Workflow Interruptions and Failed Action Regulation in Surgery Personnel

Background Workflow interruptions during surgery may cause a threat to patient's safety. Workflow interruptions were tested to predict failure in action regulation that in turn predicts near-accidents in surgery and related health care. Methods One-hundred-and-thirty-three theater nurses and physicians from eight Swiss hospitals participated in a cross-sectional questionnaire survey. The study participation rate was 43%. Results Structural equation modeling confirmed an indirect path from workflow interruptions through cognitive failure in action regulation on near-accidents (p < 0.05). The indirect path was stronger for workflow interruptions by malfunctions and task organizational blockages compared with workflow interruptions that were caused by persons. The indirect path remained meaningful when individual differences in conscientiousness and compliance with safety regulations were controlled. Conclusion Task interruptions caused by malfunction and organizational constraints are likely to trigger errors in surgery. Work redesign is recommended to reduce workflow interruptions by malfunction and regulatory constraints.

Alpine Common Property Institutions under Change: Conditions for Successful and Unsuccessful Collective Action by Alpine Farmers in the Canton of Grisons, Switzerland

The protection and sustainable management of alpine summer pastures has been stated as a goal in Swiss national law since 1996, and direct payments from the state for summer pasturing have been tied to sustainability criteria since 2000. This reflects the increasing value of the alpine cultural landscape as a public good. However, provision of this public good remains in the hands of local farmers and their local common pool resource (CPR) institutions for managing alpine pastures. These institutions are increasingly struggling to maintain their institutional arrangements, particularly regarding the work needed to maintain the pastures. This paper examines two cases of local CPR institutions for managing alpine pastures in the Swiss Canton of Grisons that manifest different institutional developments in light of changing conditions. The differences in how these institutions reacted to change and the impacts this has had on the provision of the CPR are explained by focusing on relative prices, bargaining power, and ideology as drivers of institutional change that are often neglected within common property research. Key words: summer pasture management, institutional change, bargaining power, ideology

Lessons from Ellen: A Case Study Investigation of Comprehension Strategy Instruction in Action

In the past ten years, reading comprehension instruction has received significant attention from educational researchers. Drawing on studies from cognitive psychology, reader response theory, and language arts research, current best practice in reading comprehension instruction is characterized by a strategies approach in which students are taught to think like proficient readers who visualize, infer, activate schema, question, and summarize as they read. Studies investigating the impact of comprehension strategy instruction on student achievement in reading suggest that when implemented consistently the intervention has a positive effect on achievement. Research also shows, however, that few teachers embrace this approach to reading instruction despite its effectiveness, even when the conditions for substantive professional development (i.e. prolonged engagement, support, resources, time) are present. The interpretive case study reported in this dissertation examined the year-long experience of one fourth grade teacher, Ellen, as she leanled about comprehension strategy instruction and attempted to integrate the approach in her reading program. The goal of the study was to extend current understanding of the factors that support or inhibit an individual teacher's instructional decision making. The research explored how Ellen's academic preparation, beliefs about reading comprehension instruction, and attitudes toward teacher-student interaction influenced her efforts to employ comprehension strategy instruction. Qualitative methods were the basis of this study's research design. The primary methods for collecting data included pre- and post-interviews, field notes from classroom observations and staff development sessions, infonnal interviews, e-mail correspondence, and artifacts such as reading assignments, professional writing, school newsletters, and photographs of the classroom. Transcripts from interviews, as well as field notes, e-mail, and artifacts, were analyzed according to grounded theory's constant-comparative method. The results of the study suggest that three factors were pivotal in Ellen's successful implementation of reading strategy instruction: Pedagogical beliefs, classroom relationships, and professional community. Research on instructional change generally focuses on issues of time, resources, feedback, and follow-through. The research reported here recognizes the importance of these components, but expands contemporary thinking by showing how, in Ellen's case, a teacher's existing theories, her relationship with her students, and her professional interaction with peers impact instructional decisions.

