Small Group Conversations in a POGIL-Based Class: How English Learners Engage in a Joint Knowledge Construction Process to Reach a Shared Understanding.

Collaboration is an aspect of engagement that focuses on learning through group work and having discussions with other learners. Active learning approaches are a way to foster collaborative engagement because they provide more opportunities for interaction among learners. Process Oriented Guided Inquiry Learning (POGIL), a socially mediated active learning approach, uses verbalizing and discussing ideas with peers in small groups to reach a shared understanding. Due to the growing number of immigrants in the United States, the number of English Learners (ELs) in American classrooms has been increasing rapidly. ELs encounter challenges such as unfamiliarity with American science class norms and expectations, feelings of not being valued and socially accepted, and instructors' lower expectations of them. These challenges can impact this group of students' learning and achievements. Previous studies have discussed that learning chemistry can be more challenging for EL students due to the critical role of language in learning. We argue that ELs use discourse moves differently compared to non-ELs in a POGIL-based class in terms of engaging in conversations that can lead to a shared understanding at the group level through a joint knowledge construction process. Our findings indicated that, in our sample, ELs were less likely to engage in discursive moves than non-ELs. This difference may result in missed opportunities for a shared understanding and joint knowledge construction. In addition to differences between EL and non-EL students in our samples, we also found differences between EL students who attended K-12 schools in the United States compared to international EL students. Implications for future studies of these possibly distinct EL populations are considered.

Factors associated with parent and youth athlete concussion knowledge.

INTRODUCTION: On-site health care providers are not routinely present at all youth sport events. Therefore, parents and youth athletes are often responsible for identifying and making appropriate immediate care decisions regarding concussions, which may be influenced by their injury health literacy. Previous studies have investigated the level of concussion knowledge of parents and athletes, but few have investigated factors associated with greater awareness at the youth sport level specifically. METHOD: A total of 466 parents and 390 youth contact sport athletes from Pennsylvania and Michigan completed separate surveys of concussion knowledge and personal and family demographic information. RESULTS: Parents had a mean concussion knowledge score of 39.3 ±â€¯4.6 out of a possible 47 points. Having a medical occupation (p = .04) and being older in age (p = .03) were associated with higher concussion knowledge scores in parents (R2 = 0.018; 95% CI = 32.77-38.99). Youth athletes had a mean concussion knowledge score of 35.0 ±â€¯5.7 out of 47. Having learned about concussion previously (p < .001), having a history of diagnosed concussion(s) (p = .01), sport type (relative to girls' ice hockey, p < .001), older age (p < .001), and parent concussion knowledge (p = .04) were associated with higher youth athlete concussion knowledge (R2 = 0.176; 95% CI = 19.08-31.72). CONCLUSIONS: More evidence-based concussion awareness resources are needed at the youth sport level. While it did not significantly influence concussion knowledge for parents, concussion education is a modifiable factor that may be essential for improving concussion knowledge of youth athletes, thus warranting further study into effective awareness strategies for this population. Practical Applications: The factors found to influence concussion knowledge in this study could be considered in future educational concussion initiatives for youth athletes and their parents in order to increase awareness regarding the potential dangers of participating in sport while concussed.

The Single Leg Squat Test: A "Top-Down" or "Bottom-Up" Functional Performance Test?

