A blueprint for truncation resonance placement in elastic diatomic lattices with unit cell asymmetrya).

Elastic periodic lattices act as mechanical filters of incident vibrations. By and large, they forbid wave propagation within bandgaps and resonate outside them. However, they often encounter "truncation resonances" (TRs) inside bandgaps when certain conditions are met. In this study, we show that the extent of unit cell asymmetry, its mass and stiffness contrasts, and the boundary conditions all play a role in the TR location and wave profile. The work is experimentally supported via two examples that validate the methodology, and a set of design charts is provided as a blueprint for selective TR placement in diatomic lattices.

The genomic trajectory of ovarian high-grade serous carcinoma can be observed in STIC lesions.

Ovarian high-grade serous carcinoma (HGSC) originates in the fallopian tube, with secretory cells carrying a TP53 mutation, known as p53 signatures, identified as potential precursors. p53 signatures evolve into serous tubal intraepithelial carcinoma (STIC) lesions, which in turn progress into invasive HGSC, which readily spreads to the ovary and disseminates around the peritoneal cavity. We recently investigated the genomic landscape of early- and late-stage HGSC and found higher ploidy in late-stage (median 3.1) than early-stage (median 2.0) samples. Here, to explore whether the high ploidy and possible whole-genome duplication (WGD) observed in late-stage disease were determined early in the evolution of HGSC, we analysed archival formalin-fixed paraffin-embedded (FFPE) samples from five HGSC patients. p53 signatures and STIC lesions were laser-capture microdissected and sequenced using shallow whole-genome sequencing (sWGS), while invasive ovarian/fallopian tube and metastatic carcinoma samples underwent macrodissection and were profiled using both sWGS and targeted next-generation sequencing. Results showed highly similar patterns of global copy number change between STIC lesions and invasive carcinoma samples within each patient. Ploidy changes were evident in STIC lesions, but not p53 signatures, and there was a strong correlation between ploidy in STIC lesions and invasive ovarian/fallopian tube and metastatic samples in each patient. The reconstruction of sample phylogeny for each patient from relative copy number indicated that high ploidy, when present, occurred early in the evolution of HGSC, which was further validated by copy number signatures in ovarian and metastatic tumours. These findings suggest that aberrant ploidy, suggestive of WGD, arises early in HGSC and is detected in STIC lesions, implying that the trajectory of HGSC may be determined at the earliest stages of tumour development. © 2024 The Author(s). The Journal of Pathology published by John Wiley & Sons Ltd on behalf of The Pathological Society of Great Britain and Ireland.

Evaluation of Patella Anatomy for Total Knee Arthroplasty Approaches.

BACKGROUND: The patella, or kneecap, is a sesamoid bone situated deep to the fascia latae and the tendinous fibers of the rectus femoris. The medial and lateral facets of the patella articulate with the medial and lateral condyles of the femur, respectively, to form the patellofemoral component of the knee joint. When joint cartilage is destroyed due to osteoarthritis, inflammatory arthritis, post-traumatic degenerative joint disease, or osteonecrosis/joint collapse with cartilage loss, a surgical treatment called knee arthroplasty, or total knee arthroplasty (TKA), is used to rebuild the knee joint. OBJECTIVES: The purpose of our study is to provide a detailed morphometric analysis of the human patella. METHODS: A total of 168 patellae (86 left, 82 right) were examined. Eleven parameters were determined to evaluate patella morphometry, and the bones were also evaluated with the Wiberg classification. RESULT: Type I patella was observed in 13 samples (7.74%); 109 (64.88%) and 46 (27.38%) were Type II and Type III, respectively. In the statistical analysis, significant differences were found between the right and left patellae in terms of patellar thickness, vertical ridge length, and Wiberg angle (p<0.05). There were also significant differences between the Wiberg types and the medial articular width and lateral articular width (p<0.05). CONCLUSION: In order to avoid potential difficulties during knee surgery, it is crucial to understand the typical morphological and morphometric properties of the patella. We believe that this study will be useful to surgeons who perform surgical approaches to the knee and to clinicians who evaluate the diseases of the region.

Bone Anchor Fixation in the Repair of Blunt Traumatic Abdominal Wall Hernias: A Western Trauma Association Multicenter Study.

