Hand-held voltammetric analyser for real-time monitoring of heavy metals in situ

This paper presents a novel hand-held instrument capable of real-time in situ detection and identification of heavy metals. The proposed system provides the facilities found in a traditional lab-based instrument in a hand held a design. In contrast to existing commercial systems, it can stand alone without the need of an associated computer. The electrochemical instrument uses anodic stripping voltammetry which is a precise and sensitive analytical method with excellent limits of detection. The sensors comprise disposable screen-printed (solid working) electrodes rather than the more common hanging mercury drop electrodes. The system is reliable, easy to use, safe, avoids expensive and time-consuming procedures and may be used in a variety of situations to help in the fields of environmental assessment and control.

Preferred Reporting Items for a Systematic Review and Meta-analysis of Individual Participant Data The PRISMA-IPD Statement

IMPORTANCE Systematic reviews and meta-analyses of individual participant data (IPD) aim to collect, check, and reanalyze individual-level data from all studies addressing a particular research question and are therefore considered a gold standard approach to evidence synthesis. They are likely to be used with increasing frequency as current initiatives to share clinical trial data gain momentum and may be particularly important in reviewing controversial therapeutic areas.

OBJECTIVE To develop PRISMA-IPD as a stand-alone extension to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) Statement, tailored to the specific requirements of reporting systematic reviews and meta-analyses of IPD. Although developed primarily for reviews of randomized trials, many items will apply in other contexts, including reviews of diagnosis and prognosis.

DESIGN Development of PRISMA-IPD followed the EQUATOR Network framework guidance and used the existing standard PRISMA Statement as a starting point to draft additional relevant material. A web-based survey informed discussion at an international workshop that included researchers, clinicians, methodologists experienced in conducting systematic reviews and meta-analyses of IPD, and journal editors. The statement was drafted and iterative refinements were made by the project, advisory, and development groups. The PRISMA-IPD Development Group reached agreement on the PRISMA-IPD checklist and flow diagram by consensus.

FINDINGS Compared with standard PRISMA, the PRISMA-IPD checklist includes 3 new items that address (1) methods of checking the integrity of the IPD (such as pattern of randomization, data consistency, baseline imbalance, and missing data), (2) reporting any important issues that emerge, and (3) exploring variation (such as whether certain types of individual benefit more from the intervention than others). A further additional item was created by reorganization of standard PRISMA items relating to interpreting results. Wording was modified in 23 items to reflect the IPD approach.

CONCLUSIONS AND RELEVANCE PRISMA-IPD provides guidelines for reporting systematic reviews and meta-analyses of IPD.

Field Testing a Full-Scale Tidal Turbine Part 3: Acoustic Characteristics

Like any new technology, tidal power converters are being assessed for potential environmental impacts. Similar to wind power, where noise emissions have led to some regulations and limitations on consented installation sites, noise emissions of these new tidal devices attract considerable attention, especially due to the possible interaction with the marine fauna. However, the effect of turbine noise cannot be assessed as a stand-alone issue, but must be investigated in the context of the natural background noise in high flow environments. Noise measurements are also believed to be a useful tool for monitoring the operating conditions and health of equipment. While underwater noise measurements are not trivial to perform, this non-intrusive mon- itoring method could prove to be very cost effective. This paper presents sound measurements performed on the SCHOTTEL Instream Turbine as part of the MaRINET testing campaign at the QUB tidal test site in Portaferry during the summer of 2014. This paper demonstrates a comparison of the turbine noise emissions with the normal background noise at the test site and presents possible applications as a monitoring system.

