10 research outputs found
The effect of γ-radiation on epoxy structural adhesives: a commercial case preliminary study
No full textThis Thesis describes the Ph. D. work of the author, which regards the investigation of the effect of γ-radiation on the mechanical behavior of a commercial epoxy adhesive named 3MTM Scotch-WeldTM 2216 B/A Gray. Besides the comprehension of the adhesive behavior itself, this preliminary study aims to define a pathway to characterize the bulk characteristics of this glue starting from a standard-based approach and to use those data in the design of joints.
In Chapter 1 a brief introduction to the adhesive world has been given, composed of fundamental definitions, a description of the adhesion phenomena, the pros and cons of this kind of junction, and a general classification of polymeric structural adhesives. Then, a description of the interaction between adhesives and the environmental conditions present in nuclear, high energy physics, and aerospace fields has been given, in particular for what concerns ionizing radiations. The results of a detailed literature review have been summarized, highlighting the necessity to concentrate the studies on one adhesive since no general trends are recognizable.
In Chapter 2 are described the materials and methods used for the experimental campaigns. After a description of the chosen adhesive, an excursus on bulk and in situ specimens is proposed, which outcome is that a complete experimental campaign should involve both types of specimens. The produced specimens are then described, together with their production procedure, which is based on literature and standards and adapted to the specific case. In the second part of the Chapter, the equipment to perform the different tests (tensile test, shear test, 60Co γ-rays irradiation, ATR-FTIR, ESR spectroscopy, and colorimetric analysis) is briefly described.
Chapter 3 contains the results of the performed tests together with a critical discussion. First, an unattended post-cure effect has been detected in bulk specimens, also in absence of γ irradiation. A complete characterization of the phenomena has been conducted, and a description of the non-irradiated specimens elastoplastic behavior has been given. The variation of the behavior at different values of absorbed dose (up to 500kGy) has been described and related to the outcomes of the spectroscopic analyses. In the last part of the Chapter, results for in situ specimens are exposed. Developed ad hoc FEM models and analytical solutions based on bulk mechanical characteristics are in good agreement with the experiments for what concerns the overall stiffness of the joints but underestimate their strength because of the relevant quantity of defects encountered in bulk specimens despite the taken precautions.
The last Chapter reports a summary of the whole Thesis, extrapolating the conclusions of the work. Some potential further developments of the work are proposed, based on the obtained results and the criticalities encountered during the experimental campaigns
Partial Differential Equations — Spectral gaps and non-Bragg resonances in a water channel
No full textAbstractIn this paper the essential spectrum of the linear problem of water-waves on a 3d-channel with gently periodic bottom will be studied. We show that under a certain geometric condition on the bottom profile the essential spectrum has spectral gaps. In classical analysis of waveguides it is known that the Bragg resonances at the edges of the Brillouin zones create band gaps in the spectrum. Here we demonstrate that the band gaps can be opened also in the frequency range far from the Bragg resonances. The position and the length of the gaps are found out by applying an asymptotic analysis to the model problem in the periodicity cell.Abstract
In this paper the essential spectrum of the linear problem of water-waves on a 3d-channel with gently periodic bottom will be studied. We show that under a certain geometric condition on the bottom profile the essential spectrum has spectral gaps. In classical analysis of waveguides it is known that the Bragg resonances at the edges of the Brillouin zones create band gaps in the spectrum. Here we demonstrate that the band gaps can be opened also in the frequency range far from the Bragg resonances. The position and the length of the gaps are found out by applying an asymptotic analysis to the model problem in the periodicity cell
Ventilation strategies and risk factors for intraoperative respiratory critical events and postoperative pulmonary complications in neonates and small infants: a secondary analysis of the NECTARINE cohort<sup>☆</sup>
