Hybrid architectures for terahertz molecular polaritonics.

Atoms and their different arrangements into molecules are nature's building blocks. In a regime of strong coupling, matter hybridizes with light to modify physical and chemical properties, hence creating new building blocks that can be used for avant-garde technologies. However, this regime relies on the strong confinement of the optical field, which is technically challenging to achieve, especially at terahertz frequencies in the far-infrared region. Here we demonstrate several schemes of electromagnetic field confinement aimed at facilitating the collective coupling of a localized terahertz photonic mode to molecular vibrations. We observe an enhanced vacuum Rabi splitting of 200 GHz from a hybrid cavity architecture consisting of a plasmonic metasurface, coupled to glucose, and interfaced with a planar mirror. This enhanced light-matter interaction is found to emerge from the modified intracavity field of the cavity, leading to an enhanced zero-point electric field amplitude. Our study provides key insight into the design of polaritonic platforms with organic molecules to harvest the unique properties of hybrid light-matter states.

Potential for a minor pine bark beetle pest, Dendroctonus terebrans (Coleoptera: Curculionidae: Scolytinae), to mediate host location by a major pine killer, Dendroctonus frontalis.

The southern pine beetle, Dendroctonus frontalis Zimmermann is an important mortality agent of Pinus in the eastern United States of America where it commonly shares hosts with the black turpentine beetle, Dendroctonus terebrans (Olivier), which infrequently kills trees. Unlike D. frontalis, which must kill its hosts to become established in the bark and reproduce, D. terebrans can occupy living hosts as a parasite. Olfactory mechanisms whereby D. frontalis initially locates hosts have not been demonstrated, whereas D. terebrans responds strongly to host odors. Because D. terebrans produces frontalin, the primary aggregation pheromone component for D. frontalis, and commonly arrives on hosts prior to D. frontalis, it has been hypothesized that D. terebrans pheromone components can mediate D. frontalis location of suitable, living trees. We assessed this possibility with studies of the semiochemical interactions between D. frontalis and D. terebrans. Coupled gas chromatography-electroantennographic detection analyses indicated that D. terebrans produces nine different olfactory stimulants for D. frontalis, nearly all of them known semiochemicals for D. frontalis. A trapping experiment designed to address the potentially confounding influence of lure contamination confirmed that the D. terebrans pheromone component exo-brevicomin enhances attraction of D. frontalis and thus could be an attractive kairomone. In ambulatory bioassays, male D. frontalis were strongly attracted to odors of frass of solitary female and paired D. terebrans, indicating their attraction to the naturally occurring semiochemicals of D. terebrans. Cues from D. terebrans may influence host and mate-finding success of D. frontalis and, thereby, the latter's virulence.

Optical filter wavefront distortion: out-of-band to in-band predictions and the effect of the illumination source bandwidth.

The wavefront distortion (WFD) of a surface with an optical filter coating is ideally measured at the operating wavelength (λ) and angle of incidence (θ) of the filter. However, this is not always possible, requiring that the filter be measured at an out-of-band wavelength and angle (typically λ=633n m and θ=0∘). Since the transmitted wavefront error (TWE) and reflected wavefront error (RWE) can depend on the measurement wavelength and angle, an out-of-band measurement may not give an accurate characterization of the WFD. In this paper, we will show how to predict the wavefront error (WFE) of an optical filter at the in-band wavelength and angle from a WFE measurement at an out-of-band wavelength and different angle. This method uses (i) the theoretical phase properties of the optical coating, (ii) the measured filter thickness uniformity, and (iii) the substrate's WFE dependence versus the angle of incidence. Reasonably good agreement was achieved between the RWE measured directly at λ=1050n m (θ=45∘) and the predicted RWE based on an RWE measurement at λ=660n m (θ=0∘). It is also shown through a series of TWE measurements using a light emitting diode (LED) and laser light sources that, if the TWE of a narrow bandpass filter (e.g., an 11 nm bandwidth centered at λ=1050n m) is measured with a broadband LED source, the WFD can be dominated by the chromatic aberration of the wavefront measuring system-hence, a light source that has a bandwidth narrower than the optical filter bandwidth should be used.

