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Competition is a common practice in school bands and professional music education organizations. The purpose of this study was to describe the retrospective accounts of two high school band directors’ agency during a period of their active resistance to competition. We sought to verify and supplement their recollections with the lasting memories of multiple stakeholders involved in their programs. Research questions were: (a) What led two band directors to minimize competition and create a noncompetitive concert festival for their students? and (b) What ecological elements were salient in their agency? We collected data through interviews and document review, and we used Priestley et al.’s (2015) ecological approach to examine teacher agency as an emergent phenomenon. Themes included paradigm shift, disillusionment with the status quo, and nurturing, trusting relationships. A prescribed repertoire list, dissatisfaction with state adjudicators, and personality traits of nonconformity and open mindedness fueled the two educators’ disillusionment. We provide implications for music educators, music teacher educators, and professional organizations.

Lone star ticks (Amblyomma americanum L.) are expanding within the northeast United States, a region historically focused on Ixodes scapularis-transmitted diseases. In Monmouth County, NJ, the shift has been dramatic, and lone star ticks now vastly outnumber blacklegged ticks. As a result, there is an enhanced need to focus on the potential health risks of A. americanum-transmitted pathogens, such as the emerging Heartland (HRTV) and Bourbon (BRBV) viruses. We screened 1,205 nymphal lone star ticks for HRTV and BRBV using RT-qPCR assays and detected BRBV in 3 ticks collected in Monmouth County, NJ, in 2021. Additionally, we sequenced a complete BRBV genome from a single infected specimen, finding 99.4% identity with human pathogenic isolates from the eastern-central United States. Our results have important public health implications for a region only recently becoming aware of public health risks posed by lone star ticks. Of note, we report successful detection of viral RNA in samples that were stored and intended for DNA preservation, for example, kept in ethanol at room temperature, which may reduce barriers for public health agencies seeking to expand their tick testing to include viruses.

Tick-borne diseases are a growing public health problem in the United States, and the US northeast has reported consistently high case rates for decades. Monmouth County, New Jersey, was one of the earliest jurisdictions to report Lyme disease cases in 1979 and reports several hundred cases per year nearly 40 yr later. In the time since, however, tick-borne health risks have expanded far beyond Lyme disease to include a variety of other bacterial pathogens and viruses, and additional vectors, necessitating a continually evolving approach to tick surveillance. In 2017, Monmouth County initiated an active surveillance program targeting sites across three ecological regions for collection of Ixodes scapularis Say (Acari: Ixodidae) and Amblyomma americanum L. (Acari: Ixodidae) as well as testing via qPCR for associated bacterial pathogens. During the first five years of this program (2017–2021), we report high levels of spatiotemporal variability in nymphal density and infection prevalence in both species, limiting the granularity with which human risk can be predicted from acarological data. Nonetheless, broader patterns emerged, including an ongoing trend of A. americanum dominance, risks posed by Borrelia miyamotoi, and the frequency of coinfected ticks. We present some of the first county-level, systematic surveillance of nymphal A. americanum density and infection prevalence in the northeastern US. We also documented a temporary decline in Borrelia burgdorferi that could relate to unmeasured trends in reservoir host populations. We discuss the implications of our findings for tick-borne disease ecology, public health communication, and tick surveillance strategies in endemic areas.

This article presents a field-tested approach for integrating music arranging into middle and high school music ensembles. This project-based unit of study builds on scholarship in informal music learning and social constructivism. Reflections from former high school students who participated in the project help illuminate these connections. The article provides planning and assessment documents, recognizes students’ successes, proposes solutions to challenges encountered, and reports outcomes. The article and supplemental documents demonstrate how student-led, small-group music arranging can infuse middle and high school ensembles with student creativity and choice while providing opportunities for group collaboration.

Primary and acquired resistance to anticancer antibody immunotherapies presents significant clinical challenges. Here, we demonstrate that proteolytic inactivation of cancer-targeting antibodies is an unappreciated contributor to cancer immune evasion, and the finding presents novel opportunities for therapeutic intervention. A single peptide bond cleavage in the IgG1 hinge impairs cancer cell killing due to structural derangement of the Fc region. Hinge-cleaved trastuzumab gradually accumulated on the surfaces of HER2-expressing cancer cell lines in vitro, and was greatly accelerated when the cells were engineered to express the potent bacterial IgG-degrading proteinase (IdeS). Similar to cancer-related matrix metalloproteinases (MMP), IdeS exposes a hinge neoepitope that we have developed an antibody, mAb2095-2, to specifically target the epitope. In in vitro studies, mAb2095-2 restored the lost antibody-dependent cell-mediated cytotoxicity functionality of cell-bound single-cleaved trastuzumab (scIgG-T). In vivo, mAb2095-2 rescued the impaired Fc-dependent tumor-suppressive activity of scIgG-T in a xenograft tumor model and restored the recruitment of immune effector cells into the tumor microenvironment. More importantly, an Fc-engineered proteinase-resistant version of mAb2095-2 rescued trastuzumab antitumor efficacy in a mouse tumor model with human cancer cells secreting IdeS, whereas trastuzumab alone showed significantly reduced antitumor activity in the same model. Consistently, an Fc-engineered proteinase-resistant version of trastuzumab also greatly improved antitumor efficacy in the xenograft tumor model. Taken together, these findings point to a novel cancer therapeutic strategy to rescue proteolytic damage of antibody effector function by an Fc-engineered mAb against the hinge neoepitope and to overcome cancer evasion of antibody immunity. Mol Cancer Ther; 14(3); 681–91. ©2014 AACR.

