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Hospital-based quality improvement (QI) programs are becoming increasingly common in developing countries as a sustainable method of strengthening health systems. The aim of this paper is to present the results and lessons learned from a QI program in a large, rural, district hospital in Lesotho, Southern Africa.

Over a 15-month period, a locally-relevant, hospital-wide QI program was developed and implemented. The QI program consisted of: planning meetings with district and hospitals staff; creation of multi-disciplinary QI teams; establishment of a QI steering committee; design and implementation of a locally appropriate QI curriculum; and monthly consultation from technical advisers. Initial QI programming was developed in three distinct areas: maternity care, out-patient care, and referral systems.

Partogram documentation in the maternity department increased by 78 percent, waiting time for critically ill patients in the out-patient department was reduced by 84 percent, and emergency referral times were reduced by 58 percent.

The design and early implementation of QI programs should focus on easily achievable, locally-relevant improvement projects. It was found that early successes helped to fuel further QI gains and the authors believe that the work building sustainable QI skill sets within hospital staff could be useful in the future when attempting to tackle larger national-level quality of care indicators. The findings add to the existing evidence suggesting that an increased use of locally-relevant quality improvement programming could help strengthen health care systems in low resource settings.

The information which has hitherto appeared in the daily press as to the evidence laid before the Departmental Committee which is inquiring into the use of preservatives and colouring matters can hardly have afforded pleasant reading to the apologists for the drugging of foods. It is plainly the intention of the Committee to make a thorough investigation of the whole subject, and the main conclusions which, in the result, must bo forced upon unbiassed persons by an investigation of this character will be tolerably obvious to those who have given serious attention to the subject. At a later stage of the inquiry we shall publish a full account of the evidence submitted and of the Committee's proceedings. At present we may observe that the facts which have been brought forward fully confirm the statements made from time to time upon these matters in the BRITISH FOOD JOURNAL, and amply justify the attitude which we have adopted on the whole question. Representatives of various trade interests have given evidence which has served to show the extent to which the practices now being inquired into are followed. Strong medical evidence, as to the dangers which must attach to the promiscuous and unacknowledged drugging of the public by more or less ignorant persons, has been given; and some medical evidence of that apologetic order to which the public have of late become accustomed, and which we, at any rate, regard as particularly feeble, has also been put forward. Much more will no doubt be said, but those who have borne the heat and burden of the day in forcing these matters upon the attention of the Legislature and of the public can view with satisfaction the result already attained. Full and free investigation must produce its educational effect ; and whatever legal machinery may be devised to put some kind of check upon these most dangerous forms of adulteration, the demand of the public will be for undrugged food, and for a guarantee of sufficient authority to ensure that the demand is met.

Some misconception appears to have arisen in respect to the meaning of Section 11 of the Food and Drugs Act, 1899, owing, doubtless, to the faulty punctuation of certain copies of the Act, and the Sanitary Record has done good service by calling attention to the matter. The trouble has clearly been caused by the insertion of a comma after the word “condensed” in certain copies of the Act, and the non‐insertion of this comma in other copies. The words of the section, as printed by the Sanitary Record, are as follows: “Every tin or other receptacle containing condensed, separated or skimmed milk must bear a label clearly visible to the purchaser on which the words ‘Machine‐skimmed Milk,’ or ‘Skimmed Milk,’ as the case may require, are printed in large and legible type.”

Computers have made wide inroads into the practice of medicine, sometimes insidiously and sometimes obviously. The insidious approach has been the use of computers and computer chips in machines to do specific jobs such as controlling automated biochemical analysers, or producing digital images from computerised tomographic and magnetic resonance imaging scanners. The use of pre‐programmed logic and calculation makes a repetitive or mechanical task possible and easier, although the computer itself is not immediately apparent. This will inevitably continue and the fall in price of storage devices makes the storage of large amounts of data, including images, a more attractive possibility. A few hospitals already have ‘filmless’ x‐ray departments, and images can be called up electronically and reviewed in outpatient departments or theatres when required. In contrast, the use of computers with screens and keyboards is apparent principally in clerical tasks.

