Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2018. / BACKGROUND: Temporomandibular disorders (TMDs) affect up to fifteen percent of adults. It produces craniofacial pain of musculoskeletal structures within the head and neck. One particular cause of TMDs is said to be myofascial pain syndrome (MFPS), which according to various research papers, if not considered and/or assessed, the general cause of a patient’s pain could be disregarded and incorrect treatment offered. Numerous studies conducted internationally on dental management of temporomandibular joint disorder (TMJD) concluded that there is a significant gap in dentists’ education and training regarding the identification and management of MFPS. Upon reviewing the current literature available in South Africa, very little research existed on dentists’ knowledge and the management strategies that they utilised regarding MFPS in TMJD patients. OBJECTIVES: To determine the dentists’ knowledge regarding MFPS of the temporomandibular joint (TMJ). What assessment and treatment/management strategies they use, and whether they make use of referral networks and if the respondents’ demographics influence their knowledge, utilisation, perception and referral patterns. METHODOLOGY: The researcher developed a research questionnaire, which was validated by both an expert and a pilot study group. This questionnaire was then used as a research tool in this cross-sectional study. General dental practitioners from the Greater eThekwini Region received an invitation to participate. The questionnaire-based survey consisted of five sections: biographical profile of respondents; topic background; perception; knowledge; utilisation and management (including referral patterns) of MFPS. RESULTS: The majority of respondents did receive basic education in MFPS, with 76.9% reporting that they received undergraduate education and 57.7% indicating that they had attended post-graduate courses/talks on MFPS. There was a 100% response from dentists indicating their willingness to attend post-graduate courses/talks on MFPS. The results indicated that the respondents, who felt that their curriculum regarding MFPS was sufficient, were more knowledgeable and more competent in diagnosing and managing MFPS. Overall, the average score for knowledge was 65.17%. Clinical features (78.85%) and the perpetuating and relieving factors (72.11%) scored the highest while causes (58.06%) and differential diagnoses (51.16%) scored the lowest knowledge levels. Respondents mostly made use of allopathic medical fields, and not of alternative medical fields, however a high number of respondents (73.1%) indicated that they would consider chiropractic co–management of patients with MFPS. CONCLUSION: This study adds new information in the South African context regarding dentists’ understanding of the myofascial component of TMDs. It also provides the dental profession with information about the knowledge and practices related to MFPS as well as information regarding the strengths and weaknesses on its educational component. It is recommended that dentists receive additional training on differential diagnoses and causes. It is also recommended that the chiropractic profession take this opportunity to offer courses/talks on MFPS and join forces with the dentistry profession on how they can assist in managing patients with MFPS. / M

Made available in DSpace on 2016-12-06T17:07:11Z (GMT). No. of bitstreams: 1 dissertacao mestrado Luciane Balbinot.pdf: 3627256 bytes, checksum: a36fd0300702dcd6a0c22c892c0255a9 (MD5) Previous issue date: 2006-11-24 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Computerized thermography, system with ability to capture the infrared light emissivity of any reflexive surface, is part of the current arsenal of instrumentation in biomechanics. Using this methodology, it is possible to evaluate the physiology of thermical maintenance through its skin surface representation. The aim of this work is to evaluate the thermography as the identification method of myofascial trigger points, been chosen the trapezius muscle as study focus since it is one of most affected body regions concerning myofascial syndrome. This syndrome is highly prevalent and historically sub-diagnosticated as it requires expert professionals to establish its diagnostic, through physical examination. The articipants of this study were gathered as a sample of thirty persons, fifteen men and fifteen woman, ages between twenty three and seventy years (32,5 years in average). The algometry by pressure, highly validated method on previous works, has been used as part of physical examination to confirm the thermography events. The equipment used to collect the thermograms was an infrared camera with digital image processing, with thermical sensitivity for spectral ranges from 7 to 12 micrometers, appropriate for medical diagnostic utilization; the error index for measurement on this equipment is either 2% or 2oC. It has been used a dynamometer, clock type, for the algometry, commercially available for clinical use, which makes possible to evaluate the applied pressure to the focal point. The trigger point identification was based in a pain diagram filled by the own subject using previously validated parameters. The imaging evaluation was done using a descriptive analysis, having been taking in consideration