Coordination Activities Research Articles

Putting meat on the bone: how to fast-track innovative medicines to those who need them and generate data to justify continued use.

Regulatory agencies worldwide have taken significant steps to expedite approval and market authorization of medicines based on their potential to address areas of significant unmet medical need and severe disease burden. However, initial approval of such medicines is often accompanied by limited evidence of benefit, posing a conundrum for payers and health systems who may desire greater certainty of their value. This paper describes a system of "accelerated access" to manage these tensions and coordinate activities across stakeholders, based on discussions held at a multi-stakeholder convening in June 2023. We focus on 6 core, near-term actions that can be taken to improve the current system: clarifying criteria for expedited regulatory approval, enhancing stakeholder coordination, creating expedited pathways in payer and health technology assessment settings, developing joint regulatory/payer/health technology assessment guidance on study design and data needs, linking pricing policy to data uncertainty, and improving patient and public understanding of the processes involved as well as the risks and benefits of the relevant medicines. Many of these actions will require additional resources and personnel, and some will necessitate unprecedented levels of coordination. Nevertheless, each action is designed to work with minimal adjustments to the current system rather than demanding an entirely new approach.

Antecedents of Organizational Citizenship Behaviour among primary school teachers in Alor Setar

Discussion on organizational citizenship behavior (OCB) among teachers has gained much interest among scholars. However, a review of past literature indicates lack of study towards the antecednts of teachers’ OCB in Malaysia. The study aims to explore the often-overlooked informal relationships between teachers’ Organizational Citizenship Behaviour (OCB), the school environment, their level of competency, empowerment, and commitment to the team. It also seeks to understand the impact of specific elements of job satisfaction and organizational commitment on the overall benefit teachers bring to their communities. The focus of this research is to ascertain the real-world implications of these factors on OCB and their organizational effects among teachers in Alor Setar schools. To understand these interactions and their influence on teachers’ OCB, relevant hypotheses were formulated, tested, and further examined. As part of this research, 400 primary school teachers in Alor Setar were given a set of questionnaires. The regression analysis results indicated that factors such as the school environment, competency level, empowerment, and team commitment have a significant impact on teachers’ OCB. This study holds importance as it delves into the OCB of teachers and their contribution to the increasingly crucial education sector in Malaysia. The findings of this study can guide policymaking in the education sector, particularly in enhancing teachers’ OCB and school administrators can use these insights to foster a culture that promotes OCB, thereby improving overall school performance. In the school context, OCBs were found to play a role in student achievement and increase school effectiveness. They free up resources for more productive purposes, help coordinate organisational activities, and are more effective at environmental change.

Silymarin ameliorates motor function and averts neuroinflammation-induced cell death in the rat model of Huntington’s disease

Huntington's disease (HD) is a scarce neurodegenerative disorder defined by chorea (unusual involuntary movements), behavioral presentations, psychiatric features, and cognitive deterioration. Although the precise pathogenic mechanism behind HD has not yet been identified, the most widely acknowledged pathways include excitotoxicity, mitochondrial malfunction, neuroinflammation, neurochemical imbalance, oxidative stress, and apoptosis HD has no efficient therapy. Current medications have drawbacks. Silymarin, a compound made up of standardized extracts obtained from the seeds of the Silybum marianum and polyphenolic flavonolignan, is utilized in therapeutic settings to treat a variety of experimental disorders in animals. Silymarin's key pharmacological activities include anti-cancer, hepatoprotection, antioxidant, cardioprotection, and anti-inflammatory. It also has no adverse side effects on people or animals. The current study aims to provide Silymarin's neuro-pharmacological activities or therapeutic qualities in HD. In this study, Thirty-six male Sprague-Dawley rats (200–220 g, 8 weeks) at the initial of the study were used. Silymarin solution (100 mg/Kg) was administered by oral gavage for 21 days to ameliorate neural damage in rats injected with 3-nitropropionicacid (3-NP) in a preliminary rat model of HD. The results showed that administration of silymarin to HD rats reduced gliosis, improved motor coordination and muscle activity, and increased striatal volume and the number of neurons and glial cells. Our results suggest that silymarin provides a protective environment for nerve cells and can have beneficial effects against the harmful effects of HD.

