Regularly irregular: how groups reconcile cross-cutting agendas and demand in healthcare

The flow of technical work in acute healthcare varies unpredictably, in patterns that occur regularly enough that they can be managed. Acute care organizations develop ways to hedge resources so that they are available if they are needed. This pragmatic approach to the distribution of work among and across groups shows how rules can be used to manage a response to irregular demands for care. However, no rule set can be complete enough to cover this setting’s variety of care demands. Expertise is also needed to tie together the loose ends of conflicts that remain where rules no longer suffice. Many informal solutions to systemic problems go unnoticed unless they are the subjects of study. Naturalistic decision making (NDM) methods such as observational study, interviews, and process tracing reveal the activities of workers in their natural settings. Results of findings from such explorations of technical work can improve understanding of large scale work processes and, ultimately, patient safety. We have explored how practitioners cope with the demands that the system presents to them. While not all succeed, successful initiatives workers have developed demonstrate how their solutions create resilience at large scale.     

Rubber particle agglomeration phenomena in acrylonitrile-butadiene-styrene (ABS) polymers. I. Structure-property relationships study on rubber particle agglomeration and molded surface appearance

The effects of molecular structures of ABS fabricated under a severe molding condition on rubber particle agglomeration and molded specular gloss were studied. An agglomeration index (N_P) obtained by measuring particle size was used to determine the degree of rubber particle agglomeration. It was found that as graft level decreased, agglomeration increased. The rubber particle agglomeration also increased when graft molecular weight was increased. Lowering the particle size also led to a higher degree of agglomeration. Furthermore, increasing the compositional acrylonitrile mismatch between the grafted and matrix styrene-acrylonitrile copolymers increased the rubber particle agglomeration. Molecular structures that increased rubber particle agglomeration decreased the molded gloss. © 1996 John Wiley & Sons, Inc.     

Intercomparison of the Realization of the ITS-90 at the Freezing Points of Al and Ag among European NMIs

The EUROMET.T-K4 comparison is the regional extension of CCT-K4, an intercomparison of the realizations of the freezing points of Al (660.323°C) and Ag (961.78°C). The intercomparison was organized in four loops. Long-stem standard platinum resistance thermometers (SPRTs) were used as traveling standards: 25 Ω thermometers to be used only at the Al freezing point and two high-temperature standard platinum resistance thermometers (HTSPRTs) to be used only at the Ag freezing point in each loop. Parallel to the measurements with thermometers, the pilots and sub-pilots organized an internal intercomparison using an Ag fixed-point cell. Most HTSPRTs showed a strong drift which is mainly due to mechanical stress and poisoning of the sensor by impurities. This drift can be partially compensated by a correction based on Matthiessen’s rule. An evaluation of the data taking into account both HTSPRTs in each loop, the linkage of the sub-pilots by measurements at the Ag freezing point, and a possible compensation according to Matthiessens’s rule, allows calculation of the results of the participants’ measurements at the Ag freezing point. The results of the participating laboratories are summarized, and proposals for key comparison reference values and linking of the results to CCT-K3 and CCT-K4 are presented.     

Redefining security in public space: the case of LOVE park

By controlling the public spaces in which true human interaction occurs, planners and policymakers are challenging the fundamental desires of groups to forge social bonds and enhance their own sense familiarity with the environment. Security is not merely achieved through an understanding of territory but through acknowledgement and confrontation with individuals or groups maintaining diverse perspectives on the world.     

Analysis of multiple-choice items

This paper deals with scoring and analysis of multiple-choice exam questions. Data may be read by an optical mark reader scanner or from a file created by a system editor and stored in a format convenient to be analysed by a specially designed program 'MCQ'. In addition the data file created can be linked with the package SPSSx for pertinent statistical methods or SPSS Graphics for illustration of score and item distributions. The MCQ program comprises: (1) scoring; (2) item analysis: difficulty and discrimination indices; (3) testing the goodness of alternatives attached to each question. The method is applicable to multiple-choice questions with 4.5 greater than 5; true/false and combined exam questions. The method should prove useful for instructors to build up a balanced discriminant questions bank.     

Microstructural characterisation of syntactic foams

Three types of hollow microspheres with different average diameters (100–150 μm) and two aluminium alloys as matrix material were used to produce metal matrix syntactic foams (MMSFs) by pressure infiltration. The phases, which formed at matrix-filler interface, were investigated by X-ray diffraction (XRD) and energy dispersive spectrometry (EDS). The investigation showed that in syntactic foams, with the Al99.5 matrix, an exchange reaction took place between the matrix and the amorphous components of ceramic hollow microspheres. The reaction resulted in significant formation of alumina and Si precipitates. Because of this diffusion reaction, the hollow microspheres’ walls were degraded. In the case of the AlSi12 matrix the reaction was suppressed by the considerable Si content of the matrix. Therefore, the wall of the hollow microspheres remained unharmed and no real interface layer was found.     

Basic slit lamp techniques

Get the patient comfortable in the chin rest by manipulating the machine distance, elevation of the chair, and correct angling of the machine to the patient. Elderly patients need time and assistance to get positioned. Make sure they are elevated enough to get their foreheads against the headrest with comfort, or they will tend to easily drift backward during the exam, and your focusing power will be inaccurate. A little time taken positioning the patient can mean a more expedient and efficient exam. Align the eye marker on the headrest to the lateral canthus of the eye. Always speak calmly and logically to your patient. As soon as you have positioned the patient's chin on the rest, tell the patient to look at your right ear when examining the patient's right eye, and vice versa. The patient needs something to concentrate on as soon as positioned. Practice makes perfect. If you can visualize the three main components that make up the slit lamp--the head and chin rest for the patient, the microscope, and a housing for the illumination and the diaphragm controls--the machine becomes less overwhelming and better understood. Utilizing the biomicroscope effectively can allow great views of the dynamics in ocular anatomy and physiology.     

Changes in canine bladder perfusion with distension

Using a radioisotope-labeled microsphere technique, canine bladder perfusion was investigated. Blood flow was measured in in flaccid and distended conditions. A slight decrease in total bladder blood flow was recorded. There was a relative decrease in bladder mucosal flow with distension. There was no difference in perfusion of dome versus trigone.