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.

Understanding advances in the simulation of intraseasonal variability in the ECMWF model. Part I: the representation of the MJO

As a major mode of intraseasonal variability, which interacts with weather and climate systems on a near-global scale, the Madden – Julian Oscillation (MJO) is a crucial source of predictability for numerical weather prediction (NWP) models. Despite its global significance and comprehensive investigation, improvements in the representation of the MJO in an NWP context remain elusive. However, recent modifications to the model physics in the ECMWF model led to advances in the representation of atmospheric variability and the unprecedented propagation of the MJO signal through the entire integration period. In light of these recent advances, a set of hindcast experiments have been designed to assess the sensitivity of MJO simulation to the formulation of convection. Through the application of established MJO diagnostics, it is shown that the improvements in the representation of the MJO can be directly attributed to the modified convective parametrization. Furthermore, the improvements are attributed to the move from a moisture-convergent- to a relative-humidity-dependent formulation for organized deep entrainment. It is concluded that, in order to understand the physical mechanisms through which a relative-humidity-dependent formulation for entrainment led to an improved simulation of the MJO, a more process-based approach should be taken. T he application of process-based diagnostics t o t he hindcast experiments presented here will be the focus of Part II of this study.

Available potential energy density for a multicomponent Boussinesq fluid with arbitrary nonlinear equation of state

In this paper, the concept of available potential energy (APE) density is extended to a multicomponent Boussinesq fluid with a nonlinear equation of state. As shown by previous studies, the APE density is naturally interpreted as the work against buoyancy forces that a parcel needs to perform to move from a notional reference position at which its buoyancy vanishes to its actual position; because buoyancy can be defined relative to an arbitrary reference state, so can APE density. The concept of APE density is therefore best viewed as defining a class of locally defined energy quantities, each tied to a different reference state, rather than as a single energy variable. An important result, for which a new proof is given, is that the volume integrated APE density always exceeds Lorenz’s globally defined APE, except when the reference state coincides with Lorenz’s adiabatically re-arranged reference state of minimum potential energy. A parcel reference position is systematically defined as a level of neutral buoyancy (LNB): depending on the nature of the fluid and on how the reference state is defined, a parcel may have one, none, or multiple LNB within the fluid. Multiple LNB are only possible for a multicomponent fluid whose density depends on pressure. When no LNB exists within the fluid, a parcel reference position is assigned at the minimum or maximum geopotential height. The class of APE densities thus defined admits local and global balance equations, which all exhibit a conversion with kinetic energy, a production term by boundary buoyancy fluxes, and a dissipation term by internal diffusive effects. Different reference states alter the partition between APE production and dissipation, but neither affect the net conversion between kinetic energy and APE, nor the difference between APE production and dissipation. We argue that the possibility of constructing APE-like budgets based on reference states other than Lorenz’s reference state is more important than has been previously assumed, and we illustrate the feasibility of doing so in the context of an idealised and realistic oceanic example, using as reference states one with constant density and another one defined as the horizontal mean density field; in the latter case, the resulting APE density is found to be a reasonable approximation of the APE density constructed from Lorenz’s reference state, while being computationally cheaper.

In situ and remote-sensing measurements of the mean microphysical and optical properties of industrial pollution aerosol during ADRIEX

We present a summary of the principal physical and optical properties of aerosol particles using the FAAM BAE-146 instrumented aircraft during ADRIEX between 27 August and 6 September 2004, augmented by sunphotometer, lidar and satellite retrievals. Observations of anthropogenic aerosol, principally from industrial sources, were concentrated over the northern Adriatic Sea and over the Po Valley close to the aerosol sources. An additional flight was also carried out over the Black Sea to compare east and west European pollution. Measurements show the single-scattering albedo of dry aerosol particles to vary considerably between 0.89 and 0.97 at a wavelength of 0.55 μm, with a campaign mean within the polluted lower free troposphere of 0.92. Although aerosol concentrations varied significantly from day to day and during individual days, the shape of the aerosol size distribution was relatively consistent through the experiment, with no detectable change observed over land and over sea. There is evidence to suggest that the pollution aerosol within the marine boundary layer was younger than that in the elevated layer. Trends in the aerosol volume distribution show consistency with multiple-site AERONET radiometric observations. The aerosol optical depths derived from aircraft measurements show a consistent bias to lower values than both the AERONET and lidar ground-based radiometric observations, differences which can be explained by local variations in the aerosol column loading and by some aircraft instrumental artefacts. Retrievals of the aerosol optical depth and fine-mode (<0.5 μm radius) fraction contribution to the optical depth using MODIS data from the Terra and Aqua satellites show a reasonable level of agreement with the AERONET and aircraft measurements.

