From trial data to practical knowledge: qualitative study of how general practitioners have accessed and used evidence about statin drugs in their management of hypercholesterolaemia

Objectives To explore how general practitioners have accessed and evaluated evidence from trials on the use of statin lipid lowering drugs and incorporated this evidence into their practice. To draw out the practical implications of this study for strategies to integrate clinical evidence into general medical practice.

Nitrogen management and the future of food: Lessons from the management of energy and carbon

The food system dominates anthropogenic disruption of the nitrogen cycle by generating excess fixed nitrogen. Excess fixed nitrogen, in various guises, augments the greenhouse effect, diminishes stratospheric ozone, promotes smog, contaminates drinking water, acidifies rain, eutrophies bays and estuaries, and stresses ecosystems. Yet, to date, regulatory efforts to limit these disruptions largely ignore the food system. There are many parallels between food and energy. Food is to nitrogen as energy is to carbon. Nitrogen fertilizer is analogous to fossil fuel. Organic agriculture and agricultural biotechnology play roles analogous to renewable energy and nuclear power in political discourse. Nutrition research resembles energy end-use analysis. Meat is the electricity of food. As the agriculture and food system evolves to contain its impacts on the nitrogen cycle, several lessons can be extracted from energy and carbon: (i) set the goal of ecosystem stabilization; (ii) search the entire production and consumption system (grain, livestock, food distribution, and diet) for opportunities to improve efficiency; (iii) implement cap-and-trade systems for fixed nitrogen; (iv) expand research at the intersection of agriculture and ecology, and (v) focus on the food choices of the prosperous. There are important nitrogen-carbon links. The global increase in fixed nitrogen may be fertilizing the Earth, transferring significant amounts of carbon from the atmosphere to the biosphere, and mitigating global warming. A modern biofuels industry someday may produce biofuels from crop residues or dedicated energy crops, reducing the rate of fossil fuel use, while losses of nitrogen and other nutrients are minimized.

The relationship of solid waste storage practices in the inner city to the incidence of rat infestation and fires /

"A current report on solid waste management"--Cover.

San Diego County demonstrates pyrolysis of solid waste : to recover liquid fuel, metals, and glass /

Grant No. S-801588.

Use of solid waste as a fuel by investor-owned electric utility companies : proceedings: EPA/Edison Electric Institute meeting /

"This report (SW-6p) was prepared from minutes of the meeting held March 5 and 6, 1975, in Washington, D.C."

A study of solid waste collection systems comparing one-man with multi-man crews : a condensation /

"This condensation (SW-9c. 1)--is based on the Ralph Stone and Company, Inc., report by the same title."

The coöperative group plan for the organization of elementary schools; philosophy and applications,

Contains bibliographies.

A plan for the democratization of the factory,

Mode of access: Internet.

The new farmer's calendar; or, Monthly remembrancer, for all kinds of country business: comprehending all the material improvements in the new husbandry, with the management of live stock ...

Goldsmiths'-Kress no. 17888.

Employe representation. The Pennsylvania railroad plan. The joint work of its officers and employes.

Mode of access: Internet.

Evaluation of a Quality Improvement Intervention for Anesthetic Management of Acute Ischemic Stroke Patients Undergoing Endovascular Therapy

Thesis (Master's)--University of Washington, 2016-06

Controlling Long-Range Ordered Self-assembly of Solid-Binding Peptide Monolayers on Atomically Flat Layered Materials

Thesis (Master's)--University of Washington, 2016-06

Management of a previously eroded tropical Alfisol with herbaceous legumes: Soil loss and physical properties under mound tillage

