Search

Objective The aim of this study was to determine the impact of sleep-disordered breathing on quality of life (QOL) in children with aerodigestive disease compared to children without aerodigestive disease. Methods Retrospective, IRB-approved, single-institution review of OSA-18 survey results administered to an unselected population of pediatric otolaryngology patients, some of whom had also been seen in the multidisciplinary aerodigestive clinic, was carried out. Results 476 non-aerodigestive patients and 43 aerodigestive patients were compared using total OSA-18 score and the summed scores from the 5 domains that comprise the OSA-18: (1) sleep disturbance, (2) physical suffering, (3) emotional distress, (4) daytime problems, and (5) caregiver concern. Sleep-related QOL was significantly worse for children with aerodigestive disease compared to those without aerodigestive disease across domains of sleep disturbance (P = 0.011), physical suffering (P = 0.028), and caregiver concern (P = 0.016). Total OSA-18 scores were in the mild impact range, and they did not differ significantly between the two populations. Conclusion While the focus of many aerodigestive programs is on the pathophysiological relationship between the upper digestive tract, the laryngotracheal airway, and the lungs, the present study elucidates a significant impact of upper airway obstruction during sleep on the QOL of children with aerodigestive disease. In recognition of this impact, certain airway centers have added a multidisciplinary approach to upper airway obstruction to their aerodigestive treatment armamentarium. At the minimum, airway treatment centers should consider systematic screening of all children with aerodigestive disease for QOL burden related to OSA.

Using data from the Survey of the Status of Social Studies ( S4), this article describes the instructional decisions and practices of elementary teachers in two neighboring states, one where social studies is tested and another where it is not. We define students’ opportunity to learn within these states as a composite of three variables: time allocations for social studies (teacher reported instructional time), methods for teaching social studies (teacher reported instructional strategies), and content focus (teacher reported content emphases and state-mandated curriculum standards). Our guiding research question for this study was: To what extent do teachers’ perceptions of elementary school social studies instructional practices and content vary between two states with different testing policies for social studies? Initial findings revealed notable differences that could not be explained by testing policies alone. Therefore, we conducted an exploratory content analysis of the elementary social studies curricula in these neighboring states. We uncovered curricular differences that suggest that state standards influence teachers’ decisions in both what and how they choose to teach social studies. However, there were curriculum differences that did not align with S4 instructional methods and content focus output. Thus, we concluded that other factors apart from the curriculum guide teachers’ decision-making. Results provided evidence that students have different opportunities to learn based on (1) state testing policies in social studies, (2) curriculum content, (3) how social studies is delivered (e.g., stand-alone versus integration), and (4) time allocated to social studies. We concluded that these variables constrict or expand students’ opportunity to learn social studies and may influence teachers’ pedagogical and content choices in elementary social studies.

Hickey, M. Gail, & Lanahan, Brian K. (2012). Even the Janitor Is White: Educating for Cultural Diversity in Small Colleges and Universities. New York, NY: Peter Lang. 240 pp., $37.95, paperback, IS...

Teacher educators from six states invited their social studies methodology students to complete an abbreviated version of the U.S. Citizenship and Immigration Services (USCIS) Naturalization Test. The preservice teachers were also asked to share their conceptions of citizenship and evaluate the naturalization test. The findings from this study indicate that although this sample of preservice teachers had limited conceptions of citizenship, most were able to get a satisfactory score on the test. The authors discuss the implications of these results and suggest ways to broaden citizenship education in teacher preparation programs.

The history education literature is replete with a call to help teachers understand that history should be taught as being inquiry-based and interpretive. We are encouraged, and rightfully so, to do history, to perform history, to do democracy, and to motivate students for inquiry and action by using primary sources. The authors developed a unit of study for history and social studies teacher candidates that would address several issues: (a) motivate and inspire future teachers to use inquiry as a tool to build K-12 students’ historical understanding and facilitate purposeful utilization of artifacts with ease; (b) help future teachers increase their knowledge of local history; and (c) present a unit that could be easily used in a secondary history course and, with some modifications, could be adapted for elementary and middle school history classrooms. The assignment was named Pay it Forward: Invigorating Instruction through Local History. This multifaceted assignment included the development of a lesson plan that would (a) demonstrate a robust understanding of engaging students in historical inquiry and local history, and (b) focus on an artifact that the teacher candidate would find as part of the investigation. The majority of the teacher candidates in this study did show evidence of, albeit limited at times, designing curriculum that encouraged K-12 students to engage in historical inquiry. Making the bridge between theory and practice, or showing evidence of learning from the methods courses, was clearly evident across the lesson plans.

