Musculoskeletal Coccidioidomycosis in the Setting of Adalimumab: A Case Report.

Musculoskeletal coccidioidomycosis is a rare disseminated fungal infection caused by either Coccidioides immitis or Coccidioides posadasii endemic to the southwestern United States and northwestern Mexico, as well as Guatemala, Brazil, and other locations in Central and South America. Symptomatic primary infection of coccidioidomycosis can present as pneumonia with influenza-like symptoms, but the majority of cases remain asymptomatic. When dissemination occurs, the most common extrapulmonary sites include the skin, lymph nodes, musculoskeletal system, and meninges. We present a case of a 53-year-old female with a history of breast cancer and ankylosing spondylitis treated with adalimumab who presented with disseminated coccidioidomycosis. On presentation, she reported subcutaneous nodules on the right forearm and elbow. Radiologic evaluation utilizing magnetic resonance imaging (MRI) and positron emission tomography (PET) scan revealed multiple subcutaneous and bony enhancing lesions in her right forearm, lumbar spine, iliac wing, and axillary lymphadenopathy. Given the patient's history of breast cancer, there was concern for metastatic disease. Axillary lymph node biopsies were negative for malignancy, but immunoreactive for C. immitis with a positive Grocott methenamine silver (GMS) stain and a C. immitis antibody panel confirmed the diagnosis of disseminated coccidioidomycosis. Treatment with fluconazole was initiated along with discontinuation of adalimumab. Fluconazole was transitioned to itraconazole due to adverse effects. Treatment was successful as evidenced by improved PET imaging and downtrending C. immitis antibody titers. This case highlights the concerning potential for dissemination of endemic mycoses with anti-tumor necrosis factor-α (TNF-α) therapies and the unique ways in which they can present. Further investigation is needed to determine the long-term implications of the disease and the role that immunosuppressive medications play in disease susceptibility.

Bandage contact lens for in-game corneal abrasion can allow immediate return to play.

While the prevailing treatment for corneal abrasions outside the athletic sphere is the application of a bandage contact lens (BCL), which lessens pain and allows for the maintenance of binocular vision, this is not the case during athletic play. This brief report highlights the advantage of BCLs in treating in-game corneal abrasions, ultimately allowing for an immediate return to play. Additionally, this report summarizes the mechanisms of bandage contact lenses, differentiates them from standard hydrogel contact lenses, and highlights the significant steps necessary to apply the bandage contact lens during an in-game corneal abrasion event. Overall, we link modern ophthalmology clinical practice and sports medicine, allowing for the attenuation of acutely-induced ocular pain to a manageable state.

Characterization of the robotic surgery experience in minimally invasive surgery fellowships from 2010 to 2021.

BACKGROUND: Robotic surgery has experienced exponential growth in the past decade. Few studies have evaluated the impact of robotics within minimally invasive surgery (MIS) fellowship training programs. The purpose of our study was to examine and characterize recent trends in robotic surgery within MIS fellowship training programs. METHODS: De-identified case log data from the Fellowship Council from 2010 to 2021 were evaluated. Percentage of operations performed with robot assistance over time was assessed and compared to the laparoscopic and open experience. Case logs were further stratified by operative category (e.g., bariatric, hernia, foregut), and robotic experience over time was evaluated for each category. Programs were stratified by percent robot use and the experience over time within each quartile was evaluated. RESULTS: MIS fellowship training programs with a robotic platform increased from 45.1% (51/113) to 90.4% (123/136) over the study period. The percentage of robotic cases increased from 2.0% (1127/56,033) to 23.2% (16,139/69,496) while laparoscopic cases decreased from 80.2% (44,954/56,033) to 65.3% (45,356/69,496). Hernia and colorectal case categories had the largest increase in robot usage [hernia: 0.7% (62/8614) to 38.4% (4661/12,135); colorectal 4.2% (116/2747) to 31.8% (666/2094)]. When stratified by percentage of robot utilization, current (2020-2021) programs in the > 95th percentile performed 21.8% (3523/16,139) of robotic operations and programs in the > 50th percentile performed 90.0% (14,533/16,139) of all robotic cases. The median number of robotic cases performed per MIS fellow significantly increased from 2010 to 2021 [0 (0-6) to 72.5 (17.8-171.5), p < 0.01]. CONCLUSIONS: Robotic use in MIS fellowship training programs has grown substantially in the past decade, but the laparoscopic and open experience remains robust. There remains an imbalance with the top 50% of busiest robotic programs performing over 90% of robot trainee cases. The experience in MIS programs varies widely and trainees should examine program case logs closely to confirm parallel interests.

