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Objective Static endoscopic evaluation of swallowing (SEES) is an instrumental evaluation developed for in‐office identification of patients who may benefit from a modified barium swallow study (MBSS). We aim to determine the predictive value of SEES for evaluating dysphagia. Methods A retrospective case series was performed on adults evaluated for dysphagia using SEES followed by MBSS at a single tertiary care center. Studies were evaluated by two blinded expert raters. Results Fifty‐eight patients were included. Thin liquid penetration on SEES had a sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 0.86 (95% CI 0.70‐0.95), 0.63 (95% CI 0.24‐0.91), 0.91 (95% CI 0.76‐0.98), and 0.5 (0.19‐0.81), respectively, for predicting thin liquid penetration on MBSS, and 1.0 (95% CI 0.59‐1.0), 0.29 (95% CI 0.15‐0.47), 0.23 (95% CI 0.10‐0.41), and 1.0 (95% CI 0.69‐1.0) for predicting thin liquid aspiration on MBSS. Thin liquid aspiration on SEES had a sensitivity, specificity, PPV, and NPV of 0.67 (95% CI 0.09‐0.99), 0.85 (95% CI 0.66‐0.96), 0.33 (95% CI 0.04‐0.78), and 0.96 (95% CI 0.79‐1.0), respectively, for predicting thin liquid aspiration on MBSS. Conclusions SEES may be used as an objective in‐office test to screen for aspiration and penetration. Thin liquid penetration on SEES is moderately sensitive for predicting penetration on MBSS. Absence of thin liquid penetration or aspiration on SEES has a high NPV for excluding aspiration on MBSS. Abnormalities on SEES or the need to view the entire swallowing mechanism should prompt an MBSS for a more complete evaluation of dysphagia. Level of Evidence: 4, Static endoscopic evaluation of swallowing (SEES) is an instrumental evaluation developed for in‐office identification of patients who may benefit from a modified barium swallow study (MBSS). SEES may be used as an objective in‐office test to screen for aspiration and penetration. Absence of thin liquid penetration or aspiration on SEES has a high NPV for excluding aspiration on MBSS.

Quality measurement across healthcare is undertaken with a goal of improving care and outcomes for patients; however, the relationship between quality measurement and patient outcomes remains largely untested, particularly in inpatient behavioral health. Using a retrospective quantitative design, we assessed 142 behavioral health organizations' quality data submitted to the Hospital-Based Inpatient Psychiatric Services and Inpatient Psychiatric Facility Quality Reporting programs from 2017 to 2018 and tested relationships between compliance on 16 quality measures and symptom improvement on patient self-report outcomes (SROs) at the facility level. Performance on many quality measures was negatively skewed (at least four have almost no room for improvement on average), and there was high interrelatedness between most quality measures. Nine of the assessed measures correlated with patient SROs but not in clear groupings. Findings indicate that an underlying organizational construct may be driving compliance rates on quality measures, but the measures are not linked to treatment outcomes as expected. We encourage an expansion of the current framework of behavioral health quality measurement beyond process and organization and suggest the addition of patient outcomes such as SROs as quality measures to directly assess patient improvement.

OBJECTIVES/HYPOTHESIS An artificial intelligence (AI) tool was developed using audio clips of cis-male and cis-female voices based on spectral analysis to assess %probability of a voice being perceived as female (%Prob♀). This program was validated with 92% accuracy in cisgender speakers. The aim of the study was to assess the relationship of fo on %Prob♀ by a validated AI tool in a cohort of trans females who underwent intervention to feminize their voice with behavioral modification and/or surgery. STUDY DESIGN Cohort study. METHODS Fundamental frequency (fo ) from prolonged vowel sounds (fo /a/) and fo from spontaneous speech (fo -sp) were measured using the Kay Pentax Computerized Speech Lab (Montvale, NJ) in trans females postintervention. The same voice samples were analyzed by the AI tool for %Prob♀. Chi-square analysis and regression models were performed accepting >50% Prob♀ as female voice. RESULTS Forty-two patients were available for analysis after intervention. fo -sp post-treatment was positively correlated with %Prob♀ (R = 0.645 [P 50% for the speech samples and fo -sp >160 Hz (P 160 Hz. Of these, the AI program only perceived nine patients as female (>50 %Prob♀). CONCLUSION Patients with fo -sp >160 Hz after feminization treatments are not necessarily perceived as having a high probability of being female by a validated AI tool. AI may represent a useful outcome measurement tool for patients undergoing gender affirming voice care. LEVEL OF EVIDENCE 3 Laryngoscope, 131:2567-2571, 2021.

