OBJECTIVES:Compare incidence of head injury, number of falls, and helmet use between English and Western riders. DESIGN:Cross-sectional study. SETTING:Online flyers. PARTICIPANTS:Competitive college equestrian athletes. ASSESSMENT OF RISK FACTORS:This study assesses the difference in risk of head injury between the English and Western disciplines of riding. MAIN OUTCOME MEASURES:The difference in risk of head injury between the English and Western disciplines of riding. RESULTS:Three hundred fifty-seven equestrian athletes between 18 and 24 years of age who ride competitively for their college or university's team participated in this study. Of these athletes, 297 athletes competed in English style riding, and 60 competed in Western style riding. There was a significantly higher proportion of English-style equestrians who reported always wearing a helmet while riding (92.5%), in comparison with just 23.3% of Western style riders. There were significantly more Western equestrians than English equestrians who reported multiple head injuries because of falls in the previous year. CONCLUSIONS:All equestrians have a high incidence of head injuries; however, Western riders reported a higher number of falls in the previous year than their English counterparts. In addition, Western riders reported less consistent helmet use when compared with their English counterparts, who are more likely to always wear helmets when riding. This study highlights important differences in the risk of head injury between participation in Western and English riding.

Background: Benign bone lesions are a common incidental finding in athletes during workup for musculoskeletal complaints, and athletes are frequently advised to halt participation in contact sports. There are no current guidelines to assist clinicians in referring patients with these lesions to a subspecialist or in advising athletes on the safety of returning to sport. Purpose: To assist sports medicine physicians in appropriate referral for patients with benign bone lesions through presentation of a literature review and the case of an adolescent athlete with a benign bone lesion in a location with a significant fracture risk. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic literature review was performed using the PubMed database. Search terms included “enchondroma,”“unicameral bone cyst,”“UBC,”“simple bone cyst,”“SBC,”“aneurysmal bone cysts, “ABC,”“nonossifying fibroma,”“NOF,”“non-ossifying fibroma,”“chondroblastoma,”“osteochondroma,”“exostosis,”“chondromyxoid fibroma,”“periosteal chondroma,” and “fibrous dysplasia” combined with “fracture,”“sports,”“sport,”“contact sport,”“football,” or “rugby.” Randomized controlled trials, case series, and prospective and retrospective studies were all included. Abstracts were excluded. Results: In total, 42 separate articles were reviewed. The strength of evidence for each lesion was determined using the total number of patients described in the literature with the pathology. Unicameral bone cysts, aneurysmal bone cysts, and fibrous dysplasia, particularly in the spine, are associated with a high risk of fracture; therefore, subspecialist referral is warranted before returning to sport. Osteochondromas (exostosis), juxtacortical chondromas, nonossifying fibromas, chondromyxoid fibromas, and enchondromas were associated with low fracture risk, and decisions regarding referral can be made on a case-by-case basis. Conclusion: The presence of a benign bone lesion does not always necessitate immediate, absolute restriction from participation in contact sports. After appropriate workup and diagnosis, the risk of return to sport should be evaluated based on the pathology present, and the patient and clinician should engage in a shared decision-making process. The guidelines in this paper provide context for stratifying risk and the importance of specialist referral. For athletes with a confirmed diagnosis of an asymptomatic benign bone lesion with a low risk of fracture, return to play without restrictions or referral is often safe.