Addressing Persistent Vaccine Hesitancy in a Military Community Through a Physician-Led Intervention.

INTRODUCTION: Following the identification of coronavirus disease 2019 (COVID-19) in China, the virus has spread rapidly around the world causing severe illness and death. Several vaccines were found to be safe and effective and made available first to those most at risk and then to the general public. Despite the safety and efficacy profiles, vaccine hesitancy remains a significant barrier to widespread immunity. Within the military community at Wright-Patterson Air Force Base, we provided multiple physician-led educational seminars to address vaccination concerns and decrease vaccine hesitancy. MATERIALS AND METHODS: The authors presented a PowerPoint presentation of the available vaccinations, their safety data, and efficacy, followed by a town hall-style question-and-answer period where questions were presented from the previous submission, as well as real-time submissions through Facebook Live. The questions were fielded by specialists in Internal Medicine, Infectious Disease, Pulmonary-Critical Care, Obstetrics and Gynecology, and Rheumatology. The entire presentation was streamed through Facebook Live and was freely available. Following the presentation, an online survey was provided for willing participants to complete which included demographic data and addressed their previous and current attitudes toward COVID-19 vaccinations and their opinions on the presentation. Data from the survey were then analyzed through IBM SPSS Statistics 25.0 to find any associations or risk factors for hesitancy. RESULTS: There were 73 respondents to the assessment, most of which were nonmedical. Of the 73, the majority (45) had already received a vaccine for COVID-19. Of those unvaccinated, 17 did not want a vaccination before or after the seminar. Two did change their mind about being receptive to vaccination, and one changed from receptive to hesitant. The only statistically significant risk factors for vaccine hesitancy were those with a moderate to great amount of trust in their health care provider compared to those with little to no trust (73% vs. 4%, P < .001). CONCLUSIONS: Our intervention was limited in its effectiveness to address vaccine hesitancy late in the pandemic, with our study limited by our small sample size. Regardless, it identified a peculiar discrepancy with those with the most trust in health care providers being the most likely to be vaccine-hesitant. This highlights the importance of the information that trusted health care providers are providing to their patients and may identify more effective routes to address vaccine hesitancy in the future.

Osteogenesis Imperfecta Diagnosed in an Active Duty Female Due to CREB3L1 Heterozygosity.

INTRODUCTION: Osteogenesis imperfecta (OI) is a heritable, collagen-related disorder with varying degrees of disease severity and systemic involvement. The hallmark of OI is bone matrix fragility, but diverse effects related to structural integrity and impaired development of connective tissue can account for hearing loss, blue sclera, dentinogenesis imperfecta, frequent fractures, joint hypermobility, and cardiac valve or vessel fragility in some cases. There is emerging recognition of unique genetic mutations leading to OI including CREB3L1, which codes for an important transcription factor for differentiation of osteoblasts. CASE PRESENTATION: We present a case of OI diagnosed in an active duty female with multiple prior fractures and heterozygous CREB3L1, a rare cause of OI. CONCLUSION: This case highlights the importance of consideration of the variable phenotypes of OI and careful assessment of fracture history during evaluation at the Military Entrance Processing Station and subsequent encounters at military treatment facilities to improve readiness.

Small + Safe + Well: lessons learned from a Total Worker Health® randomized intervention to promote organizational change in small business.

BACKGROUND: Leadership commitment to worker safety and health is one of the most important factors when organizations develop and implement a Total Worker Health® approach. We aimed to assess the effectiveness of a Total Worker Health ("TWH") leadership development program that targeted owners and other senior-level leadership positions on changing organizational and worker outcomes from baseline to one-year later. METHODS: The Small + Safe + Well study included small businesses from a variety of industries in the state of Colorado, USA that were participating in Health Links™. We designed a randomized waitlisted control comparison design (RCT) to evaluate the added benefit of a TWH leadership development program. An employer assessment tool was used to assess TWH policies and programs, and an employee health and safety survey was used to assess safety leadership and health leadership practices, safety climate and health climate, safety behaviors and health behaviors, and well-being. We used a linear mixed model framework with random effects for business and employee to assess the impact of intervention on the outcomes of interest. RESULTS: Thirty-six businesses (37% retention) and 250 employees (9% retention) met the RCT study inclusion criteria and were included in the analysis. Businesses improved their TWH policies and programs score from baseline to one-year later, regardless of leadership intervention group assignment. Neither intervention group demonstrated improvements in employee-reported outcomes. CONCLUSIONS: This study sought to address a gap in the literature regarding small business senior leadership development for TWH. Our study demonstrates many of the challenges of conducting studies focused on organizational change in workplaces, specifically in small businesses. When designing TWH intervention studies, researchers should consider how to best engage small business leaders in interventions and implementations early on, as well as methods that are well matched to measuring primary and secondary outcomes longitudinally. Future research is needed to test the feasibility and sustainability of TWH interventions in small business. TRIAL REGISTRATION: The trial was retrospectively registered with ClinicalTrials.gov ( ID U19OH011227 ).

