Prospective study comparing the conventional and same-day strategies to diagnose pulmonary tuberculosis.

OBJECTIVE: The WHO recommends same-day sputum smear microscopy for the diagnosis of smear-positive tuberculosis (TB) in countries with high TB burden for earlier diagnosis and treatment, a cornerstone to prevent air-borne transmission. We aimed to compare the conventional strategy (sputum collection on three consecutive days) and the same-day strategy (hour h, h+1, h+2) in France, a country with low TB burden. PATIENTS AND METHODS: Over a six-month period, all adult individuals presenting with presumptive smear-positive TB were eligible for the study, registered in https://clinicaltrials.gov/ ID (NCT02961569). Sputum specimens were collected three times the first day, then once on the second day and once on the third day. The concordance between the two strategies regarding smears and cultures were assessed. RESULTS: Of the 131 eligible individuals, 34 were given a TB treatment. Smears from hour h, h+1, h+2, day two and three were negative in 19 of these 34 patients. Positive smears were obtained in 15, 14, 15, 14, and 14 patients at hour h, h+1, h+2, on day two and three, respectively. Concordance regarding smear or culture was good, with Kappa 0.69 and 0.64, respectively. CONCLUSION: The same-day strategy seems to be a good alternative to the conventional strategy.

[Prospective study of the factors associated with the acceptance of generics substitution by patients and their liberal doctors]. / Étude prospective des facteurs associés à l'acceptation de la substitution des génériques par les patients et leurs médecins libéraux.

BACKGROUND: Many prescribers and patients remain reluctant to substitution to generics. METHODS: We conducted a prospective observational study, using semi-structured interviews adapted to identify factors independently associated with the acceptance of alternative to a generic drug by doctors and patients. RESULTS: Between December 2014 and August 2015, 108 patients and 73 private doctors from Île-de-France and Nord-Pas-de-Calais were enrolled. Only 48 % of patients thought that the effectiveness and safety of generic were identical to the brand-name, 50 % had a favorable opinion and 36 % said they routinely accept substitution, especially when substitution was proposed by the general practitioner (68 % of patients). Age, gender, occupational status and the presence of a chronic condition were not associated to acceptance of substitution (P>0, 1), unlike the opinion (P<0.001), perception of efficacy (P<0.001) and side effects (P=0.0005). Two thirds of physicians substituted more than 50 % of their brand name prescription to generics. This low figure was due to patient request not to substitute (63.9 %). CONCLUSION: The acceptance of substitution was independently associated to patient' opinion about generic drugs, further emphasizing the need for information campaigns dedicated to patients.

Assessment of the antimicrobial effectiveness of a new silver alginate wound dressing: a RCT.

OBJECTIVE: To compare the efficacy and tolerability of a new ionic silver alginate matrix (Askina Calgitrol Ag) with that of a standard silver-free alginate dressing (Algosteril). METHOD: Patients with locally infected chronic wounds (pressure ulcers, venous or mixed aetiology leg ulcers, diabetic foot ulcers) or acute wounds were eligible for this prospective, open-label, controlled and randomised trial. Patients were randomised to receive one of the two dressings for a two-week period. Criteria of efficacy were based on the evolution, from day 1 to day 15, of local signs of infection using a clinical score ranging from 0 to 18, and the evolution of the bacteriological status for each wound. The latter was determined by (blind) bacteriological examinations of results obtained from two biopsies performed at days 1 and 15. A three-point scale (deterioration, unchanged, improvement) was also used. Acceptability, usefulness and tolerance were also assessed. RESULTS: Forty-two patients (20 women and 22 men, 68.9 +/- 18.8 and 66.5 +/- 15.7 years old respectively) were randomly assigned to receive either Askina Calgitrol Ag (n=20) or Algosteril (n=22). Most had chronic wounds such as pressure ulcers (57%) or venous or mixed aetiology leg ulcers and diabetic foot ulcers (29%); few had acute wounds (14%). Clinical scores of infection were comparable in both groups at inclusion, 8.9 +/- 2.4 and 8.6 +/- 3.2 in the Askina Calgitrol Ag group and the Algosteril group respectively (not significant), but decreased significantly in both groups at day 15, 3.8 +/- 2.9 in the Askina Calgitrol Ag group (p=0.001) and 3.8 +/- 3.4 in the Algosteril group (p=0.007). There was no significant difference between the two groups at day 15. Although there was also no significant difference in bacteriological status between the treatment groups, a trend in favour of Askina Calgitrol Ag was found for the relative risk of improvement, especially in patients who were not treated with antibiotics either at the beginning of the study or during it. No differences between groups were observed regarding local tolerance, acceptability and usefulness of the dressings. CONCLUSION: The regression of local signs of infection, local tolerance, acceptability and usefulness were similar for the two dressings. However, Askina Calgitrol Ag improved the bacteriological status of the wounds. Further trials are required to show that it has a positive impact on the healing process.

