This study evaluates the effectiveness of safe offender strategies (SOS) in comparison with relapse prevention (RP) in a sample of 91 inpatient males in a secure psychiatric setting. All men evidenced a history of violent sexual offending and were diagnosed with serious psychiatric disorders and/or intellectual disabilities. Participants who received SOS (n = 58) and RP (n = 33) were followed from 6 to 36 months post release. SOS clients were significantly less likely to be arrested (0%) or rehospitalized (5.2%) than RP clients (9% arrested; 54.5% rehospitalized). In addition, SOS clients were more likely to transition continuously to less restrictive alternatives, with no returns to high security, in comparison with RP clients. The authors discuss implications for use of SOS, a treatment that facilitates skills development and affects global self-regulatory functioning, particularly in sex offenders with serious mental illness or intellectual impairment, in promoting community reintegration and limiting returns to psychiatric settings.

No description available.

Aim: The aim of this study was to examine if student nurse participation in root cause analysis has the potential to reduce harm to patients from medication errors by increasing student nurse sensitivity to signal and responder bias. Background: Schools of nursing have traditionally relied on strategies that focus on individual characteristics and responsibility to prevent harm to patients. The modern patient safety movement encourages utilization of systems theory strategies like Root Cause Analysis (RCA). The Patient Risk Detection Theory (Despins, Scott-Cawiezell, & Rouder, 2010) supports the use of nurse training to reduce harm to patients. Method. Descriptive and inferential analyses of the demographic and major study variables were conducted. Validity and reliability assessments for the instruments were performed. The Safe Administration of Medications-Revised Scale (Bravo, 2014) was used to measure sensitivity to signal. The Safety Attitudes Questionnaire (SAQ; Sexton et al., 2006) was used to assess responder bias; this was the first use of this instrument with nursing students. Results: The sample consisted of 125 senior-level nursing students from three universities in the southeastern United States. The SAQ was found to be a valid and reliable test of safety attitudes in nursing students. Further support for the validity and reliability of the SAM-R was provided. A significant difference in safety climate between schools was observed. There were no differences detected between the variables. Conclusion: The results of this study provide support for the use of the SAQ and the SAM-R to further test the PRDT, and to explore methods to improve nursing student ability to administer medications safely.

Bakgrund: Stroke är ett tidskritiskt tillstånd som kan medföra kommunikationssvårigheter. Stroke delas generellt in i två kategorier; blödning eller tromb. En blödning kan uppstå efter trauma eller att ett kärl spruckit av annan orsak. En tromb bildas någonstans i kroppen som sedan färdats med blodbanan för att slutligen fastna i ett av hjärnans blodkärl. Beroende på var i hjärnan blödningen eller tromben sitter uppvisas olika symptom. Kommunikationen med strokepatienter kan påverkas negativt av flertalet variabler. Vid stroke kan symptom som afasi, dysfasi och dysartri framträda och leda till svårigheter för ambulanspersonalen att förstå vad patienten vill förmedla. Förutom dessa faktorer påverkar även ambulanspersonalens kompetens, engagemang, den fysiska miljön och språkförbristningar kommunikationen med strokepatienter. Således är kunskap om dessa faktorer viktiga i arbetet för att kunna finna vägar för en god kommunikation. Syfte: Att belysa framgångsfaktorer och hinder för kommunikation mellan ambulanspersonal, sjukhuspersonal och strokepatienter. Metod: En strukturerad litteraturöversikt med en systematisk metod och en integrerad analys genomfördes. Resultat: Resultatet visade att faktorer såsom personcentrerad kommunikation främjade kommunikationen mellan ambulanspersonal och strokepatienter. Digitalisering samt samarbete mellan ambulans och akutsjukhus främjade kommunikationen mellan ambulanspersonalen och sjukhuspersonalen. Tillika visade resultatet att digitalisering, akuta situationer och språkförbristningar kan inverka negativt på kommunikationen mellan ambulanspersonal, sjukhuspersonal och strokepatienter. Slutsats: Faktorerna som främjar kommunikationen mellan ambulanspersonal och strokepatienter är personcentrerad kommunikation, omvårdnad och säker vård. Digitaliserade kommunikationshjälpmedel, samarbete samt standardiserad och strukturerad kommunikation var framgångsfaktorer för kommunikation mellan ambulanspersonal och sjukhuspersonal. Dock kan digitalisering hindra omvårdnaden inom ambulanssjukvården och hindra kommunikationen mellan ambulanspersonal och sjukhuspersonal. När den tekniska utrustningen inte fungerat har det lett till längre behandlingstider och en längre tid till intervention. / Background: Stroke is a time-critical condition that can cause communication difficulties. Stroke is generally divided into two categories; bleeding or thrombus. Bleeding can occur after trauma or when a vessel has ruptured for another reason. A thrombus forms somewhere in the body which then travels with the bloodstream to finally get stuck in one of the brain's blood vessels. Depending on where in the brain the bleeding or thrombus is located, different symptoms are displayed. Communication with stroke patients can be negatively affected by several variables. In stroke, symptoms such as aphasia, dysphasia and dysarthria can appear and lead to difficulties for the ambulance personell to understand what the patient wants to convey. In addition to these factors, the competence of the ambulance personnel, commitment, the physical environment and language deficiencies also affect communication with stroke patients. Thus, knowledge of these factors is important in the work to be able to find ways for good communication. Purpose: The aim was to highlight factors that promote or hinder communication between ambulance personnel, hospital personnel and stroke patients. Method: A structured literature review with a systematic method and integrated analysis was conducted. Result: The results showed that factors such as person-centred communication promoted communication between ambulance personnel and stroke patients. Digitization and cooperation between ambulances and emergency hospitals promoted communication between the ambulance staff and the hospital staff. At the same time, the results showed that digitalisation, emergency situations and language deficiencies can have a negative impact on communication between ambulance personnel, hospital staff and stroke patients. Conclusion: The factors that promote communication between ambulance personnel and stroke patients are person-centred communication, nursing and safe care. Digitized communication aids, collaboration and standardized and structured communication were success factors for communication between ambulance personnel and hospital staff. However, digitization can hinder nursing in ambulance healthcare and hinder communication between ambulance- and hospital personnel. When the technical equipment did not work, it led to longer treatment times and a longer time to intervention.

