Critical Incident Research Articles

Critical incidents in Colorado's opioid treatment programs: A comparison of the COVID-19 pandemic to previous years

IntroductionIn response to the COVID-19 pandemic, Substance Abuse and Mental Health Services Administration (SAMHSA) guidance allowed opioid treatment programs (OTPs) greater flexibility to provide take-home medication doses to patients. This study aims to characterize trends in the rates of critical incidents–safety events occurring in OTPs that are reportable to regulatory entities–across all Colorado OTPs during the COVID-19 pandemic. MethodsThis study is a retrospective review of critical incidents (CIs) for patients enrolled in Colorado OTPs between the years 2017 to 2022, as recorded in Colorado Behavioral Health Administration's (BHA) Opioid Treatment Program Critical Incident Repository Dataset. March 15, 2020 was considered the start of the COVID-19 pandemic in Colorado, so only incidents which occurred from March 15–December 31 of each year were included. CI rate per 100 patients was calculated by dividing CI annual count between March 15–December 31 by the census of enrolled patients at the calendar midpoint of this period, which is August 7. Means comparison tests assessed differences in CI rates. ResultsOTP patient enrollment in Colorado increased from 4377 in 2017 to 7327 in 2022. Overall, Medication Diversion accounted for 70 % of CIs, followed by Death (14 %), and Other (5 %). There was a significant increase in the overall rate of CIs from 2017 to 2022 (1.1 % to 3.4 %). The average post-COVID CI rate was higher than pre-COVID (4.0 % vs. 2.4 %). There was no difference, however, in the post-COVID rate of CIs when exclusively compared to 2019 (4.0 % vs. 4.1 %). Post-pandemic years had significantly more CIs per month than pre-pandemic years (27.6 ± 5.6 vs 15.8 ± 3.5). There was no difference in mean monthly CIs between 2019 and post-pandemic (28.5 ± 5.3 vs 27.6 ± 5.6). ConclusionsThere was no increase in the rate of reportable CIs in Colorado OTPs following the SAMHSA COVID-19 guidance increasing take-home doses when comparing 2019 to post-pandemic years. The notable increase in CI incidence occurred from 2018 to 2019, predating the pandemic. These data offer a measure of reassurance for the safety of increased take-home methadone doses. There should be further consideration of how a greater number of take-home doses might benefit both patients and OTPs.

Levels of Reflection in Teachers and Family Medicine Residents: A Qualitative Study

Objective: to analyze the levels of reflection according to Mezirow’s model in a group of teachers and residents in the Family Medicine specialty in Mexico. Methods: a qualitative study was conducted using a Word format questionnaire to collect sociodemographic data, and critical incidents related to teacher-student communication problems. The participants’ level of reflection was analyzed based on these incidents. Results: the study classified 192 events related to critical incidents, and the participants’ reflection levels were determined. 104 events (81.88%) described by teachers, and 45 events (69.23%) by residents were categorized in the first level of analysis, corresponding to non-reflective. 21 events (16.53%) by teachers, and 18 events (27.69%) by residents were situated in the second level: reflective, while 2 events (1.57%) by teachers, and 2 events (3.07%) by residents were classified as critical reflection. Conclusion: according to Mezirow’s model, the level of reflection in most participants did not lead to changes to favor behavioral modification. These findings suggest the need for additional strategies to promote critical reflection and facilitate attitudinal change in educational contexts.

Leadership behaviours during crises: cases from early childhood education and care in England

ABSTRACT In this paper, we present research into how leaders in early childhood education and care (ECEC) in England conceptualise and respond to sudden and challenging circumstances at organisational and personal levels. A distinction is made in this paper between critical incidents, such as a fire in the kitchen, and crises whereby leaders need to respond to unexpected, long term and evolving events. Although the impact of Covid-19 pandemic was uppermost in participants’ minds, crises emerging from other issues were also investigated. The data informing this study were collected during the first half of 2021, nearly a year after the start of the Covid-19 pandemic, with ECEC leaders experiencing drastic changes which extended existing perceptions of crises. The research employed qualitative methodology using interviews with 16 accountable leaders in 13 different settings, with a further interview of a local authority officer with responsibility for advising and guiding multiple settings.

