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.

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.

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.

Ecological notes on the East Gippsland burrowing crayfish Engaeus orientalis, including burrow structure and associated fauna

Despite Australia having a high diversity of freshwater crayfish species, the ecology of many of these species remains poorly known, particularly burrowing crayfish of the genus Engaeus. Biological information on colour, behaviour, burrow structure, associated burrow fauna and habitat of the East Gippsland Burrowing Crayfish Engaeus orientalis obtained during incidental observations in 2007 and 2008 is provided. The burrow structure took the form of radiating runways under a rock slab, while the burrow location was in a semi-disturbed site away from water. Both are atypical for this species.

Movement patterns of Sanderling (Calidris alba) in the East Asian-Australasian Flyway and a comparison of methods for identification of crucial areas for conservation

Worldwide, most populations of migratory shorebirds are in jeopardy, none more so than those of the East Asian-Australasian Flyway (EAAF). In order to preserve these highly mobile species a detailed understanding of their use of feeding and resting sites along the flyway is required. In this study we used light-level geolocators and new analytical tools to reveal individual breeding locations and migration routes of 13 Sanderlings (Calidris alba) that spend their non-breeding season in South Australia. We then used these individual migration routes to identify the timing and location of important stopping areas and compared this with assessments based on resightings of leg-flagged birds and count data. During both northward and southward migration, Sanderlings were found to make extensive use of five main areas of the Chinese coastline, the Yellow Sea and the northern end of the Sakhalin Peninsula. Insights gained from the individual migration routes highlight inherent biases in using only count and resighting data to identify important feeding and resting sites along the Flyway. These findings suggest that data on individual movements may be crucial to effective conservation planning of shorebirds in the EAAF and elsewhere in the world.

In the name of the Father : God in Lacan, Judaic or Christian?

This essay challenges the widespread notion that Lacanian psychoanalysis represents a 'Christianing' of psychoanalysis. It argues that Lacanian psychoanalysis brings to psychoanalysis a broadly "Averroist" attitude towards religion which develops out of and transcends Freud's position in Totem and Taboo. For Lacan, religious texts are an invaluable source of pre-psychoanalytic insight or another regal road into the champ Freudien: the dynamic of human beings' desire, in its co-conformity with language and Law. The text focuses on trying to decipher the missing content of the Names of the Father seminar: the seminar that "does not exist" (Miller, 2006) beyond its opening, esoteric and dramatic session. The force of doing this will be to show how much, and how fundamental, the things are that Lacan thinks the bible, and the first Abrahamic monotheism in particular, can teach us about human subjectivity and the instance of the Law that shapes it - insights which go to explain Freud's unmistakable attachment, despite himself, to the civilizational importance of his fathers.

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.

A high altitude observation of the beautiful firetail Stagonopleura bella from East Gippsland, Victoria

There has been little research on the ecological requirements of the Beautiful Firetail Stagonopleura bella, and its habitat preferences are poorly understood. On mainland Australia, the Beautiful Firetail is generally considered to be a bird of coastal regions and the lowlands. This note reports an observation of Beautiful Firetails on the Great Dividing Range at a height of more than 1100 metres above sea level from an atypical habitat for mainland Australia. It appears that the observation may be the highest altitude at which this species has been recorded on the mainland.

Environmental impact assessment of the sewage outfall at Davis Station, East Antarctica

During the summer 2009/10, an environmental impact assessment of the sewage outfall was conducted at Davis Station, East Antarctica. An investigation of the nature and extent of impacts to the marine environment associated with current sewage treatment and effluent discharge practices included ecological surveys of macrobiological communities, physico-chemical analysis of sediments and receiving waters, microbiological analysis, and histopathological analysis of fish. Ecotoxicological testing using local invertebrates to determine effluent toxicity was interpreted alongside dispersal modelling data of the discharge plume to determine the potential extent of impacts and inform recommendations on the level of treatment and dilution of sewage required to minimise impacts. No evidence of impacts was detected on soft sediment infaunal or epifaunal communities, and only low levels of contamination and accumulation were found in sediments and waters in the immediate vicinity of the outfall and in the direction of primary current flow. In contrast, sterol biomarkers and faecal coliforms (E. coli) were detected in sediments collected adjacent to the outfall and in most water column samples. Marine invertebrates (Abatus and Laternula) also tested positive for E. coli and antibiotic resistance mechanisms were present in Laternula indicating the introduction and dispersal through the water column of foreign microbes and bacteria associated with human effluent. Fish (Trematomus bernacchii) close to the outfall showed significant histological alterations in all major tissues (liver, gill, gonad, muscle) resulting from exposure to sewage. Effluent was toxic to amphipods (Paramoera walkeri) and microgastropods (Skenella paludionoides), with reduced survival in concentrations as low as 3.125% over a 21d exposure period. Acute effects were also observed in both species following 24h exposure, with 100% mortality at the highest effluent concentrations tested (68%). The application of these results to support and guide decisions regarding the planned installation of new sewage treatment facilities at Davis will be discussed.