Two families of frailty models – Makeham/Gompertz-gamma and Gompertz-inverse Gaussian – have been considered to graduate insurance-based mortality data. The aims of this exercise are twofold. The first aim is to make use of generalized linear models and to evaluate these against traditional techniques. The second aim is to measure the scale of individual heterogeneity in insurance-based populations. The results indicate that (subject to issues of identifiability) there is evidence of frailty in these populations.
Two families of frailty models – Makeham/Gompertz-gamma and Gompertz-inverse Gaussian – have been considered to graduate insurance-based mortality data. The aims of this exercise are twofold. The first aim is to make use of generalized linear models and to evaluate these against traditional techniques. The second aim is to measure the scale of individual heterogeneity in insurance-based populations. The results indicate that (subject to issues of identifiability) there is evidence of frailty in these populations.
Summary.Where personal injury results in displacement and/or continuing disability (or death), damages include an element of compensation for loss of future earnings. This is calculated with reference to the loss of future expected time in gainful employment. We estimate employment risks in the form of reductions to work life expectancies for the UK workforce by using data from the Labour Force Survey with the purpose of improving the accuracy of the calculation of future lifetime earnings. Work life expectancies and reduction factors are modelled within the framework of a multiple-state Markov process, conditional on age, sex, starting employment state, educational attainment and disability.
Management of infected wounds related to calciphylaxis poses a significant clinical challenge with high morbidity and mortality. Given no definitive management guidelines exist specific to nonuremic calciphylaxis, multiple modalities including sodium thiosulfate, antibiotics, hyperbaric oxygen therapy, and surgical debridement with wound care must be considered. When occurring over a large surface area, standard daily dressing changes are especially labor intensive, inefficient, and ineffective. Negative pressure wound therapy with instillation and dwell time offers broad wound coverage with ongoing therapeutic benefit.
We present the case of a previously healthy 19-year-old woman who was transferred for tertiary level care of extensive nonuremic calciphylaxis wounds of the bilateral lower extremities complicated by angioinvasive coinfection with fungus and mold that was managed with a multidisciplinary approach of intensive medical management, aggressive surgical debridement, and negative pressure wound therapy with instillation of hypochlorous acid solution. Ultimately, she achieved full granulation and wound coverage with skin grafting.
Large area, infected wounds related to nonuremic calciphylaxis can be successfully managed with multidisciplinary medical management, aggressive surgical debridement, and negative pressure wound therapy that can instill and dwell hypochlorous acid solution.
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