Is an Orthopaedic Surgery Resident's Previous Case Experience Associated with Success of Initial Treatment of Pediatric Forearm Fractures?

Redisplacement and subsequent intervention are common for pediatric forearm fractures. We investigated associations between the success of closed reduction and the treating provider's experience. We identified patients aged 4-16 years with forearm fractures treated by closed reduction and cast immobilization. Clinical data and radiographs of 130 patients treated by 30 residents were reviewed to determine the treating resident's pediatric forearm fracture reduction experience and the incidence of initial treatment failure (ITF). ITF was defined as subsequent intervention before union or malunion. ITF occurred in 32 of 130 patients (25%), comprising 12 of 23 patients (52%) treated by residents with no previous experience and 20 of 107 patients (19%) treated by residents who had logged ≥ 1 previous reduction (odds ratio, 4.7). ITF was more likely to occur in pediatric forearm fractures treated by residents with no previous forearm reduction experience compared with those performed by residents who had such experience. Level of Evidence: Level III, therapeutic. (Journal of Surgical Orthopaedic Advances 32(1):032-035, 2023).

The Role of Wind and Semiochemicals in Mediating Switching Behavior in the Southern Pine Beetle (Coleoptera: Curculionidae: Scolytinae).

Aggressive bark beetles colonize and kill healthy conifers through pheromone-mediated mass aggregation. In several species, the focal point of aggregation moves progressively from mass-attacked 'focus trees' to adjacent, unattacked 'recipient trees', resulting in infestation growth. This process, termed 'switching', is hypothesized to be mediated in whole or in part by antiaggregation pheromones released by beetles as colonization intensifies on a focus tree. We tested this hypothesis with the southern pine beetle, Dendroctonus frontalis Zimmermann (Coleoptera: Curculionidae: Scolytinae), by using a windvane apparatus that maintained an unbaited, black, cylindrical trap (surrogate for a recipient tree) continuously 4 m downwind from an identical trap baited with synthetic aggregation attractant (surrogate for a focus tree). In two of three replicated trials, addition of pheromone components with antiaggregation activity, endo-brevicomin or verbenone, to the upwind trap caused a significant but small (<15%) increase in the proportion of beetles caught in the downwind trap. In one of two trials with endo-brevicomin, this shift was associated with a significant reduction in catches in the downwind trap and an overall reduction in catches of beetles by the trap pair. This suggests that an inhibitor-induced increase in landings on the recipient relative to the focus tree may be countered by the radial effects of the inhibitor, which at sufficiently high release may reduce responses to both the focus and recipient tree. We discuss spatial factors that might govern the role of antiaggregation pheromones in stimulating infestation growth as well as additional factors that likely govern switching behavior.

Are We Working Harder for Less Pay? A Survey of Medicare Reimbursement for Hand and Upper Extremity Surgery.

