Patient and carer identified factors which contribute to safety incidents in primary care: a qualitative study

BACKGROUND: Patients can have an important role in reducing harm in primary-care settings. Learning from patient experience and feedback could improve patient safety. Evidence that captures patients' views of the various contributory factors to creating safe primary care is largely absent. The aim of this study was to address this evidence gap. METHODS: Four focus groups and eight semistructured interviews were conducted with 34 patients and carers from south-east Australia. Participants were asked to describe their experiences of primary care. Audio recordings were transcribed verbatim and specific factors that contribute to safety incidents were identified in the analysis using the Yorkshire Contributory Factors Framework (YCFF). Other factors emerging from the data were also ascertained and added to the analytical framework. RESULTS: Thirteen factors that contribute to safety incidents in primary care were ascertained. Five unique factors for the primary-care setting were discovered in conjunction with eight factors present in the YCFF from hospital settings. The five unique primary care contributing factors to safety incidents represented a range of levels within the primary-care system from local working conditions to the upstream organisational level and the external policy context. The 13 factors included communication, access, patient factors, external policy context, dignity and respect, primary-secondary interface, continuity of care, task performance, task characteristics, time in the consultation, safety culture, team factors and the physical environment. DISCUSSION: Patient and carer feedback of this type could help primary-care professionals better understand and identify potential safety concerns and make appropriate service improvements. The comprehensive range of factors identified provides the groundwork for developing tools that systematically capture the multiple contributory factors to patient safety.

Developing a primary care patient measure of safety (PC PMOS): a modified Delphi process and face validity testing

BACKGROUND: Patients are a valuable source of information about ways to prevent harm in primary care and are in a unique position to provide feedback about the factors that contribute to safety incidents. Unlike in the hospital setting, there are currently no tools that allow the systematic capture of this information from patients. The aim of this study was to develop a quantitative primary care patient measure of safety (PC PMOS). METHODS: A two-stage approach was undertaken to develop questionnaire domains and items. Stage 1 involved a modified Delphi process. An expert panel reached consensus on domains and items based on three sources of information (validated hospital PMOS, previous research conducted by our study team and literature on threats to patient safety). Stage 2 involved testing the face validity of the questionnaire developed during stage 1 with patients and primary care staff using the 'think aloud' method. Following this process, the questionnaire was revised accordingly. RESULTS: The PC PMOS was received positively by both patients and staff during face validity testing. Barriers to completion included the length, relevance and clarity of questions. The final PC PMOS consisted of 50 items across 15 domains. The contributory factors to safety incidents centred on communication, access to care, patient-related factors, organisation and care planning, task performance and information flow. DISCUSSION: This is the first tool specifically designed for primary care settings, which allows patients to provide feedback about factors contributing to potential safety incidents. The PC PMOS provides a way for primary care organisations to learn about safety from the patient perspective and make service improvements with the aim of reducing harm in this setting. Future research will explore the reliability and construct validity of the PC PMOS.

Exploring factors related to the anger superiority effect in children with Autism Spectrum Disorder

Despite face and emotion recognition deficits, individuals with Autism Spectrum Disorder (ASD) appear to experience the anger superiority effect, where an angry face in a crowd is detected faster than a neutral face. This study extended past research to examine the impacts of ecologically valid photographic stimuli, gender and anxiety symptoms on the anger superiority effect in children with and without ASD. Participants were 81, 7-12year old children, 42 with ASD matched on age, gender and perceptual IQ to 39 typically developing (TYP) children. The photographic stimuli did not impact on task performance in ASD with both groups exhibiting the anger superiority effect. There were no gender differences and no associations with anxiety. Age was associated with the effect in the TYP but not ASD group. These findings confirm a robust effect of speeded detection of threat in ASD which does not appear to be confounded by gender or anxiety, but may have different underlying age-associated mechanisms.

The Effect of dual-tasking on motor cortex activity

This thesis demonstrated that when participants performed two tasks concurrently, the activity of inhibitory neurons in the brain was increased in younger adults, yet decreased in older adults. In addition, our results indicated that dual-task performance in older adults may depend on the activation of prefrontal to motor cortex pathways.

