PURPOSE: The purpose of this study was to identify the response patterns of nursing unit managers regarding workplace bullying. METHODS: Q methodology was used to identify the response patterns. Thirty-six Q samples were selected from the Q population of 210 that included literature reviews and in-depth interviews with clinical nurses and nursing managers. Participants were 30 nursing unit managers who had experience managing workplace bullying and they classified the Q samples into a normal distribution frame measured on a nine-point scale. The data were analyzed using the PC-QUANL program. RESULTS: Five types of response patterns were identified: (1) sympathetic-understanding acceleration, (2) harmonious-team approach, (3) preventive-organizational management, (4) passive observation, and (5) leading-active intervention. The preventive-organizational management type was most frequently used by the nursing unit managers. CONCLUSION: The results of this study indicated that nursing unit managers attempted to prevent and solve workplace bullying in various ways. Therefore, it is necessary to develop and conduct leadership training and intervention programs that appropriately address the response patterns of nursing unit managers, such as those identified in this study.
Acceleration ; Bullying ; Leadership ; Nursing

The shoulder injury was resulted from muscle imbalance between acceleration and deceleration during the throwing. The agonist-antagonist muscle strength relationship for throwing was formerly described as functional ratios of eccentric external rotator to concentric internal rotator moments and eccentric internal rotator to concentric external rotator moments. The purpose of this study was to measure the ratio of concentric and eccentric strength of the shoulder rotators by isokinetic muscle performance in Korean throwing college athletes for descriptive data. On 10 dominant shoulders of asymptomatic throwing college athletes applying Cybex II isokinetic dynamometer, concentric and eccentric muscle strength of the rotators were measured at the speed of 90degrees/s, 180degrees/s, 240degrees/s. Maximal torque ratio of the eccentric strength of the external rotator against the concentric strength of the internal rotator was 1.25, 1.13, 1.21 at the each speed. The functional external eccentric-to-internal concentric ratio was similar with previous published studies. There was no significant difference between each speed. Eccentric strength of the external rotator was higher than concentric strength of the internal rotator during internal and external rotation at all speeds. This functional assessment of strength testing that reflected the importance of eccentric external rotation strength for the dynamic shoulder joint stability during the throwing. Therefore, the increase of the eccentric strength of the external rotator would be helpful to prevent the shoulder injury and to treat for rehabilitation of injured shoulder.
Acceleration ; Athletes ; Deceleration ; Humans ; Muscle Strength ; Muscles ; Rotator Cuff ; Shoulder ; Shoulder Joint ; Torque

BACKGROUND: An acceleration or deceleration of the heart rate (HR), which reflects autonomic effects, is observed before the onset of paroxysmal atrial fibrillation (PAF). The purpose of this study was to assess the discrepancy in the autonomic interactions before the onset of PAF for different patterns of change in the HR. MATERIALS AND METHODS: From 105 Holter tapes with the PAF recorded, 55 episodes (42 patients, 34 men, 58+/-12 years) of PAF (>5 min), preceded by a sinus rhythm for more than 1 hour, were selected and submitted to time-domain and frequency-domain HR variability analyses. Fifty-five episodes were divided into 2 groups: group A PAF (n=30) with acceleration of the HR during the last 2 minutes before the PAF and group B (n=25) with deceleration of the HR. RESULTS: A significant linear decrease in the mean R-R interval was observed in group A (924+/-30 to 835+/-28 ms, P=0.001) and an increase from 831+/-32 to 866+/-31 ms in group B PAF episodes (P=0.046). In the frequency-domain analyses, the LF/HF ratio exhibited a progressive linear increase before the PAF in group A (P=0.005). The HF normalized units (HFnu) and natural logarithm-transformed HF (lnHF) values decreased from 30.8+/-4.0 to 16.1+/-1.8 (P=0.003) and 4.49+/-0.25 to 4.07+/-0.22 (P=0.001), respectively. Contrary to the results in group A, a significant increase in the HF components (HFnu and lnHF) (from 22.6+/-3.2 to 30.2+/-4.0, P=0.005, and 4.27+/-0.27 to 4.75 0.33, P=0.001, respectively) and a resultant decrease in the LF/HF ratio were observed in group B PAF episodes. No significant changes were observed in the LF components in either PAF group. CONCLUSION: Autonomic stimuli leading to an acceleration or deceleration of the HR before the onset of AF are due to parasympathetic modulation. Parasympathetic modulation plays a key role in the initiation of PAF
Acceleration ; Atrial Fibrillation* ; Autonomic Agents ; Autonomic Nervous System ; Deceleration ; Heart Rate ; Humans ; Male