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.

The bachelor thesis was performed in cooperation with Erlandsson Bygg Öst. The purpose of this thesis is to find out how the personal protective equipment (PPE) and logistics increase the efficiency of the work and reduce the risk of accidents at building site. The project was to investigate the factors that impact the efficiency and activities some increase the risk for accidence. The study discusses only the PPE and logistics, because it considers as an important for building production. The motivation of this thesis is to look into the factors that can reduce the risk of accident in the future and make it more effective on the building method. In order to carry out the bachelor thesis there has been a combination of literature studies, questionnaires and interviews. The literature studies were in form of books and digital websites. And the interview performed with 2 managers. The questionnaires handed out to the worker that was at building site. After the work has been done was able to draw conclusion about which factors increase the risk of accidents and which factors affect the efficiency. The communication and APD-plan are the shortage of using of the PPE and problem in logistic is the factors that impact the efficiency and accidents. The recommendation has been presented to the company to raise awareness to increase efficiency and reduce the incidence of accidents.

The purpose of this qualitative study was to examine how African American female band directors create and utilize counterspaces for African American female musicians to share collective and individual experiences, maintain involvement, form positive self-definitions about themselves, and to counter intersecting forms of oppression in bands. In this study, I also examined the African American female band directors’ perceptions about counterspaces in bands. To illuminate the experiences of the 17 African American female band directors who participated in this study and their use of counterspaces as an activist response to resist intersecting forms of oppression perpetuated within the band world, Black feminist thought (BFT) as a framework was employed. The following research questions guided this study: (1) What are the African American female band directors’ perceptions and knowledge about counterspaces, and how do they utilize counterspaces to counter intersecting forms of oppression that African American female musicians face in bands?; (2) How do the African American female band directors utilize counterspaces to help the African American female band students form positive self-definitions about themselves, and to share their individual and collective experiences of involvement in bands?; and (3) How do counterspaces help African American female band directors understand common themes in the lives of African American female musicians that contribute to their sustained involvement in bands? The findings of this study revealed that counterspaces are essential for countering the perpetuation of intersecting forms of oppression and negative stereotypical images of African American females. This study further revealed that counterspaces functions as a mechanism where African American female band directors are able to foster the interconnected dimensions of self-definitions, collective and self-empowerment, and oppositional consciousness among their respective African American female band students. This study also provided insight into the current status of African American females within the field of instrumental music education in the U.S and dimensions of power structures that are continuously perpetuated to negate African American female’s equal stance within the field.

