Pharmacology and the safe prescribing of drugs

Understanding the pharmacological principles and safe use of drugs is just as important in surgical practice as in any other medical specialty. With an ageing population with often multiple comorbidities and medications, as well as an expanding list of new pharmacological treatments, it is important that surgeons understand the implications of therapeutic drugs on their daily practice. The increasing emphasis on high quality and safe patient care demands that doctors are aware of preventable adverse drug reactions (ADRs) and interactions, try to minimize the potential for medication errors, and consider the benefits and harms of medicines in their patients. This chapter examines these aspects from the view of surgical practice and expands on the implications of some of the most common medical conditions and drug classes in the perioperative period. The therapeutic care of surgical patients is obvious in many circumstances – for example, antibacterial prophylaxis, thromboprophylaxis, and postoperative analgesia. However, the careful examination of other drug therapies is often critical not only to the sustained treatment of the associated medical conditions but to the perioperative outcomes of patients undergoing surgery. The benefit–harm balance of many therapies may be fundamentally altered by the stress of an operation in one direction or the other; this is not a decision that should wait until the anaesthetist arrives for a preoperative assessment or one that should be left to junior medical or nursing staff on the ward.

Voting with their feet: Migration, partisanship, and party-safe elections in Florida

Political scientists have long noted that Congressional elections are often uncompetitive, often extremely so. Many scholars argue that the cause lies in the partisan redistricting of Congressional districts, or “gerrymandering”. Other scholars emphasize polarization created by a fragmented news media, or the candidate choices made by a more ideological primary electorate. All these explanations identify the cause of party-safe elections in institutions of various kinds. This dissertation, by contrast, presents a structural explanation of uncompetitive elections. My theory is that population composition and patterns of migration are significant causes and predictors of election results in Florida. I test this theory empirically by comparing the predictions from four hypotheses against aggregate data, using the county as the unit of analysis. The first hypothesis is that Florida can be divided into clearly distinguishable, persistent partisan sections. This hypothesis is confirmed. The second hypothesis is that Florida voters have become increasingly partisan over time. This hypothesis is confirmed. The third hypothesis is that the degree of migration into a county predicts how that county will vote. This hypothesis is partially confirmed, for the migration effect appears to have waned over time. The last hypothesis is that the degree of religiosity of a county population is a predictor of how that county will vote. This hypothesis is also supported by the results of statistical analysis. By identifying the structural causes of party-safe elections, this dissertation not only broadens our understanding of elections in Florida, but also sheds light on the current polarization in American politics.

Organizational Behavior: Forgotten Variable in Safe Food

The war on foodborne illness in hotels and restaurants is based on microbiology and critical control points. The author argues that cooks, managers, instructors, researchers, and regulators need to start looking beyond this narrow base to include more organizational behavior processes in their arsenal.

Personnel selection, safety performance, and job performance: Are safe workers better workers?

The present dissertation consists of two studies that combine personnel selection, safety performance, and job performance literatures to answer an important question: are safe workers better workers? Study 1 tested a predictive model of safety performance to examine personality characteristics (conscientiousness and agreeableness), and two novel behavioral constructs (safety orientation and safety judgment) as predictors of safety performance in a sample of forklift loaders/operators (N = 307). Analyses centered on investigating safety orientation as a proximal predictor and determinant of safety performance. Study 2 replicated Study 1 and explored the relationship between safety performance and job performance by testing an integrative model in a sample of machine operators and construction crewmembers (N = 323). Both Study 1 and Study 2 found conscientiousness, agreeableness, and safety orientation to be good predictors of safety performance. While both personality and safety orientation were positively related to safety performance, safety orientation proved to be a more proximal determinant of safety performance. Across studies, results surrounding safety judgment as a predictor of safety performance were inconclusive, suggesting possible issues with measurement of the construct. Study 2 found a strong relationship between safety performance and job performance. In addition, safety performance served as a mediator between predictors (conscientiousness, agreeableness and safety orientation) and job performance. Together these findings suggest that safe workers are indeed better workers, challenging previous viewpoints to the contrary. Further, results implicate the viability of personnel selection as means of promoting safety in organizations.^

Student, Teacher, and Administrator Perspectives on Harm: Implications for Implementing Safe and Caring School Initiatives

This article reports on a study that examines student, teacher and administrator perspectives on harm and how their schools address harm. It presents an overview of these perspectives within and across 3 different school environments. In doing so, the study contributes to a better understanding of the often ineffective implementation of safe and caring school initiatives. By drawing on restorative justice and relational theory, the findings illustrate how a focus on well-being and relationship is critical for meeting the needs of those harmed and those causing harm. Such a focus requires interaction rooted in social engagement rather than social control (Morrison 2012) and challenges current recommendations for combining the strengths of several current approaches for a more effective outcome (Osher et al. 2010).

Join the Union and Be Safe : The Effects of Unionization on Occupational Safety and Health in the European Union

Acknowledgements: Thanks go to the participants of the ‘Health and Work’ Organised Session (2011) of the Scottish Economic Society 2011 Annual Conference, Perth, Scotland, for helpful comments. The authors are also grateful to the editor Franco Peracchi and the referees of this journal for helpful comments and suggestions. The financial support of the European Commission is gratefully acknowledged (HEALTHatWORK Project) — 7th Framework Programme THEME [HEALTH-2007-4.2-3] Grant Agreement No: 200716.

