13,448 research outputs found

    How clinical and research failures lead to suboptimal prescribing: the example of chronic gout

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    Despite the existence of several effective drugs for chronic tophaceous gout, management is often neither rational nor effective. Wendy Lipworth and colleagues examine the possible reasons An evidence based or “rational” approach to prescribing is thought to maximise the benefit and minimise the harm from prescription drugs. Unfortunately, prescribing often does not meet this ideal despite clinicians’ best intentions. We use treatment of chronic tophaceous gout to show how apparently irrational prescribing arises from several interacting “failures” in both clinical practice and drug development

    Knowledge needs and use in long‐term care homes for older people: A qualitative interview study of managers’ views

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    This is the final version. Available on open access from Wiley via the DOI in this record. We explore the views of managers' knowledge needs and use to optimise care practices and enhance the life experience for older people living, and staff working, in long‐term care homes (with and without nursing). This paper contributes to previous research by offering insights into the knowledge types drawn upon and used by managers to inform efforts to better support gaining and mobilising knowledge. Using a pragmatic qualitative approach, we undertook 19 semi‐structured interviews with managers and leaders in 15 care homes in the South West of England, varying in geographical location, size and type of ownership. We did a thematic analysis of the data using Framework Analysis. Our interpretations were informed by the existing literature on knowledge types. We identified three themes from our analysis as to managers’ knowledge needs and use when implementing changes. First, views about training and formal reports or “explicit knowledge” consisting of the two sub‐themes “gaining explicit knowledge” and “research knowledge”. Second, perspectives relating to practical experience or “tacit knowledge” and judging the use of knowledge in particular cases or “phronesis”. Third, the role of emotion in managers’ knowledge needs and use. We found that having knowledge was positively valued by managers and leaders for improving care practices and enhancing the lives of people residing in care homes. Tacit knowledge and phronesis were particularly highly valued and we note challenges with the perceived applicability, relevance and use of research evidence. We identify that emotions are an important component within knowledge use and a need to further understand how to support the emotional wellbeing of managers so they can support care staff and residents. Greater consideration is needed as to how to optimise gaining and mobilising all knowledge types ‐ “know‐what,” “know‐how,” “know‐when” and “know‐feel” ‐ to benefit people living, and staff working, in care homes.National Institute for Health Research Applied Research Collaboration South West Peninsul

    Elementary amenable subgroups of R. Thompson's group F

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    The subgroup structure of Thompson's group F is not yet fully understood. The group F is a subgroup of the group PL(I) of orientation preserving, piecewise linear self homeomorphisms of the unit interval and this larger group thus also has a poorly understood subgroup structure. It is reasonable to guess that F is the "only" subgroup of PL(I) that is not elementary amenable. In this paper, we explore the complexity of the elementary amenable subgroups of F in an attempt to understand the boundary between the elementary amenable subgroups and the non-elementary amenable. We construct an example of an elementary amenable subgroup up to class (height) omega squared, where omega is the first infinite ordinal.Comment: 20 page

    Mammalian sugar-binding receptors: known functions and unexplored roles

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    Mammalian glycan-binding receptors, sometimes known as lectins, interact withglycans, the oligosaccharide portions ofendogenous mammalian glycoproteins and glycolipids as well as sugars on the surfaces of microbes.Thesereceptors guide glycoproteins out of and back into cells, facilitate communication between cells through both adhesion and signaling, and allow the innate immune system to respond quickly to viral, fungal, bacterial,and parasiticpathogens.For many of the roughly one hundred glycan-binding receptors that are known in humans,there aregood descriptions of what types of glycans they bind and how selectivity for these ligands is achievedat the molecular level.In some cases, there is also comprehensive evidencefor the roles thatthe receptors playat the cellular and organismal levels. In addition to highlighting these well-understood paradigms for glycan-binding receptors, this review will suggest where gaps remain in our understandingof the physiological functions that they can serve

    Universality of residence-time distributions in non-adiabatic stochastic resonance

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    We present mathematically rigorous expressions for the residence-time and first-passage-time distributions of a periodically forced Brownian particle in a bistable potential. For a broad range of forcing frequencies and amplitudes, the distributions are close to periodically modulated exponential ones. Remarkably, the periodic modulations are governed by universal functions, depending on a single parameter related to the forcing period. The behaviour of the distributions and their moments is analysed, in particular in the low- and high-frequency limits.Comment: 8 pages, 1 figure New version includes distinction between first-passage-time and residence-time distribution

    Numerical simulation of premixed turbulent methane combustion

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