Physical Expert Research Articles

Does company compliance with RS-17 influence the characterization of a casual nexus in expert testimony?

Objective: To examine whether company compliance with RS-17 influences the characterization of the casual nexus in physical therapists' expert reports of cumulative trauma disorders in the labor court of Pernambuco, Brazil. Method: The sample was composed of seven physical therapists who provided expert testimony regarding cumulative trauma disorder cases in the labor court of Pernambuco, Brazil. Data collection was performed across two stages. In the first stage, the experts answered a sociodemographic survey and requested the identification numbers of recent cases where expert testimony was provided to characterize the causal nexus. In the second stage, the researchers went to the labor court to collect expert testimony data. These experts indicated that of 75 total cases, 31% (N=23) of the companies fulfilled RS-17, whereas 69% (N=52) did not comply with the law. Results: Among the organizations that complied with legislation, 30% of the analyzed expert testimonies showed a positive causal nexus. However, of the companies that did not comply with RS-17, 71% of the expert testimonies revealed a causal nexus. These results indicate that the breach of the law increases the probability that a causal nexus will be determined by 54.8%. Conclusion: The results showed that failure to comply with RS-17 significantly increases the probability that a causal nexus will be determined in physical therapists' expert testimony of cumulative trauma disorders.

Injury to the posterolateral corner of the knee: emergency department assessment and management

Registered advanced nurse practitioners (RANPs) are recognised as senior decision makers within the emergency department team (ED). The RANP employs a range of skills such as comprehensive health history, advanced physical examination, problem solving, clinical decision-making, and expert judgment to formulate diagnoses andmanagement plans for their patient’s health care needs (Gibbons, 2013). Nurses working in Advanced Practice roles are an increasingly vital component of the multidisciplinary approach to care delivery within the Irish emergency care setting (HSE, 2013a). RANPs are recognised as a senior clinical decision maker within the emergency department team (HSE, 2013b). RANPs are increasingly extending and expanding their scope of practice beyond their initial competencies (Lowe, 2010), and must therefore be aware of emerging trends in injury presentations. To ensure optimal patient care many of these patient care episodes are managed collaboratively with other health care professionals (NCNM, 2008).

My Activity Coach - using video-coaching to assist a web-based computer-tailored physical activity intervention: a randomised controlled trial protocol.

BackgroundThere is a need for effective population-based physical activity interventions. The internet provides a good platform to deliver physical activity interventions and reach large numbers of people at low cost. Personalised advice in web-based physical activity interventions has shown to improve engagement and behavioural outcomes, though it is unclear if the effectiveness of such interventions may further be improved when providing brief video-based coaching sessions with participants. The purpose of this study is to determine the effectiveness, in terms of engagement, retention, satisfaction and physical activity changes, of a web-based and computer-tailored physical activity intervention with and without the addition of a brief video-based coaching session in comparison to a control group.Methods/DesignParticipants will be randomly assigned to one of three groups (tailoring + online video-coaching, tailoring-only and wait-list control). The tailoring + video-coaching participants will receive a computer-tailored web-based physical activity intervention (‘My Activity Coach’) with brief coaching sessions with a physical activity expert over an online video calling program (e.g. Skype). The tailoring-only participants will receive the intervention but not the counselling sessions. The primary time point’s for outcome assessment will be immediately post intervention (week 9). The secondary time points will be at 6 and 12 months post-baseline. The primary outcome, physical activity change, will be assessed via the Active Australia Questionnaire (AAQ). Secondary outcome measures include correlates of physical activity (mediators and moderators), quality of life (measured via the SF-12v2), participant satisfaction, engagement (using web-site user statistics) and study retention.DiscussionStudy findings will inform researchers and practitioners about the feasibility and effectiveness of brief online video-coaching sessions in combination with computer-tailored physical activity advice. This may increase intervention effectiveness at an acceptable cost and will inform the development of future web-based physical activity interventions.Trial registrationACTRN12614000339651Date: 31/03/2014.

