A atividade dos estabilizadores da omoplata e movimento compensatório do tronco no gesto de alcance em indivíduos pós AVE

Introdução: Lesões como o AVE interferem com a capacidade de recrutar níveis adequados de atividade muscular, podendo levar ao aparecimento de movimentos compensatórios como a excessiva translação anterior do tronco, associada ao gesto de alcance. Objetivos: Descrever a relação entre a atividade dos estabilizadores da omoplata e o movimento compensatório do tronco no gesto de alcance, em 4 indivíduos pós AVE. Pretendeu-se também analisar o papel dos estabilizadores da omoplata na função do membro superior. Métodos: Quatro indivíduos com diagnóstico de AVE, que apresentavam alterações no nível de actividade dos estabilizadores da omoplata contralesional, foram sujeitos a uma avaliação realizada em três momentos, antes (M0), durante (M1) e após (M2) e a um período de intervenção, segundo os princípios do Conceito de Bobath. Recorreu-se à electromiografia de superfície para avaliar a atividade e o timming dos músculos grande dorsal, trapézio superior e trapézio inferior do hemicorpo contralesional e ao software de Avaliação Postural (SAPO) para analisar o deslocamento do tronco no sentido anterior, associados à realização do gesto de alcance. Foram aplicadas as escalas RPS e MESUPES para avaliar as componentes de movimento do gesto de alcance e a função do membro superior, respetivamente. Recorreu-se ao registo fotográfico para análise dos componentes de movimento na posição de sentado e em pé.Resultados: Os dados eletromiográficos registam atividade dos estabilizadores da omoplata unicamente num indivíduo em M2. A análise do deslocamento anterior do tronco revela melhorias em M1 em todos os indivíduos, sendo que em M2 essa evolução positiva não foi observada em três dos participantes. Entre M0 e M2, na escala RPS registam-se melhorias de 7 a 9 pontos no alvo próximo e de 5 a 10 pontos no alvo distante. Na escala MESUPES verificam-se melhorias entre 5 a 18 pontos na sub-escala braço e entre 5 a 8 pontos na sub-escala mão, em M2. A avaliação do registo fotográfico revela modificações nos componentes de movimento dos quatro indivíduos, nomeadamente na integração dos MI na base de suporte, na atividade do tronco inferior e superior e no alinhamento do MS contralesional. Conclusão: A melhoria do nível da atividade dos estabilizadores dinâmicos da omoplata sugere ter influência na diminuição do movimento compensatório do tronco no gesto de alcance e parece ter um papel na melhoria da eficácia distal do MS do mesmo lado.

Educação em neurofisiologia da dor e exercício em adolescentes com dor cervical: um estudo piloto da sua efetividade

Enquadramento: A prevalência da dor cervical crónica em adolescentes está a aumentar. Estudos recentes têm comprovado a eficácia de programas de educação com base na neurofisiologia da dor e exercício na diminuição da dor, incapacidade, medo e ansiedade associados à dor crónica. Contudo, apesar deste tipo de programas apresentar resultados promissores em adultos, a sua aplicação e efetividade em populações mais jovens tem sido pouco estudada. Objetivos: Avaliar a efetividade de um programa de educação com base na neurofisiologia da dor associado a exercícios na dor cervical crónica em adolescentes na 1) frequência e intensidade da dor, 2) incapacidade associada, 3) capacidade de resistência dos músculos flexores e extensores profundos da cervical e estabilizadores da omoplata, 4) ansiedade e 5) catastrofização. Métodos: Um total de 43 adolescentes com idade entre os 15 e os 18 anos da Escola Secundária Dr. João Carlos Celestino Gomes participaram neste estudo. Foram avaliadas a intensidade, duração e frequência da dor cervical, a incapacidade associada e a resistência dos músculos flexores e extensores profundos da cervical e estabilizadores da omoplata através dos testes dos flexores e extensores profundos e estabilizadores da omoplata, respetivamente. Foram também avaliados os níveis de ansiedade, catastrofização e perceção de mudança através do Inventário de Ansiedade Estado-Traço, da Escala de Catastrofização da Dor e da Escala de Perceção Global de Mudança. Resultados: O número de participantes a referir dor na semana que precedeu a avaliação no grupo experimental reduziu em 28,5%. Verificou-se uma interação significativa entre o momento de avaliação (antes da intervenção vs após a intervenção) e o grupo (experimental vs. controlo) para as variáveis resistência dos flexores profundos e catastrofização e um efeito do momento e do grupo (mas não uma interação) para a dor, incapacidade, resistência dos músculos extensores e estabilizadores da omoplata e ansiedade traço (p<0.05). Dos 21 participantes do grupo experimental, 85,7% referiu mudanças significativas na Escala de Perceção Global de Mudança. Conclusão: A educação em neurofisiologia da dor é uma intervenção que poderá ser utilizada em adolescentes com dor crónica, com resultados significativos na redução da dor, melhoria da resistência muscular dos músculos flexores e extensores profundos da cervical e estabilizadores da omoplata e diminuição da catastrofização.

