A Video Analysis of Intra- and Inter-professional Leadership Behaviours Within “The Burns Suite”: Identifying Key Leadership Models

Objective Leadership is particularly important in complex highly interprofessional health care contexts involving a number of staff, some from the same specialty (intraprofessional), and others from different specialties (interprofessional). The authors recently published the concept of “The Burns Suite” (TBS) as a novel simulation tool to deliver interprofessional and teamwork training. It is unclear which leadership behaviors are the most important in an interprofessional burns resuscitation scenario, and whether they can be modeled on to current leadership theory. The purpose of this study was to perform a comprehensive video analysis of leadership behaviors within TBS. Methods A total of 3 burns resuscitation simulations within TBS were recorded. The video analysis was grounded-theory inspired. Using predefined criteria, actions/interactions deemed as leadership behaviors were identified. Using an inductive iterative process, 8 main leadership behaviors were identified. Cohen’s κ coefficient was used to measure inter-rater agreement and calculated as κ = 0.7 (substantial agreement). Each video was watched 4 times, focusing on 1 of the 4 team members per viewing (senior surgeon, senior nurse, trainee surgeon, and trainee nurse). The frequency and types of leadership behavior of each of the 4 team members were recorded. Statistical significance to assess any differences was assessed using analysis of variance, whereby a p < 0.05 was taken to be significant. Leadership behaviors were triangulated with verbal cues and actions from the videos. Results All 3 scenarios were successfully completed. The mean scenario length was 22 minutes. A total of 362 leadership behaviors were recorded from the 12 participants. The most evident leadership behaviors of all team members were adhering to guidelines (which effectively equates to following Advanced Trauma and Life Support/Emergency Management of Severe Burns resuscitation guidelines and hence “maintaining standards”), followed by making decisions. Although in terms of total frequency the senior surgeon engaged in more leadership behaviors compared with the entire team, statistically there was no significant difference between all 4 members within the 8 leadership categories. This analysis highlights that “distributed leadership” was predominant, whereby leadership was “distributed” or “shared” among team members. The leadership behaviors within TBS also seemed to fall in line with the “direction, alignment, and commitment” ontology. Conclusions Effective leadership is essential for successful functioning of work teams and accomplishment of task goals. As the resuscitation of a patient with major burns is a dynamic event, team leaders require flexibility in their leadership behaviors to effectively adapt to changing situations. Understanding leadership behaviors of different team members within an authentic simulation can identify important behaviors required to optimize nontechnical skills in a major resuscitation. Furthermore, attempting to map these behaviors on to leadership models can help further our understanding of leadership theory. Collectively this can aid the development of refined simulation scenarios for team members, and can be extrapolated into other areas of simulation-based team training and interprofessional education.

Do GPs Make Good Research Participants?

Background Childhood cancers cause the largest numbers of deaths by disease in children aged 0-14 years1 with more than 400 children a year dying from cancer in the UK.2 Parental preference for their child to die within the family home2 coupled with the speciality of children’s palliative care medicine being still in its infancy, highlights the importance of the GP’s role in this highly specialised area of clinical practice. An understanding of the GP’s role will help inform the development of this specialty and identify best collaborative practice. A NIHR/CAT CL funded study examined the role of the GP in paediatric oncology palliative and bereavement care from the perspective of both the GP and the bereaved parent. This presentation will detail how GPs were approached and recruited, the reasons GPs declined participation and factors influencing the actual data collection. Methods The mixed method study used both qualitative and quantitative data collection methods. Phase 1: Semi-structured interviews to explore the experiences of GPs and parents. Phase 2: Q methodology with GPs who had a child with cancer on their caseload. Q methodology is a research tool that uses statistical analysis to cluster participants’ experiences according to similarity of their viewpoint Results The method and effectiveness of recruiting GPs for both phases of the study will be presented. In addition factors influencing collecting such emotive and sensitive data will be discussed. Conclusions Researcher flexibility and perseverance in participant recruitment was rewarded by the rich data collected. Findings from this study have identified four different GP role viewpoints and have provided a new dimension in understanding GP viewpoints on their role in this arena.

