Policy-makers should not under-estimate the difficulties faced in promoting ownership of local pay-for-performance schemes.
William K. Everson in his book The Detective in Film noted that Sherlock Holmes Baffled, in common with all other silent detective films "labored under the difficulty of not being able to conduct prolonged interrogations or oral deductions ... the stress was on mystery or physical action rather than on literary-derived sleuthings".
Under Marcus Aurelius, the difficulties of the times often caused the Christians, who refused to sacrifice to the state gods and to participate in the imperial cult, to be accused of provoking the wrath of the gods: martyrs appeared in the East, in Rome, in Gaul, and in Africa.
"Things have been very difficult here and I wouldn't for a moment seek to under play the difficulties farmers and other businesses have had to face over the last few weeks, but we must also recognise that the difficulties faced here are of a different degree to those which have been faced by farmers in Northern Ireland and Scotland," he said.
In the previous issue of Critical Care, Ware and colleagues describe a clinical study using multiple host biomarkers to aid diagnosis of acute respiratory distress syndrome (ARDS), a particular complication of sepsis which is often under-diagnosed because of the difficulties in applying a non-specific definition of disease [ 1].
Had my father chosen to not stand by his vows and bow under pressure of the difficulties and left her, that would be a situation requiring special consideration.
The Ming dynasty statesman Zhang Juzheng once said: "Of all things under Heaven, the difficulty is not in establishing law, but in enacting it".
The difficulties with under-provision of doctors mean that alternative ways of providing services need to be developed.
This is consistent with the results of other studies showing COPD under-reporting [ 40] and the difficulties of recruiting patients with COPD to a PR trial.
Endocrine tumors can develop from a variety of tissue types and are often under- or misdiagnosed which underscores the difficulties to classify them.
