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assessment: Results of a comparative study (Technical Report 64). Minneapolis, MN: University of Minnesota, National Center on Educationa

The RESPITE trial: remifentanil intravenously administered patient-controlled analgesia (PCA) versus pethidine intramuscular injection for pain relief in labour: study protocol for a randomised controlled trial

Background The commonest opioid used for pain relief in labour is pethidine (meperidine); however, its effectiveness has long been challenged and the drug has known side effects including maternal sedation, nausea and potential transfer across the placenta to the foetus. Over a third of women receiving pethidine require an epidural due to inadequate pain relief. Epidural analgesia increases the risk of an instrumental vaginal delivery and its associated effects. Therefore, there is a clear need for a safe, effective, alternative analgesic to pethidine. Evidence suggests that remifentanil patient-controlled analgesia (PCA) reduces epidural conversion rates compared to pethidine; however, no trial has yet investigated this as a primary endpoint. We are, therefore, comparing pethidine intramuscular injection to remifentanil PCA in a randomised controlled trial. Methods/design Women in established labour, requesting systemic opioid pain relief, will be randomised to either intravenously administered remifentanil PCA (intervention) or pethidine intramuscular injection (control) in an unblinded, 1:1 individual randomised trial. Following informed consent, 400 women in established labour, who request systemic opioid pain relief, from NHS Trusts across England will undergo a minimised randomisation by a computer or automated telephone system to either pethidine or remifentanil. In order to balance the groups this minimisation is based on four parameters; parity (nulliparous versus multiparous), maternal age (<20, 20 < 30, 30 < 40, 40+ years), ethnicity (South Asian (Pakistani/Indian/Bangladeshi) versus Other) and induced versus spontaneous labour. The effectiveness of pain relief provided by each technique will be recorded every 30 min after time zero, until epidural placement, delivery or transfer to theatre, quantified by Visual Analogue Scale. Incidence of maternal side effects including sedation, delivery mode, foetal distress requiring delivery, neonatal status at delivery and rate of initiation of breastfeeding within the first hour of birth will also be recorded. Maternal satisfaction with her childbirth experience will be determined by a postpartum questionnaire prior to discharge from the delivery ward. Discussion The RESPITE trial’s primary outcome is the proportion of women who have an epidural placed for pain relief in labour in each arm. Trial Registration Current Controlled Trials registration number: ISRCTN29654603. Registered on 23 July 2013

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exam participation and performance (2000-2001) of English language learners with disabilities (ELLs with Disabilities Report 3). Min ne ap o lis, MN

of Education or Offices within it. NCEO Core Staff

(Technical Report 38). Min ne ap o lis, MN: Uni ver si ty of Min ne so ta, Na tion al Center on Ed u ca tion al Out comes. NATIONA

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All rights reserved. Any or all portions of this document may be reproduced and distributed without prior permission, provided the source is cited as: Johnstone, C., Liu, K., Altman, J., &amp; Thurlow, M. (2007). Student think aloud reflections on comprehensible and readable assessment items: Perspectives on what does and does not make an item readable (Technical Report 48). Minneapolis

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All rights reserved. Any or all portions of this document may be reproduced and distributed without prior permission, provided the source is cited as: Nelson, J. R. (2006). High stakes graduation exams: The intended and unintended consequences of Minnesota’s Basic Standards Tests for student

NCEO Core Staff

All rights reserved. Any or all portions of this document may be reproduced and distributed without prior permission, provided the source is cited as: Albus, D., &amp; Thurlow, M. L., (2013). Accommodation policies for states’ alternate assessments based on alternate achievement standards (AA-AAS

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projects, including those on English language learners, is provided b