Approaches to reducing the most important patient errors in primary health care : patient and professional perspectives

We have previously reported a preliminary taxonomy of patient error. However, approaches to managing patients' contribution to error have received little attention in the literature. This paper aims to assess how patients and primary care professionals perceive the relative importance of different patient errors as a threat to patient safety. It also attempts to suggest what these groups believe may be done to reduce the errors, and how. It addresses these aims through original research that extends the nominal group analysis used to generate the error taxonomy. Interviews were conducted with 11 purposively selected groups of patients and primary care professionals in Auckland, New Zealand, during late 2007. The total number of participants was 83, including 64 patients. Each group ranked the importance of possible patient errors identified through the nominal group exercise. Approaches to managing the most important errors were then discussed. There was considerable variation among the groups in the importance rankings of the errors. Our general inductive analysis of participants' suggestions revealed the content of four inter-related actions to manage patient error: Grow relationships; Enable patients and professionals to recognise and manage patient error; be Responsive to their shared capacity for change; and Motivate them to act together for patient safety. Cultivation of this GERM of safe care was suggested to benefit from 'individualised community care'. In this approach, primary care professionals individualise, in community spaces, population health messages about patient safety events. This approach may help to reduce patient error and the tension between personal and population health-care.

Removal of phosphorus using NZVI derived from reducing natural goethite

Nano zero valent iron (NZVI) prepared by reducing natural goethite in hydrogen at 550 °C was used to remove phosphate. The effect of particle size, reaction time, NZVI dose, pH, initial phosphorus concentration, and oxygen amount in reaction system on phosphorus removal was investigated. The characterization of X-ray fluorescence (XRF), X-ray diffraction (XRD), N2 adsorption and desorption (BET analysis), transmission electron microscope (TEM), field emission scanning electron microscope with a energy dispersive X-ray detector (FESEM/EDS) and X-ray photoelectron spectroscopy (XPS) indicated that nanoscale of iron (around 80–150 nm length and 5–30 nm width) was prepared successfully with high dispersion and relative large surface area around 22 m2/g. The results of batch experiments and XPS analysis suggested that this kind of NZVI had a good performance on removal of phosphate (over 99%) despite in slightly acidic media as the initial concentration of P was 5 mg/L. The reason was ascribed to the effective corrosion of this NZVI under the function of proton and dissolved oxygen in spite of the existence of thin passive films.

Simultaneous determination of aldrin, dieldrin, endrin, heptachlor, and p,p'-DDT in medicinal plant extracts using a novel high performance liquid chromatography method

A high performance liquid chromatographic method for the simultaneous determination of five organochlorine pesticides (aldrin, p,p’-DDT, dieldrin, endrin, and heptachlor) was developed. The method was used to determine the levels of these pesticides in medicinal plant samples. Analysis was carried out using a Merck LiChrospher 100 RP C18 (5 μm) column with a gradient solvent system of acetonitrile-water and PDA UV detection (224 nm). Quantification was carried out by the external standard method. The limit of detection for the utilized method was below the local legal limits (ANZFA) for similar plant materials for all 5 pesticides excepting endrin. Medicinal plant extracts were further analyzed by conventional GC-ECD and GC-NPD means using SPE and GPC cleanup as required.

Modeling the co-precipitation of silica and calcium oxalate in sugar solutions

Solution chemistry plays a significant role in the rate and type of foulant formed on heated industrial surfaces. This paper describes the effect of sucrose, silica (SiO2), Ca2+ and Mg2+ ions, and trans-aconitic acid on the kinetics and solubility of SiO2 and calcium oxalate monohydrate (COM) in mixed salt solutions containing sucrose and refines models previously proposed. The developed SiO2 models show that sucrose and SiO2 concentrations are the main parameters that determine apparent order (n) and apparent rate of reaction (k) and SiO2 solubility over a 24 h period. The calcium oxalate solubility model shows that while increasing [Mg2+] increases COM solubility, the reverse is so with increasing sucrose concentrations. The role of solution species on COM crystal habit is discussed and the appearance of the uncommon (001) face is explained.

Three-phase model of consumers' behaviours : a synthesis of the theory of planned behaviour, self-determination theory and planning

Using a longitudinal study, an overall behavioural model with three related phases (cognitive, motivational and volitional phase) across three studies was examined to identify the factors that most prominently drive consumer environmental behaviour. This thesis provides empirical evidence to support the behavioural model in an environmental consumption context and shows a new avenue for promoting consumer environmental behaviour.

Studies on the clarification of juice from whole sugar cane crop

In the sugar industry, processing juice derived from the whole sugar cane plant adversely affects the yield and quality of the product sugar. Dr Thai investigated the aggregation behaviour of sugar cane juice particles and developed strategies to improve the removal of non-sucrose impurities.

