Great Influence Research Articles

The Influence of Experiential Marketing and Service Quality on Repurchase Intention

The study entitled The Influence of Experiential Marketing and Service Quality on Repurchase Interest is a study of how much influence experiential marketing is carried out by entertainment venue managers and the quality of service carried out to support increased visitors as an impact of repurchase interest carried out by visitors. This study uses a descriptive and verification research design, with a quantitative research method. Descriptive testing in this study is done by using continuous line analysis and its verification analysis using path analysis. The results of the analysis show that experiential marketing carried out by managers is included in the good category, this is supported by the quality of service provided by managers according to respondents' responses is good. Based on the analysis carried out, shows that the relationship between the variables studied has a positive relationship, and experiential marketing and service quality both simultaneously and partially have a significant effect on consumer repurchase interest. Of the two variables studied, experiential marketing has a greater influence than service quality on the repurchase interest of visitors to Jans Park Jatinangor.

Images of Russian Pan-Slavists in German Empire of 1880s

The analysis of Russia’s image in Germany at the end of the 19th century is crucial for understanding the dynamics of the relationship between the two countries. This article aims to reconstruct the image of Russian Pan-Slavism in Germany in the 1880s through the examination of four key figures (I. S. Aksakov, M. N. Katkov, N. P. Ignatyev, and M. D. Skobelev) and compare it with reality. The study draws upon a wide range of German and Russian sources, employing qualitative content analysis as the primary method. The findings indicate that German observers — state officials, party politicians, and publicists — generally accurately assessed the views of those Russian actors labeled as “leaders of PanSlavism.” However, they significantly exaggerated the anti-German orientation of these views and the influence of the “Pan-Slavists” on Russian internal and, primarily, external policy. The “leaders of Pan-Slavism” were attributed much greater influence on Russian politics and society than they actually possessed. Additionally, their thoughts and activities were portrayed as predominantly antiGerman. This situation can be attributed to a lack of information about political decisionmaking in Russia and a preconceived perception of Pan-Slavism primarily as a threat to Germany. Such perceptions contributed to the deterioration of Russian-German relations during the period under consideration.

The secret lives of wedgefish: first insights into fine-scale behaviour and movement ecology of a globally imperilled ray

Wedgefishes have recently been recognised as one of the most imperilled marine fish families worldwide. However, many knowledge gaps about their biology and ecology hinder conservation efforts. Here we used a combination of acoustic telemetry and acceleration datalogger technology to gain fundamental insights into the fine-scale behaviour, habitat use, size of activity spaces, and residency of adult female bottlenose wedgefish (Rhynchobatus australiae) in the Ningaloo region of northwestern Australia. Acoustic tracking data over one year demonstrated that female bottlenose wedgefish continuously resided in a relatively small area of a productive coral reef lagoon. Acceleration data revealed that bottlenose wedgefish were nocturnal, with time of day having a greater influence on activity than tidal patterns. Bottlenose wedgefish also increased activity with seasonally increasing temperatures. We identified several discrete behavioural signatures in the acceleration data, inferred to correspond to chafing, settling/burying behaviour, foraging behaviour, and escape behaviour, based on their kinematics. Further observations are required to confirm these behaviours with certainty. Additionally, according to datalogger and acoustic data, tagged bottlenose wedgefish rarely inhabited areas greater than 2 m deep. Together, these first insights into behaviour and habitat use of adult female bottlenose wedgefish highlight the importance of nearshore habitats for this species and indicate that they may be highly resident to specific areas. Our findings provide important insight into the conservation of bottlenose wedgefish in northwestern Australia, including potential effectiveness of protected areas and interactions with specific anthropogenic threats such as shoreline development and recreational beach fishing.

