Trade-offs between voice and silence: a qualitative exploration of oncology staff's decisions to speak up about safety concerns

BACKGROUND Research suggests that "silence", i.e., not voicing safety concerns, is common among health care professionals (HCPs). Speaking up about patient safety is vital to avoid errors reaching the patient and thus to prevent harm and also to improve a culture of teamwork and safety. The aim of our study was to explore factors that affect oncology staff's decision to voice safety concerns or to remain silent and to describe the trade-offs they make. METHODS In a qualitative interview study with 32 doctors and nurses from 7 oncology units we investigated motivations and barriers to speaking up towards co-workers and supervisors. An inductive thematic content analysis framework was applied to the transcripts. Based on the individual experiences of participants, we conceptualize the choice to voice concerns and the trade-offs involved. RESULTS Preventing patients from serious harm constitutes a strong motivation to speaking up but competes with anticipated negative outcomes. Decisions whether and how to voice concerns involved complex considerations and trade-offs. Many respondents reflected on whether the level of risk for a patient "justifies" the costs of speaking up. Various barriers for voicing concerns were reported, e.g., damaging relationships. Contextual factors, such as the presence of patients and co-workers in the alarming situation, affect the likelihood of anticipated negative outcomes. Speaking up to well-known co-workers was described as considerably easier whereas "not knowing the actor well" increases risks and potential costs of speaking up. CONCLUSIONS While doctors and nurses felt strong obligation to prevent errors reaching individual patients, they were not engaged in voicing concerns beyond this immediacy. Our results offer in-depth insight into fears and conditions conducive of silence and voicing and can be used for educational interventions and leader reinforcement.

Age-dependent visual exploration during simulated day- and night driving on a motorway: a cross-sectional study

BACKGROUND: Central and peripheral vision is needed for object detection. Previous research has shown that visual target detection is affected by age. In addition, light conditions also influence visual exploration. The aim of the study was to investigate the effects of age and different light conditions on visual exploration behavior and on driving performance during simulated driving. METHODS: A fixed-base simulator with 180 degree field of view was used to simulate a motorway route under daylight and night conditions to test 29 young subjects (25-40 years) and 27 older subjects (65-78 years). Drivers' eye fixations were analyzed and assigned to regions of interests (ROI) such as street, road signs, car ahead, environment, rear view mirror, side mirror left, side mirror right, incoming car, parked car, road repair. In addition, lane-keeping and driving speed were analyzed as a measure of driving performance. RESULTS: Older drivers had longer fixations on the task relevant ROI, but had a lower frequency of checking mirrors when compared to younger drivers. In both age groups, night driving led to a less fixations on the mirror. At the performance level, older drivers showed more variation in driving speed and lane-keeping behavior, which was especially prominent at night. In younger drivers, night driving had no impact on driving speed or lane-keeping behavior. CONCLUSIONS: Older drivers' visual exploration behavior are more fixed on the task relevant ROI, especially at night, when driving performance becomes more heterogeneous than in younger drivers.

Hope as a resource for career exploration: Examining incremental and cross-lagged effects

Hope is believed to be beneficial for vocational pursuits, but the question of how and why hope is related to pivotal career development variables remains largely unaddressed. In a series of three studies, we investigated the relationship between hope and career exploration. Study 1 examined at-risk adolescents (N = 228) in Switzerland and showed that hope explains variance in career exploration beyond the significant effects of generalized self-efficacy beliefs and perceived social support. Study 2 found the same result among a group (N = 223) of first-year students at a Swiss university with a measure of state hope. Study 3 applied a one-year cross-lagged design with a diverse group of students (N = 266) at a German university to investigate the mutual effects of dispositional hope and career exploration over time. Although both variables were found to be related within and over time, we could not confirm lagged effects in either direction. The results suggest that hope is significantly correlated with career exploration because both are related to personality and social–contextual variables.

