Assessing Patient-Centred Outcomes in Lateral Elbow Tendinopathy: A Systematic Review and Standardised Comparison of English Language Clinical Rating Systems.

BACKGROUND: Lateral elbow tendinopathy (LET) is a common condition affecting adults. Although a lack of treatment consensus continues to prompt numerous effectiveness studies, there is a paucity of clear guidance on the choice of outcome measure. Our aim was to undertake a standardised evaluation of the available clinical rating systems that report patient-centred outcomes in LET. METHODS: A systematic review of studies reporting the development, assessment of metric properties and/or use of instruments aiming to quantify LET-specific patient-centred outcome measures was conducted in MEDLINE, Embase and CINAHL (inception-2017) adhering to PRISMA guidance. The evidence for each instrument was independently assessed by two reviewers using the standardised evaluating measures of patient-reported outcomes (EMPRO) method evaluating overall and attribute-specific instrument performance (metric properties and usability). EMPRO scores > 50/100 were considered indicative of high performance. RESULTS: Out of 7261 references, we identified 105 articles reporting on 15 instruments for EMPRO analysis. Median performance score was 41.6 (range 21.6-72.5), with four instruments meeting high-performance criteria: quick Disabilities of the Arm Shoulder and Hand score (qDASH) (72.5), DASH (66.9), Oxford Elbow Score (OES) (66.6) and Patient-Rated Tennis Elbow Evaluation (PRTEE) (57.0). One hundred seventy-nine articles reported instrument use internationally with DASH as the most frequent (29.7% articles) followed by PRTEE (25.6%), MEPS (15.1%) and qDASH (8.1%). The correlation between frequency of use and performance was r = 0.35 (95%CI - 0.11; 0.83). CONCLUSIONS: This is the first study to provide standardised guidance on the choice of measures for LET. A large number of clinical rating systems are both available and being used for patients with LETs. Robust evidence is available for four measures, the DASH, QDASH, PRTEE and OES. The use of instruments in the literature is only in part explained by instrument performance.

Clinical and radiologic outcomes following total shoulder arthroplasty using Arthrex Eclipse stemless humeral component with minimum 2 years' follow-up.

BACKGROUND: Stemless humeral components benefit from less morbidity, better reproduction of the humeral anatomy, ease of revision, and fewer stem-related complications. Encouraging results are available up to 9 years after surgery from the designer's series. This is an independent study of 100 consecutive Eclipse stemless prostheses for osteoarthritis with a minimum 2-year follow-up (range, 2-6 years). METHODS: We included only total shoulder arthroplasties performed for osteoarthritis. The primary outcome was the Oxford Shoulder Score (OSS) after 2 years. Secondary outcome measures were change in shoulder range of movement and radiographic analysis of prosthesis size and position. RESULTS: The mean OSS at 2 years was 38 of 48, with a mean improvement of +19 points (range, +17 to +22 points; P < .001). There was no significant deterioration in OSS after 3 or 4 years' follow-up. Statistically significant improvement was seen in arm elevation and external rotation (P < .001). There were 5 reoperations-1 for impingement of the biceps stump and 4 revisions to reverse arthroplasty for cuff failure. Of the prostheses, 92% were sized within 2 mm of the anatomic head size, and in 76% of prostheses, the center of rotation was within 3 mm of the native anatomy. An incomplete radiolucent line was present in zone B (around the cage screw) in a single patient at 2 years following surgery. There were no cases of loosening or infection. CONCLUSION: The functional and radiographic outcomes of Eclipse total shoulder replacement are excellent. We were able to accurately reproduce the native anatomy in the majority of cases, with no implant loosening, at 2 to 6 years' follow-up.

The spread of Injectate after ultrasound-guided lateral elbow injection - a cadaveric study.