BACKGROUND: Ongoing concern for declining Medicare payment to surgeons may incentivize surgeons to perform more cases to maintain productivity goals. The authors evaluated trends in physician payment, patient charges, and reimbursement ratios for the most common hand and upper extremity surgical procedures. METHODS: The authors examined Medicare surgeon payment, patient charges, and surgical volume from 2012 to 2017 for 83 common surgical procedures, incorporating the year-to-year Consumer Price Index to adjust for inflation. The reimbursement ratio was calculated by dividing payment by charge. Weighted (by surgery type and volume) averages were calculated. RESULTS: Total Medicare surgeon payment increased 5.6 percent to $272 million for the studied procedures. Patient charges were seven times greater than payment, growing 24 percent to $1.9 billion. Despite growth of total payment, the average overall weighted payment for a single surgery decreased 3.5 percent. The average weighted patient charge increased 8 percent, whereas the reimbursement ratio decreased 13 percent. A hand surgeon would need to perform three more cases per 100 in 2017 to maintain the same reimbursement received in 2012. After categorizing these 83 surgical procedures, distal radius fixation (>3 parts, 21 percent increase; >2-part intra-articular, extra-articular, and percutaneous pinning, 17 percent increase), bony trauma proximal to the distal radius (10 percent increase), and upper extremity flap (5 percent increase) were subject to the greatest increases in payment. Payment for forearm fasciotomy (39 percent decrease), endoscopic carpal tunnel release (30 percent decrease), and mass excisions proximal to the wrist (18 percent decrease) decreased the most. CONCLUSIONS: From 2012 to 2017, despite a disproportionate increase in procedure charges, Medicare surgeon payment has not decreased substantially; however, total reimbursement is multifactorial and involves multiple sources of revenue and cost.

Some Effects of endo-Brevicomin Background on Southern Pine Beetle (Coleoptera: Curculionidae: Scolytinae) Aggregation Behavior.

Semiochemical background in the environment can influence insect orientation to release points of the same or different semiochemicals. endo-Brevicomin is a pheromone component of the tree-killing bark beetle Dendroctonus frontalis Zimmermann (Coleoptera: Curculionidae: Scolytinae) that has a biphasic dose-response curve, enhancing attraction at low release rates but reducing attraction at high rates. We investigated the effect of artificial manipulation of background levels of endo-brevicomin on D. frontalis responses to sources of aggregation attractant in the field. Traps baited with the aggregation pheromone component frontalin and the host odor alpha-pinene were deployed either with or without a background of endo-brevicomin produced by three surrounding dispensers of this semiochemical each located 20 m away. Two tested levels of endo-brevicomin background caused catches to increase by an order of magnitude above those in the absence of background. Presence of background also altered the beetles' biphasic dose-response when endo-brevicomin dispensers were added to traps. Background reduced or concealed attraction-enhancement otherwise observed for low-release dispensers added to traps, and it decreased the release rate necessary to produce reductions in catches. We propose that spatial variability in abundance of natural, background sources of endo-brevicomin in the environment (i.e., infested trees) is a cause of the observed variability in effects of endo-brevicomin dispensers on southern pine beetle behavior in the field. Furthermore, our results illustrate the potential complexity of the density-dependent effects of biphasic pheromone components on bark beetle mass attack and colonization behavior.

Osteotomy in the newborn classic bladder exstrophy patient: A comparative study.

INTRODUCTION: Pelvic osteotomy is indicated in classic bladder exstrophy (CBE) patients with a wide pubic diastasis or non-malleable pelvis. While the safety of pelvic osteotomy in delayed and failed closures is established, there remains less clarity on their safety in newborns. The authors herein sought to present their experience with CBE patients who underwent pelvic osteotomy for assistance with bladder closure during both the newborn and delayed time periods. OBJECTIVE: The authors hypothesize that pelvic osteotomy during exstrophy closure may be performed safely in newborns with few perioperative or post-operative negative sequelae. STUDY DESIGN: A prospectively maintained IRB-approved database was reviewed for CBE patients who underwent osteotomy during primary closure. Patient demographics, performing institution (authors' or outside), closure outcome, diastasis width, and post-operative complications were noted. Patient subgroups included newborn and delayed (>28 days of life) closures. Failure was defined as bladder dehiscence, prolapse, outlet obstruction, or vesicocutaneous fistula requiring reoperation. Orthopedic complications included nerve palsies, superficial pin-site infection, and bladder neck erosion by orthopedic hardware. Analyses were performed using a Chi-square test. RESULTS: 286 patients were included: 186 newborn and 100 delayed closures. The authors' institution performed 109 cases (44 newborn and 65 delayed). Within the overall newborn closure cohort, no significant differences were found in outcomes among the osteotomy types with success rates of 80%, 60.8%, and 71.4% in the combined, posterior iliac, and anterior innominate groups, respectively (p = 0.24). In the delayed group, success rates were significantly different with rates of 100%, 72.4%, and 93.8% in the combined, posterior iliac, and anterior innominate groups, respectively (p < 0.001). Febrile urinary tract infection (UTI) was the most common complication at 8% (23/286). Only 1.7% (5/286) of patients had orthopedic complications with 3 patients in the newborn cohort, 2 patients in the delayed cohort, and only one patient requiring reoperation. DISCUSSION: Orthopedic complications are rare in CBE patients who undergo osteotomies regardless of the closure period. No clinically significant difference in orthopedic complication rate was found between newborn and delayed closure periods. CONCLUSIONS: While current trends have moved toward delayed primary closures, there remains a role for osteotomy during exstrophy closure in select newborn patients and can be performed safely with few complications.

