There is no abstract available for this thesis.

In 1999, Indiana's General Assembly enacted law requiring every Indiana school"% corporation to designate a Safety Specialist. A training and certification program was established which required the designated Safety Specialist to attend six days of training in 1999-2000, and to attend subsequent annual training.In this study, a survey was conducted among the 294 Safety Specialists from the first group of trainees to determine the impact the Safety Specialist program has had in Indiana school corporations in such areas as school climate, student behavior, administrator/teacher behavior, safety awareness, and the implementation of "best practice" programs. Variables such as school size, location, occupation of the Safety Specialist, number of buildings in the corporation, and full-time vs. part-time status of the Safety Specialist, were considered. The survey return rate was 73%.Data were analyzed using ANOVA, Pearson correlation, and a t-test. ANOVA indicated that school size, location, and the occupation of the Safety Specialist were significant (F scores greater than 1.0) in determining changes in overall safety awareness and "best practice."School corporations with more than 2000 students showed greater safety awareness and implemented "best practice" programs more often than corporations with fewer than 2000 students; urban schools indicated higher levels of safety awareness and utilized "best practice" programs more often than suburban or rural schools; schools where the Safety Specialist is the superintendent, assistant superintendent, or "other" had "best practice" programs in place and had more safety awareness than schools where the Safety Specialist was the principal, assistant principal, or teacher.Pearson correlation testing indicated little correlation between the number of school buildings and any of the research topics. However, a positive correlation of .806 did exist between school climate and administrator/teacher behavior.The t-test revealed no differences in any category between part-time and full-time Safety Specialists; mean scores in each category were similar.A follow-up case study conducted in five schools of varying size and location revealed results similar to the survey: Safety Specialists in the majority of schools considered the training to have, been worthwhile, its overall impact positive, and their schools to be safer than ever before. / Department of Educational Leadership

Division of Policy Research and Analysis, National Science Foundation under Grant no. OEP 76-00284

A small percentage of wheelchair users are unable to transfer from their wheelchair to a vehicle during transportation. Reasons for an occupant to remain in the wheelchair during transport may be the inability to safely transfer to a vehicle seat, the occupant's requirement of a specialist postural management wheelchair seating system or reliance on life support equipment attached to the wheelchair. The Rehabilitation Engineering Unit at Rookwood Hospital deal with people who require either a specialist postural support wheelchair seating system, life support equipment or both. To cater for such equipment the wheelchairs have to be modified to some degree and sometimes completely custom made. In performing modifications to the wheelchairs the Rehabilitation Engineering Unit take on the manufactures responsibilities, one of which is to ensure that the wheelchair is safe for use in transport. Standard crash tests for production wheelchairs are destructive so are impractical to use for bespoke wheelchair designs meaning that the Clinical Engineers at the Hospital have to rely on their best engineering judgement as to whether a wheelchair design is crash worthy or not. It was proposed that by using computer crash simulation techniques an informed judgement of the crashworthiness of the bespoke wheelchair designs could be attained. A series of computer models of occupied wheelchairs were created and validated against physical crash data performed on surrogate wheelchairs. These validated wheelchair computer models were then used to examine a series of different crash scenarios that provided the Clinical Engineers at Rookwood hospital with an informed process for virtually assessing the crashworthiness of their wheelchair designs. The validation results showed that the wheelchair crashworthiness could feasibly be predicted by computer simulation. This thesis concluded that attaching equipment to the wheelchair can increase both its horizontal displacement and the forces on the tiedowns securing the wheelchair to the vehicle chassis. Skewed impact simulations also highlighted the poor lateral restraint ability of the 4-point webbing tie-down system and also the importance of sufficient lateral support on the wheelchair for occupant protection.

Irrespective of all the efforts made by the Department of Labour (DoL) and other relevant stakeholders to improve the performance of Occupational Health and Safety (OH&S) in construction. In the Construction Industry, there is still a very high level of accidents and fatalities in South Africa. Injuries and accidents to workers do not help a community in any nation. The construction industry in South Africa is generally known to be one of the most hazardous and has one of the most dismal OH&S records among all industrial segments with an unacceptably high level of injuries and fatalities resulting in considerable human suffering. A doctoral study was recently conducted with the aim of investigating the effectiveness and performance of the DoL OH&S Inspectorate in South Africa. The empirical study was conducted among a range of stakeholders: civil engineering and building contractors; OH&S consultants; project managers; DoL inspectors; and designers by means of a questionnaire survey. The methodology adopted in this study included the exploratory and descriptive methods, which entails the technique of observation including the use of questionnaires and data analysis. The salient findings of the study are presented and elucidate that the DoL OH&S Inspectorate is not effective in terms of OH&S relative to the construction industry in South Africa. Conclusions and recommendations included expound that the DoL OH&S Inspectorate is not effectively conducting their duties reinforcing the need for a reviewed OH&S Inspectorate model framework. The proposed structured normative model consists of fundamental elements which would improve the effectiveness of the DoL OH&S Inspectorate. The findings of the study with recommendations are included.

