Laser therapy in pressure ulcers: evaluation by the Pressure Ulcer Scale for Healing and Nursing Outcomes Classification

AbstractOBJECTIVETo describe the pressure ulcer healing process in critically ill patients treated with conventional dressing therapy plus low-intensity laser therapy evaluated by the Pressure Ulcer Scale for Healing (PUSH) and the result of Wound Healing: Secondary Intention, according to the Nursing Outcomes Classification (NOC).METHODCase report study according to nursing process conducted with an Intensive Care Unit patient. Data were collected with an instrument containing the PUSH and the result of the NOC. In the analysis we used descriptive statistics, considering the scores obtained on the instrument.RESULTSA reduction in the size of lesions of 7cm to 1.5cm of length and 6cm to 1.1cm width, in addition to the increase of epithelial tissue and granulation, decreased secretion and odor.CONCLUSIONThere was improvement in the healing process of the lesion treated with adjuvant therapy and the use of NOC allowed a more detailed and accurate assessment than the PUSH.

Changes in spring-mass model characteristics during repeated running sprints.

This study investigated fatigue-induced changes in spring-mass model characteristics during repeated running sprints. Sixteen active subjects performed 12 × 40 m sprints interspersed with 30 s of passive recovery. Vertical and anterior-posterior ground reaction forces were measured at 5-10 m and 30-35 m and used to determine spring-mass model characteristics. Contact (P < 0.001), flight (P < 0.05) and swing times (P < 0.001) together with braking, push-off and total stride durations (P < 0.001) lengthened across repetitions. Stride frequency (P < 0.001) and push-off forces (P < 0.05) decreased with fatigue, whereas stride length (P = 0.06), braking (P = 0.08) and peak vertical forces (P = 0.17) changes approached significance. Center of mass vertical displacement (P < 0.001) but not leg compression (P > 0.05) increased with time. As a result, vertical stiffness decreased (P < 0.001) from the first to the last repetition, whereas leg stiffness changes across sprint trials were not significant (P > 0.05). Changes in vertical stiffness were correlated (r > 0.7; P < 0.001) with changes in stride frequency. When compared to 5-10 m, most of ground reaction force-related parameters were higher (P < 0.05) at 30-35 m, whereas contact time, stride frequency, vertical and leg stiffness were lower (P < 0.05). Vertical stiffness deteriorates when 40 m run-based sprints are repeated, which alters impact parameters. Maintaining faster stride frequencies through retaining higher vertical stiffness is a prerequisite to improve performance during repeated sprinting.

Honey, I shrunk the sample covariance matrix

The central message of this paper is that nobody should be using the samplecovariance matrix for the purpose of portfolio optimization. It containsestimation error of the kind most likely to perturb a mean-varianceoptimizer. In its place, we suggest using the matrix obtained from thesample covariance matrix through a transformation called shrinkage. Thistends to pull the most extreme coefficients towards more central values,thereby systematically reducing estimation error where it matters most.Statistically, the challenge is to know the optimal shrinkage intensity,and we give the formula for that. Without changing any other step in theportfolio optimization process, we show on actual stock market data thatshrinkage reduces tracking error relative to a benchmark index, andsubstantially increases the realized information ratio of the activeportfolio manager.

Why England? Demand, growth and inequality during the Industrial Revolution

Why was England first? And why Europe? We present a probabilistic model that builds on big-push models by Murphy, Shleifer and Vishny (1989), combined with hierarchical preferences. The interaction of exogenous demographic factors (in particular the English low-pressure variant of the European marriage pattern)and redistributive institutions such as the old Poor Law combined to make an Industrial Revolution more likely. Essentially, industrialization is the result of having a critical mass of consumers that is rich enough to afford (potentially) mass-produced goods. Our model is then calibrated to match the main characteristics of the English economy in 1750 and the observed transition until 1850.This allows us to address explicitly one of the key features of the British IndustrialRevolution unearthed by economic historians over the last three decades the slowness of productivity and output change. In our calibration, we find that the probability of Britain industrializing is 5 times larger than France s. Contrary to the recent argument by Pomeranz, China in the 18th century had essentially no chance to industrialize at all. This difference is decomposed into a demographic and a policy component, with the former being far more important than the latter.

