The World Health Organization Multi-Professional Patient Safety Curriculum : implementation of key modules and its impact on patient safety knowledge, skills, and attitudes of medical students at the University of Algarve

ABSTRACT - Objectives: We attempted to show how the implementation of the key elements of the World Health Organization Patient Safety Curriculum Guide Multi-professional Edition in an undergraduate curriculum affected the knowledge, skills, and attitudes towards patient safety in a graduate entry Portuguese Medical School. Methods: After receiving formal recognition by the WHO as a Complementary Test Site and approval of the organizational ethics committee , the validated pre-course questionnaires measuring the knowledge, skills, and attitudes to patient safety were administered to the 2nd and3rd year students pursuing a four-year course (N = 46). The key modules of the curriculum were implemented over the academic year by employing a variety of learning strategies including expert lecturers, small group problem-based teaching sessions, and Simulation Laboratory sessions. The identical questionnaires were then administered and the impact was measured. The Curriculum Guide was evaluated as a health education tool in this context. Results: A significant number of the respondents, 47 % (n = 22), reported having received some form of prior patient safety training. The effect on Patient Safety Knowledge was assessed by using the percentage of correct pre- and post-course answers to construct 2 × 2 contingency tables and by applying Fishers’ test (two-tailed). No significant differences were detected (p < 0.05). To assess the effect of the intervention on Patient Safety skills and attitudes, the mean and standard deviation were calculated for the pre and post-course responses, and independent samples were subjected to Mann-Whitney’s test. The attitudinal survey indicated a very high baseline incidence of desirable attitudes and skills toward patient safety. Significant changes were detected (p < 0.05) regarding what should happen if an error is made (p = 0.016), the role of healthcare organizations in error reporting (p = 0.006), and the extent of medical error (p = 0.005). Conclusions: The implementation of selected modules of the WHO Patient Safety Curriculum was associated with a number of positive changes regarding patient safety skills and attitudes, with a baseline incidence of highly desirable patient safety attitudes, but no measureable change on the patient safety knowledge, at the University of Algarve Medical School. The significance of these results is discussed along with implications and suggestions for future research.

Segurança no nível físico em sistemas multi-antena com diretividade na informação

Os sistemas de comunicação sem fios são sistemas de difusão por natureza. Devido a essa sua natureza, um dos problemas inerentes à mesma deve-se à segurança e ao secretismo, pois se o canal é partilhado a informação facilmente é obtida por um utilizador não autorizado, ao contrário dos sistemas de comunicação com fios. Tradicionalmente, a introdução de segurança em sistemas de comunicação, resulta na encriptação da informação, resultante de protocolos de encriptação. No entanto, a segurança através da criptografia baseia-se na premissa de que o utilizador não autorizado tem uma capacidade de processamento limitada, pois senão poderia simplesmente tentar todas as combinações possíveis e obter a chave de encriptação. Como a capacidade de processamento tem crescido exponencialmente, este tipo de sistemas tem se tornado cada vez mais complexos para não se tornarem obsoletos. A introdução de segurança na camada física torna-se então uma opção apelativa pois pode servir como um complemento, visto que os sistemas de criptografia funcionam em camadas superiores independentes da camada fisica, apresentando assim uma abordagem multi-camada em termos de segurança. Tipicamente as técnicas de segurança no nível físico podem se agrupar em 2 tipos: técnicas que se baseiam em códigos, ou técnicas que exploram variações temporais e espaciais do canal. As primeiras diminuem a eficiência espectral do sistema, e as segundas apresentam bons resultados em ambientes dinâmicos, mas em ambientes estáticos não são muito promissores. Há também a necessidade de aumentar as taxas de transmissão nos próximos sistemas de comunicação. Devido a estes requisitos, uma das tecnologias propostas para a nova geração de comunicações, é uma tecnologia baseada numa arquitectura Multiple-Input-Multiple-Output(MIMO). Esta tecnologia é promissora e consegue atingir taxas de transferências que correspondem aos requisitos propostos. Apresenta-se assim uma nova técnica de segurança no nível físico, que explora as caracteristicas físicas do sistema, como um complemento a outras medidas de segurança em camadas mais altas. Esta técnica não provoca diminuição da eficiência espectral e é independente do canal, o que tenta solucionar os problemas das restantes técnicas já existentes.

Understanding multi-asset factor models: Factor exposure interpretation

Field lab: Business project

Improving practical reasoning and argumentation

This thesis justifies the need for and develops a new integrated model of practical reasoning and argumentation. After framing the work in terms of what is reasonable rather than what is rational (chapter 1), I apply the model for practical argumentation analysis and evaluation provided by Fairclough and Fairclough (2012) to a paradigm case of unreasonable individual practical argumentation provided by mass murderer Anders Behring Breivik (chapter 2). The application shows that by following the model, Breivik is relatively easily able to conclude that his reasoning to mass murder is reasonable – which is understood to be an unacceptable result. Causes for the model to allow such a conclusion are identified as conceptual confusions ingrained in the model, a tension in how values function within the model, and a lack of creativity from Breivik. Distinguishing between dialectical and dialogical, reasoning and argumentation, for individual and multiple participants, chapter 3 addresses these conceptual confusions and helps lay the foundation for the design of a new integrated model for practical reasoning and argumentation (chapter 4). After laying out the theoretical aspects of the new model, it is then used to re-test Breivik’s reasoning in light of a developed discussion regarding the motivation for the new place and role of moral considerations (chapter 5). The application of the new model shows ways that Breivik could have been able to conclude that his practical argumentation was unreasonable and is thus argued to have improved upon the Fairclough and Fairclough model. It is acknowledged, however, that since the model cannot guarantee a reasonable conclusion, improving the critical creative capacity of the individual using it is also of paramount importance (chapter 6). The thesis concludes by discussing the contemporary importance of improving practical reasoning and by pointing to areas for further research (chapter 7).

Fatigue life assessment of endodontic instruments subjected to multi planar curvature

This present study aimed to investigate the fatigue life of unused (new) endodontic instruments made of NiTi with control memory by Coltene™ and subjected to the multi curvature of a mandibular first molar root canal. Additionally, the instrument‟s structural behaviour was analysed through non-linear finite element analysis (FEA). The fatigue life of twelve Hyflex™ CM files was assessed while were forced to adopt a stance with multiple radius of curvature, similar to the ones usually found in a mandibular first molar root canal; nine of them were subjected to Pecking motion, a relative movement of axial type. To achieve this, it was designed an experimental setup with the aim of timing the instruments until fracture while worked inside a stainless steel mandibular first molar model with relative axial motion to simulate the pecking motion. Additionally, the model‟s root canal multi-curvature was confirmed by radiography. The non-linear finite element analysis was conducted using the computer aided design software package SolidWorks™ Simulation, in order to define the imposed displacement required by the FEA, it was necessary to model an endodontic instrument with simplified geometry using SolidWorks™ and subsequently analyse the geometry of the root canal CAD model. The experimental results shown that the instruments subjected to pecking motion displayed higher fatigue life values and higher lengths of fractured tips than those with only rotational relative movement. The finite element non-linear analyses shown, for identical conditions, maximum values for the first principal stress lower than the yield strength of the material and those were located in similar positions to the instrument‟s fracture location determined by the experimental testing results.