Continuity of care in older adults with multiple chronic conditions

Thesis (Ph.D.)--University of Washington, 2016-08

Technical appendix to Macrodynamics of economics: a bibliometric history

A history of specialties in economics since the late 1950s is constructed on the basis of a large corpus of documents from economics journals. The production of this history relies on a combination of algorithmic methods that avoid subjective assessments of the boundaries of specialties: bibliographic coupling, automated community detection in dynamic networks, and text mining. These methods uncover a structuring of economics around recognizable specialties with some significant changes over the period covered (1956–2014). Among our results, especially noteworthy are (1) the clear-cut existence of ten families of specialties, (2) the disappearance in the late 1970s of a specialty focused on general economic theory, (3) the dispersal of the econometrics-centered specialty in the early 1990s and the ensuing importance of specific econometric methods for the identity of many specialties since the 1990s, and (4) the low level of specialization of individual economists throughout the period in contrast to physicists as early as the late 1960s.

Exploring Forensic Nursing Ethics and Practice: Roles, Loyalties and Photodocumentation Practices

Thesis (Ph.D.)--University of Washington, 2016-08

Spatially integrated erbium-doped fiber amplifiers enabling space-division multiplexing

L’augmentation exponentielle de la demande de bande passante pour les communications laisse présager une saturation prochaine de la capacité des réseaux de télécommunications qui devrait se matérialiser au cours de la prochaine décennie. En effet, la théorie de l’information prédit que les effets non linéaires dans les fibres monomodes limite la capacité de transmission de celles-ci et peu de gain à ce niveau peut être espéré des techniques traditionnelles de multiplexage développées et utilisées jusqu’à présent dans les systèmes à haut débit. La dimension spatiale du canal optique est proposée comme un nouveau degré de liberté qui peut être utilisé pour augmenter le nombre de canaux de transmission et, par conséquent, résoudre cette menace de «crise de capacité». Ainsi, inspirée par les techniques micro-ondes, la technique émergente appelée multiplexage spatial (SDM) est une technologie prometteuse pour la création de réseaux optiques de prochaine génération. Pour réaliser le SDM dans les liens de fibres optiques, il faut réexaminer tous les dispositifs intégrés, les équipements et les sous-systèmes. Parmi ces éléments, l’amplificateur optique SDM est critique, en particulier pour les systèmes de transmission pour les longues distances. En raison des excellentes caractéristiques de l’amplificateur à fibre dopée à l’erbium (EDFA) utilisé dans les systèmes actuels de pointe, l’EDFA est à nouveau un candidat de choix pour la mise en œuvre des amplificateurs SDM pratiques. Toutefois, étant donné que le SDM introduit une variation spatiale du champ dans le plan transversal de la fibre, les amplificateurs à fibre dopée à l’erbium spatialement intégrés (SIEDFA) nécessitent une conception soignée. Dans cette thèse, nous examinons tout d’abord les progrès récents du SDM, en particulier les amplificateurs optiques SDM. Ensuite, nous identifions et discutons les principaux enjeux des SIEDFA qui exigent un examen scientifique. Suite à cela, la théorie des EDFA est brièvement présentée et une modélisation numérique pouvant être utilisée pour simuler les SIEDFA est proposée. Sur la base d’un outil de simulation fait maison, nous proposons une nouvelle conception des profils de dopage annulaire des fibres à quelques-modes dopées à l’erbium (ED-FMF) et nous évaluons numériquement la performance d’un amplificateur à un étage, avec fibre à dopage annulaire, à ainsi qu’un amplificateur à double étage pour les communications sur des fibres ne comportant que quelques modes. Par la suite, nous concevons des fibres dopées à l’erbium avec une gaine annulaire et multi-cœurs (ED-MCF). Nous avons évalué numériquement le recouvrement de la pompe avec les multiples cœurs de ces amplificateurs. En plus de la conception, nous fabriquons et caractérisons une fibre multi-cœurs à quelques modes dopées à l’erbium. Nous réalisons la première démonstration des amplificateurs à fibre optique spatialement intégrés incorporant de telles fibres dopées. Enfin, nous présentons les conclusions ainsi que les perspectives de cette recherche. La recherche et le développement des SIEDFA offriront d’énormes avantages non seulement pour les systèmes de transmission future SDM, mais aussi pour les systèmes de transmission monomode sur des fibres standards à un cœur car ils permettent de remplacer plusieurs amplificateurs par un amplificateur intégré.

