Hospital Guidelines for Diabetes Management and the Joint Commission-American Diabetes Association Inpatient Diabetes Certification.

PubMed

Arnold, Pamela; Scheurer, Danielle; Dake, Andrew W; Hedgpeth, Angela; Hutto, Amy; Colquitt, Caroline; Hermayer, Kathie L

2016-04-01

The Joint Commission Advanced Inpatient Diabetes Certification Program is founded on the American Diabetes Association's Clinical Practice Recommendations and is linked to the Joint Commission Standards. Diabetes currently affects 29.1 million people in the USA and another 86 million Americans are estimated to have pre-diabetes. On a daily basis at the Medical University of South Carolina (MUSC) Medical Center, there are approximately 130-150 inpatients with a diagnosis of diabetes. The program encompasses all service lines at MUSC. Some important features of the program include: a program champion or champion team, written blood glucose monitoring protocols, staff education in diabetes management, medical record identification of diabetes, a plan coordinating insulin and meal delivery, plans for treatment of hypoglycemia and hyperglycemia, data collection for incidence of hypoglycemia, and patient education on self-management of diabetes. The major clinical components to develop, implement, and evaluate an inpatient diabetes care program are: I. Program management, II. Delivering or facilitating clinical care, III. Supporting self-management, IV. Clinical information management and V. performance measurement. The standards receive guidance from a Disease-Specific Care Certification Advisory Committee, and the Standards and Survey Procedures Committee of the Joint Commission Board of Commissioners. The Joint Commission-ADA Advanced Inpatient Diabetes Certification represents a clinical program of excellence, improved processes of care, means to enhance contract negotiations with providers, ability to create an environment of teamwork, and heightened communication within the organization. Published by Elsevier Inc.

Management of the patient with a total joint replacement: the primary care practitioner's role.

PubMed

Palmer, L M

1999-01-01

The primary care practitioner assumes chief responsibility for patients with arthritis. More than 40 million Americans experience some form of arthritis. Management of the patient with arthritis may include a referral to an orthopedic surgeon for surgical intervention. As estimated, up to 500,000 total joint replacement procedures are performed by orthopedic surgeons each year in the United States. Presurgical evaluation for a total joint replacement is imperative to ensure that the patient can safely undergo this surgical procedure. Postsurgical care of a patient with total joint replacement involves coordinating care with the physical therapist and orthopedic surgeon to ensure adequate follow-through with the recommended rehabilitation program, prophylactic antibiotic coverage, and observation for any complications including infection, deep-vein thrombosis, or loosening of the total-joint prosthesis.

Directorate of Management - Special Staff - Joint Staff - Leadership - The

Science.gov Websites

Space Management, Publications Management, Administrative Services, Joint Staff Information Data Systems J-4 J-5 J-6 J-7 J-8 Personal Staff Inspector General Judge Advocate General Officer Management Public Affairs Executive Support Services Legislative Liaison Special Staff Directorate of Management

Cost analysis of debridement and retention for management of prosthetic joint infection.

PubMed

Peel, T N; Dowsey, M M; Buising, K L; Liew, D; Choong, P F M

2013-02-01

Prosthetic joint infection remains one of the most devastating complications of arthroplasty. Debridement and retention of the prosthesis is an attractive management option in carefully selected patients. Despite this, there are no data investigating the cost of this management modality for prosthetic joint infections. The aim of this case-control study was to calculate the cost associated with debridement and retention for management of prosthetic joint infection compared with primary joint replacement surgery without prosthetic joint infection. From 1 January 2008 to 30 June 2010, there were 21 prosthetic joint infections matched to 42 control patients. Controls were matched to cases according to the arthroplasty site, age and sex. Cases had a greater number of unplanned readmissions (100% vs. 7.1%; p <0.001), more additional surgery (3.3 vs. 0.07; p <0.001) and longer total bed days (31.6 vs. 7.9 days; p <0.001). In addition they had more inpatient, outpatient and emergency department visits (p <0.001, respectively). For patients with prosthetic joint infection the total cost, including index operation and costs of management of the prosthetic joint infection, was 3.1 times the cost of primary arthoplasty; the mean cost for cases was Australian dollars (AUD) $69,414 (±29,869) compared with $22,085 (±8147) (p <0.001). The demand for arthroplasty continues to grow and with that, the number of prosthetic joint infections will also increase, placing significant burden on the health system. Our study adds significantly to the growing body of evidence highlighting the substantial costs associated with prosthetic joint infection. © 2011 The Authors. Clinical Microbiology and Infection © 2011 European Society of Clinical Microbiology and Infectious Diseases.

JOINT MOBILIZATION IN THE MANAGEMENT OF PERSISTENT INSERTIONAL ACHILLES TENDINOPATHY: A CASE REPORT.

PubMed

Jayaseelan, Dhinu J; Post, Andrew A; Mischke, John J; Sault, Josiah D

2017-02-01

Insertional Achilles tendinopathy (IAT) can be a challenging condition to manage conservatively. Eccentric exercise is commonly used in the management of chronic tendinopathy; however, it may not be as helpful for insertional tendon problems as compared to mid-portion dysfunction. While current evidence describing the physical therapy management of IAT is developing, gaps still exist in descriptions of best practice. The purpose of this case report is to describe the management of a patient with persistent IAT utilizing impairment-based joint mobilization, self-mobilization, and exercise. A 51-year-old male was seen in physical therapy for complaints of posterior heel pain and reduced running capacity. He was seen by multiple physical therapists previously, but reported continued impairment, and functional restriction. Joint-based non-thrust mobilization and self-mobilization exercise were performed to enhance his ability to run and reduce symptoms. The subject was seen for four visits over the course of two months. He made clinically significant improvements on the Foot and Ankle Activity Measure and Victorian Institute of Sport Assessment-Achilles tendon outcomes, was asymptomatic, and participated in numerous marathons. Improvements were maintained at one-year follow-up. Mobility deficits can contribute to the development of tendinopathy, and without addressing movement restrictions, symptoms and functional decline related to tendinopathy may persist. Joint-directed manual therapy may be a beneficial intervention in a comprehensive plan of care in allowing patients with chronic tendon changes to optimize function. Therapy, Level 4.

Arthroscopic Management of Scaphoid-Trapezium-Trapezoid Joint Arthritis.

PubMed

Pegoli, Loris; Pozzi, Alessandro

2017-11-01

Scaphoid-trapezium-trapezoid (STT) joint arthritis is a common condition consisting of pain on the radial side of the wrist and base of the thumb, swelling, and tenderness over the STT joint. Common symptoms are loss of grip strength and thumb function. There are several treatments, from symptomatic conservative treatment to surgical solutions, such as arthrodesis, arthroplasties, and prosthesis implant. The role of arthroscopy has grown and is probably the best treatment of this condition. Advantages of arthroscopic management of STT arthritis are faster recovery, better view of the joint during surgery, and possibility of creating less damage to the capsular and ligamentous structures. Copyright © 2017 Elsevier Inc. All rights reserved.

Models for joint ophthalmology-optometry patient management.

PubMed

Kim, John J; Kim, Christine M

2011-07-01

American Academy of Ophthalmology (AAO) and American Society of Cataract and Refractive Surgery (ASCRS) presented a joint position paper in February 2000 declaring that they do not support routine comanagement of patients with the optometrists. American Optometric Association and American Academy of Optometry quickly responded in support of AAO and ASCRS. All four entities did not preclude legitimate and proper comanagement arrangements. Since that time, the pattern of practice has changed, requiring us to rethink our positions. This paper is written to provide a possible model for the ophthalmology-optometry practice management in ophthalmic surgeries including refractive surgery. Since the publication of the Joint Position Paper, the concept of comanagement has faded and a new model of integrated management has evolved. This has occurred as the changes in the employment pattern of the ophthalmic practice have incorporated optometrists into its fold. This evolution allowed ophthalmic and optometric community to co-exist and thrive to provide better patient care.

Interim guide for optimum joint performance of concrete pavements.

DOT National Transportation Integrated Search

2011-09-01

The purpose of this guide is to help practitioners understand how to optimize concrete pavement joint performance through the identification, mitigation, and prevention of joint deterioration. It summarizes current knowledge from research and practic...

Designs and performance of three new microprocessor-controlled knee joints.

PubMed

Thiele, Julius; Schöllig, Christina; Bellmann, Malte; Kraft, Marc

2018-02-09

A crossover design study with a small group of subjects was used to evaluate the performance of three microprocessor-controlled exoprosthetic knee joints (MPKs): C-Leg 4, Plié 3 and Rheo Knee 3. Given that the mechanical designs and control algorithms of the joints determine the user outcome, the influence of these inherent differences on the functional characteristics was investigated in this study. The knee joints were evaluated during level-ground walking at different velocities in a motion analysis laboratory. Additionally, technical analyses using patents, technical documentations and X-ray computed tomography (CT) for each knee joint were performed. The technical analyses showed that only C-Leg 4 and Rheo Knee 3 allow microprocessor-controlled adaptation of the joint resistances for different gait velocities. Furthermore, Plié 3 is not able to provide stance extension damping. The biomechanical results showed that only if a knee joint adapts flexion and extension resistances by the microprocessor all known advantages of MPKs can become apparent. But not all users may benefit from the examined functions: e.g. a good accommodation to fast walking speeds or comfortable stance phase flexion. Hence, a detailed comparison of user demands and performance of the designated knee joint is mandatory to ensure a maximum in user outcome.

Fatigue Performance of Advanced High-Strength Steels (AHSS) GMAW Joints

DOE Office of Scientific and Technical Information (OSTI.GOV)

Feng, Zhili; Sang, Yan; Jiang, Cindy

2009-01-01

The fatigue performance of gas metal arc welding (GMAW) joints of advanced high strength steels (AHSS) are compared and analyzed. The steel studied included a number of different grades of AHSS and baseline mild steels: DP600, DP780, DP980, M130, M220, solution annealed boron steel, fully hardened boron steels, HSLA690 and DR210 (a mild steel). Fatigue testing was conducted under a number of nominal stress ranges to obtain the S/N curves of the weld joints. A two-phase analytical model is developed to predict the fatigue performance of AHSS welds. It was found that there are appreciable differences in the fatigue S/Nmore » curves among different AHSS joints made using the same welding practices, suggesting that the local microstructure in the weld toe and root region plays non-negligible role in the fatigue performance of AHSS welds. Changes in weld parameters can influence the joint characteristics which in turn influence fatigue life of the weld joints, particularly of those of higher strength AHSS. The analytical model is capable of reasonably predicting the fatigue performance of welds made with various steel grades in this study.« less

Joint pathology and behavioral performance in autoimmune MRL-lpr Mice.

PubMed

Sakić, B; Szechtman, H; Stead, R H; Denburg, J A

1996-09-01

Young autoimmune MRL-lpr mice perform more poorly than age-matched controls in tests of exploration, spatial learning, and emotional reactivity. Impaired behavioral performance coincides temporally with hyperproduction of autoantibodies, infiltration of lymphoid cells into the brain, and mild arthritic-like changes in hind paws. Although CNS mechanisms have been suggested to mediate behavioral deficits, it was not clear whether mild joint pathology significantly affected behavioral performance. Previously we observed that 11-week-old MRL-lpr mice showed a trend for disturbed performance when crossing a narrow beam. The first aim of the present study was to test the significance of this trend by increasing the sample size and, second, to examine the possibility that arthritis-like changes interfere with performance in brief locomotor tasks. For the purpose of the second goal, 18-week-old mice that differ widely in severity of joint disease were selectively taken from the population and tested in beam walking and swimming tasks. It was expected that the severity of joint inflammation would be positively correlated with the degree of locomotor impairment. The larger sample size revealed that young MRL-lpr mice perform significantly more poorly than controls on the beam-walking test, as evidenced by more foot slips and longer traversing time. However, significant correlation between joint pathology scores and measures of locomotion could not be detected. The lack of such relationship suggests that mild joint pathology does not significantly contribute to impaired performance in young, autoimmune MRL-lpr mice tested in short behavioral tasks.

Acromioclavicular joint injuries in the National Football League: epidemiology and management.

PubMed

Lynch, T Sean; Saltzman, Matthew D; Ghodasra, Jason H; Bilimoria, Karl Y; Bowen, Mark K; Nuber, Gordon W

2013-12-01

Previous studies investigating acromioclavicular (AC) joint injuries in professional American football players have only been reported on quarterbacks during the 1980s and 1990s. These injuries have not been evaluated across all position players in the National Football League (NFL). The purpose of this study was 4-fold: (1) to determine the incidence of AC joint injuries among all NFL position players; (2) to investigate whether player position, competition setting, type of play, and playing surface put an athlete at an increased risk for this type of injury; (3) to determine the incidence of operative and nonoperative management of these injuries; and (4) to compare the time missed for injuries treated nonoperatively to the time missed for injuries requiring surgical intervention. Descriptive epidemiological study. All documented injuries of the AC joint were retrospectively analyzed using the NFL Injury Surveillance System (NFLISS) over a 12-season period from 2000 through 2011. The data were analyzed by the anatomic location, player position, field conditions, type of play, requirement of surgical management, days missed per injury, and injury incidence. Over 12 NFL seasons, there were a total of 2486 shoulder injuries, with 727 (29.2%) of these injuries involving the AC joint. The overall rate of AC joint injuries in these athletes was 26.1 injuries per 10,000 athlete exposures, with the majority of these injuries occurring during game activity on natural grass surfaces (incidence density ratio, 0.79) and most often during passing plays. These injuries occurred most frequently in defensive backs, wide receivers, and special teams players; however, the incidence of these injuries was greatest in quarterbacks (20.9 injuries per 100 players), followed by special teams players (20.7/100) and wide receivers (16.5/100). Overall, these athletes lost a mean of 9.8 days per injury, with quarterbacks losing the most time to injury (mean, 17.3 days). The majority of

Double-button Fixation System for Management of Acute Acromioclavicular Joint Dislocation

PubMed Central

Torkaman, Ali; Bagherifard, Abolfazl; Mokhatri, Tahmineh; Haghighi, Mohammad Hossein Shabanpour; Monshizadeh, Siamak; Taraz, Hamid; Hasanvand, Amin

2016-01-01

Background: Surgical treatments for acromioclavicular (AC) joint dislocation present with some complications. The present study was designed to evaluate the double-button fixation system in the management of acute acromioclavicular joint dislocation. Methods: This cross sectional study, done between February 2011 to June 2014, consisted of 28 patients who underwent surgical management by the double-button fixation system for acute AC joint dislocation. Age, sex, injury mechanism, dominant hand, side with injury, length of follow up, time before surgery, shoulder and hand (DASH), constant and visual analogue scale (VAS) scores, and all complications of the cases during the follow up were recorded. Results: The mean age of patients was 33.23±6.7 years. Twenty four patients (85.71%) were male and four (14.28%) were female. The significant differences were observed between pre-operation VAS, constant shoulder scores and post-operation measurements. There were not any significant differences between right and left coracoclavicular, but two cases of heterotrophic ossifications were recorded. The mean follow-up time was 16.17±4.38 months. Conclusion: According to the results, the double-button fixation system for management of acute acromioclavicular joint dislocation has suitable results and minimal damage to the soft tissues surrounding the coracoclavicular ligaments. PMID:26894217

Program and Management Support for the Office for Military Performance Assessment Technology

DTIC Science & Technology

1993-03-01

AD-A270 790 AD_ _ _ _ CONTRACT NO: DAMDI7-90-C-0061 TITLE: PROGRAM AND MANAGEMENT SUPPORT FOR THE OFFICE FOR MILITARY PERFORMANCE ASSESSMENT... the Office of Military Performance Assessment Technology (OMPAT). 1.1 Bag-kg n m. The OMPAT evolved from the Joint Working Group on Drug Dependent...facility was located, leased and occupied by Morgan Management Systems, Inc. staff and designated as the OMPAT Field Office. The office was located at 12075B

Achievements and Perspectives of the Joint Convention on the Safety of Spent Fuel Management and on the Safety of Radioactive Waste Management

DOE Office of Scientific and Technical Information (OSTI.GOV)

Louvat, D.; Lacoste, A.C.

The Joint Convention on the Safety of Spent Fuel management and on the Safety of Radioactive Waste Management is the first legal instrument to directly address the safety of spent fuel and radioactive waste management on a global scale. The Joint Convention entered into force in 2001. This paper describes its process and its main achievements to date. The perspectives to establish of a Global Waste Safety Regime based on the Joint Convention are also discussed. (authors)

Predator personality and prey behavioural predictability jointly determine foraging performance.

PubMed

Chang, Chia-Chen; Teo, Huey Yee; Norma-Rashid, Y; Li, Daiqin

2017-01-17

Predator-prey interactions play important roles in ecological communities. Personality, consistent inter-individual differences in behaviour, of predators, prey or both are known to influence inter-specific interactions. An individual may also behave differently under the same situation and the level of such variability may differ between individuals. Such intra-individual variability (IIV) or predictability may be a trait on which selection can also act. A few studies have revealed the joint effect of personality types of both predators and prey on predator foraging performance. However, how personality type and IIV of both predators and prey jointly influence predator foraging performance remains untested empirically. Here, we addressed this using a specialized spider-eating jumping spider, Portia labiata (Salticidae), as the predator, and a jumping spider, Cosmophasis umbratica, as the prey. We examined personality types and IIVs of both P. labiata and C. umbratica and used their inter- and intra-individual behavioural variation as predictors of foraging performance (i.e., number of attempts to capture prey). Personality type and predictability had a joint effect on predator foraging performance. Aggressive predators performed better in capturing unpredictable (high IIV) prey than predictable (low IIV) prey, while docile predators demonstrated better performance when encountering predictable prey. This study highlights the importance of the joint effect of both predator and prey personality types and IIVs on predator-prey interactions.

Predator personality and prey behavioural predictability jointly determine foraging performance

PubMed Central

Chang, Chia-chen; Teo, Huey Yee; Norma-Rashid, Y.; Li, Daiqin

2017-01-01

Predator-prey interactions play important roles in ecological communities. Personality, consistent inter-individual differences in behaviour, of predators, prey or both are known to influence inter-specific interactions. An individual may also behave differently under the same situation and the level of such variability may differ between individuals. Such intra-individual variability (IIV) or predictability may be a trait on which selection can also act. A few studies have revealed the joint effect of personality types of both predators and prey on predator foraging performance. However, how personality type and IIV of both predators and prey jointly influence predator foraging performance remains untested empirically. Here, we addressed this using a specialized spider-eating jumping spider, Portia labiata (Salticidae), as the predator, and a jumping spider, Cosmophasis umbratica, as the prey. We examined personality types and IIVs of both P. labiata and C. umbratica and used their inter- and intra-individual behavioural variation as predictors of foraging performance (i.e., number of attempts to capture prey). Personality type and predictability had a joint effect on predator foraging performance. Aggressive predators performed better in capturing unpredictable (high IIV) prey than predictable (low IIV) prey, while docile predators demonstrated better performance when encountering predictable prey. This study highlights the importance of the joint effect of both predator and prey personality types and IIVs on predator-prey interactions. PMID:28094288

Joint angle affects volitional and magnetically-evoked neuromuscular performance differentially.

PubMed

Minshull, C; Rees, D; Gleeson, N P

2011-08-01

This study examined the volitional and magnetically-evoked neuromuscular performance of the quadriceps femoris at functional knee joint angles adjacent to full extension. Indices of volitional and magnetically-evoked neuromuscular performance (N=15 healthy males, 23.5 ± 2.9 years, 71.5 ± 5.4 kg, 176.5 ± 5.5 cm) were obtained at 25°, 35° and 45° of knee flexion. Results showed that volitional and magnetically-evoked peak force (PF(V) and P(T)F(E), respectively) and electromechanical delay (EMD(V) and EMD(E), respectively) were enhanced by increased knee flexion. However, greater relative improvements in volitional compared to evoked indices of neuromuscular performance were observed with increasing flexion from 25° to 45° (e.g. EMD(V), EMD(E): 36% vs. 11% improvement, respectively; F([2,14])=6.8, p<0.05). There were no significant correlations between EMD(V) and EMD(E) or PF(V) and P(T)F(E), at analogous joint positions. These findings suggest that the extent of the relative differential between volitional and evoked neuromuscular performance capabilities is joint angle-specific and not correlated with performance capabilities at adjacent angles, but tends to be smaller with increased flexion. As such, effective prediction of volitional from evoked performance capabilities at both analogous and adjacent knee joint positions would lack robustness. Copyright © 2011 Elsevier Ltd. All rights reserved.

Joint kinetic determinants of starting block performance in athletic sprinting.

PubMed

Brazil, Adam; Exell, Timothy; Wilson, Cassie; Willwacher, Steffen; Bezodis, Ian N; Irwin, Gareth

2018-07-01

The aim of this study was to explore the relationships between lower limb joint kinetics, external force production and starting block performance (normalised average horizontal power, NAHP). Seventeen male sprinters (100 m PB, 10.67 ± 0.32 s) performed maximal block starts from instrumented starting blocks (1000 Hz) whilst 3D kinematics (250 Hz) were also recorded during the block phase. Ankle, knee and hip resultant joint moment and power were calculated at the rear and front leg using inverse dynamics. Average horizontal force applied to the front (r = 0.46) and rear (r = 0.44) block explained 86% of the variance in NAHP. At the joint level, many "very likely" to "almost certain" relationships (r = 0.57 to 0.83) were found between joint kinetic data and the magnitude of horizontal force applied to each block although stepwise multiple regression revealed that 55% of the variance in NAHP was accounted for by rear ankle moment, front hip moment and front knee power. The current study provides novel insight into starting block performance and the relationships between lower limb joint kinetic and external kinetic data that can help inform physical and technical training practices for this skill.

A Model for a Single Unmanned Aircraft Systems (UAS) Program Office Managing Joint ISR Capabilities

DTIC Science & Technology

2017-10-01

reduction in manning from the multiple program office structure to the new single program management model. Additional information regarding this...OFFICE MANAGING JOINT ISR CAPABILITIES by Angela E. Burris A Research Report Submitted to the Faculty In Partial Fulfillment of...research paper is to answer how a single management office could provide greater agility for unmanned aircraft systems (UAS); supporting Joint concepts

Joint Assessment of Renewable Energy and Water Desalination Research Center (REWDC) Program Capabilities and Facilities In Radioactive Waste Management

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bissani, M; Fischer, R; Kidd, S

2006-04-03

The primary goal of this visit was to perform a joint assessment of the Renewable Energy and Water Desalination Center's (REWDC) program in radioactive waste management. The visit represented the fourth technical and scientific interaction with Libya under the DOE/NNSA Sister Laboratory Arrangement. Specific topics addressed during the visit focused on Action Sheet P-05-5, ''Radioactive Waste Management''. The Team, comprised of Mo Bissani (Team Lead), Robert Fischer, Scott Kidd, and Jim Merrigan, consulted with REWDC management and staff. The team collected information, discussed particulars of the technical collaboration and toured the Tajura facility. The tour included the waste treatment facility,more » waste storage/disposal facility, research reactor facility, hot cells and analytical labs. The assessment team conducted the first phase of Task A for Action Sheet 5, which involved a joint assessment of the Radioactive Waste Management Program. The assessment included review of the facilities dedicated to the management of radioactive waste at the Tourja site, the waste management practices, proposed projects for the facility and potential impacts on waste generation and management.« less

[A new joint approach to drug management: clinical pharmacy services and risk management unit].

PubMed

Schwartz, Vardit; Kravitz, Martine Szyper

2015-04-01

According to the "To Err is Human" report, medication-related errors are common in medicine and may have several and different effects. Clinical Pharmacy is a leading worldwide established pharmacy service which has been improving the quality of care for the last 30 years. The accumulated experience shows improved quality of care, improved patient safety and economic benefit. These understandings led to the definition and expansion of the Clinical Pharmacist Intervention Program and a joint project with the Risk Management Unit was created. A characterization process was conducted, parameters were defined for monitoring and surveillance and interventions were devised. The relevant data requiring pharmacist intervention was defined (e.g., dose adjustments, contraindications, side-effects); a report was devised, based on the patient's electronic medical record; daily follow-up included analysis, stratification, quantification and understanding of the different types of pharmacist interventions. The pharmacist interventions were summed up and assessed for performance and quality control. Between March 2013 and February 2014 the medical records of 14,499 patients were examined in our hospital Only in 16% of the records an active pharmacist intervention was performed, according to the parameters defined. Interventions for potentially high risk events such as therapeutic duplication, drug administration in spite of contraindication and in spite of documented allergy were very rare, less than 2% of all the pharmacist interventions. This joint venture, which is based on an existing platform, reflects an up-to-date view of an important facet of the clinical work performed at the hospital, helps identify trends, potential failures and vulnerabilities with regard to medication treatment and allows the formulation of intervention programs to improve the quality and safety of drug therapy.

Body sway reflects leadership in joint music performance.

PubMed

Chang, Andrew; Livingstone, Steven R; Bosnyak, Dan J; Trainor, Laurel J

2017-05-23

The cultural and technological achievements of the human species depend on complex social interactions. Nonverbal interpersonal coordination, or joint action, is a crucial element of social interaction, but the dynamics of nonverbal information flow among people are not well understood. We used joint music making in string quartets, a complex, naturalistic nonverbal behavior, as a model system. Using motion capture, we recorded body sway simultaneously in four musicians, which reflected real-time interpersonal information sharing. We used Granger causality to analyze predictive relationships among the motion time series of the players to determine the magnitude and direction of information flow among the players. We experimentally manipulated which musician was the leader (followers were not informed who was leading) and whether they could see each other, to investigate how these variables affect information flow. We found that assigned leaders exerted significantly greater influence on others and were less influenced by others compared with followers. This effect was present, whether or not they could see each other, but was enhanced with visual information, indicating that visual as well as auditory information is used in musical coordination. Importantly, performers' ratings of the "goodness" of their performances were positively correlated with the overall degree of body sway coupling, indicating that communication through body sway reflects perceived performance success. These results confirm that information sharing in a nonverbal joint action task occurs through both auditory and visual cues and that the dynamics of information flow are affected by changing group relationships.

Technical tips to perform safe and effective ultrasound guided steroid joint injections in children.

PubMed

Parra, Dimitri A

2015-01-01

The aim of this article is to describe the technique used to perform ultrasound guided steroid joint injections in children in a group of joints that can be injected using ultrasound as the only image guidance modality. The technique is described and didactic figures are provided to illustrate key technical concepts. It is very important to be familiar with the sonographic appearance of the pediatric joints and the developing bone when performing ultrasound-guided joint injections in children.

Maloti Drakensberg Transfrontier Park joint management: Sehlabathebe National Park (Lesotho) and the uKhahlamba Drakensberg Park World Heritage Site (South Africa)

Treesearch

John M. Crowson

2011-01-01

On 8 April 2005, the first Joint Management Committee meeting was held at Qacha's Nek, Lesotho. This was to ensure co-operative management through joint management. The formation of a Joint Management Committee was part of the Bilateral Maloti Drakensberg Transfrontier Project agreement and consisted of officials from the Ministry of Tourism, Environment and...

Management of Candida guilliermondii joint infection in a dog.

PubMed

Bufalari, Antonello; Maggio, Chiara; Moretti, Giulia; Crovace, Alberto; Stefanetti, Valentina; Straubinger, Reinhard Konrad; Passamonti, Fabrizio

2016-07-08

Candida spp. are dimorphic fungi in the family Cryptococcaceae. Infections with Candida spp. are usually rare conditions in dogs, but immunocompromised patients have a higher risk for developing invasive candidal infections. A 5-year-old male Boxer, positive to Leishmania infantum, was referred to the Veterinary Teaching Hospital of the Department of Veterinary Medicine, University of Perugia, Italy for examination of a non-weight bearing left hind limb lameness of a duration of at least 3 months. During this period, treatment involved systemic anti-inflammatory medications and intra-articular corticosteroid administration. On presentation, clinical examination and radiographic findings were suggestive of cranial cruciate ligament deficiency. To support this diagnosis a stifle arthroscopy was performed: it confirmed a partial rupture of cranial cruciate ligament. Samples culture of synovial fluid and membrane was routinely collected as well, and revealed Candida guilliermondii joint infection. Treatment for the C. guilliermondii joint infection involved systemic anti-fungal therapy, joint lavage and intra-articular administration of antifungal drugs. Lameness improved markedly during this treatment, but lameness did not resolve completely, probably due to cranial cruciate ligament deficiency. Tibial tuberosity advancement (TTA) was chosen in order to treat stifle instability and was performed 4 weeks following cessation of treatment of the C. guilliermondii joint infection. Six month after TTA the dog showed a completely recovery with no lameness. To the authors' knowledge, this is the first case of Candida spp. joint infection reported in dogs. The cause of the progression of the joint C. guilliermondii infection remains unclear but it may be associated with leishmaniasis or intra-articular corticosteroid injections. Treatment with systemic and intra-articular anti-fungal therapies was successful. In the evaluation of hind limb lameness in a chronically

Longitudinal joint specifications and performance.

DOT National Transportation Integrated Search

2012-08-01

Deterioration of longitudinal joints is widely recognized as one of the major factors contributing to failure of asphalt pavements. Finding : ways to improve the durability of longitudinal joints will lead to improved service lives and lower life cyc...

Performance limitations of joint variable-feedback controllers due to manipulator structural flexibility

NASA Technical Reports Server (NTRS)

Cetinkunt, Sabri; Book, Wayne J.

1990-01-01

The performance limitations of manipulators under joint variable-feedback control are studied as a function of the mechanical flexibility inherent in the manipulator structure. A finite-dimensional time-domain dynamic model of a two-link two-joint planar manipulator is used in the study. Emphasis is placed on determining the limitations of control algorithms that use only joint variable-feedback information in calculations of control decisions, since most motion control systems in practice are of this kind. Both fine and gross motion cases are studied. Results for fine motion agree well with previously reported results in the literature and are also helpful in explaining the performance limitations in fast gross motions.

Safe performance of spinal anesthesia in a critical patient with neurofibromatosis, pectus carinatum, and temporomandibular joint dysfunction: A case report.

PubMed

Zencirci, Beyazit

2010-05-03

Neurofibromatosis is a syndrome caused by the abnormal deposition of neural tissues of the nervous system, endocrine system, visceral structures, and skin. On the other hand, pectus carinatum and temporomandibular joint dysfunction are illnesses that adversly affect the respiratory system and cause additional problems in airway management. Fifty-eight-year-old Turkish male patient had neurofibromatosis, pectus carinatum and temporomandibular joint dysfunction. The case was due to be operated on with the diagnosis of incarcerated umbilical hernia. Spinal anesthesia was successfully performed and the duration of the surgery was 1 hour. No postoperative complications were observed and he was discharged from the hospital on the 3rd post-operative day. The anesthetic management of patients with neurofibromatosis requires attention to all possible abnormalities and associated disturbances. Furthermore, the presence of pectus carinatum and temporomandibular joint dysfunction also increase the potential risks. The operation was successfully completed with spinal anesthesia that was carefully applied upon taking the required measures and considering all pathologies that may accompany the case and complications that may occur.

Safe performance of spinal anesthesia in a critical patient with neurofibromatosis, pectus carinatum, and temporomandibular joint dysfunction: A case report

PubMed Central

2010-01-01

Background Neurofibromatosis is a syndrome caused by the abnormal deposition of neural tissues of the nervous system, endocrine system, visceral structures, and skin. On the other hand, pectus carinatum and temporomandibular joint dysfunction are illnesses that adversly affect the respiratory system and cause additional problems in airway management. Case Presentation Fifty-eight-year-old Turkish male patient had neurofibromatosis, pectus carinatum and temporomandibular joint dysfunction. The case was due to be operated on with the diagnosis of incarcerated umbilical hernia. Spinal anesthesia was successfully performed and the duration of the surgery was 1 hour. No postoperative complications were observed and he was discharged from the hospital on the 3rd post-operative day. Conclusion The anesthetic management of patients with neurofibromatosis requires attention to all possible abnormalities and associated disturbances. Furthermore, the presence of pectus carinatum and temporomandibular joint dysfunction also increase the potential risks. The operation was successfully completed with spinal anesthesia that was carefully applied upon taking the required measures and considering all pathologies that may accompany the case and complications that may occur. PMID:20438631

Anaerobic prosthetic joint infection.

PubMed

Shah, Neel B; Tande, Aaron J; Patel, Robin; Berbari, Elie F

2015-12-01

In an effort to improve mobility and alleviate pain from degenerative and connective tissue joint disease, an increasing number of individuals are undergoing prosthetic joint replacement in the United States. Joint replacement is a highly effective intervention, resulting in improved quality of life and increased independence [1]. By 2030, it is predicted that approximately 4 million total hip and knee arthroplasties will be performed yearly in the United States [2]. One of the major complications associated with this procedure is prosthetic joint infection (PJI), occurring at a rate of 1-2% [3-7]. In 2011, the Musculoskeletal Infectious Society created a unifying definition for prosthetic joint infection [8]. The following year, the Infectious Disease Society of America published practice guidelines that focused on the diagnosis and management of PJI. These guidelines focused on the management of commonly encountered organisms associated with PJI, including staphylococci, streptococci and select aerobic Gram-negative bacteria. However, with the exception of Propionibacterium acnes, management of other anaerobic organisms was not addressed in these guidelines [1]. Although making up approximately 3-6% of PJI [9,10], anaerobic microorganisms cause devastating complications, and similar to the more common organisms associated with PJI, these bacteria also result in significant morbidity, poor outcomes and increased health-care costs. Data on diagnosis and management of anaerobic PJI is mostly derived from case reports, along with a few cohort studies [3]. There is a paucity of published data outlining factors associated with risks, diagnosis and management of anaerobic PJI. We therefore reviewed available literature on anaerobic PJI by systematically searching the PubMed database, and collected data from secondary searches to determine information on pathogenesis, demographic data, clinical features, diagnosis and management. We focused our search on five commonly

Haemophilia and joint disease: pathophysiology, evaluation, and management

PubMed Central

Knobe, Karin; Berntorp, Erik

2011-01-01

In patients with haemophilia, regular replacement therapy with clotting factor concentrates (prophylaxis) is effective in preventing recurrent bleeding episodes into joints and muscles. However, despite this success, intra-articular and intramuscular bleeding is still a major clinical manifestation of the disease. Bleeding most commonly occurs in the knees, elbows, and ankles, and is often evident from early childhood. The pathogenesis of haemophilic arthropathy is multifactorial, with changes occurring in the synovium, bone, cartilage, and blood vessels. Recurrent joint bleeding causes synovial proliferation and inflammation (haemophilic synovitis) that contribute to end-stage degeneration (haemophilic arthropathy); with pain and limitation of motion severely affecting patients’ quality of life. If joint bleeding is not treated adequately, it tends to recur, resulting in a vicious cycle that must be broken to prevent the development of chronic synovitis and degenerative arthritis. Effective prevention and management of haemophilic arthropathy includes the use of early, aggressive prophylaxis with factor replacement therapies, as well as elective procedures, including restorative physical therapy, analgesia, aspiration, synovectomy, and orthopaedic surgery. Optimal treatment of patients with haemophilia requires a multidisciplinary team comprising a haematologist, physiotherapist, orthopaedic practitioner, rehabilitation physician, occupational therapist, psychologist, social workers, and nurses. Journal of Comorbidity 2011;1:51–59 PMID:29090136

Rotationplasty with vascular reconstruction for prosthetic knee joint infection.

PubMed

Fujiki, Masahide; Miyamoto, Shimpei; Nakatani, Fumihiko; Kawai, Akira; Sakuraba, Minoru

2015-01-01

Rotationplasty is used most often as a function-preserving salvage procedure after resection of sarcomas of the lower extremity; however, it is also used after infection of prosthetic knee joints. Conventional vascular management during rotationplasty is to preserve and coil major vessels, but recently, transection and reanastomosis of the major vessels has been widely performed. However, there has been little discussion regarding the optimal vascular management of rotationplasty after infection of prosthetic knee joints because rotationplasty is rarely performed for this indication. We reviewed four patients who had undergone resection of osteosarcomas of the femur, placement of a prosthetic knee joint, and rotationplasty with vascular reconstruction from 2010 to 2013. The mean interval between prosthetic joint replacement and rotationplasty was 10.4 years and the mean interval between the diagnosis of prosthesis infection and rotationplasty was 7.9 years. Rotationplasty was successful in all patients; however, in one patient, arterial thrombosis developed and necessitated urgent surgical removal and arterial reconstruction. All patients were able to walk independently with a prosthetic limb after rehabilitation. Although there is no consensus regarding the most appropriate method of vascular management during rotationplasty for revision of infected prosthetic joints, vascular transection and reanastomosis is a useful option.

Research on Joint Sealant Materials to Improve Installation and Performance : Final Report

DOT National Transportation Integrated Search

2017-12-01

The objectives of this project were to 1) identify failure modes and their mechanisms in joint seals in Texas, and to 2) identify what needs to be done to minimize the failures and improve joint seal performance. To achieve these objectives efficient...

Structural Performance of Inconel 625 Superalloy Brazed Joints

NASA Astrophysics Data System (ADS)

Chen, Jianqiang; Demers, Vincent; Cadotte, Eve-Line; Turner, Daniel; Bocher, Philippe

2017-02-01

The purpose of this work was to investigate tensile and fatigue behaviors of Inconel 625 superalloy brazed joints after transient liquid-phase bonding process. Brazing was performed in a vacuum furnace using a nickel-based filler metal in a form of paste to join wrought Inconel 625 plates. Mechanical tests were carried out on single-lap joints under various lap distance-to-thickness ratios. The fatigue crack initiation and crack growth modes were examined via metallographic analysis, and the effect of local stress on fatigue life was assessed by finite element simulations. The fatigue results show that fatigue strength and endurance limit increase with overlap distance, leading to a relatively large scatter of results. Fatigue cracks nucleated in the high-stressed region of the weld fillets from brittle eutectic phases or from internal brazing cavities. The present work proposes to rationalize the results by using the local stress at the brazing fillet. When using this local stress, all fatigue-obtained results find themselves on a single S- N curve, providing a design curve for any joint configuration in fatigue solicitation.

Comparison of structural performance of one- and two-bay rotary joints for truss applications

NASA Technical Reports Server (NTRS)

Vail, J. Douglas; Lake, Mark S.

1991-01-01

The structural performance of one- and two-bay large-diameter discrete-bearing rotary joints was addressed for application to truss-beam structures such as the Space Station Freedom. Finite element analyses are performed to determine values for rotary joint parameters that give the same bending vibration frequency as the parent truss beam. The structural masses and maximum internal loads of these joints are compared to determine their relative structural efficiency. Results indicate that no significant difference exists in the masse of one- and two-bay rotary joints. This conclusion is reinforced with closed-form calculations of rotary joint structural efficiency in extension. Also, transition truss-member loads are higher in the one-bay rotary joint. However, because of the increased buckling strength of these members, the external load-carrying capability of the one-bay concept is higher than that of the two-bay concept.

Autonomy and control in dyads: effects on interaction quality and joint creative performance.

PubMed

Weinstein, Netta; Hodgins, Holley S; Ryan, Richard M

2010-12-01

Two studies examined interaction quality and joint performance on two creative tasks in unacquainted dyads primed for autonomy or control orientations. It was hypothesized that autonomy-primed dyads would interact more constructively, experience more positive mood, and engage the task more readily, and as a result these dyads would perform better. To test this, Study 1 primed orientation and explored verbal creative performance on the Remote Associates Task (RAT). In Study 2, dyads were primed with autonomy and control orientation and videotaped during two joint creative tasks, one verbal (RAT) and one nonverbal (charades). Videotapes were coded for behavioral indicators of closeness and task engagement. Results showed that autonomy-primed dyads felt closer, were more emotionally and cognitively attuned, provided empathy and encouragement to partners, and performed more effectively. The effects of primed autonomy on creative performance were mediated by interpersonal quality, mood, and joint engagement.

Hospital Performance Trends on National Quality Measures and the Association With Joint Commission Accreditation

PubMed Central

Schmaltz, Stephen P; Williams, Scott C; Chassin, Mark R; Loeb, Jerod M; Wachter, Robert M

2011-01-01

BACKGROUND Evaluations of the impact of hospital accreditation have been previously hampered by the lack of nationally standardized data. One way to assess this impact is to compare accreditation status with other evidence-based measures of quality, such as the process measures now publicly reported by The Joint Commission and the Centers for Medicare and Medicaid Services (CMS). OBJECTIVES To examine the association between Joint Commission accreditation status and both absolute measures of, and trends in, hospital performance on publicly reported quality measures for common diseases. DESIGN, SETTING, AND PATIENTS Performance data for 2004 and 2008 from U.S. acute care and critical access hospitals were obtained using publicly available CMS Hospital Compare data augmented with Joint Commission performance data. MEASUREMENTS Changes in hospital performance between 2004 and 2008, and percent of hospitals with 2008 performance exceeding 90% for 16 measures of quality-of-care and 4 summary scores. RESULTS Hospitals accredited by The Joint Commission tended to have better baseline performance in 2004 than non-accredited hospitals. Accredited hospitals had larger gains over time, and were significantly more likely to have high performance in 2008 on 13 out of 16 standardized clinical performance measures and all summary scores. CONCLUSIONS While Joint Commission-accredited hospitals already outperformed non-accredited hospitals on publicly reported quality measures in the early days of public reporting, these differences became significantly more pronounced over 5 years of observation. Future research should examine whether accreditation actually promotes improved performance or is a marker for other hospital characteristics associated with such performance. Journal of Hospital Medicine 2011;6:458–465. © 2011 Society of Hospital Medicine PMID:21990175

The Role of Transcutaneous Electrical Nerve Stimulation in the Management of Temporomandibular Joint Disorder.

PubMed

Awan, Kamran Habib; Patil, Shankargouda

2015-12-01

Temporomandibular joint disorders (TMD) constitutes of a group of diseases that functionally affect the masticatory system, including the muscles of mastication and temporomandibular joint (TMJ). A number of etiologies with specific treatment have been identified, including the transcutaneous electrical nerve stimulation (TENS). The current paper presents a literature review on the use of TENS in the management of TMD patients. Temporomandibular joint disorder is very common disorder with approximately 75% of people showing some signs, while more than quarter (33%) having at least one symptom. An attempt to treat the pain should be made whenever possible. However, in cases with no defined etiology, starting with less intrusive and reversible techniques is prescribed. Transcutaneous electrical nerve stimulation is one such treatment modality, i.e. useful in the management of TMD. It comprises of controlled exposure of electrical current to the surface of skin, causing hyperactive muscles relaxation and decrease pain. Although the value of TENS to manage chronic pain in TMD patients is still controversial, its role in utilization for masticatory muscle pain is significant. However, an accurate diagnosis is essential to minimize its insufficient use. Well-controlled randomized trials are needed to determine the utilization of TENS in the management of TMD patients.

Astym® Therapy for the Management of Recalcitrant Knee Joint Stiffness after Total Knee Arthroplasty.

PubMed

Bhave, Anil; Corcoran, James; Cherian, Jeffery J; Mont, Michael A

2016-01-01

Knee stiffness is a common complication after total knee arthroplasty (TKA). Despite studies published on the surgical management of reduced range of motion (ROM) after TKA, there is limited evidence on the nonoperative management of joint and soft tissue imbalances possibly contributing to reduced knee ROM. This report assesses changes in ROM, pain, function, and patellar tendon length after Astym® joint mobilization use. A 38-year-old male professional skier had a right TKA 3 months before presentation with 2 subsequent manipulations under anesthesia secondary to persistent knee stiffness. He had patellar baja on radiograph, a reduced arc of ROM, reduced patellar mobility and muscular extensibility, and pain to palpation along the patellar tendon. He had 12 visits of physical therapy with the use of Astym®, patellar mobilization, and tibio-femoral mobilizations with movement. The patient also used a customized knee device at home for prolonged knee extension stretching. The patient was treated for 12 visits, along with home use of customized bracing for knee extension. Significant improvements were seen in pain, function, and ROM. He returned to work full-time, ambulated prolonged distances, and negotiated stairs pain-free. He also demonstrated resolution of patellar baja radiographically. Conservative management of recalcitrant knee joint stiffness after primary TKA can be effective in restoring knee mobility and reducing pain and activity limitation. A multimodal approach using Astym® treatment, customized knee bracing, and targeted joint mobilization can be effective in resolving knee joint stiffness.

Tribological performance of the biological components of synovial fluid in artificial joint implants

NASA Astrophysics Data System (ADS)

Ghosh, Subir; Choudhury, Dipankar; Roy, Taposh; Moradi, Ali; Masjuki, H. H.; Pingguan-Murphy, Belinda

2015-08-01

The concentration of biological components of synovial fluid (such as albumin, globulin, hyaluronic acid, and lubricin) varies between healthy persons and osteoarthritis (OA) patients. The aim of the present study is to compare the effects of such variation on tribological performance in a simulated hip joint model. The study was carried out experimentally by utilizing a pin-on-disk simulator on ceramic-on-ceramic (CoC) and ceramic-on-polyethylene (CoP) hip joint implants. The experimental results show that both friction and wear of artificial joints fluctuate with the concentration level of biological components. Moreover, the performance also varies between material combinations. Wear debris sizes and shapes produced by ceramic and polyethylene were diverse. We conclude that the biological components of synovial fluid and their concentrations should be considered in order to select an artificial hip joint to best suit that patient.

Body sway reflects leadership in joint music performance

PubMed Central

Livingstone, Steven R.; Bosnyak, Dan J.; Trainor, Laurel J.

2017-01-01

The cultural and technological achievements of the human species depend on complex social interactions. Nonverbal interpersonal coordination, or joint action, is a crucial element of social interaction, but the dynamics of nonverbal information flow among people are not well understood. We used joint music making in string quartets, a complex, naturalistic nonverbal behavior, as a model system. Using motion capture, we recorded body sway simultaneously in four musicians, which reflected real-time interpersonal information sharing. We used Granger causality to analyze predictive relationships among the motion time series of the players to determine the magnitude and direction of information flow among the players. We experimentally manipulated which musician was the leader (followers were not informed who was leading) and whether they could see each other, to investigate how these variables affect information flow. We found that assigned leaders exerted significantly greater influence on others and were less influenced by others compared with followers. This effect was present, whether or not they could see each other, but was enhanced with visual information, indicating that visual as well as auditory information is used in musical coordination. Importantly, performers’ ratings of the “goodness” of their performances were positively correlated with the overall degree of body sway coupling, indicating that communication through body sway reflects perceived performance success. These results confirm that information sharing in a nonverbal joint action task occurs through both auditory and visual cues and that the dynamics of information flow are affected by changing group relationships. PMID:28484007

[Perioperative management in outpatient arthroscopy of the knee joint].

PubMed

Müller-Rath, R; Ingenhoven, E; Mumme, T; Schumacher, M; Miltner, O

2010-05-01

Nowadays, complex arthroscopic procedures of the knee joint, such as ACL reconstruction, are routinely carried out on an outpatient basis. The reduced time spent with the patient places high demands on the surgeon with regard to the management of such cases. The aim of this study was to evaluate the current standards of perioperative management following outpatient arthroscopic surgery of the knee in Germany. A questionnaire consisting of 18 questions was sent to 215 members of the German Association of Outpatient Arthroscopy (BVASK e. V.), dealing with the following topics: antibiotic prophylaxis, DVT prophylaxis, use of a tourniquet and suction drain, physical therapy, physiotherapy, analgesia, anaesthesia and emergency management. More than 51% of the forms were returned and considered suitable for statistical analysis. A total of 62% of the surgeons reported the use of an antibiotic prophylaxis (i. v. single shot) in every arthroscopic case, while 19% administer antibiotics only occasionally, especially in ACL reconstruction. Postoperative antibiotic treatment was reserved for special situations, such as prior joint infection. Prophylaxis of DVT by means of low molecular weight heparin was carried out in 96% of the cases. 51% prescribed anticoagulant agents for 1 week, 39% for the duration of reduced weight bearing. Half of the surgeons used a tourniquet cuff, 22% exsanguinate the limb prior to cuff inflation. A suction drainage was applied by 36% of the surgeons regularly and by 45% occasionally. The drain is left for one day by 79% of the surgeons, while 11% reported a shortened use of only several hours. With regard to analgesia, 66% of all surgeons apply some kind of local anaesthetic into the knee joint post surgery. Systemic preoperative analgesics or anti-inflammatory agents are given regularly in 56 % of the cases. A total of 92% of the procedures are carried out under general anaesthesia. In 36% of the cases, some kind of additional regional peripheral

Nonsurgical Management of Pediatric Temporomandibular Joint Dysfunction.

PubMed

Scrivani, Steven John; Khawaja, Shehryar Nasir; Bavia, Paula Furlan

2018-02-01

Temporomandibular disorders (TMD) are a subgroup of craniofacial pain problems involving the temporomandibular joint (TMJ), masticatory muscles, and associated head and neck musculoskeletal structures. These disorders are subclassified into TMJ articular disorders and masticatory muscle disorders. Patients with TMD most commonly present with pain, restricted or asymmetric mandibular motion, and TMJ sounds during mandibular movements. The prevalence tends to increase with age. Management of TMJ articular disorders consists of a combination of patient education, home-care plan, biobehavioral therapy, physical therapy, orthotic jaw appliance therapy, pharmacotherapy, and/or surgery. The goal is to increase function, reduce pain, and improve quality of life. Copyright © 2017 Elsevier Inc. All rights reserved.

AN/VRC 118 Mid-Tier Networking Vehicular Radio (MNVR) and Joint Enterprise Network Manager (JENM) Early Fielding Report

DTIC Science & Technology

2017-01-18

1 AN/VRC 118 Mid-Tier Networking Vehicular Radio and Joint Enterprise Network Manager Early Fielding Report This report provides my assessment of...the AN/VRC-118 Mid-Tier Networking Vehicular Radio (MNVR) and the Joint Enterprise Network Manager (JENM) in support of the Army’s fielding of low...September 2016 ADM does not address the JENM, which must be fielded with MNVR to allow soldiers to configure and manage the software- defined radio

Management of chronic ankle pain using joint mobilization and ASTYM® treatment: a case report.

PubMed

Slaven, Emily J; Mathers, Jessie

2011-05-01

Treatment of ankle sprains predominately focuses on the acute management of this condition; less emphasis is placed on the treatment of ankle sprains in the chronic phase of recovery. Manual therapy, in the form of joint mobilization and manipulation, has been shown to be effective in the management of this condition, but the combination of joint mobilization and manipulation in tandem with ASTYM® treatment has not been explored. The purpose of this case report is to chronicle the management of a patient with chronic ankle pain who was treated with manual therapy including manipulation and ASTYM treatment. As a result of a fall down stairs 6 months previously, the patient sustained a severe ankle sprain. The soft tissue damage was accompanied by bony disruptions which warranted the patient spending 3 weeks in a walking boot. At the initial evaluation, the patient reported difficulty with descending stairs reciprocally and not being able to run more than 4 minutes on the treadmill before the pain escalated to the level that she had to stop running. After five sessions of therapy consisting of joint mobilization, manipulation and ASTYM, the patient was able to descend stairs and run 40 minutes without pain.

