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Hälso- och sjukvården anses vara en högriskverksamhet som traditionellt sett saknar en utbredd säkerhetskultur liknande flygindustrins, vilken under en längre tid har arbetat med standardiserade arbetssätt för att förbättra säkerheten. För att undvika vårdskador och för att utveckla och kvalitetssäkra patientsäkerheten är det viktigt med fortsatt förbättringsarbete inom vården. En viktig checklista inom sjukvården är WHO:s checklista för säker kirurgi, som lanserades år 2008, och som har minskat mortalitet och postoperativa komplikationer avsevärt. Forskning har dock visat att checklistor inom perioperativ vård inte alltid används på ett korrekt sätt, delvis på grund av implementeringssvårigheter. På det för studien aktuella regionsjukhuset i Sverige används en preoperativ checklista för att säkerställa att patienten förbereds på rätt sätt inför operation. En mätning på den preoperativa enheten visade dock att 30 procent av patienterna hade en eller flera brister i de preoperativa åtgärderna. Det är viktigt då ofullständiga förberedelser inför kirurgi ökar postoperativa komplikationer och bidrar till ökad mortalitet. Syftet var att beskriva sjuksköterskors upplevelser av att arbeta utifrån denna preoperativa checklista. En kvalitativ ansats valdes som metod, där två fokusgruppsintervjuer med totalt nio sjuksköterskor från två kirurgiska avdelningar genomfördes. Deltagarna var vana vid att arbeta med den preoperativa checklistan. Intervjuerna genomfördes som en semistrukturerad intervju med hjälp av en intervjuguide. Kvalitativ innehållsanalys användes för att analysera resultatet. I resultatet identifierades tre huvudkategorier: Preoperativ checklista som arbetsredskap, Den preoperativa checklistans utformning och användbarhet samt Implementering och delaktighet. Slutsatsen är att sjuksköterskorna upplever den preoperativa checklistan som ett viktigt hjälpmedel för dem i den kliniska vardagen. Sjuksköterskorna upplever osäkerhet gällande hur, när och varför en del moment i checklistan utförs. Det fanns en tydlig koppling mellan deras erfarenhet och kunskap om preoperativa förberedelser och hur de upplevde att arbeta med checklistan. Då flera av sjuksköterskorna upplevde en osäkerhet kring hur checklistan används har troligtvis implementeringen varit bristfällig. Studien visar med tydlighet att kliniskt verksamma sjuksköterskor önskar och skulle föredra checklistan i elektroniskt format. / Providing healthcare is a process that involves many risks, and unlike the airline industry which for some time has been using standardized approaches to improve safety, it lacks a widespread culture of risk management. Continual focus on improvement is necessary if risks are to be minimized and patient safety is to be assured. An important checklist in health care is the World Health Organization’s checklist for safe surgery, which was launched in 2008. It has been shown to have significantly reduced postoperative mortality and complications. Studies have shown however that checklists in perioperative care are not always used properly partly because of implementation difficulties. The Swedish regional hospital in this study has a preoperative checklist to ensure that patients are properly prepared for surgery. A study conducted in the preoperative unit of the hospital showed that 30 percent of patients had one or more deficiencies in preoperative preparation, as defined by the checklist. It is important because incomplete preparations for surgery increase postoperative complications and contribute to increased mortality. The aim of this study was to describe nurses' experiences of working with the preoperative checklist. The chosen method was a qualitative approach in which two focus group interviews with nine nurses from two surgical departments were held. The nurses were accustomed to working with the preoperative checklist. The interviews were conducted with an interview guide with semi-structured questions. Qualitative content analysis was used to analyse the material. The results identified three main categories: The preoperative checklist as a working tool, The preoperative checklist design and usability, and Implementation and participation. In conclusion, it was shown that nurses value the preoperative checklist as an important aid for them in everyday clinical practice, but that they were unsure about how, when and why some of the elements of the checklist were to be carried out. There was a clear link between nurses' experience and knowledge regarding the preoperative preparations and how they experienced working with the checklist. As several of the nurses experienced uncertainty about the usage of the checklist this may show that the implementation process was inadequate. The study also clearly showed that clinically active nurses would prefer to use the checklist in an electronic form.

