Evaluating reliability and validity of the modified radiographic union scale for tibia (mRUST) among North American and Tanzanian surgeons.

OBJECTIVES: To determine the international reliability and validity of the modified Radiographic Union Scale for Tibial fracture (mRUST) scoring method for open tibial shaft fractures based on ratings of radiographs by separate groups of North American and Tanzanian surgeons. METHODS: Seven North American and 9 Tanzanian surgeons viewed 100 pairs of AP and lateral radiographs of open tibial shaft fractures obtained in Dar Es Salaam, Tanzania. The radiographs showed 25 patients' fractures at 4 time points postfracture after treatment with either external fixation or intramedullary nailing. Surgeons evaluated each fracture using the mRUST scoring method and indicated their confidence that the fracture was healed on a scale from 1 to 10. Reliability of mRUST was determined using inter-rater agreement among North American and Tanzanian surgeons. Validity was determined via analysis of correlation between mRUST scores and EQ-5D-3L index scores at each time point postfracture. RESULTS: mRUST scores demonstrated strong reliability overall (ICC = 0.64) as well as within each group of North American (ICC = 0.72) and Tanzanian (ICC = 0.69) surgeons. Reliability was stronger for external fixation than for intramedullary nailing cases. mRUST scores were significantly correlated with overall healing confidence at all time points and with quality of life at 6 months and 1 year postfracture. mRUST scores also correlated significantly with patients' quality of life scores (EQ-5D index) at 6 months and 1 year postfracture. CONCLUSION: North American and Tanzanian surgeons exhibited strong agreement in rating open tibial shaft fractures. Using mRUST scores is a valid means of assessing radiographic healing of tibial fractures in austere environments like Tanzania.

Psychological and neural responses to architectural interiors.

People spend considerable time within built environments. In this study, we tested two hypotheses about the relationship between people and built environments. First, aesthetic responses to architectural interiors reduce to a few key psychological dimensions that are sensitive to design features. Second, these psychological dimensions evoke specific neural signatures. In Experiment 1, participants (n = 798) rated 200 images of architectural interiors on 16 aesthetic response measures. Using Psychometric Network Analysis (PNA) and Principal Components Analysis (PCA), we identified three components that explained 90% of the variance in ratings: coherence (ease with which one organizes and comprehends a scene), fascination (a scene's informational richness and generated interest), and hominess (extent to which a scene reflects a personal space). Whereas coherence and fascination are well-established dimensions in response to natural scenes and visual art, hominess emerged as a new dimension related to architectural interiors. In Experiment 2 (n = 614), the PCA results were replicated in an independent sample, indicating the robustness of these three dimensions. In Experiment 3, we reanalyzed data from an fMRI study in which participants (n = 18) made beauty judgments and approach-avoidance decisions when viewing the same images. Parametric analyses demonstrated that, regardless of task, the degree of fascination covaried with neural activity in the right lingual gyrus. In contrast, coherence covaried with neural activity in the left inferior occipital gyrus only when participants judged beauty, whereas hominess covaried with neural activity in the left cuneus only when they made approach-avoidance decisions. Importantly, this neural activation did not covary in relation to global image properties including self-similarity and complexity scores. These results suggest that the visual brain harbors sensitivities to psychological dimensions of coherence, fascination, and hominess in the context of architectural interiors. Furthermore, valuation of architectural processing in visual cortices varies by dimension and task.