Implementing Pool-Based Surveillance Testing for SARS-CoV-2 at the Army Public Health Center Laboratory and across the Army Public Health Laboratory Enterprise.

With limited clinical resources, burgeoning testing requests from Army and other Service units to clinical laboratories, and the continued spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) throughout the military population, the Army Public Health Laboratory (APHL) Enterprise was tasked to establish surveillance testing capabilities for active duty military populations in an expedient manner. Following a proof-of-concept study conducted by Public Health Command-Pacific, Public Health Command-Europe was the first public health laboratory to offer the capability to assess for SARS-CoV-2 in pooled samples, followed closely by the Army Public Health Center (APHC) at Aberdeen Proving Grounds, MD, paralleling the spread of the SARS-CoV-2 virus from China to Europe to the continental US. The APHLs have selected pool sizes of up to 10 samples per pool based on the best evidence available at the time of method development and validation. Real-Time quantitative Reverse Transcriptase-Polymerase Chain Reaction (qRT-PCR) assays using RNA extracts from pooled nasopharyngeal swabs preserved in viral transport media were selected to assess the presence of SARS-CoV-2. The rapid development of initial surveillance testing capabilities depended on existing equipment in each laboratory, with a plan to implement full operational capability using additional staff and common high-throughput platforms. APHL Enterprise has successfully used existing resources to begin to address the changing and complex needs for COVID-19 testing within the Army population. Successful implementation of pooled surveillance testing at the APHC Laboratory has enabled more than 8,600 Soldiers to avoid clinical testing to date. The APHC Laboratory alone has tested over 10,000 samples and prevented approximately 8,600 soldiers from seeking testing with clinical diagnostic assays.

Self-Efficacy, Perceived Barriers to Care, and Health-Promoting Behaviors Among Franco-Americans Across Cardiovascular Risk Factors: A Cross-Sectional Study.

PURPOSE: To assess the prevalence of perceived barriers to accessing health care services, self-efficacy, and health-promoting behaviors among Franco-Americans as a higher-risk group for familial hypercholesterolemia (FH), stratified by cardiovascular risk factors. DESIGN: Cross-sectional survey based on components of the Health Belief Model. SETTING: Administered in-person at a Franco-American cultural center and online through mailing lists and social media platforms in the Northeastern United States. SAMPLE: Franco-Americans and French Canadians (n = 170). MEASURES: Demographic and clinical characteristics (i.e. high cholesterol, prior heart attack or stroke, family history of atherosclerotic cardiovascular disease (ASCVD), diagnosis of FH), perceived barriers to accessing health care services, self-efficacy, and health-promoting behaviors (i.e. taking lipid-lowering medications, seeing a cardiovascular specialist). RESULTS: In a cohort of Franco-Americans, 42 (25%) had both high cholesterol and family history of ASCVD. Among Franco-Americans with both cardiovascular risk factors, 22% had low self-efficacy and only 16% had discussed FH with their physician. Individuals with both risk factors were significantly more likely to report a concern over a future diagnosis as a barrier to accessing health care services when compared with those with neither risk factor (36% vs. 15%, p = 0.014). Overall, other prominent barriers to care included knowledge of when to seek help (27%) and a distrust in medicine (26%). CONCLUSION: Franco-Americans report significant barriers to accessing health care services. Our findings strengthen the case for developing focused public health strategies to raise awareness for FH, particularly among high-risk subpopulations with unmet cardiovascular needs.

Baseline analysis of metal(loid)s on microplastics collected from the Australian shoreline using citizen science.

Microplastics are an emerging contaminant in aquatic environments. Information on the occurrence and characteristics of microplastics in Australia is limited and their interactions with chemical contaminants have not been addressed. Therefore, the aim of this study was to generate baseline information on the physical and chemical characteristics of microplastics on Australian shorelines to facilitate further detailed risk assessment. Field collected microplastics were categorised by colour, shape and polymer type. Plastic particles were primarily clear, blue, white and green and consisted mainly of fragments (57.80%) and pellets (30.68%). Polymer characterisation revealed that shoreline microplastics were polyethylene (53.17%), polypropylene (35.17%), polystyrene (6.61%) and polyethylene terephthalate (1.85%). Analysis of metal(loid)s found that concentrations of Mn, Cr, Cu, As, Zn and Pb were significantly higher on microplastics associated with industrial locations compared with other land uses, indicating that aged microplastics have the potential to adsorb toxic metals and that metals levels may be location-dependent.