BACKGROUND: Medial knee deviation (MKD) during the single leg squat test (SLST) is a common clinical finding that is often attributed to impairments of proximal muscular structures. Investigations into the relationship between MKD and the foot and ankle complex have provided conflicting results, which may impact clinicians' interpretation of the SLST. PURPOSE: The purpose of this study was to compare ankle dorsiflexion range of motion (ROM) and foot posture in subjects that perform the SLST with MKD (fail) versus without MKD (pass). HYPOTHESIS: There will be a difference in ankle dorsiflexion ROM and/or foot posture between healthy individuals that pass and fail the SLST for MKD. STUDY DESIGN: Cross-sectional study. METHODS: Sixty-five healthy, active volunteers (sex = 50 female, 15 male; age = 25.2 +/- 5.6 years; height = 1.7 +/- .1 m; weight = 68.5 +/- 13.5 kg) who demonstrated static balance and hip abductor strength sufficient for performance of the SLST participated in the study. Subjects were divided into pass and fail groups based on visual observation of MKD during the SLST. Foot Posture Index (FPI-6) scores and measures of non-weight bearing and weight bearing active ankle dorsiflexion (ROM) were compared. RESULTS: There were 33 individuals in the pass group and 32 in the fail group. The groups were similar on age (p = .899), sex (p = .341), BMI (p = .818), and Tegner Activity Scale score (p = .456). There were no statistically significant differences between the groups on the FPI-6 (pass group mean = 2.5 +/- 3.9; fail group mean = 2.3 +/- 3.5; p = .599), or any of the measures of dorsiflexion range of motion (non-weight bearing dorsiflexion with knee extended: pass group = 6.9o +/- 3.7o, fail group = 7.8o +/- 3.0o; non-weight bearing dorsiflexion with knee flexed: pass group = 13.5o +/- 5.6o, fail group = 13.9o +/- 5.3o; weight bearing dorsiflexion: pass group = 42.7o +/- 6.0o, 42.7o +/- 8.3o, p = .611). CONCLUSIONS: Failure on the SLST is not related to differences in clinical measures of active dorsiflexion ROM or foot posture in young, healthy individuals. These findings suggest that clinicians may continue using the SLST to assess neuromuscular performance of the trunk, hip, and knee without ankle dorsiflexion ROM or foot posture contributing to results. LEVEL OF EVIDENCE: Level 3.

Junior and Collegiate Tennis Players Display Similar Bilateral Asymmetries of Humeral Retroversion.

CONTEXT: Overhead throwing athletes consistently display significant bilateral differences in humeral retroversion (HRV). However, there is limited evidence regarding HRV asymmetries in tennis players despite similarities between the overhead throw and tennis serve. OBJECTIVE: To determine if junior and collegiate tennis players demonstrate bilateral differences in HRV, and whether the magnitude of the side-to-side difference (HRVΔ) was similar across different age groups. DESIGN: Cross-Sectional Study Setting: Field-Based Patients or Other Participants: Thirty-nine healthy tennis players were stratified into three age groups: Younger Juniors (n = 11; age = 14.5 ± 0.5 years), Older Juniors (n = 12; age = 17.1 ± 0.9 years), and Collegiate (n = 16; age = 19.6 ± 1.2 years). MAIN OUTCOME MEASURES: Three-trial means were calculated for HRV for the dominant and nondominant limbs, and HRVΔ was calculated by subtracting the mean of the nondominant side from the dominant side. Paired-sample t-tests were utilized to determine bilateral differences in HRV, while a one-way ANOVA was used to compare HRVΔ between groups. RESULTS: For all three groups, HRV was significantly greater in the dominant arm compared to the nondominant arm (Younger Juniors: dominant = 62.8° ± 9.1° vs nondominant = 56.3° ± 6.8°, P = .039; Older Juniors: dominant = 75.5° ± 11.2° vs nondominant = 68.6° ± 14.2°, P = .043; Collegiate: dominant = 71.7° ± 8.5° vs nondominant = 61.2° ± 6.9°, P = .001). However, no significant differences were detected in HRVΔ when compared across age groups (P = .511). CONCLUSIONS: Consistent with studies involving overhead throwing athletes, tennis players demonstrated significantly greater measures of HRV in the dominant limb. Further, the development of HRV asymmetries appear to have occurred prior to the teenage years as no changes were observed in HRVΔ between age groups.

Integrated Meditation and Exercise Therapy: A Randomized Controlled Pilot of a Combined Nonpharmacological Intervention Focused on Reducing Disability and Pain in Patients with Chronic Low Back Pain.

