Preoperative anxiety and depression symptoms are associated with poorer clinical outcomes following corrective surgery for adult equinocavovarus foot

PurposeThis study aimed to investigate the preoperative psychological status of adult patients with equinocavovarus foot deformity and to examine the association between preoperative anxiety/depressive symptoms and the clinical outcomes of corrective surgery in this population.MethodsA retrospective analysis was conducted on 103 adult patients who underwent corrective surgery for equinocavovarus foot at Xi’an Honghui Hospital between March 2014 and July 2023. Baseline data were collected. Patient psychological status, ankle-hindfoot function, pain, and quality of life were assessed preoperatively and at the final follow-up using the Hospital Anxiety and Depression Scale (HADS), the American Orthopedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, the Visual Analog Scale (VAS), and the 36-Item Short Form Health Survey (SF-36). Based on preoperative HADS scores, patients were categorized into an anxiety/depression group (Group A) and a non-anxiety/depression group (Group B). The two groups were compared with respect to baseline characteristics (gender, age, disease duration, BMI, follow-up duration), clinical outcomes, and the degree of improvement in all assessment metrics.ResultsA total of 83 patients completed the follow-up, among whom 38 (45.78%) exhibited preoperative anxiety/depression symptoms. No significant differences were found in baseline characteristics between the two groups (all P > 0.05). At the final follow-up, both groups showed significant improvement in VAS, AOFAS, SF-36 (PCS/MCS), and HADS (A/D) scores compared to their preoperative baselines (all P < 0.001). Intergroup comparisons revealed that Group A had significantly lower AOFAS and SF-36 (PCS/MCS) scores, and significantly higher VAS and HADS (A/D) scores than Group B, both preoperatively and at the final follow-up (all P < 0.001). Regarding the degree of improvement, Group A demonstrated a smaller magnitude of improvement in VAS (P < 0.01), AOFAS (P < 0.01), and SF-36 PCS (P < 0.001) compared to Group B. Conversely, Group A showed a greater improvement in SF-36 MCS and HADS (A/D) scores (all P < 0.001).ConclusionsWhile surgery improved all outcomes, patients with preoperative anxiety/depression exhibited persistently worse clinical scores. Their improvement profile was distinct: smaller gains in pain and physical function but greater mental health improvement. Addressing preoperative psychological status may optimize comprehensive outcomes.

Amyloid-β-driven glymphatic dysfunction in Alzheimer’s disease model mice is driven by Ca2+-mediated increases in astrocytic cholesterol

Nature Neuroscience, Published online: 15 April 2026; doi:10.1038/s41593-026-02261-9

This study uncovers how amyloid-β boosts astrocyte calcium activity, increasing cholesterol and disrupting brain waste clearance in an Alzheimer’s disease mouse model. Targeting astrocyte calcium or cholesterol restores clearance and improves cognition.

Call for expert – Research & report on deinstitutionalisation and psychosocial disabilities in Europe

Seeking an expert to support the development of a study on deinstitutionalisation (DI) and psychosocial disabilities in Europe, exploring how mental health systems and disability-inclusive policies can be better aligned at the EU level.

The post Call for expert – Research & report on deinstitutionalisation and psychosocial disabilities in Europe appeared first on Mental Health Europe.

No one’s sure if synthetic mirror life will kill us all

For four days in February 2019, some 30 synthetic biologists and ethicists hunkered down at a conference center in Northern Virginia to brainstorm high-risk, cutting-­edge, irresistibly exciting ideas that the National Science Foundation should fund. By the end of the meeting, they’d landed on a compelling contender: making “mirror” bacteria. Should they come to be, the lab-created microbes would be structured and organized like ordinary bacteria, with one important exception: Key biological molecules like proteins, sugars, and lipids would be the mirror images of those found in nature. DNA, RNA, and many other components of living cells are chiral, which means they have a built-in rotational structure. Their mirrors would twist in the opposite direction. 

Researchers thrilled at the prospect. “Everybody—everybody—thought this was cool,” says John Glass, a synthetic biologist at the J. Craig Venter Institute in La Jolla, California, who attended the 2019 workshop and is a pioneer in developing synthetic cells. It was “an incredibly difficult project that would tell us potentially new things about how to design and build cells, or about the origin of life on Earth.” The group saw enormous potential for medicine, too. Mirror microbes might be engineered as biological factories, producing mirror molecules that could form the basis for new kinds of drugs. In theory, such therapeutics could perform the same functions as their natural counterparts, but without triggering unwelcome immune responses. 

After the meeting, the biologists recommended NSF funding for a handful of research groups to develop tools and carry out preliminary experiments, the beginnings of a path through the looking glass. The excitement was global. The National Natural Science Foundation of China funded major projects in mirror biology, as did the German Federal Ministry of Research, Technology, and Space.

By five years later, in 2024, many researchers involved in that NSF meeting had reversed course. They’d become convinced that in the worst of all possible futures, mirror organisms could trigger a catastrophic event threatening every form of life on Earth; they’d proliferate without predators and evade the immune defenses of people, plants, and animals. 

