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A joint coordinate system for the clinical description of three- dimensional motions: Application to the knee purchase 40mg innopran xl visa blood pressure medicine. A mathematical model of the human body (Aerospace Medical Research Laboratories Tech innopran xl 80mg lowest price blood pressure 5332. A mathematical model for the computational determination of parameter values of anthropomorphic segments. Regression equations to predict segmental moments of inertia from anthropometric measurements. Some characteristics of EMG patterns during locomotion: Implications for the locomotor control process. Proceed- ings of IEEE (Institute of Electrical and Electronic Engineers), 55, 149-171. Doctoral dissertation 136 REFERENCES (ISBN 90-9003176-6), University of Utrecht, Netherlands. Smoothing and differentiation of displacement-time data: An application of splines and digital filtering. The appropriate use of regression equations for the estimation of segmental inertia parameters. Estimation of the mass and inertia characteristics of the human body by means of the best predictive regression equations. All the demonstrations worked with practice guidelines that were established collaboratively by the Departments of Veterans Affairs (VA) and Defense (DoD). In the first demonstration, four MTFs in the Great Plains Region implemented the practice guideline for low back pain. Next, the practice guideline for asthma was implemented by four MTFs in the Southeast Region. Last, the practice guideline for diabetes was implemented by two MTFs in the Western Region. RAND performed evaluations for each demonstration that included a process evaluation and an analysis of effects on clinical practices. This report presents the findings from our evaluation of the imple- mentation of the practice guideline for low back pain in the Great Plains Region demonstration. These findings incorporate and extend our earlier process evaluation findings for activities and progress xiii xiv Evaluation of the Low Back Pain Practice Guideline Implementation during the first three months the demonstration MTFs worked with the low back pain demonstration. BACKGROUND DoD and the VA initiated a collaborative project in early 1998 to es- tablish a single standard of care in the military and VA health sys- tems, with the goals of (1) adaptation of existing clinical practice guidelines for selected conditions, (2) selection of two to four indica- tors for each guideline to benchmark and monitor implementation progress, and (3) integration of DoD/VA prevention, pharmaceutical, and clinical information efforts. With this approach to guideline de- velopment, DoD and the VA made a commitment to use of evidence- based practices in their health care facilities. Summary xv is a statement of best practices for the management and treatment of the health condition it addresses. The DoD/VA working group desig- nated an expert panel to develop each practice guideline and to de- velop recommendations for the metrics to be used by the military services and the VA to monitor progress in guideline implementa- tion. The recommendations for practices in each component of care take into account the strength of relevant scientific evidence, which is documented in the written practice guideline (VHA/DoD, 1999). The Practice Guideline for Low Back Pain The principal emphasis of the DoD/VA low back pain practice guide- line is on acute low back pain, which is defined as low back pain oc- curring during the first six weeks after the initial onset of pain. Five key guideline elements were identified by the expert panel responsi- ble for the low back pain guideline (see Chapter One, Table 1. The guideline recommends use of conservative treatment (minimal clini- cal intervention) for acute low back pain patients to allow recovery to take place naturally, which occurs in 80–90 percent of the patients. Patients should be educated on self-care management techniques, including reduction in activity and light exercises to help ease the pain. Imaging studies or laboratory tests are not recommended ini- tially except for cases with symptoms indicating the presence of a more serious condition. Pain medications may be used to ease pa- tients’ discomfort, but these should not include muscle relaxants.