Video analysis of heading and risk of head injury situations in elite international men's football: Does the frequency of headers increase with the level of play?

AbstractFootball is the only sport in which the ball can be played with the head. Therefore, compared to other ball team sports, head injuries are quite common. Headers and head injuries are dreaded to cause severe neurological impairments in long‐term, but there is still a lack of data on how often headers are performed in different levels and how often head injuries occur. In a prospective cohort study, all heading situations as well as incidents with a propensity of injury (critical incidents) of 45 elite‐level international matches were analyzed using a standardized video analysis protocol and compared to existing data from German professional leagues. A total of 3670 headers were recorded in 4050 match minutes (0.9 headers/minute). A mean of 81.5 headers per game (SD = 18.4) and 3.7 headers per player and match (SD = 0.8) was found. Compared to a cohort group of the German Bundesliga and 2nd Bundesliga, a significant reduction of −33.8 headers per game (p < 0.01) and 1.7 per player and match was found. A total of 18 risk of injury situations were recorded giving a rate per match of 0.4 (SD = 0.6). In comparison to the German league data, this also displayed a reduction. The incidence rate was 266 risk of injury situations per 1000 h match exposure, which was far below the rates of German national data (314/1000 h) and correlated with the frequency of headers performed.

Supporting Error Management and Safety Climate in Ambulatory Care Practices: The CIRSforte Study.

To improve patient safety, it is important that healthcare facilities learn from critical incidents. Tools such as reporting and learning systems and team meetings structure error management and promote learning from incidents. To enhance error management in ambulatory care practices, it is important to promote a climate of safety and ensure personnel share views on safety policies and procedures. In contrast to the hospital sector, little research has been dedicated to developing feasible approaches to supporting error management and safety climate in ambulatory care. In this study, we developed, implemented, and evaluated a multicomponent intervention to address how error management and safety climate can be improved in ambulatory care practices. In a prospective 1-group pretest-posttest implementation study, we sought to encourage teams in German ambulatory practices to use proven methods such as guidelines, workshops, e-learning, (online) meetings, and e-mail newsletters. A pretest-posttest questionnaire was used to evaluate level and strength of safety climate and psychological behavioral determinants for systematic error management. Using 3 short surveys, we also assessed the state of error management in the participating practices. In semistructured interviews, we asked participants for their views on our intervention measures. Overall, 184 ambulatory care practices nationwide agreed to participate. Level of safety climate and safety climate strength (rwg) improved significantly. Of psychological behavioral determinants, significant improvements could be seen in "action/coping planning" and "action control." Seventy-six percent of practices implemented a new reporting and learning system or modified their existing system. The exchange of information between practices also increased over time. Interviews showed that the introductory workshop and provided materials such as report forms or instructions for team meetings were regarded as helpful. A significant improvement in safety climate level and strength, as well as participants' knowledge of how to analyze critical incidents, derive preventive measures and develop concrete plans suggest that it is important to train practice teams, to provide practical tips and tools, and to facilitate the exchange of information between practices. Future randomized and controlled intervention trials should confirm the effectiveness of our multicomponent intervention.Trial registration: Retrospectively registered on 18. November 2019 in German Clinical Trials Register No. DRKS00019053.