Using the Remnant Anterior Cruciate Ligament to Improve Knee Stability: Biomechanical Analysis Using a Cadaveric Model.

BACKGROUND: Injured anterior cruciate ligament (ACL) tissue retains proprioceptive nerve fibers, vascularity, and biomechanical properties. For these reasons, remnant ACL tissue is often preserved during the treatment of ACL injuries. PURPOSE: To assess through a cadaveric model whether reorienting and retensioning the residual ACL via an osteotomy improves knee stability after partial ACL tear, with substantial remnant tissue and intact femoral and tibial attachments. STUDY DESIGN: Controlled laboratory study. METHODS: In 8 adult cadaveric knees, we measured anterior tibial translation and rotational laxity at 30° and 90° of flexion with the ACL in its native state and in 3 conditions: partial tear, retensioned, and ACL-deficient. The partial-tear state consisted of a sectioned anteromedial ACL bundle. RESULTS: In the native state, the translation was 10 ± 2.7 mm (mean ± SD) at 30° of flexion and 8.4 ± 3.6 mm at 90° of flexion. Anterior translation of the knees in the partial-tear state (14 ± 2.7 mm at 30° and 12 ± 2.7 mm at 90°) was significantly greater than baseline (P < .001 for both). Translation in the ACL-retensioned state (9.2 ± 1.7 mm at 30° and 7.2 ± 2.1 mm at 90°) was significantly less than in the ACL-deficient state (P < .001 for both), and translation was not significantly different from that of the intact state. For ACL-deficient knees, translation (20 ± 4.3 mm at 30° and 16 ± 4.4 mm at 90°) was significantly greater than all other states (P < .001 for all). Although rotational testing demonstrated the least laxity at 30° and 90° of flexion in the retensioned and intact states and the most laxity in the ACL-deficient state, rotation was not significantly different among any of the experimental states. CONCLUSION: In a cadaveric model of an incomplete ACL tear, a reorienting and retensioning core osteotomy at the tibial insertion of the remnant ACL improved anteroposterior translation of the knee without compromising its rotational laxity. CLINICAL RELEVANCE: The findings of this study support the concept of ACL tissue reorienting and retensioning in the treatment of ACL laxity as an area for future investigation.

Alternative Formulations of Trap Lures for Operational Detection, Population Monitoring, and Outbreak Forecasting of Southern Pine Beetle in the United States.

