Patient safety ethics and human error management in ED contexts part I : development of the global patient safety movement

In recent years there has been increasing recognition internationally that health care is not as safe as it ought to be and that patient safety outcomes need to be improved. To this end patient safety has become the focus of a world-wide endeavour aimed at reducing the incidence and impact of preventable human errors and related adverse events in health care domains. The emergency department has been identified as a significant site of preventable human errors and adverse events in the health care system, raising important questions about the nature of human error management and patient safety ethics in rapidly changing environments. In this article (the first of a two-part discussion on the subject) an overview of the incidence and impact of preventable adverse events in ED contexts is explored. The development of a ‘culture of safety’ in other hazardous industries and the ‘lessons learned’ and applied to the health care industry are also briefly examined. In a second article (to be presented as Part II), some of the ethical tensions that have arisen in the context of implementing patient safety processes and their possible implications for ED contexts are explored.

π-Selective stationary phases: (I) Influence of the spacer chain length of phenyl type phases on the aromatic and methylene selectivity of aromatic compounds in reversed phase high performance liquid chromatography

Phenyl type stationary phases of increasing spacer chain length (phenyl, methyl phenyl, ethyl phenyl, propyl phenyl and butyl phenyl, with 0–4 carbon atoms in the spacer chain, respectively) were synthesised and packed in house to determine the impact that the spacer chain length has on the retention process. Two trends in the aromatic selectivity, q_aromatic, were observed, depending on whether the number of carbon atoms in the spacer chain is even or odd. Linear log k′ vs ϕ plots were obtained for each stationary phase and the S coefficient was determined from the gradient of these plots. For the phenyl type phases, the S vs n_c plots of the retention factors of linear polycyclic aromatic hydrocarbons vs the number of rings exhibit a distinct discontinuity that between 3 and 4 rings, which increases with increasing spacer chain length for even phases but decreases for odd phases. Accordingly, we suggest that the retention factors depend differently on the number of carbon atoms in the spacer chain depending on whether this number is even or odd and that this effect is caused by different orientations of the aromatic ring relative to the silica surface.

Comparisons of the two-body abrasive wear behaviour of four different ferrous microstructures with similar hardness levels

The abrasive wear resistance of four distinct metallurgical steel microstructures - bainite, pearlite, martensite and tempered martensite, with similar hardness levels was investigated. A pin-on-disc tribometer was used to simulate the two-body abrasive condition (i.e. the metallic surface abrading against the silicon carbide abrasive particles) and evaluate the specific wear rate of the microstructures. Each microstructure had a unique response towards the abrasion behaviour and this was largely evident in the friction curve. However, the multi-phase microstructures (i.e. bainite and pearlite) demonstrated better abrasion resistance than the single-phase microstructures (i.e. martensite and tempered martensite). Abrasion induced microstructural changes at the deformed surfaces were studied using sub-surface and topographical techniques. The properties of these layers (i.e. surface profile measurements) determined the amount of material loss for each microstructure. These were directly linked to the single-wear track analysis that highlighted a marked difference in their mode of material removal. Ploughing and wedge formation modes were dominant in the case of bainite and pearlite microstructures, whereas the cutting mode could be attributed to the higher material loss in the single-phase microstructures. The combination of brittle and ductile phases in the multi-phase microstructure matrix could be one of the driving factors for their superior abrasion resistance.

Diagnosis of {alpha}+-thalassemias by determining the ratio of the two {alpha}-globin gene copies by oligonucleotide hybridization and melting curve analysis

Most cases of {alpha}-thalassemia result from large deletions at the {alpha}-globin locus (1). The {alpha}-globin gene cluster contains a tandem array of 2 nearly identical {alpha}-globin genes (HBA; Fig. 1A ) (2). The {alpha}0-thalassemias are characterized by deletions that inactivate both {alpha}-globin genes of a given chromosome, whereas in {alpha}+-thalassemias, one gene remains functional. The most widespread {alpha}+-thalassemias are those designated –{alpha}3.7 and –{alpha}4.2, according to the lengths of the deleted fragments (3).

