820 resultados para Inappropriate Prescribing
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Around 40% of total energy consumption in the UK is consumed by creating comfortable indoor environment for occupants. Occupants’ behaviour in terms of achieving thermal comfort could have a significant impact on a building’s energy consumption. Therefore, understanding the interactions of occupants with their buildings would be essential to provide a thermal comfort environment that is less reliance on energy-intensive heating, ventilation and air-conditioning systems, to meet energysaving and carbon emission targets. This paper presents the findings of a year-long field study conducted in non-air-conditioned office buildings in the UK. Occupants’ adaptive responses in terms of technological and personal dimensions are dynamic processes which could vary with both indoor and outdoor thermal conditions. The adaptive behaviours of occupants in the surveyed building show substantial seasonal and daily variations. Our study shows that non-physical factors such as habit could influence the adaptive responses of occupants. However, occupants sometimes displayed inappropriate adaptive behaviour, which could lead to a misuse of energy. This paper attempts to illustrate how occupants would adapt and interact with their built environment and consequently contribute to development of a guide for future design/refurbishment of buildings and to develop energy management systems for a comfortable built environment.
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This is the second in a short series of articles that focus on what GPs should consider when monitoring and prescribing specialist‐initiated palliative‐care drugs. Here, the authors summarise the key issues around the use of methadone for pain management.
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The value of using social development knowledge as a tool for building development policy was promoted by the British Department for International Development in the late 1990s. This article takes the case of a capacity building initiative that sought to build social development knowledge as a resource for policy formulation in 'southern' countries. Situating knowledge as a development resource presents difficulties for intervention processes that have historically developed to provide access to economic and social assets. This article highlights some of the issues involved in trying to build social development capacity and questions the suitability of this style of intervention. Inappropriate and short-term support for knowledge capacity building carries the danger that the traditional separation between the academic and practice spheres will be reinforced, making the process of democratising knowledge more difficult.
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This is the fourth in a short series of articles that focus on what GPs should consider when monitoring and prescribing specialist-initiated palliative-care medicines. Here, the authors summarise the key issues around the use of apid onset opioids in palliative care.
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A steady decline in Arctic sea ice has been observed over recent decades. General circulation models predict further decreases under increasing greenhouse gas scenarios. Sea ice plays an important role in the climate system in that it influences ocean-to-atmosphere fluxes, surface albedo, and ocean buoyancy. The aim of this study is to isolate the climate impacts of a declining Arctic sea ice cover during the current century. The Hadley Centre Atmospheric Model (HadAM3) is forced with observed sea ice from 1980 to 2000 (obtained from satellite passive microwave radiometer data derived with the Bootstrap algorithm) and predicted sea ice reductions until 2100 under one moderate scenario and one severe scenario of ice decline, with a climatological SST field and increasing SSTs. Significant warming of the Arctic occurs during the twenty-first century (mean increase of between 1.6° and 3.9°C), with positive anomalies of up to 22°C locally. The majority of this is over ocean and limited to high latitudes, in contrast to recent observations of Northern Hemisphere warming. When a climatological SST field is used, statistically significant impacts on climate are only seen in winter, despite prescribing sea ice reductions in all months. When correspondingly increasing SSTs are incorporated, changes in climate are seen in both winter and summer, although the impacts in summer are much smaller. Alterations in atmospheric circulation and precipitation patterns are more widespread than temperature, extending down to midlatitude storm tracks. Results suggest that areas of Arctic land ice may even undergo net accumulation due to increased precipitation that results from loss of sea ice. Intensification of storm tracks implies that parts of Europe may experience higher precipitation rates.
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Introduction: Care home residents are at particular risk from medication errors, and our objective was to determine the prevalence and potential harm of prescribing, monitoring, dispensing and administration errors in UK care homes, and to identify their causes. Methods: A prospective study of a random sample of residents within a purposive sample of homes in three areas. Errors were identified by patient interview, note review, observation of practice and examination of dispensed items. Causes were understood by observation and from theoretically framed interviews with home staff, doctors and pharmacists. Potential harm from errors was assessed by expert judgement. Results: The 256 residents recruited in 55 homes were taking a mean of 8.0 medicines. One hundred and seventy-eight (69.5%) of residents had one or more errors. The mean number per resident was 1.9 errors. The mean potential harm from prescribing, monitoring, administration and dispensing errors was 2.6, 3.7, 2.1 and 2.0 (0 = no harm, 10 = death), respectively. Contributing factors from the 89 interviews included doctors who were not accessible, did not know the residents and lacked information in homes when prescribing; home staff’s high workload, lack of medicines training and drug round interruptions; lack of team work among home, practice and pharmacy; inefficient ordering systems; inaccurate medicine records and prevalence of verbal communication; and difficult to fill (and check) medication administration systems. Conclusions: That two thirds of residents were exposed to one or more medication errors is of concern. The will to improve exists, but there is a lack of overall responsibility. Action is required from all concerned.