Familial Hypercholesterolemia and the Founder Effect Among Franco-Americans: A Brief History and Call to Action.

Familial hypercholesterolemia (FH) is an inherited disorder characterized by chronically elevated low-density lipoprotein cholesterol levels and an increased risk of premature atherosclerotic cardiovascular disease. FH has been shown to disproportionately affect French Canadians and other ethnic populations due to the presence of a founder effect characterized by reduced genetic diversity resulting from relatively few individuals with FH-causing genetic mutations establishing self-contained populations. Beginning in the mid-1800s, approximately 1 million French Canadians immigrated to the Northeastern United States and largely remained in these small, tight-knit communities. Despite extensive genetic- and population-based research involving the French-Canadian founder population, primarily in the Province of Quebec, little is known regarding Franco-Americans in the United States. Concurrent with addressing the underdiagnosis rate of FH in the general population, we propose the following steps to leverage this founder effect and meet the cardiovascular needs of Franco-Americans: (1) increase cascade screening in regions of the United States with a high proportion of individuals of French-Canadian descent; (2) promote registry-based, epidemiological research to elucidate accurate prevalence estimates as well as diagnostic and treatment gaps in Franco-Americans; and (3) validate contemporary risk stratification strategies such as the Montreal-FH-SCORE to enable optimal lipid management and prevention of premature atherosclerotic cardiovascular disease among French-Canadian descendants.

L'hypercholestérolémie familiale (HF) est un trouble génétique caractérisé sur un mode chronique par des taux élevés de cholestérol à lipoprotéines de faible densité et un risque accru de maladie cardiovasculaire athéroscléreuse prématurée. L'HF touche de façon disproportionnée les Canadiens français et d'autres groupes ethniques par suite d'un effet fondateur caractérisé par une faible diversité génétique résultant d'un nombre relativement peu élevé d'individus ayants des mutations génétiques responsables de l'HF établissant des populations isolées. À partir du milieu des années 1800, environ un million de Canadiens français ont émigré dans la région nord-est des États-Unis et y sont pour la plupart demeurés au sein de communautés relativement restreintes et fortement homogènes. En dépit d'une vaste recherche génétique et populationnelle visant la population fondatrice canadienne-française, principalement dans la province de Québec, on sait peu de choses sur les Franco-Américains aux États-Unis. Parallèlement à une démarche ciblant le sous-diagnostic de l'HF au sein de la population générale, nous proposons les mesures suivantes pour tirer parti de cet effet fondateur et répondre aux besoins cardiovasculaires des Franco-Américains: 1) augmenter le dépistage en cascade sur les régions des États-Unis comptant une forte proportion de personnes d'ascendance canadienne-française; 2) promouvoir la recherche épidémiologique fondée sur les registres pour obtenir des estimations précises de la prévalence et cerner les lacunes touchant le diagnostic et le traitement chez les Franco-Américains; 3) valider les stratégies contemporaines de stratification du risque comme celle fondée sur le Montreal-FH-SCORE pour permettre la prise en charge optimale de la lipidémie et la prévention des maladies cardiovasculaires athéroscléreuses prématurées chez les descendants canadiens-français.

The effects of 'activating' almonds on consumer acceptance and gastrointestinal tolerance.