Critical Incident Management: Strengthening the Relationship Between Crisis Negotiations and Tactical Teams

Critical Incident Management: Strengthening the Relationship Between Crisis Negotiations and Tactical Teams

When the Confounding Effect of Optimism Meets the Collider Effect of Motivation: Prospective teachers’ Moral Motives and Moral Stances

Previous studies clearly indicate the importance of exploring factors that influence teachers’/prospective teachers’ moral stances on teaching-related ethical concerns. However, none of these studies have specifically examined the moral motives of teachers/prospective teachers based on the activation of their moral regulation systems in personal, interpersonal, and social settings, while considering both the collider effect of motivation strength and the confounding effect of dispositional optimism. Such an investigation could provide deeper insights into teachers’ moral stances regarding critical incidents that give rise to ethical concerns within educational environments, particularly during the initial stages of their teaching careers (i.e., teacher education). Therefore, in the current study, prospective teachers’ moral motives were examined as predictors of their perceptions regarding unethical teacher behaviors, considering the collider effect of motivation strength and the confounding effect of dispositional optimism. 701 prospective teachers participated in the study. Comprehensive analyses, including preliminary exploratory structural equation modeling (ESEM) and a main analysis (i.e., set-ESEM), were implemented to investigate the relationships between the research variables thoroughly. The results revealed that the moral motives of ‘self-restraint’ and ‘not harming’ had a significant negative effect on the moral stances of prospective teachers regarding the adoption of unethical teacher behaviors. In contrast, the ‘social order’ moral motive had a significant positive effect on their moral stances toward adopting unethical teacher behaviors. In particular, these effects were not due to the collider effect of motivation strength or the confounding effect of dispositional optimism. Theoretical and practical implications were also discussed in the study.

Adapting feedback to the demands of teaching in diverse classrooms. Novel feedback concepts for preservice teachers during practicum

ABSTRACT During their practical training, feedback for preservice teachers should address the demands of diverse classrooms. Using the critical incident technique within a participatory research framework, this study investigated whether and how mentors adjust their feedback in this regard. Based on a sample of 33 preservice teachers and 46 mentor teachers in German primary and lower secondary education, the results indicate that although pupils’ differing prerequisites clearly presented challenges for preservice teachers, only part of the mentors referred in their feedback to these demands. Mentors who adapted their feedback referred to well-known methods for addressing differences in pupil performance and background and suggested specific novel strategies by specifying what is possible and expedient (or not) when pupils’ prerequisites and backgrounds differ. These methods were found to enhance preservice teachers’ self-efficacy and competencies in teaching diverse classes, and mutual diversity-oriented feedback also benefited mentors. In conclusion, the study identifies implications for feedback development.

Decision-Making Model Construction of Emergency Material Allocation for Critical Incidents Based on BP Neural Network Algorithm: An Overview

Decision-Making Model Construction of Emergency Material Allocation for Critical Incidents Based on BP Neural Network Algorithm: An Overview

A brittle star is born: Ontogeny of luminous capabilities in Amphiura filiformis.

Bioluminescence is the production of visible light by living organisms thanks to a chemical reaction, implying the oxidation of a substrate called luciferin catalyzed by an enzyme, the luciferase. The luminous brittle star Amphiura filiformis depends on coelenterazine (i.e., the most widespread luciferin in marine ecosystems) and a luciferase homologous to the cnidarian Renilla luciferase to produce blue flashes in the arm's spine. Only a few studies have focused on the ontogenic apparitions of bioluminescence in marine organisms. Like most ophiuroids, A. filiformis displays planktonic ophiopluteus larvae for which the ability to produce light was not investigated. This study aims to document the apparition of the luminous capabilities of this species during its ontogenic development, from the egg to settlement. Through biochemical assays, pharmacological stimulation, and Renilla-like luciferase immunohistological detection across different developing stages, we pointed out the emergence of the luminous capabilities after the ophiopluteus larval metamorphosis into a juvenile. In conclusion, we demonstrated that the larval pelagic stage of A. filiformis is not bioluminescent compared to juveniles and adults.

