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Both Washington and American business are concerned about U.S. international trade performance and various export‐finance and related support undertakings. This paper examines the significant transition in the government’s export‐credit insurance program in terms of a major alteration of the relationship between the Export‐Import Bank and Foreign Credit Insurance Association. The result is a case study of how level and delivery of export‐credit support must be carefully evaluated by marketing executives operating in today’s global business environment.

While export‐credit insurance is traditionally utilized by exporters to protect foreign receivables, to facilitate domestic financing, or to match credit terms of competitors, there is an interesting fourth function. The exporter targeting a creditworthy foreign customer within a country undergoing a temporary economic disruption can use export‐credit insurance to provide a key addition to the foreign customer's working capital needs. This paper quantifies the working capital gains for a Mexican importer when a U.S. exporter liberalizes payment terms by using export‐credit insurance and so alleviates the importer otherwise confronting sharply higher short‐term domestic borrowing costs and a depreciating peso.

Small exporters often confront a reluctance of financial institutions to extend short‐term credit lines needed to meet the manufacturing and related marketing costs associated with an overseas order. This problem has been particularly acute in the United States in the last decade as many regional banks sought to avoid such “international” risk as accepting foreign receivables as collateral for such a working capital loan. This paper examines the evolution and success of a newly‐enhanced Working Capital Guarantee Program instituted by the Export‐Import Bank of the United States (Eximbank) that encourages local financial institutions to extend lines that selectively enable smaller firms to meet export orders.

The case is strong for declaring an inadequacy of export finance for small business. In 1988–90, the documentation has expanded beyond that of academic research and claims by the Small Business Administration to Congressional testimony by exporters and bankers, surveys by trade associations of manufacturers and bankers, and investigations by the Government's export finance agency as well as our central bank. Nonetheless, small business is exhorted to look abroad in its marketing efforts and so to participate in reducing the U.S. trade deficit. As one means of alleviating this international marketing challenge, the Export‐Import Bank of the United States (Eximbank) has moved to convert a pilot program of 1988–89 into a fall‐fledged decentralized effort to deliver export finance to qualified small firms. The intention is that carefully trained administrators in selected states will be able to match qualified exporters with financial institutions and thereby assure that the small firms receive working capital in adequate quantity to meet terms and conditions of an export contract. While Eximbank's staff is poised to support the marketing and credit analysis work of the state/local administrators, this paper examines the need for a fully cooperative effort among four parties or groups in the face of a national retrenchment by many banks in the provision of export finance for small firms.

This paper seeks to investigate how consumers in Victorian America related prices to quality and value in deliberations about urban life, housing, and a newly‐emerging consumerism. The objectives are to understand pricing practices of firms and the behavior and perception of prices by consumers in Victorian American and to determine whether Victorian pricing practices could provide important insights for twenty‐first century theory and practice.

The paper conducted a qualitative content analysis of pricing highlighted in a large sample of three cartoons appearing weekly in Puck and Judge. In these preeminent satirical magazines of the 1880‐1910 era, the authors found cartoons to be reflective of pricing practices and resultant consumer behavior of that era.

The paper confirms even on a satirical research basis that Victorian households indeed experienced price‐related stresses in urban life, housing decisions, and in daily consumption. It also reveals that during industrial revolution, rapid urbanization, waves of immigration, and a stratification of wealth, price is not only money but also time, effort, and psychic energy.

The study confirms that pricing has long influenced consumer decision making and that, even historically, price was perceived primarily as a sacrifice to obtain a product. The study uses archival data to underscore the fact that product prices are evaluated in terms of consumers' everyday life decisions.

Achieving reliable instrument reprocessing requires finding the right balance among cost, productivity, and safety. However, there have been few attempts to comprehensively examine sterile processing department (SPD) work systems. We considered an SPD as an example of a socio-technical system – where people, tools, technologies, the work environment, and the organization mutually interact – and applied work systems analysis (WSA) to provide a framework for future intervention and improvement.