Selamento coronário em Endodontia

Introdução: A Endodontia é a especialidade da Medicina Dentária responsável pelo estudo e tratamento da câmara pulpar, de todo o sistema de canais radiculares e dos tecidos periapicais, bem como das doenças que os afetam. O selamento da porção coronária dos dentes alvo de tratamento endodôntico apresenta-se como um critério determinante no sucesso ou insucesso do tratamento. São vários os fatores que podem proporcionar um correto selamento coronário evitando assim a microinfiltração de microorganismos no sistema de canais radiculares. Entre estes fatores destacam-se o tratamento pré-endodôntico, a correta e eficaz instrumentação e desinfeção dos canais radiculares, a aplicação de materiais de selamento imediato, o número de sessões em que é concluído o tratamento e ainda a restauração provisória e definitiva do dente tratado endodonticamente. Objetivos: A elaboração deste trabalho de revisão teve como principais objetivos aprofundar o conhecimento sobre o selamento coronário tendo em conta as consequências deste processo no prognóstico de dentes alvo de tratamento endodôntico, bem como, os meios a utilizar pelo clínico para prevenir a microinfiltração através da porção coronária e os materiais mais indicados para que o selamento seja alcançado. Materiais e Métodos: Foi realizada uma pesquisa bibliográfica de artigos científicos disponíveis nas bases de dados eletrónicas MEDLINE/Pubmed, Science Direct, Scielo e B-on. As palavras-chave utilizadas nesta pesquisa foram: Coronal Seal, Coronal Microleakage, Coronal Leakage, Temporary Restauration, Temporary Filling Materials, Restauration in Endodontics, Post and Core Restauration, Restorative Materials. Esta pesquisa foi realizada entre Março de 2016 e Maio do mesmo ano e dela resultou a seleção de 132 artigos publicados entre 1985 e 2016, primeiramente pela leitura do titulo e do abstract. Após a leitura completa dos artigos excluíram-se 94 por não se terem considerado relevantes para a elaboração desta revisão bibliográfica, obtendo-se um total de 38 artigos utilizados. Foi também realizada uma pesquisa bibliográfica na biblioteca da Universidade Fernando Pessoa, na secção dedicada à Endodontia, da qual resultou a seleção dos manuais que se encontram descritos pormenorizadamente na bibliografia. Conclusão: O Médico Dentista deve estar sensibilizado para as implicações que o selamento coronário tem para o sucesso do tratamento endodôntico, uma vez que este pode afetar o resultado de todo o tratamento.

Análise dos elementos que contribuem para a harmonia e estética do sorriso no contexto da face

A construção de um sorriso saudável e estético na atualidade, tem o seu sucesso associado à sinergia de todas as especialidades na área da Medicina Dentária. Este trabalho tem como objetivo determinar quais os aspetos que contribuem para a harmonia do sorriso com base na análise dos elementos faciais. Os components faciais e musculares são particulares de cada individuo e intervém diretamente no tipo de sorriso. Fatores como a raça, a idade e o género são variáveis a ter em consideração na construção de um sorriso harmónico. O presente estudo bibliográfico, faz uma abordagem sobre a estética e harmónica do sorriso analisando os aspetos tegumentares faciais, gengivais e as proporções dentárias adequadas à contrução de um sorriso belo e saudável. A aparência do sorriso tem um grande impato na vida dos indivíduos, podendo afetar desde o convívio social até mesmo as relações profissionais. Este é um dos principais motivos pelo qual pacientes recorrem a ajuda de especialistas da área. O estudo efetuado revelou que a análise da face é fundamental no estudo do sorriso. Ela identifica as caraterísticas menos favoráveis e mais favoráveis de cada pessoa com o intúito de obter um equilíbrio entre a face e o sorriso.

Caracterização da fração de óleo de café extraido de grãos sadios, verdes e preto-verdes, e a influência na adição deste na sensorial de café liofilizado

The application of roasted coffee oil directly on freeze dried soluble coffee is used to minimize the formation of fine poder which adhere on the glass packaging, which results in a negative visual appearance, as well as contributes to the aromatic impact when opening the packaging. The coffee oil is considered a high cost product obtained from Arabica coffee beans, previosly selected and roasted, by mechanical press. In Brazil the coffee culture and marketing results in the selection of the beans by type of defects and beverage, the volume of exportation works with types of coffee beans with low quantity of defects resulting in a large volume of defective coffee beans trading on the domestic market. Nevertheless, coffees which present defective grains like green, black-green beans present differences in the final flavor of the roasted coffees. The aim of this study was to evaluate the chemical composition of the oils extracted from grains classified as normal, green and black-green, at natural and roasted conditions. The oil was obtained by cold extraction using solvents of different polarities, and yield was calculated as well as its fatty acid composition. The oil of the roasted defective coffee grains was also used to prepare drinks of lyophilized soluble coffee in order to verify if jugdes were able to differenciate the sensory caracteristics of the beverages, in comparison to the product prepared using commercial oil obtained by mechanical pressing. Samples of oil obtained from defective grains showed similar extraction yields compared to hot extraction. Cromatographs of oils of the deffective grains did not showed differences compared to normal grains. In relation to the sensory analysis of the soluble coffee beverages, it was verified that when applying oils of light roasted black-green beans or oils of medium and dark roasted green beans obtained with rapid process, judges had more difficulties to distinguish differences between samples. Economic viability demonstrated that with the actual prices of the coffee beans, the use of defective beans could reduce in 64% the costs of the raw beans.