Context: Equestrian sports continue to gain popularity in the United States and are associated with a high injury rate, especially involving the central nervous system and thorax. Due to this high rate of injury and the potential for long-term consequences associated with participation, an understanding of the unique risks of this sport is needed. Objective: To describe severe injury in equestrian sports and review the role that protective gear plays in injury mitigation. Data Sources: The PubMed Database was searched using the search terms “equestrian” and “horse” combined with “spinal cord injury,” “head injury,” “traumatic brain injury,” “experience levels,” and “demographics.” Study Selection: A total of 53 papers were selected based on their relevance of epidemiology, risk factors, and management of injuries sustained during equestrian activities. Case studies, randomized controlled trials, prospective studies, and retrospective studies were all included for further review. Study Design: Systematic review. Level of Evidence: Level 4. Data Extraction: None. Results: Injuries to the thorax, including fractures, pneumothoraces, internal organ contusions, and crush injuries, have been cited in multiple national and international trauma registries as the most prevalent injury location in equestrians; however, head and neck injuries, high cervical spine fractures, and closed head injuries are reported to be associated with the highest rates of mortality. Helmets provide protection against skull fracture and traumatic brain injury. Vests were not associated with diminished rates of spinal cord injuries; however, they may provide protection to the thorax. Riding experience also plays a role in reducing the prevalence of injury. Conclusion: Equestrian-related activities are associated with a high risk of injury despite protective measures. Protective gear can mitigate some injury risk but does not protect against spinal injury. Continued investigation into improving protective equipment, rider education, and preventative strategies to mitigate this risk is needed.

Physical activity during pregnancy reduces perinatal depression in low risk patients, however, its effect in patients with medical co-morbidities is not known. We aimed to evaluate this association. Retrospective cohort of patients included in the Nulliparous Pregnancy Outcomes Study Monitoring Mothers-to-Be with ≥1 medical comorbidity (Table footnote). Activity logs reporting type and amount of activity for the previous month were completed at 3 study visits: 6.0-13.6, 14.0-21.6, and 22.0-29.6 weeks. Patients were characterized based on if they met ACOG recommendation of 150 minutes of moderate or 75 minutes of vigorous activity per week averaged across all visits (active versus not active). The primary outcome was EPDS score >10 (indicating perinatal depression) at visit 3. Secondary outcomes included change in EPDS score between visit 1 and 3, treatment for depression, and perinatal outcomes. Outcomes were compared between groups and multivariable logistic regression was used to adjust for covariates. Overall, 7,486 patients were included, 4092 (55%) were active and 3394 (45%) were not active during pregnancy. History and treatment of mental health disorder before pregnancy, chronic hypertension, and pregestational diabetes were less common in those who were active compared to those who were not. EPDS score >10 was 15% less likely in those who were active compared to those who were not (aOR 0.85 [95% CI 0.72-0.99]; Table). The average change in EPDS score from visit 1 to 3, treatment for perinatal depression, and adverse perinatal outcomes including preterm birth and SGA did not differ by activity (Table). Patients with medical co-morbidities who were active during pregnancy had lower odds of depression than those who were not active. Treatment of perinatal depression did not differ between groups, however there was not an increase in adverse perinatal outcomes with physical activity. Prospective studies are needed to evaluate the potential benefits of physical activity during pregnancy for perinatal depression in patients with medical co-morbidities.

Objective To evaluate for associations between concussion history or lower extremity (LE) injury and computerized sensory organization testing (SOT) performance in professional soccer players. Design Cross-sectional study. Setting Tertiary care center. Participants Thirty-three professional male soccer players on a single team between the years 2019–2021. Assessment of Risk Factors Age, concussion history and prior LE injury (gluteal, hamstring, ankle, knee, hip, groin and sports hernia). Outcome Measures Baseline SOT of postural sway was conducted in 6 sensory conditions for all players on the team roster. Main Results Eleven (33%) athletes reported a previous concussion and 15 (45%) reported a previous LE injury. There were no significant differences in SOT scores between those with and without a previous diagnosis of concussion (p > 0.05). Those reporting a previous LE injury performed better on Condition 3 (eyes open, unstable visual surround) than those who did not (p=0.03). Athletes 25 years or younger performed worse on Condition 3 (p=0.01) and had worse, though not statistically significant, median performance on all other balance measures than those older than 25. Intraclass correlation coefficient for repeat SOT assessment was 0.58, indicating moderate reliability, without an evident practice effect. Conclusions Professional soccer players with a previous concussion or history of LE injury did not demonstrate long-term deficits in postural control, as assessed by multi-year computerized SOT baseline testing. The SOT was reliable over time with younger athletes generally exhibiting greater postural sway than older athletes, though larger studies are required to properly assess this potential age effect.