Estratégia Nacional para Energias Domesticas em Cabo Verde

Garantir a sustentabilidade do aprovisionamento de energia para a cocção de alimentos constitui um importante desafio, para Países em Desenvolvimento, particularmente os da Africa Sub-Shaeriana, onde uma faixa significativa das famílias depende de recursos naturais escassos e formas de converter energia para a cocção de alimentos, extremamente poluentes, com impactos negativos para a saúde, qualidade de vida e equilíbrio ecológico e ambiental. A exposição aos subprodutos da combustão da biomassa, particularmente as micropartículas e o monóxido de carbono, figura entre as principais causas de infecções respiratórias crónicas e agudas, que afecta principalmente as mulheres e crianças nas zonas rurais. O relatório da Organização Mundial da Saúde de 2002, classifica o problema da poluição doméstica causada pela queima de combustíveis sólidos como o quarto maior factor de risco para a saúde nos países em desenvolvimento, sendo a maioria das vítimas mulheres, que normalmente são as responsáveis pela preparação das refeições, e recém nascidos e crianças de até cinco anos de idade, que passam parte do tempo perto das cozinhas A utilização destes combustíveis também diminui as oportunidades de desenvolvimento de actividades geradoras de rendimento devido ao facto de as mulheres despenderem uma parte considerável do tempo disponível na procura de lenha e na preparação dos alimentos em fogões pouco eficientes. Por outro lado a crescente procura de lenha para satisfação das necessidades energéticas das famílias, vem exercendo uma grande pressão sobre a frágil cobertura vegetal dos Países destas regiões, com consequências gravosas para o ambiente como a desertificação, degradação dos solos, redução da capacidade de retenção de aguas pluviais etc. Nos últimos tempos, Instituições como a ONU (Millenium Development Goals) e o Banco Mundial (PRSPs) têm realçado a inter relação existente entre o aumento do acesso das populações a fontes de energias modernas e a redução da pobreza, defendendo por isso a implementação de medidas para impulsionar a transição dos agregados pobres do uso de combustíveis tradicionais (biomassa) para energias modernas. Ao nível da região Saheliana foi instituído no âmbito do CILSS o Programa PREDAS - Programa Regional de Promoção das Energias Domesticas e Alternativas no Sahel -, que estabeleceu como objectivos específicos: (i) ajudar os estados membros do CILSS a conceber, adoptar e implementar um plano estratégico para as energias domesticas; (ii) constituir uma rede de profissionais e especialistas Sahelianos na área de energias domestica e iniciar um sistema de informação tecnológica sobre energias; e (iii) ajudar os Estados membros do CILSS a conceber e promover o seguimento ecológico dos recursos lenhosos disponíveis. Em termos de utilização de energias domésticas, a situação de Cabo Verde é muito diferente do contexto dos restantes Países da sub-região, apresentando actualmente níveis de consumo percapita de GPL muito superiores. No entanto, nas zonas rurais e periferias dos centros urbanos a lenha e os resíduos são ainda os principais recursos energéticos utilizados na preparação dos alimentos. Estas preocupações estão identificadas em documentos de carácter estratégicos já elaborados nomeadamente: O IV Plano Nacional de Desenvolvimento, O Plano Energético Nacional (PEN), O Plano de Acção Florestal Nacional (PAFN), O Plano Estratégico de Desenvolvimento da Agricultura, o Documento de Estratégia de Crescimento e Redução da Pobreza (DERCP) e o Plano de Acção Nacional para o Ambiente (PANA II). É neste contexto que se enquadra a elaboração do presente documento “ Estratégia Nacional para Energias Domesticas em Cabo Verde”, visto como um instrumento integrador das políticas concernentes ao sector de energias domésticas definidos nos planos nacionais.

On the timing of balance of payments crises: Disaggregated information and interest rate policy

This paper proposes a dynamic framework to study the timing of balance of paymentscrises. The model incorporates two main ingredients: (i) investors have private information; (ii)investors interact in a dynamic setting, weighing the high returns on domestic assets against the incentives to pull out before the devaluation. The model shows that the presence of disaggregated information delays the onset of BOP crises, giving rise to discrete devaluations. It also shows that high interest rates can be eective in delaying and possibly avoiding the abandonment of the peg. The optimal policy is to raise interest rates sharply as fundamentals become very weak. However, this policy is time inconsistent, suggesting a role for commitment devices such as currency boards or IMF pressure.

Tectonics of the Simplon massif and Lepontine gneiss dome: deformation structures due to collision between the underthrusting European plate and the Adriatic indenter