OBJECTIVES/HYPOTHESIS VT is often considered the preferred treatment for vocal feminization in transgender patients. However, Wendler glottoplasty offers a surgical option for increasing fundamental frequency and perception of vocal femininity. We aimed to determine whether the addition of glottoplasty to VT results in greater fundamental frequency elevation and improvement in quality-of-life measures. STUDY DESIGN Retrospective case series. METHODS Forty-eight trans female patients were treated for vocal feminization. Twenty-seven patients underwent VT, and 21 patients underwent VT with additional glottoplasty (VTWG). Pre- and posttreatment acoustic measures, Trans Woman Voice Questionnaire (TWVQ), and Voice Handicap Index-10 (VHI-10) data were compared. RESULTS Glottoplasty in combination with VT elevated average speaking fundamental frequency (SF0) to a greater extent than VT alone (P

OBJECTIVES Voice therapy has been the primary treatment for voice feminization in transfemale patients due to concerns that surgery worsens voice quality. We aim to determine the impact of Wendler glottoplasty on acoustic measures of voice. STUDY DESIGN Retrospective case series. METHODS Transgender female patients treated for vocal feminization with Wendler glottoplasty at a single tertiary care center were identified. Pre- and postoperative measures were taken with the Kay Elemetrics Real-Time Pitch, Analysis of Dysphonia in Speech and Voice, and Multidimensional Voice Program. RESULTS Twenty-eight patients were included in this study. There were no statistically significant changes in fundamental frequency variation, peak amplitude variation, soft phonation index, noise-to-harmonics ratio, cepstral peak prominence, or cepstral spectral index of dysphonia at a significance level of P

Background Treatment options to assist patients to produce a more perceptually feminine voice include voice therapy (VT) and surgeries to elevate pitch such as the Wendler glottoplasty (WG). The Trans Woman Voice Questionnaire (TWVQ) is a validated quality of life measure for trans women's self-reported perceptions of their voice and is frequently administered before and after such interventions. The 30 statements broadly pertain to how feminine a patient feels their voice is, how effortful it is to produce their voice, and how their voice impacts them psychosocially, making it a useful and specific outcome measure when treating trans females for voice concerns. Objective To compare quality of life outcomes between VT and VT with adjunct WG (VT+WG) based on changes in ratings of individual statements on the TWVQ. Materials and Methods A retrospective case series of 31 trans female patients treated was completed. A total of 17 patients underwent VT and 14 underwent VT with adjunctive WG. Ratings for each of the 30 TWVQ statements were compared before and after treatment for each group. Wilcoxon rank-sum tests were used to compare rating changes before and after treatment. Spearman rank-order correlation tests were used to assess the association between total TWVQ score and “current voice” rating. Results WG was associated with statistically significantly improved ratings for every statement on the TWVQ except one. In contrast, VT was associated with statistically significant improvements in 16 of the 30 statements, which largely pertained to patient emotions surrounding their voice rather than physical aspects such as pitch and dysphonia. Furthermore, while both WG+VT and VT improved the “current voice” rating significantly, WG improved the score by nearly 1 unit more. Lastly, we found a positive association between the total TWVQ score and current voice rating, indicating that lower scores were associated with more self-perceived feminine-sounding voices (P Conclusions Both VT and VT+WG result in improvements in the TWVQ. The specific statements on the TWVQ offer insight into specific quality of life treatment outcomes, with VT associated with improvements in mostly psychosocial aspects of voice production and VT+WG with both psychosocial and physical aspects.