Energy balance is the balance of the yin and the yang within the same body — although that does not mean that the two poles are equal generic innopran xl 40mg free shipping blood pressure medication. Disease was considered an expression of a disturbance in this in- ternal energy balance — too much (or not enough) yin cheap innopran xl 40 mg on-line hypertension 101, or too much (or not enough) yang. This notion of energy equilibrium goes hand in hand with a theory of the origins of the world that is based on five elements: wood, fire, earth, metal and water. Every expression of nature (including pathologies) is the complex result of the predominance of one or more of these ele- ments, together with the balance or the disturbance of the energy bal- ance. This gives you some idea of how complex the theoretical bases of Chinese medicine were; and the Chinese were familiar with traditional anatomy, as well, although they sometimes re-interpreted and cor- rected it to "adhere" to the requirements of the Taoist doctrines. For example, besides the "traditional" organs (liver, heart, spleen, pancreas, lungs, kidneys, stomach, bladder, small intestine, large intes- tine, gall bladder), man and woman were endowed with an additional 3 organ: the great heat source, which does not have any equivalent in 4 traditional W estern medicine. Each of these organs has a correspond- ing meridian line that goes from the surface of the skin to the organ in question, and to the end of the limbs. These are the "subtle channels" that enable the yin/yang energy to circulate and to manage the organ- 54 Needles and Pains ism’s equilibrium. The technique of acupuncture would be developed to bring en- ergy (toning up) or remove energy (dispersion) at the level of one acu- punctural point. The acupuncturist acts not only in the physiological plane; he works to restore the human being to the "sacred" balance of the Tao. The needle as an antenna: In a way, the needle can be compared to an antenna that connects the internal world to its environment. This interpretation goes with the concept that the needle is regarded as a link between man and "heaven" (the environment). This aspect of acupuncture seems to have taken root as soon as the tool was in- vented: it dates back to the bronze age in China, that is to say around the 17th century before Jesus Christ. And even if, since then, the forms and dimensions have been diversified to correspond with various therapeutic needs, the same inspiration continues to dominate the symbolism. As proof, the traditional range of acupuncture tools com- prises nine needles; in Chinese numerologic tradition, the number nine corresponds to "heaven". Thus, the needle remains an intermedi- ary between "heaven" and man, that is, between man and his sur- 5 roundings. The points are indexed in various treatises, the principal one be- ing the Yellow Emperor’s Book of Internal Medicine, but practitioners do not entirely agree on how many points there are: from 160 to as many as 650. It should be noted that the "great Chinese medical tradition" needed a decree from the W orld Health Organization to set the final number of points at 361. W HO, to our knowledge, has not yet weighed in with any legisla- tion to standardize the various pulses by which a Chinese doctor can make his energy diagnosis. The Book of the Yellow Emperor describes twelve anatomical locations where the pulse can be felt, but there are fifteen types of pulses (described in the Book of the Pulse, written in 55 Healing or Stealing? Each radial pulse is divided into twelve parts, corresponding to each meridian line — for which the fifteen types of pulse can be de- tected. Apparently, Chinese civilization has not been without its own share of quacks and charlatans. If we take the base of twelve pulses, with the twelve meridian lines and the fifteen types of pulse, there are several million possible combinations; and in theory, a different diagno- sis should be made for each one! The practice has had to be simplified as it evolved, and various artifices have been devised to help. Today there are practically diagnos- tic abacuses which, while they may not work, are nonetheless beautiful works of art. The W est, which has always been a sucker for easy solu- tions, uses acupuncture point detectors based on the principle of the ohmmeter. They detect the acupuncture points the way certain tools help you find a drainpipe inside a wall. These apparatuses are elegant and come with luminescent diodes giving the most beautiful effect; but they have the frightening habit of lighting up (or failing to) at any place on the body, thus demonstrating that specific points do not exist — or, is it that points do exist that have not been indexed?

We discussed old and present hurts buy innopran xl 80 mg amex heart attack lyrics 007, disappointments cheap innopran xl 80mg amex blood pressure levels of athletes, and angers (relieving the bitter bank of anger and hurts). We explored expectations about coming from a "Jewish family" plagued with sadness from loss (both emotional and financial) stemming from the Holocaust. We discussed the effects of these atrocities on the lives of their grandparents and parents as well as their own. It became apparent that Suzanne’s parents’ expectations of their own parents were very lim- ited. This set the stage for not meeting the daughter’s expectations of 222 THEORETICAL PERSPECTIVES ON WORKING WITH COUPLES so-called "modern American Jewish parents. As Harry listened, he became aware of the impact of the Holocaust on his family as well. He came to realize that his parents, like Suzanne’s parents, re- ceived little if any nurturing in their formative years. He became aware of the high level of depression and sadness in his family of origin and ex- tended family, acted out as silence and avoidance. The couple became aware that the sadness and depression in both families of origin and ex- tended families were acted out in abandonment, verbal abuse, and money control. As a result of this realization, the couple was able to make a shift in their thinking and adjust their expectations of their parents. As the couple became more secure with themselves and each other, they changed their expectations of what they wanted and expected from each other. When Suzanne’s parents felt their relationship with their daughter be- came stuck, I spoke with them on the phone, after obtaining Suzanne’s per- mission. At times, they did not agree with my view of the problems, but it appeared that these conversations relieved their anxieties and enabled them to stay in positive contact with Suzanne. Suzanne’s anger, anxiety, and overall functioning improved within nine months of our work to- gether. The couple and I decided jointly that Harry’s emotional growth was crucial to enable the couple to reach more intimacy and growth. We agreed that I would see Harry individually for a while, because in the joint ses- sions Suzanne took over, judged, criticized, and became anxious in dealing with or hearing about her husband’s problems. Her self-centeredness and level of agitation (even though improved) got in the way of Harry’s work. Therefore, I worked with Harry alone to enhance his ability to feel his and other’s feelings, and to work through his defensive structure of splitting and cutting off. He utilized these defenses when issues were explored with which he did not want to deal. He needed the safety and one-on-one expe- rience to work through these issues and to enable him to develop a new bonding. For about eight months, we worked weekly, and Harry’s level of consciousness, ability to feel, and level of interaction improved remarkably (more differentiated and assertive). He invited his family to a session, and his brothers at- tended, which was a breakthrough for him. He was able to share his feel- ings about his passive behaviors, his siblings’ actions, and how these interactions affected his life. The brothers talked about their parents, their culture, and their individual perceptions of their life histories. Harry also discussed his realization about the effect of the Holocaust on his family of origin. At this point in the treatment, Harry requested that Suzanne come back to treatment so they could work on their "stuckness" concerning money and sex in the relationship. Money was an issue that Suzanne Integrative Healing Couples Therapy: A Search for the Self 223 refused to deal with because of the anxiety it caused within her and the re- running of the old tapes from her family of origin. We worked jointly for three months discussing issues related to money and sexuality. Suzanne was interested and committed to overcoming her anxieties and fears in dealing with money. She worked with Harry in pay- ing the bills, taking responsibility for paying some bills, where previously she had worked and kept the money she earned for herself. She started to learn about their investments and began to face her fears of "not having money"(cognitive behavioral strategies). At the same time, the couple’s sex- ual relationship became more satisfying to both.