BACKGROUND: Blunt traumatic abdominal wall hernias (TAWHs) are rare but require a variety of operative techniques to repair including bone anchor fixation (BAF) when tissue tears off bony structures. This study aimed to provide a descriptive analysis of BAF technique for blunt TAWH repair. Bone anchor fixation and no BAF repairs were compared, hypothesizing increased hernia recurrence with BAF repair. METHODS: A secondary analysis of the WTA blunt TAWH multicenter study was performed including all patients who underwent repair of their TAWH. Patients with BAF were compared to those with no BAF with bivariate analyses. RESULTS: 176 patients underwent repair of their TAWH with 41 (23.3%) undergoing BAF. 26 (63.4%) patients had tissue fixed to bone, with 7 of those reinforced with mesh. The remaining 15 (36.6%) patients had bridging mesh anchored to bone. The BAF group had a similar age, sex, body mass index, and injury severity score compared to the no BAF group. The time to repair (1 vs 1 days, P = .158), rate of hernia recurrence (9.8% vs 12.7%, P = .786), and surgical site infection (SSI) (12.5% vs 15.6%, P = .823) were all similar between cohorts. CONCLUSIONS: This largest series to date found nearly one-quarter of TAWH repairs required BAF. Bone anchor fixation repairs had a similar rate of hernia recurrence and SSI compared to no BAF repairs, suggesting this is a reasonable option for repair of TAWH. However, future prospective studies are needed to compare specific BAF techniques and evaluate long-term outcomes including patient-centered outcomes such as pain and quality of life.

Magnetic resonance imaging should be the first-line imaging modality for investigating suspected proximal hamstring avulsion injuries.

PURPOSE: The purpose of the study was to evaluate how the initial diagnostic tool used-specifically ultrasound (US) or magnetic resonance imaging (MRI)-for diagnosing proximal hamstring avulsion injury affects the delay before surgery and, secondarily, the outcomes of these injuries. METHODS: This was a retrospective analysis of prospectively collected data (2012-2020). It targeted patients primarily treated for proximal hamstring avulsion injury. It included all patients with a preoperative US and/or MRI. Patients were divided into two groups based on the initial diagnostic tool used (US-first vs. MRI-first groups). The primary outcomes measure was the time from initial injury to surgical intervention (surgical delay). The secondary outcomes were the Parisien Hamstring Avulsion Score, as well as the activity level as measured by the University of California, Los Angeles (UCLA) Activity Scale and Tegner Activity Scale. RESULTS: The analysis included 392 patients with a mean age of 43.8 ± 13.6 years for the MRI-first group and 47.6 ± 12.0 years for US-first group. Patients in the MRI-first group had a significantly shorter median time from injury to surgery of 20.0 days (interquartile range [IQR]: 11.0-61.0) compared to 30 days (IQR: 18-74) in the US-first group. At the final follow-up (4.2 ± 2.2 years for the MRI-first group and 5.1 ± 1.9 years for the US-first group), the MRI-first group had significantly higher mean Tegner Activity Scale and UCLA scores than the US-first group: The Tegner Activity Scale was median 5 (IQR: 3-7) for the MRI-first group versus median 4 (IQR: 2-6) for the US-first group (p < 0.05). The UCLA scores were 7.9 ± 2.4 for the MRI-first group compared to 7.3 ± 2.4 for the US-first group (p < 0.05). This difference was more pronounced when comparing the MRI-first group with the patient-false negative initial ultrasound. No difference was found regarding the Parisien Hamstring Avulsion Score. CONCLUSION: MRI as the initial diagnostic tool for proximal hamstring avulsion injury is associated with a shorter time to surgery and better postoperative outcomes in Tegner Activity Scale and UCLA scores, compared to US. LEVEL OF EVIDENCE: Level III.

Residents Need a Dynamic Approach to Leadership Education: A Qualitative Study.

