No / Drug errors are a common and persistent problem in health care and are also associated with serious adverse events. Reporting has become the cornerstone of learning from errors, but is not without its imperfections. The aim of this study is to improve reporting and learning from drug errors through investigating the contributory factors in drug errors and quality of reporting in an acute hospital. Methods: A retrospective, random sample of 991 drug error reports from 1999 to 2003 were subjected to quantitative and qualitative analysis. This was followed by 40 qualitative interviews with a volunteer, multi‐disciplinary sample of health professionals. The combined analysis has been used to develop a knowledge base for improved drug error reporting. Results: The quality of reports varied considerably, and 27% of reports lacked any contributory factors. Documentary analysis revealed a focus on individuals, sometimes culminating in blame without obvious justification. Doctors submitted few reports, and there were notable differences in reporting according to clinical location. Communication difficulties commonly featured in causation, and high workload and interruptions were predominant contributory factors in the interview data. Interviewees viewed causation as multifactorial, including cognitive and psychosocial factors. Organizational orientation to error was predominantly perceived by interviewees as individual rather than systems‐based. Staff felt obliged to report but rarely received feedback. Implications and conclusio: Drug errors are multifactorial in causation. Current reporting schemes lack a theoretical basis, and are unlikely to capture the information required to ensure learning about causation. Health professionals have reporting fatigue and some remain concerned that reporting promotes individual blame rather than an examination of systems factors. Reporting can be strengthened by human error theory, redesigned to capture a range of contributory factors, facilitate learning and foster supportive actions. It can also be feasible in routine practice. Such an approach should be examined through multi‐centred evaluation.

This article focuses its attention on the analysis of health services provided to seniors in the framework of public politics must give them rights safeguard Social Security and Health, and their level of access in cases of poverty and others; further analysis of the work of those institutions whose responsibility was granted by the Act of Older Persons for the protection of the same in the joint work with the SIS and Essalud. / El presente artículo enfoca su atención en el análisis de los servicios de salud brindados a los adultos mayores en el marco de las políticas públicas que les deben otorgar resguardo de derechos de la Seguridad Social y de la Salud, y su nivel de acceso en casos de pobreza y otros; además se hace un análisis del trabajo de aquellas instituciones cuya responsabilidad fue otorgada por la Ley de las Personas Adultas Mayores para la protección del mismo en el trabajo articulado con el SIS y ESSALUD.

This thesis examines the influence of contributory periods and excluded periods on the pension amount. Furthermore, various pension construction elements and a retirement calculation method is discussed. The subsequent chapter is devoted to the corresponding contributory periods of insurance and their position in comparison with other insurance periods. Moreover, there are simulated model examples of situations, where the contributory periods are not included into the pension amount.

Orientador: Marcos Simão Figueiras / Resumo: O presente trabalho, em síntese, tem por objetivo investigar como o princípio da capacidade contributiva, previsto no artigo 145, § 1°, da Constituição Federal, tem sido aplicado pelo Supremo Tribunal Federal. Parte-se do pressuposto de que o Estado como instituição politicamente organizada atrai para si atribuições destinadas ao desenvolvimento e bem estar social dos cidadãos e que estes, por sua vez, devem contribuir financeiramente para o custeio das atividades desenvolvidas pelo Estado. Neste contexto, a imposição tributária se instala como contribuição de cada indivíduo em prol da coletividade. É justamente esta possibilidade de cada indivíduo concorrer para o financiamento do Estado, ou seja, a medida do sacrifício individual que o Estado poderá legitimamente cobrar revela a importância do princípio da capacidade contributiva como requisito a ser avaliado para garantir justiça na imposição tributária. Neste passo, a pesquisa se justifica para averiguar se há compatibilidade entre a interpretação dada pela doutrina e a jurisprudência da Corte Suprema do Brasil. A pesquisa parte da premissa de que a forma de tributação de Estado pode ser um instrumento de redução da desigualdade e promoção da cidadania e, desta forma, pretende contribuir para fomentar as discussões sobre a justiça fiscal no país. / Abstract: The purpose of this study is to investigate the progress of the contributory capacity, provided for in article 145, paragraph 1, of the Federal Constitution, which has been applied by the Federal Supreme Court. The State has a political organization to attract and the attributions to the development and social welfare of the citizens and that, in turn, contribute financially to the cost of activities rich by the State. In this context, taxation imposes itself as a contribution of each individual to the benefit of the collectivity. It is possible that each individual competes for state funding, that is, a measure of individual sacrifice that can be assessed to do justice to taxation. In this article, the research is justified to ascertain if there is any difference between a given given by the doctrine and a jurisprudence of the Supreme Court of Brazil. The formation of an instrument to reduce inequality and promote citizenship and, thus, the use of an instrument to reduce inequality and promote citizenship in the country. / Mestre

