Team communications in surgery - creating a culture of safety

As a key department within a healthcare organisation, the operating room is a hazardous environment, where the consequences of errors are high, despite the relatively low rates of occurrence. Team performance in surgery is increasingly being considered crucial for a culture of safety. The aim of this study was to describe team communication and the ways it fostered or threatened safety culture in surgery. Ethnography was used, and involved a 6-month fieldwork period of observation and 19 interviews with 24 informants from nursing, anaesthesia and surgery. Data were collected during 2009 in the operating rooms of a tertiary care facility in Queensland, Australia. Through analysis of the textual data, three themes that exemplified teamwork culture in surgery were generated: ‘‘building shared understandings through open communication’’; ‘‘managing contextual stressors in a hierarchical environment’’ and ‘‘intermittent membership influences team performance’’. In creating a safety culture in a healthcare organisation, a team’s optimal performance relies on the open discussion of teamwork and team expectation, and significantly depends on how the organisational culture promotes such discussions.

Analyzing the effectiveness of graph metrics for anomaly detection in online social networks

Online social networks can be modelled as graphs; in this paper, we analyze the use of graph metrics for identifying users with anomalous relationships to other users. A framework is proposed for analyzing the effectiveness of various graph theoretic properties such as the number of neighbouring nodes and edges, betweenness centrality, and community cohesiveness in detecting anomalous users. Experimental results on real-world data collected from online social networks show that the majority of users typically have friends who are friends themselves, whereas anomalous users’ graphs typically do not follow this common rule. Empirical analysis also shows that the relationship between average betweenness centrality and edges identifies anomalies more accurately than other approaches.

Nurse staffing levels and the incidence of mortality and morbidity in the adult intensive care unit : a literature review

BACKGROUND: Studies have shown that nurse staffing levels, among many other factors in the hospital setting, contribute to adverse patient outcomes. Concerns about patient safety and quality of care have resulted in numerous studies being conducted to examine the relationship between nurse staffing levels and the incidence of adverse patient events in both general wards and intensive care units. AIM: The aim of this paper is to review literature published in the previous 10 years which examines the relationship between nurse staffing levels and the incidence of mortality and morbidity in adult intensive care unit patients. METHODS: A literature search from 2002 to 2011 using the MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, and Australian digital thesis databases was undertaken. The keywords used were: intensive care; critical care; staffing; nurse staffing; understaffing; nurse-patient ratios; adverse outcomes; mortality; ventilator-associated pneumonia; ventilator-acquired pneumonia; infection; length of stay; pressure ulcer/injury; unplanned extubation; medication error; readmission; myocardial infarction; and renal failure. A total of 19 articles were included in the review. Outcomes of interest are patient mortality and morbidity, particularly infection and pressure ulcers. RESULTS: Most of the studies were observational in nature with variables obtained retrospectively from large hospital databases. Nurse staffing measures and patient outcomes varied widely across the studies. While an overall statistical association between increased nurse staffing levels and decreased adverse patient outcomes was not found in this review, most studies concluded that a trend exists between increased nurse staffing levels and decreased adverse events. CONCLUSION: While an overall statistical association between increased nurse staffing levels and decreased adverse patient outcomes was not found in this review, most studies demonstrated a trend between increased nurse staffing levels and decreased adverse patient outcomes in the intensive care unit which is consistent with previous literature. While further more robust research methodologies need to be tested in order to more confidently demonstrate this association and decrease the influence of the many other confounders to patient outcomes; this would be difficult to achieve in this field of research.

Static analysis of executables for collaborative malware detection on Android

Smartphones are getting increasingly popular and several malwares appeared targeting these devices. General countermeasures to smartphone malwares are currently limited to signature-based antivirus scanners which efficiently detect known malwares, but they have serious shortcomings with new and unknown malwares creating a window of opportunity for attackers. As smartphones become host for sensitive data and applications, extended malware detection mechanisms are necessary complying with the corresponding resource constraints. The contribution of this paper is twofold. First, we perform static analysis on the executables to extract their function calls in Android environment using the command readelf. Function call lists are compared with malware executables for classifying them with PART, Prism and Nearest Neighbor Algorithms. Second, we present a collaborative malware detection approach to extend these results. Corresponding simulation results are presented.

Smartphone malware evolution revisited : Android next target?