Editorial: European Journal of Case Reports in Internal Medicine

Modern medicine began in the last half of the nineteenth century when doctors started practising the scientific method at the bedside. However, in his presidential address to the Association of American Physicians in 1979 James Wyngaarden postulated that the clinical scientist was an endangered species. Several reasons for this have been suggested, including “the seductive incomes that now derive from procedure-based specialty medicine”. Others have suggested that it is simply because the things left to be discovered at bedside have become exhausted, and that all the big medical advances will now be made by high-powered institutions.

Oil spill environmental risk assessment of stationary sources in offshore zones (Innovating a mathematical model)

Nowadays, risks arising from the rapid development of oil and gas industries are significantly increasing. As a result, one of the main concerns of either industrial or environmental managers is the identification and assessment of such risks in order to develop and maintain appropriate proactive measures. Oil spill from stationary sources in offshore zones is one of the accidents resulting in several adverse impacts on marine ecosystems. Considering a site's current situation and relevant requirements and standards, risk assessment process is not only capable of recognizing the probable causes of accidents but also of estimating the probability of occurrence and the severity of consequences. In this way, results of risk assessment would help managers and decision makers create and employ proper control methods. Most of the represented models for risk assessment of oil spills are achieved on the basis of accurate data bases and analysis of historical data, but unfortunately such data bases are not accessible in most of the zones, especially in developing countries, or else they are newly established and not applicable yet. This issue reveals the necessity of using Expert Systems and Fuzzy Set Theory. By using such systems it will be possible to formulize the specialty and experience of several experts and specialists who have been working in petroliferous areas for several years. On the other hand, in developing countries often the damages to environment and environmental resources are not considered as risk assessment priorities and they are approximately under-estimated. For this reason, the proposed model in this research is specially addressing the environmental risk of oil spills from stationary sources in offshore zones.

PULMONARY REHABILITATION PROGRAMS IN LUNG TRANSPLANT: A LITERATURE REVIEW

Objective: To analyze, using a literature review, Pulmonary Rehabilitation (RP) Programs in lung transplant. Methods: A literature review in July 2014 in Ebsco Host, Periódicos Capes, BVS and Science Direct data bases using descriptors in English (“lung transplantation”, “lung transplant” AND/OR “rehabilitation”) and Portuguese (“reabilitação” AND/OR “transplante pulmonar”). The eligibility criterions were interventional studies of PR before and/or after lung transplant; participants who were candidates to lung transplant or lung transplant recipients; studies that applied any kind of PR program (hospital-based, homebased or outpatient) and articles published in English, Spanish or Portuguese. Literature reviews, guidelines and case reports were excluded. The search process yielded 46 articles of which two were duplicated. After title and abstract screening 13 articles remained for full text reading. Six studies met the inclusion eligibility and were included in the review. Results: The studies involved patients with Chronic Obstructive Pulmonary Disease, Cystic Fibrosis, Pulmonary Hypertension, Interstitial Lung Disease and Pulmonary Fibrosis. Pulmonary function, exercise capacity, quality of life (QoL) and quadriceps force were evaluated. Most interventions were outpatient programs with three months duration, three times a week and session with at least one hour. Protocols included physical training, educational approach and just one included nutritional, psychiatric and social assistant follow-up. The studies presented significant change in the six-minute walking distance, QoL and quadriceps force after PR programs. Conclusion: This review showed the benefits of the PR in the QoL and exercise capacity contributing to the Health Promotion of the patients.

