bluuebunny/crossref_metadata_2025 huggingface dataset:
Ultrasound transducers with both imaging and power output capabilities by anti-matching at backing layers
Authors: Cai Yiqi , Xu Lijun , Zhang Teng , Suo Dingjie , Ma Jianguo
Published: February 2024

Precise ultrasound therapy requires long-term power output and imaging guidance. However, traditional therapeutic transducers do not have imaging capabilities due to the low bandwidth and long ringing. Whereas for a diagnostic transducer, 20%–30% of the energy is dissipated as heat in the backing layer, resulting in degradation of the transducer under high duty cycle and high voltage excitation. Therefore, the transducers with both power output and imaging capabilities are unmet demands for precise ultrasonic treatment. To address this problem, we propose an ultrasound transducer with both imaging and power output capabilities. An anti-matching layer is designed at the position of the backing layer of the transducer, which reflects the backward ultrasound waves to forward waves. Therefore, the majority of the energy is transmitted efficiently and little energy is dissipated in the backing layer. Finite element simulations demonstrated that a double-layer anti-matching design reflects 99.8% of the backward energy, resulting in an insertion loss of −27.7 dB. The performance was validated by a transducer prototype with transmission measurement using hydrophone and pulse-echo test. This design of transducers with both imaging and power output capabilities indicates a promising application of self-guided ultrasound therapy.
Material gradation effects on twisting statics of bi-directional functionally graded micro-tubes
Authors: Aghazadeh Reza , Rafighi Mohammad , Kumar Raman , Awadh Mohammed Al
Published: February 2024

This study aims to characterize the twisting behavior of bi-directional functionally graded (FG) micro-tubes under torsional loads within the modified couple stress theory framework. The two material properties involved in the torsional static model of FG small-scale tubes, i.e., shear modulus and material length scale parameter, are assumed to possess smooth spatial variations in both radial and axial directions. Through the utilization of Hamilton’s principle, the governing equations and boundary conditions are derived, and then, the system of partial differential equations is numerically solved by using the differential quadrature method. A verification study is conducted by comparing limiting cases with the analytical results available in the literature to check the validity of the developed procedures. A detailed study is carried out on the influences of the phase distribution profile and geometric parameters upon twist angles and shear stresses developed in FG micro-tubes undergoing external distributed torques.
Exploring the feasibility of a gambling harm screening model in general practice and community service settings in Fairfield: a pilot study
Authors: Reid Andrew , McGhie Nick , Nguyen Thi Huyen Linh , Yadav Uday , Cullen Patricia , Booth Leon , Bestman Amy
Published: February 2024

Background Gambling is a growing public health issue in Australia. However, limited research has examined the role of primary health care and social services in routine screening for gambling harm in Australia. This research aimed to explore the enablers and barriers to implementing a co-designed gambling screening model in Fairfield, New South Wales – an area with high gambling expenditure. Methods A co-designed gambling screening and referral model for GP and community-based organisations was implemented in Fairfield in 2020. Follow-up interviews were conducted with nine health care professionals who implemented the screening in 130 patients. Thematic analysis generated key barriers and enablers for implementation of this model. Results Key enablers for the screening model implementation included structural factors (alignment of the screening model with current work), process factors and staffing factors (staff empowerment). However, we also noted process factors as a barrier to implementation, particularly the referral pathway following screening. Other barriers included social and structural factors, such as the complexity of gambling harm and project funding. Conclusions Embedding routine screening in primary and community care settings can play a role in treating, reducing and preventing gambling-related harm, and reducing stigma in Fairfield and beyond. Additionally, screening models such as this provide health systems with clear evidence on the level of gambling harm in their community (particularly important in culturally and linguistically diverse communities who are underrepresented in research). This evidence is important for addressing system-level drivers of harm and advocating for political reform to reduce the impact of gambling on communities.
Two-pore channels regulate endomembrane tension to enable remodeling and resolution of phagolysosomes
Authors: Chadwick Sarah R. , Barreda Dante , Wu Jing Ze , Ye Gang , Yusuf Bushra , Ren Dejian , Freeman Spencer A.
Published: February 2024

Phagocytes promptly resolve ingested targets to replenish lysosomes and maintain their responsiveness. The resolution process requires that degradative hydrolases, solute transporters, and proteins involved in lipid traffic are delivered and made active in phagolysosomes. It also involves extensive membrane remodeling. We report that cation channels that localize to phagolysosomes were essential for resolution. Specifically, the conductance of Na
+
by two-pore channels (TPCs) and the presence of a Na
+
gradient between the phagolysosome lumen and the cytosol were critical for the controlled release of membrane tension that permits deformation of the limiting phagolysosome membrane. In turn, membrane deformation was a necessary step to efficiently transport the cholesterol extracted from cellular targets, permeabilizing them to hydrolases. These results place TPCs as regulators of endomembrane remodeling events that precede target degradation in cases when the target is bound by a cholesterol-containing membrane. The findings may help to explain lipid metabolism dysfunction and autophagic flux impairment reported in TPC KO mice and establish stepwise regulation to the resolution process that begins with lysis of the target.
Introduction to hypocrisy
Authors: Sorlin Sandrine , Virtanen Tuija
Published: February 2024

