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Background The purpose of this study was to evaluate the effect of concomitant open distal clavicle excision (DCE) on postoperative clinical outcomes and incidence of acromial and scapular stress fractures (ASFs) in patients with symptomatic acromioclavicular joint osteoarthritis (ACJ OA) undergoing reverse total shoulder arthroplasty (RTSA). Methods A single-surgeon retrospective cohort study was conducted including patients who underwent primary elective RTSA with or without DCE from 2015 to 2019 with a minimum 6-month follow-up period. Shoulder active range of motion (AROM) and visual analog scale (VAS) pain were recorded preoperatively and postoperatively. ASFs and other adverse events were identified using postoperative notes and/or radiographs. Characteristics and outcomes were compared between the RTSA and RTSA-DCE groups. Results Forty-six RTSA patients (mean age, 67.9±8.7 years; 60.9% male; mean follow-up, 24.9±16.6 months) and 70 RTSA-DCE patients (mean age, 70.2±8.9 years; 20.0% male; mean follow-up, 22.7±12.9 months) were included. There were no significant intergroup differences in rates of ASF (RTSA, 0.0% vs. RTSA-DCE, 1.4%; P=1.00), stress reactions (RTSA, 8.7% vs. RTSA-DCE, 11.4%; P=0.76), reoperation, revision, or infection (all P>0.05), or in pre-to-postoperative reduction in VAS pain (P=0.17) at latest follow-up. However, the RTSA-DCE group had greater pre-to-postoperative improvement in flexion AROM (RTSA, 43.7°±38.5° vs. RTSA-DCE, 59.5°±33.4°; P=0.03) and internal rotation (IR) AROM (P=0.02) at latest follow-up. Conclusions Concomitant DCE in RTSA improves shoulder flexion and IR AROM, alleviates shoulder pain, and does not increase the risk of ASFs. Level of evidenceIII.

A series of experimental studies were conducted for cylindrical structures subjected to underwater shock loading to understand their dynamic responses and failure characteristics. All tests were performed inside an anechoic water tank. The submerged test cylinders were freely suspended, and an underwater shock loading was generated by the Compressed Air Shock Pipe Underwater Release (CASPUR) system. Cylinders were made of two different materials. The first group of cylinders was fabricated from carbon fiber and resin using the filament winding technique. The winding angles were ± 45° resulting in the same properties along axial and hoop directions. The second group of cylinders was constructed using a 3-D printer with polylactic acid (PLA) material. The 3-D printed cylinders had an orthotropic material property with different values in the axial and hoop directions. Both single-wall and double-wall cylindrical structures were tested. The latter consisted of two concentric cylinders of different diameters with uniform spacing between them. In addition, within the single-wall cylinders and the annuli of double-wall cylinders, the water fill was varied at 0%, 50%, or 100%. Pressure and strain gages were used to measure the shock pressure and deformation of the cylinders. The number of cylinders such as single-wall or double-wall and the internal water resulted in significant effects on the measured dynamic response (i.e., strain gage response) as well as the failure loading and failure characteristics including major failure locations. Internal water reduced the strain on the cylinders and made them withstand greater shock loading for both single-wall and double-wall cylinders.

Background: The purpose of our study was to compare the outcomes and complications after a two- vs. six-week duration of sling immobilization following reverse total shoulder arthroplasty (rTSA). Methods: We conducted a retrospective review from our institutional database on 960 patients treated by primary rTSA between 2011 and 2021. Patients were separated into two cohorts of postoperative sling immobilization (a two-week and six-week group). Multivariate analysis was conducted to evaluate what factors were associated with patients experiencing either a postoperative complication or requiring reoperation. Results: A total of 276 patients were instructed to keep their operative arm in a sling for six weeks postoperatively, and 684 patients discontinued use at two weeks. There was no difference in postoperative complication rate (15.0% vs. 12.0%, P = .21), dislocation rate (P = .79), acromion stress fractures (P = .06), implant loosening (P = .15), and periprosthetic joint infections (P = .48) between the six- and two-week sling cohorts. In the immediate 90-day postoperative time period, no difference was seen in the reoperation rates (P = .73). Discussion: Shorter duration of sling immobilization (two weeks) does not incur additional risk of complications compared to standard duration (six weeks) of sling immobilization following rTSA.

