3,318 research outputs found
Dieppe from a German Perspective German Second World War Art in the Collection of the Canadian War Museum
Effects of run-up velocity on performance, kinematics, and energy exchanges in the pole vault
Copyright @ 2012 The Authors. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and 85 reproduction in any medium, provided the original author and source are credited. The article was made available through the Brunel University Open Access Publishing Fund.This study examined the effect of run-up velocity on the peak height achieved by the athlete in the pole vault and on the corresponding changes in the athlete's kinematics and energy exchanges. Seventeen jumps by an experienced male pole vaulter were video recorded in the sagittal plane and a wide range of run-up velocities (4.5-8.5 m/s) was obtained by setting the length of the athlete's run-up (2-16 steps). A selection of performance variables, kinematic variables, energy variables, and pole variables were calculated from the digitized video data. We found that the athlete's peak height increased linearly at a rate of 0.54 m per 1 m/s increase in run-up velocity and this increase was achieved through a combination of a greater grip height and a greater push height. At the athlete's competition run-up velocity (8.4 m/s) about one third of the rate of increase in peak height arose from an increase in grip height and about two thirds arose from an increase in push height. Across the range of run-up velocities examined here the athlete always performed the basic actions of running, planting, jumping, and inverting on the pole. However, he made minor systematic changes to his jumping kinematics, vaulting kinematics, and selection of pole characteristics as the run-up velocity increased. The increase in run-up velocity and changes in the athlete's vaulting kinematics resulted in substantial changes to the magnitudes of the energy exchanges during the vault. A faster run-up produced a greater loss of energy during the take-off, but this loss was not sufficient to negate the increase in run-up velocity and the increase in work done by the athlete during the pole support phase. The athlete therefore always had a net energy gain during the vault. However, the magnitude of this gain decreased slightly as run-up velocity increased
Rhetoric in standard setting : the case of the going-concern audit
This paper seeks to explore in depth the ways in which the rhetoric of the standard setter responds to comments received during development of a standard. Previous research has explored the use of rhetorical strategies in accounting standards to construct and persuade as to what is 'good' and to silence potential criticisms and alternative proposals. The exploration is extended to the development of an auditing standard and is strengthened by relating the opinions of lobbyists to the rhetoric used in the response. The analysis shows that, in a situation where the standard setter's position changed significantly during the exposure of proposals to comment, rhetorical strategies in the exposure draft or standard were adapted to match the changing direction of persuasion, with silencing of potential counter-argument evidenced in the surrounding explanatory material. Research implications/limitations - The research demonstrates that those using standards should be aware of the normative nature of these documents and the subjectivity inherent in the nature of the text. The paper builds on Young's 2003 paper by exploring the dynamics of the ways in which the rhetoric of the standard setter responds to comment during the consultation process
Investigation of the perceived usefulness of a StudyNet group discussion facility by international students
Postgraduate international students at UK institutions of higher education often find difficulty dealing with seminar-type discussions. An attempt was made to help students with this by utilising the group discussion facility of StudyNet. However, as most of the students were from East Asia, where education is often considered as essentially a passive process rather than something they have to do for themselves, it was felt necessary to investigate this to see how seriously they took such an activity. A questionnaire was therefore given to the students and the results analysed. Despite some criticisms, the students were generally found to understand the purpose of the activity and think it beneficial. Thus, overall, when activities are clearly seen to be related to the learning outcomes and integrated into the course, they can be used with confidence with East Asian students.Peer reviewe
GP perspectives on hospital discharge letters : an interview and focus group study
Background: Written discharge communication following inpatient or outpatient clinic discharge is essential for communicating information to the GP, but GPs’ opinions on discharge communication are seldom sought. Patients are sometimes copied into this communication, but the reasons for this variation, and the resultant effects, remain unclear.
Aim: To explore GP perspectives on how discharge letters can be improved in order to enhance patient outcomes.
Design & setting: The study used narrative interviews with 26 GPs from 13 GP practices within the West Midlands, England.
Method: Interviews were transcribed and data were analysed using corpus linguistics (CL) techniques.
Results Elements pivotal to a successful letter were: diagnosis, appropriate follow-up plan, medication changes and reasons, clinical summary, investigations and/or procedures and outcomes, and what information has been given to the patient. GPs supported patients receiving discharge letters and expounded a number of benefits of this practice; for example, increased patient autonomy. Nevertheless, GPs felt that if patients are to receive direct discharge letter copies, modifications such as use of lay language and avoidance of acronyms may be required to increase patient understanding.
