UK guidance on the initial evaluation of an infant or an adolescent with a suspected disorder of sex development

It is paramount that any child or adolescent with a suspected disorder of sex development (DSD) is assessed by an experienced clinician with adequate knowledge about the range of conditions associated with DSD. If there is any doubt, the case should be discussed with the regional team. In most cases, particularly in the case of the newborn, the paediatric endocrinologist within the regional DSD team acts as the first point of contact. The underlying pathophysiology of DSD and the strengths and weaknesses of the tests that can be performed should be discussed with the parents and affected young person and tests undertaken in a timely fashion. This clinician should be part of a multidisciplinary team experienced in management of DSD and should ensure that the affected person and parents are as fully informed as possible and have access to specialist psychological support. Finally, in the field of rare conditions, it is imperative that the clinician shares the experience with others through national and international clinical and research collaboration. © 2011 Blackwell Publishing Ltd.

Unity in diversity: electronic patient record use in multidisciplinary practice

In this paper we examine the use of electronic patient records (EPR) by clinical specialists in their development of multidisciplinary care for diagnosis and treatment of breast cancer. We develop a practice theory lens to investigate EPR use across multidisciplinary team practice. Our findings suggest that there are oppositional tendencies towards diversity in EPR use and unity which emerges across multidisciplinary work, and this influences the outcomes of EPR use. The value of this perspective is illustrated through the analysis of a year-long, longitudinal case study of a multidisciplinary team of surgeons, oncologists, pathologists, radiologists, and nurse specialists adopting a new EPR. Each group adapted their use of the EPR to their diverse specialist practices, but they nonetheless orientated their use of the EPR to each others' practices sufficiently to support unity in multidisciplinary teamwork. Multidisciplinary practice elements were also reconfigured in an episode of explicit negotiations, resulting in significant changes in EPR use within team meetings. Our study contributes to the growing literature that questions the feasibility and necessity of achieving high levels of standardized, uniform health information technology use in healthcare.

Sustainable buildings need integrated teams

This report is intended to contribute to strengthening the work of the Government, the Strategic Forum and the Specialist Engineering Alliance in bringing about a more integrated and a more sustainable industry. Its aim is to examine the potential for improving the sustainability of the built environment through an integrated approach to procurement and delivery, in which the role of the specialist engineering sector is recognised for its vital ability to improve building performance. Based on wide ranging knowledge and expertise across the construction sector, it puts forward a vision for sustainable buildings and sets out the actions needed from Government, clients, consultants, contractors and manufacturers to ensure the vision is realised. The report complements the Strategy for Sustainable Construction published by the Department for Business, Enterprise and Regulatory Reform (June 2008).

Drop speeds from drop-on-demand ink-jet print heads

Measured drop speeds from a range of industrial drop-on-demand (DoD) ink-jet print head designs scale with the predictions of very simple physical models and results of numerical simulations. The main drop/jet speeds at a specified stand-off depend on fluid properties, nozzle exit diameter, and print head drive amplitude for fixed waveform timescales. Drop speeds from the Xaar, Spectra Dimatix, and MicroFab DoD print heads tested with (i) Newtonian, (ii) weakly elastic, and (iii) highly shear-thinning fluids all show a characteristic linear rise with drive voltage (setting) above an apparent threshold drive voltage. Jetting, simple modeling approaches, and numerical simulations of Newtonian fluids over the typical DoD printing range of surface tensions and viscosities were studied to determine how this threshold drive value and the slope of the characteristic linear rise depend on these fluid properties and nozzle exit area. The final speed is inversely proportional to the nozzle exit area, as expected from volume conservation. These results should assist specialist users in the development and optimization of DoD applications and print head design. For a given density, the drive threshold is determined primarily by viscosity, and the constant of proportionality k linking speed with drive above a drive threshold becomes independent of viscosity and surface tension for more viscous DoD fluid jetting. © 2013 Society for Imaging Science and Technology.