PURPOSE: Recommendations to soak nuts prior to consumption to reduce phytate concentrations and improve gastrointestinal tolerance have received much attention in the popular press. This is despite no supporting scientific evidence for the practice. There is also a lack of information about how soaking nuts might affect consumer acceptability. This study primarily assessed the effects of soaking almonds on consumer acceptance and secondly assessed effects on gastrointestinal tolerance. METHODS: In this 8-week randomised crossover trial, 76 participants were allocated in balanced order to receive 30 g/day of four different preparations of almonds for 12 days: whole unsoaked, whole soaked, sliced unsoaked, and sliced soaked. Ratings of overall liking, desire to consume, and likelihood of future consumption, and severity of gastrointestinal symptoms were measured daily on visual analogue scales. The phytate concentrations were measured in all four nut types using high-performance liquid chromatography. RESULTS: Mean acceptance ratings of all nut types were above the neutral point indicating they were acceptable. However, sliced soaked almonds were rated significantly lower overall for all three acceptance scales compared to the other treatments (all P ≤ 0.003). The sliced unsoaked almonds were rated lower than both whole nut treatments (all P ≤ 0.006), while there were no significant differences between the two whole nut treatments (all P ≥ 0.511). Gastrointestinal symptoms were minimal, but flatulence was rated significantly higher for all time points combined for soaked whole nuts compared to unsoaked whole nuts (P = 0.005). Compared to the whole unsoaked nuts (mean [SD] 531 [9] mg/100 g), phytate concentration was higher for the whole soaked almonds (563 [38] mg/100 g, P = 0.016), with no evidence of a difference for the sliced soaked almonds (548 [27] mg/100 g, P = 0.197) and no difference between the soaked forms (P = 0.262). CONCLUSIONS: This research supports previous results suggesting nuts, including different forms, are an acceptable food. They are also well tolerated gastrointestinally, but soaking does not improve gastrointestinal tolerance or acceptance as claimed in the lay literature.

Comparison of Mental Health Characteristics and Stress Between Baccalaureate Nursing Students and Non-Nursing Students.

BACKGROUND: Nurses consistently report the highest levels of job stress among all health professionals. To best prepare students for such a high-stress profession, insights into the onset of stress is warranted, especially with the literature supporting that nursing students experience significant stress during their education. METHOD: This study sought to explore the sources of stress among nursing students and to compare stress levels and selected mental health indicators between nursing students and the general student body using the paper-and-pencil version of the National College Health Assessment II. RESULTS: Nursing students were found to have significantly more stress, anxiety, sleep disturbances, and stress-related illnesses than the general student body. CONCLUSION: The findings highlight the importance of self-care and stress management skills education in nurse preparatory programs for use in both academic preparation and in future careers.

POPs monitoring in Australia and New Zealand using plastic resin pellets, and International Pellet Watch as a tool for education and raising public awareness on plastic debris and POPs.

Persistent organic pollutants (i.e. PCBs, DDTs, and HCHs) were analyzed along Australia and New Zealand North Island coastlines. PCB concentrations were high in urban areas (107-294 ng/g-pellet), with Sydney Harbour the most polluted. Hepta-chlorinated PCB was abundant, with ~30% in urban areas suggesting legacy pollution. DDT concentrations showed similar pattern except in rural agricultural sites, Taupo Bay and Ahipara, New Zealand (23 and 47 ng/g-pellet). p,p'-DDE predominance at these 2 sites suggested historical input; they also had high HCH concentrations (17 and 29 ng/g-pellet). The role of International Pellet Watch (IPW) in science communication was studied through feedbacks from IPW volunteers, case studies and examples. IPW data were categorized into understandable terms and tailored reports based on volunteers' backgrounds complemented with pollution maps. The effectiveness of IPW science communication has led to its use in awareness and education activities focusing on both POPs and plastic debris issues.

Modelling the impact of retention-detention units on sewer surcharge and peak and annual runoff reduction.

Stormwater management using water sensitive urban design is expected to be part of future drainage systems. This paper aims to model the combination of local retention units, such as soakaways, with subsurface detention units. Soakaways are employed to reduce (by storage and infiltration) peak and volume stormwater runoff; however, large retention volumes are required for a significant peak reduction. Peak runoff can therefore be handled by combining detention units with soakaways. This paper models the impact of retrofitting retention-detention units for an existing urbanized catchment in Denmark. The impact of retrofitting a retention-detention unit of 3.3 m³/100 m² (volume/impervious area) was simulated for a small catchment in Copenhagen using MIKE URBAN. The retention-detention unit was shown to prevent flooding from the sewer for a 10-year rainfall event. Statistical analysis of continuous simulations covering 22 years showed that annual stormwater runoff was reduced by 68-87%, and that the retention volume was on average 53% full at the beginning of rain events. The effect of different retention-detention volume combinations was simulated, and results showed that allocating 20-40% of a soakaway volume to detention would significantly increase peak runoff reduction with a small reduction in the annual runoff.