Self management, joint protection and exercises in hand osteoarthritis: a randomised controlled trial with cost effectiveness analyses

PubMed Central

2011-01-01

Background There is limited evidence for the clinical and cost effectiveness of occupational therapy (OT) approaches in the management of hand osteoarthritis (OA). Joint protection and hand exercises have been proposed by European guidelines, however the clinical and cost effectiveness of each intervention is unknown. This multicentre two-by-two factorial randomised controlled trial aims to address the following questions: • Is joint protection delivered by an OT more effective in reducing hand pain and disability than no joint protection in people with hand OA in primary care? • Are hand exercises delivered by an OT more effective in reducing hand pain and disability than no hand exercises in people with hand OA in primary care? • Which of the four management approaches explored within the study (leaflet and advice, joint protection, hand exercise, or joint protection and hand exercise combined) provides the most cost-effective use of health care resources Methods/Design Participants aged 50 years and over registered at three general practices in North Staffordshire and Cheshire will be mailed a health survey questionnaire (estimated mailing sample n = 9,500). Those fulfilling the eligibility criteria on the health survey questionnaire will be invited to attend a clinical assessment to assess for the presence of hand or thumb base OA using the ACR criteria. Eligible participants will be randomised to one of four groups: leaflet and advice; joint protection (looking after your joints); hand exercises; or joint protection and hand exercises combined (estimated n = 252). The primary outcome measure will be the OARSI/OMERACT responder criteria combining hand pain and disability (measured using the AUSCAN) and global improvement, 6 months post-randomisation. Secondary outcomes will also be collected for example pain, functional limitation and quality of life. Outcomes will be collected at baseline and 3, 6 and 12 months post-randomisation. The main analysis will

Study on Fatigue Performance of Composite Bolted Joints with Bolt-Hole Delamination

NASA Astrophysics Data System (ADS)

Liu, M. J.; Yu, S.; Zhao, Q. Y.

2018-03-01

Fatigue performance of composite structure with imperfections is a challenging subject at present. Based on cohesive zone method and multi-continuum theory, delamination evolution response and fatigue life prediction of a 3D composite single-lap joint with a bolt-hole have been investigated through computer codes Abaqus and Fe-safe. Results from the comparison of a perfect composite bolted joint with another defect one indicates that a relatively small delamination damage around the bolt hole brings about significant degradation of local material performance. More notably, fatigue life of stress concentration region of composite bolted joints is highly sensitive to external loads, as an increase of 67% cyclic load amplitude leads to an decrease of 99.5% local fatigue life in this study. However, the numerical strategy for solving composite fatigue problems is meaningful to engineering works.

Help Desk Answers: Surgery vs conservative management for AC joint repair: How do the 2 compare?

PubMed

Matchin, Bruce; Yee, Bruce; Mott, Timothy

2016-04-01

When not considering the grade of acromioclavicular (AC) joint dislocation, both conservative and surgical management lead to positive outcomes, although surgically managed patients require more time out of work.

Slovenian Experience with the Joint Convention on the Safety of Spent Fuel Management and on the Safety of Radioactive Waste Management

DOE Office of Scientific and Technical Information (OSTI.GOV)

Stritar, A.

Slovenia is a relatively small European country with only one operating nuclear power plant, one operating research reactor and one Central Interim Storage for Radioactive Waste from small producers. There are also a uranium mine and mill at Zirovski vrh, both in the decommissioning stage. The Slovenian Government, its public and neighboring countries are most interested in the managing of radioactive waste in the safest possible way by carefully utilizing best practices and existing human and financial resources. In order to achieve this goal the tight connection with the international community in the area of radioactive waste management is essential.more » Slovenia was among those countries involved in the process of preparation of the Joint Convention on the Safety of Spent Fuel Management and on the Safety of Radioactive Waste Management (Joint Convention) from the very beginning and was also among first ratifiers. Slovenia had prepared the first report under the Convention and took part in the first Review Meeting in November 2003. The preparation of this report was not regarded only as a fulfillment of obligation toward Joint Convention, but was considered primarily as a kind of self appraisal of the national radioactive management program. Therefore the preparation of the report primarily contributed to the improvements in the field of radioactive waste management and consequently enhanced the safety of our public. For the preparation of the second report for the review meeting in 2006 it was decided to follow the structure of the first report. Only updates were introduced and eventual changes in the area of radioactive waste management were reflected. (authors)« less

Management of temporo-mandibular joint ankylosis in growing children.

PubMed

Shashikiran, N D; Reddy, S V V; Patil, R; Yavagal, C

2005-03-01

Although temporo-mandibular joint (TMJ) ankylosis is one of the most common pathologies afflicting the facial skeleton, it is also the most overlooked and under-managed problem in children. The TMJ forms the very cornerstone of cranio-facial integrity and hence its ankylosis in growing children adversely affects the growth and development of the jaws and occlusion. Impairment of speech, difficulty in mastication, poor oral hygiene, rampant caries and acute compromise of the airway pose a severe psychologic burden on the tender minds of children. The aim of this article is to present an overview of efficient management strategies, based on a case report, so as to increase its awareness among all dental surgeons involved in the treatment of children.

Audit of conservative management of chronic low back pain in a secondary care setting--part I: facet joint and sacroiliac joint interventions.

PubMed

Chakraverty, Robin; Dias, Richard

2004-12-01

The work of a chronic back pain service in secondary care in the West Midlands is reported. The service offers acupuncture, spinal injection procedures, osteopathy and a range of other interventions for patients whose back pain has not responded to conservative management. This section of the report focuses on injection procedures for lumbar facet joint and sacroiliac joint pain, which have been shown to be the cause of chronic low back pain in 16-40% and 13-19% of patients respectively. Diagnosis relies on the use of intra-articular or sensory nerve block injections with local anaesthetic. Possible treatments following diagnosis include intra-articular corticosteroid, radiofrequency denervation (for facet joint pain) or ligament prolotherapy injections (for sacroiliac joint pain). The results of several hospital audits are reported. At six month follow up, 50% of 38 patients undergoing radiofrequency denervation following diagnostic blocks for facet joint pain had improved by more than 50%, compared to 29% of 34 patients treated with intra-articular corticosteroid injection. Sixty three per cent of 19 patients undergoing prolotherapy following diagnostic block injection for sacroiliac joint pain had improved at six months, compared to 33% of 33 who had intra-articular corticosteroid. Both radiofrequency denervation and sacroiliac prolotherapy showed good long-term outcomes at one year.

Managing employee performance.

PubMed

McConnell, Charles R

2004-01-01

Performance management consists of significantly more than periodic evaluation of performance. It is the art and science of dealing with employees in a manner intended to positively influence their thinking and behavior to achieve a desired level of performance. It is essential for the manager to always model positive behavior concerning performance; what one does or says as a manager always has an influence on others. The kinds of employee behavior most likely encountered relative to performance management efforts stem from resistance to change and lack of complete understanding of what is expected. Employee participation must be elicited whenever possible for performance improvement; as far as the inner working details of a specific job are concerned, there is no one who knows the job better than the person who does it everyday. For each task to be done, an employee needs to know what output is expected, how this output will be measured, and what standards are applied in assessing the output. Managing employee performance requires ongoing contact with each employee, regular feedback, and whatever coaching, counseling, and training are necessary to bring an employee back on track when a problem appears. Sustaining efficient and effective employee performance requires the manager's ongoing attention and involvement.

The Joint Convention on the Safety of Spent Fuel Management and on the Safety of Radioactive Waste Management

DOE Office of Scientific and Technical Information (OSTI.GOV)

Risoluti, P.

The Joint Convention on the Safety of Spent Fuel Management and the Safety of Radioactive Waste Management (the Joint Convention) is the only legally binding international treaty in the area of radioactive waste management. It was adopted by a Diplomatic Conference in September 1997 and opened for signature on 29 September 1997. The Convention entered into force on 18 June 1998, and to date (September 04) has been signed by 42 States, of which 34 have formally ratified, thus becoming Contracting Parties. The Joint Convention applies to spent fuel and radioactive waste resulting from civilian application. Its principal aim ismore » to achieve and maintain a high degree of safety in their management worldwide. The Convention is an incentive instrument, not designed to ensure fulfillment of obligations through control and sanction, but by a peer pressure. The obligations of the Contracting Parties are mainly based on the international safety standards developed by the IAEA in past decades. The Convention is intended for all countries generating radioactive waste. Therefore it is relevant not only for those using nuclear power, but for any country where application of nuclear energy in medicine, conventional industry and research is currently used. Obligations of Contracting Parties include attending periodic Review Meetings and prepare National Reports for review by the other Contracting Parties. The National Reports should describe how the country is complying with the requirements of the Articles of the Convention. The first such meeting was held at the IAEA headquarters in November 2003. This paper will describe the origin of the Convention, present its content, the expected outcome for the worldwide safety, and the benefits for a country to be part of it.« less

Double needle technique: an alternative method for performing difficult sacroiliac joint injections.

PubMed

Gupta, Sanjeeva

2011-01-01

The sacroiliac joint (SIJ) is a common source of low back pain. The most appropriate method of confirming SIJ pain is to inject local anesthesia into the joint to find out if the pain decreases. Unfortunately, although the SIJ is a large joint, it can be difficult to enter due to the complex nature of the joint and variations in anatomy. In my experience a double needle technique for sacroiliac joint injection can increase the chances of accurate injection into the SIJ in difficult cases. After obtaining appropriate fluoroscopic images, the tip of the needle is advanced into the SIJ. Once the tip of the needle is correctly placed, its position is checked under continuous fluoroscopy while moving the C-arm in the right and left oblique directions (dynamic fluoroscopy). On dynamic fluoroscopy the tip of the needle should remain within the joint line and not appear to be on the bone. If the tip of the needle appears to be on the bone a new joint line will need to be identified (the most translucent area through the joint) by dynamic fluoroscopy and another needle advanced into the newly identified joint line. Dynamic fluoroscopy is repeated again to confirm that the tip of the second needle remains within the joint line. Once both needles are in place contrast dye is injected through the needle that is most likely to be in the SIJ. If the contrast dye spread is not satisfactory then it is injected through the other needle. I have used this technique in 10 patients and found it very helpful in accurately performing SIJ injection which can at times be challenging.

Effect of Board Thickness on Sn-Ag-Cu Joint Interconnect Mechanical Shock Performance

NASA Astrophysics Data System (ADS)

Lee, Tae-Kyu; Xie, Weidong

2014-12-01

The mechanical stability of solder joints with Sn-Ag-Cu alloy joints on various board thicknesses was investigated with a high G level shock environment. A test vehicle with three different board thicknesses was used for board drop shock performance tests. These vehicles have three different strain and shock level condition couples per board, and are used to identify the joint stability and failure modes based on the board responses. The results revealed that joint stability is sensitive to board thickness. The board drop shock test showed that the first failure location shifts from the corner location near the standoff to the center with increased board thickness due to the shock wave response. From analysis of the thickness variation and failure cycle number, the strain rate during the pulse strain cycle is the dominant factor, which defines the life cycle number per board thickness, and not the maximum strain value. The failure location shift and the shock performance differentiation are discussed from the perspective of maximum principal strain, cycle frequency and strain rate per cycle.

The impact of joint ventures on U.S. hospitals.

PubMed

Harrison, Jeffrey P

2006-01-01

This quantitative research study assesses the organizational characteristics, market factors, and profitability of US hospitals that operate joint ventures with other health care organizations. Data was obtained from the 2001 American Hospital Association annual survey, the Area Resource File, and the Center for Medicare and Medicaid Services Minimum Data Set. These data files provide essential information on individual acute care hospitals, the communities they serve, and the level of financial performance. Descriptive statistics were evaluated and a logistic regression model was utilized to examine hospitals operating joint ventures. The study found hospitals that operate joint ventures are located in communities with more elderly patients, lower unemployment, and lower HMO penetration. From an operating performance perspective, hospitals that operate joint ventures have a higher occupancy rate, a higher average length of stay, more clinical services, lower long-term debt, and a greater number of managed care contracts. The results also appear to indicate that joint ventures have a positive financial impact on US hospitals. The study has managerial implications supporting the use of joint ventures to improve hospital performance and policy implications on resource allocation.

Spine epidural and sacroiliac joints injections--when and how to perform.

PubMed

D'Orazio, Federico; Gregori, Lorenzo Maria; Gallucci, Massimo

2015-05-01

To review the state-of-the-art of image-guided techniques used to treat painful syndromes of the lower back, their indications, how they should be performed, their related risks and the expected results. We describe the actual standards about image-guided infiltrative therapies both on spine and on sacroiliac joints. Both spinal epidural and sacroiliac injections appear useful in a large percentage of treated patients to get control of the perceived pain. Performing these therapies under CT or fluoroscopic guidance is the best and safest way to obtain satisfactory results because it is possible to target the use of drugs directly to the involved painful structures. Image-guided injections of the epidural space and of the sacroiliac joints are effective techniques for the treatment of pain; their effectiveness is sometimes not lasting for long periods of time but considering the low associated risk when performed by trained personnel, they can be easily repeated. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Joint Polar Satellite System (JPSS) Common Ground System (CGS) Current Technical Performance Measures

NASA Astrophysics Data System (ADS)

Cochran, S.; Panas, M.; Jamilkowski, M. L.; Miller, S. W.

2015-12-01

ABSTRACT The National Oceanic and Atmospheric Administration (NOAA) and National Aeronautics and Space Administration (NASA) are jointly acquiring the next-generation civilian weather and environmental satellite system: the Joint Polar Satellite System (JPSS). The Joint Polar Satellite System will replace the afternoon orbit component and ground processing system of the current Polar-orbiting Operational Environmental Satellites (POES) managed by NOAA. The JPSS satellites will carry a suite of sensors designed to collect meteorological, oceanographic, climatological and geophysical observations of the Earth. The ground processing system for JPSS is known as the JPSS Common Ground System (JPSS CGS). Developed and maintained by Raytheon Intelligence, Information and Services (IIS), the CGS is a multi-mission enterprise system serving NOAA, NASA and their national and international partners. The CGS has demonstrated its scalability and flexibility to incorporate multiple missions efficiently and with minimal cost, schedule and risk, while strengthening global partnerships in weather and environmental monitoring. The CGS architecture is being upgraded to Block 2.0 in 2015 to "operationalize" S-NPP, leverage lessons learned to date in multi-mission support, take advantage of more reliable and efficient technologies, and satisfy new requirements and constraints in the continually evolving budgetary environment. To ensure the CGS meets these needs, we have developed 49 Technical Performance Measures (TPMs) across 10 categories, such as data latency, operational availability and scalability. This paper will provide an overview of the CGS Block 2.0 architecture, with particular focus on the 10 TPM categories listed above. We will provide updates on how we ensure the deployed architecture meets these TPMs to satisfy our multi-mission objectives with the deployment of Block 2.0.

Managing the star performer.

PubMed

Hills, Laura

2013-01-01

Our culture seems to be endlessly fascinated with its stars in entertainment, athletics, politics, and business, and holds fast to the idea that extraordinary talent accounts for an individual's extraordinary performance. At first glance, managing a star performer in your medical practice may seem like it would be an easy task. However, there's much more to managing a star performer than many practice managers realize. The concern is how to keep the star performer happy and functioning at a high level without detriment to the rest of the medical practice team. This article offers tips for practice managers who manage star performers. It explores ways to keep the star performer motivated, while at the same time helping the star performer to meld into the existing medical practice team. This article suggests strategies for redefining the star performer's role, for holding the star performer accountable for his or her behavior, and for coaching the star performer. Finally, this article offers practical tips for keeping the star performer during trying times, for identifying and cultivating new star performers, and for managing medical practice prima donnas.

[Arthroscopy-guided fracture management. Ankle joint and calcaneus].

PubMed

Schoepp, C; Rixen, D

2013-04-01

Arthroscopic fracture management of the ankle and calcaneus requires a differentiated approach. The aim is to minimize surgical soft tissue damage and to visualize anatomical fracture reduction arthroscopically. Moreover, additional cartilage damage can be detected and treated. The arthroscopic approach is limited by deep impressions of the joint surface needing cancellous bone grafting, by multiple fracture lines on the articular side and by high-grade soft tissue damage. An alternative to the minimally invasive arthroscopic approach is open arthroscopic reduction in conventional osteosynthesis. This facilitates correct assessment of surgical reduction of complex calcaneal fractures, otherwise remaining non-anatomical reduction might not be fluoroscopically detected during surgery.

Improving stability and curving passing performance for railway vehicles with a variable stiffness MRF rubber joint

NASA Astrophysics Data System (ADS)

Harris, B. J.; Sun, S. S.; Li, W. H.

2017-03-01

With the growing need for effective intercity transport, the need for more advanced rail vehicle technology has never been greater. The conflicting primary longitudinal suspension requirements of high speed stability and curving performance limit the development of rail vehicle technology. This paper presents a novel magnetorheological fluid based joint with variable stiffness characteristics for the purpose of overcoming this parameter conflict. Firstly, the joint design and working principle is developed. Following this, a prototype is tested by MTS to characterize its variable stiffness properties under a range of conditions. Lastly, the performance of the proposed MRF rubber joint with regard to improving train stability and curving performance is numerically evaluated.

Functional added value of microprocessor-controlled knee joints in daily life performance of Medicare Functional Classification Level-2 amputees.

PubMed

Theeven, Patrick; Hemmen, Bea; Rings, Frans; Meys, Guido; Brink, Peter; Smeets, Rob; Seelen, Henk

2011-10-01

To assess the effects of using a microprocessor-controlled prosthetic knee joint on the functional performance of activities of daily living in persons with an above-knee leg amputation. To assess the effects of using a microprocessor-controlled prosthetic knee joint on the functional performance of activities of daily living in persons with an above-knee leg amputation. Randomised cross-over trial. Forty-one persons with unilateral above-knee or knee disarticulation limb loss, classified as Medicare Functional Classification Level-2 (MFCL-2). Participants were measured in 3 conditions, i.e. using a mechanically controlled knee joint and two types of microprocessor-controlled prosthetic knee joints. Functional performance level was assessed using a test in which participants performed 17 simulated activities of daily living (Assessment of Daily Activity Performance in Transfemoral amputees test). Performance time was measured and self-perceived level of difficulty was scored on a visual analogue scale for each activity. High levels of within-group variability in functional performance obscured detection of any effects of using a microprocessor-controlled prosthetic knee joint. Data analysis after stratification of the participants into 3 subgroups, i.e. participants with a "low", "intermediate" and "high" functional mobility level, showed that the two higher functional subgroups performed significantly faster using microprocessor-controlled prosthetic knee joints. MFCL-2 amputees constitute a heterogeneous patient group with large variation in functional performance levels. A substantial part of this group seems to benefit from using a microprocessor-controlled prosthetic knee joint when performing activities of daily living.

Recent advances and future directions in the management of knee osteoarthritis: Can biological joint reconstruction replace joint arthroplasty and when?

PubMed Central

Paschos, Nikolaos K

2015-01-01

In this article, a concise description of the recent advances in the field of osteoarthritis management is presented. The main focus is to highlight the most promising techniques that emerge in both biological joint replacement and artificial joint arthroplasty. A critical view of high quality evidence regarding outcome and safety profile of these techniques is presented. The potential role of kinematically aligned total knee replacement, navigation, and robotic-assisted surgery is outlined. A critical description of both primary and stem cell-based therapies, the cell homing theory, the use of biologic factors and recent advancements in tissue engineering and regenerative medicine is provided. Based on the current evidence, some thoughts on a realistic approach towards answering these questions are attempted. PMID:26495242

75 FR 17417 - Joint Meeting of the Arthritis Advisory Committee and the Drug Safety and Risk Management...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-06

...] Joint Meeting of the Arthritis Advisory Committee and the Drug Safety and Risk Management Advisory... Arthritis Advisory Committee and the Drug Safety and Risk Management Advisory Committee. This meeting was... Drug Safety and Risk Management Advisory Committee would be held on May 12, 2010. On page 10490, in the...

Results of the implementation of a pilot model for the bidirectional screening and joint management of patients with pulmonary tuberculosis and diabetes mellitus in Mexico.

PubMed

Castellanos-Joya, Martín; Delgado-Sánchez, Guadalupe; Ferreyra-Reyes, Leticia; Cruz-Hervert, Pablo; Ferreira-Guerrero, Elizabeth; Ortiz-Solís, Gabriela; Jiménez, Mirtha Irene; Salazar, Leslie Lorena; Montero-Campos, Rogelio; Mongua-Rodríguez, Norma; Baez-Saldaña, Renata; Bobadilla-del-Valle, Miriam; González-Roldán, Jesús Felipe; Ponce-de-León, Alfredo; Sifuentes-Osornio, José; García-García, Lourdes

2014-01-01

Recently, the World Health Organisation and the International Union Against Tuberculosis and Lung Disease published a Collaborative Framework for the Care and Control of Tuberculosis (TB) and Diabetes (DM) (CFTB/DM) proposing bidirectional screening and joint management. To evaluate the feasibility and effectiveness of the CFTB/DM in Mexico. Prospective observational cohort. 15 primary care units in 5 states in Mexico. Patients aged ≥20 years diagnosed with DM or pulmonary TB who sought care at participating clinics. The WHO/Union CFTB/DM was adapted and implemented according to official Mexican guidelines. We recruited participants from July 2012 to April 2013 and followed up until March 2014. Bidirectional screening was performed. Patients diagnosed with TB and DM were invited to receive TB treatment under joint management. Diagnoses of TB among DM, of DM among TB, and treatment outcomes among patients with DM and TB. Of 783 DM patients, 11 (1.4%) were unaware of their TB. Of 361 TB patients, 16 (4.4%) were unaware of their DM. 95 TB/DM patients accepted to be treated under joint management, of whom 85 (89.5%) successfully completed treatment. Multiple linear regression analysis with change in HbA1c and random capillary glucose as dependent variables revealed significant decrease with time (regression coefficients (β)  = -0.660, (95% confidence interval (CI), -0.96 to -0.35); and β = -1.889 (95% CI, -2.77 to -1.01, respectively)) adjusting by sex, age and having been treated for a previous TB episode. Patients treated under joint management were more likely to experience treatment success than patients treated under routine DM and TB programs as compared to historical (adjusted OR (aOR), 2.8, 95%CI 1.28-6.13) and same period (aOR 2.37, 95% CI 1.13-4.96) comparison groups. Joint management of TB and DM is feasible and appears to improve clinical outcomes.

Results of the Implementation of a Pilot Model for the Bidirectional Screening and Joint Management of Patients with Pulmonary Tuberculosis and Diabetes Mellitus in Mexico

PubMed Central

Castellanos-Joya, Martín; Delgado-Sánchez, Guadalupe; Ferreyra-Reyes, Leticia; Cruz-Hervert, Pablo; Ferreira-Guerrero, Elizabeth; Ortiz-Solís, Gabriela; Jiménez, Mirtha Irene; Salazar, Leslie Lorena; Montero-Campos, Rogelio; Mongua-Rodríguez, Norma; Baez-Saldaña, Renata; Bobadilla-del-Valle, Miriam; González-Roldán, Jesús Felipe; Ponce-de-León, Alfredo; Sifuentes-Osornio, José; García-García, Lourdes

2014-01-01

Background Recently, the World Health Organisation and the International Union Against Tuberculosis and Lung Disease published a Collaborative Framework for the Care and Control of Tuberculosis (TB) and Diabetes (DM) (CFTB/DM) proposing bidirectional screening and joint management. Objective To evaluate the feasibility and effectiveness of the CFTB/DM in Mexico. Design. Prospective observational cohort. Setting. 15 primary care units in 5 states in Mexico. Participants: Patients aged ≥20 years diagnosed with DM or pulmonary TB who sought care at participating clinics. Intervention: The WHO/Union CFTB/DM was adapted and implemented according to official Mexican guidelines. We recruited participants from July 2012 to April 2013 and followed up until March 2014. Bidirectional screening was performed. Patients diagnosed with TB and DM were invited to receive TB treatment under joint management. Main outcome measures. Diagnoses of TB among DM, of DM among TB, and treatment outcomes among patients with DM and TB. Results Of 783 DM patients, 11 (1.4%) were unaware of their TB. Of 361 TB patients, 16 (4.4%) were unaware of their DM. 95 TB/DM patients accepted to be treated under joint management, of whom 85 (89.5%) successfully completed treatment. Multiple linear regression analysis with change in HbA1c and random capillary glucose as dependent variables revealed significant decrease with time (regression coefficients (β)  = −0.660, (95% confidence interval (CI), −0.96 to −0.35); and β = −1.889 (95% CI, −2.77 to −1.01, respectively)) adjusting by sex, age and having been treated for a previous TB episode. Patients treated under joint management were more likely to experience treatment success than patients treated under routine DM and TB programs as compared to historical (adjusted OR (aOR), 2.8, 95%CI 1.28–6.13) and same period (aOR 2.37, 95% CI 1.13–4.96) comparison groups. Conclusions Joint management of TB and DM is feasible and appears to

Biomechanics of an orthosis-managed cranial cruciate ligament-deficient canine stifle joint predicted by use of a computer model.

PubMed

Bertocci, Gina E; Brown, Nathan P; Mich, Patrice M

2017-01-01

OBJECTIVE To evaluate effects of an orthosis on biomechanics of a cranial cruciate ligament (CrCL)-deficient canine stifle joint by use of a 3-D quasistatic rigid-body pelvic limb computer model simulating the stance phase of gait and to investigate influences of orthosis hinge stiffness (durometer). SAMPLE A previously developed computer simulation model for a healthy 33-kg 5-year-old neutered Golden Retriever. PROCEDURES A custom stifle joint orthosis was implemented in the CrCL-deficient pelvic limb computer simulation model. Ligament loads, relative tibial translation, and relative tibial rotation in the orthosis-stabilized stifle joint (baseline scenario; high-durometer hinge]) were determined and compared with values for CrCL-intact and CrCL-deficient stifle joints. Sensitivity analysis was conducted to evaluate the influence of orthosis hinge stiffness on model outcome measures. RESULTS The orthosis decreased loads placed on the caudal cruciate and lateral collateral ligaments and increased load placed on the medial collateral ligament, compared with loads for the CrCL-intact stifle joint. Ligament loads were decreased in the orthosis-managed CrCL-deficient stifle joint, compared with loads for the CrCL-deficient stifle joint. Relative tibial translation and rotation decreased but were not eliminated after orthosis management. Increased orthosis hinge stiffness reduced tibial translation and rotation, whereas decreased hinge stiffness increased internal tibial rotation, compared with values for the baseline scenario. CONCLUSIONS AND CLINICAL RELEVANCE Stifle joint biomechanics were improved following orthosis implementation, compared with biomechanics of the CrCL-deficient stifle joint. Orthosis hinge stiffness influenced stifle joint biomechanics. An orthosis may be a viable option to stabilize a CrCL-deficient canine stifle joint.

Virtual trajectories of single-joint movements performed under two basic strategies.

PubMed

Latash, M L; Gottlieb, G L

1992-01-01

The framework of the equilibrium point hypothesis has been used to analyse motor control processes for single-joint movements. Virtual trajectories and joint stiffness were reconstructed for different movement speeds and distances when subjects were instructed either to move "as fast as possible" or to intentionally vary movement speed. These instructions are assumed to be associated with similar or different rates of change of hypothetical central control variables (corresponding to the speed-sensitive and speed-insensitive strategies). The subjects were trained to perform relatively slow, moderately fast and very fast (nominal movement times 800, 400 and 250 ms) single-joint elbow flexion movements against a constant extending torque bias. They were instructed to reproduce the motor command for a series of movements while ignoring possible changes in the external torque which could slowly and unpredictably increase, decrease, or remain constant. The total muscle torque was calculated as a sum of external and inertial components. Fast movements over different distances were made with the speed-insensitive strategy. They were characterized by an increase in joint stiffness near the midpoint of the movements which was relatively independent of movement amplitude. Their virtual trajectories had a non-monotonic N-shape. All three arms of the N-shape scaled with movement amplitude. Movements over one distance at different speeds were made with a speed-sensitive strategy. They demonstrated different patterns of virtual trajectories and joint stiffness that depended on movement speed. The N-shape became less apparent for moderately fast movements and virtually disappeared for the slow movements. Slow movements showed no visible increase in joint stiffness.(ABSTRACT TRUNCATED AT 250 WORDS)

Sacroiliac Joint Dysfunction in the Athlete: Diagnosis and Management.

PubMed

Peebles, Rebecca; Jonas, Christopher E

Sacroiliac joint (SIJ) dysfunction is a common cause of low back pain in the athlete, especially in sports with repetitive, asymmetric loading. Complex anatomy and broad pain referral pattern make diagnosis difficult. Identifying three or more positive physical examination maneuvers for the SIJ improves examination sensitivity and specificity. Imaging is rarely helpful in establishing the diagnosis but is often used to rule out other pathology. Conservative management with activity modification, medication, physical therapy, manipulation and bracing is first line treatment. After at least 6 weeks of conservative efforts or if pain limits the athlete's tolerance of these measures, diagnostic and therapeutic intra-articular or periarticular injections or nerve blocks can be used. Radiofrequency ablation is recommended as the next approach for treatment. When all other options have been exhausted, surgical management can be considered. For athletes, once the underlying dysfunction is adequately addressed, gradual progression to full participation is encouraged.

Performance Management Practices, Information and Communication Technology (ICT) Adoption and Managed Performance

ERIC Educational Resources Information Center

Kagaari, James R. K.; Munene, John C.; Ntayi, Joseph Mpeera

2010-01-01

Purpose: The purpose of this paper is to demonstrate the need for managers of public universities to pay attention to performance management practices and information communication technology (ICT) adoption in order to achieve successful managed performance. Design/methodology/approach: Using a disproportionate stratified purposive approach, a…

Hemi-wedge osteotomy in the management of large angular deformities around the knee joint.

PubMed

El-Alfy, Barakat Sayed

2016-08-01

Angular deformity around the knee joint is a common orthopedic problem. Many options are available for the management of such problem with varying degrees of success and failure. The aim of the present study was to assess the results of hemi-wedge osteotomy in the management of big angular deformities about the knee joint. Twenty-eight limbs in 21 patients with large angular deformities around the knee joint were treated by the hemi-wedge osteotomy technique. The ages ranged from 12 to 43 years with an average of 19.8 years. The deformity ranged from 20° to 40° with a mean of 30.39° ± 5.99°. The deformities were genu varum in 12 cases and genu valgum in 9 cases. Seven cases had bilateral deformities. Small wedge was removed from the convex side of the bone and put in the gap created in the other side after correction of the deformity. At the final follow-up, the deformity was corrected in all cases except two. Full range of knee movement was regained in all cases. The complications included superficial wound infection in two cases, overcorrection in one case, pain along the lateral aspect of the knee in one case and recurrence of the deformity in one case. No cases were complicated by nerve injury or vascular injury. Hemi-wedge osteotomy is a good method for treatment of deformities around the knee joint. It can correct large angular deformities without major complications.

Efficacy of Temporomandibular Joint Arthrocentesis with Sodium Hyaluronate in the Management of Temporomandibular Joint Disorders: A Prospective Randomized Control Trial.

PubMed

Gorrela, Harsha; Prameela, J; Srinivas, G; Reddy, B Vijay Baskar; Sudhir, Mvs; Arakeri, Gururaj

2017-12-01

This study was designed to investigate the efficacy of the temporomandibular joint arthrocentesis with and without injection of sodium hyaluronate (SH) in the treatment of temporomandibular joint disorders. A total of sixty two TMJs in 34 males and 28 females aged 20-65 years comprised the study material. The patients' complaints were limited mouth opening, TMJ pain, and joint noises during function. Patients were randomly divided into 2 groups in which arthrocentesis plus intra-articular injection of sodium hyaluronate was performed in 1 group and only arthrocentesis was performed in the other group. Both groups contained patients with disc displacement with reduction and without reduction. Clinical evaluation of the patients was done before the procedure, immediately after the procedure, at 1 week and 1, 3 and 6 months postoperatively. Intensity of TMJ pain was assessed using visual analog scales. Maximal mouth opening and lateral jaw movements also were recorded at each follow-up visit. Both techniques increased maximal mouth opening, lateral movements, and function, while reducing TMJ pain and noise. Although patients benefitted from both techniques, arthrocentesis with injection of SH seemed to be superior to arthrocentesis alone.

Knee joint mobilization reduces secondary mechanical hyperalgesia induced by capsaicin injection into the ankle joint.

PubMed

Sluka, K A; Wright, A

2001-01-01

Joint mobilization is a treatment approach commonly used by physical therapists for the management of a variety of painful conditions. However, the clinical effectiveness when compared to placebo and the neurophysiological mechanism of action are not known. The purpose of this study was to establish that application of a manual therapy technique will produce antihyperalgesia in an animal model of joint inflammation and that the antihyperalgesia produced by joint mobilization depends on the time of treatment application. Capsaicin (0.2%, 50 microl) was injected into the lateral aspect of the left ankle joint and mechanical withdrawal threshold assessed before and after capsaicin injection in Sprague-Dawley rats. Joint mobilization of the ipsilateral knee joint was performed 2 h after capsaicin injection for a total of 3 min, 9 min or 15 min under halothane anaesthesia. Control groups included animals that received halothane for the same time as the group that received joint mobilization and those whose limbs were held for the same duration as the mobilization (no halothane). Capsaicin resulted in a decreased mechanical withdrawal threshold by 2 h after injection that was maintained through 4 h. Both 9 and 15 min of mobilization, but not 3 min of mobilization, increased the withdrawal threshold to mechanical stimuli to baseline values when compared with control groups. The antihyperalgesic effect of joint mobilization lasted 30 min. Thus, joint mobilization (9 or 15 min duration) produces a significant reversal of secondary mechanical hyperalgesia induced by intra-articular injection of capsaicin. Copyright 2001 European Federation of Chapters of the International Association for the Study of Pain.

Chronic sacroiliac joint and pelvic girdle dysfunction in a 35-year-old nulliparous woman successfully managed with multimodal and multidisciplinary approach.

PubMed

Jonely, Holly; Brismée, Jean-Michel; Desai, Mehul J; Reoli, Rachel

2015-02-01

Sacroiliac joint pain and dysfunction affect 15-25% of patients reporting low back pain, including reports of spontaneous, idiopathic, traumatic, and non-traumatic onsets. The poor reliability and validity associated with diagnostic clinical and imaging techniques leads to challenges in diagnosing and managing sacroiliac joint dysfunction. A 35-year-old nulliparous female with a 14-year history of right sacroiliac joint dysfunction was managed using a multimodal and multidisciplinary approach when symptoms failed to resolve after 2 months of physical therapy. The plan of care included four prolotherapy injections, sacroiliac joint manipulation into nutation, pelvic girdle belting, and specific stabilization exercises. The patient completed 20 physical therapy sessions over a 12-month period. At 6 months, the patient's Oswestry Disability Questionnaire score was reduced from 34% to 14%. At 1-year follow-up, her score was 0%. The patient's rating of pain on a numeric rating scale decreased to an average of 4/10 at 6 months and 0/10 at 1-year follow-up. A multidisciplinary and multimodal approach for the management of chronic sacroiliac joint dysfunction appeared successful in a single-case design at 1-year follow-up.

Mechanical performance and parameter sensitivity analysis of 3D braided composites joints.

PubMed

Wu, Yue; Nan, Bo; Chen, Liang

2014-01-01

3D braided composite joints are the important components in CFRP truss, which have significant influence on the reliability and lightweight of structures. To investigate the mechanical performance of 3D braided composite joints, a numerical method based on the microscopic mechanics is put forward, the modeling technologies, including the material constants selection, element type, grid size, and the boundary conditions, are discussed in detail. Secondly, a method for determination of ultimate bearing capacity is established, which can consider the strength failure. Finally, the effect of load parameters, geometric parameters, and process parameters on the ultimate bearing capacity of joints is analyzed by the global sensitivity analysis method. The results show that the main pipe diameter thickness ratio γ, the main pipe diameter D, and the braided angle α are sensitive to the ultimate bearing capacity N.

5 CFR 430.102 - Performance management.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Performance management. 430.102 Section 430.102 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PERFORMANCE MANAGEMENT Performance Management § 430.102 Performance management. (a) Performance management is the...

5 CFR 430.102 - Performance management.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 5 Administrative Personnel 1 2014-01-01 2014-01-01 false Performance management. 430.102 Section 430.102 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PERFORMANCE MANAGEMENT Performance Management § 430.102 Performance management. (a) Performance management is the...

5 CFR 430.102 - Performance management.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 5 Administrative Personnel 1 2012-01-01 2012-01-01 false Performance management. 430.102 Section 430.102 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PERFORMANCE MANAGEMENT Performance Management § 430.102 Performance management. (a) Performance management is the...

5 CFR 430.102 - Performance management.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 5 Administrative Personnel 1 2013-01-01 2013-01-01 false Performance management. 430.102 Section 430.102 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PERFORMANCE MANAGEMENT Performance Management § 430.102 Performance management. (a) Performance management is the...

5 CFR 430.102 - Performance management.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 5 Administrative Personnel 1 2011-01-01 2011-01-01 false Performance management. 430.102 Section 430.102 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PERFORMANCE MANAGEMENT Performance Management § 430.102 Performance management. (a) Performance management is the...

Managing the "Performance" in Performance Management.

ERIC Educational Resources Information Center

Repinski, Marilyn; Bartsch, Maryjo

1996-01-01

Describes a five-step approach to performance management which includes (1) redefining tasks; (2) identifying skills; (3) determining what development tools are necessary; (4) prioritizing skills development; and (5) developing an action plan. Presents a hiring model that includes job analysis, job description, selection, goal setting, evaluation,…

Genetic conditions of joint Nordic genetic evaluations of lifetime competition performance in warmblood sport horses.

PubMed

Viklund, Å; Furre, S; Eriksson, S; Vangen, O; Philipsson, J

2015-08-01

Breeding programmes for warmblood sport horses are similar in the Nordic countries Sweden, Denmark, Finland and Norway, and stallions of same origin are used. The aim was to investigate whether a joint Nordic genetic evaluation based on lifetime competition performance is feasible and beneficial for breeding competitive sport horses in the Nordic countries. Results for almost 45,000 horses in show jumping and 30,000 horses in dressage were available. The larger populations in Sweden and Denmark contributed with 85% of the results. Heritabilities and genetic correlations between performances in the different countries were estimated, and comparisons of accuracies of estimated breeding values (EBVs) and number of stallions with EBVs based on national or joint data were studied. The heritabilities ranged between 0.25 and 0.42 for show jumping and between 0.14 and 0.55 for dressage. The genetic correlations between competition performances in the Nordic countries were estimated to 0.63-1.00. EBVs based on joint data increased accuracies for EBVs for stallions by 38-81% and increased the number of available stallions with EBVs by 40-288%, compared to EBVs based on national data only. A joint Nordic genetic evaluation for sport horses is recommended. © 2015 Blackwell Verlag GmbH.

Utilization of Facet Joint and Sacroiliac Joint Interventions in Medicare Population from 2000 to 2014: Explosive Growth Continues!

PubMed

Manchikanti, Laxmaiah; Hirsch, Joshua A; Pampati, Vidyasagar; Boswell, Mark V

2016-10-01

Increasing utilization of interventional techniques in managing chronic spinal pain, specifically facet joint interventions and sacroiliac joint injections, is a major concern of healthcare policy makers. We analyzed the patterns of utilization of facet and sacroiliac joint interventions in managing chronic spinal pain. The results showed significant increase of facet joint interventions and sacroiliac joint injections from 2000 to 2014 in Medicare FFS service beneficiaries. Overall, the Medicare population increased 35 %, whereas facet joint and sacroiliac joint interventions increased 313.3 % per 100,000 Medicare population with an annual increase of 10.7 %. While the increases were uniform from 2000 to 2014, there were some decreases noted for facet joint interventions in 2007, 2010, and 2013, whereas for sacroiliac joint injections, the decreases were noted in 2007 and 2013. The increases were for cervical and thoracic facet neurolysis at 911.5 % compared to lumbosacral facet neurolysis of 567.8 %, 362.9 % of cervical and thoracic facet joint blocks, 316.9 % of sacroiliac joints injections, and finally 227.3 % of lumbosacral facet joint blocks.

Neuromuscular prehabilitation to prevent osteoarthritis after a traumatic joint injury.

PubMed

Tenforde, Adam S; Shull, Pete B; Fredericson, Michael

2012-05-01

Post-traumatic osteoarthritis (PTOA) is a process resulting from direct forces applied to a joint that cause injury and degenerative changes. An estimated 12% of all symptomatic osteoarthritis (OA) of the hip, knee, and ankle can be attributed to a post-traumatic cause. Neuromuscular prehabilitation is the process of improving neuromuscular function to prevent development of PTOA after an initial traumatic joint injury. Prehabilitation strategies include restoration of normative movement patterns that have been altered as the result of traumatic injury, along with neuromuscular exercises and gait retraining to prevent the development of OA after an injury occurs. A review of the current literature shows that no studies have been performed to evaluate methods of neuromuscular prehabilitation to prevent PTOA after a joint injury. Instead, current research has focused on management strategies after knee injuries, the value of exercise in the management of OA, and neuromuscular exercises after total knee arthroplasty. Recent work in gait retraining that alters knee joint loading holds promise for preventing the development of PTOA after joint trauma. Future research should evaluate methods of neuromuscular prehabilitation strategies in relationship to the outcome of PTOA after joint injury. Copyright © 2012 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

Transition Plan For the Technology Demonstration of the Joint Network Defence and Management System (JNDMS)

DTIC Science & Technology

2009-11-01

Technology Demonstration of the Joint Network Defence and Management System (JNDMS) Brett Trask; Novembre 2009. Dès le départ, nous avons mis au point le... 13 5.1 System Specification... 13 5.1.1 Scope ............................................................................................................. 13 5.2 Security

Chronic sacroiliac joint and pelvic girdle dysfunction in a 35-year-old nulliparous woman successfully managed with multimodal and multidisciplinary approach

PubMed Central

Jonely, Holly; Brismée, Jean-Michel; Desai, Mehul J; Reoli, Rachel

2015-01-01

Background and purpose: Sacroiliac joint pain and dysfunction affect 15–25% of patients reporting low back pain, including reports of spontaneous, idiopathic, traumatic, and non-traumatic onsets. The poor reliability and validity associated with diagnostic clinical and imaging techniques leads to challenges in diagnosing and managing sacroiliac joint dysfunction. Case description: A 35-year-old nulliparous female with a 14-year history of right sacroiliac joint dysfunction was managed using a multimodal and multidisciplinary approach when symptoms failed to resolve after 2 months of physical therapy. The plan of care included four prolotherapy injections, sacroiliac joint manipulation into nutation, pelvic girdle belting, and specific stabilization exercises. Outcomes: The patient completed 20 physical therapy sessions over a 12-month period. At 6 months, the patient’s Oswestry Disability Questionnaire score was reduced from 34% to 14%. At 1-year follow-up, her score was 0%. The patient’s rating of pain on a numeric rating scale decreased to an average of 4/10 at 6 months and 0/10 at 1-year follow-up. Discussion: A multidisciplinary and multimodal approach for the management of chronic sacroiliac joint dysfunction appeared successful in a single-case design at 1-year follow-up. PMID:26309378

Controversies relating to the management of acromioclavicular joint dislocations.

PubMed

Modi, C S; Beazley, J; Zywiel, M G; Lawrence, T M; Veillette, C J H

2013-12-01

The aim of this review is to address controversies in the management of dislocations of the acromioclavicular joint. Current evidence suggests that operative rather than non-operative treatment of Rockwood grade III dislocations results in better cosmetic and radiological results, similar functional outcomes and longer time off work. Early surgery results in better functional and radiological outcomes with a reduced risk of infection and loss of reduction compared with delayed surgery. Surgical options include acromioclavicular fixation, coracoclavicular fixation and coracoclavicular ligament reconstruction. Although non-controlled studies report promising results for arthroscopic coracoclavicular fixation, there are no comparative studies with open techniques to draw conclusions about the best surgical approach. Non-rigid coracoclavicular fixation with tendon graft or synthetic materials, or rigid acromioclavicular fixation with a hook plate, is preferable to fixation with coracoclavicular screws owing to significant risks of loosening and breakage. The evidence, although limited, also suggests that anatomical ligament reconstruction with autograft or certain synthetic grafts may have better outcomes than non-anatomical transfer of the coracoacromial ligament. It has been suggested that this is due to better restoration horizontal and vertical stability of the joint. Despite the large number of recently published studies, there remains a lack of high-quality evidence, making it difficult to draw firm conclusions regarding these controversial issues.

Performance Management or Managing Performance? Supporting a Vision to Become Outstanding

ERIC Educational Resources Information Center

Morton, Sam

2011-01-01

This paper provides an account of how performance management is operating in a rural primary school in the county of Rutland, UK, which aspires to provide an outstanding standard of education for its pupils. The paper begins by outlining the existing regulations for the operation of performance management in schools, before going on to explain how…

Corrosion Performance of Friction Stir Linear Lap Welded AM60B Joints

NASA Astrophysics Data System (ADS)

Kish, J. R.; Birbilis, N.; McNally, E. M.; Glover, C. F.; Zhang, X.; McDermid, J. R.; Williams, G.

2017-11-01

A corrosion investigation of friction stir linear lap welded AM60B joints used to fabricate an Mg alloy-intensive automotive front end sub-assembly was performed. The stir zone exhibited a slightly refined grain size and significant break-up and re-distribution of the divorced Mg17Al12 (β-phase) relative to the base material. Exposures in NaCl (aq) environments revealed that the stir zone was more susceptible to localized corrosion than the base material. Scanning vibrating electrode technique measurements revealed differential galvanic activity across the joint. Anodic activity was confined to the stir zone surface and involved initiation and lateral propagation of localized filaments. Cathodic activity was initially confined to the base material surface, but was rapidly modified to include the cathodically-activated corrosion products in the filament wake. Site-specific surface analyses revealed that the corrosion observed across the welded joint was likely linked to variations in Al distribution across the surface film/metal interface.

99m-Technetium phosphate compound joint scintigraphy in the management of juvenile osteochondritis dissecans of the femoral condyles

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cahill, B.R.; Berg, B.C.

The known sensitivity of joint scintigraphy in following the course of fracture healing caused the authors to believe that this radiologic technique might be valuable in the management of osteochondritis dissecans (OCD). Accordingly, 99mTc-diphosphonate joint scintigraphy was used on 18 patients with OCD of the knee. The average age was 13 1/2 years. The scintigrams were repeated at 6-week intervals until healing had occurred. When the diagnosis of OCD was established by standard roentgenograms and joint scintigraphy, the patients were placed on an activity restriction program, attempting to reach a symptom-free level. The patients were followed for an average ofmore » 18 months. Ninety-five scans were categorized according to their level of scintigraphic activity. This led to a discrete four-part scintigraphic classification that is indicative of the extent of healing or progression of this condition, and precedes changes seen on standard x-rays by months. Joint scintigraphy also rules out anomalies of ossification in the diagnosis of OCD since an anomaly should have a normal scintigraphic appearance. We have concluded that joint scintigraphy is valuable in the management of OCD because of its superior sensitivity to changes in the activity of the lesion. As experience is gained with this technique, those cases that should be prophylactically surgically stabilized may be indicated.« less

A field evaluation of Transflex bridge joint performance.

DOT National Transportation Integrated Search

1972-01-01

Presented are the results of a field evaluation of the various types of the General Tire Transflex joint known to be in use in Virginia. An effort was made, whenever possible, to qualitatively evaluate the joints with respect to their (1) watertightn...

The joint effects of personality and workplace social exchange relationships in predicting task performance and citizenship performance.

PubMed

Kamdar, Dishan; Van Dyne, Linn

2007-09-01

This field study examines the joint effects of social exchange relationships at work (leader-member exchange and team-member exchange) and employee personality (conscientiousness and agreeableness) in predicting task performance and citizenship performance. Consistent with trait activation theory, matched data on 230 employees, their coworkers, and their supervisors demonstrated interactions in which high quality social exchange relationships weakened the positive relationships between personality and performance. Results demonstrate the benefits of consonant predictions in which predictors and outcomes are matched on the basis of specific targets. We discuss theoretical and practical implications. (c) 2007 APA.

Understanding the Reliability of Solder Joints Used in Advanced Structural and Electronics Applications: Part 2 - Reliability Performance.

DOE PAGES

Vianco, Paul T.

2017-03-01

Whether structural or electronic, all solder joints must provide the necessary level of reliability for the application. The Part 1 report examined the effects of filler metal properties and the soldering process on joint reliability. Filler metal solderability and mechanical properties, as well as the extents of base material dissolution and interface reaction that occur during the soldering process, were shown to affect reliability performance. The continuation of this discussion is presented in this Part 2 report, which highlights those factors that directly affect solder joint reliability. There is the growth of an intermetallic compound (IMC) reaction layer at themore » solder/base material interface by means of solid-state diffusion processes. In terms of mechanical response by the solder joint, fatigue remains as the foremost concern for long-term performance. Thermal mechanical fatigue (TMF), a form of low-cycle fatigue (LCF), occurs when temperature cycling is combined with mismatched values of the coefficient of thermal expansion (CTE) between materials comprising the solder joint “system.” Vibration environments give rise to high-cycle fatigue (HCF) degradation. Although accelerated aging studies provide valuable empirical data, too many variants of filler metals, base materials, joint geometries, and service environments are forcing design engineers to embrace computational modeling to predict the long-term reliability of solder joints.« less

75 FR 10490 - Joint Meeting of the Arthritis Drugs Advisory Committee and the Drug Safety and Risk Management...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-08

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2010-N-0001] Joint Meeting of the Arthritis Drugs Advisory Committee and the Drug Safety and Risk Management Advisory... Drug Safety and Risk Management Advisory Committee. General Function of the Committees: To provide...

Joint Control for Dummies: An Elaboration of Lowenkron's Model of Joint (Stimulus) Control

ERIC Educational Resources Information Center

Sidener, David W.

2006-01-01

The following paper describes Lowenkron's model of joint (stimulus) control. Joint control is described as a means of accounting for performances, especially generalized performances, for which a history of contingency control does not provide an adequate account. Examples are provided to illustrate instances in which joint control may facilitate…

Imaging diagnosis--temporomandibular joint dysplasia in a Basset Hound.

PubMed

Lerer, Assaf; Chalmers, Heather J; Moens, Noel M M; Mackenzie, Shawn D; Kry, Kristin

2014-01-01

A 5-month-old intact male Basset Hound presented for evaluation of pain and crepitation during manipulation of the temporomandibular joint, worse on the right side. A computed tomography (CT) scan of the head was performed. The CT images demonstrated the osseous features of temporomandibular joint dysplasia and facilitated a 3D reconstruction, which allowed better visualization of the dysplastic features. The patient responded to conservative management with a tape muzzle with no recurrence reported by the owner 6 months after presentation. © 2013 American College of Veterinary Radiology.

