Evaluating the effectiveness of a self-management exercise intervention on wound healing, functional ability and health-related quality of life outcomes in adults with venous leg ulcers: a randomised controlled trial

Exercise that targets ankle joint mobility may lead to improvement in calf muscle pump function and subsequent healing. The objectives of this research were to assess the impact of an exercise intervention in addition to routine evidence-based care on the healing rates, functional ability and health-related quality of life for adults with venous leg ulcers (VLUs). This study included 63 patients with VLUs. Patients were randomised to receive either a 12-week exercise intervention with a telephone coaching component or usual care plus telephone calls at the same timepoints. The primary outcome evaluated the effectiveness of the intervention in relation to wound healing. The secondary outcomes evaluated physical activity, functional ability and health-related quality of life measures between groups at the end of the 12 weeks. A per protocol analysis complemented the effectiveness (intention-to-treat) analysis to highlight the importance of adherence to an exercise intervention. Intention-to-treat analyses for the primary outcome showed 77% of those in the intervention group healed by 12 weeks compared to 53% of those in the usual care group. Although this difference was not statistically significant due to a smaller than expected sample size, a 24% difference in healing rates could be considered clinically significant. The per protocol analysis for wound healing, however, showed that those in the intervention group who adhered to the exercise protocol 75% or more of the time were significantly more likely to heal and showed higher rates for wound healing than the control group (P = 0·01), that is, 95% of those who adhered in the intervention group healed in 12 weeks. The secondary outcomes of physical activity, functional ability and health-related quality of life were not significantly altered by the intervention. Among the secondary outcomes (physical activity, functional ability and health-related quality of life), intention-to-treat analyses did not support the effectiveness of the intervention. However, per protocol analyses revealed encouraging results with those participants who adhered more than 75% of the time (n = 19) showing significantly improved Range of Ankle Motion from the self-management exercise programme (P = 0·045). This study has shown that those participants who adhere to the exercise programme as an adjunctive treatment to standard care are more likely to heal and have better functional outcomes than those who do not adhere to the exercises in conjunction with usual care.

Svetlichny's inequality and genuine tripartite nonlocality in three-qubit pure states

The violation of the Svetlichny's inequality (SI) [Phys. Rev. D 35, 3066 (1987)] is sufficient but not necessary for genuine tripartite nonlocal correlations. Here we quantify the relationship between tripartite entanglement and the maximum expectation value of the Svetlichny operator (which is bounded from above by the inequality) for the two inequivalent subclasses of pure three-qubit states: the Greenberger-Horne-Zeilinger (GHZ) class and the W class. We show that the maximum for the GHZ-class states reduces to Mermin's inequality [Phys. Rev. Lett. 65, 1838 (1990)] modulo a constant factor, and although it is a function of the three tangle and the residual concurrence, large numbers of states do not violate the inequality. We further show that by design SI is more suitable as a measure of genuine tripartite nonlocality between the three qubits in the W-class states,and the maximum is a certain function of the bipartite entanglement (the concurrence) of the three reduced states, and only when their sum attains a certain threshold value do they violate the inequality.

Income Inequality and Healt: A Multi-Country Analysis

This paper investigates the effect of income inequality on health status. A model of health status was specified in which the main variables were income level, income inequality, the level of savings and the level of education. The model was estimated using a panel data set for 44 countries covering six time periods. The results indicate that income inequality (measured by the Gini coefficient) has a significant effect on health status when we control for the levels of income, savings and education. The relationship is consistent regardless of the specification of health status and income. Thus, the study results provide some empirical support for the income inequality hypothesis.

Critical leg ischaemia with tissue loss : a challenge for the vascular surgeon

There is a widespread reporting habit of combining the outcomes for patients with rest pain (Fontaine III) and tissue loss (Fontaine IV) under the single category of critical leg ischaemia (CLI). This study focused on patients with ischaemic tissue loss treated with infrainguinal bypass surgery (IBS). All patients included in the study were treated at Helsinki University Central Hospital in 2000-2007. First, ulcer healing time after IBS and factors influencing healing time were prospectively assessed in 2 studies including 148 and 110 patients, respectively. Second,the results of redo IBS were retrospectively evaluated in 593 patients undergoing primary IBS for CLI with tissue loss . Third,long-term outcome were retrospectively analysed in 636 patients who underwent IBS for CLI with tissue loss . Fourth, the outcome of IBS was retrospectively compared with endovascular treatment (PTA) of the infrapopliteal arteries in 1023 CLI patients. Fifth, the influence multidrug resistant Pseudomans aeruginosa (MDR Pa) bacteria contamination in CLI patients treated with IBS was retropectively assessed. Sixty-four patients with positive MDR Pa -culture were matched with 64 MDR Pa - negative controls. Complete ulcer healing rate, including the ischemic ulcers and incisional wounds, was 40% at 6 months after IBS and 75% at one year. Diabetes was a risk factor for prolonged complete ulcer healing time. Ischaemic tissue lesions located in mid-and hindfoot healed poorly. At one year after IBS 50% of the patients were alive with salvaged leg and completely healed ulcers. The absence of gap between tertiary graft patency and leg salvage rates indicates the importance of a patent infrainguinal graft to save a leg with ischaemic tissue loss. Long-term survival for patients with ischaemic tissue loss was poor, 38% at 5 years. Only 30% of the patients were alive without amputation at 5 years. Several of the patient comorbidities increased independently the mortality risk; coronary artery disease, renal insufficiency, chronic obstructive lung disease and high age. When both PTA and bypass is feasible, infrapopliteal PTA as a first-line strategy is expected to achieve similar long-term results to bypass surgery in CLI when redo surgery is actively utilized. MDR Pa in a patient with CLI should be considered as a serious event with increased risk of early major amputation or death. Conclusion: Despite a successful infrainguinal bypass healing of the ischaemic ulcers and incisional wounds ulcer healing is a slow process especially in diabetics. Bypass surgery and PTA improve the outcome of the ischaemic leg but the mortality rate of the patients is high due to their severe comorbidities.

