(R, S) conjugate solution to coupled Sylvester complex matrix equations with conjugate of two unknowns

In this work, we are concerned with (R, S) – conjugate solutions to coupled Sylvester complex matrix equations with conjugate of two unknowns. When the considered two matrix equations are consistent, it is demonstrated that the solutions can be obtained by utilizing this iterative algorithm for any initial arbitrary (R,S) – conjugate matrices V1,W1. A necessary and sufficient condition is established to guarantee that the proposed method converges to the (R,S) – conjugate solutions. Finally, two numerical examples are provided to demonstrate the efficiency of the described iterative technique

The quality of life and cost utility of home nocturnal and conventional in-center hemodialysis

The quality of life and cost utility of home nocturnal and conventional in-center hemodialysis.BackgroundHome nocturnal hemodialysis is an intensive form of hemodialysis, where patients perform their treatments at home for about 7hours approximately 6 nights a week. Compared with in-center conventional hemodialysis, home nocturnal hemodialysis has been shown to improve physiologic parameters and reduce health care costs; however, the effects on quality of life and cost utility are less clear. We hypothesized that individuals performing home nocturnal hemodialysis would have a higher quality of life and superior cost utility than in-center hemodialysis patients.MethodsHome nocturnal hemodialysis patients and a demographically similar group of in-center hemodialysis patients from a hospital without a home hemodialysis program underwent computer-assisted interviews to assess their utility score for current health by the standard gamble method.ResultsNineteen in-center hemodialysis and 24 home nocturnal hemodialysis patients were interviewed. Mean annual costs for home nocturnal hemodialysis were about $10,000 lower for home nocturnal hemodialysis ($55,139 ±$7651 for home nocturnal hemodialysis vs.$66,367 ±$17,502 for in-center hemodialysis, P = 0.03). Home nocturnal hemodialysis was associated with a higher utility score than in-center hemodialysis (0.77 ± 0.23 vs. 0.53 ± 0.35, P = 0.03). The cost utility for home nocturnal hemodialysis was$71,443/quality-adjusted life-year (QALY), while for in-center hemodialysis it was $125,845/QALY. Home nocturnal hemodialysis was the dominant strategy, with an incremental cost-effectiveness ratio (ICER) of -$45,932. The 95% CI for the ICER, and 2500 bootstrap iterations of the ICER all fell below the cost-effectiveness ceiling of $50,000. The net monetary benefit of home nocturnal hemodialysis ranged from$11,227 to $35,669.ConclusionHome nocturnal hemodialysis is associated with a higher quality of life and a superior cost utility when compared to in-center hemodialysis

How do existing HIV-specific instruments measure up? Evaluating the ability of instruments to describe disability experienced by adults living with HIV

Background: Despite the multitude of health challenges faced by adults living with HIV, we know of no HIV-specific instrument developed for the purpose of describing the health-related consequences of HIV, a concept known as disability. In a previous phase of research, adults living with HIV conceptualized disability as symptoms/ impairments, difficulties carrying out day-to-day activities, challenges to social inclusion, and uncertainty that may fluctuate on a daily basis and over the course of living with HIV. In this paper, we describe the extent to which existing HIV-specific health-status instruments capture the experience of disability for adults living with HIV. Methods: We searched databases from 1980 to 2006 for English language, HIV-specific, self-reported questionnaires consisting of at least two items that were tested for reliability and validity. We then conducted a content analysis to assess how well existing questionnaires describe disability as defined by the Episodic Disability Framework, a framework that conceptualizes this experience from the perspective of adults living with HIV. We matched items of the instruments with categories of the framework to evaluate the extent to which the instruments capture major dimensions of disability in the framework. Results: We reviewed 4274 abstracts, of which 30 instruments met the inclusion criteria and were retrieved. Of the four major dimensions of disability, symptoms/impairments were included in all 30 instruments, difficulties with day-to-day activities in 16, challenges to social inclusion in 16, and uncertainty in 9. Seven instruments contained at least 1 item from all 4 dimensions of disability (breadth) however, the comprehensiveness with which the dimensions were represented (depth) varied among the instruments. Conclusions: In general, symptoms/impairments and difficulties carrying out day-to-day activities were the disability dimensions characterized in greatest depth while uncertainty and challenges to social inclusion were less well represented. Although none of the instruments described the full breadth and depth of disability as conceptualized by the Episodic Disability Framework, they provide a foundation from which to build a measure of disability for adults living with HIV

Impact of Education Program about Family Planning among Yemeni Women on their “Knowledge and Attitude” in Sana’a city

