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.

REM sleep behavior disorder in Parkinson's disease: a questionnaire-based survey

REM sleep behavior disorder (RBD) is reported in up to 50% of patients with Parkinson's disease (PD). Only a few systematic, large-scale studies have addressed the characteristics of RBD in PD. The aim of the present study is to assess the frequency of RBD in patients with PD and the association with PD characteristics.

Effectiveness of Colors used on Safety and Health Signs for Communicating Severity of Injury

Signs are used extensively in workplaces and on products to identify hazards and provide instructions for appropriate behavior. A fundamental element of these signs is the signal-word panel located at the top of the sign. The colors and words in this panel are intended to convey information about the hazard identified. One type of hazard information concerns the severity of injury/illness associated with the hazard. The standard of the American National Standards Institute (ANSI) for facility signs uses three severity categories: 1) death or serious injury, 2) minor or moderate injury, and 3) property damage. The standard specifies which signal-word panel format, including color, to use based in part on the severity category. The purpose of this study was to determine if college students associate color with severity. The sample population consisted of 59 students tested in nine small groups. Twelve signs were shown to them in random order. Five of the signs had a color for the background of the signal-word panel. The colors were red, orange, yellow, blue, and gray. The signal word was a nonsense word and the text panel contained repetitions of the letter x in sentence format. Subject rated their impressions of the colors using two ordered rating scales for severity. Results indicated that color had a highly significant effect on severity ratings. Median ratings were generally consistent with the ANSI standard, except for orange. Red rated highest on both scales. Blue and gray rated lowest. Yellow and orange were in between red and blue. According to the ANSI standard, orange should indicate the same severity as red. These results indicated that orange was associated with less severity than red. Apparently, the ANSI standard's use of orange to identify a hazard associated with death or a serious injury is questionable.

Improved safety and reduction in stent thrombosis associated with biodegradable polymer-based biolimus-eluting stents versus durable polymer-based sirolimus-eluting stents in patients with coronary artery disease: final 5-year report of the LEADERS (Limus Eluted From A Durable Versus ERodable Stent Coating) randomized, noninferiority trial

OBJECTIVES This study sought to report the final 5 years follow-up of the landmark LEADERS (Limus Eluted From A Durable Versus ERodable Stent Coating) trial. BACKGROUND The LEADERS trial is the first randomized study to evaluate biodegradable polymer-based drug-eluting stents (DES) against durable polymer DES. METHODS The LEADERS trial was a 10-center, assessor-blind, noninferiority, "all-comers" trial (N = 1,707). All patients were centrally randomized to treatment with either biodegradable polymer biolimus-eluting stents (BES) (n = 857) or durable polymer sirolimus-eluting stents (SES) (n = 850). The primary endpoint was a composite of cardiac death, myocardial infarction (MI), or clinically indicated target vessel revascularization within 9 months. Secondary endpoints included extending the primary endpoint to 5 years and stent thrombosis (ST) (Academic Research Consortium definition). Analysis was by intention to treat. RESULTS At 5 years, the BES was noninferior to SES for the primary endpoint (186 [22.3%] vs. 216 [26.1%], rate ratio [RR]: 0.83 [95% confidence interval (CI): 0.68 to 1.02], p for noninferiority <0.0001, p for superiority = 0.069). The BES was associated with a significant reduction in the more comprehensive patient-orientated composite endpoint of all-cause death, any MI, and all-cause revascularization (297 [35.1%] vs. 339 [40.4%], RR: 0.84 [95% CI: 0.71 to 0.98], p for superiority = 0.023). A significant reduction in very late definite ST from 1 to 5 years was evident with the BES (n = 5 [0.7%] vs. n = 19 [2.5%], RR: 0.26 [95% CI: 0.10 to 0.68], p = 0.003), corresponding to a significant reduction in ST-associated clinical events (primary endpoint) over the same time period (n = 3 of 749 vs. n = 14 of 738, RR: 0.20 [95% CI: 0.06 to 0.71], p = 0.005). CONCLUSIONS The safety benefit of the biodegradable polymer BES, compared with the durable polymer SES, was related to a significant reduction in very late ST (>1 year) and associated composite clinical outcomes. (Limus Eluted From A Durable Versus ERodable Stent Coating [LEADERS] trial; NCT00389220).

