comprising the Society for Integrative and Comparative Biology (SICB), these topics of sex and gender in biology instruction are incredibly salient to our members. Thus, this survey aimed to determine instructors' views of and experiences with sex-diverse gender-inclusive biology. College-level biology instructors who are members of SICB were surveyed about their views of science, views of sex and gender, teaching philosophy, and their experiences with inclusive teaching and with sex-diverse gender-inclusive teaching. The resulting data lead us to implore academic biology to provide more sex-diverse and gender-inclusive teaching tools and resources to educators, while minimizing potential fear of retaliation and backlash to instructors who utilize these teaching methods.

The Physiologic Complexity of Prefrontal Oxygenation Dynamics Is Associated With Age and Executive Function: An Exploratory Study.

BACKGROUND: The hemodynamics of prefrontal cortex (PFC) oxygenation are regulated by numerous processes operating over multiple temporal scales, producing complex patterns in its output fluctuations. Age may alter this multiscale regulation of PFC oxygenation, leading to diminished physiologic complexity of this important regulatory process. We aimed to characterize the effects of age on such complexity and its relationship to performance of an executive n-back task. METHODS: Twenty-four younger (aged 28 ±â€…3 years) and 27 older (aged 78 ±â€…6 years) adults completed this study. Continuous oxygenation (HbO2) and deoxygenation (HHb) signals of PFC were recorded using functional near-infrared spectroscopy (fNIRS) while participants stood and watched a blank screen (blank), clicked a mouse when an X appeared (IdX), or when a letter was repeated from "2-back" in a sequence shown on a screen (2-back). We used multiscale entropy to quantify the HbO2 and HHb complexity of fNIRS signals. RESULTS: Older adults exhibited lower HbO2 and HHb complexity compared to younger adults, regardless of task (p = .0005-.002). Both groups exhibited greater complexity during the IdX and 2-back than blank task (p = .02-.04). Across all participants, those with greater HbO2 and/or HHb complexity during the blank task exhibited faster IdX and 2-back reaction time (ß = -0.56 to -0.6, p = .009-.02). Those demonstrating greater increase in HbO2 and/or HHb complexity from IdX to 2-back task had lower percent increase in reaction time from IdX to 2-back task (ß = -0.41 to -0.37, p = .005-.01). CONCLUSIONS: The complexity of fNIRS-measured PFC oxygenation fluctuations may capture the influence of aging on the regulation of prefrontal hemodynamics involved in executive-function-based task performance.

Secondary Surgery Following Lapidus Bunionectomy.

While the Lapidus bunionectomy is a common procedure utilized to address hallux valgus, the incidence of secondary surgery is not well established. Our primary goal was to determine the incidence of revision surgery and hardware removal following the Lapidus bunionectomy in addition to the risk factors associated with each. A retrospective nested case-control study of adult patients who underwent a Lapidus bunionectomy for symptomatic hallux valgus over a 9-year period was performed. The incidence rates and 95% confidence intervals (CI) of secondary surgery in the 3 years following the procedure along with the estimated independent associations and odds ratios between baseline demographic, clinical, and radiographic characteristics were calculated. Of the original cohort of 2540 patients, 127 were identified (5.0%; CI: 4.1%, 5.8%) who underwent revision surgery and 165 (6.5%; CI: 5.5%, 7.5%) who underwent hardware removal following Lapidus bunionectomy. Initially, the hallux valgus angle, intermetatarsal angle, and tibial sesamoid position were risk factors for revision surgery. However, in adjusted analyses for revision surgery, using a screw for third point of fixation emerged as the only independent risk factor (odds ratio [OR] = 3.01; CI: 1.59, 5.69). In adjusted analyses for hardware removal, female sex (OR = 2.33; CI: 1.08, 5.00) and third point of fixation (OR = 2.92; CI: 1.82, 4.69) emerged as independent risk factors. While the overall risks associated with Lapidus bunionectomy are low and the need for revision surgery are low, this study helps to identify specific risk factors for secondary surgery and hardware removal to help in evaluation and discussion with patients.

Incorporating Sex-Diverse and Gender-Inclusive Perspectives in Higher Education Biology Courses.

