Os Serviços de Verificação de Óbitos fornecem informações complementares para a epidemiologia e políticas de saúde pública que servem de instrumentos para medir a situação da saúde de uma comunidade e também para a elaboração e avaliação dos programas de saúde. A comparação entre o diagnóstico clínico de causa mortis e o diagnóstico após a autópsia é uma ferramenta utilizada para a auditoria de serviços médicos, e apesar dos avanços tecnológicos as discrepâncias ainda continuam altas. O presente trabalho teve como objetivo avaliar a casuística do Serviço de Verificação de Óbitos do Interior (SVOi), localizado no município de Ribeirão Preto, SP, no período de 2008 a 2012 e compará-la com as estatísticas gerais de mortalidade do município, disponibilizadas pelo Ministério da Saúde. Além disso, foi feita a classificação das discrepâncias diagnósticas entre os diagnósticos anotados nos pedidos de necropsias e laudos finais do exame nos óbitos ocorridos utilizando o critério Goldman modificado e a partir dos dados obtidos a fim de realizar uma análise crítica do impacto do SVOi no esclarecimento diagnóstico e sua importância nas estatísticas de mortalidade. Para a aplicação do critério foram utilizados dados secundários do encaminhamento de solicitação da necropsia, dos relatórios finais e dos dados sobre as estatísticas de mortalidade do Município obtidos do Ministério da Saúde, sendo que a análise dos dados foi realizada por meio de análise estatística descritiva. Os resultados evidenciaram que nos períodos do estudo foram realizadas 4464 necropsias no serviço, com predomínio de pacientes do sexo masculino e faixa etária dos 51 aos 90 anos. As doenças do aparelho circulatório foram as mais prevalentes registradas como causas de óbitos, seguidas das doenças respiratórias e neoplasias. Dentre todos os casos necropsiados, foi possível a aplicação do critério Goldman modificado em 3895 (83,28%) deles e as discrepâncias maiores foram atribuídas em 26,39% após o uso de critérios de analise, o que sugere a existência de alto grau de discrepâncias entre a hipótese diagnóstica e a real causa do óbito. Pode-se concluir que o SVOi desempenha um importante papel na auditoria diagnóstica, fato esse evidenciado pelos casos que não apresentaram correlação entre hipótese no encaminhamento e relatório final da necropsia. Além disso, 1228 (31,53%) casos foram encaminhados sem a hipótese, ou seja, sem suspeita da causa básica de morte, destacando a importância do SVOi para a sua definição. Ademais, a causa básica foi solucionada após a realização da necropsia em 99,54% do total dos casos analisados nesse estudo, o que revela a importância desse serviço para a elucidação dos casos e para a contribuição dos dados para as estatísticas de mortalidade. / The Death Verification Service provides complementary information for public epidemiology services and public health policies that are useful as tools for measuring the health status of a community and for the elaboration and evaluation of health programs. Diagnostic comparison between cause of death clinical diagnosis and the autopsy is a tool used for auditing medical services, and despite technological advances, discrepancies are still high. The present study sought to evaluate the casuistry in the Death Verification Service - Interior (DVSi) from 2008 to 2012 and to compare them with the general mortality statistics of the Ribeirão Preto municipality, which were made available by the Ministry of Health. In addition, it aimed to classify the diagnostic discrepancies between the requests for autopsies and final results of examinations in deaths using the Goldman revised criteria and, from the obtained data, to make a critical analysis of the DVSi impact on diagnostic clarification and its importance in mortality statistics. For the application of the criteria, secondary data from the cadaver referral, final reports and mortality data of the Ministry of Health were used, and data analysis was performed through descriptive statistical analysis. The results showed that during the study periods, 4464 autopsies were performed in the service, with a predominance of male patients and age range from 51 to 90 years. Circulatory system diseases were the most prevalent causes of death, followed by respiratory diseases and neoplasms. Among all autopsied cases, it was possible to apply the Goldman revised criteria in 3895 (83.28%) cases and large discrepancies were attributed in 26.39% cases after the use of analysis filter criteria, which suggests the existence of discrepancies between the diagnostic hypothesis and the actual cause of death. It can be concluded that the local DVSi plays an important role in the diagnostic audit, evidenced by the cases that did not present a correlation between the hypothesis in the referral and the final autopsy report. In addition, 1228 (31.53%) cases were referred without hypothesis, that is, without suspicion of the underlying cause of death, highlighting the importance of the DVSi for its definition. Furthermore, the basic cause was solved after performing the autopsy in 99.54% of the total cases analyzed in this study, which reveals the importance of this service for clarification of the cases and its contribution to mortality statistics.