Adjuvant use of nutritional and herbal medicines with antidepressants, mood stabilizers and benzodiazepines

Adjuvant use of nutritional and herbal medicines has potential to increase the efficacy of synthetic pharmaceuticals, and perhaps also decrease their side-effects by allowing lower doses to be prescribed. We evaluated current evidence for adjuvant use of nutritional and herbal medicines with antidepressants, mood stabilizers and benzodiazepines; and explored novel future areas of research. The paper also critiques current evidence for co-administration of St. John’s wort with synthetic antidepressants. We performed a systematic search of MEDLINE, CINAHL, PsycINFO, The Cochrane database, China National Knowledge Infrastructure and the Chinese Science Citation Database. Search results were supplemented by a review of reference lists and a forward search using the Web of Science. Where possible we calculated effect sizes. Encouraging evidence exists for the use of omega-3 fatty acids, SAMe, folic acid and l-tryptophan adjuvantly with antidepressants to enhance response and improve efficacy. Various nutrients also have emerging evidence as effective adjuncts with antipsychotics and mood stabilizers. While some evidence supports nutritional adjuvancy with various psychopharmacotherapies, adjuvant use of herbal therapies has not been sufficiently studied to warrant standard clinical application. This remains a promising area of research via robust, safety-conscious studies.

Bone response to unloaded titanium implants in the fibula, iliac crest, and scapula: an animal study in the Yorkshire pig

The reconstruction of extended maxillary and mandibular defects with prefabricated free flaps is a two stage procedure, that allows immediate function with implant supported dentures. The appropriate delay between prefabrication and reconstruction depends on the interfacial strength of the bone–implant surface. The purpose of this animal study was to evaluate the removal torque of unloaded titanium implants in the fibula, the scapula and the iliac crest. Ninety implants with a sandblasted and acid-etched (SLA) surface were tested after healing periods of 3, 6, and 12 weeks, respectively. Removal torque values (RTV) were collected using a computerized counterclockwise torque driver. The bicortical anchored 8 mm implants in the fibula revealed values of 63.73 Ncm, 91.50 Ncm, and 101.83 Ncm at 3, 6, and 12 weeks, respectively. The monocortical anchorage in the iliac crest showed values of 71.40 Ncm, 63.14 Ncm, and 61.59 Ncm with 12 mm implants at the corresponding times. The monocortical anchorage in the scapula demonstrated mean RTV of 62.28 Ncm, 97.63 Ncm, and 99.7 Ncm with 12 mm implants at 3, 6, and 12 weeks, respectively. The study showed an increase of removal torque with increasing healing time. The interfacial strength for bicortical anchored 8 mm implants in the fibula was comparable to monocortical anchored 12 mm implants in the iliac crest and the scapula at the corresponding times. The resistance to shear seemed to be determined by the type of anchorage (monocortical vs. bicortical) and the length of the implant with greater amount of bone–implant interface.

Effects of various power system stabilizers on improving power system dynamic performance

To ensure the small-signal stability of a power system, power system stabilizers (PSSs) are extensively applied for damping low frequency power oscillations through modulating the excitation supplied to synchronous machines, and increasing interest has been focused on developing different PSS schemes to tackle the threat of damping oscillations to power system stability. This paper examines four different PSS models and investigates their performances on damping power system dynamics using both small-signal eigenvalue analysis and large-signal dynamic simulations. The four kinds of PSSs examined include the Conventional PSS (CPSS), Single Neuron based PSS (SNPSS), Adaptive PSS (APSS) and Multi-band PSS (MBPSS). A steep descent parameter optimization algorithm is employed to seek the optimal PSS design parameters. To evaluate the effects of these PSSs on improving power system dynamic behaviors, case studies are carried out on an 8-unit 24-bus power system through both small-signal eigenvalue analysis and large-signal time-domain simulations.

