Errors in the administration of medication in inpatient hospitals: A systematic review of the research literature on commercial computerized physician order entry systems

Errors in the administration of medication represent a significant loss of medical resources and pose life altering or life threatening risks to patients. This paper considered the question, what impact do Computerized Physician Order Entry (CPOE) systems have on medication errors in the hospital inpatient environment? Previous reviews have examined evidence of the impact of CPOE on medication errors, but have come to ambiguous conclusions as to the impact of CPOE and decision support systems (DSS). Forty-three papers were identified. Thirty-one demonstrated a significant reduction in prescribing error rates for all or some drug types; decreases in minor errors were most often reported. Several studies reported increases in the rate of duplicate orders and failures to remove contraindicated drugs, often attributed to inappropriate design or to an inability to operate the system properly. The evidence on the effectiveness of CPOE to reduce errors in medication administration is compelling though it is limited by modest study sample sizes and designs. ^

Effects of ocean acidification on visual risk assessment in coral reef fishes

1. With the global increase in CO2 emissions, there is a pressing need for studies aimed at understanding the effects of ocean acidification on marine ecosystems. Several studies have reported that exposure to CO2 impairs chemosensory responses of juvenile coral reef fishes to predators. Moreover, one recent study pointed to impaired responses of reef fish to auditory cues that indicate risky locations. These studies suggest that altered behaviour following exposure to elevated CO2 is caused by a systemic effect at the neural level. 2. The goal of our experiment was to test whether juvenile damselfish Pomacentrus amboinensis exposed to different levels of CO2 would respond differently to a potential threat, the sight of a large novel coral reef fish, a spiny chromis, Acanthochromis polyancanthus, placed in a watertight bag. 3. Juvenile damselfish exposed to 440 (current day control), 550 or 700 µatm CO2 did not differ in their response to the chromis. However, fish exposed to 850 µatm showed reduced antipredator responses; they failed to show the same reduction in foraging, activity and area use in response to the chromis. Moreover, they moved closer to the chromis and lacked any bobbing behaviour typically displayed by juvenile damselfishes in threatening situations. 4. Our results are the first to suggest that response to visual cues of risk may be impaired by CO2 and provide strong evidence that the multi-sensory effects of CO2 may stem from systematic effects at the neural level.

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.

Resilience in Cloud Computing for Critical Systems. Resilience, Dependability, Reliability in the use of Cloud Computing in Critical Systems in Public Organizations.

La informática se está convirtiendo en la quinta utilidad (gas, agua, luz, teléfono) en parte debido al impacto de Cloud Computing en las mayorías de las organizaciones. Este uso de informática es usada por cada vez más tipos de sistemas, incluidos Sistemas Críticos. Esto tiene un impacto en la complejidad internad y la fiabilidad de los sistemas de la organización y los que se ofrecen a los clientes. Este trabajo investiga el uso de Cloud Computing por sistemas críticos, centrándose en las dependencias y especialmente en la fiabilidad de estos sistemas. Se han presentado algunos ejemplos de su uso, y aunque su utilización en sistemas críticos no está extendido, se presenta cual puede llegar a ser su impacto. El objetivo de este trabajo es primero definir un modelo que pueda representar de una forma cuantitativa las interdependencias en fiabilidad y interdependencia para las organizaciones que utilicen estos sistemas, y aplicar este modelo en un sistema crítico del campo de sanidad y mostrar sus resultados. Los conceptos de “macro-dependability” y “micro-dependability” son introducidos en el modelo para la definición de interdependencia y para analizar la fiabilidad de sistemas que dependen de otros sistemas. ABSTRACT With the increasing utilization of Internet services and cloud computing by most organizations (both private and public), it is clear that computing is becoming the 5th utility (along with water, electricity, telephony and gas). These technologies are used for almost all types of systems, and the number is increasing, including Critical Infrastructure systems. Even if Critical Infrastructure systems appear not to rely directly on cloud services, there may be hidden inter-dependencies. This is true even for private cloud computing, which seems more secure and reliable. The critical systems can began in some cases with a clear and simple design, but evolved as described by Egan to "rafted" networks. Because they are usually controlled by one or few organizations, even when they are complex systems, their dependencies can be understood. The organization oversees and manages changes. These CI systems have been affected by the introduction of new ICT models like global communications, PCs and the Internet. Even virtualization took more time to be adopted by Critical systems, due to their strategic nature, but once that these technologies have been proven in other areas, at the end they are adopted as well, for different reasons such as costs. A new technology model is happening now based on some previous technologies (virtualization, distributing and utility computing, web and software services) that are offered in new ways and is called cloud computing. The organizations are migrating more services to the cloud; this will have impact in their internal complexity and in the reliability of the systems they are offering to the organization itself and their clients. Not always this added complexity and associated risks to their reliability are seen. As well, when two or more CI systems are interacting, the risks of one can affect the rest, sharing the risks. This work investigates the use of cloud computing by critical systems, and is focused in the dependencies and reliability of these systems. Some examples are presented together with the associated risks. A framework is introduced for analysing the dependability and resilience of a system that relies on cloud services and how to improve them. As part of the framework, the concepts of micro and macro dependability are introduced to explain the internal and external dependability on services supplied by an external cloud. A pharmacovigilance model system has been used for framework validation.