The English of The Sleeping Lady: An exploration of the historical and current influences on the English of Kosrae

Kosrae, or ‘The Island of The Sleeping Lady’ as it is known to locals, is the most remote island of the Federated States of Micronesia (FSM), located in the western Pacific. FSM is an independent sovereign nation consisting of four state in total: Pohnpei, Chuuk, Yap and Kosrae. First claimed by the Spanish, who were forced to cede FSM to Germany in 1899. In 1914, the Japanese took military possession of the region resulting in considerable economic, social and political change for the islands’ inhabitants. By 1947 after WWII, the islands formed part of the Trust Territory of the Pacific Islands commissioned by the UN and administered by the US. The FSM became an independent nation in 1986 while still retaining affiliation with the US under a ‘Compact of Free Association’ encouraging the officiating of English as a language of FSM, alongside local languages. Here I examine the presence and uses of English in Kosrae with reference to these socio-historical influences. First, I discuss the extralinguistic factors which have shaped the English that is currently found on Kosrae. Secondly, I assess the use of English in this community in light of Schneider’s (2007) ‘Dynamic Model’. Finally, an overview of the salient linguistic characteristics of Kosraean English, based on data collected in informal conversations on the island, will be presented. The overall objective is to present a socio-historical, political and linguistic description of a hitherto unexamined English emerging in a postcolonial environment. Schneider, E. (2007). Postcolonial Englishes. Cambridge: Cambridge University Press. Research Interests: Global Englishes

Global Optimization with Sparse and Local Gaussian Process Models

We present a novel surrogate model-based global optimization framework allowing a large number of function evaluations. The method, called SpLEGO, is based on a multi-scale expected improvement (EI) framework relying on both sparse and local Gaussian process (GP) models. First, a bi-objective approach relying on a global sparse GP model is used to determine potential next sampling regions. Local GP models are then constructed within each selected region. The method subsequently employs the standard expected improvement criterion to deal with the exploration-exploitation trade-off within selected local models, leading to a decision on where to perform the next function evaluation(s). The potential of our approach is demonstrated using the so-called Sparse Pseudo-input GP as a global model. The algorithm is tested on four benchmark problems, whose number of starting points ranges from 102 to 104. Our results show that SpLEGO is effective and capable of solving problems with large number of starting points, and it even provides significant advantages when compared with state-of-the-art EI algorithms.

An Exploration Based Cognitive Bias Test for Mice: Effects of Handling Method and Stereotypic Behaviour

Behavioural tests to assess affective states are widely used in human research and have recently been extended to animals. These tests assume that affective state influences cognitive processing, and that animals in a negative affective state interpret ambiguous information as expecting a negative outcome (displaying a negative cognitive bias). Most of these tests however, require long discrimination training. The aim of the study was to validate an exploration based cognitive bias test, using two different handling methods, as previous studies have shown that standard tail handling of mice increases physiological and behavioural measures of anxiety compared to cupped handling. Therefore, we hypothesised that tail handled mice would display a negative cognitive bias. We handled 28 female CD-1 mice for 16 weeks using either tail handling or cupped handling. The mice were then trained in an eight arm radial maze, where two adjacent arms predicted a positive outcome (darkness and food), while the two opposite arms predicted a negative outcome (no food, white noise and light). After six days of training, the mice were also given access to the four previously unavailable intermediate ambiguous arms of the radial maze and tested for cognitive bias. We were unable to validate this test, as mice from both handling groups displayed a similar pattern of exploration. Furthermore, we examined whether maze exploration is affected by the expression of stereotypic behaviour in the home cage. Mice with higher levels of stereotypic behaviour spent more time in positive arms and avoided ambiguous arms, displaying a negative cognitive bias. While this test needs further validation, our results indicate that it may allow the assessment of affective state in mice with minimal training— a major confound in current cognitive bias paradigms.