Effects of energy input modes on energy efficiency and berry quality in continuous microwave drying

To elucidate the effects of energy input modes on energy efficiency and berry quality in continuous microwave drying, four energy input modes with variational working ways of magnetrons were investigated by using numerical simulation and bench experiments in a continuous microwave dryer. Energy efficiency was divided into absorption and conversion efficiency to study the change rule of drying process, and the retention rate of anthocyanins of berry’s representative nutrition ingredient was studied considering both of the temperature and its uniformity. Results indicate that the energy input modes affect the absorption efficiency by changing the distribution uniformity of electric field of material layer, and the conversion efficiency by altering the matching degree between the energy allocation and drying characteristics of berry, which are both determined by the ways of working magnetrons of different energy input modes. The conversion efficiency has a greater influence on the final energy efficiency, so the energy input mode should be paid attention to the provision of microwave energy by selecting proper way of working magnetrons according to the drying characteristics. The effect of temperature uniformity on anthocyanin degradation is more obvious with average temperature increasing gradually, where better uniformity of electric field strength should be provided to guarantee the quality of dried berry by adjusting the energy input mode. The research results provide significant insights to optimize the energy input mode of taking into account both the energy efficiency and dried quality of material.

Saudi Arabias New Development Path from the Perspective of Global Swing Country in the Context of Multi-polarization

After the end of the Cold War, the world pattern gradually changed from the bipolar pattern of the United States and the Soviet Union to multi-polarization. In this context, the United States, Russia, China, the European Union, the League of Arab States, and other poles have a greater influence on the change of the world situation, and the Russia-Ukraine war, the relations between the United States and China, the oil crisis, and other factors are constructing international relations. The American think tank defines some countries with an international voice but different preferences for cooperation as global swing countries and expands the original four countries (India, Indonesia, Brazil, Turkey) to six countries (adding Saudi Arabia and South Africa). These are also countries that the Western world, led by the United States, is trying to win over. This paper focuses on the development of Saudi Arabia after the implementation of the new policy in the context of multi-polarity and the reasons for the United States to regain the concept of global swing state. The main research method is literature analysis, and the data and reports obtained from the official website are combined on the basis of scholars research. It can be seen that the new policies represented by the 2030 vision introduced by Saudi Arabia since Salman came to power meet the development needs of Saudi Arabia and have achieved certain results. After a period of flat relations between the United States and Saudi Arabia, the United States has attached great importance to it. The reason is that national interests determine international relations.

Structural optimization on heat transfer characteristics in polyurethane foam film melting process by deflagration method

Flexible polyurethane foam (FPUF) is extensively utilized in various industrial sectors, due to its distinctive porosity. The deflagration approach is a prevalent method employed to reticulate polyurethane foam. The open porosity of the polymer, along with its reticular framework, significantly shape the structure of FPUF and consequently impact its mechanical properties. This study investigates the impacts of two pivotal parameters, pore size and film thickness, on the open porosity of the foam film. The heat transfer characteristics are studied by standard k-ε model coupling with the melting-solidification model based on the enthalpy-porosity method analysis model, and nine PUF models are selected as the evaluation objects. The experimental results indicate that the reticulation effect is more favorable when the open porosity ranges from 0.7 to 0.85. Based on these findings, the parameters with large variation degrees have a greater influence on the melting process of FPUF film. Furthermore, FPUF composites characterized by thicker films and smaller pores demonstrate a remarkable reticulation performance. The insights garnered from this study hold promise for advancing the comprehension of the underlying mechanisms governing FPUF deflagration, thereby facilitating the optimization of its structural applications in industrial domains.

Manipulation of Farmed Wetlands Increases use by Migrating Shorebirds and Ducks

The Drift Prairie, in central North America, has been largely converted from grasslands to croplands, but still contains thousands of wetlands used by shorebirds and waterfowl during breeding and migration periods. Consequently, many of the remaining wetlands are situated within cropland where disturbance regimes (i.e., fire, grazing, and water-level dynamics), which occurred naturally prior to agricultural development, have been highly altered by landscape fragmentation from agriculture practices. Currently, smaller wetlands within crop fields are subject to disturbances stemming from agricultural practices (i.e., manipulations), such as burning, disking, harvesting, and mowing. We evaluated vegetation structure of idled (i.e., not recently manipulated by farming practices) and manipulated agricultural wetlands to investigate whether management method or resulting vegetation structure had greater influence on occurrence probabilities and densities of dabbling ducks and shorebirds during spring. All manipulation methods reduced vegetation heights compared to idled wetlands and most manipulations reduced the proportion of vegetation cover in inundated areas. Wetland manipulations generally increased shorebird occurrence compared to idled wetlands, whereas vegetation variables better explained duck occurrence probabilities. Duck occurrence peaked in wetlands with lower vegetation coverage (32%), and duck densities decreased as vegetation coverage increased beyond 10%. While more studies are needed to understand underlying mechanisms driving these outcomes, our results indicate that including periodic disturbances that reduce dense vegetation within wetlands in agricultural fields would increase their use by migrating and breeding shorebirds and dabbling ducks.