The southern pine beetle, Dendroctonus frontalis Zimmermann (Coleoptera: Curculionidae: Scolytinae) is a major destructive pest of Pinus L. In the southeastern United States, numbers of this species and a major predator, Thanasimus dubius (Fabricius) (Coleoptera: Cleridae), captured during an annual springtime trapping survey are used to make forecasts of the likelihood and severity of an outbreak during the following summer. We investigated responses by both species to six lure formulations to evaluate their suitability for the survey and allow integration of historical data sets produced with differing lure compositions. Trapping trials were performed at four locations across three states (Louisiana, Mississippi, and Alabama) during spring, and at these and one additional location (North Carolina) in fall 2016. All lures included the pheromone component frontalin. Southern pine beetle preferred lures that additionally included the pheromone component endo-brevicomin and turpentine as a source of host odors (rather than a 7:3 mixture of monoterpenes alpha- and beta-pinene). Thanasimus dubius displayed little discrimination among lure compositions. Lure preferences by southern pine beetle did not differ significantly among locations in spring but were influenced by season. Gas chromatography (GC)-electroantennographic detection analyses with southern pine beetle and GC-mass spectrometry identified numerous known and potential semiochemicals that distinguished volatiles released by the tested host odor devices. The lure combination that included endo-brevicomin and alpha/beta-pinene is recommended for the trapping survey because of its high sensitivity for southern pine beetle and potential for greater data integrity resulting from its reproducible composition.

Ultra-high-Q resonances in plasmonic metasurfaces.

Plasmonic nanostructures hold promise for the realization of ultra-thin sub-wavelength devices, reducing power operating thresholds and enabling nonlinear optical functionality in metasurfaces. However, this promise is substantially undercut by absorption introduced by resistive losses, causing the metasurface community to turn away from plasmonics in favour of alternative material platforms (e.g., dielectrics) that provide weaker field enhancement, but more tolerable losses. Here, we report a plasmonic metasurface with a quality-factor (Q-factor) of 2340 in the telecommunication C band by exploiting surface lattice resonances (SLRs), exceeding the record by an order of magnitude. Additionally, we show that SLRs retain many of the same benefits as localized plasmonic resonances, such as field enhancement and strong confinement of light along the metal surface. Our results demonstrate that SLRs provide an exciting and unexplored method to tailor incident light fields, and could pave the way to flexible wavelength-scale devices for any optical resonating application.

Evidence for Semiochemical Divergence Between Sibling Bark Beetle Species: Dendroctonus brevicomis and Dendroctonus barberi.

We investigated geographic variation in the semiochemistry of major disturbance agents of western North American pine forests, Dendroctonus brevicomis Le Conte and Dendroctonus barberi Hopkins (Coleoptera: Curculionidae: Scolytinae), species separated by the Great Basin in the USA that until recently were synonymous. At 15 sites in the western USA and northern Mexico, beetle populations were examined to determine (1) pheromone production by solitary, mining females, (2) male electroantennogram amplitudes in response to known semiochemicals for the genus, or (3) relative attractiveness of two female-produced pheromone components (endo- and exo-brevicomin) and two host odors (alpha-pinene and myrcene) to beetles in the field. Compared to female beetles collected east of the Great Basin (D. barberi), western females (D. brevicomis) produced a consistently higher proportion of, and male antenna were correspondingly more sensitive to, the exo- than the endo-isomer of brevicomin. With the exception of one sampling location (where no preference was observed), beetles west of the Great Basin were more attracted to exo- than endo- brevicomin trap lures, whereas eastern beetles displayed the reverse preference. In contrast, there was not a consistent difference between these populations regarding relative attraction or olfactory response to myrcene or alpha-pinene, although some geographic variability was evident. These data show that the semiochemical systems of D. brevicomis and D. barberi have diverged and corroborate genetic and morphological evidence that they are distinct, allopatric species.

Effect of an optical coating on in-band and out-of-band transmitted and reflected wavefront error measurements.

The wavefront error (WE) of a surface with an optical coating ("filter") is ideally measured at the in-band wavelength of the filter. However, quite often this is not possible, requiring that the filter be measured at an out-of-band wavelength (typically 633 nm), assuming that the filter transmits (for transmitted WE, or TWE) or reflects (for reflected WE, or RWE) at this wavelength. This out-of-band TWE/RWE is generally assumed to provide a good estimation of the desired in-band TWE/RWE. It will be shown in this paper that this is not the case for a large class of filters (i.e., bandpass) where the group delay is significantly different at the in-band and out-of-band wavelengths and where the optical filter exhibits a thickness non-uniformity across the surface. A theoretical explanation will be given along with an approach to predict the in-band TWE/RWE based on the coating non-uniformity, the measured out-of-band TWE/RWE, and the theoretical properties of the optical filter at the in-band and out-of-band wavelengths. A reasonable agreement between theory and measurement was demonstrated by measuring the TWE of an 11 nm wide bandpass filter (centered at 1048 nm) at both in-band (λ=1048nm) and out-of-band (λ=625nm) wavelengths. A similar treatment is provided for RWE.