Energy and Lighting Performance of Buildings in the Neighbourhood Ciudad de los Angeles, Before and After Refurbishing.

The Spanish Ministry of Economy and Competitiveness is funding the SHERIF Research Project, which falls under the INNPACTO pr ogram. This project aims to increase the rate of the existing building refurbishment fro m the energy efficiency point of view by designing a facade system that must be an economica l, flexible and integrated solution 1 . Under this project has been performing several task s regarding the constructive characterization and energy evaluation of the therm al behaviour of facades on existing buildings . In order to perform the latter task, in which this article will focus, has been developing a survey of various buildings in the nei ghbourhood Ciudad de los Angeles, which has as main objective the comparison between the ac tual energy and light behaviour of different buildings, prior and posterior to any ref urbishment works have been undertaken. The evaluation of the actual performance of buildin gs before and after being refurbished is aimed to determine the impact of the work developed as well as learn from the work performed for future interventions.

A methodology proposal to obtain operational parameter forecasts and operational risk assessment in container terminals

Las terminales de contenedores son sistemas complejos en los que un elevado número de actores económicos interactúan para ofrecer servicios de alta calidad bajo una estricta planificación y objetivos económicos. Las conocidas como "terminales de nueva generación" están diseñadas para prestar servicio a los mega-buques, que requieren tasas de productividad que alcanzan los 300 movimientos/ hora. Estas terminales han de satisfacer altos estándares dado que la competitividad entre terminales es elevada. Asegurar la fiabilidad de las planificaciones del atraque es clave para atraer clientes, así como reducir al mínimo el tiempo que el buque permanece en el puerto. La planificación de las operaciones es más compleja que antaño, y las tolerancias para posibles errores, menores. En este contexto, las interrupciones operativas deben reducirse al mínimo. Las principales causas de dichas perturbaciones operacionales, y por lo tanto de incertidumbre, se identifican y caracterizan en esta investigación. Existen una serie de factores que al interactuar con la infraestructura y/o las operaciones desencadenan modos de fallo o parada operativa. Los primeros pueden derivar no solo en retrasos en el servicio sino que además puede tener efectos colaterales sobre la reputación de la terminal, o incluso gasto de tiempo de gestión, todo lo cual supone un impacto para la terminal. En el futuro inmediato, la monitorización de las variables operativas presenta gran potencial de cara a mejorar cualitativamente la gestión de las operaciones y los modelos de planificación de las terminales, cuyo nivel de automatización va en aumento. La combinación del criterio experto con instrumentos que proporcionen datos a corto y largo plazo es fundamental para el desarrollo de herramientas que ayuden en la toma de decisiones, ya que de este modo estarán adaptadas a las auténticas condiciones climáticas y operativas que existen en cada emplazamiento. Para el corto plazo se propone una metodología con la que obtener predicciones de parámetros operativos en terminales de contenedores. Adicionalmente se ha desarrollado un caso de estudio en el que se aplica el modelo propuesto para obtener predicciones de la productividad del buque. Este trabajo se ha basado íntegramente en datos proporcionados por una terminal semi-automatizada española. Por otro lado, se analiza cómo gestionar, evaluar y mitigar el efecto de las interrupciones operativas a largo plazo a través de la evaluación del riesgo, una forma interesante de evaluar el effecto que eventos inciertos pero probables pueden generar sobre la productividad a largo plazo de la terminal. Además se propone una definición de riesgo operativo junto con una discusión de los términos que representan con mayor fidelidad la naturaleza de las actividades y finalmente, se proporcionan directrices para gestionar los resultados obtenidos. Container terminals are complex systems where a large number of factors and stakeholders interact to provide high-quality services under rigid planning schedules and economic objectives. The socalled next generation terminals are conceived to serve the new mega-vessels, which are demanding productivity rates up to 300 moves/hour. These terminals need to satisfy high standards because competition among terminals is fierce. Ensuring reliability in berth scheduling is key to attract clients, as well as to reduce at a minimum the time that vessels stay the port. Because of the aforementioned, operations planning is becoming more complex, and the tolerances for errors are smaller. In this context, operational disturbances must be reduced at a minimum. The main sources of operational disruptions and thus, of uncertainty, are identified and characterized in this study. External drivers interact with the infrastructure and/or the activities resulting in failure or stoppage modes. The later may derive not only in operational delays but in collateral and reputation damage or loss of time (especially management times), all what implies an impact for the terminal. In the near future, the monitoring of operational variables has great potential to make a qualitative improvement in the operations management and planning models of terminals that use increasing levels of automation. The combination of expert criteria with instruments that provide short- and long-run data is fundamental for the development of tools to guide decision-making, since they will be adapted to the real climatic and operational conditions that exist on site. For the short-term a method to obtain operational parameter forecasts in container terminals. To this end, a case study is presented, in which forecasts of vessel performance are obtained. This research has been entirely been based on data gathered from a semi-automated container terminal from Spain. In the other hand it is analyzed how to manage, evaluate and mitigate disruptions in the long-term by means of the risk assessment, an interesting approach to evaluate the effect of uncertain but likely events on the long-term throughput of the terminal. In addition, a definition for operational risk evaluation in port facilities is proposed along with a discussion of the terms that better represent the nature of the activities involved and finally, guidelines to manage the results obtained are provided.