“I wish that one sunny afternoon we were having coffee and we realized the world’s about to end, but that’s not what happened.”

Kate Adamala, synthetic biologist, University of Minnesota

Over the past two years, they’ve been ringing alarm bells. They published an article in Science in December 2024, accompanied by a 299-page technical report addressing feasibility and risks. They’ve written essays and convened panels and cofounded the Mirror Biology Dialogues Fund (MBDF), a broadly funded nonprofit charged with supporting work on understanding and addressing the risk. The issue has received a blaze of media attention and ignited dialogues among not only chemists and synthetic biologists but also bioethicists and policymakers.  

What’s received less attention, however, is how we got here and what uncertainties still remain about any potential threat. Creating a mirror-life organism would be tremendously complicated and expensive. And although the scientific community is taking the alarm seriously, some scientists doubt whether it’s even possible to create a mirror organism anytime soon. “The hypothetical creation of mirror-­image organisms lies far beyond the reach of present-day science,” says Ting Zhu, a molecular biologist at Westlake University, in China, whose lab focuses on synthesizing mirror-image peptides and other molecules. He and others have urged colleagues not to let speculation and anxiety guide decision-making and argued that it’s premature to call for a broad moratorium on early-stage research, which they say could have medical benefits. 

But the researchers who are raising flags describe a pathway, even multiple pathways, to bringing mirror life into existence—and they say we urgently need guardrails to figure out what kinds of mirror-biology research might still be safe. That means they’re facing a question that others have encountered before, multiple times over the last several decades and with mixed results—one that doesn’t have a neat home in the scientific method. What should scientists do when they see the shadow of the end of the world in their own research? 

Looking-glass life

The French chemist and microbiologist Louis Pasteur was the first to recognize that biological molecules had built-in handedness. In the late 19th century, he described all living species as “functions of cosmic asymmetry.” What would happen, he mused, if one could replace these chiral components with their mirror opposites? 

Scientists now recognize that chirality is central to life itself, though no one knows why. In humans, 19 of the 20 so-called “standard” amino acids that make up proteins are chiral, and all in the same way. (The outlier, glycine, is symmetrical.) The functions of proteins are intricately tied to their shapes, and they mostly interact with other molecules through chiral structures. Almost all receptors on the surface of a cell are chiral. During an infection, the immune system’s sentinels use chirality to detect and bind to antigens—substances that trigger an immune response—and to start the process of building antibodies. 

By the late 20th century, researchers had begun to explore the idea of reversing chirality. In 1992, one team reported having synthesized the first mirror-image protein. That, in turn, set off the first clarion call about the risk: In response to the discovery, chemists at Purdue University pointed out, briefly, that mirror-life organisms, if they escaped from a lab, would be immune to any attack by “normal” life. A 2010 story in Wired highlighting early findings in the area noted that if a such a microbe developed the ability to photosynthesize, it could obliterate life as we know it. 

The synthetic biology community didn’t seriously weigh those threats then, says David Relman, a specialist who bridges infectious disease and microbiology at Stanford University and a trailblazer in studying the gut and oral microbiomes. The idea of a mirror microbe seemed too far beyond the actual progress on proteins. “This was almost a solely theoretical argument 20 years ago,” he says. 

Now the research landscape has changed. 

Scientists are quickly making progress on mirror images of the machinery cells use to make proteins and to self-replicate. Those components include DNA, which encodes the recipes for proteins; DNA polymerases, which help copy genetic material; and RNA, which carries recipes to ribosomes, the cell’s protein factories. If researchers could make self-replicating mirror ribosomes, then they would have an efficient way to produce mirror proteins. That could be used as a biological manufacturing method for therapeutics. But embedded in a self-­replicating, metabolizing synthetic cell, all these pieces could give rise to a mirror microbe. 

When synthetic biologists convened in Northern Virginia in 2019, they didn’t recognize how quickly the technology was advancing, and if they saw a threat at all, it may have been obscured by the blinding appeal of pushing the science forward. What’s become apparent now, says Glass, is that scientists in different disciplines, all related to mirror life, were largely unaware of what other scientists had been doing. Chemists didn’t know that synthetic biologists had made so much progress on creating mirror cells with natural chirality from scratch. Biologists didn’t appreciate that chemists were building ever-larger mirror macromolecules. “We tend to be siloed,” Glass says. And nobody, he says, had thought to seriously examine the immune system concerns that had already been raised in response to earlier work. “There was not an immunologist or an infectious disease person in the room,” Glass says, reflecting on the 2019 meeting. “I may have come closest, given that I work with pathogenic bacteria and viruses,” he adds, but his work doesn’t address how they cause infections in their hosts.

on the left, a hand with petri dish and the same image inverted on the right

GETTY IMAGES

These scientists also didn’t know that around the same time as their meeting, another conversation about mirror life was happening—a darker dialogue that was as focused on danger as it was on discovery. Starting around 2016, researchers with a nonprofit called Open Philanthropy had begun compiling research files on catastrophic biological risks. The organization, which rebranded as Coefficient Giving in 2025, funds projects across a range of focus areas; it adheres to a divisive philanthropic philosophy called effective altruism, which advocates giving money to projects with the highest potential benefit to the most people. While that might not sound objectionable, critics point out that the metrics devotees use to gauge “effectiveness” can prioritize long-term solutions while neglecting social injustices or systemic problems. 