Experimental study on gas uniformity at the inlets of six cyclones in a CFB with multi-tracer gas method

To investigate the non-uniform distribution of different gases passing through the parallel cyclones, experiments were conducted on a circulating fluidized bed (CFB) equipped with six asymmetrical cyclones. A multi-tracer gas method was used, with CO, O2, and CO2 chosen to represent gases with different properties in the flue gas at the inlets of the cyclones. The uniformity of multi-gas distribution was evaluated by measuring the concentration deviations of each tracer gas passing through individual cyclones. The results indicate that the concentrations of multi-tracer gases are higher in the middle cyclone among the three, which are located on the tracer gas injection side during the test of single-side secondary air (SA) tracing. The maximum concentration deviation of tracer gases is for CO2, while the minimum is for CO. At the three cyclone inlets on the opposite side, the tracer gas with higher density exhibits a more uniform distribution, and the gas uniformity decreases as the density decreases. The effects of superficial velocity, SA ratio, bed inventory, and tracer gas injection region on the uniformity of gas distribution were studied. The results show that superficial velocity and SA ratio primarily affect the uniformity of higher density gases, while bed inventory has a greater influence on lower density gases. The gas distributions are most non-uniform, especially for CO2, when the tracer gas injection region is near the rear wall closer to the induced draft fan during the test of regional SA tracing.

Stratified Effects of Tillage and Crop Rotations on Soil Microbes in Carbon and Nitrogen Cycles at Different Soil Depths in Long-Term Corn, Soybean, and Wheat Cultivation.

Understanding the soil bacterial communities involved in carbon (C) and nitrogen (N) cycling can inform beneficial tillage and crop rotation practices for sustainability and crop production. This study evaluated soil bacterial diversity, compositional structure, and functions associated with C-N cycling at two soil depths (0-15 cm and 15-30 cm) under long-term tillage (conventional tillage [CT] and no-till [NT]) and crop rotation (monocultures of corn, soybean, and wheat and corn-soybean-wheat rotation) systems. The soil microbial communities were characterized by metabarcoding the 16S rRNA gene V4-V5 regions using Illumina MiSeq. The results showed that long-term NT reduced the soil bacterial diversity at 15-30 cm compared to CT, while no significant differences were found at 0-15 cm. The bacterial communities differed significantly at the two soil depths under NT but not under CT. Notably, over 70% of the tillage-responding KEGG orthologs (KOs) associated with C fixation (primarily in the reductive citric acid cycle) were more abundant under NT than under CT at both depths. The tillage practices significantly affected bacteria involved in biological nitrogen (N2) fixation at the 0-15 cm soil depth, as well as bacteria involved in denitrification at both soil depths. The crop type and rotation regimes had limited effects on bacterial diversity and structure but significantly affected specific C-N-cycling genes. For instance, three KOs associated with the Calvin-Benson cycle for C fixation and four KOs related to various N-cycling processes were more abundant in the soil of wheat than in that of corn or soybean. These findings indicate that the long-term tillage practices had a greater influence than crop rotation on the soil bacterial communities, particularly in the C- and N-cycling processes. Integrated management practices that consider the combined effects of tillage, crop rotation, and crop types on soil bacterial functional groups are essential for sustainable agriculture.