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Huntingtin (Htt) protein interacts with many transcriptional regulators, with widespread disruption to the transcriptome in Huntington's disease (HD) brought about by altered interactions with the mutant Htt (muHtt) protein. Repressor Element-1 Silencing Transcription Factor (REST) is a repressor whose association with Htt in the cytoplasm is disrupted in HD, leading to increased nuclear REST and concomitant repression of several neuronal-specific genes, including brain-derived neurotrophic factor (Bdnf). Here, we explored a wide set of HD dysregulated genes to identify direct REST targets whose expression is altered in a cellular model of HD but that can be rescued by knock-down of REST activity. We found many direct REST target genes encoding proteins important for nervous system development, including a cohort involved in synaptic transmission, at least two of which can be rescued at the protein level by REST knock-down. We also identified several microRNAs (miRNAs) whose aberrant repression is directly mediated by REST, including miR-137, which has not previously been shown to be a direct REST target in mouse. These data provide evidence of the contribution of inappropriate REST-mediated transcriptional repression to the widespread changes in coding and non-coding gene expression in a cellular model of HD that may affect normal neuronal function and survival.
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Construction procurement is complex and there is a very wide range of options available to procurers. Inappropriate choices about how to procure may limit practical opportunities for innovation. In particular, traditional approaches to construction procurement set up many obstacles for technology suppliers to provide innovative solutions. This is because they are often employed as sub-contractors simply to provide and install equipment to specifications developed before the point at which they become involved in a project. A research team at the University of Reading has developed a procurement framework that comprehensively defines the various options open to procurers in a more fine-grained way than has been known in the past. This enables informed decisions that can establish tailor-made procurement approaches that take into account the needs of specific clients. It enables risk and reward structures to be aligned so that contracts and payment mechanisms are aligned precisely with what a client seeks to achieve. This is not a “one-size-fits-all” approach. Rather, it is an approach that enables informed decisions about how to organize individual procurements that are appropriate to particular circumstances, acknowledging that they differ for each client and for each procurement exercise. Within this context, performance-based contracting (PBC) is explored in terms of the different ways in which technology suppliers within constructed facilities might be encouraged and rewarded for the kinds of innovation sought by the ultimate clients. Examples from various industry sectors are presented, from public sector and from private sector, with a commentary about what they sought to achieve and the extent to which they were successful. The lessons from these examples are presented in terms of feasibility in relation to financial issues, governance, economics, strategic issues, contractual issues and cash flow issues for clients and for contractors. Further background documents and more detailed readings are provided in an appendix for those who wish to find out more.
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We present an experiment designed to study the psychological basis for the willingness to accept (WTA)–willingness to pay (WTP) gap. Specifically, we conduct a standard WTA–WTP economic experiment to replicate the gap and include in it five additional instruments to try to follow the psychological processes producing it. These instruments are designed to measure five psychological constructs we consider especially relevant: (1) attitudes, (2) feelings, (3) familiarity with the target good, (4) risk attitudes, and (5) personality. Our results provide important new insights into the psychological foundations of the WTA–WTP disparity, which can be used to organize some major previous results and cast serious doubts on the claim that the gap might be just a consequence of inappropriate experimental practice.
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Poorer people are more likely to use antibiotics; inappropriate antibiotic use causes resistance, and health campaigns attempt to change behaviour through education. However, fuelled by the media, the public think antibiotic resistance is outside their control. Differences in the attribution of blame for antibiotic resistance in two genres of UK newspapers, targeting distinct socioeconomic groups, were examined using a mixed methods approach. Firstly, depiction of blame was categorised as either external to the lay public (outside their control) or internal (lay person accountable) and subjected to a chi-square test. Secondly, using critical discourse analysis, we examined the portrayal of the main agents through newspaper language. Data from 597 articles (307 broadsheets) analysed revealed a significant association between newspaper genre and attribution of blame for antibiotic resistance. While both newspaper types blamed antibiotic resistance predominantly on factors external to the lay public, broadsheets were more likely to acknowledge internal factors than tabloids. Tabloids provided a more skewed representation, exposing readers to inaccurate explanations about antibiotic resistance. They highlighted ineptitude in health professionals, victimising patients and blaming others, while broadsheets used less emotive language. Pharmacists should take special care to communicate the importance of appropriate antibiotic use against this backdrop of distortion.