Background: Instability is one of the leading causes of revision for reverse total shoulder arthroplasty (RTSA). Closed reduction (CR) of a dislocated RTSA is recommended by many as initial treatment with varying degrees of success. In this study, we describe polyethylene liner dissociation from the humeral tray (PDH) as a cause of failure of CR of dislocated RTSA. Methods: In this retrospective study, patients who underwent revision RTSA for instability were identified through our institutional database review using specific International Classification of Diseases and Current Procedural Terminology codes. Pertinent clinical information including demographics, details of instability event (early vs. late), traumatic vs. atraumatic, outcomes of CR (if performed), and intraoperative findings during revision surgery were collected and analyzed. Results: Twenty-two patients met the inclusion criteria with average follow-up of 2 years. CR was attempted in 12 (55%) patients, prior to revision surgery, and was successful in 5 (23%) patients. During the revision surgery polyethylene liner dissociation from the humeral tray (PDH) was identified in 10 patients (45%). Five of these 10 patients had failed CR and the other 5 patients did not undergo CR due to primary surgeon’s preference. All patients with PDH event had onlay humeral tray RTSA system. Although not a consistent radiographic finding in our series, the presence of the metallic glenosphere in direct contact with the humeral tray on anteroposterior or axillary radiographs was diagnostic for PDH. Conclusion: Dissociation of polyethylene liner from the humeral tray can be associated with an RTSA dislocation and is a contraindication for CR. A radiographic finding of the metallic humeral tray articulating directly with the glenosphere is an indication that the polyethylene liner is dissociated from the humeral tray.

Background: The purpose of this study is to report the outcomes in patients undergoing arthroscopic tuberoplasty for symptomatic irreparable rotator cuff tear (RCT). Methods: This is a retrospective cohort study comparing preoperative and postoperative data of patients undergoing arthroscopic tuberoplasty for symptomatic irreparable RCT. Exclusion criteria included open tuberoplasty, concomitant partial RCT repair, glenohumeral arthritis, concomitant ipsilateral extremity fractures,

Background: The purpose of our study was to examine the clinical outcomes after arthroscopic scapulothoracic bursectomy for the treatment of scapulothoracic bursitis at a minimum of 2-year follow-up. Methods: Twenty patients who underwent arthroscopic scapulothoracic bursectomy for the treatment of symptomatic snapping scapula syndrome were identified from a single surgeon’s database. Patients were indicated for surgery if their symptoms persisted for more than 6 months and if they failed nonoperative treatment. Acquired data included patient demographics, shoulder range of motion, American Shoulder and Elbow Surgeon score, visual analog scale scores for pain, and the following Patient-Reported Outcomes Measurement Information System scores: Upper Extremity Computer Adaptive Test Version 2.0, pain intensity, and pain interference scores. Patient satisfaction and subjective shoulder value were also recorded out of 100. Fisher's test and unpaired t tests were performed for statistical analysis, and P values

Specimens made of various materials with different geometric features were investigated to predict the failure loads using the recently proposed criterion comprised of both stress and stress gradient conditions. The notch types were cracks and holes, and the materials were brittle, ductile, isotropic, orthotropic, or fibrous composites. The predicted failure stresses or loads were compared to experimental results, and both experimental and theoretically predicted results agreed well for all the different cases. This suggests that the stress and stress-gradient-based failure criterion is both versatile and accurate in predicting the failure of various materials and geometric features.

