Use of Root Cause Analysis in Nursing Education: Best Practice from the Quality and Safety Officer

Teaching nursing students to be safe in practice is a key element to any nursing curriculum. This article will discuss the use of a Root Cause Analysis (RCO) framework with prelicensure nursing students, by the Quality and Safety Officer (QSO) in a School of Nursing and Health Professions, as a method to enhance transparency and improve patient safety. The aim is to provide a rationale for using this strategy, to identify the steps of a root cause analysis, to disclose barriers to its successful use, and to explore dissemination to the partnering healthcare environments

Statistical Downscaling with Spatial Misalignment: Application to Wildland Fire PM2.5 Concentration Forecasting

Fine particulate matter, PM2.5, has been documented to have adverse health effects, and wildland fires are a major contributor to PM2.5 air pollution in the USA. Forecasters use numerical models to predict PM2.5 concentrations to warn the public of impending health risk. Statistical methods are needed to calibrate the numerical model forecast using monitor data to reduce bias and quantify uncertainty. Typical model calibration techniques do not allow for errors due to misalignment of geographic locations. We propose a spatiotemporal downscaling methodology that uses image registration techniques to identify the spatial misalignment and accounts for and corrects the bias produced by such warping. Our model is fitted in a Bayesian framework to provide uncertainty quantification of the misalignment and other sources of error. We apply this method to different simulated data sets and show enhanced performance of the method in presence of spatial misalignment. Finally, we apply the method to a large fire in Washington state and show that the proposed method provides more realistic uncertainty quantification than standard methods

Heuristics and policies for online pickup and delivery problems

Master ThesisIn the last few decades, increased attention has been dedicated to a speci c subclass of Vehicle Routing Problems due to its signi cant importance in several transportation areas such as taxi companies, courier companies, transportation of people, organ transportation, etc. These problems are characterized by their dynamicity as the demands are, in general, unknown in advance and the corresponding locations are paired. This thesis addresses a version of such Dynamic Pickup and Delivery Problems, motivated by a problem arisen in an Australian courier company, which operates in Sydney, Melbourne and Brisbane, where almost every day more than a thousand transportation orders arrive and need to be accommodated. The rm has a eet of almost two hundred vehicles of various types, mostly operating within the city areas. Thus, whenever new orders arrive at the system the dispatchers face a complex decision regarding the allocation of the new customers within the distribution routes (already existing or new) taking into account a complex multi-level objective function. The thesis thus focuses on the process of learning simple dispatch heuristics, and lays the foundations of a recommendation system able to rank such heuristics. We implemented eight of these, observing di erent characteristics of the current eet and orders. It incorporates an arti cial neural network that is trained on two hundred days of past data, and is supervised by schedules produced by an oracle, Indigo, which is a system able to produce suboptimal solutions to problem instances. The system opens the possibility for many dispatch policies to be implemented that are based on this rule ranking, and helps dispatchers to manage the vehicles of the eet. It also provides results for the human resources required each single day and within the di erent periods of the day. We complement the quite promising results obtained with a discussion on future additions and improvements such as channel eet management, tra c consideration, and learning hyper-heuristics to control simple rule sequences.The thesis work was partially supported by the National ICT Australia according to the Visitor Research Agreement contract between NICTA and Martin Damyanov Aleksandro

A probabilistic atlas of finger dominance in the primary somatosensory cortex

With the advent of ultra-high field (7T), high spatial resolution functional MRI (fMRI) has allowed the differentiation of the cortical representations of each of the digits at an individual-subject level in human primary somatosensory cortex (S1). Here we generate a probabilistic atlas of the contralateral SI representations of the digits of both the left and right hand in a group of 22 right-handed individuals. The atlas is generated in both volume and surface standardised spaces from somatotopic maps obtained by delivering vibrotactile stimulation to each distal phalangeal digit using a travelling wave paradigm. Metrics quantify the likelihood of a given position being assigned to a digit (full probability map) and the most probable digit for a given spatial location (maximum probability map). The atlas is validated using a leave-one-out cross validation procedure. Anatomical variance across the somatotopic map is also assessed to investigate whether the functional variability across subjects is coupled to structural differences. This probabilistic atlas quantifies the variability in digit representations in healthy subjects, finding some quantifiable separability between digits 2, 3 and 4, a complex overlapping relationship between digits 1 and 2, and little agreement of digit 5 across subjects. The atlas and constituent subject maps are available online for use as a reference in future neuroimaging studies