OBJECTIVE: Leadership is an essential skill for surgeons, but it is not systematically taught in residency. The objective of this study was to explore the current experiences, motivators, and perspectives on leadership training of general surgery residents. DESIGN/SETTING/PARTICIPANTS: Semi-structured focus groups were conducted with 20 general surgery residents at an academic training program. Six in-person sessions (one for each postgraduate year and research) were recorded, transcribed, and de-identified. Data were inductively coded by 2 independent researchers and analyzed thematically. Discrepancies were discussed and resolved through consensus. RESULTS: Participants described developing their leadership skills prior to residency through formal (e.g., job and military) and informal (e.g., extracurricular) experiences. Most reported that leadership development during residency occurred informally (e.g., emulating mentors, trial-and-error). Evolving responsibilities and expectations shaped residents' leadership values: junior residents focused on student and task management and adaptation to new teams; mid-level residents emphasized emotional intelligence and delivery of resident feedback; and senior residents stressed team engagement, inspiring the team, and teaching/mentoring. Major transition periods between residency levels were identified as critical times for leadership training as they allow for self-reflection, motivating residents to participate in a leadership curriculum. Employing level appropriate and immediately applicable content during this time would encourage curriculum attendance and prepare residents for new roles. CONCLUSIONS: There is a lack of formal leadership training in general surgery residency. There is an opportunity to design and implement leadership training that engages surgical residents with level-relevant content and strategies. Transition periods offer optimal timing for maximal curricula uptake.

Why do users override alerts? Utilizing large language model to summarize comments and optimize clinical decision support.

OBJECTIVES: To evaluate the capability of using generative artificial intelligence (AI) in summarizing alert comments and to determine if the AI-generated summary could be used to improve clinical decision support (CDS) alerts. MATERIALS AND METHODS: We extracted user comments to alerts generated from September 1, 2022 to September 1, 2023 at Vanderbilt University Medical Center. For a subset of 8 alerts, comment summaries were generated independently by 2 physicians and then separately by GPT-4. We surveyed 5 CDS experts to rate the human-generated and AI-generated summaries on a scale from 1 (strongly disagree) to 5 (strongly agree) for the 4 metrics: clarity, completeness, accuracy, and usefulness. RESULTS: Five CDS experts participated in the survey. A total of 16 human-generated summaries and 8 AI-generated summaries were assessed. Among the top 8 rated summaries, five were generated by GPT-4. AI-generated summaries demonstrated high levels of clarity, accuracy, and usefulness, similar to the human-generated summaries. Moreover, AI-generated summaries exhibited significantly higher completeness and usefulness compared to the human-generated summaries (AI: 3.4 ± 1.2, human: 2.7 ± 1.2, P = .001). CONCLUSION: End-user comments provide clinicians' immediate feedback to CDS alerts and can serve as a direct and valuable data resource for improving CDS delivery. Traditionally, these comments may not be considered in the CDS review process due to their unstructured nature, large volume, and the presence of redundant or irrelevant content. Our study demonstrates that GPT-4 is capable of distilling these comments into summaries characterized by high clarity, accuracy, and completeness. AI-generated summaries are equivalent and potentially better than human-generated summaries. These AI-generated summaries could provide CDS experts with a novel means of reviewing user comments to rapidly optimize CDS alerts both online and offline.

Is Intravitreal Injection of Recombinant Tissue Plasminogen Activator Effective for the Treatment of Refractory Diabetic Macular Edema in Patients With Posterior Vitreous Detachment?

OBJECTIVE: To determine whether intravitreal injection of recombinant tissue plasminogen activator (rTPA) is effective for the treatment of refractory diabetic macular edema (DME) in patients who already had posterior vitreous detachment (PVD). METHODS: It is a retrospective chart review of the patients with refractory DME and PVD. The efficacy of intravitreal injection of rTPA was assessed based on the changes in central macular thickness (CMT) and best-corrected visual acuity (BCVA) in these patients. RESULTS: Nine eyes of nine patients as the study group and 14 eyes of the 14 patients as the control group were examined. Before the injections, the mean CMT was 470.0± 107.6 in the study group, compared to 536.2± 150.5 in the control group, with no statistical significance (p=0.403). The statistical analysis revealed no significant differences in the mean changes in CMT from baseline to one and three months after injections between the study and control groups (p=0.439, p=0.781, respectively). Likewise, no statistically significant disparities were observed in the mean pre-injection BCVA between the study group (0.877± 0.349) and the control group (0.950± 0.300) (p=0.415). Additionally, after three months of injection, there were no significant changes in the mean BCVA of the study group (0.844± 0.304) and the control group (0.864± 0.253) (p=0.512). CONCLUSION: This study showed that rTPA has no effect on changes in CMT and BCVA in patients who had refractory DME and PVD at the same time. This may suggest that the improvement in CMT in previous studies may be due to the induction of PVD.

