Medical students' personal experience of high-stakes failure:case studies using interpretative phenomenological analysis

Abstract (provisional): Background Failing a high-stakes assessment at medical school is a major event for those who go through the experience. Students who fail at medical school may be more likely to struggle in professional practice, therefore helping individuals overcome problems and respond appropriately is important. There is little understanding about what factors influence how individuals experience failure or make sense of the failing experience in remediation. The aim of this study was to investigate the complexity surrounding the failure experience from the student’s perspective using interpretative phenomenological analysis (IPA). Methods The accounts of 3 medical students who had failed final re-sit exams, were subjected to in-depth analysis using IPA methodology. IPA was used to analyse each transcript case-by-case allowing the researcher to make sense of the participant’s subjective world. The analysis process allowed the complexity surrounding the failure to be highlighted, alongside a narrative describing how students made sense of the experience. Results The circumstances surrounding students as they approached assessment and experienced failure at finals were a complex interaction between academic problems, personal problems (specifically finance and relationships), strained relationships with friends, family or faculty, and various mental health problems. Each student experienced multi-dimensional issues, each with their own individual combination of problems, but experienced remediation as a one-dimensional intervention with focus only on improving performance in written exams. What these students needed to be included was help with clinical skills, plus social and emotional support. Fear of termination of the their course was a barrier to open communication with staff. Conclusions These students’ experience of failure was complex. The experience of remediation is influenced by the way in which students make sense of failing. Generic remediation programmes may fail to meet the needs of students for whom personal, social and mental health issues are a part of the picture.

The largest admitted IT project failure in the Southern Hemisphere: A teaching case

The Queensland Health implementation project failure is the largest IS failure in the southern hemisphere to date, costing $1.25 billion AUD. This case highlights the importance of systematically analysing project failure. It examines the case organization details, royal commission report, auditor general report and 118 witness statements pertaining to the Queensland Health implementation project. The objective of this teaching case is (1) to illustrate the factors that contributed to Queensland Health's disastrous implementation project and (2) to understand the broader applications of this project failure on state and national legislations as well as industry sectors. The case narrative and teaching notes are appropriate for both undergraduate and postgraduate students studying IS and project management subjects.

A comparative study of prognostic model for bearing failure

An effective prognostics program will provide ample lead time for maintenance engineers to schedule a repair and to acquire replacement components before catastrophic failures occur. This paper presents a technique for accurate assessment of the remnant life of machines based on health state probability estimation technique. For comparative study of the proposed model with the proportional hazard model (PHM), experimental bearing failure data from an accelerated bearing test rig were used. The result shows that the proposed prognostic model based on health state probability estimation can provide a more accurate prediction capability than the commonly used PHM in bearing failure case study.

Machine prognostics based on health state probability estimation

The ability to accurately predict the remaining useful life of machine components is critical for machine continuous operation and can also improve productivity and enhance system’s safety. In condition-based maintenance (CBM), maintenance is performed based on information collected through condition monitoring and assessment of the machine health. Effective diagnostics and prognostics are important aspects of CBM for maintenance engineers to schedule a repair and to acquire replacement components before the components actually fail. Although a variety of prognostic methodologies have been reported recently, their application in industry is still relatively new and mostly focused on the prediction of specific component degradations. Furthermore, they required significant and sufficient number of fault indicators to accurately prognose the component faults. Hence, sufficient usage of health indicators in prognostics for the effective interpretation of machine degradation process is still required. Major challenges for accurate longterm prediction of remaining useful life (RUL) still remain to be addressed. Therefore, continuous development and improvement of a machine health management system and accurate long-term prediction of machine remnant life is required in real industry application. This thesis presents an integrated diagnostics and prognostics framework based on health state probability estimation for accurate and long-term prediction of machine remnant life. In the proposed model, prior empirical (historical) knowledge is embedded in the integrated diagnostics and prognostics system for classification of impending faults in machine system and accurate probability estimation of discrete degradation stages (health states). The methodology assumes that machine degradation consists of a series of degraded states (health states) which effectively represent the dynamic and stochastic process of machine failure. The estimation of discrete health state probability for the prediction of machine remnant life is performed using the ability of classification algorithms. To employ the appropriate classifier for health state probability estimation in the proposed model, comparative intelligent diagnostic tests were conducted using five different classifiers applied to the progressive fault data of three different faults in a high pressure liquefied natural gas (HP-LNG) pump. As a result of this comparison study, SVMs were employed in heath state probability estimation for the prediction of machine failure in this research. The proposed prognostic methodology has been successfully tested and validated using a number of case studies from simulation tests to real industry applications. The results from two actual failure case studies using simulations and experiments indicate that accurate estimation of health states is achievable and the proposed method provides accurate long-term prediction of machine remnant life. In addition, the results of experimental tests show that the proposed model has the capability of providing early warning of abnormal machine operating conditions by identifying the transitional states of machine fault conditions. Finally, the proposed prognostic model is validated through two industrial case studies. The optimal number of health states which can minimise the model training error without significant decrease of prediction accuracy was also examined through several health states of bearing failure. The results were very encouraging and show that the proposed prognostic model based on health state probability estimation has the potential to be used as a generic and scalable asset health estimation tool in industrial machinery.