Someone in Open Philanthropy’s bio­security group had suggested looking into the risks posed by mirror life. In 2019 the organization began funding research by Kevin Esvelt, who leads the Sculpting Evolution group at the MIT Media Lab, on biosecurity issues, including mirror life. He began reading up to see whether mirror life was something to worry about.

Esvelt made waves in 2013 for pioneering the use of CRISPR to develop a gene drive, a technology that could spread genetic changes introduced into a living organism through a whole population. Researchers are exploring its use, for example, to make mosquitoes hostile to the parasite that causes malaria—and, as a result, lower their chance of spreading it to humans. But almost immediately after he developed the tool, Esvelt argued against using it for profit, at least until proper safeguards could be set and its use in fighting malaria had been established. “Do you really have the right to run an experiment where if you screw up, it affects the whole world?” he asked, in this magazine, in 2016. At the Media Lab, Esvelt leads efforts to safely develop gene drives that can be deployed locally but prevented from spreading globally. 

Esvelt says he’s often thinking about the security risks posed by self-sustaining genetically engineered technologies, and research led him to suspect that the threat of mirror organisms hadn’t been seriously interrogated. The more he learned about microbial growth rates, predator-prey and microbe-microbe interactions, and immunology, the more he began to worry that mirror organisms, if impervious to the innate defenses of natural ones, could cause unstoppable infections in the event that they escaped the lab. 

Even if the first experimental iteration of such a germ were too fragile to survive in the environment or a human body, Esvelt says, it would be a light lift to genetically engineer new, more resilient versions with existing technology. Even worse, he says, the results could be weaponized. The possible path from 2019 to global annihilation seemed almost too direct, he found. 

But he wasn’t an expert in all the scientific fields involved in research on mirror life, so he started making calls. He first described his concerns to Relman one night in February 2022, at a restaurant outside Washington, DC. Esvelt hoped Relman would tell him he was wrong, that he’d missed something over the years of gathering data. Instead, he was troubled. 

The concern spreads

When Relman returned to California, he read more about the technology, the risks, and the role of chirality in the immune system and the environment. And he consulted experts he knew well—ecologists, other microbiologists, immunologists, all of them leaders in their fields—in an attempt to assuage his concerns. “I was hoping that they’d be able to say, I’ve thought about this, and I see a problem with your logic. I see that it’s really not so bad,” he says. “At every turn, that did not happen. Something about it was new to every person.” 

The concern spread. Relman worked with Jack Szostak, a professor of chemistry at the University of Chicago, and a group of researchers to see if it was possible to make an argument that mirror life wasn’t going to wipe out humanity. Included in that group was Kate Adamala, a synthetic biologist at the University of Minnesota. She was a natural choice: Adamala had shared the initial grant from the NSF, in 2019, to explore mirror-life technologies. 

She also became convinced the risk was real—and was dumbfounded that she hadn’t seen it earlier. “I wish that one sunny afternoon we were having coffee and we realized the world’s about to end, but that’s not what happened,” she says. “I’m embarrassed to admit that I wasn’t even the one that brought up the risks first.” Through late 2023 and early 2024, the endeavor began to take on the form of a rigorous scientific investigation. Experts were presented with a hypothesis—namely, that if mirror cells were built, they would pose an existential threat—and asked to challenge it. The goal was to falsify the hypothesis. “It would be great if we were wrong,” says Vaughn Cooper, a microbiologist at the University of Pittsburgh and president-elect of the American Society for Microbiology. 

Relman says that as the chemists and biologists learned more about one another’s work and began to understand what immunologists know about how living things defend themselves, they started to connect the dots and see an emerging picture of an unstoppable synthetic threat.

Some scientists have pushed back against the doomsday scenario, suggesting that the case against mirror life offers an “inflated view of the danger.”

Timothy Hand, an immunologist at the University of Pittsburgh who hadn’t participated in the 2019 NSF meeting, wasn’t initially worried when he heard about mirror life, in 2024. “The mammalian immune system has this incredible capability to make antibodies against any shape,” he says. “Who cares if it’s a mirror?” But when he took a closer look at that process, he could see a cascade of potential problems far upstream of antibody production. Start with detection: Macrophages, which are cells the immune system uses to identify and dispatch invaders, use chiral sensing receptors on their surfaces. The proteins they use to grab on to those invaders, too, are chiral. That suggests the possibility that an organism could be infected with a mirror organism but not be able to detect it or defend against it. “The lack of innate immune sensing is an incredibly dangerous circumstance for the host,” Hand says.

By early 2024, Glass had become concerned as well. Relman and James Wagstaff, a structural biologist from Open Philanthropy, visited him at the Venter Institute to talk about the possibility of using synthetic cell technology—Glass’s specialty—to build mirror life. “At first I thought, This can’t be real,” Glass says. They walked through arguments and counterarguments. “The more this went on, the more I started feeling ill,” he says. “It made me realize that work I had been doing for much of the last 20 years could be setting the world up for this incredible catastrophe.” 

