Multifaceted Project Research Articles

Assessing the post-occupancy performance of educational design/build: the thinking while doing initiative

PurposeEducational design/build (e-d/b) curricula in university-level professional schools of architecture have flourished in recent years, internationally, as new programs are launched and the volume of built work increases dramatically. This growing body of built work, however, has typically not been subjected to rigorous behavioral assessment from the standpoint of what is actually built, as experienced through the eyes of user-recipients in the everyday milieu. The lack of rigor in this aspect of assessing the efficacy of what gets built continues to hinder evidence-based academic scholarship on this subject.Design/methodology/approachAn interdisciplinary research initiative titled Thinking While Doing, spanning the years 2013–2019, centered on exploring the inner profundities of e-d/b. As part of a multifaceted project involving seven universities in Canada and the United States, behaviorally focused post-occupancy assessments were conducted of three open-air pavilion structures from the viewpoint of 161 respondents' impressions, degree of satisfaction and everyday uses.FindingsFunctionality, community context, materiality and aesthetic factors were among the set of variables analyzed. Among the results, the three open air pavilions were viewed as tectonically sound and aesthetically iconic and were considered to be valued additions to their immediate physical contexts and local community.Research limitations/implicationsStudy limitations and directions for future research are discussed.Practical implicationsStudent learning objectives in relation to the design intent of the built structures are highlighted.Social implicationsThis evidence-based design research empowers stakeholders seeking campus-community partnership opportunities.Originality/valueThis is the first comparative, behaviorally focused appraisal of its type from the perspective of everyday user-recipients in the realm of e-d/b.

‘Do frogs have a palm?’Behind the scenes of the Norwegian translation of Les soleils des indépendances

ABSTRACT This article discusses challenges found in translator working papers from the process of translating the novel Les soleils des indépendances (Ahmadou Kourouma) into Norwegian. It also draws on interview material connected to the same translation process as well as a scholarly article written by the translator herself, Ingse Skattum. Anchored in the theoretical framework of genetic Translation Studies and the archival turn in Modernist Studies, the present article explores the translator’s decision-making by comparing cited passages from the published novel to the same textual issues in the working papers. Furthermore, it displays how the translator is faced with several difficulties that require creativity, a profound knowledge of cultural references, and a pedagogical orientation towards the reader. Thus, this article attempts to shed light upon the translator’s constant hesitation between textual alternatives. Using Skattum’s multifaceted translation project as a case, the article shows that the idea of the translator’s agency should be problematised. The overall aim is to bring attention to the underlying textual process normally invisible to the public and to call for a stronger consciousness and recognition of the translator’s complex work among laymen as well as among professionals.

The ISGyP Endocervical Adenocarcinoma Project: Master Plan Summary, Acknowledgment of Participants, and Participant Responses to Final Recommendations of the Expert Panels.

The International Society of Gynecological Pathologists carried out a multifaceted project with the broad aim of improving the pathological reporting of endocervical adenocarcinoma (EAC). The intentions were to promote and align practices with the WHO 2020 classification, which endorses HPV status-based classification of EAC and the Silva pattern-based assessment of HPV-associated EAC, to promote uniformity in applying the recent FIGO staging revisions on cervical carcinoma, and to provide best practice guidelines on all aspects of EAC pathology reporting. To facilitate the use of the new WHO/IECC classification and the Silva system, two online educational portals were set up with training and test sets of scanned slides; these remain available to society members on the ISGyP educational website. In addition, a large international collaborative individual data collection project is ongoing, aiming to ascertain the prognostic value of EAC categories, and to provide a database with the potential to address unanswered questions. A single on-site meeting was held on February 29, 2020 in Los Angeles, in advance of the USCAP Annual Meeting; all other correspondence was by email and through electronic surveys. Project participants were invited to vote and comment on the recommendations contained within the practice guideline articles. The project received an enthusiastic response from pathologists across the world. This report includes an overview and summary of all aspects of the project, a list of participants and the results of polling on practice recommendations.