INTRODUCTION:Veterans using the Veterans Administration Health Care System (VAHCS) for obstetrical care experience disparate pregnancy-related risks and health outcomes when compared to their pregnant counterparts. This study examined the prevalence of risk factors associated with pregnancy-related comorbidities among U.S. Veterans receiving obstetrical care using VAHCS benefits in Birmingham, Alabama. MATERIALS AND METHODS:A retrospective chart review was conducted of pregnant Veterans receiving care at a large Veterans Administration facility from 2018 to 2021. Using one-sample t-tests, the data from the study charts were compared to the Alabama overall prevalence of tobacco and alcohol use, pregnancy-related hypertension/preeclampsia, and gestational diabetes and, when the Alabama data were unavailable, the U.S. national average prevalence of overweight, obesity, pre-pregnancy hypertension, posttraumatic stress disorder, depression, and anxiety among patients receiving obstetrical care. The institutional review board at the Birmingham VAHCS approved the study, with an exemption for human subjects research. RESULTS:The study sample (N = 210) experienced higher levels of obesity (42.3% vs. 24.3%, P < .001), tobacco (21.9% vs. 10.8%, P < .001) and alcohol (19.5% vs. 5.4%, P < .001) use, pre-pregnancy hypertension (10.5% vs. 2.1%, P < .001), posttraumatic stress disorder (33.8% vs. 3.3%, P < .001), anxiety (66.7% vs. 15.2%, P < .001), and depression (66.7% vs. 15.0, P < .001). Fewer patients in the study sample were classified as overweight (16.7% vs. 25.5%, P < .001), developed pregnancy-related hypertension/preeclampsia (7.6% vs. 14.4%, P < .001), or were diagnosed with gestational diabetes (7.1% vs. 10.2%, P < .001). The results did not vary by race or age. CONCLUSION:The findings highlight the need for further examination of social factors that may be driving disparities among pregnant Veterans, who may benefit from supplemental services to address modifiable comorbidities. Additionally, the implementation of a centralized database to track pregnancy-related outcomes for Veterans would allow these comorbidities to be more closely monitored and addressed. Heightened awareness of a patient's Veteran status and associated increased risks can alert providers to screen for depression and anxiety more frequently and to familiarize themselves with additional services the VAHCS may offer to patients. These steps could improve referrals to counseling and/or targeted exercise interventions.

Airbag vests (AV) are increasingly popular in equestrian sports. The efficacy of AV in protecting against serious injury has not been adequately analyzed, nor have product testing standards been established. This study provides an overview of current research to understand AV efficacy and future areas of improvement. A systematic review applying the PRISMA framework, NIH Study Quality Assessment, and CEBM Level of Evidence was conducted. Employing variations of “equestrian sport,” “powered two-wheeled vehicle,” “thoracic injury,” “chest deflection,” “airbag vest,” and “safety vest,” 18 articles were identified for data collection from three recognized research databases and citation searching. In laboratory settings, the ability of AV to protect against thoracic injuries was variable based on concurrent foam-based safety vest (SV) usage, impact speed, and impact mechanism. Studies that examined equestrian falls with AV found an association with increased injury rates and risk. SVs were shown to provide inconclusive efficacy in protecting against injuries in experimental and cohort studies. Protective capabilities depend on material, temperature, and impact mechanism. Further limiting use, equestrians reported not wearing, or incorrectly wearing SV due to unknown benefits, low comfort, and ill fit. In equestrian sports, based on published literature to date, AV have not been associated with a reduction in injury. AV appear to be associated with an increase in the risk of serious or fatal injuries in certain settings. However, research in this area is limited and future, large-scale studies should be conducted to further evaluate the efficacy of the air vests.

