General practitioners' perceptions of effective health care

Objectives: To explore general practitioners' perceptions of effective health care and its application in their own practice; to examine how these perceptions relate to assumptions about clinicians' values and behaviour implicit in the evidence based medicine approach. Design: A qualitative study using semistructured interviews. Setting: Eight general practices in North Thames region that were part of the Medical Research Council General Practice Research Framework. Participants: 24 general practitioners, three from each practice. Main outcome measures: Respondents' definitions of effective health care, reasons for not practising effectively according to their own criteria, sources of information used to answer clinical questions about patients, reasons for making changes in clinical practice. Results: Three categories of definitions emerged: clinical, patient related, and resource related. Patient factors were the main reason given for not practising effectively; others were lack of time, doctors' lack of knowledge and skills, lack of resources, and "human failings." Main sources of information used in situations of clinical uncertainty were general practitioner partners and hospital doctors. Contact with hospital doctors and observation of hospital practice were just as likely as information from medical and scientific literature to bring about changes in clinical practice. Conclusions: The findings suggest that the central assumptions of the evidence based medicine paradigm may not be shared by many general practitioners, making its application in general practice problematic. The promotion of effective care in general practice requires a broader vision and a more pragmatic approach which takes account of practitioners' concerns and is compatible with the complex nature of their work

Integral Field Spectroscopy of two radio galaxies at z~2.3

In this article we study the morphology, kinematics and ionization properties of the giant ionized gas nebulae surrounding two high redshift radio galaxies, 4C40.36 (z=2.27) and 4C48.48 (z=2.34).}{Integral Field Spectroscopy observations were taken using the PPAK bundle of the PMAS spectrograph, mounted on the 3.5m on the Calar Alto Observatory, in order to cover a field-of-view of 64" X 72" centered in each radio galaxy. The observations spanned over 5 nights, using two different spectral resolutions (with FWHM~4 AA and ~8 AA respectively), covering the optical wavelength range from ~3700 AA to ~7100 AA, which corresponds to the rest-frame ultraviolet range from ~1100 AA to ~2000 AA >. Various emission lines are detected within this wavelength range, including Lyalpha (1216 AA), NV (1240 AA), CIV (1549 AA), HeII (1640 AA), OIII] (1663 AA) and CIII] (1909\AA). The dataset was used to derive the spatial distribution of the flux intensity of each of these lines and the gas kinematics. The properties of the emission lines in the nuclear regions were studied in detail.In agreement with previous studies, we find that both objects are embedded in a large ionized gas nebula, where Ly alpha emission is extended across ~100 kpc or more. The CIV and HeII emission lines are also spatially extended. The nebulae are generally aligned with the radio axis, although we detect emission far from it. In 4C+48.48, there is a band of low Ly-alpha/CIV running perpendicular to the radio axis, at the location of the active nucleus. This feature might be the observational signature of an edge-on disk of neutral gas. The kinematics of both nebulae are inconsistent with stable rotation, although they are not inconsistent with infall or outflow.Comment: 14 pages, 5 figures, accepted for publishing in Astronomy & Astrophysic

A Synthesis of James Howard Kunstler’s Themes of Urbanization and the Impending Oil Crisis in The Geography of Nowhere, Home from Nowhere, The City in Mind, and The Long Emergency

This paper examines and synchronizes the thoughts put forth by American social critic and author James Howard Kunstler in his four books, The Geography of Nowhere, Home from Nowhere, The City in Mind, and The Long Emergency. Kunstler asserts that human beings are losing their sense of being while simultaneously facilitating daily life, thus leaving a world rife with nothingness. A large portion of Kunstler’s argument deals with how humans have knowingly increased suburban sprawl while depleting valuable resources; such activity, left unchecked, will worsen the state of the world. The United States, in particular, is the most problematic. Through constructing building after building—which consumes a shocking amount of resources—Americans are whittling away at their sense of identity and thus creating a new, superficial identity of materialistic consumerism. Moreover, Kunstler’s largest qualm with the haphazard expenditure of resources is the impending oil crisis. It is this alone that Kunstler fears, but he offers a solution to his Long Emergency by heavily suggesting the use of renewable energy sources and a more constructive and beatific urbanism

Foreword

Punches of the invisible fist: Intra- and inter-personal relations in the neo-liberalised African university. There can be no independent thought–indeed no independence–without institutions to sustain independent research and produce relevant knowledge. The key institution is the research universit

Addressing freight imbalance in the truckload trucking industry through hierarchical planning.

Freight imbalance is a problem that negatively affects drivers and carriers within the truckload trucking industry. One result of this problem is that the industry experiences high annual driver turnover, exceeding 130% annually. The turnover can be attributed in part to driver dissatisfaction due to the inability of the carriers to provide regular driving tours as a result of freight imbalance. However, due to the complexity of the imbalance, carriers have difficulty combating the problem. This dissertation examines three problems addressing freight imbalance from a hierarchical planning perspective. The Weekend Draying Problem focuses is an operational planning approach for addressing weekend truckload dispatching. The application of this methodology to a nationwide trucking network reveals that a carrier can experience significant customer service improvements while at the same time meeting the needs and expectations of their drivers. As a result, more regular driving tours can be established. The Driver Domicile Problem uses tactical planning to examine nationwide driver recruitment strategies. With driver turnover and driver retention imposing significant burdens on the truckload trucking industry, the proposed strategy reveals key locations where a potential driver base could be recruited that would improve the carrier\u27s ability to provide the drivers with more regular tours and frequent get home opportunities. Results highlight which factors contribute to the best design of a nationwide domicile plan. The Distribution Center Location Problem is a strategic plan for the design of various sized distribution networks that minimize trucking costs without affecting delivery requirements. Whereas historical design focused on time and distance minimization, these networks address freight imbalance by focusing on cost minimization. Examination and analysis of these problems is conducted through discrete event system simulation, computer modeling, and mathematical programming. Outcomes from the research of these problems are industrially relevant. The application of these methodologies will assist the truckload trucking carriers in dealing with inherent freight imbalance issues and helping them overcome many challenges they face. Collectively this dissertation demonstrates ways to address freight imbalance both in the short term planning horizon and the long term planning horizon

Selected Recent Institutional and Rule-Making Developments in the Law of the Sea (2015-2016)

The United Nations Convention on the Law of the Sea (LOSC or the Convention) is quite simply, the greatest treaty-making achievement of the United Nations (UN) era. This appraisal of the recent developments of 2015-16 in this legal regime that governs the oceans – waters, floor and subsoil thereof – which cover ‘over 70 percent of the surface of our planet’, focuses on its oft-ignored spect, that is, its institutional framework