Boundaries in Action : An Activity-theoretical Study of Development, Learning, and Change in Health Care Organization for Patients with Multiple and Chronic Illnesses

This study examines boundaries in health care organizations. Boundaries are sometimes considered things to be avoided in everyday living. This study suggests that boundaries can be important temporally and spatially emerging locations of development, learning, and change in inter-organizational activity. Boundaries can act as mediators of cultural and social formations and practices. The data of the study was gathered in an intervention project during the years 2000-2002 in Helsinki in which the care of 26 patients with multiple and chronic illnesses was improved. The project used the Change Laboratory method that represents a research assisted method for developing work. The research questions of the study are: (1) What are the boundary dynamics of development, learning, and change in health care for patients with multiple and chronic illnesses? (2) How do individual patients experience boundaries in their health care? (3) How are the boundaries of health care constructed and reconstructed in social interaction? (4) What are the dynamics of boundary crossing in the experimentation with the new tools and new practice? The methodology of the study, the ethnography of the multi-organizational field of activity, draws on cultural-historical activity theory and anthropological methods. The ethnographic fieldwork involves multiple research techniques and a collaborative strategy for raising research data. The data of this study consists of observations, interviews, transcribed intervention sessions, and patients' health documents. According to the findings, the care of patients with multiple and chronic illnesses emerges as fragmented by divisions of a patient and professionals, specialties of medicine and levels of health care organization. These boundaries have a historical origin in the Finnish health care system. As an implication of these boundaries, patients frequently experience uncertainty and neglect in their care. However, the boundaries of a single patient were transformed in the Change Laboratory discussions among patients, professionals and researchers. In these discussions, the questioning of the prevailing boundaries was triggered by the observation of gaps in inter-organizational care. Transformation of the prevailing boundaries was achieved in implementation of the collaborative care agreement tool and the practice of negotiated care. However, the new tool and practice did not expand into general use during the project. The study identifies two complementary models for the development of health care organization in Finland. The 'care package model', which is based on productivity and process models adopted from engineering and the 'model of negotiated care', which is based on co-configuration and the public good.

Optimization models for expanding a railway’s theoretical capacity

Changing the topology of a railway network can greatly affect its capacity. Railway networks however can be altered in a multitude of different ways. As each way has significant immediate and long term financial ramifications, it is a difficult task to decide how and where to expand the network. In response some railway capacity expansion models (RCEM) have been developed to help capacity planning activities, and to remove physical bottlenecks in the current railway system. The exact purpose of these models is to decide given a fixed budget, where track duplications and track sub divisions should be made, in order to increase theoretical capacity most. These models are high level and strategic, and this is why increases to the theoretical capacity is concentrated upon. The optimization models have been applied to a case study to demonstrate their application and their worth. The case study evidently shows how automated approaches of this nature could be a formidable alternative to current manual planning techniques and simulation. If the exact effect of track duplications and sub-divisions can be sufficiently approximated, this approach will be very applicable.

Mediapolulla - Kasvatustieteellistä ja teknisen alan osaamista yhdistämässä : Opiskelijoiden yhteistyö ja oppiminen tieto- ja viestintätekniikkaprojektissa

The study concentrated on interdisciplinary teamwork of students in Helsinki University Department of Education and Helsinki University of Technology. Students worked in small interdisciplinary groups (n 12) to plan and teach in an information- and communication technology (ICT) club in elementary schools. The focus of the study was co-operation in the student groups and students learning experiences. Theoretical background of the study consists of theories of collaboration and socially shared cognition. Study was an qualitative case study and the data was collected with individual focus interviews and learning diaries. The data was categorised and the connections between categories were analysed with a table. Shared cognition appeared as a form of distribution of tasks and in the actual processes of shared expertise. The tasks were shared according to students expertise. Processes of shared expertise were joint knowledge building, integration of interests, awareness and exploitation of others expertise and allowing freedom for others to use their expertise. Additionally expression of ones own views and setting an example to others were one sided sharing of expertise. Students of technology were responsible of technical issues and the responsibility sphere of educational science students was more fragmented. For instance they concentrated in taking children s abilities into consideration. The sphere of shared cognition included also the need for tutoring and learning from others. Usually students did not directly learn from representative of other discipline, instead the learning for instance of social skills happened indirectly. Learning was fostered if learning was set as a goal and prevented if the differences in expertise were too minor. Sharing of cognition was prevented if co-operation was too problematic. Co-operation was usually successful. Good planning, good person chemistry and appreciation of expertise of others promoted success. Problems caused by different backgrounds were usually slight. Successful interaction was complementary and equal. Groups were usually able to circumvent problems in communication and use of justification in discussion promoted co-operation. When comparing the groups in the scope of the study, two were found to be notably opposed and the other groups located between these extreme cases, but the elements of success prevailed. Learning experiences concentrated on social skills, project management, school world and ICT. Essential was achieved field experience and observation of ones own capabilities. In organisation of student interdisciplinary co-operation is important to ensure sufficient differences in expertise and guide students to gain complementary interaction and appropriate setting of goals. Interdisciplinary field project prepared students to face the demands of

Type II beta-turn conformation of pivaloyl-L-prolyl-alpha-aminoisobutyryl-N-methylamide: Theoretical, spectroscopic, and X-ray studies

Pivaloyl-L-Pro-Aib-N-methylamide has been shown to possess one intramolecular hydrogen bond in (CD3)2SO solution, by 1H-nmr methods, suggesting the existence of beta -turns, with Pro-Aib as the corner residues. Theoretical conformational analysis suggests that Type II beta-turn conformations are about 2 kcal mol-1 more stable than Type III structures. A crystallographic study has established the Type II beta-turn in the solid state. The molecule crystallizes in the space group P21 with a = 5.865 Å, b = 11.421 Å, c = 12.966 Å, beta = 97.55°, and Z = 2. The structure has been refined to a final R value of 0.061. The Type II -turn conformation is stabilized by an intramolecular 4 1 hydrogen bond between the methylamide NH and the pivaloyl CO group. The conformational angles are Pro = -57.8°, Pro = 139.3°, Aib = 61.4°, and Aib = 25.1°. The Type II beta-turn conformation for Pro-Aib in this peptide is compared with the Type III structures observed for the same segment in larger peptides.

