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.

Feature integration in human vision

The earliest stages of human cortical visual processing can be conceived as extraction of local stimulus features. However, more complex visual functions, such as object recognition, require integration of multiple features. Recently, neural processes underlying feature integration in the visual system have been under intensive study. A specialized mid-level stage preceding the object recognition stage has been proposed to account for the processing of contours, surfaces and shapes as well as configuration. This thesis consists of four experimental, psychophysical studies on human visual feature integration. In two studies, classification image a recently developed psychophysical reverse correlation method was used. In this method visual noise is added to near-threshold stimuli. By investigating the relationship between random features in the noise and observer s perceptual decision in each trial, it is possible to estimate what features of the stimuli are critical for the task. The method allows visualizing the critical features that are used in a psychophysical task directly as a spatial correlation map, yielding an effective "behavioral receptive field". Visual context is known to modulate the perception of stimulus features. Some of these interactions are quite complex, and it is not known whether they reflect early or late stages of perceptual processing. The first study investigated the mechanisms of collinear facilitation, where nearby collinear Gabor flankers increase the detectability of a central Gabor. The behavioral receptive field of the mechanism mediating the detection of the central Gabor stimulus was measured by the classification image method. The results show that collinear flankers increase the extent of the behavioral receptive field for the central Gabor, in the direction of the flankers. The increased sensitivity at the ends of the receptive field suggests a low-level explanation for the facilitation. The second study investigated how visual features are integrated into percepts of surface brightness. A novel variant of the classification image method with brightness matching task was used. Many theories assume that perceived brightness is based on the analysis of luminance border features. Here, for the first time this assumption was directly tested. The classification images show that the perceived brightness of both an illusory Craik-O Brien-Cornsweet stimulus and a real uniform step stimulus depends solely on the border. Moreover, the spatial tuning of the features remains almost constant when the stimulus size is changed, suggesting that brightness perception is based on the output of a single spatial frequency channel. The third and fourth studies investigated global form integration in random-dot Glass patterns. In these patterns, a global form can be immediately perceived, if even a small proportion of random dots are paired to dipoles according to a geometrical rule. In the third study the discrimination of orientation structure in highly coherent concentric and Cartesian (straight) Glass patterns was measured. The results showed that the global form was more efficiently discriminated in concentric patterns. The fourth study investigated how form detectability depends on the global regularity of the Glass pattern. The local structure was either Cartesian or curved. It was shown that randomizing the local orientation deteriorated the performance only with the curved pattern. The results give support for the idea that curved and Cartesian patterns are processed in at least partially separate neural systems.

Structure of 2-(2,6-dimethoxyphenyl)-2,5- dimethylbicyclo[3.2.1]octane-6,8-dione

C18H2204, orthorhombic, P212~21, a = 7.343 (4), b = 11.251 (4), c = 19.357 (4)A, Z = 4, Dr, ' = 1.20, D e = 1.254 g cm -3, F(000) = 648, p(MoKa) = 0.94 cm -~. X-ray intensity data were collected on a Nonius CAD-4 diffractometer and the structure was solved by direct methods. Full-matrix least-squares refinement gave R = 0.052 (R w = 0.045) for 1053 observed reflections. The stereochemical configuration at C(2) has been shown to be 2-exo-methyl-2-endo-(2,6-dimethoxyphenyl), i.e. (3) in contrast to the structure (2) assigned earlier based on its ~H NMR data.