Made in Languaging; Ecolinguistic Expertise

Made in languaging aims to help ecolinguists with recrafting ideation and human practices. Inspired by Alexander and Stibbe, I turn to how ecolinguistic expertise can favour life-sustaining relations. In approaching normative goals, I start with how knowledge is made, self-sustains and is disseminated. Ecolinguistic analysis of languages, discourse and narratives can thus be enriched by tracing how practices inform languaging. In turning to epistemic agency, I emphasise the following: (1) building corpora popularia, organised bodies, in order to enhance life-sustaining relations; (2) illuminating life from the inside; and (3) developing bioecological awareness. I contend that, while all living beings use coordinative activities to bring forth what appears to us, humans also use wording types and practices. As we use the already known, languaging enables subjecthood, a person’s little worlds, and a group’s common realities. Hence, what appears as (and to) experience is made in languaging. When linked to normative concerns, the resulting middle worlds also offer means of putting knowledge to work. As in social epistemology, one might regard ‘wealth and well-being’ as a marker of public good. Yet, critical work shows, appeal to these values is anthropomorphic. In order to encompass nonhumans and the biogenic, one can reject market orientatation by tracing languaging, and knowing, back to living. In showing benefits of so doing, I contrast two evolving wording types. The case of growthism, I suggest, attests to praxis and contrasts starkly with the ideational value of life-sustaining relations. Yet, in both cases, languaging meshes practices, happenings and the effects of action. The move shows how one can challenge the hypostatisation of ideology by pursuing how epistemic agency can contribute to the future of evolution.

Stepwise Reduction of Redox Noninnocent Nitrosobenzene to Aniline via a Rare Phenylhydroxylamino Intermediate on a Thiolate-Bridged Dicobalt Scaffold.

Nitrosobenzene (PhNO) and phenylhydroxylamine (PhNHOH) are of paramount importance because of their involvement as crucial intermediates in the biological metabolism and catalytic transformation of nitrobenzene (PhNO2) to aniline (PhNH2). However, a complete reductive transformation cycle of PhNO to PhNH2 via the PhNHOH intermediate has not been reported yet. In this context, we design and construct a new thiolate-bridged dicobalt scaffold that can accomplish coordination activation and reductive transformation of PhNO. Notably, an unprecedented reversible ligand-based redox sequence PhNO0 ↔ PhNO•- ↔ PhNO2- can be achieved on this well-defined {CoIII(μ-SPh)2CoIII} functional platform. Further detailed reactivity investigations demonstrate that the PhNO0 and PhNO•- complexes cannot react with the usual hydrogen and hydride donors to afford the corresponding phenylhydroxylamino (PhNHO-) species. However, the double reduced PhNO2- complex can readily undergo N-protonation with an uncommon weak proton donor PhSH to selectively yield a stable dicobalt PhNHO- bridged complex with a high pKa value of 13-16. Cyclic voltammetry shows that there are two successive reduction events at E1/2 = -0.075 V and Ep = -1.08 V for the PhNO0 complex, which allows us to determine both bond dissociation energy (BDEN-H) of 59-63 kcal·mol-1 and thermodynamic hydricity (ΔGH-) of 71-75 kcal·mol-1 of the PhNHO- complex. Both values indicate that the PhNO•- complex is not a potent hydrogen abstractor and the PhNO0 complex is not an efficient hydride acceptor. In the presence of BH3 as a combination of protons and electrons, facile N-O bond cleavage of the coordinated PhNHO- group can be realized to generate PhNH2 and a dicobalt hydroxide-bridged complex. Overall, we present the first stepwise reductive sequence, PhNO0 ↔ PhNO•- ↔ PhNO2- ↔ PhNHO- → PhNH2.