Quality Assessment of Pre-Classification Maps Generated from Spaceborne/Airborne Multi-Spectral Images by the Satellite Image Automatic Mapper™ and Atmospheric/Topographic Correction™-Spectral Classification Software Products: Part 2 — Experimental Results

This paper complies with the Quality Assurance Framework for Earth Observation (QA4EO) international guidelines to provide a metrological/statistically-based quality assessment of the Spectral Classification of surface reflectance signatures (SPECL) secondary product, implemented within the popular Atmospheric/Topographic Correction (ATCOR™) commercial software suite, and of the Satellite Image Automatic Mapper™ (SIAM™) software product, proposed to the remote sensing (RS) community in recent years. The ATCOR™-SPECL and SIAM™ physical model-based expert systems are considered of potential interest to a wide RS audience: in operating mode, they require neither user-defined parameters nor training data samples to map, in near real-time, a spaceborne/airborne multi-spectral (MS) image into a discrete and finite set of (pre-attentional first-stage) spectral-based semi-concepts (e.g., “vegetation”), whose informative content is always equal or inferior to that of target (attentional second-stage) land cover (LC) concepts (e.g., “deciduous forest”). For the sake of simplicity, this paper is split into two: Part 1—Theory and Part 2—Experimental results. The Part 1 provides the present Part 2 with an interdisciplinary terminology and a theoretical background. To comply with the principle of statistics and the QA4EO guidelines discussed in the Part 1, the present Part 2 applies an original adaptation of a novel probability sampling protocol for thematic map quality assessment to the ATCOR™-SPECL and SIAM™ pre-classification maps, generated from three spaceborne/airborne MS test images. Collected metrological/ statistically-based quality indicators (QIs) comprise: (i) an original Categorical Variable Pair Similarity Index (CVPSI), capable of estimating the degree of match between a test pre-classification map’s legend and a reference LC map’s legend that do not coincide and must be harmonized (reconciled); (ii) pixel-based Thematic (symbolic, semantic) QIs (TQIs) and (iii) polygon-based sub-symbolic (non-semantic) Spatial QIs (SQIs), where all TQIs and SQIs are provided with a degree of uncertainty in measurement. Main experimental conclusions of the present Part 2 are the following. (I) Across the three test images, the CVPSI values of the SIAM™ pre-classification maps at the intermediate and fine semantic granularities are superior to those of the ATCOR™-SPECL single-granule maps. (II) TQIs of both the ATCOR™-SPECL and the SIAM™ tend to exceed community-agreed reference standards of accuracy. (III) Across the three test images and the SIAM™’s three semantic granularities, TQIs of the SIAM™ tend to be significantly higher (in statistical terms) than the ATCOR™-SPECL’s. Stemming from the proposed experimental evidence in support to theoretical considerations, the final conclusion of this paper is that, in compliance with the QA4EO objectives, the SIAM™ software product can be considered eligible for injecting prior spectral knowledge into the pre-attentive vision first stage of a novel generation of hybrid (combined deductive and inductive) RS image understanding systems, capable of transforming large-scale multi-source multi-resolution EO image databases into operational, comprehensive and timely knowledge/information products.

A computer‐aided methodology to design safe food packaging and related systems

A specific “Failure Mode, Effects, and Criticality Analysis” (FMECA) methodology has been developed to detect substances, materials, and steps that are critical for the safety of packaging systems used in food contact and related applications. Contamination levels in the finished product beyond acceptable thresholds are screened via a systematic analysis of crossed mass transfer between components and a serialization of mass‐transfer instances during product lifetime. The whole framework, including physical modeling and expert systems, has been integrated within the open‐source simulation software FMECAengine. The whole approach is illustrated on three case studies representative of applications along the food packaging supply chain: (1) identification of critical routes of the contamination by printing ink constituents, (2) concurrent engineering of multipurpose packaging, and (3) application to surveys or control plans. The implementation of this framework within industrial commitments such as compliance with EU regulations and ISO 22000 type food safety management systems is discussed. © 2013 American Institute of Chemical Engineers AIChE J, 59: 1183–1212, 2013

The Study of Crew Physical and Psychological Evaluation and Sports Intervention Expert System

The crew health evaluation model based on probability neural network and the sports items intervention expert system established in the paper. The system can track and guide n the crew physical and psychological health status at sea in real time. The research work has important practical significance and great practical value, which may enhance the crew physical and psychological health, improve work efficiency, promote the harmony and stability of the ship small environment, maintain the normal life order and ensure safety at sea.

