Measurement tools and process indicators of patient safety culture in primary care. A mixed methods study by the LINNEAUS collaboration on patient safety in primary care.

This is the author accepted manuscript. The final version is available from the publisher via the DOI in this recordBACKGROUND: There is little guidance available to healthcare practitioners about what tools they might use to assess the patient safety culture. OBJECTIVE: To identify useful tools for assessing patient safety culture in primary care organizations in Europe; to identify those aspects of performance that should be assessed when investigating the relationship between safety culture and performance in primary care. METHODS: Two consensus-based studies were carried out, in which subject matter experts and primary healthcare professionals from several EU states rated (a) the applicability to their healthcare system of several existing safety culture assessment tools and (b) the appropriateness and usefulness of a range of potential indicators of a positive patient safety culture to primary care settings. The safety culture tools were field-tested in four countries to ascertain any challenges and issues arising when used in primary care. RESULTS: The two existing tools that received the most favourable ratings were the Manchester patient safety framework (MaPsAF primary care version) and the Agency for healthcare research and quality survey (medical office version). Several potential safety culture process indicators were identified. The one that emerged as offering the best combination of appropriateness and usefulness related to the collection of data on adverse patient events. CONCLUSION: Two tools, one quantitative and one qualitative, were identified as applicable and useful in assessing patient safety culture in primary care settings in Europe. Safety culture indicators in primary care should focus on the processes rather than the outcomes of care.The research leading to these results has received funding from the European Community’s Seventh Framework Programme FP7/2008 – 2012 under grant agreement no. 223424

Novel inferences of ionisation & recombination for particle/power balance during detached discharges using deuterium Balmer line spectroscopy

The physics of divertor detachment is determined by divertor power, particle and momentum balance. This work provides a novel analysis technique of the Balmer line series to obtain a full particle/power balance measurement of the divertor. This supplies new information to understand what controls the divertor target ion flux during detachment. Atomic deuterium excitation emission is separated from recombination quantitatively using Balmer series line ratios. This enables analysing those two components individually, providing ionisation/recombination source/sinks and hydrogenic power loss measurements. Probabilistic Monte Carlo techniques were employed to obtain full error propagation - eventually resulting in probability density functions for each output variable. Both local and overall particle and power balance in the divertor are then obtained. These techniques and their assumptions have been verified by comparing the analysed synthetic diagnostic 'measurements' obtained from SOLPS simulation results for the same discharge. Power/particle balance measurements have been obtained during attached and detached conditions on the TCV tokamak.Comment: The analysis results of this paper were formerly in arXiv:1810.0496

Modern optical diagnostics in engine research

Different optical diagnistic techniques are used to gain insight into the single steps forming the functioning chain of the engine combustion process and the complex interplay between these single steps. Examples are given for the application of Mie scattering, laser-induced fluorescence, Raman scattering, CARS and laser-induced incandescence to study diesel engine, SI engine and HCCI combustion processes. The careful adaptation of each optical tool to one part of the engine process makes it possible to get valuable information with minimum change of the process investigated. The paper demonstrates that in addition to conventional engine measurement techniques, a number of different optical techniques must be applied -- and sometimes simultaneously -- to successfully determine the critical parameters of the processes and to investigate their influences on the performance and the quality of real engine combustion

Mfu16 is an unstable fire blight resistance QTL on linkage group 16 of Malus fusca MAL0045

A strong fire blight resistance QTL (Mfu10) was previously detected on linkage group 10 (LG10) of Malus fusca accession MAL0045, using several strains of the causative bacterium, Erwinia amylovora. As no strain capable of breaking the resistance of MAL0045 has been found, we hypothesized that another locus contributes to its fire blight resistance. However, none was detected with strains previously tested on the progeny. Here, an avrRpt2EA mutant strain (Ea1038) with the chromosomal S-allele deleted and complemented with the less aggressive C-allele, was used to phenotype MAL0045 × ‘Idared’ progeny. We performed phenotype-genotype analyses using the first genetic map of MAL0045, which is scarcely dense, and a recently constructed saturated map. As expected, Mfu10 was detected on LG10 with Ea1038, as was previously with other strains. Interestingly, a QTL with a logarithm of odds (LOD) thresholds of 5.5 and 2.9, significant at the genome-wide and chromosome levels, respectively, was detected with Ea1038 on LG16 (Mfu16) in a subset of 76 individuals, but only using the saturated map. Progenies carrying both Mfu10 and Mfu16 were significantly more resistant than progenies carrying only Mfu10. However, the LOD of Mfu16 diminished to 2.6 in a larger subset of individuals. We hypothesize that Mfu16 is present in the genome of MAL0045 albeit unstable in the progeny

