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The Serbian Orthodox Church has been described in scholarship as having had a significant impact onto the social and political life of Serbia, especially since the wars of the nineties. With the coming of the age of the Internet and social science automation, however, more options have gradually become available to researchers in the recent years. For this reason, this article will tackle the official rhetoric of the Serbian Orthodox Church in relation to the sociopolitical with the assistance of social science automation. Forming an examination via the methodological lens of Operational Code Analysis, this article delves into the Church’s discourse on Kosovo, via heavy vetting of all official statements given on the website of the Serbian Orthodox Church. It also expands upon the initial methodology – Operational Code Analysis – to an analysis of an institution with a uniform discourse, which has so far not seen light in scholarly production.

Introduction: The diagnosis of and risks associated with oral potentially malignant disorders (OPMD) have been widely reported, but little has been published on the management of OPMDs in a primary dental care setting. Hospital services face ongoing pressures due to long-term follow-up, with a need for surveillance to be jointly undertaken with primary dental care clinicians. In a primary care setting, identification and surveillance of OPMDs can be challenging as no universal guidance exists on recommended recall intervals. Corpus: In this article, an update on OPMDs is provided and, based on the practices of six Oral Medicine units in Europe (London (United Kingdom), Milan (Italy), Bordeaux (France), Porto (Portugal), Zagreb (Croatia) and Santiago de Compostela (Spain)), aiming to provide guidance on monitoring in a primary care setting in Europe. Conclusion: Oral medicine clinicians can provide guidance to general dental practitioners (GDPs) on recommended recall intervals. It is important that they feel confident in monitoring these conditions and, when concerned, to arrange referral to a hospital or appropriate specialist. GDPs should document descriptions of lesions and, if possible, take clinical photographs. Patients should be counselled on modifiable lifestyle factors and directed to oral medicine society websites to access patient information leaflets.

Introduction: Minimising spread of the COVID-19 infection through reducing face-to-face consults is essential. In doing so, alternative assessment and communication methods for management of patients with oral conditions should be considered. Material and methods: Patients on the waiting list for the joint oral medicine-paediatric dental clinic between March and June 2020 were prioritised based on a criteria including relevant medical history, diagnosis and clinical need and current management − monitoring, topical therapy or systemic therapy. A telephone consult method was chosen to assess and follow up patients and a parental satisfaction questionnaire was conducted following telephone consult. Results: Recurrent aphthous stomatitis (RAS) was the most common diagnosis of patients reviewed on the telephone clinic. Overall, the patient satisfaction questionnaire revealed that 100% of respondents would prefer a telephone consult during COVID-19 rather than face-to-face appointments. 74% opted for a video consult in preference to a telephone consult. Conclusion: This service evaluation has found telephone consults to be a valuable alternative to face-to-face consults in the management of patients with chronic oral mucosal diseases. Telephone consultations have high parental satisfaction and are an effective, convenient method to assess and follow up patients whilst maintaining their safety during the COVID-19 pandemic.

Abstract The Biostatistics and Methodological Innovation Working (BMIW) Group is one of several working groups within the CANadian Network and Centre for Trials INternationally (CANNeCTIN). This programme received funding from the Canadian Institutes of Health Research and the Canada Foundation for Innovation beginning in 2008, to enhance the infrastructure and build capacity for large Canadian-led clinical trials in cardiovascular diseases (CVD) and diabetes mellitus (DM). The overall aims of the BMIW Group's programme within CANNeCTIN, are to advance biostatistical and methodological research, and to build biostatistical capacity in CVD and DM. Our program of research and training includes: monthly videoconferences on topical biostatistical and methodological issues in CVD/DM clinical studies; providing presentations on methods issues at the annual CANNeCTIN meetings; collaborating with clinician investigators on their studies; training young statisticians in biostatistics and methods in CVD/DM trials and organizing annual symposiums on topical methodological issues. We are focused on the development of new biostatistical methods and the recruitment and training of highly qualified personnel - who will become leaders in the design and analysis of CVD/DM trials. The ultimate goal is to enhance global health by contributing to efforts to reduce the burden of CVD and DM.

Abstract Background Bone metastases are a common cause of skeletal morbidity in patients with advanced cancer. The pattern of skeletal morbidity is complex, and the number of skeletal complications is influenced by the duration of survival. Because many patients with cancer die before trial completion, there is a need for survival-adjusted methods to accurately assess the effects of treatment on skeletal morbidity. Methods Recently, a survival-adjusted cumulative mean function model has been generated that can provide an intuitive graphic representation of skeletal morbidity throughout a study. This model was applied to the placebo-control arm of a pamidronate study in patients with malignant bone disease from breast cancer. Results Analysis by bone lesion location showed that spinal metastases were associated with the highest cumulative mean incidence of skeletal-related events (SREs), followed by chest and pelvic metastases. Metastases located in the extremities were associated with an intermediate incidence of SREs, and those in the skull were associated with the lowest incidence of SREs. Conclusion Application of this model to data from the placebo arm of this trial revealed important insight into the natural history of skeletal morbidity in patients with bone metastases. Based on these observations, treatment for the prevention of SREs is warranted regardless of lesion location except for metastases on the skull.

