Improving disclosure of medical errors: Including patients and family members in the disclosure process

Over the last decade, adverse events and medical errors have become a main focus of interest for the standards of quality and safety in the U.S. healthcare system (Weinstein & Henderson, 2009). Particularly when a medical error occurs, the disclosure of medical errors and its practices have become a focal point of the healthcare process. Patients and family members who have experienced a medical error might be able to provide knowledge and insight on how to improve the disclose process. However, patient and family member are not typically involved in the disclosure process, thus their experiences go unnoticed. ^ The purpose of this research was to explore how best to include patients and family members in the disclosure process regarding a medical error. The research consisted of 28 qualitative interviews from three stakeholder groups: Hospital Administrators, Clinical Service Providers, and Patients and Family Members. They were asked for their ideas and suggestions on how best to include patients and family members in the disclosure process. Framework Analysis was used to analyze this data and find prevalent themes based on the primary research question. A secondary aim was to index categories created based on the interviews that were collected. Data was used from the Texas Disclosure and Compensation Study with Dr. Eric Thomas as the Principal Investigator. Full acknowledgement of access to this data is given to Dr. Thomas. ^ The themes from the research revealed that each stakeholder group was interested and open to including patients and family members in the disclosure process and that the disclosure process should not be a "one-way" avenue. The themes gave many suggestions regarding how to best include patients and family members in the disclosure process of a medical error. Secondary aims revealed several ways to assess the ideas and suggestion given by the stakeholders. Overall, acceptability of getting the perspective of patients and family members was the most common theme. Comparison of each stakeholder group revealed that including patients and family members would be beneficial to improving hospital disclosure practices. ^ Conclusions included a list of recommendations and measureable appropriate strategies that could provide hospital with key stakeholders insights on how to improve their disclosure process. Sharing patients and family members experience with healthcare providers can encourage a shift in culture where patients are valued and active in participating in hospital practices. To my knowledge, this research is the very first of its kind and moves the disclosure process conversation forward in a patient-family member inclusion direction that will assist in improving disclosure practices. Future research should implement and evaluate the success of the various inclusion strategies.^

An analysis of the revenue policy -making process of the Texas Legislature

The purpose of this dissertation was to develop a conceptual framework which can be used to account for policy decisions made by the House Ways and Means Committee (HW&MC) of the Texas House of Representatives. This analysis will examine the actions of the committee over a ten-year period with the goal of explaining and predicting the success of failure of certain efforts to raise revenue.^ The basis framework for modelling the revenue decision-making process includes three major components--the decision alternatives, the external factors and two competing contingency theories. The decision alternatives encompass the particular options available to increase tax revenue. The options were classified as non-innovative or innovative. The non-innovative options included the sales, franchise, property and severance taxes. The innovative options were principally the personal and corporate income taxes.^ The external factors included political and economic constraints that affected the actions of the HW&MC. Several key political constraints on committee decision-making were addressed--including public attitudes, interest groups, political party strength and tradition and precedents. The economic constraints that affected revenue decisions included court mandates, federal mandates and the fiscal condition of the nation and the state.^ The third component of the revenue decision-making framework included two alternative contingency theories. The first alternative theory postulated that the committee structure, including the individual member roles and the overall committee style, resulted in distinctive revenue decisions. This theory will be favored if evidence points to the committee acting autonomously with less concern for the policies of the Speaker of the House. The Speaker assignment theory, postulated that the assignment of committee members shaped or changed the course of committee decision-making. This theory will be favored if there was evidence that the committee was strictly a vehicle for the Speaker to institute his preferred tax policies.^ The ultimate goal of this analysis is to develop an explanation for legislative decision-making about tax policy. This explanation will be based on the linkages across various tax options, political and economic constraints, member roles and committee style and the patterns of committee assignment. ^

Robust trends of landscape dynamics in the Arctic Lena Delta with temporally dense Landsat time-series stacks, with links to GeoTIFFs

