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Now we will note the modi cations required to extend the above analysis by adding two neighboring interconnections on each side of the driven line on the top plane.

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Let us now consider how one might use the available evidence to choose treatment for an individual patient with anorexia nervosa who may present with a high acute medical risk or a poor long-term prognosis and or a combination of the two Anorexia Nervosa with High Acute Medical Risk Cases with a high medical risk and lack of capacity require intensive care such as that offered by a specialised inpatient unit, although it could be argued that day patient care can also give the requisite level of intensity of care (see 22) However, given the high mortality associated with this subgroup it would be ethically dif cult to conduct a randomisedcontrolled trial in which either of these treatments was compared to no treatment or even outpatient treatment.

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The one systematic review which compared inpatient versus outpatient or day patient treatment of the underweight patient (Meads, Gold & Burls, 2001) only identi ed one published RCT (Crisp et al, 1991; Gowers et al, 1994) and a second unpublished RCT (Freeman, 1992) The review concludes that for the group of people with anorexia nervosa that is ill enough for inpatient care, but not severe enough for this to be essential, outpatient treatment is at least as effective (if not more effective) than inpatient treatment The italics are our own but are essential The outcome of severe malnutrition is known and there is no doubt that the appropriate treatment is food There is some Level III evidence from a large prospective, naturalistic outcome study conducted in Germany where inpatient care is the standard treatment for all forms of eating disorder.

You can use the tail command in a similar way to view the end of a file:

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Having now addressed uncertainties associated with credit and reinvestment of cash flows, let us now consider uncertainties related to timing and payment of coupon and principal as with pass-through securities. As shown in Figure 5.29, credit risk fades as a concern with pass-through securities, though risks associated with the timing and amounts of cash flows step into the picture. We use the same key for designating cash flow characteristics as we used in 2. The cash flows of an equity can be illustrated as in Figure 5.30. As the figure confirms, there is a much greater degree of uncertainty related to an equity s cash flow profile than to that of a bond. Accordingly, it ought not come as any surprise that the price risk of equities (typically measured in terms of price volatility) is generally greater than that of bonds. Further, and consistent with risk-reward trade-offs, historically a basket of

The study showed that people with severe anorexia nervosa (ie long duration and severe weight loss) bene t from longer admission (K chele (for the study group MZ-ESS), a 1999; Kaechele et al, 2001) There is Level IV evidence to suggest that decisions on when to admit and for how long are largely dependent on the model of health service provision used in a particular country For example, current guidelines of the American Psychiatric Association (2000) suggest that intensive 24-hour care should be used when the BMI drops below 16 kg/m2 or when weight falls by 20% Admissions in the USA tend to be short In contrast, in the UK some specialist centres have very high thresholds for intensive care (eg BMI <13 kg/m2 ) For example, in Leicester only 20% of adult cases require inpatient care (Palmer et al, 2000).

The duration of inpatient admissions in specialist units catering for adults in the UK is typically around 3 4 months, whereas admissions to adolescent units are usually longer The type of service, skills mix and treatments, which are included in this form of highintensity care, are discussed in more detail in the chapters on inpatient care ( 22) and day care ( 21) Medication as an adjunct to inpatient care does not seem to have any clinical bene t in terms of weight gain (Attia et al, 1998) However, there may be a place for the SSRIs to prevent relapse as one small RCT found a better outcome in the group randomised to uoexetine (Kaye et al, 2001).

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