Nuclear functions of dynein light chain 1 in hormone action

It is widely accepted that the process of breast cancer tumorigenesis involves estrogen receptor-alpha (ER)-regulated stimulatory pathways, which feed into survival, cell cycle progression and proliferative response. Recent data from Kumar laboratory indicate that dynein light chain 1 (DLC1) plays a role in survival, motility and invasiveness, all of which are required for a successful tumorigenesis process. In the present research, we have discovered a mechanistic bidirectional regulatory link between the DLC1 and ER. We found that DLC1 facilitates ligand-induced ER transactivation involving the recruitment of the DLC1-ER complex to ER-target genes. To gain insights into the mechanism by which DLC1 regulates the ER pathway, we set out to identify novel DLC1-interacting proteins. Among other proteins, we identified KIBRA and Ciz1 as two novel DLC1-interacting proteins. We found that the KIBRA-DLC1 complex is recruited to ER-responsive promoters, and that KIBRA-DLC1 interaction is needed for the recruitment of ER to its targets as well as for ER's transactivation function. Finally, we found that KIBRA utilizes its histone H3interacting glutamic acid-rich region to regulate the transactivation activity of ER. During the course of this work, we also discovered that DLC1 interacts with Cdk2 and Ciz1, and such interactions play a direct accelerating role in the G1-S transition of breast cancer cells. While delineating the role of Ciz1 in hormone-responsive cancer cells, we found that Ciz1 is an estrogen-responsive gene, and acts as a co-regulator of ER. Accordingly, Ciz1 overexpression in breast cancer cells conferred estrogen hypersensitivity, promoted the growth-rate, anchorage-independency and tumorigenic properties. Collectively, findings made during the course of the present dissertation research introduced two new molecular players in the action of ER in breast cancer cells, with a particular focus on cell cycle progression and ER-chromatin target regulation. In addition, findings presented here provide novel mechanistic insight about the contribution of DLC1 and its interacting proteins in amplifying the hormone action and promoting the process of breast cancer tumorigenesis. ^

Mexican American parent atttitudes towards research participation

The objective of this cross sectional pilot study was to understand the cultural and social influences associated with the participation and retention of Mexican American parents in research studies. Mexican American parent's participation is limited due to cultural barriers that researchers may not recognize. Successful recruitment and retention of participants is a critical element for prevention research, particularly for groups that are underrepresented and carry a high burden of disease (Dunika, Garza, Roosa, & Stoerzinger, 1997). ^ The goal of this pilot study was to increase the understanding of research participation, recruitment and retention strategies among Mexican American adults using an instrument based on the Health Belief Model. This instrument was used to assess the cultural beliefs of Mexican American adults toward research participation. The dependent variable (research scenarios indexed by invasiveness) for each participant was compared to the independent variable (HBM scores) using chi-square analysis to see how the Health Belief Model constructs of perceived threat, perceived barriers, cues to action and perceived benefits are associated with how willing the participants are to participate in different risk levels of research. Descriptive statistics were used to assess the items on the instrument regarding acculturation, demographics, and sample size. ^ This study expands on current knowledge of research participation and retention strategies and methods involving the Mexican American parents. Using data from this study, researchers can observe relevant patterns from the participant's responses.^

Health, education and community: Assets and needs of a small urban community in north east Tamaulipas, Mexico: A community based participatory research assessment

