Implementation of Evidence-Based Patient Safety Practices: 4-Years’ Follow-up of a Nationwide Regulatory Intervention in Brazilian Hospitals

Background: Regulatory interventions are widely recommended to improve the quality of health services, but there are few studies on the possible models and their effects. The aim of this study is to describe the implementation process and analyse the results of a nationwide regulatory intervention for the implementation of patient safety practices.Methods: Four nationwide annual cross-sectional assessments were conducted in Brazilian hospitals with Intensive Care Unit beds. The participants involved all facilities operating during 2016-2019 (average N=1,989). The regulatory intervention theory aimed to increase adherence to safe evidence-based practices through national annual assessment involving a set of 21 validated structure and process indicators related to patient safety practices. At moment 1(Risk assessment), data were collected to classify hospitals according to the risk. In the sequence, the Sanitary Surveillance Centers (VISAS) carried out the analysis of the information sent by the hospitals. VISAS classified services into three groups according to compliance with the composite adherence indicator: High (67-100%); Medium (34-66%); and Low Compliance (0-33%). Moment 2 (Risk management) used responsive actions according to the hospital’s classification. Results: The intervention resulted in six annual cyclic stages and, between 2016-2019, 782 (40.1%), 980 (49.0%), 1,093 (54.3%) and 1,255 (61.8%) hospitals participated, respectively. 17 of the 20 indicators with at least two measurements had a significant improvement after national interventions (p<0.05). The overall percentage of compliance increased from 70.7 to 84.1 (p<0.001) and the percentage of hospitals with high compliance increased from 59.1 to 83.0 (p<0.001).Conclusion: The regulatory intervention used was a good tool to strengthen the information system and government actions to promote patient safety. The set of low-cost interventions seems to be useful to prioritise hospitals at higher risk and to induce responsive measures to implement patient safety practices in the evaluated context, promoting the efficiency of the regulatory process.

Surface Water Quality Assessment, Prediction & Modelling of River Daya in Odisha

A decision tree -based approach is projected to predict surface water quality and is a good tool to assess quality and guarantee property safe use of water for drinking. The most objective of this study is to assess the surface water quality of the Daya watercourse to work out the quality of drinking functions. Samples were collected from designated locations throughout totally different seasons (winter, summer, rainy) over a amount of five years (2016, 2017, 2018, 2019, and 2020). Total dissolved solids, pH, alkalinity, chloride, nitrate, total hardness, calcium, magnesium, iron, fluoride, were all tested as well as total coliform, fecal coliform, and E. coli. The main goal is to use decision tree regression to construct a model to assess and predict water quality changes in the Daya geographic region of Odisha, India, and compare it to statistical methods.

The territorial segmentation of coastal tourism areas

Purpose The purpose of this paper is to analyse the potential benefits of identifying homogeneous territorial units of the urban-tourism space at a local scale. Design/methodology/approach The territory is an essential variable for designing tourist activities adapted to the characteristics of each urban-tourism space. However, your consideration presents a series of problems, including the lack of alphanumeric, microscale, georeferenced statistical information. The territorial segmentation of the tourist accommodations supply is approached as a methodology, a technique and an instrument that can be used to apply marketing strategies in coastal tourism areas. Findings One of the most important results is that territorial segmentation is a methodology and technique that can mitigate this issue because it is well-suited to defining spatial patterns of tourist behaviour through the delimitation of territorial units that have a certain degree of homogeneity. Originality/value The idea of territorial segmentation is the ideal technique for understanding tourists and their behaviour in the territory by integrating all the variables that intervene in a trip, the different aspects of the destination and data regarding tourist behaviour, allowing them to be understood at the greatest level of territorial disaggregation and making it a good tool for public and private actors, capable of facilitating intelligent decisions in strategic territorial planning and in defining the marketing approach of tourism companies.