OBJECTIVE: This pilot trial examined the effects of a combined intervention of mindfulness meditation followed by aerobic walking exercise compared with a control condition in chronic low back pain patients. We hypothesized that meditation before exercise would reduce disability, pain, and anxiety by increasing mindfulness prior to physical activity compared with an audiobook control group. PARTICIPANTS: Thirty-eight adults completed either meditation and exercise treatment (MedExT) (n=18) or an audiobook control condition (n=20). SETTING: Duquesne University Exercise Physiology Laboratory. DESIGN: A pilot, assessor-blinded, randomized controlled trial. METHODS: Over a 4-week period, participants in the MedExT group performed 12-17 minutes of guided meditation followed by 30 minutes of moderate-intensity walking exercise 5 days per week. Measures of disability, pain, mindfulness, and anxiety were taken at baseline and postintervention. Pain perception measurements were taken daily. RESULTS: Compared with the control group, we observed larger improvements in disability in the MedExT intervention, although the changes were modest and not statistically significant (mean between-group difference, -1.24; 95% confidence interval [CI], -3.1 to 0.6). For secondary outcome measures, MedExT increased mindfulness (within-group) from pre-intervention to postintervention (P=0.0141). Additionally, mean ratings of low back pain intensity and unpleasantness significantly improved with time for the MedExT group compared with that of the control group, respectively (intensity P=0.0008; unpleasantness P=0.0022). CONCLUSION: . Overall, 4 weeks of MedExT produced suggestive between-group trends for disability, significant between-group differences for measures of pain, and significant within-group increases in mindfulness.

Ground Reaction Forces Are Predicted with Functional and Clinical Tests in Healthy Collegiate Students.

Increased vertical and posterior ground reaction forces (GRFs) are associated with anterior cruciate ligament (ACL) injury. If a practical means to predict these forces existed, ACL injury risk could be attenuated. Forty-two active college-age individuals (21 females, 20.66 ± 1.46 y, 70.70 ± 2.36 cm, 82.20 ± 7.60 kg; 21 males, 21.57 ± 1.28 y, 65.52 ± 1.87 cm, 64.19 ± 9.05 kg) participated in this controlled laboratory study. GRFs were ascertained by having the subjects perform a unilateral landing task onto a force plate. Several clinical measures (Fat Free Mass (FFM), dorsiflexion passive range of motion (DPROM), isometric peak force of the lateral hip rotators, knee flexor/extensor peak force ratio (H:Q), the completion of the overhead deep squat), two functional tests (Margaria-Kalamen, Single Leg Triple Hop (SLTH)), and sex served as the predictor variables. Regression models to predict the GRFs normalized to the FFM (nGRFz, nGRFy) were generated. nGRFz was best predicted with a linear regression equation that included SLTH and DPROM (adjusted R2 = 0.274; p = 0.001). nGRFy was best predicted with a linear regression equation that included H:Q, FFM, and DPROM (adjusted R2 = 0.476; p < 0.001). Simple clinical measures and functional tests explain a small to moderate amount of the variance associated with the FFM normalized vertical and posterior GRFs in active college-age individuals.

Conservative management acutely improves functional movement and clinical outcomes in patients with pre-arthritic hip pain.

Conservative management for individuals with pre-arthritic hip pain is commonly prescribed prior to consideration of surgical management. The purpose of this study is to determine if patients with pre-arthritic hip pain will improve their functional movement control and clinical outcome measures following the implementation of physical therapy and a home-exercise programme. Information was retrospectively collected on consecutive patients and included: demographics, diagnosis, initial and follow-up evaluation of the single leg squat test (SLST) and step-down test (SDT), and patient-reported outcome measures. An independent t-test and one-way analysis of covariance were performed for continuous patient-reported outcome measures and a Fisher's exact test was performed for patient satisfaction. Forty-six patients (31 female and 15 male) diagnosed with pre-arthritic hip pain were included. A total of 30 patients improved their functional movement control during performance of the SLST, whereas 31 patients improved performance of the SDT. There was a statistically significant difference between patients that improved and did not improve (P ≤ 0.017). Patients with pre-arthritic hip pain who improved their functional movement control following a prescribed rehabilitation intervention are likely to report less pain and greater functional ability in their daily and sports-related activities. This study supports conservative management to acutely improve outcomes for patients with pre-arthritic hip pain.