An examination of climate sensitivity for idealised climate change experiments in an intermediate general circulation model

Radiative forcing and climate sensitivity have been widely used as concepts to understand climate change. This work performs climate change experiments with an intermediate general circulation model (IGCM) to examine the robustness of the radiative forcing concept for carbon dioxide and solar constant changes. This IGCM has been specifically developed as a computationally fast model, but one that allows an interaction between physical processes and large-scale dynamics; the model allows many long integrations to be performed relatively quickly. It employs a fast and accurate radiative transfer scheme, as well as simple convection and surface schemes, and a slab ocean, to model the effects of climate change mechanisms on the atmospheric temperatures and dynamics with a reasonable degree of complexity. The climatology of the IGCM run at T-21 resolution with 22 levels is compared to European Centre for Medium Range Weather Forecasting Reanalysis data. The response of the model to changes in carbon dioxide and solar output are examined when these changes are applied globally and when constrained geographically (e.g. over land only). The CO2 experiments have a roughly 17% higher climate sensitivity than the solar experiments. It is also found that a forcing at high latitudes causes a 40% higher climate sensitivity than a forcing only applied at low latitudes. It is found that, despite differences in the model feedbacks, climate sensitivity is roughly constant over a range of distributions of CO2 and solar forcings. Hence, in the IGCM at least, the radiative forcing concept is capable of predicting global surface temperature changes to within 30%, for the perturbations described here. It is concluded that radiative forcing remains a useful tool for assessing the natural and anthropogenic impact of climate change mechanisms on surface temperature.

The impracticality of a universal drought definition

This paper demonstrates the impracticality of a comprehensive mathematical definition of the term `drought' which formalises the general qualitative definition that drought is `a deficit of water relative to normal conditions'. Starting from the local water balance, it is shown that a universal description of drought requires reference to water supply, demand and management. The influence of human intervention through water management is shown to be intrinsic to the definition of drought in the universal sense and can only be eliminated in the case of purely meteorological drought. The state of `drought' is shown to be predicated on the existence of climatological norms for a multitude of process specific terms. In general these norms are either difficult to obtain or even non-existent in the non-stationary context of climate change. Such climatological considerations, in conjunction with the difficulty of quantifying human influence, lead to the conclusion that we cannot reasonably expect the existence of any workable generalised objective definition of drought.

An AeroCom assessment of black carbon in Arctic snow and sea ice

Though many global aerosols models prognose surface deposition, only a few models have been used to directly simulate the radiative effect from black carbon (BC) deposition to snow and sea ice. Here, we apply aerosol deposition fields from 25 models contributing to two phases of the Aerosol Comparisons between Observations and Models (AeroCom) project to simulate and evaluate within-snow BC concentrations and radiative effect in the Arctic. We accomplish this by driving the offline land and sea ice components of the Community Earth System Model with different deposition fields and meteorological conditions from 2004 to 2009, during which an extensive field campaign of BC measurements in Arctic snow occurred. We find that models generally underestimate BC concentrations in snow in northern Russia and Norway, while overestimating BC amounts elsewhere in the Arctic. Although simulated BC distributions in snow are poorly correlated with measurements, mean values are reasonable. The multi-model mean (range) bias in BC concentrations, sampled over the same grid cells, snow depths, and months of measurements, are −4.4 (−13.2 to +10.7) ng g−1 for an earlier phase of AeroCom models (phase I), and +4.1 (−13.0 to +21.4) ng g−1 for a more recent phase of AeroCom models (phase II), compared to the observational mean of 19.2 ng g−1. Factors determining model BC concentrations in Arctic snow include Arctic BC emissions, transport of extra-Arctic aerosols, precipitation, deposition efficiency of aerosols within the Arctic, and meltwater removal of particles in snow. Sensitivity studies show that the model–measurement evaluation is only weakly affected by meltwater scavenging efficiency because most measurements were conducted in non-melting snow. The Arctic (60–90° N) atmospheric residence time for BC in phase II models ranges from 3.7 to 23.2 days, implying large inter-model variation in local BC deposition efficiency. Combined with the fact that most Arctic BC deposition originates from extra-Arctic emissions, these results suggest that aerosol removal processes are a leading source of variation in model performance. The multi-model mean (full range) of Arctic radiative effect from BC in snow is 0.15 (0.07–0.25) W m−2 and 0.18 (0.06–0.28) W m−2 in phase I and phase II models, respectively. After correcting for model biases relative to observed BC concentrations in different regions of the Arctic, we obtain a multi-model mean Arctic radiative effect of 0.17 W m−2 for the combined AeroCom ensembles. Finally, there is a high correlation between modeled BC concentrations sampled over the observational sites and the Arctic as a whole, indicating that the field campaign provided a reasonable sample of the Arctic.