A Novel Peer-Directed Curriculum to Enhance Medical Ethics Training for Medical Students: A Single-Institution Experience.

BACKGROUND: The best pedagogical approach to teaching medical ethics is unknown and widely variable across medical school curricula in the United States. Active learning, reflective practice, informal discourse, and peer-led teaching methods have been widely supported as recent advances in medical education. Using a bottom-up teaching approach builds on medical trainees' own moral thinking and emotion to promote awareness and shared decision-making in navigating everyday ethical considerations confronted in the clinical setting. OBJECTIVE: Our study objective was to outline our methodology of grassroots efforts in developing an innovative, student-derived longitudinal program to enhance teaching in medical ethics for interested medical students. METHODS: Through the development of a 4-year interactive medical ethics curriculum, interested medical students were provided the opportunity to enhance their own moral and ethical identities in the clinical setting through a peer-derived longitudinal curriculum including the following components: lunch-and-learn didactic sessions, peer-facilitated ethics presentations, faculty-student mentorship sessions, student ethics committee discussions, hospital ethics committee and pastoral care shadowing, and an ethics capstone scholarly project. The curriculum places emphasis on small group narrative discussion and collaboration with peers and faculty mentors about ethical considerations in everyday clinical decision-making and provides an intellectual space to self-reflect, explore moral and professional values, and mature one's own professional communication skills. RESULTS: The Leadership through Ethics (LTE) program is now in its fourth year with 14 faculty-clinician ethics facilitators and 65 active student participants on track for a distinction in medical ethics upon graduation. Early student narrative feedback showed recurrent themes on positive curricular components including (1) clinician mentorship is key, (2) peer discussion and reflection relatable to the wards is effective, and (3) hands-on and interactive clinical training adds value. As a result of the peer-driven initiative, the program has been awarded recognition as a graduate-level certification for sustainable expansion of the grassroots curriculum for trainees in the clinical setting. CONCLUSIONS: Grassroots medical ethics education emphasizes experiential learning and peer-to-peer informal discourse of everyday ethical considerations in the health care setting. Student engagement in curricular development, reflective practice in clinical settings, and peer-assisted learning are strategies to enhance clinical ethics education. The Leadership through Ethics program augments and has the potential to transform traditional teaching methodology in bioethics education for motivated students by offering protected small group discussion time, a safe environment, and guidance from ethics facilitators to reflect on shared experiences in clinical ethics and to gain more robust, hands-on ethics training in the clinical setting.

Do seizures compromise correction maintenance after spinal fusion in cerebral palsy scoliosis?

Seizure disorder in cerebral palsy (CP) has been described as a risk factor for postoperative complications after posterior spinal fusion. However, the effect of seizures on the maintenance of curve correction has not been reported. The aim of this study is to investigate associations between seizure history and maintenance of curve correction after posterior spinal fusion in children with CP. We analyzed records of 201 children with CP who underwent posterior spinal fusion with two-year follow-up. Patients were classified as having no seizures (31%); controlled seizures (54%); or poorly controlled seizures (PCS, 15%). Perioperative data, radiographic measurements, and complications were compared between groups. Groups were similar in operative time, estimated blood loss, and rates of deep wound infection and implant-related complications. The PCS group had a higher rate of respiratory complications (27%) than the no seizures (10%; P = 0.03) and controlled seizures (12%; P = 0.04) groups. Controlled seizures and PCS groups had longer ICU stays than the no seizures group (P= 0.02 and P= 0.04). Major coronal curve and pelvic obliquity were corrected significantly in all groups, and correction was maintained at 2 years. Loss of correction during follow-up was similar between groups. Although seizures were associated with longer ICU stays and more respiratory complications, there was no association between seizure history and loss of curve correction at two years of follow-up after CP scoliosis surgery.