Evaluation of the clinician’s role in the optimal interpretation of clinical exome sequencing (ES) results. Retrospective chart review of the first 155 patients who underwent clinical ES in our Exome Clinic and direct interaction with the ordering geneticist to evaluate the process of interpretation of results. The most common primary indication was neurodevelopmental problems (~66%), followed by multiple congenital anomalies (~10%). Based on sequencing data, the overall diagnostic yield was 36%. After assessment by the medical geneticist, incorporation of detailed phenotypic and molecular data, and utilization of additional diagnostic modalities, the final diagnostic yield increased to 43%. Seven patients in our cohort were included in initial case series that described novel genetic syndromes, and 23% of patients were involved in subsequent research studies directly related to their results or involved in efforts to move beyond clinical ES for diagnosis. Clinical management was directly altered due to the ES findings in 12% of definitively diagnosed cases. Our results emphasize the usefulness of ES, demonstrate the significant role of the medical geneticist in the diagnostic process of patients undergoing ES, and illustrate the benefits of postanalytical diagnostic work-up in solving the “diagnostic odyssey.” Genet Med advance online publication 02 March 2017

Domestic dogs have been central to life in the North American Arctic for millennia. The ancestors of the Inuit were the first to introduce the widespread usage of dog sledge transportation technology to the Americas, but whether the Inuit adopted local Palaeo-Inuit dogs or introduced a new dog population to the region remains unknown. To test these hypotheses, we generated mitochondrial DNA and geometric morphometric data of skull and dental elements from a total of 922 North American Arctic dogs and wolves spanning over 4500 years. Our analyses revealed that dogs from Inuit sites dating from 2000 BP possess morphological and genetic signatures that distinguish them from earlier Palaeo-Inuit dogs, and identified a novel mitochondrial clade in eastern Siberia and Alaska. The genetic legacy of these Inuit dogs survives today in modern Arctic sledge dogs despite phenotypic differences between archaeological and modern Arctic dogs. Together, our data reveal that Inuit dogs derive from a secondary pre-contact migration of dogs distinct from Palaeo-Inuit dogs, and probably aided the Inuit expansion across the North American Arctic beginning around 1000 BP. Domestic dogs have been central to life in the North American Arctic for millennia. The ancestors of the Inuit were the first to introduce the widespread usage of dog sledge transportation technology to the Americas, but whether the Inuit adopted local Palaeo-Inuit dogs or introduced a new dog population to the region remains unknown. To test these hypotheses, we generated mitochondrial DNA and geometric morphometric data of skull and dental elements from a total of 922 North American Arctic dogs and wolves spanning over 4500 years. Our analyses revealed that dogs from Inuit sites dating from 2000 BP possess morphological and genetic signatures that distinguish them from earlier Palaeo-Inuit dogs, and identified a novel mitochondrial clade in eastern Siberia and Alaska. The genetic legacy of these Inuit dogs survives today in modern Arctic sledge dogs despite phenotypic differences between archaeological and modern Arctic dogs. Together, our data reveal that Inuit dogs derive from a secondary pre-contact migration of dogs distinct from Palaeo-Inuit dogs, and probably aided the Inuit expansion across the North American Arctic beginning around 1000 BP.

Right unilateral ultrabrief (RUL-UB) pulse width electroconvulsive therapy (ECT) has attracted much research attention recently due to its smaller effect on memory than is associated with other forms of ECT, such as bitemporal placement or unilateral standard pulse width. However, RUL-UB has demonstrated slower antidepressant efficacy in comparison to the other techniques. One method to enhance the speed of response to RUL-UB ECT is administration of 5 times a week (termed "daily") treatments as opposed to the more standard twice or thrice weekly schedule. In this open label study, we treated 20 depressed patients with daily RUL-UB treatments for up to 2 weeks (ie, 10 treatments) using standardized assessments of depression and retrograde amnesia. Response and remission rates were commensurate with those reported in other recent studies using this technique with twice or thrice weekly treatment frequencies, and there was no clinically significant effect on retrograde memory function. We conclude that daily administration of RUL-UB ECT may shorten the duration of the course of ECT treatments without compromising cognition. A randomized trial comparing this technique to a thrice weekly schedule of RUL-UB treatments is indicated.