The Joint Military Medical Executive Skills initiative: an impressive response to changing human resource management rules of engagement.

PubMed

Kerr, Bernard J

2007-01-01

Confronted with a sudden and substantial change in the rules regarding who could command a military medical treatment facility (MTF), the Military Health System (MHS) responded to the challenge with an impressive human resource management solution-the Joint Medical Executive Skills Program. The history, emergence, and continuing role of this initiative exemplifies the MHS's capacity to fulfill the spirit and intent of an arduous Congressional mandate while enhancing professional development and sustaining the career opportunities of medical officers. The MHS response to the Congressional requirement that candidates for MTF command demonstrate professional administrative skills was decisive, creative, and consistent with the basic principles of human resource management. The Joint Medical Executive Skills Program is a management success story that demonstrates how strategic planning, well-defined skills requirements, and structured training can assure a ready supply of qualified commanders for the military's MTFs.

Developing an evidence-based nursing protocol on wound drain management for total joint arthroplasty.

PubMed

Tsang, Lap Fung

2015-05-01

Although various drains have long been used for many years in total joint replacement, there is a paucity of evidence for the benefit of drain applications. Evidence suggests inconsistent practice in the use of drainage systems, whether intermittently applying suction or free of suction in the application of drainage systems, as well as the optimal timing for wound drain removal. It aimed to perform a systematic review to develop an evidence-based nursing protocol to manage wound drainage following total joint arthroplasty. A comprehensive systematic review of available evidence up to 2013. Searches of the EMBASE, Cochrane library, CINAHL, Medline electronic databases and an internet search by Yahoo and Google engine returned 2840 records, of which 11 met the inclusion criteria for this review. A further two papers were obtained through scanning the reference lists of those articles included from the initial literature search. Different clamping times were retrieved from the literature. A protocol was adapted for clinical application according to the summary of the retrieved information. It is suggested that clamping is performed 1 h after the insertion of suction drains post-operatively in the operating theatre. Wound drains should be clamped for 1 h if blood loss is more than 600 ml in 6 h in first 24 h. Wound drains should be clamped for 1 h if blood loss is more than 800 ml in 8 h thereafter. It is suggested that the drainage reservoir bottle should be mark and findings recorded in line with the principle of drain clamping. This means that the amount of drainage is measured and recorded every 6 h in first 24 h and every 8 h thereafter. It is suggested that wound drains should be remove before 48 h after TJR. If blood loss is less than 50 ml in past 6 h or less than 70 ml in past 8 h, the drain should be remove and the wound site should be monitored closely. This paper has guided nurses to develop an evidence-based protocol to improve patient care on wound drain

Utilization and growth patterns of sacroiliac joint injections from 2000 to 2011 in the medicare population.

PubMed

Manchikanti, Laxmaiah; Hansen, Hans; Pampati, Vidyasagar; Falco, Frank J E

2013-01-01

  The high prevalence of persistent low back pain and growing number of diagnostic and therapeutic modalities employed to manage chronic low back pain and the subsequent impact on society and the economy continue to hold sway over health care policy. Among the multiple causes responsible for chronic low back pain, the contributions of the sacroiliac joint have been a subject of debate albeit a paucity of research. At present, there are no definitive conservative, interventional or surgical management options for managing sacroiliac joint pain. It has been shown that the increases were highest for facet joint interventions and sacroiliac joint blocks with an increase of 310% per 100,000 Medicare beneficiaries from 2000 to 2011. There has not been a systematic assessment of the utilization and growth patterns of sacroiliac joint injections. Analysis of the growth patterns of sacroiliac joint injections in Medicare beneficiaries from 2000 to 2011. To evaluate the utilization and growth patterns of sacroiliac joint injections. This assessment was performed utilizing Centers for Medicare and Medicaid Services (CMS) Physician/Supplier Procedure Summary (PSPS) Master data from 2000 to 2011. The findings of this assessment in Medicare beneficiaries from 2000 to 2011 showed a 331% increase per 100,000 Medicare beneficiaries with an annual increase of 14.2%, compared to an increase in the Medicare population of 23% or annual increase of 1.9%. The number of procedures increased from 49,554 in 2000 to 252,654 in 2011, or a rate of 125 to 539 per 100,000 Medicare beneficiaries. Among the various specialists performing sacroiliac joint injections, physicians specializing in physical medicine and rehabilitation have shown the most increase, followed by neurology with 1,568% and 698%, even though many physicians from both specialties have been enrolling in interventional pain management and pain management. Even though the numbers were small for nonphysician providers including

[Non vascularized toe phalangeal transfers for symbrachydactyly. Active range of motion without joint reconstruction].

PubMed

Leca, J-B; Auquit Auckbur, I; Bachy, B; Milliez, P-Y

2008-12-01

Symbrachydactyly is a rare congenital malformation of the hand and its treatment is controversial. Non vascularized toe phalangeal transfers have been used for management of short digits for three children. Six phalanges have been harvested complete with their periosteum. No joint reconstruction has been performed and all children have undergone surgery at a young age. Four of six digits involved have an active range of motion (range 30 to 105 degrees ). All authors who have reported active range of motion of toe phalangeal transfers have performed joint reconstruction. Here, we report obtaining active range of motion of phalangeal transfers without necessity of joint reconstruction.

Performance of a rigid and a flexible adhesive in lumber joints subjected to moisture content changes

Treesearch

G. P. Krueger; R. F. Blomquist

1964-01-01

Experimental work was undertaken to investigate the extent and magnitude of deterioration that can occur in typical plywood-to-lumber glue joints subjected to stresses resulting from changes in the moisture content of the wood, and to compare the performance of a somewhat flexible or deformable adhesive to that of a rigid adhesive in these joints. Results showed that...

Sacroiliac Joint Fusion Using Triangular Titanium Implants vs. Non-Surgical Management: Six-Month Outcomes from a Prospective Randomized Controlled Trial.

PubMed

Whang, Peter; Cher, Daniel; Polly, David; Frank, Clay; Lockstadt, Harry; Glaser, John; Limoni, Robert; Sembrano, Jonathan

2015-01-01

Sacroiliac (SI) joint pain is a prevalent, underdiagnosed cause of lower back pain. SI joint fusion can relieve pain and improve quality of life in patients who have failed nonoperative care. To date, no study has concurrently compared surgical and non-surgical treatments for chronic SI joint dysfunction. We conducted a prospective randomized controlled trial of 148 subjects with SI joint dysfunction due to degenerative sacroiliitis or sacroiliac joint disruptions who were assigned to either minimally invasive SI joint fusion with triangular titanium implants (N=102) or non-surgical management (NSM, n=46). SI joint pain scores, Oswestry Disability Index (ODI), Short-Form 36 (SF-36) and EuroQol-5D (EQ-5D) were collected at baseline and at 1, 3 and 6 months after treatment commencement. Six-month success rates, defined as the proportion of treated subjects with a 20-mm improvement in SI joint pain in the absence of severe device-related or neurologic SI joint-related adverse events or surgical revision, were compared using Bayesian methods. Subjects (mean age 51, 70% women) were highly debilitated at baseline (mean SI joint VAS pain score 82, mean ODI score 62). Six-month follow-up was obtained in 97.3%. By 6 months, success rates were 81.4% in the surgical group vs. 23.9% in the NSM group (difference of 56.6%, 95% posterior credible interval 41.4-70.0%, posterior probability of superiority >0.999). Clinically important (≥15 point) ODI improvement at 6 months occurred in 75% of surgery subjects vs. 27.3% of NSM subjects. At six months, quality of life improved more in the surgery group and satisfaction rates were high. The mean number of adverse events in the first six months was slightly higher in the surgical group compared to the non-surgical group (1.3 vs. 1.0 events per subject, p=0.1857). Six-month follow-up from this level 1 study showed that minimally invasive SI joint fusion using triangular titanium implants was more effective than non-surgical management

Sacroiliac Joint Fusion Using Triangular Titanium Implants vs. Non-Surgical Management: Six-Month Outcomes from a Prospective Randomized Controlled Trial

PubMed Central

Whang, Peter; Polly, David; Frank, Clay; Lockstadt, Harry; Glaser, John; Limoni, Robert; Sembrano, Jonathan

2015-01-01

Background Sacroiliac (SI) joint pain is a prevalent, underdiagnosed cause of lower back pain. SI joint fusion can relieve pain and improve quality of life in patients who have failed nonoperative care. To date, no study has concurrently compared surgical and non-surgical treatments for chronic SI joint dysfunction. Methods We conducted a prospective randomized controlled trial of 148 subjects with SI joint dysfunction due to degenerative sacroiliitis or sacroiliac joint disruptions who were assigned to either minimally invasive SI joint fusion with triangular titanium implants (N=102) or non-surgical management (NSM, n=46). SI joint pain scores, Oswestry Disability Index (ODI), Short-Form 36 (SF-36) and EuroQol-5D (EQ-5D) were collected at baseline and at 1, 3 and 6 months after treatment commencement. Six-month success rates, defined as the proportion of treated subjects with a 20-mm improvement in SI joint pain in the absence of severe device-related or neurologic SI joint-related adverse events or surgical revision, were compared using Bayesian methods. Results Subjects (mean age 51, 70% women) were highly debilitated at baseline (mean SI joint VAS pain score 82, mean ODI score 62). Six-month follow-up was obtained in 97.3%. By 6 months, success rates were 81.4% in the surgical group vs. 23.9% in the NSM group (difference of 56.6%, 95% posterior credible interval 41.4-70.0%, posterior probability of superiority >0.999). Clinically important (≥15 point) ODI improvement at 6 months occurred in 75% of surgery subjects vs. 27.3% of NSM subjects. At six months, quality of life improved more in the surgery group and satisfaction rates were high. The mean number of adverse events in the first six months was slightly higher in the surgical group compared to the non-surgical group (1.3 vs. 1.0 events per subject, p=0.1857). Conclusions Six-month follow-up from this level 1 study showed that minimally invasive SI joint fusion using triangular titanium implants was more

Managing Safety and Operations: The Effect of Joint Management System Practices on Safety and Operational Outcomes.

PubMed

Tompa, Emile; Robson, Lynda; Sarnocinska-Hart, Anna; Klassen, Robert; Shevchenko, Anton; Sharma, Sharvani; Hogg-Johnson, Sheilah; Amick, Benjamin C; Johnston, David A; Veltri, Anthony; Pagell, Mark

2016-03-01

The aim of this study was to determine whether management system practices directed at both occupational health and safety (OHS) and operations (joint management system [JMS] practices) result in better outcomes in both areas than in alternative practices. Separate regressions were estimated for OHS and operational outcomes using data from a survey along with administrative records on injuries and illnesses. Organizations with JMS practices had better operational and safety outcomes than organizations without these practices. They had similar OHS outcomes as those with operations-weak practices, and in some cases, better outcomes than organizations with safety-weak practices. They had similar operational outcomes as those with safety-weak practices, and better outcomes than those with operations-weak practices. Safety and operations appear complementary in organizations with JMS practices in that there is no penalty for either safety or operational outcomes.

Performance characteristics of broth-only cultures after revision total joint arthroplasty.

PubMed

Smith, Eric B; Cai, Jenny; Wynne, Rachael; Maltenfort, Mitchell; Good, Robert P

2014-11-01

Surgeons frequently obtain intraoperative cultures at the time of revision total joint arthroplasty. The use of broth or liquid medium before applying the sample to the agar medium may be associated with contamination and false-positive cultures; however, the degree to which this is the case is not known. We (1) calculated the performance characteristics of broth-only cultures (sensitivity, specificity, positive predictive value, and negative predictive value) and (2) characterized the organisms identified in broth to determine whether a specific organism showed increased proclivity for true-positive periprosthetic joint infection (PJI). A single-institution retrospective chart review was performed on 257 revision total joint arthroplasties from 2009 through 2010. One hundred ninety (74%) had cultures for review. All culture results, as well as treatment, if any, were documented and patients were followed for a minimum of 1 year for evidence of PJI. Cultures were measured as either positive from the broth only or broth negative. The true diagnosis of infection was determined by the Musculoskeletal Infection Society criteria during the preoperative workup or postoperatively at 1 year for purposes of calculating the performance characteristics of the broth-only culture. The sensitivity, specificity, positive predictive value, and negative predictive value were 19%, 88%, 13%, and 92%, respectively. The most common organism identified was coagulase-negative Staphylococcus (16 of 24 cases, 67%). Coagulase-negative Staphylococcus was present in all three true-positive cases; however, it was also found in 13 of the false-positive cases. The broth-only positive cultures showed poor sensitivity and positive predictive value but good specificity and negative predictive value. The good specificity indicates that it can help to rule in the presence of PJI; however, the poor sensitivity makes broth-only culture an unreliable screening test. We recommend that broth

Should all acromioclavicular joint injections be performed under image guidance?

PubMed

Javed, S; Sadozai, Z; Javed, A; Din, A; Schmitgen, G

2017-01-01

Steroid and local anaesthetic injection to the acromioclavicular joint (ACJ) is a very common diagnostic and therapeutic procedure, which is often performed in the outpatient department. However, it can be difficult to localize this joint because of its small size, presence of osteophytes and variable morphology in the population. We performed a study to determine whether the use of an image intensifier (X-ray guidance), in theatre, improves the accuracy of this injection. This was a prospective study carried out between March 2014 and March 2015. The injections were performed by two senior orthopaedic surgeons. First, we clinically palpated the ACJ and marked the area over this point as A. Then, with the use of a needle and an image intensifier in a single plane, we identified the actual location of the ACJ and marked this point as B. We measured the distance between A and B in millimetres (mm) and determined the accuracy of the injections. Further analysis taking into account the ACJ capsular attachments was also performed. In total, 45 patients and 50 injections were included in the study; five patients had repeated injections at different times. We found that only 12 injections (24%) were palpated to be correct with no discrepancies between A and B (95% confidence interval: 14-37%). For the remaining 38 injections (76%), the use of an image intensifier had significantly improved the accuracy of ACJ location ( p < 0.05). Taking the capsular attachments of the ACJ into consideration reduced the number of inaccurate injections to 27 (54%). We recommend the use of an image intensifier (or ultrasound guidance) to accurately determine the location of the ACJ for steroid and local anaesthetic injections. This prevents an injection into the wrong place, which can lead to wrong diagnosis and/or suboptimal treatment.

Installation and performance evaluation of the wabocrete FMV joint system for bridge decks.

DOT National Transportation Integrated Search

1990-01-01

A Wabocrete FMV bridge deck expansion joint system was installed on the Alternate Rte. 58 bridge over the Clinch River in November 1986. The bridge was placed in service in mid-1987. The report concerns an installation and performance evaluation of t...

Evaluation and management of adult shoulder pain: a focus on rotator cuff disorders, acromioclavicular joint arthritis, and glenohumeral arthritis.

PubMed

Armstrong, April

2014-07-01

Shoulder pain is a common reason for a patient to see their primary care physician. This article focuses on the evaluation and management of 3 common shoulder disorders; rotator cuff disorders, acromioclavicular joint arthritis, and glenohumeral joint arthritis. The typical history and physical examination findings for each of these entities are highlighted, in addition to treatment options. Copyright © 2014 Elsevier Inc. All rights reserved.

The Web-Based Osteoarthritis Management Resource My Joint Pain Improves Quality of Care: A Quasi-Experimental Study.

PubMed

Umapathy, Hema; Bennell, Kim; Dickson, Chris; Dobson, Fiona; Fransen, Marlene; Jones, Graeme; Hunter, David J

2015-07-07

Despite the availability of evidence-based guidelines for conservative treatment of osteoarthritis (OA), management is often confined to the use of analgesics and waiting for eventual total joint replacement. This suggests a gap in knowledge for persons with OA regarding the many different treatments available to them. Our objective was to evaluate outcomes after usage of a Web-based resource called My Joint Pain that contains tailored, evidence-based information and tools aimed to improve self-management of OA on self-management and change in knowledge. A quasi-experimental design was used to evaluate the My Joint Pain website intervention over a 12-month period. The intervention provided participants with general and user-specific information, monthly assessments with validated instruments, and progress-tracking tools. A nationwide convenience sample of 195 participants with self-assessed hip and/or knee OA completed both baseline and 12-month questionnaires (users: n=104; nonusers: n=91). The primary outcome measure was the Health Evaluation Impact Questionnaire (heiQ) to evaluate 8 different domains (health-directed activity, positive and active engagement in life, emotional distress, self-monitoring and insight, constructive attitudes and approaches, skill and technique acquisition, social integration and support, health service navigation) and the secondary outcome measure was the 17-item Osteoarthritis Quality Indicator (OAQI) questionnaire to evaluate the change in appropriateness of care received by participants. Independent t tests were used to compare changes between groups for the heiQ and chi-square tests to identify changes within and between groups from baseline to 12 months for each OAQI item. Baseline demographics between groups were similar for gender (152/195, 77.9% female), age (mean 60, SD 9 years) and body mass index (mean 31.1, SD 6.8 kg/m(2)). With the exception of health service navigation, mean effect sizes from all other heiQ domains

Physiotherapy management of joint hypermobility syndrome--a focus group study of patient and health professional perspectives.

PubMed

Palmer, S; Terry, R; Rimes, K A; Clark, C; Simmonds, J; Horwood, J

2016-03-01

To develop an understanding of patient and health professional views and experiences of physiotherapy to manage joint hypermobility syndrome (JHS). An explorative qualitative design. Seven focus groups were convened, audio recorded, fully transcribed and analysed using a constant comparative method to inductively derive a thematic account of the data. Four geographical areas of the U.K. 25 people with JHS and 16 health professionals (14 physiotherapists and two podiatrists). Both patients and health professionals recognised the chronic heterogeneous nature of JHS and reported a lack of awareness of the condition amongst health professionals, patients and wider society. Diagnosis and subsequent referral to physiotherapy services for JHS was often difficult and convoluted. Referral was often for acute single joint injury, failing to recognise the long-term multi-joint nature of the condition. Health professionals and patients felt that if left undiagnosed, JHS was more difficult to treat because of its chronic nature. When JHS was treated by health professionals with knowledge of the condition patients reported satisfactory outcomes. There was considerable agreement between health professionals and patients regarding an 'ideal' physiotherapy service. Education was reported as an overarching requirement for patients and health care professionals. Physiotherapy should be applied holistically to manage JHS as a long-term condition and should address injury prevention and symptom amelioration rather than cure. Education for health professionals and patients is needed to optimise physiotherapy provision. Further research is required to explore the specific therapeutic actions of physiotherapy for managing JHS. Copyright © 2015 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

Design and Performance Analysis of a new Rotary Hydraulic Joint

NASA Astrophysics Data System (ADS)

Feng, Yong; Yang, Junhong; Shang, Jianzhong; Wang, Zhuo; Fang, Delei

2017-07-01

To improve the driving torque of the robots joint, a wobble plate hydraulic joint is proposed, and the structure and working principle are described. Then mathematical models of kinematics and dynamics was established. On the basis of this, dynamic simulation and characteristic analysis are carried out. Results show that the motion curve of the joint is continuous and the impact is small. Moreover the output torque of the joint characterized by simple structure and easy processing is large and can be rotated continuously.

Effect of window length on performance of the elbow-joint angle prediction based on electromyography

NASA Astrophysics Data System (ADS)

Triwiyanto; Wahyunggoro, Oyas; Adi Nugroho, Hanung; Herianto

2017-05-01

The high performance of the elbow joint angle prediction is essential on the development of the devices based on electromyography (EMG) control. The performance of the prediction depends on the feature of extraction parameters such as window length. In this paper, we evaluated the effect of the window length on the performance of the elbow-joint angle prediction. The prediction algorithm consists of zero-crossing feature extraction and second order of Butterworth low pass filter. The feature was used to extract the EMG signal by varying window length. The EMG signal was collected from the biceps muscle while the elbow was moved in the flexion and extension motion. The subject performed the elbow motion by holding a 1-kg load and moved the elbow in different periods (12 seconds, 8 seconds and 6 seconds). The results indicated that the window length affected the performance of the prediction. The 250 window lengths yielded the best performance of the prediction algorithm of (mean±SD) root mean square error = 5.68%±1.53% and Person’s correlation = 0.99±0.0059.

Managing Knee Osteoarthritis: The Effects of Body Weight Supported Physical Activity on Joint Pain, Function, and Thigh Muscle Strength.

PubMed

Peeler, Jason; Christian, Mathew; Cooper, Juliette; Leiter, Jeffrey; MacDonald, Peter

2015-11-01

To determine the effect of a 12-week lower body positive pressure (LBPP)-supported low-load treadmill walking program on knee joint pain, function, and thigh muscle strength in overweight patients with knee osteoarthritis (OA). Prospective, observational, repeated measures investigation. Community-based, multidisciplinary sports medicine clinic. Thirty-one patients aged between 55 and 75 years, with a body mass index ≥25 kg/m and mild-to-moderate knee OA. Twelve-week LBPP-supported low-load treadmill walking regimen. Acute knee joint pain (visual analog scale) during full weight bearing treadmill walking, chronic knee pain, and joint function [Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire] during normal activities of daily living, and thigh muscle strength (isokinetic testing). Appropriate methods of statistical analysis were used to compare data from baseline and follow-up evaluation. Participants reported significant improvements in knee joint pain and function and demonstrated significant increases in thigh muscle strength about the degenerative knee. Participants also experienced significant reductions in acute knee pain during full weight bearing treadmill walking and required dramatically less LBPP support to walk pain free on the treadmill. Data suggest that an LBPP-supported low-load exercise regimen can be used to significantly diminish knee pain, enhance joint function, and increase thigh muscle strength, while safely promoting pain-free walking exercise in overweight patients with knee OA. These findings have important implications for the development of nonoperative treatment strategies that can be used in the management of joint symptoms associated with progressive knee OA in at-risk patient populations. This research suggests that LBPP-supported low-load walking is a safe user-friendly mode of exercise that can be successfully used in the management of day-to-day joint symptoms associated with knee OA, helping to improve the

Prosthetic Joint Infections

PubMed Central

Aslam, Saima; Darouiche, Rabih O.

2012-01-01

Prosthetic joint infections represent a major therapeutic challenge for both healthcare providers and patients. This paper reviews the predisposing factors, pathogenesis, microbiology, diagnosis, treatment and prophylaxis of prosthetic joint infection. The most optimal management strategy should be identified based on a number of considerations including type and duration of infection, antimicrobial susceptibility of the infecting pathogen, condition of infected tissues and bone stock, patient wishes and functional status. PMID:22847032

Cost-Effective Mobile-Based Healthcare System for Managing Total Joint Arthroplasty Follow-Up.

PubMed

Bitsaki, Marina; Koutras, George; Heep, Hansjoerg; Koutras, Christos

2017-01-01

Long-term follow-up care after total joint arthroplasty is essential to evaluate hip and knee arthroplasty outcomes, to provide information to physicians and improve arthroplasty performance, and to improve patients' health condition. In this paper, we aim to improve the communication between arthroplasty patients and physicians and to reduce the cost of follow-up controls based on mobile application technologies and cloud computing. We propose a mobile-based healthcare system that provides cost-effective follow-up controls for primary arthroplasty patients through questions about symptoms in the replaced joint, questionnaires (WOMAC and SF-36v2) and the radiological examination of knee or hip joint. We also perform a cost analysis for a set of 423 patients that were treated in the University Clinic for Orthopedics in Essen-Werden. The estimation of healthcare costs shows significant cost savings (a reduction of 63.67% for readmission rate 5%) in both the University Clinic for Orthopedics in Essen-Werden and the state of North Rhine-Westphalia when the mobile-based healthcare system is applied. We propose a mHealth system to reduce the cost of follow-up assessments of arthroplasty patients through evaluation of diagnosis, self-monitoring, and regular review of their health status.

Balanced scorecards for performance management.

PubMed

Park, Eun-Jun; Huber, Diane L

2007-01-01

Nurse administrators who manage nursing case management programs are challenged to demonstrate the improved quality of patient care and financial outcomes to their organization that result from such programs. This article introduces the balanced scorecard and discusses its benefits and practical concerns for adopting the scorecard. The balanced scorecard is a useful performance management tool used to both evaluate and direct case management performance in meeting organizational missions and strategies.

Strength and Performance Enhancement of Bonded Joints by Spatial Tailoring of Adhesive Compliance via 3D Printing.

PubMed

Kumar, S; Wardle, Brian L; Arif, Muhamad F

2017-01-11

Adhesive bonding continues to emerge as a preferred route for joining materials with broad applications including advanced structures, microelectronics, biomedical systems, and consumer goods. Here, we study the mechanics of deformation and failure of tensile-loaded single-lap joints with a compliance-tailored adhesive. Tailoring of the adhesive compliance redistributes stresses and strains to reduce both shear and peel concentrations at the ends of the adhesive that determine failure of the joint. Utilizing 3D printing, the modulus of the adhesive is spatially varied along the bondlength. Experimental strength testing, including optical strain mapping, reveals that the strain redistribution results in a greater than 100% increase in strength and toughness concomitant with a 50% increase in strain-to-break while maintaining joint stiffness. The tailoring demonstrated here is immediately realizable in a broad array of 3D printing applications, and the level of performance enhancement suggests that compliance tailoring of the adhesive is a generalizable route for achieving superior performance of joints in other applications, such as advanced structural composites.

Comparative effectiveness of open versus minimally invasive sacroiliac joint fusion.

PubMed

Ledonio, Charles Gt; Polly, David W; Swiontkowski, Marc F; Cummings, John T

2014-01-01

The mainstay of sacroiliac joint disruption/degenerative sacroiliitis therapy has been nonoperative management. This nonoperative management often includes a regimen of physical therapy, chiropractic treatment, therapeutic injections, and possibly radiofrequency ablation at the discretion of the treating physician. When these clinical treatments fail, sacroiliac joint fusion has been recommended as the standard treatment. Open and minimally invasive (MIS) surgical techniques are typical procedures. This study aims to compare the perioperative measures and Oswestry Disability Index (ODI) outcomes associated with each of these techniques. A comparative retrospective chart review of patients with sacroiliac joint fusion and a minimum of 1 year of follow-up was performed. Perioperative measures and ODI scores were compared using the Fisher's exact test and two nonparametric tests, ie, the Mann-Whitney U test and the Wilcoxon signed-rank test. The results are presented as percent or median with range, as appropriate. Forty-nine patients from two institutions underwent sacroiliac joint fusion between 2006 and 2012. Ten patients were excluded because of incomplete data, leaving 39 evaluable patients, of whom 22 underwent open and 17 underwent MIS sacroiliac joint fusion. The MIS group was significantly older (median age 66 [39-82] years) than the open group (median age 51 [34-74] years). Surgical time and hospital stay were significantly shorter in the MIS group than in the open group. Preoperative ODI was significantly greater in the open group (median 64 [44-78]) than in the MIS group (median 53 [14-84]). Postoperative improvement in ODI was statistically significant within and between groups, with MIS resulting in greater improvement. The open and MIS sacroiliac joint fusion techniques resulted in statistically and clinically significant improvement for patients with degenerative sacroiliitis refractory to nonoperative management. However, the number of patients

Temporomandibular joint dislocation

PubMed Central

Sharma, Naresh Kumar; Singh, Akhilesh Kumar; Pandey, Arun; Verma, Vishal; Singh, Shreya

2015-01-01

Temporomandibular joint (TMJ) dislocation is an uncommon but debilitating condition of the facial skeleton. The condition may be acute or chronic. Acute TMJ dislocation is common in clinical practice and can be managed easily with manual reduction. Chronic recurrent TMJ dislocation is a challenging situation to manage. In this article, we discuss the comprehensive review of the different treatment modalities in managing TMJ dislocation. PMID:26668447

[Analysis of influential factors for job burnout among managers in a joint venture in Guangzhou, China].

PubMed

Lin, Qiu-hong; Jiang, Chao-qiang; Liu, Yi-min; Guo, Jing-yi; Lam, Tai Hing

2013-12-01

To investigate the influential factors for job burnout among the managerial staff in a Sino-Japanese joint venture automobile manufacturer in Guangzhou, China. A total of 288 managers in a Sino-Japanese joint venture automobile manufacturer were surveyed using the Occupational Stress Indicator, Maslach Burnout Inventory (MBI), Eysenck Personality Questionnaire, Simplified Coping Style Questionnaire, and Social Support Rating Scale. On the depersonalization dimension, the male managers had significantly higher scores than the female managers. The scores of emotion exhaustion and depersonalization of MBI showed significant differences among the managers with different levels of occupational stress. The path analysis showed that occupational stress, neuroticism, and psychoticism had negative effects on emotion exhaustion, while job satisfaction and utilization of social support had direct positive effects on emotion exhaustion. Occupational stress, psychoticism, and passive coping style had direct negative effects on depersonalization, while job satisfaction, objective support, and utilization of social support had positive effects on depersonalization. Job satisfaction and active coping style had positive effects on sense of personal accomplishment, while passive coping style had a negative effect on sense of personal accomplishment. Personality exerted its effect on social support through coping style and thus on job satisfaction and job burnout. Male managers have a greater propensity to depersonalization than their female counterparts. High occupational stress is a risk factor for job burnout. Personality, social support, and coping style are influential factors for job burnout.

Evaluating the Relationship between Team Performance and Joint Attention with Longitudinal Multivariate Mixed Models

DTIC Science & Technology

2016-09-23

Lauren Menke3 5d. PROJECT NUMBER 5e. TASK NUMBER 5f. WORK UNIT NUMBER H0HJ (53290813) 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS...as prior work has demonstrated that friendship can facilitate performance in decision-making and motor tasks (e.g., Shah & Jehn, 1993). However, a...Relationship between Team Performance and Joint Attention with Longitudinal Multivariate Mixed Models 5a. CONTRACT NUMBER FA8650-14-D-6501-0009 5b

5 CFR 430.304 - SES performance management systems.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 5 Administrative Personnel 1 2013-01-01 2013-01-01 false SES performance management systems. 430... PERFORMANCE MANAGEMENT Managing Senior Executive Performance § 430.304 SES performance management systems. (a... or more performance management systems for its senior executives. (b) Performance management systems...

5 CFR 430.304 - SES performance management systems.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 5 Administrative Personnel 1 2014-01-01 2014-01-01 false SES performance management systems. 430... PERFORMANCE MANAGEMENT Managing Senior Executive Performance § 430.304 SES performance management systems. (a... or more performance management systems for its senior executives. (b) Performance management systems...

5 CFR 430.304 - SES performance management systems.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 5 Administrative Personnel 1 2012-01-01 2012-01-01 false SES performance management systems. 430... PERFORMANCE MANAGEMENT Managing Senior Executive Performance § 430.304 SES performance management systems. (a... or more performance management systems for its senior executives. (b) Performance management systems...

5 CFR 430.304 - SES performance management systems.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false SES performance management systems. 430... PERFORMANCE MANAGEMENT Managing Senior Executive Performance § 430.304 SES performance management systems. (a... or more performance management systems for its senior executives. (b) Performance management systems...

High-Performance Liquid Chromatography (HPLC) Quantification of Liposome-Delivered Doxorubicin in Arthritic Joints of Collagen-Induced Arthritis Rats.

PubMed

Niu, Hongqing; Xu, Menghua; Li, Shuangtian; Chen, Junwei; Luo, Jing; Zhao, Xiangcong; Gao, Chong; Li, Xiaofeng

2017-04-14

BACKGROUND Neoangiogenesis occurring in inflamed articular synovium in early rheumatoid arthritis (RA) is characterized by enhanced vascular permeability that allows nanoparticle agents, including liposomes, to deliver encapsulated drugs to arthritic joints and subsequently improve therapeutic efficacy and reduce adverse effects. However, the targeting distribution of liposomes in arthritic joints during RA has not been quantitatively demonstrated. We performed this study to evaluate the targeting distribution of PEGylated doxorubicin liposomes in the arthritic joints of collagen-induced arthritis (CIA) rats by high-performance liquid chromatography (HPLC). MATERIAL AND METHODS Two doxorubicin formulations were administered to CIA rats via tail intravenous injection at a single dose (50 mg/m²). CIA rats were sacrificed and the tissues of the inflamed ankle joints were collected. The content of doxorubicin in the arthritic joints was analyzed by a validated and reproducible HPLC method. A two-way ANOVA for 2×5 factorial design was used for statistical analysis. RESULTS The developed HPLC method was sensitive, precise, and reproducible. The method was successfully applied to quantify doxorubicin content in arthritic tissues. At each time point (6, 12, 24, 48, and 72 h), doxorubicin content in the arthritic joints of the doxorubicin liposome group (DOX-LIP group) was higher than in the free doxorubicin group (DOX group) (P<0.05). In the DOX-LIP group, doxorubicin levels in the arthritic joints increased gradually and significantly in the interval of 6-72 h post-administration. CONCLUSIONS PEGylated doxorubicin liposomes were targeted to, accumulated, and retained in the arthritic joints of CIA rats. The present study indicates that liposome encapsulation increases the therapeutic efficacy of antirheumatic drugs, presenting a promising therapeutic strategy for RA.

The moderating role of stakeholder management and societal characteristics in the relationship between corporate environmental and financial performance.

PubMed

Dal Maso, Lorenzo; Mazzi, Francesco; Soscia, Manuel; Terzani, Simone

2018-07-15

This study contributes to the debate about the moderating factors that affect the relationship between environmental and financial performance. Combining stakeholder theory, stakeholder salience, and legitimacy theory, and based on a large international sample, we demonstrate that stakeholder prioritization and engagement jointly positively moderate the relationship between environmental and financial performance. However, this moderating effect is only found when both formal and informal societal characteristics are strong and support the business environment surrounding the firm and its stakeholders. Contributions and implications for managers and regulators are discussed. Copyright © 2018 Elsevier Ltd. All rights reserved.

A guide to performance management for the Health Information Manager.

PubMed

Leggat, Sandra G

This paper provides a summary of human resource management practices that have been identified as being associated with better outcomes in performance management. In general, essential practices include transformational leadership and a coherent program of goal setting, performance monitoring and feedback. Some Health Information Managers may feel they require training assistance to develop the necessary skills in the establishment of meaningful work performance goals for staff and the provision of useful and timely feedback. This paper provides useful information to assist Health Information Managers enhance the performance of their staff.

Team Development for High Performance Management.

ERIC Educational Resources Information Center

Schermerhorn, John R., Jr.

1986-01-01

The author examines a team development approach to management that creates shared commitments to performance improvement by focusing the attention of managers on individual workers and their task accomplishments. It uses the "high-performance equation" to help managers confront shared beliefs and concerns about performance and develop realistic…

Does Success Of Arthroscopic Laser Surgery In The Knee Joint Warrant Its Extension To "Non-Knee" Joints?

NASA Astrophysics Data System (ADS)

Smith, Chadwick F.; Johansen, W. Edward; Vangness, C. Thomas; Yamaguchi, Ken; McEleney, Emmett T.; Bales, Peter

1987-03-01

One of the authors has performed 162 arthroscopic laser surgeries in the knee joint without any major complication. Other investigators have recently proposed diagnostic arthroscopy and arthroscopic surgery for "non-knee" joints. The authors have proposed that arthroscopic laser surgery he extended to "non-knee" joints. The authors have performed arthroscopic laser surgery on "non-knee" joints of twelve cadavers. One of the authors have performed one successful arthroscopic surgery on a shoulder joint with only a minor, transient complication of subcutaneous emphysema. Is laser arthroscopic surgery safe and effective in "non-knee" joints? The evolving answer appears to be a qualified "Yes," which needs to be verified by a multicenter trial.

A strategic approach for managing conflict in hospitals: responding to the Joint Commission leadership standard, Part 1.

PubMed

Scott, Charity; Gerardi, Debra

2011-02-01

The Joint Commission's leadership standard for conflict management in hospitals, LD.02.04.01, states, "The hospital manages conflict between leadership groups to protect the quality and safety of care." This standard is one of numerous standards and alerts issued by The Joint Commission that address conflict and communication. They underscore the significant impact of relational dynamics on patient safety and quality of care and the critical need for a strategic approach to conflict in health care organizations. Whether leadership conflicts openly threaten a major disruption of hospital operations or whether unresolved conflicts lurk beneath the surface of daily interactions, unaddressed conflict can undermine a hospital's efforts to ensure safe, high-quality patient care. How leaders manage organizational conflict has a significant impact on achieving strategic objectives. Aligning conflict management approaches with quality and safety goals is the first step in adopting a strategic approach to conflict management. A strategic approach goes beyond reducing costs of litigation or improving grievance processes--it integrates a collaborative mind-set and individual conflict competency with nonadversarial processes. Conflict assessment should determine how conflicts are handled among the leaders at the hospital, the degree of conflict competence already present among the leaders, where the most significant conflicts occur, and how leaders think a conflict management system might work for them. Strategically aligning a conflict management approach that addresses conflict among leadership groups as a means of protecting the quality and safety of patient care is at the heart of LD.02.04.01.

Trachlight management of succinylcholine-induced subluxation of the Temporo-mandibular joint: a case report and review of the literature.

PubMed

Roze des Ordons, Amanda; Townsend, Derek R

2008-09-01

We present a case of spontaneous subluxation of the Temporo-mandibular joint (TMJ) induced by succinylcholine, to compare our experience with previous cases reported in the literature, and to review the pathophysiology, preoperative screening, and intraoperative management of TMJ instability. A 39-yr-old female with primary hyperparathyroidism and a normal airway examination presented for elective parathyroidectomy. Following induction of anesthesia and the administration of succinylcholine prior to jaw manipulation, her mouth could not be opened, and we suspected spontaneous subluxation of the TMJ. We secured the airway with the use of a Trachlight and, subsequently, reduced the joint. Postoperatively, a history of mild TMJ-related symptoms was elicited. Instability of the TMJ is not uncommon, and has several implications for airway management, highlighting the importance of preoperative screening. Limited mouth opening, due to spontaneous subluxation of the TMJ following succinylcholine-induced muscle relaxation in the absence of airway manipulation, has only twice been reported in the literature. This report highlights how tracheal intubation may be accomplished using the Trachlight, in order to secure the airway prior to reduction of the subluxed joint.

Designing Flood Management Systems for Joint Economic and Ecological Robustness

NASA Astrophysics Data System (ADS)

Spence, C. M.; Grantham, T.; Brown, C. M.; Poff, N. L.

2015-12-01

Freshwater ecosystems across the United States are threatened by hydrologic change caused by water management operations and non-stationary climate trends. Nonstationary hydrology also threatens flood management systems' performance. Ecosystem managers and flood risk managers need tools to design systems that achieve flood risk reduction objectives while sustaining ecosystem functions and services in an uncertain hydrologic future. Robust optimization is used in water resources engineering to guide system design under climate change uncertainty. Using principles introduced by Eco-Engineering Decision Scaling (EEDS), we extend robust optimization techniques to design flood management systems that meet both economic and ecological goals simultaneously across a broad range of future climate conditions. We use three alternative robustness indices to identify flood risk management solutions that preserve critical ecosystem functions in a case study from the Iowa River, where recent severe flooding has tested the limits of the existing flood management system. We seek design modifications to the system that both reduce expected cost of flood damage while increasing ecologically beneficial inundation of riparian floodplains across a wide range of plausible climate futures. The first robustness index measures robustness as the fraction of potential climate scenarios in which both engineering and ecological performance goals are met, implicitly weighting each climate scenario equally. The second index builds on the first by using climate projections to weight each climate scenario, prioritizing acceptable performance in climate scenarios most consistent with climate projections. The last index measures robustness as mean performance across all climate scenarios, but penalizes scenarios with worse performance than average, rewarding consistency. Results stemming from alternate robustness indices reflect implicit assumptions about attitudes toward risk and reveal the

Governance Challenges in Joint Inter-Jurisdictional Management: The Grand Teton National Park, Wyoming, Elk Case

NASA Astrophysics Data System (ADS)

Clark, Susan G.; Vernon, Marian E.

2015-08-01

The controversial elk reduction program (elk hunt) in Grand Teton National Park, WY, has been a source of conflict since it was legislated in 1950. The hunt is jointly managed by the National Park Service and the Wyoming Game and Fish Department. This forced organizational partnership and the conflicting mandates of these two agencies have led to persistent conflict that seems irresolvable under the current decision-making process. To better understand the decision-making process and participant perspectives, we reviewed management documents, technical literature, and newspaper articles, and interviewed 35 key participants in this case. We used these data to analyze and appraise the adequacy of the decision-making process for the park elk hunt and to ask whether it reflects the common interest. We found deficiencies in all functions of the decision-making process. Neither the decisions made nor the process itself include diverse perspectives, nor do they attend to valid and appropriate participant concerns. Agency officials focus their attention on technical rather than procedural concerns, which largely obfuscates the underlying tension in the joint inter-jurisdictional management arrangement and ultimately contributes to the hunt's annual implementation to the detriment of the common interest. We offer specific yet widely applicable recommendations to better approximate an inclusive and democratic decision-making process that serves the community's common interests.

Multi-objective evolutionary optimization for the joint operation of reservoirs of water supply under water-food-energy nexus management

NASA Astrophysics Data System (ADS)

Uen, T. S.; Tsai, W. P.; Chang, F. J.; Huang, A.

2016-12-01

In recent years, urbanization had a great effect on the growth of population and the resource management scheme of water, food and energy nexus (WFE nexus) in Taiwan. Resource shortages of WFE become a long-term and thorny issue due to the complex interactions of WFE nexus. In consideration of rapid socio-economic development, it is imperative to explore an efficient and practical approach for WFE resources management. This study aims to search the optimal solution to WFE nexus and construct a stable water supply system for multiple stakeholders. The Shimen Reservoir and Feitsui Reservoir in northern Taiwan are chosen to conduct the joint operation of the two reservoirs for water supply. This study intends to achieve water resource allocation from the two reservoirs subject to different operating rules and restrictions of resource allocation. The multi-objectives of the joint operation aim at maximizing hydro-power synergistic gains while minimizing water supply deficiency as well as food shortages. We propose to build a multi-objective evolutionary optimization model for analyzing the hydro-power synergistic gains to suggest the most favorable solutions in terms of tradeoffs between WFE. First, this study collected data from two reservoirs and Taiwan power company. Next, we built a WFE nexus model based on system dynamics. Finally, this study optimized the joint operation of the two reservoirs and calculated the synergy of hydro-power generation. The proposed methodology can tackle the complex joint reservoir operation problems. Results can suggest a reliable policy for joint reservoir operation for creating a green economic city under the lowest risks of water supply.

Does performance management affect nurses' well-being?

PubMed

Decramer, Adelien; Audenaert, Mieke; Van Waeyenberg, Thomas; Claeys, Tine; Claes, Claudia; Vandevelde, Stijn; van Loon, Jos; Crucke, Saskia

2015-04-01

This article focuses on employee performance-management practices in the healthcare sector. We specifically aim to contribute to a better understanding of the impact of employee performance-management practices on affective well-being of nurses in hospitals. Theory suggests that the features of employee-performance management (planning and evaluation of individual performances) predict affective well-being (in this study: job satisfaction and affective commitment). Performance-management planning and evaluation and affective well-being were drawn from a survey of nurses at a Flemish hospital. Separate estimations were performed for different aspects of affective well-being. Performance planning has a negative effect on job satisfaction of nurses. Both vertical alignment and satisfaction with the employee performance-management system increase the affective well-being of nurses; however, the impact of vertical alignment differs for different aspects of affective well-being (i.e. job satisfaction and affective commitment). Performance-management planning and evaluation of nurses are associated with attitudinal outcomes. The results indicate that employee performance-management features have different impacts on different aspects of well-being. Copyright © 2014 Elsevier Ltd. All rights reserved.

Joint Exercise Program: DOD Needs to Take Steps to Improve the Quality of Funding Data

DTIC Science & Technology

2017-02-01

technology systems—the Joint Training Information Management System (JTIMS) and the Execution Management System—to manage the execution of the Joint...Exercise Program, but does not have assurance that funding execution data in the Execution Management System are reliable. JTIMS is the system of record...for the Joint Exercise Program that combatant commanders use to plan and manage their joint training exercises. GAO observed significant variation

Joint power and kinematics coordination in load carriage running: Implications for performance and injury.

PubMed

Liew, Bernard X W; Morris, Susan; Netto, Kevin

2016-06-01

Investigating the impact of incremental load magnitude on running joint power and kinematics is important for understanding the energy cost burden and potential injury-causative mechanisms associated with load carriage. It was hypothesized that incremental load magnitude would result in phase-specific, joint power and kinematic changes within the stance phase of running, and that these relationships would vary at different running velocities. Thirty-one participants performed running while carrying three load magnitudes (0%, 10%, 20% body weight), at three velocities (3, 4, 5m/s). Lower limb trajectories and ground reaction forces were captured, and global optimization was used to derive the variables. The relationships between load magnitude and joint power and angle vectors, at each running velocity, were analyzed using Statistical Parametric Mapping Canonical Correlation Analysis. Incremental load magnitude was positively correlated to joint power in the second half of stance. Increasing load magnitude was also positively correlated with alterations in three dimensional ankle angles during mid-stance (4.0 and 5.0m/s), knee angles at mid-stance (at 5.0m/s), and hip angles during toe-off (at all velocities). Post hoc analyses indicated that at faster running velocities (4.0 and 5.0m/s), increasing load magnitude appeared to alter power contribution in a distal-to-proximal (ankle→hip) joint sequence from mid-stance to toe-off. In addition, kinematic changes due to increasing load influenced both sagittal and non-sagittal plane lower limb joint angles. This study provides a list of plausible factors that may influence running energy cost and injury risk during load carriage running. Copyright © 2016 Elsevier B.V. All rights reserved.

Multidisciplinary approaches to managing osteoarthritis in multiple joint sites: a systematic review.

PubMed

Finney, Andrew; Healey, Emma; Jordan, Joanne L; Ryan, Sarah; Dziedzic, Krysia S

2016-07-08

The National Institute for Health and Care Excellence's Osteoarthritis (OA) guidelines recommended that future research should consider the benefits of combination therapies in people with OA across multiple joint sites. However, the clinical effectiveness of such approaches to OA management is unknown. This systematic review therefore aimed to identify the clinical and cost effectiveness of multidisciplinary approaches targeting multiple joint sites for OA in primary care. A systematic review of randomised controlled trials. Computerised bibliographic databases were searched (MEDLINE, EMBASE, CINAHL, PsychINFO, BNI, HBE, HMIC, AMED, Web of Science and Cochrane). Studies were included if they met the following criteria; a randomised controlled trial (RCT), a primary care population with OA across at least two different peripheral joint sites (multiple joint sites), and interventions undertaken by at least two different health disciplines (multidisciplinary). The Cochrane 'Risk of Bias' tool and PEDro were used for quality assessment of eligible studies. Clinical and cost effectiveness was determined by extracting and examining self-reported outcomes for pain, function, quality of life (QoL) and health care utilisation. The date range for the search was from database inception until August 2015. The search identified 1148 individual titles of which four were included in the review. A narrative review was conducted due to the heterogeneity of the included trials. Each of the four trials used either educational or exercise interventions facilitated by a range of different health disciplines. Moderate clinical benefits on pain, function and QoL were reported across the studies. The beneficial effects of exercise generally decreased over time within all studies. Two studies were able to show a reduction in healthcare utilisation due to a reduction in visits to a physiotherapist or a reduction in x-rays and orthopaedic referrals. The intervention that showed the most

Joint Polar Satellite System (JPSS) Common Ground System (CGS) Architecture Overview and Technical Performance Measures

NASA Astrophysics Data System (ADS)

Grant, K. D.; Johnson, B. R.; Miller, S. W.; Jamilkowski, M. L.

2014-12-01

The National Oceanic and Atmospheric Administration (NOAA) and National Aeronautics and Space Administration (NASA) are jointly acquiring the next-generation civilian weather and environmental satellite system: the Joint Polar Satellite System (JPSS). The Joint Polar Satellite System will replace the afternoon orbit component and ground processing system of the current Polar-orbiting Operational Environmental Satellites (POES) managed by NOAA. The JPSS satellites will carry a suite of sensors designed to collect meteorological, oceanographic, climatological and geophysical observations of the Earth. The ground processing system for JPSS is known as the JPSS Common Ground System (JPSS CGS). Developed and maintained by Raytheon Intelligence, Information and Services (IIS), the CGS is a multi-mission enterprise system serving NOAA, NASA and their national and international partners. The CGS provides a wide range of support to a number of missions. Originally designed to support S-NPP and JPSS, the CGS has demonstrated its scalability and flexibility to incorporate all of these other important missions efficiently and with minimal cost, schedule and risk, while strengthening global partnerships in weather and environmental monitoring. The CGS architecture will be upgraded to Block 2.0 in 2015 to satisfy several key objectives, including: "operationalizing" S-NPP, which had originally been intended as a risk reduction mission; leveraging lessons learned to date in multi-mission support; taking advantage of newer, more reliable and efficient technologies; and satisfying new requirements and constraints due to the continually evolving budgetary environment. To ensure the CGS meets these needs, we have developed 48 Technical Performance Measures (TPMs) across 9 categories: Data Availability, Data Latency, Operational Availability, Margin, Scalability, Situational Awareness, Transition (between environments and sites), WAN Efficiency, and Data Recovery Processing. This

New Directives in School Performance: The Legislature as Advocate and Guarantor. Report of the Joint Committee on School Performance to the Seventeenth Alaska Legislature.

ERIC Educational Resources Information Center

Alaska State Legislature, Juneau.

In its enabling legislation, the Alaska Joint Committee on School Performance was instructed to identify and recommend those subjects for priority legislative attention that might lead to improved school performance. The Committee's study found that inadequate school performance can be attributed to the following needs: (1) stricter school…

Evaluation of narrow transverse contraction joints in jointed plain concrete pavements.

DOT National Transportation Integrated Search

2006-03-01

This report presents the results of a research project conducted at the Louisiana Transportation Research Center (LTRC) to evaluate the performance of narrow transverse contraction joints to control cracking in jointed plain concrete pavements. In ad...

National Guard Bureau Joint Staff

Science.gov Websites

, Publications Management, Administrative Services, Joint Staff Information Data Systems, Property Book -7 J-8 Personal Staff Inspector General Judge Advocate General Officer Management Public Affairs Executive Support Services Legislative Liaison Special Staff Directorate of Management Office of the Provost

Joint Ventures: The Promise, Power and Performance of Partnering.

ERIC Educational Resources Information Center

Francisco, Grace; Hannah, Kathryn Covier; Keller, Shelly G.; Waters, Joan; Wong, Patricia M. Y.

This document provides case studies that represent a sampling of successful public library joint ventures in California and other U.S. cities and counties. Chapter 1 defines what a partnership is and how a joint venture differs from a partnership. It also describes the benefits of partnering, the knowledge, attitude, and skills required, and how…

Comparison of the use of notched wedge joints vs. traditional butt joints in Connecticut

DOT National Transportation Integrated Search

2008-11-07

Performance of Hot Mix Asphalt (HMA) longitudinal joints have been an item of increasing scrutiny in : Connecticut. The traditional butt joint has typically been the method used in Connecticut. These joints : have been reportedly opening up, creating...