Description of liver disease in a cohort of HIV/HBV coinfected patients.

BACKGROUND: Factors associated with advanced liver disease have been incompletely explored in HIV/HBV coinfected patients. OBJECTIVES: To describe liver-related morbidity, mortality, and related risk factors, in HIV/HBV coinfected patients. STUDY DESIGN: We followed-up 107 consecutive HIV/HBV coinfected patients. Clinical, biological and virological data were collected every 3 months. Liver-related mortality and a composite score were used to define advanced liver disease. RESULTS: The patients were mainly sub-Saharan Africans (61%) or Europeans (33%). Forty-four percent of patients had liver biopsy, 78% of patients received lamivudine. Advanced liver disease (ALD) was diagnosed in 19/107 patients during follow-up (mean 4.8 years): 10 extensive fibrosis, 5 cirrhosis, 3 hepatocellular carcinoma resulting from cirrhosis, and 1 fulminant hepatitis following lamivudine withdrawal. Eleven patients died, 4 from HBV-related liver disease. In univariate analysis, male gender, mean HIV and HBV viral loads, and raised AST/ALT transaminases were associated with increased risk of ALD. The strongest associations, in a multivariate model, were mean AST transaminase and cumulated time receiving lamivudine, with a favourable effect. 39% of patients with increased mean AST presented with ALD, versus 7% when normal mean AST (Relative Risk 5.5). CONCLUSIONS: During HIV/HBV coinfection, transaminase levels are strongly associated with ALD. Normal mean AST has a high negative predictive value, contrary to previously reported data in HIV/HCV patients.

Effect of the thromboxane prostaglandin receptor antagonist terutroban on arterial thrombogenesis after repeated administration in patients treated for the prevention of ischemic stroke.

BACKGROUND: The antithrombotic, antiplatelet and endothelial activity of terutroban, a specific thromboxane prostaglandin receptor antagonist, was assessed in patients previously treated with aspirin for the prevention of ischemic stroke. METHODS: This double-blind, parallel-group, 10-day study included 48 patients (age = 70.5 +/- 9.5 years) with cerebral ischemic event and/or carotid stenosis in 4 groups: terutroban 10 mg/day (n = 13), aspirin 300 mg/day (n = 12), terutroban 10 mg/day + aspirin 300 mg/day (n = 11) or clopidogrel 75 mg/day + aspirin 300 mg/day (n = 12). The measurements included parameters from an ex vivo model of thrombosis, platelet aggregation in platelet-rich plasma and plasma biomarkers of endothelial/platelet activation. RESULTS: Between days 0 and 10, the mean cross-sectional surface of dense thrombus significantly decreased with terutroban (58%, p = 0.001), terutroban + aspirin (63%, p = 0.005) and clopidogrel + aspirin (61%, p < 0.05). On day 10, the value for terutroban was significantly lower than that for aspirin (p < 0.01) and was comparable to the dual therapy terutroban + aspirin or clopidogrel + aspirin. Similar results were found for total thrombus surface and platelet adhesion. Platelet aggregation induced by the specific thromboxane prostaglandin receptor agonist U46619 was almost completely inhibited on day 10 in both terutroban groups but not in the others. As regards markers of endothelial/platelet activation or lesions, thrombomodulin significantly increased and plasma soluble P selectin significantly decreased by day 10 in both terutroban groups, whereas the von Willebrand factor did not change significantly. Terutroban was found to be safe and well TOLERATED. CONCLUSIONS: Terutroban has demonstrated an antithrombotic activity that is superior to aspirin and similar to clopidogrel + aspirin; it induces a significant in vivo reduction in endothelial/platelet activation.

Clinical and laboratory studies of the antacid and raft-forming properties of Rennie alginate suspension.