The Clinical Nurse Specialist as Physical Activity Expert

The Clinical Nurse Specialist as Physical Activity Expert

Perfil profesional del educador de pacientes con diabetes

Diabetes education is an interactive and ongoing process that aims to provide the knowledge and skills necessary for self-care of the patient by supporting individuals and their families in order to self-manage their lives with diabetes and achieve the best possible outcomes. Diabetes education is a multidisciplinary process that can be performed by different professionals at different stages of evolution of the disease. This paper analyzes the minimum requirements of the professional profile of the diabetes educator. The role of educator is described as a doctor, nurse, pharmacist, dietitian-nutritionist, psychologist, podiatrist, physical education consultant, social worker and patient expert

The added value of centres of expertise for rare disease patients in Europe

In many European Union (EU) Member States (MS), rare disease (RD) patients are subject to marginalisation in classic healthcare systems designed for non-rare diseases. As a result they do not experience equal access to timely, high quality health services they deserve. The restructuring of healthcare systems to better reflect the values of equity and solidarity amongst RD patients, professionals, and policy makers across Europe can be accomplished through the establishment of Centres of Expertise (CoE). Although no official definition of CoE exists, some MS have established physical expert structures for the management and care of RD patients at the national level. Specialising in a single RD or a group of RDs, CoE are ideally care centres that bring together a group of multidisciplinary, specialised competencies and ensure timely diagnosis and appropriate follow-up care by aiming to improve the continuity and coordination of care through the implementation of healthcare pathways. In addition to providing an added value to the quality of local healthcare services, CoE are also key determinants for research on rare diseases, and support the optimisation of healthcare spending in the current economic climate. Stakeholders across Europe in the rare disease community have worked together to establish several key policy elements synthesized in the Eurordis Policy Factsheet on CoE. In order to best establish, manage, and sustain long-term functioning of CoE, monitoring systems must be established appropriate for each disease and national context. Building on the previous work of many stakeholders in this discussion, MS across Europe should work toward the establishment of CoE as possibly the most crucial elements in the context of national plans and strategies. Although much success has been observed in the establishment of CoE in several MS, several challenges for future national strategies on CoE remain and are identified here.

Investigating predictors of visiting, using, and revisiting an online health-communication program: a longitudinal study.

BackgroundOnline health communication has the potential to reach large audiences, with the additional advantages that it can be operational at all times and that the costs per visitor are low. Furthermore, research shows that Internet-delivered interventions can be effective in changing health behaviors. However, exposure to Internet-delivered health-communication programs is generally low. Research investigating predictors of exposure is needed to be able to effectively disseminate online interventions.ObjectiveIn the present study, the authors used a longitudinal design with the aim of identifying demographic, psychological, and behavioral predictors of visiting, using, and revisiting an online program promoting physical activity in the general population.MethodsA webpage was created providing the public with information about health and healthy behavior. The website included a “physical activity check,” which consisted of a physical activity computer-tailoring expert system where visitors could check whether their physical activity levels were in line with recommendations. Visitors who consented to participate in the present study (n = 489) filled in a questionnaire that assessed demographics, mode of recruitment, current physical activity levels, and health motivation. Immediately after, participants received tailored feedback concerning their current physical activity levels and completed a questionnaire assessing affective and cognitive user experience, attitude toward being sufficiently physically active, and intention to be sufficiently physically active. Three months later, participants received an email inviting them once more to check whether their physical activity level had changed.ResultsAnalyses of visiting showed that more women (67.5%) than men (32.5%) visited the program. With regard to continued use, native Dutch participants (odds ratio [OR] = 2.81, 95% confidence interval [CI] = 1.16-6.81, P = .02) and participants with a strong motivation to be healthy (OR = 1.46, CI = 1.03-2.07, P = .03) were most likely to continue usage of the program. With regard to revisiting, older participants (OR = 1.04, CI = 1.01-1.06, P = .01) and highly educated participants (OR = 4.69, CI = 1.44-15.22, P = .01) were more likely to revisit the program after three months. In addition, positive affective user experience predicted revisiting (OR = 1.64, CI = 1.12-2.39, P = .01).ConclusionsThe results suggest that online interventions could specifically target men, young people, immigrant groups, people with a low education, and people with a weak health motivation to increase exposure to these interventions. Furthermore, eliciting positive feelings in visitors may contribute to higher usage rates.

Sexual violence against children and adolescents: importance of interview medical-legal

IntroductionSexual violence against children and adolescents, due to their physical, emotional, cognitive and social, has become recognised in recent decades as a public health problem. However, its diagnosis is considered...

