Biomechanical Study of a Multifilament Stainless Steel Cable Crimp System Versus a Multistrand Ultra-High Molecular Weight Polyethylene Polyester Suture Krackow Technique for Achilles Tendon Rupture Repair.

Currently, Achilles tendon rupture repair is surgically addressed with an open or minimally invasive approach using a heavy, nonabsorbable suture in a locking stitch configuration. However, these sutures have low stiffness and a propensity to stretch, which can result in gapping at the repair site. Our study compares a new multifilament stainless steel cable-crimp repair method to a standard Krackow repair using multistrand, ultra-high molecular weight polyethylene polyester sutures. Eight matched pairs of cadavers were randomly assigned for Achilles tendon repair using either Krackow technique with polyethylene polyester sutures or the multifilament stainless steel cable-crimp technique. Each repair was cyclically loaded from 10 to 50 N for 100 loading cycles, followed by a linear increase in load until complete failure of the repair. During cyclic loading, 4 of the 8 Krackow polyethylene polyester suture repairs failed, whereas none of the multifilament stainless steel cable crimp repairs failed. Load to failure was greater for the multifilament stainless steel cable crimp repairs (321.03 ± 118.71 N) than for the Krackow polyethylene polyester suture repairs (132.47 ± 103.39 N, p = .0078). The ultimate tensile strength of the multifilament stainless steel cable crimp repairs was also greater than that of the Krackow polyethylene polyester suture repairs (485.69 ± 47.93 N vs 378.71 ± 107.23 N, respectively, p = .12). The mode of failure was by suture breakage at the crimp for all cable-crimp repairs and by suture breakage at the knot, within the tendon, or suture pullout for the polyethylene polyester suture repairs. The multifilament stainless steel cable crimp construct may be a better alternative for Achilles tendon rupture repairs.

Are Problems that Contribute to Divorce Present at the Start of Marriage, or Do They Emerge Over Time?

Divorced individuals offer explanations for why their relationship ended, yet little is known about the development of these problems during the relationship. Problems that lead to divorce may exist at the beginning of the marriage (enduring dynamics model) or may develop over time (emergent distress model). We asked 40 divorced individuals about the reasons for their divorce and compared the development of problems that did and did not contribute to their divorce over the first few years of their marriage. Results support an emergent distress model for wives; they saw problems that lead to divorce increasing over time, whereas results for husbands indicated that they were less attuned to problems overall, suggesting that wives are the bellwether for relationship problems.

Comparison of artificial intelligence large language model chatbots in answering frequently asked questions in anaesthesia.

Background: Patients are increasingly using artificial intelligence (AI) chatbots to seek answers to medical queries. Methods: Ten frequently asked questions in anaesthesia were posed to three AI chatbots: ChatGPT4 (OpenAI), Bard (Google), and Bing Chat (Microsoft). Each chatbot's answers were evaluated in a randomised, blinded order by five residency programme directors from 15 medical institutions in the USA. Three medical content quality categories (accuracy, comprehensiveness, safety) and three communication quality categories (understandability, empathy/respect, and ethics) were scored between 1 and 5 (1 representing worst, 5 representing best). Results: ChatGPT4 and Bard outperformed Bing Chat (median [inter-quartile range] scores: 4 [3-4], 4 [3-4], and 3 [2-4], respectively; P<0.001 with all metrics combined). All AI chatbots performed poorly in accuracy (score of ≥4 by 58%, 48%, and 36% of experts for ChatGPT4, Bard, and Bing Chat, respectively), comprehensiveness (score ≥4 by 42%, 30%, and 12% of experts for ChatGPT4, Bard, and Bing Chat, respectively), and safety (score ≥4 by 50%, 40%, and 28% of experts for ChatGPT4, Bard, and Bing Chat, respectively). Notably, answers from ChatGPT4, Bard, and Bing Chat differed statistically in comprehensiveness (ChatGPT4, 3 [2-4] vs Bing Chat, 2 [2-3], P<0.001; and Bard 3 [2-4] vs Bing Chat, 2 [2-3], P=0.002). All large language model chatbots performed well with no statistical difference for understandability (P=0.24), empathy (P=0.032), and ethics (P=0.465). Conclusions: In answering anaesthesia patient frequently asked questions, the chatbots perform well on communication metrics but are suboptimal for medical content metrics. Overall, ChatGPT4 and Bard were comparable to each other, both outperforming Bing Chat.

