Medical error:a discussion of the medical construction of error and suggestions for reforms of medical education to decrease error

Introduction: There is a growing public perception that serious medical error is commonplace and largely tolerated by the medical profession. The Government and medical establishment's response to this perceived epidemic of error has included tighter controls over practising doctors and individual stick-and-carrot reforms of medical practice. Discussion: This paper critically reviews the literature on medical error, professional socialization and medical student education, and suggests that common themes such as uncertainty, necessary fallibility, exclusivity of professional judgement and extensive use of medical networks find their genesis, in part, in aspects of medical education and socialization into medicine. The nature and comparative failure of recent reforms of medical practice and the tension between the individualistic nature of the reforms and the collegiate nature of the medical profession are discussed. Conclusion: A more theoretically informed and longitudinal approach to decreasing medical error might be to address the genesis of medical thinking about error through reforms to the aspects of medical education and professional socialization that help to create and perpetuate the existence of avoidable error, and reinforce medical collusion concerning error. Further changes in the curriculum to emphasize team working, communication skills, evidence-based practice and strategies for managing uncertainty are therefore potentially key components in helping tomorrow's doctors to discuss, cope with and commit fewer medical errors.

Bit error rate estimation methods for QPSK CO-OFDM transmission

Coherent optical orthogonal frequency division multiplexing (CO-OFDM) is an attractive transmission technique to virtually eliminate intersymbol interference caused by chromatic dispersion and polarization-mode dispersion. Design, development, and operation of CO-OFDM systems require simple, efficient, and reliable methods of their performance evaluation. In this paper, we demonstrate an accurate bit error rate estimation method for QPSK CO-OFDM transmission based on the probability density function of the received QPSK symbols. By comparing with other known approaches, including data-aided and nondata-aided error vector magnitude, we show that the proposed method offers the most accurate estimate of the system performance for both single channel and wavelength division multiplexing QPSK CO-OFDM transmission systems. © 2014 IEEE.

Time resolved bit error rate analysis of a fast switching tunable laser for use in optically switched networks

We investigate the use of different direct detection modulation formats in a wavelength switched optical network. We find the minimum time it takes a tunable sampled grating distributed Bragg reflector laser to recover after switching from one wavelength channel to another for different modulation formats. The recovery time is investigated utilizing a field programmable gate array which operates as a time resolved bit error rate detector. The detector offers 93 ps resolution operating at 10.7 Gb/s and allows for all the data received to contribute to the measurement, allowing low bit error rates to be measured at high speed. The recovery times for 10.7 Gb/s non-return-to-zero on–off keyed modulation, 10.7 Gb/s differentially phase shift keyed signal and 21.4 Gb/s differentially quadrature phase shift keyed formats can be as low as 4 ns, 7 ns and 40 ns, respectively. The time resolved phase noise associated with laser settling is simultaneously measured for 21.4 Gb/s differentially quadrature phase shift keyed data and it shows that the phase noise coupled with frequency error is the primary limitation on transmitting immediately after a laser switching event.

Bit-error rate performance of 20 Gbit/s WDM RZ-DPSK non-slope matched submarine transmission systems

Applying direct error counting, we assess the performance of 20 Gbit/s wavelength-division multiplexing return-to-zero differential phase-shift keying (RZ-DPSK) transmission at 0.4 bit/(s Hz) spectral efficiency for application on installed non-zero dispersion-shifted fibre based transoceanic submarine systems. The impact of the pulse duty cycle on the system performance is investigated and the reliability of the existing theoretical approaches to the BER estimation for the RZ-DPSK format is discussed.

The influence on unaided vision of age, pupil diameter and spherocylindrical refractive error

Background - The aim was to derive equations for the relationship between unaided vision and age, pupil diameter, iris colour and sphero-cylindrical refractive error. Methods - Data were collected from 663 healthy right eyes of white subjects aged 20 to 70 years. Subjective sphero-cylindrical refractive errors ranged from -6.8 to +9.4 D (mean spherical equivalent), -1.5 to +1.9 D (orthogonal component, J0) and -0.8 to 1.0 D (oblique component, J45). Cylinder axis orientation was orthogonal in 46 per cent of the eyes and oblique in 18 per cent. Unaided vision (-0.3 to +1.3 logMAR), pupil diameter (2.3 to 7.5 mm) and iris colour (67 per cent light/blue irides) was recorded. The sample included mostly females (60 per cent) and many contact lens wearers (42 per cent) and so the influences of these parameters were also investigated. Results - Decision tree analysis showed that sex, iris colour, contact lens wear and cylinder axis orientation did not influence the relationship between unaided vision and refractive error. New equations for the dependence of the minimum angle of resolution on age and pupil diameter arose from step backwards multiple linear regressions carried out separately on the myopes (2.91.scalar vector +0.51.pupil diameter -3.14 ) and hyperopes (1.55.scalar vector + 0.06.age – 3.45 ). Conclusion - The new equations may be useful in simulators designed for teaching purposes as they accounted for 81 per cent (for myopes) and 53 per cent (for hyperopes) of the variance in measured data. In comparison, previously published equations accounted for not more than 76 per cent (for myopes) and 24 per cent (for hyperopes) of the variance depending on whether they included pupil size. The new equations are, as far as is known to the authors, the first to include age. The age-related decline in accommodation is reflected in the equation for hyperopes.

Is pupil diameter influenced by refractive error?

