Choirboy haunted by painful memories

IT was in the magnificent Manchester Cathedral that Eli Ward's pure soprano attracted the attention of the new dean, the Reverend Robert Waddington. When Waddington called for volunteers to help him polish the gold leaf on the altar railings, several choirboys came forward. Among them was Eli, a working-class 11-year-old from a council estate, who loved singing in the choir and was happy to help...

Noise levels in a General Surgical Ward : a descriptive study

Aims and objectives.  This study was undertaken to measure and analyse levels of acoustic noise in a General Surgical Ward. Method.  Measurements were undertaken using the Norsonic 116 sound level meter (SLM) recording noise levels in the internationally agreed ‘A’ weighted scale. Noise level data and observational data as to the number of staff present were obtained and recorded at 5-min intervals over three consecutive days. Results.  Results of noise level analysis indicated that mean noise level within this clinical area was 42.28 dB with acute spikes reaching 70 dB(A). The lowest noise level attained was that of 36 dB(A) during the period midnight to 7 a.m. Non-parametric testing, using Spearman's Rho (two-tailed), found a positive relationship between the number of staff present and the level of noise recorded, indicating that the presence of hospital personnel strongly influences the level of noise within this area. Relevance to clinical practice.  Whilst the results of this may seem self-evident in many respects the problems of excessive noise production and the exposure to it for patients, hospital personnel and relatives alike continues unabated. What must be of concern is the psychophysiological effects excessive noise exposure has on individuals, for example, decreased wound healing, sleep deprivation and cardiovascular stimulation.

Measuring multidisciplinary team effectiveness in a ward-based healthcare setting : development of the Team Functioning Assessment Tool

Nontechnical skills relating to team functioning are vital to the effective delivery of patient care and safety. In this study, we develop a reliable behavioral marker tool for assessing nontechnical skills that are critical to the success of ward-based multidisciplinary healthcare teams. The Team Functioning Assessment Tool (TFAT) was developed and refined using a literature review, focus groups, card-sorting exercise, field observations, and final questionnaire evaluation and refinement process. Results demonstrated that Clinical Planning, Executive Tasks, and Team Relations are important facets of effective multidisciplinary healthcare team functioning. The TFAT was also shown to yield acceptable inter-rater agreement.

Measuring ward-based multidisciplinary healthcare team functioning : a validation study of the Team Functioning Assessment Tool (TFAT)

The team functioning assessment tool (TFAT) has been shown to be a reliable behavioral marker tool for assessing nontechnical skills that are critical to the success of ward-based healthcare teams. This paper aims to refine and shorten the length of the TFAT to improve usability, and establish its reliability and construct validity. Psychometric testing based on 110 multidisciplinary healthcare teams demonstrated that the TFAT is a reliable and valid tool for measuring team members’ nontechnical skills in regards to Clinical Planning, Executive Tasks, and Team Functioning. Providing support for concurrent validity, high TFAT ratings were predicted by low levels of organizational constraints and high levels of group potency. There was also partial support for the negative relationships between time pressure, leadership ambiguity, and TFAT ratings. The paper provides a discussion on the applicability of the tool for assessing multidisciplinary healthcare team functioning in the context of improving team effectiveness and patient safety for ward-based hospital teams.

Physical activity and physical fitness in African-American girls with and without obesity

Lack of physical activity and low levels of physical fitness are thought to be contributing factors to the high prevalence of obesity in African-American girls, To examine this hypothesis, we compared habitual physical activity and physical fitness in 54 African-American girls with obesity and 96 African-American girls without obesity residing in rural South Carolina, Participation in vigorous (greater than or equal to 6 METs) (VPA) or moderate and vigorous physical activity (greater than or equal to 4 METs) (MVPA) was assessed on three consecutive days using the Previous Day Physical Activity Recall, Cardiorespiratory fitness was assessed using the PWC 170 cycle ergometer test, Upper body strength was determined at two sites via isometric cable tensiometer tests, Relative to their counterparts without obesity, girls with obesity reported significantly fewer 30-minute blocks of VPA (0.90 +/- 0.14 vs. 1.3 +/- 0.14) and MVPA (1.2 +/- 0.18 vs. 1.7 +/- 0.16) (p<0.01), Within the entire sample, VPA and MVPA were inversely associated with body mass index (r=-0.17 and r=-0.19) and triceps skinfold thickness (r=-0.19 and r=-0.22) (p<0.05), In the PWC 170 test and isometric strength tests, girls with obesity demonstrated absolute scores that were similar to, or greater than, those of girls without obesity; however, when scores were expressed relative to bodyweight, girls with obesity demonstrated significantly lower values (p<0.05). The results support the hypothesis that lack of physical activity and low physical fitness are important contributing factors in the development and/or maintenance of obesity in African-American girls.

