Dienstleistungsproduktivität in der Krankenhauspflege: Konzeptionelle Grundlagen und Modellentwicklung

[Fazit] Die vorliegende Arbeit hat zentrale konzeptionell-theoretische Überlegungen der Krankenhauspflegeproduktivität entwickelt und diese in einem umfasssenden integrierten Produktivitätsmodell zusammengefasst. Dabei werden erstmalig sowohl strukturelle, als auch personelle und patientenbezogene Input-Faktoren in einem Dienstleistungsproduktivitätsmodell integriert und sowohl quantitative als auch qualitative Output-Faktoren der Krankenhauspflege berücksichtigt. Dieses Modell kann als zentraler Bezugsrahmen für weitere Forschungsarbeiten zur Krankenhauspflegeproduktivität verwendet werden. Insbesondere eignet es sich als Ausgangspunkt für empirische Forschungsarbeiten, die das Modell operationalisieren und somit eine Produktivitätsmessung für die Krankenhauspflege ermöglichen. Somit könnten in weiteren Forschungsarbeiten sowohl die produktivitätsrelevanten Wirkungsbeziehungen explizit ermittelt, als auch zentrale Einflussgrößen auf die Krankenhauspflegeproduktivität identifiziert werden. Dies würde erstmals eine integrierte Betrachtung wesentlicher Stellhebel einer hohen Krankenhauspflegeproduktivität anhand von empirischen Erkenntnissen ermöglichen

Influence of Cardiovascular Risk factors on Remote Ischemic Preconditioning

A powerful therapy against microvascular endothelial ischemia-reperfusion injury is remote ischemic preconditioning (rIPC), which triggers tissue protection by exposing a limb to small cycles of vascular occlusion. Animal models indicate that CVD risk factors reduce the protective benefits of ischemic conditioning. However, there are no human studies investigating how a burden of risk factors interferes with rIPC to prevent endothelial injury. The purpose of the present study was to determine the influence of risk factor burden on the capacity of rIPC to prevent endothelial reperfusion injury in humans. Twenty-two (age: 45±14 yr., BMI: 31±8 kg/m2) sedentary adults (12 lower burden: ≤2 risk factors; 10 raised burden: 3-5 risk factors) were studied. Digital arterial tonometry (EndoPAT 2000, Itamar Medical Inc.) was used to assess microvascular endothelial vasodilation during reactive hyperemia before and after 65 min of left arm reperfusion injury (20 min brachial artery ischemia followed by 45 min reperfusion) that was preceded by rIPC (right arm: 3X5 min ischemia/reperfusion). All subjects provided written informed consent according to the Internal Review Board guidelines at South Dakota State University. Repeated measures ANOVA was used to assess group differences between the reactive hyperemia index (RHI) before and after reperfusion injury. Statistical significance was set at

Cold Air Drainage Flows and their Relation to the Formation of Nocturnal Convective Clouds at the Eastern Andes of South Ecuador

The development of clouds has many causes, not all of those are examined. In consideration of rainfall behaviour and distribution knowledge of cloud formation, processes in the tropics are of particular importance. Clouds are part of the hydrological cycle, influencing water resources and the energy budget. The insight into unknown cloud generation processes is a great benefit in the developmental procedure of understanding the structure and functionality of an ecosystem and its biodiversity. The main objective of the presented study was to investigate an unidentified nocturnal cloud formation procedure in the eastern Andes of South Ecuador and the adjacent northern Peruvian Amazon. The central theses encompass the confluence of katabatic flows in highly complex terrain due to a concave configuration. This cold drainage of air induces a surface cold front in the foothills of the eastern Andes, which initiates moisture convection due to compressional lifting by the terrain; a nocturnal LLJ triggers the development of the MCS. For the evaluation of the hypotheses the numerical model ARPS was used to analyse the not fully understood highland - lowland interactions in the PBL. At first, simulations of an accurate katabatic flow and its behaviour in complex terrain were performed with optimal conditions and without location information. The main subject of the study was the confluence of the cold drainage of air as a result of concave-lined terrain. Simplified DEMs, inspired by the Andes, were used for this analysis, due to the very steep slopes and valleys of the real terrain. A stepwise increase in their complexity, beginning with a simple slope, enabled the examination of the impact of the terrain configuration on the flow’s dynamic behaviour. With the most complex terrain model, which represents a concave ridgeline interrupted by several valleys draining into a basin, the confluence of the downslope flows due to the geometry of the terrain was demonstrated. Thus, a representative, persistent, thermally driven flow was generated, creating a convergence line that was largest in the centre of the basin. Afterwards, a simulation of a katabatically induced surface cold front with subsequent convective cloud formation was performed with the same model framework, except for the atmospheric water vapour. The simulation showed the same confluence of the downslope flows with a convergence line inside the basin as before. The development of a katabatically induced cold front was identified based on characteristic attributes described in chapter 2 using a cross-section through this line. Furthermore, the results also showed a convergence line that was largest in the centre of the basin. Because of the initiation of moisture convection in this area, due to sufficient moisture in the atmosphere, it was evident that the terrain geometry was the triggering mechanism for cloud formation. The presence of an LLJ in the basin showed the intensification of the cloud formation process. However, the previous results showed that the cluster developed primarily due to compressional lifting by the terrain. This shows that the LLJ had marginal effects on the initiation of moisture convection, acting primarily as an enhancement of its occurrence. Finally, the spatial reference was enabled and the parametrisation set-up of the idealised studies was assigned and adjusted to a multi-nested, approximately realistic model setting, strengthening the evidence from the previous results. For the study, a specific situation, selected on the basis of GOES-E satellite data was used. The main subject was the demonstration of the development of an MCS in the foothills of the eastern Andes due to the presence of katabatic flows as the driving mechanism. The GOES-E brightness temperatures were used to compare the satellite-observed data with the ARPS data to verify the simulated cloud appearance. Due to the fact that the 4 km domain revealed no convective clouds, but a convective cloud cluster was generated on the 1 km domain, a scale dependency was determined. This was caused by two factors: first of all, the NBL processes were simulated more accurately due to the higher vertical resolution, thus more accurately representing the katabatic flows. Furthermore, the higher resolved domain represented a more structured terrain, resulting in stronger convergences of the downslope flows. The comparison of the satellite and the modelled data presented a good agreement concerning the orientation, the location as well as the cold tops of the cells. A closer look at the NBL revealed cold air drainage, nourishing the cell regeneration. The typical characteristics, discussed in the idealised study without location information, confirmed the occurrence of thermally induced downslope flows as the driving process behind convective initiation