Reinforcement using undoped carbon quantum dots (CQDs) with a partially carbonized structure doubles the toughness of PVA membranes.

Nano-carbon-reinforced polymer composites have gained much consideration in functional applications due to their attractive mechanical strength and cost-effectiveness. The surface chemistry and associated mechanical strength of carbon nanotubes (CNTs), graphene, and other carbon derivative-based nanocomposites are well understood. While CQDs are considered emerging carbon derivatives, their surface chemistry, unique physio-chemical properties, and dispersion behavior in polymers are yet to be explored. Therefore, in this work, CQDs with different structures were synthesized from lemon pulp and urea, and their rheology and mechanical strength were studied in the PVA matrix. The surface chemistry and structure of CQDs were controlled using different solvents and reaction temperatures, respectively. CQDs possessed a circular shape, with a size of <10 nm, having a suitable carbon core and functional groups, as confirmed by TEM and FTIR spectroscopy. The dynamic viscosity and particle size of PVA/CQDs films peaked at 4% inclusion due to the maximum crosslinking of U-CQDs with reinforcement at 180 °C. Compared with pure PVA, the optimized composite showed an 80% larger particle size with 67% better tensile strength at 4% U-CQDs concentration. In addition to enhanced mechanical strength, CQDs exhibited antibacterial activity in composites. These CQDs-reinforced PVA composites may be suitable for different functional textile applications (shape memory composites and photo-active textiles).

THE NEUROENDOTHELIAL AXIS IN TRAUMATIC BRAIN INJURY: MECHANISMS OF MULTIORGAN DYSFUNCTION, NOVEL THERAPIES, AND FUTURE DIRECTIONS.

ABSTRACT: Severe traumatic brain injury (TBI) often initiates a systemic inflammatory response syndrome, which can potentially culminate into multiorgan dysfunction. A central player in this cascade is endotheliopathy, caused by perturbations in homeostatic mechanisms governed by endothelial cells due to injury-induced coagulopathy, heightened sympathoadrenal response, complement activation, and proinflammatory cytokine release. Unique to TBI is the potential disruption of the blood-brain barrier, which may expose neuronal antigens to the peripheral immune system and permit neuroinflammatory mediators to enter systemic circulation, propagating endotheliopathy systemically. This review aims to provide comprehensive insights into the "neuroendothelial axis" underlying endothelial dysfunction after TBI, identify potential diagnostic and prognostic biomarkers, and explore therapeutic strategies targeting these interactions, with the ultimate goal of improving patient outcomes after severe TBI.

Ammonia gas sensors based on undoped and Ca-doped ZnO nanoparticles.

Due to its large use in different industrial sectors, high toxicity, and corrosion, the demand for sensing techniques towards ammonia gas has become urgent. In this study we report on the sensing performances of a conductometric sensor for NH3 gas based on Ca-doped ZnO nanoparticles with different calcium concentrations (0, 1, and 3 at%) synthesized using the sol-gel process under supercritical dry conditions of ethanol. All samples were characterized using X-ray diffraction (XRD), scanning electron microscopy (SEM), transmission electron microscopy (TEM), and Fourier-transform infrared (FTIR) spectroscopy. Pure and Ca-doped ZnO are polycrystalline and well crystallized in the hexagonal wurtzite structure. TEM images revealed that pure ZnO is composed of spherical particles with dimensions in the nanometer range. Larger particles were observed after the incorporation of Ca ions. The average crystallite size, estimated by the Williamson-Hall method, was 43, 80, and 96 nm for pure, Ca-1 at% and Ca-3 at%, respectively. Furthermore, FTIR spectroscopy was used to prove the formation of ZnO and the incorporation of calcium ions in the Ca-doped ZnO samples. The gas sensing performances towards ammonia gas clearly ameliorated after the addition of Ca ions in the ZnO structure. The gas response to NH3, R0/Rg, of the 1% Ca-doped ZnO sensor reached a value of 33 for 4000 ppm of ammonia at T = 300 °C with good selectivity compared to other gases such as CO, CO2, and NO2. The response and recovery times were 5 s and 221 s, respectively. The reported good sensing performances indicate the potential application of Ca-doped ZnO as a sensor material for ammonia detection.

