Reliability of Hallux Rigidus Radiographic Grading System

Introduction. The purpose of this study was to determine the inter- and intra-observer reliability of a clinical radiographic scale for hallux rigidus. Methods. A total of 80 patients were retrospectively selected from the patient population of two foot and ankle orthopaedic surgeons. Each corresponding series of radiographic images (weight-bearing anteroposterior, weight-bearing lateral, and oblique of the foot) was randomized and evaluated. Re-randomization was performed and the corresponding radiograph images re-numbered. Four orthopaedic foot and ankle surgeons graded each patient, and each rater reclassified the re-randomized radiographic images three weeks later. Results. Sixty-one out of 80 patients (76%) were included in this study. For intra-observer reliability, most of the raters showed “excellent” agreement except one rater had a “substantial” agreement. For inter-observer reliability, only 14 out of 61 cases (23%) showed total agreement between the eight readings from the four surgeons, and 11 out of the 14 cases (79%) were grade 3 hallux rigidus. One of the raters had a tendency to grade at a higher grade resulting in poorer agreement. If this rater was excluded, the results demonstrated a “substantial” agreement by using this classification. Conclusion. The hallux rigidus radiographic grading system should be used with caution. Although there is an “excellent” level of intra-observer agreement, there is only “moderate” to “substantial” level of inter-observer reliability

Ideal cardiovascular health and inflammation in European adolescents: The HELENA study

Background and aims Inflammation plays a key role in atherosclerosis and this process seems to appear in childhood. The ideal cardiovascular health index (ICHI) has been inversely related to atherosclerotic plaque in adults. However, evidence regarding inflammation and ICHI in adolescents is scarce. The aim is to assess the association between ICHI and inflammation in European adolescents. Methods and results As many as 543 adolescents (251 boys and 292 girls) from the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study, a cross-sectional multi-center study including 9 European countries, were measured. C-reactive protein (CRP), complement factors C3 and C4, leptin and white blood cell counts were used to compute an inflammatory score. Multilevel linear models and multilevel logistic regression were used to assess the association between ICHI and inflammation controlling by covariates. Higher ICHI was associated with a lower inflammatory score, as well as with several individual components, both in boys and girls (p < 0.01). In addition, adolescents with at least 4 ideal components of the ICHI had significantly lower inflammatory score and lower levels of the study biomarkers, except CRP. Finally, the multilevel logistic regression showed that for every unit increase in the ICHI, the probability of having an inflammatory profile decreased by 28.1% in girls. Conclusion Results from this study suggest that a better ICHI is associated with a lower inflammatory profile already in adolescence. Improving these health behaviors, and health factors included in the ICHI, could play an important role in CVD prevention

Reverse Flipping Technique: An Alternate Approach to Tie Reversing Half-Hitches on Alternating Posts

Arthroscopic knot tying requires practice and attention to detail, especially tying the 3 reversing half-hitches on alternating posts (RHAPs) in a knot. Mistakes can occur that result in an unintentional tension (>10 N) applied to the wrapping suture limb, and by placing tension in the wrong limb, the previously “flipped” half-hitch is converted from a series of RHAPs into a series of identical half-hitches on the same post, thereby producing insecure knots or suture loops. This was hypothesized to be a source of knot failure by knot slippage. This error can be avoided by using a technique we describe as “reverse flipping,” which purposely “flips” the half-hitch down at the main knot while tying the 3 RHAPs in a knot, and then the half-hitch is retightened using either a past-pointing or over-pointing technique. This way the surgeon can be absolutely sure that the half-hitch is tightened in the direction that it was intended to be placed, and can also prevent the unintentional tension applied to the wrapping suture limb that causes the half-hitch to “flip.” However, caution should be used when tensioning the half-hitches; overtensioning (>40 N) during past-pointing or over-pointing could also potentially “flip” the previous half-hitch that has already been tightened and cause potential knot failure

