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.

A cross layer protocol for energy aware and critical data delivered applications using Wireless Sensor Networks

Environment monitoring applications using Wireless Sensor Networks (WSNs) have had a lot of attention in recent years. In much of this research tasks like sensor data processing, environment states and events decision making and emergency message sending are done by a remote server. A proposed cross layer protocol for two different applications where, reliability for delivered data, delay and life time of the network need to be considered, has been simulated and the results are presented in this paper. A WSN designed for the proposed applications needs efficient MAC and routing protocols to provide a guarantee for the reliability of the data delivered from source nodes to the sink. A cross layer based on the design given in [1] has been extended and simulated for the proposed applications, with new features, such as routes discovery algorithms added. Simulation results show that the proposed cross layer based protocol can conserve energy for nodes and provide the required performance such as life time of the network, delay and reliability.

Cross layer based protocols for energy aware and critical data delivery related applications using wireless sensor networks

Wireless Sensor Networks (WSNs) have been an exciting topic in recent years. The services offered by a WSN can be classified into three major categories: monitoring, alerting, and information on demand. WSNs have been used for a variety of applications related to the environment (agriculture, water and forest fire detection), the military, buildings, health (elderly people and home monitoring), disaster relief, and area or industrial monitoring. In most WSNs tasks like processing the sensed data, making decisions and generating emergency messages are carried out by a remote server, hence the need for efficient means of transferring data across the network. Because of the range of applications and types of WSN there is a need for different kinds of MAC and routing protocols in order to guarantee delivery of data from the source nodes to the server (or sink). In order to minimize energy consumption and increase performance in areas such as reliability of data delivery, extensive research has been conducted and documented in the literature on designing energy efficient protocols for each individual layer. The most common way to conserve energy in WSNs involves using the MAC layer to put the transceiver and the processor of the sensor node into a low power, sleep state when they are not being used. Hence the energy wasted due to collisions, overhearing and idle listening is reduced. As a result of this strategy for saving energy, the routing protocols need new solutions that take into account the sleep state of some nodes, and which also enable the lifetime of the entire network to be increased by distributing energy usage between nodes over time. This could mean that a combined MAC and routing protocol could significantly improve WSNs because the interaction between the MAC and network layers lets nodes be active at the same time in order to deal with data transmission. In the research presented in this thesis, a cross-layer protocol based on MAC and routing protocols was designed in order to improve the capability of WSNs for a range of different applications. Simulation results, based on a range of realistic scenarios, show that these new protocols improve WSNs by reducing their energy consumption as well as enabling them to support mobile nodes, where necessary. A number of conference and journal papers have been published to disseminate these results for a range of applications.

Considerations on corrosion and weld repair effects on the fatigue strength of a steel structure critical to the flight-safety

The aim of this study is to analyze the effects of corrosion and successive tungsten inert gas (TIC) welding repairs on the reverse bending fatigue strength of AISI 4130 steel used in components critical to the flight-safety. The tests were performed on hot-rolled steel plate specimens, 1.10 mm and 1.60 mm thick, by means of a SCHENK PWS equipment, with load ratio R = -1, constant amplitude, 30 Hz frequency and room temperature. It was observed that the reverse bending fatigue strength of AISI 4130 steel decreases due to the corrosion and the TIC welding and re-welding processes. (C) 2010 Elsevier Ltd. All rights reserved.

Repair Welding Effects on the Bending Fatigue Strength of AISI 4130 Aeronautical Steel used in a Critical to the Flight-Safety Structure

The aim of this study was to analyze the effect of successive TIG (tungsten inert gas) welding repairs on the reverse bending fatigue strength of AISI 4130 steel, which is widely used in components critical to the flight-safety. In order to simulate the abrupt maneuvers, wind bursts, motor vibration and helixes efforts, which generate cyclic bending loadings at the welded joints of a specific aircraft component called motor cradle, experimental reverse bending fatigue tests were carried out on specimens made from hot-rolled steel plate, 1.10 mm (0.043 in) thick, by mean of a SCHENK PWS equipment, with load ratio R = -1, under constant amplitude, at 30 Hz frequency and room temperature. It was observed that the bending fatigue strength decreases after the TIG (Tungsten Inert Gas) welding process application on AISI 4130 steel, with subsequent decrease due to re-welding sequence as well. Microstructural analyses and microhardness measurements on the base material, heat-affected zone (HAZ) and weld metal, as well as the effects of the weld bead geometry on the obtained results, have complemented this study.