Objective:To evaluate for associations between concussion history or lower extremity (LE) injury and computerized sensory organization testing (SOT) performance in professional soccer players.Design:Cross-sectional study.Setting:Tertiary care center.Participants:Thirty-three, professional, male soccer players on an American club, between the years 2019 and 2021.Assessment of Risk Factors:Player age, history of reported LE injury (gluteal, hamstring, ankle, knee, hip, groin, and sports hernia), history of diagnosed concussion, and the number of prior concussions were documented for each player.Main Outcome Measures:Baseline SOT of postural sway was conducted in 6 sensory conditions for all players.Results:Eleven athletes (33%) reported a previous concussion, and 15 (45%) reported a previous LE injury. There were no significant differences in SOT scores between those with and without a previous diagnosis of concussion (P > 0.05). Those reporting a previous LE injury performed better on condition 3 (eyes open, unstable visual surround) than those who did not (P = 0.03). Athletes aged 25 years or younger performed worse on condition 3 (P = 0.01) and had worse, although not statistically significant, median performance on all other balance measures than those older than 25 years. Intraclass correlation coefficient for repeat SOT assessment was 0.58, indicating moderate reliability, without an evident practice effect.Conclusions:Professional soccer players with a previous concussion or history of LE injury did not demonstrate long-term deficits in postural control, as assessed by multiyear computerized SOT baseline testing. The SOT was reliable over time with younger athletes exhibiting greater postural sway than older athletes.

OBJECTIVE:Employ a novel testing method to assess Multi Directional Impact Protection System (MIPS) helmet technology on rotational velocity and acceleration during head impact. METHODS:An optimization study was completed utilizing a 50th percentile male Hybrid III anthropomorphic test device (ATD). Helmets included expanded polystyrene foam (EPS) and two different MIPS helmets (MIPS 1, MIPS 2). A 24.38-m-long elevated track with rails and a motorized sled was utilized to replicate a fall from approximately 2.13 m. The sled was set to a speed of 20.92 kph, where a tripping mechanism induced rotation in the ATD from the sled and onto a sand surface. During impact of the ATD with the sand surface, head kinematics were measured using resultant acceleration (peak G's), duration of impact (ms), and rotational velocity (rad/s). RESULTS:A total of three trials for each helmet did not demonstrate a significant difference between the EPS vs. MIPS 1 group with, peak (G's) for resultant acceleration (p = 0.100), duration (ms) for resultant acceleration, (p = 0.100), peak (G's) for rotational velocity, (p = 0.700), and duration (ms) for rotational velocity (p = 0.700). Similarly, the EPS vs. MIPS 2 testing demonstrated no significant differences between the MIPS 2 helmet compared to the EPS helmet, with resultant acceleration (p = 0.400), duration acceleration (p = 0.200), rotational velocity (p = 0.400) and duration velocity (p = 0.400). However, when the MIPS helmet data were pooled, and the EPS helmet data were compared, a statistically significant difference in the duration of acceleration was found (p = 0.048). CONCLUSIONS:Current testing uses a helmeted head form which is dropped or rolled from a prescribed height. These methods discount the loading placed on the neck and head through the angular momentum of the body. Our novel testing method did not find significant differences between the helmet types in diminishing peak rotational forces to the brain; however, our data suggests that MIPS helmet liners may reduce duration of impact. The reduction of acceleration duration could indicate less rotation of the neck, due to the dampening of these forces by the MIPS liners.

Abstract Survey study of training and practice paradigms and job satisfaction of dual-boarded emergency medicine (EM) and sports medicine (SM) physicians. The REDCap survey was sent to 193 American Board of EM members who hold a Certificate of Added Qualification in SM. A total of 124 EM/SM physicians responded (67.5% male). More than 70% completed three-year residencies while only 28.5% had an EM/SM residency faculty. One-quarter delayed fellowship after residency 6.45 years on average. Regarding their first job after fellowship, 27.6% practiced only EM, 54.5% practiced both EM and SM, and 12.2% practiced only SM. Regarding their current job, 29.1% practice only EM. 47.3% practice both EM and SM, and 20.9% practice only SM. Only 13.9% and 9.9% indicated they are unhappy with their first job and current job, respectively. There is significant variability in practice settings for EM/SM physicians with the overwhelming majority being happy with their career choices.

