Quantitative microbial risk assessment (QMRA) is being increasingly used to support decision-making for food safety issues. Decision-makers need to know whether these QMRA results can be trusted, especially when urgent and important decisions have to be made. This can be achieved by setting up a quality assurance (QA) framework for QMRA. A Belgian risk assessment project (the METZOON project) aiming to assess the risk of human salmonellosis due to the consumption of fresh minced pork meat was used as a case study to develop and implement QA methods for the evaluation of the quality of input data, expert opinion, model assumptions, and the quality of the QMRA model (the METZOON model). The first part of this thesis consists of a literature review of available QA methods of interest in QMRA (chapter 2). In the next experimental part, different QA methods were applied to the METZOON model. A structured expert elicitation study (chapter 4) was set up to fill in missing parameters for the METZOON model. Judgements of experts were used to derive subjective probability density functions (PDFs) to quantify the uncertainty on the model input parameters. The elicitation was based on Cookes classical model (Cooke, 1991) which aims to achieve a rational consensus about the elicitation protocol and allowed comparing different weighting schemes for the aggregation of the experts PDFs. Unique to this method was the fact that the performance of experts as probability assessors was measured by the experts ability to correctly and precisely provide estimates for a set of seed variables (=variables from the experts area of expertise for which the true values were known to the analyst). The weighting scheme using the experts performance on a set of calibration variables was chosen to obtain the combined uncertainty distributions of lacking parameters for the METZOON model. A novel method for the assessment of data quality, known as the NUSAP (Numeral Unit Spread Assessment Pedigree) system (chapter 5) was tested to screen the quality of the METZOON input parameters. First, an inventory with the essential characteristics of parameters including the source of information, the sampling methodology and distributional characteristics was established. Subsequently the quality of these parameters was evaluated and scored by experts using objective criteria (proxy, empirical basis, methodological rigour and validation). The NUSAP method allowed to debate on the quality of the parameters within the members of the risk assessment team using a structured format. The quality evaluation was supported by graphical representations which facilitated decisions on the inclusion or exclusion of inputs into the model. It is well known that assumptions and subjective choices can have a large impact on the output of a risk assessment. To assess the value-ladenness (degree of subjectivity) of assumptions in the METZOON model a structured approach based on the protocol by Kloprogge et al. (2005) was chosen (chapter 6). The key assumptions for the METZOON model were first identified and then evaluated by experts in a workshop using four criteria: the influence of situational limitations, the plausibility, the choice space and the agreement among peers. The quality of the assumptions was graphically represented (using kite diagrams, pedigree charts and diagnostic diagrams) and allowed to identify assumptions characterised by high degree of subjectivity and high expected influence on the model results, which can be considered as weak links in the model. The quality assessment of the assumptions was taken into account to modify parts of the METZOON model, and allows to increase the transparency in the QMRA process. In a last application of a QA method, a quality audit checklist (Paisley, 2007) was used to critically review and score the quality of the METZOON model and to identify its strengths and weaknesses (chapter 7). A high total score (87%) was obtained by reviewing the METZOON model with the Paisley-checklist. A higher score would have been obtained if the model was subjected to external peer review, if a sensitivity analysis, validation of the model with recent data, updating/replacing expert judgement data with empirical data was carried out. It would also be advisable to repeat the NUSAP/Pedigree on the input data and assumptions of the final model. The checklist can be used in its current form to evaluate QMRA models and to support model improvements from the early phases of development up to the finalised model for internal as well as for external peer review of QMRAs. The applied QA methods were found useful to improve the transparency in the QMRA process and to open the debate about the relevance (fitness for purpose) of a QMRA. A pragmatic approach by combining several QA methods is recommendable, as the application of one QA method often facilitates the application of another method. Many QA methods (NUSAP, structured expert judgement, checklists) are however not yet or insufficiently described in QMRA related guidelines (at EFSA and WHO level). Another limiting factor is the time and resources which need to be taken into account as well. To understand the degree of quality required from a QMRA a clear communication with the risk managers is required. It is therefore necessary to strengthen the training in QA methods and in the communication of its results. Understanding the usefulness of these QA methods could improve among the risk analysis actors when they will be tested in large number of QMRAs.

