Reliability of the Knee Examination in Osteoarthritis: Effect of Standardization

Objective. To assess the reliability of physical examination of the osteoarthritic (OA) knee by rheumatologists, and to evaluate the benefits of standardization. Methods. Forty-two physical signs and techniques were evaluated using a 6 X 6 Latin square design. Patients with mild to severe knee OA, based on physical and radiographic signs, were examined in random order prior to and following standardization of techniques. For those signs with dichotomous scales, agreement among the rheumatologists was calculated as the prevalence-adjusted bias-adjusted kappa (PABAK), while for the signs with continuous and ordinal scales, a reliability coefficient (R-c) was calculated using analysis of variance. A PABAK of >0.60 and an Re of >0.80 were considered to indicate adequate reliability. Results. Adequate poststandardization reliability was achieved for 30 of 42 physical signs/techniques (71%). The most highly reliable signs identified by physical examination of the OA knee included alignment by goniometer (R-c = 0.99), bony swelling (R-c = 0.97), general passive crepitus (R-c = 0.96), gait by inspection (PABAK = 0.78), effusion bulge sign (R-c = 0.97), quadriceps atrophy (R. = 0.97), medial tibiofemoral tenderness (R-c = 0.94), lateral tibiofemoral tenderness (R-c = 0.85), patellofemoral tenderness by grind test (R-c = 0.94), and flexion contracture (R-c = 0.95). The standardization process resulted in substantial improvements in reliability for evaluation of a number of physical signs, although for some signs, minimal or no effect of standardization was noted. After standardization, warmth (PABAK = 0.14), medial instability at 30degrees flexion (PABAK = 0.02), and lateral instability at 30degrees flexion (PABAK = 0.34) were the only 3 signs that were highly unreliable. Conclusion. With the exception of physical examinations for instability, a comprehensive knee examination can be performed with adequate reliability. Standardization further improves the reliability for some physical signs and techniques. The application of these findings to future OA studies will contribute to improved outcome assessments in OA.

An investigation of parents' and children's beliefs of early literacy acquisition from a cross -cultural perspective

It has been reported that the cultural-historical experiences of ethnic group members can play a role in the literacy beliefs of those members. Socioeconomic conditions can also influence the belief system of the groups' constituents. This study investigated parents' and children's beliefs pertaining to early literacy acquisition as related to the ethnicity and socioeconomic status (SES) of the participants. The objectives were to determine (a) the differential patterns regarding emergent literacy and traditional skills approaches as they interact with ethnicity and SES and (b) the correspondence between parents and children's beliefs about literacy acquisition. ^ The study was conducted with 152 parents (38 low-income Hispanic, 38 middle-income Hispanic, 38 low-income African-American, and 38 middle-income African-American) and 36 of their 3-, 4-, or 5-year-old children (18 male and 18 female). ^ The parents were asked to check those items with which they agreed on a survey that consisted of an equal number of items from the traditional skills-based and emergent literacy orientations. These responses were used to determine the differences and interaction by ethnicity and SES. The children responded to open-ended questions related to the instruction of reading and writing skills. The parents' responses and children's answers were compared to ascertain the matching parent-child dyads by ethnicity and SES. ^ An item analysis was conducted to strengthen the internal reliability consistency coefficient of the traditional skills-based and emergent literacy scales as measured by the Cronbach Alpha. ^ A two-way multivariate analysis of variance (MANOVA) revealed a significant difference in traditional skill-based beliefs for the low-income African-American and Hispanic parents. There were no significant findings for the parents' traditional skill based or emergent literacy beliefs based on ethnicity, for the interaction between ethnicity and SES, or for the relationship between parents' and children's literacy beliefs by ethnicity and SES. ^ It can be concluded that low-income African-American and Hispanic parents believe in the traditional skills approach, indicating that these parents find it necessary for children to have sufficient school readiness skills prior to learning to read or write. In addition, the parent and child dyads had a strong tendency toward emergent literacy beliefs. ^

