Medical error:a discussion of the medical construction of error and suggestions for reforms of medical education to decrease error

Introduction: There is a growing public perception that serious medical error is commonplace and largely tolerated by the medical profession. The Government and medical establishment's response to this perceived epidemic of error has included tighter controls over practising doctors and individual stick-and-carrot reforms of medical practice. Discussion: This paper critically reviews the literature on medical error, professional socialization and medical student education, and suggests that common themes such as uncertainty, necessary fallibility, exclusivity of professional judgement and extensive use of medical networks find their genesis, in part, in aspects of medical education and socialization into medicine. The nature and comparative failure of recent reforms of medical practice and the tension between the individualistic nature of the reforms and the collegiate nature of the medical profession are discussed. Conclusion: A more theoretically informed and longitudinal approach to decreasing medical error might be to address the genesis of medical thinking about error through reforms to the aspects of medical education and professional socialization that help to create and perpetuate the existence of avoidable error, and reinforce medical collusion concerning error. Further changes in the curriculum to emphasize team working, communication skills, evidence-based practice and strategies for managing uncertainty are therefore potentially key components in helping tomorrow's doctors to discuss, cope with and commit fewer medical errors.

Correlations between garden design plant applications and climate change

Possible effects of climate change means great challenges to landscape design professionals in Hungary. Our climate will shift towards the Mediterranean and we have to prepare for this with among others, choosing correctly the plants to be planted. Teaching garden design dendrology has not recognized yet the necessity and urgency of this matter. Quick measures are required due to the long life-time and slow development of woody taxons. This paper presents the double relationship between landscape design and climate change emphasizing the outdoor architectural methods of adjustment. Such techniques recognized abroad are presented like precipitation drainage by vegetation and extensive green roof. Finally the effects of climate change on ornamental plants application are presented together with the associated project started at the Corvinus University of Budapest in 2010.

Estimation and prediction of average vehicle occupancies using traffic accident records

As congestion management strategies begin to put more emphasis on person trips than vehicle trips, the need for vehicle occupancy data has become more critical. The traditional methods of collecting these data include the roadside windshield method and the carousel method. These methods are labor-intensive and expensive. An alternative to these traditional methods is to make use of the vehicle occupancy information in traffic accident records. This method is cost effective and may provide better spatial and temporal coverage than the traditional methods. However, this method is subject to potential biases resulting from under- and over-involvement of certain population sectors and certain types of accidents in traffic accident records. In this dissertation, three such potential biases, i.e., accident severity, driver’s age, and driver’s gender, were investigated and the corresponding bias factors were developed as needed. The results show that although multi-occupant vehicles are involved in higher percentages of severe accidents than are single-occupant vehicles, multi-occupant vehicles in the whole accident vehicle population were not overrepresented in the accident database. On the other hand, a significant difference was found between the distributions of the ages and genders of drivers involved in accidents and those of the general driving population. An information system that incorporates adjustments for the potential biases was developed to estimate the average vehicle occupancies (AVOs) for different types of roadways on the Florida state roadway system. A reasonableness check of the results from the system shows AVO estimates that are highly consistent with expectations. In addition, comparisons of AVOs from accident data with the field estimates show that the two data sources produce relatively consistent results. While accident records can be used to obtain the historical AVO trends and field data can be used to estimate the current AVOs, no known methods have been developed to project future AVOs. Four regression models for the purpose of predicting weekday AVOs on different levels of geographic areas and roadway types were developed as part of this dissertation. The models show that such socioeconomic factors as income, vehicle ownership, and employment have a significant impact on AVOs.

Actionable pattern analysis in computing and business intelligence systems

With advances in science and technology, computing and business intelligence (BI) systems are steadily becoming more complex with an increasing variety of heterogeneous software and hardware components. They are thus becoming progressively more difficult to monitor, manage and maintain. Traditional approaches to system management have largely relied on domain experts through a knowledge acquisition process that translates domain knowledge into operating rules and policies. It is widely acknowledged as a cumbersome, labor intensive, and error prone process, besides being difficult to keep up with the rapidly changing environments. In addition, many traditional business systems deliver primarily pre-defined historic metrics for a long-term strategic or mid-term tactical analysis, and lack the necessary flexibility to support evolving metrics or data collection for real-time operational analysis. There is thus a pressing need for automatic and efficient approaches to monitor and manage complex computing and BI systems. To realize the goal of autonomic management and enable self-management capabilities, we propose to mine system historical log data generated by computing and BI systems, and automatically extract actionable patterns from this data. This dissertation focuses on the development of different data mining techniques to extract actionable patterns from various types of log data in computing and BI systems. Four key problems—Log data categorization and event summarization, Leading indicator identification , Pattern prioritization by exploring the link structures , and Tensor model for three-way log data are studied. Case studies and comprehensive experiments on real application scenarios and datasets are conducted to show the effectiveness of our proposed approaches.

