50 resultados para Patient retrieval

em CentAUR: Central Archive University of Reading - UK


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The s–x model of microwave emission from soil and vegetation layers is widely used to estimate soil moisture content from passive microwave observations. Its application to prospective satellite-based observations aggregating several thousand square kilometres requires understanding of the effects of scene heterogeneity. The effects of heterogeneity in soil surface roughness, soil moisture, water area and vegetation density on the retrieval of soil moisture from simulated single- and multi-angle observing systems were tested. Uncertainty in water area proved the most serious problem for both systems, causing errors of a few percent in soil moisture retrieval. Single-angle retrieval was largely unaffected by the other factors studied here. Multiple-angle retrievals errors around one percent arose from heterogeneity in either soil roughness or soil moisture. Errors of a few percent were caused by vegetation heterogeneity. A simple extension of the model vegetation representation was shown to reduce this error substantially for scenes containing a range of vegetation types.

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A simple formulation relating the L-band microwave brightness temperature detected by a passive microwave radiometer to the near surface soil moisture was developed using MICRO-SWEAT, a coupled microwave emission model and soil-vegetation-atmosphere-transfer (SVAT) scheme. This simple model provides an ideal tool with which to explore the impact of sub-pixel heterogeneity on the retrieval of soil moisture from microwave brightness temperatures. In the case of a bare soil pixel, the relationship between apparent emissivity and surface soil moisture is approximately linear, with the clay content of the soil influencing just the intercept of this relationship. It is shown that there are no errors in the retrieved soil moisture from a bare soil pixel that is heterogeneous in soil moisture and texture. However, in the case of a vegetated pixel, the slope of the relationship between apparent emissivity and surface soil moisture decreases with increasing vegetation. Therefore for a pixel that is heterogeneous in vegetation and soil moisture, errors can be introduced into the retrieved soil moisture. Generally, under moderate conditions, the retrieved soil moisture is within 3% of the actual soil moisture. Examples illustrating this discussion use data collected during the Southern Great Plains '97 Experiment (SGP97).

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The potential of the τ-ω model for retrieving the volumetric moisture content of bare and vegetated soil from dual polarisation passive microwave data acquired at single and multiple angles is tested. Measurement error and several additional sources of uncertainty will affect the theoretical retrieval accuracy. These include uncertainty in the soil temperature, the vegetation structure and consequently its microwave singlescattering albedo, and uncertainty in soil microwave emissivity based on its roughness. To test the effects of these uncertainties for simple homogeneous scenes, we attempt to retrieve soil moisture from a number of simulated microwave brightness temperature datasets generated using the τ-ω model. The uncertainties for each influence are estimated and applied to curves generated for typical scenarios, and an inverse model used to retrieve the soil moisture content, vegetation optical depth and soil temperature. The effect of each influence on the theoretical soil moisture retrieval limit is explored, the likelihood of each sensor configuration meeting user requirements is assessed, and the most effective means of improving moisture retrieval indicated.

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Ice clouds are an important yet largely unvalidated component of weather forecasting and climate models, but radar offers the potential to provide the necessary data to evaluate them. First in this paper, coordinated aircraft in situ measurements and scans by a 3-GHz radar are presented, demonstrating that, for stratiform midlatitude ice clouds, radar reflectivity in the Rayleigh-scattering regime may be reliably calculated from aircraft size spectra if the "Brown and Francis" mass-size relationship is used. The comparisons spanned radar reflectivity values from -15 to +20 dBZ, ice water contents (IWCs) from 0.01 to 0.4 g m(-3), and median volumetric diameters between 0.2 and 3 mm. In mixed-phase conditions the agreement is much poorer because of the higher-density ice particles present. A large midlatitude aircraft dataset is then used to derive expressions that relate radar reflectivity and temperature to ice water content and visible extinction coefficient. The analysis is an advance over previous work in several ways: the retrievals vary smoothly with both input parameters, different relationships are derived for the common radar frequencies of 3, 35, and 94 GHz, and the problem of retrieving the long-term mean and the horizontal variance of ice cloud parameters is considered separately. It is shown that the dependence on temperature arises because of the temperature dependence of the number concentration "intercept parameter" rather than mean particle size. A comparison is presented of ice water content derived from scanning 3-GHz radar with the values held in the Met Office mesoscale forecast model, for eight precipitating cases spanning 39 h over Southern England. It is found that the model predicted mean I WC to within 10% of the observations at temperatures between -30 degrees and - 10 degrees C but tended to underestimate it by around a factor of 2 at colder temperatures.