History of health, a valuable tool in public health

The aim of this article is to highlight the importance of the history of public health for public health research and practice itself. After summarily reviewing the current great vitality of the history of collective health oriented initiatives, we explain three particular features of the historical vantage point in public health, namely the importance of the context, the relevance of a diachronic attitude and the critical perspective. In order to illustrate those three topics, we bring up examples taken from three centuries of fight against malaria, the so called “re-emerging diseases” and the 1918 influenza epidemic. The historical approach enriches our critical perception of the social effects of initiatives undertaken in the name of public health, shows the shortcomings of public health interventions based on single factors and asks for a wider time scope in the assessment of current problems. The use of a historical perspective to examine the plurality of determinants in any particular health condition will help to solve the longlasting debate on the primacy of individual versus population factors, which has been particularly intense in recent times.

Innovation in public services: the case of Spanish local government

The present paper aims to determine the level of implementation of innovations in Spanish local government as well as to identify which types of innovations are most common. The paper also considers the link between innovative behavior and organizational size. However, since innovations cannot occur as isolated phenomena but rather as a part of corporate strategy, the study compares the innovative behavior of the local governments analyzed with their typologies or strategic profiles. In order to achieve the aforementioned aims, the paper uses a survey of the Human Resource Managers of Town Halls in the largest Spanish municipalities. The results of this survey show that the most frequent innovations in the local governments analyzed are collaborative; the largest town halls show more propensities to innovate and they focus on external relationships which are collaborative and on the basis on Information and Communication Technologies. The study reconfirms that town halls with a prospective profile are the most innovative.

Robotic Outcome Assessment in a Non-Human Primate Model of Middle Cerebral Artery Stroke

Stroke is a prevalent disorder with immense socioeconomic impact. A variety of chronic neurological deficits result from stroke. In particular, sensorimotor deficits are a significant barrier to achieving post-stroke independence. Unfortunately, the majority of pre-clinical studies that show improved outcomes in animal stroke models have failed in clinical trials. Pre-clinical studies using non-human primate (NHP) stroke models prior to initiating human trials are a potential step to improving translation from animal studies to clinical trials. Robotic assessment tools represent a quantitative, reliable, and reproducible means to assess reaching behaviour following stroke in both humans and NHPs. We investigated the use of robotic technology to assess sensorimotor impairments in NHPs following middle cerebral artery occlusion (MCAO). Two cynomolgus macaques underwent transient MCAO for 90 minutes. Approximately 1.5 years following the procedure these NHPs and two non-stroke control monkeys were trained in a reaching task with both arms in the KINARM exoskeleton. This robot permits elbow and shoulder movements in the horizontal plane. The task required NHPs to make reaching movements from a centrally positioned start target to 1 of 8 peripheral targets uniformly distributed around the first target. We analyzed four movement parameters: reaction time, movement time (MT), initial direction error (IDE), and number of speed maxima to characterize sensorimotor deficiencies. We hypothesized reduced performance in these attributes during a neurobehavioural task with the paretic limb of NHPs following MCAO compared to controls. Reaching movements in the non-affected limbs of control and experimental NHPs showed bell-shaped velocity profiles. In contrast, the reaching movements with the affected limbs were highly variable. We found distinctive patterns in MT, IDE, and number of speed peaks between control and experimental monkeys and between limbs of NHPs with MCAO. NHPs with MCAO demonstrated more speed peaks, longer MTs, and greater IDE in their paretic limb compared to controls. These initial results qualitatively match human stroke subjects’ performance, suggesting that robotic neurobehavioural assessment in NHPs with stroke is feasible and could have translational relevance in subsequent human studies. Further studies will be necessary to replicate and expand on these preliminary findings.

Strengthening support & recruitment of women & minorities to positions in education administration : a resource manual.

"December 1992"--T.p. verso.

Hearings in public assistance. v.1-4. 1947-1950.

Title varies: volumes 1-2 titled Hearing decisions in public assistance.

Uneconomical practices in the administration of employment service and unemployment compensation programs, Bureau of Employment Security, Department of Labor /

Mode of access: Internet.

Public administration of Florida's natural resources,

Mode of access: Internet.

The international Secretariat, a great experiment in international administration,

Includes index.

A guide for studying the utilization of nursing service personnel in Veterans Administration hospitals.

Cover title.