Broader Applicability (broader + applicability)

Distribution by Scientific Domains

Selected Abstracts

Treatment of alcoholic hepatitis

Jacquelyn J Maher
Abstract, Alcoholic hepatitis is a common disease with an overall 1-year mortality of 20%. Although the classical treatment for alcoholic hepatitis is abstinence, in some individuals abstinence alone is inadequate to promote survival and recovery. This is particularly true of patients with severe alcoholic hepatitis, who are identified by jaundice, coagulopathy and neutrophilia. Within the last two decades, several agents have been examined as treatments for alcoholic hepatitis and cirrhosis. They have targeted several key processes in the pathophysiology of alcoholic liver disease, including hypermetabolism, inflammation, cytokine dysregulation and oxidant stress. The compounds that offer the greatest survival benefit to patients with severe alcoholic hepatitis are corticosteroids. Several groups have reported excellent results with corticosteroids, but positive results are not uniform, and there remains some controversy over their efficacy. Even if corticosteroids are beneficial for alcoholic hepatitis, they are not recommended for all patients at risk. Consequently, other agents are being tested that have broader applicability to individuals with contraindications to steroids. In this regard, pentoxifylline shows some promise, as does enteral feeding with medium chain triglycerides. Independent efforts are also being directed toward treatment of chronic alcoholic liver disease and alcoholic cirrhosis. Anti-oxidants have received the greatest attention; drugs such as S -adenosyl-methionine may be of benefit. This and others are under active study. 2002 Blackwell Publishing Asia Pty Ltd [source]

Nonlinear multigrid for the solution of large-scale Riccati equations in low-rank and ,-matrix format

L. Grasedyck
Abstract The algebraic matrix Riccati equation AX+XAT,XFX+C=0, where matrices A, B, C, F,,,,n n are given and a solution X,,,,n n is sought, plays a fundamental role in optimal control problems. Large-scale systems typically appear if the constraint is described by a partial differential equation (PDE). We provide a nonlinear multigrid algorithm that computes the solution X in a data-sparse, low-rank format and has a complexity of ,,(n), subject to the condition that F and C are of low rank and A is the finite element or finite difference discretization of an elliptic PDE. We indicate how to generalize the method to ,-matrices C, F and X that are only blockwise of low rank and thus allow a broader applicability with a complexity of ,,(nlog(n)p), p being a small constant. The method can also be applied to unstructured and dense matrices C and X in order to solve the Riccati equation in ,,(n2). Copyright 2008 John Wiley & Sons, Ltd. [source]


Katrina Alford
ABSTRACT: This article evaluates the adequacy of District Nursing Service (DNS) provision in the Goulburn Murray region in Victoria. It draws on a survey of the region's DNS and communication with several community health agencies in response to problems identified by service providers. The results suggest that these rural health services face problems not experienced in urban areas. District nurses in rural areas have to travel far and wide to accommodate their clients and they put in extra unpaid hours if necessary. Their travel time, management and communication skills are not sufficiently recognised in the current funding formula. Although this includes some weighting for rurality, it is insufficient for District Nursing Services catering for smaller, more dispersed populations. Current and future demand pressures on home and community-based nursing services highlight the importance of redressing this deficiency. Several issues raised in this article may reflect problems that are common in rural regions, including funding inadequacies, unpaid additional work, access and equity difficulties and boundary issues. As a result, recommendations to improve service delivery may have broader applicability. [source]

Latent Pattern Mixture Models for Informative Intermittent Missing Data in Longitudinal Studies

BIOMETRICS, Issue 2 2004
Haiqun Lin
Summary. A frequently encountered problem in longitudinal studies is data that are missing due to missed visits or dropouts. In the statistical literature, interest has primarily focused on monotone missing data (dropout) with much less work on intermittent missing data in which a subject may return after one or more missed visits. Intermittent missing data have broader applicability that can include the frequent situation in which subjects do not have common sets of visit times or they visit at nonprescheduled times. In this article, we propose a latent pattern mixture model (LPMM), where the mixture patterns are formed from latent classes that link the longitudinal response and the missingness process. This allows us to handle arbitrary patterns of missing data embodied by subjects' visit process, and avoids the need to specify the mixture patterns a priori. One assumption of our model is that the missingness process is assumed to be conditionally independent of the longitudinal outcomes given the latent classes. We propose a noniterative approach to assess this key assumption. The LPMM is illustrated with a data set from a health service research study in which homeless people with mental illness were randomized to three different service packages and measures of homelessness were recorded at multiple time points. Our model suggests the presence of four latent classes linking subject visit patterns to homeless outcomes. [source]

Sacral nerve stimulation for faecal incontinence in the UK,

M. E. D. Jarrett
Background: Sacral nerve stimulation (SNS) is an effective therapy for faecal incontinence. Published studies derive largely from single centres and there is a need to determine the broader applicability of this procedure. Methods: Prospective data were collected for all patients undergoing SNS in the UK. Records were reviewed to determine the outcome of treatment. Results: In three UK centres 59 patients underwent peripheral nerve evaluation, with 46 (78 per cent) proceeding to permanent implantation. Of these 46 patients (40 women) all but two had improved continence at a median of 12 (range 1,72) months. Faecal incontinence improved from a median (range) of 75 (1,78) to 1 (0,39) episodes per week (P < 0001). Urgency improved in all but five of 39 patients in whom ability to defer defaecation was determined, improving from a median of 1 (range 0,5) to 10 (range from 1 to more than 15) min (P < 0001). Maximum anal squeeze pressure and sensory function to rectal distension changed significantly. Significant improvement occurred in general health (P = 0024), mental health (P = 0008), emotional role (P = 0034), social function (P = 0013) and vitality (P = 0009) subscales of the Short Form 36 health survey questionnaire. There were no major complications. One implant was removed. Conclusion: SNS is a safe and effective treatment, in the medium to long term, for faecal incontinence when conservative treatment has failed. Copyright 2004 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source]