OBJECTIVES:To determine potential factors influencing female medical students' interest and subsequent application to orthopedics, and to evaluate female and male medical students' perceptions of women in the field of orthopedics.METHODS:An institutional review board-approved survey was distributed in March 2020 and subsequently in April 2022 to medical students in the classes of 2023 and 2024 at the University of Alabama at Birmingham Heersink School of Medicine. Study data were collected and managed using REDCap electronic data capture. An e-mail link to the REDCap survey was sent to students across the southeast region of the United States, followed by three reminder e-mails. All 25 allopathic medical schools in the southeastern United States with an Orthopedics Interest Group listed on their institution's Web site were invited to participate in the study. Nine Orthopedics Interest Group leaders interested in participating were asked to provide the researchers with a list of fourth-year medical students who attended an event hosted by that group (215). A total of 39 respondents who completed the survey were included in this study.RESULTS:Overall, the majority of students (n = 35, 90%) believed that women faced more barriers to a career in orthopedics than did men. The most significant barriers to women entering the field of orthopedics were the perceived expectations of an orthopedic surgeon (n = 34, 87%), difficulty balancing career and family (n = 28, 72%), and demanding schedule (n = 13, 33%).CONCLUSIONS:This study demonstrates that both male and female medical students believe there are significant additional barriers to success for women in the field. Study participants report that expectations set by physicians, other healthcare professionals, and patients contribute to creating greater barriers that deter medical students interested in orthopedics from ultimately applying to the specialty.

The objective of this study was to investigate predictors of concussion recovery in children (5-12) versus adolescents (13-18) while identifying economic and demographic disparities in post-concussion care at a tertiary referral concussion clinic versus emergency department (ED). Race and insurance status were recorded for patients presenting to the concussion clinic (724) and ED (1,160) with an ICD-10 concussion diagnosis between 2018 and 2019. Secondly, a subset of patients from the concussion clinic group were included for retrospective cohort review based on documented recovery data. Overall, the concussion clinic saw more Caucasian patients (66.7%) than the ED (56.8%). Concussion clinic patients were more likely to have Private insurance than ED patients (67.2% vs. 55.3%) and less likely to have Medicaid and Self pay (p < 0.001). Children were more likely to be hospitalized after concussion diagnosis than adolescents (40.8% vs. 24.4%, p = 0.006). Attending public school was associated with a 1.8 times greater hazard ratio (HR) for shorter time to recovery compared to attending private school. Additionally, presence of a diagnosed psychiatric disorder was associated with a HR of 0.5, indicating a longer time to recovery (p < 0.001) than patients without a disorder. The present findings may support limitations on contact sports participation in young children given their higher hospitalization rate after concussion. Additionally, the study highlights potential barriers to care amongst youth concussion patients with those seen in specialized concussion clinics more likely to be White and have private insurance.

Objective The objective of this study was to examine the association between sport/non-sport concussions as well as age and time to recovery after concussion diagnosis in children and adolescents. Background There is an ongoing debate between policy makers and medical specialists on when is the appropriate time to allow children to begin playing contact sports. This dilemma is important because sports are incredibly prevalent in our child and adolescent population today. There is still significant debate if age at time of concussion diagnosis is associated with long term affects and time to recovery. Design/Methods Of the 725 patients who received a diagnosis of concussion at Children's of Alabama (COA) from 2018 to 2019, 350 patients were included for retrospective cohort review based on documented recovery data defined as follow up appointment PRN (as needed) or begin return to play protocol. 221 patients were lost to follow up while 7 were excluded for concomitant skull fracture. Recovery time, patient demographic data, symptoms severity score, and injury characteristics were then analyzed for each patient. Results Overall, the mean time of recovery after new diagnosis of any concussion was 87.2 days. The mean time to documented recovery in sports-related concussion was 82.6 days compared to 98.5 days in non-sports related concussion. Of note, both the 5-12 and 13-18 age groups had the same mean time to recovery at 87 days. Conclusions Sports related concussion showed decreased mean time to recovery compared to non-sports related concussion. Also, age did not play a factor in time to recovery as there was no difference in the 2 age groups. This data, along with the NCAA-DOD Care Consortium showing repetitive head injury during early adolescence is unrelated to brain health as measured by specific outcome measures, has the potential to provide valuable information for future policy on child and adolescent sports.