In the second half of 2024, the growing group of scientists assembled the report and wrote the policy forum for Science. Relman briefed policymakers at the White House, members of the defense community, and the National Security Agency. Researchers met with the National Institutes of Health and the National Science Foundation. “We briefed the United Nations, the UK government, the government of Singapore, scientific funding organizations from Brazil,” says Glass. “We’ve talked to the Chinese government indirectly. We were trying to not blindside anybody.” 

A year and a half on, the push has had an impact. UNESCO has recommended a precautionary global moratorium on creating mirror-life cells, and major philanthropic organizations that fund science, including the Alfred P. Sloan Foundation, have announced they will not finance research leading to a mirror microorganism. The Bulletin of the Atomic Scientists highlighted considerations about mirror life in its most recent report on the Doomsday Clock. In March, the United Nations Secretary-General’s Scientific Advisory Board issued a brief highlighting the risks—noting, for example, that recent progress on building mirror molecules could reduce the cost of creating a mirror microbe. 

“I think no one really believes at this stage that we should make mirror life, based on the evidence that’s available,” says James Smith, the scientist who leads the MBDF, the nonprofit focused on assessing the risks of mirror life, which is funded by Coefficient Giving, the Sloan Foundation, and other organizations. The challenge now, Smith says, is for scientists to work with policymakers and bioethicists to figure out how much research on mirror life should be permitted—and who will enforce the rules.

Drawing the line

Not everyone is convinced that mirror organisms pose an existential threat. It’s difficult to verify predictions about how mirror microbes would fare in the immune system—or the larger world—without running experiments on them. Some scientists have pushed back against the doomsday scenario, suggesting that the case against mirror life offers an “inflated view of the danger.” Others have noted that carbohydrates called glycans already exist in both left- and right-handed forms—even in pathogens—and the immune system can recognize both of them. Experiments focused on interactions between the immune system and mirror molecules, they say, could help clarify the risks of mirror organisms and reduce uncertainty. 

Even among those convinced that the worst-case scenario is possible, researchers still disagree over where to draw the line. What inquiries should be allowed and what should be prohibited?

Andy Ellington, a biotechnologist and synthetic biologist at the University of Texas at Austin, doesn’t think mirror organisms will come to fruition anytime soon. Even if they do, he isn’t sure they will pose a threat. “If there is going to be harm done to the human race, this is about position 382 on my list,” he says. But at the same time, he says it’s a complicated issue worth studying more, and he wants to see the conversations continue: “We’re operating in a space where there’s so much unknown that it’s very difficult for us to do risk assessment.” 

Even among those convinced that the worst-case scenario is possible, researchers still disagree over where to draw the line. What inquiries should be allowed and what should be prohibited? 

Adamala, of the University of Minnesota, and others see a natural line at ribosomes, the cellular factories that transform chains of amino acids into proteins. These would be a critical ingredient in creating a self-replicating organism, and Adamala says the path to getting there once mirror ribosomes are in place would be pretty straightforward. But Zhu, at Westlake, and others counter that it’s worth developing mirror ribosomes because they could possibly produce medically useful peptides and proteins more efficiently than traditional chemical methods. He sees a clear distinction, and a foundational gap, between that kind of technology and the creation of a living synthetic organism. “It is crucial to distinguish mirror-image molecular biology from mirror-image life,” he says. That said, he points out that many synthetic molecules and organisms containing unnatural components, including but not limited to the mirror-image subset, might pose health risks. Researchers, he says, should focus on developing holistic guidelines to cover such risks—not just those from mirror molecules. 

Even if the exact risk remains uncertain, Esvelt remains more convinced than ever that the work should be paused, perhaps indefinitely. No one has taken a meaningful swing at the hypothesis that mirror life could wipe out everything, he says. The primary uncertainties aren’t around whether mirror life is dangerous, he points out; they have more to do with identifying which bacterium—including what genes it encodes, what it eats, how it evades the immune system’s sentinels—could lead to the most serious consequences. “The risk of losing everything, like the entire future of humanity integrated over time, is not worth any small fraction of the economy. You just don’t muck around with existential risk like that,” he says. 

In some ways, scientists have been here before, working out rules and limits for research. Two years after the start of the covid-19 pandemic, for example, the World Health Organization published guidelines for managing risks in biological research. But the history is much deeper: Horrific episodes of human experimentation led to the establishment of institutional review boards to provide ethical oversight. In the early 1970s, in response to concerns over lab-acquired infections and growing use of biological warfare, the US Centers for Disease Control and Prevention established biohazard safety levels (BSLs), which govern work on potentially dangerous biological experiments.

And in 1975—at the dawn of recombinant DNA research, which allows researchers to put genetic material from one organism into another—geneticists met at the Asilomar conference center in Pacific Grove, California, to hammer out rules governing the work. There were concerns over what would happen if some virus or bacterium, genetically engineered to have traits that would make it particularly dangerous for people, escaped from a lab. Scientists agreed to self-imposed restrictions, like a moratorium on research until new safety guidelines were in place. As a result of the meeting, in June 1976 the NIH issued rules that, among other things, categorized the risks associated with rDNA experiments and aligned them with the newly adopted BSL system.

