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Postural control deficits are a key component to injury assessment and, more specifically, following concussion. However, these assessments are often administered in a serial manner to track deficits and recovery, thus the stability or test-retest reliability of these measures is important. With the advent of mobile applications to assess postural control, it is important to evaluate the reliability of these tools; therefore our purpose was to estimate reliability for the Sway Balance™ mobile application, a portable device for postural control assessment. Postural control assessment of males between ages 7–22 showed good-to-excellent reliability in the overall composite score of the Sway Balance™. Sway Balance™ is a reliable tool for measuring postural control.

This study builds upon a project that developed clinical criteria to identify undiagnosed hypertension patients "hiding in plain sight" (HIPS) by examining patient characteristics to understand whether there are disparities in hypertension diagnosis. We examined electronic health record demographic data for patients identified by the HIPS criteria and subgroups at 3 Missouri health centers. Identified patients who returned for a follow-up visit and were subsequently diagnosed with hypertension tended to be older, black/African American, uninsured, and classified as having obesity. Younger, white, healthy weight females were less likely to be diagnosed. These findings point to exploring possible biases/other nonclinical factors in hypertension diagnosis.

ContextGymnastics trains fundamental movement skills but has high rates of early sport specialization. Early specialization is associated with increased injury risk. Gymnasts devote time to developing technical skill, but whether specialization status influences performance is unknown.ObjectiveTo describe the participation and specialization characteristics of youth club gymnastics participants and determine whether the level of specialization is associated with fitness and functional task performance.DesignRetrospective cross-sectional study.SettingA single gymnastics facility.Patients or Other ParticipantsData on youth gymnasts (n = 131; 84 females, 47 males; age = 10.9 ± 2.9 years, height = 142.14 ± 16.23 cm, mass = 38.15 ± 12.93 kg) were reviewed.Main Outcome Measure(s)Specialization was assessed using a 3-tiered classification. Fitness measurements consisted of the Gymnastics Functional Measurement Tool, Men's Gymnastics Functional Measurement Tool, and core strength. Functional tasks evaluated hop performance, dynamic balance, and jump-landing technique. Separate analyses of covariance, covaried by age, hours of training, and years of gymnastics participation, were used to identify differences in fitness and functional performance among specialization groups. Pearson product correlations were calculated to evaluate the relationships between training hours per week and years in gymnastics with fitness and functional performance.ResultsMost gymnasts were classified as moderately (50.4%, n = 66) or highly (35.1%, n = 46) specialized. Only 14.5% (n = 19) were classified as having a low level of specialization. Weak to moderate correlations were present between years in gymnastics and most fitness tasks. Moderate to strong correlations were noted between training hours per week and most fitness tasks. Low-specialization gymnasts scored lower on right lower extremity Y-balance (P = .004), upper left extremity Y-balance (P = .033), and right hop performance (P = .039) tests.ConclusionsGymnasts reported high proportions of moderate to high specialization, and many exceeded guidelines for hours participating in gymnastics per week. We did not observe clinically meaningful group differences among specialization status and fitness or functional movement tasks, indicating no clear benefit of gymnastics training to the exclusion of other sports for increased performance.

In the original publication of the article the fourth author name was incorrectly published.

The purpose of this study was to examine the relationships between partner and parental status and self-reported weekly fruit and vegetable consumption and level of physical activity in African American adults.A national sample of 2,370 African Americans participated in a telephone survey. Demographic data were collected and compared with fruit and vegetable consumption and physical activity responses.When controlling for age (mean age = 53.6 ± 14.8 years) and education level, having children in the household was associated with greater fruit consumption. Being partnered was associated with moderate physical activity weekly for a higher percentage of women, and yet a shorter duration of minutes of moderate physical activity weekly for both women and men. Males (38.2% of the sample) reported being more physically active and females (61.8% of the sample) reported eating more fruits and vegetables.By understanding the role of partner and parental status in relation to healthy lifestyle for African Americans, family scientists and health care practitioners may be able to target the needs of this population to help prevent obesity and chronic illness.

Purpose. To develop normative reference values for grip strength of males and females between the ages of 50 and 89 years old that can be used by health care professionals in clinical settings. Methods. This study assessed data from a sample of males and females between the ages of 50 and 89 years old who participated in the Health and Retirement Study (HRS) sponsored by the National Institute on Aging. The Health and Retirement Study collected data from 6,266 participants in a physical measures sub-study. Grip strength was assessed in a standing position with the shoulder adducted and elbow flexed to 90 degrees. One practice trial was allowed and then the participant performed 2 maximal effort trials using each hand. Right and left hand mean scores were calculated. The HRS data were reported in kilograms. Results. Subjects were stratified by sex and age. Each stratum was defined using 5-year intervals, male or female, and by right or left hand. Mean grip strength, standard deviation, sample size, and percentile ranks from 5 to 95 at intervals of 5 are reported for each stratum in both kilograms and pounds. Conclusion. The normative values provided in this report should advance the clinical utility of grip strength as a physical measure. Percentile ranks are easy to determine and interpret for both the patient and clinician. Clinicians will benefit from the results of this study by better assessing the physical status of their patients, developing better goals for their patients, and providing better education to their patients on this aspect of physical health.

Context The “Appropriate Medical Coverage for Intercollegiate Athletics” (AMCIA) document was created to support assessment and calculation of athletic training personnel requirements. However, little is known regarding disparities between current and recommended staffing practices. Objective To identify the staffing and employment characteristics of athletic health care services at Football Bowl Subdivision-level institutions. Design Cross-sectional study. Setting Web-based survey. Patients or Other Participants Head athletic trainers and athletic training staff members who were knowledgeable about budget and staff. Main Outcome Measure(s) The survey, Assessment of Staffing Levels at National Collegiate Athletic Association Football Bowl Subdivision-Level Institutions, was used to evaluate personal, university, and staff demographics; staffing and employment topics; and AMCIA variables and use. Results The survey was accessed and partially completed by 104 individuals (response rate = 84.6%). A total of 79 athletic trainers (response rate = 76%) completed the entire survey. One-third of the respondents (34.2%, n = 26) met the recommended number of full-time equivalents (FTEs) for football, two-thirds of the respondents (65.7%, n = 50) failed to meet the recommendation, and 26.2% (n = 27) were missing data needed for FTE calculation. Among those who did not meet the recommended FTEs (n = 50), 38.0% (n = 19) were within 1 FTE of being compliant, 26.0% (n = 13) were within 2 FTEs, and 24.0% (n = 12) were within 3 FTEs. About one-third of respondents (35.9%, n = 37) reported not using the AMCIA, citing lack of funding (29.7%, n = 11), lack of administrative support (21.6%, n = 8), and other reasons (37.8%, n = 14). Conclusions The majority of institutions that used the AMCIA were able to provide justification for staffing. For most of the institutions that failed to meet their recommendation, adding 1–3 FTE athletic trainers for football would change their compliance status. A uniform definition of the term FTE within collegiate athletics is needed to allow for structured assessment and allocation of staffing and workloads.