No full text\ua9 2025 The Author(s)Background: Optimal ventilation strategies and use of neuromuscular blocking agents (NMBAs) in neonates and small infants undergoing anaesthesia remain unclear. We examined the association of perioperative ventilation strategies and administration of NMBAs on respiratory adverse events in the NEonate-Children sTudy of Anaesthesia pRactice IN Europe (NECTARINE) cohort. Methods: We performed a secondary analysis of NECTARINE, which included infants up to 60 weeks\u27 postmenstrual age undergoing anaesthesia for surgical or diagnostic procedures. The primary endpoint was the association between ventilation mode and intraoperative respiratory adverse events. Secondary endpoints were use of NMBA, and 30-day postoperative pulmonary complications (PPCs). Results: The dataset comprised 5609 patients undergoing 6542 procedures. Pressure-controlled ventilation was the primary ventilation modality, accounting for 52.4% (n=3428) of cases. The incidence of intraoperative respiratory critical events was 20.7% (95% confidence interval [CI] 19.7–21.7%), while PPCs were observed in 17% of cases (95% CI 16.0–18.1%). Preanaesthesia respiratory conditions and NMBA use after tracheal intubation were associated with higher incidence of PPCs. Of the children receiving NMBAs, reversal was reported in 29.8%. The absence of reversal was associated with a higher incidence of PPCs, with a relative risk of 1.50 (95% CI 1.17–1.93). Conversely, NMBA reversal was associated with a reduced relative risk of 0.43 (95% CI 0.26–0.70). Conclusions: Regardless of ventilation strategy used, mechanical ventilation and baseline respiratory conditions were risk factors for a greater incidence of adverse respiratory events and PPCs. Reversal of NMBAs before tracheal extubation was significantly associated with reduced PPCs in neonates and should be routine clinical practice. Clinical trial registration: ClinicalTrials.gov (NCT02350348)
On the Hilbert function of general fat points in
No full textWe study the bi-graded Hilbert function of ideals of general fat points with same multiplicity in . Our first tool is the multiprojective-affine-projective method introduced by the second author in previous works with A.V. Geramita and A. Gimigliano where they solved the case of double points. In this way, we compute the Hilbert function when the smallest entry of the bi-degree is at most the multiplicity of the points. Our second tool is the differential Horace method introduced by J. Alexander and A. Hirschowitz to study the Hilbert function of sets of fat points in standard projective spaces. In this way, we compute the entire bi-graded Hilbert function in the case of triple points
ДОСТИЖЕНИЯ И ПРОБЛЕМЫ ПЕДИАТРИЧЕСКОЙ АНЕСТЕЗИОЛОГИИ И ИНТЕНСИВНОЙ ТЕРАПИИ
No full textThe article describes the achievements of pediatric anesthesiology and intensive care in recent years. The author focuses on the humanization of critical medicine in children, effects of anesthesia on the developing brain, pain management in children, and also examines problems of respiratory support, diagnosis and intensive therapy of sepsis in children and newborns, nutritional support in critically ill children.Рассматриваются достижения педиатрической анестезиологии и интенсивной терапии в последние годы. Автор акцентирует внимание на гуманизации медицины критических состояний у детей, влиянии анестезии на развивающийся мозг, обеспечении терапии боли у детей, а также освещает проблемы в области респираторной поддержки, диагностики и интенсивной терапии сепсиса детей и новорожденных, нутритивной поддержки у детей в критических состояниях
Peran guru PAI dalam meningkatkan kemampuan baca tulis Al-Quran di SMA Muhammadiyah 1 Gresik
No full textABSTRAK
Peran guru dalam meningkatkan kemampuan baca tulis Al-Qur’an siswa sangatlah penting. Karena disamping peran guru sebagai pengajar guru juga memiliki peran sebagai motivator siswa dalam meningkatkan motivasi siswa khususnya ketika membaca dan menulis Al-Qur’an. Membaca Al-Qur’an dan memahami maknanya merupakan pintu awal agar kita semakin memahami tentang ajaran-ajaran dan nilai yang terdapat dalam agama islam, oleh sebab itu sudah jelas dalam membaca Al-Qur’an peran guru sebagai motivator sangatlah penting agar siswa menjadi lebih semangat dalam membaca Al-Qur’an, karena sudah menjadi tugas sebagai seorang guru agama untuk selalu memberikan motivasi terhadap muridnya untuk selalu rajin membaca dan menulis Al-Qur'an serta memahami maknanya. Bahkan begitu pentingnya membaca sehingga oleh Allah dijadikan wahyu pertama yang diturunkan kepada Nabi Muhammad SAW.