Occiput-to-Pelvis Spinal Arthrodesis: A Case Series.

STUDY DESIGN: Retrospective case series. OBJECTIVES: To describe the indications, operative course, and outcomes in eight pediatric patients who underwent occiput-to-pelvis (O-P) spinal arthrodesis. SUMMARY: Spinal arthrodesis from the occiput to pelvis is needed for some children with extensive spine deformity. There are few reports of patients with O-P arthrodesis. METHODS: We reviewed records of pediatric patients who underwent spinal arthrodesis to treat spine deformity between 1987 and 2017 at one institution. Eight patients (six girls) who underwent staged O-P arthrodesis were identified. Underlying conditions, indications for surgery, medical comorbidities, operative courses, complications, and imaging of these patients were recorded. RESULTS: Diagnoses were neuromuscular disorders in five patients and syndromic disorders in three patients. Mean ages were 9.7 ± 4.1 years at index surgery and 16.8 ± 4.6 years at completion of O-P arthrodesis. Patients underwent a mean of three operations (range, two to five). Occipitocervical arthrodesis was the final operation in six of eight patients (all but the two patients with Loeys-Dietz syndrome). Mean follow-up after the last procedure was 8.5 ± 7.1 years. Two patients underwent revision for protruding occipital implants, and one patient underwent revision for thoracic pseudarthrosis. No patients developed postoperative infections or new neurologic deficits. At final follow-up, Scoliosis Research Society-22r questionnaire scores were lowest for Function (2.6 ± 1.0 of 5 possible points) and highest for Satisfaction (4.1 ± 1.4). CONCLUSIONS: O-P arthrodesis can benefit patients with extensive spine deformity from neuromuscular or syndromic causes. Patients were young at first operation, which may suggest that younger patients are at higher risk than older patients of major progression of deformity in other spinal regions after deformity correction. Health-related quality of life and radiographic outcomes suggest that patients who underwent O-P arthrodesis had satisfactory outcomes and maintenance of correction during a mean of 8.5 years of follow-up. LEVEL OF EVIDENCE: Level IV, therapeutic study.

Cryptic Species Discrimination in Western Pine Beetle, Dendroctonus brevicomis LeConte (Curculionidae: Scolytinae), Based on Morphological Characters and Geometric Morphometrics.

The western pine beetle (WPB), Dendroctonus brevicomis LeConte, is a major mortality agent of pines in North America. A total of 706 adults of WPB from 81 geographical sites were analyzed with traditional and geometric morphometric methods to evaluate the variation of discrete and quantitative morphological characters with particular attention to the antenna, spermatheca, and seminal rod. Principal coordinates and canonical variate analyses supported three geographical groups in WPB: (1) West, from British Columbia to southern California along the Pacific coast, Idaho, and Montana; (2) East-SMOC, including Nevada, Utah, Colorado, Arizona, New Mexico, Texas, Chihuahua, and Durango; and (3) SMOR, including Coahuila, Nuevo Leon, and Tamaulipas. The pubescence length on the elytral declivity was a robust character for separating West specimens from the other groups. Additionally, the genitalia shape both female and male in dorsal view was a reliable character for discriminating among groups. Based on these results, which agree with genetic and chemical ecology evidence, we herein reinstate Dendroctonus barberi Hopkins (East-SMOC group) and remove it from synonymy with D. brevicomis (West group). Differences in the spermatheca and seminal rod shape of SMOR specimens suggest that these populations might be a different species from D. barberi and D. brevicomis.

Deep Infections After Pediatric Spinal Arthrodesis: Differences Exist with Idiopathic, Neuromuscular, or Genetic and Syndromic Cause of Deformity.