"Gangsterism," HIV, and "tik:" An exploration of Cape Town youth

Since early 2000, the Western Cape of South Africa has been documented as an area for monitoring the spread of HIV. The majority of HIV cases occur within individuals between the ages of 15-49 years, and the epidemic is believed to be complicated by the increased use of crystal methamphetamine (CM), or “tik.” Eighty percent of current CM users in Cape Town are under the age of 21 years, and almost 18% of current HIV cases are in individuals under the age of 24 years. Gang membership in youth may also be complicating the HIV problem as gangs feed the social acceptability of “tik” and encourage sexual violence. With almost half the population of Cape Town in their mid-twenties, the threat of a new HIV epidemic complicated by CM use has become a concern in the young adults of the city. Research into the relationships between gang membership and drugs/violence has been extensively studied in the Cape Flats. Yet, few have examined the role of gangs in the perpetuation of HIV. Therefore, the purpose of this investigation was exploratory in nature. Key informant interviews from Cape Town youth were used as case illustrations to generate potential hypotheses on the interrelationships between “gangsterism,” “tik” use, and HIV. Such awareness is important if effective efforts to reduce HIV incidence in Cape Town (and Sub-Saharan Africa) are to transpire. If the problem of CM is not addressed quickly, the Cape Flats may find itself with a higher rate of an already uncontrollable HIV epidemic. ^

Commercial Sexual Exploitation and Missing Children in the Coastal Region of Sao Paulo State, Brazil

The commercial sexual exploitation of children (CSEC) has emerged as one of the world’s most heinous crimes. The problem affects millions of children worldwide and no country or community is fully immune from its effects. This paper reports first generation research of the relationship that exists between CSEC and the phenomenon of missing children living in and around the coastal regions of the state of Sao Paulo, Brazil, the country’s richest State. Data are reported from interviews and case records of 64 children and adolescents, who were receiving care through a major youth serving non-governmental organization (NGO) located in the coastal city of Sao Vicente. Also, data about missing children and adolescents were collected from Police Reports – a total of 858 Police Reports. In Brazil, prostitution is not a crime itself, however, the exploitation of prostitution is a crime. Therefore, the police have no information about children or adolescents in this situation, they only have information about the clients and exploiters. Thus, this investigation sought to accomplish two objectives: 1) to establish the relationship between missing and sexual exploited children; and 2) to sensitize police and child-serving authorities in both the governmental and nongovernmental sectors to the nature, extent, and seriousness of many unrecognized cases of CSEC and missing children that come to their attention. The observed results indicated that the missing children police report are significantly underestimated. They do not represent the number of children that run away and/or are involved in commercial sexual exploitation.

Geological and geochemical characteristics of the Tersang gold deposit, Malaysia: implications for genesis and gold exploration

The Central gold belt of peninsular Malaysia comprises a number of gold deposits located in the east of the N-S striking Bentong-Raub Suture Zone. The Tersang gold deposit is one of the gold deposits in the gold belt and hosted in sandstone, rhyolite and breccia units. The deposit has an inferred resource of 528,000 ounces of gold. The geochronology of the Tersang deposit has been newly constrained by LA ICP-MS U-Pb zircon dating. The maximum depositional age of the host sedimentary rocks ranges from Early Carboniferous to Early Permian (261.5 ± 4.9 Ma to 333.5 ± 2.5 Ma) for the host sandstone and Late Triassic for the rhyolite intrusion (218.8 ± 1.7 Ma). Textural characteristics of pyrite have revealed five types including (1) Euhedral to subhedral pyrite with internal fracturing and porous cores located in the sandstone layers (pyrite 1); (2) Anhedral pyrite overgrowths on pyrite 1 and disseminated in stage 1 vein (pyrite 2); (3) Fracture-filled or vein pyrite located in stages 1 and 2 vein (pyrite 3); (4) Euhedral pyrite with internal fractures also located in stage 2 vein (pyrite 4); and (5) Subhedral clean pyrite located in the rhyolite intrusion (pyrite 5). Based on pyrite mapping and spot analyses, two main stages of gold enrichment are documented from the Tersang gold deposit. Gold in sandstone-hosted pyrite 1 (mean 4.3 ppm) shows best correlation with Bi and Pb (as evidenced on pyrite maps). In addition, gold in pyrite 3 (mean 8 ppm) located in stage 2 vein shows a good correlation with As, Ag, Sb, Cu, Tl, and Pb. In terms of gold exploration, we suggest that elements such as As, Ag, Sb, Cu, Tl, Bi, and Pb associated with Au may serve as vectoring tools in gold exploration. Our new geological, structural, geochemical and isotopic data together with mineral paragenesis, pyrite chemistry and ore fluid characteristics indicate that the Tersang gold deposit is comparable to a sediment-hosted gold deposit. Our new genetic model suggests deposition of the Permo-Carboniferous sediments followed by intrusion of rhyolitic magma in the Late Triassic. At a later stage, gold mineralisation overprinted the rhyolite intrusion and the sandstone.

