Intra and inter-examiner reliability of the subacromial impingement index

The present study aimed to assess the reliability of intra and inter-examiner subacromial impingement index (SII) measures obtained from radiographs. Thirty-six individuals were enrolled and divided into two groups: control group, composed of 18 volunteers in good general health without shoulder problems, and a group of 18 patients with subacromial impingement syndrome (SIS). Radiographic images were taken with the dominant upper limb in neutral rotation, while the volunteers held their arm at 90A degrees of abduction in the frontal plane. The beam of radiation at 30A degrees craniocaudal inclination was used to provide an antero-posterior image view. Three blinded examiners each performed three measurements from the subacromial space (SS) and the anatomical neck of the humerus (NH). The SII was calculated as the ratio of the SS and the NH measures. The mean values of SII were compared using t-tests. The intra-class correlation coefficient (ICC) was used to assess intra- and inter-examiner reliability of the measures. The mean values of SII were greater for the control group (0.12) than for the SIS group (0.08; p = 0.0071). SII measurements showed excellent intra (0.96-0.99) and inter-examiner reliability (0.94) for both the control and SIS group. The results of this study show the potential use of the SII; a greater mean value for the control group compared to the SIS group and excellent reliability for intra- and inter-examiner measurement. Validation studies of the index should be conducted to correlate the index with clinical findings from subacromial impingement syndrome.

Transgendering shojo shosetsu: Girls' inter-text/sex-uality

This essay recognises the power of reading and intertextuality (embedding texts within texts) in fiction targeted at girls and young women.

Inter-rater reliability study of the modified Oxford Grading Scale and the Peritron manometer

Objective To evaluate the inter-rater reliability of the modified Oxford Grading Scale and the Peritron manometer. Design All participants were evaluated twice, first by one examiner and 30 days later by a second examiner. Measurements of vaginal squeeze pressure were compared with the results from the palpation test. Participants Nineteen women with a mean age of 23.7 years (range 21 to 28 years). Results Inter-rater reliability for vaginal palpation was fair (kappa = 0.33, 95% confidence interval 0.09 to 0.57). Using the Peritron manometer, the difference between examiners was less than 10 cmH(2)O in 11 of the 19 (58%) cases. The palpation test did not differentiate between weak, moderate, good and strong muscle contractions. This study found fair inter-rater reliability for the modified Oxford Grading Scale and moderate inter-rater reliability for the Peritron manometer. Conclusions The inter-rater reliability of vaginal squeeze pressure measurement using the Peritron manometer is acceptable and can be used in re-evaluations performed by different examiners in clinical practice. However, for research purposes, the ideal situation would be for a single examiner to assess and re-assess the subject. Vaginal palpation is important in the clinical assessment of correctness of a pelvic floor muscle contraction, but this study does not support the use of the modified Oxford Grading Scale as a reliable and valid method to measure and differentiate pelvic floor muscle strength. (C) 2010 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

Refinements in stress echocardiographic techniques improve inter-institutional agreement in interpretation of dobutamine stress echocardiograms

Aims To determine the degree of inter-institutional agreement in the assessment of dobutamine stress echocardiograms using modern stress echo cardiographic technology in combination with standardized data acquisition and assessment criteria. Method and Results Among six experienced institutions, 150 dobutamine stress echocardiograms (dobutamine up to 40 mug.kg(-1) min(-1) and atropine up to I mg) were performed on patients with suspected coronary artery disease using fundamental and harmonic imaging following a consistent digital acquisition protocol. Each dobutamine stress echocardiogram was assessed at every institution regarding endocardial visibility and left ventricular wall motion without knowledge of any other data using standardized reading criteria. No patients were excluded due to poor image quality or inadequate stress level. Coronary angiography was performed within 4 weeks. Coronary angiography demonstrated significant coronary artery disease (less than or equal to50% diameter stenosis) in 87 patients. Using harmonic imaging an average of 5.2+/-0.9 institutions agreed on dobutamine stress echocardiogram results as being normal or abnormal (mean kappa 0.55; 95% CI 0.50-0.60). Agreement was higher in patients with no (equal assessment of dobutamine stress echocardiogram results by 5.5 +/- 0.8 institutions) or three-vessel coronary artery disease (5.4 +/- 0.8 institutions) and lower in one- or two- vessel disease (5.0 +/- 0.9 and 5.2 +/- 1.0 institutions, respectively-, P=0.041). Disagreement on test results was greater in only minor wall motion abnormalities. Agreement on dobutamine stress echocardiogram results was lower using fundamental imaging (mean kappa 0.49; 95% CI 0.44-0.54; P

Inter-relationships between rheumatoid arthritis and periodontal disease

This review considers the considerable similarities between periodontal disease and rheumatoid arthritis (RA). While the etiology of these two diseases may differ, the underlying pathogenic mechanisms are remarkably similar and it is possible that individuals manifesting both periodontitis and RA may suffer from a unifying underlying systemic dysregulation of the inflammatory response. In light of these findings, the implications for the use of disease-modifying medications in the management of these two chronic inflammatory conditions is apparent. Further longitudinal studies and medication-based intervention studies are required to determine just how closely these two conditions are allied.

