Comparison of extramedullary versus intramedullary referencing for tibial component alignment in total ankle arthroplasty.

BACKGROUND: The majority of total ankle arthroplasty (TAA) systems use extramedullary alignment guides for tibial component placement. However, at least 1 system offers intramedullary referencing. In total knee arthroplasty, studies suggest that tibial component placement is more accurate with intramedullary referencing. The purpose of this study was to compare the accuracy of extramedullary referencing with intramedullary referencing for tibial component placement in total ankle arthroplasty. METHODS: The coronal and sagittal tibial component alignment was evaluated on the postoperative weight-bearing anteroposterior (AP) and lateral radiographs of 236 consecutive fixed-bearing TAAs. Radiographs were measured blindly by 2 investigators. The postoperative alignment of the prosthesis was compared with the surgeon's intended alignment in both planes. The accuracy of tibial component alignment was compared between the extramedullary and intramedullary referencing techniques using unpaired t tests. Interrater and intrarater reliabilities were assessed with intraclass correlation coefficients (ICCs). RESULTS: Eighty-three tibial components placed with an extramedullary referencing technique were compared with 153 implants placed with an intramedullary referencing technique. The accuracy of the extramedullary referencing was within a mean of 1.5 ± 1.4 degrees and 4.1 ± 2.9 degrees in the coronal and sagittal planes, respectively. The accuracy of intramedullary referencing was within a mean of 1.4 ± 1.1 degrees and 2.5 ± 1.8 degrees in the coronal and sagittal planes, respectively. There was a significant difference (P < .001) between the 2 techniques with respect to the sagittal plane alignment. Interrater ICCs for coronal and sagittal alignment were high (0.81 and 0.94, respectively). Intrarater ICCs for coronal and sagittal alignment were high for both investigators. CONCLUSIONS: Initial sagittal plane tibial component alignment was notably more accurate when intramedullary referencing was used. Further studies are needed to determine the effect of this difference on clinical outcomes and long-term survivability of the implants. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

Impact of Funding Source on Clinical Trial Results Including Cardiovascular Outcome Trials.

Previous authors have suggested a higher likelihood for industry-sponsored (IS) studies to have positive outcomes than non-IS studies, though the influence of publication bias was believed to be a likely confounder. We attempted to control for the latter using a prepublication database to compare the primary outcome of recent trials based on sponsorship. We used the "advanced search" feature in the clinicaltrials.gov website to identify recently completed phase III studies involving the implementation of a pharmaceutical agent or device for which primary data were available. Studies were categorized as either National Institutes of Health (NIH) sponsored or IS. Results were labeled "favorable" if the results favored the intervention under investigation or "unfavorable" if the intervention fared worse than standard medical treatment. We also performed an independent literature search to identify the cardiovascular trials as a case example and again categorized them into IS versus NIH sponsored. A total of 226 studies sponsored by NIH were found. When these were compared with the latest 226 IS studies, it was found that IS studies were almost 4 times more likely to report a positive outcome (odds ratio [OR] 3.90, 95% confidence interval [CI] 2.6087 to 5.9680, p <0.0001). As a case example of a specialty, we also identified 25 NIH-sponsored and 215 IS cardiovascular trials, with most focusing on hypertension therapy (31.6%) and anticoagulation (17.9%). IS studies were 7 times more likely to report favorable outcomes (OR 7.54, 95% CI 2.19 to 25.94, p = 0.0014). They were also considerably less likely to report unfavorable outcomes (OR 0.11, 95% CI 0.04 to 0.26, p <0.0001). In conclusion, the outcomes of large clinical studies especially cardiovascular differ considerably on the basis of their funding source, and publication bias appears to have limited influence on these findings.