Intratherapist reliability in the rating of scapula posture in multiple planes of reference

Background: Evaluation of scapular posture is a fundamental component in the clinical evaluation of the upper quadrant. This study examined the intrarater reliability of scapular posture ratings. Methods: A test-retest reliability investigation was undertaken with one week between assessment sessions. At each session physical therapists conducted visual assessments of scapula posture (relative to the thorax) in five different scapula postural planes (plane of scapula, sagittal plane, transverse plane, horizontal plane, and vertical plane). These five plane ratings were performed for four different scapular posture perturbating conditions (rest, isometric shoulder; flexion, abduction, and external rotation). Results. A total of 100 complete scapular posture ratings (50 left, 50 right) were undertaken at each assessment. The observed agreement between the test and retest postural plane ratings ranged from 59% to 87%; 16 of the 20 plane-condition combinations exceeded 75% observed agreement. Kappa (and prevalence adjusted bias adjusted kappa) values were inconsistent across the postural planes and perturbating conditions. Conclusions: This investigation generally revealed fair to moderate intrarater reliability in the rating of scapular posture by visual inspection. However, enough disagreement between assessments was present to warrant caution when interpreting perceived changes in scapula position between longitudinal assessments using visual inspection alone.

Constrained predictive control of ship fin stabilizers to prevent dynamic stall

In moderate to high sea states, the effectiveness of ship fin stabilizers can severely deteriorate due to nonlinear effects arising from unsteady hydrodynamic characteristics of the fins: dynamic stall. These nonlinear effects take the form of a hysteresis, and they become very significant when the effective angle of attack of the fins exceeds a certain threshold angle. Dynamic stall can result in a complete loss of control action depending on how much the fins exceed the threshold angle. When this is detected, it is common to reduce the gain of the controller that commands the fins. This approach is cautious and tends to reduce performance when the conditions leading to dynamic stall disappear. An alternative approach for preventing the effects while keeping high performance, consists of estimating the effective angle of attack and set a conservative constraint on it as part of the control objectives. In this paper, we investigate the latter approach, and propose the use of a model predictive control (MPC) to prevent the development of these nonlinear effects by considering constraints on both the mechanical angle of the fins and the effective angle of attack.

A Modified Heffron-Phillip's Model for The Design of Power System Stabilizers

In this paper a modified Heffron-Phillip's (K-constant) model is derived for the design of power system stabilizers. A knowledge of external system parameters, such as equivalent infinite bus voltage and external impedances or their equivalent estimated values is required for designing a conventional power system stabilizer. In the proposed method, information available at the secondary bus of the step-up transformer is used to set up a modified Heffron-Phillip's (ModHP) model. The PSS design based on this model utilizes signals available within the generating station. The efficacy of the proposed design technique and the performance of the stabilizer has been evaluated over a range of operating and system conditions. The simulation results have shown that the performance of the proposed stabilizer is comparable to that could be obtained by conventional design but without the need for the estimation and computation of external system parameters. The proposed design is thus well suited for practical applications to power system stabilization, including possibly the multi-machine applications where accurate system information is not readily available.