Berpijak dari latar belakang di atas, maka fokus yang diambil dalam penelitian ini adalah Bagaimana upaya guru PAI dalam meningkatkan kemampuan baca tulis Al-Qur'an siswa SMA Muhammadiyah 1 Gresik, Bagaimana kemampuan baca tulis Al-Qur'an pada siswa SMA Muhammadiyah 1 Gresik. Adapun tujuan yang ingin di capai dalam penelitian ini adalah Untuk menjelaskan upaya-upaya yang dilakukan guru PAI dalam meningkatkan kemampuan baca tulis Al-Qur'an siswa SMA Muhammadiyah 1 Gresik, Untuk menjelaskan bagaimana kemampuan baca tulis Al-Qur'an pada siswa SMA Muhammadiyah 1 Gresik.
Penelitian yang penulis lakukan ini merupakan penelitian kualitatif adapun penelitian ini berjenis kualitatif deskriptif, dalam proses pengumpulan data penulis menggunakan metode observasi, interview dan dokumntasi, sedangkan tekhnik analasis yang digunakan adalah tekhnik analisis triangulasi.
Dari hasil penelitian ini, dapat ditarik kesimpulan, Upaya guru PAI dalam meningkatkan kemampuan baca tulis Al-Qur'an siswa SMA Muhammadiyah 1 Gresik adalah membuat jadwal membaca Al-Qur’an setiap pagi sebelum pelajaran dimulai, Pagi hari sebelum pelajaran dimulai diadakan ngaji bersama selama 15 menit dengan dipandu guru agama dikantor serta dibantu guru pelajaran jam pertama dalam mendampingi siswa disetiap kelas, membaca Al-Qur’an setiap pagi beserta artinya, Disetiap pelajaran baik pelajaran agama maupun pelajaran umum selalu menggunakan ayat-ayat Al-Qur’an sebagai landasan pelajaran yang akan disampaikan kepada siswa, Mata pelajaran agama islam berdurasi 3jam (120 menit) pelajaran selama 1minggu 1jamnya (40menit) digunakan untuk membaca Al-Qur’an, Pembelajaran bahasa arab berorientasi Al-Qur’an, adanya program ekstra belajar membaca Al-Qur’an yang dilaksanakan saat selesai sekolah, Pada hari sabtu diadakan ngaji bersama dikelas masing-masing sebelum pulang sekolah, Membuat buku modul Al-Qur’an, Dibiasakan untuk selalu membawa dan membaca Al-Qur’an ketika ada kegiatan didalam sekolah maupun diluar sekolah, Adanya pondok pesantren muhammadiyah madinatul ilmi sebagai salah satu fasilitas sekolah bagi siswa yang ingin agar budaya membaca Al-Qur’annya tetap terjaga dengan baik, disamping itu dipergunakannya metode Al-Barqy sehingga dapat meningkatkan kemampuan baca tulis siswa secara cepat. Upaya guru dalam meningkatkan kemampuan baca tulis Al-Qur’an siswa terbukti sangat berpengaruh terhadap meningkatnya kemampuan baca tulis Al-Qur’an siswa diSMA Muhammadiyah 1 Gresik. Dari hasil observasi berupa angket yang telah diberikan kepada siswa sebanyak 63,24% siswa semangat dalam membaca Al- Qur’an, selain itu sebanyak 55,68% siswa sangat antusias ketika mengikuti kegiatan peningkatan motivasi membaca Al-Qur’an yang diberikan guru di SMA Muhammadiyah 1 Gresik, dari hasil tersebut terbukti bahwa upaya guru dalam meningkatkan kemampuan baca tulis Al-Qur’an di SMA Muhammadiyah 1 Gresik termasuk berhasil.
ABSTRACT
The role of teachers in improving literacy students Qur'an is very important . Because in addition to the role of the teacher as the teacher of teachers also have a role as a motivator for students to motivate students, especially when reading and writing the Qur'an . Read the Qur'an and understand its meaning is early doors so that we better understand the teachings and values contained in the religion of Islam , and therefore it is clear in reading the Quran teacher's role as a motivator it is important that students become more spirit in reading the Qur'an , because it is the duty as a religious teacher to always provide motivation to students to always be diligent in reading and writing the Qur'an and understand its meaning . Even so the importance of reading to be a the first revelation from God revealed to the Prophet Muhammad SAW.