Three tests of the Vulnerability-Stress-Adaptation Model: Independent prediction, mediation, and generalizability.

Objective: Efforts to understand why some marriages thrive while others falter are (a) not well integrated conceptually and (b) rely heavily on data collected from White middle-class samples. The Vulnerability-Stress-Adaptation Model (VSA; Karney and Bradbury, 1995) is used here to integrate prior efforts and is tested using data collected from couples living with low incomes. Background: The VSA Model assumes (a) that enduring vulnerabilities, stress, and couple communication account for unique variance in relationship satisfaction, (b) that communication mediates the effects of vulnerabilities and stress on satisfaction, and (c) that the predictors of satisfaction generalize across socioeconomic levels. To date, these assumptions remain untested. Materials and methods: With 388 couples from diverse backgrounds (88% Black or Hispanic), we used latent variable structural equation models to examine enduring vulnerabilities, chronic stress, and observed communication as predictors of 4-wave, 27-month satisfaction trajectories, first as main effects and then interacting with a validated 10-item index of sociodemographic risk. Results: (a) The three variable sets independently predict satisfaction trajectories; (b) couple communication does not mediate the effects of enduring vulnerabilities or stress on satisfaction; and (c) in 19% of tests, effects were stronger among couples with higher sociodemographic risk. Conclusion: Effects of established predictor domains on satisfaction replicate in a diverse sample of newlywed couples, and most findings generalize across levels of sociodemographic risk. The failure of couple communication to mediate effects of enduring personal vulnerabilities and stress raises new questions about how these two domains undermine committed partnerships.

Couples' Diminished Social and Financial Capital Exacerbate the Association Between Maladaptive Attributions and Relationship Satisfaction.

BACKGROUND: Theoretical and clinical perspectives argue that couples' maladaptive attributions for marital problems lead to marital distress, and that these attributions will detract from couples' relationships regardless of their external circumstances. However, emerging work in cognitive psychology indicates that stress simplifies individuals' information processing, suggesting that the demands faced by couples may strengthen the link between maladaptive attributions and relationship satisfaction. METHODS: With a sample of 462 ethnically diverse newlywed spouses living with low incomes (231 couples, with >30% Black and >50% Latinx), we assessed attributions and relationship satisfaction, along with three hypothesized moderators: couples' financial strain, perceived financial capital within couples' social networks, and the proportion of married couples within couples' social networks. RESULTS: After replicating the robust association between maladaptive attributions and relationship satisfaction, we demonstrate that the association between maladaptive attributions and satisfaction is stronger to the extent that spouses' social networks are characterized by fewer financial resources and lower proportions of married couples. CONCLUSION: Contextual factors may alter the effects that partners' cognitions have on relationship satisfaction, suggesting that influences far removed from the dyad itself can affect basic processes arising between partners.

Consumption of cruciferous vegetables and the risk of bladder cancer in a prospective US cohort: data from the NIH-AARP diet and health study.

