Active and passive shoulder range of motion in healthy older people

This study was conducted to determine the effect of increasing age on four shoulder movements and to explore the need for normative data for shoulder range of motion (ROM) in people aged 50 years and older. Forty-one participants were conveniently recruited according to four age categories: 50-59 years, 60-69 years, 70-79 years and 80 years and over. Goniometric measurement of bilateral active and passive ROM for flexion, abduction, internal rotation and external rotation was analysed using paired sample t-tests and compared with the norms of the American Academy of Orthopaedic Surgeons (AAOS) using one sample t-tests. Passive ROM was greater than active ROM for all movements (p

Measuring range of active cervical rotation in a position of full head flexion using the 3D Fastrak measurement system: an intra-tester reliability study

Most external assessments of cervical range of motion assess the upper and lower cervical regions simultaneously. This study investigated the within and between days reliability of the clinical method used to bias this movement to the upper cervical region, namely measuring rotation of the head and neck in a position of full cervical flexion. Measurements were made using the Fastrak measurement system and were conducted by one operator. Results indicated high levels of within and between days repeatability (range of ICC2,1 values: 0.85-0.95). The ranges of axial rotation to right and left, measured with the neck positioned in full flexion, were approximately 56% and 50%, respectively of total cervical rotation, which relates well to the proportional division of rotation in the upper and lower cervical regions. These results suggest that this method of measuring rotation would be appropriate for use in subject studies where movement dysfunction is present in the upper cervical region, such as those with cervicogenic headache. (C) 2003 Elsevier Science Ltd. All rights reserved.

An evaluation of active lecturing in a computer networks course

The article describes an attempt to improve student learning outcomes in a computer networks course by making lectures more active learning experiences. Quick quizzes, group and individual exercises, the review of student questions, as well as multiple breaks, were incorporated into the weekly three-hour lectures. Student responses to the modified lectures was overwhelmingly positive: over 85% of respondents agreed that the lectures aided understanding, with large majorities of the respondents finding the individual activities useful to their learning. Although student examination performance improved over the previous year, performance on an examination question that was designed to examine deep understanding remained unchanged.

Evaluation of cyclooxygenase 2 inhibitor use in patients admitted to a large teaching hospital

Background: The heavy usage of coxibs in Australia far outstrips the predicted usage that was based on the treatment of patients with risk factors for upper gastro-intestinal adverse events from conventional anti--inflammatory agents. This raises questions regarding the appropriateness of prescribing. Aims: To determine: (i) the relationship between prescriptions for cyclooxygenase 2 (COX-2) inhibitors and objective evidence of inflammatory arthritis, (ii) prior experience with paracetamol and/or conventional non-steroidal anti-inflammatory drugs (NSAIDs), and (iii) contraindications to the use of NSAIDs. Methods: Drug utilization evaluation and rheumato-logical assessment was conducted on 70 consecutive patients admitted on COX-2 inhibitors to a 480-bed metropolitan hospital. The main outcome measures were: the indication for COX-2 inhibitor; objective -evidence of inflammatory arthritis; previous trial of -paracetamol or conventional NSAIDs; and patient -satisfaction. Results: Only 11 patients (16%) had symptoms or signs of an inflammatory arthropathy, and met Pharmaceut-ical Benefits Schedule criteria for prescribing a COX-2 inhibitor. Fifty-nine patients (84%) had chronic osteo-arthritis, degenerative spinal disease, injury or malignancy, without overt active inflammation. Fourteen patients (20%) had trialled regular paracetamol prior to using any NSAID treatment. Conventional NSAIDs had been previously used by 51 patients (73%). Eleven patients (16%) reported previous adverse gastrointestinal effects from conventional NSAIDs. On the basis of significant renal impairment (creatinine clearance 5/10). Conclusions: Drug utilization data indicate that COX-2 inhibitors are frequently used first line for degenerative osteoarthritis in the absence of overt inflammation, without prior adequate trial of paracetamol and with disregard for the cautions and contraindications of these agents. These findings may explain the unprecedented Pharmaceutical Benefits Schedule expenditure on COX-2 inhibitors in Australia.

