Surgical Triumph Over Huge Nontraumatic Myositis Ossificans of the Gluteal Region in an Epileptic Patient With History of Stroke: A Case Report.

Myositis ossificans (MO) is a benign condition where bone forms within muscles due to increased activity of the periarticular tissues. Trauma is the most common cause. Nontraumatic MO is exceedingly rare. We present a rare instance of nontraumatic MO affecting the hip in a 32-year-old patient. The patient had a known case of seizure disorder and also had a history of a cerebrovascular accident (CVA). Despite the absence of trauma or known predisposing factors, the patient developed a sizable mass in the left hip, causing pain and restricted range of motion (ROM). Surgical excision of the mass was successful, resulting in complete removal and subsequent improvement in hip function and pain relief during postoperative recovery. Histopathological examination confirmed the diagnosis of MO. The patient's ROM normalized, and there were no signs of recurrence at the one-year follow-up. This case highlights the importance of recognizing MO in hip pain cases without trauma. Timely surgery through the approach described effectively removes the mass, preventing recurrence without compromising vital structures. It showcases a successful multidisciplinary approach for rare musculoskeletal conditions, offering valuable insights into similar cases.

Neglected Anterior Shoulder Dislocation With Greater Tuberosity Fracture Managed With Open Reduction and Latarjet Procedure: A Case Report.

Neglected shoulder dislocation is a relatively rare occurrence characterized by structural changes in bone and soft tissue. Surgical intervention is often necessary, yet no universally accepted treatment approach exists, presenting a challenging clinical scenario. A 45-year-old female presented with an eight-month-old neglected anterior shoulder dislocation, compounded by a Hill-Sachs lesion from a previous fall. Treatment comprised open reduction in conjunction with the Latarjet procedure. Regular follow-up evaluations were conducted over three years post-surgery, revealing satisfactory outcomes including good range of motion, bony union, and absence of dislocation episodes. Managing neglected shoulder dislocations, particularly those with significant bone defects, poses unique challenges involving soft tissue contracture, bone loss, and associated fractures. Despite these complexities, open reduction combined with the Latarjet procedure demonstrated a high success rate in preventing further shoulder dislocation, albeit with a persistent risk of shoulder joint osteoarthritis.

Huge Distal Ulna Giant Cell Tumor Treated with Wide Local Excision and Extensor Carpi Ulnaris Tenodesis - A Rare Case Report.

Introduction: Giant cell tumors (GCT) are a relatively uncommon type of non-cancerous bone growth, representing around 4-10% of all bone tumors. These tumors tend to exhibit local aggressiveness and are typically prevalent in individuals between 20 and 40 years old. Commonly observed locations for GCT include the distal femur, proximal tibia, and the distal end of the radius. However, occurrences at the distal end of the ulna are rare, accounting for only 0.45-3.2% of cases. Case Report: In this instance, we present the case of a 36-year-old male diagnosed with a GCT specifically located in the left distal ulna. Our approach involved managing the patient through the complete removal (en-bloc resection) of the distal ulna. Following this, we performed an extensor carpi ulnaris (ECU) tenodesis to stabilize the proximal stump. After 2-year follow-up, the patient exhibited positive outcomes, displaying satisfactory wrist joint mobility and functionality without any signs of tumor recurrence. Conclusion: This case emphasizes the effectiveness of wide resection as a viable treatment for huge GCTs in the distal ulna. Utilizing tenodesis with the tendon of ECU significantly contributes to stabilizing the ulnar stump, leading to improved wrist function.

Fixation with multiple K-wires and PRP injection as an effective way to manage heel pad avulsion.

The treatment of acute heel pad avulsion differs significantly from managing other soft tissue injuries due to its unique soft tissue structure. This case report outlines a scenario involving a male in his 20s who suffered heel pad avulsion without a calcaneal fracture but with an ipsilateral medial malleolus fracture after a twisting injury to the ankle caused by a road traffic accident. Immediate action was taken within 24 hours of the injury, involving thorough debridement of the wound, fixation to the calcaneum using multiple K-wires, primary suturing and internal fixation of the medial malleolus with two cannulated cancellous screws. Postoperative care included PRP (platelet-rich plasma) injections into the wound twice, removal of K-wires after 6 weeks and allowing walking with full weight bearing after 8 weeks. A year later, the wound had completely healed, and the patient was comfortably walking pain-free with full weight-bearing capabilities.