Examining the initial prescription leading to long-term opioid use at a military medical treatment facility.

OBJECTIVE: Chronic pain is common in the military, and over a quarter of active-duty military members have received a prescription for opioids. This study reviewed the initial opioid prescription among those who became future long-term users at an Air Force base in the United States and reports the characteristics of the provider and patient. METHODS: Our single-center retrospective study evaluated initial opioid prescriptions leading to long-term use within the military's electronic medical record at a large military medical treatment facility including active-duty patients and veterans. Of the 3,701 charts reviewed, 348 patients met the inclusion criteria for the long-term opioid use. RESULTS: Older patient groups received a higher initial amount of opioids than younger groups (p = 0.007). Primary care outpatient clinics started 43 percent of initial long-term opioid users, while surgical specialties contributed to 34 percent of the sample. In our study, 35.9 percent of the long-term opioid users were given their first opioid prescription within 30 days of an operation. Veterans or those separated from the military were less likely to have a behavioral disorder than active duty or family members. CONCLUSIONS: Our sample mirrored the civilian population in terms of age, gender, and most common pain diagnosis. We found that older patients initially received a higher dispensed amount compared to our younger patients. There was a concerning trend for surgical patients to develop into chronic opioid users.

Enteroviral Meningoencephalitis as a Complication of Rituximab Therapy for Rheumatoid Arthritis.

Enteroviral meningoencephalitis is a rare complication of rituximab therapy that has been described in the treatment of hematologic malignancies. We report the first case of enteroviral meningoencephalitis in a patient receiving rituximab for the treatment of rheumatoid arthritis. A 37-year-old female treated with rituximab for severe rheumatoid arthritis presented with fever, headache, confusion, and tremor. Magnetic resonance imaging (MRI) of the brain was unrevealing. Cerebrospinal fluid showed a lymphocytic pleocytosis and multiplex polymerase chain reaction (PCR) was positive for enterovirus. She was treated with intravenous immunoglobulin (IVIG) for five days and had significant improvement in symptoms. Rituximab is an anti-CD20 monoclonal antibody that induces B-cell depletion and possible hypogammaglobulinemia, putting patients at increased risk for viral infections. We present this case to highlight that patients on rituximab, regardless of the indication for use, are susceptible to severe complications of otherwise typically self-limited viral infections. Furthermore, we describe the potential use of IVIG in treating these patients.

Quantifying and Assessing the Dosimetric Impact of Changing Gas Volumes Throughout the Course of VMAT Radiation Therapy of Upper Gastrointestinal Tumors.

PURPOSE: This retrospective patient study assessed the consistency of abdominal gas presence throughout radiation therapy for patients with upper gastrointestinal cancer and determined the impact of variations in gas volume on the calculated dose distribution of volumetric modulated arc therapy. METHODS AND MATERIALS: Eight patients with pancreatic cancer were included for analysis. A plan library consisting of 3 reference plans per patient (Ref0.0, Ref0.5, and Ref1.0) was created based on planning computed tomography (CT) with density overrides of 0.0, 0.5, and 1.0 applied to gas volumes, respectively. Corresponding cone beam CT (CBCT) data sets were obtained and density overrides were applied to enable fractional dose calculation. Variation in gas volume relative to initial volume determined from CT was assessed. Dose metrics for targets and organs at risk were compared between the accumulated CBCT dose and the planned dose of the 3 reference plans for each patient. RESULTS: There was a significant decrease in gas present from CT to treatment CBCT, with a mean decrease in volume of 48.6% for the entire cohort. Dosimetrically, all accumulated target and organ-at-risk parameters, aside from the kidneys, exhibited the smallest mean deviation from the Ref0.0 plan and largest mean deviation from the Ref1.0 plan. A statistically significant difference in mean accumulated dose to Ref0.0 and Ref1.0 was observed for the dose delivered to 95% of the planning target volume. CONCLUSIONS: Significant variation in gas volumes from CT to treatment can occur throughout volumetric modulated arc therapy for pancreatic cancer. Through the use of a plan library, it was determined that initial assessment of a patient's treatment plan with an assigned gas density of 0.0 provided the most accurate prediction of the accumulated dose.