Considerations about the welding repair effects on the structural integrity of an airframe critical to the flight-safety

Structures critical to the flight-safety are commonly submitted to several maintenance repairs at the welded joints in order to prolong the in-service life of aircrafts. The aim of this study is to analyze the effects of Tungsten Inert Gas (TIG) welding repair on the structural integrity of the AISI 4130 aeronautical steel by means of experimental fatigue crack growth tests in base-material, heat-affected zone (HAZ) and weld metal. The tests were performed on hot-rolled steel plate specimens, 0.89 mm thick, with load ratio R = 0.1, constant amplitude, at 10 Hz frequency and room temperature. Increase of the fracture resistance was observed in the weld metal but decreasing in the HAZ after repair. The results were associated to microhardness and microstructural changes with the welding sequence. (C) 2010 Published by Elsevier Ltd.

The use of the challenge test to analyse preservative efficiency in non-sterile cosmetic and health products: applications and critical points

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Fatigue Behavior of Weld Repaired AISI 4130 Aeronautic Steel Used in Critical Flight Safety Structures

Since the 1950s, fatigue is the most important project and operational consideration for both civil and military aircrafts. For some aircraft models the most loaded component is one that supports the motor: the Motor Cradle. Because they are considered critical to the flight safety the aeronautic standards are extremely rigorous in manufacturing them by imposing a zero index of defects on the final weld quality (Safe Life), which is 100% inspected by Non-Destructive Testing/NDT. This study has as objective to evaluate the effects of up to four successive TIG welding repairs on the axial fatigue strength of an AISI 4130 steel. Tests were conducted on hot-rolled steel plate specimens, 0.89 mm thick, with load ratio R = 0.1, constant amplitude, at 20 Hz frequency and in room temperature, in accordance with ASTM E466 Standard. The results were related to microhardness and microstructural and geometric changes resulting from welding cycles.

Advanced lithium and lithium-ion rechargeable batteries for automotive applications