The study was conducted at two SPD facilities at a 700-bed academic medical center servicing 56 onsite clinics, 31 operating rooms (ORs), and nine ambulatory centers. Process maps, task analyses, abstraction hierarchies, and variance matrices were developed through direct observations of reprocessing work and staff interviews and iteratively refined based on feedback from an expert group composed of eight staff from SPD, infection control, performance improvement, quality and safety, and perioperative services. Performance sampling conducted focused on specific challenges observed, interruptions during case cart preparation, and analysis of tray defect data from administrative databases.

Across five main sterilization tasks (prepare load, perform double-checks, run sterilizers, place trays in cooling, and test the biological indicator), variance analysis identified 16 failures created by 21 performance shaping factors (PSFs), leading to nine different outcome variations. Case cart preparation involved three main tasks: storing trays, picking cases, and prioritizing trays. Variance analysis for case cart preparation identified 11 different failures, 16 different PSFs, and seven different outcomes. Approximately 1% of cases had a tray with a sterilization or case cart preparation defect and 13.5 interruptions per hour were noted during case cart preparation.

While highly dependent upon the individual skills of the sterile processing technicians, making the sterilization process less complex and more visible, managing interruptions during case cart preparation, improving communication with the OR, and improving workspace and technology design could enhance performance in instrument reprocessing.

Attention was called in the March number of this Journal to the promotion of a Bill for the reconstitution of the Local Government Board, and the opinion was expressed that the renovated Department should contain among its staff “experts of the first rank in all the branches of science from which the knowledge essential for efficient administration can be drawn.”

Since the publication of the report “To Err Is Human: Building a Safer Health System” by the US Institute of Medicine in 2000, much has changed with regard to patient safety. Many of the more recent initiatives to improve patient safety target the behavior of health care staff (e.g., training, double-checking procedures, and standard operating procedures). System-based interventions have so far received less attention, even though they produce more substantial improvements, being less dependent on individuals’ behavior. One type of system-based intervention that can benefit patient safety involves improvements to hospital design. Given that people’s working environments affect their behavior, good design at a systemic level not only enables staff to work more efficiently; it can also prevent errors and mishaps, which can have serious consequences for patients. While an increasing number of studies have demonstrated the effect of hospital design on patient safety, this knowledge is not easily accessible to clinicians, practitioners, risk managers, and other decision-makers, such as designers and architects of health care facilities. This is why the Swiss Patient Safety Foundation launched its project, “More Patient Safety by Design: Systemic Approaches for Hospitals,” which is presented in this chapter.

If additional evidence were needed of the connection between food supply and the spread of infectious disease, it would be found in a report recently presented to the Finsbury Borough Council by its Medical Officer of Health, Dr. GEORGE NEWMAN. It appears that in the early part of May a number of cases of scarlet fever were notified to Dr. NEWMAN, and upon inquiry being made it was ascertained that nearly the whole of these cases had partaken of milk from a particular dairy. A most pains‐taking investigation was at once instituted, and the source of the supply was traced to a farm in the Midlands, where two or three persons were found recovering from scarlet fever. The wholesale man in London, to whom the milk was consigned, at first denied that any of this particular supply had been sent to shops in the Finsbury district, but it was eventually discovered that one, or possibly two, churns had been delivered one morning, with the result that a number of persons contracted the disease. One of the most interesting points in Dr. NEWMAN'S report is that three of these cases, occurring in one family, received milk from a person who was not a customer of the wholesale dealer mentioned above. It transpired on the examination of this last retailer's servants that on the particular morning on which the infected churn of milk had been sent into Finsbury, one of them, running short, had borrowed a quart from another milkman, and had immediately delivered it at the house in which these three cases subsequently developed. The quantity he happened to borrow was a portion of the contents of the infected churn.

Aarhus Kommunes Biblioteker (Teknisk Bibliotek), Ingerslevs Plads 7, Aarhus, Denmark. Representative: V. NEDERGAARD PEDERSEN (Librarian).