Arctic permafrost landscapes are among the most vulnerable and dynamic landscapes globally, but due to their extent and remoteness most of the landscape changes remain unnoticed. In order to detect disturbances in these areas we developed an automated processing chain for the calculation and analysis of robust trends of key land surface indicators based on the full record of available Landsat TM, ETM +, and OLI data. The methodology was applied to the ~ 29,000 km**2 Lena Delta in Northeast Siberia, where robust trend parameters (slope, confidence intervals of the slope, and intercept) were calculated for Tasseled Cap Greenness, Wetness and Brightness, NDVI, and NDWI, and NDMI based on 204 Landsat scenes for the observation period between 1999 and 2014. The resulting datasets revealed regional greening trends within the Lena Delta with several localized hot-spots of change, particularly in the vicinity of the main river channels. With a 30-m spatial resolution various permafrost-thaw related processes and disturbances, such as thermokarst lake expansion and drainage, fluvial erosion, and coastal changes were detected within the Lena Delta region, many of which have not been noticed or described before. Such hotspots of permafrost change exhibit significantly different trend parameters compared to non-disturbed areas. The processed dataset, which is made freely available through the data archive PANGAEA, will be a useful resource for further process specific analysis by researchers and land managers. With the high level of automation and the use of the freely available Landsat archive data, the workflow is scalable and transferrable to other regions, which should enable the comparison of land surface changes in different permafrost affected regions and help to understand and quantify permafrost landscape dynamics.

Global Ocean Colour for Carbon Cycle Research (full product set)

In 2005, the International Ocean Colour Coordinating Group (IOCCG) convened a working group to examine the state of the art in ocean colour data merging, which showed that the research techniques had matured sufficiently for creating long multi-sensor datasets (IOCCG, 2007). As a result, ESA initiated and funded the DUE GlobColour project (http://www.globcolour.info/) to develop a satellite based ocean colour data set to support global carbon-cycle research. It aims to satisfy the scientific requirement for a long (10+ year) time-series of consistently calibrated global ocean colour information with the best possible spatial coverage. This has been achieved by merging data from the three most capable sensors: SeaWiFS on GeoEye's Orbview-2 mission, MODIS on NASA's Aqua mission and MERIS on ESA's ENVISAT mission. In setting up the GlobColour project, three user organisations were invited to help. Their roles are to specify the detailed user requirements, act as a channel to the broader end user community and to provide feedback and assessment of the results. The International Ocean Carbon Coordination Project (IOCCP) based at UNESCO in Paris provides direct access to the carbon cycle modelling community's requirements and to the modellers themselves who will use the final products. The UK Met Office's National Centre for Ocean Forecasting (NCOF) in Exeter, UK, provides an understanding of the requirements of oceanography users, and the IOCCG bring their understanding of the global user needs and valuable advice on best practice within the ocean colour science community. The three year project kicked-off in November 2005 under the leadership of ACRI-ST (France). The first year was a feasibility demonstration phase that was successfully concluded at a user consultation workshop organised by the Laboratoire d'Océanographie de Villefranche, France, in December 2006. Error statistics and inter-sensor biases were quantified by comparison with insitu measurements from moored optical buoys and ship based campaigns, and used as an input to the merging. The second year was dedicated to the production of the time series. In total, more than 25 Tb of input (level 2) data have been ingested and 14 Tb of intermediate and output products created, with 4 Tb of data distributed to the user community. Quality control (QC) is provided through the Diagnostic Data Sets (DDS), which are extracted sub-areas covering locations of in-situ data collection or interesting oceanographic phenomena. This Full Product Set (FPS) covers global daily merged ocean colour products in the time period 1997-2006 and is also freely available for use by the worldwide science community at http://www.globcolour.info/data_access_full_prod_set.html. The GlobColour service distributes global daily, 8-day and monthly data sets at 4.6 km resolution for, chlorophyll-a concentration, normalised water-leaving radiances (412, 443, 490, 510, 531, 555 and 620 nm, 670, 681 and 709 nm), diffuse attenuation coefficient, coloured dissolved and detrital organic materials, total suspended matter or particulate backscattering coefficient, turbidity index, cloud fraction and quality indicators. Error statistics from the initial sensor characterisation are used as an input to the merging methods and propagate through the merging process to provide error estimates for the output merged products. These error estimates are a key component of GlobColour as they are invaluable to the users; particularly the modellers who need them in order to assimilate the ocean colour data into ocean simulations. An intensive phase of validation has been undertaken to assess the quality of the data set. In addition, inter-comparisons between the different merged datasets will help in further refining the techniques used. Both the final products and the quality assessment were presented at a second user consultation in Oslo on 20-22 November 2007 organised by the Norwegian Institute for Water Research (NIVA); presentations are available on the GlobColour WWW site. On request of the ESA Technical Officer for the GlobColour project, the FPS data set was mirrored in the PANGAEA data library.