Previous randomized controlled trials evaluating the efficacy of mycophenolate mofetil (MMF) in patients with immunoglobulin A nephropathy (IgAN) have produced varying results.Double-blind placebo-controlled randomized controlled trial.52 children, adolescents, and adults with biopsy-proven IgAN in 30 centers in the United States and Canada. Entry criteria: age older than 7 to younger than 70 years; urine protein-creatinine ratio (UPCR), ≥0.6g/g (males) or ≥0.8g/g (females); and estimated glomerular filtration rate ≥ 50mL/min/1.73m(2) (≥40mL/min/1.73m(2) if receiving angiotensin-converting enzyme inhibitor). Mean age, 32±12 (SD) years; 62% men; and 73% white.Lisinopril (or losartan) plus a highly purified omega-3 fatty acid (Omacor [Pronova Biocare]) was given to 94 patients for 3 months; 52 of the patients with persistent UPCR≥0.6g/g (males) and ≥0.8g/g (females) were randomly assigned to MMF or placebo (target dose, 25-36mg/kg/d) in addition to lisinopril/losartan plus Omacor.Change in UPCR after 6 and 12 months treatment with MMF/placebo and 12 months after the end of treatment.UPCR measured on 24-hour urine samples. Glomerular filtration rate estimated with the Schwartz (age 18 years) or Cockcroft-Gault (age ≥ 18 years) formula.44 patients completed 6 months of treatment with MMF (n=22) or placebo (n=22). The trial was terminated early at the recommendation of the Data Monitoring Committee because of the lack of benefit. No patient achieved a complete remission (UPCR0.2g/g). Mean UPCRs at randomization and after 6 months were 1.45 (95% CI, 1.16-1.75) and 1.40 (95% CI, 1.09-1.70) for MMF and 1.41 (95% CI, 1.17-1.65) and 1.58 (95% CI, 1.13-2.04) for placebo, respectively. The mean difference in UPCR change between these groups (MMF minus placebo) was -0.22 (95% CI, -0.75 to 0.31; P=0.4). Adverse events were rare apart from nausea (MMF, 8.7%; placebo, 3.7%); one of these MMF patients withdrew.Low patient enrollment and short follow-up.MMF did not reduce proteinuria significantly in patients with IgAN who had persistent proteinuria after lisinopril/losartan plus Omacor.

Background. Geographical location, socioeconomic status, and logistics surrounding transportation impede access of poststroke individuals to comprehensive rehabilitative services. Robotic therapy may enhance telerehabilitation by delivering consistent and state-of-the art therapy while allowing remote monitoring and adjusting therapy for underserved populations. The Hand Mentor Pro (HMP) was incorporated within a home exercise program (HEP) to improve upper-extremity (UE) functional capabilities poststroke. Objective. To determine the efficacy of a home-based telemonitored robotic-assisted therapy as part of a HEP compared with a dose-matched HEP-only intervention among individuals less than 6 months poststroke and characterized as underserved. Methods. In this prospective, single-blinded, multisite, randomized controlled trial, 99 hemiparetic participants with limited access to UE rehabilitation were randomized to either (1) the experimental group, which received combined HEP and HMP for 3 h/d ×5 days ×8 weeks, or (2) the control group, which received HEP only at an identical dosage. Weekly communication between the supervising therapist and participant promoted compliance and progression of the HEP and HMP prescription. The Action Research Arm Test and Wolf Motor Function Test along with the Fugl-Meyer Assessment (UE) were primary and secondary outcome measures, respectively, undertaken before and after the interventions. Results. Both groups demonstrated improvement across all UE outcomes. Conclusions. Robotic + HEP and HEP only were both effectively delivered remotely. There was no difference between groups in change in motor function over time. Additional research is necessary to determine the appropriate dosage of HMP and HEP.

Background: Effective use of patient-rated outcome measures to facilitate optimal patient care requires an understanding of the reference values of these measures within the population of interest. Little is known about reference values for commonly used patient-rated outcome measures in adolescent athletes. Purpose: To determine reference values for the Pediatric Quality of Life Inventory (PedsQL) and the Multidimensional Fatigue Scale (MFS) in adolescent athletes by sport and sex. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A convenience sample of interscholastic adolescent athletes from 9 sports was used. Participants completed the PedsQL and MFS during one testing session at the start of their sport season. Data were stratified by sport and sex. Dependent variables included the total PedsQL score and the 5 PedsQL subscale scores: physical functioning, psychosocial functioning, emotional functioning, social functioning, and school functioning. Dependent variables for the MFS included 3 subscale scores: general functioning, sleep functioning, and cognitive functioning. Summary statistics were reported for total and subscale scores by sport and sex. Results: Among 3574 males and 1329 female adolescent athletes, the PedsQL scores (100 possible points) generally indicated high levels of health regardless of sport played. Mean PedsQL total and subscales scores ranged from 82.6 to 95.7 for males and 83.9 to 95.2 for females. Mean MFS subscale scores (100 possible points) ranged from 74.2 to 90.9 for males and 72.8 to 87.4 for females. Conclusion: Healthy male and female adolescent athletes reported relatively high levels of health on the PedsQL subscales and total scores regardless of sport; no mean scores were lower than 82.6 points for males or 83.9 points for females. On the MFS, males and females tended to report low effect of general and cognitive fatigue regardless of sport; mean scores were higher than 83.5 points for males and 83.8 points for females. Clinically, athletes who score below the reference values for their sport have poorer health status than average adolescent athletes participating in that sport. Scores below reference values may warrant consideration of early intervention or treatment.

Context: Patient-rated outcome measures (PROMs) capture changes that are important and meaningful to patients, such as health-related quality of life (HRQOL). Although group differences in HRQOL have been reported, little is known about the effect of injury history on HRQOL in collegiate athletes. Objective: To determine whether knee-specific function (International Knee Documentation Committee Subjective Knee Evaluation Form [IKDC]) and HRQOL (Short Form 12 [SF-12]) differs in collegiate athletes based on sex and the severity of a previous knee injury. Design: Cross-sectional study. Setting: Athletic training facilities. Patients or Other Participants: Healthy collegiate athletes (n = 263) were grouped based on self-report of a previous knee injury: severe (n = 47), mild (n = 40), and no (n = 176) knee injury. Intervention(s): Participants completed the IKDC and SF-12 during their preparticipation examinations. Main Outcome Measure(s): Generalized linear models were used to assess interactions and main effects of all scores. Results: An interaction effect was observed for the SF-12 role physical subscale (P = .02), with men in the mild- and severe-injury groups reporting worse scores than men with no injury history. We noted a main effect for injury group for the IKDC total score (P < .001) and SF-12 physical functioning (P = .04) and role emotional (P = .04) subscales, with the severe-injury group reporting worse scores than the mild- and no-injury groups. No main effects of sex were reported (P > .05). Conclusions: Despite returning to full participation, collegiate athletes who previously sustained severe knee injuries tended to report worse knee-specific function and less ability to complete activities due to physical health. In addition, individuals with a history of severe knee injury tended to report more emotional concerns than athletes with a history of mild or no knee injury. Region-specific PROMs may be more sensitive in detecting deficits than generic PROMs after return to full participation. Researchers should investigate the role of PROMs, particularly region-specific PROMs, as potential screening tools for clinical care.

Background:Upper extremity (UE) region-specific, patient-reported outcome (PRO) scales assess injuries to the UE but do not account for the demands of overhead throwing athletes or measure patient-oriented domains of health-related quality of life (HRQOL).Purpose:To develop the Functional Arm Scale for Throwers (FAST), a UE region-specific and population-specific PRO scale that assesses multiple domains of disablement in throwing athletes with UE injuries. In stage I, a beta version of the scale was developed for subsequent factor identification, final item reduction, and construct validity analysis during stage II.Study Design:Descriptive laboratory study.Methods:Three-stage scale development was utilized: Stage I (item generation and initial item reduction) and stage II (factor analysis, final item reduction, and construct validity) are reported herein, and stage III (establishment of measurement properties [reliability and validity]) will be reported in a companion paper. In stage I, a beta version was developed, incorporating National Center for Medical Rehabilitation Research disablement domains and ensuring a blend of sport-related and non–sport-related items. An expert panel and focus group assessed importance and interpretability of each item. During stage II, the FAST was reduced, preserving variance characteristics and factor structure of the beta version and construct validity of the final FAST scale.Results:During stage I, a 54-item beta version and a separate 9-item pitcher module were developed. During stage II, a 22-item FAST and 9-item pitcher module were finalized. The factor solution for FAST scale items included pain (n = 6), throwing (n = 10), activities of daily living (n = 5), psychological impact (n = 4), and advancement (n = 3). The 6-item pain subscale crossed factors. The remaining subscales and pitcher module are distinctive, correlated, and internally consistent and may be interpreted individually or combined.Conclusion:This article describes the development of the FAST, which assesses clinical outcomes and HRQOL of throwing athletes after UE injury. The FAST encompasses multiple domains of disability and demonstrates excellent construct validity.Clinical Relevance:The FAST provides a single UE region-specific and population-specific PRO scale for high-demand throwers to facilitate measurement of impact of UE injuries on HRQOL and clinical outcomes while quantifying recovery for comparative effectiveness studies.

