820 resultados para Inappropriate Prescribing


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Climate model simulations of past and future climate invariably contain prescribed zonal mean stratospheric ozone. While the effects of zonal asymmetry in ozone have been examined in the Northern Hemisphere, much greater zonal asymmetry occurs in the Southern Hemisphere during the break up of the Antarctic ozone hole. We prescribe a realistic three-dimensional distribution of ozone in a high vertical resolution atmospheric model and compare results with a simulation containing zonal mean ozone. Prescribing the three dimensional ozone distribution results in a cooling of the stratosphere and upper troposphere comparable to that caused by ozone depletion itself. Our results suggest that changes in the zonal asymmetry of ozone have had important impacts on Southern Hemisphere climate, and will continue to do so in the future.

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The sensitivity of the UK Universities Global Atmospheric Modelling Programme (UGAMP) General Circulation Model (UGCM) to two very different approaches to convective parametrization is described. Comparison is made between a Kuo scheme, which is constrained by large-scale moisture convergence, and a convective-adjustment scheme, which relaxes to observed thermodynamic states. Results from 360-day integrations with perpetual January conditions are used to describe the model's tropical time-mean climate and its variability. Both convection schemes give reasonable simulations of the time-mean climate, but the representation of the main modes of tropical variability is markedly different. The Kuo scheme has much weaker variance, confined to synoptic frequencies near 4 days, and a poor simulation of intraseasonal variability. In contrast, the convective-adjustment scheme has much more transient activity at all time-scales. The various aspects of the two schemes which might explain this difference are discussed. The particular closure on moisture convergence used in this version of the Kuo scheme is identified as being inappropriate.

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The principles of organization theory are applied to the organization of construction projects. This is done by proposing a framework for modelling the whole process of building procurement. This consists of a framework for describing the environments within which construction projects take place. This is followed by the development of a series of hypotheses about the organizational structure of construction projects. Four case studies are undertaken, and the extent to which their organizational structure matches the model is compared to the level of success achieved by each project. To this end there is a systematic method for evaluating the success of building project organizations, because any conclusions about the adequacy of a particular organization must be related to the degree of success achieved by that organization. In order to test these hypotheses, a mapping technique is developed. The technique offered is a development of a technique known as Linear Responsibility Analysis, and is called "3R analysis" as it deals with roles, responsibilities and relationships. The analysis of the case studies shows that they tended to suffer due to inappropriate organizational structure. One of the prevailing problems of public sector organization is that organizational structures are inadequately defined, and too cumbersome to respond to environmental demands on the project. The projects tended to be organized as rigid hierarchies, particularly at decision points, when what was required was a more flexible, dynamic and responsive organization. The study concludes with a series of recommendations; including suggestions for increasing the responsiveness of construction project organizations, and reducing the lead-in times for the inception periods.

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Although much literature on construction procurement is based on personal experiences, there is little data available to undertake realistic comparison between regions or from one year to another. A survey was undertaken in the UK to examine the feasibility of developing a replicable survey technique that will enable longitudinal studies and international comparisons. The survey showed that a majority felt traditional procurement methods were inappropriate. However, traditional general contracting is still the most common form of procurement. There was strong agreement that economic muscle compels weaker contracting parties to accept onerous contractual terms. There is no relationship between the size of a project and its procurement method, contrary to popular belief. The findings indicate that wider surveys would generate useful data about attitudes.

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Crises cause social disturbances within their host organisation and the patterns of interpersonal ties that emerge are an important determinant of crisis management efficiency. In this article, social network analysis is used within a construction project context, to demonstrate that efficient crisis management depends upon the design and maintenance of an appropriate social fabric. However, crises have defence mechanisms that make management difficult by inducing forces that encourage people to pursue inappropriate social ties. Purposeful social intervention is therefore an essential part of the crisis management process to confront and avoid disorganisation.

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This article describes an empirical, user-centred approach to explanation design. It reports three studies that investigate what patients want to know when they have been prescribed medication. The question is asked in the context of the development of a drug prescription system called OPADE. The system is aimed primarily at improving the prescribing behaviour of physicians, but will also produce written explanations for indirect users such as patients. In the first study, a large number of people were presented with a scenario about a visit to the doctor, and were asked to list the questions that they would like to ask the doctor about the prescription. On the basis of the results of the study, a categorization of question types was developed in terms of how frequently particular questions were asked. In the second and third studies a number of different explanations were generated in accordance with this categorization, and a new sample of people were presented with another scenario and were asked to rate the explanations on a number of dimensions. The results showed significant differences between the different explanations. People preferred explanations that included items corresponding to frequently asked questions in study 1. For an explanation to be considered useful, it had to include information about side effects, what the medication does, and any lifestyle changes involved. The implications of the results of the three studies are discussed in terms of the development of OPADE's explanation facility.