Reliability of Hallux Rigidus Radiographic Grading System

Introduction. The purpose of this study was to determine the inter- and intra-observer reliability of a clinical radiographic scale for hallux rigidus. Methods. A total of 80 patients were retrospectively selected from the patient population of two foot and ankle orthopaedic surgeons. Each corresponding series of radiographic images (weight-bearing anteroposterior, weight-bearing lateral, and oblique of the foot) was randomized and evaluated. Re-randomization was performed and the corresponding radiograph images re-numbered. Four orthopaedic foot and ankle surgeons graded each patient, and each rater reclassified the re-randomized radiographic images three weeks later. Results. Sixty-one out of 80 patients (76%) were included in this study. For intra-observer reliability, most of the raters showed “excellent” agreement except one rater had a “substantial” agreement. For inter-observer reliability, only 14 out of 61 cases (23%) showed total agreement between the eight readings from the four surgeons, and 11 out of the 14 cases (79%) were grade 3 hallux rigidus. One of the raters had a tendency to grade at a higher grade resulting in poorer agreement. If this rater was excluded, the results demonstrated a “substantial” agreement by using this classification. Conclusion. The hallux rigidus radiographic grading system should be used with caution. Although there is an “excellent” level of intra-observer agreement, there is only “moderate” to “substantial” level of inter-observer reliability.</jats:p

Reverse Flipping Technique: An Alternate Approach to Tie Reversing Half-Hitches on Alternating Posts

Arthroscopic knot tying requires practice and attention to detail, especially tying the 3 reversing half-hitches on alternating posts (RHAPs) in a knot. Mistakes can occur that result in an unintentional tension (>10 N) applied to the wrapping suture limb, and by placing tension in the wrong limb, the previously “flipped” half-hitch is converted from a series of RHAPs into a series of identical half-hitches on the same post, thereby producing insecure knots or suture loops. This was hypothesized to be a source of knot failure by knot slippage. This error can be avoided by using a technique we describe as “reverse flipping,” which purposely “flips” the half-hitch down at the main knot while tying the 3 RHAPs in a knot, and then the half-hitch is retightened using either a past-pointing or over-pointing technique. This way the surgeon can be absolutely sure that the half-hitch is tightened in the direction that it was intended to be placed, and can also prevent the unintentional tension applied to the wrapping suture limb that causes the half-hitch to “flip.” However, caution should be used when tensioning the half-hitches; overtensioning (>40 N) during past-pointing or over-pointing could also potentially “flip” the previous half-hitch that has already been tightened and cause potential knot failure

Aquaporins and unloading of phloem-imported water in coats of developing bean seeds

The definitive version is available at www.blackwell-synergy.comNutrients are imported into developing legume seeds by mass flow through the phloem, and reach developing embryos following secretion from their symplasmically isolated coats. To sustain homeostasis of seed coat water relations, phloem-delivered nutrients and water must exit seed coats at rates commensurate with those of import through the phloem. In this context, coats of developing French bean seeds were screened for expression of aquaporin genes resulting in cloning PvPIP1;1, PvPIP2;2 and PvPIP2;3. These genes were differentially expressed in all vegetative organs, but exhibited their strongest expression in seed coats. In seed coats, expression was localized to cells of the nutrient-unloading pathway. Transport properties of the PvPIPs were characterized by expression in Xenopus oocytes. Only PvPIP2;3 showed significant water channel activity (Pos = 150–200 µm s−1) even when the plasma membrane intrinsic proteins (PIPs) were co-expressed in various combinations. Permeability increases to glycerol, methylamine and urea were not detected in oocytes expressing PvPIPs. Transport active aquaporins in native plasma membranes of seed coats were demonstrated by measuring rates of osmotic shrinkage of membrane vesicles in the presence and absence of mercuric chloride and silver nitrate. The functional significance of aquaporins in nutrient and water transport in developing seeds is discussed.Yuchan Zhou, Nathan Setz, Christa Niemietz, Hongxia Qu, Christina E. Offler, Stephen D. Tyerman, John W. Patric