Street crossing behavior in younger and older pedestrians: an eye- and head-tracking study

BACKGROUND: Crossing a street can be a very difficult task for older pedestrians. With increased age and potential cognitive decline, older people take the decision to cross a street primarily based on vehicles' distance, and not on their speed. Furthermore, older pedestrians tend to overestimate their own walking speed, and could not adapt it according to the traffic conditions. Pedestrians' behavior is often tested using virtual reality. Virtual reality presents the advantage of being safe, cost-effective, and allows using standardized test conditions. METHODS: This paper describes an observational study with older and younger adults. Street crossing behavior was investigated in 18 healthy, younger and 18 older subjects by using a virtual reality setting. The aim of the study was to measure behavioral data (such as eye and head movements) and to assess how the two age groups differ in terms of number of safe street crossings, virtual crashes, and missed street crossing opportunities. Street crossing behavior, eye and head movements, in older and younger subjects, were compared with non-parametric tests. RESULTS: The results showed that younger pedestrians behaved in a more secure manner while crossing a street, as compared to older people. The eye and head movements analysis revealed that older people looked more at the ground and less at the other side of the street to cross. CONCLUSIONS: The less secure behavior in street crossing found in older pedestrians could be explained by their reduced cognitive and visual abilities, which, in turn, resulted in difficulties in the decision-making process, especially under time pressure. Decisions to cross a street are based on the distance of the oncoming cars, rather than their speed, for both groups. Older pedestrians look more at their feet, probably because of their need of more time to plan precise stepping movement and, in turn, pay less attention to the traffic. This might help to set up guidelines for improving senior pedestrians' safety, in terms of speed limits, road design, and mixed physical-cognitive trainings.

Patient safety in dialysis access

Not only are dialysis access creation and maintenance prone to complications, but patients suffering from end-stage renal disease and its comorbidities generally have a high risk of adverse events during their continuous treatment. Preventive strategies are key to avoid harm and to improve the outcome of the treatment of the growing number of patients with chronic kidney failure, especially as doctors and nurses are not always aware of the consequences of unsafe behavior. This publication is intended for health care professionals – nurses as well as doctors – and aims to raise the awareness of patient safety aspects, combining medical education with evidence-based medicine. After a general overview of the topic, an international panel of authors provides a diversified insight into important concepts and technical tricks essential to create and maintain a functional dialysis access. Contributions to Nephrology, Vol. 184

Implementation of safety based incentives in Public Private Partnerships (PPPs): an empirical analysis for the case of Spain

Public Private Partnerships (PPPs) are mostly implemented to circumvent budgetary constraints, and to encourage efficiency and quality in the provision of public infrastructure in order to reach social welfare. One of the ways of reaching the latter objective is by the introduction of performance based standards tied to bonuses and penalties to reward or punish the performance of the contractor. This paper focuses on the implementation of safety based incentives in PPPs in such a way that the better the safety outcome the greater larger will be the economic reward to the contractor. The main aim of this paper is to identify whether the incentives to improve road safety in PPPs are ultimately effective in improving safety ratios in Spain. To that end, Poisson and negative binomial regression models have been applied using information of motorways of the Spanish network of 2006. The findings indicate that even though road safety is highly influenced by variables that are not much controllable by the contractor such as the Average Annual Daily Traffic and the percentage of heavy vehicles, the implementation of safety incentives in PPPs has a positive influence in the reduction of fatalities, injuries and accidents.

Differences into HT and HTO concentrations in air into the Western Mediterranean Basin and Continental Europe and Safety Related Issues.

Real time Tritium concentrations in air in two chemical forms, HT and HTO, coming from an ITER-like fusion reactor as source were coupled the European Centre Medium Range Weather Forecast (ECMWF) numerical model with the Lagrangian Atmospheric-particle dispersion model FLEXPART. This tool was analyzed in nominal tritium discharge operational reference and selected incidental conditions affecting the Western Mediterranean Basin during 45 days during summer 2010 together with surface “wind observations” or weather data based in real hourly observations of wind direction and velocity providing a real approximation of the tritium behavior after the release to the atmosphere from a fusion reactor. From comparison with NORMTRI - a code using climatologically sequences as input - over the same area, the real time results have demonstrated an apparent overestimation of the corresponding climatologically sequence of Tritium concentrations in air outputs, at several distances from the reactor. For this purpose two development patterns were established. The first one was following a cyclonic circulation over the Mediterranean Sea and the second one was based on the plume delivered over the Interior of the Iberian Peninsula and Continental Europe by another stabilized circulation corresponding to a High Pressure System. One of the important remaining activities defined then, was the qualification tool. In order to validate the model of ECMWF/FLEXPART we have developed of a new complete data base of tritium concentrations for the months from November 2010 to March 2011 and defined a new set of four patterns of HT transport in air, in each case using real boundary conditions: stationary to the North, stationary to the South, fast and very fast displacement. Finally the differences corresponding to those four early patterns (each one in assessments 1 and 2) has been analyzed in terms of the tuning of safety related issues and taking into account the primary phase o- - f tritium modeling, from its discharge to the atmosphere to the deposition on the ground, will affect to the complete tritium environmental pathway altering the chronic dose by absorption, reemission and ingestion both from elemental tritium, HT and from the oxide of tritium, HTO