The influence of digital competency and self leadership on teacher performance in Yayasan Indonesia Juara

Purpose: This study aims to examine teacher competence in facing 21st century education through digital competency, aneadership towards oneself through self-leadership, and its influence on teacher performance. Research Methodology: The method used in this study is quantitative. This study was descriptive and causal research. Based on their involvement, the researchers did not intervene in the data. This means that the data collected and processed were sourced directly from the respondents. Based on this unit, what is analyzed in this study is the individual. Based on the time of the study, this study belongs to the cross-section type; elements were measured only once during the research process in accordance with the applicable time and finished when this study was completed. Results: Digital competency and self-leadership have been proven to influence teacher performance. However, there was a difference in the influence of digital competency and self-leadership. The results showed that the magnitude of the influence of teachers’ digital competency on teacher performance was not very high. Self-leadership has a significant influence on teachers’ performance. This indicates that self-leadership has a greater influence on the quality or performance of a teacher in fulfilling his/her role. Contributions: The findings of this thesis are useful for educational institutions to determine the factors that influence teacher performance and to design effective professional development programs to improve teachers' skills and abilities. In addition, this research can be used by educators as a resource to study the impact of digital leadership and self-leadership on teacher performance.

Mercury in river samples with artisanal and small-scale gold mining influence: The case of the upper Madeira River Basin (Brazil/Bolivia)

The issue of mercury (Hg) is becoming a growing concern in the Amazon basin. The Madeira River is known for intense artisanal and small-scale gold mining (ASGM), and Hg poses a significant issue for public health and ecosystems. In this study, we analyzed Hg riverine concentrations in water samples, suspended particulate matter (SPM) and sediments in the Upper Madeira River Basin. We also examined mineralogical and elemental compositions of the solid phase to enhance our understanding of Hg behavior in the environment. Dissolved Hg was not detected in water, and Hg concentrations in solids remained in the same order of magnitude across different rivers, despite variations in gold mining intensities along their courses. Generally, Hg concentrations were higher in compartments with a greater proportion of fine sediments (clay and silt), with average concentrations of 91.4 ± 13.0, 41.6 ± 11.0, and 22.2 ± 1.6 ng g−1 for SPM (n = 14), riverbank (n = 12), and riverbed (n = 4) sediments, respectively. Multivariate analysis shows Hg chemical associations related to clay minerals and organic matter (OM) for the riverbank and SPM compartments. However, in SPM, OM had a greater influence on Hg distribution. Conversely, one riverbed sample highlights with a high Hg concentration (547.78 ng g−1), large content of heavy minerals, and a distinct geochemical signature. This sample was collected in a river section upstream of Beni River's rapids where the river's hydrodynamics can induce the high concentration of heavy minerals in this riverbed sediment. This unexpectedly high Hg concentration encountered in sediment rich in heavy minerals is likely related to contamination by Hg-rich mine tailing discarded into the river. Overall, this study discusses the issue of Hg mobility in rivers suggesting its dispersion, i) associated with fine fraction rich in clay and OM, and ii) associated with heavy minerals.

How can we better engage female athletes? A novel approach to health and performance education in adolescent athletes

ObjectivesTo evaluate the impact of a video series versus online pamphlets/blog posts on Female Athlete Triad (Triad) and Relative Energy Deficiency in Sport (REDs) knowledge in high school female runners.MethodsRunners...

The effect of the tidal cycle on the phytoplankton community assemblage in a mangrove-dominated tropical tidal creek.

A comparative assessment of phytoplankton dynamics during low tide (LT) and high tide (HT) was conducted from February 2022 to January 2023 in a tropical mesotidal creek, Manori, Mumbai, India. In total, 124 phytoplankton species were recorded. The HT resulted in greater species richness (124 species) and diversity indices (Shannon-Wiener's index) than the LT (102 species). The Pielou's evenness (J') and Simpson's dominance index (1-D) did not show significant fluctuations with the tides due to the marine phytoplankton species moving rhythmically in and out of the creek with the tides. Overall, the seasonal abundance was maximum during pre-monsoon at HT (5.79 × 103 u/L) and lowest in monsoon at LT (0.45 × 103 u/L), whereas spatial abundance was maximum at S1 (HT- 4.04 × 103 u/L) at HT and lowest at S3 (LT- 0.75 × 103 u/L) at LT. The diatoms dominated in their abundance (1.83 × 103 u/L and 3.82 × 103 u/L in HT) and diversity (77 in LT and 92 in HT). The species such as Coscinodiscus centralis, Coscinodiscus granii, Coscinodiscus radiatus, Triops furca, Melosira varians, Nitzchsia palea, Chaetoceros affinis, Skeletonema marinoi, Stephanocyclus meneghinianus, Planktoniella sol and Skeletonema costatumwere the dominant native residents in the creek. SIMPER analysis revealed that the maximum similarity was during the monsoon (47.65%), and the minimum was during the pre-monsoon (38.10%) at LT. However, in HT, the maximum similarity of phytoplankton shifted to post-monsoon (63.85%) and the minimum during the pre-monsoon (46.71%). The mean value of richness (d') and Shannon's diversity (H') showed a moderate phytoplankton diversity in the system. The environmental parameters (water temperature > pH > nitrate > salinity > DO > Alk > silicate) have a greater influence on the distribution of the phytoplankton community with tides as revealed by the Canonical correspondence analysis. Therefore, it has been found that tides play a significant role in the distribution and abundance of the phytoplankton community in a mesotidal creek environment.