Based on the above background , the focus is taken in this study is a teacher attempts PAI How to improve the literacy of students Qur'an SMA Muhammadiyah 1 Gresik , How literacy in students Qur'an SMA Muhammadiyah 1 Gresik . The objectives to be achieved in this research is to explain the efforts made PAI teachers in improving literacy students Qur'an SMA Muhammadiyah 1 Gresik , to explain how the ability to read and write the Quran on Muhammadiyah high school students 1 Gresik.
The author 's research is qualitative research as for this type of qualitative descriptive study , the authors used the process of data collection methods of observation , interviews and dokumntasi , while analasis technique used is the analysis technique of triangulation.
From these results , it can be deduced , attempts PAI teachers in improving literacy Qur'an SMA Muhammadiyah 1 Gresik students are creating a schedule to read the Qur’an every morning before school , morning before class held the Koran with for 15 minutes with guided teacher of religion at the office and assisted in the first hour lesson teacher assisting students in each class , read the Quran every morning and their meanings , in every lesson both religious studies and general studies always use the verses of the Qur'an as foundation subjects to be presented to the students , Islamic religious subjects lasted 3 hours ( 120 minutes ) for 1minggu 1jamnya lessons ( 40 minutes ) is used to read the Quran , learning Arabic language Al - Qur'an -oriented , the extra program to learn to read Al Quran is implemented when finished school , In Saturday held the Koran with each class before school , build modules book the Koran, accustomed to always carry and read the Quran when there are activities within the school and outside of school , boarding school existence muhammadiyah Madinatul ilmi as one of the school facilities for students who wish to read the culture of Al - Quran properly maintained , besides that employed the method of Al - Barqy so as to improve students' ability to read and write quickly . Teachers' efforts to improve literacy students Qur'an proved very influential on increasing literacy Qur'an students in SMA Muhammadiyah 1 Gresik . From the observations in the form of a questionnaire given to the students as much as 63.24 % of students in the spirit of reading the Quran , but it as much as 55.68 % of the students are very enthusiastic when following activities to increase motivation to read the Qur'an in a given teacher SMA Muhammadiyah 1 Gresik , the results proved that the efforts of teachers to improve literacy Qur'an in SMA Muhammadiyah 1 Gresik including successful
Understanding national trends in COVID‐19 vaccine hesitancy in Canada – April 2020 to March 2021
No full textObjective: Key to reducing COVID‐19 morbidity and mortality and reducing the need for further lockdown measures in Canada and worldwide is widespread acceptance of COVID‐19 vaccines. Vaccine hesitancy has emerged as a key barrier to achieving optimal vaccination rates, for which there is little data among Canadians. This study examined rates of vaccine hesitancy and their correlates among Canadian adults. Methods: This study analyzed data from five age, sex and province‐weighted population‐based samples to describe rates of hesitancy between April 2020 and March 2021 among Canadians who completed online surveys as part of the iCARE Study, and various sociodemographic, clinical and psychological correlates. Vaccine hesitancy was assessed by asking: “If a vaccine for COVID‐19 were available today, what is the likelihood that you would get vaccinated?” Responses were dichotomized into ‘very likely’, ‘unlikely’, ‘somewhat unlikely’ (reflecting some degree of vaccine hesitancy) vs ‘extremely likely’ to get the vaccine, which was the comparator. Results: Overall, 15,019 respondents participated in the study. A total of 42.2% of respondents reported vaccine hesitancy over the course of the study, which was lowest during surveys 1 (April 2020) and 5 (March 2021) and highest during survey 3 (November 2020). Fully adjusted multivariate logistic regression analyses revealed that women, those aged 50 and younger, non‐Whites, those with high school education or less, and those with annual household incomes below the poverty line in Canada (i.e., $60,000) were significantly more likely to report being vaccine hesitant over the study period, as were essential and healthcare workers, parents of children under the age of 18, and those who do not get regular flu vaccines. Believing engaging in infection prevention behaviours (like vaccination) is important for reducing virus transmission and high COVID‐19 health concerns (being infected and infecting others) were associated with 77% and 54% reduction in vaccine hesitancy, respectively, and having high personal financial concerns (worried about job or income loss) was associated with 1.33 times increased odds of vaccine hesitancy. Conclusion: Results point to the importance of targeting vaccine efforts to women, younger people and socioeconomically disadvantaged groups, and that vaccine messaging should emphasize the benefits of getting vaccinated, and how the benefits (particularly to health) far outweigh the risks. Future research is needed to monitor ongoing changes in vaccine intentions and behaviour, as well as to better understand motivators and facilitators of vaccine acceptance, particularly among vulnerable groups. The copyright holder for this preprint is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY-NC-ND 4.0 International license