A high-value, low-cost bubble continuous positive airway pressure system for low-resource settings:technical assessment and initial case reports

Acute respiratory infections are the leading cause of global child mortality. In the developing world, nasal oxygen therapy is often the only treatment option for babies who are suffering from respiratory distress. Without the added pressure of bubble Continuous Positive Airway Pressure (bCPAP) which helps maintain alveoli open, babies struggle to breathe and can suffer serious complications, and frequently death. A stand-alone bCPAP device can cost $6,000, too expensive for most developing world hospitals. Here, we describe the design and technical evaluation of a new, rugged bCPAP system that can be made in small volume for a cost-of-goods of approximately $350. Moreover, because of its simple design--consumer-grade pumps, medical tubing, and regulators--it requires only the simple replacement of a <$1 diaphragm approximately every 2 years for maintenance. The low-cost bCPAP device delivers pressure and flow equivalent to those of a reference bCPAP system used in the developed world. We describe the initial clinical cases of a child with bronchiolitis and a neonate with respiratory distress who were treated successfully with the new bCPAP device.

TRFS: desenvolvimento de um protótipo para simulação microscópica de tráfego

Dissertação para obtenção do grau de Mestre em Engenharia Civil na Área de Especialização de Vias de Comunicação e Transportes

Nietzsche's eternal recurrence of the same : the effect of logic abridgement, contradictions and inconsistencies

I will argue that the doctrine of eternal recurrence of the same no better interprets cosmology than pink elephants interpret zoology. I will also argue that the eternal-reiurn-of-the-same doctrine as what Magnus calls "existential imperative" is without possibility of application and thus futile. To facilitate those arguments, the validity of the doctrine of the eternal recurrence of the same will be tested under distinct rubrics. Although each rubric will stand alone, one per chapter, as an evaluation of some specific aspect of eternal recurrence, the rubric sequence has been selected to accommodate the identification of what I shall be calling logic abridgments. The conclusions to be extracted from each rubric are grouped under the heading CONCLUSION and appear immediately following rubric ten. Then, or if, at the end of a rubric a reader is inclined to wonder which rubric or topic is next, and why, the answer can be found at the top of the following page. The question is usually answered in the very first sentence, but always answered in the first paragraph. The first rubric has been placed in order by chronological entitlement in that it deals with the evolution of the idea of eternal recurrence from the time of the ancient Greeks to Nietzsche's August, 1881 inspiration. This much-recommended technique is also known as starting at the beginning. Rubric 1 also deals with 20th. Century philosophers' assessments of the relationship between Nietzsche and ancient Greek thought. The only experience of E-R, Zarathustra's mountain vision, is second only because it sets the scene alluded to in following rubrics. The third rubric explores .ii?.ih T jc,i -I'w Nietzsche's evaluation of rationality so that his thought processes will be understood appropriately. The actual mechanism of E-R is tested in rubric four...The scientific proof Nietzsche assembled in support of E-R is assessed by contemporary philosophers in rubric five. E-R's function as an ethical imperative is debated in rubrics six and seven.. .The extent to which E-R fulfills its purpose in overcoming nihilism is measured against the comfort assured by major world religions in rubric eight. Whether E-R also serves as a redemption for revenge is questioned in rubric nine. Rubric ten assures that E-R refers to return of the identically same and not merely the similar. In addition to assemblage and evaluation of all ten rubrics, at the end of each rubric a brief recapitulation of its principal points concludes the chapter. In this essay I will assess the theoretical conditions under which the doctrine cannot be applicable and will show what contradictions and inconsistencies follow if the doctrine is taken to be operable. Harold Alderman in his book Nietzsche's Gift wrote, the "doctrine of eternal recurrence gives us a problem not in Platonic cosmology, but in Socratic selfreflection." ^ I will illustrate that the recurrence doctrine's cosmogony is unworkable and that if it were workable, it would negate self-reflection on the grounds that selfreflection cannot find its cause in eternal recurrence of the same. Thus, when the cosmology is shown to be impossible, any expected ensuing results or benefits will be rendered also impossible. The so-called "heaviest burden" will be exposed as complex, engrossing "what if speculations deserving no linkings to reality. To identify ^Alderman p. 84 abridgments of logic, contradictions and inconsistencies in Nietzsche's doctrine of eternal recurrence of the same, I. will examine the subject under the following schedule. In Chapter 1 the ancient origins of recurrence theories will be introduced. ..This chapter is intended to establish the boundaries within which the subsequent chapters, except Chapter 10, will be confined. Chapter 2, Zarathustra's vision of E-R, assesses the sections of Thus Spoke Zarathustra in which the phenomenon of recurrence of the same is reported. ..Nihilism as a psychological difficulty is introduced in this rubric, but that subject will be studied in detail in Chapter 8. In Chapter 2 the symbols of eternal recurrence of the same will be considered. Whether the recurrence image should be of a closed ring or as a coil will be of significance in many sections of my essay. I will argue that neither symbolic configuration can accommodate Nietzsche's supposed intention. Chapter 3 defends the description of E-R given by Zarathustra. Chapter 4, the cosmological mechanics of E-R, speculates on the seriousness with which Nietzsche might have intended the doctrine of eternal recurrence to be taken. My essay reports, and then assesses, the argument of those who suppose the doctrine to have been merely exploratory musings by Nietzsche on cosmological hypotheses...The cosmogony of E-R is examined. In Chapter 5, cosmological proofs tested, the proofs for Nietzsche's doctrine of return of the same are evaluated. This chapter features the position taken by Martin ' Heidegger. My essay suggests that while Heidegger's argument that recurrence of the same is a genuine cosmic agenda is admirable, it is not at all persuasive. Chapter 6, E-R is an ethical imperative, is in essence the reporting of a debate between two scholars regarding the possibility of an imperative in the doctrine of recurrence. Their debate polarizes the arguments I intend to develop. Chapter 7, does E-R of the same preclude alteration of attitudes, is a continuation of the debate presented in Chapter 6 with the focus shifted to the psychological from the cosmological aspects of eternal recurrence of the same. Chapter 8, Can E-R Overcome Nihilism?, is divided into two parts. In the first, nihilism as it applies to Nietzsche's theory is discussed. ..In part 2, the broader consequences, sources and definitions of nihilism are outlined. My essay argues that Nietzsche's doctrine is more nihilistic than are the world's major religions. Chapter 9, Is E-R a redemption for revenge?, examines the suggestion extracted from Thus Spoke Zarathustra that the doctrine of eternal recurrence is intended, among other purposes, as a redemption for mankind from the destructiveness of revenge. Chapter 10, E-R of the similar refuted, analyses a position that an element of chance can influence the doctrine of recurrence. This view appears to allow, not for recurrence of the same, but recurrence of the similar. A summary will recount briefly the various significant logic abridgments, contradictions, and inconsistencies associated with Nietzsche's doctrine of eternal recurrence of the same. In the 'conclusion' section of my essay my own opinions and observations will be assembled from the body of the essay.