Improving nursing documentation for surgical patients in a referral hospital in Freetown, Sierra Leone: protocol for assessing feasibility of a pilot multifaceted quality improvement hybrid type project

BackgroundThere is an urgent need to improve quality of care to reduce avoidable mortality and morbidity from surgical diseases in low- and middle-income countries. Currently, there is a lack of knowledge about how evidence-based health system strengthening interventions can be implemented effectively to improve quality of care in these settings. To address this gap, we have developed a multifaceted quality improvement intervention to improve nursing documentation in a low-income country hospital setting. The aim of this pilot project is to test the intervention within the surgical department of a national referral hospital in Freetown, Sierra Leone.MethodsThis project was co-developed and co-designed by in-country stakeholders and UK-based researchers, after a multiple-methodology assessment of needs (qualitative, quantitative), guided by a participatory ‘Theory of Change’ process. It has a mixed-method, quasi-experimental evaluation design underpinned by implementation and improvement science theoretical approaches. It consists of three distinct phases—(1) pre-implementation(project set up and review of hospital relevant policies and forms), (2) intervention implementation (awareness drive, training package, audit and feedback), and (3) evaluation of (a) the feasibility of delivering the intervention and capturing implementation and process outcomes, (b) the impact of implementation strategies on the adoption, integration, and uptake of the intervention using implementation outcomes, (c) the intervention’s effectiveness For improving nursing in this pilot setting.DiscussionWe seek to test whether it is possible to deliver and assess a set of theory-driven interventions to improve the quality of nursing documentation using quality improvement and implementation science methods and frameworks in a single facility in Sierra Leone. The results of this study will inform the design of a large-scale effectiveness-implementation study for improving nursing documentation practices for patients throughout hospitals in Sierra Leone.Trial registrationProtocol version number 6, date: 24.12.2020, recruitment is planned to begin: January 2021, recruitment will be completed: December 2021.

Improving the implementation of the WHO Surgical Safety Checklist in a Sierra Leone teaching hospital: Experiences from a multi-faceted patient safety improvement project.

Improving the safety of surgical care is an area of growing interest in Sierra Leona, a low resource setting where health outcomes remain poor. One tool shown to improve outcomes is the WHO Surgical Safety Checklist. We report an approach for optimising adherence in a public referral hospital in Freetown, Sierra Leone. A multi-faceted series of interventions was proposed. Planning involved service evaluation, discussion with key stakeholders and formation of a working group to develop tailored interventions. Implementation involved reformatting the local checklist, formal classroom and simulation training and introduction of protocols and visual aids. Analysis of impact was performed by prospective observation of safety processes both pre- and post-intervention. Following the intervention, there was a significant increase in the total number of intraoperative safety processes performed (38.1% pre vs 73.0% post, p <0.001). A significant improvement was noted in the performance of airway evaluation, correct administration of antibiotics, marking of the surgical site and preoperative team briefing. This project describes a series of interventions taken to improve the performance of the WHO Surgical Safety Checklist in a low resource setting. We highlight the importance of local partnership working and stakeholder engagement in implementing successful change.

Between or Beyond? Jewish British Short Stories in English since the 1970s

Looking at short stories by writers as diverse as Brian Glanville, Ruth Fainlight, Clive Sinclair, Jonathan Wilson, James Lasdun, Gabriel Josipovici, Tamar Yellin, Michelene Wandor, and Naomi Alderman, and extending from the center of Jewish British writing to its margins, this article seeks to locate the defining feature of their ‘Jewish substratum’ in conditions particular to the Jewish post-war experience, and to trace its impact across their thematic plurality which, for the most part, transcends any specifically British concerns that may also emerge, opening up an Anglophone sphere of Jewish writing. More specifically, it is argued that the unease pervading so many Jewish British short stories since the 1970s is a product of, and response to, what may very broadly be described as the Jewish experience and the precarious circumstances of Jewish existence even after the Second World War and its cataclysmic impact. It is suggested that it is prompted in particular by the persistence of the Holocaust and the anxieties the historical event continues to produce; by the confrontation with competing patterns of identification, with antisemitism, and with Israel; and by anxieties of non-belonging, of fragmentation, of dislocation, and of dissolution. Turned into literary tropes, these experiences provide the basis of a Jewish substratum whose articulation is facilitated by the expansion of Jewish British writers into the space of Anglophone Jewish writing. As a result, the Jewish British short story emerges as a multifaceted and hybrid project in continuous progress.