Figure S1: IdeS expression in BT474 breast cancer cells Figure S2: Detection of MMPs in cancer cell lysates and culture supernatant Figure S3: scIgG-T was not in the SKBR-3 cell culture medium Figure S4: Detection of immune cells infiltration in mice by flow cytometry.

The public health challenge posed by tick-borne disease (TBD) has increased efforts to characterize the spatial and temporal distribution of ticks and associated pathogens to better focus tick control strategies and personal protection measures. We describe variability in nymphal Ixodes scapularis Say and Amblyomma americanum (L.) density derived from daily drag sampling at a single location in New Jersey over 4 yr and explore how observed differences in daily collections might affect the estimation of acarological risk. We found significant variability in the density of host-seeking nymphs that could suggest substantially different rates of human-tick encounters depending on sampling date, habitat, and ambient weather conditions. The spatial and temporal variability in the distribution of 2 sympatric tick species with different host preferences and questing strategies, suggests that to produce results that are comparable among sites across the area sampled, surveillance efforts may be limited to shorter collection seasons, fewer sites or less sampling effort (fewer plots or fewer visits) per site, and a geographic scope that minimizes the potential temporal and spatial biases indicated here. Our results illustrate that evaluation of models of tick distribution or relative acarological risk based on surveillance data requires a full description of the diversity of habitats sampled and the conditions under which sampling is performed. The array of factors that affect tick host-seeking and that could bias interpretation of sampling results emphasizes the need to standardize sampling protocols and for more caution when interpreting tick sampling data collected over large temporal and spatial scales.

Non-operative treatment of displaced distal clavicle fractures results in high non-union and yet there is no consensus on superior treatment modality. While there are a number of different techniques available for fixation, hook plate (HP) has been used most commonly. A number of modern techniques, including superior plate (SP), have shown less complications but equivocal union rate and shoulder function. The aim of this systematic review and meta-analysis is to compare the outcome of HP fixation with superior plate in surgical fixation of displaced distal clavicle fractures.A review of the online databases MEDLINE and Embase was conducted on 15 January 2021 according to PRISMA guidelines. The review was registered prospectively in the PROSPERO database. Clinical studies reporting union rate, complications and shoulder function were included. The studies were appraised using the Methodological Index for Non-Randomized Studies (MINORS) tool.The search strategy identified 42 studies eligible for inclusion with a total of 1,261 patients. These included 17 hook-plate case series (n = 573), 18 superior plate case series, of which 6 used SP alone (n = 223) and 12 SP and simultaneous CCLR case series (n = 189), and 7 studies comparing HP and SP (n = 276). The overall complication rate was significantly higher with HP when compared to SP [(32.7% vs 12.7%; OR 6.31 (95% CI: 2.67-14.91)]. The overall union rates in the case series appeared comparable in the current SR; HP 96.4%, SP 96.9% and SP with simultaneous CCLR 97.9%. Shoulder function was most commonly assessed using CM score and the mean ranged from 83.8 to 97.2 in HP, 89 to 98 in SP group and 90.6 to 97.6 in SP with CCLR. Meta-analysis of CM score failed to show a significant difference for HP versus SP (pooled weighted mean difference was 2.67 (95% CI: - 0.09 to 5.43) with a trend to favour SP fixation.The current review has demonstrated that HP, SP alone or with CCLR all offer excellent union rate and appear to provide comparative functional outcomes. However, HP is associated with significantly higher complication rates.

Introduction During the first wave of the COVID-19 pandemic, University Hospitals Birmingham NHS Foundation trust was able to recommence elective orthopaedic surgery using private hospitals procured by the NHS as COVID-19 free ‘green’ sites. We report on the safety of elective orthopaedic surgery with high rates of community transmission. Methods We conducted an observational cohort study on consecutive NHS patients attending three private hospitals between 4 May 2020 and 16 June 2020. Patients attended preoperative assessment, including coronavirus disease (COVID-19) symptom screening, were instructed to self-isolate for 14 days and had a negative COVID-19 swab within 72 hours of surgery. Patient age, American Society of Anesthesiologists (ASA) grade, body mass index, surgery performed, type of anaesthetic and length of stay were collected. Our primary outcome was a positive COVID-19 swab, secondary outcomes were COVID-19 symptoms, readmission, surgical complications and mortality. Results Between 4 May 2020 and 16 June 2020, 191 patients were admitted to three private hospitals for elective surgery; 121 (67%) patients underwent general or regional anaesthetic, 179 patients were ASA grades 1 or 2 (94%) and 12 (6%) were ASA 3. In total, 187 (98%) patients were successfully contacted at 30 days postoperative and no COVID-19 symptoms, positive COVID-19 swabs or mortality or were recorded. One patient was readmitted following a pulmonary embolism and two patients were treated as outpatients for a deep vein thrombosis and a superficial infection. Conclusion With ‘green pathways’ elective orthopaedic surgery can safely be performed while rates of COVID-19 in the community are high.