the thermographic event corresponding to the trigger point, the hot spot or a discoid shaped surface, with one or more degrees Celsius hotter if compared to the neighbor reference point. Algometry was used in this work as reference method It was applied descriptive statistics for evaluate sensibility and specificity in trapezius Myofascial Syndrome diagnoses. A totality of 250 trigger points had been founded: 198 (79.20%) identified by algometry and thermography; 41 points (16.40%) by thermography only; 11(4.40%) identified by algometry only. It was concluded that the thermograpy is an appropriated method for Myofascial Syndrome diagnostic on trapezius muscle. / A termografia, sistema com capacidade de captar a emissividade de luz infravermelha de qualquer superfície reflexiva, faz parte do arsenal atual de instrumentação em biomecânica. Com esta metodologia pode-se avaliar a fisiologia da manutenção térmica através de sua representação cutânea. O presente trabalho teve por objetivo avaliar a termografia comptadorizada na identificação de trigger points miofasciais, tendo sido escolhido o músculo trapézio como foco de estudo, por esta ser uma das regiões corporais mais acometidas pela Síndrome Miofascial. Esta síndrome é altamente prevalente na população adulta ativa e, historicamente, sub-diagnosticada por requerer profissional especializado e treinado para estabelecer seu diagnóstico, que é através de exame físico. Os participantes deste estudo compunham uma amostra de trinta sujeitos, quinze homens e 15 mulheres, com idade entre 23 e 70 anos (média de 32,5 anos). A algometria de pressão, método validado amplamente em estudos prévios, foi utilizada como parte do exame físico para confirmação ou não dos eventos da termografia. O equipamento utilizado para coleta dos termogramas foi uma câmara de infravermelho com processamento digital de imagens, com sensibilidade térmica em faixa espectral de 7 a 12 micrômetros, adequada à sua aplicação no diagnóstico médico; o índice de incerteza de medição deste equipamento é de 2% ou 2ºC. Para a algometria, utilizou-se um dinamômetro tipo relógio, disponível comercialmente para uso clínico, que permitiu avaliar a pressão aplicada aos pontos de interesse. A identificação dos trigger points foi baseada em diagrama de dor preenchido pelo próprio sujeito e utilizando-se parâmetros previamente validados em publicações cientificas. A avaliação das imagens foi realizada através de análise descritiva, valorizando-se o evento termográfico correspondente ao trigger point, que é um hot spot ou, área em formato discóide, com hipertermia de um ou mais graus Celsius em relação a um ponto de referência circunvizinho. A algometria foi usada como método de referência neste estudo. Utilizou-se análise estatística descritiva dos dados para avaliar a sensibilidade e a especificidade da termografia no diagnóstico de Síndrome Miofascial de músculo trapézio. Foram identificados um total de 250 trigger points; destes, 198 (79,20%) foram identificados pela algometria e termografia simultaneamente; 41 pontos (16,40%) identificados apenas pela termografia e 11 pontos (4,40%) identificados apenas pela algometria. Concluiu-se que a termografia é eficaz na identificação de trigger points miofasciais de músculo trapézio.

A utilização dos apalpadores acoplados a máquinas CNC se tornou uma realidade muito comum no mundo atual, principalmente devido à diminuição do tempo de preparação e possibilidades de realização de medições na própria máquina-ferramenta. Porém, ainda existem algumas barreiras a se transpor, como por exemplo, a dificuldade de programação, custo relativamente elevado e pouca literatura que trata exclusivamente a respeito da utilização dos apalpadores para medição nas máquinas-ferramentas. Nesse trabalho é realizada uma revisão bibliográfica sobre o uso dos apalpadores em ambiente industrial, discutindo-se as tecnologias utilizadas na geração do sinal de \"trigger\" e é proposto um novo modelo de apalpador de contato elétrico, de baixo custo, desenvolvido especialmente para atender as necessidades de medições em tornos CNC. Os testes em laboratório revelaram que a repetibilidade do protótipo construído foi de 0,003 mm dentro de uma confiabilidade de mais ou menos 3 \'sigma\' ou 99,73%. Concluiu-se que tais características são altamente compatíveis com os requisitos necessários para a maioria dos processos de torneamento. / The use of touch trigger probes attached to CNC machines has become a world standard, especially due the reduction of setup time and the ability to promote work piece measurements on machine. However, some barriers like measurement routines programming difficulties, high costs of these equipments and the low number of technical literature about this subject, still need to be transposed. This work presents a review on the applications of touch trigger probes on companies shop floor, discussing the nowadays technologies used to generate the trigger signal. A new touch trigger probe model based on a simple electrical contact is specially developed to provide the measuring characteristics required for Lathes, with the needed characteristics and low cost. The tests of the probe developed in the laboratory shown a repeatability of 0,003 mm (more and less 3 \'sigma\' or 99,73%). Those characteristics are high compatible with the most needs of the industry.