Aportes para la historia del médico laboratorista y los laboratorios clínicos de la Ciudad de Cuenca

La formación del Patólogo Clínico o Médico Laboratorista se inició en nuestro medio a partir de la primera década del siglo anterior como un aprendizaje práctico junto a un maestro, para luego independizarse, salir al exterior, realizar cursos de actualización y mantenerse al día en sus conocimientos sobre las modernas técnicas y procedimientos. Los primeros patólogos clínicos se iniciaron en el centenario Hospital “San Vicente de Paúl”. Los primeros exámenes de Laboratorio se realizaron a partir de 1912, luego del retorno de Europa de los primeros médicos que salieron al exterior. Fue el Dr. Emiliano J. Crespo A. quien inició estudios de parasitología y bacteriología. El Primer Laboratorio Clínico se fundó en el Hospital “San Vicente de Paúl” confiado al Profesor Dr. Manuel Malo Crespo, luego de su temprana muerte (1933), le sucedió desde 1937 el Dr. Timoleón Carrera Cobos que formó una escuela de Médicos Laboratoristas que ejercieron esta especialidad en la segunda mitad del siglo XX y que a su vez han continuado formando a muchos de los actuales Laboratoristas Clínicos de la ciudad de Cuenca. Termina el artículo destacando la importancia del Médico de Laboratorio en la actualidad, no solo en la medicina general, sino en la mayor parte de las especialidades, en el diagnóstico, evolución, pronóstico y seguimiento de la enfermedad. DeCS: Ciencia del Laboratorio clínico/historia; Médicos/ historia; Médicos Laboratoristas; Hospital “San Vicente de Paúl”; Historia de la Medicina.

La synthèse philosophico-juridique de V.S. Soloviev : élaboration et mise en œuvre d’un cadre théorique

Vladimir S. Soloviev (1853-1900) était un philosophe russe, poète et dissident de la période prérévolutionnaire. Comme celle de beaucoup de ses contemporains prérévolutionnaires russes, la pensée de Soloviev fut constamment sollicitée par la réfection imminente de l’État russe dans un futur très proche. Dans le contexte de cette époque, un examen des fondements théoriques du système juridique était peut-être inévitable. Néanmoins, dans la pensée russe, c’est seulement avec Soloviev que le droit cessa d’être un sujet spécialisé dans le domaine de l’administration, ne concernant guère les grands enjeux de société, et devint intimement lié au développement même de la philosophie morale et sociale. Au sein du projet philosophique systématique que propose Soloviev, le concept de l’unitotalité est envahissant, en termes épistémologique et social. Une pierre d’assise également fondamentale est le concept philosophico-religieux de la divino-humanité, à travers lequel la source de la dignité humaine est ultimement exprimée. La philosophie juridique de Soloviev, contenue pour l’essentiel dans un traité intitulé La Justification du bien : essai de philosophie morale (1897), a pour principal objet l’interaction entre le droit et la morale. Alors que l’objet et la portée du droit peuvent être directement déduits de principes moraux, le droit ne peut pas coïncider exactement avec la morale, compte tenu de son caractère plus limité, fini et coercitif. Pour Soloviev, le droit doit imposer un niveau minimum du bien en fournissant les conditions de base (par ex. la primauté du droit, le droit à une existence digne, la liberté de conscience) pour le libre développement des facultés humaines sans transposer directement en lui la plénitude complète du bien. La principale motivation de Soloviev réside dans la prémisse théologique sous-jacente que le bien ne peut jamais être complètement subsumé sauf par un acte conscient de liberté personnelle. En tandem, Soloviev souligne le rôle progressiste de l’État pour favoriser le libre perfectionnement humain. En tant que tel, Soloviev nous fournit certaines voies innovatrices dans le façonnement de la relation tant théorique que pratique entre le droit et la religion. À l’encontre d’un compromis entre objets, c’est-à-dire un arrangement de type interculturel situé entre fragmentation culturelle (multiculturalisme idéologique) et assimilation antireligieuse (laïcité militante), l’analyse de Soloviev présente la nécessité d’une conciliation temporelle, dans une perspective historique beaucoup plus large, où la laïcité est considérée non pas comme une finalité ontologique en soi, figée dans le temps, mais comme un moyen au service d’une destinée humaine en cours d’actualisation. Le cadre philosophico-juridique de Soloviev peut être utilement mis en dialogue avec des auteurs contemporains comme Stephen L. Carter, Charles Taylor, John Witte Jr, Ronald Dworkin et Jürgen Habermas. La contribution potentielle de Soloviev sur la place de la religion dans la société russe contemporaine est également mentionnée, avec un accent particulier sur le réexamen critique de l’héritage durable de la notion byzantine de la symphonie entre l’Église et l’État. Enfin, une théorie du fédéralisme inspirée par Soloviev est développée en appliquant, sur une base comparative, des avancées théoriques dans le domaine de l’histoire juridique global à l’évolution constitutionnelle du Canada et d’Israël.

Creación de neologismos en euskera: Análisis descriptivo de la terminología de la odontología en lengua vasca y propuestas para la formación de términos en los ámbitos de especialidad.

450 p.