Constitutively active signal transducer and activator of transcription 5 can replace the requirement for growth hormone in adipogenesis of 3T3-F442A preadipocytes

Although it is the best characterized in vitro model of GH action, the mechanisms used by GH to induce differentiation of murine 3T3-F442A preadipocytes remain unclear. Here we have examined the role of three transcriptional regulators in adipogenesis. These regulators are either rapidly induced in response to GH [Stra13, signal transducer and activator of transcription (Stat) 3] or of central importance to GH signaling (Stat5). Retroviral transfection of 3T3-F442A preadipocytes was used to increase expression of Stra13, Stat3, and Stat5a. Only Stat5a transfection increased the expression of adipogenic markers peroxisome proliferator-activated receptor gamma, CCAAT enhancer binding protein (C/EBP)alpha, and adipose protein 2/fatty acid-binding protein in response to GH, as determined by quantitative RT-PCR. Transfection with constitutively active Stat3 and Stat5a revealed that constitutively active Stat5a but not Stat3 was able to replace the GH requirement for adipogenesis. Constitutively active Stat5a but not Stat3 was able to increase the formation of lipid droplets and expression of alpha-glycerol phosphate dehydrogenase toward levels seen in mature adipocytes. Constitutively active Stat5a was also able to increase the expression of transcripts for C/EBPalpha to similar levels as GH, and of C/EBPbeta, peroxisome proliferator-activated receptor gamma, and adipose protein 2/fatty acid-binding protein transcripts to a lesser extent. An in vivo role for GH in murine adipogenesis is supported by significantly decreased epididymal fat depot size in young GH receptor-deleted mice, before manifestation of the lipolytic actions of GH. We conclude that Stat5 is a critical factor in GH-induced, and potentially prolactin-induced, murine adipogenesis.

Redox active macrocyclic receptors for neutral guests

A novel series of triazine-appended macrocyclic complexes has been investigated as potential hydrogen bonding receptors for complementarily disposed heterocycles. Cocrystallization of a melamine-appended azacyclam complex of Cull has been achieved with barbitone, the barbiturate anion and thymine. In each case, a complementary DAD/ADA hydrogen bonding motif between the melamine group and the heterocycle has been identified by X-ray crystallography. Electrochemical studies of the copper macrocycles in both nonaqueous and aqueous solution show anodic shifts of the CuII/I redox couple of more than 60 mV upon addition of guest molecules with matching H-bonding motifs. The Zn-II analogues have been synthesized via transmetalation of the Cull complex, and their guest binding properties investigated by NMR spectroscopy. H-1 NMR shifts of up to 0.8 ppm were observed upon addition of guest, and stability constants are similar to those obtained electrochemically.

Structural variations and formation constants of first-row transition metal complexes of biologically active aroylhydrazones

Iron chelators of the 2-pyridinecarbaldehyde isonicotinoylhydrazone (HPCIH) class show high potential for the treatment of iron overload diseases. In the present study, selected first-row transition metal (from Mn to Zn) complexes with HPCIH and 2-pyridinecarbaldehyde (4'-aminobenzoyl)hydrazone (HPCAH) were synthesised and characterised. Crystallography reveals that HPCAH exclusively forms bis complexes with divalent transition metals, with each ligand coordinating meridionally through its pyridine-N, imine-N and carbonyl-O atoms, forming distorted octahedral cis-MN4O2 complexes. Complexes of HPCIH were more varied and unpredictable, with metal/ligand ratios of 1:1, 1:2, 2:2 and 3:2 obtained with different metal ions. The isonicotinoyl ring N-atom in HPCIH was found to be an effective ligand, and this resulted in the varied metal/ligand ratios observed. The formation constants of divalent metal complexes with HPCIH were determined by potentiometric titrations and the values obtained were consistent with similar tridentate ligands and with the Irving-Williams order. ((C) Wiley-VCH Verlag GmbH & Co. KGaA, 69451 Weinheim, Germany, 2003).