A study was carried out on a previously eroded Oxic Paleustalf in Ibadan, southwestern Nigeria to determine the extent of soil degradation under mound tillage with some herbaceous legumes and residue management methods. A series of factorial experiments was carried out on 12 existing runoff plots. The study commenced in 1996 after a 5-year natural fallow. Mound tillage was introduced in 1997 till 1999. The legumes - Vigna unguiculata (cowpea), Mucuna pruriens and Pueraria phaseoloides - were intercropped with maize in 1996 and 1998 while yam was planted alone in 1997 and 1999. This paper covers 1997-1999. At the end of each year, residues were either burned or mulched on respective plots. Soil loss, runoff, variations in mound height, bulk density, soil water retention and sorptivity were measured. Cumulative runoff was similar among interactions of legume and residue management in 1997 (57-151 mm) and 1999 (206-397 mm). However, in 1998, cumulative runoff of 95 mm observed for Mucuna-burned residue was significantly greater than the 46 mm observed for cowpea-burned residue and the 39-51 mm observed for mulched residues of cowpea, Mucuna and Pueraria. Cumulative soil loss of 7.6 Mg ha(-1) observed for Mucuna-burned residue in 1997 was significantly greater than those for Pueraria-mulched (0.9 Mg ha(-1)) and Mucuna-mulched (1.4 Mg ha(-1)) residues whereas in 1999 it was similar to soil loss from cowpea treatments and Pueraria-burned residue (2.3-5.3 Mg ha(-1)). There were no significant differences in soil loss in 1998 (1-3.2 Mg ha(-1)) whereas Mucuna-burned residue had a greater soil loss (28.6 Mg ha(-1)) than mulched cowpea (6.9 Mg ha(-1)) and Pueraria (5.4 Ms ha(-1)). Mound heights (23 cm average) decreased non-linearly with cumulative rainfall. A cumulative rainfall of 500 mm removed 0.3-2.3 cm of soil from mounds in 1997, 3.5-6.9 cm in 1998 and 2.3-4.6 cm in 1999, indicating that (detached but less transported) soil from mounds was far higher than observed soil loss in each year. Soil water retention was improved at potentials ranging from -1 to -1500 kPa by Mucuna-mulched residue compared to the various burned-residue treatments. Also, mound sorptivity at -1 cm water head (14.3 cm h(-1/2)) was higher than furrow sorptivity (8.5 cm h(-1/2)), indicating differences in hydraulic characteristics between mound and furrow. Pueraria-mulched residues for mounds had the highest sorptivity of 17.24 cm h(-1/2), whereas the least value of 6.96 cm h(-1/2) was observed in furrow of Mucuna-burned residue. Pueraria phas eoloides was considered the best option for soil conservation on the previously eroded soil, cultivated with mound tillage. (c) 2005 Elsevier B.V. All rights reserved.

A core vocabulary approach for management of inconsistent speech disorder

Developmental speech disorder is accounted for by theories derived from psychology, psycholinguistics, linguistics and medicine, with researchers developing assessment protocols that reflect their theoretical perspective. How theory and data analyses lead to different therapy approaches, however, is sometimes unclear. Here, we present a case management plan for a 7 year old boy with unintelligible speech. Assessment data were analysed to address seven case management questions regarding need for intervention, service delivery, differential diagnosis, intervention goals, generalization of therapeutic gains, discharge criteria and evaluation of efficacy. Jarrod was diagnosed as having inconsistent speech disorder that required intervention. He pronounced 88% of words differently when asked to name each word in the 25 word inconsistency test of the Diagnostic Evaluation of Articulation and Phonology three times, each trial separated by another activity. Other standardized assessments supported the diagnosis of inconsistent speech disorder that, according to previous research, is associated with a deficit in phonological assembly. Core vocabulary intervention was chosen as the most appropriate therapy technique. Its nature and a possible protocol for implementation is described.

A comprehensive approach to quality management of intensive care services

Purpose – The purpose of this paper is to develop a comprehensive framework for improving intensive care unit performance. Design/methodology/approach – The study introduces a quality management framework by combining cause and effect diagram and logical framework. An intensive care unit was identified for the study on the basis of its performance. The reasons for not achieving the desired performance were identified using a cause and effect diagram with the stakeholder involvement. A logical framework was developed using information from the cause and effect diagram and a detailed project plan was developed. The improvement projects were implemented and evaluated. Findings – Stakeholders identified various intensive care unit issues. Managerial performance, organizational processes and insufficient staff were considered major issues. A logical framework was developed to plan an improvement project to resolve issues raised by clinicians and patients. Improved infrastructure, state-of-the-art equipment, well maintained facilities, IT-based communication, motivated doctors, nurses and support staff, improved patient care and improved drug availability were considered the main project outputs for improving performance. The proposed framework is currently being used as a continuous quality improvement tool, providing a planning, implementing, monitoring and evaluating framework for the quality improvement measures on a sustainable basis. Practical implications – The combined cause and effect diagram and logical framework analysis is a novel and effective approach to improving intensive care performance. Similar approaches could be adopted in any intensive care unit. Originality/value – The paper focuses on a uniform model that can be applied to most intensive care units.