The dosing of aerobic exercise therapy on experimentally-induced pain in healthy female participants.

Knowledge of efficacious dosing respective to exercise type and pain condition is extremely limited in the literature. This study aimed to determine the impact of dose of moderate intensity treadmill walking on experimentally-induced pain in healthy human participants. Forty females were divided into 4 groups: control (no exercise), low dose exercise (3×/wk), moderate dose exercise (5×/wk) or high dose exercise (10×/wk). Over a 7-day period, subjects performed treadmill walking during assigned exercise days. Both qualitative and quantitative measures of pain were measured at baseline, during the trial, and 24 hrs post-final intervention session via sensitivity thresholds to painful thermal and painful pressure stimulation. Significant effects of treatment were found post-intervention for constant pressure pain intensity (p = 0.0016) and pain unpleasantness ratings (p = 0.0014). Post-hoc tests revealed significant differences between control and moderate and control and high dose groups for constant pressure pain intensity (p = 0.0015), (p = 0.0094), respectively and constant pressure pain unpleasantness (p = 0.0040), (p = 0.0040), respectively. Moderate and high dose groups had the greatest reductions in ratings of pain, suggesting that our lowest dose of exercise was not sufficient to reduce pain and that the moderate dose of exercise may be a sufficient starting dose for exercise-based adjuvant pain therapy.

Evidence for Reliability and Validity of Functional Performance Testing in the Evaluation of Nonarthritic Hip Pain.

CONTEXT: The single-legged-squat test (SLST) and step-down test (SDT) are 2 functional performance tests commonly used to evaluate active people with nonarthritic hip pain and dysfunction. However, evidence to support the use of the SLST and SDT in this population is lacking. OBJECTIVE: To offer evidence of reliability and validity for the SLST and SDT in evaluating patients with nonarthritic hip pain. DESIGN: Cross-sectional study. SETTING: Orthopaedic surgeon's clinical office. PATIENTS OR OTHER PARTICIPANTS: Forty-five patients (27 female and 18 male participants; age = 28.5 ± 10 years, height = 171.6 ± 10.1 cm, weight = 73.9 ± 15.2 kg, and body mass index = 25 ± 4.1) diagnosed with nonarthritic hip pain. MAIN OUTCOME MEASURE(S): Participants performed the SLST and SDT. Interrater reliability and validity of passive internal rotation of the hip, visual analog scale (VAS) scores, and hip outcome scores (HOSs) for limitations in activities of daily living and sport-related activities (SRAs) were collected. RESULTS: Interrater reliability was moderate to excellent for both the SLST (0.603-0.939) and SDT (0.745-0.943). Participants who passed or failed the SLST and SDT differed on the following measures: VAS for the SLST (F1,43 = 16.21, P < .001); VAS for the SDT (F1,43 = 13.41, P = .001); HOS-activities of daily living for the SLST (F1,40 = 5.15, P = .029); HOS-SRAs for the SLST (F1,40 = 7.48, P = .009); and HOS-SRAs for the SDT (F1,40 = 6.42, P = .015). CONCLUSIONS: Our study offers evidence for the use of the SLST and SDT as reliable and valid functional performance tests in the evaluation of physical function for patients with nonarthritic hip pain.

Exercise-induced hypoalgesia: A meta-analysis of exercise dosing for the treatment of chronic pain.