Aneurysmal Bone Cyst of the Third Metatarsal Treated Using Free Nonvascular Fibular Strut Graft-A Rare Case Report.

Introduction: An aneurysmal bone cyst (ABC) is an unusual, non-cancerous bone lesion that is characterized by its lytic (causing bone loss), hemorrhagic, and expanding nature. ABCs are relatively rare, making up only 1% of all bone tumors. These cysts are typically found in long bones and the spine but are very rarely seen in the metatarsal bones, making such occurrences quite uncommon. Case Report: In this case report, we present a case of ABC of the 3rd metatarsal in a 26-year-old female with complaints of long-standing foot pain and gradually increasing swelling of the dorsum of the foot. After radiological evaluation, she had undergone histopathological evaluation. An en bloc resection of the metatarsal along with the tumor mass was performed and the gap was replaced with an ipsilateral fibular strut graft. Histopathological examination of the resected tissue was suggestive of ABC without any evidence of malignancy. At the end of 1 year of follow-up, she is now completely pain free with intact rom of foot and ankle. Conclusion: The present study aims to describe a case of ABC of the metatarsal, a condition that not only poses a diagnostic dilemma but also constitutes a challenge in the management of lesion.

Bizarre Parosteal Osteochondromatous Proliferation (Nora's Lesion) Affecting Carpal Bones of the Hand in a Middle-Aged Female: A Case Report.

A 45-year-old woman complained of left wrist pain and swelling for two years accompanied by limited dorsiflexion. Plain X-rays revealed an abnormal bony mass in the carpal bones, further evaluated using computed tomography and magnetic resonance imaging. Upon confirmation of the benign nature surgical excisional biopsy of the lesion, the histopathology confirmed the diagnosis of Bizarre parosteal osteochondromatous proliferation (BPOP). The patient has remained pain-free and actively involved in her routine for the past two years. BPOP, affecting the carpal bones of the hand, are exceptionally rare occurrence. Attentive preoperative evaluation helps in diagnosis and to initiate measures to avoid recurrence.

Peri-prosthetic Joint Infection due to Candida albicans in a Young Immunocompetent Patient - A Rare Case Report.

Introduction: The recent surge in joint replacement surgeries in India, particularly total knee and hip replacements, is notable. The majority of patients undergoing these procedures suffered from knee osteoarthritis or femoral head avascular necrosis. However, this increase in joint replacements has also led to a rise in periprosthetic joint infections (PJI), a severe and costly complication. PJI is responsible for 25% of total knee arthroplasty failures and 15% of total hip arthroplasty failures. Various risk factors, such as diabetes, fractures, and arthritis, are associated with PJI development. Bacterial infections, notably Staphylococcus species, are the primary cause of PJI, but rare fungal infections are often caused by Candida and Aspergillus. There is a lack of clinical trials and limited knowledge about the prevalence and treatment of fungal PJIs. Case Report: This report presents a unique case of delayed PJI caused by Candida albicans in an otherwise healthy patient. Conclusion: This case report emphasizes the need for further research and standardized treatment guidelines. Treatment typically involves a two-stage revision with extended antifungal therapy. The optimal duration of antifungal treatment remains uncertain.

Unique Bilaterally Symmetrical Multifocal Osteomyelitis Presentation in a Health-care Worker with Sickle Cell Disease Secondary to Klebsiella Infection - A Case Report.