Effect of Composition, Temperature, and Pressure on the Viscosities and Densities of Three Diesel Fuels

In this work, a Rolling-Ball Viscometer/Densimeter is used to measure high-pressure, hightemperature (HPHT) density and viscosity data from 298.2 to 532.6 K and pressures up to 300.0 MPa for three different diesel fuels. The densities and viscosities have combined expanded uncertainties of 0.6% and 2.5%, respectively, with a coverage factor, k = 2. Two of the diesels, Highly Paraffinic (HPF) and Highly Aromatic (HAR), contain a larger paraffinic and aromatic content relative to the others, and are standard engine test fuels. The third is a Ultra-Low Sulfur Diesel (ULSD) that resembles an unfinished commercial diesel. Detailed compositional information is also reported for each diesel that provides a basis for interpreting the impact of composition on density and viscosity at high pressures. Both density and viscosity data are correlated to Tait-type equations with uncertainties of 0.6% and 4.0%, respectively. The Tait equations provide a facile means to compare observed differences in the density-pressure and viscosity-pressure profiles of the three different diesels. Density data are modeled with the Perturbed-Chain Statistical Associating Fluid Theory (PC-SAFT) equation of state (EoS) with pure component parameters calculated representing diesel as a single, pseudo-component only requiring average molecular weight (Mave) and hydrogen to carbon ratio (RH/C) as inputs. Viscosity data are modeled reasonably well using entropy scaling coupled with the PC-SAFT EoS and information on the diesel Mave and RH/C. The HPHT viscosity data are also modeled reasonably well with Free Volume Theory (FVT) with model parameters correlated to Mave and RH/C

A research agenda on patient safety in primary care. Recommendations by the LINNEAUS collaboration on patient safety in primary care

This is the final version of the article. Available from Taylor & Francis via the DOI in this record.BACKGROUND: Healthcare can cause avoidable serious harm to patients. Primary care is not an exception, and the relative lack of research in this area lends urgency to a better understanding of patient safety, the future research agenda and the development of primary care oriented safety programmes. OBJECTIVE: To outline a research agenda for patient safety improvement in primary care in Europe and beyond. METHODS: The LINNEAUS collaboration partners analysed existing research on epidemiology and classification of errors, diagnostic and medication errors, safety culture, and learning for and improving patient safety. We discussed ideas for future research in several meetings, workshops and congresses with LINNEAUS collaboration partners, practising GPs, researchers in this field, and policy makers. RESULTS: This paper summarizes and integrates the outcomes of the LINNEAUS collaboration on patient safety in primary care. It proposes a research agenda on improvement strategies for patient safety in primary care. In addition, it provides background information to help to connect research in this field with practicing GPs and other healthcare workers in primary care. CONCLUSION: Future research studies should target specific primary care domains, using prospective methods and innovative methods such as patient involvement.The research leading to these results has received funding from the European Community’s Seventh Framework Programme FP7/2008–2012 under grant agreement no. 223424

Does patient satisfaction of general practice change over a decade?