Generating multimedia presentations that summarize the behavior of dynamic systems using a model-based approach

This article describes a knowledge-based method for generating multimedia descriptions that summarize the behavior of dynamic systems. We designed this method for users who monitor the behavior of a dynamic system with the help of sensor networks and make decisions according to prefixed management goals. Our method generates presentations using different modes such as text in natural language, 2D graphics and 3D animations. The method uses a qualitative representation of the dynamic system based on hierarchies of components and causal influences. The method includes an abstraction generator that uses the system representation to find and aggregate relevant data at an appropriate level of abstraction. In addition, the method includes a hierarchical planner to generate a presentation using a model with dis- course patterns. Our method provides an efficient and flexible solution to generate concise and adapted multimedia presentations that summarize thousands of time series. It is general to be adapted to differ- ent dynamic systems with acceptable knowledge acquisition effort by reusing and adapting intuitive rep- resentations. We validated our method and evaluated its practical utility by developing several models for an application that worked in continuous real time operation for more than 1 year, summarizing sen- sor data of a national hydrologic information system in Spain.

An abstract interpretation-based approach to mobile code safety

Recent approaches to mobile code safety, like proof- arrying code, involve associating safety information to programs. The code supplier provides a program and also includes with it a certifícate (or proof) whose validity entails compliance with a predefined safety policy. The intended benefit is that the program consumer can locally validate the certifícate w.r.t. the "untrusted" program by means of a certifícate checker—a process which should be much simpler, eflicient, and automatic than generating the original proof. We herein introduce a novel approach to mobile code safety which follows a similar scheme, but which is based throughout on the use of abstract interpretation techniques. In our framework the safety policy is specified by using an expressive assertion language defined over abstract domains. We identify a particular slice of the abstract interpretation-based static analysis results which is especially useful as a certifícate. We propose an algorithm for checking the validity of the certifícate on the consumer side which is itself in fact a very simplified and eflicient specialized abstract-interpreter. Our ideas are illustrated through an example implemented in the CiaoPP system. Though further experimentation is still required, we believe the proposed approach is of interest for bringing the automation and expressiveness which is inherent in the abstract interpretation techniques to the área of mobile code safety.

Effectiveness of safety-based incentives in Public Private Partnerships: Evidence from the case of Spain

Many countries around the world are implementing Public?Private?Partnership (PPP) contacts to manage road infrastructure. In some of these contracts the public sector introduces economic incentives to the private operator to foster the accomplishment of social goals. One of the incentives that have been introduced in some PPP contracts is related to safety in such a way that the better the safety outcome the greater will be the economic reward to the contractor. The aim of this paper is at identify whether the incentives to improve road safety in highway PPPs are ultimately effective in improving safety ratios. To this end Poisson and negative binomial regression models have been applied using information from highway sections in Spain. The findings indicate that even though road safety is highly influenced by variables that are not much controllable by the contractor such as the Average Annual Daily Traffic and the percentage of heavy vehicles, the implementation of safety incentives in PPPs has a positive influence in the reduction of fatalities, injuries and accidents.

Vision-based active safety system for automatic stopping

ntelligent systems designed to reduce highway fatalities have been widely applied in the automotive sector in the last decade. Of all users of transport systems, pedestrians are the most vulnerable in crashes as they are unprotected. This paper deals with an autonomous intelligent emergency system designed to avoid collisions with pedestrians. The system consists of a fuzzy controller based on the time-to-collision estimate – obtained via a vision-based system – and the wheel-locking probability – obtained via the vehicle’s CAN bus – that generates a safe braking action. The system has been tested in a real car – a convertible Citroën C3 Pluriel – equipped with an automated electro-hydraulic braking system capable of working in parallel with the vehicle’s original braking circuit. The system is used as a last resort in the case that an unexpected pedestrian is in the lane and all the warnings have failed to produce a response from the driver.

Spectral behavior of a low-cost all-fiber component based on untapered multifiber unions

Untapered multifiber unions are reported to show a spectral behavior similar to the tapered ones. Their oscillatory behavior does not depend on the biconical regions. This suggests a novel way to make low-cost all-fiber devices with applications as passive components such as optical filters and wavelength multiplexers/demultiplexers. Two types of multimode fibers have been studied and information about the index profile influence has been obtained. Polarization insensitivity and temperature stability have been observed.