The worldwide demand for a clean and low-fuel-consuming transport promotes the development of safe, high energy and power electrochemical storage and conversion systems. Lithium-ion batteries (LIBs) are considered today the best technology for this application as demonstrated by the recent interest of automotive industry in hybrid (HEV) and electric vehicles (EV) based on LIBs. This thesis work, starting from the synthesis and characterization of electrode materials and the use of non-conventional electrolytes, demonstrates that LIBs with novel and safe electrolytes and electrode materials meet the targets of specific energy and power established by U.S.A. Department of Energy (DOE) for automotive application in HEV and EV. In chapter 2 is reported the origin of all chemicals used, the description of the instruments used for synthesis and chemical-physical characterizations, the electrodes preparation, the batteries configuration and the electrochemical characterization procedure of electrodes and batteries. Since the electrolyte is the main critical point of a battery, in particular in large- format modules, in chapter 3 we focused on the characterization of innovative and safe electrolytes based on ionic liquids (characterized by high boiling/decomposition points, thermal and electrochemical stability and appreciable conductivity) and mixtures of ionic liquid with conventional electrolyte. In chapter 4 is discussed the microwave accelerated sol–gel synthesis of the carbon- coated lithium iron phosphate (LiFePO 4 -C), an excellent cathode material for LIBs thanks to its intrinsic safety and tolerance to abusive conditions, which showed excellent electrochemical performance in terms of specific capacity and stability. In chapter 5 are presented the chemical-physical and electrochemical characterizations of graphite and titanium-based anode materials in different electrolytes. We also characterized a new anodic material, amorphous SnCo alloy, synthetized with a nanowire morphology that showed to strongly enhance the electrochemical stability of the material during galvanostatic full charge/discharge cycling. Finally, in chapter 6, are reported different types of batteries, assembled using the LiFePO 4 -C cathode material, different anode materials and electrolytes, characterized by deep galvanostatic charge/discharge cycles at different C-rates and by test procedures of the DOE protocol for evaluating pulse power capability and available energy. First, we tested a battery with the innovative cathode material LiFePO 4 -C and conventional graphite anode and carbonate-based electrolyte (EC DMC LiPF 6 1M) that demonstrated to surpass easily the target for power-assist HEV application. Given that the big concern of conventional lithium-ion batteries is the flammability of highly volatile organic carbonate- based electrolytes, we made safe batteries with electrolytes based on ionic liquid (IL). In order to use graphite anode in IL electrolyte we added to the IL 10% w/w of vinylene carbonate (VC) that produces a stable SEI (solid electrolyte interphase) and prevents the graphite exfoliation phenomenon. Then we assembled batteries with LiFePO 4 -C cathode, graphite anode and PYR 14 TFSI 0.4m LiTFSI with 10% w/w of VC that overcame the DOE targets for HEV application and were stable for over 275 cycles. We also assembled and characterized ―high safety‖ batteries with electrolytes based on pure IL, PYR 14 TFSI with 0.4m LiTFSI as lithium salt, and on mixture of this IL and standard electrolyte (PYR 14 TFSI 50% w/w and EC DMC LiPF 6 50% w/w), using titanium-based anodes (TiO 2 and Li 4 Ti 5 O 12 ) that are commonly considered safer than graphite in abusive conditions. The batteries bearing the pure ionic liquid did not satisfy the targets for HEV application, but the batteries with Li 4 Ti 5 O 12 anode and 50-50 mixture electrolyte were able to surpass the targets. We also assembled and characterized a lithium battery (with lithium metal anode) with a polymeric electrolyte based on poly-ethilenoxide (PEO 20 – LiCF 3 SO 3 +10%ZrO 2 ), which satisfied the targets for EV application and showed a very impressive cycling stability. In conclusion, we developed three lithium-ion batteries of different chemistries that demonstrated to be suitable for application in power-assist hybrid vehicles: graphite/EC DMC LiPF 6 /LiFePO 4 -C, graphite/PYR 14 TFSI 0.4m LiTFSI with 10% VC/LiFePO 4 -C and Li 4 T i5 O 12 /PYR 14 TFSI 50%-EC DMC LiPF 6 50%/LiFePO 4 -C. We also demonstrated that an all solid-state polymer lithium battery as Li/PEO 20 –LiCF 3 SO 3 +10%ZrO 2 /LiFePO 4 -C is suitable for application on electric vehicles. Furthermore we developed a promising anodic material alternative to the graphite, based on SnCo amorphous alloy.

A systematic review of the effectiveness, compliance, and critical factors for implementation of safety checklists in surgery

A systematic literature review was conducted to assess the effectiveness of, compliance with, and critical factors for the implementation of safety checklists in surgery.

Resident work hour restrictions do not improve patient safety in surgery: a critical appraisal based on 7 years of experience in Switzerland

In 2005 the Swiss government implemented new work-hour limitations for all residency programs in Switzerland, including a 50-hour weekly limit. The reduction in the working hours of doctors in training implicate an increase in their rest time and suggest an amelioration of doctors' clinical performance and consequently in patients' outcomes and safety - which was not detectable in a preliminary study at a large referral center in Switzerland. It remains elusive why work-hour restrictions did not improve patient safety. We are well advised to thoroughly examine and eliminate the known adverse effects of reduced work-hours to improve our patients' safety.

A Critical Response to Kevin Stenson’s Governing the Local: Sovereignty, Social Governance and Community Safety

In his compelling case study of local governance and community safety in the UK Thames Valley, Kevin Stenson makes several important contributions to the field of governmentality studies. While the paper’s merits are far-reaching, to this reader’s assessment they can be summarized in the following key areas: 1) Empirically, the article enhances our knowledge of the political economic transformation of a region otherwise overlooked in social science research ; 2) Conceptually, Stenson offers several theoretical and analytical refrains that, while becoming increasingly commonplace, are nonetheless still germane and rightly oriented to offer push back against otherwise totalizing, reified accounts of roll back/roll out neoliberalism. A welcomed new approach is offered as a corrective, The Realist Governmentality perspective, which emphasizes the interrelated and co-constitutive nature of politics, local culture, and habitus in processes related to the restructuring of social governance; 3) Methodologically, the paper makes a pitch for the ways in which finely grained, nuanced, mixed-method/ethnographic analyses have the potential to further problematize and recast a field of governmentality studies far too often dominated by discursive and textual approaches.