The formation of gold nanoparticles using hydroquinone as a reducing agent through a localized pH change upon addition of NaOH to a solution of HAuCl4

We demonstrate a rapid synthesis of gold nanoparticles using hydroquinone as a reducing agent under acidic conditions without the need for precursor seed particles. The nanoparticle formation process is facilitated by the addition of NaOH to a solution containing HAuCl4 and hydroquinone to locally change the pH; this enhances the reducing capability of hydroquinone to form gold nucleation centres, after which further growth of gold can take place through an autocatalytic mechanism. The stability of the nanoparticles is highly dependent on the initial solution pH, and both the concentration of added NaOH and hydroquinone present in solution. The gold nanoparticles were characterized by UV–visible spectroscopy, transmission electron microscopy, Fourier transform infrared spectroscopy, atomic force microscopy, dynamic light scattering, and zeta potential measurements. It was found that under optimal conditions that stable aqueous suspensions of 20 nm diameter nanoparticles can be achieved where benzoquinone, the oxidized product of hydroquinone, acts as a capping agent preventing nanoparticles aggregation.

Promising interventions for reducing Indigenous juvenile offending

Indigenous juveniles (those aged 10 to 16 years in Queensland and 10 to 17 years in all other jurisdictions) are over-represented at all stages of the criminal justice system, and their over-representation becomes more pronounced at the most severe end of the system (ie in detention). Recent figures show that Indigenous juveniles are 24 times as likely to be detained in a juvenile correctional facility as non-Indigenous juveniles (Richards & Lyneham 2010). A variety of explanations for this over-representation have been proposed, including: • lack of access or disparate access to diversionary programs (Allard et al. 2010; Cunneen 2008; Snowball 2008); • systemic discrimination against Indigenous juveniles (eg police bias against Indigenous juveniles) (Cunneen 2008; Kenny & Lennings 2007); • inadequate resourcing of Aboriginal legal services (Cunneen & Schwartz 2008); and • genuinely higher levels of offending by Indigenous juveniles (Kenny & Lennings 2007; Weatherburn et al. 2003). A range of measures (including diversion and juvenile conferencing programs) has recently been implemented to reduce the over-representation of Indigenous juveniles in detention, and minimise the contact of juveniles with the formal criminal justice system. Diversionary measures can only have a limited impact, however, and reducing offending and reoffending have been identified as critical factors to address if the over-representation of Indigenous juveniles is to be reduced (Allard et al. 2010; Weatherburn et al. 2003). While acknowledging that other measures designed to reduce the over-representation of Indigenous juveniles are important, this paper reviews the evidence on policies and programs that reduce offending by Indigenous juveniles in Australia. Where relevant, research from comparable jurisdictions, such as New Zealand and Canada, is also discussed.

Adding SUGAR : service user and carer collaboration in mental health nursing research

‘SUGAR: Service users and carers group advising on research’ is an exciting initiative established to develop collaborative working in mental health nursing research between mental health service users, carers, researchers and practitioners at City University London, UK. This paper will describe the background to SUGAR and how and why it was established; how the group operates; some of the achievements to date including researcher reflections; and case studies of how this collaboration influences our research. Written reflective narratives of service user and carer experiences of SUGAR were analysed using constant comparative methods by the members. Common themes are presented with illustrative quotes. The article highlights the benefits and possible limitations identified so far by members of SUGAR; outlines future plans and considers the findings in relation to literature on involvement and empowerment. This paper has been written by staff and members of SUGAR and is the first venture into collaborative writing of the group and reflects the shared ethos of collaborative working.

Promoting self-determination for better health and wellbeing for adolescents who have an intellectual disability

The focus of this paper is on an Australian research project that evaluated the effectiveness of a resource called the Ask Health Diary, which is used in the school curriculum to promote self-determination for better health and wellbeing for adolescents who have an intellectual disability. Education and health researchers used questionnaires and interviews to gather data from adolescents attending special schools and special education units located in secondary schools in south-east Queensland, their teachers and their parents/carers. This paper reports on two research questions: First, ‘How did the teachers use the Ask Health Diary to promote self-determination in health?’, and second, ‘How did teachers, parents/carers and students perceive the benefits and value of the Ask Health Diary?’ The findings indicate that the Ask Health Diary provides a sound curriculum framework for teachers, adolescents and parents/carers to work together to promote self-determination and better health outcomes for young people who have an intellectual disability.

Application of lean production to reducing operational waste in a tile manufacturing process

Roofing tile manufacturing is a mass production process with high operational and inventory wastes and costs. Due to huge operational costs, excessive inventory and wastes, and quality problems, roofing tile manufacturers are trying to implement lean manufacturing practice in their operations in order to remain competitive in an ncreasingly competitive global market. The aim of this research is to evaluate the possibility of reducing the operational and inventory costs of the tile manufacturing process through waste minimization. This paper analyses the current waste situation in a tile manufacturing process and develops current and future value stream mapping for such a process with a view to implementing lean principles in manufacturing. The focus of the approach is on cost reduction by eliminating non-value-added activities.