Introduction: Osteomyelitis is one of the most common infectious complications in people with sickle cell disease (SCD). The most common infecting organisms in SCD are the Salmonella species and Staphylococcus aureus; Streptococcus pneumoniae and Bacteroides species have also been described, however, osteomyelitis attributable to infection with hypervirulent Klebsiella spp. is a rare entity. We describe our experience with a rare presentation of multifocal bilateral symmetrical ulna and fibula osteomyelitis in a patient with SCD due to Klebsiella bacteremia with 1-year follow-up. Case Report: A 25-year-old female known SCD since childhood who underwent treatment for dengue at our hospital had her blood cultures positive for Klebsiella, following which she was treated with appropriate antibiotics. Two weeks following the asymptomatic period patient presented with complaints of pain over the bilateral forearm and legs. The patient was evaluated for laboratory parameters and plain radiograph of the bilateral forearm and bilateral legs. The radiological features were suggestive of osteomyelitis, showing "Bilaterally symmetrical involvement." Laboratory parameters erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were found raised. The patient was planned for biopsy and debridement of the lesion from the right ulna. The culture from the biopsy showed growth of Klebsiella sp. and was sensitive to co-trimoxazole. The patient was started on co-trimoxazole for 6 weeks and had a significant clinical improvement in the form of subsidence of pain, normalization of the blood counts along with the acute phase reactants (ESR, CRP). Conclusion: Our case contributes to the growing awareness of the unusual manifestations of this serious disease and the rarity of bilateral symmetrical involvement. Our case highlights the importance of clinician awareness, manifestations, and management of Klebsiella sp. hypervirulent strains.

Rapid scan white light two-dimensional electronic spectroscopy with 100 kHz shot-to-shot detection.

We demonstrate an approach to two-dimensional electronic spectroscopy (2DES) that combines the benefits of shot-to-shot detection at high-repetition rates with the simplicity of a broadband white light continuum input and conventional optical elements to generate phase-locked pump pulse pairs. We demonstrate this through mutual synchronization between the laser repetition rate, the acousto-optical deflector, the pump delay stage, and the CCD line camera, which allows for rapid scanning of pump optical delay synchronously with the laser repetition rate, while the delay stage is moved at a constant velocity. The resulting shot-to-shot detection scheme is repetition rate scalable and only limited by the CCD line rate and the maximum stage velocity. Using this approach, we demonstrate the measurement of an averaged 2DES absorptive spectrum in as much as 1.2 s of continuous sample exposure per 2D spectrum. We achieve a signal-to-noise ratio of 6.8 for optical densities down to 0.05 with 11.6 s of averaging at 100 kHz laser repetition rate. Combining rapid scanning of mechanical delay lines with shot-to-shot detection as demonstrated here provides a viable alternative to acousto-optic pulse shaping approaches that is repetition-rate scalable, has comparable throughput and sensitivity, and minimizes sample exposure per 2D spectrum with promising micro-spectroscopy applications.

Low- and high-frequency vibrations synergistically enhance singlet exciton fission through robust vibronic resonances.

Singlet exciton fission (SEF) is initiated by ultrafast internal conversion of a singlet exciton into a correlated triplet pair [Formula: see text]. The "reaction coordinates" for ultrafast SEF even in archetypal systems such as pentacene thin film remain unclear. Couplings between fast electrons and slow nuclei are ubiquitous across a range of phenomena in chemistry. Accordingly, spectroscopic detection of vibrational coherences in the [Formula: see text] photoproduct motivated investigations into a possible role of vibronic coupling, akin to that reported in several photosynthetic proteins. However, acenes are very different from chlorophylls with 10× larger vibrational displacements upon photoexcitation and low-frequency vibrations modulating intermolecular orbital overlaps. Whether (and if so how) these unique features carry any mechanistic significance for SEF remains a poorly understood question. Accordingly, synthetic design of new molecules aiming to mimic this process across the solar spectrum has broadly relied on tuning electronic couplings. We address this gap and identify previously unrecognized synergistic interplay of vibrations, which in striking contrast to photosynthesis, vitally enhances SEF across a broad, nonselective and, therefore, unavoidable range of vibrational frequencies. We argue that attaching mechanistic significance to spectroscopically observed prominent quantum beats is misleading. Instead, we show that vibronic mixing leads to anisotropic quantum beats and propose readily implementable polarization-based two-dimensional electronic spectroscopy experiments which uniquely distinguish vibrations which drive vibronic mixing and promote SEF, against spectator vibrations simply accompanying ultrafast internal conversion. Our findings introduce crucial ingredients in synthetic design of SEF materials and spectroscopy experiments aiming to decipher mechanistic details from quantum beats.

Ultrasound: A novel alternative technique for cervical epidural space visualization-A pilot study.