This post-use evaluation research aims to investigate the appropriacy of academic writing materials to contextual needs, and to investigate the essential considerations concerning these materials. This case study was conducted with the participation of program designers, teachers, and students at three universities in Hungary, Turkey, and Oman. A unique checklist was developed to evaluate the materials. The data collection process consisted of questionnaires and interviews. The results concur with findings in the literature regarding the benefits of using computer-mediated communication in the writing class, the need to combine process and product pedagogies, the necessity of having discipline-specific themes, and the need to provide students with more guidelines and input. Interestingly, contrary to the literature, the students do not seem to benefit from peer feedback / they value teacher feedback more. Furthermore, despite their increasing role in writing, there are few collaborative writing activities in these materials. The quantitative and the qualitative data also demonstrate that the program designers and the teachers consider in-house writing materials more appropriate than global materials, since they were developed in view of the learning context and the specific requirements. However, neither global nor in-house materials are regarded as motivating and attracting for the students. There are relatively new areas for further research as a result of these findings: the role of free writing in EAP and the ways to manage mixed language levels of the students. All these findings are expected to provide insights to researchers and practitioners in the fields of writing and materials evaluation.

This post-use evaluation research aims to investigate the appropriacy of academic writing materials to contextual needs, and to investigate the essential considerations concerning these materials. This case study was conducted with the participation of program designers, teachers, and students at three universities in Hungary, Turkey, and Oman. A unique checklist was developed to evaluate the materials. The data collection process consisted of questionnaires and interviews. The results concur with findings in the literature regarding the benefits of using computer-mediated communication in the writing class, the need to combine process and product pedagogies, the necessity of having discipline-specific themes, and the need to provide students with more guidelines and input. Interestingly, contrary to the literature, the students do not seem to benefit from peer feedback / they value teacher feedback more. Furthermore, despite their increasing role in writing, there are few collaborative writing activities in these materials. The quantitative and the qualitative data also demonstrate that the program designers and the teachers consider in-house writing materials more appropriate than global materials, since they were developed in view of the learning context and the specific requirements. However, neither global nor in-house materials are regarded as motivating and attracting for the students. There are relatively new areas for further research as a result of these findings: the role of free writing in EAP and the ways to manage mixed language levels of the students. All these findings are expected to provide insights to researchers and practitioners in the fields of writing and materials evaluation.

WHO:s checklista har signifikant minskat komplikationer och dödsfall och har ökat patientsäkerheten hos kirurgiska patienter genom att vara ett standardiserat redskap vid kommunikation och samarbete i operationsteamet. Vid 2011 slut använde de flesta Svenska sjukhus WHO:s checklista, men det finns endast ett fåtal studier från Sverige efter införandet. Syftet med denna pilotstudie var att undersöka operationsteamets erfarenheter att arbeta med WHO:s checklista för säker kirurgi. En fokusgruppintervju gjordes med ett operationsteam. Analys av data skedde genom kvalitativ manifest innehållsanalys. Resultatet visar på både vinster och svårigheter när WHO:s checklista används. Checklistan är viktig för teamets kommunikation, planering och är en säkerhetsrutin och kontroll för att undvika misstag. Den är en samlingspunkt, klargör fakta, ger säkrare vård och tar minst tid om teamet synkroniserar sig, väntar in varandra, fokuserar och koncentrerar sig på checklistan. Det finns ett behov av delat ansvar för att komma ihåg att använda checklistan och det behövs ett engagemang och stöd från ledningen för god implementering. Alla måste vara delaktiga, överens om att använda den och ta den på allvar. Checklistan är mindre relevant vid små ingrepp där önskan finns att modifiera den. Vidare studier av multidisciplinär teamträning för att utveckla checklistan skulle vara av intresse. För att kunna jämföra de olika yrkeskategorierna med varandra och för att få djupare kunskaper, behövs det göras flera fokusgruppintervjuer. / WHO's checklist has significantly reduced complications and mortality and increased patient safety in surgical patients by being a standardized tool for communication and co-operation of the surgical team. At the end of 2011 most Swedish hospitals used WHO´s checklist, but there are only a few studies from Sweden after the introduction. The purpose of this pilot study was to investigate the surgical team´s experiences working with WHO´s checklist for safe surgery. A focus group interview was conducted with a surgical team. Data analysis was done by qualitative manifest content analysis. The result shows both benefits and difficulties when WHO´s checklist is used. The checklist is important for the team´s communication and planning and is a routine security and control to avoid mistakes. It´s a meeting point, it´s clarifying the facts, providing safer care and it takes less time if the team synchronizes itself, waits for each other, focuses and concentrates on the checklist. There is a need of shared responsibility to remember it and the commitment and support from the management for good implementation. Everyone must be involved, agree to use it and take it seriously. The checklist is less relevant for small procedures where the desire is to be able to modify it. Further studies of multidisciplinary team training for the development of the checklist would be interesting. In order to compare various professional categories with each other and gain deeper knowledge, it is necessary to do several focus group interviews.