First-time NCLEX-RN pass rate: measure of program quality or something else?

The first-time NCLEX-RN(®) pass rate is considered by many to be the primary, if not sole, indicator of the quality of prelicensure nursing education programs. Used by state boards of nursing, educational program accreditors, and nursing faculty, the first-time NCLEX-RN pass rate influences important decisions about overall program quality, admission and progression policies, curricula, and teaching and learning practices. In this article, the authors call for a professional dialogue about the use of first-time pass rate (F-TPR) as an indicator of program quality, offer alternative methods for using the F-TPR as one measure of program quality, and suggest further research. One program's experience with low F-TPRs is offered as an exemplar of the unintended negative consequences that occur when the F-TPR is used as a sole criterion by a state board of nursing in judging a program's quality.

Predictable pollution: an assessment of weather balloons and associated impacts on the marine environment--an example for the Great Barrier Reef, Australia.

Efforts to curb pollution in the marine environment are covered by national and international legislation, yet weather balloons are released into the environment with no salvage agenda. Here, we assess impacts associated with weather balloons in the Great Barrier Reef World Heritage Area (GBRWHA). We use modeling to assess the probability of ocean endpoints for released weather balloons and predict pathways post-release. In addition, we use 21 months of data from beach cleanup events to validate our results and assess the abundance and frequency of weather balloon fragments in the GBRWHA. We found between 65% and 70% of balloons land in the ocean and ocean currents largely determine final endpoints. Beach cleanup data revealed 2460 weather balloon fragments were recovered from 24 sites within the GBRWHA. This is the first attempt to quantify this problem and these data will add support to a much-needed mitigation strategy for weather balloon waste.

Lifelong learning in nursing: a Delphi study.

BACKGROUND: In order to foster a culture of lifelong learning in nursing, it is important to identify what the concept means in the nursing profession as well as the characteristics of a lifelong learner. OBJECTIVES: The purpose of this Delphi study was to conceptualize lifelong learning from the perspective of nursing, and to identify characteristics and essential elements of lifelong learning. DESIGN AND METHOD: A Delphi Study technique in three phases was completed using an online survey tool. Data were analyzed for conceptual description, ratings of characteristics and attributes, and expert consensus in these three phases. SETTING: An online survey tool was used in this study. PARTICIPANTS: Recognized experts in nursing education, administration and public policy participated in this study. RESULTS: Lifelong learning in nursing is defined as a dynamic process, which encompasses both personal and professional life. This learning process is also both formal and informal. Lifelong learning involves seeking and appreciating new worlds or ideas in order to gain a new perspective as well as questioning one's environment, knowledge, skills and interactions. The most essential characteristics of a lifelong learner are reflection, questioning, enjoying learning, understanding the dynamic nature of knowledge, and engaging in learning by actively seeking learning opportunities. Keeping the mind active is essential to both lifelong learning and being able to translate knowledge into the capacity to deliver high quality nursing care. CONCLUSIONS: It is hoped that a clearer understanding of lifelong learning in nursing will foster more discussion and research about intentional, active inclusion of lifelong learning behaviors in nursing curricula.

Self-efficacy and resilience in baccalaureate nursing students.

The attrition of admitted students from nursing programs has been attributed to the perceived stress of nursing school. Students who possess the characteristics of self-efficacy and resilience may be persistent and therefore academically successful as demonstrated by test scores over the course of their education. In this article, the authors report on a study that explored self efficacy and resilience in relation to test scores among 136 baccalaureate nursing students in multiple courses during one, 16 week semester. No statistically significant differences were found in perceived self-efficacy or resilience total scores between early semester and late semester measurements. Significant differences were found on the Resilience Scale subscales of Perseverence and Existential Aloneness. Test scores were weakly correlated with resilience and self-efficacy scores.

Utility of performing routine head ultrasounds in preterm infants with gestational age 30-34 weeks.