Smartphones started being targets for malware in June 2004 while malware count increased steadily until the introduction of a mandatory application signing mechanism for Symbian OS in 2006. From this point on, only few news could be read on this topic. Even despite of new emerging smartphone platforms, e.g. android and iPhone, malware writers seemed to lose interest in writing malware for smartphones giving users an unappropriate feeling of safety. In this paper, we revisit smartphone malware evolution for completing the appearance list until end of 2008. For contributing to smartphone malware research, we continue this list by adding descriptions on possible techniques for creating the first malware(s) for Android platform. Our approach involves usage of undocumented Android functions enabling us to execute native Linux application even on retail Android devices. This can be exploited to create malicious Linux applications and daemons using various methods to attack a device. In this manner, we also show that it is possible to bypass the Android permission system by using native Linux applications.

An Android application sandbox system for suspicious software detection

Smartphones are steadily gaining popularity, creating new application areas as their capabilities increase in terms of computational power, sensors and communication. Emerging new features of mobile devices give opportunity to new threats. Android is one of the newer operating systems targeting smartphones. While being based on a Linux kernel, Android has unique properties and specific limitations due to its mobile nature. This makes it harder to detect and react upon malware attacks if using conventional techniques. In this paper, we propose an Android Application Sandbox (AASandbox) which is able to perform both static and dynamic analysis on Android programs to automatically detect suspicious applications. Static analysis scans the software for malicious patterns without installing it. Dynamic analysis executes the application in a fully isolated environment, i.e. sandbox, which intervenes and logs low-level interactions with the system for further analysis. Both the sandbox and the detection algorithms can be deployed in the cloud, providing a fast and distributed detection of suspicious software in a mobile software store akin to Google's Android Market. Additionally, AASandbox might be used to improve the efficiency of classical anti-virus applications available for the Android operating system.

Collaborative intrusion detection framework : characteristics, adversarial opportunities and countermeasures

Complex Internet attacks may come from multiple sources, and target multiple networks and technologies. Nevertheless, Collaborative Intrusion Detection Systems (CIDS) emerges as a promising solution by using information from multiple sources to gain a better understanding of objective and impact of complex Internet attacks. CIDS also help to cope with classical problems of Intrusion Detection Systems (IDS) such as zero-day attacks, high false alarm rates and architectural challenges, e. g., centralized designs exposing the Single-Point-of-Failure. Improved complexity on the other hand gives raise to new exploitation opportunities for adversaries. The contribution of this paper is twofold. We first investigate related research on CIDS to identify the common building blocks and to understand vulnerabilities of the Collaborative Intrusion Detection Framework (CIDF). Second, we focus on the problem of anonymity preservation in a decentralized intrusion detection related message exchange scheme. We use techniques from design theory to provide multi-path peer-to-peer communication scheme where the adversary can not perform better than guessing randomly the originator of an alert message.

Framework for evaluating collaborative intrusion detection systems

Securing IT infrastructures of our modern lives is a challenging task because of their increasing complexity, scale and agile nature. Monolithic approaches such as using stand-alone firewalls and IDS devices for protecting the perimeter cannot cope with complex malwares and multistep attacks. Collaborative security emerges as a promising approach. But, research results in collaborative security are not mature, yet, and they require continuous evaluation and testing. In this work, we present CIDE, a Collaborative Intrusion Detection Extension for the network security simulation platform ( NeSSi 2 ). Built-in functionalities include dynamic group formation based on node preferences, group-internal communication, group management and an approach for handling the infection process for malware-based attacks. The CIDE simulation environment provides functionalities for easy implementation of collaborating nodes in large-scale setups. We evaluate the group communication mechanism on the one hand and provide a case study and evaluate our collaborative security evaluation platform in a signature exchange scenario on the other.

Detection of banana bunchy top virus in virus-infected plants using polymerase chain reaction

Polymerase chain reaction (PCR) was developed for the detection of Banana bunchy top virus (BBTV) at maximum after 210 min and at minimum after 90 min using Pc-1 and Pc-2, respectively. PCR detection of BBTV in crude sap indicated that the freezing of banana tissue in liquid nitrogen (LN2) before extraction was more effective than using sand as the extraction technique. BBTV was also detected using PCR assay in 69 healthy and diseased plants using Na-PO4 buffer containing 1 % SDS. PCR detection of BBTV in nucleic acid extracts using seven different extraction buffers to adapt the use of PCR in routine detection in the field was studied. Results proved that BBTV was detected with high sensitivity in nucleic acid extracts more than in infectious sap. The results also suggested the common aetiology for the BBTV by the PCR reactions of BBTV in nucleic acid extracts from Australia, Burundi, Egypt, France, Gabon, Philippines and Taiwan. Results also proved a positive relation between the Egyptian-BBTV isolate and abaca bunchy top isolate from the Philippines, but there no relation was found with the Cucumber mosaic cucumovirus (CMV) isolates from Egypt and Philippines and Banana bract mosaic virus (BBMV) were found.

