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Ennis & Harrington (2001) found that only 25% of the hospitals they surveyed had formal TQM programs, and half of those had started in the year prior to the survey. In sum, service companies have paid relatively little attention to competing through high-commitment work practices that invest in the skills of the workforce and provide opportunities for employee participation and collaboration in teams. National surveys show that service industries have lagged behind manufacturing in the use of high-commitment work practices, at least in the USA. For example, a 1993 national survey of establishments by the US Bureau of Labor Statistics found that 56% of manufacturing plants used at least one innovative practice (use of teams, TQM, job rotation or quality circles), but only 36% of retail rms and 41% of all service rms did (Gittleman, Horrigan & Joyce, 1998). Hunter s (2000) analysis of a US national establishment survey found that service establishments were roughly half as likely as manufacturing establishments to use TQM and self-managed teams. Our brief review of several major service industries suggests that rms have responded to intensi ed competition primarily by cutting costs and using new technologies to compete on product and process innovation. They have made relatively little use of innovative human resource practices, and where they have, these are in workplaces serving business or highvalue-added customers. The question, then, is how and why quality service strategies and high-commitment practices can lead to better performance in a broader array of service activities, particularly in the mass market.

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3.4 Increase memory Verify hardware and OS support for capacity increase Verify memory is on hardware/vendor compatibility list Verify memory compatibility (e.g., speed, brand, capacity, EDI, ECC/non-ECC, SDRAM/RDRAM) Verify that server and OS recognize the added memory Perform server optimization to make use of additional RAM Follow these steps to correctly install new memory:

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Thyroid disease is common, affecting approximately 5% of the population over their lifetime. Women have a 5 7 times higher incidence of thyroid disease than men. The peak incidence of the disease is over the age of 40 years but is common in the college age population. Screening for thyroid disease is controversial in the general population, and in the athletic population it is even more controversial. The recommendation for the general population is every 5 years in women over 35 years (Danese et al. 1996). Thyroid problems will affect performance and should be considered in athletes with reduced performance. Thyroid screening has been proposed for the elite athlete during the preparticipation physical examination (Mellman & Podesta 1997). This is hardly justi able in the elite Olympic athlete and should not be recommended in the general asymptomatic athletic population. Screening should start with thyroid-stimulating hormone (TSH) because it is a very sensitive screening test for thyroid disease. Once an abnormal value is obtained further testing should be carried out based on symptoms and clinical suspicion.

(Publisher: John Wiley & Sons, Inc.) Author(s): Carl Franklin ISBN: 0471314986 Publication Date: 02/01/99

Table 18.14 Clinical signs and symptoms of anaphylaxis. Oral Cutaneous Gastrointestinal Respiratory Pruritus of lips, tongue, and palate and edema of lips and tongue Metallic taste in the mouth Flushing, pruritus, urticaria, angioedema, morbilliform rash, and pilor erecti Nausea, abdominal pain (colic), vomiting (large amounts of stringy mucus), and diarrhea Laryngeal Pruritus, and tightness in the throat, dysphagia, dysphonia and hoarseness, dry staccato cough Ears Sensation of itching in the external auditory canal Lungs Shortness of breath, dyspnea, chest tightness, deep cough, and wheezing Nose Pruritus, congestion, rhinorrhea, and sneezing Feeling of faintness, syncope, chest pain, dysrhythmia, hypotension

Exhibit 8.4 Scenario 1: Five-Year Pro Forma Income Statement. (from Berges Investment Group, Copyright 1998)

The focus of this chapter has been the resources that comprise the system, called the physical architecture The system is rst segmented into its top-level components; the segmentation progresses down to the con guration items (CIs), or hardware and software elements, facilities, people, procedures, and user s manuals The physical architecture can be either generic or instantiated; the generic physical architecture is an abstract separation of the system s resources into components before any key performance decisions are made The instantiated physical architecture speci es the performance characteristics of each element of the generic physical architecture to the degree needed for performance modeling of the system Creativity techniques are important to aid the generation of alternate, instantiated physical architectures.

The morphological box was described in detail and illustrated as an effective technique for gathering creative ideas and increasing the chances of combining these creative ideas into a sound, instantiated physical architecture The morphological box is de ned by the generic physical architecture and then provides slots for alternate ideas for instantiated physical components of each segment Representing the physical architecture using a block diagram was presented in this chapter Block diagrams are completely non-standardized representations of the system s components, showing the major ows of electromechanical energy between the components Finally, key concepts, such as centralized and decentralized and distributed and client server architectures were presented The decentralization of transformation and control functions and the distribution of functional and physical elements of the architecture have become the norm in most system s architectures These concepts were de ned and illustrated.

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