OBJECTIVE The aim of the study was to explore patient perception and perceived benefit of electroconvulsive therapy (ECT) by assessing the real-world experience of adult patients who received ECT, focusing on clinical outcomes and patient satisfaction. METHODS This retrospective study analyzed patient self-report of depressive symptoms (Patient Health Questionnaire), perception of physical and cognitive ECT adverse effects (ECT Outcomes Survey) and satisfaction with treatment (Patient Satisfaction Survey). Symptoms and adverse effects were measured at both intake and final ECT session for comparison over time. Data were collected from 1089 adult patients with depression, bipolar disorder, or schizoaffective disorder in 23 psychiatric facilities in the United States and its territories from 2014 to 2015. RESULTS On average, patient scores reflect satisfaction with treatment and reduction in depressive symptoms and adverse effects across the course of ECT treatment. Patients reported a decrease in depression, with an average Patient Health Questionnaire change of 13.2 from intake to final ECT session (P < 0.001). Furthermore, 85.5% of patients indicated on the Patient Satisfaction Survey that they benefited or improved as a result of their ECT. Subsequent analyses revealed alleviation of depressive symptoms and ability to return to social, and work life tasks are significant contributors to satisfaction with treatment, whereas adverse effects including memory problems have less influence on satisfaction. CONCLUSIONS Patients tend to perceive ECT as a safe and beneficial treatment option for severe mood disorders, even when considering adverse effects. This study reinforces the value of standardized data collection and outcomes measures to better monitor patient response to treatment, refine the clinical practice of ECT, and provide data to support patient education.

Domesticated animals that revert to a wild state can become invasive and significantly impact native biodiversity. Although dogs can be problematic locally, only the Australasian dingo is known to occur in isolation from humans. Western dogs have experienced more intense artificial selection, which potentially limits their invasiveness. However, feral dogs eradicated from Isabela Island, Galápagos in the 1980s could be the first-known exception. We used DNA and morphometric data from 92 of these dogs to test the hypotheses that (i) these dogs persisted independently of humans for up to a century and a half since descending from a handful of dogs introduced in the early 1800s, vs. (ii) similarly to other western feral dog populations, they reflected continuous recruitment of strays from human settlements on a portion of the Island. We detected one dominant maternal lineage and one dominant paternal lineage shared by the three subpopulations, along with low autosomal genetic diversity, consistent with the hypothesized common origins from a small founder population. Genetic diversity patterns among the three island subpopulations were consistent with stepping-stone founder effects, while morphometric differentiation suggested rapid phenotypic divergence, possibly due to drift and reinforced by selection corresponding to distinct microclimates and habitats on Isabela. Despite the continued presence of free-ranging dogs in the vicinity of settlements on Isabela and other Galápagos Islands, feral populations have not reestablished in remote areas since the 1980s, emphasizing the rarity of conditions necessary for feralization of modern western dogs.

The inflammatory response is typically initiated by infection or cellular injury, and provides host protection aimed at clearing the initial triggering event, as well as providing long-term protective immunity. When properly functioning, the inflammatory process is a mediator of acute injury to restore tissue health and is characteristically self-limiting once tissue repair and homeostasis have been restored. If tissue health is not restored, such as if the tissue harbors a continuous low grade inflammatory stimulant, then the inflammatory process becomes a chronic response that continuously damages the surrounding tissue in its attempt to provide repair. Left unchecked, long-term inflammation can result in diseases of chronic inflammation, such as autoimmunity or age-related diseases. Choice of current anti-inflammatory therapies is often limited by patient risk-benefit considerations. Traditional approaches to manage chronic inflammation include non-steroidal anti-inflammatory drugs or corticosteroids which provide short-term benefits, but are often plagued with significant side effects that preclude their use for long-term therapy. The newest classes of anti-inflammatory therapeutics, biologics, are engineered monoclonal antibodies that bind pro-inflammatory mediators and neutralize their effects by preventing pro-inflammatory signaling. Unfortunately, biologic therapies are often prohibitively expensive and have serious, sometimes life-threatening side effects. In lieu of biologics or chemically synthesized small molecules, natural products have provided a rich source of small molecule effectors. One particular natural product, 1,8-cineole, also called eucalyptol, is reported to have anti-inflammatory, anti-microbial, and anti-oxidant activity. Several clinical trials have established potent anti-inflammatory activity for 1,8-cineole, which may suggest its use as a primary treatment, or at the very least, an adjunct therapy for current anti-inflammatory agents. We argue that use of 1,8-cineole as an anti-inflammatory agent needs greater study in other diseases with a chronic inflammatory component, including atherosclerotic cardiovascular disease, type 2 diabetes mellitus, and arthritic complications.