Background: Patient's willingness and barriers for discharge after shoulder arthroplasty (SA) has not been studied. The aim of this study was to prospectively analyze patient's willingness for discharge and barriers to discharge beyond postoperative day #1 (POD#1) after SA. Methods: In this prospective study, patients undergoing primary or revision SA (anatomic, reverse, or hemiarthroplasty) at our institution were enrolled to determine their willingness and concerns for discharge after SA. Patient's willingness for discharge was inquired daily until discharge. Demographic information, patient's medical history, intraoperative details (duration of surgery, estimated blood loss, intraoperative complication), discharge disposition, length of stay (LOS), and reasons for extension of LOS beyond POD#1 were analyzed. Results: A total of 184 patients who underwent SA were included. Eight patients were discharged on POD#0, 114 patients on POD#1, 37 patients on POD#2, and 25 patients after POD#2. One hundred nineteen (119) patients were discharged to home, 40 were discharged to home with services, 15 were discharged to nursing facilities, and 10 were discharged to rehabilitation centers. Reasons for extension of LOS past POD#1 included patients failing to clear home safety evaluation (n = 4), inadequate pain control (n = 6), worsening of preexisting medical conditions (n = 8), delay in patient disposition (awaiting placement in a rehabilitation facility [n = 6] and awaiting culture results [n = 9]). Social reasons (n = 29) were the most common reasons for extension of LOS. These included patients requesting an extra day of stay (n = 20), patients requesting rehabilitation facility placement (n = 5), lack of a timely ride home (n = 2), and family-related reasons (death in the family [n = 1], lack of home help [n = 1]). Conclusions: This prospective study demonstrates modifiable factors associated with LOS beyond POD#1 (inadequate pain control, logistic delays in disposition, and patient-related social concerns) after SA. With increasing interest in same-day discharge and rising concerns to control cost and use bundled payment initiatives with SA, improving patient's willingness to discharge by addressing their concerns can improve early discharge after SA.

Background: History of prior rotator cuff repair (RCR) may adversely affect the outcomes of reverse total shoulder arthroplasty (RTSA), but there is no information regarding the influence of prior superior capsular reconstruction (SCR) surgery on the outcomes of RTSA. The purpose of this study is to evaluate the outcomes of RTSA following failed arthroscopic SCR. Methods: All patients who underwent RTSA for failed SCR (SCR cohort) at our institution were identified from our institutional database. A comparative cohort of patients who had RTSA with a history of failed RCR (Control cohort) was also reviewed. Demographic information, 90-day complication rate, 90-day emergency department visits, length of stay, and outcome scores (patient-reported outcomes measurement information system [PROMIS] physical function upper extremity, Visual Analog Scale score, and range of motion) were compared. Results: From 2015 to 2020, 87 arthroscopic SCRs were performed at our institution and of these, 13 patients underwent RTSA at a mean time of 14.6 months (5.8-32.4) after SCR and were followed up for an average of 17.9 months (1.6-44.6). The average number of shoulder surgeries prior to RTSA was 2.8 (1-7), with the last surgery being SCR. During the same period, we identified 15 patients who underwent an RTSA after a failed RCR (control cohort). The RTSA in the control cohort was performed on average at 12.8 months (1.5-39.5) following the last RCR, and patients were followed up for an average of 27.7 months (2.8-53.9). The average number of shoulder surgeries before the RTSA in the control cohort was 1.4 (1-3). Although the SCR cohort had significant improvements in pain scores and forward flexion (FF), there was only a modest functional improvement with PROMIS scores and no meaningful improvement with external rotation. Complications (23%) in the SCR cohort included 1 periprosthetic joint infection requiring 2-stage revision, 1 acromion stress fracture, and 1 ulnar neuritis. Overall, compared to the SCR cohort, patients in the control cohort had better function (PROMIS physical function upper extremity), lower Visual Analog Scale score, and greater range of motion (FF and external rotation) preoperatively and at last follow-up, but there were no differences in the length of stay and 90-day emergency department visits, infection, and complication rate between the 2 cohorts. Conclusion: RTSA after failed SCR improves pain and FF but is associated with modest functional improvements and high complication rates. However, these findings will require confirmation in a larger cohort with longer follow-up.