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Accurate thermophysical property data are crucial for designing efficient chemical processes. For this reason, the Design Institute for Physical Properties (DIPPR 801) provides evaluated experimental data and prediction of various thermophysical properties. The critical temperature (Tc), critical density (ρc), critical pressure (Pc), critical compressibility factor (Zc), and normal boiling point (Tb) are important constants to check for thermodynamic consistency and to estimate other properties. The n-alkane family is of primary interest because it is generally assumed that other families of compounds behave similarly to the n-alkane family with increasing chain-length. Unfortunately, due to thermal decomposition, experimental measurements of Tc, ρc, and Pc for large n-alkanes are scarce and potentially unreliable. For this reason, molecular simulation is an attractive alternative for estimating the critical constants. However, molecular simulation has often been viewed as a tool that is limited to providing qualitative insight. One key reason for this perceived weakness is the difficulty in quantifying the uncertainty of the simulation results. This research focuses on a systematic top-down approach to quantifying the uncertainty in Gibbs Ensemble Monte Carlo (GEMC) simulations for large n-alkanes. We implemented four different methods in order to obtain quantitatively reliable molecular simulation results. First, we followed a rigorous statistical analysis to assign the uncertainty of the critical constants when obtained from GEMC. Second, we developed an improved method for predicting Pc with the standard force field models in the literature. Third, we implemented an experimental design to reduce the uncertainty associated with Tc, ρc, Pc, and Zc. Finally, we quantified the uncertainty associated with the Lennard-Jones 12-6 potential parameters. This research demonstrates how uncertainty quantification renders molecular simulation a quantitative tool for thermophysical property evaluation. Specifically, by quantifying and reducing the uncertainty associated with molecular simulation results, we were able to discern between different experimental data sets and prediction models for the critical constants. In this regard, our results enabled the development of improved prediction models for Tc, ρc, Pc, and Zc for large n-alkanes. In addition, we developed a new Tb prediction model in order to ensure thermodynamic consistency between Tc, Pc, and Tb.

This study evaluated the efficacy of Dynamic Written Corrective Feedback (DWCF) on advanced students' writing accuracy of Spanish. This method focuses on manageable, meaningful, timely and constant feedback. Previously, DWCF was studied in the context of English as a second language. The current study investigated the efficacy of DWCF in the context of students who were enrolled in an advanced Spanish grammar class at the university level. A comparative study was conducted measuring students' writing accuracy who received the DWCF against students' writing accuracy who did not receive this feedback methodology. Results showed that there was not a significant difference in writing accuracy between these two groups of students. However, both groups improved their writing accuracy over time. This study also provided a list of the most frequent writing errors made by 28 students in an advanced Spanish class. The results show that the most frequent linguistic errors for learners of Spanish are accent marks, prepositions, gender and number, punctuation, and word choice.

Very fine discretizations of differential operators often lead to large, sparse matrices A, where the condition number of A is large. Such ill-conditioning has well known effects on both solving linear systems and eigenvalue computations, and, in general, computing solutions with relative accuracy independent of the condition number is highly desirable. This dissertation is divided into two parts. In the first part, we discuss a method of preconditioning, developed by Ye, which allows solutions of Ax=b to be computed accurately. This, in turn, allows for accurate eigenvalue computations. We then use this method to develop discretizations that yield accurate computations of the smallest eigenvalue of the biharmonic operator across several domains. Numerical results from the various schemes are provided to demonstrate the performance of the methods. In the second part we address the role of the condition number of A in the context of multigrid algorithms. Under various assumptions, we use rigorous Fourier analysis on 2- and 3-grid iteration operators to analyze round off errors in floating point arithmetic. For better understanding of general results, we provide detailed bounds for a particular algorithm applied to the 1-dimensional Poisson equation. Numerical results are provided and compared with those obtained by the schemes discussed in part 1.

In this two-part study, English spelling errors of Arabic speaking students are investigated. Specifically, an empirical study is done to document and investigate exactly what kinds of English spelling errors Arabic-speaking students actually make. Then these data are analyzed. and spelling error patterns are discovered. Next. a study is done to determine if the presence of spelling errors in written work has a significant negative effect on readers' evaluations of this writing.