This introductory chapter approaches hypocrisy (i) as misalignment between two inconsistent elements and
(ii) as a sham of some kind, through a transdisciplinary discussion of the notion in public and academic discourse.
Presenting the aim of the volume and the rationale behind it, we argue for a broad perspective on hypocrisy in this
first contribution of pragmatics towards understanding what appears to be a ubiquitous and multifaceted phenomenon.
Encompassing emic and etic approaches, the chapters included in the volume jointly shed light on ideas and practices
related to the complex notion. A general overview is provided to account for the connections and relevance of the
different parts.
A pragmatic model of hypocrisy
Authors: Sorlin Sandrine , Virtanen Tuija
Published: February 2024

Based on the general definition of hypocrisy given in the introductory chapter, this chapter shows how
pragmatics can deepen and add to the understanding of hypocrisy. It first guides the reader to think differently about
this traditionally morally-laden and negatively-evaluated notion. It then sets out to establish the pragmatic space of
verbal hypocrisy by confronting it with the notions of face, tact, flattery, politeness, irony, deception, and lying.
To be identified as such, hypocrisy appears to require a reveal by or through a third party, but it can be left
unexposed in contexts where people jointly play along with it, and occasionally even be disclosed by the hypocrite. As
a first attempt to date, we devise a pragmatic model of verbal hypocrisy. The chapter concludes with a comment on the
need for a renewed philosophy of language.
Three-dimensional carbon interdigitated ring array nanofibers for electrochemical detection of dopamine neurotransmitter
Authors: Kosri Elyana , Ibrahim Fatimah , Thiha Aung , Madou Marc
Published: February 2024

Dopamine (DA) neurotransmitter is a prominent component of the central nervous system and its deficiency contributes to several diseases, such as Parkinson’s disease and schizophrenia, which significantly influence the quality of life of affected individuals. This paper introduces a circular interdigitated ring electrode, the three-dimensional carbon interdigitated ring array nanofibers (3D C-IDRA NFs), for the detection of DA using amperometric detection. The study utilized cyclic voltammetry and chronoamperometry to investigate DA. The integration of carbon nanofibers (CNFs) with 3D C-IDRA demonstrated enhanced surface area, increased current peak, and superior performance compared to the standalone 3D C-IDRA electrode, as evidenced by a redox amplification factor of 2.94 and a collection efficiency of 81.1%. The results highlight that integrating CNFs with 3D C-IDRA improves the electrochemical performance in detecting DA neurotransmitter. Thus, this discovery elucidates the advantageous potential of the 3D C-IDRA NF electrode in a wide range of applications.
Comparison of stable spin textures in in-plane vs. out-of-plane magnetized exchange-biased multilayers
Authors: Dieny B , Fruchart O , Marinero E E
Published: February 2024

This paper delves into the origins and specificity of the unique stable spin textures (360° closed loop domain walls and skyrmions) observed in exchange-biased systems, with either in-plane or out-of-plane magnetic anisotropy. In the case of skyrmions, which are nanometer-sized bubbles consisting of closed-loop 180° walls in perpendicularly-magnetized media, the stability of these spin textures arises from the existence of Dzyaloshinskii–Moriya interactions. These interactions induce chirality of the domain walls, yielding to some extent a so-called topological protection. More complex structures such as skyrmoniums have been observed, consisting of closed loop 360° walls. Recently, skyrmions formed in the absence of an applied external magnetic field have been stabilized in exchange biased out-of-plane magnetized systems. About two decades ago, another type of stable spin-textures were observed in exchange biased systems, with in-plane magnetization, in particular in the pinned reference layer of spin-valves. These textures consist of 360°-domain-wall rings, the stability of which arises from the easy-plane shape anisotropy of these layers. In this paper, we compare these spin-textures and highlight the similarities and differences in their formation, structure and origin of their stability.
Simulation study of the Gilbert damping in Ni80Fe20/Nd bilayers: comparison with experiments
Authors: Cao Lulu , Ruta Sergiu , Khamtawi Rungtawan , Chureemart Phanwadee , Zhai Ya , Evans Richard F L , Chantrell Roy W
Published: February 2024

We present an experimental and computational investigation the Neodymium thickness dependence of the effective damping constant (

α

eff

) in Ni
80
Fe
20/Neodymium (Py/Nd) bilayers. The computational results show that the magnetic damping is strongly dependent on the thickness of Nd, which is in agreement with experimental data. Self consistent solutions of the spin accumulation model and the local magnetisation were used in the simulations. It was not possible to obtain agreement with experiment under the assumption of an enhanced damping in a single Py monolayer. Instead, it was found that the enhanced damping due to spin pumping needed to be spread across two monolayers of Py. This is suggested to arise from interface mixing. Subsequently, the temperature dependence of the effective damping was investigated. It is found that, with increasing temperature, the influence of thermally-induced spin fluctuations on magnetic damping becomes stronger with increasing Nd thickness.
Modulation of electrodes on the sensitivity of the Pockels effect
Authors: Wang Jiarong , He Bo
Published: February 2024