Three essays on self-employment transitions, organizational capital, and firm formation

This dissertation explores how economic, organizational, and personal factors affect self-employment transitions, occupational decisions, and firm formation activities of individuals at different positions in the skill distribution. The first essay of my dissertation studies how local unemployment rates differentially affect entry into self-employment by individuals at different places in the skill distribution. The empirical results show a positive correlation between local unemployment rates and entry into self-employment for low-ability workers, but not for high-ability workers. Including employer size to eliminate possible distortions showed that the positive association between unemployment and self-employment among low-ability workers is in fact driven by the small firm effect. Controlling for firm size yields a negative association between unemployment and self-employment among high-ability workers. Effects of organizational capital, human capital and physical capital, on the firm formation activities of people at distinct skill levels depend on the type of the industry which is chosen for the new firm. Two types of industries, capital-intensive and ability-intensive, are utilized to explore this hypothesis in the second essay. A capital-intensive industry requires more physical investment, and consequently more funds, whereas, an ability-intensive industry requires more human capital. It is shown that high human capital requirements are associated with higher earnings among the most able individuals, and therefore makes them more likely to found firms in an ability-intensive industry. Wealthy people are more likely to establish both capital-intensive and ability-intensive firms, even though the amount of funds necessary for two industry types differs. Moreover, entry into both industries is predicted to happen later in life due to the removal of entry barriers constituted by required investment spending using savings when old. Empirical mixed results are observed. The third essay investigates earning differentials between future entrepreneurs and their non-entrepreneurial colleagues. Results show that high-ability firm-owners in an ability-intensive industry were earning more than those that remained in wage-work, whereas, low-ability firm-owners in a capital-intensive industry were earning less than those remaining in paid-work.

Controls on sensible heat and latent energy fluxes from a short-hydroperiod Florida Everglades marsh

Little is known of energy balance in low latitude wetlands where there is a year-round growing season and a climate best defined by wet and dry seasons. The Florida Everglades is a highly managed and extensive subtropical wetland that exerts a substantial influence on the hydrology and climate of the south Florida region. However, the effects of seasonality and active water management on energy balance in the Everglades ecosystem are poorly understood. An eddy covariance and micrometeorological tower was established in a short-hydroperiod Everglades marsh to examine the dominant environmental controls on sensible heat (H) and latent energy (LE) fluxes, as well as the effects of seasonality on these parameters. Seasonality differentially affected H and LE fluxes in this marsh, such that H was principally dominant in the dry season and LE was strongly dominant in the wet season. The Bowen ratio was high for much of the dry season (1.5–2.4), but relatively low (H and LE fluxes across nearly all seasons and years (). However, the 2009 dry season LE data were not consistent with this relationship () because of low seasonal variation in LE following a prolonged end to the previous wet season. In addition to net radiation, H and LE fluxes were significantly related to soil volumetric water content (VWC), water depth, air temperature, and occasionally vapor pressure deficit. Given that VWC and water depth were determined in part by water management decisions, it is clear that human actions have the ability to influence the mode of energy dissipation from this ecosystem. Impending modifications to water management under the Comprehensive Everglades Restoration Plan may shift the dominant turbulent flux from this ecosystem further toward LE, and this change will likely affect local hydrology and climate.

Service Quality and Black Customer Satisfaction - A Perspective on the United States Restaurant Industry

This paper examines the issue of racial discrimination of Black United States (U.S.) restaurant patrons from a service quality and customer satisfaction perspective. In spite of the progress the industry has made in recent years to alleviate this problem, many contemporary examples clearly demonstrate that racial discrimination is still of great concern. The articles stresses the importance of an ethical approach in human resource management-intensive and offers suggestions for reducing discriminatory practices in U.S. restaurant service delivery.