This study explored the health, education, social assets, needs, attitudes, and behaviors of residents of Ferrocarril #4, a small urban community in Tamaulipas, Mexico. A collaborative Participatory Action Research approach was used to emphasize community involvement. Using Triangulation to ensure validity, qualitative methods included key informant in depth interviews, participant observation and participatory discussion groups with women and men. A personal interview with a probability sample of women was done. The median age of interviewees was 37 years. The majority was married or had a partner. Over half of respondents completed grades 6-9. Employed women (25%) earned a median weekly salary equivalent to ∼56 USD. Women with health insurance (67.7%) were covered mainly through Social Security and Seguro Popular. One in 5 reported bad health. Barriers to care were primarily money and transportation. To improve health care, women wanted a full service clinic in or close to the community and affordable health care. Socially, 28% of respondents had no close friends in the community and most did not participate in beneficial community activities. Many women did not socialize with others and help from neighbors was situational. Primary school teachers lacked parental support and it interfered with classroom efforts. Healthy community discussion groups focused on personal and environmental hygiene and safety. Valuable assets exist in the community. To date, collaborative efforts resulted in a school First Aid station, a school nurse visit weekly, posting of emergency contact phone numbers in the school and community center, and development of a student health information form. ^

A case study approach to estimating the burden of research misconduct in publicly funded medical research

The economic impact of research misconduct in medical research has been unexplored. While research misconduct in publicly funded medical research has increasingly been the object of discussion, public policy debate, government and institutional action, and scientific research, the costs of research misconduct have been unexamined. The author develops a model to estimate the per case cost of research misconduct, specifically the costs of fabrication, falsification, and plagiarism, in publicly funded medical research. Using the database of Research Misconduct Findings maintained by the Office of Research Integrity, Department of Health and Human Services, the model is used to estimate costs of research misconduct in public funded medical research among faculty during the period 2000-2005.^

The movement toward patient safety: State action related to reporting and disclosure of healthcare-associated infections

Increasing attention has been given to the problem of medical errors over the past decade. Included within that focused attention has been a strong interest in reducing the occurrence of healthcare-associated infections (HAIs). Acting concurrently with federal initiatives, the majority of U.S. states have statutorily required reporting and public disclosure of HAI data. Although the occurrence of these state statutory enactments and other state initiatives represent a recognition of the strong concern pertaining to HAIs, vast differences in each state’s HAI reporting and public disclosure requirements creates a varied and unequal response to what has become a national problem.^ The purpose of this research was to explore the variations in state HAI legal requirements and other state mandates. State actions, including statutory enactments, regulations, and other initiatives related to state reporting and public disclosure mechanisms were compared, discussed, and analyzed in an effort to illustrate the impact of the lack of uniformity as a public health concern.^ The HAI statutes, administrative requirements, and other mandates of each state and two U.S. territories were reviewed to answer the following seven research questions: How far has the state progressed in its HAI initiative? If the state has a HAI reporting requirement, is it mandatory or voluntary? What healthcare entities are subject to the reporting requirements? What data collection system is utilized? What measures are required to be reported? What is the public disclosure mechanism? How is the underlying reported information protected from public disclosure or other legal release?^ Secondary publicly available data, including state statutes, administrative rules, and other initiatives, were utilized to examine the current HAI-related legislative and administrative activity of the study subjects. The information was reviewed and analyzed to determine variations in HAI reporting and public disclosure laws. Particular attention was given to the seven key research questions.^ The research revealed that considerable progress has been achieved in state HAI initiatives since 2004. Despite this progress, however, when reviewing the state laws and HAI programs comparatively, considerable variations were found to exist with regards to the type of reporting requirements, healthcare facilities subject to the reporting laws, data collection systems utilized, reportable measures, public disclosure requirements, and confidentiality and privilege provisions. The wide variations in state statutes, administrative rules, and other agency directives create a fragmented and inconsistent approach to addressing the nationwide occurrence of HAIs in the U.S. healthcare system. ^

Perceptions of institutional support of community -based participatory research within prevention research centers