There are growing concerns among social studies professionals that social studies instruction is disappearing from elementary schools. These concerns have become more pressing as educational policies emphasize core curricula of reading, writing, mathematics, and science. Questions arise as to how social studies can resume its traditional role as one of these core curricula. One possibility is to have social studies included in the accountability movement through testing. This article contemplates the role of testing in impacting social studies instruction in the elementary curriculum through a comparative analysis of data collected from a study of practicing elementary teachers in two states: one in which social studies instruction is tested and the other in which social studies instruction is not tested.

While many educators have praised the growth of technology in the history classroom, there is still contradictory evidence as to its ability to help strengthen students' historical understanding. One of the most difficult components of historical understanding for young people to achieve is historical empathy. For this study, Foster & Yeager's (1998) conception of empathy as a four step process helped provide a lens by which to view students' impressions of the Civil War. This study attempted to determine if technology, particularly through the use of an activity known as the WebQuest, could lead students to a strong level of historical understanding. Two classes of eighth grade students completed the WebQuest ‘Civil War Personal Journal,’ and took on various roles of people living during this conflict. Students worked cooperatively to complete journals before, during, and after the Civil War. Despite student appreciation of the WebQuest structure in the classroom and a general positive attitude toward th...

The two methods most often recommended for obtaining market-derived adjustments utilized in the sales comparison approach to appraisal are Paired Data Analysis and Multiple Regression Analysis. These approaches are viewed as competing alternatives, with advocates and detractors for each. The main purpose of this paper is to demonstrate that these two alternatives to estimating sales adjustments are equivalent under certain circumstances. This point of equivalence may prove to be a useful starting place for improving our understanding of the differences between and similarities of the two methods. After explaining the data requirements of each method, we provide a set of sufficient conditions under which the two methods produce identical adjustment estimates. We finish with a discussion ofrelative advantages and disadvantages of these two methods in estimating sale comparison adjustments.

This study uses published data on 422 market sales of FHA/VA insured/guaranteed houses to examine and compare four methods of estimating market-derived adjustment values to be employed in the sales comparison appraisal approach. These four adjustment methods are variations and combinations of matched pair and multiple regression analysis. Two major conclusions drawn from the results are: (1) regression on matched pair data set is equivalent to matched pair analysis using regression coefficients as secondary adjustments and produces the same primary adjustment estimate for the feature of interest, and (2) even under relatively ideal circumstances, market-derived adjustments contain a high degree of uncertainty.

Seventy patients were evaluated after combined intra- and extraarticular reconstruction of the anterior cruciate ligament. Semitendinosus and gracilis tendons were used for the intraarticular reconstruction and Losee iliotibial band tenodesis for the extraarticular procedure. Minimum followup was 5 years (average, 7). Clinical examination and instrumented ligament examination with the KT-1000 arthrometer and the Cybex II dyna mometer were used to evaluate results. Subjectively, patients had no complaints of instability with daily ac tivities ; 93% had no complaints of instability with athletic participation. Clinical examination demonstrated that 81 % had less than a 1 + Lachman test; 98% had a nega tive pivot shift. Instrumented examination of the antero posterior limits of motion revealed that only 57% had less than 3-mm side-to-side difference; 30% had 3- to 5-mm; and 13% had 6- to 9-mm. Mean hamstring muscle strength measured with the Cybex II dynamom eter was 94% at 60 and 96% at 100 deg/sec. When evaluated with the Zarins scale, 90% were rated good or excellent, 6% fair, and 4% poor. This reconstructive procedure restores functional, but not necessarily nor mal, stability in most anterior cruciate ligament-deficient knees. It allows patients to increase activity levels with out significant risk of additional injuries.

(2002). Dealing with Crisis: Teachable Moments in the Social Studies Classroom. The Social Studies: Vol. 93, No. 5, pp. 237-238.