Tennessee's Student Teacher Achievement Ratio (STAR) project

Overview The Student/Teacher Achievement Ratio (STAR) was a four-year longitudinal class-size study funded by the Tennessee General Assembly and conducted by the State Department of Education. Over 7,000 students in 79 schools were randomly assigned into one of three interventions: small class (13 to 17 students per teacher), regular class (22 to 25 students per teacher), and regular-with-aide class (22 to 25 students with a full-time teacher's aide). Classroom teachers were also randomly assigned to the classes they would teach. The interventions were initiated as the students entered school in kindergarten and continued through third grade. In 1996, Health and Education Research Operative Services (HEROS), Incorporated was funded to conduct a tenth grade follow-up study of Project STAR. To be on-schedule during the 1995-1996 school year, Project STAR students would be high school sophomores (10th Grade). The researchers reviewed the Tennessee Competency Examination (TCE) data for the 1993-94, 1994-95, and 1995-96 school years. Schools begin administering the TCE to students in eighth grade and they are required to pas s the TCE prior to graduating from high school. Data were collected for each administration of the TCE to a Project STAR student. A significantly larger percent of small-class students (52.9%) versus students who had attended regular (49.1%) and regular/aide (48.0%) classes passed the TCE Language requirement at grade 8. The same was true for the mathematics requirement, where 36.4% of the small-class students passed versus 32.3% of the regular class and 30.3% of the regular/aide class students. Additional data were collected from Nashville-Davidson County Schools for the school dropout pilot study. Researchers had access to three years of data from this system (1993-94, 1994-95, and 1995-96 school years). When STAR students were not found with their appropriate grade level cohort (grade ten, 1995-96), investigators searched all grades from these years and were able to identify students who were still in the system, but who were appearing at a lower grade level. This rev iew showed that more regular and regular/aide class students than small-class students had been retained in grade levels prior to tenth grade. In the 1993-1994 school year, a significantly higher percentage (12 to 19%) of students in regular and regular/aide classes were in lower grades than their counterparts in small classes (about 8%). This difference grew with time. By the 1995-1996 school year, twice the percentage of students who attended regular or regular/aide classes were found in lower grades than their STAR peers who attended small classes. An academic progress pilot study was conducted by reviewing student records from the 1996-1997 school year where students who remained on-target with their cohort would have been in eleventh grade. Three school systems, Nashville-Davidson County, Pickett County, and Fentress County had agreed to participate in this pilot. Students who attended school in Nashville-Davidson County Schools were analyzed separately from those attending Fentress and Pickett County Schools. When studen t records were not located within the eleventh-grade files, the tenth-grade files (1996-1997) were searched, and if still not located the ninth-grade records were searched (1996-1997). The findings were strong and unambiguous. Nashville-Davidson County students who attended small classes (K-3) consistently made better grades than students in regular and regular/aide classes by the end of the 1994-1995 school year. In English, math, and science, the students in the small classes outscored their counterparts by over 10 points. Since most colleges and universities require foreign language courses, investigators analyzed these data. Significantly more small-class students enrolled in such courses than regular and regular/aide-class students. Approximately 26 percent more small-class students than regular or regular/aide-class students from rural areas were enrolled in foreign language courses. In the inner-city sample, 20 percent more students from the small-class group than the other two class types are enrolled in a foreign language course. This information is especially important because it provides investigators with the first look at the academic "track" of STAR students. Overview Of The Data Files The STAR-and-Beyond database contains raw student- and school-level data from a longitudinal experiment conducted in Tennessee beginning in 1985. The experiment lasted for four years, with a single cohort of students progressing from kindergarten through third grade. Achievement tests and non-achievement measures were administered annually. The experiment ended in 1989. However, student achievement data continued to be collected through high school, and ancillary studies resulted in other non-achievement variables being added to the data set. The primary student-level data file contains information on 11,601 students who participated in the experimental phase for at least one year. Information for each of grades K-3 includes: • Demographic variables; • School and class identifiers; • School and teacher information; • Experimental condition (“class type”); • Norm-referenced and criterion-referenced achievement test scores; • Motivation and self-concept scores.<br /> Additional data, added to the records of some or all students, include: • Achievement test scores for the students when they were in grades 4 – 8, obtained from the Tennessee State Department of Education; • Teachers’ ratings of student behavior in grades 4 and 8; • Students’ self-reports of school engagement and peer effects in grade 8; • Course taking in mathematics, science, and foreign language in high school, obtained from student transcripts;<br / > • SAT/ACT participation and scores, obtained from ACT, Inc. and from Educational Testing Service; • Graduation/dropout information, obtained from high school transcripts and the Tennessee State Department of Education. Other data files include: (1) Student data on 1780 students in grades 1 – 3 in 21 comparison schools, matched with STAR schools but not participating in the experiment; (2) A school-level file with additional information about each o f the 80 STAR schools; (3) A school-level file with additional information about each high school attended by STAR students