Background Tumour resection followed by joint reconstruction is a surgical option in the appropriate patient. The evidence for such reconstructive surgery of the elbow joint is limited. The aim of this study is to review the literature to evaluate the outcomes of joint replacement surgery in tumours of the elbow. Methods A systematic review of PUBMED and EMBASE databases was conducted. Case series and comparative studies reporting results after total elbow arthroplasty, modular endo-prosthetic replacement and custom prosthesis were eligible for inclusion. Results Eleven eligible studies were identified (n = 134). At mean follow-up of 44 months, the overall revision rate was 14% and complication rate was 28%. The mean Mayo Elbow Performance Score was 75, with 56% of patients reporting good or excellent outcomes. The mean post-operative range of motion was 97°. Discussion Elbow prosthesis reconstruction after tumour resection can provide good functional outcomes at mid-term follow-up. The complication and revision rates are comparable to other indications for elbow replacement surgery. Further prospective studies are required to compare outcomes between different elbow arthroplasty options after tumour resection.

The oviducal gland is a specialised region of the elasmobranch oviduct that is thought to be a site of sperm storage, among other functions. The phenomenon of female sperm storage in elasmobranchs has implications for the understanding of their reproductive ecology and the management of exploited populations, but relatively little information exists on its taxonomic extent. In the present study, oviducal glands from 29 different species, of varying reproductive modes, from the northern Indian and North East Atlantic oceans were examined using light microscopy for the presence of sperm. The organisation of the gland into four fundamental zones; club, papillary, baffle and terminal, was conserved across all species, with slight variations in relative zone volume due to reproductive mode. Spermatozoa observed within the oviducal gland were not limited to a particular reproductive mode or maturity stage. Although spermatozoa were most commonly encountered in the terminal zone tubules, in some species they were also encountered elsewhere in the gland. The storage of sperm may be a vital reproductive strategy for many species and furthering our taxonomic understanding of which species employ this strategy will help to better inform fisheries managers and protect exploited low reproductive species.

Conducting polymer hydrogels combine electrical conductivity and tunable water content, rendering them strong candidates for a range of applications including biosensors, cell culture platforms, and energy storage devices. However, these hydrogels are mechanically brittle and prone to damage, prohibiting their use in emerging applications involving dynamic movement and large mechanical deformation. Here, we demonstrate that applying the concept of architecture to conducting polymer hydrogels can circumvent these impediments. A stereolithography 3D printing method is developed to successfully fabricate such hydrogels in complex lattice structures. The resulting hydrogels exhibit elastic compressibility, high fracture strain, enhanced cycling stability, and damage-tolerant properties despite their chemical composition being identical to their brittle, solid counterparts. Furthermore, concentrating the deformation to the 3D geometry, rather than polymer microstructure, effectively decouples the mechanical and electrical properties of the hydrogel lattices from their intrinsic properties associated with their chemical composition. The confluence of these new physical properties for conducting polymer hydrogels opens broad opportunities for a myriad of dynamic applications.

We compared the ability of product formulations representing a synthetic pyrethroid acaricide (Talstar P Professional Insecticide), a natural product-based acaricide (Essentria IC3), and an entomopathogenic fungal acaricide (Met52 EC Bioinsecticide) to suppress Ixodes scapularis Say and Amblyomma americanum (L.) nymphs when applied following USEPA approved manufacturers’ label recommendations for tick control using hand-pumped knapsack sprayers before the beginning of their seasonal activity period in the spring. We applied Met52 EC Bioinsecticide (11% Metarhizium anisopliae Strain F52) to five 100 m2 plots (10.6 ml AI/plot) in mid-April 2020. Two weeks later at the end of April 2020, we treated an additional five 100 m2 plots each with either Talstar P Professional Insecticide (7.9% bifenthrin @ 2.5 ml AI/plot) or Essentria IC3 (10% rosemary oil, 5% geraniol, and 2% peppermint oil @ 86.6 ml AI/plot). Weekly sampling of all plots through the end of June 2020 showed that both Met52 EC Bioinsecticide and Essentria IC3 failed to maintain a 90% suppression threshold for I. scapularis, compared to control plots, and required two additional applications over the course of the trial. In contrast, Talstar P Professional Insecticide suppressed 100% of I. scapularis nymphs and ≥96 and 100% of A. americanum nymphs and adults, respectively. Such pre-season applications of synthetic pyrethroids significantly reduce the early season acarological risk for exposure to host-seeking ticks as well as the frequency of acaricide applications.