this study presents a review of published geological data, combined with original observations on the tectonics of the simplon massif and the Lepontine gneiss dome in the Western Alps. New observations concern the geometry of the Oligocene Vanzone back fold, formed under amphibolite facies conditions, and of its root between Domodossola and Locarno, which is cut at an acute angle by the Miocene, epi- to anchizonal, dextral centovalli strike-slip fault. the structures of the simplon massif result from collision over 50 Ma between two plate boundaries with a different geometry: the underthrusted European plate and the Adriatic indenter. Detailed mapping and analysis of a complex structural interference pattern, combined with observations on the metamorphic grade of the superimposed structures and radiometric data, allow a kinematic model to be developed for this zone of oblique continental collision. the following main Alpine tectonic phases and structures may be distinguished: 1. NW-directed nappe emplacement, starting in the Early Eocene (similar to 50 Ma); 2. W, SW and S- verging transverse folds; 3. transpressional movements on the dextral simplon ductile shear zone since similar to 32 Ma; 4. formation of the Bergell - Vanzone backfolds and of the southern steep belt during the Oligocene, emplacement of the mantle derived 31 - 29 Ma Bergell and Biella granodiorites and porphyritic andesites as well as intrusions of 29-25 Ma crustal aplites and pegmatites; 5. formation of the dextral discrete Rhone-Simplon line and the centovalli line during the Miocene, accompanied by the pull-apart development of the Lepontine gneiss dome - Dent blanche (Valpelline) depression. It is suggested that movements of shortening in fan shaped NW, W and sW directions accompanied the more regular NW- to WNW-directed displacement of the Adriatic indenter during continental collision.

Quantitative estimation of foot-flat and stance phase of gait using foot-worn inertial sensors.

Time periods composing stance phase of gait can be clinically meaningful parameters to reveal differences between normal and pathological gait. This study aimed, first, to describe a novel method for detecting stance and inner-stance temporal events based on foot-worn inertial sensors; second, to extract and validate relevant metrics from those events; and third, to investigate their suitability as clinical outcome for gait evaluations. 42 subjects including healthy subjects and patients before and after surgical treatments for ankle osteoarthritis performed 50-m walking trials while wearing foot-worn inertial sensors and pressure insoles as a reference system. Several hypotheses were evaluated to detect heel-strike, toe-strike, heel-off, and toe-off based on kinematic features. Detected events were compared with the reference system on 3193 gait cycles and showed good accuracy and precision. Absolute and relative stance periods, namely loading response, foot-flat, and push-off were then estimated, validated, and compared statistically between populations. Besides significant differences observed in stance duration, the analysis revealed differing tendencies with notably a shorter foot-flat in healthy subjects. The result indicated which features in inertial sensors' signals should be preferred for detecting precisely and accurately temporal events against a reference standard. The system is suitable for clinical evaluations and provides temporal analysis of gait beyond the common swing/stance decomposition, through a quantitative estimation of inner-stance phases such as foot-flat.

Making land-use fit to planning goals. Weaknesses and opportunities within the Swiss land management regime

In Switzerland, the issue of land consumption has made it to the front of the political agenda in recent years. Studies conducted on a national level have concluded that there is an excess of land zoned for construction (ARE, 2008), which is seen as contributing to urban sprawl. This situation is looked upon as a failure of the Federal Law on Spatial Planning (LAT, 1979) and there is a political push to change it in order to reinforce zoning regulations. In this article, we look on the issue from a different angle. While there may be large quantities of land zoned for construction, in many urban areas land actually available for development is scarce. Building on the idea that planning's efficiency is linked to its capacity of influencing actual land-use, we focus on how this situation can be dealt with within the current Swiss institutional context.

The science of monetary policy: A new Keynesian perspective

This paper reviews the recent literature on monetary policy rules. We exposit the monetary policy design problem within a simple baselinetheoretical framework. We then consider the implications of adding various real world complications. Among other things, we show that the optimal policy implicitly incorporates inflation targeting. Wealso characterize the gains from making credible commitments to fightinflation. In contrast to conventional wisdom, we show that gains from commitment may emerge even in the central bank is not trying toinadvisedly push output above its natural level. We also consider theimplications of frictions such as imperfect information.

Hypothesis on immigration and welfare

The number of hypothesis trying to explain which are the reasons behind the decision to migrate to work into a developed country are diverse and at the same time, difficult to test due to the multiplicity of factors which affect it. This papers attempts to move forward trying to disentangle which are the socio-economic factors that explain the differences in the figures of immigrants in the OECD countries. We show empirical evidence about the determinants of the migratory flows to 17 OECD countries from 65 countries in the 1980-2000 period. Our results reveal the importance to differentiate the inflows composition by at least income in the origin countries. Thus, regarding inflows from non-high-income countries, the results suggest that there is a pull effect from monetary and not real income, and then, the welfare magnets hypothesis should be rejected. This group reacts more to the migratory policy than the inflows coming from high-income countries, although those policies designed to slow down the inflows have not been able, in the aggregate, to reduce them.