BACKGROUND: Injections into the tendinous portion of the common extensor origin are a common intervention in the treatment of Lateral Elbow Tendinopathy (LET). Clinical trials report a heterogeneous selection of injectate volumes and delivery techniques, with systematic reviews finding no clear consensus. The aim of this study was to assess the intratendinous distribution and surrounding tissue contamination of ultrasound-guided injections into the Common Extensor Tendon (CET) of the elbow. METHODS: Twenty cadaveric elbows were injected by a Consultant Radiologist under Ultrasound guidance. Elbows were randomised to equal groups of 1 or 3 mls of methylene blue injection, delivered using single shot or fenestrated techniques. Following injection, each cadaver underwent a dry arthroscopy and dissection of superficial tissues. The CET was excised, set and divided into 1 mm sections using microtome. Each slice was photographed and analysed to assess spread and pixel density of injectate in four colour graduations. The cross-sectional area of distribution was calculated and compared between groups. RESULTS: In all 20 cadaveric samples, contamination of the joint was noted on arthroscopy and dissection. Injectate spread through over 97% of the cross-sectional area. No differences were found in intratendinous spread of injectate between differing volumes or techniques. CONCLUSION: This study found that commonly used injection volumes and techniques distribute widely throughout cadaveric CETs. There was no improvement when the volume was increased from 1 to 3 mls or between single shot of fenestrated injection techniques. It should be noted that joint contamination using these techniques and volumes may be inevitable.

Clinical rating systems in elbow research-a systematic review exploring trends and distributions of use.

BACKGROUND: Clinical rating systems are used as outcome measures in clinical trials and attempt to gauge the patient's view of his or her own health. The choice of clinical rating system should be supported by its performance against established quality standards. METHODS: A search strategy was developed to identify all studies that reported the use of clinical rating systems in the elbow literature. The strategy was run from inception in Medline Embase and CINHAL. Data extraction identified the date of publication, country of data collection, pathology assessed, and the outcome measure used. RESULTS: We identified 980 studies that reported clinical rating system use. Seventy-two separate rating systems were identified. Forty-one percent of studies used ≥2 separate measures. Overall, 54% of studies used the Mayo Elbow Performance Score (MEPS). For arthroplasty, 82% used MEPS, 17% used Disabilities of Arm, Shoulder and Hand (DASH), and 7% used QuickDASH. For trauma, 66.7% used MEPS, 32% used DASH, and 23% used the Morrey Score. For tendinopathy, 31% used DASH, 23% used Patient-Rated Tennis Elbow Evaluation (PRTEE), and 13% used MEPS. Over time, there was an increased proportional use of the MEPS, DASH, QuickDASH, PRTEE, and the Oxford Elbow Score. CONCLUSIONS: This study identified a wide choice and usage of clinical rating systems in the elbow literature. Numerous studies reported measures without a history of either a specific pathology or cross-cultural validation. Interpretability and comparison of outcomes is dependent on the unification of outcome measure choice. This was not demonstrated currently.

Triceps on approach for total elbow arthroplasty: worth preserving? A review of approaches for total elbow arthroplasty.

Total elbow arthroplasty can be a rewarding operation and is becoming increasingly used in the elderly fracture population. Multiple approaches are represented in the literature and deciding on the best approach is difficult. This review discusses approaches and their reported outcomes, aiming to allow surgeons to make an informed choice about which approach to use.

Nebivolol suppresses cardiac ryanodine receptor-mediated spontaneous Ca2+ release and catecholaminergic polymorphic ventricular tachycardia.

ß-Blockers are a standard treatment for heart failure and cardiac arrhythmias. There are ∼30 commonly used ß-blockers, representing a diverse class of drugs with different receptor affinities and pleiotropic properties. We reported that among 14 ß-blockers tested previously, only carvedilol effectively suppressed cardiac ryanodine receptor (RyR2)-mediated spontaneous Ca2+ waves during store Ca2+ overload, also known as store overload-induced Ca2+ release (SOICR). Given the critical role of SOICR in arrhythmogenesis, it is of importance to determine whether there are other ß-blockers that suppress SOICR. Here, we assessed the effect of other commonly used ß-blockers on RyR2-mediated SOICR in HEK293 cells, using single-cell Ca2+ imaging. Of the 13 ß-blockers tested, only nebivolol, a ß-1-selective ß-blocker with nitric oxide synthase (NOS)-stimulating action, effectively suppressed SOICR. The NOS inhibitor (N-nitro-l-arginine methyl ester) had no effect on nebivolol's SOICR inhibition, and the NOS activator (histamine or prostaglandin E2) alone did not inhibit SOICR. Hence, nebivolol's SOICR inhibition was independent of NOS stimulation. Like carvedilol, nebivolol reduced the opening of single RyR2 channels and suppressed spontaneous Ca2+ waves in intact hearts and catecholaminergic polymorphic ventricular tachycardia (CPVT) in the mice harboring a RyR2 mutation (R4496C). Interestingly, a non-ß-blocking nebivolol enantiomer, (l)-nebivolol, also suppressed SOICR and CPVT without lowering heart rate. These data indicate that nebivolol, like carvedilol, possesses a RyR2-targeted action that suppresses SOICR and SOICR-evoked VTs. Thus, nebivolol represents a promising agent for Ca2+-triggered arrhythmias.