OBJECTIVE: Increasing evidence purports exercise as a first-line therapeutic for the treatment of nearly all forms of chronic pain. However, knowledge of efficacious dosing respective to treatment modality and pain condition is virtually absent in the literature. The purpose of this analysis was to calculate the extent to which exercise treatment shows dose-dependent effects similar to what is seen with pharmacological treatments. METHODS: A recently published comprehensive review of exercise and physical activity for chronic pain in adults was identified in May 2017. This report reviewed different physical activity and exercise interventions and their effectiveness in reducing pain severity and found overall modest effects of exercise in the treatment of pain. We analyzed this existing data set, focusing specifically on the dose of exercise intervention in these studies. We re-analyzed data from 75 studies looking at benefits of time of exercising per week, frequency of exercise per week, duration of intervention (in weeks), and estimated intensity of exercise. RESULTS: Analysis revealed a significant positive correlation with exercise duration and analgesic effect on neck pain. Multiple linear regression modeling of these data predicted that increasing the frequency of exercise sessions per week is most likely to have a positive effect on chronic pain patients. DISCUSSION: Modest effects were observed with one significant correlation between duration and pain effect for neck pain. Overall, these results provide insufficient evidence to conclude the presence of a strong dose effect of exercise in pain, but our modeling data provide tes predictions that can be used to design future studies to explicitly test the question of dose in specific patient populations.

Managing Aged Animals in Zoos to Promote Positive Welfare: A Review and Future Directions.

Improvements in veterinary care, nutrition, and husbandry of animals living in zoos have led to an increase in the longevity of these animals over the past 30 years. In this same time period, the focus of animal welfare science has shifted from concerns over mitigating negative welfare impacts to promoting positive welfare experiences for animals. For instance, providing opportunities for animals to exert agency, solve problems, or acquire rewards are all associated with positive welfare outcomes. Many common age-related changes result in limitations to opportunities for positive welfare experiences, either due to pain or other physical, cognitive, or behavioral limitations. This review aggregates information regarding common age-related physical and behavioral changes across species, discusses how age-related changes may limit positive welfare opportunities of aged animals in human care, and suggests potential management methods to help promote positive welfare for animals at all life stages in zoos and aquariums.

Reliability and Validity of a 1-Person Technique to Measure Humeral Torsion Using Ultrasound.

CONTEXT: Knowledge of the bilateral difference in humeral torsion (HT) enables clinicians to implement appropriate interventions for soft tissue restrictions of the shoulder to restore rotational motion and reduce injury risk. Whereas the current ultrasound method for measuring HT requires 2 assessors, a more efficient 1-person technique (1PT) may be of value. OBJECTIVE: To determine if a 1PT is a reliable and valid alternative to the established 2-person technique (2PT) for indirectly measuring HT using ultrasound. DESIGN: Descriptive laboratory study. SETTING: Biomechanics laboratory. PATIENTS OR OTHER PARTICIPANTS: A convenience sample of 16 volunteers (7 men, 9 women; age = 26.9 ± 6.8 years, height = 172.2 ± 10.7 cm, mass = 80.0 ± 13.3 kg). MAIN OUTCOME MEASURE(S): We collected the HT data using both the 1PT and 2PT from a total of 30 upper extremities (16 left, 14 right). Within-session intrarater reliability (intraclass correlation coefficient; ICC [3,1]) and standard error of measurement (SEM) were assessed for both techniques. Simple linear regression and Bland-Altman analysis were used to examine the validity of the 1PT when compared with the established 2PT. RESULTS: The 1PT (ICC [3,1] = 0.992, SEM = 0.8°) and 2PT (ICC [3,1] = 0.979, SEM = 1.1°) demonstrated excellent within-session intrarater reliability. A strong linear relationship was demonstrated between the HT measurements collected with both techniques ( r = 0.963, r2 = 0.928, F1,28 = 361.753, P < .001). A bias of -1.2° ± 2.6° was revealed, and the 95% limits of agreement indicated the 2 techniques can be expected to vary from -6.3° to 3.8°. CONCLUSIONS: The 1PT for measuring HT using ultrasound was a reliable and valid alternative to the 2PT. By reducing the number of testers involved, the 1PT may provide clinicians with a more efficient and practical means of obtaining these valuable clinical data. a.

An International Survey to Understand Infection Control Practices for Spinal Cord Stimulation.