Влияние различных факторов риска на формирование вторичных органических психических расстройств у лиц пожилого возраста с алкогольной зависимостью, сформированной в среднем и пожилом возрасте

Background. Alcohol slows down the work of the brain and central nervous system, leads to deterioration of memory and concentration, cognitive disorders, and the formation of organic mental disorders. Due to the retirement of elderly people, some of them resort to taking alcohol as an adaptogen to alleviate various social, mental and psychological disorders, which can lead to the emergence of new or exacerbation of existing somatic disorders, the formation of alcoholism, as well as organic mental disorders. Aim. To investigate the risk factors (RF) for the formation of secondary organic mental disorders (SOMD) in elderly people with alcohol dependence (AD), formed in middle and old age. Patients and methods. The study included only male patients for the purity of the study aged 60 to 74 years (average age 67.5±7.2), who were divided into 2 groups depending on the age of occurrence of AD: group 1 – 21 people (36.2%), AD occurred at the age of 51.6±1.2 years, and the symptoms of SOMD at 61.8±2.1 years; group 2 – 37 people (63.8%), AD occurred at the age of 64.5±2.5 years, and SOMD at 71.3±2.8 years. The following methods were used: questionnaire – using the developed "Anamnestic chart", clinical (anamnesis collection), statistical (parametric and nonparametric). Results. The main factors of the formation of SOMD in people with formed AD in middle and old age are combinations of various RF, as well as a monofactor in the form of chronic alcohol abuse, the proportion of which varies depending on the age of AD formation. Conclusion. When AD is formed in old age, combinations of RF have a greater influence on the development of SOMD. And in the formation of AD in middle age, both alcohol, as an exogenous mono-damaging factor, and a combination of RF contribute to the formation of SOMD. Hereditary burden of alcoholism affects the progrediency of alcoholism, but does not play a role in the rate of formation of SOMD. The formation of alcoholism in middle age is combined with a relatively slow rate of formation of SOMD and a smaller number of associated somatic pathology, and when formed in old age – with a relatively fast rate of development of SOMD and a large number of associated somatic pathology.

Biomechanical Effects of Different Prosthesis Types and Fixation Ranges in Multisegmental Total En Bloc Spondylectomy: A Finite Element Study.

Multi-segmental total en bloc spondylectomy (TES) gradually became more commonly used by clinicians. However, the choice of surgical strategy is unclear. This study aims to investigate the biomechanical performance of different prosthesis types and fixation ranges in multisegmental TES. In this study, a validated finite element model of T12-L2 post-spondylectomy operations were carried out. The prostheses of these models used either 3D-printed artificial vertebrae or titanium mesh cages. The fixed range was two or three segment levels. Range of motion, stress distribution of the endplate and internal fixation system, intervertebral disc pressure, and facet joint surface force of four postoperative models and intact model in flexion and extension, as well as lateral bending and rotation were analyzed and compared. The type of prosthesis used in the anterior column reconstruction mainly affected the stress of the adjacent endplate and the prosthesis itself. The posterior fixation range had a greater influence on the overall range of motion (ROM), the ROM of the adjacent segment, the stress of the screw-rod system, and adjacent facet joint surface force. For the model of the same prosthesis, the increase of fixed length resulted in an obvious reduction of ROM. The maximal decrease was 70.23% during extension, and the minimal decrease was 30.19% during rotation. In three-segment TES, the surgical strategy of using 3D-printed artificial prosthesis for anterior column support and pedicle screws for posterior fixation at both two upper and lower levels respectively can reduce the stress on internal fixation system, endplates, and adjacent intervertebral discs, resulting in a reduced risk of internal fixation failure, and ASD development.

