Diagnosis: Reasoning from first principles and experiential knowledge

Completeness, efficiency and autonomy are requirements for suture diagnostic reasoning systems. Methods for automating diagnostic reasoning systems include diagnosis from first principles (i.e., reasoning from a thorough description of structure and behavior) and diagnosis from experiential knowledge (i.e., reasoning from a set of examples obtained from experts). However, implementation of either as a single reasoning method fails to meet these requirements. The approach of combining reasoning from first principles and reasoning from experiential knowledge does address the requirements discussed above and can possibly ease some of the difficulties associated with knowledge acquisition by allowing developers to systematically enumerate a portion of the knowledge necessary to build the diagnosis program. The ability to enumerate knowledge systematically facilitates defining the program's scope, completeness, and competence and assists in bounding, controlling, and guiding the knowledge acquisition process

The Role of the Pharmacist in Optimizing Outcomes With Roflumilast, a PDE4 Inhibitor for the Treatment of COPD

Purpose The pharmacology of roflumilast, recent dosing revisions, and the integral roles of pharmacists in effective chronic obstructive pulmonary disease (COPD) management are reviewed here. Summary COPD is characterized by progressive airflow limitation and intermittent acute exacerbations of symptoms, which contribute to disease progression, worsening of comorbidities, and reduced health-related quality of life. Patients with COPD may use a variety of pharmacotherapies (in combination with nonpharmacological modalities) to prevent exacerbations, reduce the impact of symptoms, and reduce or prevent COPD progression. Given the complex and multifaceted nature of disease management, pharmacists are uniquely positioned to collaborate with other clinicians to improve treatment adherence and efficacy via a number of diverse avenues in patients with COPD. Central to this endeavor is patient education and counseling regarding their treatment regimen .Conclusion Recent findings from a phase 3 clinical trial demonstrate improved tolerability and reduced treatment discontinuation resulting from the use of an uptitration regimen in patients with severe COPD who initiate therapy with roflumilast. Pharmacists have a central role in effective COPD management, especially with respect to patient education about treatments

CHANGE AND IMPLEMENTATION IN A SOCIAL SERVICES DEPARTMENT

This work is an examination of contemporary public policy implementation. It seeks to isolate those features which need to be incorporated into implementation theory to assist in the analysis of the implementation of public policy The "new right" ideology requires that a particular organisational form be adopted by public implementing agencies. This form must reflect the need to introduce competition, the precepts of the "new managerialism" and to view the user of the public services as a "customer". These three elements will have a bearing on the process of the implementation. In particular, the need to regard the user of the services as a consumer implies that these users have an active part to play in the implementation process. The primary aim of the dissertation is to examine the nature and extent of the users involvement. A secondary aim seeks to develop and test a model of policy implementation which can incorporate the so called "top down" and "bottom up" perspectives of policy implementation. The model incorporates features which facilitate the analysis of contemporary policy implementation. These features include: the need to recognise the large amount of conflict and bargaining which is characteristic of multi - agency implementations, the dynamic and interactive nature of the process and the inclusion of the consumer as part of the process. The research uses the implementation of N.H.S. and Community Care Act (1990) in a shire county in order to examine these issues

Portraiture and Text in African-American Illustrated Biographical Dictionaries, 1876 to 1917

Containing portraiture and biography as well as protest text and affirmative text, African- American Illustrated biographical dictionaries made from 1876 to 1917 present Social Gospel ideology and are examples of Afro-Protestantism. They are similar to the first American illustrated biographical dictionaries of the 1810s in that they formed social identity after national conflict while contesting concepts of social inferiority. The production of these books occurred during the early years of Jim Crow, a period of momentous change to the legal and social fabric of the United States, and because of momentous changes in modern American print industries. While portraits within the books simultaneously form, blur, and stabilize identity, biographies convey themes of perseverance, social equity, and social struggle. More specifically, text formed an imagined community in the African-American middle class imaginary. It worked together with image to help create a proto-Civil Rights social movement identity during the beginning of racial apartheid

An Atlas for Guatemala, a Tool for Conserving World Crops

With exotic names like ayote de caballo (a wild squash), friajolito (a wild bean), and teocinte (a wild relative of corn), Guatemala’s native plants seem very different from the agricultural bounty produced by farmers in the United States and other countries. But many of these native plants carry genes that may be vital to global food security. A new tool, developed by a team that includes Agricultural Research Service scientists, will make it easier to find and preserve these important plants. The tool is an interactive atlas designed to provide Guatemalan scientists and land managers with information on where these crop wild relatives grow, where they are relatively safe from habitat destruction, and which ones are rare and most at risk. The genes these wild plants contain may prove useful in addressing threats posed by emerging diseases, insect pests, and temperature and rainfall extremes arising from a changing climate, says Karen Williams, a botanist with the ARS National Germplasm Resources Laboratory in Beltsville. “Guatemala has many genetically diverse native plants closely related to some of our most important crops, including corn, beans, peppers, and potatoes. Some of these crop wild relatives are found only in Guatemala, and they have genes that equip them with survival mechanisms that may be useful to protect crops,” Williams says. Williams worked on the atlas for almost 10 years with César Azurdia Pérez from the Agronomy Faculty at the University of San Carlos in Guatemala, David E. Williams and Veerle van Damme from Bioversity International, and Andrew Jarvis and Silvia Elena Castaño from the International Center for Tropical Agriculture

Technical Bulletins: Procedures for Issuance of Ordinance Summonses in Lieu of Arrest Warrants

In April, 1986, Tennessee Code Annotated, Sections 7-63-201 through 7-63-204 became effective, authorizing municipalities to appoint enforcement officers by resolution or ordinance to issue ordinance summonses in the areas of sanitation, litter control, and animal control. Attached to this bulletin are sample ordinance and resolution formats