Background: Neuraxial ultrasound (US), a newer modality, can be used for neuraxial imaging, helping in visualizing and aiding in epidural space catheterization. The aim of this study was to evaluate the efficacy of the US for cervical epidural access and to determine the failure rate and complication associated with this technique. Methods: A prospective single-arm pilot study was conducted on 21 participants. The neuraxial US image quality assessment by Ultrasound Visibility Score (UVS), epidural space depth measurement by US and by conventional loss of resistance (LOR) technique, and post-procedure epidural catheter confirmation by real-time US were the study parameters. Any procedural complications or failure rate were recorded. The Kolmogorov-Smirnov test, paired-samples t-test, and Chi-square test were used for the statistical comparison. Results: The pre-procedural UVS by the transverse interlaminar view (x/21) was 2.81 ± 1.94 and by the oblique paramedian sagittal view was 16.66 ± 2.39 with UVS being best in the paramedian oblique sagittal view (P- value < 0.05). The comparison of depth of the epidural space identified by USG and that by the LOR technique was statistically insignificant (P = 0.83). The average puncture attempts were 1.1 ± 0.3. Post-procedure US epidural catheter confirmation score (x/3) was 1.44 ± 0.44 with either epidural space expansion or microbubbles seen or both. Conclusion: The pilot study has successfully demonstrated the implication of US for visualizing and aiding in epidural space catheterization. Also, the failure rate and procedural complications were drastically minimized with the help of US as compared to the traditional blind technique.

A Rare Case of Large Osteochondral Fracture of Patella.

Osteochondral fractures of the patella are relatively common pediatric knee injuries, often missed during the initial evaluation, and almost always associated with acute patella dislocations. We report the case of an adolescent patient with a very large osteochondral fracture of the patella involving almost the whole of the medial patellar facet and without concomitant dislocation of the patella. A 16-year-old adolescent presented to the emergency with pain and swelling in the left knee after sustaining a road traffic accident. On evaluation with an X-ray and a CT scan, a large osteochondral fracture of the patella was diagnosed. The fracture was treated with open reduction and internal fixation with headless compression screws after performing medial parapatellar arthrotomy. After two years, the patient recovered with a full and painless range of movement of the knee, with the complete radiological union of the fracture. This case report discusses a rare case of an adolescent with a large osteochondral fracture of the patella without concomitant patella dislocation.

Vibrations That Do Not Promote Vibronic Coupling Can Dominate Observed Lineshapes in Two-Dimensional Electronic Spectroscopy.

Impulsively generated wavepackets can report on vibronic couplings underlying ultrafast electronic relaxation. Coherence maps (CMs) in multidimensional spectroscopy resolve beating amplitudes of such wavepackets as two-dimensional contour maps. A precise understanding of how these wavepackets manifest spectroscopically is vital for unambiguously deciphering their mechanistic significance and establishing CMs as a powerful tool for guiding the synthetic design of functional vibronic couplings. Here we take a step in this direction. We establish physically distinct origins of recently reported apparent similarities between diagonal node-like CM lineshapes in bacteriochlorophyll monomers and multichromophoric photosynthetic reaction centers (RCs). The former arise when vibrational wavepackets survive on both ground and excited electronic states, while nodal lines in RCs arise when vibrational wavepackets that do not participate in energy transfer are coherently transferred to the acceptor. We resolve recent spectroscopic observations and illustrate new mechanistic insights gained by connecting microscopic interference between electronic relaxation pathways and observed CMs.

Sex difference in evolution of cognitive decline: studies on mouse model and the Dominantly Inherited Alzheimer Network cohort.

Women carry a higher burden of Alzheimer's disease (AD) compared to men, which is not accounted entirely by differences in lifespan. To identify the mechanisms underlying this effect, we investigated sex-specific differences in the progression of familial AD in humans and in APPswe/PS1ΔE9 mice. Activity dependent protein translation and associative learning and memory deficits were examined in APPswe/PS1ΔE9 mice and wild-type mice. As a human comparator group, progression of cognitive dysfunction was assessed in mutation carriers and non-carriers from DIAN (Dominantly Inherited Alzheimer Network) cohort. Female APPswe/PS1ΔE9 mice did not show recall deficits after contextual fear conditioning until 8 months of age. Further, activity dependent protein translation and Akt1-mTOR signaling at the synapse were impaired in male but not in female mice until 8 months of age. Ovariectomized APPswe/PS1ΔE9 mice displayed recall deficits at 4 months of age and these were sustained until 8 months of age. Moreover, activity dependent protein translation was also impaired in 4 months old ovariectomized APPswe/PS1ΔE9 mice compared with sham female APPswe/PS1ΔE9 mice. Progression of memory impairment differed between men and women in the DIAN cohort as analyzed using linear mixed effects model, wherein men showed steeper cognitive decline irrespective of the age of entry in the study, while women showed significantly greater performance and slower decline in immediate recall (LOGIMEM) and delayed recall (MEMUNITS) than men. However, when the performance of men and women in several cognitive tasks (such as Wechsler's logical memory) are compared with the estimated year from expected symptom onset (EYO) we found no significant differences between men and women. We conclude that in familial AD patients and mouse models, females are protected, and the onset of disease is delayed as long as estrogen levels are intact.

