A randomized controlled trial of PEEK versus titanium interference screws for anterior cruciate ligament reconstruction with 2-year follow-up

Purpose: To compare the clinical performance of ACL reconstruction with PEEK and titanium interference screws at 2 years and to evaluate a novel method of measuring tunnel volume. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 133 patients underwent arthroscopic ACL reconstruction with 4-strand hamstring autografts and were randomized to have titanium or PEEK interference screws for femoral and tibial tunnel fixation. At 2 years, subjective Lysholm and International Knee Documentation Committee scores were assessed and clinical examination performed. At 12 months, MRI was performed to assess graft incorporation and cyst formation, and a novel technique was employed to measure tunnel volumes. Results: There were no significant differences in graft rerupture rate, contralateral ACL rupture rate, subjective outcomes, or objective outcomes. In the titanium and PEEK groups, MRI demonstrated high overall rates of graft integration (96%-100% and 90%-93%, respectively) and ligamentization (89% and 84%) and low rates of synovitis (22% and 10%) and cyst formation (0%-18% and 13%-15%). There was a higher proportion of patients with incomplete graft integration within the femoral tunnel in the PEEK group as compared with the titanium group (10% vs 0%, P = .03); however, the authors suggest that metal artifact precluded proper assessment of the graft in the titanium group by MRI. Tunnel volumes also appeared to be equivalent in the 2 groups and were measured with a novel technique that was highly reproducible in the PEEK group secondary to the absence of flare. Conclusion: Two-year clinical analysis of PEEK interference screws for femoral and tibial fixation of ACL reconstructions showed equivalent clinical performance to titanium interference screws. Given the excellent mechanical characteristics, biological compatibility, and absence of metal artifact on MRI, PEEK has become our material of choice for interference screw fixation in ACL reconstruction

Including Systematic Uncertainties in Confidence Interval Construction for Poisson Statistics

One way to incorporate systematic uncertainties into the calculation of confidence intervals is by integrating over probability density functions parametrizing the uncertainties. In this note we present a development of this method which takes into account uncertainties in the prediction of background processes, uncertainties in the signal detection efficiency and background efficiency and allows for a correlation between the signal and background detection efficiencies. We implement this method with the Feldman & Cousins unified approach with and without conditioning. We present studies of coverage for the Feldman & Cousins and Neyman ordering schemes. In particular, we present two different types of coverage tests for the case where systematic uncertainties are included. To illustrate the method we show the relative effect of including systematic uncertainties the case of dark matter search as performed by modern neutrino tel escopes.Comment: 23 pages, 10 figures, replaced to match published versio

Projective Fra\"{\i}ss\'{e} limits of trees

We continue study of projective Fra\"{\i}ss\'e limit developed by Irvin, Panagiotopoulos and Solecki. We modify the ideas of monotone, confluent, and light mappings from continuum theory as well as several properties of continua so as to apply to topological graphs. As the topological realizations of the projective Fra\"{\i}ss\'e limits we obtain the dendrite $D_3$ as well as quite new, interesting continua for which we do not yet have topological characterizations

Notes and Discussion Piece: Status of the Topeka Shiner in Iowa

The Topeka shiner Notropis topeka is native to Iowa, Kansas, Minnesota, Missouri, Nebraska, and South Dakota and has been federally listed as endangered since 1998. Our goals were to determine the present distribution and qualitative status of Topeka shiners throughout its current range in Iowa and characterize the extent of decline in relation to its historic distribution. We compared the current (2016–2017) distribution to distributions portrayed in three earlier time periods. In 2016–2017 Topeka shiners were found in 12 of 20 HUC10 watersheds where they occurred historically. Their status was classified as stable in 21% of the HUC10 watersheds, possibly stable in 25%, possibly recovering in 8%, at risk in 33%, and possibly extirpated in 13% of the watersheds. The increasing trend in percent decline evident in earlier time periods reversed, going from 68% in 2010–11 to 40% in the most recent surveys. Following decades of decline, the status of Topeka shiners in Iowa appears to be improving. One potential reason for the reversal in the distributional decline of Topeka shiners in Iowa is the increasing number of oxbow restorations. Until a standardized monitoring program is established for Iowa, periodic status assessments such as this will be necessary to chronicle progress toward conserving this endangered fish species

5-Year survival of pediatric anterior cruciate ligament reconstruction with living donor hamstring tendon grafts