The Institute of Medicine (IOM) report on the future of health care states that the focus on health needs to shift to the management and prevention of chronic illnesses and that academic health centers (AHCs) should play an active role in this process through community partnerships (IOM, 2002). Grant funding from the National Institutes of Health and the creation of the Centers for Disease Control and Prevention (CDC) Prevention Research Centers (PRC) across the county represent a transition toward more proactively seeking out community partnerships to better design and disseminate health promotion programs (Green, 2001). ^ The focus of the PRCs is to conduct rigorous, community-based, prevention research, to seek outcomes applicable to public health programs and policies. The PRCs work is to create and foster partnerships among public health and community organizations, to address health promotion and disease prevention issues (CDC, 2003). ^ The W.K. Kellogg Foundation defines CBPR as "a collaborative approach to research that equitably involves all partners in the research process and recognizes the unique strengths that each brings. CBPR begins with a research topic of importance to the community with the aim of combining knowledge and action for social change to improve community health." ^ In 1995, CDC asked the IOM to review the PRC program to examine the extent to which the program is providing the public health community with strategies to address public health problems in disease prevention and health promotion (IOM, 1997). No comprehensive evaluation n of the individual PRCs had ever been done (IOM, 1997). ^ The CDC was interested in understanding how it could better support the PRC program through improved management and oversight to influence the program's success. The CDC only represents one of the entities that influence the success of a PRC. Another key entity to consider is the support of and influence of the Schools of Public Health in which the PRCs reside. Using evaluation criteria similar to those that were developed by the IOM, this study examined how aspects of structural capacity of the Schools of Public Health in which the PRCs reside are perceived to influence PRC community-based research activities. ^

Territorial assemblages and Governance : The example of the Taonaba project [Town of Abymes, Guadeloupe]

This article reports on an action research to support the urban community of Cap Excellence in Guadaloupe in its local sustainable development project. After summarizing the terms of the debate around sustainable development, and presenting the region, the search will be put back into the context of a more general approach of territorial* intelligence (TI). The limits of a local Agenda 21 in the form of a 'programmed action plan' is the chance to enhance the concept of TI with that of territorial assemblage. Our study area is the natural reserve of the Grand Cul-de-Sac Marin of Guadeloupe, the second largest biosphere reserve designated by UNESCO in the archipelago of the Petites Antilles, more specifically the implementation of the Taonaba project, whose goal is to launch an ecotourism visitors' centre, operational at the end of 2012. Based on the analysis of a large amount of data, the article describes an evaluation tool for territorial assemblages for participative territorial governance. Our results were presented to local government officials in the Urban Sustainable Development Forum, which our group organised from 2 to 4 April 2012, in the district of Abymes/Pointe-à-Pitre

Territorial assemblages and Governance : The example of the Taonaba project [Town of Abymes, Guadeloupe]

This article reports on an action research to support the urban community of Cap Excellence in Guadaloupe in its local sustainable development project. After summarizing the terms of the debate around sustainable development, and presenting the region, the search will be put back into the context of a more general approach of territorial* intelligence (TI). The limits of a local Agenda 21 in the form of a 'programmed action plan' is the chance to enhance the concept of TI with that of territorial assemblage. Our study area is the natural reserve of the Grand Cul-de-Sac Marin of Guadeloupe, the second largest biosphere reserve designated by UNESCO in the archipelago of the Petites Antilles, more specifically the implementation of the Taonaba project, whose goal is to launch an ecotourism visitors' centre, operational at the end of 2012. Based on the analysis of a large amount of data, the article describes an evaluation tool for territorial assemblages for participative territorial governance. Our results were presented to local government officials in the Urban Sustainable Development Forum, which our group organised from 2 to 4 April 2012, in the district of Abymes/Pointe-à-Pitre

Territorial assemblages and Governance : The example of the Taonaba project [Town of Abymes, Guadeloupe]