Reflexive Poetry

These four poems are excerpts from a multifaceted project entitled Queerly Faithful: A Queer-Poet Community Autoethnography on Identity and Belonging in Faith Communities. This project attempts to bolster and critique contemporary studies of queer and faith identities as they manifest in the lives of queer people of faith by approaching the subject with a queer sensibility (Holman Jones &amp; Adams 2010: 204). One facet of this approach involved my use of poetry as a personal reflexive medium on the research process itself. The poems invite the reader into my experience as I wrestle with articulating methodology, theory framing, data presentation, and the questions and challenges of producing a fixed document to present the findings of a queer project that resists fixedness. By blurring the lines between poetry/narrative/storytelling and social science writing, I invite the readers “to become coparticipants, engaging the storyline morally, emotionally, aesthetically, and intellectually” (Ellis &amp; Bochner 2000: 745). The poems, which are scattered throughout the research paper, nuance the traditional academic language and prose analysis in the paper and serve to challenge conceptions of ‘proper’ social science writing and position the writing itself as a method of inquiry (Prendergast, Leggo &amp; Sameshima 2009; Richardson &amp; St. Pierre 2005; Richardson 1993). The poems in isolation, as presented here, invite the reader to consider the strengths and challenges of social science research and articulate my struggle to honour the sacred stories of my participants through fixed language. The poems play with the questions: what does it mean to be a social justice researcher and how might our work, methodologically as well as topically, critique and undermine oppressive epistemologies that elevate and prioritize certain voices over others?

Community Information Campaigns Improve Girls' Education: Evidence from an RCT in Zimbabwe

We examine the impact of a randomized Girls' Education Challenge project implemented in rural Zimbabwe. The multifaceted project initially provided information about girls' rights and education barriers to girls, caregivers, teachers, and other community members. Later, the project introduced a learn-to-read program and provided resources such as bicycles and books. The information campaign significantly improved mathematics performance and school enrolment in a short time frame. The subsequent provision of resources and curriculum changes corresponded to improvements in literacy but did not correspond to any additional improvements in mathematics and enrolment beyond what was observed following the information provision alone.

Creating a culture of respect and interprofessional teamwork on a labor and birth unit: a multifaceted quality improvement project

ABSTRACTInterprofessional teamwork is essential to high-quality healthcare, however disrespect and incivility amongst team members is a challenge to creating and sustaining effective teams. We describe and assess the impact of a multifaceted improvement project with the primary intervention being a Compassionate Communication (CC) training on a Labor and Birth unit. Our hypothesis was this improvement project would increase staff members’ capacity for perspective-taking and self-reflection, which would in turn correlate with positive interpersonal interactions, respect and teamwork. Secondly, we hypothesized that enhanced respect and teamwork would correlate with enhanced affective commitment to the organization. Staff was surveyed midway through the project and 6 months after the CC training. A total of 74 (57%) staff completed the initial pre-training surveys and 50 (38%) staff completed post-training surveys. At 6 months post-CC training we saw changes in self-reflection and an awakening of self-awareness. There were no significant changes in perspective-taking. However, we did see changes in staffs’ perceptions of respect and teamwork. Team members’ affective commitment to the organization increased. In this Labor and Birth setting, a multifaceted improvement project with the primary intervention being CC training was beneficial in improving a culture of respect and interprofessional teamwork.

Going Digital to Enrich Research and Engage the Public

Developing a public-facing website expanded the scope of my book project about pioneer monuments by opening new research questions. As public attention turned toward controversial monuments, I reimagined the role of my website. No longer just a companion to a scholarly monograph, it became a central piece of a new, multifaceted public engagement project. I now seek to inform ongoing debates about controversial statues, and to spark conversations in locations where similar monuments have thus far been less controversial.

Mana Tupuna: Honoring the Ancestors Abroad

The Mana Tupuna Project reimagines the connection between contemporary Rapanui people and the carvings of their ancestors. The inaugural iteration of this multifaceted project focuses on the Mulloy collection in the University Wyoming Museum of Art. By digitally bridging between museum art abroad and people on Rapa Nui, this project reinforces Polynesian language, culture, and values in both local and global settings. Beginning in March 2020, international travel and tourism to Rapa Nui (Easter Island) stopped due to the COVID-19 pandemic and the island was in a state of relative isolation for nearly two and a half years. Resilient and indomitable as ever, the people of Rapa Nui took this time to refocus on traditional farming, fishing, Rapanui language, and cultural revitalization projects. The Mana Tupuna project, which is a collaboration between the Rapa Nui Tour Guides Association, Rapa Nui wood carvers, and the author, explores and assesses colonial discourses, their effects on the art and culture of Rapa Nui, and the possibilities for more sustainable forms of tourism that do not rely solely on people physically visiting the island. The applications that support Mana Tupuna function as language and culture revitalization tools. Educational institutions on Rapa Nui have already begun to use them. These applications re-anchor Rapa Nui wood carvings from the 1950s and 1960s, now residing in the University of Wyoming Art Museum, to the people and places of Rapa Nui via 3D modeling, 360° photography, virtual reality, and the internet. Crucially, the global tourist audience can also access versions of these applications. Wood carvings (moai toromiro), among the first trade goods exchanged between Europeans and the Rapanui, have been a key element of social interactions between the islanders and their visitors since the first Europeans visited the island 300 years ago. This article, which privileges traditional Polynesian cultural values, explores the history of Rapa Nui wood carving and Western views of this tradition.