Background: The Patient-Reported Outcomes Measurement Information System minimal clinically important difference (PROMIS MCID), substantial clinical benefit (SCB), and patient acceptable symptom state (PASS) of patient-reported outcome measures provide clinical significance to patient-reported outcome measures scores. The goal of this study is to measure the MCID, SCB, and PASS of PROMIS Upper Extremity v2.0 (PROMIS UE) in patients undergoing total shoulder arthroplasty (TSA). Methods: All patients who underwent TSA since October 2017 were identified from our institutional database. Patients who had completed the PROMIS UE outcome measure before surgery were asked to complete a PROMIS UE and anchor survey that contained two transition questions to assess patient satisfaction and change in symptoms since treatment. The anchor-based MCID, SCB, and PASS were calculated as the change in PROMIS UE score that represented the optimal cutoff for a receiver operating characteristic curve. The distribution-based MCID was calculated as a range between the average standard error of measurement multiplied by 2 different constants: 1 and 2.77. Results: This study enrolled 165 patients. The anchor-based MCID for PROMIS UE was calculated to be 8.05 with an AUC of 0.814. The anchor-based SCB was calculated to be 10.0 with an AUC of 0.727. The distribution-based MCID was calculated to be between 3.12 and 8.65. The PASS was calculated to be 37.2 with an AUC of 0.90. Conclusions: The establishment of MCID, SCB, and PASS for PROMIS UE scores after shoulder arthroplasty provides meaningful and objective clinical interpretation of the improvements in outcome scores after TSA.

A new type of cow’s milk, called A2 milk, has appeared in the dairy aisles of supermarkets in recent years. Cows’ milk generally contains two major types of beta-casein as A1 and A2 types, although there are 13 genetic variants of β-casein: A1, A2, A3, A4, B, C, D, E, F, H1, H2, I and G. Studies have shown that A1 β-casein may be harmful, and A2 β-casein is a safer choice for human health especially in infant nutrition and health. The A2 cow milk is reportedly easier to digest and better absorb than A1 or other types of milk. The structure of A2 cow’s milk protein is more comparable to human breast milk, as well as milk from goats, sheep and buffalo. Digestion of A1 type milk produces a peptide called β-casomorphin-7 (BCM-7), which is implicated with adverse gastrointestinal effects on milk consumption. In addition, bovine milk contains predominantly αs1-casein and low levels or even absent in αs2-casein, whereby caprine milk has been recommended as an ideal substitute for patients suffering from allergies against cow milk protein or other food sources. Since goat milk contains relatively low levels of αs1-casein or negligible its content, and αs2-casein levels are high in the milk of most dairy goat breeds, it is logical to assume that children with a high milk sensitivity to αs1-casein should tolerate goat milk well. Cow milk protein allergy (CMPA) is considered a common milk digestive and metabolic disorder or allergic disease with various levels of prevalence from 2.5% in children during the first 3 years of life to 12–30% in infants less than 3 months old, and it can go up to even as high as 20% in some countries. CMPA is an IgE-mediated allergy where the body starts to produce IgE antibodies against certain protein (allergens) such as A1 milk and αs1-casein in bovine milk. Studies have shown that ingestion of β-casein A1 milk can cause ischemic heart disease, type-1 diabetes, arteriosclerosis, sudden infant death syndrome, autism, schizophrenia, etc. The knowledge of bovine A2 milk and caprine αs2-casein has been utilized to rescue CMPA patients and other potential disease problems. This knowledge has been genetically applied to milk production in cows or goats or even whole herds of the two species. This practice has happened in California and Ohio, as well as in New Zealand, where this A2 cow milk has been now advanced commercially. In the USA, there have been even promotions of bulls, whose daughters have been tested homozygous for the A2 β-casein protein.