Vertical structure and physical processes of the Madden-Julian oscillation: synthesis and summary

The "Vertical structure and physical processes of the Madden-Julian oscillation (MJO)" project comprises three experiments, designed to evaluate comprehensively the heating, moistening and momentum associated with tropical convection in general circulation models (GCMs). We consider here only those GCMs that performed all experiments. Some models display relatively higher or lower MJO fidelity in both initialized hindcasts and climate simulations, while others show considerable variations in fidelity between experiments. Fidelity in hindcasts and climate simulations are not meaningfully correlated. The analysis of each experiment led to the development of process-oriented diagnostics, some of which distinguished between GCMs with higher or lower fidelity in that experiment. We select the most discriminating diagnostics and apply them to data from all experiments, where possible, to determine if correlations with MJO fidelity hold across scales and GCM states. While normalized gross moist stability had a small but statistically significant correlation with MJO fidelity in climate simulations, we find no link with fidelity in medium-range hindcasts. Similarly, there is no association between timestep-to-timestep rainfall variability, identified from short hindcasts, and fidelity in medium-range hindcasts or climate simulations. Two metrics that relate precipitation to free-tropospheric moisture--the relative humidity for extreme daily precipitation, and variations in the height and amplitude of moistening with rain rate--successfully distinguish between higher- and lower-fidelity GCMs in hindcasts and climate simulations. To improve the MJO, developers should focus on relationships between convection and both total moisture and its rate of change. We conclude by offering recommendations for further experiments.

Vertical structure and physical processes of the Madden-Julian oscillation: Biases and uncertainties at short range

An analysis of diabatic heating and moistening processes from 12-36 hour lead time forecasts from 12 Global Circulation Models are presented as part of the "Vertical structure and physical processes of the Madden-Julian Oscillation (MJO)" project. A lead time of 12-36 hours is chosen to constrain the large scale dynamics and thermodynamics to be close to observations while avoiding being too close to the initial spin-up for the models as they adjust to being driven from the YOTC analysis. A comparison of the vertical velocity and rainfall with the observations and YOTC analysis suggests that the phases of convection associated with the MJO are constrained in most models at this lead time although the rainfall in the suppressed phase is typically overestimated. Although the large scale dynamics is reasonably constrained, moistening and heating profiles have large inter-model spread. In particular, there are large spreads in convective heating and moistening at mid-levels during the transition to active convection. Radiative heating and cloud parameters have the largest relative spread across models at upper levels during the active phase. A detailed analysis of time step behaviour shows that some models show strong intermittency in rainfall and differences in the precipitation and dynamics relationship between models. The wealth of model outputs archived during this project is a very valuable resource for model developers beyond the study of the MJO. In addition, the findings of this study can inform the design of process model experiments, and inform the priorities for field experiments and future observing systems.

Shackle on time, uncertainty and process

This paper is intended both as a contribution to the conceptual work on process in economic thought and as an attempt to connect a non-institutionalist, non-evolutionary thinker to it. The paper has two principal objectives: (i) to delineate a broad, philosophically grounded conception of what an economic process theory (EPT) is; and (ii) to locate the contributions of George Shackle within this broad conception of EPT. In pursuing these two objectives, I hope to draw out the originality and significance of Shackle’s economics with a particular emphasis on what he adds to process conceptions developed within other heterodox traditions such as institutional and evolutionary economics. I will also highlight some of the perceived limitations of Shackle’s approach and link them to the limitations of process philosophy.

Production of milk foams by steam injection: the effects of steam pressure and nozzle design

Foam properties depend on the physico-chemical characteristics of the continuous phase, the method of production and process conditions employed; however the preparation of barista-style milk foams in coffee shops by injection of steam uses milk as its main ingredient which limits the control of foam properties by changing the biochemical characteristics of the continuous phase. Therefore, the control of process conditions and nozzle design are the only ways available to produce foams with diverse properties. Milk foams were produced employing different steam pressures (100-280 kPa gauge) and nozzle designs (ejector, plunging-jet and confined-jet nozzles). The foamability of milk, and the stability, bubble size and texture of the foams were investigated. Variations in steam pressure and nozzle design changed the hydrodynamic conditions during foam production, resulting in foams having a range of properties. Steam pressure influenced foam characteristics, although the net effect depended on the nozzle design used. These results suggest that, in addition to the physicochemical determinants of milk, the foam properties can also be controlled by changing the steam pressure and nozzle design.