Abstract Background The British STRATIFY tool was previously developed to predict falls in hospital. Although the tool has several strengths, certain limitations exist which may not allow generalizability to a Canadian setting. Thus, we tested the STRATIFY tool with some modification and re-weighting of items in Canadian hospitals. Methods This was a prospective validation cohort study in four acute care medical units of two teaching hospitals in Hamilton, Ontario. In total, 620 patients over the age of 65 years admitted during a 6-month period. Five patient characteristics found to be risk factors for falls in the British STRATIFY study were tested for predictive validity. The characteristics included history of falls, mental impairment, visual impairment, toileting, and dependency in transfers and mobility. Multivariate logistic regression was used to obtain optimal weights for the construction of a risk score. A receiver-operating characteristic curve was generated to show sensitivities and specificities for predicting falls based on different threshold scores for considering patients at high risk. Results Inter-rater reliability for the weighted risk score indicated very good agreement (inter-class correlation coefficient = 0.78). History of falls, mental impairment, toileting difficulties, and dependency in transfer / mobility significantly predicted fallers. In the multivariate model, mental status was a significant predictor (P < 0.001) while history of falls and transfer / mobility difficulties approached significance (P = 0.089 and P = 0.077 respectively). The logistic regression model led to weights for a risk score on a 30-point scale. A risk score of 9 or more gave a sensitivity of 91% and specificity of 60% for predicting who would fall. Conclusion Good predictive validity for identifying fallers was achieved in a Canadian setting using a simple-to-obtain risk score that can easily be incorporated into practice.

This article will review systems available to enhance practice administration using electronic data processing; areas of practice management which may be advantaged by computerisation; the advantages and disadvantages to be expected in each area; priorities and order of commitment; and the steps involved in selection and installation of a computer system in orthodontic practice.

We report an organization's method for recruiting additional, specialized human resources during anomaly handling. The method has been tailored to encourage sharing adaptive capacity across organizational units. As predicted by Woods' theory, this case shows that sharing adaptive capacity allows graceful extensibility that is particularly useful when a system is challenged by frequent but unpredictably severe events. We propose that (1) the ability to borrow adaptive capacity from other units is a hallmark of resilient systems and (2) the deliberate adjustment adaptive capacity sharing is a feature of some forms of resilience engineering. Some features of this domain that may lead to discovery of resilience and promote resilience engineering in other settings, notably hospital emergency rooms., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Objective: The study provides a comprehensive insight into how an initial receiving hospital without adequate capacity adapted to coping with a mass casualty incident after the Formosa Fun Coast Dust Explosion (FFCDE)., Methods: Data collection was via in-depth interviews with 11 key participants. This was combined with information from medical records of FFCDE patients and admission logs from the emergency department (ED) to build a detailed timeline of patients flow and ED workload changes. Process tracing analysis focused on how the ED and other units adapted to coping with the difficulties created by the patient surge., Results: The hospital treated 30 victims with 36.3% average total body surface area burn for over 5 hours alongside 35 non-FFCDE patients. Overwhelming demand resulted in the saturation of ED space and intensive care unit beds, exhaustion of critical materials, and near-saturation of clinicians. The hospital reconfigured human and physical resources differently from conventional drills. Graphical timelines illustrate anticipatory or reactive adaptations. The hospital's ability to adapt was based on anticipation during uncertainty and coordination across roles and units to keep pace with varying demands., Conclusion: Adapting to beyond-surge capacity incident is essential to effective disaster response. Building organizational support for effective adaptation is critical for disaster planning.

Objective: To explore cognitive strategies clinicians apply while performing a medication reconciliation task, handling incomplete and conflicting information., Background: Medication reconciliation is a method clinicians apply to find and resolve inconsistencies in patients' medications and medical conditions lists. The cognitive strategies clinicians use during reconciliation are unclear. Controlled lab experiments can explore how clinicians make sense of uncertain, missing, or conflicting information and therefore support the development of a human performance model. We hypothesize that clinicians apply varied cognitive strategies to handle this task and that profession and experience affect these strategies., Method: 130 clinicians participated in a tablet-based experiment conducted in a large American teaching hospital. They were asked to simulate medication reconciliation using a card sorting task (CaST) to organize medication and medical condition lists of a specific clinical case. Later on, they were presented with new information and were asked to add it to their arrangements. We quantitatively and qualitatively analyzed the ways clinicians arranged patient information., Results: Four distinct cognitive strategies were identified ("Conditions first": n = 76 clinicians, "Medications first": n = 7, "Crossover": n = 17, and "Alternating": n = 10). The strategy clinicians applied was affected by their experience ( p = .02) but not by their profession. At the appearance of new information, clinicians moved medication cards more frequently (75.2 movements vs. 49.6 movements, p < .001), suggesting that they match medications to medical conditions., Conclusion: Clinicians apply various cognitive strategies while reconciling medications and medical conditions., Application: Clinical information systems should support multiple cognitive strategies, allowing flexibility in organizing information.

