Rhythmic variations in pain, stiffness, and manual dexterity in hand osteoarthritis

Objective: To explore circadian variation in pain, stiffness, and manual dexterity inpatients with hand osteoarthritis (OA). Methods: Twenty one patients with hand OA, as defined by ACR criteria (17 women, four men, mean age 62.2 years, range 52-74 years) self rated pain and stiffness on separate 10 cm horizontal visual analogue scales and performed bead intubation coordinometry (BIC) six times each day (on waking up, at bedtime, and every four hours in between) for 10 consecutive days. Each series (using data with the trend removed if there was a significant trend) was analysed for circadian rhythmicity by a cosine. vector technique (single cosinor). With individual data expressed as the percentage of the mean, group rhythm characteristics at period 24 hours were summarised for each variable by population mean cosinor analysis. Results: Individual analyses identified significant circadian rhythms at pless than or equal to0.05 for pain (n=15/21), stiffness (n=16/20), and dexterity (n=18/21), and a significant circadian rhythm on a group basis was identified for pain (p=0.013), stiffness (p

A pilot study of the manual force levels required to produce manipulation induced hypoalgesia

Objective. A pilot investigation of the influence of different force levels on a treatment technique's hypoalgesic effect. Design. Randomised single blind repeated measures. Background. Optimisation of such biomechanical treatment variables as the point of force application, direction of force application and the level of applied manual force is classically regarded as the basis of best practice manipulative therapy. Manipulative therapy is frequently used to alleviate pain, a treatment effect that is often studied directly in the neurophysiological, paradigm and seldom in biomechanical research. The relationship between the level of force applied by a technique (e.g. biomechanics) and its hypoalgesic effect was the focus of this study. Method. The experiment involved the application of a lateral glide mobilisation with movement treatment technique to the symptomatic elbow of six subjects with lateral epicondylalgia. Four different levels of force, which were measured with a flexible pressure-sensing mat, were randomly applied while the subject performed a pain free grip strength test. Results. Standardised manual force data varied from 0.76 to 4.54 N/cm, lower-upper limits 95 Cl, respectively. Pain free grip strength expressed as a percentage change from pre-treatment values was significantly greater with manual forces beyond 1.9 N/cm (P = 0.014). Conclusions. This study, albeit a pilot, provides preliminary evidence that in terms of the hypoalgesic effect of a mobilisation with movement treatment technique, there may be an optimal level of applied manual force.

Lateralization of speech production using verbal/manual dual tasks: meta-analysis of sex differences and practice effects

The present paper reviews the findings of 30 years of verbal/manual dual task studies, the method most commonly used to assess lateralization of speech production in non-clinical samples. Meta-analysis of 64 results revealed that both the type of manual task used and the nature of practice that is given influence the size of the laterality effect. A meta-analysis of 36 results examining the effect size of sex differences in estimate,, of lateralization of speech production indicated that males appear to show, slightly larger laterality effects than females. (C) 2002 Elsevier Science Ltd. All rights reserved.

Effect of manual hyperinflation on hemodynamics, gas exchange, and respiratory mechanics in ventilated patients

The authors investigated the effect of manual hyperinflation (MHI) with set parameters applied to patients on mechanical ventilation on hemodynamics, respiratory mechanics, and gas exchange. Sixteen critically ill patients post-septic shock, with acute lung injury, were studied. Heart rate, arterial pressure, and mean pulmonary artery pressure were recorded every minute. pulmonary artery occlusion pressure, cardiac output, arterial blood gases, and dynamic compliance (C-dyn) were recorded pre- and post-MHI. From this, systemic vascular resistance index (SVRI), cardiac index, oxygen delivery, and partial pressure of oxygen:fraction of inspired oxygen (PaO2:FiO(2)) ratio were calculated. There were significant increases in SVRI (P < 0.05) post-MHI and diastolic arterial pressure (P < 0.01)during MHI. C-dyn increased post-MHI (P < 0.01) and was sustained at 20 minutes post-MHI (P < 0.01). Subjects with an intrapulmonary cause of lung disease had a significant decrease (P = 0.02) in PaO2:FiO(2), and those with extrapulmonary causes of lung disease had a significant increase (P < 0.001) in PaO2:FiO(2) post-MHI. In critically ill patients, MHI resulted in an improvement in lung mechanics and an improvement in gas exchange in patients with lung disease due to extrapulmonary events and did not result in impairment of the cardiovascular system.