PurposeThe purpose of this study is to examine the effects of social disclosure on loan funding and repayment within the fixed-rate peer-to-peer (P2P) lending model.Design/methodology/approachBy analyzing 31,637 loans from the largest P2P lending company in the USA, the authors study the effects of different forms of social disclosures and the specific contents of such disclosures on the speed of funding, amount borrowed, recovered principal amount and loan default.FindingsSome social disclosures help to fund a loan and are positively associated with loan repayment. The findings reveal prescriptive ways P2P borrowers indicate creditworthiness through social disclosure on loan listings.Practical implicationsThe results suggest that it is advantageous for P2P borrowers to invest time into well-written loan descriptions and remain engaged with potential lenders.Originality/valueThe authors show that some social disclosure factors that affect funding time and likelihood do not necessarily affect the loan default and repayment in the same way.

The aim of this study was to compare outcomes of arthroscopic tricortical iliac crest autograft and allograft bone blocks for recurrent traumatic anterior shoulder instability in terms of bone resorption, union and recurrent instability and assess which one is a better graft choice. Twenty-two consecutive patients treated for recurrent traumatic anterior shoulder instability that required reconstruction with bone block were included in the study. Surgical reconstruction was carried out arthroscopically with contoured tricortical iliac crest autograft or allograft. At follow-up, patients were assessed for Oxford Shoulder Instability Score (OSIS), recurrent dislocation, apprehension testing, complications, and 3-dimensional computed tomography (CT) for resorption and union rate at a mean of 10.89 months. There were 10 patients in the allograft group with a median age of 27.7 years and a mean follow-up of 26.6 months. In the autograft group, there were 12 patients with a median age of 29 years and a mean follow-up of 28.7 months. The OSIS increased in both groups but was significantly higher in the autograft group (54.1 vs 48.2, p = 0.02). There were 2 failures in each group but no hardware complications. Allograft had higher resorption rate in comparison (75% in allograft vs 40% in autograft) and higher non-union rate (62.5% in allograft vs 16.5% in autograft). This study demonstrated that both tricortical iliac crest autograft and allograft can improve shoulder instability symptoms. However, the results suggest that autograft may lead to significantly improved instability score, higher union rate and less bone resorption. IV, retrospective study.

We examined whether routine fall yard maintenance, specifically depositing leaves removed from lawns and landscaping along forest margins, may increase densities of nymphal Ixodes scapularis Say and Amblyomma americanum (L.) ticks within these managed areas. Leaf blowing activities in fall 2017 and 2018 on residential properties in New Jersey, United States, significantly increased leaf litter depth in managed edge areas (range = 259.8–352.8 mm) compared to unmanaged edges (77.6–188.0 mm) and adjacent forest (39.4–166.2 mm). Drag sampling conducted on 20 and 30 dates in spring 2018 and 2019, respectively, yielded ≥3-fold more I. scapularis nymphs in managed edge plots compared to natural edge and forest plots in both years. In 2018, we collected more A. americanum nymphs from forest plots than from either natural or managed edge plots, but 2019 natural edge plots yielded the greatest number of the ticks. Nearly half of A. americanum adults were collected in forest plots in both years. Our data suggest that the acarological risk of human encounters with I. scapularis nymphs may be significantly greater in areas receiving an accumulation of leaves from leaf blowing or raking compared to adjacent unmanaged forest edges. This artificially elevated acarological risk can be mitigated if homeowners avail themselves of curbside leaf pickup or composting services offered by many municipalities or request that lawn/landscaping contractors remove collected leaves offsite, or at least to areas of less frequent use, rather than concentrating them along the lawn-forest edge.

Cutibacterium acnes (C acnes) colonization can have a significant impact on patients undergoing both arthroscopic and open shoulder surgery with regard to postoperative infection. Its resistance to standard preoperative skin preparations and prophylactic antibiotics has led to a need for a more targeted therapy. Topical benzoyl peroxide (BPO) has been used by dermatologists in the treatment for acnes due to its bactericidal and penetrative effects through the dermal layer. The aim of this systematic review is to review the effectiveness of topical BPO preoperatively in shoulder surgery in reducing C acnes colonization and postoperative infection.A review of the online databases Medline and Embase was conducted on December 15, 2021, according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The review was registered prospectively in the PROSPERO database. Clinical studies reporting superficial and deep sample microbiology and postoperative complications were included. The studies were appraised using the revised Cochrane Risk of Bias 2 (ROB 2) tool for randomized studies and the Methodological Index for Non-Randomized Studies (MINORS) tool.The search strategy identified 10 studies for inclusion (6 randomized control trials, 2 prospective cohort studies, and 2 case series), including a total of 482 patients. Seven studies were comparable, testing BPO against alternative standard skin preparations. Of the 10 studies, 7 showed a decrease in the load of C acnes on the skin and/or deep tissues, of which 6 demonstrated statistical significance. Men were shown to have a statistically significant increase in the colonization rate of C acnes. Scheer et al (2021) demonstrated 4500 colony-forming units/mL in males and 900 colony-forming units/mL in females. In studies where the number of BPO applications was higher, BPO appeared more effective. Dizay et al demonstrated C acnes elimination in 78.9% with more than 1 application compared with 66.7% if only applied once. Three studies looked at the effectiveness of BPO during the operative timeline with 1 demonstrating its statistically significant effectiveness at reducing colonization 2 hours into the operation (P = .048).BPO is effective as a topical treatment at reducing C acnes colonization before shoulder surgery. However, the relationship between duration of treatment, frequency of application, and gender requires further research.