Discharge practices for the intensive care patient : a qualitative exploration in the general ward setting

OBJECTIVE: To explore how registered nurses (RNs) in the general ward perceive discharge processes and practices for patients recently discharged from the intensive care unit (ICU). BACKGROUND: Patients discharged from the ICU environment often require complicated and multifaceted care. The ward-based RN is at the forefront of the care of this fragile patient population, yet their views and perceptions have seldom been explored. DESIGN: A qualitative grounded theory design was used to guide focus group interviews with the RN participants. METHODS: Five semi-structured focus group interviews, including 27 RN participants, were conducted in an Australian metropolitan tertiary referral hospital in 2011. Data analyses of transcripts, field notes and memos used concurrent data generation, constant comparative analysis and theoretical sampling. RESULTS: Results yielded a core category of 'two worlds' stressing the disconnectedness between ICU and the ward setting. This category was divided into sub categories of 'communication disconnect' and 'remember the family'. Properties of 'what we say', 'what we write', 'transfer' and 'information needs' respectively were developed within those sub-categories. CONCLUSION: The discharge process for patients within the ICU setting is complicated and largely underappreciated. There are fundamental, misunderstood differences in prioritisation and care of patients between the areas, with a deep understanding of practice requirements of ward based RNs not being understood. The findings of this research may be used to facilitate inter departmental communications and progress practice development.

Prediction of compressive strength of SCC and HPC with high volume fly ash using ANN

An artificial neural network (ANN) is presented to predict a 28-day compressive strength of a normal and high strength self compacting concrete (SCC) and high performance concrete (HPC) with high volume fly ash. The ANN is trained by the data available in literature on normal volume fly ash because data on SCC with high volume fly ash is not available in sufficient quantity. Further, while predicting the strength of HPC the same data meant for SCC has been used to train in order to economise on computational effort. The compressive strengths of SCC and HPC as well as slump flow of SCC estimated by the proposed neural network are validated by experimental results.

The Homeless Etiquette : Social Interaction and Behavior Among the Homeless in Taito Ward, Tokyo

The thesis focuses on the social interaction and behavior of the homeless living in Tokyo's Taito Ward. The study is based on the author's own ethnographic field research carried out in the autumn 2003. The chosen methodologies were based on the methodology called "participant observation", and they were used depending on the context. The ethnographic field research was carried out from the mid-August to the beginning of the October in 2003. The most important targets of the research were three separate loosely knit groups placed in certain parts of Taito Ward. One of these groups was based in proximity to the Ueno train station, one group gathered every morning around a homeless support organization called San'yûkai, and one was based in Tamahime Park located in the old San'ya area of Tokyo. The analysis is based on the aspects of Takie Sugiyama Lebra's theory of "social relativism". Lebra's theory consists of the following, arguably universal aspects: belongingness, empathy, dependence, place in the society, and reciprocity. In addition, all the interaction and behavior is tied to the context and the situation. According to Lebra, ritual and intimate situations produce similar action, which is socially relative. Of these, the norms of the ritual behavior are more regulated, while the intimate bahavior is less spontaneous. On the contrary, an anomic situation produces anomic behavior, which is not socially relative. Lebra's theory is critically reviewed by the author of the thesis, and the author has attempted to modify the theory to make it more adaptable to the present-day society and to the analysis. Erving Goffman's views of the social interaction and Anthony Giddens' theories about the social structures have been used as complementary thoretical basis. The aim of the thesis is to clarify, how and why the interaction and the behavior of some homeless individuals in some situations follow the aspects of Lebra's "social relativism", and on the other hand, why in some situations they do not. In the latter cases the answers can be sought from regional and individual differences, or from the inaptness of the theory to analyze the presented situation. Here, a significant factor is the major finding of the field study: the so called "homeless etiquette", which is an abstract set of norms and values that influences the social interaction and behavior of the homeless, and with which many homeless individuals presented in the study complied. The fundamental goal of the thesis is to reach profound understanding about the daily life of the homeless, whose lives were studied. The author argues that this kind of profound understanding is necessary in looking for sustainable solutions in the areas of social and housing policy to improve the position of the homeless and the qualitative functioning of the society.