Um modelos para a representação genérica de eventos e actas no SIAC O caso dos horários e sumários

O artigo aborda os resultados de um estágio desenvolvido, no Laboratório de Educação Digital da Universidade Jean Piaget de Cabo Verde no âmbito do projecto de desenvolvimento do Sistema de Informação Académico onde nos foi proposto projectar, desenvolver e testar um modelo de representação de eventos e sumários, bem como desenvolver uma rotina que permita converter os dados no formato de dados utilizado pela aplicação iCal. Para se atingir os objectivos acima propostos foi desenvolvido um modelo de representação de eventos e actas recorrendo a ferramentas UML. Posteriormente o modelo foi implementado e testado recorrendo a um SGBD orientado a objectos (ORACLE 10g). Por fim foi desenvolvida uma rotina que permite efectuar a migração e conversão dos dados extraídos da base de dados num ficheiro utilizado pela aplicação iCal.

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The driving force behind arbuscular mycorrhizal (AM) interactions is an exchange of nutrients between fungus and plant. Glomeromycotan fungi are obligate symbionts and rely on the carbon provided by their plant hosts to complete their life cycle. In return, the fungus provides nutritional benefits to the plant, notably by delivering minerals. The majority of the nutrient exchange is thought to occur in root cortical cells containing the highly-branched fungal arbuscules. In this chapter, we describe the molecular components of the arbusculated cell and the proteins involved in the transfer of nutrients between fungus and plants. We consider, in detail, the passage of phosphorous and nitrogen from the soil to the arbusculated cell and the concomitant delivery of carbon to the fungal symbiont. In natural conditions, the exchange of nutrients does not need to be completely equitable and selective pressure may act on both partners to push the balance in their favour. In cultivated plants, the artificial environment may further distort the balance. We discuss how a better understanding of the molecular regulation of nutrient transfer benefits attempts to optimise AM associations for agriculture use.

Le regard d'un psychiatre sur les écrits de la folie : la carrière de Hans Steck à l'Asile psychiatrique de Cery (1920-1960)

Quelles représentations de la schizophrénie les psychiatres vont-ils construire à travers l'étude des écrits asilaires des patients et des scientifiques dans la première moitié du XXème siècle? Le psychiatre helvétique Hans Steck (1891-1980), qui a travaillé à l'Asile psychiatrique de Cery de 1920 à 1960 et qui s'est fait connaître du public grâce à l'oeuvre d'Aloïse Corbaz, reconnue comme auteure d'art brut par Jean Dubuffet en 1945, constitue le fil rouge de la thèse. Dans le contexte des mouvements tels que Γ "art psychopathologique" et Γ "art brut", Steck étudie les théories de "la mentalité primitive et les peintures magiques des schizophrènes". En 1927, il se tourne vers les théories évolutionnistes de la régression et les premières études de Lévy-Bruhl pour avancer l'idée qu'il existe un "parallélisme schizo-primitif'. Puis il développe des explications de la pensée délirante, à partir des théories exposées lors du Premier Congrès International de Psychiatrie en 1950. Enfin, adoptant la perspective phénoménologique, il explique que "la fonction de l'art et la fonction du délire visent à reconstituer un monde viable pour le malade". En ce sens, l'expression artistique, bien que n'entrant pas dans le champ de la psychothérapie, fournit des indicateurs de l'état psychique du malade en même temps qu'elle contribue à son bien-être. Sont abordés les problèmes concernant la reconnaissance de Γ "auteur" interné, dont les oeuvres appartiennent soit aux archives médicales, soit au musée. La pérennité des critères qui définissent les oeuvres d'"art psychopathologique" ou d'"art brut" est également mise en question. Enfin, le rôle essentiel de l'écriture à l'hôpital, tant pour les patients que pour les soignants, fait l'objet de nombreux développements. - What representations of schizophrenia have psychiatrists been constructing when studying writings by patients and scientists in mental asylums in the first half of the 20th century? The Swiss psychiatrist Hans Steck (1891-1980) is the protagonist of this dissertation. From 1920 to 1960, he has been working at the "Asile psychiatrique de Cery" near Lausanne. Steck is known thanks to the paintings of Aloïse Corbaz, an artist recognized by Jean Dubuffet as belonging to the "art brut" movement in 1945. In the context of movements like "art psychopathologique" and "art brut," Steck studies theories of "primitive character and magic paintings of schizophrenics." In 1927, Steck engages with theories of regression and Lévy-Bruhl's early studies in order to push the idea of a "parallelism schizo-primitif." On the occasion of the First International Congress of psychiatry held in Paris in 1950, Steck develops explanations for the "pensée délirante." Finally, turning to a phenomenological point of view, he explains, "the function of art and the function of the delusion help the patient to reconstruct a viable environment for the sick person." In this way, artistic expression is not thought of as a psychotherapeutical means, but provides insight into the state of mind of a mentally sick person at the same time as contributing to his well-being. The dissertation discusses whether the "author's" work belongs in medical archives or museums. The continuity of "psychopathological art" and "art brut" criteria will be discussed. Finally, the essential role that writing played in the hospital for the patients as well as for the medical staff is presented.