Redundancy quantification in the safety assessment of existing concrete beam-and-slab bridges

In current practice the strength evaluation of a bridge system is typically based on firstly using elastic analysis to determine the distribution of load effects in the elements and then checking the ultimate section capacity of those elements. Ductility of the components in most bridge structures permits local yield and subsequent redistribution of the applied loads from the most heavily loaded elements. As a result a bridge can continue to carry additional loading even after one member has yielded, which has conventionally been adopted as the "failure criterion" in bridge strength evaluation. This means that a bridge with inherent redundancy has additional reserves of strength such that the failure of one element does not result in the failure of the complete system. For these bridges warning signs will show up and measures can be undertaken before the ultimate collapse is happening. This paper proposes a rational methodology for calculating the ultimate system strength and including in bridge evaluation the warning level due to redundancy. © 2004 Taylor & Francis Group, London.

Stress on the ward: evidence of safety tipping points in hospitals

Do hospitals experience safety tipping points as utilization increases, and if so, what are the implications for hospital operations management? We argue that safety tipping points occur when managerial escalation policies are exhausted and workload variability buffers are depleted. Front-line clinical staff is forced to ration resources and, at the same time, becomes more error prone as a result of elevated stress hormone levels. We confirm the existence of safety tipping points for in-hospital mortality using the discharge records of 82,280 patients across six high-mortality-risk conditions from 256 clinical departments of 83 German hospitals. Focusing on survival during the first seven days following admission, we estimate a mortality tipping point at an occupancy level of 92.5%. Among the 17% of patients in our sample who experienced occupancy above the tipping point during the first seven days of their hospital stay, high occupancy accounted for one in seven deaths. The existence of a safety tipping point has important implications for hospital management. First, flexible capacity expansion is more cost-effective for safety improvement than rigid capacity, because it will only be used when occupancy reaches the tipping point. In the context of our sample, flexible staffing saves more than 40% of the cost of a fully staffed capacity expansion, while achieving the same reduction in mortality. Second, reducing the variability of demand by pooling capacity in hospital clusters can greatly increase safety in a hospital system, because it reduces the likelihood that a patient will experience occupancy levels beyond the tipping point. Pooling the capacity of nearby hospitals in our sample reduces the number of deaths due to high occupancy by 34%.

Risk based lifetime costs assessment of a ground source heat pump (GSHP) system design: Methodology and case study

Space heating accounts for a large portion of the world's carbon dioxide emissions. Ground Source Heat Pumps (GSHPs) are a technology which can reduce carbon emissions from heating and cooling. GSHP system performance is however highly sensitive to deviation from design values of the actual annual energy extraction/rejection rates from/to the ground. In order to prevent failure and/or performance deterioration of GSHP systems it is possible to incorporate a safety factor in the design of the GSHP by over-sizing the ground heat exchanger (GHE). A methodology to evaluate the financial risk involved in over-sizing the GHE is proposed is this paper. A probability based approach is used to evaluate the economic feasibility of a hypothetical full-size GSHP system as compared to four alternative Heating Ventilation and Air Conditioning (HVAC) system configurations. The model of the GSHP system is developed in the TRNSYS energy simulation platform and calibrated with data from an actual hybrid GSHP system installed in the Department of Earth Science, University of Oxford, UK. Results of the analysis show that potential savings from a full-size GSHP system largely depend on projected HVAC system efficiencies and gas and electricity prices. Results of the risk analysis also suggest that a full-size GSHP with auxiliary back up is potentially the most economical system configuration. © 2012 Elsevier Ltd.

Stakeholder challenges in purchasing medical devices for patient safety.

OBJECTIVE: This study identifies the stakeholders who have a role in medical device purchasing within the wider system of health-care delivery and reports on their particular challenges to promote patient safety during purchasing decisions. METHODS: Data was collected through observational work, participatory workshops, and semi-structured qualitative interviews, which were analyzed and coded. The study takes a systems-based and engineering design approach to the study. Five hospitals took part in this study, and the participants included maintenance, training, clinical end-users, finance, and risk departments. RESULTS: The main stakeholders for purchasing were identified to be staff from clinical engineering (Maintenance), device users (Clinical), device trainers (Training), and clinical governance for analyzing incidents involving devices (Risk). These stakeholders display varied characteristics in terms of interpretation of their own roles, competencies for selecting devices, awareness and use of resources for purchasing devices, and attitudes toward the purchasing process. The role of "clinical engineering" is seen by these stakeholders to be critical in mediating between training, technical, and financial stakeholders but not always recognized in practice. CONCLUSIONS: The findings show that many device purchasing decisions are tackled in isolation, which is not optimal for decisions requiring knowledge that is currently distributed among different people within different departments. The challenges expressed relate to the wider system of care and equipment management, calling for a more systemic view of purchasing for medical devices.