Patient safety in health care professional educational curricula: examining the learning experience

This study has investigated the formal and informal ways pre-registration students from four healthcare professions learn about patient safety in order to become safe practitioners. The study aims to understand some of the issues which impact upon teaching, learning and practising patient safety in academic, organisational and practice „knowledge? contexts. In Stage 1 we used a convenience sample of 13 educational providers across England and Scotland linked with five universities running traditional and innovative courses for doctors, nurses, pharmacists and physiotherapists. We gathered examples of existing curriculum documents for detailed analysis, and interviewed course directors and similar informants. In Stage 2 we undertook 8 case studies to develop an in-depth investigation of learning and practice by students and newly qualified practitioners in universities and practice settings in relation to patient safety. Data were gathered to explore the planning and implementation of patient safety curricula; the safety culture of the places where learning and working take place; the student teacher interface; and the influence of role models and organisational culture on practice. Data from observation, focus groups and interviews were transcribed and coded independently by more than one of the research team. Analysis was iterative and ongoing throughout the study. NHS policy is being taken seriously by course leaders, and Patient Safety material is being incorporated into both formal and informal curricula. Patient safety in the curriculum is largely implicit rather than explicit. All students very much value the practice context for learning about patient safety. However, resource issues, peer pressure and client factors can influence safe practice. Variations exist in students? experience, in approach between university tutors, different placement locations – the experience each offers – and the quality of the supervision available. Relationships with the mentor or clinical educator are vital to student learning. The role model offered and the relationship established affects how confident students feel to challenge unsafe practice in others. Clinicians are conscious of the tension between their responsibilities as clinicians (keeping patients safe), and as educators (allowing students to learn under supervision). There are some apparent gaps in curricular content where relevant evidence already exists – these include the epidemiology of adverse events and error, root cause analysis and quality assessment. Reference to the organisational context is often absent from course content and exposure limited. For example, incident reporting is not being incorporated to any great extent in undergraduate curricula. Newly qualified staff were aware of the need to be seen to practice in an evidence based way, and, for some at least, the need to modify „the standard? way of doing things to do „what?s best for the patient?. A number of recommendations have been made, some generic and others specific to individual professions. Regulators? expectations of courses in relation to patient 9 safety education should be explicit and regularly reviewed. Educators in all disciplines need to be effective role models who are clear about how to help students to learn about patient safety. All courses should be able to highlight a vertical integrated thread of teaching and learning related to patient safety in their curricula. This should be clear to staff and students. Assessment for this element should also be identifiable as assessment remains important in driving learning. All students need to be enabled to constructively challenge unsafe or non-standard practice. Encounters with patients and learning about their experiences and concerns are helpful in consolidating learning. Further innovative approaches should be developed to make patient safety issues 'real' for students

Trend Breaks and Seasonality in the Yugoslav Black Market for Dollars, 1974-1987

We estimate a model of the black market premium for dollars in Yugoslavia from 1974-1987. Unlike previous applications of the model, our analysis addresses nonstationarity in the underlying data by allowing for trend breaks. Endogenous structural break tests indicate the presence of breaks closely associated with the death of Tito and changes in laws affecting the operation of the black market. After accounting for these breaks, we find strong support for the underlying model. In addition, we find evidence consistent with the era of increased government involvement in the black market leading to greater volatility of the premium following regime change.

BARRIERS TO ATTAINING HIGHER EDUCATION AMONG SUBSTANCE ABUSE COUNSELORS

Twenty-three million people over the age of 12 meet criteria for a substance use disorder. Drug overdose is currently the number one cause of injury-related death in the US. From 1999 to 2017, almost 218,000 people died from overdoses related to opioids. In 2017, opioid overdoses were five times higher than they were in 1999. The financial cost of substance abuse in the US is estimated at $700 billion annually. Evidence-based approaches have been shown to improve outcomes, yet substance use treatment has the lowest rates of utilization of evidence-based practices of any health care discipline. Graduate level education has been shown to increase the use of evidence-based practice. However, most states require low educational requirements for substance abuse counselors. This gap in education negatively impacts the use of evidence-based practice and is linked to many ethical issues in the field. Many studies have looked at the role of education in the use of evidence-based practices but little is understood regarding the multiple barriers substance abuse counselors experience. A mixed-methods study was conducted to investigate these barriers to higher education among substance abuse counselors in New York State. In a total of 124 participants, a significant correlation was observed between counselor’s willingness to pursue a graduate level degree and their beliefs in evidence-based approaches versus traditional 12 step ideology. Material and philosophical institutional support were significantly correlated with intentions to further one’s education. Based on these findings, recommendations for treatment and policy are provided