The Darién Region, Connecting Road of the Americas, among the expressions of hydric wealth, land vocation and the extractive exploration on its violated forms

Colombia has oceanic waters, catchment areas, like lakes, cienagas and swamps, water flows, like rivers, gorges and streams, small rivers and groundwater. The oceanic waters are the Caribbean Sea-1600 km and the Pacific Ocean-1300 km that comprise the north and west continental territory, respectively. Actually the Region of Darién, geographically bounded by the Carribean Sea to the north is becoming to be focused by studies due to use conflicts and disputes about water and a forest reserve on its territories. Considering its location, strategic at northwestern Colombia, frontier region with Central America, several dynamics are imposed. One of them is the implantation of a road system entitled Connecting Road of the Americas. This fact means the construction of an infra-structure that will cross a special zone formed by swamps and jungle known as The Darién Gap. Evidences of such interests are revealed by projects like the constructions of Turbo's Port in the Atlantic Ocean, Department of Antioquia and Tribugá's Port in the Pacific Ocean, Department of Choco, the mountain road and the coastal conection Colombia-Venezuela attending to the main intentions of the central region of the department (Metropolitan Area of Aburrá Valley-AMVA). Human settlements form a productive system, based on small and medium familiar agriculture's production, corresponding to the western portion and piedmont of Abibe's mountain at its antioquian portion, alluvial plan that forms the rivers on this area, the littoral zone that delimits the Carribean Sea, the Darién and Baudó Mountains and the gulf that receives, among other waters, the ones from Atrato and León, as well as the exodus process constitutes a forced exit resulting from actions of several armed groups. It can be identified intense historical, cultural, political and environmental relations, specially the last one associated with strategic ecosystems that are fundamental for the hydric regulation of the region, as well as food safety of the local inhabitants. Results from two researches (UPB, 2007 y 2010) reveals this quick transformation in the spatial re-configuration, demographical and economical indicators and the exacerbated fight for resources, damaging the extractive vocation in the Region. Path to commerce of illegalities (drugs, guns) and to implementation of the agroindustrial project for biofuel production, cooperation program that involves Venezuela, Brazil and Colombia. Appropriation modes allow the existence of strategies since global interests revealing a development logic that privileges the conception of an artificialized nature. Since the smallest portion of rural areas, specific modes of resources exploration are linked to imposed interests of transnational corporations. Disparate consequences are going deeper evidenced by social, technical and nature transformations, envisioning risks for the habitability's condition

The Darién Region, Connecting Road of the Americas, among the expressions of hydric wealth, land vocation and the extractive exploration on its violated forms