Evidence for crossvergence in the perception of task and contextual performance : a study of western expatriates working in Thailand

The applicability of the Western model of task and contextual performance to the context of Thai and Western managers, professionals and consultants working together in Thailand is addressed in this research. The results show a clear difference in the factor structure of how Western and Thai managers perceive the importance of performance factors. Moreover, the task and contextual factor structure found for Western managers working in a Western culture did not hold for Westerners working within the Thai cultural environment. These findings provide evidence of adaptation by the Westerner to the Thai cultural environment, supporting the notion of crossvergence.

Is there a link between motor performance variability and social-communicative impairment in children with ADHD-CT : a kinematic study using an upper limb Fitts’ aiming task

 Objective: This study investigated the relationship between motor performance and social-communicative impairment in children with ADHD-combined type (ADHD-CT). Method: An upper limb Fitts’ aiming task was used as a measure of motor performance and the Social Responsiveness Scale as a measure of social-communicative/autistic impairment in the following groups: ADHD-CT (n = 11) and typically developing (TD) controls (n = 10). Results: Children with ADHD-CT displayed greater variability in their movements, reflected in increased error variance over repeated aiming trials compared with TD controls. Motor performance variability was associated with social-communicative deficits in the ADHD-CT but not in the TD group. Conclusion: Social-communicative impairments further complicate the clinical picture of ADHD-CT; therefore, further research in this area is warranted to ascertain whether a particular pattern of motor disturbance in children with ADHD-CT may be clinically useful in identifying and assessing children with a more complex ADHD presentation. © 2012 SAGE Publications.

The metabolic and cognitive energy costs of stabilising a high-energy interlimb coordination task

Kinematic (relative phase error), metabolic (oxygen consumption, heart rate) and attentional (baseline and cycling reaction times) variables were measured while participants practised a high energy-demanding, intrinsically unstable 90° relative phase coordination pattern on independent bicycle ergometers. The variables were found to be strongly inter-correlated, suggesting a link between emerging performance stability with practice and minimal metabolic and attentional cost. The effects of practice of 90° relative phase coordination on the performance of in-phase (0°-phase) and antiphase (180°-phase) coordination were investigated by measuring the relative phase attractor layouts and recording the metabolic and attentional cost of the three coordination patterns before and after practice. The attentional variables did not differ significantly between coordination patterns and did not change with practice. Before practice, the coordination performance was most accurate and stable for in-phase cycling, with antiphase next and 90°-phase the poorest. However, metabolic cost was lower for antiphase than either in-phase or 90°-phase cycling, and the pre-practice attractor layout deviated from that predicted on the basis of dynamic stability as an attractor state, revealing an attraction to antiphase cycling. After practice of 90°-phase cycling, in-phase cycling remained the most accurate and stable, with 90°-phase next and antiphase the poorest, but antiphase retained the lowest metabolic energy cost. The attractor layout had changed, with new attractors formed at the practised 90°-phase pattern and its symmetrical partner of 270°-phase. Considering both the pre- and post-practice results, attractors were formed at either a low metabolic energy cost but less stable (antiphase) pattern or at a more stable but higher metabolic energy cost (90°-phase) pattern, but in neither case at the most stable and accurate (in-phase) pattern. The results suggest that energetic factors affect coordination dynamics and that coordination modes lower in metabolic energy expenditure may compete with dynamically stable modes.

Learning to minimize energy costs and maximize mechanical work in a bimanual coordination task

The authors addressed the hypothesis that economy in motor coordination is a learning phenomenon realized by both reduced energy cost for a given workload and more external work at the same prepractice metabolic and attentional energy expenditure. "Self-optimization" of movement parameters has been proposed to reflect learned motor adaptations that minimize energy costs. Twelve men aged 22.3 [+ or -] 3.9 years practiced a 90[degrees] relative phase, upper limb, independent ergometer cycling task at 60 rpm, followed by a transfer test of unpracticed (45 and 75 rpm) and self-paced cadences. Performance in all conditions was initially unstable, inaccurate, and relatively high in both metabolic and attentional energy costs. With practice, coordinative stability increased, more work was performed for the same metabolic and attentional costs, and the same work was done at a reduced energy cost. Self-paced cycling was initially below the metabolically optimal, but following practice at 60 rpm was closer to optimal cadence. Given the many behavioral options of the motor system in meeting a variety of everyday movement task goals, optimal metabolic and attentional energy criteria may provide a solution to the problem of selecting the most adaptive coordination and control parameters.