Online Education, Accrediting Standards, and Student Success: An Examination of the Relationship Between the Southern Association of Colleges and Schools Commission on Colleges Standards for Online Education and Student Success

Prior to 2000, there were less than 1.6 million students enrolled in at least one online course. By fall 2010, student enrollment in online distance education showed a phenomenal 283% increase to 6.1 million. Two years later, this number had grown to 7.1 million. In light of this significant growth and skepticism about quality, there have been calls for greater oversight of this format of educational delivery. Accrediting bodies tasked with this oversight have developed guidelines and standards for online education. There is a lack of empirical studies that examine the relationship between accrediting standards and student success. The purpose of this study was to examine the relationship between the presence of Southern Association of Colleges and Schools Commission on College (SACSCOC) standards for online education in online courses, (a) student support services and (b) curriculum and instruction, and student success. An original 24-item survey with an overall reliability coefficient of .94 was administered to students (N=464) at Florida International University, enrolled in 24 university-wide undergraduate online courses during fall 2014, who rated the presence of these standards in their online courses. The general linear model was utilized to analyze the data. The results of the study indicated that the two standards, student support services and curriculum and instruction were both significantly and positively correlated with student success but with small R2 and strengths of association less than .35 and .20 respectively. Mixed results were produced from Chi-square tests for differences in student success between higher and lower rated online courses when controlling for various covariates such as discipline, gender, race/ethnicity, GPA, age, and number of online courses previously taken. A multiple linear regression analysis revealed that the curriculum and instruction standard was the only variable that accounted for a significant amount of unique variance in student success. Another regression test revealed that no significant interaction effect exists between the two SACSCOC standards and GPA in predicting student success. The results of this study are useful for administrators, faculty, and researchers who are interested in accreditation standards for online education and how these standards relate to student success.

A Video Analysis of Intra- and Inter-professional Leadership Behaviours Within “The Burns Suite”: Identifying Key Leadership Models

Objective Leadership is particularly important in complex highly interprofessional health care contexts involving a number of staff, some from the same specialty (intraprofessional), and others from different specialties (interprofessional). The authors recently published the concept of “The Burns Suite” (TBS) as a novel simulation tool to deliver interprofessional and teamwork training. It is unclear which leadership behaviors are the most important in an interprofessional burns resuscitation scenario, and whether they can be modeled on to current leadership theory. The purpose of this study was to perform a comprehensive video analysis of leadership behaviors within TBS. Methods A total of 3 burns resuscitation simulations within TBS were recorded. The video analysis was grounded-theory inspired. Using predefined criteria, actions/interactions deemed as leadership behaviors were identified. Using an inductive iterative process, 8 main leadership behaviors were identified. Cohen’s κ coefficient was used to measure inter-rater agreement and calculated as κ = 0.7 (substantial agreement). Each video was watched 4 times, focusing on 1 of the 4 team members per viewing (senior surgeon, senior nurse, trainee surgeon, and trainee nurse). The frequency and types of leadership behavior of each of the 4 team members were recorded. Statistical significance to assess any differences was assessed using analysis of variance, whereby a p < 0.05 was taken to be significant. Leadership behaviors were triangulated with verbal cues and actions from the videos. Results All 3 scenarios were successfully completed. The mean scenario length was 22 minutes. A total of 362 leadership behaviors were recorded from the 12 participants. The most evident leadership behaviors of all team members were adhering to guidelines (which effectively equates to following Advanced Trauma and Life Support/Emergency Management of Severe Burns resuscitation guidelines and hence “maintaining standards”), followed by making decisions. Although in terms of total frequency the senior surgeon engaged in more leadership behaviors compared with the entire team, statistically there was no significant difference between all 4 members within the 8 leadership categories. This analysis highlights that “distributed leadership” was predominant, whereby leadership was “distributed” or “shared” among team members. The leadership behaviors within TBS also seemed to fall in line with the “direction, alignment, and commitment” ontology. Conclusions Effective leadership is essential for successful functioning of work teams and accomplishment of task goals. As the resuscitation of a patient with major burns is a dynamic event, team leaders require flexibility in their leadership behaviors to effectively adapt to changing situations. Understanding leadership behaviors of different team members within an authentic simulation can identify important behaviors required to optimize nontechnical skills in a major resuscitation. Furthermore, attempting to map these behaviors on to leadership models can help further our understanding of leadership theory. Collectively this can aid the development of refined simulation scenarios for team members, and can be extrapolated into other areas of simulation-based team training and interprofessional education.