Bearing capacity of square footings on geosynthetic reinforced sand

The results from laboratory model tests and numerical simulations on square footings resting on sand are presented. Bearing capacity of footings on geosynthetic reinforced sand is evaluated and the effect of various reinforcement parameters like the type and tensile strength of geosynthetic material, amount of reinforcement, layout and configuration of geosynthetic layers below the footing on the bearing capacity improvement of the footings is studied through systemati model studies. A steel tank of size 900 x 900 x 600 mm is used for conducting model tests. Four types of grids, namely strong biaxial geogrid, weak biaxial geogrid, uniaxial geogrid and a geonet, each with different tensile strength, are used in the tests. Geosynthetic reinforcement is provided in the form of planar layers, varying the depth of reinforced zone below the footing, number of geosynthetic layers within the reinforced zone and the width of geosynthetic layers in different tests. Influence of all these parameters on the bearing capacity improvement of square footing and its settlement is studied by comparing with the test on unreinforced sand. Results show that the effective depth of reinforcement is twice the width of the footing and optimum spacing of geosynthetic layers is half the width of the footing. It is observed that the layout and configuration of reinforcement play a vital role in bearing capacity improvement rather than the tensile strength of the geosynthetic material. Experimental observations are supported by the findings from numerical analyses.

Row spacing and planting density effects on the growth and yield of sugarcane. 3. Responses with different cultivars.

The promotion of controlled traffic (matching wheel and row spacing) in the Australian sugar industry is necessitating a widening of row spacing beyond the standard 1.5 m. As all cultivars grown in the Australian industry have been selected under the standard row spacing there are concerns that at least some cultivars may not be suitable for wider rows. To address this issue, experiments were established in northern and southern Queensland in which cultivars, with different growth characteristics, recommended for each region, were grown under a range of different row configurations. In the northern Queensland experiment at Gordonvale, cultivars Q187((sic)), Q200((sic)), Q201((sic)), and Q218((sic)) were grown in 1.5-m single rows, 1.8-m single rows, 1.8-m dual rows (50 cm between duals), and 2.3-m dual rows (80 cm between duals). In the southern Queensland experiment at Farnsfield, cvv. Q138, Q205((sic)), Q222((sic)) and Q188((sic)) were also grown in 1.5-m single rows, 1.8-m single rows, 1.8-m dual rows (50 cm between duals), while 1.8-m-wide throat planted single row and 2.0-m dual row (80 cm between duals) configurations were also included. There was no difference in yield between the different row configurations at Farnsfield but there was a significant row configuration x cultivar interaction at Gordonvale due to good yields in 1.8-m single and dual rows with Q201((sic)) and poor yields with Q200((sic)) at the same row spacings. There was no significant difference between the two cultivars in 1.5-m single and 2.3-m dual rows. The experiments once again demonstrated the compensatory capacity that exists in sugarcane to manipulate stalk number and individual stalk weight as a means of producing similar yields across a range of row configurations and planting densities. There was evidence of different growth patterns between cultivars in response to different row configurations (viz. propensity to tiller, susceptibility to lodging, ability to compensate between stalk number and stalk weight), suggesting that there may be genetic differences in response to row configuration. It is argued that there is a need to evaluate potential cultivars under a wider range of row configurations than the standard 1.5-m single rows. Cultivars that perform well in row configurations ranging from 1.8 to 2.0 m are essential if the adverse effects of soil compaction are to be managed through the adoption of controlled traffic.

Row spacing and planting density effects on the growth and yield of sugarcane. 2. Strategies for the adoption of controlled traffic.

