Indiana University-Purdue University Indianapolis (IUPUI) / Intraoperative adverse events (IAEs) due to interprofessional miscommunication continue to occur despite implementation of surgical checklists and focused communication trainings. Much of the previous intraoperative communication research has focused on the content and quantity of interprofessional communication instead of its context and quality, and current communication interventions seem to have varying levels of engagement, effectiveness, and persistence. The purpose of this dissertation study was to explore the psychosocial processes involved during the establishment and maintenance of interprofessional communication surrounding IAEs or potential IAEs in the intraoperative environment and to identify the perceived facilitators and barriers to communication. Twenty surgical team members participated in semi-structured interviews and described their experiences with interprofessional communication during IAEs. Grounded theory methodology was used to identify the central process, Testing the Water, and two subprocesses, Reading the Room and Navigating Hierarchy. Testing the Water describes the situational nature of interprofessional communication as surgical team members navigate factors influencing the context and probable trajectories of surgical cases and the perceptions of professional rights and responsibilities within surgical teams. Participants in this study experienced Testing the Water differently based on their professional roles and tenure; findings were organized around three emerging groups identified as inexperienced nurses, experienced nurses, and surgeons. Interprofessional communication surrounding IAEs occurred for study participants in fluid, iterative phases identified as 1) Recognition, 2) Reconnaissance, 3) Rallying, 4) Reaction, and 5) Resolution. Participants recognized IAEs or potential IAEs, gathered information through reconnaissance, rallied other team members, reacted to stabilize patients, and resolved IAEs through individual or surgical team reflection. Study participants reported using strategies during communication to accomplish two psychosocial goals, preserving the flow of surgical cases, and protecting the ‘face’ of themselves and other surgical team members. Supporting these psychosocial goals through increased psychological safety for all surgical team members potentially leads to more effective, timely surgical team communication. More effective interprofessional communication facilitates the improved situational awareness, collective sensemaking, and integrated team mental models that are critical to coordinated responses to IAEs. The findings of this study suggest practical implications to increase the effectiveness of interprofessional communication in the intraoperative environment.

Indiana University-Purdue University Indianapolis (IUPUI) / The Tso Morari terrane within the Himalayan orogenic belt underwent ultrahigh-pressure (UHP) coesite-eclogite metamorphism due to northward subduction of the Indian continent under the Eurasian continent during the early Eocene. In this study we optimized a best protocol for thermodynamically modelling pressure-temperature (P-T) paths of high-grade metabasites using the Tso Morari eclogite as a case study through evaluating the effects of employing commonly used thermodynamic modeling techniques (e.g., programs, thermodynamic datasets, a-X relations). A “fishhook” shaped clockwise P-T path was obtained with a peak pressure of ~28.5 kbar at ~563 °C, followed by a peak temperature of ~613 °C at ~24.5 kbar. The peak pressures predicted by modelling protocols are consistent with the conventional thermobarometry results and petrographic observations from the Tso Morari eclogites. Secondly, thermodynamic modelling using P-M(H2O) pseudosections on Tso Morari UHP rocks indicates three distinct fluid events during the prograde and retrograde metamorphism. Fluid Event 1 caused the fluid-assisted homogenization of prograde garnet cores in eclogite at ~18.5 kbar and ~555 °C; Fluid Event 2 is evidenced by the formation of poikiloblastic epidote (~23.5 kbar and ~610 °C, at the expense of lawsonite) and amphibole (from ~19.0 to ~14.5 kbar at ~610 °C, at the expense of omphacite and talc), and symplectite association (~8.7 kbar and ~625 °C) in the eclogite matrix without external fluid supply. Fluid Event 3 was determined through modelling the amphibolitization of eclogites with external fluid infiltration at ~9.0–12.5 kbar and ~608 °C. This fluid phase most likely derived from the mixing of dehydrated host orthogneiss and/or metasediments during exhumation through the amphibolite-facies zone in the subduction channel. This study demonstrates the need for using careful petrographic observations in parallel with thermodynamic modelling to achieve realistic results. / 2023-12-02