Hispanic -serving land -grant colleges: Analysis and plan for an educational policy initiative

Hispanics and other minority Americans are denied access to higher education by a system that needs structural reform. The purpose of the research was to determine whether creating Hispanic-serving land-grant colleges, similar to the Morrill land-grant colleges serving Black and Native Americans, might be an effective strategy to increase the access of Hispanic students to quality higher education. In addition to published materials, data was collected from a survey of Hispanic-serving institutions and extensive interviews with college presidents, government representatives, educational association leaders, and educational historians. ^ The research examined how existing land-grant college systems came into being and how they have evolved. A look at the functions of the land-grant systems serving Blacks and Native Americans revealed promising possibilities for a system that would include more Hispanics. Legal, fiscal, curricular, and organizational criteria were inferred from the existing systems. While none of the existing land-grant systems can be adapted to serve Hispanics or most other minorities outside their limited regions, each has elements that could be adapted by a new minority-serving system. A number of colleges already have features that could make them candidates for state designation as land-grant colleges. ^ The research suggests that a new federally funded system of Morrill land-grant colleges dedicated to serving all urban Americans, not just Hispanics, would do much to increase the numbers of Hispanic students and other racially and ethnically minority Americans in good quality higher educational institutions. An inclusive urban land-grant system would be politically feasible, whereas one meant to serve Hispanics alone would not. Because of their urban locations, these universities would serve large concentrations of minority citizens of all ethnic groups. ^ Finally, the basic elements of a strategic plan are presented for an educational organization to use for organizing leaders of minority educational associations, financing an initiative to lobby Congress, eliciting legislative and federal agency support, and securing the assistance of other educational, industrial, and special interest groups. The plan includes a suggested timetable for action. Recommendations are made for innovations that would make such a higher education system distinctive and would help meet important national needs. ^

Novel analytical methodologies for the monitoring of traditional and non-traditional pollutants in different environmental compartments of South Florida

Routine monitoring of environmental pollution demands simplicity and speed without sacrificing sensitivity or accuracy. The development and application of sensitive, fast and easy to implement analytical methodologies for detecting emerging and traditional water and airborne contaminants in South Florida is presented. A novel method was developed for quantification of the herbicide glyphosate based on lyophilization followed by derivatization and simultaneous detection by fluorescence and mass spectrometry. Samples were analyzed from water canals that will hydrate estuarine wetlands of Biscayne National Park, detecting inputs of glyphosate from both aquatic usage and agricultural runoff from farms. A second study describes a set of fast, automated LC-MS/MS protocols for the analysis of dioctyl sulfosuccinate (DOSS) and 2-butoxyethanol, two components of Corexit®. Around 1.8 million gallons of those dispersant formulations were used in the response efforts for the Gulf of Mexico oil spill in 2010. The methods presented here allow the trace-level detection of these compounds in seawater, crude oil and commercial dispersants formulations. In addition, two methodologies were developed for the analysis of well-known pollutants, namely Polycyclic Aromatic Hydrocarbons (PAHs) and airborne particulate matter (APM). PAHs are ubiquitous environmental contaminants and some are potent carcinogens. Traditional GC-MS analysis is labor-intensive and consumes large amounts of toxic solvents. My study provides an alternative automated SPE-LC-APPI-MS/MS analysis with minimal sample preparation and a lower solvent consumption. The system can inject, extract, clean, separate and detect 28 PAHs and 15 families of alkylated PAHs in 28 minutes. The methodology was tested with environmental samples from Miami. Airborne Particulate Matter is a mixture of particles of chemical and biological origin. Assessment of its elemental composition is critical for the protection of sensitive ecosystems and public health. The APM collected from Port Everglades between 2005 and 2010 was analyzed by ICP-MS after acid digestion of filters. The most abundant elements were Fe and Al, followed by Cu, V and Zn. Enrichment factors show that hazardous elements (Cd, Pb, As, Co, Ni and Cr) are introduced by anthropogenic activities. Data suggest that the major sources of APM were an electricity plant, road dust, industrial emissions and marine vessels.

Estimation and Prediction of Average Vehicle Occupancies using Traffic Accident Records

As congestion management strategies begin to put more emphasis on person trips than vehicle trips, the need for vehicle occupancy data has become more critical. The traditional methods of collecting these data include the roadside windshield method and the carousel method. These methods are labor-intensive and expensive. An alternative to these traditional methods is to make use of the vehicle occupancy information in traffic accident records. This method is cost effective and may provide better spatial and temporal coverage than the traditional methods. However, this method is subject to potential biases resulting from under- and over-involvement of certain population sectors and certain types of accidents in traffic accident records. In this dissertation, three such potential biases, i.e., accident severity, driver¡¯s age, and driver¡¯s gender, were investigated and the corresponding bias factors were developed as needed. The results show that although multi-occupant vehicles are involved in higher percentages of severe accidents than are single-occupant vehicles, multi-occupant vehicles in the whole accident vehicle population were not overrepresented in the accident database. On the other hand, a significant difference was found between the distributions of the ages and genders of drivers involved in accidents and those of the general driving population. An information system that incorporates adjustments for the potential biases was developed to estimate the average vehicle occupancies (AVOs) for different types of roadways on the Florida state roadway system. A reasonableness check of the results from the system shows AVO estimates that are highly consistent with expectations. In addition, comparisons of AVOs from accident data with the field estimates show that the two data sources produce relatively consistent results. While accident records can be used to obtain the historical AVO trends and field data can be used to estimate the current AVOs, no known methods have been developed to project future AVOs. Four regression models for the purpose of predicting weekday AVOs on different levels of geographic areas and roadway types were developed as part of this dissertation. The models show that such socioeconomic factors as income, vehicle ownership, and employment have a significant impact on AVOs.

