The island empire of the East : being a short history of Japan and missionary work therein with special reference to the mission of the M.S.C.C. / by Rev. J. Cooper Robinson ; with an introduction by the lord bishop of Algoma.

http://www.archive.org/details/theislandempire00robiuoft

The quality of diabetes care in the community: practice, policy and culture

Aim: Diabetes is an important barometer of health system performance. This chronic condition is a source of significant morbidity, premature mortality and a major contributor to health care costs. There is an increasing focus internationally, and more recently nationally, on system, practice and professional-level initiatives to promote the quality of care. The aim of this thesis was to investigate the ‘quality chasm’ around the organisation and delivery of diabetes care in general practice, to explore GPs’ attitudes to engaging in quality improvement activities and to examine efforts to improve the quality of diabetes care in Ireland from practice to policy. Methods: Quantitative and qualitative methods were used. As part of a mixed methods sequential design, a postal survey of 600 GPs was conducted to assess the organization of care. This was followed by an in-depth qualitative study using semi-structured interviews with a purposive sample of 31 GPs from urban and rural areas. The qualitative methodology was also used to examine GPs’ attitudes to engaging in quality improvement. Data were analysed using a Framework approach. A 2nd observation study was used to assess the quality of care in 63 practices with a special interest in diabetes. Data on 3010 adults with Type 2 diabetes from 3 primary care initiatives were analysed and the results were benchmarked against national guidelines and standards of care in the UK. The final study was an instrumental case study of policy formulation. Semi-structured interviews were conducted with 15 members of the Expert Advisory Group (EAG) for Diabetes. Thematic analysis was applied to the data using 3 theories of the policy process as analytical tools. Results: The survey response rate was 44% (n=262). Results suggested care delivery was largely unstructured; 45% of GPs had a diabetes register (n=157), 53% reported using guidelines (n=140), 30% had formal call recall system (n=78) and 24% had none of these organizational features (n=62). Only 10% of GPs had a formal shared protocol with the local hospital specialist diabetes team (n=26). The lack of coordination between settings was identified as a major barrier to providing optimal care leading to waiting times, overburdened hospitals and avoidable duplication. The lack of remuneration for chronic disease management had a ripple effect also creating costs for patients and apathy among GPs. There was also a sense of inertia around quality improvement activities particularly at a national level. This attitude was strongly influenced by previous experiences of change in the health system. In contrast GP’s spoke positively about change at a local level which was facilitated by a practice ethos, leadership and special interest in diabetes. The 2nd quantitative study found that practices with a special interest in diabetes achieved a standard of care comparable to the UK in terms of the recording of clinical processes of care and the achievement of clinical targets; 35% of patients reached the HbA1c target of <6.5% compared to 26% in England and Wales. With regard to diabetes policy formulation, the evolving process of action and inaction was best described by the Multiple Streams Theory. Within the EAG, the formulation of recommendations was facilitated by overarching agreement on the “obvious” priorities while the details of proposals were influenced by personal preferences and local capacity. In contrast the national decision-making process was protracted and ambiguous. The lack of impetus from senior management coupled with the lack of power conferred on the EAG impeded progress. Conclusions: The findings highlight the inconsistency of diabetes care in Ireland. The main barriers to optimal diabetes management center on the organization and coordination of care at the systems level with consequences for practice, providers and patients. Quality improvement initiatives need to stimulate a sense of ownership and interest among frontline service providers to address the local sense of inertia to national change. To date quality improvement in diabetes care has been largely dependent the “special interest” of professionals. The challenge for the Irish health system is to embed this activity as part of routine practice, professional responsibility and the underlying health care culture.

Ultrastructure of the accessory podia of Laganum depressum (Echinoidea, Clypeasteroida) with special emphasis on the disc epidermis

info:eu-repo/semantics/published

The Dietary Approaches to Stop Hypertension (DASH) eating pattern in special populations.

The Dietary Approaches to Stop Hypertension (DASH) trial showed that a diet rich in fruits, vegetables, low-fat dairy products with reduced total and saturated fat, cholesterol, and sugar-sweetened products effectively lowers blood pressure in individuals with prehypertension and stage I hypertension. Limited evidence is available on the safety and efficacy of the DASH eating pattern in special patient populations that were excluded from the trial. Caution should be exercised before initiating the DASH diet in patients with chronic kidney disease, chronic liver disease, and those who are prescribed renin-angiotensin-aldosterone system antagonist, but these conditions are not strict contraindications to DASH. Modifications to the DASH diet may be necessary to facilitate its use in patients with chronic heart failure, uncontrolled diabetes mellitus type II, lactose intolerance, and celiac disease. In general, the DASH diet can be adopted by most patient populations and initiated simultaneously with medication therapy and other lifestyle interventions.

Special Issue on Multigrid Methods

SCOPUS: ed.j

Special issue devoted to molecular complexes in our atmosphere and beyond

SCOPUS: ed.j

Guest Editorial. Special Issue: Temporal logic in engineering

Logic-based models are thriving within artificial intelligence. A great number of new logics have been defined, and their theory investigated. Epistemic logics introduce modal operators for knowledge or belief; deontic logics are about norms, and introduce operators of deontic necessity and possibility (i.e., obligation or prohibition). And then we have a much investigated class—temporal logics—to whose application to engineering this special issue is devoted. This kind of formalism deserves increased widespread recognition and application in engineering, a domain where other kinds of temporal models (e.g., Petri nets) are by now a fairly standard part of the modelling toolbox.

Two-machine open shop scheduling with special transportation times

The paper considers a problem of scheduling n jobs in a two-machine open shop to minimise the makespan, provided that preemption is not allowed and the interstage transportation times are involved. In general, this problem is known to be NP-hard. We present a linear time algorithm that finds an optimal schedule if no transportation time exceeds the smallest of the processing times. We also describe an algorithm that creates a heuristic solution to the problem with job-independent transportation times. Our algorithm provides a worst-case performance ratio of 8/5 if the transportation time of a job depends on the assigned processing route. The ratio reduces to 3/2 if all transportation times are equal.

Acknowledgement [Special Issue - Formal Approaches to Legal Evidence]

This Acknowledgement refers to the special issue "Formal Approaches to Legal Evidence" of the Artificial Intelligence and Law, September 2001, Vol. 9, Issue 2-3, which was guest edited by Ephraim Nissan.

Editorial: context, content and aims [Special Issue - Formal Approaches to Legal Evidence]

This special issue "Formal Approaches to Legal Evidence" of the Artificial Intelligence and Law, September 2001, Vol. 9, Issue 2-3, which was guest edited by Ephraim Nissan.

Preface [Special Issue: International Symposium on Combinatorial Optimisation (CO2000)]

Preface [Special Issue containing a selection of papers presented at the International Symposium on Combinatorial Optimisation (CO2000) held at the University of Greenwich, London, from 12-14 July 2000.

A two dimensional unstructured staggered mesh method with special treatment of tangential velocity

A two dimensional staggered unstructured discretisation scheme for the solution of fluid flow problems has been developed. This scheme stores and solves the velocity vector resolutes normal and parallel to each cell face and other scalar variables (pressure, temperature) are stored at cell centres. The coupled momentum; continuity and energy equations are solved, using the well known pressure correction algorithm SIMPLE. The method is tested for accuracy and convergence behaviour against standard cell-centre solutions in a number of benchmark problems: The Lid-Driven Cavity, Natural Convection in a Cavity and the Melting of Gallium in a rectangular domain.