Situation Background Assessment Recommendation (SBAR): Undergraduate Perspectives

Situation Background Assessment and Recommendation (SBAR): Undergraduate Perspectives C Morgan, L Adams, J Murray, R Dunlop, IK Walsh. Ian K Walsh, Centre for Medical Education, Queen’s University Belfast, Mulhouse Building, Royal Victoria Hospital, Grosvenor Road, Belfast BT12 6DP Background and Purpose: Structured communication tools are used to improve team communication quality.1,2 The Situation Background Assessment and Recommendation (SBAR) tool is widely adopted within patient safety.3 SBAR effectiveness is reportedly equivocal, suggesting use is not sustained beyond initial training.4-6 Understanding perspectives of those using SBAR may further improve clinical communication. We investigated senior medical undergraduate perspectives on SBAR, particularly when communicating with senior colleagues. Methodology: Mixed methods data collection was used. A previously piloted questionnaire with 12 five point Lickert scale questions and 3 open questions was given to all final year medical students. A subgroup also participated in 10 focus groups, deploying strictly structured audio-recorded questions. Selection was by convenience sampling, data gathered by open text questions and comments transcribed verbatim. In-vivo coding (iterative, towards data saturation) preceded thematic analysis. Results: 233 of 255 students (91%) completed the survey. 1. There were clearly contradictory viewpoints on SBAR usage. A recurrent theme was a desire for formal feedback and a relative lack of practice/experience with SBAR. 2. Students reported SBAR as having variable interpretation between individuals; limiting use as a shared mental model. 3. Brief training sessions are insufficient to embed the tool. 4. Most students reported SBAR helping effective communication, especially by providing structure in stressful situations. 5. Only 18.5% of students felt an alternative resource might be needed. Sub analysis of the themes highlighted: A. Lack of clarity regarding what information to include and information placement within the acronym, B. Senior colleague negative response to SBAR C. Lack of conciseness with the tool. Discussion and Conclusions: Despite a wide range of contradictory interpretation of SBAR utility, most students wish to retain the resource. More practice opportunities/feedback may enhance user confidence and understanding. References: (1) Leonard M, Graham S, Bonacum D. The human factor: the critical importance of effective teamwork and communication in providing safe care. Quality & Safety in Health Care 2004 Oct;13(Suppl 1):85-90. (2) d'Agincourt-Canning LG, Kissoon N, Singal M, Pitfield AF. Culture, communication and safety: lessons from the airline industry. Indian J Pediatr 2011 Jun;78(6):703-708. (3) Dunsford J. Structured communication: improving patient safety with SBAR. Nurs Womens Health 2009 Oct;13(5):384-390. (4) Compton J, Copeland K, Flanders S, Cassity C, Spetman M, Xiao Y, et al. Implementing SBAR across a large multihospital health system. Jt Comm J Qual Patient Saf 2012 Jun;38(6):261-268. (5) Ludikhuize J, de Jonge E, Goossens A. Measuring adherence among nurses one year after training in applying the Modified Early Warning Score and Situation-Background-Assessment-Recommendation instruments. Resuscitation 2011 Nov;82(11):1428-1433. (6) Cunningham NJ, Weiland TJ, van Dijk J, Paddle P, Shilkofski N, Cunningham NY. Telephone referrals by junior doctors: a randomised controlled trial assessing the impact of SBAR in a simulated setting. Postgrad Med J 2012 Nov;88(1045):619-626.

Adómorál, bizalom és kényszerek - adózási motivációk Magyarországon korrupciós botrányok idején

A viselkedési közgazdaságtani és a gazdaságpszichológiai kutatások szerint az adózási magatartást részben kényszerű, részben önkéntes motivációk, az adómorál alakítják. Tanulmányunk ezekre a megközelítésekre összpontosít, tudomásunk szerint ez az első hazai kutatás, amely az intézményi bizalomnak és az eljárási méltányosságnak az adófizetési attitűdökkel kapcsolatos összefüggéseit elemzi. Két - 2013-ban, illetve 2015-ben készült - reprezentatív felmérés alapján vizsgáljuk a magyar állampolgárok adózási motivációit. Az adatfelvételek időpontjának sajátossága, hogy a köztes időszakban az adóhatóság (NAV) működését korrupciós botrányok árnyékolták be. Várakozásunknak megfelelően az intézményi bizalom gyengesége és az észlelt korrupció jelentősen rombolják az adómorált, miközben a kényszerű adófizetést nem befolyásolják érdemben. Vizsgálatunk hipotézisünket cáfoló eredménye, hogy az önkéntes adófizetési hajlandóság Magyarországon is erősebb a kényszerűnél. Végül hipotézisünkkel összhangban szignifikáns és az egyéb tényezőktől függetlenül is kimutatható a NAV-botrányok negatív hatása az adóhatóság iránti bizalomra.