This article reports on an action research to support the urban community of Cap Excellence in Guadaloupe in its local sustainable development project. After summarizing the terms of the debate around sustainable development, and presenting the region, the search will be put back into the context of a more general approach of territorial* intelligence (TI). The limits of a local Agenda 21 in the form of a 'programmed action plan' is the chance to enhance the concept of TI with that of territorial assemblage. Our study area is the natural reserve of the Grand Cul-de-Sac Marin of Guadeloupe, the second largest biosphere reserve designated by UNESCO in the archipelago of the Petites Antilles, more specifically the implementation of the Taonaba project, whose goal is to launch an ecotourism visitors' centre, operational at the end of 2012. Based on the analysis of a large amount of data, the article describes an evaluation tool for territorial assemblages for participative territorial governance. Our results were presented to local government officials in the Urban Sustainable Development Forum, which our group organised from 2 to 4 April 2012, in the district of Abymes/Pointe-à-Pitre

Intereses exógenos y resistencia ciudadana en la transformación físicosocial de un asentamiento auto-producido de Dakar (2005-2011)

La presión sobre el acceso a la tierra en la península de Dakar, Senegal, ha generado un proceso de transformación físico-social del mayor asentamiento auto-producido de la periferia urbana de Dakar (Pikine Irregular Sur) en el periodo 2005-2011. Esta investigación se propone analizar en qué medida las acciones llevadas a cabo: i) satisfacen o no el sistema integral de necesidades de los afectados (Demanda); ii) favorecen la implicación de los afectados o, por el contrario, fortalecen las estructuras de poder dominantes (Oferta), y iii) promueven o no la autonomía económica, la sostenibilidad ambiental, la equidad social y la legitimidad de los actores que participan (Entorno). La investigación se ha llevado a cabo por el método de estudio de casos, mediante un proceso de recogida de información participativo, articulado de abajo hacia arriba, en el que han participado 196 personas; la información recogida se ha procesado mediante la utilización de dos herramientas de análisis de realidades complejas: flujo de programa y sistema funcional. Los resultados del estudio de los casos 1 y 2 muestran que las acciones se han llevado a cabo en beneficio de los intereses de los mercados y de los actores que toman las decisiones y gestionan los recursos, incrementando la dependencia económica, empobreciendo a los directamente afectados y fragmentando su tejido social, promoviendo un desarrollo urbano desequilibrado, disperso y segregado, y deslegitimando a las instituciones involucradas. En el estudio del caso 3, en cambio, se verifica que la acción se ha llevado a cabo en beneficio de los intereses de los directamente afectados, utilizando recursos endógenos, fortaleciendo su tejido social, promoviendo un desarrollo urbano concentrado e inclusivo, e incrementando la legitimidad de las instituciones involucradas. El análisis cruzado de los resultados muestra que la pobreza, la exclusión social y la precariedad habitacional, en el contexto específico de la periferia de Dakar, no son un problema de falta de recursos, sino de falta de ética por parte de quienes gestionan y financian los procesos de transformación físico-social, y de falta de voluntad por parte de las autoridades de implicar a los ciudadanos, y en particular a los directamente afectados, en los procesos de toma de decisiones de las acciones y los programas que les afectan. Finalmente se concluye que no se trata de luchar contra la pobreza, sino de luchar contra los sistemas injustos que generan la pobreza y la exclusión. ABSTRACT The pressure on the access to land in the area of Dakar, Senegal, has generated a physical/social transformation process in the largest self-produced settlement in the urban periphery of Dakar (South Irregular Pikine), in the period 2005-2011. This research aims to analyze to what extent the actions carried out: i) satisfy the integral needs of the affected population (Demand), ii) encourage the involvement of those affected or otherwise strengthen dominant power structures (Supply), and iii) promote or inhibit economic autonomy, environmental sustainability, social equity and legitimacy of the actors involved (Environment). The research was conducted by the case study method. 