Since 2015, there have been more than 35,000 fatalities annually due to crashes on United States roads [1], [2]. Typically, road departure crashes account for less than 10% of all annual crash occupants yet comprise nearly one third of all crash fatalities in the US [3]. In the year 2020, road departure crashes accounted for 50% of crash fatalities [2]. Road departure crashes are characterized by a vehicle leaving the intended lane of travel, departing the roadway, and striking a roadside object, such as a tree or pole, or roadside condition, such as a slope or body of water. One strategy currently implemented to mitigate these types of crashes is the use of roadside barriers. Roadside barriers, such as metal guardrails, concrete barriers, and cable barriers, are designed to reduce the severity of road departure crashes by acting as a shield between the departed vehicle and more hazardous roadside obstacles. Much like new vehicles undergo regulatory crash tests, barriers must adhere to a set of crash test procedures to ensure the barriers perform as intended. Currently, the procedures for full-scale roadside barrier crash tests used to evaluate the crash performance of roadside safety hardware are outlined in The Manual for Assessing Safety Hardware (MASH) [4]. During roadside barrier tests, the assessment of occupant injury risk is crucial, as the purpose of the hardware is to prevent the vehicle from colliding with a more detrimental roadside object, all the while minimizing, and not posing additional, risk to the occupants. Unlike the new vehicle regulatory crash tests conducted by the National Highway Traffic Safety Administration (NHTSA), MASH does not require the use of instrumented anthropomorphic test devices (ATD). Instead, one of the prescribed occupant risk assessment methods in MASH is the flail space model (FSM), which was introduced in 1981 and models an occupant as an unrestrained point mass. The FSM is comprised of two crash severity metrics that can be calculated using acceleration data from the test vehicle. Each metric is prescribed a maximum threshold in MASH and if either threshold is exceeded during a crash test the test fails due to high occupant injury risk. Since the inception of the FSM metrics and their thresholds, the injury prediction capabilities of these metrics have only been re-investigated in the frontal crash mode, despite MASH prescribing an oblique 25-degree impact angle for passenger vehicle barrier tests. The focus of this dissertation was to use EDR data from real-world crashes to assess the current relevance of roadside barrier crash test occupant risk assessment methods to the modern vehicle fleet and occupant population. Injury risk prediction models were constructed for the two FSM-based metrics and five additional crash severity metrics for three crash modes: frontal, side, and oblique. For each crash mode and metric combination, four injury prediction models were constructed: one to predict probability of injury to any region of the body and three to predict probability of injury to the head/face, neck, and thorax regions. While the direct application of these models is to inform future revisions of MASH crash test procedures, the developed models have valuable applications for other areas of transportation safety besides just roadside safety. The final two chapters of this dissertation explore these additional applications: 1) assessing the injury mitigation effectiveness of an advanced automatic emergency braking system, and 2) informing speed limit selection that supports the safe system approach. The findings in this dissertation indicate that both the FSM and additional crash severity metrics do a reasonable job predicting occupant injury risk in oblique crashes. One of the additional metrics performs better than the two FSM metrics. Additionally, several occupant factors, such as belt status and age, play significant roles in occupant risk prediction. These findings have important implications for future revisions of MASH, which could benefit from considering additional metrics and occupant factors in the occupant risk assessment procedures. / Doctor of Philosophy / Every year, there are more than 35,000 fatalities due to crashes on United States roads. While there are many different types of crashes, there is a small collection of crash types that are responsible for the majority of these fatalities. One of the worst crash types is a road departure crash. Road departure crashes describe when a vehicle leaves the roadway and collides with an object off the roadway (such as a tree, pole, or ditch). Road departure crashes typically comprise 10% of crashes but are responsible for more than 30% of the annual crash fatalities. In 2020, road departure crashes were responsible for 50% of the 39,000 fatalities. One strategy that is currently used to reduce road departure fatalities is the use of roadside barriers. Common roadside barrier types include metal guardrails, concrete barriers, and cable guardrails, and are used to prevent vehicles that are departing the roadway from hitting an object that would be more dangerous than the barrier. To ensure barriers successfully protect the vehicle and vehicle occupants from heightened danger, they are crash tested in scenarios that are designed to mimic real-world crashes. The Manual for Assessing Safety Hardware (MASH) is the document that currently outlines the details necessary to conduct one of these crash tests. During roadside barrier tests, it is crucial to determine whether occupants are at risk of injury or fatality. For a variety of reasons, barrier tests do not use the traditional crash test dummies, which are designed to replicate human presence in a crash vehicle. Instead, MASH recommends using vehicle velocity data to assess how much risk is posed to an occupant. Using this velocity data, two values can be computed and if either value exceeds the maximum values provided in MASH, the crash test fails due to high occupant risk. The suggestion to use velocity data to assess occupant risk was first introduced in 1981. Since then, there have been significant advances in vehicle design, barrier design, and occupants' willingness to partake in safe habits, such as wearing seatbelts. Therefore, it is necessary to determine if the occupant risk values used in MASH are still applicable today. The focus of this dissertation was to use real-world crash data to assess the current relevance of roadside barrier crash test occupant risk values. The results presented in this dissertation can be used to select new occupant risk values in future versions of MASH. The findings within this dissertation show that the current methods in MASH do a good job estimating an occupant's risk of injury. Additionally, the findings show that certain occupant factors, such as the age of an occupant and whether the occupant is belted, help to more accurately estimate occupant injury risk. This finding has important implications for MASH, which does not currently consider different occupant conditions.