That ice‐creams prepared with dirty materials and under dirty conditions will themselves be dirty is a proposition which, to the merely ordinary mind, appears to be sufficiently obvious without the institution of a series of elaborate and highly “scientific” experiments to attempt to prove it. But, to the mind of the bacteriological medicine‐man, it is by microbic culture alone that anything that is dirty can be scientifically proved to be so. Not long ago, it having been observed that the itinerant vendor of ice‐creams was in the habit of rinsing his glasses, and, some say, of washing himself—although this is doubtful—in a pail of water attached to his barrow, samples of the liquor contained by such pails were duly obtained, and were solemnly submitted to a well‐known bacteriologist for bacteriological examination. After the interval necessary for the carrying out of the bacterial rites required, the eminent expert's report was published, and it may be admitted that after a cautious study of the same the conclusion seems justifiable that the pail waters were dirty, although it may well be doubted that an allegation to this effect, based on the report, would have stood the test of cross‐examination. It is true that our old and valued friend the Bacillus coli communis was reported as present, but his reputation as an awful example and as a producer of evil has been so much damaged that no one but a dangerous bacteriologist would think of hanging a dog—or even an ice‐cream vendor—on the evidence afforded by his presence. A further illustration of bacteriological trop de zèle is afforded by the recent prosecutions of some vendors of ice‐cream, whose commodities were reported to contain “millions of microbes,” including, of course, the in‐evitable and ubiquitous Bacillus coli very “communis.” To institute a prosecution under the Sale of Food and Drugs Act upon the evidence yielded by a bacteriological examination of ice‐cream is a proceeding which is foredoomed, and rightly foredoomed, to failure. The only conceivable ground upon which such a prosecution could be undertaken is the allegation that the “millions of microbes ” make the ice‐cream injurious to health. Inas‐much as not one of these millions can be proved beyond the possibility of doubt to be injurious, in the present state of knowledge; and as millions of microbes exist in everything everywhere, the breakdown of such a case must be a foregone conclusion. Moreover, a glance at the Act will show that, under existing circumstances at any rate, samples cannot be submitted to public analysts for bacteriological examination—with which, in fact, the Act has nothing to do—even if such examinations yielded results upon which it would be possible to found action. In order to prevent the sale of foul and unwholesome or actual disease‐creating ice‐cream, the proper course is to control the premises where such articles are prepared; while, at the same time, the sale of such materials should also be checked by the methods employed under the Public Health Act in dealing with decomposed and polluted articles of food. In this, no doubt, the aid of the public analyst may sometimes be sought as one of the scientific advisers of the authority taking action, but not officially in his capacity as public analyst under the Adulteration Act. And in those cases in which such advice is sought it may be hoped that it will be based, as indeed it can be based, upon something more practical, tangible and certain than the nebulous results of a bacteriological test.

“GIVE a dog a bad name and hang him,” is an aphorism which has been accepted for many years. But, like many other household words, it is not always true. Even if it were, the dog to be operated upon would probably prefer a gala day at his Tyburn Tree to being executed in an obscure back yard.

Fatigue, occurring in an average healthy individual, under ordinary conditions of life, and while foodstuffs of a very usual character are being ingested, is an indication of an inability on the part of the organism to meet, with sufficient rapidity, the demands of the body created by wear and tear. It is an association of defective oxidation and the undue accumulation of waste products in the tissues and blood, and is in a very large percentage of cases caused solely by a deficiency in the average dietary of to‐day of one or more of those mineral elements which are essential to life. That mineral substances are indispensable to life has been fully demonstrated, for it has been shown that animals fed upon proteins, carbohydrates, and fats, which have been rendered as ash‐free as possible, perish even more rapidly than if they are deprived of food altogether.

The purpose of this paper is to analyze the factors shaping climate policies in two megacities in Brazil – São Paulo and Rio de Janeiro – through a multilevel perspective. The paper seeks to explore how climate change is being framed and how local governments are responding to it in terms of policy strategies.

Through empirical research based on two case studies, the authors discuss the governing of climate change action and analyze the factors that can constrain or undermine these actions based on information collected from reports, institutional web sites and academic and newspaper articles.

The participation in transnational municipal networks has been central for promoting and supporting climate change actions in both cities following the international experience. The organization and implementation of climate change measures rely on a landscape formed by multiple actors often spanning several sectors and levels of governance.

Most of the literature on climate change policy at the local level focuses on the context of developed countries. Analyses of advanced developing countries like Brazil are sparse as well as comparison in light of the international experience. The paper also draws attention for the lack of awareness for adaptation at the local level in these countries, building upon recent scientific findings on global climate change.

A RECENT visit to Norway gave me the opportunity to see a cross‐section of libraries including those of the Royal University, the Storting and the Nobel Institute, the Deichman Library and its branches in and around Oslo, an industrial research library at Blindern, and provincial public libraries at Fredrikstad, Sarpsborg and Tønsberg. In addition, I visited the Statens Bibliotektilsyn (State Library Office), the Norwegian Library School, and the A/L Biblioteksentralen (the Central Buying Agency for Libraries). I had interesting discussions with Harald L. Tveterås, director of the Royal University Library and State adviser on scientific and research libraries, and also with Anders Andreassen, State director for public and school libraries, whose help throughout was invaluable.

This chapter narrows the focus of inclusive practices and principles in literacy education to find the role that science, combined with literature can play in helping children of all abilities. Through the use of implicit and explicit language with active, social, hands-on inquiry related to science concepts and procedures children can construct new knowledge that leads to a firmer understanding of the world in which they live. The chapter demonstrates how children of all backgrounds and needs can work with others through their own investigations, and the guidance of an educator to develop, implement and present findings of scientific investigations that also develop literacy skills. The chapter also addresses the professional responsibility of educators to acknowledge and respect individual curiosity, growth, culture and diversity to plan thoughtfully, to use science language that is acceptable and understandable for children of different abilities and enhance scientific knowledge and literacy through the use of literature that evokes the sense of wonder within the children.