Development of the edible blend films with good mechanical and barrier properties from pea starch and guar gum

The individual and interactive impacts of guar gum and glycerol on the pea starch-based edible film characteristics were examined using three factors with three level Box–Behnken response surface design. The results showed that density and elongation at break were only significantly (p < 0.05) affected by pea starch and guar gum in a positive linear fashion. The quadratic regression coefficient of pea starch showed a significant effect (p < 0.05) on thickness, density, puncture force, water vapour permeability, and tensile strength. While tensile strength and Young modulus affected by the quadratic regression coefficient of glycerol and guar gum, respectively. The results were analysed using Pareto analysis of variance (ANOVA) and the developed predictive equations for each response variable presented reliable and satisfactory fit with high coefficient of determination (R2) values (≥ 0.96). The optimized conditions with the goal of maximizing mechanical properties and minimizing water vapour permeability were 2.5 g pea starch, 0.3 g guar gum and 25 % (w/w) glycerol based on the dry film matter in 100 ml of distilled water. Generally, changes in the concentrations of pea starch, guar gum and glycerol resulted in changes in the functional properties of film.

Factor structure of the General Health Questionnaire-28 (GHQ-28) from infertile women attending the Yazd Research and Clinical Center for Infertility

Background: Nowadays, infertility problems have become a social concern, and are associated with multiple psychological and social problems. Also, it affects the interpersonal communication between the individual, familial, and social characteristics. Since women are exposed to stressors of physical, mental, social factors, and treatment of infertility, providing a psychometric screening tool is necessary for disorders of this group. Objective: The aim of this study was to determine the factor structure of the general health questionnaire-28 to discover mental disorders in infertile women. Materials and Methods: In this study, 220 infertile women undergoing treatment of infertility were selected from the Yazd Research and Clinical Center for Infertility with convenience sampling in 2011. After completing the general health questionnaire by the project manager, validity and, reliability of the questionnaire were calculated by confirmatory factor structure and Cronbach's alpha, respectively. Results: Four factors, including anxiety and insomnia, social dysfunction, depression, and physical symptoms were extracted from the factor structure. 50.12% of the total variance was explained by four factors. The reliability coefficient of the questionnaire was obtained 0.90. Conclusion: Analysis of the factor structure and reliability of General Health Questionnaire-28 showed that it is suitable as a screening instrument for assessing general health of infertile women.

Online education, accrediting standards, and student success: An examination of the relationship between the southern association of colleges and schools commission on colleges standards for online education and student success