Ulkomaisen kirjallisuuden tuonti Suomeen 1800-luvun alkupuolella : Waseniuksen kirjakaupan kansainväliset yhteydet 1823-1836

Opinnäytetyöni tarkastelee eurooppalaisen kulttuurin kannalta keskeistä kommunikaatiovälinettä, painettua kirjaa, ja sen kansainvälistä luonnetta ja liikkumista. Teemaan perehdytään helsinkiläisen Gustaf Otto Waseniuksen (1789-1852) kirjakaupan toiminnan avulla keskittyen tarkastelemaan ulkomaisen kirjallisuuden tuomista Suomeen 1800-luvun alkupuolella. Tutkielma käsittelee ensisijaisesti itse kauppiastoimintaa: mitä kirjakauppayhteyksiä Waseniuksella oli sekä miten ja keiden ehdoilla ne toimivat. Näiden kysymysten ohessa pohdin myös itse kirjojen välityksellä tapahtunutta tiedonvälitystä. Työn tavoitteena on paljastaa, minkälaisia suomalaisten kirjakauppiaiden ja lukijoiden kirjallisuudenhankinnan sekä lukemisen kontekstit ja resurssit olivat 1800-luvun alkupuolella. Tutkielman lähteinä on käytetty Waseniuksen kirjakaupan kirjeitä ja kuitteja sekä sensuuriviranomaisten arkistoja. Tutkielmani jakautuu kolmeen osaan. Ensiksi paneudun Waseniuksen kauppaverkoston syntyyn ja sen esittelyyn: Waseniuksen kansainväliset yhteydet keskittyivät kolmelle kulttuurialueelle. Ruotsista hän sai kirjoja kaikilta merkittäviltä kustantajilta, kauppiailta sekä itsenäisesti toimivilta kirjailijoilta. Saksankielisen kulttuurin tarjontaa Wasenius pystyi hankkimaan Leipzigin kansainvälisten kirjakauppiaiden avulla. Ranskalaisen kirjallisuuden osalta Wasenius omasi toimivat yhteydet Pariisin kirjakauppiaisiin. Sen sijaan Brittein saaret jäivät vielä Waseniuksen kontaktiverkoston ulkopuolelle, samoin myös Pietarin huomattava kulttuurikeskus. Tämän jälkeen keskityn yhteyksien toimintaan. Wasenius solmi kauppakumppaniensa kanssa yleiseurooppalaisen komissionääri-sopimuksen, jonka valtuuttamana hän sai myydä kunkin ulkomaisen kauppiaan tuotteita liikkeessään. Ensiksi tarkastelen kauppiaiden välisten etäisyyksien ylittämistä. Aikakauden kuljetustavat huomioonottaen suuret etäisyydet eivät Waseniuksen kirjojen hankintaa juuri haitanneet, vaan suurkauppiaana hän pystyi käyttämään aikansa parhaat resurssit lähetystensä kuljettamiseen. Toiseksi pohdin aikakauden kauppiastoimintojen ja kulttuuripiirteiden vaikutusta kirjakauppaan. Waseniuksen toiminta kirjakauppiaana perustui taloudellisen voiton tavoittelulle, mikä tarkoitti mm. sitä, että lähetysten sisältö määrättiin etukäteen hyvin tarkasti. Ennen Suomeen saapumistaan kirjoilla piti olla varma ostaja, minkä Wasenius useimmiten varmisti ennakkotilausluetteloin ja etumaksuin. Kolmanneksi esiin nousevat 1800-luvun alun poliittiset tapahtumat, jotka osaltaan, kauppiaan silmiin kaikkein näkyvimmin, vaikuttivat kirjojen tuontiin. Sensuurin piti periaatteessa estää useiden satojen vaarallisena pidetyn kirjan levittäminen ja lukeminen Suomessa, mutta Wasenius ei suinkaan lopettanut kiellettyjen kirjojen tuontia, vaan salakuljetti sensuroitavia teoksia jatkuvasti liikkeeseensä myytäväksi. Suomalaiset viranomaiset hyväksyivät usein tämänkaltaisen toiminnan, joten venäläistä sensuuriasetusta tai hallintoa ei juuri kunnioitettu. Vertailu eurooppalaiseen kirjakauppatoimintaan osoittaa Waseniuksen omanneen erittäin hyvät kansainväliset suhteet. Tämä kuitenkin johtui niin kirjakauppatoiminnan keskittymisestä harvojen kauppiaiden käsiin kuin myös oman kustannustoiminnan vähyydestä. Tiedonvälityksen kehityksen ja kulttuurihistorian kannalta Waseniuksen kansainvälinen toiminta osoittautuu noudattelevan vielä vanhan eliittikulttuurin muotoja, mutta kirjakauppainstituution kehittyminen aivan uudenlaiseen kukoistukseen valmisteli jo kansallisen kulttuurin nousemista lähivuosikymmeninä.