Mitral ring motion and indices of left ventricular diastolic filling were measured by M-mode and Doppler echocardiography in apical 4 chamber view in 11 dilated cardiomyopathy patients and 9 normal subjects without clinical evidence of heart disease. The mean age of patients was 52 years and average heart rate was 76 beats/min. The parameters of mitral annulus motion include earley relaxation amplitude(ER), late atrial contraction amplitude(AC) and A2-peak excursion(A2-PE). Transmitral flow velocity parameters include peak flow velocity of early diastolic flow velocity(PFVE), peak flow velocity of late atrial contraction(PFVA), the ratio between early and late peak flow velocity(PFVE/PFVA), Acceleration rate of early diastolic peak flow(AR), deceleration rate of early diastolic peak flow(DR), time velocity integral of early diastolic flow velocity(TVIE), time velocity integral of late atrial contraction flow velocity(TVIA) and ratio between early diastolic and late atrial flow velocity integral(TVIE/TVIA). In patients with dilated cardiomyopathy, ER(4.5+/-2.3mm) and AC(2.3+/-1.6mm) were significantly decreased than normal(10.7+/-2.6mm, 6.6+/-1.6mm, p<0.01, p<0.01, respectively), whereas ER/AC(1.7+/-0.7) was not significantly different than normal subjects(1.6+/-0.5). A2-PE(100+/-80 msec) was significantly delayed in dilated cardiomyopathy patients than normal subjects(35+/-25 msec, p<0.01). In analysis of transmitral flow velocities, PFVE, PFVA and PFVE/PFVA, etc were not significantly different compared to normal subjects in patients with dilated cardiomyopathy. Mitral ring motion amplitude was decreased and A2-peak excursion time interval(A2-PE) was delayed in patients with dilated cardiomyopathy, but transmitral flow velocities were not significantly different from normal subjects in patients with dilated cardiomyopathy. These results reflect the facts that early diastolic relaxation amplitude is decreased by the change of compliance of LV and late atrial contractin amplitude is decreased by decrease of atrial contractility and increased stiffness of LA and LV. Despite of decreased mitral ring motion, transmitral flow velocity is not significantly different compared to normal subjects in patients with dilated cardiomyopathy. From these evidences, not only transmitral flow velocity affected by multiple factors but also mitral ring motion affected by LA and LV function are considered in assessment of LV diastolic dysfuction.
Acceleration ; Blood Flow Velocity* ; Cardiomyopathy, Dilated* ; Compliance ; Deceleration ; Echocardiography, Doppler ; Heart Diseases ; Heart Rate ; Humans ; Relaxation