Collaborative self-study in higher education: lessons from redesigning school placement during the pandemic

ABSTRACT This paper explores how a collaborative self-study of teacher educators in the Republic of Ireland supported pre-service and practising teachers on teacher education programmes during the COVID-19 pandemic. Teacher educators engaged in student feedback meetings conducted online as a replacement to traditional in-school visits, some of which were supported by observation of lesson recordings viewed prior to the sessions. Teacher educators engaged in critical reflection on these feedback meetings individually, guided by a critical incident template, before reflecting collaboratively with colleagues. The redesign of online placement encouraged interrogation of practices among teacher educators and led them to a greater understanding of their practice. Actions that enhanced student learning in relation to placement included adopting a student partnership approach, peer teaching using asynchronous lessons, lesson recordings and adjusting the timing of feedback. This study falls into the broader Scholarship of Teaching and Learning and adds to the body of research exploring the innovative responses and adaptations of teacher education programmes worldwide to school and Higher Education Institution closures during the pandemic. More specifically, this study offers alternative approaches to on-site school placement.

ESPE Security: Mobile and Web Application to Manage Community Emergency Alerts

This study presents the implementation of “ESPE Security,” an application designed to manage community emergency alerts. A data collection technique was employed to understand frequent incidents in the Luz de América parish in the Santo Domingo de los Tsáchilas province. A sample of 440 residents was gathered through surveys covering an age range of 15 to 60 years, including various demographic groups such as students, traders, and the general population. The collected data revealed that approximately 87.95% of the surveyed rural parish population desires an application to report community incidents, as they have reported incidents such as traffic accidents, thefts, crimes, health issues, and homelessness. Based on these findings, a mobile and web application was developed to notify incidents in real time. The design and development of these applications involved technologies such as MongoDB, React, and Node.js, focusing on providing an intuitive user interface. Tests were conducted with 69 end-users and seven experts, employing quantitative techniques to assess design and usability. The results for design were 90%, and for usability, it was 66.70%. Therefore, mobile and web applications are helpful for real-time notification of critical incidents and will contribute to the community.

Word on the street: apparel-related critical incidents leading to eWOM and channel behaviour among millennial and Gen Z consumers

PurposeThe purpose of this study is to investigate characteristics of apparel-related critical incidents that motivate both Generation Z and Y consumers to share electronic word-of-mouth (eWOM) via specific online channels.Design/methodology/approachThe current research used an exploratory mixed-methods approach.FindingsQualitative findings of critical incidents revealed that the main situations that led to the spread of eWOM involved new purchases (49%), product quality (21%), pricing and promotions (19%), complaints (9%) and brand content (48%). Participants were motivated to spread information about the critical incidents by a desire to connect with friends and family (83%), help others (37%), influence others (48%) and express brand loyalty (32%). Quantitative results indicated significant relationships between critical incidents, motivations and eWOM channel choice.Research limitations/implicationsThis study has theoretical implications for apparel researchers attempting to gain insight into critical incidents that motivate consumers to engage in eWOM on specific channels in a positive or negative manner.Practical implicationsThese findings are important for marketers as it appears that brand content does an efficient job at driving engagement on SM; marketers need to increase efforts to engage with consumers via feedback on websites, as this is an opportunity to counteract negative experiences and retain consumers’ loyalty.Originality/valueTo the best of the authors’ knowledge, the current research is the first to extend theories of communication and motivation to connect critical incidents with situational intrinsic and extrinsic motivations for spreading eWOM via online channels for Millennial and Generation Z consumers.

Workplace trauma and professional quality of Life in clinical and forensic psychiatry: the CRITIC study.