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The recent G8 Gleneagles climate statement signed on 8 July 2005 specifically mentions a determination to lessen the impact of aviation on climate [Gleneagles, 2005. The Gleneagles communique: climate change, energy and sustainable development. http://www.fco.gov.uk/Files/kfile/PostG8_Gleneagles_Communique.pdf]. In January 2005 the European Union Emission Trading Scheme (ETS) commenced operation as the largest multi-country, multi-sector ETS in the world, albeit currently limited only to CO2 emissions. At present the scheme makes no provision for aircraft emissions. However, the UK Government would like to see aircraft included in the ETS and plans to use its Presidencies of both the EU and G8 in 2005 to implement these schemes within the EU and perhaps internationally. Non-CO2 effects have been included in some policy-orientated studies of the impact of aviation but we argue that the inclusion of such effects in any such ETS scheme is premature; we specifically argue that use of the Radiative Forcing Index for comparing emissions from different sources is inappropriate and that there is currently no metric for such a purpose that is likely to enable their inclusion in the near future. (c) 2005 Elsevier Ltd. All rights reserved.

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We consider boundary value problems posed on an interval [0,L] for an arbitrary linear evolution equation in one space dimension with spatial derivatives of order n. We characterize a class of such problems that admit a unique solution and are well posed in this sense. Such well-posed boundary value problems are obtained by prescribing N conditions at x=0 and n–N conditions at x=L, where N depends on n and on the sign of the highest-degree coefficient n in the dispersion relation of the equation. For the problems in this class, we give a spectrally decomposed integral representation of the solution; moreover, we show that these are the only problems that admit such a representation. These results can be used to establish the well-posedness, at least locally in time, of some physically relevant nonlinear evolution equations in one space dimension.

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The World Bank, United Nations and UK Department for International Development (DfID) have spearheaded a recent global drive to regularize artisanal and small-scale mining (ASM), and provide assistance to its predominantly impoverished participants. To date, millions of dollars have been pledged toward the design of industry-specific policies and regulations; implementation of mechanized equipment; extension; and the launch of alternative livelihood (AL) programmes aimed at diversifying local economies. Much of this funding, however, has failed to facilitate marked improvements, and in many cases, has exacerbated problems. This paper argues that a poor understanding of artisanal, mine-community dynamics and operators’ needs has, in a number of cases, led to the design and implementation of inappropriate industry support schemes and interventions. The discussion focuses upon experiences from sub-Saharan Africa, where ASM is in the most rudimentary of states.

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This paper examines the dynamics of the ongoing conflict in Prestea, Ghana, where indigenous galamsey mining groups are operating illegally on a concession awarded to Bogoso Gold Limited (BGL), property of the Canadian-listed multinational Gold Star Resources. Despite being issued firm orders by the authorities to abandon their activities, galamsey leaders maintain that they are working areas of the concession that are of little interest to the company; they further counter that there are few alternative sources of local employment, which is why they are mining in the first place. Whilst the Ghanaian Government is in the process of setting aside plots to relocate illegal mining parties and is developing alternative livelihood projects, efforts are far from encouraging: in addition to a series of overlooked logistical problems, the areas earmarked for relocation have not yet been prospected to ascertain gold content, and the alternative income-earning activities identified are inappropriate. As has been the case throughout mineral-rich sub-Saharan Africa, the conflict in Prestea has come about largely because the national mining sector reform program, which prioritizes the expansion of predominantly foreign-controlled large-scale projects, has neglected the concerns of indigenous subsistence groups.

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In clinical trials, situations often arise where more than one response from each patient is of interest; and it is required that any decision to stop the study be based upon some or all of these measures simultaneously. Theory for the design of sequential experiments with simultaneous bivariate responses is described by Jennison and Turnbull (Jennison, C., Turnbull, B. W. (1993). Group sequential tests for bivariate response: interim analyses of clinical trials with both efficacy and safety endpoints. Biometrics 49:741-752) and Cook and Farewell (Cook, R. J., Farewell, V. T. (1994). Guidelines for monitoring efficacy and toxicity responses in clinical trials. Biometrics 50:1146-1152) in the context of one efficacy and one safety response. These expositions are in terms of normally distributed data with known covariance. The methods proposed require specification of the correlation, ρ between test statistics monitored as part of the sequential test. It can be difficult to quantify ρ and previous authors have suggested simply taking the lowest plausible value, as this will guarantee power. This paper begins with an illustration of the effect that inappropriate specification of ρ can have on the preservation of trial error rates. It is shown that both the type I error and the power can be adversely affected. As a possible solution to this problem, formulas are provided for the calculation of correlation from data collected as part of the trial. An adaptive approach is proposed and evaluated that makes use of these formulas and an example is provided to illustrate the method. Attention is restricted to the bivariate case for ease of computation, although the formulas derived are applicable in the general multivariate case.