Utilizing Microbiome and Bioinformatic Tools to Reduce Food Waste in Poultry

ObjectivesIn chicken harvest, the post-harvest chilling process is a crucial step for food safety. Most facilities use either water immersion chilling (WC) or air chilling (AC) to rapidly cool the chicken. A holistic assessment of the consequences of each method to meat quality and shelf life is necessary to determine the impacts of each method. To address this knowledge gap, a multi-faceted project was conducted to determine how the chilling system influenced the microbial ecology and subsequent deterioration of chicken breasts.Materials and MethodsThe study was conducted using a 2 × 2 × 2 factorial design to evaluate the impacts of chilling method (AC vs. WC), fabrication method (bone-in vs. boneless; BI vs. BL), and cold storage period (7 vs. 14 d) on the microbial ecology of chicken breasts. A total of 256 chicken carcasses were used for this study. Carcasses were obtained from a commercial processing plant following dressing and a single antimicrobial treatment. Twenty carcasses were removed for sampling as warm carcasses, and the remaining 236 were divided into eight groups for processing (AC-BI, AC-BL, WC-BI, WC-BL tray-wrapped for 7- and 14-d storage). Collection time-points included: warm, post-chilling, post-fabrication, post-storage, and after 3-d retail display. Microbiome samples were collected at each sampling using a PBS rinsate. Then, samples were further processed for microbiome analysis following standard methods, sequenced for the V4 region of the 16S rRNA gene, and analyzed using the QIIME2 pipeline.ResultsThere were significant differences in microbial diversity between different chilling methods, fabrications methods, and cold storage times. Both chilling methods were different from the warm carcasses based on α diversity metrics, though the two chilling methods were not different from each other. However, there were differences in the β diversity between all three groups. Storage day significantly altered the faith’s phylogenetic α diversity but had no impact on Shannon’s α diversity. By both metrics, the diversity was reduced with increased length of storage, suggesting that a few organisms begin to dominate the product during dark storage. The fabrication methods also resulted in significantly different diversities when phylogenetic metrics (Faith’s, unweighted UniFrac) were used. The products that were sampled prior to dark storage, regardless of chilling method, were dominated by Enterobacteriaceae, while those that were subjected to cold storage were dominated by Pseudomonadaceae. In the stored samples, AC samples tended to have a greater abundance of Moraxellaceae and Enterobacteriaceae than WC.ConclusionThese results suggest that different treatments of chicken breasts, including chilling, fabrication, and storage time, all correspond with changes to the product microbiome. These data will be combined with microbiology, physiochemical, nutritive, and taste and color data as well as a techno-economic analysis to provide a deeper understanding of impacts of processing methods on poultry quality and shelf life.

MAKING OLD BONES: QUALITY IMPROVEMENT IN OSTEOPOROSIS MANAGEMENT IN A GERIATRIC PRIMARY CARE CLINIC

Osteoporotic fractures and their sequelae are a leading cause of morbidity and mortality in older adults. In the United States, nearly 50% of white women and 20% of black women and white men will suffer a fragility fracture in his or her lifetime. Osteoporosis medications reduce the risk of major fragility fracture by 31-62%, but numerous care gaps exist, including screening rates as low as 1-47% and treatment rates as low as 16-30% even after a fracture has already occurred. From January to August 2019, we conducted a multi-faceted quality improvement project at a university hospital-based geriatric primary care clinic, with a goal of improving our rates of osteoporosis screening and treatment. We designed and tested electronic health record-based registries of eligible patients, and developed patient outreach workflows and physician “inreach” workflows. We piloted a bone health clinic. While we did not meaningfully affect the rate of osteoporosis screening, our efforts resulted in an increase in treatment of osteoporosis from 49% to 53%. Documentation of osteoporosis decision making among eligible patients improved from 66% to 80%. In our clinic, ongoing barriers to evidence-based osteoporosis management include competition for time with other medical issues, patient mistrust of medications, and the complexity of decision making around osteoporosis in older adults with polypharmacy and limited life expectancy. Future work must balance the broad application of treatment guidelines via population health tools with the need to individualize treatment decisions for each patient’s overall health and goals of care.