BACKGROUND: Acid pockets at the gastro-oesophageal junction escape buffering from meals in the stomach. Combining high-dose antacid with alginate may therefore be of benefit in gastro-oesophageal reflux disease. AIM: To characterize the antacid and raft-forming properties of Rennie alginate suspension (containing high-dose antacid and alginate; Bayer Consumer Care, Bladel, the Netherlands). METHODS: The in vitro acid-neutralizing capacity of Rennie algniate was compared with Gaviscon (Reckitt Benckiser, Slough, UK) by pH-recorded HCl titration. Alginate raft weight formed in vitro at different pH was used to evaluate the pH dependency of raft formation with each product. A double-blind, placebo-controlled, randomized crossover study also compared the antacid activity of Rennie alginate vs. placebo in vivo using continuous intragastric pH monitoring in 12 healthy fasting volunteers. RESULTS: Compared with Gaviscon, Rennie alginate had a higher acid-neutralizing capacity, greater maximum pH and longer duration of antacid activity in vitro. However, the two products produced comparable alginate rafts at each pH evaluated. In vivo, Rennie alginate provided rapid, effective and long-lasting acid neutralization, with an onset of action of <5 min, and duration of action of almost 90 min. CONCLUSIONS: The dual mode of action of Rennie alginate offers an effective treatment option for mild symptomatic gastro-oesophageal reflux disease particularly considering recent findings regarding 'acid pockets'.

Paracetamol: a haemorrhagic risk factor in patients on warfarin.

AIM: To quantify the effect of paracetamol on the anticoagulant effect of warfarin under normal clinical conditions. PATIENTS AND METHODS: In a prospective double-blind, cross-over, placebo-controlled study, 11 patients on stable warfarin therapy received in random order two 14-day regimens of paracetamol 4 g day(-1) or placebo, with a 14-day or more wash-out period in between, time necessary to fulfil the inclusion criteria. RESULTS: In patients on paracetamol, the mean maximum increase in the International Normalized Ratio (INR) observed was 1.04 +/- 0.55 vs. 0.20 +/- 0.32 in those on placebo (P = 0.003). The mean maximum INR observed was significantly higher with paracetamol than with placebo (3.47 vs. 2.61, P = 0.01). In patients receiving paracetamol, the mean observed INR was significantly increased after 4 days (+ 0.6 +/- 0.6, P < 0.001). CONCLUSION: Paracetamol at 4 g day(-1) induces a significant increase in INR in patients receiving a stable regimen of warfarin, increasing the risk of bleeding associated with warfarin.

Bioavailability of oral vs intramuscular iodinated oil (Lipiodol UF) in healthy subjects.

BACKGROUND: In order to fight against iodine deficiency, the essential cause of endemic goiter and cretinism, several health organizations promoted campaigns of iodinated oil (Lipiodol UF) administration using iodinated oil administered intramuscularly. However, it seems preferable to administer iodinated oil orally, as this is more appropriate and since the efficacy of this route has been demonstrated as well as for intramuscular route by controlled clinical trials. OBJECTIVE: To assess the bioavailability of iodinated oil (Lipiodol UF) administered via two different administration routes and the safety profile of this agent. DESIGN: A randomized bioavailability study was performed comparing a single oral dose of 3 capsules (570 mg of iodine) vs a single intramuscular injection of 1 ml of Lipiodol UF (480 mg of iodine) in 36 healthy subjects followed for 9 months. RESULTS: The results show that, at these dosages, the 24 h urinary iodine values are above baseline for both oral and intramuscular administrations (im: >12 months/oral: 6 months) for prolonged period of time. In terms of safety, Lipiodol, administered by im injection or orally, did not induce any undesirable effects or any alteration of thyroid function tests in this study. CONCLUSIONS: In conclusion, this study shows that im or oral administration of a single dose of Lipiodol provides a significant and prolonged iodine supplement. The results obtained confirm the possibility of protection of exposed populations after annual administration of an appropriate single oral dose, without inducing any clinical or laboratory adverse effects. The product, by either route of administration, has a prolonged efficacy in iodine-deficient subjects (im: 2-3 years/oral: 1 year).

D-dimer: a characteristic of the coagulation state of each patient with chronic atrial fibrillation.