OBJECTIVES: Surgical site infections (SSIs) are associated with significant healthcare costs and morbidity. Limited research exists specific to the prevention of spinal cord stimulation (SCS) SSIs. The objectives of this international survey were to examine current infection control practices for SCS trials and implants and to compare reported responses with evidence-based recommendations. MATERIALS AND METHODS: A 33-question survey was developed based on an extensive literature review for infection control policies. The survey was hosted on the Internet. Dispersion of the survey occurred through professional associations and device manufacturers. Responses to 15 questions directly related to defined CDC, NICE, and SCIP evidence-based infection control practice recommendations were classified as either compliant or noncompliant. The survey was open for 20 days. Responses also were grouped and analyzed based on geographic location, practice location, and procedural volumes. RESULTS: Five hundred six physicians responded to the survey. Compliance rates for CDC, NICE, SCIP infection control practice recommendations were low with only four of the 15 questions having compliance rates ≥80%. Areas associated with high levels of noncompliance included weight-based antibiotic dosing, hair removal strategies, double gloving, surgical dressing, skin antiseptic agent selection, and postoperative continuation of antibiotics. Geographic and practice type variations existed for particular infection control practices. Procedural volume influenced operative implant times with low physician procedural volumes associated with extended operative times. CONCLUSIONS: The survey provided significant insight into current practices and will assist in the development of specific SCS infection control policies. Based on the survey, further education is warranted on infection control strategies for physicians performing spinal cord stimulator trials and implants.

The effect of Astym® Therapy on muscle strength: a blinded, randomized, clinically controlled trial.

BACKGROUND: Astym(®) therapy is a manual therapy intervention used to stimulate tissue healing, decrease pain, improve mobility, and improve muscle performance associated with musculoskeletal pathology. The purpose of this study was to determine if Astym therapy administered to the lower extremity would result in an immediate change of maximal force output during a unilateral isometric squat test among individuals with a lower extremity injury. METHODS: Forty-five subjects (14 males; 31 females) between 18 and 65 years of age were randomized into 3 treatment groups: 1) Control group - received no treatment 2) Placebo group - received a sham Astym treatment 3) Astym therapy group- received Astym therapy to the lower extremity. A baseline measure of maximal force output (pre-test) during a unilateral isometric squat was performed. The subjects then received the designated treatment intervention. Immediately following the treatment intervention, maximal force output (post-test) was retested using identical testing procedures by an investigator who was blinded to the treatment intervention received by the subjects. The percent change of maximal force output from pre-test to post-test measures was compared using a one-way analysis of variance. A Tukey's post-hoc analysis determined the statistical differences between the groups. RESULTS: The treatment intervention had a significant effect on the percent change of maximal force output [F(2,42) = 7.91, p = 0.001]. Tukey's post hoc analysis demonstrated that the percent change of maximal force output was significantly greater in the Astym group (15 ± 18 % change of Newtons) compared to the placebo (-6 ± 11 % change of Newtons; p = 0.0001) and control (-1 ± 17 % change of Newtons; p = 0.0014) groups. No significant difference (p = 0.68) was noted between the control and placebo groups. CONCLUSIONS: Astym therapy to the involved lower extremity increased maximum force output during an isometric squat test immediately following treatment. The results of this study suggest that Astym therapy can immediately improve muscle performance (maximal force output) for patients presenting with muscular weakness caused by a lower extremity musculoskeletal injury. TRIAL REGISTRATION: Clinicaltrials.gov NCT02349230. Registered 23 January 2015.

THE USE OF FUNCTIONAL TESTS TO PREDICT SAGITTAL PLANE KNEE KINEMATICS IN NCAA-D1 FEMALE ATHLETES.