The aim of the thesis is to assess the state and development of indebtedness of territorial self-governing units in the Czech Republic with regard to the sustainability of public finances. The first part of this work is focused on the definition of basic terms related to this issue. The methodology contains the methods and procedures that will be used in the results section. In the result section was calculated the annual growth rate of debt of regions, the ratio of debt to average revenues or debt per capita The result section is divided into 3 parts. The first part deals with the development of debt of the regions of the Czech Republic, including contributory organizations established by them in the years 2003 - 2017. The debt of all regions of the Czech Republic is assessed together, which gives an overall view of the state and dynamics of the debt. The second part analyzes the debt of individual regions in the Czech Republic. The monitored period is 2010 - 2017. In the last part, debt consolidation occurs. Consolidated debt consists of the debt of individual regions of the Czech Republic and the debt of contributory organizations that establish the regions, as well as the debts of commercial corporations that the regions set up. Consolidated debt is assessed for 2013-2017.

In dynamic peer group communications, security has been in high demand by many applications in recent years. One of the more popular mechanisms to satisfy these security requirements is the group key scheme in which the group key is to be shared by each group communication participant. However, how to establish and manage the group key efficiently in order to protect such communications imposes new challenges - especially when such schemes are to be deployed on resource-limited networks such as Mobile Ad hoc Networks (MANETs). The basic needs of such network settings require that the group key schemes must demonstrate not only high performance but also fault-tolerance. Furthermore, to encrypt group communication messages efficiently is essential. Therefore, it is anticipated that the contributions of this thesis will address the development of lightweight and high performance key management protocols for group communications while guaranteeing the same level of security as other approaches. These contributions are listed below: First, two efficient individual rekey schemes, in which most group members process one-way hash functions and other members perform Diffie-Hellman operations, are proposed to obtain performance efficiency. Second, a periodic batch rekey scheme is proposed to handle the out-of-sync problem resulting from individual rekeying schemes in cases where there is a high rate of group member requests for joining/leaving. Third, scalable maximum matching algorithms (M2) are designed to incorporate a tree-based group key generation scheme to forward the partial keys to other group members. Fourth, a hybrid group key management architecture is proposed as well to combine the advantages of centralized and contributory group key schemes. Fifth, a Fast Encryption Algorithm for Multimedia (FEA-M) is enhanced to overcome the vulnerabilities of its original solution and its former improved variant. Performance analyses and experimental results indicate that the proposed approaches reduce computational costs and communication overhead as compared to other popular protocols.

People with schizophrenia are at an increased risk for type 2 diabetes and other metabolic abnormalities such as obesity and cardiovascular disease. Lifestyle choices of physical inactivity and diets high in fat and refined carbohydrates are significant contributory factors for obesity and diabetes in people living with schizophrenia, but there is a growing body of research and interest into the additive factor of psychotropic medications on weight gain and diabetes risk. The incidence of diabetes and the morbidity and mortality rates are reported to be approximately 2 to 3 times higher in the population with schizophrenia compared to the general population. This increased vulnerability for health complications is reflected in the profound challenges that are experienced in the population with schizophrenia. My aim for this qualitative research inquiry has been to place into questioning the encounter with diabetes mellitus for people living with schizophrenia. I entered into dialogue with seven participants to explore new possibilities of understanding that emerged between the understandings that we each bring to the conversations. It was also my intent to bring into flux the assumptions of living with two interrelated chronic iv conditions and to increase the understanding of that experience through a reflexive process that illuminates that which may be hidden or obscured. I approached this inquiry mainly drawing on Gadamerian hermeneutics; the main task being the study of ‘texts’ that give evidence to what being human means and the analysis of how different interpretations and understandings are variable depending on their cultural and historical contexts. I expect this work to contribute to the generation of a richer understanding of these co-existing conditions and to create an opportunity and desire for ethical action in diabetes prevention and management for this high-risk population.