A Predictive Study of the Redistribution of Some Bread Wheat Genotypes in Response to Climate Change in Egypt

Climate change and global warming have become the most significant challenges to the agricultural production worldwide, especially in arid and semiarid areas. The main purpose of plant breeding programs now is to produce a genetically wide range of genotypes that can withstand the adverse effects of climate change. Moreover, farmers have to reallocate their cultivars due to their ability to tolerate unfavorable conditions. During this study, two field experiments and climate analysis based on 150 years of data are conducted to reallocate some genotypes of bread wheat in respect to climate change based on their performance under drought stress conditions. Climatic data indicate that there is an increase in temperature over all Egyptian sites coupled with some changes in rain amount. Among the tested cultivars, cultivar Giza 160 was the perfect one, while cultivar Masr 03 was the weakest one. Susceptibility indices are a good tool for discovering the superior genotypes under unfavorable conditions and, interestingly, some of the cultivars with high performance were among the superior cultivars in more than one of the tested traits in this study. Finally, combining the climatic data and the experimental data, we can conclude that cultivars Giza 160 and Sakha 94 are suitable for growning in zones with harsh environments, such as the eastern desert and southern Egypt, while cultivars Gemmeza 11, Sahel 01, Sakha 98, Sids 12, and Sakha 93 are suitable for growning in zones with good growing conditions, such as the Nile Delta region and northern Egypt.

The value of SPECT/CT imaging of lacrimal glands as a means of assessing the activity of Graves’ orbitopathy

Background: Graves’ orbitopathy (GO) is an autoimmune disease with mechanical impairment of orbital muscles and lacrimal gland dysfunction. The frequently used methods of assessing GO activity include: Clinical Activity Score (CAS), computed tomography (CT), and magnetic resonance imaging (MRI). These approaches are mainly associated with orbital muscles, however, there are not many studies that focus on the lacrimal gland inflammation of GO patients. Objective: The aim of this study is to assess the usefulness of 99mTc-DTPA SPECT/CT in evaluating the lacrimal gland inflammation in Graves orbitopathy, as compared with other methods. Methods: A retrospective analysis of 48 patients with active GO compared with 33 controls was conducted. All subjects underwent clinical-endocrinological analyses, CAS evaluation, CT scans, and SPECT/CT examination. Lacrimal gland dimensions were determined and analyzed. Results: The lacrimal glands in patients with GO were significantly larger in all measured dimensions (p < 0.001) on CT scans relative to those in controls. Increased lacrimal gland DTPA uptake ratios (p < 0.001) were displayed in active GO patients compared to controls and were also correlated with TRAb levels. The cut-off value for discriminating active and inactive disease was calculated to be 1.735, with specificity of 82.6% and sensitivity of 74.2%. SPECT/CT uptake ratios and CAS values were positively correlated in all GO patients. SPECT/CT uptake ratios were also positively correlated with CT measurements including lacrimal gland volume and coronal width in GO patients. Conclusions: These data indicated that lacrimal gland SPECT/CT images can serve as a good tool for assessing the inflammation and disease activity of GO.

Electron detection with CdTe and GaAs sensors using the charge integrating hybrid pixel detector JUNGFRAU

Speed, dynamic range, and radiation hardness make hybrid pixel detectors suitable image detectors for diffraction experiments. At synchrotrons and X-ray free electron lasers they are ubiquitous. However, for electron microscopy their spatial resolution is limited by multiple scattering in the sensor layer. In this paper we examine the use of two high Z sensor materials: CdTe and GaAs, as a way to mitigate this problem. The sensors were bonded to a JUNGFRAU readout chip which is a charge integrating hybrid pixel detector developed for use at X-ray free electron lasers. Using in-pixel gain switching, it can detect single particles down to 2 keV while maintaining a dynamic range of 120 MeV/pixel/frame. The characteristics of JUNGFRAU, besides being a capable detector, make it a good tool for sensor characterization since we can measure dark current and energy deposition per pixel. The high Z material shows better spatial resolution than silicon at 200 and 300 keV, however, their practical use with integrating detectors is still limited by material defects.

