Do managed clinical networks improve quality of diabetes care? : Evidence from a retrospective mixed methods evaluation

Peer reviewedPostprin

Fostering resilience-oriented thinking in engineering practice

Round tables discussing the resilience of critical infrastructure systems held in the UK, the USA and New Zealand have provided insight into how organisations are changing the basis of planning and investment decisions to enhance resilience. The events convened stakeholders to explore how resilience is embraced in their sectors and to identify how to advance practice. The overarching premise was to convene a diverse group who would not typically have an opportunity to engage with each other, to share their perspectives on putting resilience thinking into practice. The round tables identified that early-adopting organisations are implementing approaches to decision making that embrace resilience thinking, but such approaches are not yet embedded in common practice across organisations that are responsible for planning and managing critical infrastructure. The findings emphasise that multi-agency coordination and collaboration is required to advance resilience thinking in professional practice and to move beyond traditional risk-based paradigms. Governance and policy interventions will help encourage cross-sector information sharing and enforce responsibility and transparency surrounding exposure to potential shocks and stresses. It is recommended that such interventions could expand on principles and practice in existing emergency-management efforts, on the basis that such efforts are founded on coordinating various groups. </jats:p

Case Hepatic Endometriosis: A Continuing Diagnostic Dilemma

Background. Intraparenchymal endometriosis of liver is rare. It may present as liver tumour and the diagnosis is not usually established till after surgery. Case Outline. A 48-year-old postmenopausal woman presented with right upper quadrant pain and a cystic liver mass. Liver function tests and tumour markers (αFP, CEA, CA 19-9, and CA 125) were normal. Radiological imaging (USS, CT and MRI) suggested a thick walled cystic mass involving segments IV and VIII with complex intracystic septations. Frozen section at operation suggested a benign cystadenoma. The cyst was enucleated using a CUSA (Cavitron ultrasonic aspirator). The final histology confirmed endometriosis. Discussion. Eleven cases of hepatic endometrioma have been reported and only four in postmenopausal women. Preoperative diagnosis poses a challenge and so far none of the cases have been diagnosed preoperatively. Surgery remains the treatment of choice. Accurate diagnosis at time of operation may avoid extensive liver surgery and its associated morbidity

Recursion operator for stationary Nizhnik--Veselov--Novikov equation

We present a new general construction of recursion operator from zero curvature representation. Using it, we find a recursion operator for the stationary Nizhnik--Veselov--Novikov equation and present a few low order symmetries generated with the help of this operator.Comment: 6 pages, LaTeX 2

Effective Feedback to Improve Primary Care Prescribing Safety (EFIPPS) a pragmatic three-arm cluster randomised trial:designing the intervention (ClinicalTrials.gov registration NCT01602705)

Peer reviewedPublisher PD

Lupinosis and rates of stocking of lupin stubbles

Lupin stubbles provide valuable summer sheep feed but under some conditions the fungus Phomopsis rossiana (for which lupins are the host plant) produces a toxin that causes lupinosis. Results from research at Badaingarra Research Station over the 1973-74 and 1974- 75 summers have shown that sheep liver damage associated with lupin stubble grazing is likely to be more severe at high than low stocking rates

Cermet Development for High Temperature and High Pressure Applications

Many traditionally used low cost alloys are easily corroded in steam or supercritical CO2. An effective solution is to utilize ceramic heat exchangers that are often integrated with metallic components which result in a significant thermal expansion mismatch. The goal of this project is to develop a sealing method to create a hermetic joint between the ceramic and metal alloy. Proposed is a seal ring containing a cermet powder with a coefficient of thermal expansion (CTE) higher than the ceramic and metal to produce a high temperature compressive seal. Cermets of Ag and MgO have been selected to withstand pressures of 3000 psi and temperatures above 700 °C. Three preliminary tests were conducted to study the behavior of the cermet: 1. Static heat on cermet filled stainless steel tubes; 2. Radial compression test on cermet filled stainless steel tubes; 3. Compression tests on open cermet filled cavities. Tests 2 and 3 suggest that powder flowability and densification regions decrease with increased ceramic concentrations

Book Reviews: MARRINER-TOMEY, A. (1989). Nursing Theorists and Their Work, 2nd ed. St. Louis: Mosby

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/68645/2/10.1177_089431849000300211.pd

Towards a publicly available, map-based regional software tool to estimate unregulated daily streamflow at ungauged rivers

Streamflow information is critical for addressing any number of hydrologic problems. Often, streamflow information is needed at locations that are ungauged and, therefore, have no observations on which to base water management decisions. Furthermore, there has been increasing need for daily streamflow time series to manage rivers for both human and ecological functions. To facilitate negotiation between human and ecological demands for water, this paper presents the first publicly available, map-based, regional software tool to estimate historical, unregulated, daily streamflow time series (streamflow not affected by human alteration such as dams or water withdrawals) at any user-selected ungauged river location. The map interface allows users to locate and click on a river location, which then links to a spreadsheet-based program that computes estimates of daily streamflow for the river location selected. For a demonstration region in the northeast United States, daily streamflow was, in general, shown to be reliably estimated by the software tool. Estimating the highest and lowest streamflows that occurred in the demonstration region over the period from 1960 through 2004 also was accomplished but with more difficulty and limitations. The software tool provides a general framework that can be applied to other regions for which daily streamflow estimates are needed