OBJECTIVE:Many studies have identified factors associated with increased symptom burden and prolonged recovery after pediatric and adolescent concussion. Few have systematically examined the effects of prior concussion on these outcomes in patients with concussion due to any mechanism. An improved understanding of the short- and long-term effects of a multiple concussion history will improve counseling and management of this subgroup of patients.METHODS:A retrospective review of adolescent and young adult acute concussion patients presenting to the multidisciplinary concussion clinic between 2018 and 2019 was conducted at a single center. Patient demographic data, medical history including prior concussion, initial symptom severity score (SSS), injury mechanisms, and recovery times were collected. Univariate and multivariable analyses were conducted to identify associations of history of prior concussion and patient and injury characteristics with symptom score and recovery time.RESULTS:A total of 266 patients with an average age of 15.4 years (age range 13-27 years) were included. Prior concussion was reported in 35% of patients. The number of prior concussions per patient was not significantly associated with presenting symptom severity, recovery time, or recovery within 28 days. Male sex and sports-related concussion (SRC) were associated with lower presenting SSS and shorter recovery time on univariate but not multivariable analysis. However, compared to non-sport concussion mechanisms, SRC was associated with 2.3 times higher odds of recovery within 28 days (p = 0.04). A history of psychiatric disorders was associated with higher SSS in univariate analysis and longer recovery time in univariate and multivariable analyses. Multivariable log-linear regression also demonstrated 5 times lower odds of recovery within 28 days for those with a psychiatric history.CONCLUSIONS:The results of this study demonstrated that an increasing number of prior concussions was associated with a trend toward higher presenting SSS after youth acute concussion but did not show a significant association with recovery time or delayed (> 28 days) recovery. Presence of psychiatric history was found to be significantly associated with longer recovery and lower odds of early (≤ 28 days) recovery. Future prospective, long-term, and systematic study is necessary to determine the optimal counseling and management of adolescent and young adult patients with a history of multiple concussions.

Orthostatic intolerance (OI) following pediatric concussion is not well understood. Assessing the prevalence of concussion-related OI and how it compares to non-concussion-related OI will improve care for patients suffering with these symptoms. OBJECTIVE: We set out to describe concussion-related OI in adolescence, with particular emphasis on time to recovery and differences from non-concussion-related OI (including male vs. female prevalence). Retrospective chart reviews were completed on post-concussion patients endorsing symptoms of OI. The patients' sex, sport history, previous concussions, time since injury, and recovery time were analyzed and compared between males and females as well as against general OI statistics. Thirty-nine pediatric patients, representing 8.7% of all new patients referred to a specialized concussion clinic over a 13-month interval, were included in the chart review. Mean age of onset was 15.0 +/- 2.5 years and 18 (46%) were males. The median times from evaluation to symptom resolution were 120 days. Of 18 patients who completed head-up tilt table testing, 17 (94%) had orthostatic tachycardic response (>40 bpm heart rate increment). Post-concussive OI differs from other orthostatic intolerance etiologies, lacking a strong female predominance and exhibiting a shorter time course to recovery compared to other etiologies of OI (but longer recovery time compared to concussion patients in general). Clinical orthostatic vital signs may not be sensitive for diagnosing orthostatic intolerance in athletes, likely due to higher vagal tone and more efficient skeletal muscle pump.