Raising Creativity: Exploring How Creativity Can be Nurtured in Educational Contexts

The question of how we can encourage creative capacities in young people has never been more relevant than it is today (Pink, 2006; Robinson as cited in TEDtalksDirector, 2007; Eisner as cited in VanderbiltUniversity, 2009). While the world is rapidly evolving, education has the great challenge of adapting to keep up. Scholars say that to meet the needs of 21st century learners, pedagogy must focus on fostering creative skills to enable students to manage in a future we cannot yet envision (Robinson as cited in TEDtalksDirector, 2007). Further, research demonstrates that creativity thrives with autonomy, support, and without judgment (Amabile, 1996; Codack [Zak], 2010; Harrington, Block, & Block, 1987; Holt, 1989; Kohn, 1993). So how well are schools doing in this regard? How do alternative models of education nurture or neglect creativity, and how can this inform teaching practice all around? In other words, ultimately, how can we nurture creativity in education? This documentary explores these questions from a scholarly art-based perspective. Artist/researcher/teacher Rebecca Zak builds on her experience in the art studio, academia, and the art classroom to investigate the various philosophies and strategies that diverse educational models implement to illuminate the possibilities for educational and paradigmatic transformation. The Raising Creativity documentary project consists of multiple parts across multiple platforms. There are five videos in the series that answer the why, who, how, what, and now what about creativity in education respectively (i.e., why is this topic important, who has spoken/written on this topic already, how will this issue be investigated this time, what was observed during the inquiry, and now what will this mean going forward?). There is also a self-reflexive blog that addresses certain aspects of the topic in greater depth (located here, on this website) and in the context of Rebecca's lived experience to complement the video format. Together, all video and blog artifacts housed on this website function as a polyptych, wherein the pieces can stand alone individually yet are intended to work together and fulfill the dissertation requirements for Rebecca's doctorate degree in education in reimagined ways.