In order to improve the sensitivity of the system in the Pockels effect, a design scheme for adding antennas at both ends of the crystal is proposed. Firstly, the influence of the applied electric field on the refractive index of the crystal is explored, and the relationship between the applied electric field and the output of the system is deduced. Secondly, two different antenna models are designed (one is to connect the antenna directly to both ends of the crystal, and the other is to connect the antenna after coating on the crystal), the distribution of the applied electric field in the internal field of the crystal under different models is studied, and the corresponding input and output transfer functions are analyzed. The analysis shows that the sensitivity of the system is improved in different antenna modes, and the crystal coating has little effect on the sensitivity. In addition, the antenna model without coating is simple to install, but the internal field strength of the crystal shows a tendency to be large in the middle and small at both ends, so it is easier to produce electric field breakdown effect in the strong field. The internal field strength distribution of the coated crystal is approximately uniform field, and the field strength maximum is smaller than that of the non-coated antenna model, so crystal breakdown is not easy to occur in the strong field. Finally, the effectiveness of the theoretical analysis is verified by experiments.
Comparative analysis of GNSS-IR sea-level retrieval methods
Authors: Hou Jinhua , Wang Nazi , He Kaifei , Gao Fan , Wang Shuo
Published: February 2024

A global navigation satellite system interferometric reflectometry (GNSS-IR) technique has been confirmed to retrieve sea levels using signal-to-noise ratio (SNR) data. To investigate the suitability of different GNSS-IR sea-level retrieval methods, several strategies were tested during the data process, including: the whole-arc Lomb-Scargle periodogram (whole-arc LSP) method and the window LSP (WinLSP) method, when using spectral analysis on SNR data; the tidal harmonic analysis (THA) and dynamic SNR method, when using dynamic correction on retrievals; and the moving-window smoothing method, proposed for application upon processing of retrievals. Furthermore, the THA method is improved by segmented SNR data, and the moving-window smoothing method with robust local weighted regression (RLOWESS) and a Savitzky–Golay (SG) filter was adopted for better serviceability. One-month data from the SC02 station were used to test all the strategies by comparing with local tide-gauge records. HKQT station further verified the usability of the moving-window smoothing method. The results confirmed that the WinLSP method can obtain more retrievals, implying higher temporal resolution, but the whole-arc LSP method achieves better precision. The former is easily susceptible to the sampling rate of the SNR. The correction results of the dynamic SNR method are better than those of the segmented THA method. When the former is applied to retrievals from the WinLSP method, the retrievals of all windows from multiple SNR arcs should be adjusted simultaneously. The moving-window smoothing method based on RLOWESS and the SG filter is more applicable to the retrievals corrected by the segmented THA method, and the smoothing effect of the two smoothing methods makes little difference. In addition, wind speed more than 20 m s−1 seriously affects the effect of GNSS-IR sea-level retrieval. The GNSS-IR technique has the potential for centimeter-level sea level retrieval.
A novel data augmentation method for steering mechanism fault diagnosis based on variational autoencoding generative adversarial networks with self-attention
Authors: Lei Tongfei , Pei Zeyu , Pan Feng , Li Bing , Xu Yongsheng , Shao Haidong , Zhao Ke
Published: February 2024

Learning the original data distribution and generating new samples has proven to be an effective approach in addressing the issue of data imbalance. This paper combines the strengths of generative adversarial networks and variational autoencoder, proposing a novel data augmentation method named variational autoencoding generative adversarial networks with self-attention. Specifically, an encoding-decoding process is introduced during the generative adversarial process to provide distribution information for the generator’s sampling space, thereby accelerating the model’s convergence speed and simultaneously improving the quality of generated samples. Additionally, a self-attention module is incorporated into the discriminator to capture global information from the input data, guiding the generator. During the training process, overlapping sampling and feature-layer matching are employed. Comparative experiments with other advanced algorithms on both public and engineering datasets with multiple imbalanced cases demonstrate that the proposed method can generate high-quality samples, effectively enhance original imbalanced data, and exhibit strong generalization and robustness.
Fusion Analyser: a novel measurement method and software tool for dental model analysis in orthodontics
Authors: Wang Shaofeng , Liang Shuang , Xie Xianju , Zhang Li , Chang Qiao , Zuo Feifei , Wang Yajie , Bai Yuxing , Gu Yu
Published: February 2024

Accurate analysis of dental models is crucial for diagnosing and treating malocclusion successfully. Traditional measurement techniques, however, often fail to accurately measure teeth in crowded conditions. In this study, we introduce Fusion Analyser (FA), an innovative software tool capable of calculating key dental indicators, thereby advancing the scope of digital dental model analysis. Our unique FA framework employs segmentation discs on teeth to enhance the accuracy of the anterior Bolton’s ratio, outperforming the widely-used 3Shape software when dealing with crowded teeth. The FA framework exhibits performance commensurate with the established gold standard, as evidenced by high scores across a range of evaluation metrics, thereby validating its accuracy, stability, and efficiency. The potential of the FA framework as an auxiliary tool for dentists, particularly in diagnosing and strategising treatment plans for malocclusion, is underscored.
A surprising two-inductor circuit
Authors: Mungan Carl E , Helton Joel S
Published: February 2024