O agir cotidiano dos gestores da Estratégia Saúde da Família em um município do Espírito Santo

O Sistema único de Saúde (SUS) pode ser considerado uma das maiores conquistas sociais consagradas na Constituição de 1988, representando a materialização de uma nova concepção acerca da saúde no Brasil. As diretrizes do SUS são importantes instrumentos indutores de mudanças e modernização da gestão, incluindo aspectos relativos à organização da assistência, como sua humanização e também a busca de maiores níveis de desempenho e responsabilidade institucional para com os resultados alcançados. Diversos autores tem se debruçado sobre o tema gestão, porém, qual o modelo de gestão que conseguiria combinar um papel ativo, de liderança e de coordenação para gestores com autonomia? Este estudo objetiva analisar a prática da gestão nos serviços de saúde do município de Itapemirim/ES, buscando compreender as múltiplas e complexas dimensões que orientam essa prática, tendo como principal fonte as entrevistas de seus gestores. O município adota uma política de gestão participativa na saúde com várias instâncias formais e pratica um investimento em saúde acima do preconizado pela Constituição Federal o que permite um investimento em estruturação e oferta de serviços públicos. Do ponto de vista metodológico, o estudo adota a abordagem qualitativa através de entrevistas semiestruturadas, focalizando a gestão como um mundo social e expressão dos processos presentes nas organizações e que atravessam os relatos coletados. Foram entrevistados três gestores, sendo esses, Secretário Municipal de Saúde, Diretora da Atenção Primária em Saúde e Coordenadora de Estratégia Saúde da Família do município de Itapemirim. A análise do material empírico teve como um de seus eixos o estudo do percurso profissional dos gestores, especialmente os processos que os levaram à função de gestão. A contingência marca essas trajetórias que se desenrolam em um contexto em que, em alguns dos casos, percebe-se que não existe qualquer exigência quanto à formação de gestão. Outro eixo abordado são as práticas de gestão onde são examinados os sentidos que o exercício da função de gestor tem para os sujeitos, como também as suas estratégias de trabalho, planejamento e ferramentas de uso. O exame das práticas de gestão norteia-se pela análise das possibilidades e limites para desencadear processos de mudança. Os depoimentos apontam as características dessas experiências de gestão, que procuram construir condições para processos de mudança, seja através das experiências anteriores desses gestores ou das estratégias de trabalho e do sistema de gestão articulado que procuram desenvolver. Os projetos profissionais dos gestores entrevistadas vão claramente se definindo no âmbito da gestão: se veem, não mais como profissionais de sua área de formação original (enfermeiro, farmacêutico ou cirurgião dentista), mas acima de tudo como gestores, alimentados pelo reconhecimento de suas capacidades de mobilização e de desenvolvimento de mudanças relativas a outras realizações no campo da gestão.

Active Assistance for Senior Healthcare: A Wearable System for Fall Detection

Elders lose independence and wellbeing, accompanied by decreased functions in terms of hearing, vision, strength and coordination abilities. These factors contribute to balance difficulties that eventually lead to falls. The injuries due to falls, at this age, are risky, since most of the times may cause a significant – and permanent – decrease of quality of life or, in extreme cases, death. In this context, a fall detection system can bring an added value to assist elderly people.This paper describes a system consisting of a wearable sensor unit, a smartphone and a website. When the sensor detects a fall it sends an alert using the smartphone via Bluetooth 4.0, to notify the family members or stakeholders. The sensor device includes an inertial unit, a barometer, and a temperature and humidity sensor. The website displays the log of previous falls and enables the configuration of emergency contact numbers. The proposed fall detection system is one of multiple components within a larger project under development that offers a holistic perspective on falls; the complete wearable solution will also feature, among others, physical protection (minimizing the impact of falls that occur).