Experimental and computational studies were conducted to predict failure loads of specimens containing different-sized holes made using the additive manufacturing (AM) technique. Two different types of test specimens were prepared. Flat specimens, manufactured from polylactic acid (PLA), were subjected to uniaxial loading. Tubular specimens, made of polycarbonate (PC), were subjected to combined loading that was applied using uniaxial testing equipment. Test specimens were uniquely designed and printed to apply the combined bending and torsional loads to tubular specimens. A newly developed failure theory was applied to predict the loads that would result in the fracture of these test specimens. This theory is composed of two conditions related to stress and the stress gradient to be simultaneously satisfied to predict failure. The failure loads predicted using the new failure criteria were compared closely with the experimental data for all test specimens. In addition, a semi-empirical equation was developed to predict the critical failure surface energy for different printing angles. The critical failure surface energy is a material property and is used for the stress gradient condition. Using the semi-empirically determined values for the failure criterion provided close agreement with experimental results.

Extranodal marginal zone lymphoma of mucosa‐associated lymphoid tissue (MALT) in the thymus is a rare disease. Furthermore, amyloid deposition in thymic MALT lymphoma has not been previously described. Here, we report a case of a 35‐year‐old man with thymic MALT lymphoma with amyloid deposition and myasthenia gravis. Chest computed tomography revealed an anterior mediastinal mass with internal cystic component and extensive calcification. Total thymectomy was performed and histopathologic findings were compatible with a diffuse amyloid deposition in extranodal marginal zone MALT lymphoma. The results indicate that thymic MALT lymphoma should be considered as a possible diagnosis in patients with a solid and cystic thymic mass and autoimmune disease, including myasthenia gravis.

Case. We report a rare case of a spontaneous, atraumatic rupture of the anterior and middle heads of the deltoid with an underlying massive rotator cuff tear. Unique clinical findings included a palpable mass of torn deltoid distally with a proximal tissue defect. Magnetic resonance imaging of the deltoid demonstrated complete tear of the anterior head; involvement of the middle head was found intraoperatively. Given the acute nature of injury and potential impact on the feasibility of future reverse shoulder arthroplasty, surgical repair of the torn deltoid was discussed with the patient and performed via superior approach. Conclusion. Direct surgical repair is a viable treatment option if diagnosed early.

This study proposes economic evaluation of CO 2 geological storage with enhanced oil recovery. The procedures consider capital expenditures and operating costs of infrastructures and revenues from oil recovery and carbon tax credits. Extensive CO 2 geological storage with enhanced oil recovery simulations was conducted to determine the most promising scenario among cases, where miscibility was controlled by the addition of liquefied petroleum gas. The addition of liquefied petroleum gas into a CO 2 injection stream can accelerate reduction of oil viscosity, interfacial tension, and oil density, which cause improved displacement efficiency. The larger was the amount of liquefied petroleum gas injected, the greater was the miscibility due to minimum miscibility pressure reduction, resulting in higher oil recovery and less CO 2 sequestration. Although liquefied petroleum gas addition enhances the performance of CO 2 enhanced oil recovery, economic analysis should be conducted for CO 2 geological storage with enhanced oil recovery due to the higher price of liquefied petroleum gas than that of CO 2 . Net present value decreased from liquefied petroleum gas mole fraction of 0–2% and started to increase from mole fraction 2–13% due to the miscibility effect. Then, net present value started to decrease, because the purchasing and injecting prices of the required liquefied petroleum gas exceeded that of the oil produced. Economic evaluation showed that addition of 13% liquefied petroleum gas was the most promising scenario, with a net present value of 91 MM$. Thus, we confirmed an optimum liquefied petroleum gas concentration in the CO 2 geological storage with enhanced oil recovery process.

This paper presents multiscale-based failure criteria to predict the failure of polymer composites with any shape of defect. The multiscale technique consists of bi-directional processes called upscaling and downscaling processes to link two different length scales. One is the microscale at the fiber and matrix material level, and the other is the macroscale at the homogenized composite material level. Failure criteria are applied to the microscale level such as micro-stresses and/or micro-strains occurring at the fiber and matrix material level. Recently proposed unified failure criteria are applied to the micro-stresses and/or micro-strains to predict failure at a notch. The new failure criteria have two parts, and they can be applied to any shape of defect. One is the stress or strain condition, and the other is the stress or strain gradient condition. For failure to occur, both conditions must be satisfied simultaneously. The failure criteria provide not only failure locations but also directions of failure propagation.