We performed a prospective study on 50 subjects with normal knees and 50 patients with chronic unilateral disruption of the anterior cruciate ligament. In a randomized testing sequence, both groups were examined with five arthrometers: the MEDmetric KT-1000, the Stryker Knee Laxity Tester, the Acufex Knee Signature System, the Dyonics Dynamic Cruciate Tester, and the Genucom Knee Analysis System. Each examination was performed according to protocol with the knee at 30 degrees of flexion. The total anterior laxity measurements of the normal subjects using the Dyonics Dynamic Cruciate Tester and Acufex Knee Signature System were approximately half of the KT-1000, Stryker, and Genucom values. A comparison of the side-to-side measurements revealed no statistically significant difference in the values of the five arthrometers. However, the Genucom showed an unacceptably high number of normal subjects with laxity values that suggested an anterior cruciate ligament tear. Total anterior laxity measurements of the anterior cruciate ligament deficient knees were almost twice those of normal knees with each device except the Genucom. Comparison of the mean side-to-side difference in the patients with ACL deficiency demonstrated statistically significant differences in the values recorded with the five arthrometers. The side-to-side difference was greatest with the KT-1000 and least for the KSS. In the 89 N Lachman test, the KT-1000 and Stryker demonstrated the highest diagnostic accuracy. The maximum manual test improved the accuracy of each device. This study establishes the total anterior laxity measurements cannot be generalized from one device to another in either group of subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

In the period between 1981 and 1983, we treated 40 patients who had osteochondritis dissecans of the knee. Seventeen patients were skeletally mature and had large lesions (2 to 3 cm in diameter) of the medial femoral condyle that required surgery. Each of these patients, who underwent antegrade curettement, bone grafting, and pinning, had either failed a conservative program or had a loose or separated fragment. The average age at the time of surgery was 17. Followup ranged from 5 to 7 years.Postoperative evaluation included the criteria of the Hughston et al. rating scale, subjective assessment, clinical examination, and AP, lateral, and tunnel radio graphs. According to the osteochondritis dissecans rating scale described by Hughston et al., there were two excellent, nine good, five fair, no poor results, and one failure. Additional evaluation, not included in the Hughston rating scale, consisted of Cybex II muscle strength testing, strict grading of preoperative and postoperative roentgenograms for degenerative changes, and magnetic resonance imaging.Roentgenograms demonstrated that 16 of the 17 lesions healed. The average healing time was 8 months. Preoperative degenerative changes occurred fre quently ; postoperatively, there was some progression of these changes in the majority of cases. Magnetic resonance imaging demonstrated that the articular sur face was smooth in 57% of the knees and in 43% there was some degree of irregularity. Although the integrity of the articular cartilage could be documented, mag netic resonance imaging is of questionable value in the postoperative evaluation of this condition, because the status of the articular cartilage could not be correlated with the degree of degenerative changes or results.The results appear to be worse in those who had more preoperative degenerative changes, a larger le sion, or a loose fragment. This suggests that interven tion before these changes occur may improve results.

Myositis ossificans traumatica, although it is one of a number of heterotopic bone formation entities, is a specific lesion with a clearly recognized etiology and natural evolutionary pattern. Early conservative treatment with rest, elevation, and immobilization minimizes additional trauma and decreases the likelihood of incapacitating bone formation. Subsequently, active range of motion exercises progressing to resistive exercises usually effect a satisfactory recovery and return to full athletic participation. With this treatment regimen, few athletes will be left with significant functional impairment. However, surgery does have a definite role in the treatment of this condition and is indicated in those athletes who develop a large mass of mature lamellar bone which is painful and is associated with muscle weakness and a significant loss of joint motion. Four patients are presented in which surgery resulted in satisfactory recovery and return to full participation in football.

Tears of the anterior cruciate ligament in adolescents are rare. From 1977 to 1983 we did a surgical reconstruction of that ligament, using the semitendinosus and gracilis tendons, in twenty-four athletes who were twelve to fifteen years old. We routinely supplemented that procedure with the Ellison or Losee extra-articular reconstruction. The length of follow-up averaged thirty-five months. There were sixteen excellent, seven good, and one fair-plus result. Only one patient showed a significant growth abnormality. Use of the semitendinosus and gracilis tendons did not significantly decrease the strength of flexion or internal rotation as measured by the Cybex-II dynamometer.

