503 research outputs found
Do published guidelines for evaluation of Irritable Bowel Syndrome reflect practice?
BACKGROUND: The only US guidelines listed in the National Guideline Warehouse for the diagnosis of Irritable Bowel Syndrome (IBS) are the expert opinion guidelines published by The American Gastroenterology Association. Although the listed target audience of these guidelines includes family physicians and general internists, the care recommended in the guidelines has not been compared to actual primary care practice. This study was designed to compare expert opinion guidelines with the actual primary care provided and to assess outcomes in the 3 years following the IBS diagnosis. METHODS: This is a retrospective medical record review study using a random sample of incident IBS cases from all Olmsted County, Minnesota providers diagnosed between January 1, 1993 and December 31, 1995. Data was collected on all care and testing provided to the subjects as well as 3-year outcomes related to the IBS diagnosis. RESULTS: Of the 149 IBS patients, 99 were women and the mean age was 47.6 years. No patient had all of the diagnostic tests recommended in the guidelines. 42% had the basic blood tests of CBC and a chemistry panel. Sedimentation rate (2%) and serum thyroxine level (3%) were uncommon. Colon imaging studies were done in 41% including 74% of those over the age of 50. In the 3 years following the diagnosis, only one person had a change in diagnosis and no diagnoses of gastro-intestinal malignancies were made in the cohort. CONCLUSIONS: Primary care practice based diagnostic evaluations for IBS differ significantly from the specialty expert opinion-based guidelines. Implementation of the specialty guidelines in primary care practice would increase utilization with apparent limited improvement in diagnostic outcomes
Asthma and Risk of Non-Respiratory Tract Infection: A Population-Based Case-Control Study
OBJECTIVES: Asthmatics have increased risks of airway-related infections. Little is known about whether this is true for non-airway-related serious infections such as Escherichia coli bloodstream infection (BSI). We assessed whether asthma is associated with a risk of developing community-acquired E coli BSI.
DESIGN: The study was designed as a population-based retrospective case-control study.
SETTING: This population-based study was conducted in Olmsted County, Minnesota.
PARTICIPANTS: The study included 259 all eligible community-acquired E coli BSI cases in Olmsted County, MN between 1998 and 2007 and 259 birthday-matched, gender-matched and residency-matched controls.
PRIMARY AND SECONDARY OUTCOME MEASURES: Only community-acquired E coli BSI cases as the primary outcome was included. Asthma status as an exposure was ascertained by predetermined criteria. An adjusted OR and 95% CI for the association between asthma and risk of community-acquired E coli BSI was calculated using conditional logistic regression.
RESULTS: Of 259 eligible cases, 179 (69%) were women and mean age was 61±22 years. Of the 259 cases 37 (14%) and 16 (6%) of 259 controls had a prior history of asthma (adjusted OR 2.74; 95% CI 1.11 to 6.76; p=0.029). The population attributable risk of asthma for community-acquired E coli BSI was 9%. Although not statistically significant, there was a borderline association between having a history of food allergy and increased risk of community-acquired E coli BSI (6% vs 2%; adjusted OR 3.51; 95% CI 0.94 to 13.11; p=0.062).
CONCLUSIONS: Based on the findings of the current population-based, case-control investigation, a history of asthma may be associated with risk of community-acquired E coli BSI. The impact of asthma on risk of microbial infections may go beyond airways
Dynamical N-body Equlibrium in Circular Dilaton Gravity
We obtain a new exact equilibrium solution to the N-body problem in a
one-dimensional relativistic self-gravitating system. It corresponds to an
expanding/contracting spacetime of a circle with N bodies at equal proper
separations from one another around the circle. Our methods are
straightforwardly generalizable to other dilatonic theories of gravity, and
provide a new class of solutions to further the study of (relativistic)
one-dimensional self-gravitating systems.Comment: 4 pages, latex, reference added, minor changes in wordin
Exact Relativistic Two-Body Motion in Lineal Gravity
We consider the N-body problem in (1+1) dimensional lineal gravity. For 2
point masses (N=2) we obtain an exact solution for the relativistic motion. In
the equal mass case we obtain an explicit expression for their proper
separation as a function of their mutual proper time. Our solution gives the
exact Hamiltonian to infinite order in the gravitational coupling constant.Comment: latex, 11 pages, 2 figures, final version to appear in Phys. Rev.
Let
Statistical Mechanics of Relativistic One-Dimensional Self-Gravitating Systems
We consider the statistical mechanics of a general relativistic
one-dimensional self-gravitating system. The system consists of -particles
coupled to lineal gravity and can be considered as a model of
relativistically interacting sheets of uniform mass. The partition function and
one-particle distitrubion functions are computed to leading order in
where is the speed of light; as results for the
non-relativistic one-dimensional self-gravitating system are recovered. We find
that relativistic effects generally cause both position and momentum
distribution functions to become more sharply peaked, and that the temperature
of a relativistic gas is smaller than its non-relativistic counterpart at the
same fixed energy. We consider the large-N limit of our results and compare
this to the non-relativistic case.Comment: latex, 60 pages, 22 figure
Chaos in an Exact Relativistic 3-body Self-Gravitating System
We consider the problem of three body motion for a relativistic
one-dimensional self-gravitating system. After describing the canonical
decomposition of the action, we find an exact expression for the 3-body
Hamiltonian, implicitly determined in terms of the four coordinate and momentum
degrees of freedom in the system. Non-relativistically these degrees of freedom
can be rewritten in terms of a single particle moving in a two-dimensional
hexagonal well. We find the exact relativistic generalization of this
potential, along with its post-Newtonian approximation. We then specialize to
the equal mass case and numerically solve the equations of motion that follow
from the Hamiltonian. Working in hexagonal-well coordinates, we obtaining
orbits in both the hexagonal and 3-body representations of the system, and plot
the Poincare sections as a function of the relativistic energy parameter . We find two broad categories of periodic and quasi-periodic motions that we
refer to as the annulus and pretzel patterns, as well as a set of chaotic
motions that appear in the region of phase-space between these two types.