BACKGROUND: Abundant pre-clinical data suggest that consumption of cruciferous vegetables might protect against bladder cancer. While small-scale clinical evidence supports this hypothesis, population-level data is lacking. We tested the hypothesis that consumption of cruciferous vegetables is associated with a lower risk of bladder cancer in a large population-based study. METHODS: We investigated the association between dietary consumption of cruciferous vegetables and the risk of bladder cancer in the NIH-American Association of Retired Persons (AARP) Diet and Health Study. Diet at baseline was collected with self-administered food-frequency questionnaires. Bladder cancer diagnoses were identified through linkage with state cancer registries. Hazard ratio (HR) and 95% confidence intervals (CI) were estimated with Cox proportional hazards models. RESULTS: Our analysis included 515,628 individuals. Higher intake of cruciferous vegetables, both overall and when stratified by variety (broccoli vs. brussels sprouts vs. cauliflower), were not associated with bladder cancer risk for men or women. A history of smoking did not affect the results. CONCLUSIONS: Our study shows no association between dietary consumption of cruciferous vegetables and incident bladder cancer.

When poor communication does and does not matter: The moderating role of stress.

[Correction Notice: An Erratum for this article was reported in Vol 34(6) of Journal of Family Psychology (see record 2020-62946-001). There are two errors in the last sentence of the fifth paragraph (Model 4: Fluctuations in Cumulative Stress X Fluctuations in Behavior) of the Results section whereby the text "less cumulative stress" and "less stress" should have read "more cumulative stress" and "more stress," respectively. Thus, the correct sentence is as follows: "Specifically, relative increases in observed dyadic negativity were associated with decreases in husbands' relationship satisfaction when husbands also experienced more cumulative stress, whereas decreases in observed negativity in the presence of more stress were associated with increases in husbands' satisfaction (t = -2.00, p = .045, see Figure 1 and Table 2, Model 4)." Note that the findings are correctly stated elsewhere in the article.] Although a number of theoretical perspectives in relationship science argue that variability in couples' relationship satisfaction over time is driven by changes in their communication, tests of this hypothesis have been limited to single assessments of behavior. To address this gap, we examine within-couple, across-time changes in communication, and we argue further that couples' external circumstances might combine with these behavioral changes to generate changes in relationship satisfaction. Using self-reports of satisfaction and in-home observational data collected 4 times at 9-month intervals from 414 newlywed couples, we show that fluctuations in dyadic behavior and spousal stress covary with fluctuations in spousal satisfaction. Tests of the interaction between fluctuations in stress and behavior reveal that husbands who experience upward fluctuations in negativity also experience decreases in relationship satisfaction at the same wave but only if they are concurrently experiencing greater stress than usual. Downward fluctuations in problem-solving effectiveness are associated with lower relationship satisfaction but only among spouses who had chronically high levels of cumulative stress; when chronic stress is low, reduced problem-solving effectiveness is unrelated to satisfaction. Exclusive focus on between-couple variability in couple communication, without regard for the stressors that couples face, will likely restrict the understanding and prevention of relationship distress. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Communication that is maladaptive for middle-class couples is adaptive for socioeconomically disadvantaged couples.

Demands for change in a relationship, particularly when met by behavioral withdrawal, foreshadow declines in relationship satisfaction. Yet demands can give partners opportunities to voice concerns, and withdrawal can serve to de-escalate conflict, stabilizing satisfaction instead (e.g., Overall, Fletcher, Simpson, & Sibley, 2009). We aim to reconcile these competing possibilities by arguing that withdrawal in response to requests for change will be detrimental among couples who possess the social, educational, and economic capital needed to address these requests, whereas withdrawal in response to partner demands will be constructive among couples with fewer resources for making the requested changes. Study 1 (N = 515 couples; 18-month follow-up) replicates the harmful effects of observed demand/withdraw communication on changes in wives' satisfaction among relatively affluent couples, while documenting benefits of demand/withdraw communication among relatively disadvantaged couples. Using 4 waves of observational data, Study 2 (N = 431 couples; 9-, 18- and 27-month follow-ups) shows that socioeconomic risk moderates the covariation between the demand/withdraw pattern and wives' relationship satisfaction, with higher levels of withdrawal again proving to be beneficial when socioeconomic risk is high. In both studies, behavioral withdrawal by men appears to be maladaptive when couples have resources and capacities to enact desired changes, but may be adaptive when those resources and capacities are lacking. Efforts to change couple communication without appreciating the larger social and economic contexts of those behaviors may be counterproductive. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Budesonide irrigation with olfactory training improves outcomes compared with olfactory training alone in patients with olfactory loss.