La familia de dípteros Rhiniidae (Diptera: Oestroidea) se encuentra distribuida fundamentalmente en las areas tropicales y subtropicales de las regiones Afrotropical, Australiana, Oriental y Paleártica. Tradicionalmente era considerada con el rango taxonómico de subfamilia de la familia Calliphoridae. No obstante, estudios filogenéticos recientes, basados en el análisis de caracteres morfológicos y moleculares, evidencian que Calliphoridae no es un grupo monofilético. Esto provocó diversos cambios sistemáticos, considerando a los rhiniidos con el rango taxonómico de familia independiente. Actualmente, se reconocen casi 400 especies de Rhiniidae agrupadas en dos subfamilias y 30 géneros. La región Afrotropical alberga la mayor diversidad de rhiniidos a nivel mundial, con un total aproximado de 170 especies comprendidas en 5 géneros de la subfamilia Rhiniinae y 11 de Cosmininae. Existe muy poca información sobre la diversidad, biología y distribución geográfica de la familia Rhiniidae. El ciclo biológico y en particular los hábitos y morfología larvaria es desconocido para la mayoría de las especies. La mayor parte del conocimiento se limita a unas pocas especies restringidas a enclaves geográficos muy concretos. En general, se conoce que tienen una fuerte asociación ecológica a ambientes naturales, que los adultos frecuentan flores por lo que se cree que son importantes polinizadores y que algunas especies parecen tener una estrecha relación con termitas. En cuanto al estudio de su diversidad y taxonomia, desde los años setenta muy pocas investigaciones se han realizado en relación a Rhiniidae en la región Afrotropical, por lo cual el conocimiento del grupo se encuentra desactualizado. Además, su identificación morfológica, en muchos casos, depende exclusivamente de la terminalia masculina y por lo tanto muchos ejemplares femeninos permanecen sin identificar o inadecuadamente identificados. El objetivo general de esta tesis doctoral es contribuir y actualizar el conocimiento de la familia Rhiniidae en la región Afrotropical, a través del estudio de su diversidad, taxonomía y filogenia en la región, con especial énfasis en Sudáfrica. Para ello, en primer lugar se realizó un estudio taxonómico y de la diversidad de la familia en Sudáfrica, país que a nivel mundial se considera como un hot-spot de biodiversidad. Se examinaron más de 4.000 especímenes de Rhiniidae depositados en colecciones entomológicas de África, Europa y los Estados Unidos. Se generó una lista actualizada de las especies presentes en el país, así como se revisó el estatus taxonómico de las mismas. Adicionalmente, se generaron mapas de distribución histórica y fotografías de alta resolución del habitus para la mayoría de las especies estudiadas. Entre los resultados más importantes que se han obtenido destacan nueve citas nuevas para el país, para un total de 73 especies de Rhiniidae, alrededor de 15 nuevas especies a ser descritas en trabajos futuros y la compilación de información bionómica novedosa para varias especies (Capítulo I). Posteriormente profundizamos dentro de la familia con la revisión taxonómica del género Fainia Zumpt, 1958, exclusivo de la región Afrotropical. Este género incluye siete especies descritas, pero el estatus taxonómico de algunas de ellas es controvertido. Se realizó un estudio morfológico de la terminalia masculina de las especies descritas, junto a la revisión de su respectivo material tipo disponible, para así aclarar el estatus taxonómico de sus especies. De esta forma, se aportan nuevas herramientas de identificación para el género, tales como claves de identificación para ambos sexos, redescripciones, y fotografías de alta resolución de la morfología general del adulto y terminalia masculina, así como nuevas sinonimias. Este estudio se complementó con la homogenización y actualización de la nomenclatura morfológica utilizada para la familia Rhiniidae, así como con la proposición de posibles sinapomorfias para la diagnosis de las dos subfamilias actuales Cosmininae y Rhiniinae (Capítulo II). Finalmente, empleamos herramientas moleculares con el fin de corroborar las identificaciones basadas en morfología, asociar los morfotipos femeninos a sus masculinos conspecíficos, explorar las relaciones filogenéticas entre géneros y especies, y generar la primera biblioteca de códigos de barras de ADN (CO1) para las especies de Rhiniidae. Para ello, generamos fragmentos de códigos de barras de ADN (CO1) de 138 especímenes de Rhiniidae. Para inferir los límites entre especies y su monofilia se utilizaron árboles de Inferencia Bayesiana y Máxima Verosimilitud. Esto se complementó con las variaciones genéticas intraespecíficas e interespecíficas reconstruidas con distancias por pares utilizando el modelo de sustitución de nucleótidos de Kimura-dos-parámetros (K2P) y la delimitación de especies mediante el análisis ABGD. La mayoría de las especies delimitadas a nivel morfológico se lograron recuperar como monofiléticas. Se determinaron entre 65 y 68 posibles especies de Rhiniidae presentes en nuestro estudio, así como 31 morfotipos femeninos se vincularon con éxito a sus machos conspecíficos (Capítulo III). Esta investigación demuestra la importancia de revisar las colecciones entomológicas para mejorar el conocimiento de la diversidad y de usar la información que aportan las etiquetas de los especímenes como un valioso recurso de datos para interpretar: ocurrencia temporal y espacial, preferencias ambientales y asociaciones con plantas u otros organismos como termitas, que a su vez son relevantes para estudios de biología de la conservación, polinización e interacciones ecológicas. Además, los códigos de barras de ADN mostraron eficiencia como medio complementario para la revisión taxonómica de Rhiniidae; sin embargo, entre especies muy similares a nivel morfológico no tuvo el éxito esperado, lo que sugiere una posible divergencia evolutiva reciente y la necesidad de realizar más estudios moleculares. / Parcialmente financiada por H2020 Research and Innovation Staff Exchange Programme of the European Commission (RISE), project 645636: ‘Insect-plant relationships: insights into biodiversity and new applications’ (FlyHigh).