Background: The Functional Arm Scale for Throwers (FAST) is an upper extremity (UE) region-specific and population-specific patient-reported outcome (PRO) scale developed to measure health-related quality of life in throwers with UE injuries. Stages I and II, described in a companion paper, of FAST development produced a 22-item scale and a 9-item pitcher module. Stage III of scale development, establishing reliability and validity of the FAST, is reported herein. Purpose: To describe stage III of scale development: reliability and validity of the FAST. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Data from throwing athletes collected over 5 studies were pooled to assess reliability and validity of the FAST. Reliability was estimated using FAST scores from 162 throwing athletes who were injured (n = 23) and uninjured (n = 139). Concurrent validity was estimated using FAST scores and Disabilities of the Arm, Shoulder, and Hand (DASH) and Kerlan-Jobe Orthopaedic Clinic (KJOC) scores from 106 healthy, uninjured throwing athletes. Known-groups validity was estimated using FAST scores from 557 throwing athletes who were injured (n = 142) and uninjured (n = 415). Reliability and validity were assessed using intraclass correlation coefficients (ICCs), and measurement error was assessed using standard error of measurement (SEM) and minimum detectable change (MDC). Receiver operating characteristic curves and sensitivity/specificity values were estimated for known-groups validity. Data from a separate group (n = 18) of postsurgical and nonoperative/conservative rehabilitation patients were analyzed to report responsiveness of the FAST. Results: The FAST total, subscales, and pitcher module scores demonstrated excellent test-retest reliability (ICC, 0.91-0.98). The SEM95 and MDC95 for the FAST total score were 3.8 and 10.5 points, respectively. The SEM95 and MDC95 for the pitcher module score were 5.7 and 15.7 points, respectively. The FAST scores showed acceptable correlation with DASH (ICC, 0.49-0.82) and KJOC (ICC, 0.62-0.81) scores. The FAST total score classified 85.1% of players into the correct injury group. For predicting UE injury status, a FAST total cutoff score of 10.0 out of 100.0 was 91% sensitive and 75% specific, and a pitcher module score of 10.0 out of 100.0 was 87% sensitive and 78% specific. The FAST total score demonstrated responsiveness on several indices between intake and discharge time points. Conclusion: The FAST is a reliable, valid, and responsive UE region-specific and population-specific PRO scale for measuring patient-reported health care outcomes in throwing athletes with injury.

Background: While the assessment of symptoms, cognition, balance, and oculomotor function is common among sports medicine clinicians, there has been increased attention on assessing the patient’s perception of their health status following concussion. Recent recommendations suggest the use of patient-report outcome instruments (PROs) as part of the concussion evaluation to assess health-related quality of life (HRQOL) to aid in managing the injury. At present, there is not a concussion-specific PRO developed for the assessment of HRQOL in the pediatric population. Therefore, our purpose was to develop and assess the readability of a concussion-specific HRQOL measure, the Concussion Quality of Life Scale-Youth (CQOL-Y), using a mixed method approach. Methods: For instrument development and initial item generation, we analyzed prospectively collected data from three prior studies of HRQOL that used the Pediatric Quality of Life Inventory, Multidimensional Fatigue Scale, Headache Impact Test, and Patient-Reported Outcomes Measurement Information System outcome scales. Additionally, categories and themes from a prospective qualitative study of HRQOL following concussion were analyzed. Item themes were included in the initial item generation if the item was endorsed by greater than 15% of participants at day 3 or day 10 post-injury. As part of the gap analysis, a review of the literature was also conducted for studies of HRQOL following concussion to determine domains affected after injury and to review individual items on the PROs utilized in those studies. For readability assessment, we used two approaches: participant-based and computer-based assessments. For participant-based assessment of readability sixteen participants (7 children; 10.3±1.4 years, 5.4±1.5 grade level; 9 adolescents 14.2±1.7 years, 9.4±1.6 grade level) were recruited. The San Diego Quick Assessment of Reading Ability was used to determine each participant’s reading grade level. Participants then read each item of the CQOL-Y and circled words that they did not understand. Frequency counts were determined for each word identified by participants, for each item, domain, and the total CQOL-Y. For computer-based assessment of readability, the Flesch Reading Ease (FRE) and Flesch-Kincaid Reading Level (FK) scores were calculated for each item, domain, and the total CQOL-Y. The FRE is scored 0-100, with lower scores indicating more difficult reading material. The FRE score is converted to the FK, an approximate reading level, ranging from pre-primer (12), with higher reading level indicating more difficult reading material. Summary statistics were used to report scores for each item, domain, and the total CQOL-Y. Independent t-tests were used to determine whether differences existed between children (7-12 years) and adolescents (13-18 years) on the San Diego Quick Assessment of Reading Ability and the word difficulty endorsement. Results: For instrument development, after eliminating items that were endorsed by fewer than 15% of patients, we had a total of 27 items from the established PROs related to school and cognition, social, sleep and fatigue, activities of daily living, and sport participation that were reworded to be more specific to the athletic population. The gap analysis also identified a lack of emotion or mood related items. The initial item generation phase resulted in 50 HRQOL items and 3 single-item questions in the following domains identified as important to adolescents following concussion: cognitive and school (12 items), social (11 items), mood and emotions (13 items), sleep (8 items), and activities of daily living and sport participation (6 items). For participant-based assessment of readability, the average reading levels of the participants was 6.14±1.07 (range 5-8) in children and 8.78±1.40 (range 6-10) in adolescents, which was significantly different between groups (p=.001). For the total CQOL-Y scale, children identified difficulty with .44±.73 words (range 0-4) and adolescents identified 0.33±0.71 (range 0-2 words), which was not different between groups (p=.263). Among children, difficulty was noted with irritable, errands, isolated, and occurred, whereas adolescents identified irritable and cognitive. The computer-based readability analysis of the FRE for items ranged from 34.5 to 100. The FRE of the scale as a whole was 67.6 with domains ranging from 75.4-95.3. The FK reading level ranged from 0 to 9.8 across items with a total FK score of 5.6 and domain scores ranging from 2.2-5.6. Conclusion and Significance: Using a mixed methods approach to scale development, including context identification, concept elicitation, and item pool development, we have identified a 50-item scale to assess HRQOL following concussion. The initial analysis of readability suggests the overall scale was written at an appropriate reading level for children and adolescents. Future steps of scale development, including an expert panel review, item response theory model selection, item reduction, and field-testing will be conducted to improve readability of individual items and the patient acceptability of the CQOL-Y.

Context: Increased rates of sport participation and sport-related injury have led to greater emphasis on and attention to medical care of student-athletes in the secondary school setting. Access to athletic training services is seen as a critical factor for delivering adequate injury prevention and medical care to student-athletes. However, few data are available regarding practice characteristics of athletic trainers (ATs) in this setting. Objective: To characterize the practices of secondary school athletic trainers (ATs). Design: Descriptive study. Setting: Web-based survey. Patients or Other Participants: A total of 17 558 ATs with current National Athletic Trainers' Association membership were identified for survey distribution. Of these, 4232 ATs indicated that they practiced in the secondary school setting, and 4045 completed some part of the survey. Main Outcome Measure(s): A Web-based survey was used to obtain demographic information about ATs and their secondary schools and characteristics of athletic training practice. Descriptive data regarding the athletic trainer's personal characteristics, secondary school characteristics, and practice patterns are reported as percentages and frequencies. Results: Most respondents were in the early stages of their careers and relatively new to the secondary school practice setting. Nearly two-thirds (62.4%; n = 2522) of respondents had 10 or fewer years of experience as secondary school ATs, 52% (n = 2132) had been certified for 10 or fewer years, and 53.4% (n = 2164) had 10 or fewer years of experience in any practice setting. The majority of respondents (85%) worked in public schools with enrollment of 1000 to 1999 (35.5%) and with football (95.5%). More than half of respondents were employed directly by their school. Most respondents (50.6%) reported an athletic training budget of less than $4000. The majority of ATs performed evaluations (87.5%) on-site all of the time, with a smaller percentage providing treatments (73.3%) or rehabilitation (47.4%) services all of the time. Conclusions: This is the first study to describe secondary school athletic training that reflects national practice trends. To improve the quality of athletic training care and to support and improve current working conditions, the profession must examine how its members practice on a day-to-day basis.