Evolution of Various Library Instruction Strategies: Using Student Feedback to Create and Enhance Online Active Learning Assignments

This case study traces the evolution of library assignments for biological science students from paper-based workbooks in a blended (hands-on) workshop to blended learning workshops using online assignments to online active learning modules which are stand-alone without any face-to-face instruction. As the assignments evolved to adapt to online learning supporting materials in the form of PDFs (portable document format), screen captures and screencasting were embedded into the questions as teaching moments to replace face-to-face instruction. Many aspects of the evolution of the assignment were based on student feedback from evaluations, input from senior lab demonstrators and teaching assistants, and statistical analysis of the students’ performance on the assignment. Advantages and disadvantages of paper-based and online assignments are discussed. An important factor for successful online learning may be the ability to get assistance.

Responsibility and Cross-Subsidization in Cost Sharing

We propose two axiomatic theories of cost sharing with the common premise that agents demand comparable -though perhaps different- commodities and are responsible for their own demand. Under partial responsibility the agents are not responsible for the asymmetries of the cost function: two agents consuming the same amount of output always pay the same price; this holds true under full responsibility only if the cost function is symmetric in all individual demands. If the cost function is additively separable, each agent pays her stand alone cost under full responsibility; this holds true under partial responsibility only if, in addition, the cost function is symmetric. By generalizing Moulin and Shenker’s (1999) Distributivity axiom to cost-sharing methods for heterogeneous goods, we identify in each of our two theories a different serial method. The subsidy-free serial method (Moulin, 1995) is essentially the only distributive method meeting Ranking and Dummy. The cross-subsidizing serial method (Sprumont, 1998) is the only distributive method satisfying Separability and Strong Ranking. Finally, we propose an alternative characterization of the latter method based on a strengthening of Distributivity.

The antecedents to participation in learning activities among support staff at a college in Ontario

