Thesis (J.S.D.)--University of Chicago Law School. / "August 2003." Includes bibliographical references. Also available on the Internet.

Thesis (M.S.)--Oregon State University, 1999. / Typescript (photocopy). Includes bibliographical references (leaves 58-64). Also available on the World Wide Web.

Major paper (M.U.R.P.)--Virginia Polytechnic Institute and State University, 1992. / Vita. Abstract. Includes bibliographical references (leaves 64-69). Also available via the Internet.

Risk reduction processes in healthcare remain at the core of 21st century health care provision, though the continuing scale of the problem gives little room for complacency. While other areas of complex technological activity such as air transportation can demonstrate improvements in safety performance, comparable progress eludes modern healthcare. A review of risk reduction techniques within healthcare identifies that there exists a lack of tools involving simulation of risk. It has been necessary in the context of the research to establish many wholly original information structures representing healthcare activity and associated risk related interactions This Thesis describes a new risk simulation environment for the Critical Care Unit of University Hospital, Coventry which is a 1200 bed modern acute hospital which fully opened in 2006. Available sets of patient admission/discharge information and records of patient treatment records used for cost charging together with extensive direct observation of clinical activity are used to create simulated patient episodes within the Critical Care environment. Specific patient interventions are sub divided into a series of up to 7 sub tasks which are associated with sub competencies and a linked adverse effect. Such sub competencies can be coded to reflect three levels of task complexity. Separate codes can be allocated to identify sub competencies which are supervised and sub competencies for which additional competency can be requested from other team members. A fuzzy logic framework has been adopted to combine empirically derived mathematical functions which for a specific sub task, translate values of individual effectiveness, distraction, competency mismatch of individual/team together with the level of supervision to a specific risk value for each adverse effect. This fuzzy logic framework, referenced as the ‘risk engine’ has specific responses for levels of sub task complexity and can be modified by indicators relating to sub task supervision and competency sharing. In addition, each sub task/competency is associated with an adverse effect whose probability of occurrence can be reduced through identified safe working practices which are referenced as ‘preventive measures’. Individual effectiveness is identified as being influenced by cirdadian rhythm, physical effort, emotional/stress effort, intellectual effort, sleep deficit and long term factors. Organisational factors influencing individual effectiveness are identified as patient admission and shift handover. The risk simulation process is implemented within a 10 bed Critical Care Unit which utilises a specifically designed nurse rostering process for 12 hour shift periods. Sub grades of nurse skills (1 to 15) are used to structure skill mix within each rostered group and which are based on representative nurse grades (band 5, 6 and 7). Available competencies of nursing staff for a specific sub task are allocated on the basis of sub grade value and the parameter of individual competency mismatch is derived from values of required competency and available competency for each sub task. The team competency mismatch for a specific sub task linked to a specific individual is derived from the maximum available competency within the active nursing team. Nursing staff are allocated to patients on the basis of clinical need at the start of each shift. A novel feature of the model identifies modes of interaction between nursing individuals on a ‘bed to bed’ basis as relating to parameters of distraction, supervision and competency sharing and which are related to the physical layout of the active clinical area. A fuzzy logic sub system for determining values of such interaction coefficients and which uses the same design methodology as the ‘risk engine’ is described.

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The thesis presents a series of principles, similar to those developed by the Organisation for Economic Co-operation and Development in relation to policy oriented indicators, intended to codify best-practice with regards to the design of pesticide risk indicators for use by farmers. Development of these principles was based upon extensive reviews of the literature concerning the potential exposure to and impacts of pesticides on non-target organisms and the relative merits and limitations of different methodological approaches, discussions with farmers concerning the suitability of different approaches to risk indicators and experimental assessments of indicator performance. These assessments took the form of a three-year field trial examining the impact of different levels of pesticide input upon non-target arthropods and several smaller trials that compared the performance of different insecticides and investigated the effect of differences in pesticide dose on non-target arthropods. The data were then compared with the theoretical results generated by a number of different risk indicators. The thesis also identifies a number of barriers to the implementation of these principles in the form of new pesticide risk indicators. These include restrictions on the range of non-target organisms and potential effects for which high quality data is available and the methodological difficulties associated with the incorporation of sublethal, indirect and ecosystem-level effects into risk indicators. Improvements in the validation of pesticide risk indicators that enable objective evaluations of indicator performance to be made are also required.

The purpose of this research was to examine and describe attrition and analyze factors that affect attrition at the United States Naval Academy. Specifically, the research attempts to identify characteristics that may signal a student's propensity to attrite from school. The intention is to determine if there are common characteristics among those who attrited from the Academy and to determine what role organizational factors and Academy experiences had on attrition. The desired end state is to identify a partial list of characteristics the Company Officer may use to flag at risk Midshipmen and when appropriate, intervene to reduce attrition. The results of the research indicate those who fail one or more physical readiness tests, females, and minorities have a greater probability of attriting from the Academy. This study summarizes the results, makes recommendations to the United States Naval Academy and for future research. / US Marine Corps (USMC) author.