Lukas Foss's The Prairie (1942): Building Community through Music

Lukas Foss's The Prairie, a seven-movement cantata for SATB soloists, mixed chorus, and orchestra, is a well-crafted and audience-friendly setting of the poem of the same name by Carl Sandburg. Acclaimed at its 1944 premiere, The Prairie has not enjoyed a robust performance history due in large part to numerous inconsistencies between the score and parts which render the work challenging to perform. Heretofore, each conductor has individually located these inconsistencies and made the necessary adjustments for performances. In this document, resources have been assembled which identify and correct many of the inconsistencies, thus facilitating more performances in the future. The Prairie is an ideal vehicle for a project-based chorus, which is itself an opportunity to create a new community. A correlation may exist between "community" and "vulnerability;" that is, when a choral singer feels comfortably connected to fellow singers, he or she may be more likely to open up to new ways of making sounds for the ultimate service of the music. Results are inconclusive, but the project points to a successful strategy for creating an affirming new community and to positive musical and nonmusical results of intentional community-building.

[Book review] Theory of Games and Economic Behaviour

Tony Mann provides a review of the book: Theory of Games and Economic Behavior, John von Neumann and Oskar Morgenstern, Princeton University Press, 1944.

Chronotype, sleep quality and sleep duration in adult distance education: Not related to study progress

Research in traditional education shows chronotype, sleep duration and sleep quality to be related to learning performance. Research in adult students participating in distance education (DE) is scarce. This study aims to provide knowledge on these relationships in this educational setting. In an observational longitudinal study, chronotype, sleep duration (i.e., for work and free days separately) and sleep quality of 894 students were analyzed in a multiple regression analyses. Students provided information on sleep-relatedmeasures and important covariates at the start of their study and study progress was evaluated after 14 months (i.e., the number of successfully completed modules). In linewith previous research, chronotype did not predict study progress. Further, sleep duration did not predict study progress, neither as a linear nor as a polynomial term. Third, sleep quality did not predict study progress. Concluding, these results are in linewith previous research that DE provides a solution to the asynchrony problem. Findings regarding sleep duration and sleep quality are new and unexpected, asking for attention and further research. Despite the study's observational nature, findings suggest that students participating in DE may benefit from this type of education as the asynchrony problem appears not to apply here, as students can choose their own study schedule.

Contributions to the bryological flora of the tropical and subtropical forests from the Argentina (Bryophyta, Musci).

The authors present here a list of 32 mosses belonging to 15 families: Brachytheciaceae, Cryphaeaceae, Entodontaceae, Hedwigiaceae, Hypnaceae, Leptodontaceae, Meteoriaceae, Neckeraceae, Pilotrichaceae, Polytrichaceae, Pterobryaceae, Racopilaceae, Rigodiaceae, Stereophyllaceae, and Trachypodaceae, all collected in the mountainous forests of the Yungas of the NW of the Argentina (Jujuy, Salta, Catamarca and Tucumán provinces), and also in the rainforests from the NE of the country (Misiones province). Eight species: Atrichum polycarpum, Chrysohypnum elegantulum, Pilosium chlorophyllum, Pilotrichella flexilis, Porotrichodendron lindigii, Pseudotrachypus martinicensis, Steerecleus scariosus, and Thamnobryum fasciculatum are new records for the bryologic flora from Argentina. Braunia imberbis and Squamidium brasiliense are two new records for the bryophytic flora of the Catamarca province; Porotrichodendron superbum is new for the Salta province, while Forsstroemia coronata is the first record for the Catamarca and Jujuy provinces. Aerolindigia capillacea, Braunia reflexifolia, Chryso-hypnum diminutivum, Meteorium deppei and Meteoridium remotifolium are five new citations for the Jujuy province, and Schoenobryum concavifolium is new for the bryophytic flora of the Misiones province. Many studied species occur more frequently in the Yungas than in the NE rainforests; others show separated distribution but live in both areas, the Yungas and Paranaense area, and others are more or less restricted to the Paranaense rainforest of the NE of Argentina. The taxonomy of species is updated, and comments are included on bibliographical precedents, ecology and chorology of each taxon.