Alloplastic total temporomandibular joint replacements: do they perform like natural joints? Prospective cohort study with a historical control.

PubMed

Wojczyńska, A; Leiggener, C S; Bredell, M; Ettlin, D A; Erni, S; Gallo, L M; Colombo, V

2016-10-01

The aim of this study was to qualitatively and quantitatively describe the biomechanics of existing total alloplastic reconstructions of temporomandibular joints (TMJ). Fifteen patients with unilateral or bilateral TMJ total joint replacements and 15 healthy controls were evaluated via dynamic stereometry technology. This non-invasive method combines three-dimensional imaging of the subject's anatomy with jaw tracking. It provides an insight into the patient's jaw joint movements in real time and provides a quantitative evaluation. The patients were also evaluated clinically for jaw opening, protrusive and laterotrusive movements, pain, interference with eating, and satisfaction with the joint replacements. The qualitative assessment revealed that condyles of bilateral total joint replacements displayed similar basic motion patterns to those of unilateral prostheses. Quantitatively, mandibular movements of artificial joints during opening, protrusion, and laterotrusion were all significantly shorter than those of controls. A significantly restricted mandibular range of motion in replaced joints was also observed clinically. Fifty-three percent of patients suffered from chronic pain at rest and 67% reported reduced chewing function. Nonetheless, patients declared a high level of satisfaction with the replacement. This study shows that in order to gain a comprehensive understanding of complex therapeutic measures, a multidisciplinary approach is needed. Copyright © 2016 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

The association between physical characteristics of the ankle joint and the mobility performance in elderly people with type 2 diabetes mellitus.

PubMed

Ng, Thomas Ka-Wai; Lo, Sing-Kai; Cheing, Gladys Lai-Ying

2014-01-01

Previous studies showed that older adults with diabetes have a worse mobility performance as compared with those without diabetes. Studies also demonstrated that older adults with diabetes have weakened ankle muscle strength, reduced joint range in ankle dorsiflexion and worsened ankle joint proprioception as compared with control population. The purpose of the present study was to examine the relationship between the physical characteristics of the ankle joint and the mobility performance in older adults with type 2 diabetes. Older adults with type 2 diabetes (n=85) were recruited, and Timed Up and Go test (TUG) for mobility assessment was performed. Active ankle joint repositioning test was used for assessing the ankle joint proprioception sense; peak torque of ankle dorsiflexors and plantar flexors were tested by using a Cybex Norm dynamometer, and weight-bearing lunge test (WBLT) was used for assessing the stiffness of ankle dorsiflexion. Our results showed that age, body mass index (BMI), normalized peak torque of plantar flexors and dorsiflexors, active ankle joint repositioning test errors and the WBLT distance were significantly correlated with the TUG (all p<0.001). These ankle characteristics, together with the demographic data of the subjects, contributed 59.9% of the variance in the TUG by multiple regression analysis. Body mass, ankle plantar flexors strength and ankle joint proprioception are important factors contributing to the physical mobility of the older adults with type 2 diabetes. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

2000 Worldwide Joint Lessons Learned Conference. Forging a Future Joint Lessons Learned System. (Joint Center for Lessons Learned Special Bulletin. Volume 3, Special Issue 1, January 2001)

DTIC Science & Technology

2001-01-01

Management System (JTIMS) followed, and generated spirited discussion regarding the respective roles of JTIMS and the JLLP. The discussion concluded...waiting for the Director, Joint Staff�s signature and should be in official distribution by January 2001. An update on the Joint Training Information

75 FR 39244 - Arizona Public Service Company, Sequent Energy Management, L.P.; Notice of Joint Petition for...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-08

... DEPARTMENT OF ENERGY Federal Energy Regulatory Commission [Docket No. PR10-45-000] Arizona Public Service Company, Sequent Energy Management, L.P.; Notice of Joint Petition for Clarification, or in the Alternative, Request for Limited Waiver June 30, 2010. Take notice that on June 25, 2010, Arizona Public...

Joint Strength Control at the Fiber/Matrix Interface during the Production of Polymer Composite Materials Reinforced with High Performance Fibers

NASA Astrophysics Data System (ADS)

Kudinov, Vladimir V.; Korneeva, Natalia V.

2010-06-01

The paper presents the results obtained in the study of the joint strength between polymer matrix and high performance polyethylene fiber. The fiber/matrix joints simulate the unit cell of the fiber-reinforced composite materials. Effect of heat treatment on the composite properties at the interface was estimated by a multifilament wet-pull-out method. It was found that the joint strength may be increased with the help of extra heart treatment. Both the energy to peak load and the energy to failure for CM joints at various stages of loading were determined.

5 CFR 430.304 - SES performance management systems.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 5 Administrative Personnel 1 2011-01-01 2011-01-01 false SES performance management systems. 430.304 Section 430.304 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PERFORMANCE MANAGEMENT Managing Senior Executive Performance § 430.304 SES performance management systems. (a...

A Modelling Method of Bolt Joints Based on Basic Characteristic Parameters of Joint Surfaces

NASA Astrophysics Data System (ADS)

Yuansheng, Li; Guangpeng, Zhang; Zhen, Zhang; Ping, Wang

2018-02-01

Bolt joints are common in machine tools and have a direct impact on the overall performance of the tools. Therefore, the understanding of bolt joint characteristics is essential for improving machine design and assembly. Firstly, According to the experimental data obtained from the experiment, the stiffness curve formula was fitted. Secondly, a finite element model of unit bolt joints such as bolt flange joints, bolt head joints, and thread joints was constructed, and lastly the stiffness parameters of joint surfaces were implemented in the model by the secondary development of ABAQUS. The finite element model of the bolt joint established by this method can simulate the contact state very well.

Arthroscopic evaluation and management after repeated luxatio erecta of the glenohumeral joint.

PubMed

Tracy, Sean C; Myer, Jonathan J

2009-05-01

Luxatio erecta, inferior dislocation of the glenohumeral joint, is a relatively rare type of glenohumeral dislocation, accounting for <0.5% of all shoulder dislocations. It has been well described in terms of presentation and conservative management. Arthroscopic findings after the more commonly found anteroinferior glenohumeral dislocation have also been described. However, we know of only 1 case report that details the arthroscopic findings and open surgical management in a patient who sustained a single episode of luxatio erecta. Additionally, we were unable to find any reports in the literature of the arthroscopic management of this type of dislocation. We present the arthroscopic findings and arthroscopic management of an 18-year-old male college football player who reported 7 episodes of left shoulder luxatio erecta. Arthroscopic evaluation revealed an extensive anterior capsulolabral injury as well as a superior labrum anteroposterior (SLAP) tear. Additionally, there were extensive articular cartilage changes of the anterosuperior glenoid, a posterior Hill-Sachs lesion, and an anterosuperior humeral head cartilage indentation. The anterior capsulolabral injury and the SLAP lesion were fixed arthroscopically with suture anchors. The remainder of the lesions were debrided. The patient was able to return to college-level football and reported no further episodes of instability, pain, or stiffness at 3-year follow-up.

Periprosthetic Joint Infections: Clinical and Bench Research

PubMed Central

Legout, Laurence; Senneville, Eric

2013-01-01

Prosthetic joint infection is a devastating complication with high morbidity and substantial cost. The incidence is low but probably underestimated. Despite a significant basic and clinical research in this field, many questions concerning the definition of prosthetic infection as well the diagnosis and the management of these infections remained unanswered. We review the current literature about the new diagnostic methods, the management and the prevention of prosthetic joint infections. PMID:24288493

Temporal gene expression profiling of the rat knee joint capsule during immobilization-induced joint contractures.

PubMed

Wong, Kayleigh; Sun, Fangui; Trudel, Guy; Sebastiani, Paola; Laneuville, Odette

2015-05-26

Contractures of the knee joint cause disability and handicap. Recovering range of motion is recognized by arthritic patients as their preference for improved health outcome secondary only to pain management. Clinical and experimental studies provide evidence that the posterior knee capsule prevents the knee from achieving full extension. This study was undertaken to investigate the dynamic changes of the joint capsule transcriptome during the progression of knee joint contractures induced by immobilization. We performed a microarray analysis of genes expressed in the posterior knee joint capsule following induction of a flexion contracture by rigidly immobilizing the rat knee joint over a time-course of 16 weeks. Fold changes of expression values were measured and co-expressed genes were identified by clustering based on time-series analysis. Genes associated with immobilization were further analyzed to reveal pathways and biological significance and validated by immunohistochemistry on sagittal sections of knee joints. Changes in expression with a minimum of 1.5 fold changes were dominated by a decrease in expression for 7732 probe sets occurring at week 8 while the expression of 2251 probe sets increased. Clusters of genes with similar profiles of expression included a total of 162 genes displaying at least a 2 fold change compared to week 1. Functional analysis revealed ontology categories corresponding to triglyceride metabolism, extracellular matrix and muscle contraction. The altered expression of selected genes involved in the triglyceride biosynthesis pathway; AGPAT-9, and of the genes P4HB and HSP47, both involved in collagen synthesis, was confirmed by immunohistochemistry. Gene expression in the knee joint capsule was sensitive to joint immobility and provided insights into molecular mechanisms relevant to the pathophysiology of knee flexion contractures. Capsule responses to immobilization was dynamic and characterized by modulation of at least three

Comparative effectiveness of open versus minimally invasive sacroiliac joint fusion

PubMed Central

Ledonio, Charles GT; Polly, David W; Swiontkowski, Marc F; Cummings, John T

2014-01-01

Background The mainstay of sacroiliac joint disruption/degenerative sacroiliitis therapy has been nonoperative management. This nonoperative management often includes a regimen of physical therapy, chiropractic treatment, therapeutic injections, and possibly radiofrequency ablation at the discretion of the treating physician. When these clinical treatments fail, sacroiliac joint fusion has been recommended as the standard treatment. Open and minimally invasive (MIS) surgical techniques are typical procedures. This study aims to compare the perioperative measures and Oswestry Disability Index (ODI) outcomes associated with each of these techniques. Methods A comparative retrospective chart review of patients with sacroiliac joint fusion and a minimum of 1 year of follow-up was performed. Perioperative measures and ODI scores were compared using the Fisher’s exact test and two nonparametric tests, ie, the Mann–Whitney U test and the Wilcoxon signed-rank test. The results are presented as percent or median with range, as appropriate. Results Forty-nine patients from two institutions underwent sacroiliac joint fusion between 2006 and 2012. Ten patients were excluded because of incomplete data, leaving 39 evaluable patients, of whom 22 underwent open and 17 underwent MIS sacroiliac joint fusion. The MIS group was significantly older (median age 66 [39–82] years) than the open group (median age 51 [34–74] years). Surgical time and hospital stay were significantly shorter in the MIS group than in the open group. Preoperative ODI was significantly greater in the open group (median 64 [44–78]) than in the MIS group (median 53 [14–84]). Postoperative improvement in ODI was statistically significant within and between groups, with MIS resulting in greater improvement. Conclusion The open and MIS sacroiliac joint fusion techniques resulted in statistically and clinically significant improvement for patients with degenerative sacroiliitis refractory to nonoperative

A joint labor-management hazard communication training program: a case study in worker health and safety training.

PubMed

Robins, T G; Hugentobler, M K; Kaminski, M; Klitzman, S

1994-01-01

The 1983 OSHA Hazard Communication Standard requires training of employees exposed to hazardous chemicals. The authors provide a detailed look at the successes and failures of a joint labor-management training program that was designed to bring a firm with more than 50 manufacturing facilities into compliance with the standard.

Measuring, managing and maximizing refinery performance

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bascur, O.A.; Kennedy, J.P.

1996-01-01

Implementing continuous quality improvement is a confluence of total quality management, people empowerment, performance indicators and information engineering. Supporting information technologies allow a refiner to narrow the gap between management objectives and the process control level. Dynamic performance monitoring benefits come from production cost savings, improved communications and enhanced decision making. A refinery workgroup information flow model helps automate continuous improvement of processes, performance and the organization. The paper discusses the rethinking of refinery operations, dynamic performance monitoring, continuous process improvement, the knowledge coordinator and repository manager, an integrated plant operations workflow, and successful implementation.

Performance of bolted closure joint elastomers under cask aging conditions

DOE Office of Scientific and Technical Information (OSTI.GOV)

Verst, C.; Sindelar, R.; Skidmore, E.

The bolted closure joint of a bare spent fuel cask is susceptible to age-related degradation and potential loss of confinement function under long-term storage conditions. Elastomeric seals, a component of the joint typically used to facilitate leak testing of the primary seal that includes the metallic seal and bolting, is susceptible to degradation over time by several mechanisms, principally via thermo-oxidation, stress-relaxation, and radiolytic degradation under time and temperature condition. Irradiation and thermal exposure testing and evaluation of an ethylene-propylene diene monomer (EPDM) elastomeric seal material similar to that used in the CASTOR® V/21 cask for a matrix of temperaturemore » and radiation exposure conditions relevant to the cask extended storage conditions, and development of semiempirical predictive models for loss of sealing force is in progress. A special insert was developed to allow Compressive Stress Relaxation (CSR) measurements before and after the irradiation and/or thermal exposure without unloading the elastomer. A condition of the loss of sealing force for the onset of leakage was suggested. The experimentation and modeling being performed could enable acquisition of extensive coupled aging data as well as an estimation of the timeframe when loss of sealing function under aging (temperature/radiation) conditions may occur.« less

Spectral unmixing of agents on surfaces for the Joint Contaminated Surface Detector (JCSD)

NASA Astrophysics Data System (ADS)

Slamani, Mohamed-Adel; Chyba, Thomas H.; LaValley, Howard; Emge, Darren

2007-09-01

ITT Corporation, Advanced Engineering and Sciences Division, is currently developing the Joint Contaminated Surface Detector (JCSD) technology under an Advanced Concept Technology Demonstration (ACTD) managed jointly by the U.S. Army Research, Development, and Engineering Command (RDECOM) and the Joint Project Manager for Nuclear, Biological, and Chemical Contamination Avoidance for incorporation on the Army's future reconnaissance vehicles. This paper describes the design of the chemical agent identification (ID) algorithm associated with JCSD. The algorithm detects target chemicals mixed with surface and interferent signatures. Simulated data sets were generated from real instrument measurements to support a matrix of parameters based on a Design Of Experiments approach (DOE). Decisions based on receiver operating characteristics (ROC) curves and area-under-the-curve (AUC) measures were used to down-select between several ID algorithms. Results from top performing algorithms were then combined via a fusion approach to converge towards optimum rates of detections and false alarms. This paper describes the process associated with the algorithm design and provides an illustrating example.

Radiologic Analysis and Clinical Study of the Upper One-third Joint Technique for Fluoroscopically Guided Sacroiliac Joint Injection.

PubMed

Park, Junghyun; Park, Hue Jung; Moon, Dong Eon; Sa, Gye Jeol; Kim, Young Hoon

2015-01-01

Sacroiliac intraarticular injection by the traditional technique can be challenging to perform when the joint is covered with osteophytes or is extremely narrow. To examine whether there is enough space for the needle to be advanced from the L5-S1 interspinous space to the upper one-third sacroiliac joint (SIJ) by magnetic resonance image (MRI) analysis as an alternative to fluoroscopically guided SIJ injection with the lower one-third joint technique, and to determine the feasibility of this novel technique in clinical practice. MRI analysis and observational study. An interventional pain management practice at a university hospital. We analyzed 200 axial T2-weighted MRIs between the L5 and S1 vertebrae of 100 consecutive patients. The following measurements were obtained on both sides: 1) the thickness of fat in the midline; 2) the distance between the midline (Point C) and the junction (Point A) of the skin and the imaginary line that connects the SIJ and the most medial cortex of the ilium; 3) the distance between the midline (Point C) and the junction (Point B) of the skin and the imaginary line that connects the SIJ and the L5 spinous process; 4) the distance between the SIJ and midline (Point C) on the skin, or between the SIJ and the midpoint (Point C') of the line from Point A to Point B; and 5) the angle between the sagittal line and the imaginary line that connects the SIJ and the midline on the skin. The upper one-third joint technique was performed to establish the feasibility of the alternative technique in 20 patients who had unsuccessful sacroiliac intraarticular injections using the lower one-third joint technique. The mean distances from the midline to Point A and to Point B were 21.9 ± 13.7 mm and 27.8 ± 13.6 mm, respectively. The mean distance between the SIJ and Point C (or Point C') was 81.0 ± 13.3 mm. The angle between the sagittal line and the imaginary line that connects the SIJ and the midline on the skin was 42.8 ± 5.1°. The success

Use of an elastic transarticular external fixator construct for immobilization of the elbow joint

PubMed Central

Vedrine, Bertrand

2017-01-01

Transarticular external skeletal fixation usually involves rigid bars that result in a stable but stiff joint. This study describes the technique and the outcome of an elastic transarticular external fixator (ETEF) applied to the elbow joint. Four cases of elbow luxation with collateral ligament injuries were managed with closed reduction and application of an ETEF to maintain the reduction. A triceps tendon avulsion was surgically managed before applying an ETEF. The clinical outcome was considered excellent in 2 cats, good in 2 dogs (1 elbow luxation and the avulsion of the triceps tendon), and poor in 1 dog presented for elbow luxation and a permanent neurological defect. The procedure was rapid, easy to perform, and inexpensive. All animals except the one with a neurological defect had an early return to weight bearing. This method maintains extension of the joint while permitting its motion thereby promoting rehabilitation. PMID:28373726

Use of an elastic transarticular external fixator construct for immobilization of the elbow joint.

PubMed

Vedrine, Bertrand

2017-04-01

Transarticular external skeletal fixation usually involves rigid bars that result in a stable but stiff joint. This study describes the technique and the outcome of an elastic transarticular external fixator (ETEF) applied to the elbow joint. Four cases of elbow luxation with collateral ligament injuries were managed with closed reduction and application of an ETEF to maintain the reduction. A triceps tendon avulsion was surgically managed before applying an ETEF. The clinical outcome was considered excellent in 2 cats, good in 2 dogs (1 elbow luxation and the avulsion of the triceps tendon), and poor in 1 dog presented for elbow luxation and a permanent neurological defect. The procedure was rapid, easy to perform, and inexpensive. All animals except the one with a neurological defect had an early return to weight bearing. This method maintains extension of the joint while permitting its motion thereby promoting rehabilitation.

Relationship between time management in construction industry and project management performance

NASA Astrophysics Data System (ADS)

Nasir, Najuwa; Nawi, Mohd Nasrun Mohd; Radzuan, Kamaruddin

2016-08-01

Nowadays, construction industry particularly in Malaysia struggle in achieving status of eminent time management for construction project. Project managers have a great responsibility to keep the project success under time of project completion. However, studies shows that delays especially in Malaysian construction industry still unresolved due to weakness in managing the project. In addition, quality of time management on construction projects is generally poor. Due to the progressively extended delays issue, time performance becomes an important subject to be explored to investigate delay factors. The method of this study is review of literature towards issues in construction industry which affecting time performance of project in general by focusing towards process involved for project management. Based on study, it was found that knowledge, commitment, cooperation are the main criteria as an overall to manage the project into a smooth process during project execution until completion. It can be concluded that, the strength between project manager and team members in these main criteria while conducting the project towards good time performance is highly needed. However, there is lack of establishment towards factors of poor time performance which strongly related with project management. Hence, this study has been conducted to establish factors of poor time performance and its relations with project management.

Impact extractive fracture of jointed steel plates of a bolted joint

NASA Astrophysics Data System (ADS)

Daimaruya, M.; Fujiki, H.; Ambarita, H.

2012-08-01

This study is concerned with the development of a fracture criterion for the impact fracture of jointed steel plates of a bolted joint used in a car body. For the accurate prediction of crash characteristics of car bodies by computer-aided engineering (CAE), it is also necessary to examine the behavior and fracture of jointed steel plates subjected to impact loads. Although the actual impact fracture of jointed steel plates of a bolted joint used in cars is complicated, for simplifying the problem it might be classified into the shear fracture and the extractive fracture of jointed steel plates. Attention is given to the extractive fracture of jointed steel plates in this study. The extractive behavior and fracture of three kinds of steel plates used for cars are examined in experiments and numerical simulations. The impact extraction test of steel plates jointed by a bolt is performed using the one-bar method, together with the static test. In order to understand the mechanism of extractive fracture process of jointed steel plates, numerical simulations by a FEM code LS-DYNA are also carried out. The obtained results suggest that a stress-based fracture criterion may be developed for the impact extractive fracture of jointed steel plates of a bolted joint used in a car body.

Excellence in School Performance: The Role of the Legislature. A Report of the Joint House-Senate Committee on School Performance to the Sixteenth Alaska Legislature.

ERIC Educational Resources Information Center

Alaska State Legislature, Juneau.

Alaskans are increasingly dissatisfied with the performance of their schools. Many students are poorly educated, have low self-esteem, and suffer other social problems. The Alaskan Joint House-Senate Committee on School Performance was created to set priorities for ways to improve school performance. The committee was guided by three basic…

Motivation, Management, and Performance.

ERIC Educational Resources Information Center

Olmstead, Joseph A.

There is an increasing interest today in the ways in which human motivation contributes to the productivity and performance of personnel. This early study of motivation management emphasizes that the organizational environment is a principal determinant of the quality of employee motivation. Concrete considerations in the management of motivation…

Minimally invasive arthrodesis for chronic sacroiliac joint dysfunction using the SImmetry SI Joint Fusion system.

PubMed

Miller, Larry E; Block, Jon E

2014-01-01

Chronic sacroiliac (SI) joint-related low back pain (LBP) is a common, yet under-diagnosed and undertreated condition due to difficulties in accurate diagnosis and highly variable treatment practices. In patients with debilitating SI-related LBP for at least 6 months duration who have failed conservative management, arthrodesis is a viable option. The SImmetry(®) SI Joint Fusion System is a novel therapy for SI joint fusion, not just fixation, which utilizes a minimally invasive surgical approach, instrumented fixation for immediate stability, and joint preparation with bone grafting for a secure construct in the long term. The purpose of this report is to describe the minimally invasive SI Joint Fusion System, including patient selection criteria, implant characteristics, surgical technique, postoperative recovery, and biomechanical testing results. Advantages and limitations of this system will be discussed.

Randomized Controlled Trial of Minimally Invasive Sacroiliac Joint Fusion Using Triangular Titanium Implants vs Nonsurgical Management for Sacroiliac Joint Dysfunction: 12-Month Outcomes

PubMed Central

Polly, David W.; Wine, Kathryn D.; Whang, Peter G.; Frank, Clay J.; Harvey, Charles F.; Lockstadt, Harry; Glaser, John A.; Limoni, Robert P.; Sembrano, Jonathan N.

2015-01-01

BACKGROUND: Sacroiliac joint (SIJ) dysfunction is a prevalent cause of chronic, unremitting lower back pain. OBJECTIVE: To concurrently compare outcomes after surgical and nonsurgical treatment for chronic SIJ dysfunction. METHODS: A total of 148 subjects with SIJ dysfunction were randomly assigned to minimally invasive SIJ fusion with triangular titanium implants (n = 102) or nonsurgical management (n = 46). Pain, disability, and quality-of-life scores were collected at baseline and at 1, 3, 6, and 12 months. Success rates were compared using Bayesian methods. Crossover from nonsurgical to surgical care was allowed after the 6-month study visit was complete. RESULTS: Six-month success rates were higher in the surgical group (81.4% vs 26.1%; posterior probability of superiority > 0.9999). Clinically important (≥ 15 point) Oswestry Disability Index improvement at 6 months occurred in 73.3% of the SIJ fusion group vs 13.6% of the nonsurgical management group (P < .001). At 12 months, improvements in SIJ pain and Oswestry Disability Index were sustained in the surgical group. Subjects who crossed over had improvements in pain, disability, and quality of life similar to those in the original surgical group. Adverse events were slightly more common in the surgical group (1.3 vs 1.1 events per subject; P = .31). CONCLUSION: This Level 1 study showed that minimally invasive SIJ fusion using triangular titanium implants was more effective than nonsurgical management at 1 year in relieving pain, improving function, and improving quality of life in patients with SIJ dysfunction caused by degenerative sacroiliitis or SIJ disruptions. Pain, disability, and quality of life also improved after crossover from nonsurgical to surgical treatment. ABBREVIATIONS: EQ-5D, EuroQoL-5D INSITE, Investigation of Sacroiliac Fusion Treatment MCS, mental component summary NSM, nonsurgical management ODI, Oswestry Disability Index PCS, physical component summary RFA, radiofrequency ablation SF

Distraction osteogenesis for management of obstructive sleep apnoea in temporomandibular joint ankylosis patients before the release of joint.

PubMed

Yadav, Rahul; Bhutia, Ongkila; Shukla, Garima; Roychoudhury, Ajoy

2014-07-01

To evaluate the effects of distraction osteogenesis in management of obstructive sleep apnoea patients secondary to temporomandibular joints ankylosis. Fifteen patients were included in study. Preoperatively the patients were worked up for polysomnography and CT scans. Only those patients with Apnoea-hypopnoea index >15 events/h denoting moderate to severe obstructive sleep apnoea were included in the study. Distraction osteogenesis was followed with 5 days latency period in adult patients and 0 days for children. Rate of distraction was 1 mm/day for adults and 2 mm/day for children till the mandibular incisors were in reverse overjet. After 3 months post distraction assessment was done using polysomnography and CT scan. TMJ ankylosis was released by doing gap arthroplasty after distraction osteogenesis. Post distraction improvement was seen in clinical features of OSA like daytime sleepiness and snoring. Epworth sleepiness scale improved from a mean of 10.25 to 2.25. Polysomnographic analysis also showed improvement in all cases with apnoea-hypopnoea index from 57.03 to 6.67 per hour. Lowest oxygen saturation improved from 64.47% to 81.20% and average minimum oxygen saturation improved from 92.17% to 98.19%. Body mass index improved from a mean of 18.26 to 21.39 kg/m2. Distraction osteogenesis is a stable and beneficial treatment option for temporomandibular joint ankylosis patients with obstructive sleep apnoea. Copyright © 2013 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Understanding performance management in primary care.

PubMed

Rogan, Lisa; Boaden, Ruth

2017-02-13

Purpose Principal-agent theory (PAT) has been used to understand relationships among different professional groups and explain performance management between organisations, but is rarely used for research within primary care. The purpose of this paper is to explore whether PAT can be used to attain a better understanding of performance management in primary care. Design/methodology/approach Purposive sampling was used to identify a range of general practices in the North-west of England. Interviews were carried out with directors, managers and clinicians in commissioning and regional performance management organisations and within general practices, and the data analysed using matrix analysis techniques to produce a case study of performance management. Findings There are various elements of the principal-agent framework that can be applied in primary care. Goal alignment is relevant, but can only be achieved through clear, strategic direction and consistent interpretation of objectives at all levels. There is confusion between performance measurement and performance management and a tendency to focus on things that are easy to measure whilst omitting aspects of care that are more difficult to capture. Appropriate use of incentives, good communication, clinical engagement, ownership and trust affect the degree to which information asymmetry is overcome and goal alignment achieved. Achieving the right balance between accountability and clinical autonomy is important to ensure governance and financial balance without stifling innovation. Originality/value The principal-agent theoretical framework can be used to attain a better understanding of performance management in primary care; although it is likely that only partial goal alignment will be achieved, dependent on the extent and level of alignment of a range of factors.

Running stability is enhanced by a proximo-distal gradient in joint neuromechanical control.

PubMed

Daley, M A; Felix, G; Biewener, A A

2007-02-01

We currently know little about how animals achieve dynamic stability when running over uneven and unpredictable terrain, often characteristic of their natural environment. Here we investigate how limb and joint mechanics of an avian biped, the helmeted guinea fowl Numida meleagris, respond to an unexpected drop in terrain during running. In particular, we address how joint mechanics are coordinated to achieve whole limb dynamics. Based on muscle-tendon architecture and previous studies of steady and incline locomotion, we hypothesize a proximo-distal gradient in joint neuromechanical control. In this motor control strategy, (1) proximal muscles at the hip and knee joints are controlled primarily in a feedforward manner and exhibit load-insensitive mechanical performance, and (2) distal muscles at the ankle and tarsometatarso-phalangeal (TMP) joints are highly load-sensitive, due to intrinsic mechanical effects and rapid, higher gain proprioceptive feedback. Limb kinematics and kinetics during the unexpected perturbation reveal that limb retraction, controlled largely by the hip, remains similar to level running throughout the perturbed step, despite altered limb loading. Individual joints produce or absorb energy during both level and perturbed running steps, such that the net limb work depends on the balance of energy among the joints. The hip maintains the same mechanical role regardless of limb loading, whereas the ankle and TMP switch between spring-like or damping function depending on limb posture at ground contact. Initial knee angle sets limb posture and alters the balance of work among the joints, although the knee contributes little work itself. This distribution of joint function results in posture-dependent changes in work performance of the limb, which allow guinea fowl to rapidly produce or absorb energy in response to the perturbation. The results support the hypothesis that a proximo-distal gradient exists in limb neuromuscular performance and motor

Running stability is enhanced by a proximo-distal gradient in joint neuromechanical control

PubMed Central

Daley, M. A.; Felix, G.; Biewener, A. A.

2008-01-01

Summary We currently know little about how animals achieve dynamic stability when running over uneven and unpredictable terrain, often characteristic of their natural environment. Here we investigate how limb and joint mechanics of an avian biped, the helmeted guinea fowl Numida meleagris, respond to an unexpected drop in terrain during running. In particular, we address how joint mechanics are coordinated to achieve whole limb dynamics. Based on muscle–tendon architecture and previous studies of steady and incline locomotion, we hypothesize a proximo-distal gradient in joint neuromechanical control. In this motor control strategy, (1) proximal muscles at the hip and knee joints are controlled primarily in a feedforward manner and exhibit load-insensitive mechanical performance, and (2) distal muscles at the ankle and tarsometatarso-phalangeal (TMP) joints are highly load-sensitive, due to intrinsic mechanical effects and rapid, higher gain proprioceptive feedback. Limb kinematics and kinetics during the unexpected perturbation reveal that limb retraction, controlled largely by the hip, remains similar to level running throughout the perturbed step, despite altered limb loading. Individual joints produce or absorb energy during both level and perturbed running steps, such that the net limb work depends on the balance of energy among the joints. The hip maintains the same mechanical role regardless of limb loading, whereas the ankle and TMP switch between spring-like or damping function depending on limb posture at ground contact. Initial knee angle sets limb posture and alters the balance of work among the joints, although the knee contributes little work itself. This distribution of joint function results in posture-dependent changes in work performance of the limb, which allow guinea fowl to rapidly produce or absorb energy in response to the perturbation. The results support the hypothesis that a proximo-distal gradient exists in limb neuromuscular performance

Performance Information Management System (PIMS) Communication

DTIC Science & Technology

1992-10-15

AD-A267 040 AD 14IPR NO: 92M•2501 TITLE: PERFORMANCE INFORMATION MANAGEMENT SYSTEM (PIMS) COMMUNICATION V G ,c¶• PRINCIPAL INVESTIGATOR: Kathryn P...Performance Information Management System (PIMS) MIPR No. Communication 92MM2501 6. AUTHOR(S) Kathryn P. Winter 7. PERFORMING ORGANIZATION NAME(S) AND

Farm Management, Environment, and Weather Factors Jointly Affect the Probability of Spinach Contamination by Generic Escherichia coli at the Preharvest Stage

PubMed Central

Navratil, Sarah; Gregory, Ashley; Bauer, Arin; Srinath, Indumathi; Szonyi, Barbara; Nightingale, Kendra; Anciso, Juan; Jun, Mikyoung; Han, Daikwon; Lawhon, Sara; Ivanek, Renata

2014-01-01

The National Resources Information (NRI) databases provide underutilized information on the local farm conditions that may predict microbial contamination of leafy greens at preharvest. Our objective was to identify NRI weather and landscape factors affecting spinach contamination with generic Escherichia coli individually and jointly with farm management and environmental factors. For each of the 955 georeferenced spinach samples (including 63 positive samples) collected between 2010 and 2012 on 12 farms in Colorado and Texas, we extracted variables describing the local weather (ambient temperature, precipitation, and wind speed) and landscape (soil characteristics and proximity to roads and water bodies) from NRI databases. Variables describing farm management and environment were obtained from a survey of the enrolled farms. The variables were evaluated using a mixed-effect logistic regression model with random effects for farm and date. The model identified precipitation as a single NRI predictor of spinach contamination with generic E. coli, indicating that the contamination probability increases with an increasing mean amount of rain (mm) in the past 29 days (odds ratio [OR] = 3.5). The model also identified the farm's hygiene practices as a protective factor (OR = 0.06) and manure application (OR = 52.2) and state (OR = 108.1) as risk factors. In cross-validation, the model showed a solid predictive performance, with an area under the receiver operating characteristic (ROC) curve of 81%. Overall, the findings highlighted the utility of NRI precipitation data in predicting contamination and demonstrated that farm management, environment, and weather factors should be considered jointly in development of good agricultural practices and measures to reduce produce contamination. PMID:24509926

Advances in Proximal Interphalangeal Joint Arthroplasty: Biomechanics and Biomaterials.

PubMed

Zhu, Andy F; Rahgozar, Paymon; Chung, Kevin C

2018-05-01

Proximal interphalangeal (PIP) joint arthritis is a debilitating condition. The complexity of the joint makes management particularly challenging. Treatment of PIP arthritis requires an understanding of the biomechanics of the joint. PIP joint arthroplasty is one treatment option that has evolved over time. Advances in biomaterials have improved and expanded arthroplasty design. This article reviews biomechanics and arthroplasty design of the PIP joint. Copyright © 2018 Elsevier Inc. All rights reserved.

Cost Minimization for Joint Energy Management and Production Scheduling Using Particle Swarm Optimization

NASA Astrophysics Data System (ADS)

Shah, Rahul H.

Production costs account for the largest share of the overall cost of manufacturing facilities. With the U.S. industrial sector becoming more and more competitive, manufacturers are looking for more cost and resource efficient working practices. Operations management and production planning have shown their capability to dramatically reduce manufacturing costs and increase system robustness. When implementing operations related decision making and planning, two fields that have shown to be most effective are maintenance and energy. Unfortunately, the current research that integrates both is limited. Additionally, these studies fail to consider parameter domains and optimization on joint energy and maintenance driven production planning. Accordingly, production planning methodology that considers maintenance and energy is investigated. Two models are presented to achieve well-rounded operating strategy. The first is a joint energy and maintenance production scheduling model. The second is a cost per part model considering maintenance, energy, and production. The proposed methodology will involve a Time-of-Use electricity demand response program, buffer and holding capacity, station reliability, production rate, station rated power, and more. In practice, the scheduling problem can be used to determine a joint energy, maintenance, and production schedule. Meanwhile, the cost per part model can be used to: (1) test the sensitivity of the obtained optimal production schedule and its corresponding savings by varying key production system parameters; and (2) to determine optimal system parameter combinations when using the joint energy, maintenance, and production planning model. Additionally, a factor analysis on the system parameters is conducted and the corresponding performance of the production schedule under variable parameter conditions, is evaluated. Also, parameter optimization guidelines that incorporate maintenance and energy parameter decision making in the

Surface Modifications for Improved Wear Performance in Artificial Joints: A Review

NASA Astrophysics Data System (ADS)

Sullivan, Stacey J. L.; Topoleski, L. D. Timmie

2015-11-01

Artificial joint replacement is one of the most successful treatments for arthritis. Excellent wear and corrosion resistance, together with high strength and fracture toughness, are fundamental requirements for implant materials. Wear and/or corrosion of the materials used in artificial joints may lead to implant failure. Therefore, hard and wear-resistant materials, like cobalt-chromium-molybdenum and ceramic, are currently used as bearing surfaces. However, even using such hard materials, wear and/or corrosion related failure of artificial joints remains a central concern. One primary goal in orthopedic biomaterials research is to create more wear-resistant surfaces. Different technologies have been used to create new surfaces, or to modify existing surfaces, to prevent wear. It is the intent of this overview first to provide a summary of materials currently used as bearing surfaces in artificial joints, their functions, and their contributions to device longevity. Then, we will discuss advancements in modifying those bearing surfaces to produce more wear-resistant artificial joints.

24 CFR 904.306 - Performing management services.

Code of Federal Regulations, 2010 CFR

2010-04-01

... Performing management services. The LHA may also contract with the HBA to perform some or all of the functions of project management for which the HBA may be better suited or located than the LHA. Such... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false Performing management services. 904...

24 CFR 904.306 - Performing management services.

Code of Federal Regulations, 2014 CFR

2014-04-01

... Performing management services. The LHA may also contract with the HBA to perform some or all of the functions of project management for which the HBA may be better suited or located than the LHA. Such... 24 Housing and Urban Development 4 2014-04-01 2014-04-01 false Performing management services. 904...

24 CFR 904.306 - Performing management services.

Code of Federal Regulations, 2011 CFR

2011-04-01

... Performing management services. The LHA may also contract with the HBA to perform some or all of the functions of project management for which the HBA may be better suited or located than the LHA. Such... 24 Housing and Urban Development 4 2011-04-01 2011-04-01 false Performing management services. 904...

24 CFR 904.306 - Performing management services.

Code of Federal Regulations, 2013 CFR

2013-04-01

... Performing management services. The LHA may also contract with the HBA to perform some or all of the functions of project management for which the HBA may be better suited or located than the LHA. Such... 24 Housing and Urban Development 4 2013-04-01 2013-04-01 false Performing management services. 904...

24 CFR 904.306 - Performing management services.

Code of Federal Regulations, 2012 CFR

2012-04-01

... Performing management services. The LHA may also contract with the HBA to perform some or all of the functions of project management for which the HBA may be better suited or located than the LHA. Such... 24 Housing and Urban Development 4 2012-04-01 2012-04-01 false Performing management services. 904...

Learning from Top-Performing Managers.

ERIC Educational Resources Information Center

Brown, Paul L.

2000-01-01

Illustrates five criteria that can be used to identify the "best" managers in any organization: business results, employee attitudes, peer confirmation, upper-level manager appraisal, and customer satisfaction. Examines what top-performing managers say and do, and concludes that their thinking processes and their specific sets of skills…

Stochastic Management of Non-Point Source Contamination: Joint Impact of Aquifer Heterogeneity and Well Characteristics

NASA Astrophysics Data System (ADS)

Henri, C. V.; Harter, T.

2017-12-01

Agricultural activities are recognized as the preeminent origin of non-point source (NPS) contamination of water bodies through the leakage of nitrate, salt and agrochemicals. A large fraction of world agricultural activities and therefore NPS contamination occurs over unconsolidated alluvial deposit basins offering soil composition and topography favorable to productive farming. These basins represent also important groundwater reservoirs. The over-exploitation of aquifers coupled with groundwater pollution by agriculture-related NPS contaminant has led to a rapid deterioration of the quality of these groundwater basins. The management of groundwater contamination from NPS is challenged by the inherent complexity of aquifers systems. Contaminant transport dynamics are highly uncertain due to the heterogeneity of hydraulic parameters controlling groundwater flow. Well characteristics are also key uncertain elements affecting pollutant transport and NPS management but quantifying uncertainty in NPS management under these conditions is not well documented. Our work focuses on better understanding the joint impact of aquifer heterogeneity and pumping well characteristics (extraction rate and depth) on (1) the transport of contaminants from NPS and (2) the spatio-temporal extension of the capture zone. To do so, we generate a series of geostatistically equivalent 3D heterogeneous aquifers and simulate the flow and non-reactive solute transport from NPS to extraction wells within a stochastic framework. The propagation of the uncertainty on the hydraulic conductivity field is systematically analyzed. A sensitivity analysis of the impact of extraction well characteristics (pumping rate and screen depth) is also conducted. Results highlight the significant role that heterogeneity and well characteristics plays on management metrics. We finally show that, in case of NPS contamination, the joint impact of regional longitudinal and transverse vertical hydraulic gradients and

Performance Testing of Best Management Practices

EPA Science Inventory

The U.S. Environmental Protection Agency (EPA) lacks robust data documenting the performance of best Management practices (BMPs) regarding stormwater management, and a clear understanding of the performance changes associated with conditions. By generating these data, The Nation...

The sacroiliac joint: anatomy, physiology and clinical significance.

PubMed

Forst, Stacy L; Wheeler, Michael T; Fortin, Joseph D; Vilensky, Joel A

2006-01-01

The sacroiliac joint (SIJ) is a putative source of low back pain. The objective of this article is to provide clinicians with a concise review of SIJ structure and function, diagnostic indicators of SIJ-mediated pain, and therapeutic considerations. The SIJ is a true diarthrodial joint with unique characteristics not typically found in other diarthrodial joints. The joint differs with others in that it has fibrocartilage in addition to hyaline cartilage, there is discontinuity of the posterior capsule, and articular surfaces have many ridges and depressions. The sacroiliac joint is well innervated. Histological analysis of the sacroiliac joint has verified the presence of nerve fibers within the joint capsule and adjoining ligaments. It has been variously described that the sacroiliac joint receives its innervation from the ventral rami of L4 and L5, the superior gluteal nerve, and the dorsal rami of L5, S1, and S2, or that it is almost exclusively derived from the sacral dorsal rami. Even though the sacroiliac joint is a known putative source of low back and lower extremity pain, there are few findings that are pathognomonic of sacroiliac joint pain. The controlled diagnostic blocks utilizing the International Association for the Study of Pain (IASP) criteria demonstrated the prevalence of pain of sacroiliac joint origin in 19% to 30% of the patients suspected to have sacroiliac joint pain. Conservative management includes manual medicine techniques, pelvic stabilization exercises to allow dynamic postural control, and muscle balancing of the trunk and lower extremities. Interventional treatments include sacroiliac joint, intra-articular joint injections, radiofrequency neurotomy, prolotherapy, cryotherapy, and surgical treatment. The evidence for intra-articular injections and radiofrequency neurotomy has been shown to be limited in managing sacroiliac joint pain.

Performance management of multiple access communication networks

NASA Astrophysics Data System (ADS)

Lee, Suk; Ray, Asok

1993-12-01

This paper focuses on conceptual design, development, and implementation of a performance management tool for computer communication networks to serve large-scale integrated systems. The objective is to improve the network performance in handling various types of messages by on-line adjustment of protocol parameters. The techniques of perturbation analysis of Discrete Event Dynamic Systems (DEDS), stochastic approximation (SA), and learning automata have been used in formulating the algorithm of performance management. The efficacy of the performance management tool has been demonstrated on a network testbed. The conceptual design presented in this paper offers a step forward to bridging the gap between management standards and users' demands for efficient network operations since most standards such as ISO (International Standards Organization) and IEEE address only the architecture, services, and interfaces for network management. The proposed concept of performance management can also be used as a general framework to assist design, operation, and management of various DEDS such as computer integrated manufacturing and battlefield C(sup 3) (Command, Control, and Communications).

Minimally invasive arthrodesis for chronic sacroiliac joint dysfunction using the SImmetry SI Joint Fusion system

PubMed Central

Miller, Larry E; Block, Jon E

2014-01-01

Chronic sacroiliac (SI) joint-related low back pain (LBP) is a common, yet under-diagnosed and undertreated condition due to difficulties in accurate diagnosis and highly variable treatment practices. In patients with debilitating SI-related LBP for at least 6 months duration who have failed conservative management, arthrodesis is a viable option. The SImmetry® SI Joint Fusion System is a novel therapy for SI joint fusion, not just fixation, which utilizes a minimally invasive surgical approach, instrumented fixation for immediate stability, and joint preparation with bone grafting for a secure construct in the long term. The purpose of this report is to describe the minimally invasive SI Joint Fusion System, including patient selection criteria, implant characteristics, surgical technique, postoperative recovery, and biomechanical testing results. Advantages and limitations of this system will be discussed. PMID:24851059

The Joint Clinic: Managing Excess Demand for Hip and Knee Osteoarthritis Referrals Using a New Physiotherapy-Led Outpatient Service.

PubMed

Gwynne-Jones, David P; Hutton, Liam R; Stout, Kirsten M; Abbott, J Haxby

2018-04-01

There are increasing problems with access to both outpatient assessment and joint replacement surgery for patients with hip or knee osteoarthritis. Data were collected on all patients seen at the Joint Clinic over a 2-year period with minimum 12-month follow-up. Patients were assessed by a nurse and a physiotherapist, baseline scores and demographic details collected, and an individualized personal care plan developed. Patients could be referred for a first specialist assessment (FSA) if their severity justified surgical assessment. Three hundred fifty-eight patients were seen at Joint Clinic, of whom 150 (44%) had hip and 189 (56%) had knee OA. The mean age was 67.4 years and there were 152 men (45%) and 187 women (55%). The mean baseline Oxford score was 19.8 (standard deviation 8.2). Fifty-four patients were referred directly to FSA (mean Oxford score 13.0, standard deviation 6.7) and 89 after a subsequent review. The scores of patients referred for FSA were significantly worse than those managed in the Joint Clinic (P < .001). Of the 143 referred for FSA, 115 underwent or were awaiting surgery, 18 were recommended surgery but scored below prioritization threshold, and 10 were not recommended surgery. The Oxford scores of the 194 patients managed non-operatively improved from 22.0 to 25.0 (P = .0013). This study shows that the Joint Clinic was effective as a triage tool with 93% of those referred for FSA being recommended surgery. This has freed up surgeon time to see only those patients most in need of surgical assessment. Copyright © 2017 Elsevier Inc. All rights reserved.

High heat flux performance of W-Eurofer brazed joints

NASA Astrophysics Data System (ADS)

de Prado, J.; Sánchez, M.; Wirtz, M.; Pintsuk, G.; Du, J.; Linke, J.; Ureña, A.

2018-02-01

The qualification process of the materials and components for the next generation of fusion reactors makes it necessary to expose them to similar service conditions as expected during the service life of the reactor. In the present work, W-Eurofer brazed joints (tungsten block: 8 × 8 × 4 mm; steel block: 8 × 8 × 4 mm; joined to an actively cooled copper heat sink) were exposed to steady state heat loads to study the effect of the thermal fatigue on their microstructure and mechanical integrity. Three different W surface temperatures were tested (400, 500 and 600 °C) varying the number of applied cycles (100 and 1000). The results allowed identifying a braze temperature of 359 °C as threshold condition under which the brazed joints could be used without deterioration. The increase of the surface temperature deteriorated the mechanical integrity of the joints in comparison to those analyzed after the brazing process and accordingly reduced the refrigeration capabilities.

Trainees' Perceived Knowledge Gain Unrelated to the Training Domain: The Joint Action of Impression Management and Motives

ERIC Educational Resources Information Center

Chiaburu, Dan S.; Huang, Jason L.; Hutchins, Holly M.; Gardner, Richard G.

2014-01-01

Trainees' knowledge gains represent an important outcome in human resource development. In this research, we tested a model examining the joint influence of social desirability (impression management, self-deception) and motives (need for power, need for approval) on trainees' self-reported knowledge gain. We conducted a study with…

HMA Longitudinal Joint Evaluation and Construction

DOT National Transportation Integrated Search

2011-02-01

Longitudinal joint quality is essential to the successful performance of asphalt pavements. A number of states have begun to implement longitudinal joint specifications, and most are based on determinations of density. However, distress at the joint ...

Evaluation of Lumbar Facet Joint Nerve Blocks in Managing Chronic Low Back Pain: A Randomized, Double-Blind, Controlled Trial with a 2-Year Follow-Up

PubMed Central

Manchikanti, Laxmaiah; Singh, Vijay; Falco, Frank J.E.; Cash, Kimberly A.; Pampati, Vidyasagar

2010-01-01

Study Design: A randomized, double-blind, controlled trial. Objective: To determine the clinical effectiveness of therapeutic lumbar facet joint nerve blocks with or without steroids in managing chronic low back pain of facet joint origin. Summary of Background Data: Lumbar facet joints have been shown as the source of chronic pain in 21% to 41% of low back patients with an average prevalence of 31% utilizing controlled comparative local anesthetic blocks. Intraarticular injections, medial branch blocks, and radiofrequency neurotomy of lumbar facet joint nerves have been described in the alleviation of chronic low back pain of facet joint origin. Methods: The study included 120 patients with 60 patients in each group with local anesthetic alone or local anesthetic and steroids. The inclusion criteria was based upon a positive response to diagnostic controlled, comparative local anesthetic lumbar facet joint blocks. Outcome measures included the numeric rating scale (NRS), Oswestry Disability Index (ODI), opioid intake, and work status, at baseline, 3, 6, 12, 18, and 24 months. Results: Significant improvement with significant pain relief of ≥ 50% and functional improvement of ≥ 40% were observed in 85% in Group 1, and 90% in Group II, at 2-year follow-up. The patients in the study experienced significant pain relief for 82 to 84 weeks of 104 weeks, requiring approximately 5 to 6 treatments with an average relief of 19 weeks per episode of treatment. Conclusions: Therapeutic lumbar facet joint nerve blocks, with or without steroids, may provide a management option for chronic function-limiting low back pain of facet joint origin. PMID:20567613

Cryoanalgesia in the management of intractable pain in the temporomandibular joint: a five-year retrospective review.

PubMed

Sidebottom, A J; Carey, E C; Madahar, A K

2011-12-01

Cryoanalgesia is a controversial adjunct to the management of chronic pain, but we know of no studies that have investigated its effect in the management of temporomandibular joint (TMJ) pain. In this five-year retrospective study we treated 17 patients who had severe pain that had failed to respond to all forms of conventional conservative treatment and were not appropriate for simple open operation. None had a clear indication for open operation on the joint or had too severe disease to warrant a simple procedure. Preliminary diagnostic injections of bupivacaine to the TMJ relieved the pain. We applied the cryoprobe in the region of the auriculotemporal nerve and TMJ capsule. There was a small but insignificant improvement in mean mouth opening together with a significant (p=0.000) improvement in visual analogue pain scores (VAS) from 6.8 (range 4-10) to 2.0 (range 0-7). Two patients had no change in their pain scores, and 2 had complete resolution of their pain. The mean number of pain-free months after treatment was 7 (IQR 3-15). Three patients had long-term pain relief, and 12 temporary relief; 6 of these subsequently had successful relief after total replacement of the TMJ. One patient had further cryoanalgesia, one was referred for specialist pain management, and one controlled the pain with nortriptyline. Of the 17 cases studied, 2 had temporary complications after cryoanalgesia. Cryoanalgesia is a useful adjunct to the management of intractable pain in the TMJ. Short-term pain relief can be achieved, and long-term relief is possible in some, deferring more complex and costly treatments. Crown Copyright © 2010. Published by Elsevier Ltd. All rights reserved.

Joint Chiefs of Staff > Media > News

Science.gov Websites

Facebook on Flickr Joint Chiefs Army Chief of Staff Marine Corps Commandant Chief of Naval Operations Air Force Chief of Staff Chief of National Guard Bureau Biographies Directorates Directorates of Management Readout of Chairman of the Joint Chiefs of Staff Gen. Dunford's Meeting with Chief of the Turkish General

Environmental Management Performance Report June 2000

DOE Office of Scientific and Technical Information (OSTI.GOV)

EDER, D.M.