The influence of branched polyethyleneimine concentration on the spectroscopic and morphology of BPEI/AuNPs for photocatalytic reduction of 4-nitrophenol

In this work, gold nanoparticles (AuNPs) were synthesized and stabilized by branched polyethyleneimine (BPEI) due to their amine groups as a low-cost alternative method. The concentration of BPEI as a critical factor can be used to optimize stable AuNPs with varying sizes. To evaluate BPEI concentrations on surface plasmonic resonance (SPR), size distribution, chemical coordination, and photocatalytic activity of BPEI-AuNPs products, UV–visible, transmission electron microscope, and Fourier transform infrared spectroscopy were used. The SPR bands appeared at 524, 520, and 517 nm as the BPEI concentration increased (10–30 µL), and the band remained stable as BPEI increased. TEM images show a wide range of sizes (polydisperse) for BPEI/AuNPs were formed. According to TEM images, gold nanoparticle sizes were calculated at (18, 12, and 5 nm) for BPEI concentrations 10, 20, and 30 µL. Fourier transform infrared spectroscopy (FTIR) revealed that amine groups from BPEI play an important role in stabilizing AuNPs. For accessing the photocatalytic activity of BPEI-AuNPs, the reduction of 4-nitrophenol (4-NP) by borohydride is a widely used model reaction. As the AuNPs sizes decreased from 18 to 5 nm, the reduction rate was accelerated and the reaction time of 4-NP to 4-AP conversion decreased from 270 to 150 s.

Experiences of children with bronchiectasis and their parents in a novel play-based therapeutic exercise programme: a qualitative analysis

ObjectivesTo explore the experiences and perceptions of children with bronchiectasis and their parents regarding an 8-week play-based therapeutic exercise programme.DesignQualitative study with inductive content analysis.SettingIndividual semistructured interviews were conducted. Interview...

Organization of project activities at the university in the system of scientific reflection

Introduction. The relevance of the study of project activities in higher education is related to the role that this form of educational activity plays at the present stage of education development. Interdisciplinary studies emerging at the intersection of sociology, political science, anthropology, philosophy and economics are promising. This article raises the problem of the contribution of the experience, reflections and mediation of a teacher of a pedagogical university to the project method, on the one hand, and the requirements that apply to the competence of student researchers– on the other. The concept of autonomy of student research activity is proposed as a key idea for the transformation of the directions of the modern Russian educational space.Materials and methods. The materials are based on a study conducted by teachers and students of the Stavropol Pedagogical Institute, a branch in the city of Yessentuki in the period from 2015 to 2022 as part of a research project designed at the same institute. Seven research projects were completed: four with certified teachers, three with students who received a history teacher's diploma, and twenty introductory pedagogical projects. In the process of working on projects, coordination activities were regularly carried out aimed at analyzing the work already done and planning the next stages. The frequency of variables in the method was tested with the participation of teachers, young researchers and students enrolled in historical and social studies programs of the Stavropol State Pedagogical Institute, a branch in the city of Yessentuki.Results. The conducted research made it possible to identify the key positions of the researcher in decision-making, to identify the main starting points of the scientific hypothesis in the process of forming goals and objectives, to describe a set of methodological developments and ideas in the implementation of project activities within the framework of a pedagogical university, the problems of human inclusion in the collective social consciousness in the space of a modern city.Discussion and conclusions. It was concluded that experience contributes to reflection, and reflection contributes to building knowledge and changing paradigms.