Posterior shoulder instability (PSI) is a rare and challenging pathology to manage. The aim of this review was to assess and compare whether open and arthroscopic iliac crest bone graft (ICBG) bone block procedures succeeded in improving functional and clinical outcomes as well as radiological outcomes of union and graft resorption.We hypothesised that there will be no difference in recurrence rate and functional outcome between open and arthroscopic procedures but there will be a higher complication rate with open bone block procedures.A systematic review was conducted in accordance with PRISMA guidelines using the online databases MEDLINE and Embase. The review was registered on the PROSPERO database. Studies of open or arthroscopic ICBG bone block procedures reporting patient reported outcome measures, recurrence, complications and progression to osteoarthritis and radiological outcomes of graft union and resorption were selected. Studies were appraised using the Methodical index for non-randomised studies (MINORS) tool.14 studies satisfied the inclusion criteria; five studies were arthroscopic and nine used open techniques. A total of 183 patients and 201 shoulders were included, mean age was 25 years range (14-75 years). Recurrent instability ranged from 0% to 12.5% for arthroscopic and 0% to 36.4% for open studies. Arthroscopic studies had statistically significant increases in numerous functional outcome scores but there was no evidence for similar improvements in open studies. Osteoarthritis at follow-up ranged from 12.5% to 47% in arthroscopic and 0% to 81.8% for open studies. Arthroscopic complication rate ranged from 6.7% to 75% compared to 0% to 80% for open studies. Majority of complications were metalware related requiring surgical intervention. Partial graft resorption ranged from 7.7-100% after arthroscopic and 4.8-100% after open procedures. High union rates were seen with both open and arthroscopic techniques.This study highlights a lack of high-level evidence for arthroscopic and open posterior bone block procedures using ICBG to manage PSI. Functional and instability outcome scores showed significant improvement with arthroscopic ICBG bone block procedures however limited evidence was available for open studies. Metalwork related complications requiring revision and radiographic progression to osteoarthritis was high in both arthroscopic and open studies.IV, systematic review.

Ticks and tickborne diseases are increasingly problematic. There have been positive developments that should result in improved strategies and better tools to suppress ticks, reduce human tick bites, and roll back tickborne diseases. However, we equally need to address the question of who is responsible for implementing the solutions. The current model of individual responsibility for tick control evolved from a scenario in the 1990s focusing strongly on exposure to blacklegged ticks and Lyme disease spirochetes in peridomestic settings of the northeastern United States. Today, the threat posed by human-biting ticks is more widespread across the eastern United States, increasingly complex (multiple tick species and >10 notable tickborne pathogens), and, across tick species, more spatially diffuse (including backyards, neighborhood green spaces, and public recreation areas). To mitigate tick-associated negative societal effects, we must consider shifting the responsibility for tick control to include both individual persons and professionally staffed tick-management programs.

In an update of earlier surveys conducted in Connecticut and New Jersey in the mid-1990s, an online survey of private commercial pest control firms engaged in residential tick control showed that the application of synthetic acaricides continues to be the primary method of control used. The carbamate and organophospate acaricides, previously the most commonly used against ticks, have given way to synthetic pyrethroids and, to a lesser extent, the use of natural product/organic acaricides. Typical costs for a single acaricide application today ($100–$200 for a 1 acre [0.4 ha] property) remain similar to those reported from the earlier surveys, although the frequency of applications and, therefore, also the overall annual cost has increased. The application habitats within residential properties, life stages targeted, and application equipment used have not changed appreciably since the mid-1990s. While most survey respondents expressed knowledge of natural product acaricides and Damminix Tick Tubes, many reported that they either did not employ or knew very little about other alternative tick control methods (including entomopathogenic fungus and topical application of acaricides to tick hosts via 4-Poster deer treatment stations or Select TCS rodent bait boxes). This suggests either a failure to adequately inform the pest management industry and their potential client base of the availability of alternate methods, and/or industry concerns about cost and effectiveness of the alternatives.

Background Irreparable rotator cuff tears in active patients provide a significant challenge and a consensus on the gold standard treatment is currently lacking. Superior capsule reconstruction (SCR) has recently been advocated and functions by providing a passive biological constraint to superior humeral head migration. The aim of this study is to systematically review the literature to evaluate the role of SCR in terms of functional outcome scores and failure rates. Patients and methods A review of the online databases Medline and EMBASE was conducted in accordance with the PRISMA guidelines on the 28th January 2019. Clinical studies reporting SCR using any type of graft or surgical technique were included if reporting either functional outcome scores or rate of secondary surgery. The studies were appraised using the Methodological index for non-randomised studies tool. Results The search strategy identified nine studies eligible for inclusion; five reported on fascia lata autografts and four studies reported on dermal allografts. All nine studies reported significant improvement in functional scores after SCR. Rates of secondary surgery were only provided in the dermal allograft studies at short-term follow-up (mean 10.9 to 32.4 months) and ranged from 0 to 18.6%. Radiological assessment revealed graft failure in 5.5 to 55% of dermal allografts and 4.2 to 36.1% of fascia lata autografts. Conclusion This review demonstrates that SCR is a useful treatment modality for patients with irreparable rotator cuff tears. SCR was associated with significantly improved functional outcome scores in all studies. All studies reported a preserved or increased mean AHD. The radiological graft failure rate ranged from 4.2 to 55% and the short duration of follow-up in most studies means that this remains an important concern that requires longer-term evaluation. Level of evidence IV, systematic review.

