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Background: The primary aim was to determine the clinical success rate after treatment for talocalcaneal (TCC) and calcaneonavicular coalitions (CNC). The secondary aim was to evaluate the complication, recurrence and revision rate. Methods: A search was carried out in MEDLINE, EMBASE and Cochrane Library. Methodological quality was assessed using the Methodological Index for Non-Randomised Studies (MINORS) criteria. The primary outcome was the clinical success rate and was pooled per type of coalition and treatment modality. 95% Confidence Intervals (CI) of the success rates were calculated. Secondary outcomes included complication rates, coalition recurrence rates, revision rates and pain improvement using the Visual Analogue Scale (VAS). A sub-analysis on interposition material was performed. Results: 43 articles comprising of 1284 coalitions were included, with a pooled mean follow-up of 51 months. Methodological quality was fair. The overall pooled success rate for TCCs was 79% (95% CI, 75%−83%). Conservative treatment, open resection and arthroscopic resection of TCCs resulted in success rates of 58% (95% CI, 42%−73%), 80% (95% CI, 76%−84%) and 86% (95% CI, 71%−94%), respectively. CNCs have an overall success rate of 81% (95% CI, 75%−85%), with 100% (95% CI, 34%−100%), 80% (95% CI, 74%−85%) and 100% (95% CI, 65%−100%) for conservative treatment, open resection and arthroscopic resection, respectively. Pooled complication rates of 4% (95% CI, 3%−7%) for TCCs and 6% (95% CI, 4%−11%) for CNCs were found. The success rates of resection with and without interposition material for TCCs were 83% (95% CI, 78%−87%) and 79% (95% CI, 65%−88%), and for CNCs 81% (95% CI, 76%−86%) and 69% (95% CI, 44%−85%), respectively. Conclusion: Treatment of tarsal coalitions can be considered good to excellent as well as safe, with an overall clinical success rate of 79% for TCCs and 81% for CNCs. Arthroscopic resection of the coalition appears to be non-inferior to open resection of TCCs and CNCs. Level of evidence: Level IV, Systematic Review.

Online professional networks (OPNs) are an increasingly common tool used by recruiters to find and vet qualified job candidates for open positions. These sites allow users to publish recommendations given by other users to supplement their profile information and add credibility to the information provided. OPN recommendations offer a rich source of information to recruiters. Unlike recommendations shared in other ways (non-OPN recommendations), OPN recommendations are publicly accessible, and candidates have complete control over which recommendations they show to others. In this study, we investigate how recommendations may have a different effect when presented as an OPN recommendation versus a non-OPN recommendation. Furthermore, we explore how to improve the effectiveness of recommendations. We conducted a field study where we leveraged the candidate tracking system of a large recruitment firm to measure the varying impact recommendations have on recruiters’ decisions. Our findings show that OPN and non-OPN recommendations that discuss an expected weakness positively affect a candidate’s likelihood of being interviewed. In contrast, recommendations that discuss an unexpected weakness have a negative effect. Furthermore, we find that non-OPN recommendations with no discussion of weakness are significantly more effective than OPN recommendations with no discussion of weakness. We then show that the potential benefits of discussing an expected weakness are more pronounced for OPN recommendations, whereas the potential harm of discussing an unexpected weakness is more severe for non-OPN recommendations.

Companies are using online professional networks at an increasing rate to find qualified candidates to interview for job openings. Although recommendations published on these sites can provide valuable information and influence hiring decisions, the information may suffer from credibility issues due to the medium by which it is shared. In this study, we investigate whether including a discussion of a candidate’s weakness in a recommendation may be an effective way to increase the perceived credibility of the recommender and thereby improve the candidate’s chance of receiving an interview. We surveyed hiring managers and recruiters to collect data to measure the impact different recommendations have on their decisions. Our findings show that including a discussion of weakness in a recommendation increases the perceived credibility of the recommender, which has a positive effect on the candidate’s likelihood of being interviewed. However, when the discussion of weakness counters common gender-based expectations, it is harmful. When the discussion of weakness is consistent, it is helpful. Furthermore, we find that the physically attractive candidates (as shown in their profile picture) are harmed regardless of the weakness discussed. We investigate this further and find that additional discussion of the candidate’s strengths can reduce the negative impact of the discussion of weakness, but only if the strengths are consistent with common gender-based expectations.