A crise do transporte a??reo no Brasil: 2006-2007

Este estudo de caso aborda a crise vivida pelo setor de transporte a??reo brasileiro nos anos de 2006 e 2007. Deflagrada por um acidente de vulto, a crise teve como protagonistas os controladores de tr??fego a??reo, que, sob suspeita de falha funcional e comunica????o dif??cil com as autoridades do setor, reagiram por meio de uma estrat??gia de opera????o-padr??o (greve branca). Essa situa????o, somada ?? escassez de pessoal, provocou, de novembro de 2006 at?? meados de 2007, o descontrole operacional dos principais aeroportos do pa??s, com grandes preju??zos aos usu??rios. Um novo acidente a??reo, no decorrer da crise, agravou ainda mais a situa????o do setor, expondo defici??ncias estruturais e profissionais ?? opini??o p??blica brasileira, em uma ??rea at?? ent??o considerada segura. O caso relata as tentativas de equacionamento da crise por parte das autoridades respons??veis pela pol??tica de transporte a??reo, frente ao descontentamento e ??s reivindica????es dos controladores de tr??fego a??reo e ?? indigna????o da sociedade. O objetivo do estudo de caso ?? ilustrar uma situa????o de crise e de processo de negocia????o, tendo sido originalmente utilizado em uma oficina sobre negocia????es no setor p??blico. O caso pode ser utilizado como material de apoio em cursos que abordem, entre outros, os seguintes t??picos: negocia????o, gest??o de crises, comunica????o e planejamento estrat??gico

A????es premiadas no 11?? Concurso Inova????o na Gest??o P??blica Federal 2006

Nesta publica????o, referente ao 11?? Concurso Inova????o na Gest??o P??blica Federal, o leitor encontrar?? iniciativas inovadoras nas seguintes ??reas: Arranjos institucionais para coordena????o e implementa????o de pol??ticas p??blicas (intra e inter-governamental); atendimento ao usu??rio; avalia????o e monitoramento de pol??ticas p??blicas; cidadania e inclus??o social; controle de resultados; estabelecimento de padr??es e atendimento de servi??os; implementa????o de melhoria cont??nua; planejamento e gest??o estrat??gica

Viabilizando o neg??cio de transporte mar??timo no sistema Petrobr??s

O texto descreve o processo de reorganiza????o e implanta????o de mudan??as na FRONAPE que a levou, em um curto espa??o de tempo, a uma fant??stica revers??o de resultados que vem criando valor e viabilizando o neg??cio de transporte mar??timo dentro do sistema Petrobr??s, se constituindo no fortalecimento e na viabiliza????o da pr??pria marinha mercante brasileira

An??lise da estrutura organizacional da fiscaliza????o do transporte rodovi??rio na ag??ncia nacional de transportes terrestres

Fiscalizar a presta????o dos servi??os de transporte interestadual e internacional de passageiros e de transporte rodovi??rio de cargas ?? atribui????o da Superintend??ncia de Fiscaliza????o da Ag??ncia Nacional de Transportes Terrestres ??? ANTT. Esta pesquisa visa analisar a efici??ncia e efic??cia desta estrutura organizacional

Transporte de trabalhadores rurais: parceria para uma nova realidade

Parceria concebida pela DRT-GO que envolve as Pol??cias Rodovi??rias com outros ??rg??os do governo e entidades sindicais, para equacionar problemas existentes no transporte de trabalhadores rurais devido ?? falta de fiscaliza????o. As Pol??cias Rodovi??rias Federal e Estadual assumiram a fiscaliza????o e o controle do transporte de trabalhadores em todo o estado. Foram reduzidas as den??ncias de transporte irregular de trabalhadores rurais. A incid??ncia de mortes ou invalidez por acidentes de trajeto devido ao transporte irregular dos trabalhadores foi praticamente eliminada no Estado

BPPH: banco de pre??os praticados na ??rea hospitalar

O BPPH foi idealizado pelo Ministro Jos?? Serra no in??cio de sua gest??o em Abril de 1998, visando uma pol??tica de transpar??ncia na utiliza????o dos recursos p??blicos e, tamb??m a busca da disponibilidade de mais um instrumento regulador de mercado. A implanta????o do sistema, abrange atualmente 32 hospitais federais, estaduais, municipais e 5 secretarias estaduais de sa??de que alimentam o BPPH via INTERNET, permitindo contabilizar um benef??cio de R$ 1.373.687,00 (redu????o do custo entre 2 compras consecutivas) somente nos 5 hospitais fundadores do sistema, sendo que 50% desse valor pode-se atribuir ao uso do Banco de Pre??os. Este trabalho foi apresentado no CONIP99 - Congresso de Inform??tica P??blica 1999 - em nome do Minist??rio da Sa??de, com a autoriza????o emitida pelo Senhor Chefe de Gabinete do Ministro, Dr. Ot??vio Azevedo Mercadante. O BPPH foi desenvolvido e implantado no per??odo de Maio de 1998 a Abril de 1999 como um projeto do Grupo Executivo de A????o Estrat??gica na ??rea Hospitalar, grupo este coordenado pelo Dr. Benedito Nicotero Filho, Assessor Especial do Ministro da Sa??de. O BPPH no seu processo de institucionaliza????o foi transferido do Gabinete do Ministro para a Secretaria de Gest??o de Investimentos em Sa??de. As Portarias do Ministro da Sa??de que regulamentam o sistema s??o: Portaria 3.505 publicada em 28 de Agosto de 1998 cria a C??mara T??cnica Consultiva do BPPH; Portaria 74 publicada em 02 de Fevereiro de 1999 institui a obrigatoriedade para hospitais p??blicos de mais de 320 leitos e a Portaria 481 publicada em 19 de Abril de 1999 transfere a subordina????o da C??mara T??cnica e do Sistema para a Secretaria de Gest??o de Investimentos em Sa??de. Este trabalho foi o ganhador do Pr??mio CONIP99 de Excel??ncia em Inform??tica P??blica