Conclusion: GPs reported that discharge letters frequently lacked content items they assessed to be important; GPs highlighted that this can have subsequent ramifications on resources and patient experiences. Templates should be devised that put discharge letter elements assessed to be important by GPs to the forefront. Future research needs to consider other perspectives on letter content, particularly those of patients
The Pathogenesis of Hashimoto's Thyroiditis: Further Developments in our Understanding
Hashimoto’s thyroiditis (HT) is part of a spectrum of thyroid autoimmune conditions and this review provides an update on the latest developments in the field. HT has a genetic predisposition with a number of immune-related and thyroid-specific genes conferring disease susceptibility. However, disentangling genes with protective and predisposing effect is a complex process that requires further work. The recent increase in the incidence of HT implicates environmental factors in disease pathogenesis including improved hygiene, increased dietary iodine intake, new treatment modalities and chemical agents. Additional unmodifiable predisposing factors include stress, climate, age and gender. Both cellular and humoral immunity play a role in HT pathogenesis. Defects in T regulatory cells and increased activation of follicular helper T cells may have a role in disease initiation/perpetuation. Infiltrating lymphocytes can be directly cytotoxic to thyroid follicular cells (TFC) or may affect cell viability/function indirectly through cytokine production, which alters TFC integrity and modulates their metabolic and immune function. Thyroid peroxidase and thyroglobulin antibodies are present in the majority of HT patients and help with management decisions. Antibodies against the sodium iodide symporter and pendrin are present in a minority with little known about their clinical relevance. In addition to immune cells, recent work has identified DNA fragments, generated following cell death, and micro RNA as potential factors in HT pathogenesis. Despite the large number of studies, the mechanistic pathways in HT are still not fully understood and further work is required to enhance our knowledge and identify novel preventative and therapeutic clinical targets
Surfing or still drowning? Student nurses’ Internet skills
A study into student nurses’ ability to use the Internet was published in Nurse Education Today in 2004. This paper repeats the research with a cohort of students starting their pre-registration programme in a UK university in 2007.
In 2004 students were reported as having poor Internet skills, and as not being frequent users of the Internet. In this study students were found to have significantly better ability to carry out basic tasks and significantly higher levels of Internet use. Their ability to apply these skills to more complex information literacy tasks however had not increased, with more than half of all students saying they found far too much irrelevant information when searching for specific information on the Internet. The earlier study found that skills and age were not related, which appears to still be the case.
The need for these skills is increasing as education, lifelong learning, and patient information are all increasingly drawing on the developing Internet. Nurse education however is not integrating the skill and knowledge base essential to support this into pre-registration programmes, and the evidence suggests that this will not happen without active management
Acetylcholinesterase (Ace-1) target site mutation 119S is strongly diagnostic of carbamate and organophosphate resistance in Anopheles gambiae s.s. and Anopheles coluzzii across southern Ghana.
BACKGROUND
With high DDT resistance present throughout much of West Africa, carbamates and organophosphates are increasingly important alternatives to pyrethroids for indoor residual spraying (IRS). Though less widespread, resistance to both of these alternative insecticide classes has also been documented within the Anopheles gambiae species pair (formerly the M and S molecular forms) in West Africa. To manage insecticide efficacy, it is important to predict how and where resistance is likely to occur and spread, which could be aided by using molecular diagnostics with high predictive value.
METHODS
Anopheles coluzzii and An. gambiae s.s. were collected from 18 sites throughout southern Ghana and bioassayed with bendiocarb, the most commonly applied carbamate, and an organophosphate, fenitrothion. The Ace-1 target site substitution G119S was genotyped by qPCR.
RESULTS
Fenitrothion induced higher mortality than bendiocarb, though phenotypes correlated strongly across populations. Ace-1 119S was found at much higher frequency in An. gambiae s.s than An. coluzzii, exceeding 90 % in a population from Greater Accra, the highest frequency reported to date. Ace-1 G119S was very strongly associated with resistance to both insecticides, providing high predictive power for diagnosis, though with some evidence for a differential effect between molecular forms for bendiocarb. Sequencing of the gene revealed a lack of variation in resistant alleles precluding determination of origin, but Ace-1 copy number variation was detected for the first time in Ghana.