Asilomar is often hailed as a successful model for scientific self-governance. But that perception reflects a tendency to recall the meeting through a nostalgic haze. “In fact, it was incredibly messy and human,” says Luis Campos, a historian of science at Rice University. Equally brilliant Nobelists argued on either side of the question of whether to rein in rDNA research. Technical discussions dominated; talks about who would be affected by the technology were missing. The meeting didn’t start establishing guidelines, says Campos, until the lawyers mentioned liability and lab leaks. 

For now it’s unclear whether these examples of self-­governance, which arose from the demonstrated risks of existing technologies, hold useful lessons for the mirror-life community. Three competing images of the future are coming into focus: Mirror life might not be possible, it might be possible but not threatening, or it might be possible and capable of obliterating all life on Earth. 

Scientists may be censoring themselves out of fear and speculation. To some, shutting down the work seems necessary and urgent; to others, it is unnecessarily limiting. What’s clear is that the question of what to do about mirror life has been both illuminating and disorienting, pushing scientists to interrogate not only their current research but where it might lead. This is uncharted territory. 

Stephen Ornes is a science writer based in Nashville, Tennessee.

STAT+: Flawed study on the antidepressant Paxil came with a cautionary note — if you knew how to find it

File this under “hiding in plain sight.”

Last fall, the Journal of the American Academy of Child & Adolescent Psychiatry issued a so-called expression of concern about a controversial study that was published in 2001 about the widely prescribed antidepressant known as Paxil.

Such a step is taken when a study may have errors or include unreliable information. The notice, which followed a request for a retraction, indicated that a review was underway. Meanwhile, it served as a warning, of sorts, to health care providers who might consult the study when deciding whether to prescribe the medicine.

Continue to STAT+ to read the full story…

NASA is building the first nuclear reactor-powered interplanetary spacecraft. How will it work?

MIT Technology Review Explains: Let our writers untangle the complex, messy world of technology to help you understand what’s coming next. You can read more from the series here.

Just before Artemis II began its historic slingshot around the moon, Jared Isaacman, the recently confirmed NASA administrator, made a flurry of announcements from the agency’s headquarters in Washington, DC. He said the US would soon undertake far more regular moon missions and establish the foundations for a base at the lunar south pole before the end of the decade. He also affirmed the space agency’s commitment to putting a nuclear reactor on the lunar surface.

These goals were largely expected—but there was still one surprise. Isaacman also said NASA would build the first-ever nuclear reactor-powered interplanetary spacecraft and fly it to Mars by the end of 2028. It’s called the Space Reactor-1 Freedom, or SR-1 for short. “After decades of study, and billions spent on concepts that have never left Earth, America will finally get underway on nuclear power in space,” he said at the event. “We will launch the first-of-its-kind interplanetary mission.”

A successful mission would herald a new era in spaceflight, one in which traveling between Earth, the moon, and Mars would—according to a range of experts—be faster and easier than ever. And it might just give the US the edge in the race against China—allowing the country to beat its greatest geopolitical rival to landing astronauts on another planet.

While experts agree the timeline is extremely tight, they’re excited to see if America’s space agency and its industry partners can deliver an engineering miracle. “You wake up to that announcement, and it puts a big smile on your face,” says Simon Middleburgh, co-director of the Nuclear Futures Institute at Bangor University in Wales.

Little detail on SR-1 is publicly available, and NASA’s own spaceflight researchers did not respond to requests for comment. But MIT Technology Review spoke to several nuclear power and propulsion experts to find out how the new nuclear-powered spacecraft might work.

Nuclear propulsion 101

Traditionally, spaceflight has been powered by chemical propulsion. Liquefied hydrogen and liquefied oxygen are mixed, and then ignited, within a rocket; the searingly hot exhaust from this explosion is ejected through a nozzle, which propels the rocket forth.

Chemical propulsion offers a significant amount of thrust and will, for the foreseeable future, still be used to launch spacecraft from Earth. But nuclear propulsion would enable spacecraft to fly through the solar system for far longer, and faster, than is currently possible. 

“You get more bang per kilogram,” says Middleburgh. A nuclear fuel source is far more energy-dense than its conventional cousin, which means it’s orders of magnitude more efficient. “It’s really, really, really high efficiency,” says Lindsey Holmes, an expert in space nuclear technology and the vice president of advanced projects at Analytical Mechanics Associates, an aerospace company in Virginia. 

The approach also removes one other element of the traditional power equation: solar. Spacecraft, including the Artemis II mission’s Orion space capsule, often rely on the sun for power. But this can be a problem, since it doesn’t always shine in space, particularly when a planet or moon gets in its way—and as you head toward the outer solar system, beyond Mars, there’s just less sunlight available. 