Decreasing light exposure increases the abundance of antibiotic resistance genes in the cecum and feces of laying hens

The gut microbiome plays a crucial role in maintaining animal health and is influenced by various factors, including light exposure; however, the response in laying hens of the gut microbiome to intermittent light regimes and the related impact on antibiotic resistance genes (ARGs) remain poorly understood. In this study, we divided 20-week-old laying hens into two groups. These groups were exposed to either continuous normal light or intermittent light for 8 weeks. The feces and cecal contents of laying hens were collected for analysis. Metagenomic analysis of both feces and cecal content samples revealed significant shifts in the microbial composition and abundance of ARGs under intermittent light exposure compared to normal light exposure (P < 0.05). Furthermore, metabolomic analysis of the cecal contents revealed substantial alterations in the abundance and composition of ARGs and mobile genetic elements (MGEs) in response to intermittent light exposure (P < 0.05). Network analysis revealed intricate co-occurrence patterns among bacterial communities, metabolites, and ARGs, highlighting correlations between Bacteroidetes species, ARGs, and metabolites. Although certain bacterial species showed differential associations, the dominant bacteria carrying ARGs or MGEs had relatively low numbers, suggesting that other bacterial communities may have had a greater influence on ARG dissemination. Moreover, our observations highlight the crucial role of metabolites as mediators between bacterial communities and ARGs, providing novel insights into the dynamics of antibiotic resistance development. Our findings underscore the impact of intermittent light exposure on ARG proliferation in poultry farming and emphasize interconnections among ARGs, bacterial communities, and metabolic pathways. The results underscore the importance of considering both microbial communities and metabolic processes to understand antibiotic resistance in agricultural settings.

Local factors have a greater influence on the abundance of alfalfa weevil and its larval parasitoids than landscape complexity in heterogeneous landscapes

ContextThe alfalfa weevil Hypera postica Gyllenhal (Coleoptera: Curculionidae) is one of the most destructive pests of alfalfa worldwide. Both local and landscape-scale factors can significantly influence crop pests, natural enemies, and the effectiveness of biological control services, but the relative influence of these factors is unclear.ObjectivesWe investigated the influence of the local variables and surrounding landscape composition and configuration on the abundance of alfalfa weevil, and on the abundance and parasitism rates of its larval parasitoids, Bathyplectes spp.MethodsWe sampled 65 commercial alfalfa fields along the Ebro Basin, Spain, over a period of 3 years, recording the field characteristics and landscape structure at three buffer radii of 250, 500 and 1000 m from the center of each field.ResultsThe abundance of weevil larvae was positively associated with the field perimeter and with the uncut alfalfa surrounding the pipes of the sprinkler irrigation system, but only one configuration variable was positively correlated: the alfalfa edge density. No local characteristics or landscape structures were associated with the abundance of adult weevils. The abundance of Bathyplectes spp. adults was positively associated to local factors such as the densities of alfalfa weevils and aphids. Few landscape structure variables, such as alfalfa edge density and Simpson’s Diversity Index, had explanatory value only at 250 m buffer radius. The rate of larval parasitism was affected by local variables, such as alfalfa weevil abundance and field age.ConclusionOur results provide, for the first time in the Mediterranean region and Europe, evidence of the relative importance of landscape structure and local factors on the abundance of the alfalfa weevil and its larval parasitoids, Bathyplectes spp. The strongest influences were based on local characteristics.

ZCHSound: Open-Source ZJU Paediatric Heart Sound Database With Congenital Heart Disease.