Dermatomyositis Flare With Immune Checkpoint Inhibitor Therapy for Melanoma.

Immune checkpoint inhibitor (ICI) medications have seen expanded use in the management of numerous malignancies. These therapies encompass a unique spectrum of immune-related adverse events (irAEs). Rheumatological irAEs from ICIs have been described in various case reports; however, limited literature exists regarding the treatment of patients with pre-existing myositis. We describe a case of myositis flare after initiation of nivolumab for metastatic melanoma in a patient who had previously achieved remission of dermatomyositis.

Evaluation of a Total Worker Health® leadership program for small business leaders.

Leaders play a critical role in the development and execution of Total Worker Health (TWH). Small businesses, in particular, can benefit from strong leadership support for TWH as the burden of work-related injury, illness and fatality, as well as poor health and well-being is high in this population. In the present study, we conducted a program evaluation of a TWH leadership development program for small business leaders using the RE-AIM framework. The goal of the program was to help change leaders' behaviors around health, safety and well-being practices following the theory of transformational leadership. Two leaders from each business participated in pre-training activities on their own, a 6-hour in-person training, and three months of access to virtual training transfer activities, including coaching and goal tracking. Our results suggest that the TWH leadership development program is effective at improving leaders' self-reported TWH leadership practices and that the in-person training was implemented successfully. However, leaders did not report improvements in their personal health and in fact reported increased levels of work stress after the program. We also observed some challenges when implementing our training transfer strategies. Our study suggests that leaders may benefit from attending TWH leadership trainings alongside other colleagues in their organization to facilitate a shared vision and goals for TWH in their organization. As a next step, it will be important to determine the program's effectiveness in changing business TWH policies and practices, employee perceptions of TWH and leadership, and employee health and safety outcomes.

Education and Training to Build Capacity in Total Worker Health®: Proposed Competencies for an Emerging Field.

OBJECTIVE: Establishment of core competencies for education and training of professionals entering the emerging field of Total Worker Health®. METHODS: Compilation and distillation of information obtained over a 5-year period from Total Worker Health symposia, workshops, and academic offerings, plus contributions from key stakeholders regarding education and training needs. RESULTS: A proposed set of Total Worker Health competencies aligns under six broad domains: Subject Matter Expertize; Advocacy and Engagement; Program Planning, Implementation and Evaluation; Communications and Dissemination; Leadership and Management; and Partnership Building and Coordination. CONCLUSIONS: Proposed set of core competencies will help standardize education and training for professionals being trained in Total Worker Health. It serves as an invitation for further input from stakeholders in academia, business, labor, and government.

Evaluation of an Occupational Safety and Health Training for Cannabis Cultivation Workers.

OBJECTIVES: As the commercial cannabis industry grows, there is an increased need to characterize potentially hazardous workplace exposures and provide training to workers to mitigate these exposures with the goal of reducing accidents and injuries from cannabis cultivation, processing, and manufacturing. Public health and safety stakeholders in Colorado developed a worker-focused training designed to improve hazard awareness, recognition, and controls related to commercial cannabis cultivation. This paper describes the evaluation of this training. METHODS: The training was a full day, in-person educational experience directed to workers in the cannabis cultivation industry. Training topics included an overview of occupational safety and health hazards, chemical exposures, slip, trips, and falls, repetitive motion, the application of the hierarchy of control including lockout/tagout, machine guarding, personal protective equipment, among others. Evaluation surveys assessed attendee demographics, perceived job hazards, confidence to change workplace practices, knowledge, training relevancy and quality, intent to change behavior, as well as barriers and resources. RESULTS: A total of 208 people attended the safety trainings. One hundred and thirty-four participants (64%) completed the pre-training survey and 107 (51%) completed the post-training survey. Respondents provided high ratings for the quality and relevance of the training, with 91.3% of respondents rating the training very good or excellent. Before the training, the attendees listed their most concerning safety and health issues as exposure to pesticides and other chemicals (65.7%), absorbing chemicals through the skin (56.7%), slips, trips, and falls (52.2%), and respiratory hazards (50.7%). After the training, they reported the most concerning hazards to be slips, trips, and fall hazards (65.4%), ergonomic problems (64.5%), and respiratory issues (61.7%). There was a statistically non-significant increase in knowledge scores from 67.1% correct to 76.0% correct. Finally, 88.5% of respondents felt extremely or very confident that they could change their own health and safety practices at work. CONCLUSIONS: The training successfully reached cannabis employees in cultivation, compliance, and management. Survey respondents felt that the training was of high quality and addressed gaps in their knowledge related to safety and health hazards in the cannabis industry. The workplace safety and health concerns shifted from pre- to post-training. There was a statistically non-significant increase in knowledge. Additional follow-up of training attendees would be beneficial to measure sustained impact of training.