Prior to 2000, there were less than 1.6 million students enrolled in at least one online course. By fall 2010, student enrollment in online distance education showed a phenomenal 283% increase to 6.1 million. Two years later, this number had grown to 7.1 million. In light of this significant growth and skepticism about quality, there have been calls for greater oversight of this format of educational delivery. Accrediting bodies tasked with this oversight have developed guidelines and standards for online education. ^ There is a lack of empirical studies that examine the relationship between accrediting standards and student success. The purpose of this study was to examine the relationship between the presence of Southern Association of Colleges and Schools Commission on College (SACSCOC) standards for online education in online courses, (a) student support services and (b) curriculum and instruction, and student success. An original 24-item survey with an overall reliability coefficient of .94 was administered to students (N=464) at Florida International University, enrolled in 24 university-wide undergraduate online courses during fall 2014, who rated the presence of these standards in their online courses. The general linear model was utilized to analyze the data. The results of the study indicated that the two standards, student support services and curriculum and instruction were both significantly and positively correlated with student success but with small R2 and strengths of association less than .35 and .20 respectively. Mixed results were produced from Chi-square tests for differences in student success between higher and lower rated online courses when controlling for various covariates such as discipline, gender, race/ethnicity, GPA, age, and number of online courses previously taken. A multiple linear regression analysis revealed that the curriculum and instruction standard was the only variable that accounted for a significant amount of unique variance in student success. Another regression test revealed that no significant interaction effect exists between the two SACSCOC standards and GPA in predicting student success. ^ The results of this study are useful for administrators, faculty, and researchers who are interested in accreditation standards for online education and how these standards relate to student success.^

Scalar turbulent behavior in the roughness sublayer of an Amazonian forest.

An important current problem in micrometeorology is the characterization of turbulence in the roughness sublayer (RSL), where most of the measurements above tall forests are made. There, scalar turbulent fluctuations display significant departures from the predictions of Monin?Obukhov similarity theory (MOST). In this work, we analyze turbulence data of virtual temperature, carbon dioxide, and water vapor in the RSL above an Amazonian forest (with a canopy height of 40 m), measured at 39.4 and 81.6 m above the ground under unstable conditions. We found that dimensionless statistics related to the rate of dissipation of turbulence kinetic energy (TKE) and the scalar variance display significant departures from MOST as expected, whereas the vertical velocity variance follows MOST much more closely. Much better agreement between the dimensionless statistics with the Obukhov similarity variable, however, was found for the subset of measurements made at a low zenith angle Z, in the range 0°  <  |Z|  <  20°. We conjecture that this improvement is due to the relationship between sunlight incidence and the ?activation?deactivation? of scalar sinks and sources vertically distributed in the forest. Finally, we evaluated the relaxation coefficient of relaxed eddy accumulation: it is also affected by zenith angle, with considerable improvement in the range 0°  <  |Z|  <  20°, and its values fall within the range reported in the literature for the unstable surface layer. In general, our results indicate the possibility of better stability-derived flux estimates for low zenith angle ranges.

Effects of the orientation of the mountainside, altitude and varieties on the quality of the coffee beverage from the "Matas de Minas" region, brazilian Southeast.

Based upon qualitative parameters experiments, this study aims to investigate how the elements of the environment, where the coffee is produced, contribute to the final quality of the product. For the analyses, it was used approximately one kilogram of coffee cherry samples collected in 14municipalities previously chosen on the East side of the Minas Gerais State, Brazil. The coffee cherry samples were collected and analyzed for each of the two varieties in four levels of altitude for each exposure side of the mountain in relation to the Sun. The quality of the coffee was evaluated through the analysis of its physical characteristics and sensory analysis, popularly known as "Test of drink or Cupping" carried out by three tasters that belonging to the group of Q -Graders, according to the rules of national and international competitions of the Brazilian Association of Special Coffees (BSCA). Were performed analysis by means descriptive statistics, analysis of variance and multivariate analysis, all of them aiming to study the individual sensor y characteristics of quality of the coffee beverage from the ?Matas de Minas? region. Path coefficient analysis also was carried out for the partition of the phenotypic correlation coefficients into measures of direct and indirect effects, in order to determine the individual sensory characteristics that playeda major role in the beverage final score. The results demonstrat e that it is not possible to concl usively establish the differences among coffees evaluated with basis on varieties and environmental factors previously cited. It can be concluded that it is not recommended to associate the quality of coffee only to a specific factor whether from the environment or being it a specific of the culture of coffee. However, the cafes that were evaluated had intrinsic quality, which were derived from the specific characteristics of the ?Matas de Minas? region where they were grown.