Introductory textbooks often consider circuits in which a switch is used to alternately connect or disconnect a battery from series or parallel combinations of simple components such as resistors and inductors. An example circuit is presented here whose behaviour is contradictory if all components are ideal. A simple modification is proposed for the behaviour of the switch to resolve the contradiction.
Mutually enhanced multi-view information learning for segmentation of lung tumor in CT images
Authors: Xuan Ping , Xu Yinfeng , Cui Hui , Jin Qiangguo , Wang Linlin , Nakaguchi Toshiya , Zhang Tiangang
Published: February 2024

Objective. The accurate automatic segmentation of tumors from computed tomography (CT) volumes facilitates early diagnosis and treatment of patients. A significant challenge in tumor segmentation is the integration of the spatial correlations among multiple parts of a CT volume and the context relationship across multiple channels. Approach. We proposed a mutually enhanced multi-view information model (MEMI) to propagate and fuse the spatial correlations and the context relationship and then apply it to lung tumor CT segmentation. First, a feature map was obtained from segmentation backbone encoder, which contained many image region nodes. An attention mechanism from the region node perspective was presented to determine the impact of all the other nodes on a specific node and enhance the node attribute embedding. A gated convolution-based strategy was also designed to integrate the enhanced attributes and the original node features. Second, transformer across multiple channels was constructed to integrate the channel context relationship. Finally, since the encoded node attributes from the gated convolution view and those from the channel transformer view were complementary, an interaction attention mechanism was proposed to propagate the mutual information among the multiple views. Main results. The segmentation performance was evaluated on both public lung tumor dataset and private dataset collected from a hospital. The experimental results demonstrated that MEMI was superior to other compared segmentation methods. Ablation studies showed the contributions of node correlation learning, channel context relationship learning, and mutual information interaction across multiple views to the improved segmentation performance. Utilizing MEMI on multiple segmentation backbones also demonstrated MEMI's generalization ability. Significance. Our model improved the lung tumor segmentation performance by learning the correlations among multiple region nodes, integrating the channel context relationship, and mutual information enhancement from multiple views.
Generative adversarial neural network for 3D-hologram reconstruction
Authors: Kiriy Semen A , Rymov Dmitry A , Svistunov Andrey S , Shifrina Anna V , Starikov Rostislav S , Cheremkhin Pavel A
Published: February 2024

Neural-network-based reconstruction of digital holograms can improve the speed and the quality of micro- and macro-object images, as well as reduce the noise and suppress the twin image and the zero-order. Usually, such methods aim to reconstruct the 2D object image or amplitude and phase distribution. In this paper, we investigated the feasibility of using a generative adversarial neural network to reconstruct 3D-scenes consisting of a set of cross-sections. The method was tested on computer-generated and optically-registered digital inline holograms. It enabled the reconstruction of all layers of a scene from each hologram. The reconstruction quality is improved 1.8 times when compared to the U-Net architecture on the normalized standard deviation value.
Effect of spermidine on reproductive, seed quality and bio-physiological characteristics of chickpea (Cicer arietinum L.) genotypes under salt stress
Authors: Sawariya Mamta , Yadav Neha , Kumar Ajay , Mehra Himanshu , Kumar Naveen , Devi Sarita , Arya Sunder Singh
Published: February 2024

The experiment aimed to investigate the impact of foliar application of spermidine on the physiological and reproductive aspects of chickpea genotypes subjected to salt stress, with a focus on its consequences for seed quality. The study involved treating chickpea genotypes (CSG 8962, HC 3, HC 5, RSG 931) with 4 and 8 dSm−1 Cl− dominate salinity during the seedling stage, and application of 0.5 and 1.0 mM spermidine at the flowering stage. Result revealed that salinity significantly reduced chlorophyll and membrane stability index by approximately 46.97% and 23.19%, respectively. Concurrently, pollen germination and viability decreased about 14.14% and 22.24%, leading to a substantial decline in seed protein content (37.70%) at 8 dSm−1 salinity. While there was an increase in antioxidant activity (45.83%), phenol content decreased in response to salinity stress. Foliar application of spermidine (0.5 and 1.0 mM) proved to be a promising intervention, enhancing chlorophyll stability and phenol content by approximately 24.35% and 36.05%, respectively, at 8 dSm−1 salinity. This improvement is associated with a notable 20.01% increase in pollen viability, resulting in a subsequent rise in protein content by about 20.73% at 1.0 mM spermidine. Additionally, the application of spermidine mitigated Na+ ion accumulation in chickpea seeds. The findings underscore the varying performance of chickpea genotypes under salinity stress, with CSG 8962 and RSG 931 exhibiting poorer outcomes compared to other genotypes. Notably, the positive impact of spermidine was more pronounced, especially with the use of 1.0 mM spermidine, which demonstrated a more significant positive effect in salt-sensitive chickpea genotypes. These results emphasize the potential of spermidine as a strategic tool in alleviating the adverse effects of salinity on chickpea crops, offering valuable insights for the development of sustainable practices to enhance chickpea resilience and seed quality under challenging environmental conditions.
Do private firms invest more in environmental protection under political control? Evidence from China
Authors: Guo Chu-Yu , Wen Jiandong , Hu Hui
Published: February 2024