2000-06-01

The purpose of this report is to provide the Department of Energy Richland Operations Office (DOE-RL) a monthly summary of the Project Hanford Management Contractor's (PHMC) Environmental Management (EM) performance by Fluor Hanford (FH) and its subcontractors. In addition to project-specific information, it includes some PHMC-level data not detailed elsewhere in the report. Section A, Executive Summary, provides an executive level summary of the cost, schedule, and technical performance described in this report. It summarizes performance for the period covered, highlights areas worthy of management attention, and provides a forward look to some of the upcoming key performance activities asmore » extracted from the PHMC baseline. The remaining sections provide detailed performance data relative to each individual Project (e.g., Waste Management, Spent Nuclear Fuels, etc.), in support of Section A of the report. Unless otherwise noted, the Safety, Conduct of Operations, and Cost/Schedule data contained herein is as of April 30, 2000. All other information is updated as of May 19, unless otherwise noted.« less

Together I Can! Joint Attention Boosts 3- to 4-Year-Olds' Performance in a Verbal False-Belief Test.

PubMed

Psouni, Elia; Falck, Andreas; Boström, Leni; Persson, Martin; Sidén, Lisa; Wallin, Maria

2018-04-20

Effects of joint attention were addressed on 3- to 4-year-olds' performance in a verbal false-Belief Test (FBT), featuring the experimenter as co-watcher rather than narrator. In two experiments, children (N = 183) watched a filmed-FBT jointly with a test leader, disjointed from a test leader, or alone. Children attending jointly with a test leader were more likely to pass the FBT compared with normative data and to spontaneously recall information indicating false-belief understanding, suggesting that joint attention strengthens the plausibility of the FBT and renders plot-critical information more salient. In a third experiment (N = 59), results were replicated using a typical, image-based FBT. Overall findings highlight the profound impact of experimenter as social context in verbal FBTs, and link recall of specific story features to false-belief understanding. © 2018 Society for Research in Child Development.

Joint Venture Health Plans May Give ACOs a Run for Their Money.

PubMed

Reinke, Thomas

2016-12-01

Joint venture plans are starting to demonstrate their ability to implement clinical management and financial management reforms. A JV health plan replaces the offloading of financial risk by health plans to ill-equipped providers with an executive-level cost management committee stated jointly by the hospital and payer.

Performance Information Management System (PIMS) Communication

DTIC Science & Technology

1993-12-31

34AD-A284 851 AD MIPR NO. MIPR 92MM2501 TITLE: Performance Information Management System (PIMS) Communication PRINCIPAL INVESTIGATOR: Kathryn P...93 . . ..- F •nal,. 12/1/91 - 12/31/93- ...... . ..... PIMS-Performance Information Management System Communications 92MM2501 Kathryn P. Winter Navy

A New Perspective on Fatigue Performance of Advanced High- Strength Steels (AHSS) GMAW Joints

DOE Office of Scientific and Technical Information (OSTI.GOV)

Feng, Zhili; Chiang, Dr. John; Kuo, Dr. Min

2008-01-01

Weld fatigue performance is a critical aspect for application of advanced high-strength steels (AHSS) in automotive body structures. A comparative study has been conducted to evaluate the fatigue life of AHSS welds. The material studied included seven AHSS of various strength levels - DP 600, DP 780, DP 980, M130, M220, solution annealed boron and fully hardened boron steels. Two conventional steels, HSLA 590 and DR 210, were also included for baseline comparison. Lap fillet welds were made on 2-mm nominal thick sheets by the gas metal arc welding process (GMAW). Fatigue test was conducted under a number of stressmore » levels to obtain the S/N curves of the weld joints. It was found that, unlike in the static and impact loading conditions, the fatigue performance of AHSS is not influenced by the HAZ softening in AHSS. There are appreciable differences in the fatigue lives among different AHSS. Changes in weld parameters can influence the fatigue life of the weld joints, particularly of these of higher strength AHSS. A model is developed to predict the fatigue performance of AHSS welds. The validity of the model is benchmarked with the experimental results. This model is capable to capture the effects of weld geometry and weld microstructure and strength on the fatigue performance experimentally observed. The theoretical basis and application of the newly developed fatigue modeling methodology will be discussed.« less

Medial Elbow Joint Space Increases With Valgus Stress and Decreases When Cued to Perform A Maximal Grip Contraction.

PubMed

Pexa, Brett S; Ryan, Eric D; Myers, Joseph B

2018-04-01

Previous research indicates that the amount of valgus torque placed on the elbow joint during overhead throwing is higher than the medial ulnar collateral ligament (UCL) can tolerate. Wrist and finger flexor muscle activity is hypothesized to make up for this difference, and in vitro studies that simulated activity of upper extremity musculature, specifically the flexor digitorum superficialis and flexor carpi ulnaris, support this hypothesis. To assess the medial elbow joint space at rest, under valgus stress, and under valgus stress with finger and forearm flexor contraction by use of ultrasonography in vivo. Controlled laboratory study. Participants were 22 healthy males with no history of elbow dislocation or UCL injury (age, 21.25 ± 1.58 years; height, 1.80 ± 0.08 m; weight, 79.43 ± 18.50 kg). Medial elbow joint space was measured by use of ultrasonography during 3 separate conditions: at rest (unloaded), under valgus load (loaded), and with a maximal grip contraction under a valgus load (loaded-contracted) in both limbs. Participants lay supine with their arm abducted 90° and elbow flexed 30° with the forearm in full supination. A handgrip dynamometer was placed in the participants' hand to grip against during the contracted condition. Images were reduced in ImageJ to assess medial elbow joint space. A 2-way (condition × limb) repeated-measures analysis of variance and Cohen's d effect sizes were used to assess changes in medial elbow joint space. Post hoc testing was performed with a Bonferroni adjustment to assess changes within limb and condition. The medial elbow joint space was significantly larger in the loaded condition (4.91 ± 1.16 mm) compared with the unloaded condition (4.26 ± 1.23 mm, P < .001, d = 0.712) and the loaded-contracted condition (3.88 ± 0.94 mm, P < .001, d = 1.149). No significant change was found between the unloaded and loaded-contracted conditions ( P = .137). Medial elbow joint space increases under a valgus load and then

The Joint Convention on the Safety of Spent fuel Management and on the safety of Radioactive Waste Management: A UK Regulator's Perspective

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lacey, D.; Bacon, M.L.

The UK fully supports the objective of the Joint Convention on the Safety of Spent Fuel Management and on the Safety of Radioactive Waste Management to achieve and maintain a high level of safety worldwide in spent fuel and radioactive waste management, through the enhancement of national measures and international co-operation, including where appropriate, safety-related co-operation. The UK's Health and Safety Executive, through its Nuclear Safety Directorate (NSD), has been committed to the Convention since the initial negotiations to set up the Convention and provided the president of the first review meeting in 2003. It would be wrong of anymore » nation to believe that they have all the best solutions to managing spent fuel and radioactive waste. The process of compiling reports for the Convention review meetings provides a structured process through which every contracting party can review its provisions against a common set of standards and identify for itself possible areas of improvements. The sharing of reports and the asking and answering of questions then provides a further opportunity for both sharing of experience and learning. The UK was encouraged by the spirit of constructive discussion rather than negative criticism that pervaded the first review meeting that provided an incentive for all to learn and improve. While, as could be expected of the first meeting of such a group, not everything worked as well as could be hoped for, all parties seemed committed to learn from mistakes and to make the process more effective. Lessons were learned from the Nuclear Safety Convention on the process of submitting reports electronically and the UK actively supported aims to use IAEA requirements documents as an additional focus for reports. This should, we hope, provide for even better benchmarking of achievements and provide feedback for improvements of the IAEA requirements where appropriate. In summary, the UK finds the Joint Convention process to be a

Subtalar joint arthroscopy for sinus tarsi syndrome: a review of 29 cases.

PubMed

Oloff, L M; Schulhofer, S D; Bocko, A P

2001-01-01

Twenty-nine consecutive patients who underwent diagnostic or therapeutic subtalar joint arthroscopy for sinus tarsi syndrome were retrospectively reviewed. The mean length of follow-up was 18 months. There was a history of trauma in 86% of the patients, with an inversion sprain being the most common predisposing injury (63%). All patients had a primary preoperative diagnosis of sinus tarsi syndrome. Magnetic resonance imaging was useful in identifying subtalar joint chronic synovitis and/or fibrosis in all 26 patients who were imaged. Subtalar joint synovectomy was the most common procedure performed. Twelve patients had 15 additional operative procedures. One patient required an arthrotomy secondary to arthrofibrosis. There were no postoperative complications. The mean return to full activity was 4 months. The mean postoperative AOFAS Ankle-Hindfoot Scale score was 85 points. Subtalar joint arthroscopy has proven to be a relatively safe and effective diagnostic and therapeutic technique in the management of sinus tarsi syndrome.

Blood management and transfusion strategies in 600 patients undergoing total joint arthroplasty: an analysis of pre-operative autologous blood donation.

PubMed

Perazzo, Paolo; Viganò, Marco; De Girolamo, Laura; Verde, Francesco; Vinci, Anna; Banfi, Giuseppe; Romagnoli, Sergio

2013-07-01

Blood loss during total joint arthroplasty strongly influences the time to recover after surgery and the quality of the recovery. Blood conservation strategies such as pre-operative autologous blood donation and post-operative cell salvage are intended to avoid allogeneic blood transfusions and their associated risks. Although widely investigated, the real effectiveness of these alternative transfusion practices remains controversial. The surgery reports of 600 patients undergoing total joint arthroplasty (312 hip and 288 knee replacements) were retrospectively reviewed to assess transfusion needs and related blood management at our institute. Evaluation parameters included post-operative blood loss, haemoglobin concentration measured at different time points, ASA score, and blood transfusion strategies. Autologous blood donation increased the odds of receiving a red blood cell transfusion. Reinfusion by a cell salvage system of post-operative shed blood was found to limit adverse effects in cases of severe post-operative blood loss. The peri-operative net decrease in haemoglobin concentration was higher in patients who had predeposited autologous blood than in those who had not. The strengths of this study are the high number of cases and the standardised procedures, all operations having been performed by a single orthopaedic surgeon and a single anaesthesiologist. Our data suggest that a pre-operative autologous donation programme may often be useless, if not harmful. Conversely, the use of a cell salvage system may be effective in reducing the impact of blood transfusion on a patient's physiological status. Basal haemoglobin concentration emerged as a useful indicator of transfusion probability in total joint replacement procedures.

Ligamentous and capsular injuries to the metacarpophalangeal joints of the hand.

PubMed

Shah, Smiresh Suresh; Techy, Fernando; Mejia, Alfonso; Gonzalez, Mark H

2012-01-01

The mechanism of dorsal dislocation of the metacarpophalangeal (MCP) joint is with forced hyperextension of the joint and the main structure injured is the volar plate. A simple dislocation can be reduced by closed means whereas a complex dislocation cannot. Care must be taken not to put traction across the joint, which may cause the volar plate to slip into the joint, converting a simple dislocation into a complex dislocation. Volar dislocations are rare and mainly treated nonoperatively. Sagittal band injuries can be treated with extension splinting or surgical management with direct repair or reconstruction. A locked MCP joint can usually be treated with closed manipulation. This article discusses these injuries and management options.

Effect of Nd:YAG laser beam welding on weld morphology and mechanical properties of Ti-6Al-4V butt joints and T-joints

NASA Astrophysics Data System (ADS)

Kashaev, Nikolai; Ventzke, Volker; Fomichev, Vadim; Fomin, Fedor; Riekehr, Stefan

2016-11-01

A Nd:YAG single-sided laser beam welding process study for Ti-6Al-4V butt joints and T-joints was performed to investigate joining techniques with regard to the process-weld morphology relationship. An alloy compatible filler wire was used to avoid underfills and undercuts. The quality of the butt joints and T-joints was characterized in terms of weld morphology, microstructure and mechanical properties. Joints with regular shapes, without visible cracks, pores, and geometrical defects were achieved. Tensile tests revealed high joint integrity in terms of strength and ductility for both the butt joint and T-joint geometries. Both the butt joints and T-joints showed base material levels of strength. The mechanical performance of T-joints was also investigated using pull-out tests. The performance of the T-joints in such tests was sensitive to the shape and morphology of the welds. Fracture always occurred in the weld without any plastic deformation in the base material outside the weld.

Performance Management in Education: Improving Practice. British Educational Management Series.

ERIC Educational Resources Information Center

Reeves, Jenny; Forde, Christine; O'Brien, Jim; Smith, Pauline; Tomlinson, Harry

This book explores managing the performance of education staff in England and Wales and in Scotland. It compares the different policies of performance management as practiced in England and Wales and in Scotland. (The Scottish system of education is independent of that of England and Wales.) Chapter 1 provides an introduction to performance…

The effect of additional joint mobilization on neuromuscular performance in individuals with functional ankle instability.

PubMed

Shih, Yi-Fen; Yu, Hsiang-Ting; Chen, Wen-Yin; Liao, Kwong-Kum; Lin, Hsiu-Chen; Yang, Yea-Ru

2018-03-01

To examine the effects of joint mobilization and exercise training on neuromuscular performance in individuals with functional ankle instability (FAI). A cross-sectional study. Forty five subjects with FAI were randomized into three groups: control (CG, n = 15, 27.9 ± 6.6yr), training (TG, n = 15, 26.9 ± 5.8yr) and mobilization with training group (MTG, n = 15, 26.5 ± 4.8yr). Four weeks of neuromuscular training for TG; neuromuscular training and joint mobilization for MTG. Electromyography of the peroneus longus (PL), tibialis anterior (TA), and soleus (SOL) and the reaching distance of the Y balance test (YBT), dorsiflexion range of motion (DFROM), Cumberland ankle instability tool (CAIT), and global rating scale (GRS). Two-way repeated measures MANOVA were used with the significance level p < .05. MANOVA found significant group by time interactions on posterolateral reaching distance (p = .032), PL activation (p = .006-.03), DFROM (p < .001), CAIT (p < .001) and GRS (p < .001). The post hoc tests indicated significantly improved PL muscle activity and posterolateral reaching distance for MTG compared to TG (p = .004) and CG (p = .006). Joint mobilization resulted in additional benefits on self-reported ankle instability severity, dorsiflexion mobility, and posterolateral balance performance in individuals with FAI, but its effects on general improvement, muscle activation, and other balance tasks remained uncertain. Copyright © 2017 Elsevier Ltd. All rights reserved.

Performance measurement: integrating quality management and activity-based cost management.

PubMed

McKeon, T

1996-04-01

The development of an activity-based management system provides a framework for developing performance measures integral to quality and cost management. Performance measures that cross operational boundaries and embrace core processes provide a mechanism to evaluate operational results related to strategic intention and internal and external customers. The author discusses this measurement process that allows managers to evaluate where they are and where they want to be, and to set a course of action that closes the gap between the two.

Radiographic followup of joints injected with triamcinolone hexacetonide for the management of childhood arthritis.

PubMed

Sparling, M; Malleson, P; Wood, B; Petty, R

1990-06-01

Evidence of deleterious effects following intraarticular injection of triamcinolone hexacetonide was sought through a review of radiographs of 145 joints of 55 children with chronic arthritis. Possible deleterious effects were noted in 16 joints of 11 patients. These effects included: small patella (2 joints), patellar osteochondritis dissecans (1 joint), periarticular calcification (9 joints), intraarticular tibial bony spur (1 joint), avascular necrosis of the distal radial epiphysis (2 joints), and avascular necrosis of the proximal femoral epiphysis (1 joint). Only the latter possible complication was symptomatic. Serial radiographs of 76 joints of 30 children showed mild progressive changes compatible with the underlying disease, except in the hip joint, where changes were more severe. The intraarticular injection of triamcinolone hexacetonide is a procedure that appears to be associated with an acceptably low frequency of radiologic abnormalities for many joints in children with chronic arthritis, but its effects on the hip joint remain uncertain.

Neocondyle distraction osteogenesis in the management of temporomandibular joint ankylosis: Report of five cases with review of literature.

PubMed

Sharma, Ravi; Manikandhan, R; Sneha, P; Parameswaran, Anantanarayanan; Kumar, J Naveen; Sailer, Hermann F

2017-01-01

Management of temporomandibular joint (TMJ) ankylosis is a challenging and rather daunting task owing to complex abnormal anatomy and its sequel to craniofacial structures. Various autogenous grafts and alloplastic materials have been tried with variable success for creation of a near-normal joint. In recent years, neocondyle distraction has added a new dimension to the management of TMJ ankylosis. The aim of this paper is to describe the role of neocondyle distraction in TMJ ankylosis. Neocondyle distraction was carried out in five patients with TMJ ankylosis following gap arthroplasty. Computed tomogram scans were taken before surgery and 1-year postdistraction for surgical planning and postoperative assessment, respectively. The intraoral distractors (KLS Martin, Jacksonville, FL, USA) were used in this study. All five patients reported with adequate mouth opening and functional jaw movements. The procedure was well tolerated by all the patients. None of the patients underwent reankylosis following neocondyle distraction. With proper surgical planning and distraction protocol, neocondyle distraction is an effective and safe technique for TMJ reconstruction and preventing reankylosis.

Matthews device arthroplasty presents superior long-term mouth opening than interpositional arthroplasty in the management of temporomandibular joint ankylosis.

PubMed

Denadai, Rafael; Raposo-Amaral, Cassio Eduardo; Buzzo, Celso Luiz; Raposo-Amaral, Cesar Augusto

2016-08-01

The aim of this study is to describe the surgical outcomes of a single-institution experience in the surgical management of temporomandibular joint ankylosis, comparing interpositional arthroplasty with autogenous tissue and Matthews device arthroplasty. A retrospective analysis of temporomandibular joint ankylosis patients (n = 15), who underwent interpositional arthroplasty or Matthews device arthroplasty, was conducted. The surgical outcomes (preoperative, recent [4-6 weeks], intermediate [1 year], and late [3 years] postoperative maximal incisal opening, hospital stay, and complication, relapse, and reoperation rates) were compared. Significant (all p < 0.05) differences were recorded in temporomandibular joint ankylosis patients treated with interpositional arthroplasty with autogenous tissue (53.3%) versus Matthews device arthroplasty (46.7%) according to intermediate (25 ± 7 vs. 34 ± 5 mm) and late (19 ± 8 vs. 33 ± 5 mm) postoperative maximal incisal opening, intermediate (31% vs. 7%) and late (47% vs. 12%) postoperative relapse, and reoperation rate (38% vs. 0%). There was similarity (all p > 0.05) in preoperative (4.8 ± 2.9 vs. 4.9 ± 2.9 mm) and recent (35 ± 4 vs. 37 ± 4 mm) postoperative maximal incisal opening, hospital stay (3.5 ± 0.8 vs. 3.6 ± 0.8 days), and surgery-related complications (13% vs. 14%). Both surgical procedures evaluated were successful in initial management of temporomandibular joint ankylosis, but the Matthews device arthroplasty avoided postoperative relapse. Copyright © 2016 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

A systematic review of recommendations and guidelines for the management of osteoarthritis: The chronic osteoarthritis management initiative of the U.S. bone and joint initiative.

PubMed

Nelson, Amanda E; Allen, Kelli D; Golightly, Yvonne M; Goode, Adam P; Jordan, Joanne M

2014-06-01

Although a number of osteoarthritis (OA) management guidelines exist, uptake has been suboptimal. Our aim was to review and critically evaluate existing OA management guidelines to better understand potential issues and barriers. A systematic review of the literature in MEDLINE published from January 1, 2000 to April 1, 2013 was performed and supplemented by bibliographic reviews, following PRISMA guidelines and a written protocol. Following initial title and abstract screening, 2 authors independently reviewed full-text articles; a third settled disagreements. Two independent reviewers extracted data into a standardized form. Two authors independently assessed guideline quality using the AGREE II instrument; three generated summary recommendations based on the extracted guideline data. Overall, 16 articles were included in the final review. There was broad agreement on recommendations by the various organizations. For non-pharmacologic modalities, education/self-management, exercise, weight loss if overweight, walking aids as indicated, and thermal modalities were widely recommended. For appropriate patients, joint replacement was recommended; arthroscopy with debridement was not recommended for symptomatic knee OA. Pharmacologic modalities most recommended included acetaminophen/paracetamol (first line) and NSAIDs (topical or oral, second line). Intra-articular corticosteroids were generally recommended for hip and knee OA. Controversy remains about the use of acupuncture, knee braces, heel wedges, intra-articular hyaluronans, and glucosamine/chondroitin. The relative agreement on many OA management recommendations across organizations indicates a problem with dissemination and implementation rather than a lack of quality guidelines. Future efforts should focus on optimizing implementation in primary care settings, where the majority of OA care occurs. Copyright © 2014 Elsevier Inc. All rights reserved.

Performance specifications of critical results management.

PubMed

Piva, Elisa; Sciacovelli, Laura; Pelloso, Michela; Plebani, Mario

2017-07-01

Formerly defined "critical values", the importance of critical results (CRs) management in patient care has grown in recent years. According to the George Lundberg definition the result becomes "critical" when, exceeding actionable thresholds, it suggests imminent danger for the patient, unless appropriate therapy is initiated promptly. As required in most important accreditation standards, such as the ISO:15,189 or the Joint Commission standards, a quality reporting system should deliver the correct result to the appropriate clinician in a time-frame that ensures patient safety. From this point of view, medical laboratories should implement a process that assures the most effective communication in a timely manner, to the referring physician or care team member. Failure in communication, particularly in this type of situation, continues to be one of the most common factors contributing to the occurrence of adverse events. In the last few decades, Information Technology (IT) in Health Care has become increasingly important. The ability to interface radiology, anatomic pathology or laboratory information systems with electronic medical records is now a real opportunity, offering much safer communication than in the past. Future achievements on performance criteria and quality indicators for the notification of CRs, should ensure a comparable examination across different institutions, adding value to clinical laboratories in controlling post-analytical processes that concern patient safety. Therefore, the novel approach to CRs should combine quality initiatives, IT solutions and a culture to strengthen professional interaction. Copyright © 2017. Published by Elsevier Inc.

5 CFR 9701.405 - Performance management system requirements.

Code of Federal Regulations, 2010 CFR

2010-01-01

... requirements. 9701.405 Section 9701.405 Administrative Personnel DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM (DEPARTMENT OF HOMELAND SECURITY-OFFICE OF PERSONNEL MANAGEMENT) DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM Performance Management § 9701.405 Performance...

Fluoroscopic caudal epidural injections in managing chronic axial low back pain without disc herniation, radiculitis, or facet joint pain

PubMed Central

Manchikanti, Laxmaiah; Cash, Kimberly A; McManus, Carla D; Pampati, Vidyasagar

2012-01-01

Background Chronic low back pain without disc herniation is common. Various modalities of treatments are utilized in managing this condition, including epidural injections. However, there is continued debate on the effectiveness, indications, and medical necessity of any treatment modality utilized for managing axial or discogenic pain, including epidural injections. Methods A randomized, double-blind, actively controlled trial was conducted. The objective was to evaluate the ability to assess the effectiveness of caudal epidural injections of local anesthetic with or without steroids for managing chronic low back pain not caused by disc herniation, radiculitis, facet joints, or sacroiliac joints. A total of 120 patients were randomized to two groups; one group did not receive steroids (group 1) and the other group did (group 2). There were 60 patients in each group. The primary outcome measure was at least 50% improvement in Numeric Rating Scale and Oswestry Disability Index. Secondary outcome measures were employment status and opioid intake. These measures were assessed at 3, 6, 12, 18, and 24 months after treatment. Results Significant pain relief and functional status improvement (primary outcome) defined as a 50% or more reduction in scores from baseline, were observed in 54% of patients in group 1 and 60% of patients in group 2 at 24 months. In contrast, 84% of patients in group 1 and 73% in group 2 saw significant pain relief and functional status improvement in the successful groups at 24 months. Conclusion Caudal epidural injections of local anesthetic with or without steroids are effective in patients with chronic axial low back pain of discogenic origin without facet joint pain, disc herniation, and/or radiculitis. PMID:23091395

The effects of transcutaneous electrical nerve stimulation on joint position sense in patients with knee joint osteoarthritis.

PubMed

Shirazi, Zahra Rojhani; Shafaee, Razieh; Abbasi, Leila

2014-10-01

To study the effects of transcutaneous electrical nerve stimulation (TENS) on joint position sense (JPS) in knee osteoarthritis (OA) subjects. Thirty subjects with knee OA (40-60 years old) using non-random sampling participated in this study. In order to evaluate the absolute error of repositioning of the knee joint, Qualysis Track Manager system was used and sensory electrical stimulation was applied through the TENS device. The mean errors in repositioning of the joint, in two position of the knee joint with 20 and 60 degree angle, after applying the TENS was significantly decreased (p < 0.05). Application of TENS in subjects with knee OA could improve JPS in these subjects.

Prosthetic Joint Infection

PubMed Central

Tande, Aaron J.

2014-01-01

SUMMARY Prosthetic joint infection (PJI) is a tremendous burden for individual patients as well as the global health care industry. While a small minority of joint arthroplasties will become infected, appropriate recognition and management are critical to preserve or restore adequate function and prevent excess morbidity. In this review, we describe the reported risk factors for and clinical manifestations of PJI. We discuss the pathogenesis of PJI and the numerous microorganisms that can cause this devastating infection. The recently proposed consensus definitions of PJI and approaches to accurate diagnosis are reviewed in detail. An overview of the treatment and prevention of this challenging condition is provided. PMID:24696437

24 CFR 902.43 - Management operations performance standards.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 24 Housing and Urban Development 4 2014-04-01 2014-04-01 false Management operations performance... URBAN DEVELOPMENT PUBLIC HOUSING ASSESSMENT SYSTEM Management Operations Indicator § 902.43 Management operations performance standards. (a) Management operations subindicators. The following subindicators listed...

24 CFR 902.43 - Management operations performance standards.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 24 Housing and Urban Development 4 2012-04-01 2012-04-01 false Management operations performance... URBAN DEVELOPMENT PUBLIC HOUSING ASSESSMENT SYSTEM Management Operations Indicator § 902.43 Management operations performance standards. (a) Management operations subindicators. The following subindicators listed...

24 CFR 902.43 - Management operations performance standards.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 24 Housing and Urban Development 4 2011-04-01 2011-04-01 false Management operations performance... URBAN DEVELOPMENT PUBLIC HOUSING ASSESSMENT SYSTEM Management Operations Indicator § 902.43 Management operations performance standards. (a) Management operations subindicators. The following subindicators listed...

24 CFR 902.43 - Management operations performance standards.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 24 Housing and Urban Development 4 2013-04-01 2013-04-01 false Management operations performance... URBAN DEVELOPMENT PUBLIC HOUSING ASSESSMENT SYSTEM Management Operations Indicator § 902.43 Management operations performance standards. (a) Management operations subindicators. The following subindicators listed...

The Cultural Context of Learning in International Joint Ventures.

ERIC Educational Resources Information Center

Liu, Shimin; Vince, Russ

1999-01-01

A study of Chinese-Western joint business ventures showed that cultural context and different modes of managing and organizing must be considered. Successful joint ventures involve a process of collective, two-way learning. (SK)

The joint flanker effect and the joint Simon effect: On the comparability of processes underlying joint compatibility effects.

PubMed

Dittrich, Kerstin; Bossert, Marie-Luise; Rothe-Wulf, Annelie; Klauer, Karl Christoph

2017-09-01

Previous studies observed compatibility effects in different interference paradigms such as the Simon and flanker task even when the task was distributed across two co-actors. In both Simon and flanker tasks, performance is improved in compatible trials relative to incompatible trials if one actor works on the task alone as well as if two co-actors share the task. These findings have been taken to indicate that actors automatically co-represent their co-actor's task. However, recent research on the joint Simon and joint flanker effect suggests alternative non-social interpretations. To which degree both joint effects are driven by the same underlying processes is the question of the present study, and it was scrutinized by manipulating the visibility of the co-actor. While the joint Simon effect was not affected by the visibility of the co-actor, the joint flanker effect was reduced when participants did not see their co-actors but knew where the co-actors were seated. These findings provide further evidence for a spatial interpretation of the joint Simon effect. In contrast to recent claims, however, we propose a new explanation of the joint flanker effect that attributes the effect to an impairment in the focusing of spatial attention contingent on the visibility of the co-actor.

Comparison of the use of a notched wedge joint vs. traditional butt joints in Connecticut : phase 1 report.

DOT National Transportation Integrated Search

2008-05-14

Performance of Hot Mix Asphalt (HMA) longitudinal joints have been an : item of increasing scrutiny in Connecticut. The traditional butt joint : has typically been the method used in Connecticut. These joints have : been reportedly opening up creatin...

5 CFR 9701.405 - Performance management system requirements.

Code of Federal Regulations, 2013 CFR

2013-01-01

... performance management systems for DHS employees, subject to the requirements set forth in this subpart. (b) Each DHS performance management system must— (1) Specify the employees covered by the system(s); (2... 5 Administrative Personnel 3 2013-01-01 2013-01-01 false Performance management system...

5 CFR 9701.405 - Performance management system requirements.

Code of Federal Regulations, 2011 CFR

2011-01-01

... performance management systems for DHS employees, subject to the requirements set forth in this subpart. (b) Each DHS performance management system must— (1) Specify the employees covered by the system(s); (2... 5 Administrative Personnel 3 2011-01-01 2011-01-01 false Performance management system...

5 CFR 9701.405 - Performance management system requirements.

Code of Federal Regulations, 2012 CFR

2012-01-01

... performance management systems for DHS employees, subject to the requirements set forth in this subpart. (b) Each DHS performance management system must— (1) Specify the employees covered by the system(s); (2... 5 Administrative Personnel 3 2012-01-01 2012-01-01 false Performance management system...

5 CFR 9701.405 - Performance management system requirements.

Code of Federal Regulations, 2014 CFR

2014-01-01

... performance management systems for DHS employees, subject to the requirements set forth in this subpart. (b) Each DHS performance management system must— (1) Specify the employees covered by the system(s); (2... 5 Administrative Personnel 3 2014-01-01 2014-01-01 false Performance management system...

Tertiary care centre adherence to unified guidelines for management of periprosthetic joint infections: a gap analysis

PubMed Central

Armstrong, Mitchel D.; Carli, Alberto V.; Abdelbary, Hesham; Poitras, Stephane; Lapner, Peter; Beaulé, Paule E.

2018-01-01

Background The success rate of surgical treatment for periprosthetic joint infection (PJI) remains inconsistent in the literature. Variability in PJI clinical guidelines and surgeon adherence to guidelines could affect treatment success. The objectives of this study were to appraise current recommendations for PJI management and develop a unified clinical standard of care, to perform a gap analysis of PJI cases in a tertiary institution to determine the rate of guideline adherence, and to determine if adherence to unified PJI guidelines affected 2-year treatment outcomes. Methods We appraised the PJI guidelines from 3 academic medical societies, and consistent statements were aggregated. We retrospectively reviewed all PJI cases in a tertiary care institution. We defined PJI based on Musculoskeletal Infection Society PJI criteria. Surgeon adherence to preoperative, intraoperative, surgical and medical management guidelines was calculated, and we evaluated the association between guideline adherence and 2-year treatment outcomes. Results The institutional rate of PJI was 1.13% (38 of 3368). Treatment success was 57.8% at 2 years. Unified guideline adherence percentages varied substantially: 92% of patients had preoperative erythrocyte sedimentation rate and C-reactive protein, 97% had intraoperative tissue cultures, 42% had appropriate preoperative arthrocentesis, and 74% underwent guideline-appropriate surgery. Performing appropriate preoperative arthrocentesis significantly correlated with positive treatment outcomes at 2 years (p = 0.028). Conclusion Adherence to PJI guidelines varies considerably, indicating that clinicians are either unaware of them or do not recognize their value for PJI treatment. This study shows the need for institution-based PJI treatment pathways that are consistent with published guidelines and the need to monitor adherence. PMID:29368675

Managing Recurrence in Intraarticular Melorheostosis Involving the Knee Joint: A Case Report.

PubMed

John, Bobby; Sharma, Anirudh; Pandey, Ritesh A

2017-01-01

Melorheostosis is a rare benign sclerosing dysplasia affecting bone, which causes significant morbidity in the form of pain and restriction of joint movement. Treatment options are varied, and recurrence is common after surgical treatment. Choosing the most appropriate treatment option in the management of a recurrent case is challenging, with very little supporting evidence in literature owing to the rarity of the disease. We hereby present a case of recurrent melorheostosis involving the knee; discuss treatment options and the rationale of our treatment. We present the case of a 42-year-old female who was operated at our institution previously 7 years ago for melorheostosis of her left knee and had undergone excision of intrarticular hyperostotic masses. However, pain and limitation of motion recurred in the operated knee 4 years later, and radiographs and computed tomography revealed a mineralized mass situated behind the patella in the patellofemoral joint. She was treated with repeat open excision of the mass and put on a regimen of physiotherapy and bisphosphonates. Open excision of symptomatic hyperostotic or mineralized soft tissue masses is perhaps the favored treatment option in such cases, the other options being arthroscopic excision and total knee arthroplasty. Limited knee motion and size of the mass often make arthroscopy an unfeasible option. Total knee arthroplasty should be reserved for cases with significant flexion contractures of the knee, or where multiple excisions have failed.

24 CFR 902.43 - Management operations performance standards.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false Management operations performance... URBAN DEVELOPMENT PUBLIC HOUSING ASSESSMENT SYSTEM PHAS Indicator #3: Management Operations § 902.43 Management operations performance standards. (a) Management operations sub-indicators. The following sub...

Unloading joints to treat osteoarthritis, including joint distraction.

PubMed

Lafeber, Floris P J G; Intema, Femke; Van Roermund, Peter M; Marijnissen, Anne C A

2006-09-01

Patients are increasingly becoming interested in nonpharmacologic approaches to manage their osteoarthritis. This review examines the recent literature on the potential beneficial effects of unloading joints in the treatment of osteoarthritis, with a focus on joint distraction. Mechanical factors are involved in the development and progression of osteoarthritis. If "loading" is a major cause in development and progression of osteoarthritis, then "unloading" may be able to prevent progression. There is evidence that unloading may be effective in reducing pain and slowing down structural damage. This review describes unloading by footwear and bracing (nonsurgical), unloading by osteotomy (surgical), and has a focus on unloading by joint distraction. Excellent reviews in all these three fields have been published over the past few years. Recent studies argue for the usefulness of a biomechanical approach to improve function and possibly reduce disease progression in osteoarthritis. To improve patient function and possibly reduce disease progression, a biomechanical approach should be considered in treating patients with osteoarthritis. Further research (appropriate high-quality clinical trials) and analysis (clinical as well as preclinical and fundamental) are still necessary, however, to understand, validate, and refine the different approaches of unloading to treat osteoarthritis.

FAA/NASA Joint University Program for Air Transportation Research, 1992-1993

NASA Technical Reports Server (NTRS)

Morrell, Frederick R. (Compiler)

1994-01-01

The research conducted during the academic year 1992-1993 under the FAA/NASA sponsored Joint University Program for Air Transportation Research is summarized. The year end review was held at Ohio University, Athens, Ohio, 17-18 June 1993. The Joint University Program is a coordinated set of three grants sponsored by the Federal Aviation Administration and NASA Langley Research Center, one each with the Massachusetts Institute of Technology, Ohio University, and Princeton University. Completed works, status reports, and annotated bibliographies are presented for research topics, which include navigation, guidance, and control theory and practice, aircraft performance, human factors and air traffic management. An overview of the year's activities for each university is also presented.

The joint venture alternative to mergers.

PubMed

Enders, R J

1995-02-01

However, while a joint venture may be "safe" from antitrust challenge, it is not without some practical difficulties, especially with respect to consolidating services at one location or jointly offering services provided at multiple facilities. These practical concerns include: 1. Who will exercise operational management of the joint venture? 2. How will the joint venture deal with different pricing for services that will be provided at multiple locations? 3. What criteria will be used to decide the location at which consolidated tertiary services will be offered? 4. In what circumstances can the joint venture be unwound, either in its entirety or as to discrete functions? When clinical services have been consolidated at one location, there is an appropriate concern by the other hospital that it will be unable to provide or re-enter the market for those services if the joint venture dissolves. These operational concerns, of course, are not addressed in the Consent Decree. Thus, even if a joint venture relationship survives antitrust scrutiny, the parties must still negotiate and resolve these operational issues in order for the joint venture to be viable.

Future developments in health care performance management

PubMed Central

Crema, Maria; Verbano, Chiara

2013-01-01

This paper highlights the challenges of performance management in health care, wherein multiple different objectives have to be pursued. The literature suggests starting with quality performance, following the sand cone theory, but considering a multidimensional concept of health care quality. Moreover, new managerial approaches coming from an industrial context and adapted to health care, such as lean management and risk management, can contribute to improving quality performance. Therefore, the opportunity to analyze them arises from studying their overlaps and links in order to identify possible synergies and to investigate the opportunity to develop an integrated methodology enabling improved performance. PMID:24255600

Effects of different overlap lengths and composite adherend thicknesses on the performance of adhesively-bonded joints under tensile and bending loadings

NASA Astrophysics Data System (ADS)

Kadioglu, F.; Avil, E.; Ercan, M. E.; Aydogan, T.

2018-05-01

Fiber-reinforced polymer composites are being used in an increasingly wide range of products. They are particularly popular in automotive and aerospace sectors because they offer an attractive combination of stiffness, strength and low mass. Adhesively-bonded joints of such materials are preferred by many designers due to their assembling advantages over other traditional mechanical joining systems, such as bolted and riveted joints. In this study, some experimental works have been carried out on adhesively-bonded adherends manufactured from a woven carbon fiber-reinforced polymer matrix composite (Hexply 8552S/A280-5H, produced by Hexcel), by using a film adhesive (AF163-2K produced by 3 M). The bonded specimens were prepared in the Single Lap Joint (SLJ) configuration, and tested in tensile and also in four-point bending loading. In order to assess the joint performance, three different overlap lengths, 15 mm, 25 mm and 40 mm, and two different thicknesses of the composite adherends, 2 mm and 3 mm, were used. The results shown that the parameters are controlled by the loading modes; while the overlap length increases the joint performance significantly in tensile loading, the opposite was the case for those in bending loading, which was affected mainly by the adherend thicknesses. The results were related to the mechanisms of joint failures; while the joints in the tensile failed in the adhesive layer with some exceptions, those in the bending mainly failed in the plies adjacent to the layer. The current study indicates that one of the important factors affecting the joint strength of the adherends manufactured from the laminated composites is the local failure of the plies. It is thought more focused-studies would be needed to lessen such problems, which would be possible via in-depth numerical analysis.

Lower limb joint kinetics and ankle joint stiffness in the sprint start push-off.

PubMed

Charalambous, Laura; Irwin, Gareth; Bezodis, Ian N; Kerwin, David

2012-01-01

Sprint push-off technique is fundamental to sprint performance and joint stiffness has been identified as a performance-related variable during dynamic movements. However, joint stiffness for the push-off and its relationship with performance (times and velocities) has not been reported. The aim of this study was to quantify and explain lower limb net joint moments and mechanical powers, and ankle stiffness during the first stance phase of the push-off. One elite sprinter performed 10 maximal sprint starts. An automatic motion analysis system (CODA, 200 Hz) with synchronized force plates (Kistler, 1000 Hz) collected kinematic profiles at the hip, knee, and ankle and ground reaction forces, providing input for inverse dynamics analyses. The lower-limb joints predominately extended and revealed a proximal-to-distal sequential pattern of maximal extensor angular velocity and positive power production. Pearson correlations revealed relationships (P < 0.05) between ankle stiffness (5.93 ± 0.75 N x m x deg(-1)) and selected performance variables. Relationships between negative power phase ankle stiffness and horizontal (r = -0.79) and vertical (r = 0.74) centre of mass velocities were opposite in direction to the positive power phase ankle stiffness (horizontal: r = 0.85; vertical: r = -0.54). Thus ankle stiffness may affect the goals of the sprint push-off in different ways, depending on the phase of stance considered.

Improvement in Fatigue Performance of Aluminium Alloy Welded Joints by Laser Shock Peening in a Dynamic Strain Aging Temperature Regime.

PubMed

Su, Chun; Zhou, Jianzhong; Meng, Xiankai; Huang, Shu

2016-09-26

As a new treatment process after welding, the process parameters of laser shock peening (LSP) in dynamic strain aging (DSA) temperature regimes can be precisely controlled, and the process is a non-contact one. The effects of LSP at elevated temperatures on the distribution of the surface residual stress of AA6061-T6 welded joints were investigated by using X-ray diffraction technology with the sin² ϕ method and Abaqus software. The fatigue life of the welded joints was estimated by performing tensile fatigue tests. The microstructural evolution in surface and fatigue fractures of the welded joints was presented by means of surface integrity and fracture surface testing. In the DSA temperature regime of AA6061-T6 welded joints, the residual compressive stress was distributed more stably than that of LSP at room temperature. The thermal corrosion resistance and fatigue properties of the welded joints were also improved. The experimental results and numerical analysis were in mutual agreement.

Improvement in Fatigue Performance of Aluminium Alloy Welded Joints by Laser Shock Peening in a Dynamic Strain Aging Temperature Regime

PubMed Central

Su, Chun; Zhou, Jianzhong; Meng, Xiankai; Huang, Shu

2016-01-01

As a new treatment process after welding, the process parameters of laser shock peening (LSP) in dynamic strain aging (DSA) temperature regimes can be precisely controlled, and the process is a non-contact one. The effects of LSP at elevated temperatures on the distribution of the surface residual stress of AA6061-T6 welded joints were investigated by using X-ray diffraction technology with the sin2ϕ method and Abaqus software. The fatigue life of the welded joints was estimated by performing tensile fatigue tests. The microstructural evolution in surface and fatigue fractures of the welded joints was presented by means of surface integrity and fracture surface testing. In the DSA temperature regime of AA6061-T6 welded joints, the residual compressive stress was distributed more stably than that of LSP at room temperature. The thermal corrosion resistance and fatigue properties of the welded joints were also improved. The experimental results and numerical analysis were in mutual agreement. PMID:28773920

Predicting the Drop Performance of Solder Joints by Evaluating the Elastic Strain Energy from High-Speed Ball Pull Tests

NASA Astrophysics Data System (ADS)

You, Taehoon; Kim, Yunsung; Kim, Jina; Lee, Jaehong; Jung, Byungwook; Moon, Jungtak; Choe, Heeman

2009-03-01

Despite being expensive and time consuming, board-level drop testing has been widely used to assess the drop or impact resistance of the solder joints in handheld microelectronic devices, such as cellphones and personal digital assistants (PDAs). In this study, a new test method, which is much simpler and quicker, is proposed. The method involves evaluating the elastic strain energy and relating it to the impact resistance of the solder joint by considering the Young’s modulus of the bulk solder and the fracture stress of the solder joint during a ball pull test at high strain rates. The results show that solder joints can be ranked in order of descending elastic strain energy as follows: Sn-37Pb, Sn-1Ag-0.5Cu, Sn-3Ag-0.5Cu, and Sn-4Ag-0.5Cu. This order is consistent with the actual drop performances of the samples.

Outcome of Joint-Preserving Arthroplasty for Rheumatoid Forefoot Deformities.

PubMed

Fukushi, Jun-ichi; Nakashima, Yasuharu; Okazaki, Ken; Yamada, Hisakata; Mawatari, Taro; Ohishi, Masanobu; Oyamada, Akiko; Akasaki, Yukio; Iwamoto, Yukihide

2016-03-01

Along with the recent advances in the pharmacological management of rheumatoid arthritis, there is a trend toward the use of joint-preserving surgery in the treatment of rheumatoid forefoot deformities. However, the clinical outcomes of joint-preserving surgery for rheumatoid forefoot deformities have not been assessed in comparison to resection arthroplasty. We retrospectively evaluated 23 feet in 17 patients with rheumatoid forefoot deformities who underwent surgery between January 2010 and December 2013. The patients included 1 male (1 foot) and 16 females (22 feet), with a mean age of 62 years. The mean length of follow-up was 28 months. The patients were treated by 3 surgeons. One surgeon performed joint-preserving procedures (JP group) to the feet in which (1) no pain with motion existed, and (2) the range of motion in the first metatarsophalangeal (MTP) joint was greater than 30 degrees (n = 10); otherwise, resection arthroplasty with arthrodesis of the first MTP joint was performed (n = 3). The other surgeons performed resection arthroplasty in all cases (n = 10) (RA group, n = 13 in total). The clinical outcomes of the patients were evaluated using the Japanese Society for Surgery of the Foot (JSSF) hallux and lesser toe scales. There were no significant differences in the preoperative total JSSF scores for either the hallux (54.5 and 61.4 points) or the lesser toe (45.2 and 57.4 points) between the RA and JP groups, respectively. Postoperatively, the total JSSF scores for both the hallux (79.4 and 88.2 points) and lesser toes (73.6 and 87.7 points) showed significant improvement in both the RA and JP groups, respectively; however, the JP group showed a greater postoperative improvement. The scores relating to the function category on the hallux scale and the alignment category on the lesser toe scale were significantly higher in the JP group. With regard to the function of the hallux and the alignment of the lesser toes, the joint-preserving procedures

41 CFR 101-6.212-5 - Consolidated or joint hearings.

Code of Federal Regulations, 2010 CFR

2010-07-01

..., provide for the conduct of consolidated or joint hearings, and for the application to such hearings of... 41 Public Contracts and Property Management 2 2010-07-01 2010-07-01 true Consolidated or joint...-Nondiscrimination in Programs Receiving Federal Financial Assistance § 101-6.212-5 Consolidated or joint hearings...

Performance of concrete joint sealants in hot climates

DOT National Transportation Integrated Search

1987-11-01

A research project was initiated in 1979 on project IR-17-1(126) to compare and evaluate several joint sealants. In 1982 another test section on project F 028-1-506 was established to evaluate several other sealants. This report documents the placeme...

Reduced complexity of multi-track joint 2-D Viterbi detectors for bit-patterned media recording channel

NASA Astrophysics Data System (ADS)

Myint, L. M. M.; Warisarn, C.

2017-05-01

Two-dimensional (2-D) interference is one of the prominent challenges in ultra-high density recording system such as bit patterned media recording (BPMR). The multi-track joint 2-D detection technique with the help of the array-head reading can tackle this problem effectively by jointly processing the multiple readback signals from the adjacent tracks. Moreover, it can robustly alleviate the impairments due to track mis-registration (TMR) and media noise. However, the computational complexity of such detectors is normally too high and hard to implement in a reality, even for a few multiple tracks. Therefore, in this paper, we mainly focus on reducing the complexity of multi-track joint 2-D Viterbi detector without paying a large penalty in terms of the performance. We propose a simplified multi-track joint 2-D Viterbi detector with a manageable complexity level for the BPMR's multi-track multi-head (MTMH) system. In the proposed method, the complexity of detector's trellis is reduced with the help of the joint-track equalization method which employs 1-D equalizers and 2-D generalized partial response (GPR) target. Moreover, we also examine the performance of a full-fledged multi-track joint 2-D detector and the conventional 2-D detection. The results show that the simplified detector can perform close to the full-fledge detector, especially when the system faces high media noise, with the significant low complexity.

Stabilization of the sacroiliac joint.

PubMed

Shaffrey, Christopher I; Smith, Justin S

2013-07-01

Lower back pain and pain involving the area of the posterior iliac spine are extremely common. Degeneration of the sacroiliac joint (SIJ) is one potential cause for lower back pain and pain radiating into the groin or buttocks. Degenerative changes to the lumbar spine and sacroiliac joints are common. A recent study evaluating SIJ abnormalities in a primary low back pain population demonstrated 31.7% of patients demonstrated SI joint abnormalities. (4) As is the case for the evaluation and management of isolated lower back pain, the evaluation, management, and role for surgical intervention in SIJ pain is very controversial. Many patients have degenerative changes of the disc, facet joints, and SIJs. A recent systematic review performed to determine the diagnostic accuracy of tests available to clinicians to identify the disc, facet joint, or SIJ as the source of low back pain concluded that tests do exist that change the probability of the disc or SIJ (but not the facet joint) as the source of low back pain. (3) It was also concluded that the usefulness of these tests in clinical practice, particularly for guiding treatment selection, remains unclear. (3) Although there is general agreement that SIJ pathological changes are a potential cause of pain, there is far less agreement about the optimal management of these conditions. A variety of conditions can cause SIJ dysfunction including degenerative and inflammatory arthritis, trauma, prior lumbosacral fusion, hip arthritis, limb length inequality, infections, and neoplasia. (8) There is increasing evidence that image intensifier-guided single periarticular injection can correctly localize pain to the SIJ but the optimal management strategy remains controversial. Recent publications have compared surgical versus injection treatments and fusion versus denervation procedures. (1 , 8) A systematic review found improvement regardless of the treatment, with most studies reporting over 40% improvement in pain as measured

Effect of aerated concrete blockwork joints on the heat transfer performance uniformity

NASA Astrophysics Data System (ADS)

Pukhkal, Viktor; Murgul, Vera

2018-03-01

Analysis of data on the effect of joints of the aerated concrete blocks on the heat transfer uniformity of exterior walls was carried out. It was concluded, that the values of the heat transfer performance uniformity factor in the literature sources were obtained for the regular fragment of a wall construction by approximate addition of thermal conductivities. Heat flow patterns for the aerated concrete exterior walls amid different values of the thermal conductivity factors and design ambient air temperature of -26 °C were calculated with the use of "ELCUT" software for modelling of thermal patterns by finite element method. There were defined the values for the heat transfer performance uniformity factor, reduced total thermal resistance and heat-flux density for the exterior walls. The calculated values of the heat transfer performance uniformity factors, as a function of the coefficient of thermal conductivity of aerated concrete blocks, differ from the known data by a more rigorous thermal and physical substantiation.

A theoretical framework for understanding neuromuscular response to lower extremity joint injury.

PubMed

Pietrosimone, Brian G; McLeod, Michelle M; Lepley, Adam S

2012-01-01

Neuromuscular alterations are common following lower extremity joint injury and often lead to decreased function and disability. These neuromuscular alterations manifest in inhibition or abnormal facilitation of the uninjured musculature surrounding an injured joint. Unfortunately, these neural alterations are poorly understood, which may affect clinical recognition and treatment of these injuries. Understanding how these neural alterations affect physical function may be important for proper clinical management of lower extremity joint injuries. Pertinent articles focusing on neuromuscular consequences and treatment of knee and ankle injuries were collected from peer-reviewed sources available on the Web of Science and Medline databases from 1975 through 2010. A theoretical model to illustrate potential relationships between neural alterations and clinical impairments was constructed from the current literature. Lower extremity joint injury affects upstream cortical and spinal reflexive excitability pathways as well as downstream muscle function and overall physical performance. Treatment targeting the central nervous system provides an alternate means of treating joint injury that may be effective for patients with neuromuscular alterations. Disability is common following joint injury. There is mounting evidence that alterations in the central nervous system may relate to clinical changes in biomechanics that may predispose patients to further injury, and novel clinical interventions that target neural alterations may improve therapeutic outcomes.