Introduction: In recent decades, there has been considerable international attention directed towards minimising healthcare-associated harm and improving the safety of hospital care. More recently, this attention has broadened to include primary medical care. In 2002, the World Health Assembly recognised the issue of inadequate levels of patient safety as a major threat to global public health. In the following years, many countries have developed national strategies for the measurement, monitoring and prevention of patient safety incidents (PSIs) and their outcomes. Experience accumulated from secondary care has shown that the initial steps for understanding patient safety include the systematic identification of the most frequent and most harmful threats. However, the safety profile of primary care dentistry remains poorly investigated. As a result, current evidence cannot provide reliable estimates of the types of PSIs in primary care dentistry, the causes of these incidents, or the associated disease burden caused by such incidents. In medicine, improvements in patient safety were achieved at a national level by developing a shared conceptual understanding, the standardisation of terminology and through preventive initiatives such as the introduction of a national incident reporting and learning system. In the United Kingdom (UK), the England and Wales’ National Reporting Learning System (NRLS) has been an important source of insight, from the perspectives of the reporter, into understanding why PSIs occur. This initiative has led to the implementation of patient safety oriented policies to monitor and reduce cases of healthcare-associated harm. Examples of such policy initiatives include national guidelines and national safety recommendations to encourage the reporting of serious reportable events called ‘never events’ (NEs). These are defined as serious, preventable PSIs that should not occur if the available preventive measures are implemented. At a national level, serious incidents and NEs must be reported to the NRLS and/or other reporting systems. However, little is known about NEs in dentistry as wrong-tooth extractions are the only currently defined NE that has a clear application in dentistry. Although surgical NEs, such as wrong-site surgery and wrong implants may be related to dental procedures, these overlap with procedures conducted in secondary care. As a result, there is no agreed list of NEs for primary care dentistry. The overall aim of my PhD was to explore patient safety, its concepts, including error and harm, and how these can help to create an understanding of the types of PSIs that occur in primary care dentistry, their contributory factors and their consequences. In addition, I also aimed to identify NEs with the greatest need and opportunity for future intervention strategies, in order to improve patient safety in primary care dentistry. Methodology and methods: My PhD was conducted in three phases. For the first phase, I conducted a systematic scoping review of the empirical evidence published over a 20-year period (1994-2014). To achieve this, I searched MEDLINE and EMBASE for articles reporting incidents that could have or did result in unnecessary harm from primary dental care. I also extracted and synthesised data on the types and frequencies of PSIs (including NEs) and adverse outcomes. Then, for the second phase, I undertook an exploratory sequential mixed-methods evaluation, which involved the qualitative exploration and analysis of a weighted-by-year randomised sample (n=2,000) of the most severe incident reports from primary care dentistry submitted to the England and Wales’ NRLS. This approach generated three coding frameworks, aligned to the International Classification for Patient Safety developed by the World Health Organization, for i) the classification of incidents, ii) contributor y factors and iii) incident outcomes. These coding frameworks informed the quantitative analysis, during which myself together with a trained second coder, applied codes to deconstruct the narrative of these patient safety incident reports whilst retaining the meaning of the report. To assess inter-rater reliability, Cohen’s Kappa statistic was calculated for the primary incident type which was defined as “the incident that resulted in the outcome experienced by the patient.” Finally, for the third phase, I undertook an electronic Delphi exercise to achieve international agreement on NEs for primary care dentistry. The results obtained from Phases 1 and 2 were used to identify candidate NEs. I then invited an international panel of 41 experts to complete two rounds of questionnaires; 32 (78%) agreed to participate and completed the first round, and 29 (91%) completed the second round. I provided anonymised controlled feedback between rounds and used a cut-off of 80% agreement to define consensus. The results from the first stage built the evidence base for the second and third phases. Likewise, the results from the second phase further informed the third and final stage of my PhD. Results: I undertook a systematic scoping review which demonstrated: a) there were considerable differences