For the first time, this study investigates the environmental performance outcomes of integrating local political committees into private firms. Using a nationwide survey of Chinese private firms, we find that the involvement of local party committees significantly bolsters corporate environmental investment. This finding remains consistent across various samples, alternative measures of the dependent variable, and different estimation methodologies. Notably, the influence of local party committees on pro-environmental practices is more pronounced in firms with lower family ownership, in regions with weaker environmental regulations, and where the owner is also the Party secretary. This study reveals local party committees as key mediators between government and firms, enhancing corporate engagement in environmental initiatives. It advocates for policies promoting collaboration between government and private firms, particularly emphasizing the strategic placement of party committees in firms with specific ownership and leadership characteristics to maximize environmental investment.
Two new 𝑞-supercongruences arising from Carlitz’s identity
Authors: Liu Ji-Cai , Qi Wei-Wei
Published: February 2024

From Carlitz’s identity, we deduce two newqq-supercongruences modulo the square of a cyclotomic polynomial, which were originally conjectured by Guo. These results establish newqq-analogues of a supercongruence of Sun.
Federalism, Decentral Governance, and Joint Decision-Making: Bad News for the Implementation of International Environmental Agreements?
Authors: Müller Gómez Johannes
Published: February 2024

There is a lingering myth in the international compliance literature that domestic multilevel structures have a negative impact on the fulfilment of international commitments. This article argues that this literature has failed to understand multilevel structures as a multi-layered concept. Instead of viewing multilevel governance as a one-dimensional concept or a mere system of veto-players, I propose to study the effects of the individual components, i.e., federalism, decentral governance, and joint decision-making. I test the plausibility of this approach by analyzing the implementation of the Ramsar Wetlands Convention. My findings debunk the myth about the negative effects of multilevel structures on the implementation of international agreements. I show that states in which subnational decision-makers can act autonomously from the central level are better placed to produce implementation measures in the area of environmental conservation.
A Randomized Trial Assessing the Effect of Exercise on Residents’ Podcast Knowledge Acquisition and Retention
Authors: Gottlieb Michael , Cooney Robert , Haas Mary R.C. , King Andrew , Fung Cha-Chi , Riddell Jeffrey
Published: February 2024

Purpose

Podcasts are commonly used by residents as part of their learning, with many listening concomitantly with other activities (e.g., driving and exercise). The effects of exercise on learning are controversial, with some suggesting potential benefit and others suggesting impaired learning. This study examined whether exercise influences knowledge acquisition and retention among resident physicians listening to a podcast while exercising versus those with undistracted listening.

Method

This multicenter, randomized, crossover trial assessed emergency medicine residents across 5 U.S. institutions from September 2022 to January 2023. Residents were randomized to a group that listened to one 30-minute podcast while seated or a group that listened to a 30-minute podcast while engaging in 30 minutes of continuous aerobic exercise, with stratification by site and postgraduate year. Within 30 minutes of completing the podcast, they completed a 20-question multiple-choice test. They subsequently crossed over to the other intervention and listened to a different 30-minute podcast followed by another 20-question test. Each podcast focused on emergency medicine–relevant journal articles that had not been covered in journal club or curriculum at any sites. Residents also completed a 40-question delayed recall test with separate questions on both podcasts at 30 days.

Results

Ninety-six residents were recruited for the study, with 95 (99.0%) completing the initial recall portion and 92 (97.0%) completing the delayed recall tests. No statistically significant differences were found between the exercise and seated cohorts on initial recall (74.4% vs 76.3%;d= −0.12; 95% CI, −0.33 to 0.08;P= .12) or delayed recall (52.3% vs 52.5%;d= −0.01; 95% CI, −0.22 to −0.19;P= .46).

Conclusions

Exercising while listening to podcasts did not appear to meaningfully affect knowledge acquisition or retention at 30 days when compared with listening while seated and undistracted.
Characterizing Negative Online Reviews of Spine Surgeons
Authors: Artz Nicolas , Dalton Jonathan , Ramanathan Rahul , Lin Ryan T. , Sadhwani Shaan , Como Christopher J. , Oyekan Anthony , Tang Yunting Melissa , Li Vivian , Nwankwo Josephine , Lee Joon Y. , Shaw Jeremy D.
Published: February 2024

Design.

Retrospective review.

Objective.

Characterize negative reviews of spine surgeons in the United States.

Physician rating websites significantly influence the selection of doctors by other patients. Negative experiences are impacted by various factors, both clinical and nonclinical, geography, and practice structure. The purpose of this study was to evaluate and categorize negative reviews of spine surgeons in the United States, with a focus on surgicalversusnonsurgical reviewers.

Methods.

Spine surgeons were selected from available online professional society membership directories. A search for reviews was performed on Healthgrades.com, Vitals.com, and RateMDs.com for the past 10 years. Free response reviews were coded by complaint, and qualitative analysis was performed. χ2and Fisher exact tests were used to compare categorical variables, and multiple comparisons were adjusted with Benjamini-Hochberg correction. A binary logistic regression model was performed for the top three most mentioned nonclinical and clinical complaint labels. AP-value <0.05 was considered statistically significant.

Results.