CONCLUSIONS
The results validate the utility of G119S as a useful diagnostic of organophosphate and carbamate resistance within and among populations, whilst highlighting the potential for an aggregate nature of Ace-1 genotypes, which may comprise both single-copy and duplicated genes. Further work is now required to determine the distribution and resistance-association of Ace-1 duplication
IL-14 and IL-16 are expressed in the thyroid of patients with either Graves' disease or Hashimoto's thyroiditis
OBJECTIVES: Cytokines have an important role in orchestrating the pathophysiology in autoimmune thyroid disease. The aim of the current study was to analyse the expression of interleukin (IL)-14 and IL-16 in the thyroid tissue of patients with Graves' disease (GD), Hashimoto's thyroiditis (HT) or multi-nodular goitre (MNG) and in that of normal individuals, in patients' intra-thyroidal CD4(+) and CD8(+) T cells, and in patient and normal cultured thyroid follicular cells. METHODS: The expression of IL-14 and IL-16 mRNA and protein was investigated using reverse transcription-polymerase chain reaction (RT-PCR) amplification, and western blotting and ELISAs, respectively. RESULTS: IL-14 mRNA expression was detected in thyroid tissue from 8/9 GD, 3/4 HT and 3/13 MNG patients and 1/6 normal individuals, and IL-16 mRNA expression in thyroid tissue from 9/9 GD, 4/4 HT and 9/13 MNG patients and 4/6 normal individuals. IL-14 mRNA expression was detected in intra-thyroidal CD4(+) and CD8(+) T cells from 2/2 GD and 2/2 HT patients, while IL-16 mRNA was detected in samples from 1/2 HT but not in those from either GD patients. IL-14 and IL-16 mRNA expression was found in thyroid follicular cells derived from 2/2 patients with GD and 1/1 normal individual. IL-14 protein was detected in thyroid tissue from 6/6 GD, 1/1 HT and 0/6 MNG patients and 0/6 normal individuals, and IL-16 protein in thyroid tissue from 6/6 GD, 1/1 HT and 1/6 MNG patients and 0/6 normal individuals. Expression of IL-14 protein was stimulated in thyroid follicular cells derived from two GD patients and one normal individual by peripheral blood mononuclear cell (PBMC)-conditioned medium. Treatment of thyrocytes from two GD patients and one normal individual with PBMC-conditioned medium and tumour necrosis factor (TNF)-α stimulated IL-16 protein expression. In normal thyrocytes, IL-16 protein synthesis was induced also by IL-1β, IL-17A, IL-4 and transforming growth factor (TGF)-β. CONCLUSIONS: The data provide evidence that the intra-thyroidal production of IL-14 and IL-16 is associated with the pathogenesis of autoimmune thyroid disease. Thyroid follicular cells display the ability to express IL-14 and IL-16 mRNA and can be stimulated to express IL-16 protein, by a panel of cytokines, and IL-14 protein, by as yet unidentified factors. This article is protected by copyright. All rights reserved
The discharge communication study : research protocol for a mixed methods study to investigate and triangulate discharge communication experiences of patients, GPs, and hospital professionals, alongside a corresponding discharge letter sample
Background:
Discharge letters are crucial during care transitions from hospital to home. Research indicates a need for improvement to increase quality of care and decrease adverse outcomes. These letters are often sent from the hospital discharging physician to the referring clinician, typically the patient’s General Practitioner (GP) in the UK, and patients may or may not be copied into them. Relatively little is known about the barriers and enablers to sending patients discharge letters. Hence, the aim of this study was to investigate from GP, hospital professional (HP) and patient perspectives how to improve processes of patients receiving letters and increase quality of discharge letters. The study has a particular focus on the impacts of receiving or not receiving letters on patient experiences and quality of care.
Methods:
The setting was a region in the West Midlands of England, UK. The research aimed to recruit a minimum of 30 GPs, 30 patients and 30 HPs in order to capture 90 experiences of discharge communication. Participating GPs initially screened and selected a range of recent discharge letters which they assessed to be successful and unsuccessful exemplars. These letters identified potential participants who were invited to take part: the HP letter writer, GP recipient and patient. Participant viewpoints are collected through interviews, focus groups and surveys and will be “matched” to the discharge letter sample, so forming multiple-perspective “quartet” cases. These “quartets” allow direct comparisons between different discharge experiences within the same communicative event. The methods for analysis draw on techniques from the fields of Applied Linguistics and Health Sciences, including: corpus linguistics; inferential statistics; content analysis.
Discussion:
This mixed-methods study is novel in attempting to triangulate views of patients, GPs and HPs in relation to specific discharge letters. Patient and practitioner involvement will inform design decisions and interpretation of findings. Recommendations for improving discharge letters and the process of patients receiving letters will be made, with the intention of informing guidelines on discharge communication. Ethics approval was granted in July 2017 by the UK Health Research Authority. Findings will be disseminated in peer-reviewed journals, reports and newsletters, and presentations
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