Controlled traffic (matching wheel and row spacing) is being promoted as a means to manage soil compaction in the Australian sugar industry. However, machinery limitations dictate that wider row spacings than the standard 1.5-m single row will need to be adopted to incorporate controlled traffic and many growers are reluctant to widen row spacing for fear of yield penalties. To address these concerns, contrasting row configuration and planting density combinations were investigated for their effect on cane and sugar yield in large-scale experiments in the Gordonvale, Tully, Ingham, Mackay, and Bingera (near Bundaberg) sugarcane-growing regions of Queensland, Australia. The results showed that sugarcane possesses a capacity to compensate for different row configurations and planting densities through variation in stalk number and individual stalk weight. Row configurations ranging from 1.5-m single rows (the current industry standard) to 1.8-m dual rows (50 cm between duals), 2.1-m dual (80 cm between duals) and triple ( 65 cm between triples) rows, and 2.3-m triple rows (65 cm between triples) produced similar yields. Four rows (50 cm apart) on a 2.1-m configuration (quad rows) produced lower yields largely due to crop lodging, while a 1.8-m single row configuration produced lower yields in the plant crop, probably due to inadequate resource availability (water stress/limited radiation interception). The results suggest that controlled traffic can be adopted in the Australian sugar industry by changing from a 1.5-m single row to 1.8-m dual row configuration without yield penalty. Further, the similar yields obtained with wider row configurations (2 m or greater with multiple rows) in these experiments emphasise the physiological and environmental plasticity that exists in sugarcane. Controlled traffic can be implemented with these wider row configurations (>2 m), although it will be necessary to carry out expensive modifications to the current harvester and haul-out equipment. There were indications from this research that not all cultivars were suited to configurations involving multiple rows. The results suggest that consideration be given to assessing clones with different growth habits under a range of row configurations to find the most suitable plant types for controlled traffic cropping systems.

XPES studies of oxides of second- and third-row transition metals including rare earths

X-ray photoelectron spectroscopy has been employed to investigate oxides of second- and third-row transition metals, including those of rare earths. Systematics in the spin—orbit splittings and binding energies of core levels of the metals are described. In most of the cases studied, the dependence of the spin—orbit splittings on the atomic number Z is given by the relation ΔE = a(Z - Z0)4, where a is the quantum defect parameter and Z0 is the effective screening. Core-level binding energies are found to increase with the oxidation state of the metal. Most of the core-level binding energies are related to the atomic number Z by the expression E = x(Z - Z0)2, giving rise to linear plots of ln E versus ln Z. Specific features of individual oxides, with respect to satellites, multiplet structure, configuration mixing, and other properties are also discussed. The spectra of PrO2, Pr6O11, TbO2 and Tb4O7 are reported for the first time.

Determining and quantifying components of an aquaculture soundscape.

Recirculating aquaculture systems have a unique anthropogenic-based soundscape which is characterized by the type of equipment utilized, the structural configuration of walls, tanks, equipment, the substrate the tanks are situated on and even the activities of the personnel operating the facility. The soundscape of recirculation facilities is inadequately understood and remains poorly characterized, although it is generally accepted that the dominant sounds found in such facilities are within the hearing range of fish. The objective of this study was to evaluate the soundscape in a recirculating aquaculture facility from an intra-tank perspective and determine how the soundscape is shaped by a range of characteristics within the facility. Sounds were recorded across an operating aquaculture facility including different tank designs. The sounds recorded fell within previously measured pressure level ranges for recirculating systems, with the highest maximum sound pressure level (SPL) recorded at 124 dB re 1 mu Pa-2/Hz (with an FFT bin width of 46.9 Hz, centered at 187.5 Hz). The soundscape within the tanks was stratified and positively correlated with depth, the highest sound pressure occurring at the base of the tanks. Each recording of the soundscape was dominated by a frequency component of 187.5 Hz (corresponding centre of the 4th 46.9 Hz FFT analysis bin) that produced the highest observed SPL Analysis of sound recordings revealed that this peak SPL was associated with the acoustic signature of the pump. The soundscape was also evaluated for impacts of tank hood position, time of day, transient sounds and airstone particle size types, all of which were found to appreciably influence sound levels and structure within the tank environment. This study further discusses the distinctiveness of the soundscape, how it is shaped by the various operating components and considers the aquaculture soundscape in relation to natural soundscapes found within aquatic tropical environments.