Feeding Techniques To Increase Calf Growth In The First Two Months Of Life

End of project reportData from Cornell University and the University of Illinois in the USA suggested that average daily liveweight gains of 900 to 1000 g/calf/day could be achieved from birth to weaning provided the calf milk replacer (CMR) is formulated to meet the calf’s amino acid requirements for such a rate of gain. Their findings suggested a daily milk replacer DM allowance of 1250 to 1500 g/d with a crude protein content of 26 to 30%. A series of studies were undertaken, at ARINI with home born dairy calves and at Grange Beef Research Centre with purchased dairy calves, to determine the effect of increasing the daily milk replacer DM allowance and or increasing the crude protein content of the CMR on calf performance.The main outcomes of these studies were There was no growth or intake response in any of the studies to increasing the crude protein content of the CMP from 23% to 28%. Calf growth rates responded to increasing the dailymilk replacer allowance from 600 to 1200 g/day for both home bred and purchased calves. However, the effect was not significant post-weaning in any of the studies. In all of the studies (for both home reared and purchased calves) feeding a high level of CMRdecreased concentrate DM intake. However, the calves concentrate intakes were similar post-weaning. The home bred calves with free access to the milk replacer feeders failed to consume their 1200 g/day allowance. Calves offered 600 or 1200 g of CMR/day had average consumption of 554 and 944 g/d, respectively, in the milk feeding period. Feeding a high (1200 g/d) compared to a low level (600 g/d) CMRdiet for the first 56 days had no significant effect on carcass weight or carcass characteristics when purchased male calves were slaughtered off an ad libitum concentrate diet after 388 days. The final carcass weights were 231 and 240 kg for the respective 600 and 1200 g/d CMR. Reducing the fat content of the CMRfrom 18% to 12% did not have any effect on concentrate intake or liveweight gain

Lateralized Emotional and Cognitive Processes in Personality

Research on hemispheric specialization has generated theories of lateralized cognition, personality traits, and emotional experience and expression. Of these the research on lateralized cognition has provided the most reliable and interpretable results. Using the lateralized cognitive attributes as a guideline, a personality model of hemispheric activation is hypothesized which suggests that each hemisphere provides a distinctive overall approach to information gathering, cognitive processing, emotional experience and behavioral expression. This model predicts that detai1-oriented perception, rumination, and analytic processing are the domain of the left hemisphere, while a more spatial perceptual approach and holistic cognitive processing are the domain of the right hemisphere. Interestingly, these lateralized cognitive and personality styles appear quite similar to two of the neurotic styles observed and described by Shapiro (1965)--the obsessive-compulsive and the hysteri neurotic styles. The similarities and further implications between these models are discussed with reference to recent empirical support for such a correlary (Smokier & Snevrin 1979). In order to investigate the validity of the personality model of hemispheric activation and its possible relationship to clinically observed neurotic styles, a wide variety of personality and cognitive variables were collected across thirty-three undergraduate students. Simple and complex statistical analyses were performed comparing the variables to an index of hemispheric activation, lateral eye movement. Although the results from the simple analyses are minimal, the complex analyses reveal a lateralized personality/cognitive factor that is loaded in a way consistent with the hypothesized model. Caution is suggested in interpreting the results since the number of variables manipulated outnumber the number of subjects in the experiment. Suggestions for further research are offered. The ramifications and utility of such a model in the conceptualization of diagnosis and treatment of mental health problems are explored

The Construct of Personality and Hemispheric Usage

Studies on the differential contributions of the cerebral hemispheres to human experience and behavior have demonstrated that the hemispheres are lateralized for cognitive strategies and, possibly, for emotional valance. Recently researchers have demonstrated that the hemispheres may also be lateralized for certain personality disorders and personality traits. Using lateral eye movements as a measure of hemispheric activation, Dawson, Tucker, and Swenson (in preparation) have shown that certain self-description questionnaires may serve to discriminate subjects who characteristically utilize one hemisphere over the other, regardless of the relative adaptiveness of the cognitive strengths of that hemisphere for the task at hand. This study replicated the findings of the Dawson et al. study, using brain wave activity as an index of lateralized activation. Separating subjects on the basis of their scores on self-description personality measures, it was discovered that subjects who were unrealistically favorable in their self-descriptions (deniers) evidenced greater right hemisphere activation, regardless of the task being performed. Subjects who were overly critical in their self-descriptions (critics) evidenced symmetrical hemispheric activation with a tendency toward greater left hemispheric activation, particularly evident during the baseline and spatial tasks. These findings were evidenced in both the theta and alpha bands for average power, with comparisons in the theta band demonstrating the clearest personality related effects. Analyses on coherence data were performed and described without interpretation. The results of this study were used to provide support for a theory of hemispheric personality. A model is built on the research findings on lateralized cognition and then extended to address some of the recent controversies in the lateralization literature. Implications for further research are discussed and suggestions of how such a model might be used in psychological/medical treatment and diagnoses are discussed