A systematic review of postoperative hand therapy management of basal joint arthritis.

PubMed

Wolfe, Terri; Chu, Jennifer Y; Woods, Tammy; Lubahn, John D

2014-04-01

There are a variety of postoperative immobilization and therapy options for patients with basal joint arthritis. Although prior systematic reviews have compared surgical procedures used to treat basal joint arthritis, none to our knowledge compares therapy protocols for this condition, which are considered an important part of the treatment. (1) We sought to determine whether differences in the length and type of postoperative immobilization affect clinical results after basal joint arthritis surgery. (2) We also compared specific therapy protocols that were prescribed. (3) Finally, we evaluated published protocols to determine when patients were released to full activity to see whether these appeared to affect clinical results. A systematic review of English-language studies in the PubMed and Cochrane databases was performed. Studies were then reviewed to determine what postoperative immobilization and therapy protocols the authors used and when patients were released to full activities. A total of 19 studies were identified using the search criteria. All but one of the studies included a postoperative period of immobilization in either a cast or splint. Immobilization time varied depending on whether Kirschner wires were used for the surgery and whether an implant was placed. Postoperative therapy protocols also varied but followed three general patterns. Some therapy protocols involved teaching patients a home exercise program only, whereas some authors described routine referral to a therapist. The third group consisted of studies in which patients were only referred for therapy if the physicians determined it was necessary during followup. Many studies did not give a specific time for full return to activity and instead described a gradual transition to full activity after immobilization was discontinued. Because of the variability and small numbers, no conclusive recommendations could be made on any of the three study questions. Comparative, multicenter

Business School's Performance Management System Standards Design

ERIC Educational Resources Information Center

Azis, Anton Mulyono; Simatupang, Togar M.; Wibisono, Dermawan; Basri, Mursyid Hasan

2014-01-01

This paper aims to compare various Performance Management Systems (PMS) for business school in order to find the strengths of each standard as inputs to design new model of PMS. There are many critical aspects and gaps notified for new model to improve performance and even recognized that self evaluation performance management is not well…

Surrogate modeling of joint flood risk across coastal watersheds

NASA Astrophysics Data System (ADS)

Bass, Benjamin; Bedient, Philip

2018-03-01

This study discusses the development and performance of a rapid prediction system capable of representing the joint rainfall-runoff and storm surge flood response of tropical cyclones (TCs) for probabilistic risk analysis. Due to the computational demand required for accurately representing storm surge with the high-fidelity ADvanced CIRCulation (ADCIRC) hydrodynamic model and its coupling with additional numerical models to represent rainfall-runoff, a surrogate or statistical model was trained to represent the relationship between hurricane wind- and pressure-field characteristics and their peak joint flood response typically determined from physics based numerical models. This builds upon past studies that have only evaluated surrogate models for predicting peak surge, and provides the first system capable of probabilistically representing joint flood levels from TCs. The utility of this joint flood prediction system is then demonstrated by improving upon probabilistic TC flood risk products, which currently account for storm surge but do not take into account TC associated rainfall-runoff. Results demonstrate the source apportionment of rainfall-runoff versus storm surge and highlight that slight increases in flood risk levels may occur due to the interaction between rainfall-runoff and storm surge as compared to the Federal Emergency Management Association's (FEMAs) current practices.

Shear fracture of jointed steel plates of bolted joints under impact load

NASA Astrophysics Data System (ADS)

Daimaruya, M.; Fujiki, H.; Ambarita, H.; Kobayashi, H.; Shin, H.-S.

2013-07-01

The present study is concerned with the development of a fracture criterion for the impact fracture of jointed steel plates of bolted joints used in a car body, which contributes to crash simulations by CAE. We focus our attention on the shear fracture of the jointed steel plates of lap-bolted joints in the suspension of a car under impact load. Members of lap-bolted joints are modelled as a pair of steel plates connected by a bolt. One of the plates is a specimen subjected to plastic deformation and fracture and the other is a jig subjected to elastic deformation only. Three kinds of steel plate specimens are examined, i.e., a common steel plate with a tensile strength of 270 MPa and high tensile strength steel plates of 440 and 590 MPa used for cars. The impact shear test was performed using the split Hopkinson bar technique for tension impact, together with the static test using a universal testing machine INSTRON 5586. The behaviour of the shear stress and deformation up to rupture taking place in the joint was discussed. The obtained results suggest that a stress-based fracture criterion may be developed for the impact fracture of jointed steel plates of a lap-bolted joint.

Blood management and transfusion strategies in 600 patients undergoing total joint arthroplasty: an analysis of pre-operative autologous blood donation

PubMed Central

Perazzo, Paolo; Viganò, Marco; de Girolamo, Laura; Verde, Francesco; Vinci, Anna; Banfi, Giuseppe; Romagnoli, Sergio

2013-01-01

Background Blood loss during total joint arthroplasty strongly influences the time to recover after surgery and the quality of the recovery. Blood conservation strategies such as pre-operative autologous blood donation and post-operative cell salvage are intended to avoid allogeneic blood transfusions and their associated risks. Although widely investigated, the real effectiveness of these alternative transfusion practices remains controversial. Materials and methods The surgery reports of 600 patients undergoing total joint arthroplasty (312 hip and 288 knee replacements) were retrospectively reviewed to assess transfusion needs and related blood management at our institute. Evaluation parameters included post-operative blood loss, haemoglobin concentration measured at different time points, ASA score, and blood transfusion strategies. Results Autologous blood donation increased the odds of receiving a red blood cell transfusion. Reinfusion by a cell salvage system of post-operative shed blood was found to limit adverse effects in cases of severe post-operative blood loss. The peri-operative net decrease in haemoglobin concentration was higher in patients who had predeposited autologous blood than in those who had not. Discussion The strengths of this study are the high number of cases and the standardised procedures, all operations having been performed by a single orthopaedic surgeon and a single anaesthesiologist. Our data suggest that a pre-operative autologous donation programme may often be useless, if not harmful. Conversely, the use of a cell salvage system may be effective in reducing the impact of blood transfusion on a patient’s physiological status. Basal haemoglobin concentration emerged as a useful indicator of transfusion probability in total joint replacement procedures. PMID:23736922

Muscular performance and body composition changes following multi-joint versus combined multi- and single-joint exercises in aging adults.

PubMed

Bezerra, Ewertton de Souza; Moro, Antônio Renato Pereira; Orssatto, Lucas Bet da Rosa; da Silva, Mariane Eichendorf; Willardson, Jeffrey Michael; Simão, Roberto

2018-06-01

The aim of the present study was to compare muscular performance and body composition changes following low-volume resistance-training programs consisting of multi-joint (MJ) exercises (cable chest press and seated row) versus a combination of multi- and single-joint (MJ+SJ) exercises (cable chest press, seated row, biceps curl, and triceps extension). Thirty untrained healthy aging adults were randomly assigned to 3 groups: MJ (n = 11), MJ+SJ (n = 11), and control (n = 8). Twelve-repetition maximums (12-RMs) for the cable chest press and seated row, localized muscular endurance for the elbow flexors handgrip strength, and body composition were assessed before and after the 8-week training program. All comparisons were analyzed via a mixed-model analysis with repeated measures (group × time) and the Bonferroni post hoc test (p < 0.05). The MJ and MJ+SJ groups increased performance in the 12-RM cable chest press (MJ = 61.5% ± 24.6% and MJ+SJ = 71.1% ± 25.6%), 12-RM seated row (MJ = 46.4% ± 26.3% and MJ+SJ = 51.5% ± 21.0%), localized muscular endurance (MJ = 24.7% ± 16.7% and MJ+SJ = 37.0% ± 11.4%), and handgrip strength (MJ = 9.3% ± 10.4% and MJ+SJ = 16.6% ± 25.3%) after the intervention. Body composition (i.e., trunk and upper limb fat and lean mass) did not change for any groups. No significant differences were observed between the MJ versus the MJ+SJ protocols after the intervention for any variables. In conclusion, for aging adults, either MJ or MJ+SJ low-volume resistance training resulted in similar increases in 12-RM, localized muscular endurance, and handgrip strength, without changes in body composition after 8 weeks of training.

The High performance of nanocrystalline CVD diamond coated hip joints in wear simulator test.

PubMed

Maru, M M; Amaral, M; Rodrigues, S P; Santos, R; Gouvea, C P; Archanjo, B S; Trommer, R M; Oliveira, F J; Silva, R F; Achete, C A

2015-09-01

The superior biotribological performance of nanocrystalline diamond (NCD) coatings grown by a chemical vapor deposition (CVD) method was already shown to demonstrate high wear resistance in ball on plate experiments under physiological liquid lubrication. However, tests with a close-to-real approach were missing and this constitutes the aim of the present work. Hip joint wear simulator tests were performed with cups and heads made of silicon nitride coated with NCD of ~10 μm in thickness. Five million testing cycles (Mc) were run, which represent nearly five years of hip joint implant activity in a patient. For the wear analysis, gravimetry, profilometry, scanning electron microscopy and Raman spectroscopy techniques were used. After 0.5 Mc of wear test, truncation of the protruded regions of the NCD film happened as a result of a fine-scale abrasive wear mechanism, evolving to extensive plateau regions and highly polished surface condition (Ra<10nm). Such surface modification took place without any catastrophic features as cracking, grain pullouts or delamination of the coatings. A steady state volumetric wear rate of 0.02 mm(3)/Mc, equivalent to a linear wear of 0.27 μm/Mc favorably compares with the best performance reported in the literature for the fourth generation alumina ceramic (0.05 mm(3)/Mc). Also, squeaking, quite common phenomenon in hard-on-hard systems, was absent in the present all-NCD system. Copyright © 2015 Elsevier Ltd. All rights reserved.

Nonparametric EROC analysis for observer performance evaluation on joint detection and estimation tasks

NASA Astrophysics Data System (ADS)

Wunderlich, Adam; Goossens, Bart

2014-03-01

The majority of the literature on task-based image quality assessment has focused on lesion detection tasks, using the receiver operating characteristic (ROC) curve, or related variants, to measure performance. However, since many clinical image evaluation tasks involve both detection and estimation (e.g., estimation of kidney stone composition, estimation of tumor size), there is a growing interest in performance evaluation for joint detection and estimation tasks. To evaluate observer performance on such tasks, Clarkson introduced the estimation ROC (EROC) curve, and the area under the EROC curve as a summary figure of merit. In the present work, we propose nonparametric estimators for practical EROC analysis from experimental data, including estimators for the area under the EROC curve and its variance. The estimators are illustrated with a practical example comparing MRI images reconstructed from different k-space sampling trajectories.

Development and validation of a periarticular injection technique of the sacroiliac joint in horses.

PubMed

Engeli, E; Haussler, K K; Erb, H N

2004-05-01

sacroiliac joint margins in 88% of the specimens. Median distance of the MB from the sacroiliac joint margins was 1.0 cm (range 0.2-3.8 cm). The overall success rate considering both location and distance of the MB-stained tissue relative to sacroiliac joint margins was 83% (40 of 48 joints). The injection technique provides a reliable, easy to perform and consistent access to the medial periarticular aspect of the sacroiliac joint. The described injection technique has the potential for both diagnostic and therapeutic applications in the medical management of equine sacroiliac joint disease. Further investigation is necessary to evaluate clinical efficacy and potential adverse effects.

Managing Learning for Performance.

ERIC Educational Resources Information Center

Kuchinke, K. Peter

1995-01-01

Presents findings of organizational learning literature that could substantiate claims of learning organization proponents. Examines four learning processes and their contribution to performance-based learning management: knowledge acquisition, information distribution, information interpretation, and organizational memory. (SK)

The economics of water reuse and implications for joint water quality-quantity management

NASA Astrophysics Data System (ADS)

Kuwayama, Y.

2015-12-01

Traditionally, economists have treated the management of water quality and water quantity as separate problems. However, there are some water management issues for which economic analysis requires the simultaneous consideration of water quality and quantity policies and outcomes. Water reuse, which has expanded significantly over the last several decades, is one of these issues. Analyzing the cost effectiveness and social welfare outcomes of adopting water reuse requires a joint water quality-quantity optimization framework because, at its most basic level, water reuse requires decision makers to consider (a) its potential for alleviating water scarcity, (b) the quality to which the water should be treated prior to reuse, and (c) the benefits of discharging less wastewater into the environment. In this project, we develop a theoretical model of water reuse management to illustrate how the availability of water reuse technologies and practices can lead to a departure from established rules in the water resource economics literature for the optimal allocation of freshwater and water pollution abatement. We also conduct an econometric analysis of a unique dataset of county-level water reuse from the state of Florida over the seventeen-year period between 1996 and 2012 in order to determine whether water quality or scarcity concerns drive greater adoption of water reuse practices.

Development of access management performance measures.

DOT National Transportation Integrated Search

2009-05-01

In 2007, the Virginia General Assembly passed legislation calling for Access Management, the : regulation of entrances and intersections along highway corridors in Virginia. Some property owners may oppose : access management. Therefore, performance ...

Performance of two predictive uncertainty estimation approaches for conceptual Rainfall-Runoff Model: Bayesian Joint Inference and Hydrologic Uncertainty Post-processing

NASA Astrophysics Data System (ADS)

Hernández-López, Mario R.; Romero-Cuéllar, Jonathan; Camilo Múnera-Estrada, Juan; Coccia, Gabriele; Francés, Félix

2017-04-01

It is noticeably important to emphasize the role of uncertainty particularly when the model forecasts are used to support decision-making and water management. This research compares two approaches for the evaluation of the predictive uncertainty in hydrological modeling. First approach is the Bayesian Joint Inference of hydrological and error models. Second approach is carried out through the Model Conditional Processor using the Truncated Normal Distribution in the transformed space. This comparison is focused on the predictive distribution reliability. The case study is applied to two basins included in the Model Parameter Estimation Experiment (MOPEX). These two basins, which have different hydrological complexity, are the French Broad River (North Carolina) and the Guadalupe River (Texas). The results indicate that generally, both approaches are able to provide similar predictive performances. However, the differences between them can arise in basins with complex hydrology (e.g. ephemeral basins). This is because obtained results with Bayesian Joint Inference are strongly dependent on the suitability of the hypothesized error model. Similarly, the results in the case of the Model Conditional Processor are mainly influenced by the selected model of tails or even by the selected full probability distribution model of the data in the real space, and by the definition of the Truncated Normal Distribution in the transformed space. In summary, the different hypotheses that the modeler choose on each of the two approaches are the main cause of the different results. This research also explores a proper combination of both methodologies which could be useful to achieve less biased hydrological parameter estimation. For this approach, firstly the predictive distribution is obtained through the Model Conditional Processor. Secondly, this predictive distribution is used to derive the corresponding additive error model which is employed for the hydrological parameter

Management system, organizational climate and performance relationships

NASA Technical Reports Server (NTRS)

Davis, B. D.

1979-01-01

Seven aerospace firms were investigated to determine if a relationship existed among management systems, organizational climate, and organization performance. Positive relationships were found between each of these variables, but a statistically significant relationship existed only between the management system and organizational climate. The direction and amount of communication and the degree of decentralized decision-making, elements of the management system, also had a statistically significant realtionship with organization performance.

5 CFR 9901.405 - Performance management system requirements.

Code of Federal Regulations, 2011 CFR

2011-01-01

... management system for NSPS employees, subject to the requirements set forth in this subpart. (b) The NSPS performance management system— (1) Provides for the appraisal of the performance of each employee annually; (2... employees based on performance and contribution; (3) Foster and reward excellent performance; (4) Address...

Confronting uncertainty in wildlife management: performance of grizzly bear management.

PubMed

Artelle, Kyle A; Anderson, Sean C; Cooper, Andrew B; Paquet, Paul C; Reynolds, John D; Darimont, Chris T

2013-01-01

Scientific management of wildlife requires confronting the complexities of natural and social systems. Uncertainty poses a central problem. Whereas the importance of considering uncertainty has been widely discussed, studies of the effects of unaddressed uncertainty on real management systems have been rare. We examined the effects of outcome uncertainty and components of biological uncertainty on hunt management performance, illustrated with grizzly bears (Ursus arctos horribilis) in British Columbia, Canada. We found that both forms of uncertainty can have serious impacts on management performance. Outcome uncertainty alone--discrepancy between expected and realized mortality levels--led to excess mortality in 19% of cases (population-years) examined. Accounting for uncertainty around estimated biological parameters (i.e., biological uncertainty) revealed that excess mortality might have occurred in up to 70% of cases. We offer a general method for identifying targets for exploited species that incorporates uncertainty and maintains the probability of exceeding mortality limits below specified thresholds. Setting targets in our focal system using this method at thresholds of 25% and 5% probability of overmortality would require average target mortality reductions of 47% and 81%, respectively. Application of our transparent and generalizable framework to this or other systems could improve management performance in the presence of uncertainty.

[Juvenile rheumatoid diseases: Endoprosthetic care of destroyed hip joints].

PubMed

Rehart, S; Henniger, M

2015-07-01

Patients with juvenile idiopathic arthritis (JIA) often suffer from involvement of the hip joints, with joint destruction and related functional limitations, making hip replacement necessary. To discover what special features are to be expected in patients with JIA and hip arthroplasty and what impact they have on surgical indication, choice of implant, and technique. Selective literature review and evaluation of our patient population. Compared with osteoarthritis patients, JIA patients are on average much younger at the time of hip replacement. Owing to the onset of the disease in childhood or adolescence and the frequent glucocorticoid therapy, growth disorders or abnormal anatomical findings are common in these patients. Bone density is often reduced at an early age. The perioperative management of medication has to be planned. Special implants for patients with rheumatic diseases do not exist, but the above peculiarities of this group of patients should be considered for surgical procedure and choice of implant and material. Overall, the results of hip arthroplasty in juvenile rheumatic diseases, in terms of pain relief and functional improvement, are good. The limited life of the arthroplasty is problematic. By relieving pain, improvement of the range of motion and activity level very high patient satisfaction is usually achieved by hip arthroplasty in JIA patients. In the case of involvement of the contralateral hip or the ipsilateral knee joint it may be useful to perform a simultaneous, single-stage joint replacement of both joints.

Managing Excellence in Sports Performance.

ERIC Educational Resources Information Center

Lyle, John W. B.

1997-01-01

Conceptualizes excellence in sports performance and suggests that there is a failure to distinguish between community recreation and performance sports as well as lack of knowledge about talent identification. Proposes a structure for management and investment in education and training in the field. (SK)

Bonded composite to metal scarf joint performance in an aircraft landing gear drag strut. [for Boeing 747 aircraft

NASA Technical Reports Server (NTRS)

Howell, W. E.

1974-01-01

The structural performance of a boron-epoxy reinforced titanium drag strut, which contains a bonded scarf joint and was designed to the criteria of the Boeing 747 transport, was evaluated. An experimental and analytical investigation was conducted. The strut was exposed to two lifetimes of spectrum loading and was statically loaded to the tensile and compressive design ultimate loads. Throughout the test program no evidence of any damage in the drag strut was detected by strain gage measurements, ultrasonic inspection, or visual observation. An analytical study of the bonded joint was made using the NASA structural analysis computer program NASTRAN. A comparison of the strains predicted by the NASTRAN computer program with the experimentally determined values shows excellent agreement. The NASTRAN computer program is a viable tool for studying, in detail, the stresses and strains induced in a bonded joint.

Effects of joints in truss structures

NASA Technical Reports Server (NTRS)

Ikegami, R.

1988-01-01

The response of truss-type structures for future space applications, such as Large Deployable Reflector (LDR), will be directly affected by joint performance. Some of the objectives of research at BAC were to characterize structural joints, establish analytical approaches that incorporate joint characteristics, and experimentally establish the validity of the analytical approaches. The test approach to characterize joints for both erectable and deployable-type structures was based upon a Force State Mapping Technique. The approach pictorially shows how the nonlinear joint results can be used for equivalent linear analysis. Testing of the Space Station joints developed at LaRC (a hinged joint at 2 Hz and a clevis joint at 2 Hz) successfully revealed the nonlinear characteristics of the joints. The Space Station joints were effectively linear when loaded to plus or minus 500 pounds with a corresponding displacement of about plus or minus 0.0015 inch. It was indicated that good linear joints exist which are compatible with errected structures, but that difficulty may be encountered if nonlinear-type joints are incorporated in the structure.

Managing Recurrence in Intraarticular Melorheostosis Involving the Knee Joint: A Case Report

PubMed Central

John, Bobby; Sharma, Anirudh; Pandey, Ritesh A

2017-01-01

Introduction: Melorheostosis is a rare benign sclerosing dysplasia affecting bone, which causes significant morbidity in the form of pain and restriction of joint movement. Treatment options are varied, and recurrence is common after surgical treatment. Choosing the most appropriate treatment option in the management of a recurrent case is challenging, with very little supporting evidence in literature owing to the rarity of the disease. We hereby present a case of recurrent melorheostosis involving the knee; discuss treatment options and the rationale of our treatment. Case Report: We present the case of a 42-year-old female who was operated at our institution previously 7 years ago for melorheostosis of her left knee and had undergone excision of intrarticular hyperostotic masses. However, pain and limitation of motion recurred in the operated knee 4 years later, and radiographs and computed tomography revealed a mineralized mass situated behind the patella in the patellofemoral joint. She was treated with repeat open excision of the mass and put on a regimen of physiotherapy and bisphosphonates. Conclusion: Open excision of symptomatic hyperostotic or mineralized soft tissue masses is perhaps the favored treatment option in such cases, the other options being arthroscopic excision and total knee arthroplasty. Limited knee motion and size of the mass often make arthroscopy an unfeasible option. Total knee arthroplasty should be reserved for cases with significant flexion contractures of the knee, or where multiple excisions have failed. PMID:29242791

Longitudinal pavement joint performance : a field study of infrared heated and notched wedge joint construction.

DOT National Transportation Integrated Search

2012-12-01

This report presents the findings of a field study in Maine, constructed during summer 2012 using : two different joint technologies and an infrared heater. MaineDOT has previously used an infrared : heater and notch-wedge apparatus to improve longit...

Digital tomosynthesis rendering of joint margins for arthritis assessment

NASA Astrophysics Data System (ADS)

Duryea, Jeffrey W.; Neumann, Gesa; Yoshioka, Hiroshi; Dobbins, James T., III

2004-05-01

PURPOSE: Rheumatoid arthritis (RA) of the hand is a significant healthcare problem. Techniques to accurately quantity the structural changes from RA are crucial for the development and prescription of therapies. Analysis of radiographic joint space width (JSW) is widely used and has demonstrated promise. However, radiography presents a 2D view of the joint. In this study we performed tomosynthesis reconstructions of proximal interphalangeal (PIP), and metacarpophalangeal (MCP) joints to measure the 3D joint structure. METHODS: We performed a reader study using simulated radiographs of 12 MCP and 12 PIP joints from skeletal specimens imaged with micro-CT. The tomosynthesis technique provided images of reconstructed planes with 0.75 mm spacing, which were presented to 2 readers with a computer tool. The readers were instructed to delineate the joint surfaces on tomosynthetic slices where they could visualize the margins. We performed a quantitative analysis of 5 slices surrounding the central portion of each joint. Reader-determined JSW was compared to a gold standard. As a figure of merit we calculated the average root-mean square deviation (RMSD). RESULTS: RMSD was 0.22 mm for both joints. For the individual joints, RMSD was 0.18 mm (MCP), and 0.26 mm (PIP). The reduced performance for the smaller PIP joints suggests that a slice spacing less than 0.75 mm may be more appropriate. CONCLUSIONS: We have demonstrated the capability of limited 3D rendering of joint surfaces using digital tomosynthesis. This technique promises to provide an improved method to visualize the structural changes of RA.

Strategic performance management: development of a performance measurement system at the Mayo Clinic.

PubMed

Curtright, J W; Stolp-Smith, S C; Edell, E S

2000-01-01

Managing and measuring performance become exceedingly complex as healthcare institutions evolve into integrated health systems comprised of hospitals, outpatient clinics and surgery centers, nursing homes, and home health services. Leaders of integrated health systems need to develop a methodology and system that align organizational strategies with performance measurement and management. To meet this end, multiple healthcare organizations embrace the performance-indicators reporting system known as a "balanced scorecard" or a "dashboard report." This discrete set of macrolevel indicators gives senior management a fast but comprehensive glimpse of the organization's performance in meeting its quality, operational, and financial goals. The leadership of outpatient operations for Mayo Clinic in Rochester, Minnesota built on this concept by creating a performance management and measurement system that monitors and reports how well the organization achieves its performance goals. Internal stakeholders identified metrics to measure performance in each key category. Through these metrics, the organization links Mayo Clinic's vision, primary value, core principles, and day-to-day operations by monitoring key performance indicators on a weekly, monthly, or quarterly basis.

Shading aboveground L-joint and lap-joint tests : comparison of white pine and sugar maple test assemblies

Treesearch

Carol A. Clausen; Daniel L. Lindner

2011-01-01

Five-year performance ratings are presented for two types of untreated, uncoated wood joints (L and lap) in aboveground tests under shaded conditions. The effect of shading on moisture entrapment in pine and maple L and lap joints was evaluated in a moderate decay zone (Madison, Wisconsin). Variations were observed between wood species, visual ratings, joint type,...

Management of proximal interphalangeal joint injuries

PubMed Central

Freiberg, Arnis

2007-01-01

Injuries to the proximal interphalangeal joint are common but frequently missed. They are often overtreated by prolonged immobilization, resulting in stiffness, which may be permanent. The purpose of the present article is to briefly review the relevant anatomy and biomechanics, present an approach to physical examination and diagnosis, and propose a practical clinical classification. The treatment of the most severe injury – the intra-articular fracture dislocation – is controversial. The various treatment options are discussed, based on personal experience and a review of the literature. A list of relevant references is presented. PMID:19554177

Performance Management and Reward

NASA Astrophysics Data System (ADS)

Yiannis, Triantafyllopoulos; Ioannis, Seimenis; Nikolaos, Konstantopoulos

2009-08-01

The article aims to examine, current Performance Management practices on Reward, financial or non-financial using lessons from the literature and the results of a qualitative analysis as these revealed from the interview of some executive members of Greek companies.

Common Bolted Joint Analysis Tool

NASA Technical Reports Server (NTRS)

Imtiaz, Kauser

2011-01-01

Common Bolted Joint Analysis Tool (comBAT) is an Excel/VB-based bolted joint analysis/optimization program that lays out a systematic foundation for an inexperienced or seasoned analyst to determine fastener size, material, and assembly torque for a given design. Analysts are able to perform numerous what-if scenarios within minutes to arrive at an optimal solution. The program evaluates input design parameters, performs joint assembly checks, and steps through numerous calculations to arrive at several key margins of safety for each member in a joint. It also checks for joint gapping, provides fatigue calculations, and generates joint diagrams for a visual reference. Optimum fastener size and material, as well as correct torque, can then be provided. Analysis methodology, equations, and guidelines are provided throughout the solution sequence so that this program does not become a "black box:" for the analyst. There are built-in databases that reduce the legwork required by the analyst. Each step is clearly identified and results are provided in number format, as well as color-coded spelled-out words to draw user attention. The three key features of the software are robust technical content, innovative and user friendly I/O, and a large database. The program addresses every aspect of bolted joint analysis and proves to be an instructional tool at the same time. It saves analysis time, has intelligent messaging features, and catches operator errors in real time.

Features that exacerbate fatigue severity in joint hypermobility syndrome/Ehlers-Danlos syndrome - hypermobility type.

PubMed

Krahe, Anne Maree; Adams, Roger David; Nicholson, Leslie Lorenda

2018-08-01

To assess the prevalence, severity and impact of fatigue on individuals with joint hypermobility syndrome (JHS)/Ehlers-Danlos syndrome - hypermobility type (EDS-HT) and establish potential determinants of fatigue severity in this population. Questionnaires on symptoms and signs related to fatigue, quality of life, mental health, physical activity participation and sleep quality were completed by people with JHS/EDS-HT recruited through two social media sites. Multiple regression analysis was performed to identify predictors of fatigue in this population. Significant fatigue was reported by 79.5% of the 117 participants. Multiple regression analysis identified five predictors of fatigue severity, four being potentially modifiable, accounting for 52.3% of the variance in reported fatigue scores. Predictors of fatigue severity were: the self-perceived extent of joint hypermobility, orthostatic dizziness related to heat and exercise, levels of participation in personal relationships and community, current levels of physical activity and dissatisfaction with the diagnostic process and management options provided for their condition. Fatigue is a significant symptom associated with JHS/EDS-HT. Assessment of individuals with this condition should include measures of fatigue severity to enable targeted management of potentially modifiable factors associated with fatigue severity. Implications for rehabilitation Fatigue is a significant symptom reported by individuals affected by joint hypermobility syndrome/Ehlers-Danlos syndrome - hypermobility type. Potentially modifiable features that contribute to fatigue severity in this population have been identified. Targeted management of these features may decrease the severity and impact of fatigue in joint hypermobility syndrome/Ehlers-Danlos syndrome - hypermobility type.

Accuracy of acromioclavicular joint injections.

PubMed

Wasserman, Bradley R; Pettrone, Sarah; Jazrawi, Laith M; Zuckerman, Joseph D; Rokito, Andrew S

2013-01-01

Injection to the acromioclavicular (AC) joint can be both diagnostic and therapeutic. The purpose of this study was to evaluate the accuracy of in vivo AC joint injections. Case series; Level of evidence, 4. Thirty patients with pain localized to the AC joint were injected with 1 mL of 1% lidocaine and 0.5 mL of radiographic contrast material (Isovue). Radiographs of the AC joint were taken after the injection. Each radiograph was reviewed by a musculoskeletal radiologist and graded as intra-articular, extra-articular, or partially intra-articular. Of the 30 injections performed, 13 (43.3%) were intra-articular, 7 (23.3%) were partially articular, and 10 (33.3%) were extra-articular. When the intra-articular and the partially articular groups were combined, 20 patients (66.7%) had some contrast dye in the AC joint. This study demonstrates that despite the relatively superficial location of the AC joint, the clinical accuracy of AC joint injections remains relatively low.

Designing an International Joint Venture Negotiation Game.

ERIC Educational Resources Information Center

Kenkel, Phil; And Others

1996-01-01

Evaluates a simulation game that models management problems encountered in negotiating and managing international joint ventures. Designed to instruct executives of state-owned agribusinesses in Indonesia in abstract concepts such as partner rapport, transfer price conflicts, and marketing disagreements, its success suggests that simulation games…

Method of joint bit rate/modulation format identification and optical performance monitoring using asynchronous delay-tap sampling for radio-over-fiber systems

NASA Astrophysics Data System (ADS)

Guesmi, Latifa; Menif, Mourad

2016-08-01

In the context of carrying a wide variety of modulation formats and data rates for home networks, the study covers the radio-over-fiber (RoF) technology, where the need for an alternative way of management, automated fault diagnosis, and formats identification is expressed. Also, RoF signals in an optical link are impaired by various linear and nonlinear effects including chromatic dispersion, polarization mode dispersion, amplified spontaneous emission noise, and so on. Hence, for this purpose, we investigated the sampling method based on asynchronous delay-tap sampling in conjunction with a cross-correlation function for the joint bit rate/modulation format identification and optical performance monitoring. Three modulation formats with different data rates are used to demonstrate the validity of this technique, where the identification accuracy and the monitoring ranges reached high values.

Dorsoradial capsulodesis for trapeziometacarpal joint instability.

PubMed

Rayan, Ghazi; Do, Viet

2013-02-01

We describe an alternative method for treating chronic trapeziometacarpal (TM) joint instability after acute injury or chronic repetitive use of the thumb by performing a dorsoradial capsulodesis procedure. The procedure is done by imbricating the redundant TM joint dorsoradial ligament and capsule after reducing the joint by pronating the thumb. The dorsoradial capsulodesis is a reasonable reconstructive option for chronic TM joint instability and subluxation. Copyright © 2013 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Knowledge, assessment, and management of adults with joint hypermobility syndrome/Ehlers-Danlos syndrome hypermobility type among Flemish physiotherapists.

PubMed

Rombaut, Lies; Deane, Janet; Simmonds, Jane; De Wandele, Inge; De Paepe, Anne; Malfait, Fransiska; Calders, Patrick

2015-03-01

Physiotherapy plays a fundamental role in managing adults with the joint hypermobility syndrome/Ehlers-Danlos syndrome hypermobility type (JHS/EDS-HT). However, it is a challenge for both the patient and the physiotherapist as the condition is poorly understood and treatment for JHS/EDS-HT is currently undefined. Insight into current practice is, therefore, necessary in order to establish baseline knowledge in this area and in the long term to improve the standard of patient care. Therefore, the purpose of this study was to evaluate current physiotherapists' knowledge of JHS/EDS-HT and to gain insight into current physiotherapy practice with emphasis on assessment, management, and treatment efficacy. Three hundred twenty-five Flemish physiotherapists participated in the study by filling out electronically a modified version of the "Hypermobility and Hypermobility Syndrome Questionnaire" (HHQ), which covered theoretical constructs such as general knowledge, assessment, management, and learning in relation to generalized joint hypermobility and JHS/EDS-HT. The results show that physiotherapists report a low level of confidence with regard to assessment and management of JHS/EDS-HT. Knowledge of hypermobility and JHS/EDS-HT is weak, especially regarding the features associated with JHS/EDS-HT. Many treatment approaches are used by physiotherapists with the majority showing preference for education, reassurance, muscle strengthening, proprioceptive and core stability training. Almost all approaches were perceived as being clinically effective by the physiotherapists, highlighting a lack of consensus. In conclusion, this study in Flemish physiotherapists confirms that JHS/EDS-HT is under-recognized, not well known and deemed difficult to treat. Further education is required and sought by the physiotherapists surveyed, and future research is needed. © 2015 Wiley Periodicals, Inc.

Optimal joint management of a coastal aquifer and a substitute resource

NASA Astrophysics Data System (ADS)

Moreaux, M.; Reynaud, A.

2004-06-01

This article characterizes the optimal joint management of a coastal aquifer and a costly water substitute. For this purpose we use a mathematical representation of the aquifer that incorporates the displacement of the interface between the seawater and the freshwater of the aquifer. We identify the spatial cost externalities created by users on each other and we show that the optimal water supply depends on the location of users. Users located in the coastal zone exclusively use the costly substitute. Those located in the more upstream area are supplied from the aquifer. At the optimum their withdrawal must take into account the cost externalities they generate on users located downstream. Last, users located in a median zone use the aquifer with a surface transportation cost. We show that the optimum can be implemented in a decentralized economy through a very simple Pigouvian tax. Finally, the optimal and decentralized extraction policies are simulated on a very simple example.

How joint characteristics between a piezoelectric beam and the main structure affect the performance of an energy harvester

NASA Astrophysics Data System (ADS)

Jahani, K.; Rafiei, M. M.; Aghazadeh, P.

2017-09-01

In this paper, the influence of the joint region between a piezoelectric energy harvesting beam and the vibratory main structure is studied. The investigations are conducted in two separate sections, namely numerical and experimental studies. In numerical studies, the effects of nonlinear parameters on generated power are investigated while the joint characteristics the between vibrating base and a piezoelectric energy harvester are taken into consideration. A unimorph beam with a tip mass and a nonlinear piezoelectric layer that undergoes a large-amplitude deflection is considered as an energy harvester. By applying the Euler-Lagrange equation and Gauss’s law the mechanical and electrical equations of motion are obtained, respectively. The excitation frequency is assumed to be close to the first natural frequency. Thus, a unimodal response is considered to be like that of a system with a single degree of freedom (SDOF). The joint between the vibrating main structure and the cantilevered beam is then added to the SDOF model. The joint characteristics are simulated with a light mass, mj , linear spring stiffness, kj , and equivalent viscous damper, cj . In two scenarios, i.e. with a rigid joint and with a flexible one, a numerical approach is followed to investigate the effects of each nonlinear parameter of the harvester (stiffness, damping and piezoelectric coefficient) on the harvested power. In experimental studies, the influence of a bolted joining technique and a flexible adhesive bonding method on the harvested power is investigated. The results achieved experimentally confirm those obtained numerically, i.e. a stiffer joint leads to a greater power produced by the harvester. In other words, neglecting the joint characteristics will cause the performance (maximum output power and the range of excitation frequency) of the harvester to be overestimated in numerical simulations.

Performance management system enhancement and maintenance

NASA Technical Reports Server (NTRS)

Cleaver, T. G.; Ahour, R.; Johnson, B. R.

1984-01-01

The research described in this report concludes a two-year effort to develop a Performance Management System (PMS) for the NCC computers. PMS provides semi-automated monthly reports to NASA and contractor management on the status and performance of the NCC computers in the TDRSS program. Throughout 1984, PMS was tested, debugged, extended, and enhanced. Regular PMS monthly reports were produced and distributed. PMS continues to operate at the NCC under control of Bendix Corp. personnel.

Manager traits and quality-of-care performance in hospitals.

PubMed

Aij, Kjeld Harald; Aernoudts, René L M C; Joosten, Gepke

2015-07-06

This paper aims to assess the impact of the leadership traits of chief executive officers (CEOs) on hospital performance in the USA. The effectiveness and efficiency of the CEO is of critical importance to the performance of any organization, including hospitals. Management systems and manager behaviours (traits) are of crucial importance to any organization because of their connection with organizational performance. To identify key factors associated with the quality of care delivered by hospitals, the authors gathered perceptions of manager traits from chief executive officers (CEOs) and followers in three groups of US hospitals delivering different levels of quality of care performance. Three high- and three low-performing hospitals were selected from the top and bottom 20th percentiles, respectively, using a national hospital ranking system based on standard quality of care performance measures. Three lean hospitals delivering intermediate performance were also selected. A survey was used to gather perceptions of manager traits (providing a modern or lean management system inclination) from CEOs and their followers in the three groups, which were compared. Four traits were found to be significantly different (alpha < 0.05) between lean (intermediate-) and low-performing hospitals. The different perceptions between these two hospital groups were all held by followers in the low-performing hospitals and not the CEOs, and all had a modern management inclination. No differences were found between lean (intermediate-) and high-performing hospitals, or between high- and low-performing hospitals. These findings support a need for hospital managers to acquire appropriate traits to achieve lean transformation, support a benefit of measuring manager traits to assess progress towards lean transformation and lend weight to improved quality of care that can be delivered by hospitals adopting a lean system of management.

Space Station Freedom (SSF) Data Management System (DMS) performance model data base

NASA Technical Reports Server (NTRS)

Stovall, John R.

1993-01-01

The purpose of this document was originally to be a working document summarizing Space Station Freedom (SSF) Data Management System (DMS) hardware and software design, configuration, performance and estimated loading data from a myriad of source documents such that the parameters provided could be used to build a dynamic performance model of the DMS. The document is published at this time as a close-out of the DMS performance modeling effort resulting from the Clinton Administration mandated Space Station Redesign. The DMS as documented in this report is no longer a part of the redesigned Space Station. The performance modeling effort was a joint undertaking between the National Aeronautics and Space Administration (NASA) Johnson Space Center (JSC) Flight Data Systems Division (FDSD) and the NASA Ames Research Center (ARC) Spacecraft Data Systems Research Branch. The scope of this document is limited to the DMS core network through the Man Tended Configuration (MTC) as it existed prior to the 1993 Clinton Administration mandated Space Station Redesign. Data is provided for the Standard Data Processors (SDP's), Multiplexer/Demultiplexers (MDM's) and Mass Storage Units (MSU's). Planned future releases would have added the additional hardware and software descriptions needed to describe the complete DMS. Performance and loading data through the Permanent Manned Configuration (PMC) was to have been included as it became available. No future releases of this document are presently planned pending completion of the present Space Station Redesign activities and task reassessment.

A Theoretical Framework for Understanding Neuromuscular Response to Lower Extremity Joint Injury

PubMed Central

Pietrosimone, Brian G.; McLeod, Michelle M.; Lepley, Adam S.

2012-01-01

Background: Neuromuscular alterations are common following lower extremity joint injury and often lead to decreased function and disability. These neuromuscular alterations manifest in inhibition or abnormal facilitation of the uninjured musculature surrounding an injured joint. Unfortunately, these neural alterations are poorly understood, which may affect clinical recognition and treatment of these injuries. Understanding how these neural alterations affect physical function may be important for proper clinical management of lower extremity joint injuries. Methods: Pertinent articles focusing on neuromuscular consequences and treatment of knee and ankle injuries were collected from peer-reviewed sources available on the Web of Science and Medline databases from 1975 through 2010. A theoretical model to illustrate potential relationships between neural alterations and clinical impairments was constructed from the current literature. Results: Lower extremity joint injury affects upstream cortical and spinal reflexive excitability pathways as well as downstream muscle function and overall physical performance. Treatment targeting the central nervous system provides an alternate means of treating joint injury that may be effective for patients with neuromuscular alterations. Conclusions: Disability is common following joint injury. There is mounting evidence that alterations in the central nervous system may relate to clinical changes in biomechanics that may predispose patients to further injury, and novel clinical interventions that target neural alterations may improve therapeutic outcomes. PMID:23016066

Investigating Secondary School Leaders' Perceptions of Performance Management

ERIC Educational Resources Information Center

Moreland, Jan

2009-01-01

Much of the research into teacher appraisal and performance management has focused on the experience of the classroom teacher. In this article, I will: (1) concentrate on the perspectives of the senior managers in secondary schools; (2) consider their views of the purpose of performance management; (3) compare their methods of implementation of…

Temporo-mandibular joint dislocation: an unusual complication of transoesophageal echocardiography.

PubMed

Anantharam, Brijesh; Chahal, Navtej; Stephens, Nigel; Senior, Roxy

2010-03-01

Temporo-mandibular joint (TMJ) dislocation is an unusual complication of transoesophageal echocardiography (TEE). We report a rare case of bilateral TMJ dislocation in an 84-year-old man prior to DC cardioversion (DCCV) for atrial flutter. Shortly after TEE and DCCV, the patient complained of bilateral facial pain. An orthopantomogram revealed bilateral TMJ dislocation. A closed reduction was performed by maxillo-facial surgeons under intravenous anaesthesia. Although very uncommon, the physician should be aware of the complication and its management.

Performance Analysis of a Self-Propelling Flat Plate Fin with Joint Compliance

NASA Astrophysics Data System (ADS)

Reddy, N. Srinivasa; Sen, Soumen; Pal, Sumit; Shome, Sankar Nath

2017-12-01

Fish fin muscles are compliant and they regulate the stiffness to suit different swimming conditions. This article attempts to understand the significance of presence of compliance in fin muscle with help of a flexible joint flat plate fin model. Blade element method is employed to model hydrodynamics and to compute the forces of interaction during motion of the plate within fluid. The dynamic model of self-propelling fin is developed through multi-body dynamics approach considering the hydrodynamic forces as external forces acting on the fin. The derived hydrodynamic model is validated with experiments on rigid flat plate fin. The effect of the joint stiffness and flapping frequency on the propulsion speed and efficiency is investigated through simulations using the derived and validated model. The propulsion efficiency is found to be highly influenced by the joint stiffness at a given flapping frequency. The fin attained maximum propulsion efficiency when the joint stiffness is tuned to a value at which flapping frequency matches near natural frequency of the fin. At this tuned joint stiffness and flapping frequency, the resulted Strouhal numbers are observed to fall within the optimum range (0.2 to 0.4) for maximized propulsion efficiency of flying birds and swimming aquatic animals reported in literature.

The JOINT model of nurse absenteeism and turnover: a systematic review.

PubMed

Daouk-Öyry, Lina; Anouze, Abdel-Latef; Otaki, Farah; Dumit, Nuhad Yazbik; Osman, Ibrahim

2014-01-01

Absenteeism and turnover among healthcare workers have a significant impact on overall healthcare system performance. The literature captures variables from different levels of measurement and analysis as being associated with attendance behavior among nurses. Yet, it remains unclear how variables from different contextual levels interact to impact nurses' attendance behaviors. The purpose of this review is to develop an integrative multilevel framework that optimizes our understanding of absenteeism and turnover among nurses in hospital settings. We therefore systematically examine English-only studies retrieved from two major databases, PubMed and CINAHL Plus and published between January, 2007 and January, 2013 (inclusive). Our review led to the identification of 7619 articles out of which 41 matched the inclusion criteria. The analysis yielded a total of 91 antecedent variables and 12 outcome variables for turnover, and 29 antecedent variables and 9 outcome variables for absenteeism. The various manifested variables were analyzed using content analysis and grouped into 11 categories, and further into five main factors: Job, Organization, Individual, National and inTerpersonal (JOINT). Thus, we propose the JOINT multilevel conceptual model for investigating absenteeism and turnover among nurses. The JOINT model can be adapted by researchers for fitting their hypothesized multilevel relationships. It can also be used by nursing managers as a lens for holistically managing nurses' attendance behaviors. Copyright © 2013 Elsevier Ltd. All rights reserved.

Managing uncertainty - a qualitative study of surgeons' decision-making for one-stage and two-stage revision surgery for prosthetic hip joint infection.

PubMed

Moore, Andrew J; Blom, Ashley W; Whitehouse, Michael R; Gooberman-Hill, Rachael

2017-04-12

Approximately 88,000 primary hip replacements are performed in England and Wales each year. Around 1% go on to develop deep prosthetic joint infection. Between one-stage and two-stage revision arthroplasty best treatment options remain unclear. Our aims were to characterise consultant orthopaedic surgeons' decisions about performing either one-stage or two-stage revision surgery for patients with deep prosthetic infection (PJI) after hip arthroplasty, and to identify whether a randomised trial comparing one-stage with two-stage revision would be feasible. Semi-structured interviews were conducted with 12 consultant surgeons who perform revision surgery for PJI after hip arthroplasty at 5 high-volume National Health Service (NHS) orthopaedic departments in England and Wales. Surgeons were interviewed before the development of a multicentre randomised controlled trial. Data were analysed using a thematic approach. There is no single standardised surgical intervention for the treatment of PJI. Surgeons balance multiple factors when choosing a surgical strategy which include multiple patient-related factors, their own knowledge and expertise, available infrastructure and the infecting organism. Surgeons questioned whether it was appropriate that the two-stage revision remained the best treatment, and some surgeons' willingness to consider more one-stage revisions had increased over recent years and were influenced by growing evidence showing equivalence between surgical techniques, and local observations of successful one-stage revisions. Custom-made articulating spacers was a practice that enabled uncertainty to be managed in the absence of definitive evidence about the superiority of one surgical technique over the other. Surgeons highlighted the need for research evidence to inform practice and thought that a randomised trial to compare treatments was needed. Most surgeons thought that patients who they treated would be eligible for trial participation in instances

Integrating policy-based management and SLA performance monitoring

NASA Astrophysics Data System (ADS)

Liu, Tzong-Jye; Lin, Chin-Yi; Chang, Shu-Hsin; Yen, Meng-Tzu

2001-10-01

Policy-based management system provides the configuration capability for the system administrators to focus on the requirements of customers. The service level agreement performance monitoring mechanism helps system administrators to verify the correctness of policies. However, it is difficult for a device to process the policies directly because the policies are the management concept. This paper proposes a mechanism to decompose a policy into rules that can be efficiently processed by a device. Thus, the device may process the rule and collect the performance statistics information efficiently; and the policy-based management system may collect these performance statistics information and report the service-level agreement performance monitoring information to the system administrator. The proposed policy-based management system achieves both the policy configuration and service-level agreement performance monitoring requirements. A policy consists of a condition part and an action part. The condition part is a Boolean expression of a source host IP group, a destination host IP group, etc. The action part is the parameters of services. We say that an address group is compact if it only consists of a range of IP address that can be denoted by a pair of IP address and corresponding IP mask. If the condition part of a policy only consists of the compact address group, we say that the policy is a rule. Since a device can efficiently process a compact address and a system administrator prefers to define a range of IP address, the policy-based management system has to translate policy into rules and supplements the gaps between policy and rules. The proposed policy-based management system builds the relationships between VPN and policies, policy and rules. Since the system administrator wants to monitor the system performance information of VPNs and policies, the proposed policy-based management system downloads the relationships among VPNs, policies and rules to the

Effects of Energy Density and Shielding Medium on Performance of Laser Beam Welding (LBW) Joints on SAF2205 Duplex Stainless Steel

NASA Astrophysics Data System (ADS)

Zhang, W. W.; Cong, S.; Luo, S. B.; Fang, J. H.

2018-05-01

The corrosion resistance performance of SAF2205 duplex stainless steel depends on the amount of ferrite to austenite transformation, but the ferrite content after power beam welding is always excessively high. To obtain laser beam welding joints with better mechanical and corrosion resistance performance, the effects of the energy density and shielding medium on the austenite content, hardness distribution, and shear strength were investigated. The results showed that ferrite to austenite transformation was realized with increase in the energy density. When the energy density was increased from 120 J/mm to 200 J/mm, the austenite content of the welding joint changed from 2.6% to 38.5%. Addition of nitrogen gas to the shielding medium could promote formation of austenite. When the shielding medium contained 50% and 100% nitrogen gas, the austenite content of the welding joint was 42.7% and 47.2%, respectively. The hardness and shear strength were significantly improved by increase in the energy density. However, the shielding medium had less effect on the mechanical performance. Use of the optimal welding process parameters resulted in peak hardness of 375 HV and average shear strength of 670 MPa.

Experimental cryo-irrigation of the knee joint.

PubMed

Chen, S C; Helal, B; Revell, P A; Brocklehurst, R; Currey, H L

1986-10-01

Experiments have been carried out to test the feasibility of using cryo-irrigation as a means of ablating the synovium in the rheumatoid knee joint. Cryo-irrigation was performed by a cooling machine and pump, which circulated cold 200/10 centistoke (cSt) silicone through the knee joint of rabbits anaesthetised with intravenous (IV) 'Saffan'. Fluid left the joint at -5 to -10 degrees C. Sixteen normal New Zealand rabbits received cryo-irrigation of one knee joint for 10-20 minutes and were killed at one day, and one, two, and 12 weeks thereafter. Judged by radioactive sulphate incorporation there was no impairment of chondrocyte function in the articular cartilage of irrigated joints. Histological examination showed mild synovitis and some loss of staining of superficial cartilage in 6/16 irrigated joints (v 1/16 control joints). Similar treatment of rabbit joints in which the Glynn model of synovitis had been induced showed marked reduction of synovitis 14-45 days after silicone treatment. Nine of 26 animals in which synovitis was induced in both knees and cryo-irrigation performed in one knee died either immediately postoperatively or during the next week. These deaths remain unexplained. A single dog received cryo-irrigation of one knee (-6 to -9 degrees C for 22 min) and remained perfectly well up to sacrifice at six months, when the joint appeared histologically completely normal.