BACKGROUND: Landing with the knee in extension places increased loads on ligamentous restraints at the knee versus landing in flexion. Unfortunately, existing methods to predict landing kinematics require sophisticated equipment and expertise. The purpose of this study was to develop predictive models for sagittal plane tibiofemoral landing kinematics from the results of functional tests. METHODS: Twenty-nine female, NCAA-D1 college athletes (mean ± standard deviation, age = 19.03 ± 1.09; mass=66.56 ± 13.47 kg; height = 171.16 ± 7.92 cm) participated in a descriptive, laboratory study. Participants performed five unilateral, dominant lower extremity (LE) landings from a 35cm platform onto a forceplate. LE three-dimensional kinematics were captured with electromagnetic sensors interfaced with motion analysis software. Then in a randomized order, participants performed three standardized functional tests: single limb triple hop (SLTH), countermovement vertical jump (CMVJ) and the Margaria-Kalamen (MK) test. Sagittal plane tibiofemoral joint angle at initial contact (IC) and excursion (EXC) in the first 0.1s after ground contact were entered into a statistical software package. Multiple linear regression analyses generated one model predicting IC and one predicting EXC from the independent variables. Alpha levels were set a priori at p ≤ .05. RESULTS: A two variable (MK, SLTH) linear regression model that predicted EXC was significant (Adjusted R (2) = .213, p = .017), however the model that predicted IC was not (p = .890). CONCLUSION: Knee flexion excursion following a single leg landing task may be predicted with the MK and SLTH. The use of functional tests provides a practical means to predict landing kinematics to clinicians working with an active, athletic population. LEVEL OF EVIDENCE: 3, cohort study.

Chronic headache and backache are long-term sequelae of unintentional dural puncture in the obstetric population.

INTRODUCTION: Unintentional dural puncture (UDP) and postdural puncture headache (PDPH) occur during the course of epidural catheter placement for labor analgesia with a reported incidence of 1%-5%. After UDP with an epidural needle, 80%-86% of patients develop PDPH. Acute symptoms after UDP are well known. However, few studies have evaluated the long-term complications of UDP, which is important in assisting parturients in the decision-making informed consent process. We sought to elucidate the long-term (>6 weeks) sequelae of PDPH by examining parturients who had UDP (both recognized and unrecognized) associated with labor epidural analgesia. METHODS: Parturients with a documented UDP (n = 308) over a 5-year period were followed up for acute and long-term residual symptoms (lasting >6 weeks) and compared with a control group (no documented UDP, n = 50) in the same period. Specific symptoms included headache, backache, neck ache, auditory symptoms, and visual symptoms. RESULTS: In comparing parturients with a UDP with control group (no UDP), differences were noted in overall acute symptoms (75.9% vs 21.7%, P < .001), specifically headache (87.0% vs 8.7%, P < .001), backache (47.2% vs 19.6%, P = .002), neck ache (30.1% vs 2.2%, P < .001), auditory (13.8% vs 0%, P = .02), and visual symptoms (19.5% vs 0%, P = .002). Differences were also noted in comparing chronic symptoms (26.5% vs 10.9%, P = .04) and specifically with respect to chronic headache (34.9% vs 2.2%, P < .001), backache (58.1% vs 4.4%, P < .001), and neck ache (14.0% vs 0%, P = .02). No differences were noted between groups in comparing chronic auditory and visual symptoms. CONCLUSION: Chronic headache and backache sequelae persist in the obstetrical population after UDP. When parturients are considering labor epidural analgesia, long-term sequelae should be discussed in the informed consent decision-making process.

Clinical utility of postoperative hemoglobin level testing following total laparoscopic hysterectomy.

OBJECTIVE: To determine the clinical utility of hemoglobin level testing in guiding postoperative care following total laparoscopic hysterectomies performed for benign indications. STUDY DESIGN: Retrospective cohort study. RESULTS: A total of 629 women underwent total laparoscopic hysterectomies during the 24 month study period. Only 16 (2.5%) developed symptoms and/or signs suggestive of hemodynamic compromise. When compared to asymptomatic patients, symptomatic patients had a larger decrease in postoperative hemoglobin level (2.66 vs 1.80g/dL, P = .007) and were more likely to undergo blood transfusion, pelvic imaging or reoperation (P < .001). Women with a smaller body mass index and/or higher intraoperative intravenous fluid volume were more likely to have a larger decrease in postoperative hemoglobin level (P < .05). Past surgical history, duration and complexity of the hysterectomy, estimated surgical blood loss, uterine weight, and perioperative use of intravenous ketorolac were not associated with a greater decrease in postoperative hemoglobin (P > .05). Using the University of Pittsburgh Medical Center's annual laparoscopic hysterectomy rate and insurance companies' reimbursement for blood hemoglobin testing, we estimated the national annual cost for hemoglobin testing following total laparoscopic hysterectomy to be $2,804,662. CONCLUSION: Hemoglobin level testing has little clinical benefit following elective total laparoscopic hysterectomy and should be reserved for patients who develop signs or symptoms suggestive of acute anemia. Heath care cost savings can be substantial if this test is no longer routinely requested following total laparoscopic hysterectomies.