Twelve new polymorphic microsatellite markers from the loggerhead sea turtle (Caretta caretta) and cross-species amplification on other marine turtle species

[EN] We describe 12 new polymorphic dinucleotide microsatellite loci and multiplex Polymerase Chain Reaction conditions from the loggerhead sea turtle Caretta caretta. Levels of polymorphism were assessed in 50 individuals from the nesting population of the Cape Verde Islands.

Flame-propagation rates in ammonia-air combustion at high pressure

The reluctance of ammonia to be ignited easily and the necessity to advance the spark for optimum performance in combustion engines led to this investigation. Ionization gap techniques showed that long induction times and slow flame speed were both contributors to the observed phenomena. The most important factor in determining combustion characteristics of ammonia was found to be the extent of predissociation prior to attempted ignition. There was evidence from combustion gas analysis that NO + was the probable most abundant ion contributing to succesful application of the ionization gap techniques, and that the NO + was probably produced in the pyrolysis of ammonia rather than by equilibrium reactions. © 1967 Combustion Institute.

Experiencias de planeación organizacional en centros y grupos de investigación.

Este escrito ofrece una visión acerca del significado que tiene un proceso de planeación organizacional para una institución, y describe y analiza su aplicación en entidades de investigación. Para este efecto se presenta una parte teórica y un análisis de entrevistas a centros y grupos de investigación. Al final del escrito se destaca la relación que pareciera existir entre el proceso de planeación de cada centro o grupo y su proceso de consolidación como institución.

When males are more inclined to stay at home :Insights into the partial migration of a pelagic seabird provided by geolocators and isotopes

Partial migration has never been studied in pelagic seabirds, but investigating old unresolved questions in new contexts can provide useful fresh insights. We used geolocators and stable isotopes to investigate this phenomenon in a migratory pelagic seabird, the Cory’s shearwater (Calonectris diomedea). Although most birds migrated to the southern hemisphere, 8.1% of studied birds (N = 172) remained close to the breeding colony (Selvagem Grande, Madeira, Portugal), foraging within the Canary current. Almost all resident birds were males, while age or body size did not predict migratory status. Despite displaying a high repeatability (R = 0.72) in the choice of wintering area, residency was not a fixed strategy and individuals could switch between migrating and staying in the Canary current in different years. The predictions resulting from the “body size” and the “social dominance” hypotheses, in which larger individuals or dominant individuals, respectively, remain closer to the breeding areas, were not supported by our data. Resident males were able to occupy the nesting burrows much earlier than migratory males and arrival time in this species is known to affect the probability of engaging in a reproductive attempt. The selective pressure to arrive early at the colony is therefore the most likely explanation for the maintenance of this partial migration system.

Avaliação de um chiller de absorção numa unidade de cogeração e trigeração

Portugal é um país dependente da energia do exterior, devido à elevada percentagem de consumo de energia a partir de fontes primárias, como por exemplo o gasóleo. Para colmatar este cenário, têm vindo a criar-se incentivos para o uso de energias renováveis e para intensificação de medidas de eficiência energética, como os sistemas de cogeração, de forma a tornar os processos industriais nacionais mais autónomos e mais competitivos. O presente trabalho, centra-se na avaliação do chiller de absorção na central de trigeração da empresa Monteiro, Ribas-Indústria, SA, com a finalidade de identificar algum problema no funcionamento do chiller. Após efetuado o estudo do chiller, verificou-se que o coeficiente de performance do chiller apresenta valores que variam entre 0,75 e 0,81, que comparado com o valor especificado, não apresenta grande diferença. No que toca à potência do chiller, esta apresentou valores entre 948 e 1045 kW. Estes valores estavam bem abaixo da potência especificada pelos fornecedores. Assim, pretendeu-se propor medidas para melhor a potência obtida. Para o efeito foi sugerido o aquecimento da corrente que atua como fonte de calor para o chiller, a corrente de água quente. Embora a empresa apresente a solução para o problema, um permutador de vapor para o aquecimento da corrente de água quente, este não se encontra em funcionamento contínuo, levando a uma potência mais baixa.