Synergistic CuCoS-PANI materials for binder-free electrodes in asymmetric supercapacitors and oxygen evolution.

In advanced electronics, supercapacitors (SCs) have received a lot of attention. Nevertheless, it has been shown that different electrode designs that are based on metal sulfides are prone to oxidation, instability, and poor conductance, which severely limits their practical application. We present a very stable, free-standing copper-cobalt sulfide doped with polyaniline as an electrode coated on nickel foam (CuCoS/PANI). The lightweight nickel foam encourages current collection as well as serving as a flexible support. The CuCoS-PANI electrode had a substantially greater 1659 C g-1 capacity at 1.0 A g-1. The asymmetric supercapacitor (ASC) can provide an impressive 54 W h kg-1 energy density while maintaining 1150 W kg-1 power. Additionally, when employed as an electrocatalyst in the oxygen evolution reaction, CuCoS/PANI exhibited a 200 mV overpotential and 55 mV dec-1 Tafel slope, demonstrating its effectiveness in facilitating the reaction.

Finding the Right Balance: Partial REBOA in a Swine Model of Uncontrolled Vascular Injury.

BACKGROUND: We have previously shown that partial REBOA (pREBOA) deployment in the thoracic aorta is safe for 2 to 4 hours, but it is unclear whether the distal blood flow after partial aortic occlusion would lead to ongoing hemorrhage. The objective of this study was to evaluate the hemostatic efficacy of pREBOA in a model of uncontrolled vascular injury. STUDY DESIGN: Female Yorkshire swine (n = 10, 40 to 45 kg) were anesthetized and instrumented. A through-and-through injury was created in the common iliac artery. The animals were randomly assigned to: (1) pREBOA-PRO deployment after 3 minutes and (2) control. Both groups were given normal saline resuscitation for hypotension. The pREBOA was adjusted to partial occlusion (distal mean arterial pressure of 30 mmHg), and then left without titration for 2 hours. Then, fresh frozen plasma was transfused and the vessel repaired. The balloon was deflated and the animals were monitored for 2 hours. In the critical care period, 2 L of normal saline was infused, norepinephrine was given for mean arterial pressure ≤55, and electrolytes and acidosis were corrected. Organs were examined for gross and histologic evidence of ischemic injuries. The primary endpoint was post-inflation blood loss. RESULTS: All the pREBOA animals survived until the end, whereas control animals had a mean survival time of 38.2 minutes (p < 0.05). The pREBOA group showed significantly less bleeding after balloon deployment (93.8 vs 1,980.0 mL, p < 0.05), and had appropriate lactate clearance, with minimal histologic distal organ ischemia. CONCLUSIONS: Partial aortic occlusion with the newly designed balloon can achieve the desired balance between effective hemorrhage control and adequate distal flow, without a need for ongoing balloon titration.

A western trauma association multicenter comparison of mesh versus non-mesh repair of blunt traumatic abdominal wall hernias.

BACKGROUND: Blunt traumatic abdominal wall hernias (TAWH) occur in <1 % of trauma patients. Optimal repair techniques, such as mesh reinforcement, have not been studied in detail. We hypothesize that mesh use will be associated with increased surgical site infections (SSI) and not improve hernia recurrence. MATERIALS AND METHODS: A secondary analysis of the Western Trauma Association blunt TAWH multicenter study was performed. Patients who underwent TAWH repair during initial hospitalization (1/2012-12/2018) were included. Mesh repair patients were compared to primary repair patients (non-mesh). A logistic regression was conducted to assess risk factors for SSI. RESULTS: 157 patients underwent TAWH repair during index hospitalization with 51 (32.5 %) having mesh repair: 24 (45.3 %) synthetic and 29 (54.7 %) biologic. Mesh patients were more commonly smokers (43.1 % vs. 22.9 %, p = 0.016) and had a larger defect size (10 vs. 6 cm, p = 0.003). Mesh patients had a higher rate of SSI (25.5 % vs. 9.5 %, p = 0.016) compared to non-mesh patients, but a similar rate of recurrence (13.7 % vs. 10.5%, p = 0.742), hospital length of stay (LOS), and mortality. Mesh use (OR 3.66) and higher ISS (OR 1.06) were significant risk factors for SSI in a multivariable model. CONCLUSION: Mesh was used more frequently in flank TAWH and those with a larger defect size. Mesh use was associated with a higher incidence and risk of SSI but did not reduce the risk of hernia recurrence. When repairing TAWH mesh should be employed judiciously, and prospective randomized studies are needed to identify clear indications for mesh use in TAWH.