A síndrome da dor miofascial crônica é a causa mais frequente das dores musculoesqueléticas com prevalência mundial que varia entre 13,7% e 47% da população, destes, em torno de 17% apresentam dores na região do retropé medial. O músculo abdutor do hálux que se localiza na região medial do pé representa grande importância para as síndromes dolorosas plantares, seu estudo será importante para compreender melhor a fisiopatologia da dor miofascial que ainda permanece desconhecida. Objetivos: Descrição dos pontos de penetração dos ramos do nervo plantar medial no ventre do músculo abdutor do hálux através da dissecção anatômica e a sua inter-relação com os sintomas clínicos de dor plantar nos pacientes ortopédicos. Método: O estudo foi realizado em dois grupos com a amostra calculada pelo projeto piloto realizado anteriormente. No grupo de dissecção anatômica (GDA) foram dissecados 30 pés para a avaliação do número de pontos de entrada dos ramos nervosos no músculo associado ao grupo dos pacientes ortopédicos (GPO) onde 30 pés com sintomas de dor no retropé medial foram submetidos à avaliação da sensibilidade dolorosa com o dolorímetro digital de pressão. Ambos os grupos utilizaram o referencial dos quadrantes no músculo abdutor do hálux. O GDA foi submetido a análise de equações de estimação generalizadas com distribuição Poisson e função de log logaritmo seguida de comparações múltiplas de Bonferroni assim como no GPO mas para a distribuição normal e função de ligação identidade, os dados foram expressos em média ± desvio padrão. O nível de significância foi ajustado para 5% (p < 0,05). Resultados: Neste estudo o GDA apresentou uma diferença estatisticamente significante de pontos de entrada dos ramos do nervo plantar medial no ventre muscular do abdutor do hálux no primeiro quadrante (póstero-lateral, Q1, p < 0,05) em relação aos demais quadrantes, assim como no GPO onde Q1 também apresentou uma maior sensibilidade dolorosa quando comparado aos demais quadrantes (p < 0,05). Foi registrado a partir das dissecções uma inédita fixação no osso navicular do músculo abdutor do hálux. Conclusão: Nossos resultados sugerem que existe uma possível relação entre o maior número de entrada dos ramos do nervo plantar medial no ventre do músculo abdutor do hálux e a maior sensibilidade dolorosa no retropé medial, ou seja, os problemas musculares podem desencadear sintomas clínicos dolorosos a partir da compressão nervosa na região. Os dados vão cooperar para a melhor compreensão das síndromes miofasciais dos pés que auxiliarão para o desenvolvimento de futuros tratamentos / Chronic myofascial pain syndrome is the most frequent cause of musculoskeletal pain, with a worldwide prevalence ranging from 13.7% to 47% of the population, which 17% have pain in the retromedial area. The abductor hallucis muscle is located in the medial region of the foot represent high importance for plantar painful syndromes and your study will be important to better understand the pathophysiology of myofascial pain that remains unknown. Objectives: Description through anatomical dissection of the penetration points of the medial plantar nerve branches in the abductor hallucis muscle layer and their interrelationship with the clinical symptoms of plantar pain in orthopedic patients. Methods: The study was carried out in two groups, the sample size was calculated by the previous pilot study. In the anatomical dissection group (ADG), 30 feet were dissected for the evaluation of the number of entry points of the nerve branches in the muscle belly associated with the orthopedic patients group (OPG) where 30 feet with pain symptoms were submitted to the evaluation of pain sensitivity with digital pressure gauge, both groups used the quadrants referential in the abductor hallucis muscle for the evaluation. The ADG were submitted to the analysis of generalized equation of estimation with Poisson distribuition and log logarithnm and was followed by Bonferroni multiple comparisons, for OPG the same analysis but for normal distribution and identity link function, the datas were expressed as mean ± standard deviation. The level of significance was adjusted to 5% (p < 0.05) for all tests. Results: In this study, the ADG presented a statistically significant difference of medial plantar nerve branches entry points in the first quadrant (posterolateral, Q1) in the abductor halluccis muscle (p < 0.05) in relation to the others, as well as in the OPG, where the first quadrant (Q1) also presented a greater pain sensitivity when compared to the other quadrants (p < 0.05). It was recorded an unprecedented navicular bone fixation from abductor hallucis muscle. Conclusion: Our results suggests that there are a possible relationship between the greater number of entry of the medial plantar nerve branches in the abductor hallucis muscle and the higher pain sensation in the retromedial plantar area and the muscle can trigger an nervous compression to develop painful symptoms. These datas will cooperate to better understand myofascial pain syndromes that will help to develop new treatments