Phase relations between Al2O3---Cr2O3 and FeAl2O4---FeCr2O4 solid solutions at 1823 K

Tie-lines between the corundum and spinel solid solutions have been determined experimentally at 1823 K. Next, activities of FeCr2O4 and FeAl2O4 in the spinel solid solution were determined by combining the tie-line data with literature values for the activities of Cr2O3 and Al2O3 in the corundum phase. Activities and the Gibbs energy of mixing for the spinel solid solution were also obtained from a model based on cation distribution between nonequivalent crystallographic sites in the oxide lattice. The difference between the Gibbs energy of mixing obtained experimentally and from the model has been attributed to a strain enthalpy term which is relatively unchanged in magnitude from the reported at 1373 K. The integral enthalpy of mixing obtained from experimental data at 1373 and 1823 K using the second law is compared with the model result.

Ann and Grete Unger seated outdoors with Dick and Gitta Meier with their infant daughter Karen.

Digital Image

Feasibility of a stepped wedge cluster RCT and concurrent observational sub-study to evaluate the effects of modified ward night lighting on inpatient fall rates and sleep quality: A protocol for a pilot trial

Background: Falls among hospitalised patients impose a considerable burden on health systems globally and prevention is a priority. Some patient-level interventions have been effective in reducing falls, but others have not. An alternative and promising approach to reducing inpatient falls is through the modification of the hospital physical environment and the night lighting of hospital wards is a leading candidate for investigation. In this pilot trial, we will determine the feasibility of conducting a main trial to evaluate the effects of modified night lighting on inpatient ward level fall rates. We will test also the feasibility of collecting novel forms of patient level data through a concurrent observational sub-study. Methods/design: A stepped wedge, cluster randomised controlled trial will be conducted in six inpatient wards over 14 months in a metropolitan teaching hospital in Brisbane (Australia). The intervention will consist of supplementary night lighting installed across all patient rooms within study wards. The planned placement of luminaires, configurations and spectral characteristics are based on prior published research and pre-trial testing and modification. We will collect data on rates of falls on study wards (falls per 1000 patient days), the proportion of patients who fall once or more, and average length of stay. We will recruit two patients per ward per month to a concurrent observational sub-study aimed at understanding potential impacts on a range of patient sleep and mobility behaviour. The effect on the environment will be monitored with sensors to detect variation in light levels and night-time room activity. We will also collect data on possible patient-level confounders including demographics, pre-admission sleep quality, reported vision, hearing impairment and functional status. Discussion: This pragmatic pilot trial will assess the feasibility of conducting a main trial to investigate the effects of modified night lighting on inpatient fall rates using several new methods previously untested in the context of environmental modifications and patient safety. Pilot data collected through both parts of the trial will be utilised to inform sample size calculations, trial design and final data collection methods for a subsequent main trial.

Mauerberger Family 1823-1957

Photocopy of family tree of Mauerberger and related families.

Characterization of Failure Modes in CFRP Composites - An ANN Approach

Carbon fiber reinforced polymer (CFRP) composite specimens with different thickness, geometry, and stacking sequences were subjected to fatigue spectrum loading in stages. Another set of specimens was subjected to static compression load. On-line acoustic Emission (AE) monitoring was carried out during these tests. Two artificial neural networks, Kohonen-self organizing feature map (KSOM), and multi-layer perceptron (MLP) have been developed for AE signal analysis. AE signals from specimens were clustered using the unsupervised learning KSOM. These clusters were correlated to the failure modes using available a priori information such as AE signal amplitude distributions, time of occurrence of signals, ultrasonic imaging, design of the laminates (stacking sequences, orientation of fibers), and AE parametric plots. Thereafter, AE signals generated from the rest of the specimens were classified by supervised learning MLP. The network developed is made suitable for on-line monitoring of AE signals in the presence of noise, which can be used for detection and identification of failure modes and their growth. The results indicate that the characteristics of AE signals from different failure modes in CFRP remain largely unaffected by the type of load, fiber orientation, and stacking sequences, they being representatives of the type of failure phenomena. The type of loading can have effect only on the extent of damage allowed before the specimens fail and hence on the number of AE signals during the test. The artificial neural networks (ANN) developed and the methods and procedures adopted show significant success in AE signal characterization under noisy environment (detection and identification of failure modes and their growth).