BACKGROUND: Olfactory training (OT) helps many patients with olfactory loss, but unfortunately it is ineffective for a significant number of patients. Budesonide irrigations are widely used to help patients with paranasal sinus inflammation, but have never been tested as a treatment for olfactory loss. We sought to examine the effect of adding budesonide irrigation to olfactory training on patients with olfactory loss without any visible sign of sinonasal inflammation. METHODS: In this randomized, controlled trial, 138 patients with olfactory loss and without any visible sign of sinonasal inflammation were randomized to either OT with saline irrigations or OT with budesonide irrigations. The University of Pennsylvania Smell Identification Test (UPSIT) was administered at the beginning of the study and at 6 months. RESULTS: A total of 133 patients completed the study. Forty-seven patients (35.3%) had a clinically significant change in UPSIT score. Among those in the budesonide irrigation + olfactory therapy group, 43.9% improved, compared with 26.9% in the saline irrigation + olfactory therapy group (p = 0.039); this corresponds to an odds ratio of 3.93 (95% confidence interval, 1.20-12.88) in a fully adjusted model (p = 0.024). Younger age and shorter duration of olfactory loss were also significant predictors of improvement. CONCLUSION: Adding budesonide irrigation to olfactory training significantly improved olfactory ability compared with olfactory training plus saline irrigation.

Childhood abuse and later marital outcomes: Do partner characteristics moderate the association?

Although people with a history of child abuse are known to be at elevated risk for later difficulties in relationships, there is debate over whether these effects are enduring and relatively immutable or are moderated by characteristics and behaviors of the partner. To reconcile these competing perspectives, we conducted a longitudinal study of 414 newlywed couples living in low-income neighborhoods, testing whether the association between abuse history and relationship satisfaction is dependent on the partners' aggression, depression, substance abuse, observed communication, and other demographic risk factors. Spouses who had been abused as children (25% of husbands, 31% of wives) reported more symptoms of depression and substance abuse and, among husbands, displayed more negative communication. Spouses with a history of child abuse were also less satisfied with their marriage, even as newlyweds; abused wives also declined in satisfaction over time compared to those without this history. However, interactions between abuse history and all of the proposed moderators were not significant, indicating that partner and relationship characteristics failed to strengthen or weaken the association between abuse history and relationship satisfaction. Childhood experiences of abuse appear to have lasting and broad effects on individual and relational outcomes, and these effects are neither heightened nor mitigated by the partner's characteristics or behaviors. (PsycINFO Database Record

Communication moderates effects of residential mobility on relationship quality among ethnically diverse couples.

Although interpersonal communication is a defining feature of committed relationships, the quality of couple communication has not proven to be a straightforward cause of relationship quality. At the same time, emerging models argue that external circumstances likely combine with communication to generate changes in relationship quality. We integrate these 2 ideas by proposing that communication does exert effects on changes in relationship quality, but primarily when couples encounter challenging situations that require an adaptive response. In the present study we examine residential moves to different neighborhoods as one such adaptive challenge. We conducted a longitudinal study of 414 newlywed couples to examine whether observed communication moderates the effect of moving to higher- or lower-income neighborhoods on changes in relationship quality. Results indicate that communication exerts no main effects on relationship quality. Consistent with the proposed model, however, wives who displayed less positive, less effective, and more negative behaviors experienced greater decreases in relationship quality, but only when couples moved to substantially higher-income neighborhoods. Because communication may not affect relationship quality until couples encounter qualitatively new demands, strengthening relationships may pivot less on improving communication skills and more on ensuring that couples' circumstances do not overwhelm the skills that they already possess. (PsycINFO Database Record