Real-time 3D interactive segmentation of echocardiographic data through user-based deformation of B-spline explicit active surfaces

Image segmentation is an ubiquitous task in medical image analysis, which is required to estimate morphological or functional properties of given anatomical targets. While automatic processing is highly desirable, image segmentation remains to date a supervised process in daily clinical practice. Indeed, challenging data often requires user interaction to capture the required level of anatomical detail. To optimize the analysis of 3D images, the user should be able to efficiently interact with the result of any segmentation algorithm to correct any possible disagreement. Building on a previously developed real-time 3D segmentation algorithm, we propose in the present work an extension towards an interactive application where user information can be used online to steer the segmentation result. This enables a synergistic collaboration between the operator and the underlying segmentation algorithm, thus contributing to higher segmentation accuracy, while keeping total analysis time competitive. To this end, we formalize the user interaction paradigm using a geometrical approach, where the user input is mapped to a non-cartesian space while this information is used to drive the boundary towards the position provided by the user. Additionally, we propose a shape regularization term which improves the interaction with the segmented surface, thereby making the interactive segmentation process less cumbersome. The resulting algorithm offers competitive performance both in terms of segmentation accuracy, as well as in terms of total analysis time. This contributes to a more efficient use of the existing segmentation tools in daily clinical practice. Furthermore, it compares favorably to state-of-the-art interactive segmentation software based on a 3D livewire-based algorithm.

Active and passive behaviors of soft tissues: Pelvic floor muscles

: A new active-contraction visco-elastic numerical model of the pelvic floor (skeletal) muscle is presented. Our model includes all elements that represent the muscle constitutive behavior, contraction and relaxation. In contrast with the previous models, the activation function can be null. The complete equations are shown and exactly linearized. Small verification and validation tests are performed and the pelvis is modeled using the data from the intra-abdominal pressure tests

The active mathematics project at ISCAP

This paper summarizes a project that is contributing to a change in the way of teaching and learning Mathematics. Mathematics is a subject of the Accounting and Administration course. In this subject we teach: Functions and Algebra. The aim is that the students understand the basic concepts and is able to apply them in other issues, when possible, establishing a bridge between the issues that they have studied and their application in Accounting. As from this year, the Accounting course falls under in Bologna Process. The teacher and the student roles have changed. The time for theoretical and practical classes has been reduced, so it was necessary to modify the way of teaching and learning. In the theoretical classes we use systems of multimedia projection to present the concepts, and in the practical classes we solve exercises. To supplement our theoretical and practical classes we have developed an active mathematics project called MatActiva based on the Moodle platform offered by PAOL - Projecto de Apoio Online (Online Support Project). In the last versions of Moodle, it is possible use the TeX language to create math questions. Using this tool we created a set of interactive materials. With the creation of this new project we wanted to take advantage already obtained results with the previous experiences, giving to the students opportunities to complement their study in Mathematics. One of the great objectives is to motivate students, encourage them to overcome theirs difficulties through an auto-study, giving them more confidence and the opportunity to seeing others perspectives of the mathematics subjects. In the MatActiva project the students have a big collection of information about the way of the subject works, which includes the objectives, the program, recommended bibliography, evaluation method and summaries. It works as material support for the practical and theoretical classes, the slides of the theoretical classes are available, the sheets with exercises for the students to do in the classroom and complementary exercises, as well as the exams of previous years. Students can also do diagnostic tests and evaluation tests online. Our approach is a reflexive one, based on the professional experience of the teachers that explore and incorporate new tools of Moodle with their students and coordinate the project MatActiva.

Photonics Active Filters Based on SiC Multi layer Structures: A Two Stage Active Circuit

Characteristics of tunable wavelength filters based on a-SiC:H multi-layered stacked cells are studied both theoretically and experimentally. Results show that the light-activated photonic device combines the demultiplexing operation with the simultaneous photodetection and self amplification of an optical signal. The sensor is a bias wavelength current-controlled device that make use of changes in the wavelength of the background to control the power delivered to the load, acting a photonic active filter. Its gain depends on the background wavelength that controls the electrical field profile across the device.