Attitudes towards vaccines and intention to vaccinate against COVID-19: a cross-sectional analysis - implications for public health communications in Australia
No full textObjective To examine SARS-CoV-2 vaccine confidence, attitudes and intentions in Australian adults as part of the iCARE Study. Design and setting Cross-sectional online survey conducted when free COVID-19 vaccinations first became available in Australia in February 2021. Participants Total of 1166 Australians from general population aged 18-90 years (mean 52, SD of 19). Main outcome measures Primary outcome: responses to question € If a vaccine for COVID-19 were available today, what is the likelihood that you would get vaccinated?'. Secondary outcome: analyses of putative drivers of uptake, including vaccine confidence, socioeconomic status and sources of trust, derived from multiple survey questions. Results Seventy-eight per cent reported being likely to receive a SARS-CoV-2 vaccine. Higher SARS-CoV-2 vaccine intentions were associated with: increasing age (OR: 2.01 (95% CI 1.77 to 2.77)), being male (1.37 (95% CI 1.08 to 1.72)), residing in least disadvantaged area quintile (2.27 (95% CI 1.53 to 3.37)) and a self-perceived high risk of getting COVID-19 (1.52 (95% CI 1.08 to 2.14)). However, 72% did not believe they were at a high risk of getting COVID-19. Findings regarding vaccines in general were similar except there were no sex differences. For both the SARS-CoV-2 vaccine and vaccines in general, there were no differences in intentions to vaccinate as a function of education level, perceived income level and rurality. Knowing that the vaccine is safe and effective and that getting vaccinated will protect others, trusting the company that made it and vaccination recommended by a doctor were reported to influence a large proportion of the study cohort to uptake the SARS-CoV-2 vaccine. Seventy-eight per cent reported the intent to continue engaging in virus-protecting behaviours (mask wearing, social distancing, etc) postvaccine. Conclusions Most Australians are likely to receive a SARS-CoV-2 vaccine. Key influencing factors identified (eg, knowing vaccine is safe and effective, and doctor's recommendation to get vaccinated) can inform public health messaging to enhance vaccination rates
How well do covariates perform when adjusting for sampling bias in online COVID-19 research? Insights from multiverse analyses
No full textCOVID-19 research has relied heavily on convenience-based samples, which-though often necessary-are susceptible to important sampling biases. We begin with a theoretical overview and introduction to the dynamics that underlie sampling bias. We then empirically examine sampling bias in online COVID-19 surveys and evaluate the degree to which common statistical adjustments for demographic covariates successfully attenuate such bias. This registered study analysed responses to identical questions from three convenience and three largely representative samples (total N = 13,731) collected online in Canada within the International COVID-19 Awareness and Responses Evaluation Study (www.icarestudy.com). We compared samples on 11 behavioural and psychological outcomes (e.g., adherence to COVID-19 prevention measures, vaccine intentions) across three time points and employed multiverse-style analyses to examine how 512 combinations of demographic covariates (e.g., sex, age, education, income, ethnicity) impacted sampling discrepancies on these outcomes. Significant discrepancies emerged between samples on 73% of outcomes. Participants in the convenience samples held more positive thoughts towards and engaged in more COVID-19 prevention behaviours. Covariates attenuated sampling differences in only 55% of cases and increased differences in 45%. No covariate performed reliably well. Our results suggest that online convenience samples may display more positive dispositions towards COVID-19 prevention behaviours being studied than would samples drawn using more representative means. Adjusting results for demographic covariates frequently increased rather than decreased bias, suggesting that researchers should be cautious when interpreting adjusted findings. Using multiverse-style analyses as extended sensitivity analyses is recommended
Эпидемиология медицинских ошибок и инцидентов в неотложной медицине