Scalar turbulent behavior in the roughness sublayer of an Amazonian forest.

An important current problem in micrometeorology is the characterization of turbulence in the roughness sublayer (RSL), where most of the measurements above tall forests are made. There, scalar turbulent fluctuations display significant departures from the predictions of Monin?Obukhov similarity theory (MOST). In this work, we analyze turbulence data of virtual temperature, carbon dioxide, and water vapor in the RSL above an Amazonian forest (with a canopy height of 40?m), measured at 39.4 and 81.6?m above the ground under unstable conditions. We found that dimensionless statistics related to the rate of dissipation of turbulence kinetic energy (TKE) and the scalar variance display significant departures from MOST as expected, whereas the vertical velocity variance follows MOST much more closely. Much better agreement between the dimensionless statistics with the Obukhov similarity variable, however, was found for the subset of measurements made at a low zenith angle Z, in the range 0°??of scalar sinks and sources vertically distributed in the forest. Finally, we evaluated the relaxation coefficient of relaxed eddy accumulation: it is also affected by zenith angle, with considerable improvement in the range 0°??of better stability-derived flux estimates for low zenith angle ranges.

Evaluation Of The Radiopacity Of Esthetic Root Canal Posts.

The radiopacity of esthetic root canal posts may impair the assessment of their fit to the root canal when using radiographic images. This study determined in vitro the radiographic density of esthetic root canal posts using digital images. Thirty-six roots of human maxillary canines were assigned to six groups (N=6 per group): Reforpost (RP); Aestheti-Plus (AP); Reforpost MIX (RPM); D.T. Light Post (LP); Reforpost Radiopaque (RPR); and White Post DC (WP). Standardized digital images of the posts were obtained in different conditions: outside the root canal, inside the canal before and after cementation using luting material, and with a tissue simulator. Analysis of variance was used to compare the radiopacity mean values among the posts outside the root canal and among the posts under the other conditions, and the t unpaired test to compare the radiopacity between the posts and the dentin, and between the posts and the root canal space. There was no statistically significant difference in radiopacity between RP and RPM, and LP and WP. AP posts showed radiopacity values significantly lower than those for dentin. No statistically significant difference was found between posts (RP and AP) and the root canal space. A statistically significant difference was observed between the luted and non-luted posts; additionally, luted posts with and without tissue simulator showed no significant differences. Most of the cement-luted posts analyzed in this study were distinguishable from the density of adjacent dentin surfaces, allowing radiographic confirmation of the fit of the post in the canal. The success of using esthetic root canal posts depends mainly on the fit of the post within the canal.[1] The radiopacity of a post allows for radiographic imaging to be used to determine the fit, an important factor in a clinical perspective.

A Highly Improved Method For Sensitive Determination Of Amitriptyline In Pharmaceutical Formulations Using An Unmodified Carbon Nanotube Electrode In The Presence Of Sulfuric Acid.

The present paper describes a novel, simple and reliable differential pulse voltammetric method for determining amitriptyline (AMT) in pharmaceutical formulations. It has been described for many authors that this antidepressant is electrochemically inactive at carbon electrodes. However, the procedure proposed herein consisted in electrochemically oxidizing AMT at an unmodified carbon nanotube paste electrode in the presence of 0.1 mol L(-1) sulfuric acid used as electrolyte. At such concentration, the acid facilitated the AMT electroxidation through one-electron transfer at 1.33 V vs. Ag/AgCl, as observed by the augmentation of peak current. Concerning optimized conditions (modulation time 5 ms, scan rate 90 mV s(-1), and pulse amplitude 120 mV) a linear calibration curve was constructed in the range of 0.0-30.0 μmol L(-1), with a correlation coefficient of 0.9991 and a limit of detection of 1.61 μmol L(-1). The procedure was successfully validated for intra- and inter-day precision and accuracy. Moreover, its feasibility was assessed through analysis of commercial pharmaceutical formulations and it has been compared to the UV-vis spectrophotometric method used as standard analytical technique recommended by the Brazilian Pharmacopoeia.