Predicting the acoustic performance of concert halls

Predicting the acoustic outcome and acceptance of a concert performance hall by its users could be a difficult and onerous task even for an acoustician. This paper discusses a process of how previous research findings from expert authorities have been assembled into a method of evaluating acoustic hall performance. Several parameters of acoustic qualities and quantitative measures have been identified in the literature. These relate to Beranek’s acoustic variables of performance. Existing famous concert halls which have been previously evaluated and rated are now studies in terms of their results from a computer simulation. The research findings suggest that the use of a simulation program can be extremely accurate in the prediction of acoustic performance of new non-existing concert halls.

Delivery and assessment strategies to improve on- and off-campus student performance in structural mechanics

This paper considers the delivery and assessment strategies used in two structural mechanics units at Deakin University, a leader in distance education in Australia. The two units have had unacceptably high rates of student failure. Student perceptions of the delivery method were analysed and an investigation was carried out of the performance of 329 (173 on- and 156 off-campus) students enrolled in the two units. An analysis of the assignment, laboratory and examination marks is presented. Consideration is also given to the total marks. The results show that on-campus students performed better in structural mechanics than their off-campus counterparts. Plots of the distributions of student performance for the three assessment methods are provided (for each unit) and high failure rates are linked to low examination marks. Students tended to perform best in assignments and worst in examinations. Parametric statistical tests show a correlation between the marks obtained in continuous assessment and in examinations, and it is therefore proposed that, in order to improve performance, the students must be encouraged to participate fully in all aspects of the course. Many students were unenthusiastic about laboratory practical sessions and did not think they aided their understanding of the theoretical material. Motivation to participate is often dependent on the perceived relevance of a given task and its contribution to the total mark and, thus, to help motivate students to participate fully in the continuous assessment tasks, the authors propose several changes to the delivery methods, as well as to assessment criteria and marking schemes.

Mechanisms that contribute to differences in motor performance between young and old adults

This paper examines the physiological mechanisms responsible for differences in the amplitude of force fluctuations between young and old adults. Because muscle force is a consequence of motor unit activity, the potential mechanisms include both motor unit properties and the behavior of motor unit populations. The force fluctuations, however, depend not only on the age of the individual but also on the muscle group performing the task, the type and intensity of the muscle contraction, and the physical activity status of the individual. Computer simulations and experimental findings performed on tasks that involved single agonist and antagonist muscles suggest that differences in force fluctuations are not attributable to motor unit twitch force, motor unit number, or nonuniform activation of the agonist muscle, but that they are influenced by the variability and common modulation of motor unit discharge in both the agonist and antagonist muscles. Because the amplitude of the force fluctuations does not vary linearly with muscle activation, these results suggest that multiple mechanisms contribute to the differences in force fluctuations between young and old adults, although the boundary conditions for each mechanism remain to be determined.

A performance model for analysis of heterogeneous multi-cluster systems

This paper addresses the problem of performance modeling for large-scale heterogeneous distributed systems with emphases on multi-cluster computing systems. Since the overall performance of distributed systems is often depends on the effectiveness of its communication network, the study of the interconnection networks for these systems is very important. Performance modeling is required to avoid poorly chosen components and architectures as well as discovering a serious shortfall during system testing just prior to deployment time. However, the multiplicity of components and associated complexity make performance analysis of distributed computing systems a challenging task. To this end, we present an analytical performance model for the interconnection networks of heterogeneous multi-cluster systems. The analysis is based on a parametric family of fat-trees, the m-port n-tree, and a deterministic routing algorithm, which is proposed in this paper. The model is validated through comprehensive simulation, which demonstrated that the proposed model exhibits a good degree of accuracy for various system organizations and under different working conditions.