The lipid flippase ATP8A1 regulates the recruitment of ARF effectors to the trans-Golgi Network

Formation of transport vesicles requires the coordinate activity of the coating machinery that selects cargo into the nascent vesicle and the membrane bending machinery that imparts curvature to the forming bud. Vesicle coating at the trans-Golgi Network (TGN) involves AP1, GGA2 and clathrin, which are recruited to membranes by activated ARF GTPases. The ARF activation at the TGN is mediated by the BIG1 and BIG2 guanine nucleotide exchange factors (GEFs). Membrane deformation at the TGN has been shown to be mediated by lipid flippases, including ATP8A1, that moves phospholipids from the inner to the outer leaflet of the TGN membrane. We probed a possible coupling between the coating and deformation machineries by testing for an interaction between BIG1, BIG2 and ATP8A1, and by assessing whether such an interaction may influence coating efficiency. Herein, we document that BIG1 and BIG2 co-localize with ATP8A1 in both, static and highly mobile TGN elements, and that BIG1 and BIG2 bind ATP8A1. We show that the interaction involves the catalytic Sec7 domain of the GEFs and the cytosolic C-terminal tail of ATP8A1. Moreover, we report that the expression of ATP8A1, but not ATP8A1 lacking the GEF-binding cytosolic tail, increases the generation of activated ARFs at the TGN and increases the selective recruitment of AP1, GGA2 and clathrin to TGN membranes. This occurs without increasing BIG1 or BIG2 levels at the TGN, suggesting that the binding of the ATP8A1 flippase tail to the Sec7 domain of BIG1/BIG2 increases their catalytic activity. Our results support a model in which a flippase component of the deformation machinery impacts the activity of the GEF component of the coating machinery.

Mechanosensory bristles mediate avoidance behavior by triggering sustained local motor activity in Drosophila melanogaster

During locomotion, most vertebrates-and invertebrates such as Drosophila melanogaster-are able to quickly adapt to terrain irregularities or avoid physical threats by integrating sensory information along with motor commands. Key to this adaptability are leg mechanosensory structures, which assist in motor coordination by transmitting external cues and proprioceptive information to motor centers in the central nervous system. Nevertheless, how different mechanosensory structures engage these locomotor centers remains poorly understood. Here, we tested the role of mechanosensory structures in movement initiation by optogenetically stimulating specific classes of leg sensory structures. We found that stimulation of leg mechanosensory bristles (MsBs) and the femoral chordotonal organ (ChO) is sufficient to initiate forward movement in immobile animals. While the stimulation of the ChO required brain centers to induce forward movement, unexpectedly, brief stimulation of leg MsBs triggered a fast response and sustained motor activity dependent only on the ventral nerve cord (VNC). Moreover, this leg-MsB-mediated movement lacked inter- and intra-leg coordination but preserved antagonistic muscle activity within joints. Finally, we show that leg-MsB activation mediates strong avoidance behavior away from the stimulus source, which is preserved even in the absence of a central brain. Overall, our data show that mechanosensory stimulation can elicit a fast motor response, independently of central brain commands, to evade potentially harmful stimuli. In addition, it sheds light on how specific sensory circuits modulate motor control, including initiation of movement, allowing a better understanding of how different levels of coordination are controlled by the VNC and central brain locomotor circuits.

Patient Navigation for Lung Cancer Screening at a Health Care for the Homeless Program