Income inequality in the process of economic development : An empirical approach

This thesis studies the effect of income inequality on economic growth. This is done by analyzing panel data from several countries with both short and long time dimensions of the data. Two of the chapters study the direct effect of inequality on growth, and one chapter also looks at the possible indirect effect of inequality on growth by assessing the effect of inequality on savings. In Chapter two, the effect of inequality on growth is studied by using a panel of 70 countries and a new EHII2008 inequality measure. Chapter contributes on two problems that panel econometric studies on the economic effect of inequality have recently encountered: the comparability problem associated with the commonly used Deininger and Squire s Gini index, and the problem relating to the estimation of group-related elasticities in panel data. In this study, a simple way to 'bypass' vagueness related to the use of parametric methods to estimate group-related parameters is presented. The idea is to estimate the group-related elasticities implicitly using a set of group-related instrumental variables. The estimation results with new data and method indicate that the relationship between income inequality and growth is likely to be non-linear. Chapter three incorporates the EHII2.1 inequality measure and a panel with annual time series observations from 38 countries to test the existence of long-run equilibrium relation(s) between inequality and the level of GDP. Panel unit root tests indicate that both the logarithmic EHII2.1 inequality measure and the logarithmic GDP per capita series are I(1) nonstationary processes. They are also found to be cointegrated of order one, which implies that there is a long-run equilibrium relation between them. The long-run growth elasticity of inequality is found to be negative in the middle-income and rich economies, but the results for poor economies are inconclusive. In the fourth Chapter, macroeconomic data on nine developed economies spanning across four decades starting from the year 1960 is used to study the effect of the changes in the top income share to national and private savings. The income share of the top 1 % of population is used as proxy for the distribution of income. The effect of inequality on private savings is found to be positive in the Nordic and Central-European countries, but for the Anglo-Saxon countries the direction of the effect (positive vs. negative) remains somewhat ambiguous. Inequality is found to have an effect national savings only in the Nordic countries, where it is positive.

Violation of entropic Leggett-Garg inequality in nuclear spins

We report an experimental study of recently formulated entropic Leggett-Garg inequality (ELGI) by Usha Devi et al. Phys. Rev. A 87, 052103 (2013)]. This inequality places a bound on the statistical measurement outcomes of dynamical observables describing a macrorealistic system. Such a bound is not necessarily obeyed by quantum systems, and therefore provides an important way to distinguish quantumness from classical behavior. Here we study ELGI using a two-qubit nuclear magnetic resonance system. To perform the noninvasive measurements required for the ELGI study, we prepare the system qubit in a maximally mixed state as well as use the ``ideal negative result measurement'' procedure with the help of an ancilla qubit. The experimental results show a clear violation of ELGI by over four standard deviations. These results agree with the predictions of quantum theory. The violation of ELGI is attributed to the fact that certain joint probabilities are not legitimate in the quantum scenario, in the sense they do not reproduce all the marginal probabilities. Using a three-qubit system, we also demonstrate that three-time joint probabilities do not reproduce certain two-time marginal probabilities.

Experimental Study on Switching Characteristics of an Inverter Leg Consisting of IGBTs of Dissimilar Makes

Usually the top and bottom IGBT devices in an inverter leg are of the same make (i.e. from same manufacturer). At low power level, these two devices even may be contained in the same module. However at high power levels the top and bottom devices are in separate modules. Sometimes, in the event of device failure, device of particular make may be replaced by one of another make, but of same ratings (on account of non-availability of the original make). This paper investigates the effect of such intermixing of two different makes of high power IGBTs in an inverter leg on the switching characteristics. The switching transitions between IGBT and diode of similar make and those of IGBT and diode of dissimilar make are compared experimentally at various DC link voltages and currents. The comparisons are made in terms of, IGBT peak turn-on di/dt, IGBT peak turn-off di/dt, peak diode reverse recovery current (I-rr), peak IGBT voltage overshoot and switching energy losses.