To circumvent this issue, nuclear energy sources have been used in spacecraft plenty of times before—including on both Voyager missions and the Saturn-interrogating Cassini probe. Known as radioisotope thermoelectric generators, or RTGs, these use plutonium, which radioactively decays and generates heat in the process. That heat is then converted into electricity for the spacecraft to use. RTGs, however, aren’t the same as nuclear reactors; they are more akin to radioactive batteries—more rudimentary and considerably less powerful.

So how will a nuclear-reactor-powered spacecraft work? 

Despite operational differences, the fundamentals of running a nuclear reactor in space are much the same as they are on Earth. First, get some uranium fuel; then bombard it with neutrons. This ruptures the uranium’s unstable atomic nuclei, which expel a torrent of extra neutrons—and that rapidly escalates into a self-sustaining, roasting-hot nuclear fission reaction. Its prodigious heat output can then be used to produce electricity.

Doing this in space may sound like an act of lunacy, but it’s not: The idea, and even a lot of the basic technology, has been around for decades. The Soviet Union sent dozens of nuclear reactors into orbit (often to power spy satellites), while the US deployed just one, known as SNAP-10A, back in 1965—a technological demonstration to see if it would operate normally in space. The aim was for the reactor to generate electricity for at least a year, but it ran for just over a month before a high-voltage failure in the spacecraft caused it to malfunction and shut down. 

Now, more than half a century later, the US wants its second-ever space-based nuclear reactor to do something totally different: power an interplanetary spacecraft.

To be clear, the US has started, and terminated, myriad programs looking into nuclear propulsion. The latest casualty was DRACO, a collaboration between NASA and the Department of Defense, which ended in 2025. Like several previous efforts, DRACO was canceled because of a mix of high experimentation costs, lower prices for conventional rocket propulsion, and the difficulty of ensuring that ground tests could be performed safely and effectively (they are creating an incredibly powerful nuclear reaction, after all).

But now external considerations may be changing the calculus. The Artemis program has jump-started America’s return to the moon, and the new space race has palpable momentum behind it. The first nation to deploy nuclear propulsion would have a serious advantage navigating through deep space. 

“I think it’s a very doable technology,” says Philip Metzger, a spaceflight engineering researcher at the Florida Space Institute. “I’m happy to see them finally doing this.”

One version of this technology is known as nuclear thermal propulsion, or NTP. You start with a nuclear reactor, one that’s cooking at around 5,000°F. Then “you’ve got a cold gas, and you squirt cold gas over the hot reactor,” says Middleburgh. “The gas expands, you shoot it out the back of a nozzle, and you have an impulse. And that impulse drives you forward.” 

Because the thrust depends on the speed of the gas being ejected, the propellant gas needs to be light, making hydrogen a popular choice. But hydrogen is a corrosive and explosive substance, so using it in NTP engines can make them precarious to operate. On top of this, NTP doesn’t necessarily have a very long operating life.

Alternatively, there’s nuclear electric propulsion, or NEP, which “is very low thrust, but very efficient, so you can use it for a long period of time,” says Sebastian Corbisiero, the US Department of Energy’s national technical director of space reactor programs. This method uses heat from a fission reactor to generate power. That power is used to electrify a gas and then  blast it out of the spacecraft, generating thrust.  

Both NTP and NEP have been investigated by US researchers, because both have the added benefit of making it easier and safer for human beings to explore the solar system. Astronauts in space are exposed to harmful cosmic radiation, but because nuclear propulsion makes spacecraft speedier and more agile, they’d spend less time in it. “It solves the radiation problem,” says Metzger. “That’s one of the main motivations for inventing better propulsion to and from Mars.”

How to build a nuclear-powered spaceship

For SR-1, NASA has opted for nuclear electric propulsion. NEP is “a much simpler affair” than its thermal counterpart, says Middleburgh. Essentially, you just need to plug a nuclear reactor into a power-and-propulsion system. Luckily for NASA, it’s already got one.

For many years, NASA—along with its space agency partners in Canada, Europe, Japan, and the Middle East—was preparing for Gateway, meant to be humanity’s first space station to orbit around the moon. Isaacman canceled the project in March, but that doesn’t mean its technology will go to waste; the power-and-propulsion element of the nixed space station will be used in SR-1 instead. This contraption was going to be powered by solar energy. It’ll now be attached to an in-development nuclear reactor custom built to survive in space.

What might the SR-1 look like? MIT Technology Review saw a presentation by Steve Sinacore, program executive of NASA’s Space Reactor Office, that offers some clues. So far, the concept art makes it look like a colossal fletched arrow. At the back will be the power-and-propulsion system, while its tip will hold a 20-kilowatt-or-greater uranium-filled nuclear reactor. (For context, a typical nuclear plant on Earth is 50,000 times more powerful, producing a gigawatt of power.) 

Annotated diagram of the key systems of SR-1 Freedom. Indicated at the front is the power and propulsion element, up to 48kw Advanced electric propulsion system. Panels at the middle are high performance, light weight composite and titanium heat rejection system. At the tail there is indicated an advanced closed Brayton cycle power conversion system and a .20kWe Reactor with HALEU UO2 fuel, heat pipe thermal transfer and boron carbide radiation shield. A small attachment at midcraft is labelled. :High Rate Direct to Earth Communications."