A total of 16,695 online reviews were evaluated, including 1690 one-star reviews (10.1%). Among one-star reviews, 64.7% were written by nonsurgical patients and 35.3% by surgical patients. Nonclinical and clinical comments constituted 54.9% and 45.1% of reviews, respectively. Surgeons in the South had more “bedside manner” comments (43.3%,P<0.0001), while Northeast surgeons had more “poor surgical outcome” remarks compared with all other geographic regions (14.4%,P<0.001). Practicing in the South and Northeast were independent predictors of having complaints about “bedside manner” and “poor surgical outcome,” respectively.

Conclusion.

Most one-star reviews of spine surgeons were attributed to nonsurgical patients, who tended to be unsatisfied with nonclinical factors, especially “bedside manner.” However, there was substantial geographic variation. These results suggest that spine surgeons could benefit from focusing on nonclinical factors (bedside manner), especially among nonoperative patients, and that regional nuances should be considered in delivering spine care.

Level of Evidence.

Level— 5
“A Caregiver’s Marriage”: The Impact of Blood Cancer on the Spousal Connection
Authors: Mullis M. Devyn , Wollney Easton N. , Bylund Carma L. , Campbell-Salome Gemme , Wright Kevin B. , Sae-Hau Maria , Weiss Elisa S. , Rajotte Michelle , Fisher Carla L.
Published: February 2024

Background:

Spouses are the most common type of cancer caregiver and a primary source of support across the cancer continuum. While studies show that cancer can impact caregivers’ health outcomes, less is known about how blood cancer impacts the spousal relationship.

Objective:

We sought to examine the impact of blood cancer on the relational connection of married couples from the perspective of the spousal caregiver.

Interventions/Methods:

We thematically analyzed transcripts of in-depth interviews with caregivers of a spouse diagnosed with a blood cancer.

Results:

Caregivers (n = 27) identified positive and negative relational impacts related to physical intimacy, emotional intimacy, marital roles, discordance between spouses in coping, and a disrupted relational future.

Conclusions:

Spousal caregivers must navigate ongoing relational impacts across the care continuum. These relational effects illustrate how cancer jointly impacts diagnosed individuals and their caregiving spouses, altering their relational connection, roles, and future as a couple. While marital bonds can become strengthened after cancer, it also challenges couples and how they typically relate, which may be informed by gendered norms in some marital relationships.

Implications for Practice:

To provide better support, educational resources and interventions are needed to help couples prepare for and address challenges with intimacy, gender roles, discordant communication and coping preferences, managing discussions about their future, and coping with uncertainty.

What Is Foundational:

To support individuals living with blood cancer and their caregiving spouses, their needs must be understood from a family-centered or relational perspective to better facilitate psychosocial adjustment during and after cancer treatment.
A Comparison of Preferentially Expressed Antigen in Melanoma Immunohistochemistry and Diagnostic Gene Expression-Profiling Assay in Challenging Melanocytic Proliferations
Authors: Casillas Austin C. , Muhlbauer Aaron , Barragan Victor A. , Jefferson Itisha , Speiser Jodi J.
Published: February 2024

Most melanocytic tumors are classified as benign or malignant based on clinical morphology, histology, and immunohistochemical (IHC) analysis. A subset of more challenging cases with ambiguous features may require further evaluation with established ancillary diagnostic molecular studies, including fluorescence in situ hybridization and/or single nucleotide polymorphism array, to increase diagnostic certainty. More recently, a diagnostic gene expression-profiling (GEP) assay and an IHC stain for the detection of PRAME (PReferentially expressed Antigen in MElanoma) have been developed. The use of PRAME IHC has been validated in cases of unequivocal and ambiguous melanocytic proliferations via comparing results with fluorescence in situ hybridization and/or single nucleotide polymorphism array. A study comparing performance metrics of PRAME IHC and diagnostic GEP has not been previously published. Herein, we evaluated the use of PRAME IHC in 55 melanocytic tumors with challenging histomorphology by comparing the results with diagnostic GEP and final histomorphologic diagnosis. Intertest agreement occurred in 88% of cases. PRAME IHC supported the final diagnosis in 89% of cases with a sensitivity of 79%, specificity of 95%, and positive predictive value of 88.2%. GEP agreed with the final diagnosis in 88% of cases with a sensitivity of 65%, 97% specificity, and positively predicted melanoma in 91.7% of cases. Because the results of this study align with past publications evaluating the performance metrics of PRAME IHC, showing it to be as sensitive as and more cost effective than all other ancillary molecular tests, we propose the use of PRAME IHC as the optimal first-line diagnostic tool for ambiguous melanocytic proliferations.
Pesticide exposure, birth size, and gestational age in the ISA birth cohort, Costa Rica
Authors: van Wendel de Joode Berna , Peñaloza-Castañeda Jorge , Mora Ana M. , Corrales-Vargas Andrea , Eskenazi Brenda , Hoppin Jane A. , Lindh Christian H.
Published: February 2024

Purpose:

To examine associations of prenatal biomarkers of pesticide exposure with birth size measures and length of gestation among newborns from the Infants’ Environmental Health (ISA) birth cohort, Costa Rica.

Methods:

We included 386 singleton liveborn newborns with data on birth size measures, length of gestation, and maternal urinary biomarkers of chlorpyrifos, synthetic pyrethroids, mancozeb, pyrimethanil, and 2, 4-D during pregnancy. We associated biomarkers of exposure with birth outcomes using multivariate linear regression and generalized additive models.