196 people participated in a bottom-up participatory process of information gathering. The information collected was processed using two custom tools aimed to analyse complex systems: the program flow and the functional system. The results of case studies 1 and 2 show that the actions were carried out in the best interest of the markets and the actors who made decisions and managed resources, increasing economic dependence, impoverishing those directly affected and fragmenting their social network by promoting an unbalanced, dispersed and segregated urban development, and de-legitimizing the institutions involved in the process. On the contrary, in the case study 3 it is verified that the action has been carried out on behalf of the interests of those directly affected, using endogenous resources, strengthening the social network, promoting a focused and inclusive urban development, and increasing legitimacy of the institutions involved. The comparative analysis of the results shows that poverty, social exclusion and precarious housing in South Irregular Pikine are not a problem of lack of resources but of unethical behaviour of those who manage and finance physical and social transformation processes, as well as unwillingness on the part of the authorities to involve citizens in the decision making processes for the actions and programs that affect them. Finally we conclude that the enemy to fight against is not poverty but unfair systems that generate poverty and exclusion. RÉSUMÉ La pression sur le foncier dans la presqu'île de Dakar, au Sénégal, a généré un processus de transformation physico-sociale du plus grand établissement auto-produit de la périphérie urbaine de Dakar (Pikine Irrégulier Sud), durant la période 2005-2011. Cette recherche vise à analyser dans quelle mesure les actions menées: i) répondent ou non à l’ensemble des besoins intégrales des personnes concernés (Demande), ii) encouragent l'implication des concernées ou au contraire renforcent les structures de pouvoir dominant (Offre), et iii) favorisent ou non l'autonomie économique, la durabilité environnementale, l'équité sociale et la légitimité des acteurs concernés (Contexte). La recherche a été menée par la méthode des études de cas, par un processus de collecte d'information participative articulée du bas vers le haut dans lequel ont participé 196 personnes. Les informations recueillies ont été traitées à l'aide de deux outils d'analyse de réalités complexes: le système fonctionnel et le flux de programme. Les résultats de l'étude de cas 1 et 2 montrent que les actions ont été menées au profit des intérêts des marchés et des acteurs qui prennent les décisions et gèrent les ressources, augmentant la dépendance économique, appauvrissant ceux qui sont directement concernés et fragmentant leur tissu social, encourageant un développement urbain déséquilibré, dispersé et ségrégé, et délégitimant les institutions concernées. Dans l'étude de cas 3, cependant, il est vérifié que l'action a été menée au profit des intérêts de ceux qui sont directement concernés, en utilisant des ressources endogènes, en renforçant son tissu social, en encourageant un développement urbain concentré et inclusif, et en augmentant la légitimité des institutions concernées. L'analyse comparée des résultats montre que la pauvreté, l'exclusion sociale et le logement précaire, dans le contexte spécifique de la banlieue de Dakar, ne sont pas un problème de manque de ressources, mais de manque d'éthique de la part de ceux qui gèrent et financent les processus de transformation physico-sociale, et de manque de volonté de la part des autorités d'impliquer les citoyens, en particulier ceux qui sont directement concernés, dans le processus de prise de décision des actions et des programmes qui les impliquent. Finalement, on conclut qu'il ne s'agit pas de lutter contre la pauvreté, mais de lutter contre les systèmes injustes qui produisent la pauvreté et l'exclusion.

Integration of research advances in modelling and monitoring in support of WFD river basin management planning in the context of climate change

The integration of scientific knowledge about possible climate change impacts on water resources has a direct implication on the way water policies are being implemented and evolving. This is particularly true regarding various technical steps embedded into the EU Water Framework Directive river basin management planning, such as risk characterisation, monitoring, design and implementation of action programmes and evaluation of the "good status" objective achievements (in 2015). The need to incorporate climate change considerations into the implementation of EU water policy is currently discussed with a wide range of experts and stakeholders at EU level. Research trends are also on-going, striving to support policy developments and examining how scientific findings and recommendations could be best taken on board by policy-makers and water managers within the forthcoming years. This paper provides a snapshot of policy discussions about climate change in the context of the WFD river basin management planning and specific advancements of related EU-funded research projects. Perspectives for strengthening links among the scientific and policy-making communities in this area are also highlighted.