Scania is among the leading companies in the heavy vehicle industry. Scania also assemble engines for their trucks and buses, as well as to external marine and industrial applications. Wrongly assembled parts leads to quality problems, which makes it important to secure that the assembly is correct. To do this Design For Assembly (DFA) is used to describe how parts should become easier to assemble. Scania’s production unit for engine assembly has had a working method for DFA in the shape of a checklist, which is not used. The goal in this project was to investigate why the method is not used and to give suggestions for improvements.The problem with the existing DFA-method and the reasons it was not used was investigated through interviews and observations. A literature review was done to study other, established DFA-methods. Other production units at Scania were looked into as well, to compare their working approach towards DFA.Many rounds of tests were conducted to improve the DFA-method. The tests were applications to real cases. One problem was that the checklist was too complicated. The result was a modified checklist in which the number of questions went from 45 in the original to 24 in the final version. New response levels were introduced containing decision-making responses in a combination with points for the ability to measure and compare different DFA-analyses. The questions were organised into three main areas: product questions, assembly questions and remaining questions.In accordance to how other production units at Scania works with DFA, a new method, parallel to the checklist, was created to visualise easy assembled engine parts through the revision of an old. The old method contained articles with descriptions of good solutions regarding assembly. Using an internal Wikipedia system links were created between these articles to be able to reach all of them through three main categories: the DFA-technique is known, the product category is known or going through the subsystems in the engine’s design structure.A simple implementation plan was developed to recommend an implementation of the working method. Suggestions for further improvements when working using the method were given as well. An important improvement area was to find out where in the development process the DFA-method should be used. / Scania är ett av de ledande företagen inom den tunga fordonsindustrin. Scania tillverkar även motorer till sina lastbilar och bussar, samt till externa industri- och marinapplikationer. Då felmonterade motordelar leder till kvalitetsproblem är det viktigt att säkerställa att monteringen blir rätt. Dessutom ska den göras på en så kort tid som möjligt. För att göra detta används Design For Assembly (DFA) för att beskriva hur delar ska bli mer monteringsvänliga. Scanias produktionsenhet för motormontering har haft en arbetsmetod för DFA i form av en checklista som inte använts. Målet med detta projekt blev att ta reda på varför metoden inte används och ge förslag på förbättringar.Genom intervjuer och observationer undersöktes var problemen fanns med den existerande DFA-metoden och anledningar till att den inte använts. En litteraturstudie gjordes för att undersöka andra, etablerade, DFA-metoder. Dessutom undersöktes andra produktionsenheter på Scania för att jämföra deras arbetssätt med DFA.Tester gjordes för att förbättra DFA-metoden. Dessa tester tillämpades på verkliga typfall. Ett av problemen var att checklistan uppfattades som för komplex. Resultatet blev en reviderad checklista där antalet frågor gick från 45 i början till de slutgiltiga 24. Nya svarsnivåer infördes med beslutande svar i kombination med poäng för att kunna mäta och jämföra olika utförda DFA-analyser. Frågorna organiserades i tre huvudkategorier för att följa en mer logisk ordning: produktfrågor, monteringsfrågor och övriga frågor.I linje med hur andra produktionsenheter på Scania arbetar med DFA skapades en ny metod för att visualisera monteringsvänliga motorkomponenter genom att en gammal metod reviderades. Den gamla metoden innehöll artiklar med beskrivningar på bra lösningar ur monteringssynpunkt. Med hjälp av ett internt Wikipedia-system skapades länkar mellan dessa artiklar för att kunna nå dem ur tre olika huvudspår: DFA-tekniken är känd, produktkategorin är känd samt med utgångspunkt från delsystem i motorns konstruktionsstruktur.En enklare införandeplan togs fram för att ge en rekommendation på införande av arbetsmetoden. Dessutom gavs förslag på vidare förbättringar genom arbete med denna. Ett viktigt förbättringsområde blev på vilken plats i utvecklingsprocessen metoden ska användas

Science has recently begun showing interest in the different mechanisms of the psychopathic brain, and current scientific research points to deficits in the structural and functional brain regions of psychopaths. Psychopathy is a disorder distinguished by its persistent antisocial behavior, emotional callousness, grandiose self-estimation, and lack of empathy. Further, it is also a disorder which is hard to classify. Notably, the Hare-Psychopathy Checklist-Revised (PCL-R) is the most common clinical rating scale used to diagnose psychopaths. This current systematic review aims to scrutinize literature that reviews psychopathy, delving into articles on neural correlates of emotion recognition of psychopaths. By using the PRISMA guidelines, this systematic research was conducted through, MEDLINE EBSCO, Web of Science, PubMed, and Scopus. Through predisposed eligibility criteria, articles were chosen and reviewed. All selected articles found a significant result where psychopaths performed poorly on emotion recognition and important areas such as the prefrontal cortex and amygdala could be seen to perform worse. Notably, due to different test methods, one is unable to properly evaluate the results between the studies. Therefore, upcoming studies need to shed light on performing the same tests to provide stronger and equal evidence. This systematic review was done to shed better light on the disorder.