A prospective study was performed on 50 patients who were thought or suspected to have cruciate ligament tears. Each patient had a clinical examination preoper atively and under anesthesia and instrumented exami nation using the MedMetric KT-1000 arthrometer, Stry ker knee laxity tester, and Genucom knee analysis. The diagnosis was confirmed by arthrotomy or arthroscopy. Thirty had acute knee injuries (within 2 weeks), 9 had subacute (2 weeks to 3 months), and 11 had chronic injuries. The surgical findings demonstrated that five had other maladies, but no cruciate ligament tears. Two had a partial ACL tear, and the remaining 43 patients had at least one cruciate tear. The preoperative clinical examination for cruciate lig ament integrity was completely correct in 92%, correct but incomplete in 6%, and incorrect in 2%. Examination under anesthesia was correct in 98%, the KT-1000 was correct in 75% (involved knee minus noninvolved knee was ≥3 mm laxity equal to ACL tear), the Stryker was correct in 75%, and Genucom in 70%. The average laxity of those with ACL tears was 4.4 mm with the KT- 1000, 4.6 mm with the Stryker, and 2.0 mm with the Genucom. The methods of testing with the Stryker and the KT- 1000 are similar and the laxity recorded in patients with a torn ACL were almost identical. However, the KT- 1000 can be used to identify the quadriceps neutral position and therefore more accurately determine PCL instability. The Genucom has the most versatility, but the laxity recorded in patients with a torn ACL was significantly lower than the other devices. It had the poorest correlation with the clinical Lachman test. This study suggests that clinical examination by an experienced examiner is the most accurate way to determine cruciate ligament integrity. However, instru mented testing was beneficial. In many cases, confi dence in clinical diagnosis was improved by instru mented confirmation.

Stress fractures of the tibia commonly occur in the proximal metaphysis and heal readily with rest. Frac tures of the middle third of the tibia, on the other hand, are uncommon. We encountered six stress fractures of the middle third of the tibia over a 5 year period. None of these fractures healed with simple immobilization. One was treated with electromagnetic stimulation and failed to unite 2 years after presentation. One patient underwent a biopsy of the lesion without bone grafting and it had not healed when he was last seen. One patient sustained two acute complete fractures, and the stress fracture finally healed after the second acute fracture was openly reduced and internally fixed. The other three lesions were excised and grafted because of failure to unite. They all healed promptly. Stress fractures of the middle third of the tibia are unusual lesions. However, care must be taken in treating them. The patient must protect the extremity until the fracture has completely healed. Surgical excision and bone grafting of the lesion may be required if the fracture does not heal with plaster immobilization.

The accuracy in clinical diagnosis of meniscal tears was assessed in 100 knees. Arthroscopy was performed in each case to establish the diagnosis. The clinical diag nosis was correct in 87 cases, correct but incomplete in 4, and incorrect in 9. In those with mensical tears repeated popping occurred in 43%, swelling in 51%, and pain localized to the joint line in 63%. Tenderness over the joint line, the most accurate clinical sign, was positive in 77% and false positive in 11 % of meniscal tears. McMurray's test was positive in 58% and false positive in 5%, while the medial-lateral grind test was positive in 68% and false positive in 1 %. At least one of these manipulative tests was positive in 79% of meniscal tears. Repeated examination and addition of the medial-lateral grind test to the clinical evaluation of meniscal tears significantly improves diagnostic accu racy.

The purposes of this study were to document the dimensions and configuration of the intercondylar notch in the normal knee; to compare normal knee intercon dylar notches to those of knees with unilateral and bilateral ACL tears to determine if there is a relationship between intercondylar notch stenosis and ACL tears; and to determine if generalized ligamentous laxity is associated with intercondylar notch stenosis and ACL tears. Three groups were compared: Group I, bilateral ACL tears; Group II, unilateral tears; and Group III, normal knees. Notch dimensions were computer-gen erated from CT scans. All patients were examined for ligamentous laxity. Statistically significant differences were found between normal and ACL-injured knees in regard to opening notch angle, ratio of notch width at two-thirds of the notch length to condylar width, and ratio of maximum notch width to condylar width, sug gesting a significant association between anterior outlet stenosis and unilateral and bilateral ACL tears. The shapes of the notches were determined from tracings of the distal CT scan. Shapes ranged from inverted U to cresting wave. Narrow notches tended to be wave- shaped, but more study is needed in this area. Notch- plasty is recommended for those with documented stenosis. The ratio of maximum notch width at two- thirds of the notch height to maximum condyle width should not be much less than 0.2, and the opening notch angle should be at least 50°.