Urban and rural groundwater use in Zhengzhou, China: challenges in joint management

NASA Astrophysics Data System (ADS)

Sun, Ronglin; Jin, Menggui; Giordano, Mark; Villholth, Karen G.

2009-09-01

Groundwater plays an important role in the total water supply of much of China, particularly in the north. It has contributed substantially to both agricultural growth and urban and industrial expansion. However, overexploitation and poor management have contributed to infamous groundwater depletion problems and less publicized groundwater quality deterioration. One of the key challenges for China will be how to make groundwater use sustainable while still meeting increased food needs as well as the industrial and domestic demands of a rapidly urbanizing society. Zhengzhou City, one of China’s test cities for building a “water saving society” highlights both the difficulties and potential solutions to northern China’s joint rural and urban groundwater challenges. Based on secondary data and a primary survey of groundwater management in the region, this report provides an overview of Zhengzhou’s groundwater development and use as well as the ongoing institutional and policy reform processes within the water sector. The results highlight how a deepening of ongoing reforms, which simultaneously consider groundwater as an integral rural and urban issue and a fundamental economic and social asset, may improve groundwater outcomes, not only in Zhengzhou but in China, as the country’s economy and demography continue to change.

Joint Force Quarterly. Number 1, Summer 1993

DTIC Science & Technology

1993-01-01

Contributors Joint Force Quarterly A PROFESSIONAL MILITARY JOURNAL Editor-in-Chief Alvin H. Bernstein Executive Editor Patrick M. Cronin Managing Editor Robert...understanding of the integrated employ- ment of land, sea, air, space, and special operations forces. The journal focuses on joint doctrine, coalition...other agency of the Federal Government. Por- tions of this journal are protected by copyright and may not be reproduced or extracted without the

Review of Prosthetic Joint Infection from Listeria monocytogenes.

PubMed

Bader, Gilbert; Al-Tarawneh, Mohammed; Myers, James

2016-12-01

Prosthetic joint infection from Listeria monocytogenes is rare. We decided to shed light on this illness and review the reported cases to better understand its characteristics. We conducted a comprehensive review of the English literature using PubMed. We also included one case that we had managed. We found 25 cases of prosthetic joint infection from L. monocytogenes reported individually and a retrospective study of 43 cases of joint and bone listerial infection, including 34 with prosthetic joint infection, conducted in France. We have described their clinical and para-clinical features and tried to elaborate on the pathophysiology, treatment, and prevention. Prosthetic joint infection from L. monocytogenes is mainly late. Systemic inflammation may be absent. Although rare, it must be suspected in patients at high risk for both prosthetic joint and listerial infections. In addition, those patients must be instructed on appropriate preventive measures.

Connecting the Force from Space: The IRIS Joint Capability Technology Demonstration

DTIC Science & Technology

2010-01-01

the Joint in Joint Capability Technology Demonstration, we have two sponsors, both U.S. Strategic Command and the Defense Information Systems...Capability Technology Demonstration will provide an excellent source of data on space-based Internet Protocol net- working. Operational... Internet Routing in Space Joint Capability Technology Demonstration Operational Manager, Space and Missile Defense Battle Lab, Colorado Springs

Information basis for developing comprehensive waste management system-US-Japan joint nuclear energy action plan waste management working group phase I report.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Nutt, M.; Nuclear Engineering Division

2010-05-25

The activity of Phase I of the Waste Management Working Group under the United States - Japan Joint Nuclear Energy Action Plan started in 2007. The US-Japan JNEAP is a bilateral collaborative framework to support the global implementation of safe, secure, and sustainable, nuclear fuel cycles (referred to in this document as fuel cycles). The Waste Management Working Group was established by strong interest of both parties, which arise from the recognition that development and optimization of waste management and disposal system(s) are central issues of the present and future nuclear fuel cycles. This report summarizes the activity of themore » Waste Management Working Group that focused on consolidation of the existing technical basis between the U.S. and Japan and the joint development of a plan for future collaborative activities. Firstly, the political/regulatory frameworks related to nuclear fuel cycles in both countries were reviewed. The various advanced fuel cycle scenarios that have been considered in both countries were then surveyed and summarized. The working group established the working reference scenario for the future cooperative activity that corresponds to a fuel cycle scenario being considered both in Japan and the U.S. This working scenario involves transitioning from a once-through fuel cycle utilizing light water reactors to a one-pass uranium-plutonium fuel recycle in light water reactors to a combination of light water reactors and fast reactors with plutonium, uranium, and minor actinide recycle, ultimately concluding with multiple recycle passes primarily using fast reactors. Considering the scenario, current and future expected waste streams, treatment and inventory were discussed, and the relevant information was summarized. Second, the waste management/disposal system optimization was discussed. Repository system concepts were reviewed, repository design concepts for the various classifications of nuclear waste were summarized, and the

Joint Fire Support

DTIC Science & Technology

2010-06-30

intelligence application package for theater battle management core system ( TBMCS ) functionality at wing and squadron levels. The automated four... TBMCS , Joint Surveillance and Target Attack Radar System (Ground Control Station), and Global Command and Control System, as well as with Allied FA...The TBMCS is a force level integrated air C2 system. TBMCS provides hardware, software, and communications interfaces to support the preparation

The Joint Convention - Its Structure, the Articles and its Administration

DOE Office of Scientific and Technical Information (OSTI.GOV)

Metcalf, P.; Louvat, D.

The objective of the Joint Convention on the Safety of Spent Fuel Management and on the Safety of Radioactive Waste Management (The Joint Convention) is to achieve a high level of safety worldwide in the management of spent nuclear and fuel and radioactive waste. [1] It is an incentive convention designed to encourage and assist countries to achieve the objective. Contracting Parties to the Joint Convention are required to compile and submit a national report on how they meet the articles of the Joint Convention. The reports are peer reviewed by other Contracting Parties to the Joint Convention and thenmore » countries have to defend the report at a review meeting of all the Contracting Parties. The process entails both a self appraisal in compiling the report and independent international peer review. Summaries are compiled of the various reviews and these are presented in plenary, with a view to identifying generic issues and areas in which countries are improving safety or have identified for further development. The process also presents an opportunity for countries involved to benchmark their national spent fuel and radioactive waste safety programmes against prevailing international practice. The paper elaborates the detailed elements involved and discusses the experience from the first review meeting of Contracting Parties, and issues envisaged for consideration at the second review meeting scheduled for May 2006. (authors)« less

An Investigation of Joint Service Acquisition Logistics Issues/Problems and Automated Joint Program Support.

DTIC Science & Technology

1984-09-01

Management Information System (ALMIS) to address them. Literature was surveyed and problems were summarized and developed into a questionnaire. Structured interviews were then conducted with over 100 different Air Force and civilian upper and middle JSAP managers. Many general and specific problems and issues were identified and validated using statistical and qualitative methods. General use of ALMIS to address certain joint service problem areas was confirmed. Potential use and desirable capabilities for ALMIS were also determined. Recommendations for ALMIS

Implementing a Nurse Manager Profile to Improve Unit Performance.

PubMed

Krugman, Mary E; Sanders, Carolyn L

2016-06-01

Nurse managers face significant pressures in the rapidly changing healthcare environment. Staying current with multiple sources of data, including reports that detail institutional and unit performance outcomes, is particularly challenging. A Nurse Manager Customized Profile was developed at a western academic hospital to provide a 1-page visual of pertinent data to help managers and director supervisors focus coaching to improve unit performance. Use of the Decisional Involvement Scale provided new insights into measuring manager performance.

Wide field of view CT and acromioclavicular joint instability: A technical innovation.

PubMed

Dyer, David R; Troupis, John M; Kamali Moaveni, Afshin

2015-06-01

A 21-year-old female with a traumatic shoulder injury is investigated and managed for symptoms relating to this injury. Pathology at the acromioclavicular joint is detected clinically; however, clinical examination and multiple imaging modalities do not reach a unified diagnosis on the grading of this acromioclavicular joint injury. When management appropriate to that suggested injury grading fail to help the patient's symptoms, further investigation methods were utilised. Wide field of view, dynamic CT (4D CT) is conducted on the patient's affected shoulder using a 320 × 0.5 mm detector multislice CT. Scans were conducted with a static table as the patient completed three movements of the affected shoulder. Capturing multiple data sets per second over a z-axis of 16 cm, measurements of the acromioclavicular joint were made, to show dynamic changes at the joint. Acromioclavicular (AC) joint translations were witnessed in three planes (a previously unrecognised pathology in the grading of acromioclavicular joint injuries). Translation in multiple planes was also not evident on careful clinical examination of this patient. AC joint width, anterior-posterior translation, superior-inferior translation and coracoclavicular width were measured with planar reconstructions while volume-rendered images and dynamic sequences aiding visual understanding of the pathology. Wide field of view dynamic CT (4D CT) is an accurate and quick modality to diagnose complex acromioclavicular joint injury. It provides dynamic information that no other modality can; 4D CT shows future benefits for clinical approach to diagnosis and management of acromioclavicular joint injury, and other musculoskeletal pathologies. © 2015 The Royal Australian and New Zealand College of Radiologists.

Midshaft clavicle fractures with associated ipsilateral acromioclavicular joint dislocations: Incidence and risk factors.

PubMed

Ottomeyer, Christina; Taylor, Benjamin C; Isaacson, Mark; Martinez, Lara; Ebaugh, Pierce; French, Bruce G

2017-02-01

Simultaneous ipsilateral clavicle and acromioclavicular (AC) joint injury have been infrequently reported in the literature at this time. The purpose of this study was to assess incidence as well as assess risk factors for this dual injury pattern. We performed a retrospective review of a prospectively collected database (Level III evidence), evaluating 383 adult patients without previous shoulder girdle injury or trauma with a minimum 1-year follow-up who sustained a displaced diaphyseal clavicle fracture. All patients in the study underwent either nonoperative management or surgical reduction and stabilization of a diaphyseal clavicle fracture with a plate and screw construct. Study subjects were followed with serial radiographs. Clavicle and shoulder radiographs, as well as chest radiographs and contralateral films in questionable cases, were used to assess for acromioclavicular joint injury in both operative and nonoperative groups. Additional data was collected on concurrent injuries, patient demographics, fracture characteristics, fixation techniques, surgical/post-operative data, and operative or nonoperative treatment. We found that 13/183 (7.1%) of patients undergoing fixation of a diaphyseal clavicle fracture had an ipsilateral AC joint injury, while 13/200 (6.5%) of patients undergoing conservative management had an ipsilateral AC joint injury. Critical analysis of the data revealed that presence of ipsilateral scapular body fractures, and a likely incidental association with superior plating fixation, were associated with an increased rate of this injury pattern. Ipsilateral clavicle fracture and AC joint injury is much more common than traditionally believed, with an incidence of 6.8% overall. It is unknown how the presence of an associated AC injury influences outcome, as AC injury was not universally symptomatic. Copyright © 2016 Elsevier Ltd. All rights reserved.

Private sector data for performance management.

DOT National Transportation Integrated Search

2011-07-01

This report examines and analyzes technical and institutional issues associated with the use of private sector travel time and speed data for public sector performance management. The primary data needs for congestion performance measures are outline...

44 CFR 150.5 - Joint Public Safety Awards Board.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Joint Public Safety Awards Board. 150.5 Section 150.5 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY FIRE PREVENTION AND CONTROL PUBLIC SAFETY AWARDS TO PUBLIC SAFETY OFFICERS...

Subtalar joint stress imaging with tomosynthesis.

PubMed

Teramoto, Atsushi; Watanabe, Kota; Takashima, Hiroyuki; Yamashita, Toshihiko

2014-06-01

The purpose of this study was to perform stress imaging of hindfoot inversion and eversion using tomosynthesis and to assess the subtalar joint range of motion (ROM) of healthy subjects. The subjects were 15 healthy volunteers with a mean age of 29.1 years. Coronal tomosynthesis stress imaging of the subtalar joint was performed in a total of 30 left and right ankles. A Telos stress device was used for the stress load, and the load was 150 N for both inversion and eversion. Tomographic images in which the posterior talocalcaneal joint could be confirmed on the neutral position images were used in measurements. The angle of the intersection formed by a line through the lateral articular facet of the posterior talocalcaneal joint and a line through the surface of the trochlea of the talus was measured. The mean change in the angle of the calcaneus with respect to the talus was 10.3 ± 4.8° with inversion stress and 5.0 ± 3.8° with eversion stress from the neutral position. The result was a clearer depiction of the subtalar joint, and inversion and eversion ROM of the subtalar joint was shown to be about 15° in healthy subjects. Diagnostic, Level IV.

Dynamic Analyses Including Joints Of Truss Structures

NASA Technical Reports Server (NTRS)

Belvin, W. Keith

1991-01-01

Method for mathematically modeling joints to assess influences of joints on dynamic response of truss structures developed in study. Only structures with low-frequency oscillations considered; only Coulomb friction and viscous damping included in analysis. Focus of effort to obtain finite-element mathematical models of joints exhibiting load-vs.-deflection behavior similar to measured load-vs.-deflection behavior of real joints. Experiments performed to determine stiffness and damping nonlinearities typical of joint hardware. Algorithm for computing coefficients of analytical joint models based on test data developed to enable study of linear and nonlinear effects of joints on global structural response. Besides intended application to large space structures, applications in nonaerospace community include ground-based antennas and earthquake-resistant steel-framed buildings.

Introduction of the UNIX International Performance Management Work Group

NASA Technical Reports Server (NTRS)

Newman, Henry

1993-01-01

In this paper we presented the planned direction of the UNIX International Performance Management Work Group. This group consists of concerned system developers and users who have organized to synthesize recommendations for standard UNIX performance management subsystem interfaces and architectures. The purpose of these recommendations is to provide a core set of performance management functions and these functions can be used to build tools by hardware system developers, vertical application software developers, and performance application software developers.

Joint Laxity in Preschool Children Born Preterm.

PubMed

Romeo, Domenico M; Velli, Chiara; Lucibello, Simona; Ferrantini, Gloria; Leo, Giuseppina; Brogna, Claudia; Cota, Francesco; Ricci, Daniela; Gallini, Francesca; Romagnoli, Costantino; Vento, Giovanni; Mercuri, Eugenio

2018-06-01

To evaluate the prevalence of joint laxity in children born preterm assessed in the first 2 years, the relationship between joint laxity and motor performance at preschool age, and possible changes over time in a subgroup of children followed longitudinally. The revised scale of Beighton Score was used to evaluate joint laxity in a population of 132 preschool children born preterm between 24 and 32 weeks of gestational age. All were assessed for joint laxity between 12 and 24 months of age. Children also performed the Movement Assessment Battery for Children-Second Edition between the age of 3 years and 6 months and 4 years; the age at onset of independent walking also was recorded. The total Beighton Score ranged between 0 and 8. Twenty percent of the cohort showed joint laxity. No differences related to sex or gestational age were observed. Children born preterm with joint laxity achieved later independent walking and achieved lower scores on Movement Assessment Battery for Children-Second Edition than those without joint laxity. In 76 children born preterm, an assessment for joint laxity was repeated once between 25 and 36 months and again after >36 months. No statistically significant difference was observed between the 3 assessments. The Beighton Score can be used to assess generalized joint laxity in children born preterm. As the presence of joint laxity influenced motor competences, the possibility to early identify these infants in the first 2 years is of interest to benefit from early intervention and potentially improve gross motor skills and coordination. Copyright © 2018 Elsevier Inc. All rights reserved.

[Injuries of the acromioclavicular joint].

PubMed

Meeder, P J; Dannöhl, C

1988-07-01

The injuries of the acromio-clavicular joint require a differentiated diagnosis and treatment. The classification of the acromio-clavicular dislocations from grade I to grade III according to Tossy is proved. The diagnosis of a complete acromio-clavicular dislocation (Tossy III) is an indication for a surgical repair. Many and different methods are reported in the literature. 178 patients with a fresh acromio-clavicular dislocation (Typ Tossy II and III) were treated at the BG-Unfallklinik Tübingen from 1970 to 1987 by suturing the ligaments, inserting pins across the joint and tension wire bending. In old cases with Tossy III dislocation of the acromio-clavicular joint an oblique osteotomy combined with the reduction of the clavicle is recommended as a method of choice. The results of these procedures and there possible intra- and postoperative complications are reported. The incision along the clavicle quite often gives scar problems. Therefore the advantages of an arched incision across the acromio-clavicular joint is pointed out. Because of there biomechanical relationship fractures in the lateral third of the clavicle are similar to dislocations of the acromio-clavicular joint. The classification of these fractures according to Jäger, Buschle and Breitner allows a differentiated management of these lesions.

Generalised joint hypermobility and knee joint hypermobility: prevalence, knee joint symptoms and health-related quality of life in a Danish adult population.

PubMed

Junge, Tina; Henriksen, Peter; Hansen, Sebrina; Østengaard, Lasse; Golightly, Yvonne M; Juul-Kristensen, Birgit

2017-10-27

Several biomechanical factors, such as knee joint hypermobility (KJH), are suggested to play a role in the etiology of knee joint symptoms and knee osteoarthritis. Nevertheless, the prevalence or consequences of KJH solely or included in the classification of generalized joint hypermobility (GJHk) is unknown for a general population. Therefore, the objectives were to report the prevalence of self-reported GJHk and KJH, as well as the association of these conditions to knee joint symptoms, severity and duration of symptoms, and health-related quality of life (HRQoL) in a Danish adult population. This study is a cross-sectional population-based survey of 2056 Danish adults. Respondents received online questionnaires of GJHk and KJH, knee joint symptoms, the severity and duration of these, as well as HRQoL. Total response rate was 49% (n = 1006). The prevalence of self-reported GJHk and KJH was 13% and 23%, mostly representing women. More than half of the respondents with GJHk and KJH had knee joint symptoms. The odds for reporting knee joint symptoms, severity of knee joint symptoms and duration of knee joint symptoms were twice as high for respondents with GJHk and KJH. Respondents with GJHk and KJH reported lower HRQoL. GJHk and KJH were frequently reported in the Danish adult population, mostly in women. Respondents with GJHk and KJH were two times more likely to report knee joint-related symptoms such as pain, reduced performance of usual activity and lower HRQoL. The impact of these conditions on HRQoL is comparable with knee osteoarthritis. © 2017 Asia Pacific League of Associations for Rheumatology and John Wiley & Sons Australia, Ltd.

Sacroiliac joint tuberculosis

PubMed Central

Govender, S.

2006-01-01

Infections of the sacroiliac joint are uncommon and the diagnosis is usually delayed. In a retrospective study, 17 patients who had been treated for tuberculosis sacroiliitis between 1994 and 2004 were reviewed. Two patients were excluded due to a short follow-up (less than 2 years). Low back pain and difficulty in walking were the most common presenting features. Two patients presented with a buttock abscess and spondylitis of the lumbar spine was noted in two patients. The Gaenslen’s and FABER (flexion, abduction and external rotation) tests were positive in all patients. Radiological changes included loss of cortical margins with erosion of the joints. An open biopsy and curettage was performed in all patients; histology revealed chronic infection and acid-fast bacilli were isolated in nine patients. Antituberculous (TB) medication was administered for 18 months and the follow-up ranged from 3 to 10 years (mean: 5 years). The sacroiliac joint fused spontaneously within 2 years. Although all patients had mild discomfort in the lower back following treatment they had no difficulty in walking. Sacroiliac joint infection must be included in the differential diagnosis of lower back pain and meticulous history and clinical evaluation of the joint are essential. PMID:16673102

Performance Management in Healthcare Organizations: Concept and Practicum.

PubMed

Dimitropoulos, Panagiotis E

2017-01-01

Organizational performance can create and sustain competitive advantages for corporations and even improve their sustainability and future prospects. Health care organizations present a sector where performance management is structured by multiple dimensions. The scope of this study is to analyze the issue of performance management in healthcare organizations and specifically the implementation of the Balanced Scorecard (BSC) methodology on organizations providing health services. The study provides a discussion on the BSC development process, the steps that management has to take in order to prepare the implementation of the BSC and finally discusses a practical example of a scorecard with specific strategic goals and performance indicators. Managers of healthcare organizations and specifically those providing services to the elderly and the general population could use the propositions of the study as a roadmap for processing, analyzing, evaluating and implementing the balanced scorecard approach in their organizations' daily operations. BSC methodology can give an advantage in terms of enhanced stakeholder management and preservation within a highly volatile and competitive economic environment.

Simulating the Structural Response of a Preloaded Bolted Joint

NASA Technical Reports Server (NTRS)

Knight, Norman F., Jr.; Phillips, Dawn R.; Raju, Ivatury S.

2008-01-01

The present paper describes the structural analyses performed on a preloaded bolted-joint configuration. The joint modeled was comprised of two L-shaped structures connected together using a single bolt. Each L-shaped structure involved a vertical flat segment (or shell wall) welded to a horizontal segment (or flange). Parametric studies were performed using elasto-plastic, large-deformation nonlinear finite element analyses to determine the influence of several factors on the bolted-joint response. The factors considered included bolt preload, washer-surface-bearing size, edge boundary conditions, joint segment length, and loading history. Joint response is reported in terms of displacements, gap opening, and surface strains. Most of the factors studied were determined to have minimal effect on the bolted-joint response; however, the washer-bearing-surface size affected the response significantly.

Shoe collar height effect on athletic performance, ankle joint kinematics and kinetics during unanticipated maximum-effort side-cutting performance.

PubMed

Lam, Gilbert Wing Kai; Park, Eun Jung; Lee, Ki-Kwang; Cheung, Jason Tak-Man

2015-01-01

Side-step cutting manoeuvres comprise the coordination between planting and non-planting legs. Increased shoe collar height is expected to influence ankle biomechanics of both legs and possibly respective cutting performance. This study examined the shoe collar height effect on kinematics and kinetics of planting and non-planting legs during an unanticipated side-step cutting. Fifteen university basketball players performed maximum-effort side-step cutting to the left 45° direction or a straight ahead run in response to a random light signal. Seven successful cutting trials were collected for each condition. Athletic performance, ground reaction force, ankle kinematics and kinetics of both legs were analysed using paired t-tests. Results indicated that high-collar shoes resulted in less ankle inversion and external rotation during initial contact for the planting leg. The high-collar shoes also exhibited a smaller ankle range of motion in the sagittal and transverse planes for both legs, respectively. However, no collar effect was found for ankle moments and performance indicators including cutting performance time, ground contact time, propulsion ground reaction forces and impulses. These findings indicated that high-collar shoes altered ankle positioning and restricted ankle joint freedom movements in both legs, while no negative effect was found for athletic cutting performance.

Total knee arthroplasty for the management of joint destruction in tuberculous arthritis.

PubMed

Oztürkmen, Yusuf; Uzümcügil, Onat; Karamehmetoğlu, Mahmut; Leblebici, Cem; Caniklioğlu, Mustafa

2014-05-01

The purpose of this study was to evaluate our experience to clarify the suggestion that there should be a significant disease-free interval before total knee arthroplasty (TKA) and to determine the correct timing of surgery for reconstruction of the joint destruction in patients suffering from tuberculous arthritis. Twelve patients with advanced joint destruction and tuberculous arthritis of the knee with recent onset were reviewed in this study. The time interval from our diagnosis of active infection to arthroplasty averaged 4 ± 1.5 months. Histopathology of the biopsy specimens revealing granulomatous lesions, including epithelioid histiocytes surrounded by lymphocytes, confirmed the diagnosis of each patient. A primary knee prosthesis was performed in seven knees. In five knees, there was severe bone loss after the extensive debridement of the entire joint, and thereafter, revision prosthesis was preferred to preserve the joint line. Patients were given post-operative antituberculous treatment for a total of 1 year, whereas for three patients, whose erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) values remained above normal by the sixth month, the chemotherapy was continued for up to 18 months. The Knee Society TKA roentgenographic evaluation and scoring system was used for radiological evaluation of the knees. Clinical evaluation of the knees was done preoperatively and at the time of the most recent follow-up using the American Knee Society Scoring System. Within the average follow-up period of 6.1 ± 1.8 years, no reactivation of tuberculous infection was found in any of the patients. ESR was normal, less than 20 mm/h, after a mean time of 5.5 ± 2.0 months. The CRP was normal, less than 0.8 mg/dl, after a mean time of 4.6 ± 1.3 months. At the most recent follow-up, the average knee score improved from 32.4 ± 19.4 to 83.4 ± 14.0 points (p < 0.05), and the average function score improved from 33.3 ± 11.9 to 86

Cytokine mRNA expression in synovial fluid of affected and contralateral stifle joints and the left shoulder joint in dogs with unilateral disease of the stifle joint.

PubMed

de Bruin, Tanya; de Rooster, Hilde; van Bree, Henri; Duchateau, Luc; Cox, Eric

2007-09-01

To examine mRNA expression of cytokines in synovial fluid (SF) cells from dogs with cranial cruciate ligament (CrCL) rupture and medial patellar luxation (MPL) and determine mRNA expression for 3 joints (affected stifle, unaffected contralateral stifle, and left shoulder joints) in dogs with unilateral CrCL rupture. 29 stifle joints with CrCL rupture (29 dogs), 8 stifle joints with MPL (7 dogs), and 24 normal stifle joints (16 clinically normal dogs). Immediately before reconstructive surgery, SF was aspirated from the cruciate-deficient stifle joint or stifle joint with MPL. Fourteen of 29 dogs had unilateral CrCL rupture; SF was also aspirated from the unaffected contralateral stifle joint and left shoulder joint. Those 14 dogs were examined 6 and 12 months after reconstructive surgery. Total RNA was extracted from SF cells and reverse transcription-PCR assay was performed to obtain cDNA. Canine-specific cytokine mRNA expression was determined by use of a real-time PCR assay. Interleukin (IL)-8 and -10 and interferon-gamma expression differed significantly between dogs with arthropathies and dogs with normal stifle joints. For the 14 dogs with unilateral CrCL rupture, a significant difference was found for IL-8 expression. Before reconstructive surgery, IL-8 expression differed significantly between the affected stifle joint and left shoulder joint or contralateral stifle joint. Six months after surgery, IL-8 expression was significantly increased in the unaffected contralateral stifle joint, compared with the shoulder joint. No conclusions can be made regarding the role of the examined cytokines in initiation of CrCL disease.

Congenital cheek teratoma with temporo-mandibular joint ankylosis managed with ultra-thin silicone sheet interpositional arthroplasty.

PubMed

Bhatnagar, Ankur; Verma, Vinay Kumar; Purohit, Vishal

2013-01-01

Primary cheek teratomas are rare with < 5 reported cases. None had associated temporo mandibular joint ankylosis (TMJA). The fundamental aim in the treatment of TMJA is the successful surgical resection of ankylotic bone, prevention of recurrence, and aesthetic improvement by ensuring functional occlusion. Early treatment is necessary to promote proper growth and function of mandible and to facilitate the positive psychological development of child. Inter-positional arthroplasty with ultra-thin silicone sheet was performed. Advantages include short operative time, less foreign material in the joint space leading to negligible foreign body reactions and least chances of implant extrusion. Instead of excising a large bony segment, a thin silicone sheet was interposed and then sutured ensuring preservation of mandibular height. Aggressive post-operative physiotherapy with custom made dynamic jaw exerciser was used to prevent recurrence.

Increasing the marketability and recognition of provider network joint ventures.

PubMed

Sjobeck, S J

1998-08-01

Physicians have been developing provider network joint ventures to market their services jointly to managed care plans, employers, and other purchasers. Over the past few years, external market factors have produced a growing impact on these joint ventures. These external market factors include the Federal government's revised antitrust guidelines, National Committee for Quality Assurance activities, and state and Federal consumer protection laws. Simply responding to these forces may not increase a provider network's marketability unless the network can demonstrate its value in the terms and measurements accepted by the consumer, managed care plans, and provider networks. By doing so, a provider network can not only increase its marketability, but also increase its recognition in the market, improve its competitive advantage, and enhance its return on investment.

Soft tissue artifact compensation in knee kinematics by multi-body optimization: Performance of subject-specific knee joint models.

PubMed

Clément, Julien; Dumas, Raphaël; Hagemeister, Nicola; de Guise, Jaques A

2015-11-05

Soft tissue artifact (STA) distort marker-based knee kinematics measures and make them difficult to use in clinical practice. None of the current methods designed to compensate for STA is suitable, but multi-body optimization (MBO) has demonstrated encouraging results and can be improved. The goal of this study was to develop and validate the performance of knee joint models, with anatomical and subject-specific kinematic constraints, used in MBO to reduce STA errors. Twenty subjects were recruited: 10 healthy and 10 osteoarthritis (OA) subjects. Subject-specific knee joint models were evaluated by comparing dynamic knee kinematics recorded by a motion capture system (KneeKG™) and optimized with MBO to quasi-static knee kinematics measured by a low-dose, upright, biplanar radiographic imaging system (EOS(®)). Errors due to STA ranged from 1.6° to 22.4° for knee rotations and from 0.8 mm to 14.9 mm for knee displacements in healthy and OA subjects. Subject-specific knee joint models were most effective in compensating for STA in terms of abduction-adduction, inter-external rotation and antero-posterior displacement. Root mean square errors with subject-specific knee joint models ranged from 2.2±1.2° to 6.0±3.9° for knee rotations and from 2.4±1.1 mm to 4.3±2.4 mm for knee displacements in healthy and OA subjects, respectively. Our study shows that MBO can be improved with subject-specific knee joint models, and that the quality of the motion capture calibration is critical. Future investigations should focus on more refined knee joint models to reproduce specific OA knee geometry and physiology. Copyright © 2015 Elsevier Ltd. All rights reserved.

Chiropractic management of capsulitis and synovitis of the temporomandibular joint.

PubMed

Curl, D D; Stanwood, G

1993-01-01

Localized inflammatory conditions (eg, synovitis and capsulitis) of the temporomandibular joint are commonly seen in clinical practice. Regardless of their frequency of occurrence, these conditions must be differentially diagnosed from conditions that also may cause pain in the temporomandibular joint region. Capsulitis or synovitis should be considered if such pain is present and historical, physical, and laboratory findings do not indicate a referred pain phenomena or systemic, tumorous, or infectious involvement. This article reviews the clinical characteristics, etiology, physical examination methods, treatment, and prognosis for capsulitis and synovitis, and three cases that illustrate these conditions are reported.

Joint attention and language evolution

NASA Astrophysics Data System (ADS)

Kwisthout, Johan; Vogt, Paul; Haselager, Pim; Dijkstra, Ton

2008-06-01

This study investigates how more advanced joint attentional mechanisms, rather than only shared attention between two agents and an object, can be implemented and how they influence the results of language games played by these agents. We present computer simulations with language games showing that adding constructs that mimic the three stages of joint attention identified in children's early development (checking attention, following attention, and directing attention) substantially increase the performance of agents in these language games. In particular, the rates of improved performance for the individual attentional mechanisms have the same ordering as that of the emergence of these mechanisms in infants' development. These results suggest that language evolution and joint attentional mechanisms have developed in a co-evolutionary way, and that the evolutionary emergence of the individual attentional mechanisms is ordered just like their developmental emergence.

Joint design of QC-LDPC codes for coded cooperation system with joint iterative decoding

NASA Astrophysics Data System (ADS)

Zhang, Shunwai; Yang, Fengfan; Tang, Lei; Ejaz, Saqib; Luo, Lin; Maharaj, B. T.

2016-03-01

In this paper, we investigate joint design of quasi-cyclic low-density-parity-check (QC-LDPC) codes for coded cooperation system with joint iterative decoding in the destination. First, QC-LDPC codes based on the base matrix and exponent matrix are introduced, and then we describe two types of girth-4 cycles in QC-LDPC codes employed by the source and relay. In the equivalent parity-check matrix corresponding to the jointly designed QC-LDPC codes employed by the source and relay, all girth-4 cycles including both type I and type II are cancelled. Theoretical analysis and numerical simulations show that the jointly designed QC-LDPC coded cooperation well combines cooperation gain and channel coding gain, and outperforms the coded non-cooperation under the same conditions. Furthermore, the bit error rate performance of the coded cooperation employing jointly designed QC-LDPC codes is better than those of random LDPC codes and separately designed QC-LDPC codes over AWGN channels.

The serpentine end-matched joint: evaluating strength and stability

Treesearch

Charles J. Gatchell; Curtis C. Peters

1981-01-01

The Serpentine end-matched (Sem) joint is a precisely machined butt joint with a sine wave shape. The joint is not readily visible to the eye and performs well in panels made of sugar maple, red oak, black walnut, and black cherry. The Sem joint is unaffected by changes in equilibrium moisture content from 6 to 12 to 18 to 6 percent. Panels containing Sem joints have...

Revision for prosthetic joint infection following hip arthroplasty: Evidence from the National Joint Registry.

PubMed

Lenguerrand, E; Whitehouse, M R; Beswick, A D; Jones, S A; Porter, M L; Blom, A W

2017-06-01

We used the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man (NJR) to investigate the risk of revision due to prosthetic joint infection (PJI) for patients undergoing primary and revision hip arthroplasty, the changes in risk over time, and the overall burden created by PJI. We analysed revision total hip arthroplasties (THAs) performed due to a diagnosis of PJI and the linked index procedures recorded in the NJR between 2003 and 2014. The cohort analysed consisted of 623 253 index primary hip arthroplasties, 63 222 index revision hip arthroplasties and 7585 revision THAs performed due to a diagnosis of PJI. The prevalence, cumulative incidence functions and the burden of PJI (total procedures) were calculated. Overall linear trends were investigated with log-linear regression. We demonstrated a prevalence of revision THA due to prosthetic joint infection of 0.4/100 procedures following primary and 1.6/100 procedures following revision hip arthroplasty. The prevalence of revision due to PJI in the three months following primary hip arthroplasty has risen 2.3-fold (95% confidence interval (CI) 1.3 to 4.1) between 2005 and 2013, and 3.0-fold (95% CI 1.1 to 8.5) following revision hip arthroplasty. Over 1000 procedures are performed annually as a consequence of hip PJI, an increase of 2.6-fold between 2005 and 2013. Although the risk of revision due to PJI following hip arthroplasty is low, it is rising and, coupled with the established and further predicted increased incidence of both primary and revision hip arthroplasty, this represents a growing and substantial treatment burden. Cite this article : E. Lenguerrand, M. R. Whitehouse, A. D. Beswick, S. A. Jones, M. L. Porter, A. W. Blom. Revision for prosthetic joint infection following hip arthroplasty: Evidence from the National Joint Registry. Bone Joint Res 2017;6:391-398. DOI: 10.1302/2046-3758.66.BJR-2017-0003.R1. © 2017 Lenguerrand et al.

Pain and pain management in haemophilia

PubMed Central

Auerswald, Günter; Dolan, Gerry; Duffy, Anne; Hermans, Cedric; Jiménez-Yuste, Victor; Ljung, Rolf; Morfini, Massimo; Lambert, Thierry; Šalek, Silva Zupančić

2016-01-01

Joint pain is common in haemophilia and may be acute or chronic. Effective pain management in haemophilia is essential to reduce the burden that pain imposes on patients. However, the choice of appropriate pain-relieving measures is challenging, as there is a complex interplay of factors affecting pain perception. This can manifest as differences in patients’ experiences and response to pain, which require an individualized approach to pain management. Prophylaxis with factor replacement reduces the likelihood of bleeds and bleed-related pain, whereas on-demand therapy ensures rapid bleed resolution and pain relief. Although use of replacement or bypassing therapy is often the first intervention for pain, additional pain relief strategies may be required. There is an array of analgesic options, but consideration should be paid to the adverse effects of each class. Nevertheless, a combination of medications that act at different points in the pain pathway may be beneficial. Nonpharmacological measures may also help patients and include active coping strategies; rest, ice, compression, and elevation; complementary therapies; and physiotherapy. Joint aspiration may also reduce acute joint pain, and joint steroid injections may alleviate chronic pain. In the longer term, increasing use of prophylaxis or performing surgery may be necessary to reduce the burden of pain caused by the degenerative effects of repeated bleeds. Whichever treatment option is chosen, it is important to monitor pain and adjust patient management accordingly. Beyond specific pain management approaches, ongoing collaboration between multidisciplinary teams, which should include physiotherapists and pain specialists, may improve outcomes for patients. PMID:27439216

Road weather management performance metrics.

DOT National Transportation Integrated Search

2008-04-29

This report presents the results of a study to identify appropriate measures of performance that can be attributed to the Federal Highway Administrations (FHWA) Road Weather Management Program (RWMP) products and activities. Specifically, the stud...

Wormhole Formation in RSRM Nozzle Joint Backfill

NASA Technical Reports Server (NTRS)

Stevens, J.

2000-01-01

The RSRM nozzle uses a barrier of RTV rubber upstream of the nozzle O-ring seals. Post flight inspection of the RSRM nozzle continues to reveal occurrence of "wormholes" into the RTV backfill. The term "wormholes", sometimes called "gas paths", indicates a gas flow path not caused by pre-existing voids, but by a little-understood internal failure mode of the material during motor operation. Fundamental understanding of the mechanics of the RSRM nozzle joints during motor operation, nonlinear viscoelastic characterization of the RTV backfill material, identification of the conditions that predispose the RTV to form wormholes, and screening of candidate replacement materials is being pursued by a joint effort between Thiokol Propulsion, NASA, and the Army Propulsion & Structures Directorate at Redstone Arsenal. The performance of the RTV backfill in the joint is controlled by the joint environment. Joint movement, which applies a tension and shear load on the material, coupled with the introduction of high pressure gas in combination create an environment that exceeds the capability of the material to withstand the wormhole effect. Little data exists to evaluate why the material fails under the modeled joint conditions, so an effort to characterize and evaluate the material under these conditions was undertaken. Viscoelastic property data from characterization testing will anchor structural analysis models. Data over a range of temperatures, environmental pressures, and strain rates was used to develop a nonlinear viscoelastic model to predict material performance, develop criteria for replacement materials, and quantify material properties influencing wormhole growth. Three joint simulation analogs were developed to analyze and validate joint thermal barrier (backfill) material performance. Two exploratory tests focus on detection of wormhole failure under specific motor operating conditions. A "validation" test system provides data to "validate" computer models and

Performance measures for public transit mobility management.

DOT National Transportation Integrated Search

2011-12-01

"Mobility management is an innovative approach for managing and delivering coordinated public : transportation services that embraces the full family of public transit options. At a national level, there are : currently no industry recognized perform...

Interactional leader–follower sensorimotor communication strategies during repetitive joint actions

PubMed Central

Candidi, Matteo; Curioni, Arianna; Donnarumma, Francesco; Sacheli, Lucia Maria; Pezzulo, Giovanni

2015-01-01

Non-verbal communication is the basis of animal interactions. In dyadic leader–follower interactions, leaders master the ability to carve their motor behaviour in order to ‘signal’ their future actions and internal plans while these signals influence the behaviour of follower partners, who automatically tend to imitate the leader even in complementary interactions. Despite their usefulness, signalling and imitation have a biomechanical cost, and it is unclear how this cost–benefits trade-off is managed during repetitive dyadic interactions that present learnable regularities. We studied signalling and imitation dynamics (indexed by movement kinematics) in pairs of leaders and followers during a repetitive, rule-based, joint action. Trial-by-trial Bayesian model comparison was used to evaluate the relation between signalling, imitation and pair performance. The different models incorporate different hypotheses concerning the factors (past interactions versus online movements) influencing the leader's signalling (or follower's imitation) kinematics. This approach showed that (i) leaders' signalling strategy improves future couple performance, (ii) leaders used the history of past interactions to shape their signalling, (iii) followers' imitative behaviour is more strongly affected by the online movement of the leader. This study elucidates the ways online sensorimotor communication help individuals align their task representations and ultimately improves joint action performance. PMID:26333815

Interactional leader-follower sensorimotor communication strategies during repetitive joint actions.

PubMed

Candidi, Matteo; Curioni, Arianna; Donnarumma, Francesco; Sacheli, Lucia Maria; Pezzulo, Giovanni

2015-09-06

Non-verbal communication is the basis of animal interactions. In dyadic leader-follower interactions, leaders master the ability to carve their motor behaviour in order to 'signal' their future actions and internal plans while these signals influence the behaviour of follower partners, who automatically tend to imitate the leader even in complementary interactions. Despite their usefulness, signalling and imitation have a biomechanical cost, and it is unclear how this cost-benefits trade-off is managed during repetitive dyadic interactions that present learnable regularities. We studied signalling and imitation dynamics (indexed by movement kinematics) in pairs of leaders and followers during a repetitive, rule-based, joint action. Trial-by-trial Bayesian model comparison was used to evaluate the relation between signalling, imitation and pair performance. The different models incorporate different hypotheses concerning the factors (past interactions versus online movements) influencing the leader's signalling (or follower's imitation) kinematics. This approach showed that (i) leaders' signalling strategy improves future couple performance, (ii) leaders used the history of past interactions to shape their signalling, (iii) followers' imitative behaviour is more strongly affected by the online movement of the leader. This study elucidates the ways online sensorimotor communication help individuals align their task representations and ultimately improves joint action performance. © 2015 The Author(s).

Percutaneous CT-Guided Treatment of Osteochondritis Dissecans of the Sacroiliac Joint

DOE Office of Scientific and Technical Information (OSTI.GOV)

Becce, Fabio, E-mail: fabio.becce@chuv.ch; Mouhsine, Elyazid; Mosimann, Pascal John

2012-08-15

Osteochondritis dissecans (OCD) is a joint disorder that affects the articular cartilage and subchondral bone, most commonly at the knee. OCD of the sacroiliac joint is extremely rare. Management of OCD remains controversial, and surgery is often needed, especially when conservative treatment fails. We present a rare case of OCD involving the left sacroiliac joint successfully treated by percutaneous computed tomography-guided retrograde drilling and debridement.

Developing Joint Information Operations Warriors

DTIC Science & Technology

2006-04-13

the spectrum of conflict more than ever before. Information dominance has always been important, but the speed and methods at which it can be sent... information dominance . The analysis begins with a quick review of joint IO doctrine, Service approaches to IO, and IO personnel management. Next, IO

Haemorrhoids and joint hypermobility: a new extra-articular association.

PubMed

Yousif, Uqba N; Bird, Howard A

2013-04-01

An association has been demonstrated between haemorrhoids and joint hypermobility. Reasons for this are discussed. Many performing artists are hypermobile and the extra-articular features of joint hypermobility should not be forgotten or underestimated as a potential constraint upon performance.

Seventh Joint Meeting of K-J-CaP and CaPSURE: extending the global initiative to improve prostate cancer management

PubMed Central

Akaza, Hideyuki; Kim, Choung Soo; Carroll, Peter; Choi, In Young; Chung, Byung Ha; Cooperberg, Matthew R.; Hirao, Yoshihiko; Hinotsu, Shiro; Horie, Shigeo; Lee, Ji Youl; Namiki, Mikio; Ng, Chi-Fai; Onozawa, Mizuki; Ozono, Seiichiro; Ueno, Satoru; Umbas, Rainy; Ye, Dingwei; Zhu, Gang

2014-01-01

This report summarizes the presentations and discussions that took place at the Seventh Joint Meeting of the Korea–Japan Study Group of Prostate Cancer (K-J-CaP) and the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) held in Seoul, Korea, in September 2013. The original J-CaP and CaPSURE Joint Initiative has now been established since 2007 and since the initial collaboration between research teams in the United States (US) and Japan, the project has expanded to include several other Asian countries. The objective of the initiative is to analyze and compare data for prostate cancer patients in the participating countries, looking at similarities and differences in patient management and outcomes. Until now the focus has been primarily on data generated within J-CaP and CaPSURE, both large-scale, longitudinal, observational databases of prostate cancer patients in Japan and the US, respectively. This year’s meeting was hosted for the first time in Korea which has recently established its own national database–K-CaP–to add to the wealth of data generated by J-CaP and CaPSURE. As a newly-developed database, K-CaP has also provided a valuable ‘template’ for other countries, such as China and Indonesia, planning to establish their own national databases and this will ultimately allow greater opportunities for international data comparisons. A range of topics was discussed at this Seventh Joint Meeting including comparison of outcomes following androgen deprivation therapy or radical prostatectomy in patients with localized prostate cancer, the use of active surveillance as a treatment option and the triggers for intervention when employing this regimen, patient quality of life during treatment, the impact of comorbidities on outcomes, and a comparison of recent outcomes data between J-CaP and CaPSURE. The participants recognized that prostate cancer was now a global disease and therefore major insights into understanding and improving

Seventh Joint Meeting of K-J-CaP and CaPSURE: extending the global initiative to improve prostate cancer management.

PubMed

Akaza, Hideyuki; Kim, Choung Soo; Carroll, Peter; Choi, In Young; Chung, Byung Ha; Cooperberg, Matthew R; Hirao, Yoshihiko; Hinotsu, Shiro; Horie, Shigeo; Lee, Ji Youl; Namiki, Mikio; Ng, Chi-Fai; Onozawa, Mizuki; Ozono, Seiichiro; Ueno, Satoru; Umbas, Rainy; Ye, Dingwei; Zhu, Gang

2014-01-01

This report summarizes the presentations and discussions that took place at the Seventh Joint Meeting of the Korea-Japan Study Group of Prostate Cancer (K-J-CaP) and the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) held in Seoul, Korea, in September 2013. The original J-CaP and CaPSURE Joint Initiative has now been established since 2007 and since the initial collaboration between research teams in the United States (US) and Japan, the project has expanded to include several other Asian countries. The objective of the initiative is to analyze and compare data for prostate cancer patients in the participating countries, looking at similarities and differences in patient management and outcomes. Until now the focus has been primarily on data generated within J-CaP and CaPSURE, both large-scale, longitudinal, observational databases of prostate cancer patients in Japan and the US, respectively. This year's meeting was hosted for the first time in Korea which has recently established its own national database-K-CaP-to add to the wealth of data generated by J-CaP and CaPSURE. As a newly-developed database, K-CaP has also provided a valuable 'template' for other countries, such as China and Indonesia, planning to establish their own national databases and this will ultimately allow greater opportunities for international data comparisons. A range of topics was discussed at this Seventh Joint Meeting including comparison of outcomes following androgen deprivation therapy or radical prostatectomy in patients with localized prostate cancer, the use of active surveillance as a treatment option and the triggers for intervention when employing this regimen, patient quality of life during treatment, the impact of comorbidities on outcomes, and a comparison of recent outcomes data between J-CaP and CaPSURE. The participants recognized that prostate cancer was now a global disease and therefore major insights into understanding and improving the

Performance-based management and quality of work: an empirical assessment.

PubMed

Falzon, Pierre; Nascimento, Adelaide; Gaudart, Corinne; Piney, Cécile; Dujarier, Marie-Anne; Germe, Jean-François

2012-01-01

In France, in the private sector as in the public sector, performance-based management tends to become a norm. Performance-based management is supposed to improve service quality, productivity and efficiency, transparency of allotted means and achieved results, and to better focus the activity of employees and of the whole organization. This text reports a study conducted for the French Ministry of Budget by a team of researchers in ergonomics, sociology and management science, in order to assess the impact of performance-based management on employees, on teams and on work organization. About 100 interviews were conducted with employees of all categories and 6 working groups were set up in order to discuss and validate or amend our first analyses. Results concern several aspects: workload and work intensification, indicators and performance management and the transformation of jobs induced by performance management.

Evaluation of longitudinal joint tie bar system.

DOT National Transportation Integrated Search

2011-09-01

"An adequate longitudinal joint tie bar system is essential in the overall performance of concrete pavement. Excessive : longitudinal joint openings are believed to be caused by either inadequate tie bar size or spacing or improper tie bar : installa...

Simplifying Bridge Expansion Joint Design and Maintenance

DOT National Transportation Integrated Search

2011-10-19

This report presents a study focused on identifying the most durable expansion joints for the South : Carolina Department of Transportation. This is performed by proposing a degradation model for the : expansion joints and updating it based on bridge...

U.S. Perspectives on the Joint Convention

DOE Office of Scientific and Technical Information (OSTI.GOV)

Strosnider, J.; Federline, M.; Camper, L.

The Joint Convention on the Safety of Spent Fuel Management and on the Safety of Radioactive Waste Management (Joint Convention) is an international convention, under the auspices of the International Atomic Energy Agency (IAEA). It is a companion to a suite of international conventions on nuclear safety and physical security, which serve to promote a global culture for the safe use of radioactive materials. Although the U.S. was the first nation to sign the Joint Convention on September 29, 1997, the ratification process was a challenging experience for the U.S., in the face of legislative priorities dominated by concerns formore » national security and threats from terrorism after September 11, 2001. Notwithstanding these prevailing circumstances, the U.S. ratified the Joint Convention in 2003, just prior to the First Review Meeting of the Contracting Parties, and participated fully therein. For the United States, participation as a Contracting Party provides many benefits. These range from working with other Parties to harmonize international approaches to achieve strong and effective nuclear safety programs on a global scale, to stimulating initiatives to improve safety systems within our own domestic programs, to learning about technical innovations by other Parties that can be useful to U.S. licensees, utilities, and industry in managing safety and its associated costs in our waste management activities. The Joint Convention process also provides opportunities to identify future areas of bilateral and multilateral technical and regulatory cooperation with other Parties, as well as an opportunity for U.S. vendors and suppliers to broaden their market to include foreign clients for safety improvement equipment and services. The Joint Convention is consistent with U.S. foreign policy considerations to support, as a priority, the strengthening of the worldwide safety culture in the use of nuclear energy. Because of its many benefits, we believe it is important

Joint mobilization acutely improves landing kinematics in chronic ankle instability.

PubMed

Delahunt, Eamonn; Cusack, Kim; Wilson, Laura; Doherty, Cailbhe

2013-03-01

The objective of this study is to examine the acute effect of ankle joint mobilizations akin to those performed in everyday clinical practice on sagittal plane ankle joint kinematics during a single-leg drop landing in participants with chronic ankle instability (CAI). Fifteen participants with self-reported CAI (defined as <24 on the Cumberland Ankle Instability Tool) performed three single-leg drop landings under two different conditions: 1) premobilization and, 2) immediately, postmobilization. The mobilizations performed included Mulligan talocrural joint dorsiflexion mobilization with movement, Mulligan inferior tibiofibular joint mobilization, and Maitland anteroposterior talocrural joint mobilization. Three CODA cx1 units (Charnwood Dynamics Ltd., Leicestershire, UK) were used to provide information on ankle joint sagittal plane angular displacement. The dependent variable under investigation was the angle of ankle joint plantarflexion at the point of initial contact during the drop landing. There was a statistically significant acute decrease in the angle of ankle joint plantarflexion from premobilization (34.89° ± 4.18°) to postmobilization (31.90° ± 5.89°), t(14) = 2.62, P < 0.05 (two-tailed). The mean decrease in the angle of ankle joint plantarflexion as a result of the ankle joint mobilization was 2.98° with a 95% confidence interval ranging from 0.54 to 5.43. The eta squared statistic (0.32) indicated a large effect size. These results indicate that mobilization acted to acutely reduce the angle of ankle joint plantarflexion at initial contact during a single-leg drop landing. Mobilization applied to participants with CAI has a mechanical effect on the ankle joint, thus facilitating a more favorable positioning of the ankle joint when landing from a jump.