Arthroscopic SLAP tear repair has become an increasingly used treatment for patients presenting with symptomatic SLAP tears after failed nonoperative management. Debridement, SLAP repair, and open or arthroscopic biceps tenodesis or tenotomy have been used for the treatment of SLAP tears. Various techniques for repair have been described, and furthermore, there is a high incidence of concomitant pathology of the shoulder. Repair remains an excellent option in isolated SLAP tears amenable to repair, with excellent outcomes in well-indicated patients. We present a method for repairing a SLAP tear using standard suture anchor fixation, anterior and posterior portals, and an accessory portal of Wilmington. Adequate labral repair can be achieved with this technique in patients with no concomitant biceps pathology. This report highlights this technique for SLAP repair in patients with isolated symptomatic SLAP tears that have failed conservative management.

Following a failed course of conservative management, arthroscopic rotator cuff repair (ARCR) has become the gold standard treatment for patients presenting with symptomatic rotator cuff (RC) tears. Traditionally, the single-row repair technique was used. Although most patients enjoy good to excellent clinical outcomes, structural healing to bone remains problematic. As a result, orthopaedic surgeons have sought to improve outcomes with various technological and technical advancements. One such possible advancement is the double-row technique.We present a method for repairing an RC tear using double-row suture anchors in a transosseous equivalent suture bridge technique. The double-row technique is believed to more effectively re-create the anatomic footprint of the tendon, as well as increase tendon to bone surface area, and apposition for healing. However, it requires longer operating times and is costlier. This report highlights this technique for ARCR in an adult by using a double-row transosseous equivalent suture bridge.

In this study, the impact of seven different gums on textural and microbiological properties of goat milk yogurt during refrigerated storage was investigated. The results showed that yogurt containing xanthan and locust bean gums had enhanced firmness, consistency, cohesiveness, and viscosity during four weeks of storage compared to the control and yogurt fortified with other gums (p < 0.05). The addition of gums also helped to maintain the microbial viability of the yogurt culture and the probiotic Bifidobacterium spp. This study thus demonstrated that these gums could be used in the production of goat milk yogurt with enhanced textural properties.

Quasi-static crack growth in a composite beam was modeled using the structural synthesis technique along with a finite element model. The considered crack was an interface crack in the shear mode (i.e. mode II), which occurs frequently in the scarf joint of composite structures. The analysis model was a composite beam with an edge crack at the midplane of the beam subjected to a three-point bending load. In the finite element model, beam finite elements with translational degrees of freedom only were used to model the crack conveniently. Then, frequency domain structural synthesis (substructure coupling) was applied to reduce the computational time associated with a repeated finite element calculation with crack growth. The quasi-static interface crack growth in a composite beam was predicted using the developed computational technique, and its result was compared to experimental data. The computational and experimental results agree well. In addition, the substructure-based synthesis technique showed the significantly improved computational efficiency when compared to the conventional full analysis.

There is a lack of data for how the viability of biological agents may degrade over time in different environments. In this study, experiments were conducted to determine the persistence of Bacillus anthracis and Bacillus subtilis spores on outdoor materials with and without exposure to simulated sunlight, using ultraviolet (UV)-A/B radiation. Spores were inoculated onto glass, wood, concrete, and topsoil and recovered after periods of 2, 14, 28, and 56 days. Recovery and inactivation kinetics for the two species were assessed for each surface material and UV exposure condition. Results suggest that with exposure to UV, decay of spore viability for both Bacillus species occurs in two phases, with an initial rapid decay, followed by a slower inactivation period. The exception was with topsoil, in which there was minimal loss of spore viability in soil over 56 days, with or without UV exposure. The greatest loss in viable spore recovery occurred on glass with UV exposure, with nearly a four log10 reduction after just two days. In most cases, B. subtilis had a slower rate of decay than B. anthracis, although less B. subtilis was recovered initially.