NASA

The “fletches” on SR-1 are large fins that allow the reactor to cool down. “You have to have really large radiators,” says Holmes, since the nuclear fission process produces so much heat that much of it has to be vented into space—otherwise, the reactor and spacecraft will melt.

According to that presentation, the spacecraft’s hardware development is due to start this June. By January 2028, SR-1’s systems should be ready for assembly and testing. And by that October, the spacecraft will arrive at the launch site, ready for liftoff before the year’s end. Will the nuclear reactor manage to hold itself together? “Going through the launch safely is going to be a challenge,” says Middleburgh. “You are being shaken, rattled, and rolled.” 

Then, he says, “once you’re up in space, once you’ve got through that few minutes of hell in getting there, it’s zero-gravity considerations you have to worry about.” The question then becomes: Will the mechanics of the reactor, built on terra firma, still work? 

For safety reasons, the nuclear reactor will be switched on around two days post-launch, when it’s comfortably in space. Uranium isn’t tremendously dangerous by itself, but that can’t be said of the nuclear waste products that emerge when the reactor is activated, so you don’t want any of that to fall back to Earth. 

If this schedule is adhered to, and SR-1 works as planned, it’s expected to reach Mars about a year after launch. “It’s an aggressive timeline,” says Holmes, something she suspects is being driven partly by China’s and Russia’s own deep-space nuclear ambitions. The two countries aim to place their own nuclear reactor on the moon’s surface to power the planned International Lunar Research Station—a jointly operated lunar base—by 2035. 

Whether it flies or fails in space, SR-1’s operations should help NASA with putting a nuclear reactor on the moon soon after. “All of the things we’d be learning about how that system operates in space [are] very helpful for a surface application, because basically it’s the same,” says Corbisiero. “There’s still no air on the moon.”

And if SR-1 does triumph, it will be a game-changing victory for NASA. It will also be “a massive win for the human race, frankly,” says Middleburgh. “It will be a marvel of engineering, and it will move the dial in humans potentially taking a step on Mars.” Like many of his colleagues, including Holmes, he remains thrilled by the prospect of the first-ever nuclear-powered interplanetary spacecraft—even with the incredibly ambitious timeline. 

“These are the things that get us up in the morning,” he says. “These are the sorts of things we will remember when we’re old.”

Popular AI Chatbots Can Provide Misleading Medical Information

Around half the outputs from five commonly used artificial intelligence (AI) chatbots could lead users to ineffective or harmful medical choices without professional guidance, suggests research led by the Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center.

As reported in BMJ Open, the researchers tested the free web versions of Gemini, DeepSeek, Meta AI, ChatGPT 3.5 and Grok available in 2024. They created 50 different adversarial prompts intended to test whether the AI models would give a problematic response or not.

The prompts were intended to realistically represent the kinds of queries members of the public might enter about health topics ranging from cancer to vaccines to stem cells, nutrition, and athletic performance. Some prompts required a specific answer and some were more open.

The researchers collected 250 responses to their prompts and categorized them as non-, somewhat, or highly problematic, using pre-defined criteria. Around 50% were problematic, 30% somewhat problematic and 19.6% highly problematic.  Open-ended prompts received the most problematic answers.

In terms of the specific models, Grok produced a disproportionate share of highly problematic answers, while Gemini produced the fewest highly problematic and the most non-problematic responses. Topic-wise, the chatbots appeared more accurate when asked about cancer and vaccines, but less so when asked about stem cells, athletic performance, and nutrition.

Reference lists provided to users by the models were limited or inaccurate and the answers required some knowledge to interpret properly and were aimed at college-educated users.

“Despite adversarial pressure, chatbots typically responded in a confident, authoritative tone. Refusals to answer and explicit caveats or disclaimers were rare, reflecting the models’ strong tendency to provide an output even when prompts steered toward contraindicated advice,” write lead author Nicholas Tiller, PhD, a research associate at the Lundquist Institute, Harbor-UCLA Medical Center, and colleagues.

“As the use of AI chatbots continues to expand, our data highlight a need for public education, professional training and regulatory oversight to ensure that generative AI supports, rather than erodes, public health,” they conclude.

The post Popular AI Chatbots Can Provide Misleading Medical Information appeared first on Inside Precision Medicine.

The Influence of the COVID-19 Pandemic on Current Teaching Methods, Training, and Perception Among Romanian Surgery-Oriented Students: Cross-Sectional Study