The ability to consider multiple possibilities forms the basis for a wide variety of human-unique cognitive capacities. When does this skill develop? Previous studies have narrowly focused on children's ability to prepare for incompatible future outcomes. Here, we investigate this capacity in a causal learning context. Adults (N = 109) and 18- to 30-month olds (N = 104) observed evidence that was consistent with two hypotheses, each occupying a different level of abstraction (individual vs. relational causation). Results suggest that adults and toddlers identified multiple candidate causes for an effect, held these possibilities in mind, and flexibly applied the appropriate hypothesis to inform subsequent inferences. These findings challenge previous suggestions that the ability to consider multiple alternatives does not emerge until much later in development.

Online professional networks are important tools used by recruiters to find qualified candidates for job openings. Within these networks, professional recommendations are used to supplement profiles and add credibility. These recommendations tend to be overly positive, full of superlatives, and lacking in critical statements (referred to as scope of improvement). We draw on the theory of online trust to argue that having scope of improvement and superlatives may affect various dimensions of trust and to show how online trust, in turn, can affect the usefulness of a recommendation and the likelihood of receiving an interview. We contribute to the body of work on online trust both theoretically and empirically. From a theory perspective, we explain why including scope of improvement and superlatives in recommendations on online professional networks may help certain candidates in getting an interview but hurt others. From an empirical perspective, we provide a unique empirical setting that allows us to observe not only the effect of scope of improvement and superlatives, but also validate the theoretically argued underlying process. Furthermore, through discussion with recruiters, we identify then test contextual factors that differentiate recommendations on online professional networks from traditional recommendations. In this study, we use a scenario-based, quasi-experimental survey to test the effects of superlatives and scope of improvement on the usefulness and effectiveness of recommendations. Further, we test the mediating role of trust and how the experience levels of the recommendee affect the sign and strength of these relationships. Our findings indicate that including scope of improvement increases the effectiveness and usefulness of recommendations for candidates at low- and middle levels of experience. For the most experienced candidates, including scope of improvement has a negative effect on effectiveness. Superlatives negatively affect the perceived competence of the recommender and thus should be avoided. This negative effect is reduced when combined with scope of improvement.

Background: Challenges remain in determining which displaced supracondylar humerus fractures are safe to postpone surgical treatment until daylight hours. The purpose of this study is to determine which characteristics can be identified to guide the timing of treatment of supracondylar humerus fractures. Methods: 225 completely displaced Gartland extension type 3/4 supracondylar humerus fractures in healthy patients that presented between 6 am and 7 am were identified. Data were collected retrospectively. Data analysis included univariate, multivariable logistic regression and classification and regression tree analysis. Results: 5% (78/225) underwent surgical treatment the night they presented, while 65% (147/225) were treated the next day. Overall complication rate was 6%, with no difference based on timing of surgery. 12% (28/225) presented with a motor nerve injury, while 6% (14/225) a “pink pulseless” extremity. Statistical analysis found the most reliable radiographic predictor to be the maximum displacement on the anterior–posterior or lateral view. Classification and regression tree analysis developed a clinical algorithm; patients with a “pink pulseless” extremity or motor nerve injury were recommended for surgery overnight, while those with an anterior–posterior or lateral view Conclusion: This study provides guidance on the timing of treatment for displaced supracondylar humerus fractures that present overnight. We provide a simple algorithm with three key clinical predictors for timing of treatment: presence of a “pink pulseless” arm, presence of a motor nerve injury, and displacement of any cortex by at least 25 mm (anterior–posterior or lateral view). This provides a step forward to help practitioners make safer evidenced-based timing decisions for their patients. Level of evidence: Prognostic Study, Level II.

Many universities in the United States have resumed campus-based learning during the coronavirus disease of 2019 (COVID-19) pandemic. Under these special circumstances, many instructors have considered the HyFlex approach to redesign their undergraduate courses. However, a HyFlex teaching model that one adopts in reaction to a global pandemic significantly differs from HyFlex teaching that one adopts under normal conditions. In this paper, we provide actionable practical tips that will allow fellow instructors to better prepare themselves for running a COVID-19 HyFlex classroom. First, we explain how the COVID-19 HyFlex model has some key distinctions from the regular HyFlex teaching model. Then, in the COVID-19 HyFlex classroom, we focus specifically on how to effectively use group work as the learning instrument in these types of classrooms. We consciously seek to go narrow and deep on the dimension of group work as it has the most potential to yield beneficial outcomes while also being fraught with logistical challenges in the COVID-19 HyFlex context. Our collective success with undergraduate HyFlex teaching in future academic terms during COVID-19 will determine our universities' economic success and our jobs' security.