Non-ß-blocking R-carvedilol enantiomer suppresses Ca2+ waves and stress-induced ventricular tachyarrhythmia without lowering heart rate or blood pressure.

Carvedilol is the current ß-blocker of choice for suppressing ventricular tachyarrhythmia (VT). However, carvedilol's benefits are dose-limited, attributable to its potent ß-blocking activity that can lead to bradycardia and hypotension. The clinically used carvedilol is a racemic mixture of ß-blocking S-carvedilol and non-ß-blocking R-carvedilol. We recently reported that novel non-ß-blocking carvedilol analogues are effective in suppressing arrhythmogenic Ca(2+) waves and stress-induced VT without causing bradycardia. Thus, the non-ß-blocking R-carvedilol enantiomer may also possess this favourable anti-arrhythmic property. To test this possibility, we synthesized R-carvedilol and assessed its effect on Ca(2+) release and VT. Like racemic carvedilol, R-carvedilol directly reduces the open duration of the cardiac ryanodine receptor (RyR2), suppresses spontaneous Ca(2+) oscillations in human embryonic kidney (HEK) 293 cells, Ca(2+) waves in cardiomyocytes in intact hearts and stress-induced VT in mice harbouring a catecholaminergic polymorphic ventricular tachycardia (CPVT)-causing RyR2 mutation. Importantly, R-carvedilol did not significantly alter heart rate or blood pressure. Therefore, the non-ß-blocking R-carvedilol enantiomer represents a very promising prophylactic treatment for Ca(2+)- triggered arrhythmia without the bradycardia and hypotension often associated with racemic carvedilol. Systematic clinical assessments of R-carvedilol as a new anti-arrhythmic agent may be warranted.

Association between Propionibacterium acnes and frozen shoulder: a pilot study.

BACKGROUND: Frozen shoulder has not previously been shown to be associated with infection. The present study set out to confirm the null hypothesis that there is no relationship between infection and frozen shoulder using two modern scientific methods, extended culture and polymerase chain reaction (PCR) for bacterial nucleic acids. METHODS: A prospective cohort of 10 patients undergoing arthroscopic release for stage II idiopathic frozen shoulder had two biopsies of tissue taken from the affected shoulder joint capsule at the time of surgery, along with control biopsies of subdermal fat. The biopsies and controls were examined with extended culture and PCR for microbial nucleic acid. RESULTS: Eight of the 10 patients had positive findings on extended culture in their shoulder capsule and, in six of these, Propionibacterium acnes was present. CONCLUSIONS: The findings mean that we must reject the null hypothesis that there is no relationship between infection and frozen shoulder. More studies are urgently needed to confirm or refute these findings. If they are confirmed, this could potentially lead to new and effective treatments for this common, painful and disabling condition. Could P. acnes be the Helicobacter of frozen shoulder?

Novel carvedilol analogues that suppress store-overload-induced Ca2+ release.

Carvedilol is a uniquely effective drug for the treatment of cardiac arrhythmias in patients with heart failure. This activity is in part because of its ability to inhibit store-overload-induced calcium release (SOICR) through the RyR2 channel. We describe the synthesis, characterization, and bioassay of ca. 100 compounds based on the carvedilol motif to identify features that correlate with and optimize SOICR inhibition. A single-cell bioassay was employed on the basis of the RyR2-R4496C mutant HEK-293 cell line in which calcium release from the endoplasmic reticulum through the defective channel was measured. IC50 values for SOICR inhibition were thus obtained. The compounds investigated contained modifications to the three principal subunits of carvedilol, including the carbazole and catechol moieties, as well as the linker chain containing the ß-amino alcohol functionality. The SAR results indicate that significant alterations are tolerated in each of the three subunits.

Social insect genomes exhibit dramatic evolution in gene composition and regulation while preserving regulatory features linked to sociality.