Title: Organization of voluteers at the RunTour running series Objectives: The main objective of this diploma thesis is to evaluace the satisfaction of volunteers and organizers with the volunteer program on the running series RunTour and to suggest possible recommendations for its improvement. Methods: As part of the qualitative survey, the method of in-depth interviews was used, which took place with the coordinator of the volunteer program and with the heads of selected sections. Furthermore, a quantitative method of electronic interrogation was applied. The research was complemented by observations made by the author of the thesis, who personally participated in all races. Results: The research shows that most volunteers and organizers evaluate the volunteer program very positively. However, research has identified several areas where there is room for improvement. These are the areas of organization, communication and refreshments. Keywords: running, volunteering, volunteers management, satisfaction, sport events, organization

The discovery of solidus coins on the islands of Öland and Gotland, propose a contactbetween Scandinavia and the Roman Empire during the Migration Period (AD 400-550), buthow did the Scandinavians get access to these coins? In this essay, I will study thestampidentity and coin embossing from 572 coins found on Öland and Gotland. The aim is tounderstand where the coins were minted and during which periods there was a big influx ofsolidus coins to Scandinavia. But also, to understand what European regions the people ofÖland and Gotland were in contact with. This essay will also map certain events that are vitalfor understanding why the solidus coins are found in Scandinavia.

This dissertation examines the relationship between economic resilience, disaster experience, and smart growth policies at the local government level. The study is based upon three research questions that examine spatial distribution of economic resilience in Florida cities, and examines the impact of disaster experience, and smart growth policies adopted by local governments on economic resilience. Based upon the bounce-forward approach (Cowell, 2013; Klein et al. 2003), economic resilience is defined using three dimensions—economic stability, economic equity, and economic diversity. The spatial analysis is conducted by mapping economic resilience scores across 780 Census Designated Places in Florida through standard deviation method of classification, and conducting cluster-outlier analysis. Results suggest difference in economic resilience within coastal and inland communities—with higher scores mostly situated inland. East Central Florida, Tampa Bay, and South Florida were identified as high economic resilience clusters, and Northwest Florida was identified as low resilience cluster. Impact of disaster experience, and smart growth policies on economic resilience was examined based upon logic of focusing events by Birkland (1997, 2010). Data was collected from the U.S. Census, the National Climatic Data Center, and the Energy Sustainable Florida Communities Survey conducted by Florida State University in 2009. Results suggest significant association between disaster experience of communities and their level of economic resilience, highlighting the importance of community learning in building capacity for resilience after disasters. The results also highlight the need of balancing mitigation and adaptation strategies. Mixed-use development policies, green building certification, and energy savings policies were found to have a significant positive impact on economic resilience.

The criminal law has been critiqued as an unsuitable system to regulate adverse medical events (AME) because the unintentional nature of AME renders it incompatible with the penal objectives of the criminal law. This project uses an interpretivist approach to examine how blameworthiness is constructed in criminal cases involving AME. Situated within a contextual constructionist paradigm, and utilizing a theoretical framework that draws on legal pragmatism, symbolic interactionism, Habermasian thought, and Goffmanian frame analysis, this project employs a case study approach to explore how appellate courts construct AME as a product of fate or agency. The British case of Bawa-Garba v. R. (2016) and the Canadian case of R. v. Javanmardi (2019) are analysed using thematic analysis. It is concluded that the majority of the Supreme Court of Canada in Javanmardi constructed the AME within the realm of fate, contrasting the minority in Javanmardi and full panel of the England and Wales Court of Appeal in Bawa-Garba which constructed the AME within the realm of agency. It is also concluded that the majority in Javanmardi utilised pragmatic adjudication to determine blameworthiness. It is suggested that these findings could reduce fear of criminal liability among Canadian health care professionals. Future research is suggested to examine the legal cultures underlying this variation, critically explore the intersection of race and criminal prosecution of AME, and apply structural violence as a theoretical frame to further interrogate AME as a systemic failure.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第18676号 / 医博第3948号 / 新制||医||1007(附属図書館) / 31609 / 京都大学大学院医学研究科医学専攻 / (主査)教授 中山 健夫, 教授 川上 浩司, 教授 柳田 素子 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

