Do all bunions need surgery? An investigation of Google searches for Hallux Valgus

Introduction: Hallux valgus (HV) or a bunion is one of the most common forefoot deformities. Approximately one in four adults will develop HV with a higher prevalence in adult females. Given the high prevalence of HV along with the wide variety of non-surgical and surgical treatment options for it, we believe patients are likely turning to internet search engines for questions germane to HV. Previous orthopaedic investigations have used Google’s “People Also Ask” box to characterize frequently asked questions (FAQs) regarding total knee and hip arthroplasty. Yet, no such investigation has been conducted for HV. Using Google’s Frequently Asked Questions (FAQs), we sought to classify these questions as well as assess their levels quality and transparency.Methods: On October 9, 2022, we searched Google using these four phrases: “Hallux Valgus Treatment,” “Hallux Valgus Treatment Surgery,” “Bunion Treatment,” and “Bunion Surgery.” We refreshed search results until a minimum of 100 FAQs were produced; we extracted the sources of these 100 questions for content analysis. Information transparency was assessed using the Journal of the American Medical Association’s (JAMA) Benchmark tool, question classification was defined using the Rothwell Classification of Questions, and information quality was assessed using Brief DISCERN. This study was approved by an IRB.Results section: Our Google search returned 299 unique FAQs after removing duplicates and unrelated FAQs. The majority were classified as fact based questions (149/299, 49.8%), followed by value (92/299, 30.8%) and policy questions (58/299, 19.4%). Overall the most common topic searched was related to the evaluation of treatment or surgery (79/299, 26.4%). The frequent answer sources were medical practices (158/299, 52.8%), followed by commercial (69/299, 23.1%) and academic (38/299, 12.7%). The one-way analysis of variance revealed a significant difference in mean quality scores among the 5 source types (F= 54.49, P<.001) with medical practices averaging the worst score (12.1/30) compared to academic sources which were found to have the highest score (21.8/30).Discussion: Patients seeking online information concerning treatment options for HV appear to search Google for questions related to treatment efficacy and restrictions. The most common source type encountered by patients are small medical practices; these were found to have both poor transparency and poor quality. Our study has several limitations, JAMA benchmark and Brief DISCERN do not assess the accuracy of the information. Secondly, our study is cross-sectional in design limiting the generalizability of our findings to the time when the search was performed.Significance/Clinical Relevance: In order to increase the transparency and quality of online information regarding HV treatment, online sources should refer to established rubrics such as JAMA benchmark and Brief DISCERN when publishing online information. Physicians should be aware that patients are commonly searching for information related to the evaluation of treatments or surgeries for HV

Target and beam-target spin asymmetries in exclusive pion electroproduction for Q2>1GeV2 . I. ep→eπ+n

Beam-target double-spin asymmetries and target single-spin asymmetries were measured for the exclusive π + electroproduction reaction γ ∗ p → n π + . The results were obtained from scattering of 6-GeV longitudinally polarized electrons off longitudinally polarized protons using the CEBAF Large Acceptance Spectrometer at Jefferson Laboratory. The kinematic range covered is 1.1 &lt; W &lt; 3 GeV and 1 &lt; Q 2 &lt; 6 GeV 2 . Results were obtained for about 6000 bins in W ,   Q 2 ,   cos ( θ ∗ ) , and ϕ ∗ . Except at forward angles, very large target-spin asymmetries are observed over the entire W region. Reasonable agreement is found with phenomenological fits to previous data for W &lt; 1.6 GeV, but very large differences are seen at higher values of W . A generalized parton distributions (GPD)-based model is in poor agreement with the data. When combined with cross-sectional measurements, the present results provide powerful constraints on nucleon resonance amplitudes at moderate and large values of Q 2 , for resonances with masses as high as 2.4 GeV

Beam-target helicity asymmetry for γ→n→→π−p in the N*resonance region

We report the first beam-target double-polarization asymmetries in the γ þ nðpÞ → π− þ pðpÞ reaction spanning the nucleon resonance region from invariant mass W ¼ 1500 to 2300 MeV. Circularly polarized photons and longitudinally polarized deuterons in solid hydrogen deuteride (HD) have been used with the CEBAF Large Acceptance Spectrometer (CLAS) at Jefferson Lab. The exclusive final state has been extracted using three very different analyses that show excellent agreement, and these have been used to deduce the E polarization observable for an effective neutron target. These results have been incorporated into new partial wave analyses and have led to significant revisions for several γnN* resonance photocouplings

Demonstration of a novel technique to measure two-photon exchange effects in elastic e±pe^\pm p scattering