The Effect Of Soy Dietary Supplement And Low Dose Of Hormone Therapy On Main Cardiovascular Health Biomarkers: A Randomized Controlled Trial.

To assess the effects of a soy dietary supplement on the main biomarkers of cardiovascular health in postmenopausal women compared with the effects of low-dose hormone therapy (HT) and placebo. Double-blind, randomized and controlled intention-to-treat trial. Sixty healthy postmenopausal women, aged 40-60 years, 4.1 years mean time since menopause were recruited and randomly assigned to 3 groups: a soy dietary supplement group (isoflavone 90mg), a low-dose HT group (estradiol 1 mg plus noretisterone 0.5 mg) and a placebo group. Lipid profile, glucose level, body mass index, blood pressure and abdominal/hip ratio were evaluated in all the participants at baseline and after 16 weeks. Statistical analyses were performed using the χ2 test, Fisher's exact test, Kruskal-Wallis non-parametric test, analysis of variance (ANOVA), paired Student's t-test and Wilcoxon test. After a 16-week intervention period, total cholesterol decreased 11.3% and LDL-cholesterol decreased 18.6% in the HT group, but both did not change in the soy dietary supplement and placebo groups. Values for triglycerides, HDL-cholesterol, glucose level, body mass index, blood pressure and abdominal/hip ratio did not change over time in any of the three groups. The use of dietary soy supplement did not show any significant favorable effect on cardiovascular health biomarkers compared with HT. The trial is registered at the Brazilian Clinical Trials Registry (Registro Brasileiro de Ensaios Clínicos - ReBEC), number RBR-76mm75.

Measuring The Hydrodynamic Radius Of Quantum Dots By Fluorescence Correlation Spectroscopy.

Fluorescence Correlation Spectroscopy (FCS) is an optical technique that allows the measurement of the diffusion coefficient of molecules in a diluted sample. From the diffusion coefficient it is possible to calculate the hydrodynamic radius of the molecules. For colloidal quantum dots (QDs) the hydrodynamic radius is valuable information to study interactions with other molecules or other QDs. In this chapter we describe the main aspects of the technique and how to use it to calculate the hydrodynamic radius of quantum dots (QDs).

Mastication Movements And Sleep Quality Of Patients With Myofascial Pain: Occlusal Device Therapy Improvements.

Patients with myofascial pain experience impaired mastication, which might also interfere with their sleep quality. The purpose of this study was to evaluate the jaw motion and sleep quality of patients with myofascial pain and the impact of a stabilization device therapy on both parameters. Fifty women diagnosed with myofascial pain by the Research Diagnostic Criteria were enrolled. Pain levels (visual analog scale), jaw movements (kinesiography), and sleep quality (Epworth Sleepiness Scale; Pittsburgh Sleep Quality Index) were evaluated before (control) and after stabilization device use. Range of motion (maximum opening, right and left excursions, and protrusion) and masticatory movements during Optosil mastication (opening, closing, and total cycle time; opening and closing angles; and maximum velocity) also were evaluated. Repeated-measures analysis of variance in a generalized linear mixed models procedure was used for statistical analysis (α=.05). At baseline, participants with myofascial pain showed a reduced range of jaw motion and poorer sleep quality. Treatment with a stabilization device reduced pain (P<.001) and increased both mouth opening (P<.001) and anteroposterior movement (P=.01). Also, after treatment, the maximum opening (P<.001) and closing (P=.04) velocities during mastication increased, and improvements in sleep scores for the Pittsburgh Sleep Quality Index (P<.001) and Epworth Sleepiness Scale (P=.04) were found. Myofascial pain impairs jaw motion and quality of sleep; the reduction of pain after the use of a stabilization device improves the range of motion and sleep parameters.