People experiencing homelessness die of lung cancer at rates more than double those in the general population. Lung cancer screening (LCS) with low-dose computed tomography (LDCT) reduces lung cancer mortality, but the circumstances of homelessness create barriers to LCS participation. To determine whether patient navigation, added to usual care, improved LCS LDCT receipt at a large Health Care for the Homeless (HCH) program. This parallel group, pragmatic, mixed-methods randomized clinical trial was conducted at Boston Health Care for the Homeless Program (BHCHP), a federally qualified HCH program that provides tailored, multidisciplinary care to nearly 10 000 homeless-experienced patients annually. Eligible individuals had a lifetime history of homelessness, had a BHCHP primary care practitioner (PCP), were proficient in English, and met the pre-2022 Medicare coverage criteria for LCS (aged 55-77 years, ≥30 pack-year history of smoking, and smoking within the past 15 years). The study was conducted between November 20, 2020, and March 29, 2023. Participants were randomized 2:1 to usual BHCHP care either with or without patient navigation. Following a theory-based, patient-centered protocol, the navigator provided lung cancer education, facilitated LCS shared decision-making visits with PCPs, assisted participants in making and attending LCS LDCT appointments, arranged follow-up when needed, and offered tobacco cessation support for current smokers. The primary outcome was receipt of a 1-time LCS LDCT within 6 months after randomization, with between-group differences assessed by χ2 analysis. Qualitative interviews assessed the perceptions of participants and PCPs about the navigation intervention. In all, 260 participants (mean [SD] age, 60.5 [4.7] years; 184 males [70.8%]; 96 non-Hispanic Black participants [36.9%] and 96 non-Hispanic White participants [36.9%]) were randomly assigned to usual care with (n = 173) or without (n = 87) patient navigation. At 6 months after randomization, 75 participants in the patient navigation arm (43.4%) and 8 of those in the usual care-only arm (9.2%) had completed LCS LDCT (P < .001), representing a 4.7-fold difference. Interviews with participants in the patient navigation arm and PCPs identified key elements of the intervention: multidimensional social support provision, care coordination activities, and interpersonal skills of the navigator. In this randomized clinical trial, patient navigation support produced a 4.7-fold increase in 1-time LCS LDCT completion among HCH patients in Boston. Future work should focus on longer-term screening participation and outcomes. ClinicalTrials.gov Identifier: NCT04308226.

High resolution assessment of commercial fisheries activity along the US West Coast using Vessel Monitoring System data with a case study using California groundfish fisheries

Commercial fisheries along the US West Coast are important components of local and regional economies. They use various fishing gear, target a high diversity of species, and are highly spatially heterogeneous, making it challenging to generate a synoptic picture of fisheries activity in the region. Still, understanding the spatial and temporal dynamics of US West Coast fisheries is critical to meet the US legal mandate to manage fisheries sustainably and to better coordinate activities among a growing number of users of ocean space, including offshore renewable energy, aquaculture, shipping, and interactions with habitats and key non-fishery species such as seabirds and marine mammals. We analyzed vessel tracking data from Vessel Monitoring System (VMS) from 2010 to 2017 to generate high-resolution spatio-temporal estimates of contemporary fishing effort across a wide range of commercial fisheries along the entire US West Coast. We identified over 247,000 fishing trips across the entire VMS data, covering over 25 different fisheries. We validated the spatial accuracy of our analyses using independent estimates of spatial groundfish fisheries effort generated through the NOAA’s National Marine Fisheries Service Observer Program. Additionally, for commercial groundfish fisheries operating in federal waters in California, we combined the VMS data with landings and ex-vessel value data from California commercial fisheries landings receipts to generate highly resolved estimates of landings and ex-vessel value, matching over 38,000 fish tickets with VMS data that included 87% of the landings and 76% of the ex-vessel value for groundfish. We highlight fisheries-specific and spatially-resolved patterns of effort, landings, and ex-vessel value, a bimodal distribution of fishing effort with respect to depth, and variable and generally declining effort over eight years. The information generated by our study can help inform future sustainable spatial fisheries management and other activities in the marine environment including offshore renewable energy planning.

PENYELENGGARAAN SISTEM PEMERINTAHAN BERBASIS ELEKTRONIK DI LINGKUNGAN PEMERINTAH KOTA BATAM

Batam City is the only city in the Riau Islands Province with a good SPBE index out of the 5 regencies and cities in the province. However, in implementing the SPBE policy, problems were encountered, one of which was related to the lack of coordination between SPBE organizers. This creates a discrepancy between the predicate achieved and what is implemented. Bearing in mind that the SPBE maturity level of the Batam City government is the highest in the Riau Islands Province. This research uses a qualitative research method with a descriptive approach. Data collection techniques were carried out by interviews, observation and documentation with the informant selection technique, namely purposive sampling. Meanwhile, the data validity technique uses source triangulation. This research uses the theory of policy implementation proposed by Ripley and Franklin which consists of 2 variables, namely Compliance and What's Happening and Why (What happened and why?) The results of this research indicate that the implementation of the SPBE policy in Batam City has not been implemented optimally. This is caused by (1) minimal understanding of the policy by implementors, unplanned coordination activities between implementers, and no socialization of policy guidelines. (2) factors beyond control that influence the implementation process, namely the agency's lack of awareness of the existence of policy guidelines. (3) inadequate infrastructure factors, and very rapid technological development factors. Thus, the Batam City Communication and Information Department as the main actor needs to fix these problems so that the implementation of the SPBE policy can run effectively