Les tendances de la participation à la formation des adultes au Canada n’ont pas évolué depuis des décennies, malgré les nouvelles influences économiques qui ont stimulé l’augmentation et la diversification permanente de la formation des employés et malgré les initiatives plus nombreuses en faveur de l’apprentissage des employés en milieu de travail. Il est donc nécessaire de ne plus se contenter d’étudier les prédicteurs de la formation déjà connus dans les profils des employés et des employeurs. Il est, en revanche, indispensable d’étudier les antécédents de la participation des employés à la formation, y compris les aspects et les étapes du processus qui la précède. Cette étude porte sur les antécédents de la participation des employés aux formations dans un important collège communautaire urbain en Ontario. Afin de préparer le recueil des données, un cadre théorique a été élaboré à partir du concept d’expression de la demande. Ce cadre implique l’existence d’un processus qui comporte plusieurs étapes, au cours desquelles plusieurs intervenants interagissent et dont la formation est susceptible d’être le résultat. Les résultats de l’enquête sur le profil d’apprentissage ont permis de conclure que le comportement des employés et de l’employeur est conforme aux modèles de prédicteurs existants et que les taux et les types de participation étaient similaires aux tendances nationales et internationales. L’analyse des entrevues d’un groupe d’employés atypiques, de leurs superviseurs, ainsi que de représentants du collège et du syndicat, a révélé d’importants thèmes clés : l’expression de la demande n’est pas structurée et elle est communiquée par plusieurs canaux, en excluant parfois les superviseurs. De plus, la place de l’auto évaluation est importante, ainsi que la phase de prise de décision. Ces thèmes ont souligné l’interaction de plusieurs intervenants dans le processus d’expression de la demande d’apprentissage et pendant la prise de décision. L’examen des attentes de chacun de ces intervenants au cours de ce processus nous a permis de découvrir un désir tacite chez les superviseurs et les employés, à savoir que la conversation soit à l’initiative de « l’autre ». Ces thèmes clés ont été ensuite abordés dans une discussion qui a révélé une discordance entre le profil de l’employeur et les profils des employés. Celle-ci se prête à la correction par l’employeur de son profil institutionnel pour l’harmoniser avec le profil dispositionnel des employés et optimiser ainsi vraisemblablement son offre de formation. Ils doivent, pour cela, appliquer un processus plus systématique et plus structuré, doté de meilleurs outils. La discussion a porté finalement sur les effets des motivations économiques sur la participation des employés et a permis de conclure que, bien que les employés ne semblent pas se méfier de l’offre de formation de l’employeur et que celle ci ne semble pas non plus les décourager, des questions de pouvoir sont bel et bien en jeu. Elles se sont principalement manifestées pendant le processus de prise de décision et, à cet égard, les superviseurs comme les employés reconnaissent qu’un processus plus structuré serait bénéfique, puisqu’il atténuerait les problèmes d’asymétrie et d’ambiguïté. Les constatations de cette étude sont pertinentes pour le secteur de la formation des adultes et de la formation en milieu de travail et, plus particulièrement, pour la méthodologie de recherche. Nous avons constaté l’avantage d’une méthodologie à deux volets, à l’écoute de l’employeur et des employés, afin de mieux comprendre la relation entre l’offre de formation et la participation à la formation. La définition des antécédents de la participation sous la forme d’un processus dans lequel plusieurs intervenants remplissent plusieurs rôles a permis de créer un modèle plus détaillé qui servira à la recherche future. Ce dernier a démontré qu’il est indispensable de reconnaître que la prise de décision constitue une étape à part entière, située entre l’expression de la demande et la participation à la formation. Ces constatations ont également révélé qu’il est véritablement indispensable que le secteur de la formation des adultes continue à traiter les questions reliées à la reconnaissance de la formation informelle. Ces conclusions et la discussion sur les constatations clés nous ont inspiré des recommandations à appliquer pour modifier les retombées du processus précédant la participation des employés à la formation. La majorité de ces recommandations ont trait à l’infrastructure de ce processus et ciblent donc principalement l’employeur. Certaines recommandations sont cependant destinées aux syndicats, aux superviseurs et aux employés qui peuvent aider l’employeur à remplir son rôle et favoriser la participation efficace de tous à ce processus. Les recommandations qui précédent impliquent que ce sont les antécédents de la formation qui gagneraient à être plus structurés et non la formation elle même. La structuration de l’infrastructure de l’apprentissage présente cependant des risques à elle seule. En liaison avec ce phénomène, une étude spécifique des effets de la nature, de la qualité et de l’asymétrie de la relation superviseur employé sur la participation des employés à la formation serait bénéfique. Mots clés : formation en entreprise, formation professionnelle continue, antécédents à la participation, employés de soutien

Disunion City : the fashion of urban youth in Montreal, Quebec

Ce petit échantillon d’une étude ethnographique, fait à partir de la méthode d’observation participante, interroge la nature de la tendance de la mode auprès de jeunes citadins au coeur d'un centre urbain francophone du Canada. Les participants identifient un « look » comme étant emblématique du Plateau, un arrondissement de Montréal qui est démographiquement divers et contenant beaucoup de commerces dynamiques. Le Plateau a été promu par les organisations de la ville de Montréal comme le point central de la mode, arts et culture. Locaux ou simples touristes voient le Plateau comme un environnement aidant à la transformation personnelle et à l’autoréalisation, particulièrement chez les locaux de 18-30 ans. Plus particulièrement, les membres appartenant à cette tranche d’âge conçoivent leurs propres interprétations de la mode et participent à un certains nombres de projets créatifs en vue de réaliser d’authentiques et véritables expressions de soi. Cependant, à cause de la commercialisation de la mode présentée pour les consommateurs du Plateau, la jeune population perçoit le courant dominant du « hipster » comme n’étant plus l’authentique représentation à leur course à l’authenticité individuelle dans un monde en perpétuel globalisation. La chercheuse a découvert l’existence d’une idéologie de l’individu restreint à ce quartier. Vu l’animosité présente parmi la population locale du Plateau pour le courant principal hipster, l’ensemble de ces données montrent qu’il y a un besoin d’une meilleure compréhension de la relation entre la commercialisation de la mode occidentale et de ces acheteurs au niveau de l’individu et au niveau local dans les espaces urbaine en perpétuel globalisation. Le contexte de la mode dans cet environnement est contraint par l’hypothèse de la valeur qu'être différent est imaginé et digne d’intérêt dans cette communauté si et seulement si quelqu’un est confiant au point de se tenir debout avec ses idéaux au milieu des autres.

