Are clinical documents optimised for patient safety? A critical analysis of patient safety outcomes using the EDA error model

Iatrogenic errors and patient safety in clinical processes are an increasing concern. The quality of process information in hardcopy or electronic form can heavily influence clinical behaviour and decision making errors. Little work has been undertaken to assess the safety impact of clinical process planning documents guiding the clinical actions and decisions. This paper investigates the clinical process documents used in elective surgery and their impact on latent and active clinical errors. Eight clinicians from a large health trust underwent extensive semi- structured interviews to understand their use of clinical documents, and their perceived impact on errors and patient safety. Samples of the key types of document used were analysed. Theories of latent organisational and active errors from the literature were combined with the EDA semiotics model of behaviour and decision making to propose the EDA Error Model. This model enabled us to identify perceptual, evaluation, knowledge and action error types and approaches to reducing their causes. The EDA error model was then used to analyse sample documents and identify error sources and controls. Types of knowledge artefact structures used in the documents were identified and assessed in terms of safety impact. This approach was combined with analysis of the questionnaire findings using existing error knowledge from the literature. The results identified a number of document and knowledge artefact issues that give rise to latent and active errors and also issues concerning medical culture and teamwork together with recommendations for further work.

Pervasive environment for gases detection and collapses in underground mines

Safety is an element of extreme priority in mining operations, currently many traditional mining countries are investing in the implementation of wireless sensors capable of detecting risk factors; through early warning signs to prevent accidents and significant economic losses. The objective of this research is to contribute to the implementation of sensors for continuous monitoring inside underground mines providing technical parameters for the design of sensor networks applied in underground coal mines. The application of sensors capable of measuring in real time variables of interest, promises to be of great impact on safety for mining industry. The relationship between the geological conditions and mining method design, establish how to implement a system of continuous monitoring. In this paper, the main causes of accidents for underground coal mines are established based on existing worldwide reports. Variables (temperature, gas, structural faults, fires) that can be related to the most frequent causes of disaster and its relevant measuring range are then presented, also the advantages, management and mining operations are discussed, including the analyzed of applying these systems in terms of Benefit, Opportunity, Cost and Risk. The publication focuses on coal mining, based on the proportion of these events a year worldwide, where a significant number of workers are seriously injured or killed. Finally, a dynamic assessment of safety at underground mines it is proposed, this approach offers a contribution to design personalized monitoring networks, the experience developed in coal mines provides a tool that facilitates the application development of technology within underground coal mines.

The long-term safety and efficacy of bilateral transplantation of human fetal striatal tissue in patients with mild to moderate Huntington's disease.

Huntington's disease (HD) is a fatal autosomal dominant neurodegenerative disease involving progressive motor, cognitive and behavioural decline, leading to death approximately 20 years after motor onset. The disease is characterised pathologically by an early and progressive striatal neuronal cell loss and atrophy, which has provided the rationale for first clinical trials of neural repair using fetal striatal cell transplantation. Between 2000 and 2003, the 'NEST-UK' consortium carried out bilateral striatal transplants of human fetal striatal tissue in five HD patients. This paper describes the long-term follow up over a 3-10-year postoperative period of the patients, grafted and non-grafted, recruited to this cohort using the 'Core assessment program for intracerebral transplantations-HD' assessment protocol. No significant differences were found over time between the patients, grafted and non-grafted, on any subscore of the Unified Huntington's Disease Rating Scale, nor on the Mini Mental State Examination. There was a trend towards a slowing of progression on some timed motor tasks in four of the five patients with transplants, but overall, the trial showed no significant benefit of striatal allografts in comparison with a reference cohort of patients without grafts. Importantly, no significant adverse or placebo effects were seen. Notably, the raclopride positron emission tomography (PET) signal in individuals with transplants, indicated that there was no obvious surviving striatal graft tissue. This study concludes that fetal striatal allografting in HD is safe. While no sustained functional benefit was seen, we conclude that this may relate to the small amount of tissue that was grafted in this safety study compared with other reports of more successful transplants in patients with HD.