No full textRelevance the issues of patient care and quality management have acquired particular relevance in modern healthcare. Improvement in the clinical performance of medical technologies has led to a significant reduction in deaths and complications associated with the disease and side effects of interventions. As a result, the share of additional harm related to the process of providing medical services has become more noticeable. Accurate data regarding the type, frequency and severity of active threats and incidents they cause are needed to reduce the likelihood and severity of additional harm. In this respect, emergency medical care is the subject of special attention and is characterized by the greatest difficulty in terms of obtaining valid and relevant information about deviations associated with health worker performance, equipment operation and patient behavior.The aim of the study was to explore the main epidemiological characteristics of medical errors and incidents associated with the provision of emergency medical care.Material and methods We present a literature review followed by an analytical study of the epidemiology of incidents and active threats (including medical errors) that precede those incidents in various areas of emergency medical care. By an incident, the authors understood an event with a patient that was more related to the process of providing medical care than to the course of the disease or comorbid conditions which led or could lead to causing additional harm. Active threats included events that subsequently became the direct cause of the incident (medical errors and malpractice, mistakes and deviations in patient behavior, emergency situations in the physical environment). By the “mortality from adverse events”, the authors understood the proportion of deaths from adverse events among all hospitalized patients. By the concept of “lethality associated with adverse events”, the authors denoted the proportion of deaths from adverse events among all the patients affected by adverse events. The search for information was carried out for the period of 1995–2021 using the following medical databases: medline; cochrane collaboration; embase; scopus; isi web of science. For analysis, we used prospective and retrospective observational studies of high methodological quality, meta-analyses and systematic reviews. For the statistical evaluation of frequency characteristics, indicators of incidence, prevalence, and incidence density were used. The calculation of generalized frequency indicators for large samples was carried out with a 95% confidence interval.Results The epidemiology of medical errors and incidents depends on the area in which emergency care is provided. For prehospital emergency medical care, there are 12.45 medical errors and 4.50 incidents with consequences for every 100 visits. In emergency departments, one in fourteen patients suffers additional harm which in 10.14% of cases has severe consequences, and in 3.18% of cases leads to unexpected death. In intensive care units, incidents related to the provision of medical care are recorded in every third patient in the amount of 1.55 per 1 patient. Of these, 58.67% of incidents are accompanied by harm, but the fatality associated with the incidents is only 0.77%. The prevalence of patients affected by incidents during the provision of anesthesia for children is almost 2 times higher than for adults (4.79% vs. 2.03%). At the same time, mortality due to anesthesia-related incidents in children is 11 times lower than in adults (0.27% versus 3.09%). The author draws attention to a number of factors contributing to the development of incidents during the provision of emergency medical care. These include environmental complexity, suboptimal configuration of the workspace, technological interface complexity, the effects of acute stress on performers, and organizational vulnerabilities. A special role was assigned to environmental complexity which was studied in detail both in terms of the complexity of the tasks being solved, and in connection with obstacles to solving problems. It was shown that the intensity of the influence of various components of environmental complexity is not the same in different departments providing emergency care. Particular attention was paid to the fact that organizational vulnerabilities reduce the effectiveness of protective mechanisms during the interaction of the human factor with a complex environment.Conclusion The study showed that the provision of emergency medical care is associated with moderately high risks of incidents, including severe and critical consequences for patients. The main factor contributing to the development of incidents is environmental complexity which becomes much harder to counter under the influence of organizational vulnerabilities. Identification and registration of errors and incidents in units providing medical care is difficult due to the short time of contact with patients, the high speed of situation update, and the constant impact of chronic and acute stressors on staff. In this connection, the optimization and improvement of the efficiency of the system for recording errors and incidents in departments providing emergency medical care remains an area for improvement.