Join the Union and Be Safe : The Effects of Unionization on Occupational Safety and Health in the European Union

Acknowledgements: Thanks go to the participants of the ‘Health and Work’ Organised Session (2011) of the Scottish Economic Society 2011 Annual Conference, Perth, Scotland, for helpful comments. The authors are also grateful to the editor Franco Peracchi and the referees of this journal for helpful comments and suggestions. The financial support of the European Commission is gratefully acknowledged (HEALTHatWORK Project) — 7th Framework Programme THEME [HEALTH-2007-4.2-3] Grant Agreement No: 200716.

Crimes Against Women conference with Pauline Haines, International Indian Treaty Council; Sandy Ramos, N.J. Battered Women's Safe House Founder; and Daphne Busby, Sisterhood of Black Single Mothers

General note: Title and date provided by Bettye Lane.

Battered woman describing and showing her fear of her husband taken at battered women's safe house in New Jersey. Digital reproduction

General note: Title and date provided by Bettye Lane.

Battered women's conference and safe house

General note: Title and date provided by Bettye Lane.

SAFE: A Declarative Trust-Agile System with Linked Credentials

Secure Access For Everyone (SAFE), is an integrated system for managing trust

using a logic-based declarative language. Logical trust systems authorize each

request by constructing a proof from a context---a set of authenticated logic

statements representing credentials and policies issued by various principals

in a networked system. A key barrier to practical use of logical trust systems

is the problem of managing proof contexts: identifying, validating, and

assembling the credentials and policies that are relevant to each trust

decision.

SAFE addresses this challenge by (i) proposing a distributed authenticated data

repository for storing the credentials and policies; (ii) introducing a

programmable credential discovery and assembly layer that generates the

appropriate tailored context for a given request. The authenticated data

repository is built upon a scalable key-value store with its contents named by

secure identifiers and certified by the issuing principal. The SAFE language

provides scripting primitives to generate and organize logic sets representing

credentials and policies, materialize the logic sets as certificates, and link

them to reflect delegation patterns in the application. The authorizer fetches

the logic sets on demand, then validates and caches them locally for further

use. Upon each request, the authorizer constructs the tailored proof context

and provides it to the SAFE inference for certified validation.

Delegation-driven credential linking with certified data distribution provides

flexible and dynamic policy control enabling security and trust infrastructure

to be agile, while addressing the perennial problems related to today's

certificate infrastructure: automated credential discovery, scalable

revocation, and issuing credentials without relying on centralized authority.

We envision SAFE as a new foundation for building secure network systems. We

used SAFE to build secure services based on case studies drawn from practice:

(i) a secure name service resolver similar to DNS that resolves a name across

multi-domain federated systems; (ii) a secure proxy shim to delegate access

control decisions in a key-value store; (iii) an authorization module for a

networked infrastructure-as-a-service system with a federated trust structure

(NSF GENI initiative); and (iv) a secure cooperative data analytics service

that adheres to individual secrecy constraints while disclosing the data. We

present empirical evaluation based on these case studies and demonstrate that

SAFE supports a wide range of applications with low overhead.

PoisonIvy: Safe speculation for secure memory

Encryption and integrity trees guard against phys- ical attacks, but harm performance. Prior academic work has speculated around the latency of integrity verification, but has done so in an insecure manner. No industrial implementations of secure processors have included speculation. This work presents PoisonIvy, a mechanism which speculatively uses data before its integrity has been verified while preserving security and closing address-based side-channels. PoisonIvy reduces per- formance overheads from 40% to 20% for memory intensive workloads and down to 1.8%, on average.

Non-invasive Ventilation of Patients with ARDS: Insights from the LUNG SAFE Study

Background: Non-invasive ventilation (NIV) is increasingly used in patients with Acute Respiratory Distress Syndrome (ARDS). Whether, during NIV, the categorization of ARDS severity based on the PaO2/FiO2 Berlin criteria is useful is unknown. The evidence supporting NIV use in patients with ARDS remains relatively sparse.

Methods: The Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study described the management of patients with ARDS. This sub-study examines the current practice of NIV use in ARDS, the utility of the PaO2/FiO2 ratio in classifying patients receiving NIV and the impact of NIV on outcome.

Results: Of 2,813 patients with ARDS, 436 (15.5%) were managed with NIV on days 1 and 2 following fulfillment of diagnostic criteria. Classification of ARDS severity based on PaO2/FiO2 ratio was associated with an increase in intensity of ventilatory support, NIV failure, and Intensive Care Unit (ICU) mortality. NIV failure occurred in 22.2% of mild, 42.3% of moderate and 47.1% of patients with severe ARDS. Hospital mortality in patients with NIV success and failure was 16.1 % and 45.4%, respectively. NIV use was independently associated with increased ICU (HR 1.446; [1.159-1.805]), but not hospital mortality. In a propensity matched analysis, ICU mortality was higher in NIV than invasively ventilated patients with a PaO2/FiO2 lower than 150 mmHg.

Conclusions: NIV was used in 15% of patients with ARDS, irrespective of severity category. NIV appears to be associated with higher ICU mortality in patients with a PaO2/FiO2 lower than 150 mmHg.

Trial Registration: ClinicalTrials.gov NCT02010073