A rapid population growth is a burden on the resources of many developing countries. Unregulated fertility, which contributes to such situations, compromises the economic development and political stability of these countries. Contraceptive use is the lowest in Yemen where about 1 out of 5 married women of reproductive age use contraception and only about 1 out of 10 married women use a modern method. The study conducted to evaluate the impact of implementing an educational program of family planning upon Yemeni women at Sana'a City. The study was Quasi-experimental research design. It was conducted in Al-Sabeen Hospital and Al-Olofi Center for Childhood and Motherhood which included a sample of one hundred and forty women, divided equally into two groups: study group and control group (seventy for each group). It included three tools; tool one a social demographic data and women’ knowledge about family planning. Tool two women’ attitude toward birth control. Tool three educational program about family planning. More than half of the control group (57.1%) whose age was between 30 years and less than 40 years and (40%) of studied group and (45.7 %) of the control group had preparatory education. The number of pregnancies was more than two fifth (41.4%) of the study group had three or more times while (58.6%) about two third for the control group. Unwanted pregnancy represented (64.3% and 57.1% respectively) of both study and control group. Women' knowledge had a poor score on pretest, improved  to good score on immediate post test, and  remaining good score with slight decrease on follow up test. Their attitudes score were slight positive attitudes on pretest, but increased on immediate post test, and on follow up test. There was highly statistically significant difference between the women’ knowledge about FP in pre, immediate post test and follow-up. Also, there was a highly statistically significant difference between women’ attitude in pre and immediate post test and follow-up test. Family planning program should involve men as well as women, design and implement a strategy to ensure all primary health care clinics provide counseling on FP. Keywords: Family planning, Control birth, Spacing, Contraception.

Improving the Diagnosis of Acute Heart Failure Using a Validated Prediction Model

ObjectivesWe sought to derive and validate a prediction model by using N-terminal pro–B-type natriuretic peptide (NT-proBNP) and clinical variables to improve the diagnosis of acute heart failure (AHF).BackgroundThe optimal way of using natriuretic peptides to enhance the diagnosis of AHF remains uncertain.MethodsPhysician estimates of probability of AHF in 500 patients treated in the emergency department from the multicenter IMPROVE CHF (Improved Management of Patients With Congestive Heart Failure) trial recruited between December 2004 and December 2005 were classified into low (0% to 20%), intermediate (21% to 79%), or high (80% to 100%) probability for AHF and then compared with the blinded adjudicated AHF diagnosis. Likelihood ratios were calculated and multiple logistic regression incorporated covariates into an AHF prediction model that was validated internally by the use of bootstrapping and externally by applying the model to another 573 patients from the separate PRIDE (N-Terminal Pro-BNP Investigation of Dyspnea in the Emergency Department) study of the use of NT-proBNP in patients with dyspnea.ResultsLikelihood ratios for AHF with NT-proBNP were 0.11 (95% confidence interval [CI]: 0.06 to 0.19) for cut-point values <300 pg/ml; increasing to 3.43 (95% CI: 2.34 to 5.03) for values 2,700 to 8,099 pg/ml, and 12.80 (95% CI: 5.21 to 31.45) for values ≥8,100 pg/ml. Variables used to predict AHF were age, pre-test probability, and log NT-proBNP. When applied to the external data by use of its adjudicated final diagnosis as the gold standard, the model appropriately reclassified 44% of patients by intermediate clinical probability to either low or high probability of AHF with negligible (<2%) inappropriate redirection.ConclusionsA diagnostic prediction model for AHF that incorporates both clinical assessment and NT-proBNP has been derived and validated and has excellent diagnostic accuracy, especially in cases with indeterminate likelihood for AHF

Exploring disability from the perspective of adults living with HIV/AIDS: Development of a conceptual framework

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Ideas for Extending the Approach to Evaluating Health in All Policies in South Australia Comment on “Developing a Framework for a Program Theory-Based Approach to Evaluating Policy Processes and Outcomes: Health in All Policies in South Australia”

Abstract Since 2008, the government of South Australia has been using a Health in All Policies (HiAP) approach to achieve their strategic plan (South Australia Strategic Plan of 2004). In this commentary, we summarize some of the strengths and contributions of the innovative evaluation framework that was developed by an embedded team of academic researchers. To inform how the use of HiAP is evaluated more generally, we also describe several ideas for extending their approach, including: deeper integration of interdisciplinary theory (eg, public health sciences, policy and political sciences) to make use of existing knowledge and ideas about how and why HiAP works; including a focus on implementation outcomes and using developmental evaluation (DE) partnerships to strengthen the use of HiAP over time; use of systems theory to help understand the complexity of social systems and changing contexts involved in using HiAP; integrating economic considerations into HiAP evaluations to better understand the health, social and economic benefits and trade-offs of using HiA

A Catalog of Dermatology Utilities: A Measure of the Burden of Skin Diseases

Utilities are measures of quality of life that reflect the strength of individuals' preferences or values for a particular health outcome. As such, utilities represent a measure of disease burden. The aim of this article is to introduce the concept of utilities to the dermatology community and to present a catalog of dermatology utilities obtained from direct patient interviews. Our data are based on 236 total subjects from Grady Hospital (Atlanta, GA), Stanford Medical Center (Palo Alto, CA), and Parkland Hospital (Dallas, TX). The mean time trade-off utilities ranged from 0.640 for blistering disorders to 1.000 for alopecia, cosmetic, and urticaria. The mean utility across all diagnoses was 0.943. We present utilities for 17 diagnostic categories and discuss the underlying reasons for the significant disease burden that these utilities represent. We also present these dermatology categories relative to noncutaneous diseases to place the cutaneous utilities in perspective and to compare the burden of disease. We have demonstrated that skin diseases have considerable burden of disease and provided a preliminary repository of utility data for future researchers and policy makers