Background: Errors related to patient safety are a major contributor to adverse incidents and preventable deaths. Interventions aimed at changing team behaviour and implementing World Health Organisation Safe Surgical Checklists (WHO SSCL) have been associated with improved outcomes. We required a cost- and timeefficient vehicle to address low adoption rates of the WHO SSCL, barriers to interdisciplinary teamwork, and inadequate attention to patient safety. Method: We aimed to test the feasibility and efficacy of a simulation-based intervention to improve behaviour influencing patient safety in operating theatres. We performed a prospective cohort study using survey tools for attendee feedback immediately after the event and at 6 weeks. We report feasibility and efficacy data plus qualitative feedback from the education team describing the advantages of this instructional design. The intervention was a 2-stage simulation. First, learners watched a 5-minute film, set in the operating theatre, depicting an error-filled WHO SSCL timeout. Second, learners entered a simulated operating theatre environment with multiple errors and risks to patient safety. Learners identified errors and prioritised them in order of importance. Their observations were discussed in a small group debrief session facilitated by novice debriefers before a whole group plenary discussion. Results: One hundred and three health workers attended the education event and 77 (75%) responded to the Immediate Questionnaire. Surgeons (27), Anaesthetists (18) and Scrub Nurses (12) made up the majority of respondents. Sixty-seven (87%) participants agreed or strongly agreed that they “now have an increased awareness of patient safety”, while 75 (97%) agreed or strongly agreed that they “feel more committed to ensuring a team approach to patient safety”. Thirty (29%) attendees responded to the Delayed Questionnaire distributed via email 6 weeks after the event. Twenty-eight (93%) agreed or strongly agreed that they felt more committed to ensuring a team approach to patient safety. Conclusion: The total cost of the event was low. Faculty reported that the instructional design afforded deliberate targeting of the importance of multi-disciplinary teamwork in patient safety. The simulation event was feasible at low monetary, time, and human resource costs. This approach offers a scalable instructional design that targets inter-professional learning.

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The Children's Communication Checklist-Second Edition (CCC-2) is a behavior rating scale developed to address the difficulties of assessing social communication in children. It was designed to be completed by a parent rater. However, since it would be helpful to know the extent to which ratings are context-dependent, this study looked at the agreement between parent and teacher ratings on the CCC-2 as well as the percent agreement on the severity of disorder. Twelve parent-teacher pairs completed the CCC-2 for children who had a documented developmental language disorder with specific impairment in social communication. Cohen's kappas, Cohen's weighted kappas, and percent agreement of severity of disorder were calculated. Kappa results ranged from less than chance agreement to fair agreement. When differentiating between scores that represent disorder and no disorder, parent and teacher percent agreement for the CCC-2 10 subscales range from 42% to 75%. Further delineation between no disorder, disorder, or severe disorder yielded percent agreement ranging from 17% to 50%. Overall percent agreement on the general communication composite was 92%. Results indicate that while parents and teachers have poor to fair agreement on the exact nature of a child's social communication strengths and weaknesses, they largely agree when a social communication problem exists. Lack of agreement likely resulted from the parent and teacher seeing the child in different contexts which required a somewhat different set of social communication abilities, or a difference in rater perception of what is within the developmental norms. These findings suggest that the best indication of a child's social communication profile may lie in a holistic assessment of performance in all the important contexts in a child's life, including school and home.

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