Little is known about the relationship between post-concussion impairments and health-related quality-of-life (HRQoL). The primary purpose of this study was to determine the relationship between traditional concussion assessments and HRQoL in adolescent athletes post-concussion. The secondary purpose was to determine the association between HRQoL deficits and time lost.In total, 1134 athletes completed a baseline assessment battery. HRQoL measures included the Pediatric Quality of Life Inventory (PedsQL), Multidimensional Fatigue Scale (MFS) and Headache Impact Test-6. In total, 122 athletes sustained a concussion and underwent follow-up testing at 3 and 10 days post-injury.The strongest relationships were between symptom severity and HRQoL. For concurrent regression analyses at Day 3, PedsQL-Physical accounted for 17.9% of the variance in time lost beyond that accounted for by traditional measures. At Day 10, PedsQL-School accounted for 15.2% and symptom severity for 7.1% of this variance. In predictive analyses, at Day 3, PedsQL-Physical accounted for 3.9% and MFS-General for 3.3% of the variance in time lost beyond that accounted for by traditional measures. At Day 10, MFS-Cognitive accounted for 12.0% of this variance.HRQoL appears to play a role in time lost post-concussion and should be measured in combination with traditional concussion assessments.

Purpose The purpose of this study was to evaluate the efficacy of peanut ball use on duration of first stage labor and pushing time in women who were scheduled for elective induction of labor at ≥39 weeks gestation and planning an epidural. Study design and methods In this randomized controlled trial, women having labor induction and planning a labor epidural were assigned (1:1) to one of two groups: one group used a peanut ball and one group did not. Outcome variables were time spent in first stage labor and time spent pushing. Factors included group assignment (peanut ball, no peanut ball), parity (primiparous, multiparous), and race. Age and maximum oxytocin dose served as covariates. Results Among women having elective induction with epidural analgesia, use of a peanut ball reduced first stage labor duration for primiparous patients significantly more than multiparous patients, p = 0.018. There was no significant difference in the reduction of length of first stage labor for multiparous women, p = 0.057 with use of the peanut ball. Peanut ball use did not alter length of pushing time for either group, p > 0.05. Clinical implications Use of peanut balls may reduce total labor time to a greater degree in primiparous patients than multiparous patients having elective induction at ≥39 weeks with epidural analgesia.

Background: To improve and standardize the sideline evaluation of sports-related concussion, the Sport Concussion Assessment Tool 2 (SCAT2) was developed. This tool assesses concussion-related signs and symptoms, cognition, balance, and coordination. This newly published assessment tool has not established representative baseline data on adolescent athletes. Hypothesis: Representative baseline SCAT2 scores in adolescent athletes will differ by gender, grade in school, and self-reported concussion history. Study Design: Descriptive epidemiology study. Methods: Interscholastic athletes were administered the SCAT2 during a preseason concussion baseline testing session. The SCAT2 total score ranges from 0 to 100 points, with lower scores indicating poorer performance. Overall, representative values were calculated using descriptive statistics. Separate independent-samples t tests, with gender and concussion history as the independent variables, and a 1-way analysis of variance, with grade as the independent variable, were conducted to assess differences in SCAT2 total score ( P < .05). Results: There were 1134 high school athletes (872 male and 262 female) who participated. The SCAT2 total score across all participants was 88.3 ± 6.8 (range, 58-100); skewness was −0.86 ± 0.07, and kurtosis was 0.73 ± 0.14. Male athletes scored significantly lower on the SCAT2 total score ( P = .03; 87.7 ± 6.8 vs 88.7 ± 6.8), and 9th graders (86.9 ± 6.8) scored significantly lower than 11th (88.7 ± 7.0) and 12th (89.0 ± 6.6) graders ( P < .001). Athletes with a self-reported concussion history scored significantly lower on the SCAT2 total score than those with no concussion history ( P < .001; 87.0 ± 6.8 vs 88.7 ± 6.5). Conclusion: These data provide representative scores on the SCAT2 in adolescent athletes and show that male athletes, 9th graders, and those with a self-reported concussion history scored significantly lower than their female, upperclassmen, or nonconcussed peers. Clinical Relevance: These results suggest that healthy adolescent athletes display variability on the SCAT2 at baseline. Therefore, clinicians should administer baseline assessments of the SCAT2 because assuming a perfect baseline score of 100 points is not appropriate in an adolescent athlete population.

Context:Recurrent headaches significantly affect health-related quality of life (HRQOL) in adults; the impact of headache on HRQOL among adolescents is unknown, and the psychometric properties of headache-specific outcomes instruments have not been adequately studied in this population.Objective:To evaluate the psychometric properties of the Headache Impact Test (HIT-6) and Pediatric Migraine Disability Assessment (PedMIDAS) in healthy adolescent athletes.Design:Descriptive survey.Setting:High school athletic training facilities during the fall sports season.Participants:177 high school athletes (89 males and 88 females).Interventions:A survey consisting of a demographic and concussion-history questionnaire, a graded symptom scale, the HIT-6, and the PedMIDAS. Internal consistency (α), test–retest reliability (rs), Bland-Altman analyses, and the Mann-Whitney U test were used to evaluate psychometric properties and age and gender differences.Main Outcome Measures:The HIT-6 and PedMIDAS item and total scores.Results:Test–retest reliability for the HIT-6 total score was rs = .72, and reliability of individual items ranged from rs = .52 to .67. The test–retest reliability for the PedMIDAS total score was rs = .61, and reliability of individual items ranged from rs = .23 to .62. Both scales demonstrated acceptable internal consistency: HIT-6 α = .89−.90 and PedMIDAS α = .71−.75.Conclusions:The authors found moderate test–retest reliability for the HIT-6 and the PedMIDAS in a healthy adolescent athlete population. Research on the applicability and utility of the HIT-6 and PedMIDAS in concussed adolescents is warranted.

Context:Throwing-related arm injuries are common in softball pitchers and may lead to diminished health-related quality of life (HRQOL). Arm symptoms such as pain have been reported to be more common in healthy overhead athletes than nonoverhead athletes. Furthermore, more frequent shoulder symptoms and lower shoulder function have been demonstrated in athletes with self-reported history of shoulder injury.Objective:To evaluate the relationship between arm injury history, current pain rating, and HRQOL assessed via 2 region-specific patient self-report scales in high school and college softball pitchers.Design:Cross-sectional.Setting:High school and college athletic training facilities.Participants:25 female softball pitchers (10 high school, 15 college; 18 ± 2 y, 169 ± 7.6 cm, 67.5 ± 10.3 kg).Intervention:Self-reported arm injury history and rating of current pain and HRQOL were collected during the late season.Main Outcome Measures:A self-report questionnaire of arm injury history and current pain rating was used, and HRQOL was assessed via 2 region-specific scales: the Disabilities of the Arm, Shoulder, and Hand (DASH) and the Functional Arm Scale for Throwers© (FAST©). Correlational analysis was used to evaluate the relationships between arm injury history, current pain rating, and the DASH total score and sport module and the FAST total score, pitching module, and subscales.Results:A history of arm injury from throwing was reported by 64% of participants, 31% of whom had to cease activity for more than 10 d. The most common site of arm time-loss injury was the shoulder (81%). Mild to severe shoulder pain during the competitive season was reported by 60% of respondents. The DASH and the FAST total scores were significantly correlated (r = .79, P < .001). Respondent rating of shoulder pain correlated significantly with the DASH total (r = .69) and sports module (r = .69) and the FAST total (r = .71), pitching module (r = .65), and pain (r = .73), impairment (r = .76), functional-limitation (r = .79), disability (r = .52), and societal-limitations (r = .46) subscales.Conclusion:History of arm injury is common in female high school and college softball pitchers. Severe injury and elevated pain are associated with lower HRQOL that extends beyond the playing field.