Salted yoghurt (SY) is one of the most popular dairy products in Hatay region of Turkey. It is made of goat milk, and known as ";yoghurt cheese"; or ";winter yoghurt"; due to its high solids content and long shelf life. Two different salting methods are traditionally used in manufacturing the SY: First by direct salting to the yogurt, and second by salting to whey removed yogurt before boiling. The SYs were manufactured using the direct salting method to compare the differences between the two salting methods in chemical parameters and changes in color values during salted yoghurt processing with reference to the original milk. Chemical composition and parameters such as total solids, fat, ash, salt and pH of the products were evaluated. The color characteristics of the samples were measured by the Minolta Chroma Meter CR-400 (Minolta Co., Ltd, Japan). Results showed that the mean chemical composition and indices of the original goat milk, regular yoghurt and SY were: total solids (%) 12.2, 12.0 and 31.9; total fat (%) 4.40, 4.20 and 10.20; ash (%) 0.58, 0.60 and 2.26; pH 6.53, 3.67 and 3.77, respectively. The slight decreases in total solids and fat contents of the regular yogurt may be due to the water from the yoghurt culture, where one-day old yogurt was used as starter culture. SY has substantially (P

Wise Young,1 Ziad M AlZoubi,2 Hooshang Saberi,3 Alok Sharma,4 Dafin Muresanu,5,6 Shiqing Feng,7 Lin Chen,8 Hongyun Huang91W. M. Keck Center for Collaborative Neuroscience, Rutgers The State University of New Jersey, NJ, USA; 2Jordan Orthopedic and Spinal Center (JOSC), Amman, Jordan; 3Department of Neurosurgery, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran; 4Department of Neurosurgery, Lokmanya Tilak Municipal General Hospital and Medical College, Sion Mumbai, Mumbai, India; 5Department of Neurosciences, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania; 6RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania; 7Department of Orthopaedics, Tianjin Medical University General Hospital, Tianjin, People's Republic of China; 8Department of Neurosurgery, Yuquan Hospital, Tsinghua University, Beijing, People's Republic of China; 9Center of Neurorestoratology, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, People's Republic of ChinaOn behalf of the International Association of NeurorestoratologyWith rapid development of basic and clinical advancement on neurorestoration, neurorestoratology has become a distinct medical discipline.Wide neurological impairment due to neurodegeneration and neural injury is a major factor reducing human longevity and quality of life. Neurorestoratology seeks appropriate interventional strategies to solve this problem.Neurorestoratology is the discipline that studies neurorestorative strategies and mechanisms of neural regeneration, repair and replacement of damaged components of the nervous system, neuroplasticity, neuroprotection, neuromodulation, vasculogenesis, and immune regulation. The goal of neurorestoratology is to restore, promote, and maintain the integrity of impaired or lost neuronal functions and structures.

The Science Teaching Experience Program--Working in Science Education (STEP-WISE) provides teaching experience for postdoctoral scholars holding full-time research appointments. Through a combination of mentorship, deliberate practice, and feedback, the postdocs learn and apply inclusive, evidence-based pedagogies. STEP-WISE is integrated into postdocs' demanding schedules and is sustainable for institutions to run. Here, we assess the effectiveness of STEP-WISE. We used the Classroom Observation Protocol for Undergraduate STEM instruction to quantify instructor and student behaviors in 20 STEP-WISE class sessions from seven courses designed and taught by postdocs in the program. We found that all of the postdocs used student-centered teaching strategies. Also, using a design-based research framework, we studied the program to identify the salient components of its design. Four interconnected key elements contribute to the program's success: (1) two training sessions, (2) a precourse meeting with the mentor, (3) implementation of active-learning strategies with support, and (4) debriefing with the mentor after each class session. STEP-WISE is a replicable model to support postdocs seeking training and experience in evidence-based teaching practices geared to improving undergraduate education and transforming pedagogical practice. We conclude that high-impact teaching can be learned early in a career with streamlined training and intensive mentoring.