Purpose: This article provides a review of published evidence-based guidance about culturally sensitive assessment and treatment intervention strategies addressing perinatal depression in black American women. Culturally sensitive approaches focus more on the woman’s environment than on her race and thus may improve access to treatment for perinatal depression by increasing health literacy. Methods: The authors abstracted evidence-based guidance from articles published between November 2005 and September 2011, including only articles specifically analyzing a discrete sample of black American women during pregnancy or within 6 months postpartum. They also examined research on unique cultural characteristics of black American women. To obtain relevant studies, the authors searched for research literature indexed in PubMed, using key terms associated with 2 systematic reviews of prevalence and risk factors for perinatal depression and additional keywords as used in the articles found. They abstracted the focus, design and methods, population, and results for each article in a table; discussed the findings; and suggested assessment and intervention strategies based on the studies’ results. Findings: Sixteen articles from 13 journals provide compelling evidence of culture-based risk factors for perinatal depression for black American women and information to guide culturally sensitive assessments and interventions. The literature provides a rich compendium of relevant and useful implications for clinical practice in assessing and addressing depression among pregnant black American women. Conclusions: Primary care providers may want to incorporate culturally sensitive screening questions to early identify and facilitate treatment interventions for depressive symptoms in their pregnant black American patients.

Introduction: The purpose of this survey was to obtain information that would elucidate what types and amounts of international clinical experiences are available to midwifery students in accredited midwifery programs. Furthermore, the survey assessed the need for and interest in an online pre-trip preparation course and the possibility of future collaborative efforts between midwifery programs. Methods: A formal electronic descriptive survey was sent to eligible directors of midwifery education (DOME) from 38 accredited institutions in the United States. Results: Twenty-nine of 38 (76%) responded to the survey, and 9 of 29 programs (31%) offer international clinical experiences. Sixteen (80%) of the 20 programs not currently offering international experiences indicated interest in offering these experiences. Of the 9 programs that have international experiences, only 1 reported offering a formal pre-trip course. Discussion: The results of this survey suggest that there is interest in collaborative efforts for developing a formal pre-trip preparation course and sharing international experiences that would promote sustainable programs of international experiences for student midwives.

Background Volcanic eruptions can cause loss of life and livelihoods, damage critical infrastructure and have long-term impacts, including displaced populations and long-lasting economic implications. Many factors contribute to disasters from natural hazards. One of these is the institutional capacity to enable hazard assessment for pre-emergency planning to protect populations and environments, provide early warning when volcanoes threaten to erupt, to provide forecasts and scientific advice during volcanic emergencies, and to support post-eruption recovery and remediation. Volcano observatories play a critical role in supporting communities to reduce the adverse effects of eruptions [Chapter 15]. Their capacity to monitor volcanoes is thus a central component of disaster risk reduction. The resources are not available for extensive monitoring of all 596 historically active volcanoes. The availability of resources varies on local, national, regional and global scales, resulting in highly variable monitoring levels from volcano to volcano. Some countries have observatories dedicated to volcano monitoring, others monitor from within larger organisations, and still others have no permanent monitoring group. Individual volcanoes may have large comprehensive monitoring networks of multiple monitoring systems whilst a neighbouring volcano is unmonitored. It is therefore vital to understand the monitoring capacity at local, national, regional and global scales to establish how well volcanoes are monitored, the distribution of monitoring equipment, the human resources, experience and education and the instrumental and laboratory capabilities. To this end a database has been developed: Global Volcano Research and Monitoring Institutions Database (GLOVOREMID). GLOVOREMID In 2011 IAVCEI funded the development of VOMODA (Volcano Monitoring Database), whose main purpose was to obtain a realistic diagnosis of volcano monitoring and training of the human resources working on volcanological research and monitoring institutions (VRMI) in Latin America. In 2013, VOMODA was adopted and adapted for worldwide use as GLOVOREMID. The Global Volcano Model (GVM) supports this work. It is currently in both Spanish and English. This database will contribute to improving communication and cooperation between scientists and technicians responsible for volcano monitoring and may help to reduce the effects of volcanic crises. GLOVOREMID can be accessed online via http://132.248.182.158/glovoremid/.