Hemodynamic and ventilatory effects of manual respiratory physiotherapy techniques of chest clapping, vibration, and shaking in an animal model

Chest clapping, vibration, and shaking were studied in 10 physiotherapists who applied these techniques on an anesthetized animal model. Hemodynamic variables (such as heart rate, blood pressure, pulmonary artery pressure, and right atrial pressure) were measured during the application of these techniques to verify claims of adverse events. In addition, expired tidal volume and peak expiratory flow rate were measured to ascertain effects of these techniques. Physiotherapists in this study applied chest clapping at a rate of 6.2 +/- 0.9 Hz, vibration at 10.5 +/- 2.3 Hz, and shaking at 6.2 +/- 2.3 Hz. With the use of these rates, esophageal pressure swings of 8.8 +/- 5.0, 0.7 +/- 0.3, and 1.4 +/- 0.7 mmHg resulted from clapping, vibration, and shaking respectively. Variability in rates and forces generated by these techniques was 80% of variance in shaking force (P = 0.003). Application of these techniques by physiotherapists was found to have no significant effects on hemodynamic and most ventilatory variables in this study. From this study, we conclude that chest clapping, vibration, and shaking 1) can be consistently performed by physiotherapists; 2) are significantly related to physiotherapists' characteristics, particularly clinical experience; and 3) caused no significant hemodynamic effects.

Compromisso nacional para aperfei??oar as condi????es de trabalho na cana-de-a????car

O Compromisso Nacional para Aperfei??oar as Condi????es de Trabalho na Cana-de-A????car, firmado pelo Governo Federal e entidades de trabalhadores e empres??rios do setor sucroenerg??tico, ?? resultado de uma experi??ncia in??dita no pa??s de negocia????o tripartite para enfrentar o desafio de melhorar as condi????es de vida e trabalho no cultivo manual da cana-de-a????car. Por meio de uma Mesa de Di??logo, sob a coordena????o da Secretaria-Geral da Presid??ncia da Rep??blica, foi constru??do um acordo hist??rico para valorizar e disseminar as melhores pr??ticas trabalhistas na lavoura da cana, evidenciando a import??ncia do di??logo social na elabora????o das Pol??ticas P??blicas. Atrav??s da ades??o volunt??ria das empresas ao Compromisso, da divulga????o das boas pr??ticas empresariais e do cadastro positivo formado pelo selo ???Empresa Compromissada???, conferido ap??s verifica????o in loco de auditoria independente, a iniciativa induz os demais atores do setor a aderir ao Compromisso e adotar as boas pr??ticas trabalhistas

Gest??o eletr??nica de documentos na Marinha

Em um mundo cada vez mais virtual, em que a facilidade, a agilidade e a presteza na troca de informa????es s??o preponderantes para as organiza????es obterem sucesso, n??o h?? mais espa??o para um processo manual de gest??o de documentos, extremamente burocr??tico, lento, ineficiente e dotado de uma s??rie de procedimentos que n??o agregam valor ?? informa????o tramitada. Pensando nisso, a Marinha do Brasil (MB) buscou a mudan??a do paradigma burocr??tico para o da gest??o da informa????o, por meio do desenvolvimento de um sistema capaz de introduzir um novo modelo de gest??o na administra????o p??blica: a Gest??o Eletr??nica de Documentos (GED). Tal iniciativa, pioneira na Administra????o P??blica Federal, j?? ?? um sucesso, sendo a MB constantemente solicitada a fornecer subs??dios para a implementa????o da GED em outros ??rg??os da administra????o p??blica

A iniciativa da Delegacia Federal de Agricultura do Mato Grosso do Sul na padroniza????o de procedimentos e no controle de "n??o conformidades" no processo de fiscaliza????o, do Minist??rio da Agricultura e do Abastecimento