Ultrasonographic Assessment of Indian Patients With Plantar Fasciitis and Its Clinical Correlation: A Prospective Observational Study.

INTRODUCTION: Plantar fasciitis is a debilitating clinical condition and is one of the most common causes of heel pain. The risk factors include frequent and prolonged running, obesity, a sedentary lifestyle, work-related weight bearing, and inappropriate footwear. Ultrasonography being a non-invasive, cost-effective, and easily available modality is a useful adjunct in the diagnosis. METHODS: A prospective observational study was conducted among 30 patients with unilateral plantar fasciitis. The diagnosis was based on history and examination. Heel pad thickness and plantar fascia thickness were recorded using ultrasonography. RESULTS: The ultrasonography results showed increased plantar fascia and heel pad thickness in the affected limb with plantar fasciitis than the normal one (p<0.001). The BMI was positively correlated with the heel pad thickness (p<0.05). The receiver operating characteristic (ROC) curve showed 90% sensitivity and 60% specificity for heel pad thickness (p<0.001). CONCLUSIONS: Ultrasonography is a sensitive and specific tool to identify patients with plantar fasciitis.

High-sensitivity fluorescence-detected multidimensional electronic spectroscopy through continuous pump-probe delay scan.

Fluorescence-detected multidimensional electronic spectroscopy (fMES) promises high sensitivity compared to conventional approaches and is an emerging spectroscopic approach toward combining the advantages of MES with the spatial resolution of a microscope. Here, we present a visible white light continuum-based fMES spectrometer and systematically explore the sensitivity enhancement expected from fluorescence detection. As a demonstration of sensitivity, we report room temperature two-dimensional coherence maps of vibrational quantum coherences in a laser dye at optical densities of ∼2-3 orders of magnitude lower than conventional approaches. This high sensitivity is enabled by a combination of biased sampling along the optical coherence time axes and a rapid scan of the pump-probe waiting time T at each sample. A combination of this approach with acousto-optic phase modulation and phase-sensitive lock-in detection enables measurements of room temperature vibrational wavepackets even at the lowest ODs. Alternative faster data collection schemes, which are enabled by the flexibility of choosing a non-uniform undersampled grid in the continuous T scanning approach, are also demonstrated.

Motion-compensated online object tracking for activity detection and crowd behavior analysis.

It is a nontrivial task to manage crowds in public places and recognize unacceptable behavior (such as violating social distancing norms during the COVID-19 pandemic). In such situations, people should avoid loitering (unnecessary moving out in public places without apparent purpose) and maintain a sufficient physical distance. In this study, a multi-object tracking algorithm has been introduced to improve short-term object occlusion, detection errors, and identity switches. The objects are tracked through bounding box detection and with linear velocity estimation of the object using the Kalman filter frame by frame. The predicted tracks are kept alive for some time, handling the missing detections and short-term object occlusion. ID switches (mainly due to crossing trajectories) are managed by explicitly considering the motion direction of the objects in real time. Furthermore, a novel approach to detect unusual behavior of loitering with a severity level is proposed based on the tracking information. An adaptive algorithm is also proposed to detect physical distance violation based on the object dimensions for the entire length of the track. At last, a mathematical approach to calculate actual physical distance is proposed by using the height of a human as a reference object which adheres more specific distancing norms. The proposed approach is evaluated in traffic and pedestrian movement scenarios. The experimental results demonstrate a significant improvement in the results.

Total Elbow Arthroplasty from Indian Perspective: A Systematic Review.