ObjectiveThe purpose of this study was to evaluate test-retest reliability and practice effects of the Dynavision D2 in active adolescents.BackgroundFollowing sport-related concussion, assessment of oculomotor function and vision is important. While clinical tests are recommended, computerized devices, such as the Dynavision D2, are emerging as viable tools for vision assessment. As with all concussion assessments, understanding test-retest reliability and susceptibility to practice effects is important for appropriate interpretation of serial assessments post-injury.Design/methodsParticipants included 20 female adolescents (age = 16.6 ± 1.10 years, mass = 62.0 ± 5.9 kg, height = 169.2 ± 5.1 cm). Participants completed 2 test sessions 1 week apart using the Dynavision D2. The Dynavision D2 includes a one-minute drill task where a single light illuminates, and participants hit the light as quickly as possible, completing 3 drills per trial. Participants completed 3 trials during the first session and 2 during the second. Independent variables were day (day 1, day 2) and drills (15 drills). Dependent variables were the number of hits per minute (Hits/min) and average reaction time (AvgRT). Within-day and between-day test-retest reliabilities were analyzed using two-way random effects intraclass correlation coefficients for consistency. Practice effects were analyzed with repeated measures analysis of variance and Helmert contrasts (p = 0=.05).ResultsModerate-to-strong reliability was demonstrated for Hits/min (within-day 1 [ICC = 0.74; 95% CI: 0.53, 0.87]; within-day 2 [ICC = 0.91; 95% CI. 77.97]; between-days [ICC = 0.86; 95% CI. 65.95]). Moderate-to-strong reliability was demonstrated for AvgRT (within-day 1 [ICC = 0.70, 95% CI. 48.86], within-day 2 [ICC = 0.92; 95% CI. 78.97]; between-days [ICC = 0.85; 95% CI: 0.64.94]). Practice effects were noted for Hits/Min (p = 0.001) and AvgRT (p < 0.001). Helmert contrasts suggested that the practice effect plateaued at drill 11 for Hits/min and drill 12 for AvgRT.ConclusionsModerate-to-excellent test-retest reliability was found for the one-minute task drill with better reliability noted on day 2 and between days, compared to day 1. This task is susceptible to practice effects, highlighting the need for familiarization or practice trials prior to documenting patient scores.

Context:Electrical stimulation is often used to control edema formation after acute injury. However, it is unknown whether its theoretical benefits translate to benefits in clinical practice.Objectives:To systematically review the basic-science literature regarding the effects of high-voltage pulsed stimulation (HVPS) for edema control.Evidence Acquisition:CINAHL (1982 to February 2010), PubMed (1966 to February 2010), Medline (1966 to February 2010), and SPORTDiscus (1980 to February 2010) databases were searched for relevant studies using the following keywords: edema, electrical stimulation, high-volt electrical stimulation, and combinations of these terms. Reference sections of relevant studies were hand-searched. Included studies investigated HVPS and its effect on acute edema formation and included outcome measures specific to edema. Eleven studies met the inclusion criteria. Methodological quality and level of evidence were assessed for each included study. Effect sizes were calculated for primary edema outcomes.Evidence Synthesis:Studies were critiqued by electrical stimulation treatment parameters: mode of stimulation, polarity, frequency, duration of treatment, voltage, intensity, number of treatments, and overall time of treatments. The available evidence indicates that HVPS administered using negative polarity, pulse frequency of 120 pulses/s, and intensity of 90% visual motor contraction may be effective at curbing edema formation. In addition, the evidence suggests that treatment should be administered in either four 30-min treatment sessions (30-min treatment, 30-min rest cycle for 4 h) or a single, continuous180-min session to achieve the edemasuppressing effects.Conclusions:These findings suggest that the basic-science literature provides a general list of treatment parameters that have been shown to successfully manage the formation of edema after acute injury in animal subjects. These treatment parameters may facilitate future research related to the effects of HVPS on edema formation in humans and guide practical clinical use.

Assessing the awareness and recognition of concussion is im- portant at all levels of athletics, especially youth sports. This study assessed the knowledge base of youth athletes and their parents regarding concussion and their ability to recognize it. Seventy-three youth athletes (age range, 10-14 years) and 100 parents responded to the survey. An athlete or parent version of a previously published survey about concussion was complet- ed by each participant. Athletes and parents did not differ ( P = .94) in their ability to recognize concussion symptoms. Youth athletes who reported having their "bell rung" did no better (P = .36) in recognizing concussion symptoms than those who had not. Parents with first aid certification or general medical train - ing recognized significantly more symptoms ( P = .01 and .01, respectively) than those without training. A knowledge deficit exists regarding symptom recognition and issues about sport- related concussion among youth athletes and their parents.

Objective The purpose of this study was to investigate factors influencing the success rate of orthodontic microimplants (OMIs) using panoramic radiographs (PRs). Methods We examined 160 OMIs inserted bilaterally in the maxillary buccal alveolar bone between the second premolars and first molars of 80 patients (51 women, 29 men; mean age, 18.0 ± 6.1 years) undergoing treatment for malocclusion. The angulation and position of OMIs, as well as other parameters, were measured on PRs. The correlation between each measurement and the OMI success rate was then evaluated. Results The overall success rate was 85.0% (136/160). Age was found to be a significant predictor of implant success (p < 0.05), while sex, side of placement, extraction, and position of the OMI tip were not significant predictors (p > 0.05). The highest success rate was observed for OMIs with tips positioned on the interradicular midline (IRML; central position). Univariate analyses revealed that the OMI success rate significantly increased with an increase in the OMI length and placement height of OMI (p = 0.001). However, in simultaneous analyses, only length remained significant (p = 0.027). Root proximity, distance between the OMI tip and IRML, interradicular distance, alveolar crest width, distance between the OMI head and IRML, and placement angle were not factors for success. Correlations between the placement angle and all other measurements except root proximity were statistically significant (p < 0.05). Conclusions Our findings suggest that OMIs positioned more apically with a lesser angulation, as observed on PRs, exhibit high success rates.

Context: Health-related quality of life (HRQOL) is a global concept that takes into account the physical, psychological, and social domains of health. Determining the extent to which injury affects HRQOL is an important aspect of rehabilitation practice, enabling comparisons of clinical outcomes across different conditions in diverse patient groups. Objective: To examine the extent to which a self-reported recent injury affected HRQOL in adolescent athletes using 2 generic patient self-report scales. Design: Cross-sectional study. Setting: High school classrooms and athletic training facilities. Patients or Other Participants: A convenience sample of uninjured (n = 160) and injured (n = 45) adolescent athletes. Intervention(s): The independent variable was injury status: uninjured versus injured. All participants completed a self-administered brief health status questionnaire and the Short Form–36 Health Survey Questionnaire (SF-36) and Pediatric Outcomes Data Collection Instrument (PODCI) in a counterbalanced manner. Main Outcome Measure(s): Dependent variables included 8 subscale and 2 composite scores of the SF-36 and 5 subscale scores and 1 global score of the PODCI. Group differences were assessed with the Mann-Whitney U test (P ≤ .05) and reported as median and interquartile range. Results: On the SF-36, the injured group demonstrated lower scores (P < .008) for physical functioning, limitations due to physical health problems, bodily pain, social functioning, and the physical composite. On the PODCI, the injured group reported lower scores (P < .01) on the pain and comfort subscale and the global score. Conclusions: Adolescent athletes with self-reported injuries demonstrated lower HRQOL than their uninjured peers. As expected, recent injury affected physical functioning and pain. Social functioning (on the SF-36) and global HRQOL (on the PODCI) also decreased, suggesting that injuries affected areas beyond the expected physical component of health. Clinicians need to recognize the full spectrum of negative influences that injuries may have on HRQOL in adolescent athletes.