The implementation of a literacy intervention 'Station Teaching' in infant classes in Irish primary schools

Background: I conducted my research in the context of The National Literacy Strategy (DES, 2011), which maintains that every young person should be literate and it outlines targets for improving literacy in schools from 2011 to 2020. There has been much debate on the teaching of literacy and in particular the teaching of reading. Clark (2014) outlines how learning to read should be a developmental language process and that the approaches in the early years of schooling will colour the children’s motivation and their perception of reading as a purposeful activity. The acquisition of literacy begins in the home but this study focuses on the implementation of a literacy intervention Station Teaching in the infant classes in primary school. Station Teaching occurs when a class is divided into four or five small groups of pupils and they receive intensive tuition at four or five different Stations with the help of Support teachers: New Reading, Familiar Reading, Phonics, Writing and Oral Language. Research Questions: These research questions frame my study: How is Station Teaching implemented? What is the experience of the intervention Station Teaching from the participants’ point of view: teachers, pupils, parents? What notion of literacy is Station Teaching facilitating? Methods: I chose a pragmatic parallel mixed methods design as suggested by Mertens (2010). I collected and analysed both the quantitative and qualitative data to answer the study’s research questions. In the study the quantitative data were collected from a questionnaire issued to 21 schools in Ireland. I used Excel as a data management package and thematic analysis to analyse and present the data in themes. I collected qualitative data from a case study in a school. This data included observations of two classes over a period of a year; interviews with teachers, pupils and parents; children’s drawings, photographs, teachers’ diaries and video evidence. I analysed and presented the evidence from the qualitative data in themes. Main Findings: There are many skills and strategies that are essential to effective literacy teaching in the early years including phonological awareness, phonics, vocabulary, fluency, comprehension and writing. These skills can be taught during Station Teaching. Early intervention in the early years is essential to pupils’ acquisition of literacy. The expertise of the teacher is key to improving the literacy achievement of pupils Teachers and pupils enjoy participating in ST. Pupils are motivated to read and engage in meaningful activities during ST. Staff collaboration is vital for ST to succeed ST facilitates small group work and teachers can differentiate accordingly while including all pupils in the groups. Pupils’ learning is extended in ST but extension activities need to be addressed in the Writing Station. More training should be provided for teachers on the implementation of ST and more funding for resources should be available to schools Significant contribution of the work: The main significance of the study includes: insights into the classroom implementation of Station Teaching in infant classes and extensive research into characteristics of an effective teacher of literacy.

(Table 1) Sample locations and clay mineral data of sediment surface samples from the Barents Sea region

A new surface sediment sample set gained in the western Barents Sea by the MAREANO program has been analysed for basic clay mineral assemblages. Distribution maps including additional samples from earlier German research cruises to and off Svalbard are compiled. Some trends in the clay mineral assemblages are related to the sub-Barents Sea geology because the Quaternary sediment cover is rather thin. Additionally, land masses like Svalbard and northern Scandinavia dominate the clay mineral signal with their erosional products. Dense bottom water, very often of brine origin, that flows within deep troughs, such as the Storfjorden or Bear Island Trough, transport the clay mineral signal from their origin to the Norwegian-Greenland Sea.

Admittance Control for Robotic Loading: Design and Experiments with a 1-Tonne Loader and a 14-Tonne LHD

This paper describes the design, tuning, and extensive field testing of an admittance-based Autonomous Loading Controller (ALC) for robotic excavation. Several iterations of the ALC were tuned and tested in fragmented rock piles—similar to those found in operating mines—by using both a robotic 1-tonne capacity Kubota R520S diesel-hydraulic surface loader and a 14-tonne capacity Atlas Copco ST14 underground load-haul-dump (LHD) machine. On the R520S loader, the ALC increased payload by 18 % with greater consistency, although with more energy expended and longer dig times when compared with digging at maximum actuator velocity. On the ST14 LHD, the ALC took 61 % less time to load 39 % more payload when compared to a single manual operator. The manual operator made 28 dig attempts by using three different digging strategies, and had one failed dig. The tuned ALC made 26 dig attempts at 10 and 11 MN target force levels. All 10 11 MN digs succeeded while 6 of the 16 10 MN digs failed. The results presented in this paper suggest that the admittance-based ALC is more productive and consistent than manual operators, but that care should be taken when detecting entry into the muck pile