Background Globally, more than 800 million people live in areas that have the potential to be affected by volcanic hazards, and this number is growing [Chapter 4]. The need for informed judgements regarding the global extent of potential volcanic hazards and the relative threats is therefore more pressing than ever. There is also an imperative to identify areas of relatively high hazard where studies and risk reduction measures may be best focussed. Various authors have tackled this task at a range of spatial scales, using a variety of techniques. At some well-studied volcanoes, the geological record has been used in combination with numerical modelling to create probabilistic hazard maps of volcanic flows and tephra fall [Chapter 6 and 20]. Such sources of information can be hugely beneficial in land use planning during times of quiescence and in emergency planning during times of unrest. Unfortunately, creating high-resolution probabilistic hazard maps for all volcanoes is not yet feasible. There is therefore a need for a methodology for volcanic hazard assessment that can be applied universally and consistently, which is less data-and computing-intensive. The aim of such an approach is to identify, on some objective overall basis, those volcanoes that pose the greatest danger, in order that more indepth investigations and disaster risk reduction efforts can then be focused on them. Previous methods An index-based approach to volcanic hazard assessment involves assigning scores to a series of indicators, which are then combined to give an overall hazard score. Indicators typically include measures of the frequency of eruptions, the relative occurrence of different kinds of eruptions and their related hazards, the footprints of these hazards, and eruption size. Indices are well suited to the problem of volcanic hazard assessment, as they allow the decomposition of the complex system into a suite of volcanic system controls and simple quantitative variables and factors that jointly characterise threat potential. Ewert (2007) presented an index-based methodology for assessing volcanic threat (the combination of hazard and exposure) in the USA, to permit prioritisation of research, monitoring and mitigation.

Acute low back pain (ALBP) may limit mobility and impose functional limitations in active duty military personnel. Although some manual therapies have been reported effective for ALBP in military personnel, there have been no published randomized controlled trials (RCTs) of osteopathic manipulative treatment (OMT) in the military. Furthermore, current military ALBP guidelines do not specifically include OMT.This RCT examined the efficacy of OMT in relieving ALBP and improving functioning in military personnel at Fort Lewis, Washington. Sixty-three male and female soldiers ages 18 to 35 were randomly assigned to a group receiving OMT plus usual care or a group receiving usual care only (UCO).The primary outcome measures were pain on the quadruple visual analog scale, and functioning on the Roland Morris Disability Questionnaire. Outcomes were measured immediately preceding each of four treatment sessions and at four weeks post-trial. Intention to treat analysis found significantly greater post-trial improvement in 'Pain Now' for OMT compared to UCO (P = 0·026). Furthermore, the OMT group reported less 'Pain Now' and 'Pain Typical' at all visits (P = 0·025 and P = 0·020 respectively). Osteopathic manipulative treatment subjects also tended to achieve a clinically meaningful improvement from baseline on 'Pain at Best' sooner than the UCO subjects. With similar baseline expectations, OMT subjects reported significantly greater satisfaction with treatment and overall self-reported improvement (P0·01).This study supports the effectiveness of OMT in reducing ALBP pain in active duty military personnel.