BACKGROUND: The American Academy of Neurology and Child Neurology Society recommend performing routine screening head ultrasounds (HUS) on preterm infants of less than 30 weeks gestation. OBJECTIVE: To study the incidence of intraventricular hemorrhage (IVH) and evaluate the need for screening HUS in preterm infants with gestational age (GA) of 30-34 weeks. DESIGN/METHODS: Preterm infants (GA; 30-34 weeks) admitted to the neonatal intensive care unit (NICU) between January 1997 and September 2007 were included in this study. Grades of IVH were defined as per the Papile classification. RESULTS: Screening HUS were performed on 463 infants with GA of 30-34 weeks. Twenty-seven (5.8%) infants had abnormal cranial ultrasound (US) (IVH or periventricular leucomalacia [PVL]). The incidence of IVH ranged from 3.3% to 6.3% at various GA. Seven (1.5%) infants had severe abnormalities on HUS (grades III/IV or PVL). CONCLUSIONS: A significant number of infants born between 30 and 34 weeks of gestation have abnormalities on screening cranial US. Since not all infants born at 30-34 weeks of gestation received a HUS, the incidence of HUS abnormalities might have been overestimated due to a possible 'selection bias'. Additional studies are needed to examine the adverse neurodevelopmental outcomes in this group of preterm infants with mild abnormalities (IVH grades I or II) on cranial US before recommending routine screenings for IVH.

Measurement of persistent organic pollutants (POPs) in plastic resin pellets from remote islands: toward establishment of background concentrations for International Pellet Watch.

Plastic resin pellets collected from remote islands in the Pacific, Atlantic, and Indian Oceans and the Caribbean Sea were analyzed for polychlorinated biphenyls (PCBs), dichloro-diphenyltrichloroethane and its degradation products (DDTs), and hexachlorocyclohexanes (HCHs). Concentrations of PCBs (sum of 13 congeners) in the pellets were 0.1-9.9 ng/g-pellet. These were 1-3 orders of magnitude smaller than those observed in pellets from industrialized coastal shores. Concentrations of DDTs in the pellets were 0.8-4.1 ng/g-pellet. HCH concentrations were 0.6-1.7 ng/g-pellet, except for 19.3 ng/g-pellet on St. Helena, where current use of lindane is likely influence. This study provides background levels of POPs (PCBs<10 ng/g-pellet, DDTs <4 ng/g-pellet, HCHs <2 ng/g-pellet) for International Pellet Watch. Sporadic large concentrations of POPs were found in some pellet samples from remote islands and should be considered in future assessments of pollutants on plastic debris.

The cervical flexion-relaxation ratio: reproducibility and comparison between chronic neck pain patients and controls.

STUDY DESIGN: Reliability study. OBJECTIVE: To determine the reproducibility of the cervical flexion-relaxation ratio (FRR) measured 4 weeks apart in a group of chronic neck pain patients and healthy control group and to compare the FRR between the 2 groups. SUMMARY OF BACKGROUND DATA: The cervical FRR measures the ability of the neck extensor muscles to relax during forward flexion, similar to the lumbar FRR. Its reliability and ability to discriminate neck pain patients from controls has not been investigated. METHODS: Fourteen participants with chronic neck pain and a control group of 14 individuals with no neck pain were recruited via advertisement and word of mouth. The cervical FRR was determined at baseline and 4 weeks later using standardized electromyographic data collection and analysis procedures. RESULTS: The mean FRR value for the combined left and right side data for the neck pain groups was 1.93 ± 0.8, and 1.73 ± 0.61 at 4-week follow-up. The intraclass correlation coefficient (ICC) was 0.83 (95% CI = 0.67-0.92). Three participants in the control group developed neck pain in the 4 weeks and their data were not included in the reliability calculation. For the control group, the combined (left and right side) mean FRR value was 4.09 ± 1.58 at baseline and 4.27 ± 1.71 on retest 4 weeks later. The ICC (intraclass r) was 0.89 (95% confidence interval = 0.76-0.95). The overall ICC for the combined groups was 0.92 (95% confidence interval = 0.86-0.95). An independent 2 group t test revealed a significant difference in the baseline FRR data between the control group and the neck pain group (P < 0.001). CONCLUSION: The cervical extensor muscles exhibit a consistent flexion-relaxation phenomenon in healthy control subjects and the measurement is highly reproducible when measured 4 weeks apart in both controls and chronic neck pain patients. The FRR in neck pain patients is significantly higher than in control subjects suggesting that this measure may be a useful marker of altered neuromuscular function.

