General Practitioners' Barriers Toward Medication Reviews in Polymedicated Multimorbid Patients:How can a Focus on the Pharmacotherapy in an Outpatient Clinic Support GPs?

Purpose: The aim of this study was to explore whether general practitioners (GPs) experienced barriers toward medication reviews in polymedicated, multimorbid patients, and how a clinical pharmacologist with a focus on pharmacotherapy can support the GPs in an outpatient clinic. Design: The study was descriptive and exploratory and had a qualitative design with a phenomenological/hermeneutic orientation for the interviews. Participants: The study comprised 14 interviews with 14 different GPs from the Capital Region of Denmark. Results: Three themes emerged from the interviews: (1) The care of patients With polypharmacy is challenged by the lack of professional dialogue and collaboration between GPs and hospital-based clinical pharmacologists, (2) the relationship between the patients with polypharmacy and the GP is characterized by care and individual considerations, and (3) the culture encourages adding medication and inhibits dialogue about medication withdrawal even for patients with polypharmacy. Conclusion and implications for practice: This study found that the primary barriers toward multimorbid patients with polypharmacy were the need for communication and teamwork with specialists (cardiologists, neurologists, endocrinologists, etc). Often, GPs felt that the specialists at the hospitals were more concerned about following standards and guidelines regarding specific diseases instead of a more holistic patient approach. To improve management of polypharmacy patients, the GPs suggest that a joint force is necessary, a partner-like relationship with greater transparency regarding information transfer, feedback, and shared decision-making, but also more education in the pharmacological field is essential

Cooling and the SU(2) Instanton Vaccuum

We present results of an investigation into the nature of instantons in 4-dimensional pure gauge lattice $SU(2)$\ obtained from configurations which have been cooled using an under-relaxed cooling algorithm. We discuss ways of calibrating the cooling and the effects of different degrees of cooling, and compare our data for the shapes, sizes and locations of instantons with continuum results. In this paper we extend the ideas and techniques developed by us for use in $O(3)$, and compare the results with those obtained by other groups.Comment: 22 pages, LaTeX, uuencoded compressed tarfile of figures sent separately. Full (compressed) postscript version (118k)available from ftp://rock.helsinki.fi/pub/preprints/tft/Year1995/HU-TFT-95-21/paper.ps.

Galaxy Counterparts of metal-rich Damped Lyman-alpha Absorbers - I: The case of the z=2.35 DLA towards Q2222-0946

We have initiated a survey using the newly commissioned X-shooter spectrograph to target candidate relatively metal-rich damped Lyman-alpha absorbers (DLAs). The spectral coverage of X-shooter allows us to search for not only Lyman-alpha emission, but also rest-frame optical emission lines. We have chosen DLAs where the strongest rest-frame optical lines ([OII], [OIII], Hbeta and Halpha) fall in the NIR atmospheric transmission bands. In this first paper resulting from the survey, we report on the discovery of the galaxy counterpart of the z_abs = 2.354 DLA towards the z=2.926 quasar Q2222$-0946. This DLA is amongst the most metal-rich z>2 DLAs studied so far at comparable redshifts and there is evidence for substantial depletion of refractory elements onto dust grains. We measure metallicities from ZnII, SiII, NiII, MnII and FeII of -0.46+/-0.07, -0.51+/-0.06, -0.85+/-0.06, -1.23+/-0.06, and -0.99+/-0.06, respectively. The galaxy is detected in the Lyman-alpha, [OIII] lambda4959,5007 Halpha emission lines at an impact parameter of about 0.8 arcsec (6 kpc at z_abs = 2.354). We infer a star-formation rate of 10 M_sun yr^-1, which is a lower limit due to the possibility of slit-loss. Compared to the recently determined Halpha luminosity function for z=2.2 galaxies the DLA-galaxy counterpart has a luminosity of L~0.1L^*_Halpha. The emission-line ratios are 4.0 (Lyalpha/Halpha) and 1.2 ([OIII]/Halpha). The Lyalpha line shows clear evidence for resonant scattering effects, namely an asymmetric, redshifted (relative to the systemic redshift) component and a much weaker blueshifted component. The fact that the blueshifted component is relatively weak indicates the presence of a galactic wind. The properties of the galaxy counterpart of this DLA is consistent with the prediction that metal-rich DLAs are associated with the most luminous of the DLA-galaxy counterparts.Comment: 9 pages, 7 figures. Accepted for publication in MNRA

Calorons and localization of quark eigenvectors in lattice QCD

We analyze the localization properties for eigenvectors of the Dirac operator in quenched lattice QCD in the vicinity of the deconfinement phase transition. Studying the characteristic differences between the Z_3 sectors above the critical temperature T_c, we find indications for the presence of calorons.Comment: 4 pages, 4 figure