Key Factors to Successful Community Development: The Korean Experience

The Saemaul Undong of the Republic of Korea has been world-widely recognized as a successful model of rural community development. The Saemaul Undong was a pure Korean way of community development program which was initiated by the political will of the top national leadership in order to escape from poverty. There are several key factors to the success of the Saemaul Undong. First, the national government's guidance and support for the movement played a very important role in the whole period of the movement. Second, there was a wide range of people's participation in the implementation process. Third, the Saemaul Undong could make a big success by nurturing community leadership which was selected by rural residents themselves. Finally, as a movement for the spiritual reform, the Saemaul Undong imbued the people with the spirits of diligence, the self-reliance, and cooperation.

Industrial Development and the Innovation System of the Ethanol Sector in Brazil

The purpose of this paper is to analyze innovations and the innovation system and its dynamics in the ethanol sector in the State of Sao Paulo. More specifically, this paper focuses on the development process in the sector, the public policies taken to promote the sector, and the organizations and key players involved in these policies and their responses to unforeseeable changes in economic, social and technological environments. To this end, this paper takes an historical perspective and reviews data on the cultivation of sugar cane, the production of ethanol, and on sugar cane yields as indicators of the innovations achieved in the sector. The geographical distribution of these indicators is also examined. Next, several cases in Piracicaba and Campinas in the State of Sao Paulo are presented; these give us a more concrete idea of the processes involved in innovation and technology transfer. Based on these observations, the ethanol cluster and the innovation system of the State of Sao Paulo are discussed from the viewpoint of the flowchart approach to industrial cluster policy.

Improved ore processing assessed by digital image análisis of the ores: a key to the sustainable development of the Iberian Pyrite Belt

Mining in the Iberian Pyrite Belt (IPB), the biggest VMS metallogenetic province known in the world to date, has to face a deep crisis in spite of the huge reserves still known after ≈5 000 years of production. This is due to several factors, as the difficult processing of complex Cu-Pb-Zn-Ag- Au ores, the exhaustion of the oxidation zone orebodies (the richest for gold, in gossan), the scarce demand for sulphuric acid in the world market, and harder environmental regulations. Of these factors, only the first and the last mentioned can be addressed by local ore geologists. A reactivation of mining can therefore only be achieved by an improved and more efficient ore processing, under the constraint of strict environmental controls. Digital image analysis of the ores, coupled to reflected light microscopy, provides a quantified and reliable mineralogical and textural characterization of the ores. The automation of the procedure for the first time furnishes the process engineers with real-time information, to improve the process and to preclude or control pollution; it can be applied to metallurgical tailings as well. This is shown by some examples of the IPB.

Competence Monitoring in Project Teams by using Web based portfolio management systems

This paper reports a learning experience related to the acquisition of project management competences. Students from three different universities and backgrounds, cooperate in a common project that drives the learning-teaching process. Previous related works on this initiative have already evaluated the goodness of this multidisciplinary, project-based learning approach in the context of a new educative paradigm. Yet the innovative experience has allowed the authors to define a rubric in order to measure specific competences in project management. The study shows the rubric’s main aspects as well as competence acquisition evaluation alternatives, based in the metrics defined. Key indicators and specific reports obtained from data base fields in the web tool will support this work. As a result, new competences can be assessed, such ones like teamwork, problem solving, communication and leadership. Final goal is to provide an overall competence map to the students at the same time they improve their skills.

