Prevalence of radiographic findings in individuals with chronic low back pain screened for a randomized controlled trial: secondary analysis and clinical implications.

OBJECTIVE: The purpose of this study is to measure the prevalence of graded disc degeneration, spondylolisthesis, transitional segmentation, and the distribution of sacral slope in patients 21 to 65 years of age with chronic low back pain (CLBP). METHODS: This retrospective study analyzed 247 digital lumbar radiographic series obtained during a randomized controlled trial of chiropractic patients with CLBP. Chronic low back pain was defined as pain in the low back lasting 12 weeks or longer. Radiographic findings of disc degeneration, spondylolisthesis, and lumbosacral transitional segmentation were graded by 2 authors using established classification criteria. Sacral slope was measured with a digital tool contained within imaging software. RESULTS: Lumbosacral transitional segments graded I to IV (Castellvi classification) were present in 14% of cases. Lumbar disc degeneration was most prevalent at L3-4 (49%), followed by L4-5 (42%), L2-3 (41%), L5-S1 (37%), and L1-2 (29%). Isthmic spondylolisthesis was present in 5% of cases, with L5 the most common location. Degenerative spondylolisthesis demonstrated a prevalence of 18%, most commonly occurring at L4. The prevalence of degenerative spondylolisthesis was 51% for women aged 50 to 59 years and 24% for men in the same age range. CONCLUSIONS: Moderate-severe disc degeneration, multilevel disc narrowing, and degenerative spondylolisthesis were common in individuals with CLBP with age more than 40 years. Isthmic spondylolisthesis was not more prevalent than what has been reported in other populations. Transitional segmentation was identified in a minority of participants, with some of these exhibiting accessory joints or fusion. Mean sacral slope in individuals with CLBP was not substantially different from mean slopes reported in other populations.

Development of an evidence-based application and rubric for evaluating applicants' qualifications for promotion to professor.

OBJECTIVE: Every promotion committee is challenged by the need to make value judgments on the quantity and quality of peer work. Decisions based upon subjective assessments may not do justice to the applicant's or the institution's needs. The purpose of this article is to (1) describe the process a college promotion committee used to increase the objectivity brought to this activity, (2) present the tools developed that facilitated the collection and evaluation of faculty work, and (3) describe their usage in a promotion cycle. METHODS: The Professor Promotion Committee met weekly for 6 months engaging in lengthy and comprehensive discourse to capture the breadth of scholastic and service activities normally engaged in by faculty. RESULTS: The committee's work culminated in the development of 4 electronic applications soliciting specific evidence aligned with faculty work and 1 scoring rubric tied directly to the e-applications. More than 55 activities were identified, divided into 4 levels of accomplishment using quantitative and qualitative criteria and weighted according to their centrality to faculty work and relative importance to the institution. Each activity was assigned to one of the following categories: teaching/academic support, scholarship/research, service, and professional development. A consensus score based upon the evidence was used to generate promotion discussions. CONCLUSIONS: The committee believes the online application aids applicants in recognizing the breadth and depth of promotable work. It provides them the opportunity to structure their work in ways that enhance their chances for promotion. The evidence-based rubric helps to reduce subjectivity in the evaluation process.

Cyclooxygenase-2 expression in uveal melanoma: novel classification of mixed-cell-type tumours.

BACKGROUND: The expression of cyclooxygenase-2 (COX-2), an inducible prostaglandin (PG) synthase, has been investigated in various human malignant diseases, such as cutaneous melanoma. We investigated the expression of COX-2 in uveal melanoma and related the findings to prognostic factors. METHODS: In 40 cases of uveal melanoma, immunostaining for COX-2 was done. COX-2 expression was related to histopathological prognostic markers, such as cell type, the presence of lymphocytic infiltration and vascular closed loops in the tumour, and cytomorphometry results. RESULTS: COX-2 expression was found in 58% of the cases, and it correlated with markers of poor prognosis, such as epithelioid cell type and the presence of lymphocytic infiltration and vascular closed loops. The uveal melanomas expressing COX-2 had larger nuclei, as determined by cytomorphometry. INTERPRETATION: Whereas epithelioid tumours carry a worse prognosis than spindle cell tumours, until now it has not been possible to give a strong indication of prognosis in mixed-cell tumours. This study showed that mixed-cell tumours, representing the majority of uveal melanomas, may be further subclassified according to COX-2 expression, which serves as a marker of poor prognosis. The role of COX-2 in uveal melanoma should be further elucidated, and the use of COX-2 inhibitors warrants investigation as adjuvant treatment for this life-threatening malignant disease.