Background: Total elbow arthroplasty (TEA) provides satisfactory pain relief and restores elbow range of motion and function in patients with end-stage arthritis. Due to advances in implant design and surgical techniques, the indications for surgery have expanded to include various other conditions affecting the elbow. The previous studies and systematic reviews reported satisfactory mid-term and long-term clinical outcomes after TEA with relatively stable complication and revision rates. However, there is lack of information in the literature about the results of TEA in Indian patients. Methods: Two reviewers performed a comprehensive literature search using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in three online databases-Pubmed/MEDLINE, Google scholar and the Cochrane database for clinical trials. Only original studies published in the English literature reporting outcomes of primary TEA in Indian patients were included for analysis. Using pre-defined inclusion and exclusion criteria, articles were screened and the relevant articles identified. Data were extracted with the primary objective to assess pain relief and functional outcome after TEA in Indian patients, and secondary objective to identify indications for surgery, complication rates and incidence of implant removals. Results: A total of 212 TEAs (210 patients) from ten articles were included in this systematic review. All the TEAs were done using Baksi's semi-constrained sloppy-hinged elbow prosthesis. The most common indication of TEA was post-traumatic sequelae (124 elbows, 58.5%), followed by comminuted intra-articular fracture distal humerus (53 elbows, 25%). At a weighted mean follow-up of 7.5 years, 80.7% cases had complete pain relief. The weighted mean flexion, extension restriction, supination and pronation were 122.6°, 20.8°, 57.3°, and 48.6°; respectively. The weighted mean Mayo Elbow Performance Score was 92.1 points with excellent outcome. Overall, a total of 68 complications were reported (32%) and the implants needed to be removed in 14 elbows (6.6%) including two revisions. Conclusions: This systematic review found that the functional outcome and pain relief obtained with TEA using Baksi's sloppy-hinged prosthesis in Indian patients were satisfactory overall. The complication rates and implant removal rates were lower than those reported with other patient populations.

Changes in the Management of Malignant Bone Tumors in the COVID-19 Pandemic in Developing Countries.

The COVID-19 pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has drastically affected healthcare delivery to cancer patients, including those with malignant bone tumors, worldwide. Such cancer patients are more susceptible to COVID-19 infection and risk contracting the severe disease, but their holistic tumor management has also suffered a significant impact. Because of the acute shortage of healthcare resources due to their diversion in COVID management, substantial changes are needed in various aspects of management for high-grade tumor patients, particularly in developing countries and population-dense regions, so that their evidence-based appropriate treatment is ensured. Owing to a lack of consensus regarding the ideal course of action for the management of malignant bone tumors in the current situation, many such patients often get neglected, leading to loss of life/limb. This review elaborates on various guidelines proposed by different healthcare organizations and institutes regarding the modified care pathways for malignant bone neoplasms in the current coronavirus pandemic. The early published results of these modified care pathways and the changes in the oncology practice brought about by the pandemic are also discussed.

Vibronic resonance along effective modes mediates selective energy transfer in excitonically coupled aggregates.

We recently proposed effective normal modes for excitonically coupled aggregates that exactly transform the energy transfer Hamiltonian into a sum of one-dimensional Hamiltonians along the effective normal modes. Identifying physically meaningful vibrational motions that maximally promote vibronic mixing suggested an interesting possibility of leveraging vibrational-electronic resonance for mediating selective energy transfer. Here, we expand on the effective mode approach, elucidating its iterative nature for successively larger aggregates, and extend the idea of mediated energy transfer to larger aggregates. We show that energy transfer between electronically uncoupled but vibronically resonant donor-acceptor sites does not depend on the intermediate site energy or the number of intermediate sites. The intermediate sites simply mediate electronic coupling such that vibronic coupling along specific promoter modes leads to direct donor-acceptor energy transfer, bypassing any intermediate uphill energy transfer steps. We show that the interplay between the electronic Hamiltonian and the effective mode transformation partitions the linear vibronic coupling along specific promoter modes to dictate the selectivity of mediated energy transfer with a vital role of interference between vibronic couplings and multi-particle basis states. Our results suggest a general design principle for enhancing energy transfer through synergistic effects of vibronic resonance and weak mediated electronic coupling, where both effects individually do not promote efficient energy transfer. The effective mode approach proposed here paves a facile route toward four-wavemixing spectroscopy simulations of larger aggregates without severely approximating resonant vibronic coupling.