Exposure to As(III) and As(V) changes the Ca²⁺-activation properties of the two major fibre types from the chelae of the freshwater crustacean Cherax destructor

Arsenic is a known carcinogen found in the soil in gold mining regions at concentrations thousands of times greater than gold. Mining releases arsenic into the environment and surrounding water bodies. The main chemical forms of arsenic found in the environment are inorganic arsenite (As(III)) and arsenate (As(V)). Yabbies (Cherax destructor) accumulate arsenic at levels comparable to those in the sediment of their environment but the effect on their physiological function is not known. The effects of arsenic exposure (10 ppm sodium arsenite, AsNaO2 - 5.7 ppm As(III)) and 10 ppm arsenic acid, Na2HAsO4·7H2O - 2.6 ppm As(V)) for 40 days on the contractile function of the two major fibre types from the chelae were determined. After exposure, individual fibres were isolated from the chela, "skinned" (membrane removed) and attached to the force recording apparatus. Contraction was induced in solutions containing increasing [Ca(2+)] until a maximum Ca(2+)-activation was obtained. Submaximal force responses were plotted as a percentage of the maximum Ca(2+)-activated force. As(V) exposure resulted in lower levels of calcium required for activation than As(III) indicating an increased sensitivity to Ca(2+) after long term exposure to arsenate compared to arsenite. Myosin heavy chain and tropomyosin content in individual fibres was also decreased as a result of arsenic exposure. Single fibres exposed to As(V) produced significantly more force than muscle fibres from control animals. Long-term exposure of yabbies to arsenic alters the contractile function of the two major fibre types in the chelae.

1948 and 1968 Czech refugee settlers in Australia : a comparison of the settlement and integration processes among two waves of settlers

Nearly eighteen years ago when I first became interested in the history and sociology of Australian immigration, I was particularly attracted by the fact and opportunity to incorporate immigration settlement, experience and accomplishments in my history teaching in secondary school. In particular it was the area of the settlement of Australia that needed a fuller understanding in the teaching of Australian history. By that I mean it was needed to show that there were many other ethnic groups besides the Anglo-Saxon group which had participated in the development of Australia since 1788. Since the end of World War II, the Australian population has doubled, the population structure and characteristics have changed and knowledge about the diverse groups forming the Australian nation is now sought. Sane ethnic groups, mainly the numerically large, have been studied and numerous reports are available. But many of the smaller groups have attracted little interest among Australian scholars. This was one of the reasons that I decided to research the behaviour of one of the smaller groups - the Czechs - to find out about their immigration history to Australia; their immigration processes such as re-settlement and re-establishment; and their community life since World War II. Because of the scarcity of written materials on Czechs in Australia, I had to rely on interviews, personal reminiscenses, letters and documents translated from the Czech language. I should like to express my gratitude to all people and officials of Czech ethnic organisations and clubs in Australia, who agreed to be interviewed and who provided me with documentary material so important for my work. Respecting the wishes of my interviewees their anonymity had to be preserved. In the course of my research, I have received substantial help and the encouragement from the Editor of the now extinct Czech language paper Newspaper Hlas domova, Mr. F.V., whose co-operation is gratefully recognised. I am also grateful to Associate Professor William D. Rubinstein for his help and encouragement in all stages of my work. The introductory part of the study is covered in Chapter One. She reasons for the need to increase Australia's population after World War II and an analysis of the development of settlement in Australia between 1947 and 1984 are discussed. The emigration of Czechs into Australia and their place in the post-war immigration scheme is introduced. To obtain an overview of how Czechs have emigrated around the world, the literature describing their settlement is compared. Also discussed in the literature on Czech settlement in Australia from an historical point of view. The studies on the concept of ethnicity and settlement in Australia are used to document the theoretical issues for an understanding of Australian society. This chapter also contains aspects of sources and research, shewing the processes of documentary research, interviews and related matters. In Chapter Two the history of Czech emigration is discussed, covering the period from the seventeenth to the twentieth century. The first contacts with Australia are highlighted, continuing into the inter-war period and finally the re-settlement of Czechs after World War II. To understand why Czechs left their ancestral country after World War II, the political situation in Czechoslovakia is analysed. The third chapter concentrates mainly in the 1948 wave of settlers, who left Czechoslovakia after the communist take-over in 1948. Their means of departure from their homeland, selection of Australia as a new homeland and their re-settlement and re-establishment are discussed. Their attitudes after their arrival and their later stages of their settlement are analysed. The formation of numerous Czech ethnic organisations which mushroomed between 1950 and 1954 led to an active community life which began to change about five years after their arrival. These charges led to disorganisation of Czech community's life. The causes of these changes which were influential for the failure of the 1948 group to establish a viable community in Australia are analysed. In Chapter Four the wave of 1968 is viewed, their arrival and settling is covered. The study of their group attitudes and formation of group institutions is the main part of this section. A comparison of my data of the two waves, 1948 and 1968, reveals the information that these two groups did not develop the harmonious relationship expected of them as members of the one ethnic group. Chapter Five discusses immigration typologies and concentrates on the differences between legal and illegal emigrants from the Czechoslovak point of view. The integration processes of Czechs and their incorporation into Australian society are discussed. The sixth chapter sums up the findings of this disertation and states the influences which were responsible for the divisions in Czech ethnic life in Australia in the 1980s.