Highlights from occupational safety and health continuing education needs assessment.

BACKGROUND: There is a lack of trained Occupational Safety and Health (OSH) professionals able to meet the current and future demand for such expertize in the United States. Many OSH professionals are required to perform duties, which are outside of their primary area of expertize; thus, expansion of continuing education (CE) may be necessary to properly train individuals for new OSH responsibilities. METHODS: The National Institute for Occupational Safety and Health-funded Education and Research Centers collectively developed and distributed an internet-based survey to gauge the CE needs and interests of the OSH workforce. RESULTS: A total of 2064 responses were received. The most common primary professions represented were safety (28%), occupational health nursing (18%), and industrial hygiene (12%). The majority of respondents (61%) reported that they perform work activities outside of those associated with their primary OSH profession. The CE offerings with the highest interest among respondents were related to safety. Other courses with high levels of interest included topics such as legal issues in OSH (88%), compliance (88%), risk management (85%), OSH management (83%), risk communication (83%), and communication in accident prevention (81%). Health and safety leadership (82%), health and safety culture (78%) and total worker health (74%) were also significant interests. CONCLUSIONS: It is important to be responsive to the evolving needs of the OS&H community. Developing relevant courses will help ensure that OS&H professionals have access to the training they need to perform essential job functions and keep employees healthy and safe.

Health Links™ Assessment of Total Worker Health® Practices as Indicators of Organizational Behavior in Small Business.

OBJECTIVE: The aim of this study was to conduct a cross-sectional assessment of the adoption of Total Worker Health (TWH) policies and practices by business size and evaluate extent and alignment of their safety and health. METHODS: We conducted an analysis of 382 businesses that completed the Health Links Assessment. We measured organizational adoption of TWH across six benchmarks: organizational supports, workplace assessments, health policies and programs, safety, engagement, and evaluation. RESULTS: Benchmark scores were significantly associated with business size. Larger businesses were more likely to score higher across each benchmark. CONCLUSION: Small businesses are implementing TWH in a variety of ways and the level of implementation differs by business size. Practical interventions as well as dissemination and implementation research should take business size into account to ensure that TWH is both effective and sustainable in meeting the needs of employees.

Small business Total Worker Health: A conceptual and methodological approach to facilitating organizational change.

Nearly half of Americans are employed by small businesses, and future projections suggest that the number of those employed by small businesses will rise. Despite this, there is relatively little small business intervention research on the integration of health protection and health promotion, known as Total Worker Health® (TWH). We first discuss the importance of studying small businesses in TWH research and practice. Second, we describe an example of a small business TWH intervention, Health Links™ plus TWH owner/senior manager leadership training, that we are evaluating via the Small+Safe+Well (SSWell) study. Key features of the intervention and the SSWell study include attention to multi-level influences on worker health, safety and well-being; organizational change; and dissemination and implementation science strategies via the RE-AIM model. We offer several considerations for future small business TWH research and practice both in terms of the small business context as well as intervention development and evaluation. Our goal is to provide TWH researchers and practitioners with a framework and an example of how to approach small business TWH interventions. Ultimately, through the SSWell study, we aim to provide small businesses with strong evidence to support the use of TWH strategies that are practical, effective and sustainable.

Reversible Plastic Deformation of Polymer Blends as a Means to Achieve Stretchable Organic Transistors.