Based on a survey of undergraduate business students at a private Midwestern university in the United States, we found that the abrupt mid-semester transition from campus learning to at-home online learning due to the coronavirus disease of 2019 (COVID-19) pandemic led to an unexpected challenge for students. Students reported that stay-at-home learning eroded support for their student role while also creating conflicts between the student role and other competing roles, such as child, sibling, or supplemental wage earner. As a result, they significantly lacked motivation to complete schoolwork during stay-at-home orders. Using a framework rooted in role identity theory, we analyze this role erosion and role conflict. Based on that analysis, we suggest potential actions for faculty to mitigate the adverse impact that this role erosion/conflict has on learning and, thus, bolster the student role while simultaneously reducing conflict between the student role and other competing roles. As we brace for multiple semesters of teaching during the COVID-19 pandemic, such efforts to facilitate positive stay-at-home learning experiences for our students will contribute to determining our academic success and our educational institutions' economic viability.

While the benefits of multidisciplinary ward round (WR) participation by clinical pharmacists have been demonstrated, it can be time-consuming. No previous studies have compared the specific benefits of WR participation and other clinical activities.To assess the clinical impact of different clinical pharmacist activities and analyse patterns of practice based on WR involvement and timing and significance of clinical interventions.In a prospective, observational time and motion study, clinical pharmacists servicing 6 unmatched specialty areas in a major quaternary public hospital were observed and their activities documented. Pharmacists' self-recorded interventions underwent expert panel assessment for significance and potential cost savings. Workflows and interventions were analysed for the 4 pharmacists involved in WRs ('WR pharmacists') during their time 'on' and 'off' rounds and for 2 pharmacists not involved in WRs ('non-WR pharmacists') using chi-square analyses.During 170 h of observation, 267 clinical interventions (53.9% minor, 40.1% moderate, 6.0% major) were recorded. WR pharmacists spent 24.3% of their time on rounds, and 64.8% of interventions were made during this time (intervention rates: 4.5/hour on WR vs. 0.8/hour off WR vs. 1.3/hour for non-WR pharmacists). Differences in WR and non-WR pharmacists' workflows were observed, although there was no difference in time spent on clinical/patient-centred activities (p = 0.70). WR involvement was associated with significantly quicker interventions (p 0.001). All major interventions were made by WR pharmacists; 80% were made on rounds. Major interventions were estimated to have decreased lengths of stay, intensive care requirements and procedure costs.Clinical pharmacists focussed on patient-centred activities, regardless of WR involvement. Notwithstanding differences in the WR and non-WR specialty areas, WR participation was associated with more significant and timely interventions and potential cost savings. Coupled with the subjective benefits of WR participation observed, these findings support the potential value of clinical pharmacist WR participation.

Objective(s)There has been a recent increase in awareness of the importance of bone health in children treated by paediatric orthopaedic and sports medicine providers. The purpose of this study was to assess our utilisation of 25 hydroxy vitamin D (25(OH)Vit D) testing in the past 10 years, and to evaluate the level of 25(OH)Vit D sufficiency in various populations of patients seen.DesignThis is a single site, retrospective medical record review study.SettingThe study took place at a single large, private, paediatric level 1 trauma teaching hospital in the Northeast USA.ParticipantsOur internal medical records query system identified all patients who have had 25(OH)Vit D testing in the past 10 years, from 1 January 2009 to 31 December 2018. All patients included were seen on an outpatient basis at our Orthopaedic clinics.InterventionsNo interventions for strict research, however, eligible patients have had 25(OH)Vit D testing during their standard of care treatment.Main outcome measure(s)The varying number of 25(OH)Vit D testing that occurred over the study time period within Orthopaedic groups, and by Vit D levels as sufficient, insufficient and deficient. 25(OH)Vit D sufficiency was ≥30 ng/mL, insufficiency ResultsBetween 2009 and 2018, there were 4426 patients who had 25(OH)Vit D testing. Vitamin D testing increased significantly (pConclusionMore frequent testing has led to an increased identification of patients with insufficient and deficient 25(OH)Vit D levels. We found over 50% of patients tested were found to have 25(OH)Vit D levels under 30 ng/mL. There should be an increased awareness of patients with orthopaedic problems who may present with 25(OH) insufficiency.

We use an acousto-optical modulator as a rapidly steerable mirror to multiplex several static patterns on a spatial light modulator, demonstrating both generation and projection of 5 spatial modes of light, with up to 500 kHz bandwidth.