Room-temperature insertion of elemental tellurium into the Cspł-Br and -I bonds of α-bromo-and α-iodopinacolone

Pinacolyltellurium(IV) dihalides, (t-BuCOCH₂)₂TeX₂ (X ) Br (1b), I (1c)) and Ar(t-BuCOCH₂)TeCl₂ (Ar == 1-C₁₀H₇ (Np) (2a), 2,4,6-Me₃C₆H₂ (Mes) (3a)), are readily prepared at room temperature by the oxidative insertion of elemental tellurium into the C_sp³-Br or -I bond of the α-halopinacolone and by the reaction of ArTeCl₃ with the pinacolone t-BuCOCH₃. The bromides Np(t-BuCOCH₂)TeBr₂ (2b) and Mes(t-BuCOCH₂)TeBr₂ (3b) can be prepared by the addition of bromine to the telluride Ar(t-BuCOCH₂)-Te or of α-bromopinacolone to ArTeBr. Variable-temperature ¹H and ¹³C NMR of the separate signals for the o-Me groups in 3a,b indicate a very high barrier to rotation about the Te-C(aryl) bond. Crystal diffraction data for 1c, 2a-c, and 3b show that intramolecular 1,4-Te …O(C) secondary bonding interactions (SBIs) are retained even in the presence of bulky aryl groups and intermolecular Te …X SBIs are subject to electronic population and steric congestion around the Te(IV) center in the solid state.

Fusulinoideans from the early Midian (late Middle Permian) Metadoliolina dutkevitchi-Monodiexodina sutchanica Zone of the Senkina Shapka section, South Primorye, Far East Russia.

Fusulinoideans from the Metadoliolina dutkevitchi-Monodiexodina sutchanica Zone of the lower part of the Chandalaz Formation in the Senkina Shapka section in South Primorye, Far East Russia, are described. The fusulinoidean zone is assigned to the early Midian (=Capitanian: late Middle Permian) based mainly on the morphologie and biostratigraphic characteristics of Metadoliolina dutkevitchi. Previously, a Midian age has been established for the Metadoliolina dutkevitchi-Monodiexodina sutchanica Zone by the coexistence of Lepidolina species. However, the occurrence of Lepidolina with the two zonal species in this area has not been verified by the illustration of Lepidolina specimens. We examined a fusulinoidean-bearing sample from the Metadoliolina dutkevitchi-Monodiexodina sutchanica Zone, and three fusulinoidean species, Monodiexodina sutchanica, Pseudofusulina sp. and Metadoliolina dutkevitchi, are de-scribed and illustrated.

A qualitative investigation of the safety culture of two organisations

A qualitative investigation of the safety culture of two contrasting organisations was undertaken. The research sought to identify categories and themes in the data that highlighted similarities and differences in salient safety issues for employees from the two organisations. The participants were 131 employees attending safety training sessions in a large national retail organisation and a heavy manufacturing organisation. Unobtrusive observation was used to collect data during the safety training sessions. Thematic analysis was used to identify emergent categories and themes from the data. Ten broad categories with relevant themes were identified and provided some insight into the safety culture of the two organisations, with both similarities and differences being evident. Participants from both organisations mentioned management issues in relation to safety, discussed the impact of employee risk- taking behaviour on safety, made reference to a blame culture, and raised integrity issues regarding safety. For the manufacturing organisation, a number of themes focused on contractor issues, while in the retail organisation, several themes highlighted differences in safety attitudes between head office and store-level employees.