Algorithmes heuristiques et exacts pour le problème de l’ensemble dominant connexe minimum.

Dans ce mémoire, nous abordons le problème de l’ensemble dominant connexe de cardinalité minimale. Nous nous penchons, en particulier, sur le développement de méthodes pour sa résolution basées sur la programmation par contraintes et la programmation en nombres entiers. Nous présentons, en l’occurrence, une heuristique et quelques méthodes exactes pouvant être utilisées comme heuristiques si on limite leur temps d’exécution. Nous décrivons notamment un algorithme basé sur l’approche de décomposition de Benders, un autre combinant cette dernière avec une stratégie d’investigation itérative, une variante de celle-ci utilisant la programmation par contraintes, et enfin une méthode utilisant uniquement la programmation par contraintes. Des résultats expérimentaux montrent que ces méthodes sont efficaces puisqu’elles améliorent les méthodes connues dans la littérature. En particulier, la méthode de décomposition de Benders avec une stratégie d’investigation itérative fournit les résultats les plus performants.

An Effective Path Protection Method to Attain the Route Stability in MANET

With the increasing popularity of wireless network and its application, mobile ad-hoc networks (MANETS) emerged recently. MANET topology is highly dynamic in nature and nodes are highly mobile so that the rate of link failure is more in MANET. There is no central control over the nodes and the control is distributed among nodes and they can act as either router or source. MANTEs have been considered as isolated stand-alone network. Node can add or remove at any time and it is not infrastructure dependent. So at any time at any where the network can setup and a trouble free communication is possible. Due to more chances of link failures, collisions and transmission errors in MANET, the maintenance of network became costly. As per the study more frequent link failures became an important aspect of diminishing the performance of the network and also it is not predictable. The main objective of this paper is to study the route instability in AODV protocol and suggest a solution for improvement. This paper proposes a new approach to reduce the route failure by storing the alternate route in the intermediate nodes. In this algorithm intermediate nodes are also involved in the route discovery process. This reduces the route establishment overhead as well as the time to find the reroute when a link failure occurs.