Background A ubiquitous dilemma in medical education continues to be whether and how to integrate research competencies into the predoctoral curriculum. Understanding research concepts is imbedded in the six core competencies for physicians, but predoctoral medical education typically does not explicitly include research education. In an effort to quickly report academic research findings to the field, this is the second in a series of articles reporting the outcomes of a research education initiative at one college of osteopathic medicine. The first article described the competency model and reported baseline performance in applied understanding of targeted research concepts. This second article reports on the learning outcomes from the inaugural year of a course in basic biomedical research concepts. Methods This course consisted of 24 total hours of classroom lectures augmented with web-based materials using Blackboard Vista, faculty moderated student presentations of research articles, and quizzes. To measure changes in applied understanding of targeted research concepts in the inaugural year of the course, we administered a pretest and a posttest to second year students who took the course and to first year students who took an informatics course in the same academic year. Results We analyzed 154 matched pretests and posttests representing 56% of the 273 first and second year students. On average, the first year (53) and second year students (101) did not differ in their mean pretest scores. At posttest the second year students showed significant improvement in their applied understanding of the concepts, whereas the first year students' mean posttest score was lower than their mean pretest score. Conclusions This biomedical research course appears to have increased the second year students' applied understanding of the targeted biomedical research concepts. This assessment of learning outcomes has facilitated the quality improvement process for the course, and improved our understanding of how to measure the benefits of research education for medical students. Some of the course content and methods, and the outcome measures may need to be approached differently in the future to more effectively lay the foundation for osteopathic medical students to utilize these concepts in the clinical setting.

The purpose of this study was to evaluate the efficacy of osteopathic manipulative treatment (OMT) to reduce low back pain and improve functioning during the third trimester in pregnancy and to improve selected outcomes of labor and delivery.Pregnancy research on osteopathic manipulation optimizing treatment effects was a randomized, placebo-controlled trial of 400 women in their third trimester. Women were assigned randomly to usual care only (UCO), usual care plus OMT (OMT), or usual care plus placebo ultrasound treatment (PUT). The study included 7 treatments over 9 weeks. The OMT protocol included specific techniques that were administered by board-certified OMT specialists. Outcomes were assessed with the use of self-report measures for pain and back-related functioning and medical records for delivery outcomes.There were 136 women in the OMT group: 131 women in the PUT group and 133 women in the UCO group. Characteristics at baseline were similar across groups. Findings indicate significant treatment effects for pain and back-related functioning (P.001 for both groups), with outcomes for the OMT group similar to that of the PUT group; however, both groups were significantly improved compared with the UCO group. For secondary outcome of meconium-stained amniotic fluid, there were no differences among the groups.OMT was effective for mitigating pain and functional deterioration compared with UCO; however, OMT did not differ significantly from PUT. This may be attributed to PUT being a more active treatment than intended. There was no higher likelihood of conversion to high-risk status based on treatment group. Therefore, OMT is a safe, effective adjunctive modality to improve pain and functioning during the third trimester.

Background Without systematic exposure to biomedical research concepts or applications, osteopathic medical students may be generally under-prepared to efficiently consume and effectively apply research and evidence-based medicine information in patient care. The academic literature suggests that although medical residents are increasingly expected to conduct research in their post graduate training specialties, they generally have limited understanding of research concepts. With grant support from the National Center for Complementary and Alternative Medicine, and a grant from the Osteopathic Heritage Foundation, the University of North Texas Health Science Center (UNTHSC) is incorporating research education in the osteopathic medical school curriculum. The first phase of this research education project involved a baseline assessment of students' understanding of targeted research concepts. This paper reports the results of that assessment and discusses implications for research education during medical school. Methods Using a novel set of research competencies supported by the literature as needed for understanding research information, we created a questionnaire to measure students' confidence and understanding of selected research concepts. Three matriculating medical school classes completed the on-line questionnaire. Data were analyzed for differences between groups using analysis of variance and t-tests. Correlation coefficients were computed for the confidence and applied understanding measures. We performed a principle component factor analysis of the confidence items, and used multiple regression analyses to explore how confidence might be related to the applied understanding. Results Of 496 total incoming, first, and second year medical students, 354 (71.4%) completed the questionnaire. Incoming students expressed significantly more confidence than first or second year students (F = 7.198, df = 2, 351, P = 0.001) in their ability to understand the research concepts. Factor analyses of the confidence items yielded conceptually coherent groupings. Regression analysis confirmed a relationship between confidence and applied understanding referred to as knowledge. Confidence scores were important in explaining variability in knowledge scores of the respondents. Conclusion Medical students with limited understanding of research concepts may struggle to understand the medical literature. Assessing medical students' confidence to understand and objectively measured ability to interpret basic research concepts can be used to incorporate competency based research material into the existing curriculum.