Inclusive teaching is teaching in a way that reaches all students in the classroom; this is beneficial for everyone and particularly for those with minoritized identities. Instructors play a critical role in scaffolding how students are exposed to and learn science content in the classroom. In this manuscript we discuss how biology instructors can make their classrooms more inclusive with regard to sex and gender diversity content. Many topics in biology are based on androcentric, heteronormative, and oppressive framing, even though those lenses are more reflective of our own history and culture than they are of the diversity we see in nature. Here, we summarize information presented in the SICB 2024 workshop titled "Incorporating sex diversity and gender inclusivity in biology undergraduate classrooms" and provide instructors with a) rationale for why inclusive teaching matters, b) guidance on how to challenge unscientific views and make their curricula more sex-diverse and gender inclusive, and c) practical and easy-to-implement strategies for discussing "contentious" topics in the classroom. Incorporation of this material will be beneficial for students, for science and medicine, and for accurately representing the diversity found across the tree of life.

Virtual Remote Pathology Education in Support of Virtual Remote Gynecologic-Oncology Training: The Open Pathology Education Network Pilot Proof of Concept Experience.

CONTEXT.­: The subspecialty workforce in pathology globally is inadequate for the demands of many modern therapies. The Open Pathology Education Network (OPEN) was formed to augment the global pathology workforce. The International Gynecologic Cancer Society (IGCS) virtual gynecologic-oncology (gyn-onc) fellowship training identified needs for higher-level pathology support. OBJECTIVE.­: To report on an OPEN-IGCS pilot project to support gyn-onc and pathology education efforts in a developing country. DESIGN.­: Curriculum with learning objectives and content from open sources was assembled. Mentoring sessions included bidirectional case sharing. Trainees received sequential curricula assignments and had options for communication outside mentoring sessions. Pretest and posttest digital slide assessments were included. Mentors attended the gynecology tumor board, allowing for the assessment of quality and accuracy of pathology diagnosis for cases discussed. RESULTS.­: Learners completing the pretest and posttest showed substantial improvement, with 2 practicing pathologists improving their diagnostic scores from 60% to an average of 95%. A third trainee-level participant also improved, but to a lesser degree. Qualitative assessments included increased confidence in presentation and an increased ability to anticipate questions, raise issues of expanded differential diagnoses, and articulate appropriate workup. Observations of clinicians who participated also noted increased confidence in participating pathologists. Secondary value included establishing an expanded network of support in other subspecialties for participants. Pathologic issues at the tumor board decreased, from more than 50% in the first 3 months of study to 0% in the last 3 months of study. The curriculum was embedded into a self-paced learning portal at courses.open-pathology.org. CONCLUSIONS.­: The OPEN-IGCS collaboration model shows the potential to provide subspecialty pathology training remotely.

Early Jurassic origin of avian endothermy and thermophysiological diversity in dinosaurs.

A fundamental question in dinosaur evolution is how they adapted to long-term climatic shifts during the Mesozoic and when they developed environmentally independent, avian-style acclimatization, becoming endothermic.1,2 The ability of warm-blooded dinosaurs to flourish in harsher environments, including cold, high-latitude regions,3,4 raises intriguing questions about the origins of key innovations shared with modern birds,5,6 indicating that the development of homeothermy (keeping constant body temperature) and endothermy (generating body heat) played a crucial role in their ecological diversification.7 Despite substantial evidence across scientific disciplines (anatomy,8 reproduction,9 energetics,10 biomechanics,10 osteohistology,11 palaeobiogeography,12 geochemistry,13,14 and soft tissues15,16,17), a consensus on dinosaur thermophysiology remains elusive.1,12,15,17,18,19 Differential thermophysiological strategies among terrestrial tetrapods allow endotherms (birds and mammals) to expand their latitudinal range (from the tropics to polar regions), owing to their reduced reliance on environmental temperature.20 By contrast, most reptilian lineages (squamates, turtles, and crocodilians) and amphibians are predominantly constrained by temperature in regions closer to the tropics.21 Determining when this macroecological pattern emerged in the avian lineage relies heavily on identifying the origin of these key physiological traits. Combining fossils with macroevolutionary and palaeoclimatic models, we unveil distinct evolutionary pathways in the main dinosaur lineages: ornithischians and theropods diversified across broader climatic landscapes, trending toward cooler niches. An Early Jurassic shift to colder climates in Theropoda suggests an early adoption of endothermy. Conversely, sauropodomorphs exhibited prolonged climatic conservatism associated with higher thermal conditions, emphasizing temperature, rather than plant productivity, as the primary driver of this pattern, suggesting poikilothermy with a stronger dependence on higher temperatures in sauropods.