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A number of methods of evaluating the validity of interval forecasts of financial data are analysed, and illustrated using intraday FTSE100 index futures returns. Some existing interval forecast evaluation techniques, such as the Markov chain approach of Christoffersen (1998), are shown to be inappropriate in the presence of periodic heteroscedasticity. Instead, we consider a regression-based test, and a modified version of Christoffersen's Markov chain test for independence, and analyse their properties when the financial time series exhibit periodic volatility. These approaches lead to different conclusions when interval forecasts of FTSE100 index futures returns generated by various GARCH(1,1) and periodic GARCH(1,1) models are evaluated.
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This paper considers the effect of using a GARCH filter on the properties of the BDS test statistic as well as a number of other issues relating to the application of the test. It is found that, for certain values of the user-adjustable parameters, the finite sample distribution of the test is far-removed from asymptotic normality. In particular, when data generated from some completely different model class are filtered through a GARCH model, the frequency of rejection of iid falls, often substantially. The implication of this result is that it might be inappropriate to use non-rejection of iid of the standardised residuals of a GARCH model as evidence that the GARCH model ‘fits’ the data.
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This paper tests directly for deterministic chaos in a set of ten daily Sterling-denominated exchange rates by calculating the largest Lyapunov exponent. Although in an earlier paper, strong evidence of nonlinearity has been shown, chaotic tendencies are noticeably absent from all series considered using this state-of-the-art technique. Doubt is cast on many recent papers which claim to have tested for the presence of chaos in economic data sets, based on what are argued here to be inappropriate techniques.
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The sensitivity of sea breeze structure to sea surface temperature (SST) and coastal orography is investigated in convection-permitting Met Office Unified Model simulations of a case study along the south coast of England. Changes in SST of 1 K are shown to significantly modify the structure of the sea breeze immediately offshore. On the day of the case study, the sea breeze was partially blocked by coastal orography, particularly within Lyme Bay. The extent to which the flow is blocked depends strongly on the static stability of the marine boundary layer. In experiments with colder SST, the marine boundary layer is more stable, and the degree of blocking is more pronounced. Although a colder SST would also imply a larger land–sea temperature contrast and hence a stronger onshore wind – an effect which alone would discourage blocking – the increased static stability exerts a dominant control over whether blocking takes place. The implications of prescribing fixed SST from climatology in numerical weather prediction model forecasts of the sea breeze are discussed.
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Milk provides many key nutrients but the saturated and trans fatty acids in milk fat are associated with perceived negative effects on human health, especially cardiovascular disease. Recent epidemiological studies and dietary intervention trials challenge this perception, however; available evidence does not support the concept that consumption of saturated fats or dairy products adversely affects the risk of coronary heart disease (although replacing some saturated fats with mono or polyunsaturated fats is likely to provide benefit). Furthermore, the trans fats found in dairy products are consumed in very low amounts and do not appear to have the negative health effects associated with the consumption of industrial sources of trans fat. Milk fat is an excellent source of oleic acid that originates mainly by endogenous synthesis from stearic acid, but increasing the milk fat content of unsaturated fatty acids requires dietary formulations that bypass rumen biohydrogenation. Recent research indicates that long-chain omega-3 fatty acids and conjugated linoleic acids have potential beneficial effects in health maintenance and the prevention of chronic diseases. Enhancing the milk fat content of these fatty acids offers exciting possibilities, but educating consumers about inaccurate and inappropriate generalisations about fat remains the primary challenge. Finally, individuals do not simply consume milk-fat-derived fatty acids on their own, but rather as components in dairy foods which are highly complex and may contain many beneficial ingredients. Overall, dairy products are critical in providing many of the essential nutrients in the human diet. Nevertheless, dairy products vary in their nutrient composition, including fat, and this needs to be considered in the context of dietary recommendations and our need to consume a balanced diet.