Colombia has oceanic waters, catchment areas, like lakes, cienagas and swamps, water flows, like rivers, gorges and streams, small rivers and groundwater. The oceanic waters are the Caribbean Sea-1600 km and the Pacific Ocean-1300 km that comprise the north and west continental territory, respectively. Actually the Region of Darién, geographically bounded by the Carribean Sea to the north is becoming to be focused by studies due to use conflicts and disputes about water and a forest reserve on its territories. Considering its location, strategic at northwestern Colombia, frontier region with Central America, several dynamics are imposed. One of them is the implantation of a road system entitled Connecting Road of the Americas. This fact means the construction of an infra-structure that will cross a special zone formed by swamps and jungle known as The Darién Gap. Evidences of such interests are revealed by projects like the constructions of Turbo's Port in the Atlantic Ocean, Department of Antioquia and Tribugá's Port in the Pacific Ocean, Department of Choco, the mountain road and the coastal conection Colombia-Venezuela attending to the main intentions of the central region of the department (Metropolitan Area of Aburrá Valley-AMVA). Human settlements form a productive system, based on small and medium familiar agriculture's production, corresponding to the western portion and piedmont of Abibe's mountain at its antioquian portion, alluvial plan that forms the rivers on this area, the littoral zone that delimits the Carribean Sea, the Darién and Baudó Mountains and the gulf that receives, among other waters, the ones from Atrato and León, as well as the exodus process constitutes a forced exit resulting from actions of several armed groups. It can be identified intense historical, cultural, political and environmental relations, specially the last one associated with strategic ecosystems that are fundamental for the hydric regulation of the region, as well as food safety of the local inhabitants. Results from two researches (UPB, 2007 y 2010) reveals this quick transformation in the spatial re-configuration, demographical and economical indicators and the exacerbated fight for resources, damaging the extractive vocation in the Region. Path to commerce of illegalities (drugs, guns) and to implementation of the agroindustrial project for biofuel production, cooperation program that involves Venezuela, Brazil and Colombia. Appropriation modes allow the existence of strategies since global interests revealing a development logic that privileges the conception of an artificialized nature. Since the smallest portion of rural areas, specific modes of resources exploration are linked to imposed interests of transnational corporations. Disparate consequences are going deeper evidenced by social, technical and nature transformations, envisioning risks for the habitability's condition

The Darién Region, Connecting Road of the Americas, among the expressions of hydric wealth, land vocation and the extractive exploration on its violated forms

Colombia has oceanic waters, catchment areas, like lakes, cienagas and swamps, water flows, like rivers, gorges and streams, small rivers and groundwater. The oceanic waters are the Caribbean Sea-1600 km and the Pacific Ocean-1300 km that comprise the north and west continental territory, respectively. Actually the Region of Darién, geographically bounded by the Carribean Sea to the north is becoming to be focused by studies due to use conflicts and disputes about water and a forest reserve on its territories. Considering its location, strategic at northwestern Colombia, frontier region with Central America, several dynamics are imposed. One of them is the implantation of a road system entitled Connecting Road of the Americas. This fact means the construction of an infra-structure that will cross a special zone formed by swamps and jungle known as The Darién Gap. Evidences of such interests are revealed by projects like the constructions of Turbo's Port in the Atlantic Ocean, Department of Antioquia and Tribugá's Port in the Pacific Ocean, Department of Choco, the mountain road and the coastal conection Colombia-Venezuela attending to the main intentions of the central region of the department (Metropolitan Area of Aburrá Valley-AMVA). Human settlements form a productive system, based on small and medium familiar agriculture's production, corresponding to the western portion and piedmont of Abibe's mountain at its antioquian portion, alluvial plan that forms the rivers on this area, the littoral zone that delimits the Carribean Sea, the Darién and Baudó Mountains and the gulf that receives, among other waters, the ones from Atrato and León, as well as the exodus process constitutes a forced exit resulting from actions of several armed groups. It can be identified intense historical, cultural, political and environmental relations, specially the last one associated with strategic ecosystems that are fundamental for the hydric regulation of the region, as well as food safety of the local inhabitants. Results from two researches (UPB, 2007 y 2010) reveals this quick transformation in the spatial re-configuration, demographical and economical indicators and the exacerbated fight for resources, damaging the extractive vocation in the Region. Path to commerce of illegalities (drugs, guns) and to implementation of the agroindustrial project for biofuel production, cooperation program that involves Venezuela, Brazil and Colombia. Appropriation modes allow the existence of strategies since global interests revealing a development logic that privileges the conception of an artificialized nature. Since the smallest portion of rural areas, specific modes of resources exploration are linked to imposed interests of transnational corporations. Disparate consequences are going deeper evidenced by social, technical and nature transformations, envisioning risks for the habitability's condition