Despite the high degree of non-linearity in the relativistic system, we find
that the the global structure of its phase space remains qualitatively the same
as its non-relativisitic counterpart for all values of that we could
study. However the relativistic system has a weaker symmetry and so its
Poincare section develops an asymmetric distortion that increases with
increasing . For the post-Newtonian system we find that it experiences a
KAM breakdown for : above which the near integrable regions
degenerate into chaos.Comment: latex, 65 pages, 36 figures, high-resolution figures available upon
reques
Exact self-gravitating N-body motion in the CGHS model
In the asymptotically flat two-dimensional dilaton gravity, we present an
N-body particle action which has a dilaton coupled mass term for the exact
solubility. This gives nonperturbative exact solutions for the N-body
self-gravitating system, so the infalling particles form a black hole and their
trajectories are exactly described. In our two-dimensional case, the critical
mass for the formation of black holes does not exist, so even a single particle
forms a black hole, which means that we can treat many black holes. The
infalling particles give additional time-like singularities in addition to the
space-like black hole singularity. However, the latter singularities can be
properly cloaked by the future horizons within some conditions.Comment: 13 pages, no figure
Using the ecology model to describe the impact of asthma on patterns of health care
BACKGROUND: Asthma changes both the volume and patterns of healthcare of affected people. Most studies of asthma health care utilization have been done in selected insured populations or in a single site such as the emergency department. Asthma is an ambulatory sensitive care condition making it important to understand the relationship between care in all sites across the health service spectrum. Asthma is also more common in people with fewer economic resources making it important to include people across all types of insurance and no insurance categories. The ecology of medical care model may provide a useful framework to describe the use of health services in people with asthma compared to those without asthma and identify subgroups with apparent gaps in care. METHODS: This is a case-control study using the 1999 U.S. Medical Expenditure Panel Survey. Cases are school-aged children (6 to 17 years) and young adults (18 to 44 years) with self-reported asthma. Controls are from the same age groups who have no self-reported asthma. Descriptive analyses and risk ratios are placed within the ecology of medical care model and used to describe and compare the healthcare contact of cases and controls across multiple settings. RESULTS: In 1999, the presence of asthma significantly increased the likelihood of an ambulatory care visit by 20 to 30% and more than doubled the likelihood of making one or more visits to the emergency department (ED). Yet, 18.8% of children and 14.5% of adults with asthma (over a million Americans) had no ambulatory care visits for asthma. About one in 20 to 35 people with asthma (5.2% of children and 3.6% of adults) were seen in the ED or hospital but had no prior or follow-up ambulatory care visits. These Americans were more likely to be uninsured, have no usual source of care and live in metropolitan areas. CONCLUSION: The ecology model confirmed that having asthma changes the likelihood and pattern of care for Americans. More importantly, the ecology model identified a subgroup with asthma who sought only emergent or hospital services
A dynamical classification of the range of pair interactions
We formalize a classification of pair interactions based on the convergence
properties of the {\it forces} acting on particles as a function of system
size. We do so by considering the behavior of the probability distribution
function (PDF) P(F) of the force field F in a particle distribution in the
limit that the size of the system is taken to infinity at constant particle
density, i.e., in the "usual" thermodynamic limit. For a pair interaction
potential V(r) with V(r) \rightarrow \infty) \sim 1/r^a defining a {\it
bounded} pair force, we show that P(F) converges continuously to a well-defined
and rapidly decreasing PDF if and only if the {\it pair force} is absolutely
integrable, i.e., for a > d-1, where d is the spatial dimension. We refer to
this case as {\it dynamically short-range}, because the dominant contribution
to the force on a typical particle in this limit arises from particles in a
finite neighborhood around it. For the {\it dynamically long-range} case, i.e.,
a \leq d-1, on the other hand, the dominant contribution to the force comes
from the mean field due to the bulk, which becomes undefined in this limit. We
discuss also how, for a \leq d-1 (and notably, for the case of gravity, a=d-2)
P(F) may, in some cases, be defined in a weaker sense. This involves a
regularization of the force summation which is generalization of the procedure
employed to define gravitational forces in an infinite static homogeneous
universe. We explain that the relevant classification in this context is,
however, that which divides pair forces with a > d-2 (or a < d-2), for which
the PDF of the {\it difference in forces} is defined (or not defined) in the
infinite system limit, without any regularization. In the former case dynamics
can, as for the (marginal) case of gravity, be defined consistently in an
infinite uniform system.Comment: 12 pages, 1 figure; significantly shortened and focussed, additional
references, version to appear in J. Stat. Phy
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