Multiple mating and a low incidence of cuckoldry for nest-holding males in the two-spotted goby, Gobiusculus flavescens

Background: A major question in behavioural ecology concerns the relationship between genetic mating systems and the strength of sexual selection. In this study, we investigated the genetic mating system of the two-spotted goby (Gobiusculus flavescens), a useful fish model for the study of sexual selection whose genetic mating system remains uncharacterized. We developed four polymorphic microsatellite markers and used them to conduct parentage analyses on 21 nests collected during the breeding season to examine the rates of multiple mating by males and to test for evidence of alternative mating strategies.

Results: Results of this study indicate that male G. flavescens mate with multiple females and enjoy confidence of paternity. We detected only one instance of sneaking, so cuckoldry contributed a very small percentage (~0.1%) of the total fertilizations in this population. Nests were nearly full and males that maintain larger nests have higher mating and reproductive success, irrespective of body size.

Conclusion: Overall, our investigation shows that G. flavescens is similar to other, related gobies in that the nests of care-giving males often contain eggs from multiple females. However, G. flavescens differs from other gobies in displaying an extremely low rate of cuckoldry. The study of ecological factors responsible for this important

Monumental vision : a confrontation with the image of the Eternal Return

"Monumental Vision” is a nuanced summary of Nietzschean nihilism and the Eternal Return as rite of passage for free subjects and as condensed image of speculative intelligence proper. Utilizing Gerhard Richter’s “Sheet 692” from Atlas, a series of photographs of the mountains and lake at Sils Maria, Switzerland, as summary judgment of the limit imposed by this condition on all systems of representation, this form of vision discloses the chiasmus embedded in consciousness itself. In constantly revisiting Sils, the very location where Nietzsche “suffered” the vision of the Eternal Return, Richter has engaged repeatedly this origin for what has come into his work via Nietzsche – that is, an elective veil that refuses all compromises with transcendence until such is merged with immanence.

As situated amidst modernist “ideology as intellection”, and subsequent nascent forms of anti-modernism, the Eternal Return as image also signals the return of the Kantian “aesthetic-teleological” synthesis in non-discursive or purely visual agency. As an elective form of aesthetic vision, and as image of time insofar as it registers an overwhelming externality (Other) that nominally swallows and empowers the subject at once, this excoriating sense of universal praxis underwrites artistic and architectural production of the highest order, renegotiating concepts of the paradigmatic.

Utilizing Georg Simmel’s late work on Rembrandt (1916) and his encounter with Schopenhauer and Nietzsche (1907), the essay suggests that by the 1920s the avant-garde premises of modernism had already come under attack by an ahistorical and synoptic vision here denoted “monumental vision,” which also contains the imprint of eschatological time (invoking a schism present in rationality as such). The two readings of this image perpetrated by Karl Löwith in Nietzsche’s Philosophy of the Eternal Recurrence of the Same (Nietzsches Philosophie der ewigen Wiederkehr des Gleichen, 1935), or the cosmological and the ethical, while considered irreconcilable by Löwith, have since the 1960s been recalibrated through the figure of the event to pose possible scenarios out of the stalemate of the confrontation between Self and Other (ipseity and alterity) buried within this image as limit. In this manner, the image of the Eternal Return stands at the boundary between two forms of time (or two worlds) and signals the irreducible confrontation present in speculative thought and the necessity of closure through an aesthetic vision that produces a unitary field for all creative acts.

Notably, Nietzsche’s startling vision from Zarathustra suggests that the limit imposed by the Eternal Return is also a mask for an austere condition within subjectivity closely resembling the conundrum of Fichte’s I facing I, or thought turned toward thought itself (absolute subjectivity as cipher for Being). In Alenka Zupančič’s reading, in The Shortest Shadow: Nietzsche’s Philosophy of the Two (2003), the Eternal Return effectively contains a secret formal function that grinds all “error” to dust – a highly suggestive interpretation that also neutralizes the schism introduced by Löwith between the cosmological and the ethical.

Policy and practice impacts of applied research: a case study analysis of the New South Wales Health Promotion Demonstration Research Grants Scheme 2000-2006

Background
Intervention research provides important information regarding feasible and effective interventions for health policy makers, but few empirical studies have explored the mechanisms by which these studies influence policy and practice. This study provides an exploratory case series analysis of the policy, practice and other related impacts of the 15 research projects funded through the New South Wales Health Promotion Demonstration Research Grants Scheme during the period 2000 to 2006, and explored the factors mediating impacts.

