Guidewire retention following central venous catheterisation: a human factors and safe design investigation.

BACKGROUND: Central Venous Catheterisation (CVC) has occasionally been associated with cases of retained guidewires in patients after surgery. In theory, this is a completely avoidable complication; however, as with any human procedure, operator error leading to guidewires being occasionally retained cannot be fully eliminated. OBJECTIVE: The work described here investigated the issue in an attempt to better understand it both from an operator and a systems perspective, and to ultimately recommend appropriate safe design solutions that reduce guidewire retention errors. METHODS: Nine distinct methods were used: observations of the procedure, a literature review, interviewing CVC end-users, task analysis construction, CVC procedural audits, two human reliability assessments, usability heuristics and a comprehensive solution survey with CVC end-users. RESULTS: The three solutions that operators rated most highly, in terms of both practicality and effectiveness, were: making trainees better aware of the potential guidewire complications and strongly emphasising guidewire removal in CVC training, actively checking that the guidewire is present in the waste tray for disposal, and standardising purchase of central line sets so that differences that may affect chances of guidewire loss is minimised. CONCLUSIONS: Further work to eliminate/engineer out the possibility of guidewires being retained is proposed.

In situ characterization of alloy catalysts for low-temperature graphene growth.

Low-temperature (∼450 °C), scalable chemical vapor deposition of predominantly monolayer (74%) graphene films with an average D/G peak ratio of 0.24 and domain sizes in excess of 220 μm(2) is demonstrated via the design of alloy catalysts. The admixture of Au to polycrystalline Ni allows a controlled decrease in graphene nucleation density, highlighting the role of step edges. In situ, time-, and depth-resolved X-ray photoelectron spectroscopy and X-ray diffraction reveal the role of subsurface C species and allow a coherent model for graphene formation to be devised.

Robust estimation of local genetic ancestry in admixed populations using a nonparametric Bayesian approach.

We present a new haplotype-based approach for inferring local genetic ancestry of individuals in an admixed population. Most existing approaches for local ancestry estimation ignore the latent genetic relatedness between ancestral populations and treat them as independent. In this article, we exploit such information by building an inheritance model that describes both the ancestral populations and the admixed population jointly in a unified framework. Based on an assumption that the common hypothetical founder haplotypes give rise to both the ancestral and the admixed population haplotypes, we employ an infinite hidden Markov model to characterize each ancestral population and further extend it to generate the admixed population. Through an effective utilization of the population structural information under a principled nonparametric Bayesian framework, the resulting model is significantly less sensitive to the choice and the amount of training data for ancestral populations than state-of-the-art algorithms. We also improve the robustness under deviation from common modeling assumptions by incorporating population-specific scale parameters that allow variable recombination rates in different populations. Our method is applicable to an admixed population from an arbitrary number of ancestral populations and also performs competitively in terms of spurious ancestry proportions under a general multiway admixture assumption. We validate the proposed method by simulation under various admixing scenarios and present empirical analysis results from a worldwide-distributed dataset from the Human Genome Diversity Project.

Healthcare human reliability analysis - By heart

As part of the investigations into a surgical incident involving the accidental retention inside a patient's venous system of a guide wire for central venous catheterisation (CVC), the Human Error Assessment and Reduction Technique (HEART) was used to examine the potential for further occurrences. It was found to be time-efficient and to yield plausible probabilities of human error, although its use in healthcare has challenges, suggesting adaptation would be beneficial.

The potential use of 241Am as proliferation resistant burnable poison in PWRs

This paper discusses the use of 241Am as proliferation resistant burnable poison for light water reactors. Homogeneous addition of small (as little as 0.12%) amounts of 241Am to the conventional light water reactor fuel results in significant increase in 238Pu/Pu ratio in the discharged fuel improving its proliferation resistance. Moreover, 241Am, admixed to the fuel, acts as burnable absorber allowing for substantial reduction in conventional reactivity control means without a notable fuel cycle length penalty. This is possible due to favorable characteristics of 241Am transmutation chain. The fuel cycle length penalty of introducing 241Am into the core is evaluated and discussed, as well as the impact of He production in the fuel pins and degradation of reactivity feedback coefficients. Proliferation resistance and reactivity control features related to the use of 241Am are compared to those of using 237Np, which has also been suggested as an additive to the conventional fuel in order to improve its proliferation resistance. It was found that 241Am admixture is more favorable than 237Np admixture because of the smaller fuel cycle length penalty and higher burnable poison savings. Addition of either 237Np or 241Am would provide substantial but not ultimate protection from misuse of Pu originating in the spent fuel from the commercial power reactors. Therefore, the benefits from application of the concept would have to be carefully evaluated against the additional costs and proliferation risks associated with manufacturing of 237Np or 241Am doped fuel. Although this work concerns specifically with PWRs, the conclusions could also be applied to BWRs and, to some extent, to other thermal spectrum reactor types. © 2009 Elsevier Ltd. All rights reserved.

The potential use of 241Am as proliferation resistant burnable poison

This paper discusses the use of 141Am as proliferation resistant burnable poison for light water reactors. Homogeneous addition of small (less than 1 %) amounts of 241Am to the conventional LWR fuel results in significant increase in 238Pu/Pu ratio in the discharged fuel improving its proliferation resistance. Moreover, 241Am, admixed to the fuel, acts as burnable absorber allowing for substantial reduction in conventional reactivity control means without notable fuel cycle length penalty. This is possible due to favourable characteristics of 241Am transmutation chain. The fuel cycle length penalty of introducing 241Am into the core is evaluated and discussed, as well as the impact of He production in the fuel pins and degradation of reactivity feedback coefficients. Proliferation resistance and reactivity control features related to the use of 241Am are compared to those of using 237Np, which has also been suggested as an additive to the conventional fuel in order to improve its proliferation resistance. It was found that 241Am admixture is more favourable than 237Np admixture because of the smaller fuel cycle length penalty and higher burnable poison savings.