The discrepancy between proton electromagnetic form factors extracted using unpolarized and polarized scattering data is believed to be a consequence of two-photon exchange (TPE) effects. However, the calculations of TPE corrections have significant model dependence, and there is limited direct experimental evidence for such corrections. We present the results of a new experimental technique for making direct $e^\pm p$ comparisons, which has the potential to make precise measurements over a broad range in $Q^2$ and scattering angles. We use the Jefferson Lab electron beam and the Hall B photon tagger to generate a clean but untagged photon beam. The photon beam impinges on a converter foil to generate a mixed beam of electrons, positrons, and photons. A chicane is used to separate and recombine the electron and positron beams while the photon beam is stopped by a photon blocker. This provides a combined electron and positron beam, with energies from 0.5 to 3.2 GeV, which impinges on a liquid hydrogen target. The large acceptance CLAS detector is used to identify and reconstruct elastic scattering events, determining both the initial lepton energy and the sign of the scattered lepton. The data were collected in two days with a primary electron beam energy of only 3.3 GeV, limiting the data from this run to smaller values of $Q^2$ and scattering angle. Nonetheless, this measurement yields a data sample for $e^\pm p$ with statistics comparable to those of the best previous measurements. We have shown that we can cleanly identify elastic scattering events and correct for the difference in acceptance for electron and positron scattering. The final ratio of positron to electron scattering: $R=1.027\pm0.005\pm0.05$ for $=0.206$ GeV$^2$ and $0.830\leq \epsilon\leq 0.943$

Transverse Polarization of Σ+(1189)\Sigma^{+}(1189) in Photoproduction on a Hydrogen Target in CLAS

Experimental results on the $\Sigma^+(1189)$ hyperon transverse polarization in photoproduction on a hydrogen target using the CLAS detector at Jefferson laboratory are presented. The $\Sigma^+(1189)$ was reconstructed in the exclusive reaction $\gamma+p\rightarrow K^{0}_{S} + \Sigma^+(1189)$ via the $\Sigma^{+} \to p \pi^{0}$ decay mode. The $K^{0}_S$ was reconstructed in the invariant mass of two oppositely charged pions with the $\pi^0$ identified in the missing mass of the detected $p\pi^+\pi^-$ final state. Experimental data were collected in the photon energy range $E_{\gamma}$ = 1.0-3.5 GeV ($\sqrt{s}$ range 1.66-2.73 GeV). We observe a large negative polarization of up to 95%. As the mechanism of transverse polarization of hyperons produced in unpolarized photoproduction experiments is still not well understood, these results will help to distinguish between different theoretical models on hyperon production and provide valuable information for the searches of missing baryon resonances.Comment: pages 1

Induced polarization of {\Lambda}(1116) in kaon electroproduction

We have measured the induced polarization of the ${\Lambda}(1116)$ in the reaction $ep\rightarrow e'K^+{\Lambda}$, detecting the scattered $e'$ and $K^+$ in the final state along with the proton from the decay $\Lambda\rightarrow p\pi^-$.The present study used the CEBAF Large Acceptance Spectrometer (CLAS), which allowed for a large kinematic acceptance in invariant energy $W$ ($1.6\leq W \leq 2.7$ GeV) and covered the full range of the kaon production angle at an average momentum transfer $Q^2=1.90$ GeV$^2$.In this experiment a 5.50 GeV electron beam was incident upon an unpolarized liquid-hydrogen target. We have mapped out the $W$ and kaon production angle dependencies of the induced polarization and found striking differences from photoproduction data over most of the kinematic range studied. However, we also found that the induced polarization is essentially $Q^2$ independent in our kinematic domain, suggesting that somewhere below the $Q^2$ covered here there must be a strong $Q^2$ dependence. Along with previously published photo- and electroproduction cross sections and polarization observables, these data are needed for the development of models, such as effective field theories, and as input to coupled-channel analyses that can provide evidence of previously unobserved $s$-channel resonances.Comment: 13 figure

Cross sections for the γp→K*+Λ and γp→K*+Σ0 reactions measured at CLAS

The first high-statistics cross sections for the reactions γp→K*+Λ and γp→K*+Σ0 were measured using the CLAS detector at photon energies between threshold and 3.9 GeV at the Thomas Jefferson National Accelerator Facility. Differential cross sections are presented over the full range of the center-of-mass angles, and then fitted to Legendre polynomials to extract the total cross section. Results for the K*+Λ final state are compared with two different calculations in an isobar and a Regge model, respectively. Theoretical calculations significantly underestimate the K*+Λ total cross sections between 2.1 and 2.6 GeV, but are in better agreement with present data at higher photon energies