BACKGROUND: Little is known about the rates, timing, and causative microorganisms of deep surgical site infections after spinal arthrodesis in patients with genetic and syndromic scoliosis compared with patients with adolescent idiopathic scoliosis and kyphosis or patients with neuromuscular scoliosis. METHODS: We reviewed data from 1,353 patients who were <21 years of age and had undergone spinal arthrodesis for deformity correction by 1 surgeon from 2000 to 2015. Deformity causes were genetic, idiopathic, or neuromuscular. We identified patients who had undergone an unplanned surgical procedure for a deep surgical site infection that was early (≤90 days after the procedure) or late (>90 days after the procedure). We compared deep surgical site infection rates, timing, and causative microorganisms by deformity cause. RESULTS: Deep surgical site infections occurred in 65 patients (4.8%): 4.2% for patients with genetic and syndromic scoliosis, 2.7% for patients with adolescent idiopathic scoliosis and kyphosis, and 10.0% for patients with neuromuscular scoliosis. Of the deep surgical site infections, 26 (40%) occurred early and 39 (60%) occurred late. The median times to deep surgical site infection onset were 51 days (range, 7 days to 7 years) in patients with genetic and syndromic scoliosis, 827 days (range, 10 days to 12 years) in patients with adolescent idiopathic scoliosis and kyphosis, and 45 days (range, 13 days to 6 years) in patients with neuromuscular scoliosis. Seventy-six microorganisms (41 gram-positive and 35 gram-negative) were isolated from 47 children with positive cultures; the most common was coagulase-negative Staphylococcus (n = 13). The ratio of gram-positive to gram-negative microorganisms was highest in patients with adolescent idiopathic scoliosis and kyphosis (4:1) and lowest in patients with genetic and syndromic scoliosis (0.5:1). In genetic and syndromic scoliosis, both early and late deep surgical site infections were more frequently caused by gram-negative bacteria. In neuromuscular scoliosis, early deep surgical site infections were more frequently caused by gram-negative bacteria, and late deep surgical site infections were more frequently caused by gram-positive bacteria. In adolescent idiopathic scoliosis and kyphosis, both early and late deep surgical site infections were more commonly caused by gram-positive bacteria. Methicillin-resistant Staphylococcus aureus was identified in 2 late deep surgical site infections in patients with neuromuscular scoliosis. CONCLUSIONS: Deep surgical site infections were more common in genetic and syndromic scoliosis than in adolescent idiopathic scoliosis and kyphosis, but less common than in neuromuscular scoliosis. Adolescent idiopathic scoliosis and kyphosis had the highest ratio of late to early deep surgical site infections. Patients with genetic and syndromic scoliosis had predominantly gram-negative microorganisms, particularly in early deep surgical site infections. Methicillin-resistant S. aureus infection was rare, occurring in only 2 patients with neuromuscular scoliosis. Gram-negative and gram-positive prophylactic antibiotics may be indicated for patients with genetic and syndromic scoliosis after spinal arthrodesis. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Multiresonant High-Q Plasmonic Metasurfaces.

Resonant metasurfaces are devices composed of nanostructured subwavelength scatterers that generate narrow optical resonances, enabling applications in filtering, nonlinear optics, and molecular fingerprinting. It is highly desirable for these applications to incorporate such devices with multiple high-quality-factor resonances; however, it can be challenging to obtain more than a pair of narrow resonances in a single plasmonic surface. Here, we demonstrate a multiresonant metasurface that operates by extending the functionality of surface lattice resonances, which are the collective responses of arrays of metallic nanoparticles. This device features a series of resonances with high-quality factors (Q ∼ 40), an order of magnitude larger than what is typically achievable with plasmonic nanoparticles, as well as a narrow free spectral range. This design methodology can be used to better tailor the transmission spectrum of resonant metasurfaces and represents an important step toward the miniaturization of optical devices.