Impact of genomic testing and patient-reported outcomes on receipt of adjuvant chemotherapy

Practice guidelines incorporate genomic tumor profiling, using results such as the Oncotype DX Recurrence Score (RS), to refine recurrence risk estimates for the large proportion of breast cancer patients with early-stage, estrogen receptor-positive disease. We sought to understand the impact of receiving genomic recurrence risk estimates on breast cancer patients’ well-being and the impact of these patient-reported outcomes on receipt of adjuvant chemotherapy. Participants were 193 women (mean age 57) newly diagnosed with early-stage breast cancer. Women were interviewed before and 2–3 weeks after receiving the RS result between 2011 and 2015. We assessed subsequent receipt of chemotherapy from chart review. After receiving their RS, perceived pros (t = 4.27, P < .001) and cons (t = 8.54, P <.001) of chemotherapy increased from pre-test to post-test, while perceived risk of breast cancer recurrence decreased (t = 2.90, P = .004). Women with high RS tumors were more likely to receive chemotherapy than women with low RS tumors (88 vs. 5 %, OR 0.01, 0.00–0.02, P < .001). Higher distress (OR 2.19, 95 % CI 1.05–4.57, P < .05) and lower perceived cons of chemotherapy (OR 0.50, 95 % CI 0.26–0.97, P < .05) also predicted receipt of chemotherapy. Distressed patients who saw few downsides of chemotherapy received this treatment. Clinicians should consider these factors when discussing chemotherapy with breast cancer patients

Neural Synchrony Examined with Magnetoencephalography (MEG) During Eye Gaze Processing in Autism Spectrum Disorders: Preliminary Findings

Gaze processing deficits are a seminal, early, and enduring behavioral deficit in autism spectrum disorder (ASD); however, a comprehensive characterization of the neural processes mediating abnormal gaze processing in ASD has yet to be conducted. This study investigated whole-brain patterns of neural synchrony during passive viewing of direct and averted eye gaze in ASD adolescents and young adults (M Age  = 16.6) compared to neurotypicals (NT) (MAge  = 17.5) while undergoing magnetoencephalography. Coherence between each pair of 54 brain regions within each of three frequency bands (low frequency (0 to 15 Hz), beta (15 to 30 Hz), and low gamma (30 to 45 Hz)) was calculated

Neural Synchrony Examined with Magnetoencephalography (MEG) During Eye Gaze Processing in Autism Spectrum Disorders: Preliminary Findings

Gaze processing deficits are a seminal, early, and enduring behavioral deficit in autism spectrum disorder (ASD); however, a comprehensive characterization of the neural processes mediating abnormal gaze processing in ASD has yet to be conducted. This study investigated whole-brain patterns of neural synchrony during passive viewing of direct and averted eye gaze in ASD adolescents and young adults (M Age  = 16.6) compared to neurotypicals (NT) (MAge  = 17.5) while undergoing magnetoencephalography. Coherence between each pair of 54 brain regions within each of three frequency bands (low frequency (0 to 15 Hz), beta (15 to 30 Hz), and low gamma (30 to 45 Hz)) was calculated

Disparities and guideline adherence in drugs of abuse screening in intracerebral hemorrhage