BACKGROUND AND OBJECTIVE: It is accepted that patients with atrial fibrillation (AF) are characterised by increased levels of plasmatic D-dimers, with a wide inter-individual variability depending on the patients and therapeutic characteristics, but it has not been established if this level was predictive of the risk of arterial thromboembolic event. In order to answer such a question, it has to be established if the D-dimer level in a given patient is characteristic of such a patient (stable over time) if also fluctuating with time (and useless to characterise the patient). METHODS AND RESULTS: One hundred thirty clinically stable patients with chronic AF were recruited (anticoagulant: group 1, antiaggregant aspirin: group 2, no antithrombotic: group 3). During the follow-up of patients without clinical events (n=63), it is notable that in patients with D-dimer levels <500 ng/ml, these remained <1000 ng/ml, in patients with levels between 500 and 1000 ng/ml, these did not reach 1590 ng/ml, and in those with D-dimers >1000 ng/ml, the levels remained relatively stable. Mean age and D-dimer levels were lower in group 1 (74.4 years and 509.1 ng/ml, respectively) than in group 2 (82.4 years, p=0.0003 and 1015.7 ng/ml, p<0.0001, respectively) and in group 3 (79.3 years and 1289.3 ng/ml, p<0.0001, respectively). The effect of the antithrombotic therapy was independent of the age of patients (p=0.017). CONCLUSION: D-dimer levels in patients with chronic AF remain in the same range over time. They are lower on anticoagulant therapy than on antiaggregant or no antithrombotic therapy, irrespective of age. Thus, D-dimers appear to be a useful parameter for assessing the degree of hypercoagulability of patients whatever their age.

Effect of computer keyboard slope and height on wrist extension angle.

The goal of this study was to determine the systematic effect that varying the slope angle of a computer keyboard along with varying keyboard height (relative to elbow height) have on wrist extension angle while typing. Thirty participants typed on a keyboard whose slope was adjusted to +15 degrees, +7.5 degrees, 0 degrees, -7.5 degrees, and -15 degrees. The height of the keyboard was set up such that participants' wrists were at the same height as their elbows, above their elbows, and four cm below their elbows. Results showed that as keyboard slope angle moved downward from +15 degrees to -15 degrees, mean wrist extension decreased approximately 13 degrees (22 degrees at +15 degrees slope to 9 degrees at -15 degrees slope). Keyboard height had a similar effect with mean wrist extension decreasing from 21.8 degrees when the keyboard was lower than elbow height, to 7.3 degrees when the keyboard was higher than elbow height. Potential application of this research includes the downward sloping of computer keyboards, which could possibly be beneficial in the prevention of musculoskeletal disorders affecting the wrist.

Walker-assisted gait in rehabilitation: a study of biomechanics and instrumentation.

While walkers are commonly prescribed to improve patient stability and ambulatory ability, quantitative study of the biomechanical and functional requirements for effective walker use is limited. To date no one has addressed the changes in upper extremity kinetics that occur with the use of a standard walker, which was the objective of this study. A strain gauge-based walker instrumentation system was developed for the six degree-of-freedom measurement of resultant subject hand loads. The walker dynamometer was integrated with an upper extremity biomechanical model. Preliminary system data were collected for seven healthy, right-handed young adults following informed consent. Bilateral upper extremity kinematic data were acquired with a six camera Vicon motion analysis system using a Micro-VAX workstation. Internal joint moments at the wrist, elbow, and shoulder were determined in the three clinical planes using the inverse dynamics method. The walker dynamometer system allowed characterization of upper extremity loading demands. Significantly differing upper extremity loading patterns were identified for three walker usage methods. Complete description of upper extremity kinetics and kinematics during walker-assisted gait may provide insight into walker design parameters and rehabilitative strategies.

Endoscopic evaluation of the gastrotolerance of short-term antalgic treatment with low dose k-diclofenac: a comparison of ibuprofen and aspirin.

In a short-term gastro-duodenal endoscopic study in 12 healthy volunteers, the gastrotoxicity was not different after intake of diclofenac-K 12.5 mg (0.33) or ibuprofen 200 mg (0.42, P=0.66) but significantly higher after aspirin 500 mg (2.67, P=0.002).

Reducing resistance and denial by exercising ambivalence during the treatment of addiction.