Att drabbas av en reumatisk sjukdom kan ge fysiska symtom som inflammation, funktionsinskränkning och immunreaktioner. Sjukdomen ger konsekvenser i vardagslivet som kan påverka aktivitetsutförandet i roller. Syftet med studien var att beskriva hur personer med reumatisk sjukdom kan uppleva påverkan på sina roller i vardagslivet. Integrerad metod användes med lämplighetssampling på tio personer med reumatisk sjukdom. Instrumentet Rollchecklistan och semistrukturerade intervjuer användes för att få en täckande och tillförlitlig bild av upplevd påverkan av roller. Resultatet beskrevs genom en tabell, en schematisk bild samt beskrivande text med citat. Studien visade att reumatisk sjukdom upplevdes påverka roller i vardagslivet genom bland annat funktionsinskränkning och minskad uthållighet. Rollen som yrkesarbetande och hemarbetande upplevdes påverkade genom att de minskade eller försvann helt. Personer som hade utvecklat strategier upplevde inte lika stor påverkan på sina roller. Författarna anser att strategier kan hjälpa personer med reumatisk sjukdom att bevara sina roller trots insjuknandet. Arbetsterapeuter spelar en viktig och avgörande roll där de genom att lära ut strategier gör det möjligt för människor att engagera sig i aktiviteter som skapar mening och tillfredställelse. Detta främjar fysiskt och emotionellt välbefinnande för personen. / To suffer from a rheumatic disease may cause physical symptoms such as inflammation, functional impairment and immune reactions. The disease results in consequences in the everyday life that may affect activity performance in roles. The purpose of this study was to describe how people with rheumatic disease can experience impact on their roles in everyday life. Integral method was used with match sampling on ten people with rheumatic disease. The instrument Role Checklist and semi-structured interviews were used to obtain a comprehensive and reliable picture of experiences impact in roles. The result was described in a table, a schematic figure and descriptive text with quotations. The study showed that a rheumatic disease had an experienced impact on roles in everyday life through functional impairments and reduced endurance. The worker-role and home maintainer influenced, since they were decreased or completely missing. People who had developed strategies did not experience as much influence on their roles. The authors believe that strategies can help people with rheumatic disease to maintain their roles despite sickness. Occupational therapists plays an important and crucial role by teaching strategies enabling people to engage in activities which can cause meaning and satisfaction. This promotes physical and emotional wellbeing for the person.

<p>Att drabbas av en reumatisk sjukdom kan ge fysiska symtom som inflammation, funktionsinskränkning och immunreaktioner. Sjukdomen ger konsekvenser i vardagslivet som kan påverka aktivitetsutförandet i roller.</p><p>Syftet med studien var att beskriva hur personer med reumatisk sjukdom kan uppleva påverkan på sina roller i vardagslivet.</p><p>Integrerad metod användes med lämplighetssampling på tio personer med reumatisk sjukdom. Instrumentet Rollchecklistan och semistrukturerade intervjuer användes för att få en täckande och tillförlitlig bild av upplevd påverkan av roller.</p><p>Resultatet beskrevs genom en tabell, en schematisk bild samt beskrivande text med citat. Studien visade att reumatisk sjukdom upplevdes påverka roller i vardagslivet genom bland annat funktionsinskränkning och minskad uthållighet. Rollen som yrkesarbetande och hemarbetande upplevdes påverkade genom att de minskade eller försvann helt. Personer som hade utvecklat strategier upplevde inte lika stor påverkan på sina roller.</p><p>Författarna anser att strategier kan hjälpa personer med reumatisk sjukdom att bevara sina roller trots insjuknandet. Arbetsterapeuter spelar en viktig och avgörande roll där de genom att lära ut strategier gör det möjligt för människor att engagera sig i aktiviteter som skapar mening och tillfredställelse. Detta främjar fysiskt och emotionellt välbefinnande för personen.</p> / <p>To suffer from a rheumatic disease may cause physical symptoms such as inflammation, functional impairment and immune reactions. The disease results in consequences in the everyday life that may affect activity performance in roles.</p><p>The purpose of this study was to describe how people with rheumatic disease can experience impact on their roles in everyday life.</p><p>Integral method was used with match sampling on ten people with rheumatic disease. The instrument Role Checklist and semi-structured interviews were used to obtain a comprehensive and reliable picture of experiences impact in roles.</p><p>The result was described in a table, a schematic figure and descriptive text with quotations. The study showed that a rheumatic disease had an experienced impact on roles in everyday life through functional impairments and reduced endurance. The worker-role and home maintainer influenced, since they were decreased or completely missing. People who had developed strategies did not experience as much influence on their roles.</p><p>The authors believe that strategies can help people with rheumatic disease to maintain their roles despite sickness. Occupational therapists plays an important and crucial role by teaching strategies enabling people to engage in activities which can cause meaning and satisfaction. This promotes physical and emotional wellbeing for the person.</p>