Three‐dimensional (3D) printing brings exciting prospects to the realm of conjugated polymers (CPs) and organic electronics through vastly enhanced design flexibility, structural complexity, and environmental sustainability. However, the use of 3D printing for CPs is still in its infancy and remains full of challenges. In this review, we highlight recent studies that demonstrate proof‐of‐concept strategies to mitigate some of these problems. Two general additive manufacturing approaches are featured: direct ink writing and vat photopolymerization. We conclude with an outlook for this thriving field of research and draw attention to the new possibilities that 3D printing can bring to CPs. © 2019 Wiley Periodicals, Inc. J. Polym. Sci., Part B: Polym. Phys. 2019, 57, 1592–1605

Background Management of displaced midshaft clavicle fractures is controversial. Nonoperative treatment can lead to shortening, a risk factor for nonunion and poor functional outcomes. These inferior results have resulted in authors recommending surgical fixation for fractures with significant shortening. The aim of this systematic review was to analyze the effect of fracture shortening on shoulder function and nonunion rates in nonoperatively managed displaced midshaft clavicle fractures. Methods A review of the online databases MEDLINE and Embase was conducted on February 16, 2018, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The review was registered prospectively in the PROSPERO database. Clinical studies with midshaft clavicle fractures treated nonoperatively reporting an evaluation of the degree of clavicle shortening and either shoulder function or nonunion were included. The studies were appraised using the Methodological Index for Non-Randomized Studies (MINORS) tool. Results The search strategy identified 16 studies eligible for inclusion, comprising 4 randomized controlled trials and 12 nonrandomized retrospective comparative studies. Of the 12 case series, 11 failed to demonstrate any correlation between shortening and shoulder outcome scores. Of the 4 randomized controlled trials, 3 reported no significant association between fracture shortening and shoulder outcome scores. The studies also failed to demonstrate a significant association between nonunion and the presence of clavicle shortening. Conclusion There is no significant association between fracture shortening and nonunion rates or shoulder outcome scores in displaced midshaft clavicle fractures managed nonoperatively.

Purpose The aim of this systematic review was to assess the clinical outcome of arthroscopically assisted coraco-clavicular ligament (AACCL) reconstruction for treatment of displaced distal clavicle fractures in terms of union rate, complications, and shoulder function. Methods A review of the online databases Medline and Embase was conducted on January 1, 2021, according to PRISMA guidelines. The review was registered prospectively in the PROSPERO database. Clinical studies reporting union rate, complications, and shoulder function were included. The studies were appraised using the Methodological Index for Non-Randomized Studies (MINORS) tool. Results The search strategy identified 14 studies eligible for inclusion, 12 retrospective case series and 2 nonrandomized retrospective comparative studies. All studies reported on shoulder function, union rate, and complications. The overall shoulder function was good to excellent according to Constant-Murley score, with mean scores ranging from 81.8 to 96.2 [I2 (inconsistency) = 0% (95% confidence interval [CI] = 0% to 61%)]. The mean union rate ranged from 70% to 100% [I2 = 32.6% (95% CI = 0% to 63.4%)], and the mean complication rate ranged from 0 to 28.6% [I2 = 43.4% (95% CI = 0% to 68.4%)]. The most common complications were hardware related (3.1%), wound related (2.7%), and postoperative shoulder stiffness (2.2%). Conclusion This systematic review analyzed clinical studies that evaluated the outcome of AACCL reconstruction in displaced distal clavicle fractures. The overall findings of this systematic review are that the union rate can be as low as 70% with this technique and the complication rate as high as 28.6%. Overall shoulder function was good to excellent according to Constant-Murley score. As the literature surrounding this topic is heterogeneous, further comparative clinical studies are required to assess superiority compared with other traditional techniques. Level of Evidence V: systematic review of level III and IV studies.

Introduction Glenohumeral joint degeneration in young patients has varying aetiology and provides a challenging clinical problem whose management is controversial. This review aims to provide an overview of the surgical options for managing these young patients. Methods A systematic review of the literature was conducted in accordance with the PRISMA guidelines using the online databases Medline and EMBASE. Cases series and comparative studies reporting on surgical interventions for glenohumeral joint degeneration in young patients ( Results 30 eligible studies were identified; 10 hemiarthroplasty (HA) and glenoid resurfacing, 4 HA and glenoid reaming, 4 total shoulder arthroplasty (TSA), 3 glenoid resurfacing, 3 arthroscopic debridement, 3 reverse shoulder arthroplasty (RSA), 2 humeral resurfacing and 1 pyrocarbon interposition arthroplasty. Arthroscopic treatments reported good post-operative functional results, but revision rates ranged from 15.8% to 22% at short term follow-up. Although HA and glenoid resurfacing provided an improvement in functional scores, a high revision rate was reported in most studies (9.1%–77%) which was higher than after HA and glenoid reaming (2.8%–16.7%) and humeral resurfacing (2%–12%). TSA was reported to improve the mean Constant Score from 34 to 64 but glenoid loosening ranged from 17.6% to 43.8% and revision rate 6.5%–34% across the studies. Conclusion Surgical intervention in young patients with glenohumeral degeneration carries higher risk of failure and subsequent need for potentially complex revision surgery. Therefore, non-operative measures should be exhausted and patients adequately counselled prior to proceeding to arthroplasty.