Brillouin-zone definition in non-reciprocal Willis monatomic lattices.

Brillouin-zone (BZ) definition in a class of non-reciprocal Willis monatomic lattices (WMLs) is analytically quantified. It is shown that BZ boundaries only shift in response to non-reciprocity in one-dimensional WMLs, implying a constant BZ width, with asymmetric dispersion diagrams exhibiting unequal wavenumber ranges for forward and backward going waves. An extension to square WMLs is briefly discussed, analogously demonstrating the emergence of shifted and irregularly shaped BZs, which maintain constant areas regardless of non-reciprocity strength.

Optimization of physical and dielectric properties of Co-doped ZnO nanoparticles for low-frequency devices.

In this study, zinc-oxide (ZnO) nanoparticles (NPs) doped with cobalt (Co) were synthesized using a simple coprecipitation technique. The concentration of Co was varied to investigate its effect on the structural, morphological, optical, and dielectric properties of the NPs. X-ray diffraction (XRD) analysis confirmed the hexagonal wurtzite structure of both undoped and Co-doped ZnO-NPs. Scanning electron microscopy (SEM) was used to examine the morphology of the synthesized NPs, while energy-dispersive X-ray spectroscopy (EDX) was used to verify their purity. The band gap of the NPs was evaluated using UV-visible spectroscopy, which revealed a decrease in the energy gap as the concentration of Co2+ increased in the ZnO matrix. The dielectric constants and AC conductivity of the NPs were measured using an LCR meter. The dielectric constant of the Co-doped ZnO-NPs continuously increased from 4.0 × 10-9 to 2.25 × 10-8, while the dielectric loss decreased from 4.0 × 10-8 to 1.7 × 10-7 as the Co content increased from 0.01 to 0.07%. The a.c. conductivity also increased with increasing applied frequency. The findings suggest that the synthesized Co-doped ZnO-NPs possess enhanced dielectric properties and reduced energy gap, making them promising candidates for low-frequency devices such as UV photodetectors, optoelectronics, and spintronics applications. The use of a cost-effective and scalable synthesis method, coupled with detailed material characterization, makes this work significant in the field of nanomaterials and device engineering.

The Significance of Artificial Intelligence Platforms in Anatomy Education: An Experience With ChatGPT and Google Bard.

This study evaluated the use of two large language models (LLMs), ChatGPT and Google Bard, in anatomy education. The models were asked to answer questions, generate multiple-choice questions, and write articles on anatomy topics. The results showed that the models were able to perform these tasks with varying degrees of accuracy. ChatGPT and Google Bard did not differ significantly in terms of answering questions. Both models were able to generate multiple-choice questions with a high degree of accuracy. However, the performance of the models in article writing was not yet at a sufficient level. The study also found that the use of LLMs in medical education requires caution. This is because LLMs are still under development and they can sometimes generate inaccurate or misleading information. It is important to carefully evaluate the output of LLMs before using them in educational settings. Overall, the study found that LLMs have the potential to be valuable tools for anatomy education. However, more research is needed to improve the accuracy of the models and to better understand how they can be used effectively in educational settings.

"You've Got Gratitude!"- A Multispecialty and Multi-institution Program Encouraging Expressions of Gratitude.

OBJECTIVE: Efforts to improve physician well-being have focused on gratitude, which predicts health and happiness. Despite reported benefits, expressions of gratitude in healthcare can seem infrequent. Here, we describe Gratitude-Grams, an intervention to cultivate expressions of gratitude throughout a department. METHODS/APPROACH: Piloted in our Department of Surgery and adopted by others, Gratitude-Grams employs a web-based platform (Qualtrics). Program feedback was solicited during teaching conferences using an anonymous department survey. RESULTS: Gratitude-Grams streamlines and encourages expressions of gratitude while minimizing maintenance, cost, and time. The platform has been highly utilized and well-received in our Department of Surgery. CONCLUSION: Expressing and receiving gratitude has been shown to be critical for well-being. Gratitude-Grams is a highly utilized, simple, and attainable system to support expressions of gratitude and is ready for rapid implementation.