Genomes of eusocial insects code for dramatic examples of phenotypic plasticity and social organization. We compared the genomes of seven ants, the honeybee, and various solitary insects to examine whether eusocial lineages share distinct features of genomic organization. Each ant lineage contains ∼4000 novel genes, but only 64 of these genes are conserved among all seven ants. Many gene families have been expanded in ants, notably those involved in chemical communication (e.g., desaturases and odorant receptors). Alignment of the ant genomes revealed reduced purifying selection compared with Drosophila without significantly reduced synteny. Correspondingly, ant genomes exhibit dramatic divergence of noncoding regulatory elements; however, extant conserved regions are enriched for novel noncoding RNAs and transcription factor-binding sites. Comparison of orthologous gene promoters between eusocial and solitary species revealed significant regulatory evolution in both cis (e.g., Creb) and trans (e.g., fork head) for nearly 2000 genes, many of which exhibit phenotypic plasticity. Our results emphasize that genomic changes can occur remarkably fast in ants, because two recently diverged leaf-cutter ant species exhibit faster accumulation of species-specific genes and greater divergence in regulatory elements compared with other ants or Drosophila. Thus, while the "socio-genomes" of ants and the honeybee are broadly characterized by a pervasive pattern of divergence in gene composition and regulation, they preserve lineage-specific regulatory features linked to eusociality. We propose that changes in gene regulation played a key role in the origins of insect eusociality, whereas changes in gene composition were more relevant for lineage-specific eusocial adaptations.

Cyclic seleninate esters as catalysts for the oxidation of sulfides to sulfoxides, epoxidation of alkenes, and conversion of enamines to α-hydroxyketones.

Cyclic seleninate esters serve as catalysts for the rapid oxidation of sulfides to sulfoxides, alkenes to epoxides, and enamines to α-hydroxyketones. Optimal conditions were found that minimize the overoxidation of the product sulfoxides to sulfones and the hydrolysis of epoxides to diols. In some examples such as styrene derivatives, oxidative cleavage was observed instead of epoxidation. The enamine oxidations proceed via the initial formation of dimeric 2,5-diamino-1,4-dioxane species, which were hydrolyzed in situ to the final products. The structure of one such dimer was confirmed by X-ray crystallography.

Carvedilol and its new analogs suppress arrhythmogenic store overload-induced Ca2+ release.

Carvedilol is one of the most effective beta blockers for preventing ventricular tachyarrhythmias in heart failure, but the mechanisms underlying its favorable antiarrhythmic benefits remain unclear. Spontaneous Ca(2+) waves, also called store overload-induced Ca(2+) release (SOICR), evoke ventricular tachyarrhythmias in individuals with heart failure. Here we show that carvedilol is the only beta blocker tested that effectively suppresses SOICR by directly reducing the open duration of the cardiac ryanodine receptor (RyR2). This unique anti-SOICR activity of carvedilol, combined with its beta-blocking activity, probably contributes to its favorable antiarrhythmic effect. To enable optimal titration of carvedilol's actions as a beta blocker and as a suppressor of SOICR separately, we developed a new SOICR-inhibiting, minimally beta-blocking carvedilol analog, VK-II-86. VK-II-86 prevented stress-induced ventricular tachyarrhythmias in RyR2-mutant mice and did so more effectively when combined with either of the selective beta blockers metoprolol or bisoprolol. Combining SOICR inhibition with optimal beta blockade has the potential to provide antiarrhythmic therapy that can be tailored to individual patients.

Changing prophylactic antibiotic protocol for reducing Clostridium difficile-associated diarrhoeal infections.

PURPOSE: To determine whether a change in prophylactic antibiotic protocol for orthopaedic surgeries may reduce the frequency of Clostridium difficile-associated diarrhoeal infections. METHODS: Records of 1331 patients who underwent trauma or elective surgeries involving implantation of metalwork were reviewed. 231 trauma and 394 elective patients who received intravenous cefuroxime-based antibiotic prophylaxis between August 2006 and January 2007 were compared with 216 trauma and 490 elective patients who received a single dose of gentamicin and flucloxacillin or teicoplanin for antibiotic prophylaxis between August 2007 and January 2008. Diarrhoeal faecal specimens of 148 (33%) trauma patients and 106 (12%) elective patients were examined. The outcome variables were the rates of C difficile infection and early deep wound infection. RESULTS: There were 32 cases of C difficile-associated diarrhoeal infection and 28 cases of early deep wound infection. The frequency of C difficile-associated diarrhoeal infection decreased after use of the new antibiotic protocol (from 4 to 1%, p = 0.004), particularly in the trauma patients (from 8 to 3%, p = 0.02); in the elective patients the difference was not significant (from 1 to 0.5%, p = 0.27). The change of antibiotic protocol did not significantly affect the incidence of deep wound infections in the trauma (p = 0.46) or elective (p = 0.90) patients. The rate of C difficile infection was 8-fold higher in the trauma than elective patients, both before and after the change of protocol. CONCLUSION: Changing antibiotic protocol is one way of reducing the incidence of C difficile-associated diarrhoeal infections in orthopaedic patients, without increasing the rate of deep wound infections.