Work in progress - Exploiting videoconferencing possibilities to promote the European convergence process

This paper introduces the experience of using videoconferencing and recording as a mechanism to support courses which need to be promoted or discontinued within the framework of the European convergence process. Our objective is to make these courses accessible as live streaming during the lessons as well as recorded lectures and associated documents available to the students as soon as the lesson has finished. The technology used has been developed in our university and it is all open source. Although this is a technical project the key is the human factor involved. The people managing the virtual sessions are students of the courses being recorded. However, they lack technical knowledge, so we had to train them in audiovisuals and enhance the usability of the videoconferencing tool and platform. The validation process is being carried out in five real scenarios at our university. During the whole period we are evaluating technical and pedagogical issues of this experience for both students and teachers to guide the future development of the service. Depending on the final results, the service of lectures recording will be available as educational resource for all of the teaching staff of our university.

Fish communities as indicators of biological conditions of rivers: methods for reference conditions

Fish communities are a key element in fluvial ecosystems Their position in the top of the food chain and their sensitivity to a whole range of impacts make them a clear objective for ecosystem conservation and a sound indicator of biological integrity. The UE Water Framework Directive includes fish community composition, abundance and structure as relevant elements for the evaluation os biological condition. Several approaches have been proposed for the evaluation of the condition of fish communities, from the bio-indicator concept to the IBI (Index of biotic integrity) proposals. However, the complexity of fish communities and their ecological responses make this evaluation difficult, and we must avoid both oversimplified and extreme analytical procedures. In this work we present a new proposal to define reference conditions in fish communities, discussing them from an ecological viewpoint. This method is a synthetic approach called SYNTHETIC OPEN METHODOLOGICAL FRAMEWORK (SOMF) that has been applied to the rivers of Navarra. As a result, it is recommended the integration of all the available information from spatial, modelling, historical and expert sources, providing the better approach to fish reference conditions, keeping the highest level of information and meeting the legal requirements of the WFD.

Modelo multifactorial para optimización de la productividad en el proceso de generación de energía eléctrica : aplicación al caso de las centrales hidroeléctricas venezolanas