State-space model identification and feedback control of unsteady aerodynamic forces

Unsteady aerodynamic models are necessary to accurately simulate forces and develop feedback controllers for wings in agile motion; however, these models are often high dimensional or incompatible with modern control techniques. Recently, reduced-order unsteady aerodynamic models have been developed for a pitching and plunging airfoil by linearizing the discretized Navier-Stokes equation with lift-force output. In this work, we extend these reduced-order models to include multiple inputs (pitch, plunge, and surge) and explicit parameterization by the pitch-axis location, inspired by Theodorsen's model. Next, we investigate the na\"{\i}ve application of system identification techniques to input--output data and the resulting pitfalls, such as unstable or inaccurate models. Finally, robust feedback controllers are constructed based on these low-dimensional state-space models for simulations of a rigid flat plate at Reynolds number 100. Various controllers are implemented for models linearized at base angles of attack $\alpha_0=0^\circ, \alpha_0=10^\circ$, and $\alpha_0=20^\circ$. The resulting control laws are able to track an aggressive reference lift trajectory while attenuating sensor noise and compensating for strong nonlinearities.Comment: 20 pages, 13 figure

Quasi-Exact Helical Cone Beam Reconstruction for Micro CT

A cone beam micro-CT system is set up to collect truncated helical cone beam data. This system includes a micro-focal X-ray source, a precision computer-controlled X-Y-Z-theta stage, and an image-intensifier coupled to a large format CCD detector. The helical scanning mode is implemented by rotating and translating the stage while keeping X-ray source and detector stationary. A chunk of bone and a mouse leg are scanned and quasi-exact reconstruction is performed using the approach proposed in J. Hu et al. (2001). This approach introduced the original idea of accessory paths with upper and lower virtual detectors having infinite axial extent. It has a filtered backprojection structure which is desirable in practice and possesses the advantages of being simple to implement and computationally efficient compared to other quasi-exact helical cone beam algorithms for the long object problem

Measuring the effect of airway pressure on pulmonary arterial diameter in the intact rat lung

To study the relationship between transpulomnary pressure (Ptp), intravascular pressure (Pv), and the pulmonary arterial tree structure, morphometric measurements of pulmonary arterial trees were made in intact lungs from Sprague-Dawley rats. Using cone beam micro-CT and techniques we developed for imaging small animal lungs, volumetric CT data were acquired for Ptp from 0 - 12 mmHg and Pv from 5 - 30 mmHg. The diameter, D (measured range approximately 0.08-2.0 mm), vs. pressure, P, relation can be described by D(P) = D(0)(1+ α P), where α is a distensibility coefficient. Unlike studies performed in larger animals, where changes in either Ptp or Pv had nearly identical effect on vessel distensibility, we found that there is only a small dependence of arterial diameter on Ptp in the rat. For example, using the above relation where P=Ptp and Pv is held constant at 12mmHg, alpha = 0.55±0.42(SE) %/mmHg, compared with when P=Pv and Ptp is held at 12mmHg, alpha = 2.59±0.17(SE) %/mmHg

Post-Acquisition Small-Animal Respiratory Gated Imaging Using Micro Cone-Beam CT

On many occasions, it is desirable to image lungs in vivo to perform a pulmonary physiology study. Since the lungs are moving, gating with respect to the ventilatory phase has to be performed in order to minimize motion artifacts. Gating can be done in real time, similar to cardiac imaging in clinical applications, however, there are technical problems that have lead us to investigate different approaches. The problems include breath-to-breath inconsistencies in tidal volume, which makes the precise detection of ventilatory phase difficult, and the relatively high ventilation rates seen in small animals (rats and mice have ventilation rates in the range of a hundred cycles per minute), which challenges the capture rate of many imaging systems (this is particularly true of our system which utilizes cone-beam geometry and a 2 dimensional detector). Instead of pre-capture ventilation gating we implemented a method of post-acquisition gating. We acquire a sequence of projections images at 30 frames per second for each of 360 viewing angles. During each capture sequence the rat undergoes multiple ventilation cycles. Using the sequence of projection images, an automated region of interest algorithm, based on integrated grayscale intensity, tracts the ventilatory phase of the lungs. In the processing of an image sequence, multiple projection images are identified at a particular phase and averaged to improve the signal-to-ratio. The resulting averaged projection images are input to a Feldkamp cone-beam algorithm reconstruction algorithm in order to obtain isotropic image volumes. Minimal motion artifact data sets improve qualitative and quantitative analysis techniques useful in physiologic studies of pulmonary structure and function