A RESEARCH REPORT SUBMITTED TO THE FACULTY OF HEALTH SCIENCES, UNIVERSITY OF THE WITWATERSRAND, IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF PUBLIC HEALTH IN THE FIELD OF HOSPITAL MANAGEMENT Johannesburg, September 2014 / Background: Although the Free State Psychiatry Complex has collected information on adverse events, the reporting processes have not been consistent, systematic or transparent and this information was not used in the planning process. In addition, there is also a perception that the rate of adverse events is increasing, that these adverse events are not managed adequately and the extent of the problem could not be determined. It was for this reason that this study was found to be necessary to investigate further on patterns of serious adverse event occurrence, to put the argu-ments to a scientific test and be certain about the extent to which contributory factors were associated with the occurrence of these events in the Free State Psychiatry Complex. Aim: The aim of the study was to describe the inpatient-related adverse events and factors contributing to these adverse events reported at the Free State Psychiatry Complex in order to develop effective strategies to prevent and reduce these ad-verse events. Methodology: This was a cross sectional study design based on a retrospective re-view of records of patients who were involved in these adverse events. The study was undertaken at Free State Psychiatric Complex which is a specialized Mental Health Care Establishment from 1 April 2008 to 31 March 2010. All records of re-ported adverse events of all inpatients at Free State Psychiatry Complex were re-viewed and no sampling was done. The study included review of routinely collected hospital information on patients’ records and registers and from the Advance Incident Management System (AIMS). Results: There were 419 Serious Adverse Events reported during 1 April 2008 to 31 March 2010. The most commonly reported SAE’s included Aggressor-Aggressor, Aggression-victim, Behaviour/Human Performance, Accident/occupational health and safety and falls. The Aggression related adverse event type was one of the most common types of SAE’s, constituting 40% of the Serious Adverse Events reported. The Behaviour /Human Performance adverse event type was second in frequency. Other common SAE’s reported during the study period included Medication, Pres-sure ulcer, Clinical Management and Organisation Management. These Serious Ad-verse Events occurred in 5% of the inpatients at Free State Psychiatry Complex and the findings showed an increase rate of 3.3%. Although more than 80% of the ad-verse events gave rise to moderate disability, 2% caused permanent disabling inju-ries and 2% led to death. However, only 15% of the SAE’s caused minor harm to pa-tients. The most Serious Adverse Events occurred in the months of March, Decem-ber and November which indicate that seasonal changes are associated with in-creased risk for Serious Adverse Events. Most SAE’s happened during the day-shift which might be ascribed to the organisational routines such as medication rounds, handover periods and mealtimes. Human and System Adverse Event Error Types accounted for more than 70% of these SAE’s. The study revealed a positive relationship between the patients in the Intellectual disability and Psycho-geriatric specialities and Accident/occupational health and safety as well as falls related adverse event types. There was also a posi-tive correlation between male patients in the age group of 9-38 in the Acute and Fo-rensic Specialities and Aggression- as well Behaviour Performance related Adverse Event Types. The patients diagnosed with Schizophrenia, Substance Induced Psy-chosis and Intellectual Disability was mostly associated with an increased risk for Se-rious Adverse Events. The results showed that co-morbidity, the patient’s disease profile, age, admission classification, organisational routines and seasonal changes are associated are contributory factors too Serious Adverse Events. It supports the premise that human and system errors as well as the profile of the patient are con-tributing to SAE’s. Conclusion: Safety issues in mental health are unique and are in that way different to the safety issues in medical care. Both the patient population and the environment make patient safety in mental health unique. The uniqueness is associated more with the diagnosis, the patient population and with the mental health setting. SAE’s included Aggressor-aggression, Aggressor-victim, Behavior Performance (abscond-ing, self-harm, suicide); Occupational health and safety, falls and other injuries are particularly prominent to mental health patients. Although patient safety in mental health was considered a field of importance, there is still a lack of awareness of the issues as well as a shortage of research and readily available information to guide patient safety systems, practices, policies, and care delivery in mental health. Work is required to establish a clear definition, set priorities, and develop strategies for re-sponding to patient safety concerns. Models of quality improvement are being uti-lized in psychiatry hospitals but the need for evidenced-based quality improvement models for inpatient psychiatric care still exist. Findings from my study showed that Serious Adverse Events are prevalent in Free State Psychiatry Complex and factors significantly associates with the frequency of aggression-, behavior/occupational health and safety and falls related adverse event types. Advancing a quality and safety research agenda for inpatient psychiatric care will guide practice, improve care, and help ensure efficient and effective care. Complicated problems such as the provision of acute psychiatric hospital services require solutions that incorporate depth of understanding the complexities of acute mental illness as well as changes in prevailing attitudes and systems. This study has also highlighted that Serious Adverse Events are contributed by a varied set of contributing and interacting elements, including patient factors, human factors, system factors, and environmental factors. A complex interaction between the mental health environment and the diagnosis/patient population was found which differentiates patient safety from other health sectors is. Understanding this interac-tion and its relationship to patient safety is very important. It is believed that research in scientific advances, systems analysis, education and development, dissemination of guidelines and improved standard of practice is required for reduction of SAE’s (Leappe et al. 1991) This was the first study to systematically evaluate adverse events in a mental health establishment in the Free State province. The researcher hopes that the Department of Health in the Free State Province would utilise the findings of this study to review and to improve the safety programmes on the care, treatment and rehabilitation of the mental health care services.