Las organizaciones son sistemas o unidades sociales, compuestas por personas que interactúan entre sí, para lograr objetivos comunes. Uno de sus objetivos es la productividad. La productividad es un constructo multidimensional en la que influyen aspectos tecnológicos, económicos, organizacionales y humanos. Diversos estudios apoyan la influencia de la motivación de las personas, de las habilidades y destrezas de los individuos, de su talento para desempeñar el trabajo, así como también del ambiente de trabajo presente en la organización, en la productividad. Por esta razón, el objetivo general de la investigación, es analizar la influencia entre los factores humanos y la productividad. Se hará énfasis en la persona como factor productivo clave, para responder a las interrogantes de la investigación, referidas a cuáles son las variables humanas que inciden en la productividad, a la posibilidad de plantear un modelo de productividad que considere el impacto del factor humano y la posibilidad de encontrar un método para la medición de la productividad que contemple la percepción del factor humano. Para resolver estas interrogantes, en esta investigación se busca establecer las relaciones entre las variables humanas y la productividad, vistas desde la perspectiva de tres unidades de análisis diferentes: individuo, grupo y organización, para la formulación de un modelo de productividad humana y el diseño de un instrumento para su medida. Una de las principales fuente de investigación para la elección de las variables humanas, la formulación del modelo, y el método de medición de la productividad, fue la revisión de la literatura disponible sobre la productividad y el factor humano en las organizaciones, lo que facilitó el trazado del marco teórico y conceptual. Otra de las fuentes para la selección fue la opinión de expertos y de especialistas directamente involucrados en el sector eléctrico venezolano, lo cual facilitó la obtención de un modelo, cuyas variables reflejasen la realidad del ámbito en estudio. Para aportar una interpretación explicativa del fenómeno, se planteó el modelo de los Factores Humanos vs Productividad (MFHP), el cual se analizó desde la perspectiva del análisis causal y fue conformado por tres variables latentes exógenas denominadas: factores individuales, factores grupales y factores organizacionales, que estaban relacionadas con una variable latente endógena denominada productividad. El MFHP se formuló mediante la metodología de los modelos de ecuaciones estructurales (SEM). Las relaciones inicialmente propuestas entre las variables latentes fueron corroboradas por los ajustes globales del modelo, se constataron las relaciones entre las variables latentes planteadas y sus indicadores asociados, lo que facilitó el enunciado de 26 hipótesis, de las cuales se comprobaron 24. El modelo fue validado mediante la estrategia de modelos rivales, utilizada para comparar varios modelos SEM, y seleccionar el de mejor ajuste, con sustento teórico. La aceptación del modelo se realizó mediante la evaluación conjunta de los índices de bondad de ajuste globales. Asimismo, para la elaboración del instrumento de medida de la productividad (IMPH), se realizó un análisis factorial exploratorio previo a la aplicación del análisis factorial confirmatorio, aplicando SEM. La revisión de los conceptos de productividad, la incidencia del factor humano, y sus métodos de medición, condujeron al planteamiento de métodos subjetivos que incorporaron la percepción de los principales actores del proceso productivo, tanto para la selección de las variables, como para la formulación de un modelo de productividad y el diseño de un instrumento de medición de la productividad. La contribución metodológica de este trabajo de investigación, ha sido el empleo de los SEM para relacionar variables que tienen que ver con el comportamiento humano en la organización y la productividad, lo cual abre nuevas posibilidades a la investigación en este ámbito. Organizations are social systems or units composed of people who interact with each other to achieve common goals. One objective is productivity, which is a multidimensional construct influenced by technological, economic, organizational and human aspects. Several studies support the influence on productivity of personal motivation, of the skills and abilities of individuals, of their talent for the job, as well as of the work environment present in the organization. Therefore, the overall objective of this research is to analyze the influence between human factors and productivity. The emphasis is on the individual as a productive factor which is key in order to answer the research questions concerning the human variables that affect productivity and to address the ability to propose a productivity model that considers the impact of the human factor and the possibility of finding a method for the measurement of productivity that includes the perception of the human factor. To consider these questions, this research seeks to establish the relationships between human and productivity variables, as seen from the perspective of three different units of analysis: the individual, the group and the organization, in order to formulate a model of human productivity and to design an instrument for its measurement. A major source of research for choosing the human variables, model formulation, and method of measuring productivity, was the review of the available literature on productivity and the human factor in organizations which facilitated the design of the theoretical and conceptual framework. Another source for the selection was the opinion of experts and specialists directly involved in the Venezuelan electricity sector which facilitated obtaining a model whose variables reflect the reality of the area under study. To provide an interpretation explaining the phenomenon, the model of the Human Factors vs. Productivity Model (HFPM) was proposed. This model has been analyzed from the perspective of causal analysis and was composed of three latent exogenous variables denominated: individual, group and organizational factors which are related to a latent variable denominated endogenous productivity. The HFPM was formulated using the methodology of Structural Equation Modeling (SEM). The initially proposed relationships between latent variables were confirmed by the global fits of the model, the relationships between the latent variables and their associated indicators enable the statement of 26 hypotheses, of which 24 were confirmed. The model was validated using the strategy of rival models, used for comparing various SEM models and to select the one that provides the best fit, with theoretical support. The acceptance of the model was performed through the joint evaluation of the adequacy of global fit indices. Additionally, for the development of an instrument to measure productivity, an exploratory factor analysis was performed prior to the application of a confirmatory factor analysis, using SEM. The review of the concepts of productivity, the impact of the human factor, and the measurement methods led to a subjective methods approach that incorporated the perception of the main actors of the production process, both for the selection of variables and for the formulation of a productivity model and the design of an instrument to measure productivity. The methodological contribution of this research has been the use of SEM to relate variables that have to do with human behavior in the organization and with productivity, opening new possibilities for research in this area.

Information as a Key Tool for Rural Development. 25 Years of Experience in Spain

The lack of useful information has become a major obstacle that hinders the participation of the members of the community in the development process because they can not accurately perceive how their individual and/or collective action can influence their environment, and because of the lack of elements that support the decision-making processes. This article addresses these issues from the work carried out by the Association Instituto de Desarrollo Comunitario de Cuenca (IDC Cuenca) in the rural areas of this province of Spain for 25 years. The results show how the application of methodologies for the transmission of information tailored to each group of recipients in some aspects, enhances the participation of individuals.