The national food safety control system of China: a systematic review

In recent years, there have been increasing concerns over the safety of the Chinese food supply. Although many of these have only raised concern internally within China, several major food safety issues have had international repercussions. In response, China has implemented new food safety laws and management systems to improve its national food safety control system and reduce public and international concerns. This paper has describes and discusses the components of the Chinese system using the five key elements of a national food control system identified by the World Health Organization (WHO) and the Food and Agriculture Organization (FAO) as essential for an effective system. The latest Chinese national food safety control has made significantly improvement on its regulation framework, however, more work need to be done on standards, law enforcement, and information exchange.

A decade of plant proteomics and mass spectrometry: translation of technical advancements to food security and safety issues

Tremendous progress in plant proteomics driven by mass spectrometry (MS) techniques has been made since 2000 when few proteomics reports were published and plant proteomics was in its infancy. These achievements include the refinement of existing techniques and the search for new techniques to address food security, safety, and health issues. It is projected that in 2050, the world’s population will reach 9–12 billion people demanding a food production increase of 34–70% (FAO, 2009) from today’s food production. Provision of food in a sustainable and environmentally committed manner for such a demand without threatening natural resources, requires that agricultural production increases significantly and that postharvest handling and food manufacturing systems become more efficient requiring lower energy expenditure, a decrease in postharvest losses, less waste generation and food with longer shelf life. There is also a need to look for alternative protein sources to animal based (i.e., plant based) to be able to fulfill the increase in protein demands by 2050. Thus, plant biology has a critical role to play as a science capable of addressing such challenges. In this review, we discuss proteomics especially MS, as a platform, being utilized in plant biology research for the past 10 years having the potential to expedite the process of understanding plant biology for human benefits. The increasing application of proteomics technologies in food security, analysis, and safety is emphasized in this review. But, we are aware that no unique approach/technology is capable to address the global food issues. Proteomics-generated information/resources must be integrated and correlated with other omics-based approaches, information, and conventional programs to ensure sufficient food and resources for human development now and in the future.

An industry viewpoint on the role of farm assurance in delivering food safety to the consumer: the case of the dairy sector in England and Wales

Food safety, alongside food quality, remains a primary concern of both consumers and those along the whole food supply chain, leading to regulation by government alongside private third party certification. Much has been written about the value of these systems primarily from the perception of the consumer. This paper reports on a study that examined industry perceptions on the regulatory and assurance systems within the dairy sector of England and Wales. It found that the primary producer found value in both systems, although from a food hygiene focus regulation was seen to be more rigorous. Other stakeholders along the dairy food supply chain saw the assurance scheme as more rigorous. All stakeholders recognised the need to reduce duplication in delivering food safety through combining key elements of both systems with the added potential for better communication of both food safety and quality to the final consumer.

The rough guide to the Moon and Mars

Space is a dangerous place for humans, once we step beyond the rotection of Earth’s atmosphere and magnetic field. Galactic cosmic rays and bursts of charged particles from the Sun damaging to health happen with alarming frequency – the Apollo astronauts were very lucky. Understanding the physics of radiation from distinct sources in space will be useful to help future space voyagers plan journeys in greater safety, and produce effective shields for these unavoidable events on journeys to Mars or beyond.

The evolution of the Sun's open magnetic flux: I. a single bipole

In this paper the origin and evolution of the Sun’s open magnetic flux are considered for single magnetic bipoles as they are transported across the Sun. The effects of magnetic flux transport on the radial field at the surface of the Sun are modeled numerically by developing earlier work by Wang, Sheeley, and Lean (2000). The paper considers how the initial tilt of the bipole axis (α) and its latitude of emergence affect the variation and magnitude of the surface and open magnetic flux. The amount of open magnetic flux is estimated by constructing potential coronal fields. It is found that the open flux may evolve independently from the surface field for certain ranges of the tilt angle. For a given tilt angle, the lower the latitude of emergence, the higher the magnitude of the surface and open flux at the end of the simulation. In addition, three types of behavior are found for the open flux depending on the initial tilt angle of the bipole axis. When the tilt is such that α ≥ 2◦ the open flux is independent of the surface flux and initially increases before decaying away. In contrast, for tilt angles in the range −16◦ < α < 2◦ the open flux follows the surface flux and continually decays. Finally, for α ≤ −16◦ the open flux first decays and then increases in magnitude towards a second maximum before decaying away. This behavior of the open flux can be explained in terms of two competing effects produced by differential rotation. Firstly, differential rotation may increase or decrease the open flux by rotating the centers of each polarity of the bipole at different rates when the axis has tilt. Secondly, it decreases the open flux by increasing the length of the polarity inversion line where flux cancellation occurs. The results suggest that, in order to reproduce a realistic model of the Sun’s open magnetic flux over a solar cycle, it is important to have accurate input data on the latitude of emergence of bipoles along with the variation of their tilt angles as the cycle progresses.

