Amsterdam Nursing Home

We consider the problem of estimating an unknown $n_{1}\times n_{2}$ matrix $\mathbf{\theta}^{*}$ from noisy observations under the constraint that $\mathbf{\theta}^{*}$ is nondecreasing in both rows and columns. We consider the least squares estimator (LSE) in this setting and study its risk properties. We show that the worst case risk of the LSE is $n^{-1/2}$, up to multiplicative logarithmic factors, where $n=n_{1}n_{2}$ and that the LSE is minimax rate optimal (up to logarithmic factors). We further prove that for some special $\mathbf{\theta}^{*}$, the risk of the LSE could be much smaller than $n^{-1/2}$; in fact, it could even be parametric, that is, $n^{-1}$ up to logarithmic factors. Such parametric rates occur when the number of “rectangular” blocks of $\mathbf{\theta}^{*}$ is bounded from above by a constant. We also derive an interesting adaptation property of the LSE which we term variable adaptation – the LSE adapts to the “intrinsic dimension” of the problem and performs as well as the oracle estimator when estimating a matrix that is constant along each row/column. Our proofs, which borrow ideas from empirical process theory, approximation theory and convex geometry, are of independent interest.

Autosomal dominant polycystic kidney disease (ADPKD) is the most common monogenic cause of chronic kidney disease (CKD). As this disease has increasingly been diagnosed in the primary care setting, advanced practice registered nurses (APRNs) must be able to identify and effectively care for patients

A clinical practice guideline for uncomplicated urinary tract infections in an ambulatory urgent care practice was implemented. Aims were to increase the number of first-line antibiotics prescribed to treat uncomplicated urinary tract infections, increase the use of second-line antibiotics prescribed when appropriate, and decrease the number of unnecessary urine cultures.

A pesquisa visou avaliar a metodologia do projeto Tree Vis para determinar a nutrio de ferro, boro, zinco e cobre em plantas de milho submetidas a doses desses nutrientes. Foram utilizados tratamentos constitudos pela omisso, 1/5, 2/5 e a dose completa dos elementos com quatro repeties em cada fase de coleta, sendo essas V4, V7 e R1. Os experimentos foram realizados em casa de vegetao, em cultivo hidropnico, conduzidos em vasos com soluo nutritiva. Foi determinada a produo de massa seca da parte area e do sistema radicular, alm da determinao dos teores dos nutrientes nas folhas indicativas dos estdios fenolgicos de cada poca de coleta. Em cada estdio foram coletadas imagens das folhas indicativas e novas atravs de um scanner para as anlises de viso artificial. As doses crescentes dos nutrientes promoveram maior produo de massa seca na parte area e nas razes e reduziram a produo quando utilizada a dose mxima do nutriente. O sistema de viso artificial mostrou-se promissor na identificao de deficincia de ferro com 77,5% de acerto, boro com 81,7% de acerto, zinco com 81,0% e cobre com 57,2 % de acerto, tendo identificado as com boa confiabilidade.

Scientific and Clinical Abstracts From the 40th Annual Wound, Ostomy and Continence Nurses Annual Conference: Orlando, Florida: June 21–25, 2008: Practice Innovation Abstracts: Wound-Product Selection and Innovations

Elizabeth Norman, who coordinates Critical Questions, is an associate professor of nursing at New York University, Division of Nursing, New York, NY.

The term "failure to thrive" is frequently used to describe older adults whose independence is declining. The term was exported from pediatrics in the 1970s and is used to describe older adults with various concurrent chronic diseases, functional impairments, or both. Despite this heterogeneity, failure to thrive has had its own international Classification of Diseases, Ninth Revision (ICD-9) code since 1979 and has been approached as a clinically meaningful diagnosis in many review articles. This conceptual framework, however, can create barriers to proper evaluation and management. The most worrisome of these barriers is the reinforcement of both fatalism and intellectual laziness, which need to be balanced with a deconstructionist approach, wherein the major areas of impairment are identified and quantified and have their interactions considered. Four syndromes known to be individually predictive of adverse outcomes in older adults are repeatedly cited as prevalent in patients with failure to thrive: impaired physical functioning, malnutrition, depression, and cognitive impairment. The differential diagnosis of contributors to each of these syndromes includes the other three syndromes, and multiple contributors often exist concurrently. Some of these contributors are unmodifiable, some are easily modifiable, and some are potentially modifiable but only with the use of resource-intensive strategies, initial interventions should be directed at easily remediable contributors in the hope of improving overall functional status, because a single contributor may simultaneously influence several other syndromes that conspire to create the phenotype of failure to thrive. How aggressively should more resource-intensive strategies for less easily modifiable contributors be pursued? This is a central clinical, ethical, and policy issue in geriatric medicine that cannot be settled without better process and outcome data. This paper examines the medical etymology of failure to thrive and proposes a rational approach to evaluation and management that is based on the limited medical literature.