Objective: To provide an overview of clinical outcomes assessment, discuss the classification of outcomes measures, present considerations for choosing outcomes scales, identify the importance of assessing clinical outcomes, and describe the critical link between the utilization of disablement models and clinical outcomes assessment. Background: Clinical outcomes are the end result of health care services. Clinical outcomes assessment is based on the conceptual framework of disablement models and serves as the measurement method for the collection of patient-oriented evidence, a concept central to evidence-based practice. Description: Clinical outcomes management refers to the use of outcomes measures in the course of routine clinical care and provides athletic trainers with a mechanism to assess treatment progress and to measure the end results of the services they provide. Outcomes measures can be classified as either clinician based or patient based. Clinician-based measures, such as range of motion and strength, are taken directly by clinicians. Patient-based measures solicit a patient's perception as to health status in the form of questionnaires and survey scales. Clinician-based measures may assist with patient evaluation, but patient-based measures should always be included in clinical assessment to identify what is important to the patient. Clinical and Research Advantages: Evidence-based athletic training practice depends on clinical outcomes research to provide the foundation of patient-oriented evidence. The widespread use of clinical outcomes assessment, based on the disablement model framework, will be necessary for athletic trainers to demonstrate the effectiveness of therapies and interventions, the provision of patient-centered care, and the development of evidence-based practice guidelines.

Objective: To present and discuss disablement models and the benefits of using these models as a framework to assess clinical outcomes in athletic training. Background: Conceptual schemes that form the basic architecture for clinical practice, scholarly activities, and health care policy, disablement models have been in use by health care professions since the 1960s. Disablement models are also the foundation for clinical outcomes assessment. Clinical outcomes assessment serves as the measurement tool for patient-oriented evidence and is a necessary component for evidence-based practice. Description: Disablement models provide benefits to health professions through organization of clinical practice and research activities; creation of a common language among health care professionals; facilitation of the delivery of patient-centered, whole-person health care; and justification of interventions based on a comprehensive assessment of the effect of illness or injury on a person's overall health-related quality of life. Currently, the predominant conceptual frameworks of disability in health care are those of the National Center for Medical Rehabilitation Research and the World Health Organization. Disablement models need to be understood, used, and studied by certified athletic trainers to promote patient-centered care and clinical outcomes assessment for the development of evidence-based practice in athletic training. Clinical and Research Advantages: For clinicians and researchers to determine effective athletic training treatments, prevention programs, and practices, they must understand what is important to patients by collecting patient-oriented evidence. Patient-oriented evidence is the most essential form of outcomes evidence and necessitates an appreciation of all dimensions of health, as outlined by disablement models. The use of disablement models will allow the athletic training profession to communicate, measure, and prioritize the health care needs of patients, which will facilitate organized efforts aimed at assessing the quality of athletic training services and practices and ultimately promote successful evidence-based athletic training practice.

Context:Clinicians often rely on the self-report symptoms of patients in making clinical decisions; hence it is important that these scales be reliable.Objective:To determine the test-retest reliability of healthy youth in completing a graded symptom scale (GSS), modified from the Head Injury Scale Self-Report Concussion Symptoms Scale (HIS).Design:Repeated-measures.Setting:Middle school classroom.Patients or Other Participants:126 middle school students.Intervention:A survey consisting of a demographic and life events questionnaire and a GSS asking about symptom severity and duration.Main Outcomes Measures:Score for each symptom on the severity and duration scale and a total symptom score (TSS) and the total number of symptoms endorsed (TSE) from the severity scale. Responses on a life events questionnaire were also recorded.Results:We found excellent reliability for TSS (ICC = .93) and TSE (ICC = .88) for the severity scale. We found moderate to excellent reliability on the individual symptoms of both the severity (ICC = .65-.89) and duration (ICC =.56-.96) scales.Conclusions:Healthy youth can reliably self-report symptoms using a GSS. This patient-oriented outcome measure should be incorporated into more investigations in this age group.

Serious burn injuries are a potential threat to patients with seizure disorder. There are limited studies addressing this issue. Therefore, a retrospective study was undertaken with two goals: one to develop better understanding of this potential threat and two to create a prevention message regarding seizure-related burns. The burn center registry was reviewed to ascertain the number of patients who sustained burn injury during or directly after a seizure from 2000 to 2005. Thirty-two patients were admitted (44% female, 56% male) with mean age of 39 years (SD +/- 10.4) after sustaining a burn during or after a seizure. Average TBSA was 8.3% (SD +/- 4.8) with 72% of patients experiencing full-thickness burns. The three most prevalent etiologies were falling into a stove while cooking (34%; n = 11), falling on hot pavement (31%; n = 10), and falling into a campfire (9%; n = 3). A full 88% of patients (n = 28) reported a previous diagnosis of seizure disorder, whereas the other 9% (n = 3) reported seizures related to alcohol consumption. Laboratory reports revealed 20 patients (63%) had subtherapeutic levels of antiseizure medication, 1 patient (3%) had toxic levels, and 5 patients (16%) were not being treated for seizures. Upon discharge, 23 patients went home with family, 5 were discharged to skilled nursing, 1 to a homeless shelter, 1 died, and 2 patients were lost to follow-up. Because of the severe burns observed in epileptic burn patients, a burn-prevention brochure was developed and is being distributed to seizure patients and their families.

Mandibular repositioning and subsequent neuromuscular signaling are proposed mechanisms of action for commercial mouthguards marketed for performance enhancement. A prospective cross-sectional study of 24 healthy adult weightlifters with normal occlusal relationships was designed to determine whether 2 self-fit performance mouthguards; a custom-fabricated, bilaterally balanced, dual-laminated mouthguard; and no mouthguard (control) differed in their effects on vertical dimension, muscle activation, and user preference during a 75% maximum power clean lift. Each subject was tested for each of the mouthguard categories: Power Balance POWERUP, Under Armour ArmourBite, custom, and no mouthguard. Interocclusal distance was measured at baseline and with each mouthguard. Mean and peak activity of the anterior temporalis, masseter, sternocleidomastoid, and cervical paraspinal muscles was measured during sitting and during a 75% maximum power clean lift. A mouthguard preference questionnaire was completed. Analyses were conducted to determine whether interocclusal distance differed among mouthguard type and to examine the effect of mouthguard type on mean and peak muscle activation during the clean lift. Interocclusal distance was affected by mouthguard type (P = 0.01). Mean and peak activity of the anterior temporalis and masseter muscles and mean activity of the sternocleidomastoid muscle differed among mouthguards (P0.05). Mouthguard type did not influence muscle activation of the cervical paraspinal muscle group. Overall, the Power Balance mouthguard produced more muscle activity. Participants preferred custom mouthguards nearly 2:1 over self-fit performance mouthguards (P = 0.05). Participants perceived that they were stronger and were less encumbered when using a custom mouthguard during submaximum power clean lifts.