Radial head subluxation secondary to traumatic rupture of the annular ligament has been well described in the literature. Annular ligament reconstruction utilizing fascia lata graft has been proposed and described, but no follow-up reports have been published. A 21-year-old man was treated by annular ligament reconstruction for recurrent radial head subluxation with a good result and no recurrent subluxation at more than four years postoperatively. The operative technique is as follows: a fascia lata graft 1.5 x 12 cm was anchored through a drill hole in the posterolateral ulna, passed around the radial neck, and sutured back onto itself to reconstruct an annular ligament.

A review of charts and x-ray films of individuals who sustained ankle sprains was carried out to determine the presence of calcaneonavicular coalition. Coali tions were present in 63% of 215 patients with 223 ankle sprains. In 130 ankle sprains recorded as oc curring directly in athletics, 65% of the x-ray films showed some degree of calcaneal navicular abnor mality. This study found a much higher percentage of coalitions than anticipated in either the general pop ulation or the injured athletic population and rein forced the belief that there may be an underlying anatomic predisposition to ankle sprains.

Tears of the anterior cruciate ligament in adolescents are rare. From 1977 to 1983 we did a surgical reconstruction of that ligament, using the semitendinosus and gracilis tendons, in twenty-four athletes who were twelve to fifteen years old. We routinely supplemented that procedure with the Ellison or Losee extra-articular reconstruction. The length of follow-up averaged thirty-five months. There were sixteen excellent, seven good, and one fair-plus result. Only one patient showed a significant growth abnormality. Use of the semitendinosus and gracilis tendons did not significantly decrease the strength of flexion or internal rotation as measured by the Cybex-II dynamometer.

Numerous postoperative therapies have been advo cated for the rehabilitation of patients who have under gone ACL reconstruction. The effectiveness of these various methods, many of which are based on sound scientific principles, has yet to be documented. The purpose of this study was to determine the efficacy of five commonly used rehabilitation programs. Five groups of 20 patients, all of whom underwent the same method of ACL reconstruction, were compared in order to determine the effects of the following treatments (some in combination): transcutaneous electrical nerve stimulation (TENS), immobilization in flexion, immobili zation in extension, electrical muscle stimulation (EMS), and continuous passive motion (CPM). Clinical evalua tion, volumetric thigh measurements, instrumented varus-valgus stress testing, KT-1000 arthometer (Med metric, San Diego, CA) measurements, and Cybex II (Cybex, Division of Lumex, Ronkonkoma, NY) muscle evaluation were used to examine the patients. TENS did not reduce the amount of pain medication required, nor was there improvement in any other clin ically measurable parameter of performance. There was no clear difference in stability between those treated in extension and those treated in flexion; however, since three patients who were treated in extension required manipulation, there may be some advantage to treating patients with early limited range of motion in flexion. EMS did not reduce atrophy but it did minimize strength decrease during immobilization. EMS also resulted in significantly greater range of motion than those treated with extension or flexion with early limited motion. Compared to all groups, EMS patients had a significant reduction in the incidence of patellofemoral crepitation. As compared to immobilization in extension, CPM re duced the need for manipulation, but was not as effec tive as early limited range of motion. The optimal rehabilitation program included EMS and immobilization in flexion with early limited range of motion.

A case report of acute peroneal compartment syndrome occurring in a 25-year-old male softball player is presented, in which neuropraxia of the common peroneal nerve occurred within 8 hr after onset and in which complete recovery occurred after fasciotomy was done 13 hr after onset of symptoms. A plea is made for early diagnosis and complete fasciotomy carried out as a surgical emergency. This must be accomplished if results previously reported, indicating permanent disability in 80%, are to be improved.