The use of tantalum is well established in orthopaedic surgery. It has a modulus of elasticity that is close to bone and a high yield and ultimate strength allowing it to be used to form large, weight-bearing constructs with a high volumetric porosity conducive to osseointegration. However, its role in soft tissue re-attachment remains undefined due to variable clinical outcomes. Successful re-attachment of tendons to tantalum mega-prostheses, in tumour and revision surgery, has been reported but several authors report almost universal failure of long term soft tissue re-attachment with tantalum patella augments when no residual bone stock is present. It is postulated that these failures are due to a lack of stability of the implants and an inhibitory effect of tantalum on soft tissue integration. Tantalum has previously been considered an excellent biomaterial for soft tissue integration based on animal studies where implants were retrieved and subjected to mechanical testing. However, clinical studies suggest that this soft tissue in-growth does not reliably tolerate the high mechanical loads that are generated in the clinical setting. Furthermore, recent laboratory evidence suggests that tantalum may in fact directly inhibit fibroblasts, limiting the potential for mature collagen fibrillogenesis. This review collates the evidence from laboratory, animal and clinical studies to inform and guide future directions in biomaterial research and to drive improved outcomes for soft tissue re-attachment surgery.

Background Posterior shoulder instability (PSI) is becoming an increasingly recognised condition. A number of different treatment modalities exist to treat PSI including arthroscopic or open surgeries when non-operative treatment has failed. The primary aim of this systematic review was to analyse the rate of recurrent instability after posterior glenoid osteotomy (PGO) for recurrent PSI, while secondary aim was to identify complication rate and the amount of retroversion correction. Patients and methods A review of the online databases MEDLINE and Embase was conducted on 1 November 2019 according to PRISMA guidelines. The review was registered prospectively in the PROSPERO database (Registration No. CRD42020161984). Clinical studies reporting either the recurrence rate, complications or amount of retroversion correction after PGO for PSI were included. The studies were appraised using the Methodological Index for Non-Randomized Studies (MINORS) tool. Results The search strategy identified 9 studies eligible for inclusion. Of the 9 studies, 4 showed an improvement in retroversion with a mean change in retroversion of 10o. All 9 studies reported on recurrence rate with an overall rate of 22%. Complications were discussed in only 7 of the studies with overall rate of 18.3%. The most common complication reported in the studies were degenerative changes of the glenohumeral joint (7.3%) and iatrogenic fractures (5.5%). Conclusion PGO is a viable option in patients with recurrent PSI that have increased retroversion and have failed non-operative or arthroscopic treatment. It does however carry a significant risk of complications. Level of evidence IV; Systematic review.

Background: Distal humeral fractures represent about 1% to 2% of adult fractures. Open reduction and internal fixation (ORIF) has traditionally been the standard treatment; however, fracture comminution and osteoporotic bone may prevent adequate fixation, and total elbow arthroplasty (TEA) is an alternative. The aim of this meta-analysis was to determine which procedure provided superior clinical outcomes for elderly patients with distal humeral fractures. Methods: A systematic review of the literature was conducted in accordance with the PRISMA guidelines. Cases series and comparative studies reporting functional outcomes or complications after TEA and ORIF in patients over 60 yr of age with an acute distal humeral fracture were included. The studies were appraised using validated quality assessment scales. Results were pooled from different studies using meta-analysis techniques, and the functional outcomes, complications, and frequency of revision surgery were compared. Results: The search strategy identified 27 studies: one randomized controlled trial, four comparative studies, 14 ORIF cases series, and eight TEA case series. TEA was associated with statistically significant and clinically superior Mayo Elbow Performance score (MEPS) and Disability of the Arm, Shoulder and Hand (DASH) scores when compared to ORIF in elderly patients while having a statistically significant lower complication rate. Conclusions: Meta-analysis of comparative studies demonstrated that TEA is associated with statistically significant and clinically superior MEPS and DASH scores when compared to ORIF in elderly patients.

Modified polyolefin separators fabricated via a roll-to-roll system exhibit markedly improved compatibility with lithium ion battery electrolytes. Zwitterionic molecules containing a perfluorophenyl azide functional group were synthesized and covalently bound to the surface of commercial polyolefin separators via UV-activated photochemistry. A roll-to-roll prototype system was constructed allowing for the functionalization of large areas of separator under ambient conditions at low cost. Lithium-ion battery cells containing the modified separators exhibit superior electrochemical performance using a common commercial electrolyte. The modified separators, both monolayer PE and trilayer PP/PE/PP, are wetted instantly upon contact with liquid electrolytes lacking linear carbonates. These electrolytes have been designed for use in batteries with advanced thermal stability properties and/or higher voltage windows, which have previously been hindered by incompatibility with commercial trilayer polyolefin separa...