Background The Patient Participation Program (PPP) was a patient satisfaction survey endorsed by the Royal Australian College of General Practitioners and designed to assist general practitioners in continuous quality improvement (CQI). The survey was been undertaken by 3500 practices and over a million patients between 1994 and 2003. This study aimed to use pooled patient questionnaire data to investigate changes in satisfaction with primary care over time. Methods The results of 10 years of the PPP surveys were analyzed with respect to 10 variables including the year of completion, patient age, gender, practice size, attendance at other doctors, and whether the practice had previously undertaken the survey. Comparisons were made using Logistic Generalized Estimating Equations (LGEE). Results There was a very high level of satisfaction with general practice in Australia (99% of respondents). An independent indicator of satisfaction was created by pooling the results of 12 questions. This new indicator had a greater variance than the single overall satisfaction question. Participants were shown to have higher levels of satisfaction if they were male, older, did not attend other practitioners or the practice was small in size. A minimal improvement in satisfaction was detected in this pooled indicator for the second or third survey undertaken by a practice. There was however no statistically significant change in pooled satisfaction with the year of survey. Conclusion The very high level of satisfaction made it difficult to demonstrate change. It is likely that this and the presentation of results made it difficult for GPs to use the survey to improve their practices. A more useful survey would be more sensitive to detect negative patient opinions and provide integrated feedback to GPs. At present, there are concerns about the usefulness of the PPP in continuous quality improvement in general practice.James Allan, Peter Schattner, Nigel Stocks and Emmae Ramsa

Hybrid Volitional Control of a Robotic Transtibial Prosthesis using a Phase Variable Impedance Controller

For robotic transtibial prosthesis control, the global kinematics of the tibia can be used to monitor the progression of the gait cycle and command smooth and continuous actuation. In this work, these global tibia kinematics are used to define a phase variable impedance controller (PVIC), which is then implemented as the nonvolitional base controller within a hybrid volitional control framework (PVI-HVC). The gait progression estimation and biomechanic performance of one able-bodied individual walking on a robotic ankle prosthesis via a bypass adapter are compared for three control schemes: a passive benchmark controller, PVIC, and PVI-HVC. The different actuation of each controller had a direct effect on the global tibia kinematics, but the average deviation between the estimated and ground truth gait percentage were 1.6%, 1.8%, and 2.1%, respectively, for each controller. Both PVIC and PVI-HVC produced good agreement with able-bodied kinematic and kinetic references. As designed, PVI-HVC results were similar to those of PVIC when the user used low volitional intent, but yielded higher peak plantarflexion, peak torque, and peak power when the user commanded high volitional input in late stance. This additional torque and power also allowed the user to volitionally and continuously achieve activities beyond level walking, such as ascending ramps, avoiding obstacles, standing on tip-toes, and tapping the foot. In this way, PVI-HVC offers the kinetic and kinematic performance of the PVIC during level ground walking, along with the freedom to volitionally pursue alternative activities.Comment: 7 pages, 7 figures, submitted to ICRA 202

Does patient satisfaction of general practice change over a decade?

Background The Patient Participation Program (PPP) was a patient satisfaction survey endorsed by the Royal Australian College of General Practitioners and designed to assist general practitioners in continuous quality improvement (CQI). The survey was been undertaken by 3500 practices and over a million patients between 1994 and 2003. This study aimed to use pooled patient questionnaire data to investigate changes in satisfaction with primary care over time. Methods The results of 10 years of the PPP surveys were analyzed with respect to 10 variables including the year of completion, patient age, gender, practice size, attendance at other doctors, and whether the practice had previously undertaken the survey. Comparisons were made using Logistic Generalized Estimating Equations (LGEE). Results There was a very high level of satisfaction with general practice in Australia (99% of respondents). An independent indicator of satisfaction was created by pooling the results of 12 questions. This new indicator had a greater variance than the single overall satisfaction question. Participants were shown to have higher levels of satisfaction if they were male, older, did not attend other practitioners or the practice was small in size. A minimal improvement in satisfaction was detected in this pooled indicator for the second or third survey undertaken by a practice. There was however no statistically significant change in pooled satisfaction with the year of survey. Conclusion The very high level of satisfaction made it difficult to demonstrate change. It is likely that this and the presentation of results made it difficult for GPs to use the survey to improve their practices. A more useful survey would be more sensitive to detect negative patient opinions and provide integrated feedback to GPs. At present, there are concerns about the usefulness of the PPP in continuous quality improvement in general practice.James Allan, Peter Schattner, Nigel Stocks and Emmae Ramsa