Mannans as film formers and emulsion stabilizers

Mannans are abundant plant polysaccharides found in the endosperm of certain leguminous seeds (guar gum galactomannan, GG; locust bean gum galactomannan, LBG), in the tuber of the konjac plant (konjac glucomannan, KGM), and in softwoods (galactoglucomannan, GGM). This study focused on the effects of the chemical structure of mannans on their film-forming and emulsion-stabilizing properties. Special focus was on spruce GGM, which is an interesting new product from forest biorefineries. A plasticizer was needed for the formation of films from mannans other than KGM and the optimal proportion was 40% (w/w of polymers) glycerol or sorbitol. Galactomannans with lower galactose content (LBG, modified GG) produced films with higher elongation at break and tensile strength. The mechanical properties of GG-based films were improved by decreasing the degree of polymerization of the polysaccharide with moderate mannanase treatments. The improvement of mechanical properties of GGM-based films was sought by blending GGM with each of poly(vinyl alcohol) (PVOH), corn arabinoxylan (cAX), and KGM. Adding other polymers increased the elongation at break of GGM blend films. The tensile strength of films increased with increasing amounts of PVOH and KGM, but the effect of cAX was the opposite. Dynamic mechanical analysis showed two separate loss modulus peaks for blends of GGM and PVOH, but a single peak for all other films. Optical and scanning electron microscopy confirmed good miscibility of GGM with cAX and KGM. In contrast, films blended from GGM and PVOH showed phase separation. GGM and KGM were mixed with cellulose nanowhiskers (CNW) to form composite films. Addition of CNW to KGM-based films induced the formation of fiberlike structures with lengths of several millimeters. In GGM-based films, rodlike structures with lengths of tens of micrometers were formed. Interestingly, the notable differences in the film structure did not appear to be related to the mechanical and thermal properties of the films. Permeability properties of GGM-based films were compared to those of films from commercial mannans KGM, GG, and LBG. GGM-based films had the lowest water vapor permeability when compared to films from other mannans. The oxygen permeability of GGM films was of the same magnitude as that of commercial polyethylene / ethylene vinyl alcohol / polyethylene laminate film. The aroma permeability of GGM films was low. All films were transparent in the visible region, but GGM films blocked the light transmission in the ultraviolet region of the spectra. The stabilizing effect of GGM on a model beverage emulsion system was studied and compared to that of GG, LBG, KGM, and cAX. In addition, GG was enzymatically modified in order to examine the effect of the degree of polymerization and the degree of substitution of galactomannans on emulsion stability. Use of GGM increased the turbidity of emulsions both immediately after preparation and after storage of up to 14 days at room temperature. GGM emulsions had higher turbidity than the emulsions containing other mannans. Increasing the storage temperature to +45 ºC led to rapid emulsion breakdown, but a decrease in storage temperature increased emulsion stability after 14 days. A low degree of polymerization and a high degree of substitution of the modified galactomannans were associated with a decrease in emulsion turbidity.

Power System Stability Enhancement by Single Network Adaptive Critic Stabilizers

This paper proposes a Single Network Adaptive Critic (SNAC) based Power System Stabilizer (PSS) for enhancing the small-signal stability of power systems over a wide range of operating conditions. SNAC uses only a single critic neural network instead of the action-critic dual network architecture of typical adaptive critic designs. SNAC eliminates the iterative training loops between the action and critic networks and greatly simplifies the training procedure. The performance of the proposed PSS has been tested on a Single Machine Infinite Bus test system for various system and loading conditions. The proposed stabilizer, which is relatively easier to synthesize, consistently outperformed stabilizers based on conventional lead-lag and linear quadratic regulator designs.

Power System Stabilizers Design for Interconnected Power Systems

This paper proposes a method of designing fixed parameter decentralized power system stabilizers (PSS) for interconnected multi-machine power systems. Conventional design technique using a single machine infinite bus approximation involves the frequency response estimation called the GEP(s) between the AVR input and the resultant electrical torque. This requires the knowledge of equivalent external reactance and infinite bus voltage or their estimated values at each machine. Other design techniques using P-Vr characteristics or residues are based on complete system information. In the proposed method, information available at the high voltage bus of the step-up transformer is used to set up a modified Heffron-Phillip's model. With this model it is possible to decide the structure of the PSS compensator and tune its parameters at each machine in the multi-machine environment, using only those signals that are available at the generating station. The efficacy of the proposed design technique has been evaluated on three of the most widely used test systems. The simulation results have shown that the performance of the proposed stabilizer is comparable to that which could be obtained by conventional design but without the need for the estimation and computation of external system parameters.

Low frequency oscillations in power systems: A physical account and adaptive stabilizers

This paper presents a physical explanation of the phenomenon of low frequency oscillations experienced in power systems. A brief account of the present practice of providing fixed gain power system stabilizers (PSS) is followed by a summary of some of the recent design proposals for adaptive PSS. A novel PSS based on the effort of cancelling the negative damping torque produced by the automatic voltage regulator (AVR) is presented along with some recent studies on a multimachine system using a frequency identification technique.