Simulation of academic performance rates, estimation of indicators of subjects and of a complete degree

The purpose of this paper is to present a program written in Matlab-Octave for the simulation of the time evolution of student curricula, i.e, how students pass their subjects along time until graduation. The program computes, from the simulations, the academic performance rates for the subjects of the study plan for each semester as well as the overall rates, which are a) the efficiency rate defined as the ratio of the number of students passing the exam to the number of students who registered for it and b) the success rate, defined as the ratio of the number of students passing the exam to the number of students who not only registered for it but also actually took it. Additionally, we compute the rates for the bachelor academic degree which are established for Spain by the National Quality Evaluation and Accreditation Agency (ANECA) and which are the graduation rate (measured as the percentage of students who finish as scheduled in the plan or taking an extra year) and the efficiency rate (measured as the percentage of credits which a student who graduated has really taken). The simulation is done in terms of the probabilities of passing all the subjects in their study plan. The application of the simulator to Polytech students in Madrid, where requirements for passing are specially stiff in first and second year subjects, is particularly relevant to analyze student cohorts and the probabilities of students finishing in the minimum of four years, or taking and extra year or two extra years, and so forth. It is a very useful tool when designing new study plans. The calculation of the probability distribution of the random variable "number of semesters a student has taken to complete the curricula and graduate" is difficult or even unfeasible to obtain analytically, and this is even truer when we incorporate uncertainty in parameter estimation. This is why we apply Monte Carlo simulation which not only provides illustration of the stochastic process but also a method for computation. The stochastic simulator is proving to be a useful tool for identification of the subjects most critical in the distribution of the number of semesters for curriculum vitae (CV) completion and subsequently for a decision making process in terms of CV planning and passing standards in the University. Simulations are performed through a graphical interface where also the results are presented in appropriate figures. The Project has been funded by the Call for Innovation in Education Projects of Universidad Politécnica de Madrid (UPM) through a Project of its school Escuela Técnica Superior de Ingenieros Industriales ETSII during the period September 2010-September 2011.

Using configuration management and product line software paradigms to support the experimentation process in software engineering.

There is no empirical evidence whatsoever to support most of the beliefs on which software construction is based. We do not yet know the adequacy, limits, qualities, costs and risks of the technologies used to develop software. Experimentation helps to check and convert beliefs and opinions into facts. This research is concerned with the replication area. Replication is a key component for gathering empirical evidence on software development that can be used in industry to build better software more efficiently. Replication has not been an easy thing to do in software engineering (SE) because the experimental paradigm applied to software development is still immature. Nowadays, a replication is executed mostly using a traditional replication package. But traditional replication packages do not appear, for some reason, to have been as effective as expected for transferring information among researchers in SE experimentation. The trouble spot appears to be the replication setup, caused by version management problems with materials, instruments, documents, etc. This has proved to be an obstacle to obtaining enough details about the experiment to be able to reproduce it as exactly as possible. We address the problem of information exchange among experimenters by developing a schema to characterize replications. We will adapt configuration management and product line ideas to support the experimentation process. This will enable researchers to make systematic decisions based on explicit knowledge rather than assumptions about replications. This research will output a replication support web environment. This environment will not only archive but also manage experimental materials flexibly enough to allow both similar and differentiated replications with massive experimental data storage. The platform should be accessible to several research groups working together on the same families of experiments.

Including hardware/software co-design in the ASSERT model driven engineering process.

Abstract. The ASSERT project de?ned new software engineering methods and tools for the development of critical embedded real-time systems in the space domain. The ASSERT model-driven engineering process was one of the achievements of the project and is based on the concept of property- preserving model transformations. The key element of this process is that non-functional properties of the software system must be preserved during model transformations. Properties preservation is carried out through model transformations compliant with the Ravenscar Pro?le and provides a formal basis to the process. In this way, the so-called Ravenscar Computational Model is central to the whole ASSERT process. This paper describes the work done in the HWSWCO study, whose main objective has been to address the integration of the Hardware/Software co-design phase in the ASSERT process. In order to do that, non-functional properties of the software system must also be preserved during hardware synthesis. Keywords : Ada 2005, Ravenscar pro?le, Hardware/Software co-design, real- time systems, high-integrity systems, ORK