Finding alternative roles for Traditional Birth Attendants: an experience from the south of Angola

Abstract Background Reduction of maternal mortality ratio (MMR), a key indicator contained in the Sustainable Development Goals (SDGs), is strictly related to maternal empowerment and to an increasing access to skilled care in pregnancy, childbirth and postpartum. The WHO recommends to define alternative roles for Traditional Birth Attendants (TBAs) in the transition from birth with TBAs to birth with Skilled Birth Attendants (SBAs), in particular in countries where maternal care services still do not meet recommended standards. Objectives In 2018, the Italian Non-Governmental Organization Doctors with Africa CUAMM and the District Health Department of Ombadja (a 350000 inhabitants district in Cunene province, south of Angola) started a three-year multifaceted project to support and strengthen local health services. Aim of this work is to describe the first six months of an implemented activity involving 120 local TBAs, identified and trained to perform basic educational talks in the district territory regarding topical issues of mother and child health. TBAs were also engaged in the referral of pregnant women to health facilities with SBAs. Results From June to November 2018, TBAs performed 2272 talks about maternal and child health issues: healthy pregnancy (551 talks, 24.3%), nutrition (404, 17.8%) and malaria (370, 16.3%) were the most debated topics. The total of women’s presences during these educational talks was 57504, and 15379 of them (26.7%) were pregnant. TBAs referred to health facilities 226 pregnant women for a delivery assisted by SBAs. Conclusions Angolan estimated MMR in 2015 was 477/100000 live births: therefore, more efforts should be made to contribute to the achievement of 2030 SDGs target of 70/100000 globally. Moreover, the country percentage of deliveries assisted by SBAs is less than 50%. Promoting alternative roles for TBAs into the mother and child health framework could represent an effective way to improve maternal and neonatal outcomes. Key messages According to the World Health Organization, defining alternative roles for traditional birth attendants could represent an effective way to support the health of women and children. Traditional Birth Attendants can play an important role in providing basic health education and in the “referral chain” of pregnant women to health facilities with skilled birth attendants.

What Lies Ahead?

How will trends in climate change, alternative energy, high-tech construction, autonomous vehicles, smart cities, and public funding affect communities, infrastructure, and the practice of civil engineering in the short and long terms? And how can civil engineers prepare now for a future that is so uncertain? These are the questions that ASCE is helping members answer with its new multifaceted project, Future World Vision: Infrastructure Reimaged.

IDEAL: Institutions Developing Excellence in Academic Leadership

The goal of this project is to contribute to the development of a national science and engineering academic workforce that includes the full participation of women at all levels of faculty and academic leadership, particularly at the senior academic ranks, through the transformation of institutional practices, policies, climate, and culture. Case Western Reserve University (CWRU) proposes a multifaceted project called Academic Careers in Engineering and Science (ACES) to increase the number of women faculty in science and engineering at all academic ranks. The ACES project will operate on 3 levels: (1) At the highest levels of leadership of the University, including the President, Provost, and Deputy Provost. This leadership is committed to fundraising for 5 endowed chairs to attract senior women scientists and engineers and to annual evaluation of deans' progress toward transformational change. (2) At the school and departmental level with intensive coaching, mentoring, networking, and training and development of deans, chairs, faculty, and students in 4 test departments in Phase 1, and extension of the best practices to all science and engineering departments in Phase 2. (3) At the campus-wide level with distinguished lectureships for senior women in science and engineering, mentoring opportunities, a spousal hiring network, and a unique minority pipeline initiative including faculty exchanges with Fisk University and summer research internships. The outcome of the proposed institutional transformation will be increased transparency and accountability as well as more equitable practices, procedures, and structures. Throughout the ACES project, CWRU will self-study, evaluate, and disseminate the findings so that other private institutions can benefit from their work, building on a resource equity study begun two years ago. Case Western Reserve University is at a pivotal time in its history, and is poised to make transformational change at every level of the university.