BACKGROUND:The Valsalva maneuver may increase maternal blood pressure and intra-abdominal pressure, resulting in decreased blood flow to the fetus during resistance training.HYPOTHESIS:There is no significant reduction in placental blood flow in pregnancy during resistance training in recreational athletes, as documented by a 3-dimensional power flow Doppler ultrasonography.STUDY DESIGN:Cohort.LEVEL OF EVIDENCE:Level 3.METHODS:A cohort of healthy women who participated in recreational athletics was enrolled in a prospective study to assess placental blood flow during a resistance exercise. A 1 repetition maximum (1RM, up to 50 lb) was determined through a modified chest press as a marker of heavy resistance training. Three-dimensional volume measurements and power Doppler flow were determined at the rest phase and during the 1RM lift phase. The vascular flow index (VFI) was calculated to determine placental perfusion during each phase.RESULTS:A total of 22 women participated. The mean age of participants was 31 years. Gestational age ranged from 13 to 28 weeks. Average 1RM weight lifted was 30 lb. Four women (18%) were able to lift 50 lb, the maximum weight that the study allowed. The remaining 18 women (82%) lifted their true 1RM. Mean VFI during lift phase was 2.185 compared with 2.071 at rest (P = 0.03). There was a slight mean increase in VFI during lift phase, 0.114 (95% CI 0.009-0.182) from 2.071 to 2.185 with lifting (P = 0.03). The 15 women who participated in structured exercise had a mean VFI at rest and during the lift phase of 2.031 and 2.203, respectively (P = 0.01).CONCLUSION:Three-dimensional power flow Doppler imaging can guide resistance training during pregnancy to prevent fetal injury due to hypoperfusion. Resistance training up to an RM1 of 50 lb did not result in a significant reduction of placental blood flow from resting state in the study population.CLINICAL RELEVANCE:This technique may be used to guide training parameters among pregnant athletes.

Background Peak fertility and athletic performance coincide, placing a subset of women into competition with sparse guidance. The Valsalva maneuver has been hypothesized to increase maternal blood pressure and intra-abdominal pressure, resulting in decreased blood flow to the fetus during resistance training. Objective We present a technique employing three dimensional (3D) power Doppler ultrasound analysis to evaluate placental blood flow during resistance exercise. This technique may be used to prevent fetal injury by guiding training parameters. Design This is a proof of principal study describing the technique and documenting its use to determine placental blood flow. Setting This research was conducted in an academic clinical enter. Participants varied from an actively exercising, former collegiate athlete, to participants who performed no scheduled physical activity. Patients (or Participants) Four normal weight women less than 35 years of age with uncomplicated pregnancies were included. Interventions (or Assessment of Risk Factors) One repetition maximum (1RM) via modified chest press was determined. Ultrasonography with power Doppler and 3D volume measurements were then performed on the visualized portions of the placenta. The vascular flow index (VFI) was then calculated for each phase. Main Outcome Measurements VFI was measured during lifting and at rest. The paired t-test was used for statistical analysis. Z scores from previously established normative data (Noguchi, et al 2009) provided benchmarks. Results VFI was not significantly different between lift and rest phase for any of our participants. All measurements were within a standard deviation of previously established normative data. There were no incidences of fetal bradycardia. Conclusions 3D power flow Doppler imaging can guide resistance training during pregnancy to prevent fetal injury due to hypoperfusion. Resistance training up to an RM1 of 50lbs did not result in a significant reduction in placental blood flow from resting state in the study population.

OBJECTIVE: To determine whether premedical programming can address the interest level and perception of barriers to women in orthopaedics held by female high school and medical students. DESIGN: A thirteen-question paper-based survey was distributed among the high school and medical school participants prior to the January 2020 Perry Outreach Program and Medical Student Outreach Program. After a day of participation in mock procedures and speaker sessions, participants subsequently completed another survey of seven-questions. SETTING: The Perry Outreach Program and Medical Student Outreach Program were conducted at the University of Alabama at Birmingham campus. PARTICIPANTS: Participants consisted of high school and medical school women hailing from the Birmingham metropolitan area, who had signed up for the Perry programs via email, outreach to local high schools, and social media interest pages. Participant sampling was stratified by race and level of education (high school vs. medical school). RESULTS: A total of 36 women, 18 high school and 18 medical school, attended the Perry Initiative events and responded to the pre-event and post-event surveys. Before the Perry Initiative programs, all participants felt women faced more barriers than men in pursuing a career in orthopaedics. Participation in the Perry Initiative event increased average interest in orthopaedics by 28% among high school and 11% among medical school students. CONCLUSIONS: Prior to the Perry Initiative, 31% percent of the total attendees reported knowing a female orthopaedist. The Perry Initiative improved perceptions of both high school and medical students regarding the ability of women to have a work/life balance, family life, and children during orthopaedics residency. Medical student participation in the events led to a decreased belief in barriers regarding schedule, family life, perceptions of an orthopaedic surgeon, and perceptions of peers within healthcare setting. (C) 2021 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.