PURPOSE: Doppler echocardiography provides a noninvasive technique for the evaluation of left ventricular diastolic function. This study was performed to define the normal pattern of left ventricular diastolic filling by real-time Doppler flow mapping, and to determine how this pattern changes with aging in normal children. METHODS: The changes in diastolic function in 89 normal subjects less than 15 years old were assessed through the analysis of transmitral Doppler flow pattern. Diastolic time intervals, Doppler flow velocities and area fractions in early and late diastole were measured from mitral valve Doppler tracing. The changes in each variable with aging were determined. RESULTS: From the diastolic time intervals, acceleration and deceleration time increased significantly with aging. The percentage of isovolumic relaxation time to cycle length decreased with aging, but there were no significant differences in the percentage of acceleration and deceleration time to cycle length between each age group. The Doppler area of early diastolic flow, E and 0.33 area, significantly increased with aging than that of late diastolic flow, A area. The E and A area fractions to total area were significantly different in the age group of less than 2 months old compared with those of other age groups. The ratios of early to late diastolic flow velocities and early to late area fractions were increased with aging. CONCLUSION: Although many factors affect transmitral Doppler flow pattern, it is important to know the changes of left ventricular diastolic filling with aging to accurately evaluate diastolic dysfunction in children. Further investigation of work in large populations is needed to provide reference values of children with aging.
Acceleration ; Adolescent ; Aging ; Child* ; Deceleration ; Diastole ; Echocardiography, Doppler ; Humans ; Infant ; Mitral Valve ; Reference Values ; Relaxation

Shaken baby syndrome develop as a form of child abuse, with the majority of cases occurring during the first year of life. It results from extreme rotational cranial acceleration and deceleration effects induced by violent shaking of an infant. The characteristic injuries include subdural and subarachnoid hemorrhages, and retinal hemorrhages. We experienced three cases of shaken baby syndrome. Although the history of trauma was little known, all of these cases had subdural hemorrhages. We present the cases with a review of related literature.
Acceleration ; Child ; Child Abuse ; Deceleration ; Hematoma, Subdural ; Humans ; Infant ; Retinal Hemorrhage ; Shaken Baby Syndrome* ; Subarachnoid Hemorrhage

To determine the early diagnostic parameters of the left ventricular diastolic filling defect in the uncontrolled adult onset diabetes mellitus, 86 diabetics were evaluated from the left ventricular inflow velocity pattern using pulsed Doppler echocardiography compared with normal 21 subjects. The diabetics were divided into 3 groups according to the presence or absence of background diabetic retinopathy(RE or coexisting cardiovascular diseases(group I : 34 cases without RE, group II : 24 cases with RE, group III : 28 cases with CVD). RE was thought to be having microangiopathy, but the cases with persistant massive proteinuria were excluded in this study. The left ventricular inflow velocity patterns were recorded from the apical approach. Peak velocity of the rapid filling phase(PFVE), that in the atrial systole(PFVA), E/A ratio, acceleration time(AT), deceleration time(DT), acceleration rate(ATR) and deceleration rate(DTR) were measured in the left ventricular inflow patterns. The results were ; 1) PFVE, AT and ATR in group I(56.26+/-12.21mm/sec, 70.91+/-14.98msec, 858.5+/-247mm/sec2), group II(51.91+/-14.35mm/sec, 64.84+/-14.98msec, 855.7+/-248.5mm/sec2) and group III(50.07+/-12.45mm/sec, 67.59+/-17.46msec, 817.5+/-266.8mm/sec2) were not significantly changed(p>0.05) compared to the controls(50.24+/-8.24mm/sec, 66.19+/-10.98msec, 784.5+/-221mm/sec2). 2) PFVA and DT in group I(51.21+/-14.86mm/sec, 156.2+/-23.42msec) and group II(64.26+/-13.93mm/sec, 64.84+/-14.13msec) were significantly increased(p<0.05, p<0.0001) compared to the controls(43.43+/-9.1mm/sec, 140.05+/-25.22msec). But those were not significantly different between group II and group III(p>0.05). 3) E/A ratio was significantly decreased in group II(0.82+/-0.21) and III(0.75+/-0.23) compared to the controls(1.19+/-0.25, p<0.0001) or group I(1.16+/-0.41, p<0.0001). But not significantly different between group II and group III(p>0.05) was noted. 4) DTR was also decreased in group II(311.9+/-95mm/sec2, p<0.05) and group III(297.7+/-125.8mm/sec2, p<0.05) compared to the controls(370.2+/-88mm/sec2) and group I(379.8+/-126mm/sec2). In conclusion, left ventricular diastolic filling defect in adult onset diabetics could be determined by using a various parameters of the pulsed Doppler echocardiography, which were closely related with diabetic retinopathy(RE). And DT and PFVA could be used as good parameters for early determination of the left ventricular diastolic filling defect in diabetics even without microangiopathy.
Acceleration ; Adult* ; Deceleration ; Diabetes Mellitus* ; Diabetic Angiopathies ; Echocardiography* ; Echocardiography, Doppler, Pulsed ; Humans ; Proteinuria