Intrinsically stretchable semiconductors will facilitate the realization of seamlessly integrated stretchable electronics. However, to date demonstrations of intrinsically stretchable semiconductors have been limited. In this study, a new approach to achieve intrinsically stretchable semiconductors is introduced by blending a rigid high-performance donor-acceptor polymer semiconductor poly[4(4,4dihexadecyl4Hcyclopenta [1,2b:5,4b' ] dithiopen2yl) alt [1,2,5] thiadiazolo [3,4c] pyridine] (PCDTPT) with a ductile polymer semiconductor poly(3hexylthiophene) (P3HT). Under large tensile strains of up to 75%, the polymers are shown to orient in the direction of strain, and when the strain is reduced, the polymers reversibly deform. During cyclic strain, the local packing order of the polymers is shown to be remarkably stable. The saturated field effect charge mobility is shown to be consistently above 0.04 cm2 V-1s-1 for up to 100 strain cycles with strain ranging from 10% to 75% when the film is printed onto a rigid test bed. At the 75% strain state, the charge mobility is consistently above 0.15 cm2 V-1s-1. Ultimately, the polymer blend process introduced here results in an excellent combination of device performance and stretchability providing an effective approach to achieve intrinsically stretchable semiconductors.

Ultrasound Features of the Posterior Tibialis Tendon and Peroneus Brevis Tendon Entheses: Comparison Study Between Healthy Adults and Those With Inflammatory Arthritis.

OBJECTIVE: Limited literature exists on the sonographic appearance of the posterior tibialis tendon (PTT) and the peroneus brevis tendon (PBT) entheses. We determined the anatomic features and best imaging techniques of normal PTT and PBT using musculoskeletal ultrasound and compared these findings to subjects with inflammatory arthritis. METHODS: Adult subjects were enrolled as healthy controls (HCs), rheumatoid arthritis (RA) patients, or spondyloarthropathy (SpA) patients. Bilateral PTT and PBT entheses were imaged longitudinally, comparing 2 angles of insonation: perpendicular to the skin surface and 45° cephalad. Images were scored on semiquantitative scales assessing pathology. RESULTS: A total of 78 subjects were enrolled (37 HC, 21 RA, and 20 SpA). Complete enthesis visualization was achieved more frequently in the perpendicular than in the cephalad view for the PBT (76.3% versus 58.7%), but more frequently in the cephalad view for the PTT (58.0% versus 19.6%). RA and SpA subjects had higher rates of PTT fiber disruption (P < 0.001), PTT tenosynovial effusion (P < 0.001), and Doppler signal (P < 0.001) than HCs. No significant differences existed at the PBT enthesis. In multivariate analysis, RA and SpA subjects were found to be 5.1 times (P < 0.001) and 3.6 times (P < 0.001) more likely to exhibit ultrasound-detected pathology, respectively, than HCs. CONCLUSION: The perpendicular transducer aim is optimal for imaging the PBT, while the cephalad transducer orientation was more effective for evaluation of the PTT. Unlike distal PBT imaging, PTT imaging distinguished healthy and disease states, with both RA and SpA patients showing features of PTT enthesopathy. Distal PTT imaging is a useful technique for musculoskeletal ultrasound.

Significantly Increasing the Ductility of High Performance Polymer Semiconductors through Polymer Blending.

Polymer semiconductors based on donor-acceptor monomers have recently resulted in significant gains in field effect mobility in organic thin film transistors (OTFTs). These polymers incorporate fused aromatic rings and have been designed to have stiff planar backbones, resulting in strong intermolecular interactions, which subsequently result in stiff and brittle films. The complex synthesis typically required for these materials may also result in increased production costs. Thus, the development of methods to improve mechanical plasticity while lowering material consumption during fabrication will significantly improve opportunities for adoption in flexible and stretchable electronics. To achieve these goals, we consider blending a brittle donor-acceptor polymer, poly[4-(4,4-dihexadecyl-4H-cyclopenta[1,2-b:5,4-b']dithiophen-2-yl)-alt-[1,2,5]thiadiazolo[3,4-c]pyridine] (PCDTPT), with ductile poly(3-hexylthiophene). We found that the ductility of the blend films is significantly improved compared to that of neat PCDTPT films, and when the blend film is employed in an OTFT, the performance is largely maintained. The ability to maintain charge transport character is due to vertical segregation within the blend, while the improved ductility is due to intermixing of the polymers throughout the film thickness. Importantly, the application of large strains to the ductile films is shown to orient both polymers, which further increases charge carrier mobility. These results highlight a processing approach to achieve high performance polymer OTFTs that are electrically and mechanically optimized.