198 research outputs found
The Effects of Lifestyle Modification on Glycemic Levels and Medication Intake: The Rockford CHIP
Introduction: The high prevalence of cardiovascular disease (CVD) in the past 50 years has led to intense research, resulting in many improvements in treatment. At the same time, type 2 diabetes, with its concomitant increase in vascular complications, has become a serious, exploding and costly public health concern .
Diabetes now affects 285 million adults worldwide and 344 million with pre-diabetes. Of these, 25.8 million diabetics and 79 million pre-diabetics are found in the United States alone.The current cost of diabetes in the US is likely to exceed the $174 billion estimate, which includes 2/3 for direct medical costs and 1/3 for indirect costs, such as disability, work loss, and premature death, but omits the social cost of intangibles (e.g. pain, suffering, lower quality of life). The diabetes epidemic has been accompanied by a similarly drastic increase in obesity. Although the relationship between the two developments is a matter of debate, both are presumably caused by changes in dietary habits and an increasingly sedentary modern
lifestyle . Compelling evidence has shown that lifestyle changes can effectively prevent or delay the occurrence of type 2 diabetes. Because individuals at risk for this disease can usually be identified during the pre-diabetic phase of impaired glucose tolerance, early intervention and lifestyle change offer a logical approach to preventing this disease and its devastating vascular complications. Additionally, community-based lifestyle interventions for high risk groups and for the general population are a cost-effective way of curbing the growing burden of the disease.
Solidifying the scientific basis for the prevention, treatment and control of this disease and its implementation on a national level, however, remains a difficult challenge. Moreresearch is needed to provide comprehensive and more effective strategies for weight-loss,especially over time.
Therefore, the objectives of this study were to identify diabetics and those at risk (prediabetics) out of the total cohort of 1,517 who selected themselves into an intensive community-based lifestyle intervention program, and to assess its clinical efficacy ineffecting medication status as determined and managed by their personal physicians
Dental attendance, restoration and extractions in adults with intellectual disabilities compared with the general population: a record linkage study
Background:
Oral health may be poorer in adults with intellectual disabilities (IDs) who rely on carer support and medications with increased dental risks.
Methods:
Record linkage study of dental outcomes, and associations with anticholinergic (e.g. antipsychotics) and sugar‐containing liquid medication, in adults with IDs compared with age–sex–neighbourhood deprivation‐matched general population controls.
Results:
A total of 2933/4305 (68.1%) with IDs and 7761/12 915 (60.1%) without IDs attended dental care: odds ratio (OR) = 1.42 [1.32, 1.53]; 1359 (31.6%) with IDs versus 5233 (40.5%) without IDs had restorations: OR = 0.68 [0.63, 0.73]; and 567 (13.2%) with IDs versus 2048 (15.9%) without IDs had dental extractions: OR = 0.80 [0.73, 0.89]. Group differences for attendance were greatest in younger ages, and restoration/extractions differences were greatest in older ages. Adults with IDs were more likely prescribed with anticholinergics (2493 (57.9%) vs. 6235 (48.3%): OR = 1.49 [1.39, 1.59]) and sugar‐containing liquids (1641 (38.1%) vs. 2315 (17.9%): OR = 2.89 [2.67, 3.12]).
Conclusion:
Carers support dental appointments, but dentists may be less likely to restore teeth, possibly extracting multiple teeth at individual appointments instead
The Computational Complexity of Generating Random Fractals
In this paper we examine a number of models that generate random fractals.
The models are studied using the tools of computational complexity theory from
the perspective of parallel computation. Diffusion limited aggregation and
several widely used algorithms for equilibrating the Ising model are shown to
be highly sequential; it is unlikely they can be simulated efficiently in
parallel. This is in contrast to Mandelbrot percolation that can be simulated
in constant parallel time. Our research helps shed light on the intrinsic
complexity of these models relative to each other and to different growth
processes that have been recently studied using complexity theory. In addition,
the results may serve as a guide to simulation physics.Comment: 28 pages, LATEX, 8 Postscript figures available from
[email protected]
Natural history and prognostic significance of iron deficiency and anaemia in ambulatory patients with chronic heart failure
Aims: Iron deficiency (ID) and anaemia are common in heart failure; less is known about changes over time. Methods and results: We investigated prevalence, incidence and resolution of ID and anaemia in 906 patients with chronic heart failure (median age 73 (65–79) years, 70% men, 51% with heart failure with reduced ejection fraction) 1 year apart. ID was defined as serum iron ≤13 μmol/L and anaemia as haemoglobin <13.0 g/dL for men or <12.0 g/dL for women. FAIR-HF criteria for ID were also considered. At baseline, 10% had anaemia without ID, 23% had ID without anaemia, 20% had both, and 47% had neither. Percentages changed little over 1 year, but 157 (30%) patients had new-onset ID, 104 (16%) new-onset anaemia, whilst ID resolved in 173 (44%) and anaemia in 63 (23%). Compared to those who remained iron replete (iron >13 μmol/L), mortality was higher in those with persistent or incident ID at 1 year [hazard ratio (HR) 1.81 (1.23–2.67), and HR 1.40 (0.91–2.14), respectively] in multivariable models (P = 0.02). Compared to persistent ID, resolution of ID was associated with a lower mortality [HR 0.61 (0.44–0.86); P = 0.004]. Changes in ID defined by FAIR-HF criteria were not similarly associated with mortality. Anaemia was associated with a poor outcome even if it resolved. Conclusions: The prevalence and incidence of ID and anaemia are high in chronic heart failure but so is the rate of resolution. Persistent or incident ID, defined by a serum iron ≤13 μmol/L, is associated with higher mortality and resolution of ID with lower mortality
The Computational Complexity of the Lorentz Lattice Gas
The Lorentz lattice gas is studied from the perspective of computational
complexity theory. It is shown that using massive parallelism, particle