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The significance of Plasmodiophora brassicae Woronin and clubroot disease which it incites in members of the family Brassicaceae is reviewed as the focus for this special edition of the Journal of Plant Growth Regulation. This is a monographic treatment of recent research into the pathogen and disease; previous similar treatments are now well over half a century old. Vernacular nomenclature of the disease indicates that it had a well-established importance in agriculture and horticulture from at least the Middle Ages onward in Europe and probably earlier. Subsequently, the pathogen probably spread worldwide as a result of transfer on and in fodder taken by colonists as livestock feed. It is a moot point, however, whether there was much earlier spread by P. brassicae into China and subsequently Japan as Brassica rapa (Chinese cabbage and many variants) colonized those lands in archaeological time. Symptoms, worldwide distribution, and economic impact are briefly described here to provide a basis for understanding subsequent papers. Clubroot disease devastates both infected field and protected vegetable and agricultural Brassica crops. Particular importance is placed on recent reports of crop losses in tropical countries, albeit where the crops are grown in cooler altitudes, and in the Canadian prairie land canola crops. The latter is of enormous importance because this crop is the single most important and essential source of vegetable oils used in human foodstuffs and in industrial lubricants where mineral oils are inappropriate.

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Soluble factors such as ADP and thromboxane (TX) A(2) that are secreted or released by platelets at sites of tissue injury, mediate autocrine and paracrine regulation of platelet function, resulting in rapid localised thrombus formation. The suppression of platelet function, particularly through targeting such secondary regulatory mechanisms, that serve to 'fine-tune' the platelet response, has proven effective in the prevention of inappropriate platelet activation that results in thrombosis. The most commonly used anti-platelet approaches (ADP receptor antagonism or inhibition of TXA(2) synthesis), however, lack efficacy in many patients, suggesting the existence of additional uncharacterised mechanisms for the regulation of platelet function. Recent data, which form a focus of this review, have identified peripheral tachykinin peptide family members, such as substance P and the newly identified endokinins, as physiologically important positive feedback regulators of platelet function. The actions of tachykinins that are released from platelets during activation are mediated by the neurokinin-1 receptor. Initial analysis of the role of this receptor in platelet thrombus formation, and thrombosis in the mouse, indicate this to be a promising new target for the development of anti-thrombotic drugs. (C) 2008 Elsevier Ireland Ltd. All rights reserved.

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Over the years, the MCF7 human breast cancer cell line has provided a model system for the study of cellular and molecular mechanisms in oestrogen regulation of cell proliferation and in progression to oestrogen and antioestrogen independent growth. Global gene expression profiling has shown that oestrogen action in MCF7 cells involves the coordinated regulation of hundreds of genes across a wide range of functional groupings and that more genes are down regulated than upregulated. Adaptation to long-term oestrogen deprivation, which results in loss of oestrogen-responsive growth, involves alterations to gene patterns not only at early time points (0-4 weeks) but continuing through to later times (20-55 weeks), and even involves alterations to patterns of oestrogen-regulated gene expression. Only 48% of the genes which were regulated >= 2-fold by oestradiol in oestrogen-responsive cells retained this responsiveness after long-term oestrogen deprivation but other genes developed de novo oestrogen regulation. Long-term exposure to fulvestrant, which resulted in loss of growth inhibition by the antioestrogen, resulted in some very large fold changes in gene expression up to 10,000-fold. Comparison of gene profiles produced by environmental chemicals with oestrogenic properties showed that each ligand gave its own unique expression profile which suggests that environmental oestrogens entering the human breast may give rise to a more complex web of interference in cell function than simply mimicking oestrogen action at inappropriate times. (C) 2009 Elsevier Ltd. All rights reserved.

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The platelet surface is a dynamic interface that changes rapidly in response to stimuli to coordinate the formation of thrombi at sites of vascular injury. Tight control is essential as loss of organisation may result in the inappropriate formation of thrombi (thrombosis) or excessive bleeding. In this paper we describe the comparative analysis of resting and thrombin-stimulated platelet membrane proteomes and associated proteins to identify proteins important to platelet function. Surface proteins were labelled using a biotin tag and isolated by NeurtrAvidin affinity chromatography. Liquid phase IEF and SDS-PAGE were used to separate proteins, and bands of increased intensity in the stimulated platelet fractions were digested and identified by FT-ICR mass spectrometry. Novel proteins were identified along with proteins known to be translocated to the platelet surface. Furthermore, many platelet proteins revealed changes in location associated with function, including G6B and Hip-55. HIP-55 is an SH3-binding protein important in T-cell receptor signalling. Further analysis of HIP-55 revealed that this adaptor protein becomes increasingly associated with both Syk and integrin beta 3 upon platelet activation. Analysis of HIP-55 deficient platelets revealed reduced fibrinogen binding upon thrombin stimulation, suggesting HIP-55 to be an important regulator of platelet function.