Manual The Operation - Putting Him Under: Two Journeys in the Female-Led.

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Putting behavioral psychology back” perspective driven by the customer's wants, not a company's traditional its customers; and the essential link between customer experience and value operations but forget to look at them through the eyes . Exhibit 2. Best-in-class companies optimize customer journeys, not just.
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It can "go down the wrong pipe" called aspiration and block the airway or get into the lung. Or, it may be toxic and make the child sick. Here, Jill Jeffe, MD , a pediatric ear, nose and throat specialist at Rush University Medical Center, identifies four common culprits — and offers advice for preventing mishaps. Babies and toddlers are attracted to shiny objects, like coins.

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So it's no surprise that about 75 percent of the objects found in children's esophagi are coins. Although you don't want anything to get trapped in a child's esophagus, coins and most other items — unless they are sharp — usually won't cause much damage if they are removed in a timely fashion. They may need to be removed in the operating room, but afterward the child is usually fine. The most notable exception: button batteries, found in everything from key fobs to talking storybooks. They look like coins, especially to a child, but they are far more perilous.

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Why are button batteries dangerous? When one gets stuck in the esophagus, the mucus membrane on both sides completes the battery's circuit. This generates a current, even if the battery is thought to be "dead" because it can't power an electronic device. While a button battery in the nose is not as deadly, it can still lead to severe injuries.

The most serious: perforation in the septum the thin wall of cartilage that divides the nasal cavities , which can create a "saddle nose" deformity, or droopy nose, that requires surgery to repair later in life. Even in the ear — which is lined with skin — a button battery can do damage through leakage of electrolytes, which can eat away at the skin, cartilage and bone.

This is a set-up for infection, scarring and other serious problems.

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What to do if swallowed or stuck. Take your child to the emergency room immediately if you suspect he or she has swallowed a button battery, or has one trapped in a nostril or ear. If it is a button battery, there's a very short treatment window," Jeffe says. An ounce of prevention. Warn kids about putting anything other than food in their mouths, especially round, shiny objects. And always store and dispose of button batteries in places where children can't reach them.


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Food is one of the biggest choking hazards for kids under the age of five, and especially under age three. When is food potentially dangerous? There are several concerns when it comes to food and kids:. First, make sure foods like hot dogs, grapes and carrots are cut into tiny pieces. Children younger than five should never be given hard candies or gum, especially gumballs.

In a child-sized esophagus, even a seemingly small hard candy or gumball can get stuck. Touted as a more convenient way to get clothes or dishes clean, detergent pods burst onto the scene in But this popular product has since proven to be a serious threat to young children. From January 1 to April 30, , alone, poison control centers received reports of more than 3, exposures any type of contact, not just poisonings or overdoses to laundry detergent pods by children age 5 and younger. Why are detergent pods dangerous?

Brightly colored, squishy and bite-sized, the pods can look like toys or food to babies and young children. They are easy for tiny hands to grasp, and can fit in a child's mouth. But within the pretty packaging are harsh chemicals, and the pods tend to be highly concentrated compared to traditional liquid or powdered detergents.

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That means they can do a lot more damage. Spent horses were replaced with fresh horses at stage stations , posts, or relays. In addition to the stage driver or coachman who guided the vehicle, a shotgun messenger armed with a coach gun might travel as a guard beside him. A simplified and lightened vehicle known as a stage wagon , mud-coach, or mud-wagon, was used in the United States under difficult conditions.

A canvas-topped wagon had a lower center of gravity, and it could not be loaded on the roof with heavy freight or passengers as an enclosed coach so often was. A stagecoach traveled at an average speed of about 5 miles per hour 8.

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The first crude depiction of a coach was in an English manuscript from the 13th century. This was followed by a steady proliferation of other routes around the island. The stagecoach would depart every Monday and Thursday and took roughly ten days to make the journey during the summer months.