Languaging and Practices: Intimations of a Singular Ontology

Abstract The paper rejects both mentalism and reduction of the trait of Language (capital L) to linguistic phenomena. What is termed lingualism is replaced by tracing wordings to practices that unite metabolism, coordinative activity and linguistic history. Like other partly cultural, partly natural traits (e.g. grazing), languaging enacts modelling (Sebeok 1988). In Yu’s (2021) terms, it extends how supersession informs morphogenesis, agency, sensing and acting. Having challenged lingualism, one deflates reports of experience. Appeal to practices and ontologies (not ontology) posit linguistic ‘objects’ or, in Sellars’s terms, versions of the Myth of the Given. With Sellars, therefore, I rethink the analytic/synthetic divide around the normative power of languaging. On such a view, practices, nonhumans and humans co-evolve with manifest and scientific modes of acting that are constituted by unknowable singular ontology. Knowing is inextricable from languaging and how the resources of cultural modelling are rendered and grasped by using the (simplexifying) powers of living human beings.

Ambient intelligent framework for modelling critical medical events based on context awareness

With the rapid pace of communication technology, the modern communication system still encounters challenges in meeting the dynamic requirements of users. Facilitating emergency services for patients without a caretaker side by is quite challenging. This work contributes a solution towards state-of-the-art research problems by introducing a novel architecture using collaboration, coordination and user activity detection using contextual information. A prototype is built and experiment is carried out to emphasize the importance of real-time activity-based context awareness in ambient intelligence (AmI) applications. The primary contributions of this work are introduction of novel architecture and usage of both static and dynamic activity-based contextual parameters. The secondary contribution of this model is to integrate ambient intelligence with context awareness to offer higher accuracy in determining the critical condition of a patient. Initially, analytical models are built using the context-based attributes that consider both clinical and non-clinical entities based on the minimal and essential vital information of patient. This paper further discusses the experimental model, which is highly cost-efficient both from an operational and usage viewpoint. Different assessment environments have been used for assessing the performance of the model.

Implementasi Kegiatan Fisik Pada Kegiatan Senam Untuk Menstimulasi Perkembangan Fisik Pada Anak Sekolah Dasar

Every child needs activities that are beneficial for their health. One of the activities that can be done is rhythmic gymnastics. This study uses the literature review method. A literature review is an approach in a traditionally conducted literature review with the aim of collecting and critically evaluating various reference sources related to the topic being discussed. Every child needs physical activity for their physical development later on, the factors that affect physical development in children are gross motor physical development where children are not yet able to perform body movement activities in coordination, lack of body flexibility and balance in the strength of the child's leg muscles. Children's motor development can be said to be mature if children have body skills and a healthy way of life, with this can support strong, healthy and skillful physical growth. The form of activities that can develop gross motor skills in children is to invite children to exercise one of them with this rhythmic gymnastics, with this the child can freely move all his limbs.

Systematic review of contemporary interventions for improving discharge support and transitions of care from the patient experience perspective.