Purpose: To investigate the relationship between pupil diameter and refractive error and how refractive correction, target luminance, and accommodation modulate this relationship. Methods: Sixty emmetropic, myopic, and hyperopic subjects (age range, 18 to 35 years) viewed an illuminated target (luminance: 10, 100, 200, 400, 1000, 2000, and 4100 cd/m2) within a Badal optical system, at 0 diopters (D) and −3 D vergence, with and without refractive correction. Refractive error was corrected using daily disposable contact lenses. Pupil diameter and accommodation were recorded continuously using a commercially available photorefractor. Results: No significant difference in pupil diameter was found between the refractive groups at 0 D or −3 D target vergence, in the corrected or uncorrected conditions. As expected, pupil diameter decreased with increasing luminance. Target vergence had no significant influence on pupil diameter. In the corrected condition, at 0 D target vergence, the accommodation response was similar in all refractive groups. At −3 D target vergence, the emmetropic and myopic groups accommodated significantly more than the hyperopic group at all luminance levels. There was no correlation between accommodation response and pupil diameter or refractive error in any refractive group. In the uncorrected condition, the accommodation response was significantly greater in the hyperopic group than in the myopic group at all luminance levels, particularly for near viewing. In the hyperopic group, the accommodation response was significantly correlated with refractive error but not pupil diameter. In the myopic group, accommodation response level was not correlated with refractive error or pupil diameter. Conclusions: Refractive error has no influence on pupil diameter, irrespective of refractive correction or accommodative demand. This suggests that the pupil is controlled by the pupillary light reflex and is not driven by retinal blur.

Measurement and compensation of pivot point positional error on five-axis machines

Measuring and compensating the pivot points of five-axis machine tools is always challenging and very time consuming. This paper presents a newly developed approach for automatic measurement and compensation of pivot point positional errors on five-axis machine tools. Machine rotary axis errors are measured using a circular test. This method has been tested on five-axis machine tools with swivel table configuration. Results show that up to 99% of the positional errors of the rotary axis can be compensated by using this approach.

Real-time error compensation of a three-axis machine tool using a laser tracker

The concept of measurement-enabled production is based on integrating metrology systems into production processes and generated significant interest in industry, due to its potential to increase process capability and accuracy, which in turn reduces production times and eliminates defective parts. One of the most promising methods of integrating metrology into production is the usage of external metrology systems to compensate machine tool errors in real time. The development and experimental performance evaluation of a low-cost, prototype three-axis machine tool that is laser tracker assisted are described in this paper. Real-time corrections of the machine tool's absolute volumetric error have been achieved. As a result, significant increases in static repeatability and accuracy have been demonstrated, allowing the low-cost three-axis machine tool to reliably reach static positioning accuracies below 35 μm throughout its working volume without any prior calibration or error mapping. This is a significant technical development that demonstrated the feasibility of the proposed methods and can have wide-scale industrial applications by enabling low-cost and structural integrity machine tools that could be deployed flexibly as end-effectors of robotic automation, to achieve positional accuracies that were the preserve of large, high-precision machine tools.

Target/error overlap in jargonaphasia:the case for a one-source model, lexical and non-lexical summation, and the special status of correct responses

We present three jargonaphasic patients who made phonological errors in naming, repetition and reading. We analyse target/response overlap using statistical models to answer three questions: 1) Is there a single phonological source for errors or two sources, one for target-related errors and a separate source for abstruse errors? 2) Can correct responses be predicted by the same distribution used to predict errors or do they show a completion boost (CB)? 3) Is non-lexical and lexical information summed during reading and repetition? The answers were clear. 1) Abstruse errors did not require a separate distribution created by failure to access word forms. Abstruse and target-related errors were the endpoints of a single overlap distribution. 2) Correct responses required a special factor, e.g., a CB or lexical/phonological feedback, to preserve their integrity. 3) Reading and repetition required separate lexical and non-lexical contributions that were combined at output.

Comparison of numerical bit error rate estimation methods in 112Gbs QPSK CO-OFDM transmission

We demonstrate an accurate BER estimation method for QPSK CO-OFDM transmission based on the probability density function of the received QPSK symbols. Using a 112Gbs QPSK CO-OFDM transmission as an example, we show that this method offers the most accurate estimate of the system's performance in comparison with other known approaches.

Intraoperative prediction of refractive error using a prototype surgical aberrometer

Purpose: To ascertain the agreement level between intra-operative refraction using a prototype surgical Hartmann-Shack aberrometer and subjective refraction a month later. Methods: Fifty-four consecutive patients had their pseudophakic refractive measured with the aberrometer intra-operatively at the end of their cataract surgery. A masked optometrist performed subjective refraction 4 weeks later. The two sets of data were then analysed for correlation. Results: The mean spherical equivalent was −0.14 ± 0.37 D (Range: −1.41 to +1.72 D) with the prototype aberrometer and −0.34 ± 0.32 (−1.64 to +1.88 D) with subjective refraction. The measurements positively correlated to a very high degree (r =+0.81, p < 0.01). In 84.3% of cases the two measurements were within 0.50D of each other. Conclusion: The aberrometer can verify the aimed refractive status of the eye intraoperatively to avoid a refractive surprise. The aberrometer is a useful tool for real time assessment of the ocular refractive status.

The framework of the virtual laser tracker - A systematic approach to the assessment of error sources and uncertainty in laser tracker measurement

Laser trackers have been widely used in many industries to meet increasingly high accuracy requirements. In laser tracker measurement, it is complex and difficult to perform an accurate error analysis and uncertainty evaluation. This paper firstly reviews the working principle of single beam laser trackers and state-of- The- Art of key technologies from both industrial and academic efforts, followed by a comprehensive analysis of uncertainty sources. A generic laser tracker modelling method is formulated and the framework of the virtual tracker is proposed. The VLS can be used for measurement planning, measurement accuracy optimization and uncertainty evaluation. The completed virtual laser tracking system should take all the uncertainty sources affecting coordinate measurement into consideration and establish an uncertainty model which will behave in an identical way to the real system. © Springer-Verlag Berlin Heidelberg 2010.