京都大学 / 0048 / 新制・課程博士 / 博士(理学) / 甲第20179号 / 理博第4264号 / 新制||理||1613(附属図書館) / 京都大学大学院理学研究科物理学・宇宙物理学専攻 / (主査)准教授 上田 佳宏, 教授 嶺重 慎, 教授 長田 哲也 / 学位規則第4条第1項該当 / Doctor of Science / Kyoto University / DFAM

This thesis evaluated physiological responses of young and older adults during extreme heat events and the extent to which commonly recommended heat-health guidelines (indoor temperature limits) and heat mitigation strategies (cooling centres) are effective at limiting hyperthermia and cardiovascular burden. A multidisciplinary narrative review and three experimental studies were conducted. In the review, the mechanisms by which aging impairs the regulation of body temperature and hemodynamic stability, and how they may contribute to the increased risk of heat-related mortality and morbidity in older adults, were summarized. A lack of ecologically minded study designs in previous research evaluating the physiological responses supporting homeostasis and health during heat stress (i.e., body temperature regulation and cardiovascular stability) was also identified. The three experiments were therefore designed as day-long (8-9 hour) extreme heat simulations to 1) evaluate age-related alterations in thermoregulatory and cardiovascular function during peak heat conditions; 2) assess how these responses translate to indoor environments; and 3) quantify the effectiveness of cooling centers, a widely recommended heat mitigation strategy, for limiting hyperthermia and cardiovascular burden. In the first study, healthy older adults (age: 64-78 years; n=19) stored 87 kJ [95% confidence limits: 33, 141] more heat than their younger (age: 19-31 years; n=20) counterparts (328 [71] kJ vs. 241 [SD: 87]; P<0.001) during the first three hours of a 9-hour exposure to extreme heat (40°C and 15% relative humidity). This resulted in a 0.4°C [0.2, 0.6] greater increase in body core temperature in the older adults that was maintained throughout exposure (1.0 [0.3] vs 0.6 [0.3]°C; P<0.001). These findings were extended in the second study, wherein it was demonstrated that healthy older adults (age: 66-78 years, n=8) exhibit progressive elevations in body temperatures (P<0.001) and attenuations in cardiovascular autonomic function (P<0.001) during 8 hours of rest in conditions representative of those experienced indoors during extreme heat events. These ranged from an actively cooled environment (22°C), through indoor temperature thresholds recommended by Toronto Public Health (26°C) and the World Health Organization (31°C), to poorly insulated and ventilated homes and/or dwellings without access to air conditioning (36°C; 45% relative humidity in all conditions). In the third study, it was shown that short-term exposure to a cool environment midway through (hours 5-6) a day-long (9 hour) simulated heat event reduced core temperature in a group of healthy older adults (age: 67-78 years; n=8) by 0.8°C [0.6, 1.0] compared to an age-matched group not removed from the heat (from study 1). Despite this, core temperature rose rapidly upon return to the heat and was statistically equivalent in both groups by the end of exposure (37.8 [0.3] vs 37.9 [0.3]°C; P=0.011). The findings of this thesis indicate that even healthy older adults experience sustained elevations in body temperature and cardiovascular burden during extreme heat events and that commonly recommended heat-health guidelines (indoor temperature limits) and mitigation strategies (cooling centres) may not provide adequate protection. Collectively, this work represents a considerable advance in our understanding of the physiological burden experienced by older adults during hot weather and extreme heat events.

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