Reliability and validity of functional performance tests in dancers with hip dysfunction.

STUDY DESIGN: Quasi-experimental, repeated measures. PURPOSE/BACKGROUND: Functional performance tests that identify hip joint impairments and assess the effect of intervention have not been adequately described for dancers. The purpose of this study was to examine the reliability and validity of hop and balance tests among a group of dancers with musculoskeletal pain in the hip region. METHODS: NINETEEN FEMALE DANCERS (AGE: 18.90±1.11 years; height: 164.85±6.95 cm; weight: 60.37±8.29 kg) with unilateral hip pain were assessed utilizing the cross-over reach, medial triple hop, lateral triple hop, and cross-over hop tests on two occasions, 2 days apart. Test-retest reliability and comparisons between the involved and uninvolved side for each respective test were determined. RESULTS: Intra-class correlation coefficients for the functional performance tests ranged from 0.89-0.96. The cross-over reach test had a SEM of 2.79 cm and a MDC of 7.73 cm. The medial and lateral triple hop tests had SEM values of 7.51 cm and 8.17 cm, and MDC values of 20.81 cm and 22.62 cm, respectively. The SEM was 0.15 seconds and the MDC was 0.42 seconds for the cross-over hop test. Performance on the medial triple hop test was significantly less on the involved side (370.21±38.26 cm) compared to the uninvolved side (388.05±41.49 cm); t(18) = -4.33, p<0.01. The side-to-side comparisons of the cross-over reach test (involved mean=61.68±10.9 cm; uninvolved mean=61.69±8.63 cm); t(18) = -0.004, p=0.99, lateral triple hop test (involved mean=306.92±35.79 cm; uninvolved mean=310.68±24.49 cm); t(18) = -0.55, p=0.59, and cross-over hop test (involved mean=2.49±0.34 seconds; uninvolved mean= 2.61±0.42 seconds; t(18) = -1.84, p=0.08) were not statistically different between sides. CONCLUSION: The functional performance tests used in this study can be reliably performed on dancers with unilateral hip pain. The medial triple hop test was the only functional performance test with evidence of validity in side-to-side comparisons. These results suggest that the medial triple hop test may be a reliable and valid functional performance test to assess impairments related to hip pain among dancers. LEVEL OF EVIDENCE: 3b. Non-consecutive cohort study.

Epidural catheter placement in morbidly obese parturients with the use of an epidural depth equation prior to ultrasound visualization.

BACKGROUND: Previously, Balki determined the Pearson correlation coefficient with the use of ultrasound (US) was 0.85 in morbidly obese parturients. We aimed to determine if the use of the epidural depth equation (EDE) in conjunction with US can provide better clinical correlation in estimating the distance from the skin to the epidural space in morbidly obese parturients. METHODS: One hundred sixty morbidly obese (≥40 kg/m(2)) parturients requesting labor epidural analgesia were enrolled. Before epidural catheter placement, EDE was used to estimate depth to the epidural space. This estimation was used to help visualize the epidural space with the transverse and midline longitudinal US views and to measure depth to epidural space. The measured epidural depth was made available to the resident trainee before needle insertion. Actual needle depth (ND) to the epidural space was recorded. RESULTS: Pearson's correlation coefficients comparing actual (ND) versus US estimated depth to the epidural space in the longitudinal median and transverse planes were 0.905 (95% CI: 0.873 to 0.929) and 0.899 (95% CI: 0.865 to 0.925), respectively. CONCLUSION: Use of the epidural depth equation (EDE) in conjunction with the longitudinal and transverse US views results in better clinical correlation than with the use of US alone.