Paradoxical worsening of tuberculosis in a heart-lung transplant recipient.

We report on a heart-lung transplant recipient who presented with pulmonary tuberculosis (TB) 2.5 months after transplantation and then developed a paradoxical reaction after 4 months of adequate anti-TB treatment. She eventually recovered with anti-TB and high-dose steroid treatments. METHODS: Using sequential bronchoalveolar lavages, we assessed the inflammatory response in the lung and investigated the alveolar immune response against a Mycobacterium tuberculosis antigen. RESULTS: The paradoxical reaction was characterized by a massive infiltration of the alveolar space by M. tuberculosis antigen-specific CD4(+) T cells and by the presence of a CD4(-)CD8(-) T lymphocyte subpopulation bearing phenotypic markers (CD16(+)/56(+)) classically associated with NK cells. CONCLUSION: This case report illustrates that even solid organ transplant recipients receiving intense triple-drug immune suppression may be able to develop a paradoxical reaction during TB treatment. Transplant physicians should be aware of this phenomenon in order to differentiate it from treatment failure.

Las Medidas organizativas de atención a la diversidad en un centro de enseñanza secundaria: un estudio de casos

Sabemos que al menos un 20% del alumnado entre 12 y 16 años no manifiesta ninguna motivación para el aprendizaje en la mayoría de las áreas del currículum escolar (Marchesi, 2004) y que esa desafección, al menos en España, se gesta en la educación primaria de manera que el éxito (o el fracaso) escolar en esa etapa se convierte en el principal predictor del éxito (o del fracaso) en la ESO (Marchesi y Martín, 2002). La primera conclusión parece obvia: si queremos que los alumnos vayan bien en la educación secundaria hemos de conseguir que vayan bien en la educación primaria. Pero, ¿qué ocurre cuando nuestro alumnado llega a los institutos sin esos conocimientos mínimos sin los cuales no hay garantía posible de éxito? ¿Hemos de aceptar ese determinismo y convertirnos en meros espectadores de un fracaso anunciado? Uno de los principales indicadores de la calidad de la educación en un estado democrático es el trato que se da a aquella parte del alumnado que presenta dificultades para aprender. El hecho de que la enseñanza secundaria en el actual sistema educativo español sea obligatoria y comprensiva (es decir, que se enseñen los mismos contenidos a todos los alumnos) dificulta considerablemente la tarea del profesorado a la vez que incrementa el riesgo de fracaso escolar. Para contrarrestar dicho riesgo, los legisladores han dotado a los centros de una mayor autonomía que se pone de manifiesto en tres ámbitos fundamentales: 1. En el diseño currricular, a través del Proyecto Curricular de Centro (PCC). El currículum ha dejado de ser rígido y dictado por la administración a ser abierto y flexible, con un diseño final que ahora es responsabilidad de los claustros de profesores . 2. En la organización del centro, que toma decisiones sobre la forma de agrupar el alumnado, la adscripción del profesorado a los distintos grupos o la coordinación efectiva del profesorado. 3. En el acceso a recursos materiales y humanos que respondan a las necesidades reales del centro como consecuencia del ejercicio de su autonomía. Los diferentes decretos y resoluciones de las autoridades educativas de cada Comunidad Autónoma han delimitado el campo de actuación de los centros para que, dentro de su autonomía, puedan hacer frente a una diversidad creciente del alumnado (en capacidades, en intereses y motivación y en su condición social) con el objetivo final de garantizar el éxito 2 escolar. En Cataluña, por ejemplo, las instrucciones para la organización y el funcionamiento de los centros de secundaria, que son publicadas para cada curso escolar, regulan de manera cada vez más extensa aspectos relativos a la atención a las necesidades educativas del alumnado. Así, dichas medidas incrementan año tras año el abanico de recursos que se ponen a disposición de los centros: Aula abierta, Unidad de soporte a la educación especial, Unidad de educación especial, Unidad de escolarización compartida, Aula de acogida, etc. Todas estas medidas organizativas se complementan con puntos concretos relativos a los criterios generales sobre la distribución de grupos, la dedicación horaria del profesorado y de los diferentes órganos de coordinación, las funciones del profesorado de la especialidad de Psicología y Pedagogía y de los Maestros de Pedagogía terapéutica o las adaptaciones curriculares, así como la puesta a disposición