A síndrome dolorosa miofascial (SDM) é uma disfunção musculoesquelética não articular caracterizada por pontos-gatilho miofasciais. Estes pontos, identificados por meio da palpação, são descritos como bandas tensas na fibra muscular, podendo apresentar dor referida à compressão. Sabe-se que os pontos-gatilho miofasciais provocam hiperatividade simpática regional de temperatura local devido à atividade vasoconstritora cutânea. Para documentação objetiva por imagem desta alteração funcional, a termografia tem sido proposta como método auxiliar diagnóstico. O objetivo deste estudo foi correlacionar os exames clínico e termográfico dos pontos-gatilho nos músculos da mastigação masseter e temporal parte anterior. A amostra constituiu-se por 26 mulheres voluntárias com 41 ± 15 anos. Os resultados demonstraram correlação diretamente proporcional entre algometria e termografia na avaliação do ponto-gatilho miofascial, onde, quanto menor a força aplicada, menor a temperatura local (p<0,001). As áreas com dor referida apresentaram níveis de limiar de dor à pressão (1.28±0.45 kgf) menores quando comparados às áreas de dor local (1.73±0,59 kgf; p<0.001). Sendo assim, a imagem termográfica de um ponto-gatilho apresentou-se hiporradiante quando comparada à região de ausência de ponto-gatilho (&#916;T>0,4ºC; p<0.001). Além disso, a avaliação termográfica dos pontos-gatilho nos músculos masseter e temporal pelo gradiente térmico (&#916;T e &#916;&#952;) apresentou maior sensibilidade e especificidade em comparação com a temperatura absoluta (T), mesmo quando corrigidos estes valores para a temperatura ambiente e temperatura timpânica da voluntária durante o exame (&#952;). A termografia isoladamente identificou pontos-gatilho com sensibilidade de 62,5% e especificidade de 71,31%. Os autores concluíram que a termografia é um método de imagem não invasivo, com potencial de identificação de pontos-gatilho miofasciais na região facial. / Myofascial pain syndrome is a myalgic dysfunction characterized by myofascial trigger points (MTP). The taut band is a constant feature of a trigger point characterized by referred pain when stimulated. It is known that the myofascial trigger points cause regional sympathetic hyperactivity in local temperature due to the cutaneous vasoconstrictor activity. For detection of functional changes, thermography may be used as an auxiliary diagnostic imaging. The aim of this study was to correlate clinical and thermographic myofascial trigger points in the masticatory muscles masseter and temporalis. Twenty six women volunteers were included, having a mean age of 41 ± 15 years. The results showed directly proportional relationship by algometry and thermography in the assessment of MTP, where smaller the force applied, lower the local temperature will be (p<0.001). Moreover, when the soreness was evaluated and local vasomotor response, the temperature decreases as the worst local situation. PPT (pressure pain threshold) levels measured at the points of referred pain in MTP (1.28±0.45 kgf) were significantly lower than the areas of local pain in MTP (1.73±0,59 kgf; p<0.001). Thus, the thermographic image of a MTP presented colder than the area without trigger point (&#916;T>0,4ºC; p<0.001). In the thermographic assessment of MTP in the masseter and temporalis muscles, the results suggest that the parameters of thermal asymmetry (&#916;T and &#916;&#952;) show greater sensitivity and specificity in comparison to local absolute temperature values (T), even when corrected for the volunteer\'s core temperature and the temperature of the room during the exam (&#952;). Thermography can identify trigger points (referred pain) with sensitivity of 62,50% and specificity of 71,31%. The authors concluded that thermography is a noninvasive imaging method with potential for screening patients with MTP in the facial region.

