Search

Purpose To evaluate sensitivity, specificity and accuracy of a radiographic slipped capital femoral epiphysis (SCFE)-diagnosis among medical specialists. Methods Three paediatricians, three paediatric radiologists and three paediatric orthopaedic surgeons completed two rounds of a survey of anteroposterior and frog-leg lateral radiographs of patients with a diagnosis of SCFE (25), femoroacetabular impingement (four), Legg-Calvé-Perthes (11) or no hip pathology (ten). Intra- and interobserver agreement among specialties regarding the diagnosis of a SCFE were assessed using Cohen's kappa coefficient (κ). Diagnostic accuracy of SCFE relative to the benchmark, a combination of the radiographic diagnosis based on Klein's line, clinical symptoms and surgical treatment, was assessed computing sensitivity, specificity and accuracy. Results Intraobserver agreement between the surveys was moderate among paediatricians (κ-range, 0.44 to 0.52), moderate to almost perfect among orthopaedic surgeons (κ-range, 0.79 to 0.88) and almost perfect among paediatric radiologists (κ-range, 0.83 to 1.00). Interobserver agreement for survey 1 and 2 was slight among paediatricians (mean κ, 0.19), substantial among orthopaedic surgeons (mean κ, 0.77) and almost perfect among paediatric radiologists (mean κ, 0.86). Sensitivity of SCFE-diagnosis was high among radiologists and orthopaedic surgeons (88% to 100% for both specialties), but lower for paediatricians (24% to 76%). Specificity was high among radiologists and orthopaedic surgeons (72% to 84%), however, variable among paediatricians (56% to 80%). Accuracy of a SCFE-diagnosis was highest in radiologists (84% to 92%), followed by orthopaedic surgeons (80% to 88%) and paediatricians (48% to 78%). Conclusion SCFE can be detected on radiographs by different medical specialties. Intra- and interobserver agreement, specificity, sensitivity and accuracy for radiographic SCFE-diagnosis amongst paediatric radiologists and orthopaedic surgeons are better than that of general paediatricians. Level of Evidence II

(1972). A Versatile Vector Mean Value Theorem. The American Mathematical Monthly: Vol. 79, No. 4, pp. 381-383.

1. Paul Bachmann, Die analytische Zahlentheorie, Leipzig, 1894. 2. Ernest Ceshro, Atude moyenne du plus grand commun diviseur de deux nombres, Ann. Mat. Pura Appl. (2) vol. 13 (1885) pp. 233-268. 3. Leonard Eugene Dickson, History of the theory of numbers, vol. II, reprinted New York, 1952. 4. J. Franel, Sur une formule utile dans la determination de certaines valeurs asymptotiques, Math. Ann. vol. 51 (1899) pp. 369-387. 5. J. J. Sylvester, Sur le nombre de fractions ordinaires indgales qu'on peut exprimer en se servant de chiffres qui n'excedent pas un nombre donna, C. R. Acad. Sci. Paris vol. 96 (1883) p. 409.

Although important high-dimensional cases of the polyhedral Schoenflies theorem are yet unsettled (see [4] and [11]), there has been considerable success in the past ten years in generalizing the theorem, proved by Schoenflies in 1906, to the effect that every one-dimensional sphere embedded in the plane is tame. Of course Alexander's horned sphere and others show the necessity of a further condition to obtain a generalization to embeddings of S in E +1 for n> 1. Alexander proved tameness in the combinatorial and differential categories for n=2, M. H. A. Newman extended the result to include all finite dimensions in the combinatorial category [10] and Barry Mazur accomplished the same for the differential category [7]. In the topological category, Marston Morse showed that Mazur's result implies tameness of semilocally tame (bicollared) n-spheres in En+, [9] and at the same time Morton Brown gave an elegant proof independent of Mazur's result [3]. As might be expected, in infinite-dimensional normed linear spaces even the counterpart of the Jordan curve theorem does not hold. However, it is shown in this paper that with the bicollared condition one does get Jordan separation. In fact tameness is proved by a modification of Brown's technique. Hopefully this infinite-dimensional Schoenflies theorem will be as useful in infinite-dimensional topology as has been the case in finite dimensions. To give substance to this hope a number of applications are given including an annulus theorem, a contribution to the classification of convex sets and partial answers to questions raised by R. H. Bing and R. D. Anderson [2]. 1.0 DEFINITIONS. Unless otherwise stated, X denotes a topological space and E (with or without subscripts or superscripts) an infinite-dimensional normed linear space with the norm topology. Let Bt={xeFII xI ? t} and St={xeFII xI=t} for t > 0. If A c X, Bd A denotes the point-set boundary of A and 'A its interior. If h: (B2, S2) -> (A, Bd A) is a homeomorphism, then A is called a (closed) E-cell in X, h(B1) is a collared E-cell in X, collared by h and A is a tame E-cell if X= E and h extends to a space homeomorphism. On the other hand, if h: (B3 -B1, S3 u S1) -(A, Bd A) is a homeomorphism, A is called a (closed) E-annulus in X and h(S2) a bicollared E-sphere in X, bicollared by h. The prefix Ewill be omitted if no confusion is likely.

(1962). Riemann Integration on Subspaces of the Reals. The American Mathematical Monthly: Vol. 69, No. 6, pp. 492-498.