Methods
Data collection included semi-structured interviews with the chief investigators (n = 17) and end-users (n = 29) of each of the 15 projects to explore if, how and under what circumstances the findings had been used, as well as bibliometric analysis and verification using documentary evidence. Data analysis involved thematic coding of interview data and triangulation with other data sources to produce case summaries of impacts for each project. Case summaries were then individually assessed against four impact criteria and discussed at a verification panel meeting where final group assessments of the impact of research projects were made and key influences of research impact identified.

Results
Funded projects had variable impacts on policy and practice. Project findings were used for agenda setting (raising awareness of issues), identifying areas and target groups for interventions, informing new policies, and supporting and justifying existing policies and programs across sectors. Reported factors influencing the use of findings were: i) nature of the intervention; ii) leadership and champions; iii) research quality; iv) effective partnerships; v) dissemination strategies used; and, vi) contextual factors.

Conclusions
The case series analysis provides new insights into how and under what circumstances intervention research is used to influence real world policy and practice. The findings highlight that intervention research projects can achieve the greatest policy and practice impacts if they address proximal needs of the policy context by engaging end-users from the inception of projects and utilizing existing policy networks and structures, and using a range of strategies to disseminate findings that go beond traditional peer review publications.

The advantages of the construction sector of China and India: a comparison

With the spectacular rise of the Chinese and Indian economies the accompanying growth in these two countries' construction sectors justifies more understanding. There is, however, a lot of unknowns about the two countries' construction sectors from a comparative perspective. This study attempted to identify and compare the comparative/competitive advantages of the two fast-growing economies in construction in pursuit of policy and management implications, which can benefit not only the two countries but also other developing countries. In this regard, a comparative advantage framework and Porter's Diamond Framework were applied to analyze the relative advantages of the Chinese and Indian construction sectors. The comparative analyses showed that China appears better endowed in labor with high productivity. Government intervention was identified as benefiting Chinese firms with support for the development of human resources. China also benefits from superior access to a wide range of inputs, including equipment, construction materials, and technology. The existence of large corporate champions provides scale of economy and contributes to the advantage of the construction sector of China. In contrast, India benefits from the increased competitive rivalry thanks to its more hands-off government policies that focus primarily on providing a good business environment with a favorable tax system, market entry policies, laws and regulations, and code/standard systems. The differences identified provide policy implications to the decision makers of the two countries in further developing their construction sectors. © 2014 American Society of Civil Engineers.

Spectral sensitivity of cone photoreceptors and opsin expression in two colour-divergent lineages of the lizard Ctenophorus decresii

Intraspecific differences in sensory perception are rarely reported but may occur when a species range extends across varying sensory environments, or there is coevolution between the sensory system and a varying signal. Examples in colour vision and colour signals are rare in terrestrial systems. The tawny dragon lizard Ctenophorus decresii is a promising candidate for such intraspecific variation, because the species comprises two geographically and genetically distinct lineages in which throat colour (a social signal used in intra- and inter-specific interactions) is locally adapted to the habitat and differs between lineages. Male lizards from the southern lineage have UV-blue throats, whereas males from the northern lineage are polymorphic with four discrete throat colours that all show minimal UV reflectance. Here, we determine the cone photoreceptor spectral sensitivities and opsin expression of the two lineages, to test whether they differ, particularly in the UV wavelengths. Using microspectrophotometry on retinal cone photoreceptors, we identified a long-wavelength-sensitive (LWS) visual pigment, a 'short' and 'long' medium-wavelength-sensitive (MWS) pigment and a short-wavelength-sensitive (SWS) pigment, all of which did not differ in λmax between lineages. Through transcriptome analysis of opsin genes we found that both lineages express four cone opsin genes, including the SWS1 opsin with peak sensitivity in the UV range, and that amino acid sequences did not differ between lineages with the exception of a single leucine to valine substitution in the RH2 opsin. Counts of yellow and transparent oil droplets associated with LWS+MWS and SWS+UVS cones, respectively, showed no difference in relative cone proportions between lineages. Therefore, contrary to predictions, we find no evidence of differences between lineages in single cone photoreceptor spectral sensitivity or opsin expression. However, we confirm the presence of four single cone classes, suggesting tetrachromacy in C. decresii, and we also provide the first evidence of UV sensitivity in agamid lizards.