A Pulsewidth Modulated Control of Induction Motor Drive Using Multilevel 12-Sided Polygonal Voltage Space Vectors

In this paper, a novel 12-sided polygonal space vector structure is proposed for an induction motor drive. The space vector pattern presented in this paper consists of two 12-sided concentric polygons with the outer polygon having a radius double the inner one. As compared to previously reported 12-sided polygonal space vector structures, this paper subdivides the space vector plane into smaller sized triangles. This helps in reducing the switching frequency of the inverters without deteriorating the output voltage quality. It also reduces the device ratings and dv/dt stress on the devices to half. At the same time, other benefits obtained from the existing 12-sided space vector structure, such as increased linear modulation range and complete elimination of 5th and 7th order harmonics in the phase voltage, are also retained in this paper. The space vector structure is realized by feeding an open-end induction motor with two conventional three-level neutral point clamped (NPC) inverters with asymmetric isolated dc link voltage sources. The neutral point voltage fluctuations in the three-level NPC inverters are eliminated by utilizing the switching state multiplicities for a space vector point. The pulsewidth modulation timings are calculated using sampled reference waveform amplitudes and are explained in detail in this paper. Experimental verification on a laboratory prototype shows that this configuration may be considered suitable for high power drives.

Hip power analysis in individuals with transfemoral amputation: A different strategy different from stabilisation during gait stance

Introduction and Objectives Joint moments and joint powers during gait are widely used to determine the effects of rehabilitation programs as well as prosthetic fitting. Following the definition of power (dot product of joint moment and joint angular velocity) it has been previously proposed to analyse the 3D angle between both vectors, αMw. Basically, joint power is maximised when both vectors are parallel and cancelled when both vectors are orthogonal. In other words, αMw < 60° reveals a propulsion configuration (more than 50% of the moment contribute to positive power) while αMw > 120° reveals a resistance configuration (more than 50% of the moment contribute to negative power). A stabilisation configuration (less than 50% of the moment contribute to power) corresponds to 60° < αMw < 120°. Previous studies demonstrated that hip joints of able-bodied adults (AB) are mainly in a stabilisation configuration (αMw about 90°) during the stance phase of gait. [1, 2] Individuals with transfemoral amputation (TFA) need to maximise joint power at the hip while controlling the prosthetic knee during stance. Therefore, we tested the hypothesis that TFAs should adopt a strategy that is different from a continuous stabilisation. The objective of this study was to compute joint power and αMw for TFA and to compare them with AB. Methods Three trials of walking at self-selected speed were analysed for 8 TFAs (7 males and 1 female, 46±10 years old, 1.78±0.08 m 82±13 kg) and 8 ABs (males, 25±3 years old, 1.75±0.04, m 67±6 kg). The joint moments are computed from a motion analysis system (Qualisys, Goteborg, Sweden) and a multi-axial transducer (JR3, Woodland, USA) mounted above the prosthetic knee for TFAs and from a motion analysis system (Motion Analysis, Santa Rosa, USA) and force plates (Bertec, Columbus, USA) for ABs. The TFAs were fitted with an OPRA (Integrum, AB, Gothengurg, Sweden) osseointegrated implant system and their prosthetic designs include pneumatic, hydraulic and microprocessor knees. Previous studies showed that the inverse dynamics computed from the multi-axial transducer is the proper method considering the absorption at the foot and resistance at the knee. Results The peak of positive power at loading response (H1) was earlier and lower for TFA compared to AB. Although the joint power is lower, the 3D angle between joint moment and joint angular velocity, αMw, reveals an obvious propulsion configuration (mean αMw about 20°) for TFA compared to a stabilisation configuration (mean αMw about 70°) for AB. The peaks of negative power at midstance (H2) and of positive power at preswing / initial swing (H3) occurred later, lower and longer for TFA compared to AB. Again, the joint powers are lower for TFA but, in this case, αMw is almost comparable (with a time lag), demonstrating a stabilisation (almost a resistance for TFA, mean αMw about 120°) and a propulsion configuration, respectively. The swing phase is not analysed in the present study. Conclusion The analysis of hip joint power may indicate that TFAs demonstrated less propulsion and resistance than ABs during the stance phase of gait. This is true from a quantitative point of view. On the contrary, the 3D angle between joint moment and joint angular velocity, αMw, reveals that TFAs have a remarkable propulsion strategy at loading response and almost a resistance strategy at midstance while ABs adopted a stabilisation strategy. The propulsion configuration, with αMw close to 0°, seems to aim at maximising the positive joint power. The configuration close to resistance, with αMw far from 180°, might aim at unlocking the prosthetic knee before swing while minimising the negative power. This analysis of both joint power and 3D angle between the joint moment and the joint angular velocity provides complementary insights into the gait strategies of TFA that can be used to support evidence-based rehabilitation and fitting of prosthetic components.