Submitted by isabela.moljf@hotmail.com (isabela.moljf@hotmail.com) on 2017-07-21T15:18:26Z No. of bitstreams: 1 davispereirabarbosa.pdf: 59375438 bytes, checksum: b4bcce98691deb4c521a6546b7bb6083 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2017-08-08T18:22:42Z (GMT) No. of bitstreams: 1 davispereirabarbosa.pdf: 59375438 bytes, checksum: b4bcce98691deb4c521a6546b7bb6083 (MD5) / Made available in DSpace on 2017-08-08T18:22:42Z (GMT). No. of bitstreams: 1 davispereirabarbosa.pdf: 59375438 bytes, checksum: b4bcce98691deb4c521a6546b7bb6083 (MD5) Previous issue date: 2012-07-03 / CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Atualmente, o LHC é o maior e mais energético colisionador de partículas em fun-cionamento, colidindo prótons com energias de 7 TeV no centro de massa a cada 50 ns. Vários detectores estão posicionados para medir as características das partículas após a colisão, sendo então utilizadas para verificar a validade das novas teorias de física de partículas. O ATLAS é o maior dos detectores do LHC, estando em operação desde 2009 e fornecendo uma grande quantidade de dados para as análise físicas para a busca do Higgs. Um dos principais responsáveis pelas qualidade das informações adquiridas pelo ATLAS é o seu sistema de seleção de eventos online que foi desenvolvido para rejeitar informações irrelevantes das colisões, excluindo a enorme quantidade de ruído de fundo do experimento. Entretanto, o LHC passará por atualizações visando o au-mento da sua luminosidade em uma ordem de grandeza (103' para 1035) nos próximos dez anos, gerando assim uma maior quantidade de eventos por colisão, aumentando a probabilidade de empilhamento de eventos. Desta forma, o ATLAS e o seu sistema de seleção de eventos online também deverão sofrer modificações para atender aos novos requisitos do experimento. O presente trabalho realizou estudos sobre a utilização de novos algoritmos para estimação da energia de jatos no primeiro nível de seleção de eventos do detector ATLAS. Inicialmente, uma janela bidimensional é aplicada na região onde o jato foi identificado, visando a redução do impacto do empilhamento dos eventos nas bordas desta região. Em seguida, é proposta a utilização da informação de profundidade do calorímetro hadrônico do ATLAS na estimação de energia do jato, através de técnicas de otimização linear (mínimos quadrados) e não-linear (redes neu-rais artificiais). Os resultados obtidos, através de simulações Monte Carlo, mostraram que a informação de profundidade do TileCal reduz o erro de estimação da energia dos jatos em aproximadamente 23%, enquanto que a utilização da janela bidimen-sional melhora o comportamento inicial da curva de acionamento de jatos indicando sua efetividade em cenários de empilhamento de eventos. / The LHC is the biggest and most energetic particle collider, performing proton-proton collisions with 7 TeV on center of mass at 50 ns rate. Several detectors are placed along the LHC in order to measure the collisions results, envisaging the validation or rejection of the new particle physics theories. The ATLAS experiment is the biggest detector at LHC, operating very well since 2009 and providing large amount of data for the physics analysis envisaging the search for the Higgs Particle. The online event selection system (trigger) is one of the major reponsibles for the quality of the acquired data in ATLAS, it was designed to reject the huge amount of background noise generated at LHC. However, the LHC upgrade for high luminosity (10' to 1035) in the following ten years will increase the amount of events per collison, increasing the event pileup probability. In order to cope with the new luminosity requirements, the ATLAS and its trigger system will also upgrade its components and algorithms. This work presents the studies about the use of new algorithms for jet energy estimation in the first level of the ATLAS trigger system. Envisaging the reduction of the pileup effect, a bidimensional window is applied on the region where the event was identified (RoI). Additionally, the longitudinal information from the ATLAS hadronic calorimeter (TileCal) is used in order to improve the jet energy estimation, using linear (Least Square) and nonlinear (Artificial Neural Networks) optimization techniques. The achieved results, through Monte Carlo simulations, show that the TileCal logitudinal information reduces the energy estimation error by 23%, while the bidimensional window slightly improves the jet turn on curve indicating the reduction of the pileup effects.