Long-term variations in the magnetic fields of the Sun and the heliosphere: their origin, effects, and implications

Recent studies of the variation of geomagnetic activity over the past 140 years have quantified the "coronal source" magnetic flux F-s that leaves the solar atmosphere and enters the heliosphere and have shown that it has risen, on average, by an estimated 34% since 1963 and by 140% since 1900. This variation of open solar flux has been reproduced by Solanki et al. [2000] using a model which demonstrates how the open flux accumulates and decays, depending on the rate of flux emergence in active regions and on the length of the solar cycle. We here use a new technique to evaluate solar cycle length and find that it does vary in association with the rate of change of F-s in the way predicted. The long-term variation of the rate of flux emergence is found to be very similar in form to that in F-s, which may offer a potential explanation of why F-s appears to be a useful proxy for extrapolating solar total irradiance back in time. We also find that most of the variation of cosmic ray fluxes incident on Earth is explained by the strength of the heliospheric field (quantified by F-s) and use observations of the abundance of the isotope Be-10 (produced by cosmic rays and deposited in ice sheets) to study the decrease in F-s during the Maunder minimum. The interior motions at the base of the convection zone, where the solar dynamo is probably located, have recently been revealed using the helioseismology technique and found to exhibit a 1.3-year oscillation. This periodicity is here reported in observations of the interplanetary magnetic field and geomagnetic activity but is only present after 1940, When present, it shows a strong 22-year variation, peaking near the maximum of even-numbered sunspot cycles and showing minima at the peaks of odd-numbered cycles. We discuss the implications of these long-term solar and heliospheric variations for Earth's environment.

Long-term variations in the magnetic field of the Sun and possible implications for terrestrial climate

Recent studies of the variation of geomagnetic activity over the past 140 years have quantified the "coronal source" or "open" magnetic flux F-s that leaves the solar atmosphere and enters the heliosphere and have shown that it has risen, on average, by 34% since 1963 and by 140% since 1900. This variation is reflected in studies of the heliospheric field using isotopes deposited in ice sheets and meteorites by the action of galactic comic rays. The variation has also been reproduced using a model that demonstrates how the open flux accumulates and decays, depending on the rate of flux emergence in active regions and on the length of the solar cycle. The cosmic ray flux at energies > 3 GeV is found to have decayed by about 15% during the 20(th) century (and by about 4% at > 13 GeV). We show that the changes in the open flux do reflect changes in the photospheric and sub-surface field which offers an explanation of why open flux appears to be a good proxy for solar irradiance extrapolation. Correlations between F-s, solar cycle length, L, and 11-year smoothed sunspot number, R-11, explain why the various irradiance reconstructions for the last 150 years are similar in form. Possible implications of the inferred changes in cosmic ray flux and irradiance for global temperatures on Earth are discussed.

The Sun-Earth connection in time scales from years to decades and centuries

The Sun-Earth connection is studied using long-term measurements from the Sun and from the Earth. The auroral activity is shown to correlate to high accuracy with the smoothed sunspot numbers. Similarly, both geomagnetic activity and global surface temperature anomaly can be linked to cyclic changes in the solar activity. The interlinked variations in the solar magnetic activity and in the solar irradiance cause effects that can be observed both in the Earth's biosphere and in the electromagnetic environment. The long-term data sets suggest that the increase in geomagnetic activity and surface temperatures are related (at least partially) to longer-term solar variations, which probably include an increasing trend superposed with a cyclic behavior with a period of about 90 years.