Results:

Concentrations were highest for ethylene thiourea (ETU, metabolite of mancozeb), median = 3.40; p10–90 = 1.90–6.79 µg/L, followed by 3,5,6-trichloro-2-pyridinol (TCP, metabolite of chlorpyrifos) p50 = 1.76 p10–90 = 0.97–4.36 µg/L, and lowest for 2,4-D (p50 = 0.33 p10–90 = 0.18–1.07 µg/L). Among term newborns (≥37 weeks), higher prenatal TCP was associated with lower birth weight and smaller head circumference (e.g., β per 10-fold-increase) during the second half of pregnancy = −129.6 (95% confidence interval [CI] = −255.8, −3.5) grams, and −0.61 (95% CI = −1.05, −0.17) centimeters, respectively. Also, among term newborns, prenatal 2,4-D was associated with lower birth weight (β per 10-fold-increase = −125.1; 95% CI = −228.8, −21.5), smaller head circumference (β = −0.41; 95% CI = −0.78, −0.03), and, during the second half of pregnancy, with shorter body length (β = −0.58; 95% CI = −1.09, −0.07). Furthermore, ETU was nonlinearly associated with head circumference during the second half of pregnancy. Biomarkers of pyrethroids and pyrimethanil were not associated with birth size, and none of the biomarkers explained the length of gestation.

Conclusions:

Prenatal exposure to chlorpyrifos and 2,4-D, and, possibly, mancozeb/ETU, may impair fetal growth.
Intravenous iron in patients with iron deficiency and heart failure: a review of modern evidence
Authors: Gale Stormi E. , Willeford Andrew , Sandquist Katherine , Watson Kristin
Published: February 2024

Purpose of review

Iron deficiency is common in patients with heart failure, affecting up to half of ambulatory patients and an even greater percentage of patients admitted for acute decompensation. Iron deficiency in this population is also associated with poor outcomes, including worse quality of life in addition to increased hospitalizations for heart failure and mortality. Evidence suggests that patients with iron deficiency in heart failure may benefit from repletion with IV iron.

Recent findings

In this review, we outline the etiology and pathophysiology of iron deficiency in heart failure as well as various iron formulations available. We discuss evidence for intravenous iron repletion with a particular focus on recent studies that have evaluated its effects on hospitalizations and mortality. Finally, we discuss areas of uncertainty and future study and provide practical guidance for iron repletion.

In summary, there is overwhelming evidence that intravenous iron repletion in patients with iron deficiency in heart failure is both beneficial and safe. However, further evidence is needed to better identify which patients would most benefit from iron repletion as well as the ideal repletion strategy.
Meconium aspiration syndrome: from pathophysiology to treatment
Authors: Dini Gianluca , Ceccarelli Sara , Celi Federica , Semeraro Carla Maria , Gorello Paolo , Verrotti Alberto
Published: February 2024

Meconium aspiration syndrome (MAS) is a clinical condition characterized by respiratory distress in neonates born through meconium-stained amniotic fluid (MSAF). Despite advances in obstetric practices and perinatal care, MAS remains an important cause of morbidity and mortality in term and post-term newborns. Since the 1960s, there have been significant changes in the perinatal and postnatal management of infants born through MSAF. Routine endotracheal suctioning is no longer recommended in both vigorous and non-vigorous neonates with MSAF. Supportive care along with new treatments such as surfactant, inhaled nitric oxide, and high-frequency ventilation has significantly improved the outcome of MAS patients. However, determining the most appropriate approach for this condition continues to be a topic of debate. This review offers an updated overview of the epidemiology, etiopathogenesis, diagnosis, management, and prognosis of infants with MAS.
Recurrent GATA3 P409Afs*99 Frameshift Extension Mutations in Sweat-gland Carcinoma With Neuroendocrine Differentiation
Authors: Goto Keisuke , Kiniwa Yukiko , Kukita Yoji , Ohe Shuichi , Hiraki Tsubasa , Hishima Tsunekazu , Takai Toshihiro , Honma Keiichiro
Published: February 2024

Sweat-gland carcinoma with neuroendocrine differentiation (SCAND) was recently proposed as a new cutaneous adnexal neoplasm with neuroendocrine differentiation; however, its genetics are not well known. Herein, we performed clinicopathologic and genetic analyses of 13 SCAND cases and 5 control cases of endocrine mucin-producing sweat gland carcinoma (EMPSGC). The SCAND group included 11 males and 2 females with a median age of 68 years (range, 50 to 80 y). All SCAND lesions occurred in the ventral trunk or genital area. Of the 13 SCAND cases, 9 and 5 exhibited lymph node and distant metastases, respectively. Three (23.1%) patients with SCAND died of the disease. In contrast, neither metastasis nor mortality was confirmed in the EMPSGC cases. Immunoexpression of the androgen receptor, c-Myb, and MUC2 was limited in SCAND, whereas EMPSGC frequently expressed these immunomarkers. GATA3 P409Afs*99 extension mutations were detected in 7 (53.8%) of the 13 SCAND cases, using Sanger or panel sequencing. All 7 SCAND cases with GATA3 mutations were located in the genital, inguinal, or lower abdominal regions, whereas 5 of the other 6 SCAND cases were located in the anterior upper to mid-trunk. No GATA3 mutations were detected in the EMPSGC cases (0/5, 0%). These clinicopathologic and genetic findings support SCAND as a tumor entity distinguishable from EMPSGC. In addition, the characteristic frameshift extension mutations in GATA3 contribute to the establishment of the tumor-type concept of SCAND.
Single-Center, Long-Term Experience with Mentor Contour Profile Gel Implants: What Can We Learn after 21 Years of Follow-Up?
Authors: Martin del Yerro Jose L. , Bengoa Sara D.
Published: February 2024

Background:

The difficulty in obtaining long-term data with the use of breast implants is well known. The majority of available data are from multicenter studies with different surgical techniques, and different implants.