This thesis, "A Hypothetical Model for System Safety in Air Transportation," is addressed to an individual having a basic technical background and some familiarity with the air transportation system in the United States. The thesis identifies the need for the benefits to be obtained from a system-side program of safety activities. The organizational framework for implementation of a system safety program is presented as well as techniques of safety analysis.

This thesis "System Safety in Rail Transportation," is addressed to an individual having a basic technical background but little or no experience in this field. The thesis discusses the need for and the benefits to be obtained by using system safety techniques and principles in the railroad industry. Examples of typical railroad accidents are reviewed, and it is pointed out that analysis of the hazards in the railroad industry prior to the accidents would have identified problems which eventually resulted in the accidents. The system safety approach, which was developed for use in the aerospace and aviation fields, has proved to be extremely effective and is now being adapted to many other areas. The surface modes of transportation have the greatest need for these techniques. The techniques covered in this thesis include Hazard Analysis, Fault or Logic Tree Analysis, Failure Modes and Effects Analysis, and Probabilistic Cost Analysis. The thesis also describes a hypothetical model for organizing and implementing system safety approaches in an existing railroad company.

Digitized by Kansas Correctional Industries

Purpose: There is a pressing need to enhance patient safety in the hospital environment. While there are many initiatives that focus on improving patient safety, few have studied engaging patients themselves to participate in patient safety efforts. This work was motived by the belief that patients can contribute valuable information to their care and when equipped with the right tools, can play a role in improving medication safety in the hospital. Methods: This research had three aims and used a mixed-methods approach to better understand the concept of engaging patients to improve medication safety. In order to gain insight into whether patients could beneficially contribute to the safety of their hospital care, my first aim was to understand current perspectives on the sharing of clinical information with patients while they were in the hospital. To accomplish this aim, I conducted surveys with clinicians and enrolled patients in a short field study in which they received full access to their clinical chart. In Aim 2, I conducted a study to establish that the Patient Activation Measure (PAM), a common measure of patient engagement in the outpatient setting, showed reliability and validity in the inpatient setting. Building on the knowledge from Aim 1 and using the PAM instrument from Aim 2, my third aim evaluated the impact of providing patients with access to a medication review tool while they were preparing to be admitted to the hospital. Aim 3 was achieved through a randomized controlled trial (RCT) involving 65 patients I recruited from the emergency department at Columbia University Medical Center. I also conducted a survey of admitting clinicians who had patients participate in the trial to identify the impact on clinician practices and to elicit feedback on their perceptions of the intervention. Results: My research findings suggest that increased patient information sharing in the inpatient setting is beneficial and desirable to patients, and generally acceptable to clinicians. The clinician survey from Aim 1 showed that most respondents were comfortable with the idea of providing patients with their clinical information. Some expressed reservations that patients might misunderstand information and become unnecessarily alarmed or offended. In the patient field study from Aim 1, patients reported perceiving the information they received as highly useful, even if they did not fully understand complex medical terms. My primary contribution in Aim 2 was to provide sound evidence that the Patient Activation Measure is a valid and reliable tool for use in the inpatient setting. Establishing the validity and reliability of the PAM instrument in inpatient setting was essential for conducting the RCT in Aim 3, and it will provide a foundation for future clinicians and research investigators to measure and understand hospital patients’ levels of engagement. The results from the RCT in Aim 3 did not support my primary hypothesis that clinicians who had patients participate in their medication review process using an informatics tool would make more changes to the home medication list than clinicians who had patients in the control group. However, the results did suggest that most hospital patients are knowledgeable, willing, and able to contribute useful and important information to the medication reconciliation process. Interestingly, the clinicians I surveyed seemed far less convinced that their patients would be able to beneficially participate in the medication reconciliation process due to low health literacy and other barriers. Nevertheless, the clinicians did seem to believe that in theory, at least, patient involvement in the medication reconciliation process could have positive impacts on their workflow and potentially save them time. Conclusion: The overall theme resulting from my research is that patients can be a valuable resource to improve patient safety in the hospital. Patients are generally knowledgeable and willing to more actively participate in their hospital care. By developing the structures and processes to facilitate greater patient engagement, hospitals can provide an extra layer of safety and error prevention, particularly with respect to the medications patients take at home. As with any medical treatment, active participation in patient safety efforts may not be possible for all patients. However, I believe that if the culture of a hospital encourages openness and transparency, and if patients are given the proper tools and information, the quality and safety of hospital care will improve.

No description available.