Frontline staff in psychiatry need to perform at a very high professional level in order to ensure patient and community safety. At the same time they are exposed to high levels of stress and workplace trauma. This may have severe consequences for their professional quality of life. In addition, health care workers in general have higher incidence levels of childhood adversity than the general population. The CRITIC (CRITical Incidents and aggression in Caregivers) Study aims to improve increased understanding of the interaction between personal life history (childhood adversity and benevolence), individual capabilities, exposure to trauma and violence at work and Professional Quality of Life (ProQOL). The Critic Study is a cross-sectional survey of these aspects in frontline, treatment and administrative staff in clinical and forensic psychiatry. We aim to include 360 participants. Participants will be asked to complete questionnaires on childhood adversity and childhood benevolence (assessing personal life history), professional quality of life, current trauma and violence exposure, current mental health (depression, anxiety and stress), coping, social support, work engagement and resilience. In this study we will examine the moderating role of adverse and benevolent childhood experiences in the association between workplace trauma exposure and professional quality of life. Finally, a theoretical model on the relationships between trauma, stress and coping in the context of professional functioning will be tested using structural equation modelling. The CRITIC study examines which factors influence the complex relationship between childhood adversity and benevolence, and ProQOL in healthcare workers. It also aims to provide insight into the complex relationship between personal life history, individual characteristics, exposure to trauma and violence at work and ProQOL. The results can be used for designing interventions to increase resilience to trauma and to improve professional quality of life among health care professionals. The CRITIC study has been approved by the Medical Ethical Committee of the Erasmus Medical Centre, under trial registration number NL73417.078.20.

Psychometric properties of the Buss-Perry Aggression Questionnaire-short form among law enforcement officers.

Repeatedly capturing national headlines, excessive law enforcement officer (LEO) use of force in critical incident encounters is one of the most divisive human rights issues in the United States. Valid and reliable measures of potential precursors to LEO excessive use of force, such as aggression, are needed. The Buss-Perry Aggression Questionnaire-short form (BPAQ-SF) is a validated measure of aggression across various populations; however, evaluation of this easily administered measure in high-stress, frontline populations such as LEOs is limited. The primary goal of this study was to evaluate the validity, reliability, and sensitivity to change the BPAQ-SF in a sample of LEOs. A confirmatory factor analysis suggested that the hierarchical solution provides a mixed fit to the data:SBχ²(25.84) = 62.50, p = .0001; comparative fit index = .94, non-normed fit index = .92, root mean square error of approximation = .19 (90% confidence interval = .17-.21), standardized root mean squared residual = .08. The BPAQ-SF demonstrated good internal consistency (α = .84) and test-retest reliability (r = .86), correlations in the expected direction with predictors of and buffers against aggression, and sensitivity to change among LEOs who participated in an intervention targeting aggression. Results support and extend previous findings suggesting that the BPAQ-SF is a valid and reliable measure of aggression among LEOs.

Intraoperative Cardiac Arrest During Liposuction: A Case Report.

With the popularity of liposuction surgery, more awareness should be obtained regarding complications. Liposuction has been thought of as a safe procedure with a very low incidence of major complications. However, life-threatening risks of liposuction have rarely been reported. We present a case of a 36-year-old woman who developed cardiac arrest during a liposuction procedure, and we present a literature review. She was previously healthy and had no risk factors for pulmonary embolism. The diagnosis was made based on clinical presentation and the presence of an electrolyte disorder and a positive sign on computed tomography pulmonary angiogram (CTPA). Mild hypothermia treatment, symptomatic treatment, and supportive therapy were applied. As the respiratory and circulation were smooth, she was discharged to a rehabilitation hospital. Seven months after discharge, the patient was still in a coma with eye opening. Spinal anesthesia, pulmonary embolism, and hyperkalemia are the most probable contributors to the cardiac arrest observed during the liposuction procedure in this specific case. There is a heightened imperative to vigilantly monitor for critical incidents during these operations and to meticulously identify associated risk factors during liposuction.