The effects of spinal manipulation on central integration of dual somatosensory input observed after motor training: a crossover study.

OBJECTIVE: This study sought to investigate the influence of spinal dysfunction and spinal manipulation on the response of the central nervous system to a motor training task. METHODS: The dual peripheral nerve stimulation somatosensory evoked potential (SEP) ratio technique was used in 11 subjects before and after a 20-minute typing task and again when the typing task was preceded with cervical spine manipulation. Somatosensory evoked potentials were recorded after median and ulnar nerve stimulation at the wrist (1 millisecond square wave pulse, 2.47 Hz, 1x motor threshold). The SEP ratios were calculated for the N9, N11, N13, P14-18, N20-P25, and P22-N30 peak complexes from SEP amplitudes obtained from simultaneous median and ulnar (MU) stimulation divided by the arithmetic sum of SEPs obtained from individual stimulation of the median (M) and ulnar (U) nerves. RESULTS: There was a significant increase in the MU/M+U ratio for both cortical (ie, N20-P25 and P22-N30) SEP components after the 20-minute repetitive contraction task. This did not occur when the motor training task was preceded with spinal manipulation. Instead, there was a significant decrease in the MU/M+U ratio for the cortical P22-N30 SEP component. The ratio changes appear to be due to changes in the ability to suppress the dual input as concurrent changes in the MU amplitudes were observed. DISCUSSION: This study suggests that cervical spine manipulation not only alters cortical integration of dual somatosensory input but also alters the way the central nervous system responds to subsequent motor training tasks. CONCLUSION: These findings may help to clarify the mechanisms responsible for the effective relief of pain and restoration of functional ability documented after spinal manipulation and the mechanism involved in the initiation of overuse injuries.

The effect of spinal manipulation on the efficacy of a rehabilitation protocol for patients with chronic neck pain: a pilot study.

OBJECTIVE: This pilot study sought to (1) determine whether a 4-week period of chiropractic care improved the ability of chronic neck pain patients to respond to an 8-week period of exercise rehabilitation and (2) determine effect sizes to use in sample size calculations for future studies. METHODS: Twenty male and female participants (age, 43 +/- 12 years; body mass index, 27 +/- 4.5 [mean +/- SD]) with chronic nonspecific neck pain were randomized into either a chiropractic care combined with exercise or an exercise only group. Group 1 received 4 weeks of chiropractic care, and group 2 waited 4 weeks before both groups participated in an 8-week exercise intervention. The following outcome measures were assessed in week 1 (baseline), week 4, and at week 12: Neck Disability Index (NDI); Visual Analogue Scale (VAS), both now and worst; neck flexion-relaxation response; and feed-forward activation (FFA) times. A repeated-measures analysis of variance was used to evaluate the changes in the NDI and VAS over time. Effect sizes were calculated for changes in neuromuscular parameters. RESULTS: There were significant decreases in the NDI score (P < .001) and VAS in (P < .005) in both groups with no significant differences between the groups. Effect sizes (ESs) were as follows: NDI (.293); VAS now (.175); VAS worst (.392); flexion-relaxation (.636); FFA times: sternocleidomastoid (.1321), anterior scalene (.195). This lead to sample size estimates as follows: flexion-relaxation response, 64 subjects per group; NDI, 145 subjects per group; VAS, 166 subjects per group. CONCLUSIONS: Chiropractic care combined with exercise and exercise alone are both effective at reducing functional disability and pain in chronic nonspecific neck pain patients. Future studies will need at least 64 subjects per group to determine if there are differences between the groups and if these differences are attributable to changes in neuromuscular measures.

Altered central integration of dual somatosensory input after cervical spine manipulation.

