WALKINSENSE VALIDATION: PRELIMINARY TESTS OF MOBILITY PARAMETERS

The purpose of this study was to perform a preliminary validation of a new electronic instrument for human movement and performance assessment in sports. Measurements of distance, walking speed, step length and frequency were acquired, for a small sample of 15 subjects in a track of 10 m length, and compared to reference data. Results show good repeatability and data agreement across several trials at three different selfselected walking speeds

The influence of gait cadence on the ground reaction forces and plantar pressures during load carriage of young adults

Biomechanical gait parameters ground reaction forces (GRFs) and plantar pressures during load carriage of young adults were compared at a low gait cadence and a high gait cadence. Differences between load carriage and normal walking during both gait cadences were also assessed. A force plate and an in-shoe plantar pressure system were used to assess 60 adults while they were walking either normally (unloaded condition) or wearing a backpack (loaded condition) at low (70 steps per minute) and high gait cadences (120 steps per minute). GRF and plantar pressure peaks were scaled to body weight (or body weight plus backpack weight). With medium to high effect sizes we found greater anterior-posterior and vertical GRFs and greater plantar pressure peaks in the rearfoot, forefoot and hallux when the participants walked carrying a backpack at high gait cadences compared to walking at low gait cadences. Differences between loaded and unloaded conditions in both gait cadences were also observed.info:eu-repo/semantics/acceptedVersio

Analysis of the backpack loading efects on the human gait

Gait is a simple activity of daily life and one of the main abilities of the human being. Often during leisure, labour and sports activities, loads are carried over (e.g. backpack) during gait. These circumstantial loads can generate instability and increase biomechanicalstress over the human tissues and systems, especially on the locomotor, balance and postural regulation systems. According to Wearing (2006), subjects that carry a transitory or intermittent load will be able to find relatively efficient solutions to compensate its effects.info:eu-repo/semantics/publishedVersio

An educational training program for physicians for diagnosis and treatment of depression

OBJECTIVE: The American Regional Office of the WHO has launched a major initiative to reduce the prevalence of affective disorders region-wide that includes focusing on the primary health care system. This study evaluated the results of an educational training program for Brazilian primary care physicians that measured changes in knowledge, attitudes, and practice. METHODS: A total of 17 primary care physicians and 1,224 patients participated in the study. Physician's knowledge, attitudes, and clinical practice were assessed one-month prior and one-month following the training program. In addition, the patients that visited the clinic during a typical week completed depression symptom self-ratings, including the Zung and a DSM-IV/ICD-10 major depression checklist at both times. RESULTS: The training program showed limited benefits in this small sample of physicians. The program was unable to demonstrate benefit in improving knowledge about depression and in changing disorder-related attitudes. There were no changes in the diagnostic rates of major depression. There was some evidence to support improvement in psychopharmacological management. The physicians seemed more confident in treating patients, as there was a reduction of referrals to the specialists. Lack of statistical power prevented the latter two findings from reaching statistical significance. CONCLUSIONS: The inclusion of primary care physicians is a central component of any initiative to reduce the treatment gap and lag of depression. However, more effective methods of training Brazilian primary care physicians in the management of major depression need to be tested.OBJETIVO: Avaliar os resultados da aplicação de programa de treinamento da Organização Mundial de Saúde, voltado para diagnóstico e tratamento da depressão, dirigido a médicos clínicos gerais. MÉTODOS: Dezessete clínicos e 1.224 pacientes da cidade de Campinas, SP, participaram do estudo. Um mês antes e um após o treinamento, foram avaliados o conhecimento dos médicos, suas atitudes e o atendimento prestado aos pacientes; esses, por sua vez, completaram escalas de auto-avaliação de sintomas depressivos: Zung e um checklist para depressão maior do manual para diagnóstico e estatística em saúde mental (DSM-IV/CID-10). A mudança de conhecimento e atitude dos clínicos entre as fases 1 e 2 foi avaliada pelos testes t de Student. Mudanças com relação ao conhecimento de cada indivíduo foram mensuradas pelo teste de qui-quadrado de McNemar. As diferenças entre o modo de atender os pacientes entre as duas fases foram determinadas pelo teste de qui-quadrado de Pearson. A concordância diagnóstica foi analisada utilizando o Kappa, com o intuito de corrigir a concordância ao acaso. RESULTADOS: O programa mostrou benefícios limitados nessa amostra de clínicos gerais. Não foi capaz de mostrar aumento do conhecimento sobre a depressão e nem quanto à atitude dos médicos com relação a esse transtorno. Não houve modificação no número de casos diagnosticados antes ou após o programa. Existiram algumas evidências com relação à melhora no manejo psicofarmacológico. Aparentemente, o programa tornou os clínicos mais confiantes para o tratamento da depressão, diminuindo o número de encaminhamentos feitos aos profissionais da área de saúde mental. Porém, um baixo poder estatístico não permitiu que os dois últimos achados atingissem significância. CONCLUSÕES: A inclusão de clínicos gerais é um componente central de qualquer iniciativa para melhorar a detecção e o tratamento da depressão, porém faz-se necessário testar melhores métodos de treinamento dos clínicos brasileiros no manejo desta.Serviço de Saúde 'Dr. Cândido Ferreira'Ministério da SaúdeBrown University Providence Department of Psychiatry and Human BehaviorOrganização Mundial da Saúde Organização Panamericana de SaúdeUniversidade Federal de São Paulo (UNIFESP)UNIFESP, Departamento de PsiquiatriaSciEL

Computed tomographic assessment of lung weights in trauma patients with early posttraumatic lung dysfunction