Hole Pairing In Antiferromagnetically Correlated Layered Oxides

We have considered a two-band Hubbard model having interlaced Cu-3d(x2−y2) and O-2p(x, y) orbitals representing the CuO2 square planes. Simple CuO2 -cluster calculation suggests that the additional holes created by doping stay mainly on oxygen. Motion of an oxygen hole interlacing with the antiferromagnetically correlated background of copper spins, creates a string of high energy spin configuration of finite length giving mass renormalization. Another hole of opposite spin can now anneal this string tension providing a triangular pairing potential for large pair momentum. The latter implies unusual Bose condensation of the wake-bound compact Bose-like pairs on a non-zero momentum shell. Effect of disorder favouring condensation at the mobility edge is pointed out.

Auger studies of transition metal oxides

Intra-atomic Auger transitions involving metal energy levels are found to be useful in studying the surface oxidation state as well as the oxidation of metals. Transition Metal oxides also exhibit interatomic Auger transitions, the intensities of which depend on the occupation of the metal d level. The probability of the interatomic transition is therefore highest in oxides where the metal has the d' configuration. The competition between intra-atomic and interatomic Auger transitions in oxides will be discussed as also the use of the interatomic transitions in the study of metal oxidation.

Rate capability of graphite materials as negative electrodes in lithium-ion capacitors

The lithium-ion exchange rate capability of various commercial graphite materials are evaluated using galvanostatic charge/discharge cycling in a half-cell configuration over a wide range of C-rates (0.1 similar to 60C). The results confirm that graphite is capable of de-intercalating stored charge at high rates, but has a poor intercalating rate capability. Decreasing the graphite coating thickness leads to a limited rate performance improvement of the electrode. Reducing the graphite particle size shows enhanced C-rate capability but with increased irreversible capacity loss (ICL). It is demonstrated that the rate of intercalation of lithium-ions into the graphite is significantly limited compared with the corresponding rate of de-intercalation at high C-rates. For the successful utilisation of commercially available conventional graphite as a negative electrode in a lithium-ion capacitor (LIC), its intercalation rate capability needs to be improved or oversized to accommodate high charge rates.

Wear lip formation during dry sliding

A pin-on-disc test configuration has been used to examine the formation of the strain-hardened projection, or wear lips, especially at the trailing edge of the pin during dry sliding of aluminium alloys against steel discs. The mechanism of formation of such wear lips is studied with the aid of optical and electron microscopes. The plastic deformation of the pin, growth and eventual removal of the wear lip as wear debris are elucidated. The size and shape of the wear lips in pins of different shapes, i.e. square, rectangular, triangular and circular cross-sections, are described.

Tertiary Treatment of Ayr Municipal Wastewater using Bioremediation: A Pilot-Scale Study. A Report Prepared for the Burdekin Shire Council and the Burdekin Rangeland Reef Initiative