АКТУАЛЬНОСТЬ Вопросы управления качеством и безопасностью медицинской помощи приобрели особую актуальность в современном здравоохранении. Повышение клинической результативности используемых медицинских технологий привело к существенному сокращению числа смертей и осложнений, связанных с заболеванием и побочными эффектами вмешательств. В результате стала более заметной доля дополнительного вреда, связанного с самим процессом оказания медицинской помощи. Для уменьшения вероятности и тяжести дополнительного вреда необходимы точные данные, касающиеся вида, частоты и тяжести активных угроз и обусловленных ими инцидентов. Неотложная медицинская помощь (НМП) в этом отношении является предметом особого внимания и характеризуется наибольшей сложностью с точки зрения получения валидной и релевантной информации об отклонениях, связанных с действиями медицинских работников, работой оборудования и поведением больного.ЦЕЛЬ ИССЛЕДОВАНИЯ Изучить основные эпидемиологические характеристики медицинских ошибок и инцидентов, связанных с оказанием НМП.МАТЕРИАЛ И МЕТОДЫ Работа представляет собой обзор литературы с последующим аналитическим исследованием эпидемиологии инцидентов и предшествующих инцидентам активных угроз (в том числе медицинских ошибок) в различных сферах оказания НМП. Под термином «инцидент» авторы понимают происшествие с пациентом, в наибольшей степени связанное с процессом оказания медицинской помощи, чем с течением заболевания или сопутствующими состояниями, которое привело или могло привести к причинению дополнительного вреда. К активным угрозам были отнесены события, которые в последующем явились непосредственной причиной инцидента (медицинские ошибки и нарушения, ошибки и нарушения в поведении больного, аварийные ситуации в физической среде). Под «смертностью» от неблагоприятных событий авторы понимали долю умерших от неблагоприятных событий среди всех госпитализированных больных. Понятием «летальность», связанная с неблагоприятными событиями, авторы обозначали долю умерших от неблагоприятных событий среди всех больных с неблагоприятными событиями. Поиск информации проведен за период 1995–2021 гг. с использованием медицинских баз данных MEDLINE, Cochrane Collaboration, EMBASE, SCOPUS, ISI Web of Science. Для анализа использованы проспективные и ретроспективные обсервационные исследования высокого методологического качества, метаанализы и систематические обзоры. Для статистической оценки частотных характеристик применялись показатели инциденса, преваленса и плотности инцидентности. Расчет обобщенных частотных показателей для больших выборок был проведен с указанием 95% доверительного интервала.РЕЗУЛЬТАТЫ Эпидемиология медицинских ошибок и инцидентов зависит от области, в которой оказывается неотложная помощь. Для догоспитальной скорой медицинской помощи на каждые 100 выездов наблюдается 12,45 медицинских ошибки и 4,50 инцидентов с последствиями. В отделениях неотложной помощи один из 14 больных становится жертвой дополнительного вреда, который в 10,14% имеет тяжелые последствия, а в 3,18% случаев приводит к непредвиденной смерти. В отделениях интенсивной терапии и реанимации инциденты, связанные с оказанием медицинской помощи, регистрируются у каждого 3-го пациента в количестве 1,55 на одного больного. Из них 58,67% инцидентов сопровождается причинением вреда, но при этом суммарная летальность, связанная с инцидентами, составляет всего 0,77%. Преваленс больных с инцидентами при оказании анестезиологического пособия у детей почти в 2 раза выше, чем у взрослых (4,79% против 2,03%). В то же время летальность, обусловленная анестезиологическими инцидентами у детей, в 11 раз ниже, чем у взрослых (0,27% против 3,09%).Автором обращено внимание на ряд факторов, способствующих развитию инцидентов при оказании НМП. К ним отнесены сложность среды, неоптимальная конфигурация рабочего пространства, сложность технологического интерфейса, последствия воздействия острого стресса на исполнителей и организационные уязвимости. Особая роль при этом отведена сложности среды, которая подробно изучена как с точки зрения сложности решаемых задач, так и с точки зрения препятствий решению задач. Показано, что интенсивность влияния различных компонентов сложности среды неодинакова в различных подразделениях, оказывающих неотложную помощь. Обращено особое внимание на то, что организационные уязвимости снижают эффективность протективных механизмов в ходе взаимодействия человеческого фактора со сложной средой.ЗАКЛЮЧЕНИЕ Проведенное исследование показало, что оказание неотложной медицинской помощи сопряжено с умеренно высокими рисками развития инцидентов, в том числе с тяжелыми и критическими последствиями для пациентов. Главным фактором, способствующим развитию инцидентов, является сложность среды, противостояние которой значительно снижается при воздействии организационных уязвимостей. Идентификация и регистрация ошибок и инцидентов в подразделениях, оказывающих медицинскую помощь, затруднена в связи коротким временем контакта с больными, высокой скоростью обновления ситуации, постоянным воздействием хронических и острых стрессоров на персонал. В связи с этим оптимизация и повышение эффективности системы учета ошибок и инцидентов в отделениях, оказывающих неотложную медицинскую помощь, остается зоной улучшения