Kryzys idei neutralności moralnej prawa

The idea of the moral neutrality of law is a characteristic element of liberal political and legal doctrines. This concept is also an element of constitutional principles regulating the limits of permissible legislative interference in the sphere of freedom. In such context, the bond linking it with the clearly defined axiology from which it derives is severed. The aim of this study is to consider to what extent the principle of the moral neutrality of law, being a principle affecting the activity of the legislator, retains its potential in identifying and limiting totalizing practices aimed at systematically limiting choices in the field of the concept of a good life and favouring a specific vision of the legal and political order in both spheres of human activity, individual and collective. The numerous variants of the moral neutrality of law formulated in political philosophy, and the distinctions between individual variants, in conjunction with the criticism of this concept, make it necessary to pay attention to whether this way of limiting totalizing practices is a good tool, resistant to the changing conditions. A review of critical arguments directed against the idea of neutrality leads to the conclusion that the weakening of the concept of the moral neutrality of law translates not only into its value in identifying and preventing totalizing practices, but also into weakening the protection of fundamental values, such as individual autonomy.

Review of Custom Grids for Updated Vehicles on VANET Simulators

VANET deployment and testing is time-consuming and costly. Simulation is a handy and less expensive alternative to real implementation as a workaround. It is required to develop accurate models in order to receive excellent results from a VANET simulation, which difficult operation owes to the complexity of the VANET infrastructure (for example, simulators have to model the navigation models and communication protocols). The network and navigation components, which are the building blocks of contemporary VANET simulators, are described in this section. Simulators are a useful tool for testing VANETs at a minimal cost and without endangering users. However, in order to be helpful and convey trustworthy findings, simulators must be able to simulate new technologies that enter the VANET and enable safety and security procedures. To put it another way, if simulation is a good tool for VANET development it should be enhanced. VANET simulators have been the subject of research since early 2010 [1-4]. They analyze the correctness of VANET's numerous tools like a navigation simulator and network simulator, as well as how these building blocks are connected. The introduction of new network technologies such as 5G, SDN, edge computing, and VANET research as a result of investments in autonomous cars is forcing VANET simulators to re-evaluate their support for these new capabilities. We present an updated evaluation of VANET simulators in this post, highlighting their key features and current support for emerging technologies.

A Predictable Approach of a Rare and Frequently Misdiagnosed Entity: Laryngeal Nerve Schwannoma

(1) Background: Schwannoma, a mesenchymal neoplasm derived from Schwann cells that line peripheral nerve sheaths, has a challenging diagnosis, due to the non-specific medical history and clinical examination. Nowadays, virtual reality (VR) is increasingly more used for enhancing diagnosis and for preoperative planning of surgical procedures. With VR, the surgeon can interact, before any surgery, with a virtual environment that is completely generated by a computer, offering them a real experience inside a virtual 3D model. (2) Methods and Results: The aim of the present paper was to present a case of surgically removal of a schwannoma, which originated from the fibers of the superior laryngeal nerve, in a predictable and minimally invasive fashion, upon using VR for diagnosis and surgical procedure planning. (3) Conclusions: The current clinical report attracted the attention of including schwannoma in the possible differential diagnosis of a swelling in the anterior cervical region, mainly when a nonspecific radiological appearance is noticed, even with the use of multiple imaging modalities. Virtual reality can increase the predictability and success rate of the surgical procedure, being in the meantime a good tool for communication with the patient.

Online Simulations for Teaching Professional Legal Skills

Experiential learning approach in legal education is a global influential trend. Legal clinics is one of the most obvious examples of including experiential learning approach into the educational curriculum for law students. The main educational value of legal clinics is a providing training opportunity for students to apply their legal knowledge and skills in professional simulations like role plays of interviewing, counselling, negotiations, mock trials (first instance hearing) and moot courts (appeal hearing). These type of training programs allow law students to test their ability to client-oriented and problem-solving. The Russian legal clinics community has been actively developing since the mid of 1990s for more than 30 years. More than 100 Law Schools over Russia have own legal clinics. Clinicians overview their experience and share this experience between clinicians community. At the same time only relevantly small part of law students have access to effective training of legal skills because of various reasons, but mostly because of relevantly small number of legal educators who use the experiential-learning approach. Transition of experiential-learning best practices into online format is a good tool of scaling the number of students who could be trained in legal skills significantly. The paper describes the collection of unsupervised online learning modules devoted to legal skills, including case strategy, interviewing, counselling, legal writing and trial skills. These unsupervised online learning modules are developed based on modern instructional approaches to developing of online educational courses. The piloting of the unsupervised online learning modules demonstrates that these modules might be used as a supplementary educational tool and as a part of main educational curriculum for law students.