Stage change models and motivational enhancement therapies have significantly influenced the therapeutic tactics clinicians employ in the treatment of addictive behaviors. While motivational enhancement strategies have addressed client ambivalence to increase motivation to change, this article suggests that focusing on ambivalence during treatment has even wider clinical utility than previously thought. Resistance reduction concentrates on exercising ambivalence without an investment in clients changing, thereby strengthening client tolerance for ambivalent thoughts and feelings. Exercising ambivalence reduces resistance to treatment and change by validating a wide array of possible outcomes through detailed exploration of how a behavior pattern works for a client. Since resistance reduction does not require clients to want to change for therapy to progress, exploring the decision-making process becomes paramount. A general discussion of the resistance reduction model, ambivalence, and how clients present for treatment precedes clinical case examples.

Effect of setup configurations of split computer keyboards on wrist angle.

BACKGROUND AND PURPOSE: Alternative computer keyboards whose halves can be slanted toward each other can reduce a risk factor (ulnar deviation) for work-related musculoskeletal disorders (WMSDs) affecting the upper limbs. Two questions that computer keyboard operators face when using keyboards that can be separated into halves (split keyboards) are: (1) At what angle should the keyboard halves be opened? and (2) At what distance apart should the keyboard halves be placed? The objective of this study was to investigate the effects of the opening angle and separation distance between halves of a split keyboard on wrist ulnar deviation and typing efficiency. METHODS: Eleven experienced computer keyboard operators participated in this study and used a split keyboard that was set up in a conventional (nonsplit) format and also in 3 alternative configurations: (1) centers of keyboard halves were separated at 20-cm distance, (2) keyboard halves were separated half of the distance of shoulder width, and (3) keyboard halves were separated at shoulder width distance. RESULTS: The 3 alternative configurations resulted in ulnar deviation of both wrists that were less than ulnar deviation from typing on a conventional setup. There were no differences in ulnar deviations among the 3 alternative configurations. DISCUSSION AND CONCLUSION: The results of this research provide physical therapists and ergonomists with a set of configurations of a split keyboard that they can recommend to their patients or clients. All of the alternative configurations of the split keyboard are beneficial in promoting a neutral wrist position, which theoretically would decrease exposure to WMSDs such as tenosynovitis in the wrist and carpal tunnel syndrome.

Interaction between angiotensin-converting enzyme inhibitors and aspirin: a review.

Aspirin and angiotensin-converting enzyme inhibitors (ACEIs) are often associated for the treatment of coronary disease and/or chronic heart failure, but conclusions of some prospective and retrospective studies show a possible negative interaction between aspirin and ACEIs. ACEIs inhibit the conversion of angiotensin I to angiotensin II and also the catabolism of bradykinin, which results in increased synthesis of vasodilatory agents [prostaglandins and nitric oxide (NO)], whereas aspirin inhibits prostaglandin synthesis. Thus, a potential interaction from the opposing effects of aspirin and ACEIs could affect the metabolism of bradykinin. We conducted an extensive Medline search, as well as a manual search, of published literature including pharmacodynamic studies and clinical trials concerning the impact of aspirin on the effect of ACEIs in hypertension, coronary disease and chronic heart failure. A review of this literature shows five studies in hypertension (all prospective and using blood pressure as the main criterion of assessment), five in coronary disease (three retrospective and two prospective trials, four of which use mortality as the criterion of assessment) and 13 in chronic heart failure (eight using haemodynamic measurements of which seven are prospective--one prospective study using pulmonary tests, four using clinical events including mortality as criterion of assessment of which two are prospective). The counteraction of ACEI efficacy by aspirin is demonstrated in one out of five studies in hypertension, one out of four of studies in coronary disease and nine out of thirteen in chronic heart failure. This counteraction is more often observed with high dosages of aspirin (greater than 250 mg/day, four out of six studies) and less often with lower dosages (less than or equal to 250 mg/day, three out of 11 studies). These studies are retrospective analyses or use haemodynamic end-points, so there is as yet no methodological argument strong enough to contraindicate the aspirin-ACEI association or to prove the clinical relevance of this interaction. In conclusion, prospective studies using mortality as a criterion of assessment are needed to offer the practitioner the answer to the question of ACEI-aspirin association.

Foot and ankle sensory neuropathy, proprioception, and postural stability.