Ara Irititja and Ara Winki in the APY Lands: connecting archives to communities through mobile apps on portable devices

ABSTRACTAra Irititja is an enduring and multifaceted project that returns and collectively documents Anangu historical material and preserves it for the future. This paper explains why the archival project has been so effective in engaging Indigenous communities and what it is doing to ensure its longevity. In particular, the paper provides details about a new pilot project which has resulted in a software application entitled Ara Winki No. 1, ‘a whole lot of stories’, specifically for use on portable electronic devices, which delivers historical and cultural content of relevance to Anangu in local languages and works to connect the existing archive to younger generations.

Utilizing Microbiome and Bioinformatic Tools to Reduce Food Waste in Poultry

ObjectivesIn chicken harvest, the post-harvest chilling process is a crucial step for food safety. Most facilities use either water immersion chilling (WC) or air chilling (AC) to rapidly cool the chicken. A holistic assessment of the consequences of each method to meat quality and shelf life is necessary to determine the impacts of each method. To address this knowledge gap, a multi-faceted project was conducted to determine how the chilling system influenced the microbial ecology and subsequent deterioration of chicken breasts.Materials and MethodsThe study was conducted using a 2 × 2 × 2 factorial design to evaluate the impacts of chilling method (AC vs. WC), fabrication method (bone-in vs. boneless; BI vs. BL), and cold storage period (7 vs. 14 d) on the microbial ecology of chicken breasts. A total of 256 chicken carcasses were used for this study. Carcasses were obtained from a commercial processing plant following dressing and a single antimicrobial treatment. Twenty carcasses were removed for sampling as warm carcasses, and the remaining 236 were divided into eight groups for processing (AC-BI, AC-BL, WC-BI, WC-BL tray-wrapped for 7- and 14-d storage). Collection time-points included: warm, post-chilling, post-fabrication, post-storage, and after 3-d retail display. Microbiome samples were collected at each sampling using a PBS rinsate. Then, samples were further processed for microbiome analysis following standard methods, sequenced for the V4 region of the 16S rRNA gene, and analyzed using the QIIME2 pipeline.ResultsThere were significant differences in microbial diversity between different chilling methods, fabrications methods, and cold storage times. Both chilling methods were different from the warm carcasses based on α diversity metrics, though the two chilling methods were not different from each other. However, there were differences in the β diversity between all three groups. Storage day significantly altered the faith’s phylogenetic α diversity but had no impact on Shannon’s α diversity. By both metrics, the diversity was reduced with increased length of storage, suggesting that a few organisms begin to dominate the product during dark storage. The fabrication methods also resulted in significantly different diversities when phylogenetic metrics (Faith’s, unweighted UniFrac) were used. The products that were sampled prior to dark storage, regardless of chilling method, were dominated by Enterobacteriaceae, while those that were subjected to cold storage were dominated by Pseudomonadaceae. In the stored samples, AC samples tended to have a greater abundance of Moraxellaceae and Enterobacteriaceae than WC.ConclusionThese results suggest that different treatments of chicken breasts, including chilling, fabrication, and storage time, all correspond with changes to the product microbiome. These data will be combined with microbiology, physiochemical, nutritive, and taste and color data as well as a techno-economic analysis to provide a deeper understanding of impacts of processing methods on poultry quality and shelf life.

Multi-Site Bilingual Team-Based Grounded Theory Research: A Retrospective Methodological Review

Successful management of a multi-site bilingual team-based grounded theory study requires overcoming key challenges associated with implementation of a large-scale, multi-faceted project. This article retrospectively reviews the methodological strategies employed during a multi-site bilingual team-based grounded theory study that investigated the professional adaptation experiences of migrant social workers in Canada. The article presents the strategies that the research team engaged to overcome numerous challenges and successfully work together across a variety of contexts and systems, including (a) provincial contexts, (b) languages, (c) university systems, (d) virtual spaces, and (e) epistemological perspectives. The findings highlight the importance of leadership and teamwork as central to successful project completion.

It’s Like Scanning the Spoon: Problems and Interventions in Insulin Pen Safety

This paper describes a multifaceted patient safety project undertaken to address the complex medication safety issues of single-patient insulin pens in the hospital setting. The project makes the following contributions: a) provides observation- and data-based insight into root causes for the wrong pen/wrong patient problem; b) provides multiple solutions that can work together to significantly reduce the incidence of insulin pen-related safety events; c) shows how Quality and Safety methodologies can work hand-in-hand with human factors and human computer interaction methodologies to produce richer, more in depth results, and d) confirm expert recommendations for best practices that can reduce risks.