Investigation of substituent effects on the selectivity of 4pi-electrocyclization of 1,3-diarylallylic cations for the formation of highly substituted indenes.

Differentially substituted 1,3-diaryl-substituted allylic cations generated by ionization of the corresponding allylic alcohols in the presence of a Lewis acid undergo chemoselective and regioselective electrocyclization reactions to generate 1-aryl-1H-indenes. Electrocyclization only occurs for allylic cations bearing a 2-substituent, with 2-ester and 2-alkyl substituents both tolerated. In general, the presence of electron-withdrawing substituents deactivates the ring and disfavors cyclization. In contrast, the selectivity of cyclization of systems containing electron-donating substituents depends on the nature and position of the electron-donating group. Electron-donating substituents at the meta position particularly favor cyclization. There was no obvious correlation of cyclization selectivity with calculated electron densities as has been suggested for electrophilic aromatic substitution reactions. However, the calculated selectivities determined by a gas-phase (B3LYP/6-31G* + ZPVE) comparison of the relative rates of cyclization were in remarkably good agreement with the observed selectivities. Calculated transition-state structures for cyclization are consistent with a cationic pi4(a) conrotatory electrocyclization mechanism. In some cases involving more electron-deficient systems, the initially formed 1H-indene underwent subsequent alkene isomerization to the 3H-indene. In one example, an unusual dimerization reaction occurred to give a cyclopenta[a]indene via an unusual formal cationic 2pi+2pi cycloaddition of the allylic cation with the intermediate indene.

Cutaneous periocular Habronema infection in a dromedary camel (Camelus dromedarius).

A 6-year-old castrated dromedary camel (Camelus dromedarius) presented with a non-healing, severely pruritic, ulcerative fibrotic plaque located at the medial canthus. Histological examination of surgical biopsies identified degenerating nematode larvae within eosinophilic granulomas. Treatment involved repeated debridement of the lesion, injectable ivermectin and anti-inflammatory therapies, and injectable and topical antibiotics. A specially constructed mask with goggles to prevent the camel from continuing to self-traumatize the eye and lesion was also placed. Full recovery occurred approximately 1 month after diagnosis. Because of the location of the lesion, time of year, the gross and microscopic characteristics of the lesion, the presence of a likely nematode larva and the response to treatment, a diagnosis of cutaneous habronemiasis was made.

Dynamic and static external fixation for distal radius fractures--a systematic review.

INTRODUCTION: External fixation of distal radius fractures may be static (wrist-bridging) or dynamic (wrist-bridging with mobile hinge or non-bridging). The aim of this systematic review is to investigate the effectiveness of different methods of external fixation for unstable distal radius fractures. METHODS: A Medline database search was performed with strict eligibility criteria to obtain the highest quality evidence from meta-analyses, RCTs and comparative studies. Eligible studies were critically appraised using levels of evidence and RCTs were further appraised using a validated scoring tool. RESULTS: Fifty-four studies were identified of which eight were included. There were six RCTs and two retrospective comparative studies. Three RCTs compared non-bridging with static wrist-bridging fixation. Two RCTs compared dynamic wrist-bridging with static wrist-bridging fixation. One study compared dynamic wrist-bridging with non-bridging fixation. The RCTs varied in quality and scored between 12 and 23 out of a maximum of 33 points. The evidence suggests that there are no functional or radiological benefits for a dynamic wrist-bridging external fixator with a mobile hinge joint over a static wrist-bridging external fixator. The evidence also suggests that there are no benefits for non-bridging over static wrist-bridging external fixation in older patients but there do appear to be clear benefits both functionally and radiologically when considering patients of all ages. CONCLUSION: Dynamic and static external fixators both achieve good outcomes for patients with unstable distal radius fractures with comparable complication rates. Non-bridging fixation may result in better functional and radiological results than static wrist-bridging fixation when considering patients of all ages with earlier return of function. This benefit does not seem apparent when considering older patients. Although a benefit was not seen in this group, the technique may have practical advantages over wrist-bridging fixation by allowing increased mobility and use of the limb during the fixation period and enabling such patients to maintain their independence. Cost effective analyses are required to assess whether this would be an economically viable option for this group of patients.