Effects of curved vanes on aerodynamic performance and flow structures in highly loaded tandem cascades

Combining tandem cascades and curved vanes can mitigate the separation in highly loaded compressor cascades. Flow loss mechanisms in curved tandem cascades are crucial for fundamental design and optimization. This study investigates the flow losses and vortex structures in curved tandem cascades with different curved angles and an original straight tandem cascade. Numerical simulations are conducted at variable incidence angles. The results indicate no consistent effect of curved angles on the aerodynamic performance of curved tandem cascades. The tandem cascade with a curved angle of 5° effectively reduces losses at all incidence angles, while the tandem cascade with a curved angle of 15° extends the critical incidence angle to 3°. The comparative analyses reveal that curved vanes increase spanwise pressure gradients, causing low-energy fluid near endwalls to move toward the midspan. The weighting coefficient of losses quantitatively describes that curved vanes weaken the trailing edge shedding vortices of both vanes and passage vortex while enhancing the end wall spanwise vortex of the front vane, thus affecting the loss distribution. Finally, this study innovatively applies topological analysis methods to curved tandem cascades, establishing the relationship between topological structures and vortex structures in corner regions of tandem cascades, which provides a valid research approach to reveal the vortex dynamics mechanisms of the loss distribution in tandem cascades influenced by curved vanes.

Critical incidents as a strategy to enhance student teachers’ reflection about practice through immersive learning

ABSTRACT Critical incidents are unanticipated events (either positive or negative) that teachers may encounter during a lesson or other situation causing them to reflect on their approach and change accordingly. .Critical incidents have great potential for learning as they are vividly remembered and set the conditions for systematic reflection. However, despite the importance of the critical incident technique for professional learning in Initial Teacher Education (ITE), it is not generally used in teacher education programmes until the practicum stage when video-analysis is used. This study aims to analyse student teachers’ individual and group reflections regarding two cases recorded on video in Portugal and Spain. Under the context of an Erasmus research project entitled ‘Digital Practicum 3.0: Exploring Augmented Reality, Remote Classrooms, and Virtual Learning to enrich and expand preservice teacher education preparation (2020–1-ES01-KA226-HE - 096,120)’ two cohorts of 39 and 22 student teachers, respectively, reflected upon two critical incidents previously selected by the student teachers who had taught the two lessons that were video recorded. They had to watch the videos and analyse the incidents both in group discussion and individual reflection. Findings suggest that such a strategy is key to enhancing the development of critical reflection in Initial Teacher Education.

Academic middle leadership: An exploration of Arab women's professional identities in higher education

This study explored the professional identities of four Arab women holding academic middle leadership roles in higher education within the Arab States Region. Employing a narrative inquiry approach and guided by the Dynamic Systems Model of Role Identity, the research investigates how these women leaders perceived their career trajectories and navigated their role identities. The study sheds light on the multifaceted nature of their identity negotiations, influenced by a complex interplay of circumstances, social processes, critical incidents, key individuals, and opportunities. Notably, the study brings attention to the pervasive challenges faced by these women, not only externally but also from internalized biases ingrained within the system, perpetuated even by fellow women. The intricacies of these identity negotiations are further contextualized within micro-political processes and the inherent asymmetrical distribution of power in organizational hierarchies, marked by androcentric dominance, and lack of trust. Despite these challenges, the narratives suggest that women in these roles actively embrace collaborative and inclusive leadership styles, potentially enhancing their effectiveness in navigating the complexities of higher education leadership.

Удосконалення системи управління ризиками підприємства через впровадження системи HACCP

The article discusses the advantages and disadvantages of implementing the HACCP system, along with a detailed algorithm for its implementation. Currently, businesses are increasingly facing new challenges: growing consumer demands, stiff market competition, and heightened legislative requirements. This forces them to seek new methods of effective risk management. Despite existing practices, many companies continue to experience issues with risk management, especially in the realm of product safety. Critical incidents underscore the need for production control at all stages. Enhancing the risk management system in enterprises through the implementation of the HACCP system is a significant step towards ensuring the safety of food products. Its integration helps address issues related to potential risks in food safety within the food industry. Identification, assessment, and control of potentially hazardous factors ensure the production of safe products.