trajectories can be simulated in a time that scales logarithmically in the
length of the trajectory. This result characterizes the ``logical depth" of the
Lorentz lattice gas and allows us to compare it to other models in statistical
physics.Comment: 9 pages, LaTeX, to appear in J. Stat. Phy
Parallel Algorithm and Dynamic Exponent for Diffusion-limited Aggregation
A parallel algorithm for ``diffusion-limited aggregation'' (DLA) is described
and analyzed from the perspective of computational complexity. The dynamic
exponent z of the algorithm is defined with respect to the probabilistic
parallel random-access machine (PRAM) model of parallel computation according
to , where L is the cluster size, T is the running time, and the
algorithm uses a number of processors polynomial in L\@. It is argued that
z=D-D_2/2, where D is the fractal dimension and D_2 is the second generalized
dimension. Simulations of DLA are carried out to measure D_2 and to test
scaling assumptions employed in the complexity analysis of the parallel
algorithm. It is plausible that the parallel algorithm attains the minimum
possible value of the dynamic exponent in which case z characterizes the
intrinsic history dependence of DLA.Comment: 24 pages Revtex and 2 figures. A major improvement to the algorithm
and smaller dynamic exponent in this versio
The Parallel Complexity of Growth Models
This paper investigates the parallel complexity of several non-equilibrium
growth models. Invasion percolation, Eden growth, ballistic deposition and
solid-on-solid growth are all seemingly highly sequential processes that yield
self-similar or self-affine random clusters. Nonetheless, we present fast
parallel randomized algorithms for generating these clusters. The running times
of the algorithms scale as , where is the system size, and the
number of processors required scale as a polynomial in . The algorithms are
based on fast parallel procedures for finding minimum weight paths; they
illuminate the close connection between growth models and self-avoiding paths
in random environments. In addition to their potential practical value, our
algorithms serve to classify these growth models as less complex than other
growth models, such as diffusion-limited aggregation, for which fast parallel
algorithms probably do not exist.Comment: 20 pages, latex, submitted to J. Stat. Phys., UNH-TR94-0
Comparison of the two most commonly used treatments for pyoderma gangrenosum: results of the STOP GAP randomised controlled trial
Objective
To determine whether ciclosporin is superior to prednisolone for the treatment of pyoderma gangrenosum, a painful, ulcerating skin disease with a poor evidence base for management.
Design
Multicentre, parallel group, observer blind, randomised controlled trial.
Setting
39 UK hospitals, recruiting from June 2009 to November 2012.
Participants
121 patients (73 women, mean age 54 years) with clinician diagnosed pyoderma gangrenosum. Clinical diagnosis was revised in nine participants after randomisation, leaving 112 participants in the analysis set (59 ciclosporin; 53 rednisolone).
Intervention
Oral prednisolone 0.75 mg/kg/day compared with ciclosporin 4 mg/kg/day, to a maximum dose of 75 and 400 mg/day, respectively.
Main outcome measures
The primary outcome was speed of healing over six weeks, captured using digital images and assessed by blinded investigators. Secondary outcomes were time to healing, global treatment response, resolution of inflammation, self reported pain, quality of life, number of treatment failures, adverse reactions, and time to recurrence. Outcomes were assessed at baseline and six weeks and when the ulcer had healed (to a maximum of six months).
Results
Of the 112 participants, 108 had complete primary outcome data at baseline and six weeks (57 ciclosporin; 51 rednisolone). Groups were balanced at baseline. The mean (SD) speed of healing at six weeks was −0.21 (1.00) cm2/day in the ciclosporin group compared with −0.14 (0.42) cm2/day in the prednisolone group. The adjusted mean difference showed no between group difference (0.003 cm2/day, 95% confidence interval −0.20 to 0.21; P=0.97). By six months, ulcers had healed in 28/59 (47%) participants in the ciclosporin group compared with 25/53 (47%) in the prednisolone group. In those with healed ulcers, eight (30%) receiving ciclosporin and seven (28%) receiving prednisolone had a recurrence. Adverse reactions were similar for the two groups (68% ciclosporin and 66% prednisolone), but serious adverse reactions, especially infections, were more common in the prednisolone group.
Conclusion
Prednisolone and ciclosporin did not differ across a range of objective and patient reported outcomes. Treatment decisions for individual patients may be guided by the different side effect profiles of the two drugs and patient preference.
Trial registration
Current Controlled Trials ISRCTN35898459
Characteristics, Distribution and Persistence of Thin Layers Over a 48 Hour Period
The biological and physical processes contributing to planktonic thin layer dynamics were examined in a multidisciplinary study conducted in East Sound, Washington, USA between June 10 and June 25, 1998. The temporal and spatial scales characteristic of thin layers were determined using a nested sampling strategy utilizing 4 major types of platforms: (1) an array of 3 moored acoustical instrument packages and 2 moored optical instrument packages that recorded distributions and intensities of thin layers; (2) additional stationary instrumentation deployed outside the array comprised of meteorological stations, wave-tide gauges, and thermistor chains; (3) a research vessel anchored 150 m outside the western edge of the array; (4) 2 mobile vessels performing basin-wide surveys to define the spatial extent of thin layers and the physical hydrography of the Sound. We observed numerous occurrences of thin layers that contained locally enhanced concentrations of material; many of the layers persisted for intervals of several hours to a few days. More than one persistent thin layer may be present at any one time, and these spatially distinct thin layers often contain distinct plankton assemblages. The results suggest that the species or populations comprising each distinct thin layer have responded to different sets of biological and/or physical processes. The existence and persistence of planktonic thin layers generates extensive biological heterogeneity in the water column and may be important in maintaining species diversity and overall community structure
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