Theoretical study of the optimum performance of a two-phase flow CO2 gasdynamic laser

Theoretical optimization studies of the performance of a combustion driven premixed two-phase flow gasdynamic laser are presented. The steady inviscid nonreacting quasi-one-dimensional two-phase flow model including appropriate finite rate vibrational kinetic rates has been used in the analysis. The analysis shows that the effect of the particles on the optimum performance of the two-phase laser is very small. The results are presented in graphical form. Applied Physics Letters is copyrighted by The American Institute of Physics.

Pulsatile blood flow in a stenosed arteryâ a theoretical model

Abstract is not available.

Theoretical studies on the conformation of beta-D-N-acetyl neuraminic acid (sialic acid)

The possible conformations of sialic acid were analysed using semi-empirical potential functions. The solid state conformation has approx. 0.2 kcal/mol higher energy than the minimum energy conformation. These studies suggest that in solution sialic acid may exist preponderantly in two different conformations which differ in the orientation of the terminal hydroxymethyl group of glycerol side-chain. The present model is consistent with 1H- and 13C-NMR data, but differs from the earlier models.

Theoretical Maximum Limits on Power-Handling Capacity of HVDC Cables

In the case of an ac cable, power transmission is limited by the length of the cable due to the capacitive reactive current component. It is well known that high-voltage direct current (HVDC) cables do not have such limitations. However, insulation-related thermal problems pose a limitation on the power capability of HVDC cables. The author presents a viable theoretical development, a logical extension to Whitehead's theory on thermal limitations of the insulation. The computation of the maximum power-carrying capability of HVDC cables subject to limits on the maximum operable temperature of the insulation is presented. The limitation on the power-carrying capability is closely associated with the electrothermal insulation failure. The effect of environmental interaction by way of external thermal resistance, an important aspect, is also considered in the formulations. The Lagrange multiplier method has been used to handle the ensuing optimization problem. The theory is based on an accepted theory of thermal breakdown in insulation and is an important and a coherent extension of great significance.

The modes of binding methyl-alpha (and beta)-D-glucopyranosides and some of their derivatives to concanavalin A--a theoretical approach

The probable modes of binding of Methyl--alpha (and beta)-D-glucopyranosides and some of their derivatives to concanavalin A have been proposed from theoretical studies. Theory predicts that beta-MeGlcP can bind to ConA in three different modes whereas alpha-MeGlcP can bind only in one mode. beta-MeGlcP in its most favourable mode of binding differs from alpha-MeGlcP in its alignment in the active-site of the lectin where it binds in a flipped or inverted orientation. Methyl substitution at the C-2 atom of the alpha-MeGlcP does not significantly affect the possible orientations of the sugar in the active-site of the lectin. Methyl substitution at C-3 or C-4, however, affects the allowed orientations drastically leading to the poor inhibiting power of Methyl-3-O-methyl-alpha-D-glucopyranoside and the inactivity of Methyl-4-O-methyl-alpha-D-glycopyranoside. These studies suggest that the increased activity of the alpha-MeGlcP over beta-MeGlcP may be due to the possibility of formation of better hydrogen bonds and to hydrophobic interactions rather than to steric factors as suggested by earlier workers. These models explain the available NMR and other binding studies.

Theoretical investigations of the two-bond proton-carbon-13 coupling constants. Angular variations of the couplings involving carboxyl carbon

A formulation has been developed using perturbation theory to evaluate the π-contribution to the nuclear spin coupling constants involving nuclei at least one of which is an unsaturated center. This fromulation accounts for the π-contribution in terms of the core polarization and one-center exchange at the π-center. The formulation developed together with the Dirac vector model and Penney-Dirac bond-order formalisms was employed to calculate the geminal (two-bond) proton coupling constants of carboxyl carbons in α-disubstituted acetic acids. The calculated coupling constants were found to have an orientational dependence. The results of the calculation are in good agreement with the experimental values.

Theoretical studies of lithium bonding in lithium chloride/aliphatic amine complexes

In the systematic study of amine … LiCl [amines = NH3, CH3NH2, (CH3)2NH] complexes the possibility of an ion-pair structure and the effect of methylation on the stabilization energy is investigated. ΔEis evaluated by the SCF/4-31G method and augmented by the approximate dispersion energy calculated perturbationally. The interaction energy decreases with the increasing number of methyl groups in the amine. The dispersion energy plays a negligible role in the stabilization of complexes. None of the systems studied are ion pairs; their Li bonds are of a so-called molecular type. Due to the divergence of the multipole expansion, the attempt to correct the 4-31G stabilization energies via the electrostatic energy fails. The relative order of the ΔE in the series of complexes is verified instead in the extended basis set calculation. The lithium bonds are compared with their H-bonded analogues.