OBJECTIVE: The aim of the current study was to investigate changes in the intrinsic inhibitory interactions within the somatosensory system subsequent to a session of spinal manipulation of dysfunctional cervical joints. METHOD: Dual peripheral nerve stimulation somatosensory evoked potential (SEP) ratio technique was used in 13 subjects with a history of reoccurring neck stiffness and/or neck pain but no acute symptoms at the time of the study. Somatosensory evoked potentials were recorded after median and ulnar nerve stimulation at the wrist (1 millisecond square wave pulse, 2.47 Hz, 1 x motor threshold). The SEP ratios were calculated for the N9, N11, N13, P14-18, N20-P25, and P22-N30 peak complexes from SEP amplitudes obtained from simultaneous median and ulnar (MU) stimulation divided by the arithmetic sum of SEPs obtained from individual stimulation of the median (M) and ulnar (U) nerves. RESULTS: There was a significant decrease in the MU/M + U ratio for the cortical P22-N30 SEP component after chiropractic manipulation of the cervical spine. The P22-N30 cortical ratio change appears to be due to an increased ability to suppress the dual input as there was also a significant decrease in the amplitude of the MU recordings for the same cortical SEP peak (P22-N30) after the manipulations. No changes were observed after a control intervention. CONCLUSION: This study suggests that cervical spine manipulation may alter cortical integration of dual somatosensory input. These findings may help to elucidate the mechanisms responsible for the effective relief of pain and restoration of functional ability documented after spinal manipulation treatment.

Interexaminer reliability of a leg length analysis procedure among novice and experienced practitioners.

OBJECTIVE: The purpose of this study was to evaluate the interexaminer reliability of a leg length analysis protocol between an experienced chiropractor and an inexperienced chiropractic student who has undergone an intensive training program. METHODS: Fifty participants, aged from 18 to 55 years, were recruited from the New Zealand College of Chiropractic teaching clinic. An experienced chiropractor and a final-year chiropractic student were the examiners. Participants were examined for leg length inequality in the prone straight leg and flexed knee positions by each of the examiners. The examiners were asked to record which leg appeared shorter in each position. Examiners were blinded to each other's findings. kappa statistics and percent agreement between examiners were used to assess interexaminer reliability. RESULTS: kappa analysis revealed substantial interexaminer reliability in both leg positions and also substantial agreement when straight and flexed knee results were combined for each participant. kappa scores ranged from 0.61, with 72% agreement, for the combined positions to 0.70, with 87% agreement, for the extended knee position. All of the kappa statistics analyzed surpassed the minimal acceptable standard of 0.40 for a reliability trial such as this. CONCLUSION: This study revealed good interexaminer reliability of all aspects of the leg length analysis protocol used in this study.

Altered sensorimotor integration with cervical spine manipulation.

OBJECTIVE: This study investigates changes in the intrinsic inhibitory and facilitatory interactions within the sensorimotor cortex subsequent to a single session of cervical spine manipulation using single- and paired-pulse transcranial magnetic stimulation protocols. METHOD: Twelve subjects with a history of reoccurring neck pain participated in this study. Short interval intracortical inhibition, short interval intracortical facilitation (SICF), motor evoked potentials, and cortical silent periods (CSPs) were recorded from the abductor pollicis brevis and the extensor indices proprios muscles of the dominant limb after single- and paired-pulse transcranial magnetic stimulation of the contralateral motor cortex. The experimental measures were recorded before and after spinal manipulation of dysfunctional cervical joints, and on a different day after passive head movement. To assess spinal excitability, F wave persistence and amplitudes were recorded after median nerve stimulation at the wrist. RESULTS: After cervical manipulations, there was an increase in SICF, a decrease in short interval intracortical inhibition, and a shortening of the CSP in abductor pollicis brevis. The opposite effect was observed in extensor indices proprios, with a decrease in SICF and a lengthening of the CSP. No motor evoked potentials or F wave response alterations were observed, and no changes were observed after the control condition. CONCLUSION: Spinal manipulation of dysfunctional cervical joints may alter specific central corticomotor facilitatory and inhibitory neural processing and cortical motor control of 2 upper limb muscles in a muscle-specific manner. This suggests that spinal manipulation may alter sensorimotor integration. These findings may help elucidate mechanisms responsible for the effective relief of pain and restoration of functional ability documented after spinal manipulation.