Historical specimens, when available, can provide new insight into the distribution and evolution of pathogens that may not be discernible from more recent samples. We used ticks collected from hunter-killed white-tailed deer in New Jersey in 2002 to examine the prevalence and distribution of four pathogens transmitted by Ixodes scapularis, the blacklegged tick. Infection with Borrelia burgdorferi sensu stricto, Babesia microti, and Anaplasma phagocytophilum (the agents of Lyme disease, human babesiosis, and human granulocytic anaplasmosis, respectively) was highest in the Coastal Plain and lowest in the northwestern Skylands region. These patterns correspond well with the historically observed northward expansion of I. scapularis within New Jersey and the comparatively recent increase in human cases of these pathogens in the northern part of the state. Additionally, we provide evidence that Borrelia miyamotoi, a relatively new emerging pathogen and agent of relapsing fever, was widespread (though not common) throughout the state in 2002. Our findings highlight the need for enhanced awareness of tick-borne diseases other than Lyme and implementation of large-scale tick surveillance in endemic regions.

Background:Radial head fractures are common elbow injuries in adults and are frequently associated with additional soft tissue and bone injuries.Methods:A literature search was performed and the authors’ personal experiences are reported.Results:Mason type I fractures are treated non-operatively with splinting and early mobilisation. The management of Mason type II injuries is less clear with evidence supporting both non-operative treatment and internal fixation. The degree of intra-articular displacement and angulation acceptable for non-operative management has yet to be conclusively defined. Similarly the treatment of type III and IV fractures remain controversial. Traditional radial head excision is associated with valgus instability and should be considered only for patients with low functional demands. Comparative studies have shown improved results from internal fixation over excision. Internal fixation should only be attempted when anatomic reduction and initiation of early motion can be achieved. Authors have reported that results from fixation are poorer and complication rates are higher if more than three fragments are present. Radial head arthroplasty aims to reconstruct the native head and is indicated when internal fixation is not feasible and in the presence of complex elbow injuries. Overstuffing of the radiocapitellar joint is a frequent technical fault and has significant adverse effects on elbow biomechanics. Modular design improves the surgeon’s ability to reconstruct the native joint. Two randomised controlled trials have shown improved clinical outcomes and lower complication rate following arthroplasty when compared to internal fixation.Conclusion:We have presented details regarding the treatment of various types of radial head fractures - further evidence, however, is still required to provide clarity over the role of these different management strategies.

Background:The elbow is the second most commonly dislocated joint in adults and up to 20% of dislocations are associated with a fracture. These injuries can be categorised into groups according to their mechanism and the structures injured.Methods:This review includes a literature search of the current evidence and personal experiences of the authors in managing these injuries.Results:All injuries are initially managed with closed reduction of the ulno-humeral joint and splinting before clinical examination and radiological evaluation. Dislocations with radial head fractures should be treated by restoring stability, with treatment choice depending on the type and size of radial head fracture. Terrible triad injuries necessitate operative treatment in almost all cases. Traditionally the LCL, MCL, coronoid and radial head were reconstructed, but there is recent evidence to support repairing of the coronoid and MCL only if the elbow is unstable after reconstruction of lateral structures. Surgical treatment of terrible triad injuries carries a high risk of complications with an average reoperation rate of 22%. Varus posteromedial rotational instability fracture-dislocations have only recently been described as having the potential to cause severe long-term problems. Cadaveric studies have reinforced the need to obtain post-reduction CT scans as the size of the coronoid fragment influences the long-term stability of the elbow. Anterior dislocation with olecranon fracture has the same treatment aims as other complex dislocations with the added need to restore the extensor mechanism.Conclusion:Complex elbow dislocations are injuries with significant risk of long-term disability. There are several case-series in the literature but few studies with sufficient patient numbers to provide evidence over level IV.

We demonstrate a highly efficient thermal conversion of four differently substituted polydiacetylenes (PDAs 1 and 2a–c) into virtually indistinguishable N = 8 armchair graphene nanoribbons ([8]AGNR). PDAs 1 and 2a–c are themselves easily accessed through photochemically initiated topochemical polymerization of diynes 3 and 4a–c in the crystal. The clean, quantitative transformation of PDAs 1 and 2a–c into [8]AGNR occurs via a series of Hopf pericyclic reactions, followed by aromatization reactions of the annulated polycyclic aromatic intermediates, as well as homolytic bond fragmentation of the edge functional groups upon heating up to 600 °C under an inert atmosphere. We characterize the different steps of both processes using complementary spectroscopic techniques (CP/MAS 13C NMR, Raman, FT-IR, and XPS) and high-resolution transmission electron microscopy (HRTEM). This novel approach to GNRs exploits the power of crystal engineering and solid-state reactions by targeting very large organic structures th...