How safe is safe enough? : a socio-technical view of low-cost level crossing safety

Low-cost level crossings are often criticized as being unsafe. Does a SIL (safety integrity level) rating make the railway crossing any safer? This paper discusses how a supporting argument might be made for low-cost level crossing warning devices with lower levels of safety integrity and issues such as risk tolerability and derivation of tolerable hazard rates for system-level hazards. As part of the design of such systems according to fail-safe principles, the paper considers the assumptions around the pre-defined safe states of existing warning devices and how human factors issues around such states can give rise to additional hazards.

An innovative information gathering and data analysis platform for railway level crossing safety data

This paper describes an innovative platform that facilitates the collection of objective safety data around occurrences at railway level crossings using data sources including forward-facing video, telemetry from trains and geo-referenced asset and survey data. This platform is being developed with support by the Australian rail industry and the Cooperative Research Centre for Rail Innovation. The paper provides a description of the underlying accident causation model, the development methodology and refinement process as well as a description of the data collection platform. The paper concludes with a brief discussion of benefits this project is expected to provide the Australian rail industry.

Can a community pharmacy sleep assessment tool aid the identification of patients at risk of sleep disorders in the community : a pilot study

Background: When experiencing sleep problems for the first time, consumers may often approach community pharmacists for advice as they are easily accessible health care professionals in the community. In Australian community pharmacies there are no specific tools available for use by pharmacists to assist with the assessment and handling of consumers with sleep enquiries. Objective: To assess the feasibility of improving the detection of sleep disorders within the community through the pilot of a newly developed Community Pharmacy Sleep Assessment Tool (COP-SAT). Method: The COP-SAT was designed to incorporate elements from a number of existing, standardized, and validated clinical screening measures. The COP-SAT was trialed in four Australian community pharmacies over a 4-week period. Key findings: A total of 241 community pharmacy consumers were assessed using the COP-SAT. A total of 74 (30.7%) were assessed as being at risk of insomnia, 26 (10.7%) were at risk of daytime sleepiness, 19 (7.9%) were at risk of obstructive sleep apnea, and 121 (50.2%) were regular snorers. A total of 116 (48.1%) participants indicated that they consume caffeine before bedtime, of which 55 (47%) had associated symptoms of sleep onset insomnia. Moreover, 85 (35%) consumed alcohol before bedtime, of which 50 (58%) experienced fragmented sleep, 50 (58%) were regular snorers, and nine (10.6%) had apnea symptoms. The COP-SAT was feasible in the community pharmacy setting. The prevalence of sleep disorders in the sampled population was high, but generally consistent with previous studies on the general population. Conclusion: A large proportion of participants reported sleep disorder symptoms, and a link was found between the consumption of alcohol and caffeine substances at bedtime and associated symptoms. While larger studies are needed to assess the clinical properties of the tool, the results of this feasibility study have demonstrated that the COP-SAT may be a practical tool for the identification of patients at risk of developing sleep disorders in the community.

Hot topic detection in news blogs from the perspective of W2T

News blog hot topics are important for the information recommendation service and marketing. However, information overload and personalized management make the information arrangement more difficult. Moreover, what influences the formation and development of blog hot topics is seldom paid attention to. In order to correctly detect news blog hot topics, the paper first analyzes the development of topics in a new perspective based on W2T (Wisdom Web of Things) methodology. Namely, the characteristics of blog users, context of topic propagation and information granularity are unified to analyze the related problems. Some factors such as the user behavior pattern, network opinion and opinion leader are subsequently identified to be important for the development of topics. Then the topic model based on the view of event reports is constructed. At last, hot topics are identified by the duration, topic novelty, degree of topic growth and degree of user attention. The experimental results show that the proposed method is feasible and effective.

Elemental characterisation and detection of heavy metals in house dusts collected from sites in South-East Queensland, Australia

Knowledge of the elements present in house dusts is important in understanding potential health effects on humans. In this study, dust samples collected from 10 houses in south-east Queensland have been analysed by scanning electron microscopy and X-ray microanalysis to measure the inorganic element compositions and to investigate the form of heavy metals in the dusts. The overall analytical results were then used to discriminate between different localities using chemometric techniques. The relative amounts of elements, particularly of Si, Ca, and Fe, varied between size fractions and between different locations for the same size fraction. By analysing individual small particles, many other constituents were identified including Ti, Cr, Mn, Ni, Cu, Zn, Ba, Ag, W, Au, Hg, Pb, Bi, La and Ce. The heavy metals were mostly concentrated in small particles in the smaller size fractions, which allowed detection by particle analysis, though their average concentrations were very low.