Lewis Acid catalyzed three-component hetero-Diels-alder (povarov) reaction of N-arylimines with strained norbornene-derived dienophiles.

Generally, the hetero-Diels-Alder reaction (Povarov reaction) of N-arylimine dienes are limited to reaction with activated, electron-rich alkenes. However, introduction of ring strain in the dienophile, as with moderately strained bicyclo[2.2.1]heptenes (norbornene), enables three-component Povarov reaction with in situ formed N-arylimines under Lewis acid catalyzed conditions (BF(3).OEt(2)). The reactions proceed efficiently with a diverse set of commercially available anilines and benzaldehydes, as well as a variety of substituted norbornenes. The corresponding tetrahydroquinolines are formed with high complexity in a multicomponent fashion and are obtained in good yield and high diastereoselectivity. In addition, more reactive ethyl glyoxylate derived imines were utilized to achieve faster, room temperature reactions with norbornene. In all cases, attack of the N-arylimine dienes occurred exclusively from the exo-face of the norbornene ring, but the relative stereochemistry of the substituent alpha to the tetrahydroquinoline nitrogen, as well as the regioselectivity of reaction, was shown to depend upon subtle substituent effects on the aniline precursors. In most cases, a preference for the formation of exo-exo diastereomeric adducts was observed, but for reactions of ortho- or meta-substituted anilines, the formation of exo-endo adducts was also observed. These observations may be rationalized by two competing mechanistic models, involving either a concerted asynchronous [4 + 2]-like mechanism or a stepwise mechanism.

The compressive behavior of the human glenoid labrum may explain the common patterns of SLAP lesions.

PURPOSE: The aim of the study was to define the normalized compressive stiffness (modulus) of the glenoid labrum around its circumference and to characterize the difference in modulus between different areas. METHODS: Sixteen fresh-frozen cadaveric shoulders were harvested and dissected down to the glenoid labrum. Any specimens with significant degenerative changes were discarded, leaving 8 labra for testing. The labrum was divided into 8 segments, to allow comparison around its circumference. A uniform testing specimen was produced from each area by use of a microtome. Each specimen measured 3 x 1 mm in cross section and was 6 mm in length. Indentation testing was conducted in a controlled environment of 100% humidity at 37 degrees C +/- 1 degrees C. RESULTS: We obtained 52 test samples from 8 labra. The mean modulus of the glenoid labrum was 69.7 megapascal (standard deviation, 36.2 megapascal). The anterosuperior portion of the labrum had a higher modulus than the posteroinferior portion (P = .0075). CONCLUSIONS: This study has shown that the human glenoid labrum's compressive behavior varies around its circumference. The greater modulus of the anterosuperior portion of the labrum supports the theory that this area is anatomically different from the rest of the labrum and resists compressive loads. CLINICAL RELEVANCE: These results may explain why the common type of SLAP lesions seen show failure at the interface between the labrum and the glenoid rather than within the substance of the labrum itself.

The early identification of dyslexia: children with English as an additional language.

It is generally accepted that dyslexia should be identified early for interventions to have maximum effect. However, when children speak English as an additional language (EAL), diagnosis is more complex and there is concern that these children tend to be under-identified. This paper reports a longitudinal study following the development of phonological awareness skills in relation to progress in learning to read with a cohort of British Asian children learning EAL and their monolingual peers. It also sought to determine the usefulness of a measure of phonological skills for the identification of dyslexic-type difficulties in children learning EAL. Analysis revealed that both cohorts achieved similar levels of reading accuracy in school Years 2, 4 and 6, with higher levels of reading comprehension for the monolingual children and faster reading fluency for children learning EAL in each school year. There was a similar pattern of relationships between the reading measures and measures of phonological awareness for both groups of children. However, monolingual children achieved higher levels of rhyme detection and alliteration fluency whilst the children learning EAL achieved faster number naming times. Overall, a phonological assessment battery was useful in identifying reading accuracy related difficulties in both groups of children. However, concerns are raised about the sensitivity of such measures following the introduction of the Literacy Hour.