A Delegacia Federal de Agricultura/MS- DFA/MS elaborou um manual de procedimento padr??o no processo de fiscaliza????o e criou um in??dito sistema de controle e registro de "n??o conformidades" nos processos de fiscaliza????o, que al??m de n??o trazer nenhum custo extra ?? reparti????o, motiva o trabalho em equipe e ?? melhoria cont??nua nos processos de trabalho. Esta a????o inova, tamb??m, por constituir-se numa ferramenta de trabalho que permite a avalia????o do desempenho institucional e do desempenho individual do servidor, e induz por, conseq????ncia, ao aumento da efici??ncia organizacional

Cat??logo de cursos Enap - 2013

O cat??logo de cursos e atividades de aprendizagem da Escola Nacional de Administra????o P??blica (ENAP) tem como objetivo apoiar a escolha de a????es de desenvolvimento de compet??ncias de dirigentes p??blicos brasileiros

Mesa-redonda de pesquisa-a????o: guias de orienta????o

Este material ?? uma tradu????o dos Toolkits da Mesa-redonda de Pesquisa-A????o que foram fornecidos ?? ENAP por meio do Projeto de Coopera????o ???Parceria para a Excel??ncia da Gest??o no Setor P??blico???. Esse projeto foi estabelecido entre a Escola e a Canada School of Public Service, com apoio da Ag??ncia Canadense de Desenvolvimento Internacional, e teve vig??ncia entre 2003 e 2007. Este material foi criado para ensinar os potenciais Coordenadores de Mesas-redondas de Pesquisa-A????o (MRPA) a desenvolver o conhecimento e o know-how que lhe permitir??o conduzir Mesas-redondas.

Programa????o do sistema de manuten????o

Este projeto refere-se ?? implanta????o de um sistema operacional criado para sanar as dificuldades encontradas na manuten????o da ??rea de 800 ha ocupada pela Funda????o Oswaldo Cruz. O campus ?? dividido em cinco ??reas. Cada uma delas ?? visitada diariamente por um programador respons??vel que alimenta o sistema informatizado em rede com as requisi????es de servi??o, desdobrando-as em a????es internas, que por sua vez s??o distribu??das aos departamentos executantes. O sistema foi divulgado para a institui????o por meio de um Manual de Manuten????o explicando os novos procedimentos. A implanta????o do sistema possibilitou mudan??as qualitativas e quantitativas no conjunto da organiza????o

Consolida????o autom??tica da folha de pagamento de pessoal

Este projeto refere-se ao processo de informatiza????o da consolida????o da folha de pagamento de pessoal ativo, inativo e pensionista da Delegacia de Administra????o do Paran??, anteriormente realizada de forma manual, o que demandava aproximadamente cinco dias. A implanta????o das planilhas eletr??nicas proporcionou maior confiabilidade dos lan??amentos cont??beis, rapidez na consolida????o e emiss??o de relat??rios interligados, fornecendo dados precisos nas elabora????es das NL??s (Notas de Lan??amentos), OB??s (Ordens Banc??rias) e DARF??s (Documento de Arrecada????o de Receitas Federais), inclusive fornecendo dados essenciais para o preenchimento do relat??rio mensal de Recursos Humanos

Reestrutura????o da ger??ncia de conv??nios

Este projeto refere-se ?? implanta????o, pela ??rea de conv??nios da Funda????o Nacional de Sa??de, de uma infra-estrutura que d?? respostas ??geis e concretas ?? Dire????o da FNS para que ela possa atingir seus objetivos institucionais, descentralizando as a????es gerenciais e os recursos financeiros. Foram elaborados o Manual de Procedimentos Internos da Ger??ncia de Conv??nios com o intuito de sistematizar todos os procedimentos a serem cumpridos pela institui????o, e o Manual de Normas e Procedimentos Administrativos para celebra????o de conv??nios com a FNS, distribu??do aos ??rg??os proponentes. A cria????o do Sistema de Monitoramento de Conv??nios permitiu o acompanhamento administrativo de todas as solicita????es em andamento na Funda????o e o cadastramento de toda demanda apresentada