Decision analytic tools for resolving uncertainty in the energy debate

Within the context of a Social Compatibility Study on Energy Supply Systems a complex decision making model was used to incorporate scientific expertize and public participation into the process of policy formulation and evaluation. The study was directed by the program group “Technology and Society” of the Nuclear Research Centre Jülich. It consisted of three parts: First, with the aid of value tree analysis the whole spectrum of concern and dimensions relevant to the energy issue in Germany was collected and structured in a combined value tree representing the values and criteria of nine important interest groups in the Federal Republic of Germany. Second, the revealed criteria were translated into indicators. Four different energy scenarios were evaluated with respect to each indicator making use of physical measurement, literature review and expert surveys. Third, the weights for each indicator were elicited by interviewing randomly chosen citizens. Those citizens were informed about the scenarios and their impacts prior to the weighting process in a four day seminar. As a result most citizens favoured more moderate energy scenarios assigning high priority to energy conservation. Nuclear energy was perceived as necessary energy source in the long run, but should be restricted to meet only the demand that cannot be covered by other energy means.

CHANGES IN SELF CONCEPT AND STATED BEHAVIORAL PREFERENCES

Seventh- and eighth-grade boys performed various simple physical tasks in front of a physical development expert. The expert then uttered either approval or disapproval statements to the Ss, irrespective of their performances. Tests of Ss' physical self concept, general self concept, and of their preferences for physical activities were administered prior to the evaluation by the experts and at various intervals thereafter. Increases in self-concept rating and in preference for directly related physical activities followed the approval treatment. In some cases, these changes persisted for a 3-week period. Disapproval treatment was, in general, followed by an analogous opposite effect, although there were important exceptions to this tendency. Results were interpreted as supportive of 2 critical hypotheses of selfconcept theory: (a) self-concept change is a function of the reaction of significant others, and (b) changes in self concept eventuate in changes in preference and choice. An attempt was also made to determine the varied effectiveness of the treatment when the treatment was either congruent or incongruent with Ss pretreatment view of self. The results were suggestive but equivocal.

Surgery in the Treatment of Rheumatoid Arthritis and Ankylosing Spondylitis

The pain, deformities and disabilities resulting from rheumatoid arthritis and ankylosing spondylitis must be treated by a team composed of physician, physical medicine expert, orthopaedic surgeon, and, in certain cases, deep X-ray therapist working simultaneously.The principle of "rest" in order to relieve pain has to be combined with methods designed to preserve and restore function. The multiple joint deformities in these cases may necessitate a long programme of reconstructive or functional treatment, which entails whole-hearted co-operation on the part of the patient in intensive post-operative exercise regime.PROCEDURES ADVOCATED FOR THE UPPER LIMB INCLUDE EXCISION OF THE ACROMION PROCESS TOGETHER WITH THE SUBACROMIAL BURSA TO ALLOW FREE MOVEMENT BETWEEN THE CENTRAL TENDON OF THE DELTOID AND THE TENDINOUS SHOULDER CUFF: arthrodesis of the shoulder in cases where there is more severe joint destruction: in certain cases of elbow-joint arthritis, excision of the radial head and sub-total synovectomy may preserve joint function and avoid or delay the necessity for arthroplasty which can be carried out in two ways: (a) similar to the formal joint excision, or (b) re-shaping the lower end of the humerus and upper end of the ulna lining these surfaces with fascia. The former method is preferable in cases of rheumatoid arthritis. To overcome wrist-joint deformity and restore pronation and supination excision of the lower end of the ulna together with radiocarpal fusion in position for optimum function is advocated. Finger and toe joints may be corrected by resection of the bone ends and capsulectomy.In the lower limbs bilateral involvement of the hip-joint is best treated by vitallium mould arthroplasty which may be carried out in four ways: (1) Routine arthroplasty; (2) Modified Whitman procedure; (3) Modified Colonna operation; and (4) The proximal shaft or intertrochanteric arthroplasty. It is essential in these operations to have knowledge of the operative technique, the use of special hip gouges and reamers, and detailed post-operative supervision.For dorsal kyphosis of the spine, spinal osteotomy at the lumbar level provides excellent correction but is an operation demanding care and skill in its execution.The author's remarks are based on experience gained when working with Dr. M. N. Smith-Petersen at the Massachusetts General Hospital, Boston, U.S.A.