Effectiveness of pilot car operations in reducing speeds in a long-term rural highway work zone

Pilot cars are used in one-lane two-way work zones to guide traffic and keep their speeds within posted limits. While many studies have examined the effectiveness of measures to reduce vehicle speeds in work zones, little is known about the reductions achievable through the use of pilot cars. This paper examines the effectiveness of a pilot car in reducing travel speeds in a rural highway work zone in Queensland, Australia. Analysis of speed data covering a period of five days showed that a pilot car reduced average speeds at the treatment location, but not downstream. The proportion of vehicles speeding through the activity area was also reduced, particularly those traveling at 10 km/h or more above the posted limit. Motorists were more likely to speed during the day, under a 40 kh/h limit, when traffic volumes were higher and when there were fewer vehicles in the traffic stream. Medium vehicles were less likely to speed in the presence of a pilot car than light vehicles. To maximize these benefits, it is necessary to ensure that the pilot car itself is not speeding.

The impact of risk-reducing hysterectomy and bilateral salpingo-oophorectomy on survival in patients with a history of breast cancer – a population-based data linkage study

Prophylactic surgery including hysterectomy and bilateral salpingo-oophorectomy (BSO) is recommended in BRCA positive women, while in women from the general population, hysterectomy plus BSO may increase the risk of overall mortality. The effect of hysterectomy plus BSO on women previously diagnosed with breast cancer is unknown. We used data from a population-base data linkage study of all women diagnosed with primary breast cancer in Queensland, Australia between 1997 and 2008 (n=21,067). We fitted flexible parametric breast cancer specific and overall survival models with 95% confidence intervals (also known as Royston-Parmar models) to assess the impact of risk-reducing surgery (removal of uterus, one or both ovaries). We also stratified analyses by age 20-49 and 50-79 years, respectively. Overall, 1,426 women (7%) underwent risk-reducing surgery (13% of premenopausal women and 3% of postmenopausal women). No women who had risk-reducing surgery, compared to 171 who did not have risk-reducing surgery developed a gynaecological cancer. Overall, 3,165 (15%) women died, including 2,195 (10%) from breast cancer. Hysterectomy plus BSO was associated with significantly reduced risk of death overall (adjusted HR = 0.69, 95% CI 0.53-0.89; P =0.005). Risk reduction was greater among premenopausal women, whose risk of death halved (HR, 0.45; 95% CI, 0.25-0.79; P < 0.006). This was largely driven by reduction in breast cancer-specific mortality (HR, 0.43; 95% CI, 0.24-0.79; P < 0.006). This population-based study found that risk-reducing surgery halved the mortality risk for premenopausal breast cancer patients. Replication of our results in independent cohorts, and subsequently randomised trials are needed to confirm these findings.

Firmicutes dominate the bacterial taxa within sugar-cane processing plants

Sugar cane processing sites are characterised by high sugar/hemicellulose levels, available moisture and warm conditions, and are relatively unexplored unique microbial environments. The PhyloChip microarray was used to investigate bacterial diversity and community composition in three Australian sugar cane processing plants. These ecosystems were highly complex and dominated by four main Phyla, Firmicutes (the most dominant), followed by Proteobacteria, Bacteroidetes, and Chloroflexi. Significant variation (p , 0.05) in community structure occurred between samples collected from ‘floor dump sediment’, ‘cooling tower water’, and ‘bagasse leachate’. Many bacterial Classes contributed to these differences, however most were of low numerical abundance. Separation in community composition was also linked to Classes of Firmicutes, particularly Bacillales, Lactobacillales and Clostridiales, whose dominance is likely to be linked to their physiology as ‘lactic acid bacteria’, capable of fermenting the sugars present. This process may help displace other bacterial taxa, providing a competitive advantage for Firmicutes bacteria.

Load profile based determination of distribution feeder configuration by dynamic programming

This paper presents a new method to determine feeder reconfiguration scheme considering variable load profile. The objective function consists of system losses, reliability costs and also switching costs. In order to achieve an optimal solution the proposed method compares these costs dynamically and determines when and how it is reasonable to have a switching operation. The proposed method divides a year into several equal time periods, then using particle swarm optimization (PSO), optimal candidate configurations for each period are obtained. System losses and customer interruption cost of each configuration during each period is also calculated. Then, considering switching cost from a configuration to another one, dynamic programming algorithm (DPA) is used to determine the annual reconfiguration scheme. Several test systems were used to validate the proposed method. The obtained results denote that to have an optimum solution it is necessary to compare operation costs dynamically.