This joint DPI/Burdekin Shire Council project assessed the efficacy of a pilot-scale biological remediation system to recover Nitrogen (N) and Phosphorous (P) nutrients from secondary treated municipal wastewater at the Ayr Sewage Treatment Plant. Additionally, this study considered potential commercial uses for by-products from the treatment system. Knowledge gained from this study can provide directions for implementing a larger-scale final effluent treatment protocol on site at the Ayr plant. Trials were conducted over 10 months and assessed nutrient removal from duckweed-based treatments and an algae/fish treatment – both as sequential and as stand-alone treatment systems. A 42.3% reduction in Total N was found through the sequential treatment system (duckweed followed by algae/fish treatment) after 6.6 days Effluent Retention Time (E.R.T.). However, duckweed treatment was responsible for the majority of this nutrient recovery (7.8 times more effective than algae/fish treatment). Likewise, Total P reduction (15.75% reduction after 6.6 days E.R.T.) was twice as great in the duckweed treatment. A phytoplankton bloom, which developed in the algae/fish tanks, reduced nutrient recovery in this treatment. A second trial tested whether the addition of fish enhanced duckweed treatment by evaluating systems with and without fish. After four weeks operation, low DO under the duckweed blanket caused fish mortalities. Decomposition of these fish led to an additional organic load and this was reflected in a breakdown of nitrogen species that showed an increase in organic nitrogen. However, the Dissolved Inorganic Nitrogen (DIN: ammonia, nitrite and nitrate) removal was similar between treatments with and without fish (57% and 59% DIN removal from incoming, respectively). Overall, three effluent residence times were evaluated using duckweed-based treatments; i.e. 3.5 days, 5.5 days and 10.4 days. Total N removal was 37.5%, 55.7% and 70.3%, respectively. The 10.4-day E.R.T. trial, however, was evaluated by sequential nutrient removal through the duckweed-minus-fish treatment followed by the duckweed-plus-fish treatment. Therefore, the 70.3% Total N removal was lower than could have been achieved at this retention time due to the abovementioned fish mortalities. Phosphorous removal from duckweed treatments was greatest after 10.4-days E.R.T. (13.6%). Plant uptake was considered the most important mechanism for this P removal since there was no clay substrate in the plastic tanks that could have contributed to P absorption as part of the natural phosphorous cycle. Duckweed inhibited phytoplankton production (therefore reducing T.S.S) and maintained pH close to neutral. DO beneath the duckweed blanket fell to below 1ppm; however, this did not limit plant production. If fish are to be used as part of the duckweed treatment, air-uplifts can be installed that maintain DO levels without disturbing surface waters. Duckweed grown in the treatments doubled its biomass on average every 5.7 days. On a per-surface area basis, 1.23kg/m2 was harvested weekly. Moisture content of duckweed was 92%, equating to a total dry weight harvest of 0.098kg/m2/week. Nutrient analysis of dried duckweed gave an N content of 6.67% and a P content of 1.27%. According to semi-quantitative analyses, harvested duckweed contained no residual elements from the effluent stream that were greater than ANZECC toxicant guidelines proposed for aquaculture. In addition, jade perch, a local aquaculture species, actively consumed and gained weight on harvested duckweed, suggesting potential for large-scale fish production using by-products from the effluent treatment process. This suggests that a duckweed-based system may be one viable option for tertiary treatment of Ayr municipal wastewater. The tertiary detention lagoon proposed by the Burdekin Shire Council, consisting of six bays approximately 290 x 35 metres (x 1.5 metres deep), would be suitable for duckweed culture with minor modification to facilitate the efficient distribution of duckweed plants across the entire available growing surface (such as floating containment grids). The effluent residence time resulting from this proposed configuration (~30 days) should be adequate to recover most effluent nutrients (certainly N) based on the current trial. Duckweed harvest techniques on this scale, however, need to be further investigated. Based on duckweed production in the current trial (1.23kg/m2/week), a weekly harvest of approximately 75 000kg (wet weight) could be expected from the proposed lagoon configuration under full duckweed production. A benefit of the proposed multi-bay lagoon is that full lagoon production of duckweed may not be needed to restore effluent to a desirable standard under the present nutrient load, and duckweed treatment may be restricted to certain bays. Restored effluent could be released without risk of contaminating the receiving waterway with duckweed by evacuating water through an internal standpipe located mid-way in the water column.