Background: Surgical complications has been the main cause of medical injuries and deaths worldwide. In 2008 WHO developed the checklist for safe surgery to reduce the number of surgical complications. The objective of the checklist is to strengthen already established safety routines and contribute to better cooperation and communication. Research shows that compliance to the checklist is deficient, which can affect patient safety. Aim: The aim was to study the extent to which theatre nurses participate in the use of the checklist. Method: Observational study was conducted with a descriptive design and quantitative approach. 24 observations were carried out with aid of an observation protocol of two surgical units at a hospital in central Sweden. Result: The results showed that Timeout initiated widely but compliance to all items was considerably lower. Team member introductions, patient ID, planned surgery and antibiotic prophylaxis had highest compliance. Theatre nurse responsibilities in Timeout, particularly sterility and positioning of the patient had low compliance. During Sign In the majority of theatre nurses greeted the patient in the operating room and everyone performed skin control. One theatre nurse asked the patient about allergies/intolerance. The theatre nurses participated rarely in Sign Out. Conclusions: The study showed that there are large differences in compliance between items of the checklist. Theatre nurses can increase their participation by being more involved in the surgical team communication and thus clearly demonstrate her responsibilities in the perioperative nursing. Revisited routines and continuous monitoring may be needed for increased checklist compliance

The application of Sustainability Assessment (SA) within Canadian municipalities is a recent notion, but is quickly becoming widespread. The Government of Saskatchewan alone has already released two SA checklists. However, such tools are normally aimed at communities of all sizes, ranging from rural municipalities to big cities, without considering differences in the capacity base, needs, and conditions among those types of communities. Additionally, practical implementation of SA often does not reflect the scope of scientifically established criteria for SA tools. This paper will present the analysis of the 2009 Saskatchewan Sustainability Checklist for Municipalities (comparing it to one of the most prominent frameworks for SA and other similar checklists developed in Canada and internationally) in order to identify possible areas for improvement so that the Checklist reflects established SA principles and is sensitive to a small town context. Based on the results of interviews with 16 small town administrators in Saskatchewan, this thesis demonstrates that, from a theoretical perspective, both of the existing SA tools are deficient in a number of important ways. The tools mainly focus on evaluating the municipal and service provision, rather than evaluating the sustainability of a community as a whole, including such areas as environmental conditions; social equity; livelihood sufficiency; resource maintenance; and intragenerational and intergenerational equity. However, the research reveals even if all of the above-mentioned criteria are integrated within the existing tools, it will be challenging for municipalities to perform a full sustainability assessment, since small towns’ administrations often have limited financial and human capacity to perform such exercises. Additionally, there is a lack of understanding on how to integrate the results of an assessment into decision-making, and a perceived inability to change some of the existing economic or social conditions in a town, due to the limited scope of influence that local municipalities have. There is a need for an alternative approach to sustainability assessment in the case of small towns; one that is sensitive to their unique pressures, circumstances, and capacities to enact change.