To determine the longitudinal and concurrent validity of single-item patient-rated outcomes (PROs) in adolescent football athletes with concussion.Longitudinal.Athletic training facilities.Convenience sample of male adolescent interscholastic athletes (n=94; mean age, 15.7±1.1y; mean grade, 10.1±1.1) from a larger investigation who suffered a sport-related concussion during football and had at least 3 follow-up assessments at 3, 10, and 30 days postinjury (N=249).Not applicable.Participants were administered 3 global rating questions (1 generic, 1 for daily activities, and 1 for athletic activities) along with the Pediatric Quality of Life Inventory (PedsQL), Multidimensional Fatigue Scale (MFS), and Headache Impact Test-6 (HIT-6) at 3, 10, and 30 days postconcussion. Longitudinal validity was determined through a mixed linear model with random effects for subjects, with pairwise differences assessed using Bonferroni correction (P.05). Concurrent validity was determined by examining Spearman ρ correlations between the single-item PROs and multi-item PROs.All 3 single-item PROs improved over time, demonstrating longitudinal validity (P.001), except day 10 versus day 30 for global change (P=.072). Fair to moderate correlations were identified between the single-item PROs and the PedsQL, MFS, and HIT-6.The improvement of single-item PRO scores over a postinjury time period of 30 days suggests that these PROs respond as expected to patient recovery. The correlations identified between the single-item PROs and common multi-item PROs used in athletes with concussion demonstrate concurrent validity. Therefore, single-item PROs appear to measure patient progress in adolescent football athletes postconcussion.

Methods We performed a cross-sectional survey of 357 reproductive-aged women, mostly Hispanic (81.8%), presenting for ambulatory and hospital reproductive care in Phoenix, AZ, about their interest in natural family planning (NFP). Participants completed questionnaires, and responses were analyzed to determine predictors of interest in NFP. Results Sixty-one percent stated that they were likely or very likely to use NFP to avoid pregnancy, and 50% would use NFP to achieve pregnancy. Of factors studied, Hispanic ethnicity, lower level of acculturation, less education and recent use of condoms or withdrawal were independently associated with interest in using NFP to avoid pregnancy. Younger age and desire for future pregnancy were independently predictive of potential NFP use to achieve pregnancy. Conclusion This study suggests that Hispanic women find NFP to be an appealing family planning alternative.

Objective The purpose of this study was to determine if cesarean delivery is a risk factor for respiratory distress syndrome (RDS) and if this risk is modified by labor before cesarean. Study design This population-based case-control study compared 4778 cases of RDS to 5 times as many controls. Results Unadjusted, cesarean delivery was associated with RDS, odds ratio (OR) 3.5 (95% CI 3.2–3.8). After controlling for potential confounding variables, cesarean remained an independent risk factor, OR 2.3 (95% CI 2.1–2.6). Labor modified this risk significantly ( P =.02)—with labor, cesarean delivery had an OR of 1.9 (95% CI 2.2–2.9), without labor, the OR was 2.6 (95% CI 1.3–2.8). Conclusion Cesarean delivery was an independent risk factor for RDS. The risk was reduced with labor before cesarean, but still elevated. This supports the importance of being certain of fetal lung maturity before cesarean delivery, particularly when done before labor.

Objective This study was undertaken to use the Arizona State birth certificate database for Phoenix metropolitan hospitals, in conjunction with National Weather Service records to determine whether there is a relationship between birth rate and meteorologic or lunar conditions. This study attempts to dispel or lend significance to beliefs among hospital staff that the phase of the moon and/or meteorologic conditions are related to birth rate. Study design Birth records were limited to spontaneous vaginal deliveries, 37 to 40 weeks' gestation, in Phoenix, between 1995 and 2000 (n = 167,956). Daily birth counts were merged with daily surface weather statistics from the National Weather Service for Sky Harbor Airport, and records of lunar phase for the same period. Results The analyses revealed no significant correlates of birth rate. Conclusion Although there exists a popular belief that the phase of the lunar cycle and weather conditions affect birth rate, no such evidence was found in this study.

Glioblastoma multiforme is extraordinarily aggressive due to the propensity of cells to migrate away from the tumor core into the surrounding normal brain. In this report, we investigated the role of proline-rich tyrosine kinase 2 (Pyk2) and FAK with regard to influencing glioma cell phenotypes. Expression of Pyk2 stimulated glioma cell migration, whereas expression of FAK inhibited glioma cell migration and stimulated cell cycle progression. Pyk2 autophosphorylation was necessary, but not sufficient, to stimulate cellular migration. The N-terminal domain of Pyk2 is required for stimulation of migration as an N-terminally deleted variant of Pyk2 failed to stimulate migration, whereas expression of an autonomous Pyk2 N-terminal domain inhibited cell migration. Substitution of the C-terminal domain of Pyk2 with the corresponding domain of FAK stimulated cell migration as effectively as wild-type Pyk2; however, substitution of the N-terminal domain of Pyk2 with that of FAK inhibited cell migration, substantiating that the N-terminal domain of Pyk2 was required to stimulate migration. Silencing of Pyk2 expression by RNA interference significantly inhibited glioma migration. Cell migration was restored on reexpression of Pyk2, but expression of FAK in Pyk2 knockdown cells failed to restore migration. We conclude that Pyk2 plays a central role in the migratory behavior of glioblastomas.

Objective: To investigate whether US-born infants of mothers of Mexican descent who were enrolled in Arizona’s Newborn Intensive Care Program (NICP) received follow-up services (developmental clinic and community health nurse [(CHN)] home visits) at the rates similar to White non-Hispanic (WNH) infants. Socio-economic and health status characteristics were controlled using stepped regressions in order to assess the impact of each on service use. Methods: This population-based study used retrospective data from the NICP administrative database that were linked to birth certificates for years 1994–1998. The study population was limited to Arizona-born infants; it included 7442 infants of WNH mothers, 2612 infants of US-born Mexican American (MA) mothers and 2872 infants of Mexico-born mothers. Four service use indicators were used in the analysis. Results: Both Hispanic infant subgroups were less likely to have a CHN visit by 6 months and by 1 year, and to average fewer CHN visits. A smaller percent attended the developmental clinic by age one. After controlling for language, demographics, health status, socio-economic characteristics, and mothers’ prenatal care use, infants of US-born MA mothers had rates of use similar to WNH. However, even after controlling for the study variables, infants of Mexico-born mothers were less likely (OR =.83) to use the developmental clinic. Hispanics continued to lag behind in the use of services compared with WNHs. The disparity is not a function of ethnicity, but appears attributable to demographic and socio-economic characteristics. Infants who had a CHN visit were significantly more likely (OR = 2.51) to use the developmental clinic than those without a nurse visit. Infants whose mothers had inadequate prenatal care were less likely to use these follow-up services even after controlling for study variables. Conclusions: Infants whose mothers had inadequate prenatal care should be targeted for more intense CHN visits. Infants of mothers born in Mexico may need additional support/assistance in using the developmental clinic.

OBJECTIVES: Victims of domestic violence presenting for health care are frequently referred to medical specialists, but little is known about domestic violence screening among specialists. The aim of this study was to evaluate attitudes and behaviors concerning domestic violence of all physicians in Arizona. METHODS: A cross-sectional survey of 2244 physicians from 13 medical specialties describes domestic violence screening practices, attitudes, and behaviors of practicing physicians in Arizona. RESULTS: Among 976 respondents, 56% reported prior education on domestic violence screening; 50.5% rarely or never screen their female patients for domestic violence; and 52% reported their competence for providing treatment for victims as poor to fair. Physicians from emergency medicine, psychiatry, obstetrics/gynecology, and family practice reported higher rates of domestic violence education, screening, awareness of services, and competence at treating victims. Physical medicine/rehabilitation, anesthesiology/pain control, surgical subspecialty, medicine subspecialty, general surgery, and orthopedic physicians scored lowest on these characteristics. CONCLUSIONS: Differences in attitudes and behaviors regarding domestic violence screening were noted among specialty groups. Customizing physician training based on these findings may be beneficial.

Background: As domestic violence (DV) is frequently unrecognized by physicians, efforts to improve education on the topic have been undertaken. Purpose: To assess changes in medical education about DV. Methods: Incoming residents from 1995 (N = 52) and 2001 (N = 43) were surveyed regarding education and attitudes about DV. Results: The resident-reported emphasis on DV education increased significantly from 1995 to 2001. Hours devoted to the subject experienced no significant change. The likelihood they would ask female patients about DV and their competence in dealing with DV-specific situations experienced no significant improvement-both were rated below average. Conclusions: Although emphasis on medical education about DV has improved from 1995 to 2001, likelihood of screening and competence at dealing with DV has not improved. The content of undergraduate medical education about DV should be strengthened, and the educational process should continue during residency training.