Introduction: Quantitative computed tomography (qCT)-based assessment of total lung weight (M(lung)) has the potential to differentiate atelectasis from consolidation and could thus provide valuable information for managing trauma patients fulfilling commonly used criteria for acute lung injury (ALI). We hypothesized that qCT would identify atelectasis as a frequent mimic of early posttraumatic ALI. Methods: In this prospective observational study, M(lung) was calculated by qCT in 78 mechanically ventilated trauma patients fulfilling the ALI criteria at admission. A reference interval for M(lung) was derived from 74 trauma patients with morphologically and functionally normal lungs (reference). Results are given as medians with interquartile ranges. Results: The ratio of arterial partial pressure of oxygen to the fraction of inspired oxygen was 560 (506 to 616) mmHg in reference patients and 169 (95 to 240) mmHg in ALI patients. The median reference M(lung) value was 885 (771 to 973) g, and the reference interval for M(lung) was 584 to 1164 g, which matched that of previous reports. Despite the significantly greater median M(lung) value (1088 (862 to 1,342) g) in the ALI group, 46 (59%) ALI patients had M(lung) values within the reference interval and thus most likely had atelectasis. In only 17 patients (22%), Mlung was increased to the range previously reported for ALI patients and compatible with lung consolidation. Statistically significant differences between atelectasis and consolidation patients were found for age, Lung Injury Score, Glasgow Coma Scale score, total lung volume, mass of the nonaerated lung compartment, ventilator-free days and intensive care unit-free days. Conclusions: Atelectasis is a frequent cause of early posttraumatic lung dysfunction. Differentiation between atelectasis and consolidation from other causes of lung damage by using qCT may help to identify patients who could benefit from management strategies such as damage control surgery and lung-protective mechanical ventilation that focus on the prevention of pulmonary complications.Leipzig University Hospita

Force irradiation effects during upper limb diagonal exercises on contralateral muscle activation

The aim of this study was to explore the force irradiation effects of upper limb isometric diagonal exercises on shoulder muscle activities. Interactions among diagonal directions, contraction intensities (moderate and maximum) and sex were assessed. Thirty healthy subjects (11 males) performed isometric unilateral diagonal exercises based on proprioceptive neuromuscular facilitation technique in an isokinetic dynamometer with their dominant upper limbs. The second diagonal for flexion and for extension were assessed while the participants performed their maximum isometric torque (MIT) and at 25% of their MIT. During the exercise the muscle activity of the medial deltoid, pectoralis major and upper trapezius in the non-dominant (non-exercised) upper limbs of the participants was recorded by surface electromyography. The highest muscle activity occurred in the upper trapezius during the diagonal for flexion (27% of maximum isometric voluntary contractions). Upper trapezius and pectoralis major were more active during the diagonal for flexion than diagonal for extension (p 0.05). In conclusion, we observed that force irradiation during upper limb diagonal exercises is affected by diagonal direction, contraction intensity and sex when performed by healthy participants.info:eu-repo/semantics/publishedVersio

Duality in a fermion-like formulation for the electromagnetic field

We employ the Dirac-like equation for the gauge field proposed by Majorana to obtain an action that is symmetric under duality transformation. We also use the equivalence between duality and chiral symmetry in this fermion-like formulation to show how the Maxwell action can be seen as a mass term.Comment: 4 pages. Revtex. Final version to be published in Phys. Rev.

Effective Action for QED with Fermion Self-Interaction in D=2 and D=3 Dimensions

In this work we discuss the effect of the quartic fermion self-interaction of Thirring type in QED in D=2 and D=3 dimensions. This is done through the computation of the effective action up to quadratic terms in the photon field. We analyze the corresponding nonlocal photon propagators nonperturbatively in % \frac{k}{m}, where k is the photon momentum and m the fermion mass. The poles of the propagators were determined numerically by using the Mathematica software. In D=2 there is always a massless pole whereas for strong enough Thirring coupling a massive pole may appear . For D=3 there are three regions in parameters space. We may have one or two massive poles or even no pole at all. The inter-quark static potential is computed analytically in D=2. We notice that the Thirring interaction contributes with a screening term to the confining linear potential of massive QED_{2}. In D=3 the static potential must be calculated numerically. The screening nature of the massive QED$_{3}$ prevails at any distance, indicating that this is a universal feature of % D=3 electromagnetic interaction. Our results become exact for an infinite number of fermion flavors.Comment: Latex, 13 pages, 3 figure

Lung-protective ventilation for the surgical patient: international expert panel-based consensus recommendations

Postoperative pulmonary complications (PPCs) occur frequently and are associated with substantial morbidity and mortality. Evidence suggests that reduction of PPCs can be accomplished by using lung-protective ventilation strategies intraoperatively, but a consensus on perioperative management has not been established. We sought to determine recommendations for lung protection for the surgical patient at an international consensus development conference. Seven experts produced 24 questions concerning preoperative assessment and intraoperative mechanical ventilation for patients at risk of developing PPCs. Six researchers assessed the literature using questions as a framework for their review. The modified Delphi method was utilised by a team of experts to produce recommendations and statements from study questions. An expert consensus was reached for 22 recommendations and four statements. The following are the highlights: (i) a dedicated score should be used for preoperative pulmonary risk evaluation; and (ii) an individualised mechanical ventilation may improve the mechanics of breathing and respiratory function, and prevent PPCs. The ventilator should initially be set to a tidal volume of 6-8 ml kg-1 predicted body weight and positive end-expiratory pressure (PEEP) 5 cm H2O. PEEP should be individualised thereafter. When recruitment manoeuvres are performed, the lowest effective pressure and shortest effective time or fewest number of breaths should be used. ispartof: BJA: British Journal of Anaesthesia vol:123 issue:6 pages:898-913 ispartof: location:England status: Published onlin