One of the challenges in understanding polymer flammability is the lack of information about microscopic events that lead to macroscopically observed species, and Reactive Molecular Dynamics is a promising approach to obtain this crucially needed information. The development of a predictive method for condensed-phase reaction kinetics can provide significant insight into polymer ammability, thus helping guide future synthesis of fire-resistant polymers. Through this dissertation, a new reactive forcefield, RMDff, and Reactive Molecular Dynamics program, RxnMD, have been developed and used to simulate such material chemistry. It is necessary to have accurate description of chemical kinetics to describe quantitative chemical kinetics. Typical equilibrium forcefields are inadequate for describing chemical reactions due to the inability to represent bonding transformations. This issue was resolved by developing a new method, RMDff, that allows standard equilibrium forcfields to describe reactive transitions. The chemical reactions are described by employing switching functions that permit smooth transitions between the reactant and product descriptions available from traditional forcefields. Because all of the chemical motions are described, a complete potential energy surface is obtained for the course of the reaction. Descriptions of scission, addition/beta-scission, and abstraction reactions were developed for hydrocarbon species. Reactive potentials were developed using a representative reaction involving small molecules. It is shown that the overall geometric and energetic changes are transferable to larger and substituted molecules. The main source of error found in RMDff resulted from errors within the equilibrium forcefield descriptions. In order to simulate the chemical kinetics, it was necessary to create a molecular dynamics program that could implement the reactions from RMDff. RxnMD was developed as a new C++-based Reactive Molecular Dynamics code to simulate the dynamics using RMDff. Polymer kinetics were predicted for high-density polyethylene and used to test the method and code. Conformational changes and polymer length in the initial polyethylene molecules did not significantly alter the backbone decomposition kinetics. The results also revealed that the backbone carbon-carbon bonds could break with an activation energy approximately 100 kJ/mol below the carbon-carbon bond dissociation energy. This decrease was believed to occur from intramolecular polymer stress, which is relieved via backbone scission. Such stress was also observed to increase the beta-scission reaction rate at high temperatures, apparently because the scission reaction alone is not always sufficient to remove the energy associated with the polymer stress concentrated near the scission location. Finally, the RMD method was also shown to be transferable and applicable in describing the decomposition of novel fire-resistant polymers.

<p>  </p> <p>Many engineering structures are designed to withstand a critical mechanical load before failure. When a load greater than the critical load is encountered, the manner of structural failure is important. Nature has been a source of technical inspiration for centuries, and the power of modern scientific investigative techniques has enhanced engineers’ abilities to learn from millennia of evolutionary mechanical refinement. </p> <p>Chitons, a family of marine mollusks, feed on algae attached to rocky substrates, and parts of their feeding organs are subjected to varied loads in the process. In this work, the manner of failure of a chiton’s tooth and supporting structure is investigated, and it is suggested that mechanical details of the structure enable load-limiting and fail-safe performance that protects the animal from potentially dangerous overloading.</p>