Mediating Multi-Party Disputes: Reflections on Leadership in Mediation

Leadership in mediating multi-party matters is imperative. In my work as Claims Administrator for one of the largest ever personal injury/bankruptcy settlements ($2.3 billion, net present value), I am charged with four primary areas of responsibility: (1) the efficient and fair evaluation of claims consistent with provisions of the Joint Plan of Reorganization; (2) the efficient delivery of payments to all approved claimants pursuant to the provisions of the Joint Plan; (3) the management and custody of the assets paid to the Settlement Facility; and finally (4) the faithful execution of the provisions of the Joint Plan in all respects. In my daily work I must mediate (and arbitrate) but, most important, I must LEAD. When I assumed my present position, I identified several important skills I felt a Claims Administrator needed. The skills I have identified as core competencies for this position are the same leadership skills that must be considered by mediators in multi-party mediation - dealing with ambiguity, business or industry knowledge, conflict management, ethics and values, organizing, managing and measuring work, building effective teams, written and oral communications, process management, patience, perseverance and managerial courage

TechnoNatures

Diese Dissertation untersucht am Fall von Ernährung, wie heute angesichts großer Herausforderungen die Beziehungen von Natur und Technologie verändert werden. Dazu nutzt sie theoretische Konzepte der Science and Technology Studies und verbindet diese mit einem diskursanalytischen Vorgehen. Sie entwickelt eine Analytik der Konfigurierung von TechnoNaturen, mit der sie aktuelle Entwicklungen der Ernährung in drei Fallstudien zu Konsum, Regulierung und Forschung untersucht. Sie stellt fest, dass die Konfigurierungen verschiedene Mechanismen haben, die eine Rationalität produktiver Mach- und Vereinbarkeiten realisieren.This dissertation investigates reconfigurations of food in the light of grand challenges. It analyzes how – by which means – relations of nature and technology change. The study uses theoretical concepts of Science and Technology Studies and combines them with a discourse analytical approach. It develops an analytics of TechnoNatures and conducts three case studies in the area of consumption, regulation and research. It shows that reconfigurations have different mechanisms, which realize a rationality of feasibility and compatibility

Endothelial C-type natriuretic peptide maintains vascular homeostasis

PMCID: PMC4151218Wellcome Trust (084449/Z/07/Z and 078496/Z/05/Z

Transportation of building materials, an environmental issue?

peer reviewed11. Sustainable cities and communitie

Collecting: A Process of Learning, Growth, and Forming Identity

Why do people stuff their homes full of things that have no real utility and attach such great personal attachment to them? It is the relationships involved in any action that provide a lasting sense of satisfaction. Transformation in life as with education is about being able to sit with uncertainty, asking questions, and seeking to understand with the spirit of earnest curiosity. We should seek to hold each other gently in the uncertainty of learning and growth. What if instead of focusing on rushing to meet standards and goals, we slow down and embrace the process of learning missteps and all? As we go through life we collect experiences and through relationships are gifted pieces of ourselves