Can foster carers help children resolve their emotional and behavioural difficulties?

Although foster care is generally seen as providing a positive experience for the children and young people for whom it caters, it is rarely conceived of as a place where the children are helped to address their emotional difficulties and modify their often difficult behaviour. Yet research evidence suggests that some foster carers are consistently less likely to have placements which break down, and that foster carers who show particular skills in parenting can make a difference to successful outcomes. The paper draws on a large longitudinal study of foster care to argue that it is possible to learn from what these foster carers do in order to develop these skills in others. A model of successful foster care. developed from the main statistical part of the study is first described. Two cases from the qualitative, case studies component of the research are then analysed to demonstrate a quality of responsive parenting. The model is further developed within the framework of the dynamic of attachment and interest sharing proposed by Heard and Lake, to show how this can be used as a basis for future approaches to working with foster placements.

Análise e avaliação dos elementos de penetração no solo de equipamentos rodoviários após revestimento

The main objective is to analyze the abrasive wear resistance to the low stress of the elements that make up the organs of road machinery that are exposed directly to contact with abrasives. These samples were analyzed after these elements are coated superficially by the process of welding electrode coated with (SAER) and the manual process of coating type LVOF thermal spraying. As well, is to provide suggestions for a better recovery and return of these elements, which are reducing costs and avoiding downtime in the fronts of service. The samples were made from a substrate of carbon ABNT 1045 tempered steel, following the same specifications and composition of metals and alloys of constituents was followed the standard governing the dimensions of these samples and in accordance with the corresponding size. The results were evaluated by testing the hardness, abrasion resistance to wear by the low stress and the loss of volume involving the microstructure of coatings analyzed

Estudos de Durabilidade Frente ao Ataque Ácido de Compósitos Portland-Polímero para Cimentação de Poços de Petróleo

Portland-polymers composites are promising candidates to be used as cementing material in Northeastern oil wells of Brazil containing heavy oils submitted to steam injection. In this way, it is necessary to evaluate its degradation in the commonly acidizind agents. In addition, to identify how aggressive are the different hostile environments it is an important contribution on the decision of the acidic systems to be used in. It was investigated the performance of the Portland-polymer composites using powdered polyurethane, aqueous polyurethane, rubber tire residues and a biopolymer, those were reinforced with polished carbon steel SAE 1045 to make the electrochemical measurements. HCl 15,0 %, HCl 6,0 % + HF 1,5 % (soft mud acid), HCl 12,0 % + HF 3,0 % (regular mud acid) and HAc 10 % + HF 1,5 % were used as degrading environment and electrolytes. The more aggressive acid solution to the plain Portland hardened cement paste was the regular mud acid, that showed loss of weight around 23.0 %, followed by the soft mud acid, the showed 11.0 %, 15.0 % HCl with 7,0 % and, at last the 10.0 % HAc plus HF 1.5 % with just 1.0 %. The powdered polyurethane-composite and the aqueous polyurethane one showed larger durability, with reduction around 87.0 % on the loss of weight in regular mud acid. The acid attack is superficial and it occurs as an action layer, where the degraded layer is responsible for the decrease on the kinetic of the degrading process. This behavior can be seen mainly on the Portland- aqueous polyurethane composite, because the degraded layer is impregnated with chemically modified polymer. The fact of the acid attack does not have influence on the compressive strength or fratography of the samples, in a general way, confirms that theory. The mechanism of the efficiency of the Portland-polymers composites subjected to acid attack is due to decreased porosity and permeability related with the plain Portland paste, minor quantity of Ca+2, element preferentially leached to the acidic solution, wave effect and to substitute part of the degrading bulk for the polymeric one. The electrolyte HAc 10 % + HF 1,5 % was the least aggressive one to the external corrosion of the casing, showing open circuit potentials around +250 mV compared to -130 mV to the simulated pore solution to the first 24 hours immersion. This behavior has been performed for two months at least. Similar corrosion rates were showed between both of the electrolytes, around 0.01 μA.cm-2. Total impedance values, insipient arcs and big polarization resistance capacitive arcs on the Nyquist plots, indicating passivity process, confirm its efficiency. In this way, Portlandpolymers composites are possible solutions to be succeed applied to oilwell cementing concomitant submitted to steam injection and acidizing operation and the HAc 10,0 % + HF 1,5 % is the less aggressive solution to the external corrosion of the casing

From the Elementary to the Circuitous: Digital Processing Workflows at FIU

This presentation was given at the FLVC regional conference at Broward College on May 7, 2015 and introduced scanning, processing, record creation, dissemination, and preservation in FIU Libraries' Digital Collections Center. The main focus was on processing, specifically employing OCR technology with difficult sources.