To synthesize the impact of improvement interventions related to care coordination, discharge support and care transitions on patient experience measures. Systematic review. Searches were completed in six scientific databases, five specialty journals, and through snowballing. Eligibility included studies published in English (2015-2023) focused on improving care coordination, discharge support, or transitional care assessed by standardized patient experience measures as a primary outcome. Two independent reviewers made eligibility decisions and performed quality appraisals. Of 1240 papers initially screened, 16 were included. Seven studies focused on care coordination activities, including three randomized controlled trials [RCTs]. These studies used enhanced supports such as improvement coaching or tailoring for vulnerable populations within Patient-Centered Medical Homes or other primary care sites. Intervention effectiveness was mixed or neutral relative to standard or models of care or simpler supports (e.g., improvement tool). Eight studies, including three RCTs, focused on enhanced discharge support, including patient education (e.g., teach back) and telephone follow-up; mixed or neutral results on the patient experience were also found and with more substantive risks of bias. One pragmatic trial on a transitional care intervention, using a navigator support, found significant changes only for the subset of uninsured patients and in one patient experience outcome, and had challenges with implementation fidelity. Enhanced supports for improving care coordination, discharge education, and post-discharge follow-up had mixed or neutral effectiveness for improving the patient experience with care, compared to standard care or simpler improvement approaches. There is a need to advance the body of evidence on how to improve the patient experience with discharge support and transitional approaches.

Catalytic Intramolecular Ketone Haloacylation Enabled Stereoselective Heterolytic Cleavage of Cyclopropyl Ketones with Enhanced Reactivity and Regioselectivity beyond Electronics.

By integration of oxocarbenium activation and Lewis acid coordination activation via conformational proximity-driven, Pd(II)- or Cu(I)-catalyzed intramolecular ketone haloacylation, regio- and stereoselective heterolytic ring-opening 1,5-haloacylation of cyclopropyl ketones, including those with weak single alkyl donors, has been developed for the synthesis of valuable α-quaternary halo-γ-butenolides. The vicinal carboxylic acid and ketone acceptors are no longer just spectator activators. Further, this reaction delivers a constant regioselectivity regardless of the electronic nature of substituents, even the malonate.

A Comparison of Strength Training and Coordination Exercises to Improve Quality of life and functional Independence in the elderly

Maintaining the functional independence and quality of life of the elderly has become increasingly important as the world's population ages. The effectiveness of strength training and coordination exercises in improving older individuals' autonomy and well being is investigated in this systematic study. This review assesses the effect of these exercise interventions on a range of outcomes, including muscle strength, balance, mobility, fall prevention, and overall quality of life. It does this by thoroughly analysing the body of existing literature, which includes randomized controlled trials, systematic reviews, and meta analyses. Further, the synergistic effects of combining exercises for coordination and strength are examined, along with practical considerations and future areas for research. The results of this analysis demonstrate the substantial benefits of strength training and coordination activities for encouraging healthy aging and enhancing function.

The Pencil Exercise

Background: Voluntary posterior shoulder instability is a rare condition, with a prevalence of 0.5% to 2.6% in young adults, in which the patient is able to provoke a dislocation or subluxation through voluntary activation of the muscles. Studies have shown results that highlight the importance of abnormal cortical activation in this population and suggest physiotherapeutic treatment as first line. Indications: Currently, there are a wide range of options of physiotherapeutic treatment for this condition, such as muscle reinforcement, scapulohumeral coordination, and/or muscle activation with electrodes, all with acceptable results. Simple, low-cost neuromotor rehabilitation is based on the simplicity of a different approach. We believe that with distal-proximal neuromotor rehabilitation we can improve a physiological muscle function. Technique Description: The goal of the pencil exercise is to stimulate the cerebral cortex by making circular movements with a pen between the fingers, bridging abnormal voluntary stimulation and activation of the shoulder muscles, allowing the patient to focus, by the view, only on hand movements. Results: In this case, we have achieved the bypass of the abnormal voluntary stimulation and activation of the shoulder muscles and improve the patient's physiological shoulder function with the implementation of the pencil exercise. Conclusion: This technique may be an effective option for the treatment of voluntary posterior shoulder dislocation because it is based on the stimulation of the cerebral cortex and not on traditional physiotherapeutic or surgical interventions. It is important to note that more research is needed to validate the results of this technique and determine its long-term efficacy. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.