Specimen collection and identification errors are a significant problem in healthcare, contributing to incorrect diagnoses, delayed care, lack of essential treatments, patient injury or death, increased length of stay and increased healthcare costs, and decreased patient satisfaction. The purpose of the project was to evaluate the implementation of specimen collection technology with barcode scanning and bedside label printing in the maternal child health division of a community teaching hospital. The project was driven from Donabedian's quality framework for healthcare implementations, indicating that evaluating the quality of health care can be drawn from the categories of structure, process, and outcomes. The project featured a quantitative analysis with a pretest-posttest design. Mislabeled specimen rates and collection turnaround times were generated from laboratory quality data and measured before, during, and after implementation of specimen collection technology. Data analysis using an independent samples t test in SPSS 17.0 compared the changes in the mean scores of specimen collection turnaround times and mislabeled specimen rates. Mislabeled specimen percentages in all areas decreased from 0.0250% preimplementation to 0.0023% postimplementation with a p value less than 0.001. Collection turnaround times greater than 60 minutes decreased following implementation of specimen collection technology by 22% with a p value less than 0.001. The implementation of specimen collection technology has positive implications for social change, including the expectation that as technology is proven to significantly improve the safety and quality of laboratory collections, there will be a mandate for implementation of safer collection processes in healthcare.

Approximately 43.4% of medication errors occur at the time of administration despite the use of bar code medication administration (BCMA) System. This trend has prompted a national effort to mitigate this problem in the United States. Implementing BCMA in health care settings is one of those efforts. Studies focusing on the approaches employed by nurses when using this system are scant. The purpose of this qualitative case study was to investigate strategies nurses and their leaders use to ensure BCMA is implemented, maximized, and sustained. The technology acceptance model was used to guide the study. The 2 research questions addressed nurses' perceptions regarding the use and optimization of BCMA, and approaches of clinical nurses and their leaders to ensure that BCMA technology is properly used, optimized, and sustained in acute care units. Data collection included semistructured interviews with 8 participants. Thematic data analysis generated themes including ease of use, reduce errors, time saving, old technology, overreliance on technology, paper backups, and hope for future development. Common barriers to system effectiveness were system errors and inadequate training; intragroup and self-monitoring were important strategies to sustain use of the system. Study results may be used by health care leadership to reduce medication errors by adopting easy to use technology, change policies regarding training of BCMA end users in hospitals, increase the culture of patient safety among nurses, and prompt technology redesign within health care settings that meets the national patient safety goals.

Care of the elderly, long-term care resident in the emergency department is an issue of importance because of the overall impact on healthcare costs, potential for negative outcomes for the resident, and the loss of revenue. The purpose of this project was to decrease avoidable transfer of residents to the Emergency Department. Using the Antecedent, Target, Measurement logic model, poor quality assessment data was deemed the antecedent of the avoidable transfer. The goal of the project was the implementation of a standardized process of assessment that would have decreased avoidable transfer of the resident. The project would have involved training of the nursing staff in the use of the Situation Background Assessment and Recommendation tool for collecting and communicating pertinent data. The tool would have been completed at each acute complaint and would have indicated disposition. Data would have been collected by the Education Coordinator and organized for review and comparison with preintervention data. Social change implications would have included enhanced communication, potential for increased nurse and physician satisfaction which could have potentially increased job satisfaction, and improved recruitment and retention. Autonomy and self-pertinence empowers the nurse to be a stronger advocate. Positive outcomes increase when care is provided by those familiar with the patient norms and the setting. Financial savings can have an impact on the cost of healthcare. This project would also have allowed for and encouraged internal review of process and practices. This project was not implemented and so remains inconclusive.

The purpose of this body of work was to address medication errors and safe medication administration practices in relation to practicing nurses and nursing students via several different approaches. These different approaches will be presented as three separate papers but interrelated themes. The specific purpose for each paper and the corresponding research questions were addressed individually in each chapter. The approach used in the first paper was a systematic literature search of medication administration errors and the pediatric population; five themes emerged including the incidence rate of medication administration errors, specific medications involved in medication administration errors and classification of the errors, why medication administration errors occur, medication error reporting, and interventions to reduce medication errors. The approach used in the second paper included a systematic literature review and implementation of a survey, both focusing on the assessment strategies for safe medication administration with practicing nurses and nursing students. Results of both the review and the survey indicated a lack of a comprehensive assessment of safe medication administration. The approach used in the third paper was a research study to conduct a psychometric evaluation of the Safe Medication Administration (SAM) Scale with baccalaureate nursing students. Results provided evidence of the validity and reliability of the SAM Scale. This body of work exposed a gap in nursing and demonstrates the importance of having a standardized assessment of safe medication administration with evidence of validity and reliability to demonstrate competency in this area.