Niche segregation between immature and adult seabirds: Does progressive maturation play a role?

In long-lived species with slow maturation, prebreeders often represent a large percentage of the individuals alive at any moment, but their ecology is still understudied. Recent studies have found prebreeding seabirds to differ in their isotopic (and trophic) niche from adult breeders attending the same nesting colonies. These differences have been hypothesized to be linked to the less-developed foraging performance of younger and less-experienced immatures or perhaps to their inferior competitive abilities. Such differences from adults would wane as individuals mature (“the progressive ontogenetic shift hypothesis”) and could underpin the prolonged breeding deferral until adulthood displayed by those species. This study documents a marked difference in the nitrogen and carbon isotopic ratios measured in the whole blood of immatures and breeders in 2 pelagic seabird species (Cory’s shearwaters, Calonectris borealis, and black-browed albatrosses, Thalassarche melanophris) nesting in contrasting environments. However, blood isotopic values did not present a relationship with prebreeder age, suggesting no gradual ontogenetic shift from an immature toward an adult isotopic niche. Furthermore, isotopic signatures of sabbatical adults could not be separated from those of immatures attending the same colonies, but were clearly segregated from adult breeders. These results suggest that isotopic differentiation between immatures and breeders is mainly linked to a factor unrelated to previous experience and hence probably unrelated to a hypothetical gradual improvement of foraging competence or competitive abilities. Any ecological differentiation between breeders and nonbreeders is more likely related to the severity of the central-place foraging constraints and to the energetic requirements of reproduction (“the reproductive constraint hypothesis”).

Reproductive biology of the blackmouth catshark, Galeus melastomus (Chondrichthyes : Scyliorhinidae) off the south coast of Portugal

The reproductive biology of 1045 female (9.5-67 cm (total length(TL)) and 1007 male (9.4-64.3 cm TL) blackmouth catsharks, Galeus melastomus, was investigated. The sharks were caught off southern Portugal by bottom crustacean trawlers at depths from 209 to 754 m. The sex ratio was 1:1, and this species is sexually dimorphic with males approaching maturity at smaller size than females. Sexual segregation appears to be given for the stork within the study area. Sexual maturity was reached at a total length above 49 cm in males and above 56 cm in females. Mating and egg-deposition take place all year round, with two reproductive peaks of activity, in winter and summer. Egg capsules are, on average, 54 mm long and 21 mm wide, with a maximum of 63 x 25 mm encountered. Morphometric measurements of claspers, testes, ovaries, and oviducal glands were suitable for determining sexual maturity of blackmouth catshark.

Predição de ganhos genéticos via modelos mistos em progênies de café Conilon.

Objetivou-se, neste trabalho, avaliar os ganhos genéticos preditos por meio de diferentes índices de seleção pela metodologia REML/BLUP, em cinco caracteres de interesse ao programa de melhoramento do café conilon do Incaper. Foram avaliadas 8 progênies de meios-irmãos, de ciclo de maturação precoce, média de duas safras, com três repetições, o que totalizou 1368 observações, utilizados os índices de seleção clássico, multiplicativo e com base na soma de postos. Avaliaramse, na época de colheita, as características tamanho dos grãos (TG), produtividade (PRO), porte (PT), vigor vegetativo (VIG) e grau de inclinação (GI). A população foi avaliada na Fazenda Experimental de Marilândia, região Noroeste do estado do Espírito Santo. As análises genético-estatísticas foram realizadas pelo programa Selegen - REM/BLUP. Verificou-se, a partir da análise dos parâmetros genéticos, um excelente potencial seletivo entre famílias, para todas as características avaliadas. O índice Mulamba e Mock foi o que mostrou maior eficiência de seleção entre famílias de meios-irmãos de café conilon.