in definitions for terms used to describe patient safety, b) that a range of populations had been studied, and c) that major differences in sampling strategies exist between studies. The main five PSIs I identified were errors in i) diagnosis/examination, ii) treatment planning, iii) communication, iv) procedural errors and v) the accidental ingestion or inhalation of foreign objects. However, little attention has been paid to wider organisational factors such as problems within the physical environment, scheduling (e.g. errors in managing appointments) and patient access, management and lines of responsibility. Also there is very little evidence of interest in researching into the influence of policies for either quality or patient safety assurance. The retrieved evidence was used to build a conceptual literature-derived model of patient safety risks in primary care dentistry. This model helped to bring structure to the analysis of the 1,456 patient incident reports that were eligible for analysis out of a total of 2,000. These reports described incidents across the preoperative (40.3%; n=587), intra-operative (56.1%; n=817) and post-operative (3.6%; n=52) clinical stages of care delivery. Further analysis showed the more frequently reported incidents were related to a) delays in treatment (333/1,456; 22.9%), b) procedural errors (220/11,456; 15.1%), c) medication-related adverse incidents (160/1,456; 11.0%), d) equipment failure (90/1,456; 6.2%) and e) errors in obtaining or processing x-rays (87/1,1456; 6.0%). Only 5.3% (77/1,456) of the incidents resulted in harmful outcomes. Of the 77 incidents that resulted in a harmful outcomes (n=77; 5.3%), around half were due to wrong tooth extractions (37/77; 48.1%) and resulted in unnecessary procedures. Three out of the 1,456 incidents (0.2%) resulted in death. Data from the scoping review and the mixed-method analysis informed a list of 42 candidate NEs. I further sought and achieved international consensus for 23 of these NEs. These were related to routine assessment, and pre-operative, intra-operative and post-operative stages of dental procedures. Conclusions: The findings from my PhD have revealed that patient safety research in dentistry is mostly descriptive and poorly organised with various approaches to defining and measuring PSIs and their outcomes. This poor organisation of patient safety research also includes differing study designs and patient populations studied. The evidence-based conceptual framework from the systematic scoping review, and coding frameworks from analysis of PSI reports selected from a national database, can bring structure to future work by providing a robust approach to classifying PSIs, their contributory factors and outcomes. / My research findings also show that PSI reports are an important source of information that can generate important insights about patient safety in primary care dentistry. The mixed-method analysis of PSI reports showed that most incidents in primary dental care do not result in harm. PSIs that resulted in harmful outcomes more frequently occurred intra-operatively. My findings also reveal that unsafe care in dentistry is not limited to human error, but can also be ascribed to the presence of other administrative or organisational flaws that contribute to the reported incidents. Future initiatives to improve and research clinical practice should focus on improving administrative processes to reduce delays in treatment. Also, the reduction of procedural errors through the standardisation of x-rays, medication prescription and other clinical procedures is needed. Lastly, I have constructed the first comprehensive international list of NEs for primary care dentistry. I believe my findings, including the list of NEs, can provide an evidence-base which will encourage researchers to further expand the patient safety research and development agenda in dentistry, as well as encouraging decision-makers and professional bodies to translate my findings into quality improvement strategies.

The main objective of this diploma thesis is to identify and characterize the changes in economic, social and legislative conditions and their impact on the financial results of selected non-profit organization.

This thesis deals with financing of the National Theatre in Prague, with the attention to voluntary philanthropic sources of its income. The National Theatre is a symbol of Czech national identity and commitment. According to legend, its origin is associated with a philanthropic tradition that has continued almost uninterrupted throughout his whole existence. Verification of the philanthropic tradition is the main aim of this thesis. It also examines revenues, expenditures and deficits of the theater. Thesis is trying to find out the volume of revenue from its own activities and from public budgets, which concludes the percentage of self-sufficiency. It focuses on the presence of patrons and the amount of voluntary contributions to finance the total cost. Thesis also seeks to capture the economic, institutional and political development of the theatre. Finally, determine the common and different tendencies of development.