Background: A widely reported ABO-mismatch accident in March of 2003 raised concerns about the reliability of the transplantation system. Because this type of failure is rare and significant, we performed a probabilistic risk assessment (PRA) of the donor-recipient matching processes for thoracic organ transplantation., Methods: A probabilistic risk assessment was performed., Results: The likelihood of accidental incompatible implantation was already low in 2003. The PRA model indicates that the likelihood of such an event was 1.38x10 per donated organ. This estimate correlates closely with the observed rate of these accidents. Based on this model, process changes put in place shortly after the accident reduced the probability to approximately 3.08x10 and changes put in place in October 2004 further reduced the probability to approximately 2.22x10 per organ donated., Conclusions: The observed and predicted likelihoods of accidental incompatible thoracic organ transplantation are comparable. These likelihoods are several orders of magnitude smaller than other hazards associated with solid organ transplantation. The PRA model indicates that changes that followed the March 2003 accident further reduced the likelihood of accidental incompatible implantation by roughly two orders of magnitude. Quantitative estimates from PRA can be used to assess risks in healthcare and to gauge the impact of system changes on these risks.

Objective: In addition to providing new capabilities, the introduction of technology in complex, sociotechnical systems, such as health care and aviation, can have unanticipated side effects on technical, social, and organizational dimensions. To identify potential accidents in the making, the authors looked for side effects from a natural experiment, the implementation of bar code medication administration (BCMA), a technology designed to reduce adverse drug events (ADEs)., Design: Cross-sectional observational study of medication passes before (21 hours of observation of 7 nurses at 1 hospital) and after (60 hours of observation of 26 nurses at 3 hospitals) BCMA implementation., Measurements: Detailed, handwritten field notes of targeted ethnographic observations of in situ nurse-BCMA interactions were iteratively analyzed using process tracing and five conceptual frameworks., Results: Ethnographic observations distilled into 67 nurse-BCMA interactions were classified into 12 categories. We identified five negative side effects after BCMA implementation: (1) nurses confused by automated removal of medications by BCMA, (2) degraded coordination between nurses and physicians, (3) nurses dropping activities to reduce workload during busy periods, (4) increased prioritization of monitored activities during goal conflicts, and (5) decreased ability to deviate from routine sequences., Conclusion: These side effects might create new paths to ADEs. We recommend design revisions, modification of organizational policies, and "best practices" training that could potentially minimize or eliminate these side effects before they contribute to adverse outcomes.

The effects of new technology on human performance in domains such as anesthesiology, commercial aviation, and nuclear power operations remain controversial. To study the impact of new technology on skilled practitioner performance, we observed the introduction of a new, highly integrated, microprocessor-based physiological monitoring system for use in cardiac anesthesia. The new computer system differed from its predecessors in method of display, human interface, level of integration, and automation of functions. A process-tracing technique was used to examine physician-computer interaction in the context of 22 anesthesia procedures for cardiothoracic surgery, most of which involved cardiopulmonary bypass. Practitioners experienced a series of problems with the new computer system. Computer system characteristics relative to the specific context of cardiac surgery created new cognitive and physical burdens that tended to congregate at times of high demand, the characteristic feature of clumsy automation. Practitioners as individuals and as a group tried to overcome these problems by adapting the computer system (system tailoring) and their behavior (task tailoring) as they learned about the interaction between characteristics of the new system and characteristics of their field of practice.

Although human engineering features are widely appreciated as a potential cause of operating room incidents, evaluating the human engineering features of devices is not widely understood. Standards, guidelines, laboratory and field testing, and engineering discipline are all proposed methods for improving the human engineering of devices. New microprocessor technology offers designers great flexibility in the design of devices, but this flexibility is often coupled with complexity and more elaborate user interaction. Guidelines and standards usually do not capture these features of new equipment, in part because technology improvements occur faster than meaningful guidelines can be developed. Professional human engineering of new devices relies on a broad, user-centered approach to design and evaluation. Used in the framework of current knowledge about human operator performance, these techniques offer guidance to new equipment designers and to purchasers and users of these devices.

Comparison of 46 handwritten and electromechanically generated blood pressure records revealed substantial differences between the recordings. The highest automated record pressures exceeded the highest pressures found in corresponding handwritten records. Similarly, the lowest pressures from automated records were lower than those from handwritten records. Seventeen records (37%) had at least three automatic blood pressure determinations with values substantially in excess of the most extreme values recorded by hand. No handwritten record contained a diastolic pressure above 110 mmHg. Discrepancies between handwritten and automatic records may arise from one or more causes. Among these are readings captured automatically but not observed by the anesthesiologist, faulty reconstruction of handwritten records from memory, and bias in favor of less controversial values.