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By stepwise challenging the lung, taking into account the individual distribution of the threshold-opening airway pressures to achieve maximal recruitment, a redistribution of the tidal volume from overdistended to newly recruited lung occurs.
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The in vitro release of insulin indicated that the insulin release was influenced by glucose concentrations, and a desired pulsatile release behavior was detected in response to stepwise glucose challenges for more than eight cycles.
Bronchial hyperresponsiveness (BHR) was tested using APS nebulizers (Viasys Health Care) according to the adapted ECRHS protocol for a stepwise methacholine challenge [ 29, 30].
In the control condition there is also a training program for healthcare professionals/nurses focusing on challenging behaviour and pain, but without the stepwise approach.
However, the immediate transition from once- or twice-daily injection of basal insulin to a complex regimen consisting of 4 5 total daily injections with the addition of three injections of bolus insulin may be initially challenging for some patients, thus making the stepwise approach a more attractive option.
The nursing home physicians (and nurse practitioners if available) in the experimental and control group receive, besides the training sessions focusing on challenging behaviour and pain (with or without a stepwise approach), both exactly the same training regarding the (evidence based) treatment of pain and challenging behaviour.
Although tools, such as the WHO recommended STEPWise approach to surveillance (STEPs) of NCDs, exist to track NCD epidemics, implementation of STEPs can be challenging.
Incredibly challenging".
How challenging?
Recent findings of no common metastasis-specific genes have challenged the metastasis paradigm of stepwise evolution by acquiring metastasis-specific gene mutations.
Previous theoretical work and simulation studies have shown that conventional stepwise algorithms perform particularly poorly when thus challenged [ 2, 9], and are outperformed by BMA [ 11, 48] and penalized regression methods [ 49, 50].
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