Foot and ankle sensory neuropathy may result from a variety of pathologic conditions, especially diabetes mellitus. Decreased sensation, particularly on the plantar surface of the feet, leads to obvious risks of cutaneous injury. Less obvious are the risks of fall-related injury associated with changes in other sensory systems of the foot and ankle, such as the receptors involved in joint movement and position perception. The results of a number of studies demonstrate that the neuropathic process affects these receptors in individuals with diabetes mellitus. Associated with the decreased sensory function of the foot and ankle is decreased performance on tests of static and dynamic postural stability. Subjective feelings of instability and an increased incidence of fall-related injuries have also been reported. The reduced postural stability in persons with diabetic neuropathy cannot be attributed exclusively to loss of plantar cutaneous sensation; it appears to be the result of a general loss of peripheral sensory receptor function in the lower legs, including that of the muscle spindles. During the evaluation of an individual with foot and ankle sensory neuropathy, the possibility of balance deficits should be given proper attention. Assessment of balance deficits could be particularly important when planning the course of rehabilitation for individuals with foot and ankle neuropathy who use modified footwear or have an amputation of a section of the foot or lower extremity.

Wrist and forearm postures of users of conventional computer keyboards.

The aim of this study was to perform a comprehensive investigation to document wrist and forearm postures of users of conventional computer keyboards. We instrumented 90 healthy, experienced clerical workers with electromechanical goniometers to measure wrist and forearm position and range of motion for both upper extremities while typing. For an alphabetic typing task, the left wrist showed significantly greater (p < .01) mean ulnar deviation (15.0 degrees +/- 7.7 degrees) and extension (21.2 degrees +/- 8.8 degrees) than the right wrist (10.1 degrees +/- 7.2 degrees and 17.0 degrees +/- 7.4 degrees for ulnar deviation and extension, respectively). Conversely, the right forearm had greater mean pronation (65.6 degrees +/- 8.3 degrees) than the left forearm (62.2 degrees +/- 10.6 degrees). We noted minimal functional differences in the postures of the wrists and forearms between alphabetic and alphanumeric typing tasks. Ergonomists should consider the statistically significant and probable practical difference in wrist and forearm posture between the left and right hand in ergonomic interventions in the office and in the design of computer keyboards. Actual or potential applications of this research include guiding the design of new computer keyboards.

Wrist and forearm posture from typing on split and vertically inclined computer keyboards.

A study was conducted on 90 experienced office workers to determine how commercially available alternative computer keyboards affected wrist and forearm posture. The alternative keyboards tested had the QWERTY layout of keys and were of three designs: split fixed angle, split adjustable angle, and vertically inclined (tilted or tented). When set up correctly, commercially available split keyboards reduced mean ulnar deviation of the right and left wrists from 12 degrees to within 5 degrees of a neutral position compared with a conventional keyboard. The finding that split keyboards place the wrist closer to a neutral posture in the radial/ulnar plane substantially reduces one occupational risk factor of work-related musculoskeletal disorders (WMSDs): ulnar deviation of the wrist. Applications of this research include commercially available computer keyboard designs that typists can use and ergonomists can recommend to their clients in order to minimize wrist ulnar deviation from typing.

Influence of hip position and gender on active hip internal and external rotation.

A general lack of descriptive details exists for measurements of hip rotation range of motion. This study was designed to establish the influence of gender and hip flexion position on active range of motion of the hip in external and internal rotation. Sixty (39 females and 21 males) healthy college-age (21.8 +/- 1.7 years) subjects were studied. Hip rotation of the dominant leg of each subject was measured in the prone (hip near 0 degree of flexion) and seated (hip near 90 degrees of flexion) positions using a standard goniometer. Data were analyzed using an analysis of variance model. Pearson's r statistics were used to determine the degree of association between measurements of hip rotation made seated vs. prone. A statistically significant difference (p < 0.05) was found between mean hip external rotation (ER) measured seated (36 +/- 7 degrees) and mean hip ER measured prone (45 +/- 10 degrees). Conversely, mean hip internal rotation (IR) measured seated (33 +/- 7 degrees) was not statistically different than mean hip IR measured prone (36 +/- 9 degrees). Females had statistically more active hip internal and external rotation than males (p < 0.05). A moderate degree of association existed between measurements of hip ER taken in the prone vs. seated position (r = 0.57, p < 0.05). For IR, the degree of association between the two measurement positions was slightly higher (r = 0.72, p < 0.05). Unlike the amount of active hip internal rotation which showed little difference between measurements made prone vs. seated, our data indicate that measurement position had a significant effect on the amount of active range of motion of the hip in ER. These findings are clinically significant for they stress the importance of documenting measurement position. They also stress the need for representative norms to be established for each hip position and gender.