de los equipos directivos (ED) de un número creciente de recursos humanos. Sin embargo, todo ello choca en ocasiones con una realidad que se caracteriza por : ¿ La resistencia de una parte del profesorado hacia la generalización de la educación secundaria obligatoria y comprensiva, en parte como consecuencia del deterioro que ha experimentado en sus condiciones de trabajo: un ambiente de clase poco propició al aprendizaje, una mayor exigencia de coordinación, una adaptación de sus quehaceres a una mayor diversidad de alumnado, un incremento de la burocracia administrativa docente, etc. (Fernández, 2001; Bolívar, 2004). ¿ La resistencia de una parte de los ED a la aplicación estricta de las normas en perjuicio de los principios pedagógicos y de igualdad que las impulsaban. Por ejemplo, los itinerarios escolares, que quedaron descartados en la LOGSE y posteriormente en la LOE, se han aplicado en innumerables centros a través de los criterios seguidos para agrupar a los alumnos (Cucurella, 2002; Estruch, 2002; Muñoz, 2000). ¿ Un profesorado instalado en una auténtica crisis de identidad que no acaba de asumir la enorme complejidad del proceso de educar en una sociedad incierta como la actual (pero en la que la educación es un derecho fundamental) y al que no ayuda una legislación en continuo cambio y cada vez más extensa (Fernández, 2001). ¿ Un profesorado que, a pesar de asumir la importancia de atender las necesidades educativas de todos los alumnos y alumnas, manifiesta un escaso conocimiento de las medidas destinadas a su tratamiento. Además, reconoce el escaso seguimiento y revisión que se lleva a cabo en los centros de los objetivos y de la planificación de la atención de la diversidad (Muñoz et all, 2007). El resultado de todo ello es un tira y afloja entre lo que pide la administración y lo que dan los centros escolares de secundaria. Desconocemos en qué medida la realidad del conjunto de los 3 centros de secundaria se acerca a la teoría que propugna la norma. En Cataluña, los últimos datos conocidos (los del Plan director 1997-2001, de la Inspección de educación) ponen de manifiesto una caída en picado de algunas actuaciones relacionadas con la atención de la diversidad cuando pasamos de la educación primaria a la educación secundaria, justo en el momento en el que los alumnos con menos expectativas de éxito demandan de una atención redoblada. El discurso sobre la diversidad y las teorías mejor elaboradas se estrellan a menudo sobre la organización encargada de llevarlas a la práctica. La existencia de un proyecto pedagógico realista, ajustado a las necesidades del centro y consensuado, la actuación colegiada del profesorado, la flexibilidad que sucede a la valoración crítica de los resultados, las adaptaciones curriculares, etc. son actuaciones que se han descrito como potenciadoras del tratamiento de la diversidad (Santos, 2002). Cuando se dispone de medios humanos suficientes, la adopción de una organización del centro que dé respuesta a la diversidad de su alumnado dentro de los límites legales depende sólo de la voluntad de los ED. Es cierto que dicha voluntad se haya limitada por las características del claustro y por la cultura del centro. Pero esos condicionantes ni son definitivos ni son ajenos a la acción transformadora del propio ED. El propósito de la investigación es analizar el conjunto de medidas organizativas que aplica un centro de enseñanza secundaria para dar respuesta a las necesidades educativas del alumnado que tiene dificultades para adquirir los conocimientos mínimos que le permitan pasar de curso y/o acreditar la ESO.

Design industrial como fonte de vantagem estratégica: estudo de caso na indústria moveleira

This research was based on the lack of academic investigations which recognize industrial design as an strategic advantages source. It was chosen to adopt a wide approach, not common in administration researches, through which aspects frequently ignored by most of the strategy and marketing literature could be recognized. The investigation took place at a big brazilian company, from the furniture industry, more specifically from the office furniture segment. Two product development cases were selected: one of them classified by the company as an example of success and the other as a failure case. It is an exploratory study. Some important topics were identified, and they may be developed in future researches: the existence of intra-organizational conflicts between marketing and engineering; the big companies' power over market configuration, and the State influence over local markets dinamics.