To evaluate a new low lint, nonwoven surgical sponge material, a prospective, stratified, randomized, single blind study of 232 patients was carried out. Patients studied underwent thoracic, upper abdominal or lower abdominal operations. The new material, in the form of laparotomy pads and sponges, was compared with cotton gauze. Safety of the material was evaluated by a battery of biochemical and hematologic tests. No clinically significant differences were seen. Effectiveness was evaluated by measuring fluid absorption. The new material was significantly more effective than cotton gauze in both configurations studied. Since this article was completed, the sponge material has been refabricated into laparotomy pads which are appreciably softer and more comformable than the study pads. The newest revision has been cleared by the Food and Drug Administration for clinical use.

Because of the effects of fluctuations in water levels of the Great Lakes on economic interests, consideration is being given to engineering works to regulate these levels. The surplus water of Lake Erie is funneled through the Niagara River, the link between Lakes Erie and Ontario, and thus the capacity of the river controls flow from, and heights of, Lake Erie. The purpose of the model study was to determine the nature and extent of excavation in the Niagara River required to increase the capacity of the river at times of high lake levels, the best location for a regulating structure extending completely across the river channel, and the length of regulating structure that would have to be closed to reduce flow into the river during periods of low lake levels. The hydraulic investigation was conducted on an existing model used to study the development of power and preservation of the scenic spectacle at Niagara Falls. The model was of the fixed-bed type, constructed to linear scale ratios of 1:360 horizontally and 1:60 vertically, and reproduced 26 miles of the Niagara River from Lake Erie to the Falls. Two excavation plans were investigated: one based on a wide, shallow channel and the other on a deep, narrow channel. Test results indicated that either plan would produce substantial lowering of lake levels through excavation of up to about 10,000,000 cu yd; greater amounts of excavation would produce only slight additional lowerings. Of the two plans, the deep, narrow design was found more efficient. Two locations of the regulating structure were studied: one at Bird Island about 4000 ft upstream from Peace Bridge, and the other about 700 ft downstream from Peace Bridge. At each location tests were made of the structure closing from both the American and Canadian sides.

Tests to investigate surges that could occur in the intermediate pool of' Long Sault Canal between Eisenhower and Grass River Locks through accidental failure of' the gates in the upstream lock were conducted on a fixed-bed model built to a horizontal scale of' 1 to 200 and a vertical scale of' 1 to 100. The test results showed that the maximum height of the surge above normal pool elevation would be 4.5 ft at the downstream (Grass River) lock when closing of the emergency lift gate of Eisenhower Lock was started 10 minutes after the miter gates failed and closure was completed in 19 additional minutes. For these conditions, the design height of the Grass River Lock walls is adequate to contain the surges produced. However, if water were prevented from flowing onto overbank areas adjacent to the canal, surges at Grass River lock would increase to 14.4 ft above normal pool elevation.

The general question which forms the background of this study is the basic unsolved problem of how the binocular field is related to the monocular fields which must underlie it. The theory usually taught in psychology courses is the Fusion Theory. It assumes that there are corresponding areas of the two eyes, that fibers from each pair of such corresponding points meet in the occipital lobe and fusion occurs. Further, an isodynamic cell is assumed, one which can be fired by either or both fibers of each pair, and one which is responsible for sensation. This form of the Fusion Theory may be attributed to Cajal.1 There are three rivals to the Fusion Theory. First, there is the Suppression (or Replacement) Theory. It assumes that there are corresponding areas of the two eyes, that the two fibers from each pair of such corresponding points meet in the occipital lobe, but only one fiber of each pair is responsible for sensation-the sensation associated with stimulation of one of the pair of corresponding points is suppressed. One form of this theory has recently been espoused by Asher; another form of it has continually been put forward over the last half a century by Verhoeff.2 In opposition to both the Fusion Theory and the Suppression Theory is a NonPhysiological Theory. Its major champions have been Helmholtz8 and Sherrington.4 Both recognize the notion of corresponding areas of the two eyes and the convergence of afferent pathways, but they deny that such an arrangement has major relevance for sensation. Both assert that processes associated with sensation remain independent between the two eyes, and the binocular percept represents a psy