Background: Distal radial physeal stress syndrome, or ‘gymnast’s wrist’ (GW), refers to an overuse condition of the distal radial physis, resulting from repetitive compressive loading and shear forces on an extended wrist. As the distal radius (DR) bears nearly the entire axial load imparted on the extended wrist, the DR is at increased risk. Affected gymnasts often present with chronic wrist pain in the absence of discreet trauma. Physical examination will generally show tenderness to palpation along the DR physis and pain with hyperextension and axial loading. The condition, most commonly diagnosed radiographically, will include abnormalities at the DR such as widening distal radial physis and can lead to more debilitating conditions (e.g. distal physeal growth disturbance). Previous literature has been limited to small populations of elite level gymnasts. The primary aim of the current study was to assess a larger and more varied population of gymnasts at different ages and levels to better elucidate the descriptive epidemiology, presenting clinical and radiologic findings, treatment, and outcomes in a cohort treated at a tertiary care pediatric hospital over a 14 year period. Methods: A word search query was performed on a departmental database for records from January 1, 2003 thru January 1, 2017 using a series of words or phrases inclusive of GW. A subsequent retrospective medical record and radiologic review was conducted on all patients diagnosed with ‘GW’, as reported in clinical or radiologic documentation, which was then confirmed by the senior authors. Data that was collected and analyzed included demographic features, presenting signs and symptoms, imaging modalities pursued, and treatment methods for each patient. The clinical course for each patient was followed, based upon clinic notes and any subsequent imaging. The natural history, recurrence rates, and potential sequellae of this overuse condition were recorded, with special attention towards the details of physeal growth disturbance and surgeries required to address symptomatic ulnar impaction syndrome. Results: 100 study subjects were identified with GW over the study period. Demographic features of the population included a mean age of 11.7 years (range: 6-17) at the age of diagnosis, with a strong female preponderance (F = 95, M = 5), and a different mean age between males (12.4y) and females (11.6y). The mean level of gymnasts was 4.5 (range: level 1 –10). The mean hours of gymnastics practice was 13.4 hours per week (range: 1–30), with over 90% of patients reporting that gymnastics was their primary sport. All of the patients reported pain about the DR with activities involving wrist impact, and about 75% of patients reported that they have been practicing though the pain prior to clinical presentation. The condition was shown to present on either the left (37%), the right (27%), or bilaterally (35%); where the location of pain was present mostly on the radial side (52%) or both the radial and ulnar side (38%) versus only the ulnar side (5%). The average duration of symptoms before presentation or diagnosis was about 98.7 days (range: 0-730) and resolution of symptoms occurred after an average of 3.5 subsequent visits (range: 1-14). The sequence of imaging modalities pursued and providing definitive diagnosis can be seen below in Image 1 and Table 1. Treatment most commonly consisted of cessation of all upper extremity impact activity, but was formally recommended to only 89% of patients. Other treatment strategies included physical therapy (49%) and gymnast-specific braces (46%). The mean time of complete rest pursued was 68 days, the mean time of from initial clinical evaluation to symptom resolution was 208 days, and mean time from initial onset of pain to resolution was about 351 days (due to frequent delays in presentation or diagnosis). 12 patients (12%) developed recurrence of GW, and 10 (10%) developed radial or ulnar growth disturbance (or both), with 3% undergoing corrective surgery. Conclusions/discussion: In a large series of skeletally immature gymnasts who developed GW, the vast majority of patients were female, though 5% of the population were males who developed the condition at a relatively older age than their female counterparts. The mean level of gymnast activity (4.5) and hours practicing (13) suggests that even lower level gymnasts can develop this overuse injury. Around 75% of patients were still practicing despite pain, greater than 3 months prior to presentation, which may reflect a poor understanding of the condition by the athletes, their coaches/trainers, and their families. The majority (71%) of cases were diagnosed by XR, but sometimes required advanced imaging (5%) to definitively diagnose or corroborate radiographically suspicious cases. Perhaps most importantly, alarmingly high rates of recurrence (12%), growth disturbance (10%) and surgical intervention were seen associated with the condition, underscoring the notion that delays in diagnosis or inadequate treatment may have lasting adverse impacts on these young athletes, and that strict adherence to prolonged periods of rest are critical to avoiding debilitating sequellae of GW. Tables and Figures: [Table: see text][Figure: see text]