The Economic Case for Electric Mining Equipment and Technical Considerations Relating to their Implementation

Underground hardrock mining can be very energy intensive and in large part this can be attributed to the power consumption of underground ventilation systems. In general, the power consumed by a mine’s ventilation system and its overall scale are closely related to the amount of diesel power in operation. This is because diesel exhaust is a major source of underground air pollution, including diesel particulate matter (DPM), NO2 and heat, and because regulations tie air volumes to diesel engines. Furthermore, assuming the size of airways remains constant, the power consumption of the main system increases exponentially with the volume of air supplied to the mine. Therefore large diesel fleets lead to increased energy consumption and can also necessitate large capital expenditures on ventilation infrastructure in order to manage power requirements. Meeting ventilation requirements for equipment in a heading can result in a similar scenario with the biggest pieces leading to higher energy consumption and potentially necessitating larger ventilation tubing and taller drifts. Depending on the climate where the mine is located, large volumes of air can have a third impact on ventilation costs if heating or cooling the air is necessary. Annual heating and cooling costs, as well as the cost of the associated infrastructure, are directly related to the volume of air sent underground. This thesis considers electric mining equipment as a means for reducing the intensity and cost of energy consumption at underground, hardrock mines. Potentially, electric equipment could greatly reduce the volume of air needed to ventilate an entire mine as well as individual headings because they do not emit many of the contaminants found in diesel exhaust and because regulations do not connect air volumes to electric motors. Because of the exponential relationship between power consumption and air volumes, this could greatly reduce the amount of power required for mine ventilation as well as the capital cost of ventilation infrastructure. As heating and cooling costs are also directly linked to air volumes, the cost and energy intensity of heating and cooling the air would also be significantly reduced. A further incentive is that powering equipment from the grid is substantially cheaper than fuelling them with diesel and can also produce far fewer GHGs. Therefore, by eliminating diesel from the underground workers will enjoy safer working conditions and operators and society at large will gain from a smaller impact on the environment. Despite their significant potential, in order to produce a credible economic assessment of electric mining equipment their impact on underground systems must be understood and considered in their evaluation. Accordingly, a good deal of this thesis reviews technical considerations related to the use of electric mining equipment, especially ones that impact the economics of their implementation. The goal of this thesis will then be to present the economic potential of implementing the equipment, as well as to outline the key inputs which are necessary to support an evaluation and to provide a model and an approach which can be used by others if the relevant information is available and acceptable assumptions can be made.

RELIBILITY ANALYSIS OF SIMPLE SLOPES AND SOIL-STRUCTURES WITH LINEAR LIMIT STATES

The first objective of this research was to develop closed-form and numerical probabilistic methods of analysis that can be applied to otherwise conventional methods of unreinforced and geosynthetic reinforced slopes and walls. These probabilistic methods explicitly include random variability of soil and reinforcement, spatial variability of the soil, and cross-correlation between soil input parameters on probability of failure. The quantitative impact of simultaneously considering the influence of random and/or spatial variability in soil properties in combination with cross-correlation in soil properties is investigated for the first time in the research literature. Depending on the magnitude of these statistical descriptors, margins of safety based on conventional notions of safety may be very different from margins of safety expressed in terms of probability of failure (or reliability index). The thesis work also shows that intuitive notions of margin of safety using conventional factor of safety and probability of failure can be brought into alignment when cross-correlation between soil properties is considered in a rigorous manner. The second objective of this thesis work was to develop a general closed-form solution to compute the true probability of failure (or reliability index) of a simple linear limit state function with one load term and one resistance term expressed first in general probabilistic terms and then migrated to a LRFD format for the purpose of LRFD calibration. The formulation considers contributions to probability of failure due to model type, uncertainty in bias values, bias dependencies, uncertainty in estimates of nominal values for correlated and uncorrelated load and resistance terms, and average margin of safety expressed as the operational factor of safety (OFS). Bias is defined as the ratio of measured to predicted value. Parametric analyses were carried out to show that ignoring possible correlations between random variables can lead to conservative (safe) values of resistance factor in some cases and in other cases to non-conservative (unsafe) values. Example LRFD calibrations were carried out using different load and resistance models for the pullout internal stability limit state of steel strip and geosynthetic reinforced soil walls together with matching bias data reported in the literature.