Background: It is well accepted that there is a higher incidence of repeat anterior cruciate ligament (ACL) injuries in the pediatric population after ACL reconstruction (ACLR) with autograft tissue compared with adults. Hamstring autograft harvest may contribute to the risk for repeat ACL injuries in this high functional demand group. A novel method is the use of a living donor hamstring tendon (LDHT) graft from a parent; however, there is currently limited research on the outcomes of this technique, particularly beyond the short term. Purpose/Hypothesis: The purpose was to determine the medium-term survival of the ACL graft and the contralateral ACL (CACL) after primary ACLR with the use of an LDHT graft from a parent in those aged less than 18 years and to identify factors associated with subsequent ACL injuries. It was hypothesized that ACLR with the use of an LDHT provides acceptable midterm outcomes in pediatric patients. Study Design: Case series; Level of evidence, 4. Methods: Between 2005 and 2014, 247 (of 265 eligible) consecutive patients in a prospective database, having undergone primary ACLR with the use of an LDHT graft and aged less than 18 years, were included. Outcomes were assessed at a minimum of 2 years after surgery including data on ACL reinjuries, International Knee Documentation Committee (IKDC) scores, and current symptoms, as well as factors associated with the ACL reinjury risk were investigated. Results: Patients were reviewed at a mean of 4.5 years (range, 24-127 months [10.6 years]) after ACLR with an LDHT graft. Fifty-one patients (20.6%) sustained an ACL graft rupture, 28 patients (11.3%) sustained a CACL rupture, and 2 patients sustained both an ACL graft rupture and a CACL rupture (0.8%). Survival of the ACL graft was 89%, 82%, and 76% at 1, 2, and 5 years, respectively. Survival of the CACL was 99%, 94%, and 86% at 1, 2, and 5 years, respectively. Survival of the ACL graft was favorable in patients with Tanner stage 1-2 at the time of surgery versus those with Tanner stage 3-5 at 5 years (87% vs 69%, respectively; hazard ratio, 3.7; P = .01). The mean IKDC score was 91.7. A return to preinjury levels of activity was reported by 59.1%. Conclusion: After ACLR with an LDHT graft from a parent in those aged less than 18 years, a second ACL injury (ACL graft or CACL injury) occurred in 1 in 3 patients. The 5-year survival rate of the ACL graft was 76%, and the 5-year survival rate of the CACL was 86%. High IKDC scores and continued participation in sports were maintained over the medium term. Importantly, there was favorable survival of the ACL graft in patients with Tanner stage 1-2 compared with patients with Tanner stage 3-5 over 5 years. Patients with Tanner stage 1-2 also had a significantly lower incidence of second ACL injuries over 5 years compared with those with Tanner stage 3-5, occurring in 1 in 5 patients. Thus, an LDHT graft from a parent is an appropriate graft for physically immature children

Lifshitz points in blends of AB and BC diblock copolymers

We consider micro- and macro-phase separation in blends of AB and BC flexible diblock copolymers. We show that, depending on architecture, a number of phase diagram topologies are possible. Microphase separation or macrophase separation can occur, and there are a variety of possible Lifshitz points. Because of the rich parameter space, Lifshitz points of multiple order are possible. We demonstrate Lifshitz points of first and second order, and argue that, in principle, up to 5th-order Lifshitz points are possible

Quantum oscillations of self-dual Abrikosov-Nielsen-Olesen vortices

The mass shift induced by one-loop quantum fluctuations on self-dual ANO vortices is computed using heat kernel/generalized zeta function regularization methods. The quantum masses of super-imposed multi-vortices with vorticity lower than five are given. The case of two separate vortices with a quantum of magnetic flux is also discussed.Comment: RevTex, 13 pages, 4 figures, 7 tables. Minor corrections. Version to appear in Physical Review

The projective Fra\"{\i}ss\'{e} limit of the class of all connected finite graphs with confluent epimorphisms

We show that the class of finite connected graphs with confluent epimorphism is a projective Fra\"{\i}ss\'e class and we investigate the continuum obtained as the topological realization of the projective Fra\"{\i}ss\'e limit. This continuum was unknown before. We show that it is indecomposable, but not hereditarily indecomposable, one-dimensional, Kelley, pointwise self-homeomorphic, but not homogeneous. It is hereditarily unicoherent and each point is the top of the Cantor fan. Moreover, the universal solenoid, the universal pseudo-solenoid, and the pseudo-arc may be embedded in it

How effective is the Forestry Commission Scotland's woodland improvement programme--'Woods In and Around Towns' (WIAT)--at improving psychological well-being in deprived urban communities? A quasi-experimental study

Introduction: There is a growing body of evidence that suggests that green spaces may positively influence psychological well-being. This project is designed to take advantage of a natural experiment where planned physical and social interventions to enhance access to natural environments in deprived communities provide an opportunity to prospectively assess impacts on perceived stress and mental well-being.<p></p> Study design and methods: A controlled, prospective study comprising a repeat cross-sectional survey of residents living within 1.5 km of intervention and comparison sites. Three waves of data will be collected: prephysical environment intervention (2013); postphysical environment intervention (2014) and postwoodland promotion social intervention (2015). The primary outcome will be a measure of perceived stress (Perceived Stress Scale) preintervention and postintervention. Secondary, self-report outcomes include: mental well-being (Short Warwick-Edinburgh Mental Well-being Scale), changes in physical activity (IPAQ-short form), health (EuroQoL EQ-5D), perception and use of the woodlands, connectedness to nature (Inclusion of Nature in Self Scale), social cohesion and social capital. An environmental audit will complement the study by evaluating the physical changes in the environment over time and recording any other contextual changes over time. A process evaluation will assess the implementation of the programme. A health economics analysis will assess the cost consequences of each stage of the intervention in relation to the primary and secondary outcomes of the study.<p></p> Ethics and dissemination: Ethical approval has been given by the University of Edinburgh, Edinburgh College of Art Research, Ethics and Knowledge Exchange Committee (ref. 19/06/2012). Findings will be disseminated through peer-reviewed publications, national and international conferences and, at the final stage of the project, through a workshop for those interested in implementing environmental interventions.<p></p&gt