Sett till samhället i helhet samt till hela branscher och sektorer är förändring konstant. Dessutom är ett känt problem att förändring kan skapa motstånd hos individer och grupper. Eftersom människan är grunden i alla organisationer innebär det att en av de stora utmaningarna i förändringsarbete är att få stöd från organisationen. Samtidigt har det inom beteendevetenskapen identifierats ett stort antal faktorer som influerar människors beteende. Syftet med denna kandidatuppsats är att identifiera och förklara vilka påverkbara faktorer som triggar konstruktivt beteende i förändringsarbete. Teorigrunden är forskning och litteratur inom beteendevetenskap och organisationsförändring vilket initialt har gett till följd att sex faktorer har valts ut. Utifrån den referensramen har en fallstudie av ett omfattande förändringsarbete i en stor statlig organisation genomförts med totalt fyra kvalitativa intervjuer med enhetschefer, samt en kvalitativ intervju med en extern specialistkonsult inom förändringsledning. Dessutom har en tidigare studie i form av en medarbetarundersökning använts med över 1,000 respondenter från 2013 och 2015. Fallföretaget är Xmentor Management AB med fokus på när deras kund Trafikverket införde Nationell och Regional Operativ Ledning. Slutsatserna visar att de sex faktorer som har identifierats i litteraturstudien har möjlighet att trigga konstruktivt beteende i förändringsarbete. Dessutom är tre av faktorerna möjliga att påverka i hög grad. Uppsatsens tre viktigaste rekommendationer är att maximera belöningar på individnivå, att skapa effektiv kommunikation som i god tid och med upprepning kommunicerar till alla i organisationen, samt att erbjuda möjlighet till medskapande för de anställda. / In terms of society as a whole and in industries and whole sectors; change is constant. Additionally, a known problem is that change may create resistance among individuals and groups. Since people are the foundation of all organisations it means that one of the major challenges of change management is to get supportive behaviour from the organisation. At the same time behavioural sciences has identified numerous factors that influence people's behaviour.  The aim of this bachelor thesis is to identify and explain factors that are possible to influence and which triggers constructive behaviour in change processes. The theory foundation consists of research and literature in behavioural sciences and change management which initially resulted in six selected factors. Based on that frame of reference a case study of an extensive change process has been conducted with a total of four interviews with heads of units, as well as one interview with an external consultant in change management. In addition, employee surveys with data from more than 1,000 respondents from 2011, 2013 and 2015 has been used. The case company is Xmentor Management AB with focus on when their customer Trafikverket, the Transport Administration of Sweden, created National and Regional Operational Management.  The findings show that the six selected factors are able to trigger constructive behaviour in change processes. Three of the factors are also possible to influence to a great extent. The three main conclusions are to maximize rewards on an individual level, to create effective communication to everyone in the organization, as well as to offer the possibility of co-creation.

This PhD thesis compared incidents of violence in two Malaysian hospitals and two English hospitals. Using a model of workplace violence, the aims of the thesis were to explore and compare six constructs: extrinsic, intrinsic, triggers, experiences, moderators, and consequences of workplace violence as perceived by Malaysian and English hospital staff. This study used data on experiences of violence gathered in 2005 for incidences in hospitals that occurred up to one year before the survey. The 2004 data from the Incident Report database (IRD) of the English hospitals was also used. Two instruments were developed for this thesis. First was the General Violence Victimization Questionnaire (GVQ), an instrument to identify the types, prevalence, nature, consequences, post-incident support, and reporting trends of violence in hospitals. The second instrument was the Violence Victimization Semi-structured Interview (VicQ) which explored factors leading to the violent incident, the violent incident itself, and psycho-social issues relating to the violent incident. Both instruments were translated into the Malay language for use in Malaysia. 227 people participated in the quantitative survey: 162 people from the Malaysian Government Hospitals (MGH) and 115 people from the National Health Service (NHS). A total of 25 people volunteered to be interviewed as part of the qualitative aspect of the study: 15 from the MGH and 10 from the NHS. Six categories of violence were compared: verbal, nonverbal, threat, physical, sexual, and psychologically-based. A total of 4118 violent incidents (1402 in MGH and 2716 in NHS) were reported. The most common type of violence was psychologically-based violence in the MGH and verbal violence in the NHS. Both samples perceived that the major source of workplace violence was from patients and involved one male perpetrator. There were differences between the two samples indicative of cultural differences. Of those interviewed, the Malaysian participants perceived that offenders were intrinsically motivated to offend. The English participants perceived that offenders had either intrinsic or extrinsic motivation for perpetuating violence. Differences were noted for substance abuse and customer relations as triggers of organisational violence. Comparisons of moderators were different for the two country samples. Comparisons of consequences were not significantly different. Comparisons across several demographic variables (gender, age, and occupational groupings) were not significant between the two country samples with regards to workplace violence victimisation. However, a comparison of length of service was found to be significant. The final path model differed from the original model of workplace violence. Additional findings include a difference between the established definition and participants‘ definition of workplace violence, a lack of anti-violence policies in Malaysian hospitals, under reporting, and unforeseen direct and direct relationships among the six constructs.