Stagecoaches also became widely adopted for travel in and around London by mid-century and generally travelled at a few miles per hour. Shakespeare 's first plays were performed at coaching inns such as The George Inn, Southwark. By the end of the 17th century stagecoach routes ran up and down the three main roads in England. The novelty of this method of transport excited much controversy at the time.


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  7. One pamphleteer denounced the stagecoach as a "great evil [ Besides the excellent arrangement of conveying men and letters on horseback, there is of late such an admirable commodiousness, both for men and women, to travel from London to the principal towns in the country, that the like hath not been known in the world, and that is by stage-coaches, wherein any one may be transported to any place, sheltered from foul weather and foul ways; free from endamaging of one's health and one's body by the hard jogging or over-violent motion; and this not only at a low price about a shilling for every five miles , but with such velocity and speed in one hour, as that the posts in some foreign countries make in a day.

    The speed of travel remained constant until the midth century. Reforms of the turnpike trusts , new methods of road building and the improved construction of coaches led to a sustained rise in the comfort and speed of the average journey - from an average journey length of 2 days for the Cambridge -London route in to a length of under 7 hours in Robert Hooke helped in the construction of some of the first spring-suspended coaches in the s and spoked wheels with iron rim brakes were introduced, improving the characteristics of the coach.

    In , a Manchester -based company began a new service called the "Flying Coach". It was advertised with the following announcement - "However incredible it may appear, this coach will actually barring accidents arrive in London in four days and a half after leaving Manchester. This coach took an unprecedented three days to reach London with an average speed of eight miles per hour. The postal delivery service in Britain had existed in the same form for about years—from its introduction in , mounted carriers had ridden between "posts" where the postmaster would remove the letters for the local area before handing the remaining letters and any additions to the next rider.

    The riders were frequent targets for robbers, and the system was inefficient. Palmer made much use of the "flying" stagecoach services between cities in the course of his business, and noted that it seemed far more efficient than the system of mail delivery then in operation. His travel from Bath to London took a single day to the mail's three days. It occurred to him that this stagecoach service could be developed into a national mail delivery service, so in he suggested to the Post Office in London that they take up the idea.

    He met resistance from officials who believed that the existing system could not be improved, but eventually the Chancellor of the Exchequer , William Pitt , allowed him to carry out an experimental run between Bristol and London. Under the old system the journey had taken up to 38 hours. Impressed by the trial run, Pitt authorised the creation of new routes.

    Within the month the service had been extended from London to Norwich , Nottingham , Liverpool and Manchester , and by the end of services to the following major towns and cities of England and Wales had also been linked: Leeds , Dover , Portsmouth , Poole , Exeter , Gloucester , Worcester , Holyhead and Carlisle. A service to Edinburgh was added the next year, and Palmer was rewarded by being made Surveyor and Comptroller General of the Post Office.

    The period from to saw great improvements in the design of coaches, notably by John Besant in and His coach had a greatly improved turning capacity and braking system , and a novel feature that prevented the wheels from falling off while the coach was in motion.

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    Besant, with his partner John Vidler, enjoyed a monopoly on the supply of stagecoaches to the Royal Mail and a virtual monopoly on their upkeep and servicing for the following few decades. Steel springs had been used in suspensions for vehicles since His patent lasted 14 years delaying development because Elliott allowed no others to license and use his patent. Elliott mounted each wheel with two durable elliptic steel leaf springs on each side and the body of the carriage was fixed directly to the springs attached to the axles.

    After the expiry of his patent most British horse carriages were equipped with elliptic springs; wooden springs in the case of light one-horse vehicles to avoid taxation, and steel springs in larger vehicles. Steady improvements in road construction were also made at this time, most importantly the widespread implementation of Macadam roads up and down the country. The speed of coaches in this period rose from around 6 miles per hour including stops for provisioning to 8 miles per hour [14] and greatly increased the level of mobility in the country, both for people and for mail.