The objective of this study was to evaluate knowledge regarding folic acid among postpartum Mexican-American patients. A survey regarding folate was administered to postpartum women at a public hospital serving primarily Mexican-Americans (n = 393). English and Spanish speakers were compared. Fifty eight percent cited prevention of birth defects as a reason to take folate. English speakers were less likely to know this than Spanish speakers (p = 0.005). Fifty-one percent of women stated they had learned about folate from radio or television. Of these, 83% knew that folic acid prevents birth defects and that it should be taken prior to pregnancy. Only 16% learned about folate from a health care provider. Compared to previous research, Mexican-American women have increased awareness of the association between folate consumption and birth defects, especially Spanish speakers. Patients citing radio/television as a source of information tended to answer questions correctly, suggesting that media efforts in this area have been effective.

It has been suggested that walking speed is the sixth vital sign. To adequately assess the status of walking speed of patients, normative data or percentile ranks are required. The purpose of this study was to develop percentile ranks for walking speed using a meta-analytic approach for independent, community-dwelling males and females between 70 and 79 years of age. Using PubMed and CINAHL, articles were included in the analysis if: 1) subjects were between 70 and 79 years of age; 2) “walking speed” was described as “comfortable,” “preferred,” “usual,” “normal,” or “self-selected”; 3) subjects were classified as independent and community-dwelling; 4) data were provided separately for males and female; 5) means, standard deviations (SD) and sample size were presented or easily discerned; and 6) the English language was used. Two systematic reviews (Bohannon and Andrews, Rydwik et al) were also used to help identify relevant studies. Articles were not included if the sampling methods or testing protocol were not well described by the authors. Principal author, country of study, and timing method, mean walking speed, SD, and number of subjects were obtained for each article. Weighted means, pooled SD, and percentile ranks from 5 to 95 were calculated. Samples of 6359 males from 22 studies representing 10 countries and 12064 females from 34 studies representing 12 countries were used for analysis. Minimal Detectable Changes (MDC) were also calculated for 95% and 90% confidence levels. The weighted mean walking speed was 116.72 cm/sec (pooled SD + 18.77) for males and 105.49 cm/sec (pooled SD + 21.20) for females. Percentile ranks from 5 to 95 were calculated for males and females. For females, the MDC95 was 10.18 cm/sec, while the MDC90 was 8.57 cm/sec. For males, the MDC95 was 9.01 cm/sec, while the MDC90 was 7.59 cm/sec. Percentile ranks are easy to explain and easy to understand, and may be used as adjunctive information during routine healthcare visits. INTRODUCTION Adequate mobility is essential for individuals to maintain an independent and active lifestyle. Because of its prevalence, decreased mobility is particularly problematic among older adults. Walking is a common means of mobility for most individuals, whether in the home or the community. The World Health Organization defined walking in its International Classification of Function as “moving along a surface on foot, step by step, so that one foot is always on the ground, such as when strolling, sauntering, walking forwards, backwards, or sideways.”1 The speed at which an individual walks can be a predictive of overall function and the assistance level required in performing everyday tasks.2-4 However, data on normative walking speed values by age group are sparse. Walking is a complex functional task that requires full body support, correct timing, power, balance and coordination.4 Walking places high demands on the brain, spinal cord, muscles, joints, lungs and heart, and requires coordination among the musculoskeletal, neuromuscular, and cardiovascular systems.4 An individual’s walking speed also depends on cognition, mental health, and motivational level.4 Percentile Ranks for Walking Speed in Subjects 70-79 Years: A Meta-analysis 2 © The Internet Journal of Allied Health Sciences and Practice, 2014 Walking speed has been shown to correlate with functional ability, balance, and coordination in older adults.4 It is associated with future hospitalizations, increased risk of dependency, fall risk, increased risk of institutionalization, decreased mobility, and mortality.5-47 It has recently been proposed as the sixth vital sign, along with blood pressure, heart rate, respiratory rate, pain, and temperature.4 Researchers have found high intraand inter-rater reliability when measuring comfortable walking speed.3,4,48 A systematic review by Rydwik et al examined the validity and reliability of walking speed distances ranging from 2 meters to 40 meters in institutionalized and community-dwelling adults ages 60 years or greater.3 Their findings suggest that comfortable walking speed is a highly reliable measure in both community-dwelling and mixed settings, such as nursing homes.3 A decrease in walking speed may provide clinicians an early warning sign of possible disruptions in one or many body systems. Early detection of decline in function can lead to early intervention for older adults, which may result in fewer hospitalizations and increased functional independence. For walking speed to have clinical relevance and applicability in the clinic, normative, reference values by age group and sex are required. Peters et al reported the reliability and validity of walking speed measurements for the 4-meter walk test (4MWT) and the 10meter walk test (10MWT) in healthy, older adults.48 Both tests were found to have high test-retest reliability, with intraclass correlation coefficients (ICC) ranging from .96 to .98. These authors also examined the reliability of two timing methods: stopwatch and automatic timer. Both methods had similar standard errors of measurement, between 0.04 and 0.08 cm/s. The agreement between the two methods was also high with ICC values ranging from 0.99 to 1.00. They concluded that measurement of both the 4MWT and 10MWT were reliable and valid using either a stopwatch or automatic timer, and both testing distances rendered walking speed values with excellent agreement. However, Peters et al also noted that for clinical use, testing distances should not be used interchangeably for the same patients over time.48 References values, in the form of percentile ranks, may be calculated using the area under the Gaussian (normal) distribution. They are easy to calculate, easy to explain, and easy to understand. Minimal detectable change (MDC) is the smallest change in a score that is result of an actual change in performance and not the result of measurement error or chance.49 It is the smallest difference in scores for repeated measures that is considered real. 50 MDC is the product of the standard error of the measurement for a test, the critical value chosen by the investigator (usually at a significance level of .05 or .10), and the square root of two. Researchers have focused on walking speed in populations presenting with significant gait deviations as a result of disease or trauma such as Parkinson’s disease, cerebral vascular accidents, Alzheimer’s disease, and post-hip surgery. Little of the literature, however, is applicable to healthy, community-dwelling older adults. The purpose of this meta-analysis was to identify data on comfortable walking speed in individuals aged 70 to 79 years. Using these data, weighted means and pooled standard deviations could be calculated to develop reference values and minimal detectable change scores that can be used in a clinical setting. These values can be used to inform patients about their functional level in reference to the performance of a population and may help to identify those patients who will benefit from early intervention. METHODS A search was conducted in the PubMed and the Cumulative Index of Allied Health Literature (CINAHL) databases using the search terms “walking speed OR gait speed.” Inclusion and exclusion criteria for articles can be found in Table 1. Abstracts and titles were reviewed to determine relevance. Full-text, portable document format (PDF) articles were obtained for further review if gait speed measurements were collected in subjects between 70 and 79 years of age. Reference lists of appropriate studies were also examined to locate additional studies. During the course of data collection, two systematic reviews were identified in which the authors investigated walking speed in older adults.3,5 These articles were used to locate additional studies. If primary study authors did not report data separately for males and females, means and standard deviations (SD) reported in the meta-analysis by Bohannon et al were used.5 Similarly, if authors did not report data separately for the age group used for inclusion, means and SD reported by Bohannon et al were used.5 Means, SD, and number of subjects were obtained from or calculated for each dataset and entered into two Microsoft Excel spreadsheets – one for males and one for females. The main author, country of study, and timing method were also included in the spreadsheet. Percentile Ranks for Walking Speed in Subjects 70-79 Years: A Meta-analysis 3 © The Internet Journal of Allied Health Sciences and Practice, 2014 Procedure for Calculating the Weighted Mean From each article, the arithmetic mean was obtained. The weighted mean was calculated as the overall sum of individual scores divided by the number of scores from all subjects. The formula for calculating the weighted mean can be found in Equation 1.51