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The difference between cirrus emissivities at 8 and 11 μm is sensitive to the mean effective ice crystal size of the cirrus cloud, De. By using single scattering properties of ice crystals shaped as planar polycrystals, diameters of up to about 70 μm can be retrieved, instead of up to 45 μm assuming spheres or hexagonal columns. The method described in this article is used for a global determination of mean effective ice crystal sizes of cirrus clouds from TOVS satellite observations. A sensitivity study of the De retrieval to uncertainties in hypotheses on ice crystal shape, size distributions, and temperature profiles, as well as in vertical and horizontal cloud heterogeneities shows that uncertainties can be as large as 30%. However, the TOVS data set is one of few data sets which provides global and long-term coverage. Having analyzed the years 1987–1991, it was found that measured effective ice crystal diameters De are stable from year to year. For 1990 a global median De of 53.5 μm was determined. Averages distinguishing ocean/land, season, and latitude lie between 23 μm in winter over Northern Hemisphere midlatitude land and 64 μm in the tropics. In general, larger Des are found in regions with higher atmospheric water vapor and for cirrus with a smaller effective emissivity.

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Objective The Medicines Use Review (MUR) community pharmacy service was introduced in 2005 to enhance patient empowerment but the service has not been taken up as widely as expected. We investigated the depiction of the patient–pharmacist power relationship within MUR patient information leaflets. Methods We identified 11 MUR leaflets including the official Department of Health MUR booklet and through discourse analysis examined the way language and imagery had been used to symbolise and give meaning to the MUR service, especially the portrayal of the patient–pharmacist interactions and the implied power relations. Results A variety of terminology was used to describe the MUR, a service that aimed ultimately to produce more informed patients through the information imparted by knowledgeable, skilled pharmacists. Conclusion The educational role of the MUR overshadowed the intended patient empowerment that would take place with a true concordance-centred approach. Although patient empowerment was implied, this was within the boundaries of the biomedical model with the pharmacist as the expert provider of medicines information. Practice implications If patient empowerment is to be conveyed this needs to be communicated to patients through consistent use of language and imagery that portrays the inclusivity intended.

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The community pharmacy service medicines use review (MUR) was introduced in 2005 ‘to improve patient knowledge, concordance and use of medicines’ through a private patient–pharmacist consultation. The MUR presents a fundamental change in community pharmacy service provision. While traditionally pharmacists are dispensers of medicines and providers of medicines advice, and patients as recipients, the MUR considers pharmacists providing consultation-type activities and patients as active participants. The MUR facilitates a two-way discussion about medicines use. Traditional patient–pharmacist behaviours transform into a new set of behaviours involving the booking of appointments, consultation processes and form completion, and the physical environment of the patient–pharmacist interaction moves from the traditional setting of the dispensary and medicines counter to a private consultation room. Thus, the new service challenges traditional identities and behaviours of the patient and the pharmacist as well as the environment in which the interaction takes place. In 2008, the UK government concluded there is at present too much emphasis on the quantity of MURs rather than on their quality.[1] A number of plans to remedy the perceived imbalance included a suggestion to reward ‘health outcomes’ achieved, with calls for a more focussed and scientific approach to the evaluation of pharmacy services using outcomes research. Specifically, the UK government set out the main principal research areas for the evaluation of pharmacy services to include ‘patient and public perceptions and satisfaction’as well as ‘impact on care and outcomes’. A limited number of ‘patient satisfaction with pharmacy services’ type questionnaires are available, of varying quality, measuring dimensions relating to pharmacists’ technical competence, behavioural impressions and general satisfaction. For example, an often cited paper by Larson[2] uses two factors to measure satisfaction, namely ‘friendly explanation’ and ‘managing therapy’; the factors are highly interrelated and the questions somewhat awkwardly phrased, but more importantly, we believe the questionnaire excludes some specific domains unique to the MUR. By conducting patient interviews with recent MUR recipients, we have been working to identify relevant concepts and develop a conceptual framework to inform item development for a Patient Reported Outcome Measure questionnaire bespoke to the MUR. We note with interest the recent launch of a multidisciplinary audit template by the Royal Pharmaceutical Society of Great Britain (RPSGB) in an attempt to review the effectiveness of MURs and improve their quality.[3] This template includes an MUR ‘patient survey’. We will discuss this ‘patient survey’ in light of our work and existing patient satisfaction with pharmacy questionnaires, outlining a new conceptual framework as a basis for measuring patient satisfaction with the MUR. Ethical approval for the study was obtained from the NHS Surrey Research Ethics Committee on 2 June 2008. References 1. Department of Health (2008). Pharmacy in England: Building on Strengths – Delivering the Future. London: HMSO. www. official-documents.gov.uk/document/cm73/7341/7341.pdf (accessed 29 September 2009). 2. Larson LN et al. Patient satisfaction with pharmaceutical care: update of a validated instrument. JAmPharmAssoc 2002; 42: 44–50. 3. Royal Pharmaceutical Society of Great Britain (2009). Pharmacy Medicines Use Review – Patient Audit. London: RPSGB. http:// qi4pd.org.uk/index.php/Medicines-Use-Review-Patient-Audit. html (accessed 29 September 2009).