Kinematics and dynamics of Jansen leg mechanism: A bond graph approach

The Jansen mechanism is a one degree-of-freedom, planar, 12-link, leg mechanism that can be used in mobile robotic applications and in gait analysis. This paper presents the kinematics and dynamics of the Jansen leg mechanism. The forward kinematics, accomplished using circle intersection method, determines the trajectories of various points on the mechanism in the chassis (stationary link) reference frame. From the foot point trajectory, the step length is shown to vary linearly while step height varies non-linearly with change in crank radius. A dynamic model for the Jansen leg mechanism is proposed using bond graph approach with modulated multiport transformers. For given ground reaction force pattern and crank angular speed, this model helps determine the motor torque profile as well as the link and joint stresses. The model can therefore be used to rate the actuator torque and in design of the hardware and controller for such a system. The kinematics of the mechanism can also be obtained from this dynamic model. The proposed model is thus a useful tool for analysis and design of systems based on the Jansen leg mechanism. (C) 2015 Elsevier B.V. All rights reserved.

A C-0 Interior Penalty Method for a Fourth-order Variational Inequality of the Second Kind

In this article, we propose a C-0 interior penalty ((CIP)-I-0) method for the frictional plate contact problem and derive both a priori and a posteriori error estimates. We derive an abstract error estimate in the energy norm without additional regularity assumption on the exact solution. The a priori error estimate is of optimal order whenever the solution is regular. Further, we derive a reliable and efficient a posteriori error estimator. Numerical experiments are presented to illustrate the theoretical results. (c) 2015Wiley Periodicals, Inc.

Governing Equations and Numerical Solutions of Tension Leg Platform with Finite Amplitude Motion

It is demonstrated that when tension leg platform (TLP) moves with finite amplitude in waves, the inertia force, the drag force and the buoyancy acting on the platform are nonlinear functions of the response of TLP. The tensions of the tethers are also nonlinear functions of the displacement of TLP. Then the displacement, the velocity and the acceleration of TLP should be taken into account when loads are calculated. In addition, equations of motions should be set up on the instantaneous position. A theoretical model for analyzing the nonlinear behavior of a TLP with finite displacement is developed, in which multifold nonlinearities are taken into account, i.e., finite displacement, coupling of the six degrees of freedom, instantaneous position, instantaneous wet surface, free surface effects and viscous drag force. Based on the theoretical model, the comprehensive nonlinear differential equations are deduced. Then the nonlinear dynamic analysis of ISSC TLP in regular waves is performed in the time domain. The degenerative linear solution of the proposed nonlinear model is verified with existing published one. Furthermore, numerical results are presented, which illustrate that nonlinearities exert a significant influence on the dynamic responses of the TLP.

Does spatial clustering help explaining differences in the inequality of income distribution? : evidence from Argentina

Resumen: Este artículo analiza la relación entre la agrupación espacial de la distribución del ingreso y la desigualdad en las provincias de Argentina. El objetivo de este trabajo es usar técnicas espaciales para analizar hasta que punto la agrupación espacial de la distribución del ingreso afecta la desigualdad de la distribución del ingreso en un contexto regional de Argentina. En general, la literatura de desigualdad implícitamente considera a cada región o provincia como una entidad independiente y el potencial para la observación de la interacción a través del espacio a menudo se ha ignorado. Mientras tanto, la autocorrelación espacial ocurre cuando la distribución espacial de la variable de interés exhibe un patrón sistemático. Yo computo tres medidas de autocorrelación espacial global: La I de Moran, c de Geary, y G de Getis y Ord, como grado de CLUSTERING provincial entre 1991 y 2002. La principal conclusión del trabajo es que hay evidencia que provincias con desigualdad relativamente alta (baja) tienden a ser localizadas cerca de otras provincias con alta (baja) desigualdad más a menudo de lo esperado debido al azar. Por ende cada provincia no debería ser vista como una observación independiente, como ha sido supuesto implícitamente en estudios previos sobre la desigualdad de ingresos regional.

The Impact of Firm Level Contracting on Wage Levels and Inequality: Spain 1995-2002

This paper provides microeconomic evidence on the variation over time of the firm-specific wage premium in Spain from 1995 to 2002, and its impact on wage inequality. We make use of two waves of a detailed linked employer-employee data set. In addition, a new data set with financial information on firms is used for 2002 to control as flexibly as possible for differences in the performance of firms (aggregated at industry level). To our knowledge, there is no microeconomic evidence on the dynamics of the firm-specific wage premium for Spain or for any other country with a similar institutional setting. Our results suggest that there is a clear tendency towards centralization in the collective bargaining process in Spain over this seven-year period, that the firm-level contract wage premium undergoes a substantial decrease, particularly for women, and finally that the "centralization" observed in the collective bargaining process has resulted in a slight decrease in wage inequality.

Inequality for Wage Earners and Self-Employed: Evidence from Panel Data

Published as an article in: Oxford Bulletin of Economics and Statistics, 2009, vol. 71, issue 4, pages 491-518.