OBJECTIVE: To characterize the pattern of urine drug screening in a cohort of intracerebral hemorrhage (ICH) patients at our academic centers. METHODS: We identified cases of primary ICH occurring from 2009 to 2011 in our academic centers. Demographic data, imaging characteristics, processes of care, and short-term outcomes were ascertained. We performed logistic regression to identify predictors for screening and evaluated preguideline and postguideline reiteration screening patterns. RESULTS: We identified 610 patients with primary ICH in 2009-2011; 379 (62.1%) were initially evaluated at an outside hospital. Overall, 142/610 (23.3%) patients were screened, with 21 positive for cocaine and 3 for amphetamine. Of patients <55 years of age, only 65/140 (46.4%) were screened. Black patients <55 years of age were screened more than nonblack patients <55 years of age (38/61 [62.3%] vs 27/79 [34.2%]; p = 0.0009). In the best multivariable model, age group (p = 0.0001), black race (p = 0.4529), first Glasgow Coma Scale score (p = 0.0492), current smoking (p < 0.0001), and age group × black race (p = 0.0097) were associated with screening. Guideline reiteration in 2010 did not improve the proportion <55 years of age who were screened: 42/74 (56.8%) were screened before and 23/66 (34.9%) after (p = 0.01). CONCLUSIONS: We found disparities in drugs of abuse (DOA) screening and suboptimal guideline adherence. Systematic efforts to improve screening for DOA are warranted. Improved identification of sympathomimetic exposure may improve etiologic classification and influence decision-making and prognosis counseling

Object Relations in the Museum: A Psychosocial Perspective

This article theorises museum engagement from a psychosocial perspective. With the aid of selected concepts from object relations theory, it explains how the museum visitor can establish a personal relation to museum objects, making use of them as an ‘aesthetic third’ to symbolise experience. Since such objects are at the same time cultural resources, interacting with them helps the individual to feel part of a shared culture. The article elaborates an example drawn from a research project that aimed to make museum collections available to people with physical and mental health problems. It draws on the work of the British psychoanalysts Donald Winnicott and Wilfred Bion to explain the salience of the concepts of object use, potential space, containment and reverie within a museum context. It also refers to the work of the contemporary psychoanalyst Christopher Bollas on how objects can become evocative for individuals both by virtue of their intrinsic qualities and by the way they are used to express personal idiom

Profiles in Community-Engaged Learning

To provide a snapshot of the many impressive manifestations of community-engaged learning at the University of San Francisco, a 2014-2015 Faculty Learning Community (FLC), supported by the Center for Teaching Excellence (CTE), has collected the following profiles of selected faculty members across all the schools and colleges. This report was prepared by members of the CTE’s Faculty Learning Community on Community-Engaged Learning: Kevin D. Lo, Facilitator (School of Management), Emma Fuentes (School of Education), David Holler (College of Arts and Sciences), Tim Iglesias (School of Law), Susan Roberta Katz (School of Education), Star Moore (Leo T. McCarthy Center for Public Service and the Common Good), Chenit Ong-Flaherty (School of Nursing and Health Professions), Jennifer Parlamis (School of Management) Susan Pauly-O’Neill (School of Nursing and Health Professions). Our intent with this report is to offer USF administrators and incoming faculty members a sense of what’s being done well in community-engaged learning (CEL), while also pointing out what challenges remain as we establish our identity as a university that prioritizes community engagement. (Incidentally, we prefer the term “community-engaged learning” to “service-learning,” which we feel more precisely defines the scope of our activities. For more about this designation, please see the Executive Report on Community Engaged Learning issued by this same committee in June 2015.) Community-engaged learning as defined by Eyler and Giles is “a form of experiential education where learning occurs through a cycle of action and reflection as students . . . seek to achieve real objectives for the community and deeper understanding and skills for themselves. In the process, students link personal and social development with academic and cognitive development . . . experience enhances understanding; understanding leads to more effective action.” (qtd. in Bandy, Vanderbilt Center for Teaching, “What Is Service Learning or Community Engagement?”). We invited at least two faculty members from each school/college to answer several questions about the application of CEL in their courses. After providing a brief overview of activities in each course, we asked each professor what works well and what challenges persist. The successes and the challenges, as you’ll see, vary widely, and yet they clearly delineate, limited though our present sample size is, the great variety and energy and commitment our faculty have demonstrated in working with community partners and students. It is our hope that this report is merely the beginning of a much more ambitious project to be taken up by the McCarthy Center which will provide many more profiles of professors in the months and years to come