Modelling and simulation of a photovoltaic fuel cell hybrid system

A stand-alone power system is an autonomous system that supplies electricity to the user load without being connected to the electric grid. This kind of decentralized system is frequently located in remote and inaccessible areas. It is essential for about one third of the world population which are living in developed or isolated regions and have no access to an electricity utility grid. The most people live in remote and rural areas, with low population density, lacking even the basic infrastructure. The utility grid extension to these locations is not a cost effective option and sometimes technically not feasible. The purpose of this thesis is the modelling and simulation of a stand-alone hybrid power system, referred to as “hydrogen Photovoltaic-Fuel Cell (PVFC) hybrid system”. It couples a photovoltaic generator (PV), an alkaline water electrolyser, a storage gas tank, a proton exchange membrane fuel cell (PEMFC), and power conditioning units (PCU) to give different system topologies. The system is intended to be an environmentally friendly solution since it tries maximising the use of a renewable energy source. Electricity is produced by a PV generator to meet the requirements of a user load. Whenever there is enough solar radiation, the user load can be powered totally by the PV electricity. During periods of low solar radiation, auxiliary electricity is required. An alkaline high pressure water electrolyser is powered by the excess energy from the PV generator to produce hydrogen and oxygen at a pressure of maximum 30bar. Gases are stored without compression for short- (hourly or daily) and long- (seasonal) term. A proton exchange membrane (PEM) fuel cell is used to keep the system’s reliability at the same level as for the conventional system while decreasing the environmental impact of the whole system. The PEM fuel cell consumes gases which are produced by an electrolyser to meet the user load demand when the PV generator energy is deficient, so that it works as an auxiliary generator. Power conditioning units are appropriate for the conversion and dispatch the energy between the components of the system. No batteries are used in this system since they represent the weakest when used in PV systems due to their need for sophisticated control and their short lifetime. The model library, ISET Alternative Power Library (ISET-APL), is designed by the Institute of Solar Energy supply Technology (ISET) and used for the simulation of the hybrid system. The physical, analytical and/or empirical equations of each component are programmed and implemented separately in this library for the simulation software program Simplorer by C++ language. The model parameters are derived from manufacturer’s performance data sheets or measurements obtained from literature. The identification and validation of the major hydrogen PVFC hybrid system component models are evaluated according to the measured data of the components, from the manufacturer’s data sheet or from actual system operation. Then, the overall system is simulated, at intervals of one hour each, by using solar radiation as the primary energy input and hydrogen as energy storage for one year operation. A comparison between different topologies, such as DC or AC coupled systems, is carried out on the basis of energy point of view at two locations with different geographical latitudes, in Kassel/Germany (Europe) and in Cairo/Egypt (North Africa). The main conclusion in this work is that the simulation method of the system study under different conditions could successfully be used to give good visualization and comparison between those topologies for the overall performance of the system. The operational performance of the system is not only depending on component efficiency but also on system design and consumption behaviour. The worst case of this system is the low efficiency of the storage subsystem made of the electrolyser, the gas storage tank, and the fuel cell as it is around 25-34% at Cairo and 29-37% at Kassel. Therefore, the research for this system should be concentrated in the subsystem components development especially the fuel cell.

Incident-Reporting-Systeme als Möglichkeit zum organisationalem Lernen (nicht nur) aus Fehlern und kritischen Ereignissen