Einleitung: Arbeitsbedingte Erkrankungen des Muskel-Skelett-Systems sind unter Physiotherapeuten sehr häufig. Die präventive Forschung hat diese Berufsgruppe bisher kaum untersucht. In diesem Zusammenhang stellt die Veränderung des Arbeitsumfeldes einen vielversprechenden Ansatz für die Verhinderung arbeitsbedingter Erkrankungen dar. Das Ziel dieser Arbeit ist die Erstellung einer Checkliste zur Bewertung des Arbeitsplatzes eines Physiotherapeuten zu erstellen. Material und Methoden: Es wurde im September 2011 eine Literatursuche mit folgenden Datenbanken und Suchmaschinen durchgeführt: „CEBP“, „Cochrane“, „Ebsco“, „GoogleScholar“, „Medpilot“, „PeDro“, „Pubmed“ und dem Online-Katalog der württembergischen Landesbibliothek. Nach systematischem Aussortieren verblieben 13 Studien und zwei Bücher, zu denen durch unsystematische Suche weitere zwei Bücher hinzukamen. Aus den Suchergebnissen wurden Daten erhoben, die für die Erstellung einer Checkliste relevant sind. Ergebnisse: Es entstand eine literaturgestützte Checkliste, die sowohl direkt angewendet, als auch als Hilfe zur Entwicklung einer individuellen Arbeitsplatzumgestaltung verwendet werden kann. Diskussion: Eine literaturgestützte Checkliste zur Beurteilung des Arbeitsplatzes eines Physiotherapeuten ist, nach Wissensstand des Autors, in dieser Form einzigartig. Jeder einzelne Punkt der Checkliste wird näher und von verschiedenen Blickwinkeln beleuchtet. / Introduction: Work related musculoskeletal disorders are common among physiotherapists. Preventive research examined this profession rarely until today. In this background changing working environment could be an important way to prevent work related illnesses. The aim of this study is the creation of a checklist for assessing the workplace of a physiotherapist. Material and Methods: A search for literature took place in September 2011 in following databases and search engines: “CEBP“, “Cochrane“, “Ebsco“, “GoogleScholar“, “Medpilot“, “PeDro“, “Pubmed“ and the online-catalogue of the “württembergische Landesbibliothek”. After a systematic sort out remained 13 studies and two books to which another two books from an unsystematic search were added. From the results of the searches relevant data to create a checklist were extracted. Results: A literature-based checklist was developed, which can be used directly or as a help to develop an individual workplace change program. Discussion: In the knowledge of the author a literature-based checklist for assessing the workplace of a physiotherapist is unique. Each checklist item is described more closely and discussed separately.

The prediction of adolescents' antisocial behavior was central to this investigation. Specifically, use of the Psychopathy Checklist, Revised (PCL) as a predictor of the treatment outcome of a residential unit for juvenile delinquents was evaluated. Toward this goal, three foci guided hypothesis generation and testing. Multiple hypotheses were tested to consider (a) the predictive validity of the PCL, (b) the match between the PCL and Moffitt's (1993b) taxonomy of antisocial behavior and (c) the utility of the PCL as a selection instrument for assignment of juvenile delinquents to behavioral residential unit treatment. Subjects consisted of 80 adolescent, racially-mixed males (28 unit residents, 52 high school students).Predictive validity was evidenced for criteria consisting of future incarceration and future violent and nonviolent criminal offenses committed over the year following PCL administration. Prediction of future incarceration produced results similar to those found with adult prisoners (80% of psychopaths and 21% of nonpsychopaths were incarcerated). Moreover, PCL scores accounted for 26% of the variability in violent offenses and 40% of the variability of nonviolent offenses committed by subjects during the follow-up year.The match between Moffitt's taxonomy of antisocial behavior and the PCL was evidenced by data gathered on those subjects who were known to have engaged in antisocial behavior (N=71). The constructs that Moffitt (1993b) argued would mediate antisocial behavior and are measured with PCL items (such as neuropsychological executive functioning) significantly improved the prediction of future antisocial behavior over that accounted for by Moffitt's taxonomy. In fact, PCL items accounted for more unique variability in future offenses committed than did Moffitt's taxonomy.Utility analyses indicated that the PCL could be used to improve the prevention of success-improbable delinquents from being assigned residential treatment. Dollar value utility analysis indicated that over $5800 per resident could be reallocated to other interventions by assigning success-improbable delinquents to other treatments. Doing so was projected to result in over $175,000 less to be spent on treating unsuccessful residents. It was also argued that utility analysis figures could be to argue for development of alternative programs for delinquents who would probably be unsuccessful in the residential unit program. Residents who presented with internalized psychiatric disorders were not identified using the proposed cutoff score. Therefore, it was recommended that a second test be used to detect delinquents in need of in-patient psychiatric care. / Department of Educational Psychology