This study was carried out to analyse the economic feasibility of EPR. A hospital with 500 beds under the construction was selected for this study. The economic effect was performed with cost-benefit analysis for 5 years from the year 1998 to 2002. The results of this study were as follows; The economic effect of EPR was classified into direct benefit, value acceleration, and value linking. Each factor was applied and analyzed step by step. In the analysis including only direct benefit, the net present value and the ratio of benefit to cost were minus 82,920,000 won and 0.8. With this traditional cost-benefit analysis alone, the EPR in hospital can be regarded as very unprofitable. However, when value acceleration was added, the net present value and the ratio of benefit to cost rose to 748,637,000 won and 2.7 respectively. Moreover, when value linking was added, the net present value and the ratio of benefit to cost were 1,473,162,000 won and 4.3, respectively. In the results of this study, as EPR has only direct benefit, EPR can be regarded as unprofitable project. However, when value acceleration and value linking were added, EPR can be profitable project.
Acceleration ; Cost-Benefit Analysis ; Humans

PURPOSE: The aim of this study was to introduce a method of obtaining the oscillation graphs of the dental x-ray tube heads relative to time using an accelerometer. MATERIALS AND METHODS: An Accelerometer, Piezotron type 8704B25 (Kistler Instrument Co., Amherst, NY, USA) was utilized to measure the horizontal oscillation of the x-ray tube head immediately after positioning the tube head for an intraoral radiograph. The signal from the sensor was transferred to a dynamic signal analyzer, which displayed the magnitude of the acceleration on the Y-axis and time lapse on the X-axis. The horizontal oscillation of the tube head was measured relative to time, and the settling time was also determined on the basis of the acceleration graphs for 6 wall type, 5 floor-fixed type, and 4 mobile type dental x-ray machines. RESULTS: The oscillation graphs showed that tube head movement decreased rapidly over time. The settling time varied with x-ray machine types. Wall-type x-ray machines had a settling time of up to 6 seconds, 5 seconds for fixed floor-types, and 11 seconds for the mobile-types. CONCLUSION: Using an accelerometer, we obtained the oscillation graphs of the dental x-ray tube head relative to time. The oscillation graph with time can guide the operator to decide upon the optimum exposure moment after xray tube head positioning for better radiographic resolution.
Acceleration ; Head Movements ; Head* ; Radiography

PURPOSE: The aim of this study was to introduce a method of obtaining the oscillation graphs of the dental x-ray tube heads relative to time using an accelerometer. MATERIALS AND METHODS: An Accelerometer, Piezotron type 8704B25 (Kistler Instrument Co., Amherst, NY, USA) was utilized to measure the horizontal oscillation of the x-ray tube head immediately after positioning the tube head for an intraoral radiograph. The signal from the sensor was transferred to a dynamic signal analyzer, which displayed the magnitude of the acceleration on the Y-axis and time lapse on the X-axis. The horizontal oscillation of the tube head was measured relative to time, and the settling time was also determined on the basis of the acceleration graphs for 6 wall type, 5 floor-fixed type, and 4 mobile type dental x-ray machines. RESULTS: The oscillation graphs showed that tube head movement decreased rapidly over time. The settling time varied with x-ray machine types. Wall-type x-ray machines had a settling time of up to 6 seconds, 5 seconds for fixed floor-types, and 11 seconds for the mobile-types. CONCLUSION: Using an accelerometer, we obtained the oscillation graphs of the dental x-ray tube head relative to time. The oscillation graph with time can guide the operator to decide upon the optimum exposure moment after xray tube head positioning for better radiographic resolution.
Acceleration ; Head Movements ; Head* ; Radiography