Die vorliegende Dissertation betrachtet institutionsinterne lokale (Critical-)Incident-Reporting-Systeme ((C)IRS) als eine Möglichkeit zum Lernen aus Fehlern und unerwünschten kritischen Ereignissen (sogenannte Incidents) im Krankenhaus. Die Notwendigkeit aus Incidents zu lernen, wird im Gesundheitswesen bereits seit den 1990er Jahren verstärkt diskutiert. Insbesondere risikoreichen Organisationen, in denen Incidents fatale Konsequenzen haben können, sollten umfassende Strategien erarbeiten, die sie vor Fehlern und unerwünschten Ereignissen schützen und diese als Lernpotenzial nutzen können. Dabei können lokale IRS als ein zentraler Bestandteil des Risikomanagements und freiwillige Dokumentationssysteme im Krankenhaus ein Teil dieser Strategie sein. Sie können eine Ausgangslage für die systematische Erfassung und Auswertung von individuellen Lerngelegenheiten und den Transfer zurück in die Organisation schaffen. Hierfür sind eine lernförderliche Gestaltung, Implementierung und Einbettung lokaler IRS eine wichtige Voraussetzung. Untersuchungen über geeignete lerntheoretisch fundierte und wirkungsvolle IRS-Modelle und empirische Daten fehlen bisher im deutschsprachigen Raum. Einen entsprechenden Beitrag leistet die vorliegende Fallstudie in einem Schweizer Universitätsspital (800 Betten, 6.100 Mitarbeitende). Zu diesem Zweck wurde zuerst ein Anforderungsprofil an lernförderliche IRS aus der Literatur abgeleitet. Dieses berücksichtigt zum einen literaturbasierte Kriterien für die Gestaltung und Nutzung aus der IRS-Literatur, zum anderen die aus der Erziehungswissenschaft und Arbeitspsychologie entlehnten Gestaltungsbedingungen und Erfolgskriterien an organisationales Lernen. Das Anforderungsprofil wurde in drei empirischen Teilstudien validiert und entsprechend adaptiert. In der ersten empirischen Teilstudie erfolgte eine Standortbestimmung der lokalen IRS. Die Erhebung erfolgte in vier Kliniken mittels Dokumentenanalyse, leitfadengestützter Interviews (N=18), sieben strukturierter Gruppendiskussionen und teilnehmender Beobachtungen über einen Zeitraum von 22 Monaten. Erfolgskritische IRS-Merkmale wurden identifiziert mit dem Ziel einer praxisgerechten lernförderlichen Systemgestaltung und Umsetzung von Incident Reporting unter Betrachtung von organisationalen Rahmenbedingungen, Lernpotenzialen und Barrieren. Die zweite Teilstudie untersuchte zwei Fallbeispiele organisationalen Lernens mittels Prozessbegleitung, welche zu einem verwechslungssicheren Design bei einem Medizinalprodukt und einer verbesserten Patientenidentifikation in Zusammenhang mit Blutentnahmen führten. Für das organisationale Lernen im Spital wurden dabei Chancen, Barrieren und Gestaltungsansätze abgeleitet, wie erwünschte Veränderungen und Lernen unter Nutzung von IRS initiiert werden können und dabei ein besseres Gesundheitsresultat erreicht werden kann. Die dritte Teilstudie überprüfte, inwiefern die Nutzung und Implementierung lokaler IRS mittels einer Mitarbeitervollbefragung zur Sicherheitskultur gefördert werden kann. Hierfür wurde eine positive Interaktion, zwischen einer starken Sicherheitskultur und der Bereitschaft ein IRS zu implementieren und Incidents zu berichten, angenommen. Zum Einsatz kam eine deutschsprachige Version des Hospital Survey on Patient Safety Culture (Patientensicherheitsklimainventar) mit einem Rücklauf von 46.8% (2.897 gültige Fragebogen). In 23 von 37 Kliniken führte laut einer Nachbefragung die Sicherheitskulturbefragung zum Implementierungsentscheid. Dies konnte durch Monitoring der IRS-Nutzung bestätigt werden. Erstmals liegen mit diesen Studien empirische Daten für eine wirkungsvolle und lernförderliche Gestaltung und Umsetzung von lokalen IRS am Beispiel einer Schweizer Gesundheitsorganisation vor. Die Ergebnisse der Arbeit zeigen Chancen und Barrieren für IRS als Berichts- und Lernsysteme im Krankenhaus auf. Als Resultat unsachgemäss gestalteter und implementierter IRS konnte dabei vor allem Lernverhinderung infolge IRS aufgezeigt werden. Blinder Aktionismus und eine fehlende Priorisierung von Patientensicherheit, unzureichende Kompetenzen, Qualifikationen und Ressourcen führten dabei zur Schaffung neuer Fehlerquellen mit einer Verstärkung des Lernens erster Ordnung. Eine lernförderliche Gestaltung und Unterhaltung der lokalen IRS, eingebettet in eine klinikumsweite Qualitäts- und Patientensicherheitsstrategie, erwiesen sich hingegen als wirkungsvoll im Sinne eines organisationalen Lernens und eines kontinuierlichen Verbesserungsprozesses. Patientensicherheitskulturbefragungen erwiesen sich zudem bei entsprechender Einbettung als effektives Instrument, um die Implementierung von IRS zu fördern. Zwölf Thesen zeigen in verdichteter Form auf, welche Gestaltungsprinzipien für IRS als Instrument des organisationalen Lernens im Rahmen des klinischen Risikomanagements und zur Förderung einer starken Patientensicherheitskultur zu berücksichtigen sind. Die Erkenntnisse aus den empirischen Studien münden in ein dialogorientiertes Rahmenmodell organisationalen Lernens unter Nutzung lokaler IRS. Die Arbeit zeigt damit zum einen Möglichkeiten für ein Lernen auf den verschiedenen Ebenen der Organisation auf und weist auf die Notwendigkeit einer (Re-)Strukturierung der aktuellen IRS-Diskussion hin.