From 2020 to 2022, we collaborated with experienced cardiac surgeons from three general children's hospitals to collect heart sound signals from 1259 participants using electronic stethoscopes. To ensure the accuracy of the labels, the labels for all data were confirmed by two cardiac experts. To establish the baseline of ZCHsound, we extracted 84 features and used machine learning models to evaluate the performance of the classification task. The ZCHSound database was divided into two datasets: one is a high-quality, filtered clean heart sound dataset, and the other is a low-quality, noisy heart sound dataset. In the evaluation of the high-quality dataset, our random forest ensemble model achieved an F1 score of 90.3% in the classification task of normal and pathological heart sounds. This study has successfully established a large-scale, high-quality, rigorously standardized pediatric CHD sound database with precise disease diagnosis. This database not only provides important learning resources for clinical doctors in auscultation knowledge but also offers valuable data support for algorithm engineers in developing intelligent auscultation algorithms.

The option of transosseous distal suture placement during minimally invasive Achilles tendon repair for high-risk patients can improve outcomes, however does not prevent re-rupture

PurposeAchilles tendon ruptures (ATRs) close to the insertion, in high-level athletes, and in patients at high risk of re-rupture, may be better suited to operative repair. Minimally Invasive Repair (MIR) of the Achilles tendon has excellent outcome and low complication rates. Traditionally MIR has showed lower repair strength, failing due to suture pull-out from the distal tendon stump. The aim of this study was to describe the outcome of ATR patients who received transosseous distal suture placement using a standard technique as a reference.MethodsFollowing ATR, patients were evaluated for pre-injury activity level, body weight, location of the tear and size of the distal Achilles tendon stump. Patients considered to be at high-risk of re-rupture: Tegner level ≥ 8, body weight ≥ 105Kg and distal ATR, received transosseous (TO) distal suture placement (n = 20) rather than the usual transtendinous (TT) technique (n = 55). Patient reported outcome measures and functional evaluation was performed at 12 months following repair.ResultsAt 12 months follow up both methods resulted in good median (IQR) Achilles tendon Total Rupture Score TO 83.8 (74-88.3) vs. TT 90 (79–94), low increased relative Achilles Tendon Resting Angle TO -3.5˚ (3.6) vs. TT -3.5˚ (3.3) and mean (SD) Single leg Heel-Rise Height Index TO 88.2% (9.9) vs. TT 85.6% (9.9) (n.s.). There were 4 re-ruptures in the high-risk group and 2 in the group receiving TT distal suture placement. All but one of these were traumatic in nature. The mode of failure following TO distal suture placement was proximal suture pull out.ConclusionsTo distal suture placement during minimally-invasive Achilles tendon repair for higher-risk patients can lead to results equivalent to those in lower-risk patients treated with a standard TT MIR technique, except for the re-rupture rate which remained higher. There may be factors that have greater influence on outcome other than suture placement following ATR.

The beauty premium: Physicians’ facial expressions and patients’ selection and evaluation behavior in online health communities

BackgroundWith the development of information technology, online health communities (OHCs) are becoming an increasingly popular source of health information. ObjectivesWhile the impact of beauty has been extensively studied in various research fields, its role in OHCs has received little attention. This study aims to evaluate the effect of physicians’ appearance, smile, and positive emotions on patients’ selection and evaluation behavior in OHCs. Additionally, it explores the difference in the beauty premium among different types of physicians. MethodsOver 13,000 images of physicians and their relevant information were collected from the Good Doctor website, which is now China's leading OHC. We identified facial features in physicians’ photos based on deep learning and used Ordinary Least Squares (OLS) regression models to estimate the relationship between physicians’ facial expressions and patients’ behavior. We used PSM to address endogeneity issues and test the robustness of the results. ResultsThis study found that physicians’ appearance and smile positively impact patients’ selection and evaluation behavior, the results indicated that the beauty premium does exist in OHCs. In addition, heterogeneity analysis showed that the beauty of high titles, longer service duration of physicians has a greater influence on patients’ selection and evaluation behavior. ConclusionsThe beauty premium exists in OHCs. Therefore, this study provides new evidence on the impact of physicians’ facial attractiveness in OHCs and provides useful insights for patients, physicians, and platforms about the relationship between physician's structured or unstructured information and patients’ decision-making behaviors.