A figure skater spins about her longitudinal axis with constant angular speed of 5 rad/s order innopran xl 80 mg online blood pressure 40 year old woman. Three-Dimensional Motion Show that it can be written in the following form for the planar motion: EaP 5 EaQ 1 EaB 3 rP/Q 2 (EvB)2 rP/Q Problem 9 generic innopran xl 80mg mastercard zofran arrhythmia. A gyroscope is a wheel mounted in a successive series of rings so that its axis is free to turn in any direction. When the wheel is spun rapidly, it will keep its original plane of rotation no matter which way the rings are turned. The unit vec- tors b, c, and d are parallel to the axes of B, C, and D, respectively. The angles of rotation shown in the figure were determined to obey the fol- lowing equations: u 522t3 f 5 15 2 5t C567t2 (all in radians) Determine SvB, CvB, SvD as a function of time t. Determine the mass moment of inertia matrix about the cen- ter of mass of the shapes shown in Fig. Answer: For the bent rod of length of 4L and mass 4m shown in the fig- ure, the mass moment of inertia matrix is equal to Ic 5 (2/3) mL2, Ic 5 (8/3) mL2, Ic 5 (10/3) mL2 11 22 33 Ic 5 Ic 5 mL2, Ic 5 Ic 5 Ic 5 Ic 5 0 12 21 13 31 23 32 Problem 9. A man stands still on a turntable that isolates his body from external torques around the vertical b3 axis (Fig. He then begins to swing his arms from one side to the other, as shown in the figure. The angular momentum of the swinging arms about the center of mass of the man is equal to 8 (kg-m2/s) b. Determine the angular velocity 3 of the trunk of the man after he begins swinging his arms. A man standing on a frictionless turntable begins swinging a pendulum of 10 kg (Fig. The man keeps his hands fixed at the center of the body while swing- ing the pendulum. Which direction does his trunk rotate to balance the angular momentum produced by the swinging of the pendulum? A thin disk D of mass m rolls on a table while at the same time it rotates around a vertical axis that passes through point O (Fig. The system is set up so that the cable that connects the center of the disk to point O is horizontal. The angle the rope makes with the e1 direction varies with time according to the equation: f 5 p/4 1 0. The length of the cable above the table is 48 cm, and the diameter of the disk is 14 cm. Determine the position, velocity, and the acceleration of the center of mass of the disk at t 5 2s. The desired twist is in the counterclockwise di- rection with respect to an axis that is directed from his foot toward his head. Propose a number of shape changes involving upper and lower limbs that would cause the desired twist. Show that the magnitude v of the velocity of the center of mass of the coin is related to the angle u by the following equation: v2 5 (2/3) g cot u (r 2 R cos u)2/[r 2 (5/6) R cos u] Hint: Let E denote the reference frame fixed on earth such that e3 points vertical upward. The unit vector d1 remains always in the horizontal plane while the coin rolls without slip. Using these angles and their time derivatives, one can derive expressions for the angular velocity of D in E (V1, V2, V3) and the angular velocity of the coin in E (v1, v2, v3). The rate at which the unit vector d1 rotates in the horizontal plane is given by the following equation dC/dt 5 v/(r 2 R cos u) 294 9. Three-Dimensional Motion e3 (a) C r O e 2 R e1 A e3 d (b) 2 e 2 d3 θ ψ d1 θ e 1 (c) C mg A O f N FIGURE P. Note also that the no-slip condition essentially determines the spin rate (df/dt). Show that the condition that the velocity of the point of contact with the flat surface is zero leads to the relation (df/dt) 52(v/R) 2 cos u v/(r 2 R cos u) The free-body diagram of the coin is shown in the figure (Fig.