Methods:

The authors provide retrospective 10-year study data (2001 to 2011) with Mentor Contour Profile Gel implants after a mean of 13 years of follow-up, in the first single-center study of such size and length. This study included 835 patients with 1674 Mentor implants across 6 surgery types, all of them performed with a consistent surgical technique developed by the senior author (J.L.M.Y.). Long-term complication rates were analyzed. For the safety analysis, Kaplan-Meier risk rates were calculated.

Results:

A total of 85% of the patients had long-term follow-up data (at least 7 years). The overall complication rate was 13.2%. The reoperation rate was 12.3%, being just 6.2% caused by complications. The 21-year Kaplan Meier cumulative incidence rate was 1.7% for capsular contracture and 5.1% for implant rupture. The periareolar approach and having a previous capsular contracture were found to be risk factors to develop a new capsular contracture. Low-height, high-projected implants had a significant higher risk of implant rotation. No breast implant-associated anaplastic large cell lymphoma or breast implant illness cases were found; 89.2% of the patients reported being satisfied or very satisfied with the surgery and the implant.

Conclusion:

With a consistent surgical technique, these 21-year follow-up data of the Mentor Contour Profile Gel implants reaffirm the very strong safety profile of these implants, and continued patient satisfaction with them.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Lower Third Soft Tissue Changes After Orthognathic Surgery
Authors: Reategui Alvaro , Mier Alexa , Khetpal Sumun , Lopez Joseph , Steinbacher Derek
Published: February 2024

Background:

Triple jaw surgery, inclusive of a LeFort osteotomy, bilateral sagittal split osteotomy, and genioplasty, is used to maximize functional and esthetic outcomes for patients. This is achieved through the procedure’s measurable effects on the craniofacial skeleton but is also influenced by the soft tissue changes that occur as a result of the procedure. This study aims to characterize the three-dimensional (3D) soft tissue changes of triple jaw surgery.

Methods:

Patient demographics were collected along with pre and postoperative 3D images (3D VECTRA photosystem, Canfield, Fairfield, NJ). Orolabial anthropometric measurements were performed using Mirror (Canfield Scientific Inc., Fairfield, NJ).

Results:

Forty-eight 3D data sets were included. The male/female ratio was 0.6, with a mean age of 23.4 years. Significant postoperative decreases (P<0.001) were seen in the mean absolute distance from the lower lip to S-line and distance from lower lip to H-line. In female patients, upper vermilion fullness, lower lip height, lower vermilion fullness, distance from lower lip to S-line, and absolute distance from lower lip to H-line were found to fall within ideal norms postoperatively. In male patients, lower lip height, lower vermilion fullness, distance from lower lip to S-line, and absolute distance from lower lip to H-line were found to fall within ideal norms postoperatively.

Conclusions:

Triple jaw surgery has a significant soft tissue impact and can transform some orolabial measurements to conform to ideal norms.
Spring-Assisted Surgery of Unilambdoid Craniosynostosis
Authors: Mellgren Jonas , Maltese Giovanni , Tarnow Peter , Bhatti-Søfteland Madiha , Kölby Lars , Säljö Karin
Published: February 2024

Craniosynostosis is traditionally treated with extensive cranial vault reconstructions (CVRs). Although less invasive techniques, such as endoscopic strip craniectomy with postoperative helmet therapy, have been successful, they also present difficulties. An alternative method is distraction osteogenesis using either manually controlled devices or specially designed springs. In this study, the authors provide the first comparison of spring-assisted surgery (SAS) with CVR for the treatment of unilambdoid synostosis (ULS). Fourteen consecutive patients (8 CVR and 6 SAS) treated for ULS at Sahlgrenska University Hospital between 2005 and 2018 were included. Skull shape and deviations were evaluated using previously defined measurement points on 3-dimensional computed tomography scans preoperatively, at spring removal, and at 3 years of age. Posterior and middle cranial fossa (PCF and MCF, respectively), skull-base cant, facial twist, and mastoid bulge (MB) were measured, and clinical data were obtained from chart reviews. The results indicated that at the 3-year follow-up, PCF, MCF, and MB improved in both groups, with no significant difference in outcome observed between methods. In the SAS group, duration of operation [61±27 min (mean±SD)] and perioperative bleeding (3.5±2.8 mL/kg body weight) were both significantly lower relative to the CVR group (P<0.05). These findings showed that both SAS and CVR resulted in similar improvements in treating ULS, although neither produced complete normalization of skull shape. The results suggest that early diagnosis and operation allow less extensive SAS to be performed without adversely affecting the results.