Government of Canada Initiatives in Support of the Joint Convention

DOE Office of Scientific and Technical Information (OSTI.GOV)

Brown, P.A.; Metcalfe, D.E.; Lojk, R.

The Government of Canada strongly supported international efforts to bring into force the Joint Convention on the Safety of Spent Fuel Management and on the Safety of Radioactive Waste Management (the Joint Convention), and was the second country to ratify it. The Joint Convention places a number of obligations on Contracting Parties aimed at achieving and maintaining a high level of safety worldwide in spent fuel and radioactive waste management, ensuring that effective defenses against potential hazards are in place during all management stages, preventing accidents with radiological consequences and mitigating their consequences should they occur. In addition to establishingmore » and maintaining a modem regulatory framework and an independent regulatory body through the 2000 Nuclear Safety and Control Act, the Government of Canada has implemented a number of initiatives that address its responsibilities and serve to further enhance Canada's compliance with the Joint Convention. For nuclear fuel waste, the Government of Canada brought into force the Nuclear Fuel Waste Act in 2002 to require waste owners to develop, fund, organize and implement a long-term solution for Canada's nuclear fuel waste. The Act clearly reserves for Government the decision on the solution to be implemented in the best interests of Canadians, as well as oversight to ensure that waste owners are fulfilling their responsibilities. In the case of low-level radioactive waste, long-term solutions are being developed to ensure the protection of health, safety, and the environment, both now and in the future. Regarding uranium mine and mill tailings, current operators have state-of-the-art waste management facilities in place. The Government of Canada works with provincial governments to ensure that any potential abandoned or legacy mines sites where no owner can be held responsible are safely decommissioned and managed over the long term. (authors)« less

Augmented Reality-Guided Lumbar Facet Joint Injections.

PubMed

Agten, Christoph A; Dennler, Cyrill; Rosskopf, Andrea B; Jaberg, Laurenz; Pfirrmann, Christian W A; Farshad, Mazda

2018-05-08

The aim of this study was to assess feasibility and accuracy of augmented reality-guided lumbar facet joint injections. A spine phantom completely embedded in hardened opaque agar with 3 ring markers was built. A 3-dimensional model of the phantom was uploaded to an augmented reality headset (Microsoft HoloLens). Two radiologists independently performed 20 augmented reality-guided and 20 computed tomography (CT)-guided facet joint injections each: for each augmented reality-guided injection, the hologram was manually aligned with the phantom container using the ring markers. The radiologists targeted the virtual facet joint and tried to place the needle tip in the holographic joint space. Computed tomography was performed after each needle placement to document final needle tip position. Time needed from grabbing the needle to final needle placement was measured for each simulated injection. An independent radiologist rated images of all needle placements in a randomized order blinded to modality (augmented reality vs CT) and performer as perfect, acceptable, incorrect, or unsafe. Accuracy and time to place needles were compared between augmented reality-guided and CT-guided facet joint injections. In total, 39/40 (97.5%) of augmented reality-guided needle placements were either perfect or acceptable compared with 40/40 (100%) CT-guided needle placements (P = 0.5). One augmented reality-guided injection missed the facet joint space by 2 mm. No unsafe needle placements occurred. Time to final needle placement was substantially faster with augmented reality guidance (mean 14 ± 6 seconds vs 39 ± 15 seconds, P < 0.001 for both readers). Augmented reality-guided facet joint injections are feasible and accurate without potentially harmful needle placement in an experimental setting.

Autonomous Quality Control of Joint Orientation Measured with Inertial Sensors.

PubMed

Lebel, Karina; Boissy, Patrick; Nguyen, Hung; Duval, Christian

2016-07-05

Clinical mobility assessment is traditionally performed in laboratories using complex and expensive equipment. The low accessibility to such equipment, combined with the emerging trend to assess mobility in a free-living environment, creates a need for body-worn sensors (e.g., inertial measurement units-IMUs) that are capable of measuring the complexity in motor performance using meaningful measurements, such as joint orientation. However, accuracy of joint orientation estimates using IMUs may be affected by environment, the joint tracked, type of motion performed and velocity. This study investigates a quality control (QC) process to assess the quality of orientation data based on features extracted from the raw inertial sensors' signals. Joint orientation (trunk, hip, knee, ankle) of twenty participants was acquired by an optical motion capture system and IMUs during a variety of tasks (sit, sit-to-stand transition, walking, turning) performed under varying conditions (speed, environment). An artificial neural network was used to classify good and bad sequences of joint orientation with a sensitivity and a specificity above 83%. This study confirms the possibility to perform QC on IMU joint orientation data based on raw signal features. This innovative QC approach may be of particular interest in a big data context, such as for remote-monitoring of patients' mobility.

Osseous associated cervical spondylomyelopathy at the C2-C3 articular facet joint in 11 dogs.

PubMed

Cooper, C; Gutierrez-Quintana, R; Penderis, J; Gonçalves, R

2015-11-21

In dogs, vertebral canal stenosis at C2-C3 due to articular facet joint degeneration is only sporadically identified. The authors' aims were to review the clinical presentation, MRI characteristics, treatment and outcome of dogs presenting with this condition. Eleven cases were eligible for inclusion. Neurological examination revealed tetraparesis and proprioceptive ataxia in all 4 limbs in 3/11, proprioceptive tetra-ataxia only in 4/11, pelvic limb proprioceptive ataxia in 2/11 and no gait abnormalities in 2/11 dogs. Cervical hyperaesthesia was present in 7/11 dogs. MRI revealed bilateral articular facet joint degeneration in 10/11 cases and unilateral degeneration in one. Surgery was performed in six cases and medical management elected in five. Long-term follow-up information was available for 11 animals. Four of the surgical cases are alive and have no neurological deficits, one was euthanased for an unrelated condition and one lost to follow-up. Of the cases managed medically, three are alive showing no neurological deficits, one is alive still displaying neurological deficits and one euthanased for an unrelated condition whilst still ataxic. This study shows that both medical and surgical management can result in good outcomes in dogs with vertebral canal stenosis resulting from articular facet joint degeneration at the level of C2-C3. British Veterinary Association.

Congenital cheek teratoma with temporo-mandibular joint ankylosis managed with ultra-thin silicone sheet interpositional arthroplasty

PubMed Central

Bhatnagar, Ankur; Verma, Vinay Kumar; Purohit, Vishal

2013-01-01

Primary cheek teratomas are rare with < 5 reported cases. None had associated temporo mandibular joint ankylosis (TMJA). The fundamental aim in the treatment of TMJA is the successful surgical resection of ankylotic bone, prevention of recurrence, and aesthetic improvement by ensuring functional occlusion. Early treatment is necessary to promote proper growth and function of mandible and to facilitate the positive psychological development of child. Inter-positional arthroplasty with ultra-thin silicone sheet was performed. Advantages include short operative time, less foreign material in the joint space leading to negligible foreign body reactions and least chances of implant extrusion. Instead of excising a large bony segment, a thin silicone sheet was interposed and then sutured ensuring preservation of mandibular height. Aggressive post-operative physiotherapy with custom made dynamic jaw exerciser was used to prevent recurrence. PMID:24163567

Understanding the Effectiveness of Performance Management Practices

DTIC Science & Technology

2010-03-01

clarity and precision focus defining accomplishments and practices. Jones (1995) research on organizational transformation in the Monsanto Company...Performance managment in a changing context: Monsanto Pioneers a competency-based, developmental approach. Human Resource Management , 34 (3), 425-442

Predicting maximal strength of quadriceps from submaximal performance in individuals with knee joint osteoarthritis.

PubMed

McNair, Peter J; Colvin, Matt; Reid, Duncan

2011-02-01

To compare the accuracy of 12 maximal strength (1-repetition maximum [1-RM]) equations for predicting quadriceps strength in people with osteoarthritis (OA) of the knee joint. Eighteen subjects with OA of the knee joint attended a rehabilitation gymnasium on 3 occasions: 1) a familiarization session, 2) a session where the 1-RM of the quadriceps was established using a weights machine for an open-chain knee extension exercise and a leg press exercise, and 3) a session where the subjects performed with a load at which they could lift for approximately 10 repetitions only. The data were used in 12 prediction equations to calculate 1-RM strength and compared to the actual 1-RM data. Data were examined using Bland and Altman graphs and statistics, intraclass correlation coefficients (ICCs), and typical error values between the actual 1-RM and the respective 1-RM prediction equation data. Difference scores (predicted 1-RM--actual 1-RM) across the injured and control legs were also compared. For the knee extension exercise, the Brown, Brzycki, Epley, Lander, Mayhew et al, Poliquin, and Wathen prediction equations demonstrated the greatest levels of predictive accuracy. All of the ICCs were high (range 0.96–0.99), and typical errors were between 3% and 4%. For the knee press exercise, the Adams, Berger, Kemmler et al, and O'Conner et al equations demonstrated the greatest levels of predictive accuracy. All of the ICCs were high (range 0.95-0.98), and the typical errors ranged from 5.9-6.3%. This study provided evidence supporting the use of prediction equations to assess maximal strength in individuals with a knee joint with OA.

Effects of individual strengthening exercises for the stabilization muscles on the nutation torque of the sacroiliac joint in a sedentary worker with nonspecific sacroiliac joint pain.

PubMed

Yoo, Won-Gyu

2015-01-01

[Purpose] We investigated the effects of individual strengthening exercises for the stabilization muscles on the nutation torque of the sacroiliac joint in a sedentary worker with nonspecific sacroiliac joint pain. [Subject] A 36-year-old female complained of pain in the sacroiliac joints. [Methods] The subject performed individual strengthening exercises for the stabilization muscles for nutation torque of the sacroiliac joint for 3 weeks. Pain-provocation tests and visual analog scale (VAS) scores were evaluated before and after the exercises. [Results] After performing the individual strengthening exercises for the erector spinae, rectus abdominis, and biceps femoris muscles for 3 weeks, the subject displayed no pain in the pain provocation tests, and the VAS score was 2/10. [Conclusion] The individual strengthening exercises for the stabilization muscles of the sacroiliac joint performed in the present study appear to be effective for sedentary workers with sacroiliac joint pain.

Interface management of pharmacotherapy. Joint hospital and primary care drug recommendations.

PubMed

Björkhem-Bergman, Linda; Andersén-Karlsson, Eva; Laing, Richard; Diogene, Eduardo; Melien, Oyvind; Jirlow, Malena; Malmström, Rickard E; Vogler, Sabine; Godman, Brian; Gustafsson, Lars L

2013-05-01

In September 2012 an interactive course on the "Interface Management of Pharmacotherapy" was organized by the Stockholm Drug and Therapeutics Committee in cooperation with Department of Clinical Pharmacology at Karolinska Institutet and at Karolinska University Hospital in Stockholm, Sweden, in collaboration with the WHO. The basis for the course was the "Stockholm model" for the rational use of medicines but also contained presentations about successful models in interface management of pharmacotherapy in other European countries. The "Stockholm model" consists of 8 components: 1) Independent Drug and Therapeutics Committee with key role for respected drug experts with policy for "interest of conflicts", 2) The "Wise List", recommendations of medicines jointly for primary and hospital care, 3) Communication strategy with continuous medical education, 4) Systematic introduction of new expensive medicines, 5) E-pharmacological support at "point of care", 6) Methods and tools for follow-up of medicines use, 7) Medicines policy strategy and 8) Operative resources. The course highlighted the importance of efficient and targeted communication of drug recommendations building on trust among prescribers and patients for the guidelines to achieve high adherence. Trust is achieved by independent Drug and Therapeutics Committees with a key role for respected experts and a strict policy for "conflicts of interest". Representations of GPs are also crucial for successful implementation, being the link between evidence based medicine and practice. The successful models in Scotland and in Stockholm as well as the ongoing work in Catalonia were considered as examples of multifaceted approaches to improve the quality of medicine use across primary and hospital care.

Synergistic Approach Integrating Joint Capabilities for USSOCOM Contingency Contracting: Construction Management Module

DTIC Science & Technology

2010-12-01

59 a. The Joint Uniform Lessons Learned System (JULLS) .........59 b. Acquisition Community Connection (ACC) ..........................59 c...Report ACC Acquisition Community Connection ADDIE Analyze, Design, Develop, Implement, Evaluate AFFARS Air Force Federal Acquisition Regulation...Operations J4 Logistics J5 Plans J6 Communications J8 Programming and Comptroller J&A Justification and Approval JARB Joint Acquisition

Innervation of the Anterior Sacroiliac Joint.

PubMed

Cox, Marcus; Ng, Garrett; Mashriqi, Faizullah; Iwanaga, Joe; Alonso, Fernando; Tubbs, Kevin; Loukas, Marios; Oskouian, Rod J; Tubbs, R Shane

2017-11-01

Sacroiliac joint pain can be disabling and recalcitrant to medical therapy. The innervation of this joint is poorly understood, especially its anterior aspect. Therefore, the present cadaveric study was performed to better elucidate this anatomy. Twenty-four cadaveric sides underwent dissection of the anterior sacroiliac joint, with special attention given to any branches from regional nerves to this joint. No femoral, obturator, or lumbosacral trunk branches destined to the anterior sacroiliac joint were identified in the 24 sides. In 20 sides, one or two small branches (less than 0.5 mm in diameter) were found to arise from the L4 ventral ramus (10%), the L5 ventral ramus (80%), or simultaneously from both the L4 and L5 ventral rami (10%). The length of the branches ranged from 5 to 31 mm (mean, 14 mm). All these branches arose from the posterior part of the nerves and traveled to the anterior surface of the sacroiliac joint. No statistical significance was found between sides or sexes. An improved knowledge of the innervation of the anterior sacroiliac joint might decrease suffering in patients with chronic sacroiliac joint pain. Copyright © 2017 Elsevier Inc. All rights reserved.

Group benefits in joint perceptual tasks-a review.

PubMed

Wahn, Basil; Kingstone, Alan; König, Peter

2018-05-12

In daily life, humans often perform perceptual tasks together to reach a shared goal. In these situations, individuals may collaborate (e.g., by distributing task demands) to perform the task better than when the task is performed alone (i.e., attain a group benefit). In this review, we identify the factors influencing if, and to what extent, a group benefit is attained and provide a framework of measures to assess group benefits in perceptual tasks. In particular, we integrate findings from two frequently investigated joint perceptual tasks: visuospatial tasks and decision-making tasks. For both task types, we find that an exchange of information between coactors is critical to improve joint performance. Yet, the type of exchanged information and how coactors collaborate differs between tasks. In visuospatial tasks, coactors exchange information about the performed actions to distribute task demands. In perceptual decision-making tasks, coactors exchange their confidence on their individual perceptual judgments to negotiate a joint decision. We argue that these differences can be explained by the task structure: coactors distribute task demands if a joint task allows for a spatial division and stimuli can be accurately processed by one individual. Otherwise, they perform the task individually and then integrate their individual judgments. © 2018 New York Academy of Sciences.

Arch structure is associated with unique joint work, relative joint contributions and stiffness during landing.

PubMed

Powell, Douglas W; Queen, Robin M; Williams, D S Blaise

2016-10-01

To examine lower extremity joint contributions to a landing task in high-(HA) and low-arched (LA) female athletes by quantifying vertical stiffness, joint work and relative joint contributions to landing. Twenty healthy female recreational athletes (10 HA and 10 LA) performed five barefoot drop landings from a height of 30cm. Three-dimensional kinematics (240Hz) and ground reaction forces (960Hz) were recorded simultaneously. Vertical stiffness, joint work values and relative joint work values were calculated using Visual 3D and MatLab. HA athletes had significantly greater vertical stiffness compared to LA athletes (p=0.013). Though no differences in ankle joint work were observed (p=0.252), HA athletes had smaller magnitudes of knee (p=0.046), hip (p=0.019) and total lower extremity joint work values (p=0.016) compared to LA athletes. HA athletes had greater relative contributions of the ankle (p=0.032) and smaller relative contributions of the hip (p=0.049) compared to LA athletes. No differences in relative contributions of the knee were observed (p=0.255). These findings demonstrate that aberrant foot structure is associated with unique contributions of lower extremity joints to load attenuation during landing. These data may provide insight into the unique injury mechanisms associated with arch height in female athletes. Copyright © 2016 Elsevier B.V. All rights reserved.

Coupled Viscous Fluid Flow and Joint Deformation Analysis for Grout Injection in a Rock Joint

NASA Astrophysics Data System (ADS)

Kim, Hyung-Mok; Lee, Jong-Won; Yazdani, Mahmoud; Tohidi, Elham; Nejati, Hamid Reza; Park, Eui-Seob

2018-02-01

Fluid flow modeling is a major area of interest within the field of rock mechanics. The main objective of this study is to gain insight into the performance of grout injection inside jointed rock masses by numerical modeling of grout flow through a single rock joint. Grout flow has been widely simulated using non-Newtonian Bingham fluid characterized by two main parameters of dynamic viscosity and shear yield strength both of which are time dependent. The increasing value of these properties with injection time will apparently affect the parameters representing the grouting performance including grout penetration length and volumetric injection rate. In addition, through hydromechanical coupling a mutual influence between the injection pressure from the one side and the joint opening/closing behavior and the aperture profile variation on the other side is anticipated. This is capable of producing a considerable impact on grout spread within the rock joints. In this study based on the Bingham fluid model, a series of numerical analysis has been conducted using UDEC to simulate the flow of viscous grout in a single rock joint with smooth parallel surfaces. In these analyses, the time-dependent evolution of the grout fluid properties and the hydromechanical coupling have been considered to investigate their impact on grouting performance. In order to verify the validity of these simulations, the results of analyses including the grout penetration length and the injection flow rate were compared with a well-known analytical solution which is available for the simple case of constant grout properties and non-coupled hydraulic analysis. The comparison demonstrated that the grout penetration length can be overestimated when the time-dependent hardening of grout material is not considered. Moreover, due to the HM coupling, it was shown that the joint opening induced by injection pressure may have a considerable increasing impression on the values of penetration length and

5 CFR 9901.405 - Performance management system requirements.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Performance management system requirements. 9901.405 Section 9901.405 Administrative Personnel DEPARTMENT OF DEFENSE HUMAN RESOURCES MANAGEMENT AND LABOR RELATIONS SYSTEMS (DEPARTMENT OF DEFENSE-OFFICE OF PERSONNEL MANAGEMENT) DEPARTMENT OF...

Toward a joint health and disease management program. Toronto hospitals partner to provide system leadership.

PubMed

Macleod, Anne Marie; Gollish, Jeffrey; Kennedy, Deborah; McGlasson, Rhona; Waddell, James

2009-01-01

The Joint Health and Disease Management Program in the Toronto Central Local Health Integration Network (TC LHIN) is envisioned as a comprehensive model of care for patients with hip and knee arthritis. It includes access to assessment services, education, self-management programs and other treatment programs, including specialist care as needed. As the first phase of this program, the hospitals in TC LHIN implemented a Hip and Knee Replacement Program to focus on improving access and quality of care, coordinating services and measuring wait times for patients waiting for hip or knee replacement surgery. The program involves healthcare providers, consumers and constituent hospitals within TC LHIN. The approach used for this program involved a definition of governance structure, broad stakeholder engagement to design program elements and plans for implementation and communication to ensure sustainability. The program and approach were designed to provide a model that is transferrable in its elements or its entirety to other patient populations and programs. Success has been achieved in creating a single wait list, developing technology to support referral management and wait time reporting, contributing to significant reductions in waits for timely assessment and treatment, building human resource capacity and improving patient and referring physician satisfaction with coordination of care.

Weightlifting performance is related to kinematic and kinetic patterns of the hip and knee joints.

PubMed

Kipp, Kristof; Redden, Josh; Sabick, Michelle B; Harris, Chad

2012-07-01

The purpose of this study was to investigate the correlations between biomechanical outcome measures and weightlifting performance. Joint kinematics and kinetics of the hip, knee, and ankle were calculated while 10 subjects performed a clean at 85% of 1 repetition maximum (1RM). Kinematic and kinetic time-series patterns were extracted with principal components analysis. Discrete scores for each time-series pattern were calculated and used to determine how each pattern was related to body mass-normalized 1RM. Two hip kinematic and 2 knee kinetic patterns were significantly correlated with relative 1RM. The kinematic patterns captured hip and trunk motions during the first pull and hip joint motion during the movement transition between the first and second pulls. The first kinetic pattern captured a peak in the knee extension moment during the second pull. The second kinetic pattern captured a spatiotemporal shift in the timing and amplitude of the peak knee extension moment. The kinematic results suggest that greater lift mass was associated with steady trunk position during the first pull and less hip extension motion during the second-knee bend transition. Further, the kinetic results suggest that greater lift mass was associated with a smaller knee extensor moments during the first pull, but greater knee extension moments during the second pull, and an earlier temporal transition between knee flexion-extension moments at the beginning of the second pull. Collectively, these results highlight the importance of controlled trunk and hip motions during the first pull and rapid employment of the knee extensor muscles during the second pull in relation to weightlifting performance.

A Police and Insurance Joint Management System Based on High Precision BDS/GPS Positioning

PubMed Central

Zuo, Wenwei; Guo, Chi; Liu, Jingnan; Peng, Xuan; Yang, Min

2018-01-01

Car ownership in China reached 194 million vehicles at the end of 2016. The traffic congestion index (TCI) exceeds 2.0 during rush hour in some cities. Inefficient processing for minor traffic accidents is considered to be one of the leading causes for road traffic jams. Meanwhile, the process after an accident is quite troublesome. The main reason is that it is almost always impossible to get the complete chain of evidence when the accident happens. Accordingly, a police and insurance joint management system is developed which is based on high precision BeiDou Navigation Satellite System (BDS)/Global Positioning System (GPS) positioning to process traffic accidents. First of all, an intelligent vehicle rearview mirror terminal is developed. The terminal applies a commonly used consumer electronic device with single frequency navigation. Based on the high precision BDS/GPS positioning algorithm, its accuracy can reach sub-meter level in the urban areas. More specifically, a kernel driver is built to realize the high precision positioning algorithm in an Android HAL layer. Thus the third-party application developers can call the general location Application Programming Interface (API) of the original standard Global Navigation Satellite System (GNSS) to get high precision positioning results. Therefore, the terminal can provide lane level positioning service for car users. Next, a remote traffic accident processing platform is built to provide big data analysis and management. According to the big data analysis of information collected by BDS high precision intelligent sense service, vehicle behaviors can be obtained. The platform can also automatically match and screen the data that uploads after an accident to achieve accurate reproduction of the scene. Thus, it helps traffic police and insurance personnel to complete remote responsibility identification and survey for the accident. Thirdly, a rapid processing flow is established in this article to meet the

A Police and Insurance Joint Management System Based on High Precision BDS/GPS Positioning.

PubMed

Zuo, Wenwei; Guo, Chi; Liu, Jingnan; Peng, Xuan; Yang, Min

2018-01-10

Car ownership in China reached 194 million vehicles at the end of 2016. The traffic congestion index (TCI) exceeds 2.0 during rush hour in some cities. Inefficient processing for minor traffic accidents is considered to be one of the leading causes for road traffic jams. Meanwhile, the process after an accident is quite troublesome. The main reason is that it is almost always impossible to get the complete chain of evidence when the accident happens. Accordingly, a police and insurance joint management system is developed which is based on high precision BeiDou Navigation Satellite System (BDS)/Global Positioning System (GPS) positioning to process traffic accidents. First of all, an intelligent vehicle rearview mirror terminal is developed. The terminal applies a commonly used consumer electronic device with single frequency navigation. Based on the high precision BDS/GPS positioning algorithm, its accuracy can reach sub-meter level in the urban areas. More specifically, a kernel driver is built to realize the high precision positioning algorithm in an Android HAL layer. Thus the third-party application developers can call the general location Application Programming Interface (API) of the original standard Global Navigation Satellite System (GNSS) to get high precision positioning results. Therefore, the terminal can provide lane level positioning service for car users. Next, a remote traffic accident processing platform is built to provide big data analysis and management. According to the big data analysis of information collected by BDS high precision intelligent sense service, vehicle behaviors can be obtained. The platform can also automatically match and screen the data that uploads after an accident to achieve accurate reproduction of the scene. Thus, it helps traffic police and insurance personnel to complete remote responsibility identification and survey for the accident. Thirdly, a rapid processing flow is established in this article to meet the

Sonication contribution to identifying prosthetic joint infection with Ralstonia pickettii: a case report and review of the literature.

PubMed

Birlutiu, Rares Mircea; Roman, Mihai Dan; Cismasiu, Razvan Silviu; Fleaca, Sorin Radu; Popa, Crina Maria; Mihalache, Manuela; Birlutiu, Victoria

2017-07-19

In the context of an increase number of primary and revision total hip and total knee arthroplasty performed yearly, an increased risk of complication is expected. Prosthetic joint infection (PJI) remains the most common and feared arthroplasty complication. Ralstonia pickettii is a Gram-negative bacterium, that has also been identified in biofilms. It remains an extremely rare cause of PJI. There is no report of an identification of R. pickettii on an extracted spacer loaded with antibiotic. We present the case of an 83-years-old Caucasian male patient, that underwent a right cemented total hip replacement surgery. The patient is diagnosed with an early PJI with no isolated microorganism. A debridement and change of mobile parts is performed. At the beginning of 2016, the patient in readmitted into the Orthopedic Department for sever, right abdominal and groin pain and elevated serum erythrocyte sedimentation rate and C-reactive protein. A joint aspiration is performed with a negative microbiological examination. A two-stage exchange with long interval management is adopted, and a preformed spacer loaded with gentamicin was implanted. In July 2016, based on the proinflammatory markers evolution, a shift a three-stage exchange strategy is decided. In September 2016, a debridement, and changing of the preformed spacer loaded with gentamicin with another was carried out. Bacteriological examination of the tissues sampled intraoperatively was positive for Pseudomonas aeruginosa. From the sonication fluid, no bacteria were isolated on culture or identified using the bbFISH assay. During the hospitalization period, the patient received i.v. ceftazidime 3x2g/day and p.o. ciprofloxacin 2x750mg/day, antibiotic therapy that was continued after discharge with p.o. ciprofloxacin 2x750mg/day for 6 weeks. In February 2017, a reimplantation of a revision prosthesis is performed. The retrieved spacer is sonicated, and after 4 days of incubation of the sonication fluid, R

Elbow joint fatigue and bench-press training.

PubMed

Huang, Yen-Po; Chou, You-Li; Chen, Feng-Chun; Wang, Rong-Tyai; Huang, Ming-Jer; Chou, Paul Pei-Hsi

2014-01-01

Bench-press exercises are among the most common form of training exercise for the upper extremity because they yield a notable improvement in both muscle strength and muscle endurance. The literature contains various investigations into the effects of different bench-press positions on the degree of muscle activation. However, the effects of fatigue on the muscular performance and kinetics of the elbow joint are not understood fully. To investigate the effects of fatigue on the kinetics and myodynamic performance of the elbow joint in bench-press training. Controlled laboratory study. Motion research laboratory. A total of 18 physically healthy male students (age = 19.6 ± 0.8 years, height = 168.7 ± 5.5 cm, mass = 69.6 ± 8.6 kg) participated in the investigation. All participants were right-hand dominant, and none had a history of upper extremity injuries or disorders. Participants performed bench-press training until fatigued. Maximal possible number of repetitions, cycle time, myodynamic decline rate, elbow-joint force, and elbow-joint moment. We observed a difference in cycle time in the initial (2.1 ± 0.42 seconds) and fatigue (2.58 ± 0.46 seconds) stages of the bench-press exercise (P = .04). As the participants fatigued, we observed an increase in the medial-lateral force (P = .03) and internal-external moment (P ≤ .04) acting on the elbow joint. Moreover, a reduction in the elbow muscle strength was observed in the elbow extension-flexion (P ≤ .003) and forearm supination-pronation (P ≤ .001) conditions. The results suggest that performing bench-press exercises to the point of fatigue increases elbow-joint loading and may further increase the risk of injury. Therefore, when clinicians design bench-press exercise regimens for general athletic training, muscle strengthening, or physical rehabilitation, they should control carefully the maximal number of repetitions.

Performance management in healthcare: a critical analysis.

PubMed

Hewko, Sarah J; Cummings, Greta G

2016-01-01

Purpose - The purpose of this paper is to explore the underlying theoretical assumptions and implications of current micro-level performance management and evaluation (PME) practices, specifically within health-care organizations. PME encompasses all activities that are designed and conducted to align employee outputs with organizational goals. Design/methodology/approach - PME, in the context of healthcare, is analyzed through the lens of critical theory. Specifically, Habermas' theory of communicative action is used to highlight some of the questions that arise in looking critically at PME. To provide a richer definition of key theoretical concepts, the authors conducted a preliminary, exploratory hermeneutic semantic analysis of the key words "performance" and "management" and of the term "performance management". Findings - Analysis reveals that existing micro-level PME systems in health-care organizations have the potential to create a workforce that is compliant, dependent, technically oriented and passive, and to support health-care systems in which inequalities and power imbalances are perpetually reinforced. Practical implications - At a time when the health-care system is under increasing pressure to provide high-quality, affordable services with fewer resources, it may be wise to investigate new sector-specific ways of evaluating and managing performance. Originality/value - In this paper, written for health-care leaders and health human resource specialists, the theoretical assumptions and implications of current PME practices within health-care organizations are explored. It is hoped that readers will be inspired to support innovative PME practices within their organizations that encourage peak performance among health-care professionals.

Internal derangements of the temporomandibular joint: A review of the anatomy, diagnosis, and management

PubMed Central

Young, Andrew L.

2015-01-01

Internal derangements of the temporomandibular joint are conditions in which the articular disc has become displaced from its original position the condylar head. Relevant anatomic structures and their functional relationships are briefly discussed. The displacement of the disc can result in numerous presentations, with the most common being disc displacement with reduction (with or without intermittent locking), and disc displacement without reduction (with or without limited opening). These are described in this article according to the standardized Diagnostic Criteria for Temporomandibular Disorders, as well as the less common posterior disc displacement. Appropriate management usually ranges from patient education and monitoring to splints, physical therapy, and medications. In rare and select cases, surgery may be necessary. However, in for the majority of internal derangements, the prognosis is good, particularly with conservative care. PMID:26929478

Internal derangements of the temporomandibular joint: A review of the anatomy, diagnosis, and management.

PubMed

Young, Andrew L

2015-01-01

Internal derangements of the temporomandibular joint are conditions in which the articular disc has become displaced from its original position the condylar head. Relevant anatomic structures and their functional relationships are briefly discussed. The displacement of the disc can result in numerous presentations, with the most common being disc displacement with reduction (with or without intermittent locking), and disc displacement without reduction (with or without limited opening). These are described in this article according to the standardized Diagnostic Criteria for Temporomandibular Disorders, as well as the less common posterior disc displacement. Appropriate management usually ranges from patient education and monitoring to splints, physical therapy, and medications. In rare and select cases, surgery may be necessary. However, in for the majority of internal derangements, the prognosis is good, particularly with conservative care.

Centerline (longitudinal) joint adhesive performance : two to three-year review.

DOT National Transportation Integrated Search

2009-11-01

This report discusses preliminary evaluations of adhesive use along longitudinal paving : joints on hot mix asphalt pavements to help prevent longitudinal cracking. Seven : pavements where adhesive was applied to the vertical or sloped face of the fi...

Performance Management: The Neglected Imperative of Accountability Systems in Education

ERIC Educational Resources Information Center

Mosoge, M. J.; Pilane, M. W.

2014-01-01

The first aim of this paper is to clarify the concept "performance management" as an aspect of the Integrated Quality Management System (IQMS). The second is to report on an exploration into the experiences and perceptions of management teams in the implementation of performance management. As part of the qualitative research design, the…

Relationship of medial gastrocnemius relative fascicle excursion and ankle joint power and work performance during gait in typically developing children

PubMed Central

Martín Lorenzo, Teresa; Albi Rodríguez, Gustavo; Rocon, Eduardo; Martínez Caballero, Ignacio; Lerma Lara, Sergio

2017-01-01

Abstract Muscle fascicles lengthen in response to chronic passive stretch through in-series sarcomere addition in order to maintain an optimum sarcomere length. In turn, the muscles’ force generating capacity, maximum excursion, and contraction velocity is enhanced. Thus, longer fascicles suggest a greater capacity to develop joint power and work. However, static fascicle length measurements may not be taking sarcomere length differences into account. Thus, we considered relative fascicle excursions through passive ankle dorsiflexion may better correlate with the capacity to generate joint power and work than fascicle length. Therefore, the aim of the present study was to determine if medial gastrocnemius relative fascicle excursions correlate with ankle joint power and work generation during gait in typically developing children. A sample of typically developing children (n = 10) were recruited for this study and data analysis was carried out on 20 legs. Medial gastrocnemius relative fascicle excursion from resting joint angle to maximum dorsiflexion was estimated from trigonometric relations of medial gastrocnemius pennation angle and thickness obtained from B-mode real-time ultrasonography. Furthermore, a three-dimensional motion capture system was used to obtain ankle joint work and power during the stance phase of gait. Significant correlations were found between relative fascicle excursion and peak power absorption (–) r(14) = −0.61, P = .012 accounting for 31% variability, positive work r(18) = 0.56, P = .021 accounting for 31% variability, and late stance positive work r(15) = 0.51, P = .037 accounting for 26% variability. The large unexplained variance may be attributed to mechanics of neighboring structures (e.g., soleus or Achilles tendon mechanics) and proximal joint kinetics which may also contribute to ankle joint power and work performance, and were not taken into account. Further studies are encouraged to provide

The carry-over effect of competition in task-sharing: evidence from the joint Simon task.

PubMed

Iani, Cristina; Anelli, Filomena; Nicoletti, Roberto; Rubichi, Sandro

2014-01-01

The Simon effect, that is the advantage of the spatial correspondence between stimulus and response locations when stimulus location is a task-irrelevant dimension, occurs even when the task is performed together by two participants, each performing a go/no-go task. Previous studies showed that this joint Simon effect, considered by some authors as a measure of self-other integration, does not emerge when during task performance co-actors are required to compete. The present study investigated whether and for how long competition experienced during joint performance of one task can affect performance in a following joint Simon task. In two experiments, we required pairs of participants to perform together a joint Simon task, before and after jointly performing together an unrelated non-spatial task (the Eriksen flanker task). In Experiment 1, participants always performed the joint Simon task under neutral instructions, before and after performing the joint flanker task in which they were explicitly required either to cooperate with (i.e., cooperative condition) or to compete against a co-actor (i.e., competitive condition). In Experiment 2, they were required to compete during the joint flanker task and to cooperate during the subsequent joint Simon task. Competition experienced in one task affected the way the subsequent joint task was performed, as revealed by the lack of the joint Simon effect, even though, during the Simon task participants were not required to compete (Experiment 1). However, prior competition no longer affected subsequent performance if a new goal that created positive interdependence between the two agents was introduced (Experiment 2). These results suggest that the emergence of the joint Simon effect is significantly influenced by how the goals of the co-acting individuals are related, with the effect of competition extending beyond the specific competitive setting and affecting subsequent interactions.

Models of evaluation of public joint-stock property management

NASA Astrophysics Data System (ADS)

Yakupova, N. M.; Levachkova, S.; Absalyamova, S. G.; Kvon, G.

2017-12-01

The paper deals with the models of evaluation of performance of both the management company and the individual subsidiaries on the basis of a combination of elements and multi-parameter and target approaches. The article shows that due to the power of multi-dimensional and multi-directional indicators of financial and economic activity it is necessary to assess the degree of achievement of the objectives with the use of multivariate ordinal model as a set of indicators, ordered by growth so that the maintenance of this order on a long interval of time will ensure the effective functioning of the enterprise in the long term. It is shown that these models can be regarded as the monitoring tools of implementation of strategies and guide the justification effectiveness of implementation of management decisions.

Lower limb joint work and joint work contribution during downhill and uphill walking at different inclinations.

PubMed

Alexander, Nathalie; Strutzenberger, Gerda; Ameshofer, Lisa Maria; Schwameder, Hermann

2017-08-16

Work performance and individual joint contribution to total work are important information for creating training protocols, but were not assessed so far for sloped walking. Therefore, the purpose of this study was to analyze lower limb joint work and joint contribution of the hip, knee and ankle to total lower limb work during sloped walking in a healthy population. Eighteen male participants (27.0±4.7yrs, 1.80±0.05m, 74.5±8.2kg) walked on an instrumented ramp at inclination angles of 0°, ±6°, ±12° and ±18° at 1.1m/s. Kinematic and kinetic data were captured using a motion-capture system (Vicon) and two force plates (AMTI). Joint power curves, joint work (positive, negative, absolute) and each joint's contribution to total lower limb work were analyzed throughout the stance phase using an ANOVA with repeated measures. With increasing inclination positive joint work increased for the ankle and hip joint and in total during uphill walking. Negative joint work increased for each joint and in total work during downhill walking. Absolute work was increased during both uphill (all joints) and downhill (ankle & knee) walking. Knee joint contribution to total negative and absolute work increased during downhill walking while hip and ankle contributions decreased. This study identified, that, when switching from level to a 6° and from 6° to a 12° inclination the gain of individual joint work is more pronounced compared to switching from 12° to an 18° inclination. The results might be used for training recommendations and specific training intervention with respect to sloped walking. Copyright © 2017 Elsevier Ltd. All rights reserved.

FAA/NASA Joint University Program for Air Transportation Research 1994-1995

NASA Technical Reports Server (NTRS)

Remer, J. H.

1998-01-01

The Joint University Program for Air Transportation Research (JUP) is a coordinated set of three grants co-sponsored by the Federal Aviation Administration (FAA) and the National Aeronautics and Space Administration (NASA). Under JUP, three institutions: the Massachusetts Institute of Technology, Princeton, and Ohio Universities receive research grants and collaborate with FAA and NASA in defining and performing civil aeronautics research in a multitude of areas. Some of these disciplines are artificial intelligence, control theory, atmospheric hazards, navigation, avionics, human factors, flight dynamics, air traffic management, and electronic communications.

American College of Rheumatology/European League Against Rheumatism remission criteria for rheumatoid arthritis maintain reliable performance when evaluated in 44 joints.

PubMed

Kaneko, Yuko; Kondo, Harumi; Takeuchi, Tsutomu

2013-08-01

To investigate the performance of the new remission criteria for rheumatoid arthritis (RA) in daily clinical practice and the effect of possible misclassification of remission when 44 joints are assessed. Disease activity and remission rate were calculated according to the Disease Activity Score (DAS28), Simplified Disease Activity Index (SDAI), Clinical Disease Activity Index (CDAI), and a Boolean-based definition for 1402 patients with RA in Keio University Hospital. Characteristics of patients in remission were investigated, and the number of misclassified patients was determined--those classified as being in remission based on 28-joint count but as nonremission based on a 44-joint count for each definition criterion. Of all patients analyzed, 46.6%, 45.9%, 41.0%, and 31.5% were classified as in remission in the DAS28, SDAI, CDAI, and Boolean definitions, respectively. Patients classified into remission based only on the DAS28 showed relatively low erythrocyte sedimentation rates but greater swollen joint counts than those classified into remission based on the other definitions. In patients classified into remission based only on the Boolean criteria, the mean physician global assessment was greater than the mean patient global assessment. Although 119 patients had ≤ 1 involved joint in the 28-joint count but > 1 in the 44-joint count, only 34 of these 119 (2.4% of all subjects) were found to have been misclassified into remission. In practice, about half of patients with RA can achieve clinical remission within the DAS28, SDAI, and CDAI; and one-third according to the Boolean-based definition. Patients classified in remission based on a 28-joint count may have pain and swelling in the feet, but misclassification of remission was relatively rare and was seen in only 2.4% of patients under a Boolean definition. The 28-joint count can be sufficient for assessing clinical remission based on the new remission criteria.

Joint Chiefs of Staff > Directorates > J1 | Manpower and Personnel

Science.gov Websites

Management J1 | Manpower and Personnel J2 | Joint Staff Intelligence J3 | Operations J4 | Logistics► J8 | Force Structure, Resources & Assessment Contact J1 Manpower and Personnel Home : Directorates : J1 | Manpower and Personnel Mission To provide the Chairman of the Joint Chiefs of Staff

Meloxicam and surgical denervation of the coxofemoral joint for the treatment of degenerative osteoarthritis in a Bengal tiger (Panthera tigris tigris).

PubMed

Whiteside, Douglas P; Remedios, Audrey M; Black, Sandra R; Finn-Bodner, Susan T

2006-09-01

An adult male white Bengal tiger (Panthera tigris tigris) with pronounced atrophy of the pelvic musculature was diagnosed with degenerative osteoarthritis of the coxofemoral joints. Initial management with the nonsteroidal anti-inflammatory drug meloxicam and a semisynthetic sodium pentosan polysulfate resulted in clinical improvement and radiographic stabilization of the arthritic condition over several months. However, because pain was still evident, bilateral denervation of the coxofemoral joints was performed, successfully ameliorating the signs of osteoarthritic pain in the tiger. Meloxicam has shown good clinical efficacy for the treatment of osteoarthritis and other painful conditions in large felids. Coxofemoral joint denervation offers many advantages for the treatment of osteoarthritis in exotic carnivore species, and should be considered a viable treatment modality.

Results and Analysis from Space Suit Joint Torque Testing

NASA Technical Reports Server (NTRS)

Matty, Jennifer E.; Aitchison, Lindsay

2009-01-01

A space suit s mobility is critical to an astronaut s ability to perform work efficiently. As mobility increases, the astronaut can perform tasks for longer durations with less fatigue. The term mobility, with respect to space suits, is defined in terms of two key components: joint range of motion and joint torque. Individually these measures describe the path which in which a joint travels and the force required to move it through that path. Previous space suits mobility requirements were defined as the collective result of these two measures and verified by the completion of discrete functional tasks. While a valid way to impose mobility requirements, such a method does necessitate a solid understanding of the operational scenarios in which the final suit will be performing. Because the Constellation space suit system requirements are being finalized with a relatively immature concept of operations, the Space Suit Element team elected to define mobility in terms of its constituent parts to increase the likelihood that the future pressure garment will be mobile enough to enable a broad scope of undefined exploration activities. The range of motion requirements were defined by measuring the ranges of motion test subjects achieved while performing a series of joint maximizing tasks in a variety of flight and prototype space suits. The definition of joint torque requirements has proved more elusive. NASA evaluated several different approaches to the problem before deciding to generate requirements based on unmanned joint torque evaluations of six different space suit configurations being articulated through 16 separate joint movements. This paper discusses the experiment design, data analysis and results, and the process used to determine the final values for the Constellation pressure garment joint torque requirements.

Interdependence of torque, joint angle, angular velocity and muscle action during human multi-joint leg extension.

PubMed

Hahn, Daniel; Herzog, Walter; Schwirtz, Ansgar

2014-08-01

Force and torque production of human muscles depends upon their lengths and contraction velocity. However, these factors are widely assumed to be independent of each other and the few studies that dealt with interactions of torque, angle and angular velocity are based on isolated single-joint movements. Thus, the purpose of this study was to determine force/torque-angle and force/torque-angular velocity properties for multi-joint leg extensions. Human leg extension was investigated (n = 18) on a motor-driven leg press dynamometer while measuring external reaction forces at the feet. Extensor torque in the knee joint was calculated using inverse dynamics. Isometric contractions were performed at eight joint angle configurations of the lower limb corresponding to increments of 10° at the knee from 30 to 100° of knee flexion. Concentric and eccentric contractions were performed over the same range of motion at mean angular velocities of the knee from 30 to 240° s(-1). For contractions of increasing velocity, optimum knee angle shifted from 52 ± 7 to 64 ± 4° knee flexion. Furthermore, the curvature of the concentric force/torque-angular velocity relations varied with joint angles and maximum angular velocities increased from 866 ± 79 to 1,238 ± 132° s(-1) for 90-50° knee flexion. Normalised eccentric forces/torques ranged from 0.85 ± 0.12 to 1.32 ± 0.16 of their isometric reference, only showing significant increases above isometric and an effect of angular velocity for joint angles greater than optimum knee angle. The findings reveal that force/torque production during multi-joint leg extension depends on the combined effects of angle and angular velocity. This finding should be accounted for in modelling and optimisation of human movement.

Healthcare managers' roles, competencies, and outputs in organizational performance improvement.

PubMed

Wallick, William G

2002-01-01

Healthcare CEOs recognize that managers are under increasing pressure to work smarter and more efficiently with fewer available resources. Jobs in the healthcare industry are in a constant state of change, requiring a workforce that is not only prepared to adjust quickly to the changing environment but to simultaneously maintain or improve overall organizational performance. Traditionally, trainers were viewed as the people with the primary responsibility for improving organizational performance. Today some CEOs believe healthcare managers should own that responsibility, and other CEOs believe the responsibility should be shared among healthcare managers and trainers. This shift in how accountability is viewed poses at least two important questions. Are managers aware of the various roles they need to enact to achieve successful organizational performance improvement? Do managers possess the competencies associated with those roles? The seven most contemporary trainer roles, now referred to as workplace learning and performance roles, are examined in this article to help managers increase their knowledge of the roles, competencies, and outputs expected of them. Based on findings of a study conducted to examine CEO's perceptions of managers' roles in the performance improvement process, this article provides theoretical backgrounds, includes verbatim study comments, and offers practical recommendations or tips for managers.

Role of Academic Managers in Workload and Performance Management of Academic Staff: A Case Study

ERIC Educational Resources Information Center

Graham, Andrew T.

2016-01-01

This small-scale case study focused on academic managers to explore the ways in which they control the workload of academic staff and the extent to which they use the workload model in performance management of academic staff. The links that exist between the workload and performance management were explored to confirm or refute the conceptual…

[Primary management of endometrial carcinoma. Joint recommendations of the French society of gynecologic oncology (SFOG) and of the French college of obstetricians and gynecologists (CNGOF)].

PubMed

Querleu, D; Darai, E; Lecuru, F; Rafii, A; Chereau, E; Collinet, P; Crochet, P; Marret, H; Mery, E; Thomas, L; Villefranque, V; Floquet, A; Planchamp, F

2017-12-01

The management of endometrial carcinoma is constantly evolving. The SFOG and the CNGOF decided to jointly update the previous French recommendations (Institut national du cancer 2011) and to adapt to the French practice the 2015 recommendations elaborated at the time of joint European consensus conference with the participation of the three concerned European societies (ESGO, ESTRO, ESMO). A strict methodology was used. A steering committee was put together. A systematic review of the literature since 2011 has been carried out. A first draft of the recommendations has been elaborated, with emphasis on high level of evidence. An external review by users representing all the concerned discipines and all kinds of practice was completed. Three hundred and four comments were sent by 54 reviewers. The management of endometrial carcinoma requires a precise preoperative workup. A provisional estimate of the final stage is provided. This estimation impact the level of surgical staging. Surgery should use a minimal invasive approach. The final pathology is the key of the decision concerning adjuvant therapy, which involves surveillance, radiation therapy, brachytherapy, or chemotherapy. The management algorithms allow a fast, state of the art based, answer to the clinical questions raised by the management of endometrial cancer. They must be used only in the setting of a multidisciplinary team at all stages of the management. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Performance Results for a Universal Lithium Ion Battery Management System

DTIC Science & Technology

2012-08-01

MODELING & SIMULATION, TESTING AND VALIDATION (MSTV) MINI-SYMPOSIUM AUGUST 14-16, MICHIGAN PERFORMANCE RESULTS FOR A UNIVERSAL LITHIUM ION BATTERY MANAGEMENT...Article 3. DATES COVERED 12-08-2012 to 12-08-2012 4. TITLE AND SUBTITLE PERFORMANCE RESULTS FOR A UNIVERSAL LITHIUM ION BATTERY MANAGEMENT SYSTEM...Engineering and Technology Symposium (GVSETS) Performance Results for a Universal Lithium Ion Battery Management System UNCLASSIFIED – Page 2 of 11

A systematic evaluation of the therapeutic effectiveness of sacroiliac joint interventions.

PubMed

Hansen, Hans; Manchikanti, Laxmaiah; Simopoulos, Thomas T; Christo, Paul J; Gupta, Sanjeeva; Smith, Howard S; Hameed, Haroon; Cohen, Steven P

2012-01-01

The contribution of the sacroiliac joint to low back and lower extremity pain has been a subject of debate with extensive research. It is generally accepted that approximately 10% to 25% of patients with persistent low back pain may have pain arising from the sacroiliac joints. In spite of this, there are currently no definite conservative, interventional, or surgical management options for managing sacroiliac joint pain. In addition, there continue to be significant variations in the application of various techniques as well as a paucity of literature. A systematic review of therapeutic sacroiliac joint interventions. To evaluate the accuracy of therapeutic sacroiliac joint interventions. The available literature on therapeutic sacroiliac joint interventions in managing chronic low back and lower extremity pain was reviewed. The quality assessment and clinical relevance criteria utilized were the Cochrane Musculoskeletal Review Group criteria for randomized trials of interventional techniques and the criteria developed by the Newcastle-Ottawa Scale for observational studies. The level of evidence was classified as good, fair, or poor based on the quality of evidence developed by the U.S. Preventive Services Task Force (USPSTF). Data sources included relevant literature published from 1966 through December 2011 that was identified through searches of PubMed and EMBASE, and manual searches of the bibliographies of known primary and review articles. The primary outcome measure was pain relief (short-term relief = up to 6 months and long-term > 6 months). Secondary outcome measures were improvement in functional status, psychological status, return to work, and reduction in opioid intake. For this systematic review, 56 studies were considered for inclusion. Of these, 45 studies were excluded and a total of 11 studies met inclusion criteria for methodological quality assessment with 6 randomized trials and 5 non-randomized studies. The evidence for cooled

DEMES rotary joint: theories and applications

NASA Astrophysics Data System (ADS)

Wang, Shu; Hao, Zhaogang; Li, Mingyu; Huang, Bo; Sun, Lining; Zhao, Jianwen

2017-04-01

As a kind of dielectric elastomer actuators, dielectric elastomer minimum energy structure (DEMES) can realize large angular deformations by small voltage-induced strains, which make them an attractive candidate for use as biomimetic robotics. Considering the rotary joint is a basic and common component of many biomimetic robots, we have been fabricated rotary joint by DEMES and developed its performances in the past two years. In this paper, we have discussed the static analysis, dynamics analysis and some characteristics of the DEMES rotary joint. Based on theoretical analysis, some different applications of the DEMES rotary joint were presented, such as a flapping wing, a biomimetic fish and a two-legged walker. All of the robots are fabricated by DEMES rotary joint and can realize some basic biomimetic motions. Comparing with traditional rigid robot, the robot based on DEMES is soft and light, so it has advantage on the collision-resistant.

Cancer risk among patients with finger and hand joint and temporo-mandibular joint prostheses in Denmark.