<strong>Background:</strong> The COVID-19 pandemic prompted rapid changes in medical education, accelerating the adoption of online and distance learning methods as alternatives to traditional teaching. While these approaches offered logistical advantages, students worldwide reported significant limitations, particularly in terms of motivation, clinical exposure, and hands-on skill acquisition. Despite the increased use of digital teaching during the pandemic, core educational objectives and the mission of medical training remained unchanged, emphasizing the continued importance of practical experience. <strong>Objective:</strong> This study aims to investigate the impact of the COVID-19 pandemic on current teaching methods in medical education and to explore students’ perceptions of online learning, telemedicine, artificial intelligence, and other modern educational alternatives. <strong>Methods:</strong> This observational, cross-sectional multicentric study surveyed a cohort of Romanian medical students using a self-developed 48-item online questionnaire distributed via social media. Data were collected over 6 weeks (February-March), yielding 451 responses, of which eligible participants included students in clinical years or preclinical students interested in surgical or orthopedic careers, with a heavy representation of the Medicine and Pharmacy University of Timisoara. Statistical analysis was performed using Microsoft Excel and JASP (University of Amsterdam; version 0.95.4). <strong>Results:</strong> A total of 436 responses were analyzed, with students favoring online or hybrid formats for lectures but preferring on-site teaching for practical training. Reduced patient interaction and limited skill acquisition were the main drawbacks of online practical education. Acceptance of hybrid learning correlated with more positive perceptions of teaching methods and a lower perceived desire to cheat. <strong>Conclusions:</strong> The COVID-19 pandemic brought significant changes to the way medicine is being taught in Romania, but it also brought a clearer picture for students and medical staff on how they want medical education to be done. Online cheating remains a significant challenge, but it is being tackled at the moment with different algorithms being tested.

Evaluating the Feasibility of Technology-Based Interventions in Disability and Rehabilitation: Definitions, Considerations, and Dimensions

Technology-based interventions in the field of disability and rehabilitation, which serve assistive, therapeutic, and/or service delivery functions, are considered complex due to the skills required of providers and recipients, degree of individual tailoring, and diversity of use settings. Feasibility studies are an important step in the evolution of complex interventions that can help refine the intervention, inform implementation, and prevent wasted resources. However, guidance is lacking regarding specific considerations for feasibility studies of technology-based interventions in disability and rehabilitation, which leaves researchers and developers reliant on resources from other fields that do not address important technology properties. To advance the field, context-specific definitions, considerations, and evaluation dimensions must be explicitly outlined to ensure that feasibility studies are constructively designed to meet the unique needs of these interventions. In this viewpoint article, we (1) propose a definition and framework for feasibility studies within the specific context of technology-based disability and rehabilitation interventions, (2) highlight important and unique imperatives for feasibility studies of these interventions, and (3) articulate relevant feasibility dimensions and associated evaluation criteria for these interventions. Building on previous work, we distinguish between feasibility studies, wherein we focus on iterative intervention refinement by addressing key development questions (eg, usability), and pilot studies, which are small-scale versions of a larger study that will evaluate intervention outcomes. Integrating previous typologies, we present 13 feasibility dimensions relevant to technology-based interventions and provide sample evaluation criteria, focusing on the intervention itself rather than study design considerations (eg, trial management). This information may be useful for research and development communities (academic, clinical, or industry) to inform comprehensive feasibility studies that examine unique aspects of technology-based interventions to promote real-world impact. This contribution encourages greater harmonization of terminology and evaluation methods to streamline interpretation and comparison across studies.
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User Experience and Early Clinical Outcomes of a Mental Wellness Chatbot for Depression and Anxiety: Pilot Evaluation Mixed Methods Study

Background: Artificial intelligence–powered conversational agents (ie, chatbots) are increasingly popular outlets for users seeking psychological support, yet little is known about how users experience early-stage prototypes or which therapeutic processes contribute to clinical improvement. A transparent evaluation of emerging chatbot prototypes is needed to clarify if, how, and why artificial intelligence companions work and to guide their continued development. Objective: This mixed methods pilot study evaluated user experience, acceptability, and preliminary clinical signals for an early-stage mental wellness chatbot. We also examined whether baseline symptom severity moderated clinical improvement. Methods: Three sequential cohorts (n=125) completed a 2-week, incentivized chatbot exposure (approximately 60 min per week). Participants provided first-impression ratings, qualitative feedback, and pre–post assessments of depressive symptoms (PHQ-8 [Patient Health Questionnaire-8]), anxiety symptoms (GAD-7 [Generalized Anxiety Disorder-7]), psychological distress, well-being, and loneliness. Statistical models estimated symptom change and tested interactions with baseline symptom severity. Mixed methods analysis integrated quantitative outcomes with large language model–assisted qualitative content analysis of open-ended responses. Results: Participants described the chatbot as accessible, easy to use, and emotionally validating, while citing limitations in personalization and conversational depth. Qualitative responses consistently highlighted early therapeutic processes such as emotional validation, goal setting, and perceived attunement. Regression models showed significant pre–post reductions in depressive (Hedges =–0.32) and anxiety (=–0.32) symptoms, alongside modest improvements in distress and well-being. Baseline severity moderated improvement, with marginal effects indicating larger predicted reductions at higher PHQ-8 and GAD-7 baseline scores (eg, PHQ-8=15: =–0.84; GAD-7=15: =–0.62). Conclusions: This pilot provides a comprehensive view of early chatbot development and suggests promising user experiences and preliminary symptom improvements under structured pilot conditions. By integrating experiential and exploratory clinical data, the study identifies candidate process targets to inform ongoing refinement. Findings support continued development and demonstrate procedural feasibility for progression to larger, longer-term trials evaluating engagement and clinical outcomes under more naturalistic conditions.
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