The term "joint centration" is recently perceived primarily in its biomechanical context. This paper suggests a possible neurophysiological point of view and examines the effect of centered or decentered position on pressure pain treshold (PPT) of three muscles (m. temporalis, m. tibialis anterior, m. interosseus dorsalis I) in sitting and lying position, researched on healthy volunteers. PPT was measured in four randomly ordered positions with 49 people (21 women, 28 men). Significantly higher PPT was detected in all three muscles (p=0,001; 0,0016; 0,00009). In percent the PPT change resembles some of studies working with therapeutical techniques (mobilization, joint manipulation, exercise). Influence of higher postural position (sitting compared to lying down) on PPT was not proved. Cenetered joint position increases the PPT of healthy young adults compared to decentered position. This newly proved fact opens further possibilities of conceiving the key physiotherapeutical notion of "joint centration".

Bakgrund: Patientinvolvering och patientdelaktighet inom vården har blivit allt mer aktuellt de senaste åren. En metod för patientdelaktighet som testats framför allt inom somatisk vård är Experience-Based Co-Design (EBCD). Lokalt problem: Verksamheten har strukturer för att fånga erfarenheter från patienter, men det saknas strukturer för att fånga närståendes och personals erfarenheter. Det saknas ett forum där patienter, närstående och personal kan mötas och tillsammans arbeta med förbättringar. Syfte: För förbättringsarbetet, testa metoder från EBCD inom kontexten psykiatrisk heldygnsvård. För studien, beskriva deltagares erfarenheter av att involveras i förbättringsarbete utifrån EBCD, samt att belysa vad som gör det svårt att engagera patienter i förbättringsarbete. Metod: Övergripande struktur för förbättringsarbetet är Nolans förbättringsmodell och PDSA. Studien utgörs av kvalitativ innehållsanalys av två semistrukturerade fokusgruppsintervjuer. Interventioner: Metoder från EBCD har anpassats efter kontexten och testats. Resultat: Att delta i förbättringsarbete utifrån EBCD har varit uppskattat och utvecklande. Svårigheter har framför allt varit rekrytering av patienter. Slutsatser: EBCD går att använda inom psykiatrisk heldygnsvård, modifieringar är nödvändiga. Vilka och hur behöver studeras vidare. EBCD påverkar individen och organisationen. För att uppnå ett önskat utfall och för att engagera deltagare behöver vissa förutsättningar uppfyllas vad gäller strukturer och maktutjämning mellan patienter, närstående och personal. / Background: Patient involvement and patient participation within health care has been more and more important the last years. One method for patient involvement that has been tested (mostly in somatic care) is Experience-Based Co-Design (EBCD).  Local problem: The organization has structures to gather experiences from patients, but there is no structure to gather experiences from dependants or staff. There is no forum for patients, dependants and staff to meet and together work with improvement. Aim: For the Quality Improvement project (QIP) try methods from EBCD in the context of psychiatric in-patient care. For the study of the QIP describe participant’s experiences of being part of a QIP based on EBCD, and highlight what makes it difficult to engage patients in QIP. Method: The main structure for the QIP is Nolan’s model of change and PDSA. The study consists of a qualitative content analysis based on two semi-structured focus group interviews. Interventions: Methods from EBCD has been adjusted according to the context and then tested. Result: To participate in a QIP based on EBCD has been appreciated and developing. Difficulties have above all been the recruiting of patients. Conclusions: EBCD is possible to use in psychiatric in-patient care, modifications are necessary. Which modifications and how needs to be examined further. EBCD affects both the individual and the organization. To achieve asked goals and to engage patients there are some conditions that need to be fulfilled according to structures and equalisation of power between patients, dependants and staff.