Cost of an emerging epidemic: an economic analysis of atrial fibrillation in the UK

Objective: To evaluate the cost of atrial fibrillation (AF) to health and social services in the UK in 1995 and, based on epidemiological trends, to project this estimate to 2000. Design, setting, and main outcome measures: Contemporary estimates of health care activity related to AF were applied to the whole population of the UK on an age and sex specific basis for the year 1995. The activities considered ( and costs calculated) were hospital admissions, outpatient consultations, general practice consultations, and drug treatment ( including the cost of monitoring anticoagulant treatment). By adjusting for the progressive aging of the British population and related increases in hospital admissions, the cost of AF was also projected to the year 2000. Results: There were 534 000 people with AF in the UK during 1995. The direct'' cost of health care for these patients was pound 244 million (similar toE350 million) or 0.62% of total National Health Service ( NHS) expenditure. Hospitalisations and drug prescriptions accounted for 50% and 20% of this expenditure, respectively. Long term nursing home care after hospital admission cost an additional pound46.4 million (similar toE66 million). The direct cost of AF rose to pound459 million (similar toE655 million) in 2000, equivalent to 0.97% of total NHS expenditure based on 1995 figures. Nursing home costs rose to pound111 million (similar toE160 million). Conclusions: AF is an extremely costly public health problem.

An Intelligent System for Investigations and Provision of Safety for Complex Constructions

Methodology of computer-aided investigation and provision of safety for complex constructions and a prototype of the intelligent applied system, which implements it, are considered. The methodology is determined by the model of the object under scrutiny, by the structure and functions of investigation of safety as well as by a set of research methods. The methods are based on the technologies of object-oriented databases, expert systems and on the mathematical modeling. The intelligent system’s prototype represents component software, which provides for support of decision making in the process of safety investigations and investigation of the cause of failure. Support of decision making is executed by analogy, by determined search for the precedents (cases) with respect to predicted (on the stage of design) and observed (on the stage of exploitation) parameters of the damage, destruction and malfunction of a complex hazardous construction.

Exploring the World's Visual History

Thesis (Ph.D.)--University of Washington, 2016-08

Rural and Urban Differentials in Primary Care Management of Chronic Heart Failure: New Data from the CASE Study

Objective: To determine whether primary care management of chronic heart failure (CHF) differed between rural and urban areas in Australia. Design: A cross-sectional survey stratified by Rural, Remote and Metropolitan Areas (RRMA) classification. The primary source of data was the Cardiac Awareness Survey and Evaluation (CASE) study. Setting: Secondary analysis of data obtained from 341 Australian general practitioners and 23 845 adults aged 60 years or more in 1998. Main outcome measures: CHF determined by criteria recommended by the World Health Organization, diagnostic practices, use of pharmacotherapy, and CHF-related hospital admissions in the 12 months before the study. Results: There was a significantly higher prevalence of CHF among general practice patients in large and small rural towns (16.1%) compared with capital city and metropolitan areas (12.4%) (P < 0.001). Echocardiography was used less often for diagnosis in rural towns compared with metropolitan areas (52.0% v 67.3%, P < 0.001). Rates of specialist referral were also significantly lower in rural towns than in metropolitan areas (59.1% v 69.6%, P < 0.001), as were prescribing rates of angiotensin-converting enzyme inhibitors (51.4% v 60.1%, P < 0.001). There was no geographical variation in prescribing rates of β-blockers (12.6% [rural] v 11.8% [metropolitan], P = 0.32). Overall, few survey participants received recommended “evidence-based practice” diagnosis and management for CHF (metropolitan, 4.6%; rural, 3.9%; and remote areas, 3.7%). Conclusions: This study found a higher prevalence of CHF, and significantly lower use of recommended diagnostic methods and pharmacological treatment among patients in rural areas.

The incidence and predictors of lower limb split skin graft failure and primary closure dehiscence in day case surgical patients

This project was an observational study of outpatients following lower limb surgical procedures for removal of skin cancers. Findings highlight a previously unreported high surgical site failure rate. Results also identified four potential risk factors (increasing age, presence of leg pain, split skin graft and haematoma) which negatively impact on surgical site healing in this population.

Incidence and predictors of lower limb split-skin graft failure and primary closure dehiscence in day-case surgical patients

BACKGROUND After general surgery, the lower limb experiences some of the highest complication rates. However, little is known about contributing factors to surgical site failure in the lower limb dermatological surgery population. OBJECTIVE To determine the incidence of lower limb surgical site failure and to explore the predictors that contribute to surgical site failure. METHODS A prospective observational study design was used to collect data from 73 participants, from July 2010, to March 2012. Incidence was determined as a percentage of surgical site failure from the total population. Predictors were determined by the use of a binary logistic regression model. RESULTS The surgical site failure rate was 53.4%. Split-skin grafting had a higher failure rate than primary closures, 66% versus 26.1%. Predictors of lower limb surgical site failure were identified as increasing age (p = .04) and the presence of postoperative hematoma (p = .01), with all patients who developed surgical site infection experiencing surgical site failure (p = .01). CONCLUSION Findings from this study confirmed that the lower limb is at high risk of surgical site failure. Two predictors of surgical site failure from this cohort were determined. However, to understand this phenomenon and make recommendations to assist and reduce surgical site complications, further research in this field is required.