Spatial modes of light provide a high-dimensional space that can be used to encode both classical and quantum information. Current approaches for dynamically generating and measuring these modes are slow, due to the need to reconfigure a high-resolution phase mask such as a spatial light modulator or digital micromirror device. The process of updating the spatial mode of light can be greatly accelerated by multiplexing a set of static phase masks with a fast, image-preserving optical switch, such as an acousto-optic modulator (AOM). We experimentally realize this approach, using a double-pass AOM to generate one of five orbital angular momentum states with a switching rate of up to 500 kHz. We then apply this system to perform fast quantum state tomography of spatial modes of light in a 2-dimensional Hilbert space, by projecting the unknown state onto six spatial modes comprising three mutually unbiased bases. We are able to reconstruct arbitrary states in under 1 ms with an average fidelity of 96.9%., 11 pages, 6 figures

oping world. You’ve seen the reality: most mobile money schemes are still like large pilots, and the majority of people are still unbanked. To date, mobile money has not been as transformative as mobile phones. Perhaps it’s too much to expect two epochal waves of change in one decade and we need to give mobile money more time. Or perhaps the idea of financial inclusion is itself a threadbare hope: there may be neither sufficient demand for formal banking among poor people who have evolved “good enough” ways to manage what little they have, nor sufficient revenue among commercial providers to sustain what would be a large number of new formal accounts. Or perhaps we are simply missing the socioeconomic changes that mobile money already brings to the poor because we are too wedded to traditional notions of financial inclusion. Whatever the results to date, we maintain that the potential for mobile money to change the financial lives of 70 percent of the world population—that is, the unbanked—is huge. However, in our view, we also need to reset expectations based on two considerations

A 10-year survivorship of 100% was reported for patients with PFC cruciate-retaining prostheses. Beyond 10 years, we observed additional polyethylene wear likely related to thin liners gamma-irradiated in air and were concerned this wear might predispose to implant construct failure. We therefore determined (1) the functional scores at a minimum of 15 years followup, (2) rates of radiographic failure, (3) overall revision rates, and (4) mode of failure after 10 years and the fate of the revised implants. We retrospectively reviewed 75 patients with 101 press-fit condylar posterior cruciate-retaining prostheses. At a minimum followup of 15 years, 35 patients (47 knees) were living and evaluated clinically. No patients were lost to followup. There were no revisions during the first 11 years and six reoperations subsequently were performed in five patients (6% overall rate of revision but 12.8% in patients who survived more than 15 years). Three of six revisions had concerning liner wear at 10 years and all six were revised for polyethylene wear. Polyethylene exchange was performed in four of the five patients who underwent revisions, all of whom were doing well at an average of 7.2 years (range, 4.7–9.1 years) after the revision procedure. At long-term followup, the overall revision rate remained low (6%). For patients surviving 15 years or more, the rate of revision was 12.8% and all revisions were secondary to aseptic sequelae of polyethylene wear. All revisions occurred more than 10 years after the initial procedures. Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Exclusion from financial services has an economic impact that can exacerbate poverty. In the past three years — prompted by the dramatic increase in the use of mobile phones and other information and communications technologies in developing countries — telecommunications companies, traditional financial institutions, and third parties have sought new ways to extend financial services to the billions around the world who remain unbanked. As a result, millions of the previously unbanked have successfully "leapfrogged" over the ATM- and branch-based customer service model that is the norm in the developed world.

Of the three billion people in the developing world, fully two-thirds live on small farms. Among them are over 800 million people who earn under a dollar a day or less — the majority of those globally who endure absolute poverty.Smallholder farmers have meager incomes largely because the methods they employ undervalue their time, the scale of the plots they cultivate under-utilizes their assets, and the mix of crops they plant under-performs potential alternatives in the marketplace. One simple, proven solution to these three related problems exists: micro-irrigation. Around the world, most smallholder farmers who lack access to a stream or pond can reach water by digging a 5- to 60-foot well. Where available, technologies that are both affordable to dollar-a-day farmers and efficient for the irrigation of small plots from shallow wells provide a mechanism for increasing labor productivity, expanding planting options, extending the growing season, and obtaining higher prices in the market. The results are increased income and improved well-being for smallholder farmers. This profile describes an approach to building markets for micro-irrigation systems that has been successfully employed in South Asia and Africa, reaching more than two million households and typically boosting the incomes of small farmers by over 500 percent. The approach has three elements: designing agricultural tools, notably treadle-pumps and drip-irrigation systems, that can be used cost-effectively by dollar-a-day farmers; seeding supply chains to ensure broad availability; and innovating new marketing approaches in order to build market acceptance.