Enzyme assisted extraction of chitin from shrimp shells (Litopenaeus vannamei)

BACKGROUND: Chemical chitin extraction generates large amounts of wastes and increases partial deacetylation of the product. Therefore, the use of biological methods for chitin extraction is an interesting alternative. The effects of process conditions on enzyme assisted extraction of chitin from the shrimp shells in a systematic way were the focal points of this study. RESULTS: Demineralisation conditions of 25C, 20 min, shells-lactic acid ratio of 1:1.1 w/w; and shells-acetic acid ratio of 1:1.2 w/w, the maximum demineralisation values were 98.64 and 97.57% for lactic and acetic acids, respectively. A total protein removal efficiency of 91.10% by protease from Streptomyces griseus with enzyme-substrate ratio 55 U/g, pH 7.0 and incubation time 3 h is obtained when the particle size range is 50-25 μm, which was identified as the most critical factor. The X-ray diffraction and 13C NMR spectroscopy analysis showed that the lower percent crystallinity and higher degree of acetylation of chitin from enzyme assisted extraction may exhibit better solubility properties and less depolymerisation in comparison with chitin from the chemical extraction. CONCLUSION: The present work investigates the effects of individual factors on process yields, and it has shown that, if the particle size is properly controlled a reaction time of 3 h is more than enough for deproteination by protease. Physicochemical analysis indicated that the enzyme assisted production of chitin seems appropriate to extract chitin, possibly retaining its native structure.

Reverse transfers of innovation and national development: evidence from Brazilian subsidiaries

The search for innovation has become an important motivation for the internationalization of companies in emerging countries. In that context, this study tests the impact that a nation’s development has on whether subsidiaries transfer innovation of products or that of processes. Survey data collected from 73 subsidiaries of Brazilian companies indicate that companies located in developed markets tend to transfer more product-oriented innovations than do those based in emerging countries. Furthermore, the size and age of a subsidiary has an impact on the transfer process. The larger and younger the subsidiary, the more likely a company is to favor the flow of product innovation into its headquarters. The level of national development was not identified as an influence on the flow of process innovation.

A possible reconceptualization of food engineering discipline

Food industry is critical to any nation’s health and well-being; it is also critical to the economic health of a nation, since it can typically constitute over a fifth of the nation’s manufacturing GDP. Food Engineering is a discipline that ought to be at the heart of the food industry. Unfortunately, this discipline is not playing its rightful role today: engineering has been relegated to play the role of a service provider to the food industry, instead of it being a strategic driver for the very growth of the industry. This paper hypothesises that food engineering discipline, today, seems to be continuing the way it was in the last century, and has not risen to the challenges that it really faces. This paper therefore categorises the challenges as those being posed by: 1. Business dynamics, 2. Market forces, 3. Manufacturing environment and 4. Environmental Considerations, and finds the current scope and subject-knowledge competencies of food engineering to be inadequate in meeting these challenges. The paper identifies: a) health, b) environment and c) security as the three key drivers of the discipline, and proposes a new definition of food engineering. This definition requires food engineering to have a broader science base which includes biophysical, biochemical and health sciences, in addition to engineering sciences. This definition, in turn, leads to the discipline acquiring a new set of subject-knowledge competencies that is fit-for-purpose for this day and age, and hopefully for the foreseeable future. The possibility of this approach leading to the development of a higher education program in food engineering is demonstrated by adopting a theme based curriculum development with five core themes, supplemented by appropriate enabling and knowledge integrating courses. At the heart of this theme based approach is an attempt to combine engineering of process and product in a purposeful way, termed here as Food Product Realisation Engineering. Finally, the paper also recommends future development of two possible niche specialisation programs in Nutrition and Functional Food Engineering and Gastronomic Engineering. It is hoped that this reconceptualization of the discipline will not only make it more purposeful for the food industry, but it will also make the subject more intellectually challenging and attract bright young minds to the discipline.

Non-autonomous semilinear evolution equations with almost sectorial operators

Inspired by the theory of semigroups of growth a, we construct an evolution process of growth alpha. The abstract theory is applied to study semilinear singular non-autonomous parabolic problems. We prove that. under natural assumptions. a reasonable concept of solution can be given to Such semilinear singularly non-autonomous problems. Applications are considered to non-autonomous parabolic problems in space of Holder continuous functions and to a parabolic problem in a domain Omega subset of R(n) with a one dimensional handle.