The movement toward patient safety: State action related to reporting and disclosure of healthcare-associated infections

Increasing attention has been given to the problem of medical errors over the past decade. Included within that focused attention has been a strong interest in reducing the occurrence of healthcare-associated infections (HAIs). Acting concurrently with federal initiatives, the majority of U.S. states have statutorily required reporting and public disclosure of HAI data. Although the occurrence of these state statutory enactments and other state initiatives represent a recognition of the strong concern pertaining to HAIs, vast differences in each state’s HAI reporting and public disclosure requirements creates a varied and unequal response to what has become a national problem.^ The purpose of this research was to explore the variations in state HAI legal requirements and other state mandates. State actions, including statutory enactments, regulations, and other initiatives related to state reporting and public disclosure mechanisms were compared, discussed, and analyzed in an effort to illustrate the impact of the lack of uniformity as a public health concern.^ The HAI statutes, administrative requirements, and other mandates of each state and two U.S. territories were reviewed to answer the following seven research questions: How far has the state progressed in its HAI initiative? If the state has a HAI reporting requirement, is it mandatory or voluntary? What healthcare entities are subject to the reporting requirements? What data collection system is utilized? What measures are required to be reported? What is the public disclosure mechanism? How is the underlying reported information protected from public disclosure or other legal release?^ Secondary publicly available data, including state statutes, administrative rules, and other initiatives, were utilized to examine the current HAI-related legislative and administrative activity of the study subjects. The information was reviewed and analyzed to determine variations in HAI reporting and public disclosure laws. Particular attention was given to the seven key research questions.^ The research revealed that considerable progress has been achieved in state HAI initiatives since 2004. Despite this progress, however, when reviewing the state laws and HAI programs comparatively, considerable variations were found to exist with regards to the type of reporting requirements, healthcare facilities subject to the reporting laws, data collection systems utilized, reportable measures, public disclosure requirements, and confidentiality and privilege provisions. The wide variations in state statutes, administrative rules, and other agency directives create a fragmented and inconsistent approach to addressing the nationwide occurrence of HAIs in the U.S. healthcare system. ^

An assessment of the relative influence of a vapor recovery system in reducing occupational exposure to volatile organic compounds in high performance liquid chromatography

Occupational exposures to organic solvents, specifically acetonitrile and methanol, have the potential to cause serious long-term health effects. In the laboratory, these solvents are used extensively in protocols involving the use of high performance liquid chromatography (HPLC). Operators of HPLC equipment may be potentially exposed to these organic solvents when local exhaust ventilation is not employed properly or is not available, which can be the case in many settings. The objective of this research was to characterize the various sites of vapor release in the HPLC process and then to determine the relative influence of a novel vapor recovery system on the overall exposure to laboratory personnel. The effectiveness of steps to reduce environmental solvent vapor concentrations was assessed by measuring exposure levels of acetonitrile and methanol before and after installation of the vapor recovery system. With respect to acetonitrile, the concentration was not statistically significant with p=0.938; moreover, exposure after the intervention was actually higher than prior to intervention. With respect to methanol, the concentration was not statistically significant with p=0.278. This indicates that the exposure to methanol after the intervention was not statistically significantly higher or lower than prior to intervention. Thus, installation of the vapor recovery device did not result in statistically significant reduction in exposures in the settings encountered, and acetonitrile actually increased significantly.^

Implementing and evaluating a Web -based close call reporting system at an urban hospital

Medical errors and close calls are pervasive in health care. It is hypothesized that the causes of close calls are the same as for medical errors; therefore learning about close calls can help prevent errors and increase patient safety. Yet despite efforts to encourage close call reporting, close calls as well as medical errors are under-reported in health care. The purpose of this dissertation was to implement and evaluate a web-based anonymous close call reporting system in three units at an urban hospital. ^ The study participants were physicians, nurses and medical technicians (N = 187) who care for patients in the Medical Intermediate Care Unit, the Surgical Intermediate Care Unit, and the Coronary Catheterization Laboratory in the hospital. We provided educational information to the participants on how to use the system and e-mailed and delivered paper reminders to report to the participants throughout the 19-month project. We surveyed the participants at the beginning and at the end of the study to assess their attitudes and beliefs regarding incident reporting. We found that the majority of the health care providers in our study are supportive of incident reporting in general but in practice very few had actually reported an error or a close call, semi-structured interview 20 weeks after we made the close call reporting system available. The purpose of the interviews was to further assess the participants' attitudes regarding incident reporting and the reporting system. Our findings suggest that the health care providers are supportive of medical error reporting in general, but are not convinced of the benefit of reporting close calls. Barriers to close call reporting cited include lack of time, heavy workloads, preferring to take care of close calls "on the spot", and not seeing the benefits of close call reporting. Consequently only two = close calls were reported via the system by two separate caregivers during the project. ^ The findings suggest that future efforts to increase close call reporting must address barriers to reporting, especially the belief among care givers that it is not worth taking time from their already busy schedules to report close calls. ^

Ocean acidification increases cadmium accumulation in marine bivalves: a potential threat to seafood safety

To date, the effects of ocean acidification on toxic metals accumulation and the underlying molecular mechanism remains unknown in marine bivalve species. In the present study, the effects of the realistic future ocean pCO2 levels on the cadmium (Cd) accumulation in the gills, mantle and adductor muscles of three bivalve species, Mytilus edulis, Tegillarca granosa, and Meretrix meretrix, were investigated. The results obtained suggested that all species tested accumulated significantly higher Cd (p<0.05) in the CO2 acidified seawater during the 30 days experiment and the health risk of Cd (based on the estimated target hazard quotients, THQ) via consumption of M. meretrix at pH 7.8 and 7.4 significantly increased 1.21 and 1.32 times respectively, suggesting a potential threat to seafood safety. The ocean acidification-induced increase in Cd accumulation may have occurred due to (i) the ocean acidification increased the concentration of Cd and the Cd2+/Ca2+ in the seawater, which in turn increased the Cd influx through Ca channel; (ii) the acidified seawater may have brought about epithelia damage, resulting in easier Cd penetration; and (iii) ocean acidification hampered Cd exclusion.

Safety assessment of underground vehicles passing over highly resilient straight tracks in the presence of a broken rail

In this paper, vehicle-track interaction for a new slab track design, conceived to reduce noise and vibration levels has been analyzed, assessing the derailment risk for trains running on curved track when encountering a broken rail. Two different types of rail fastening systems with different elasticities have been analysed and compared. Numerical methods were used in order to simulate the dynamic behaviour of the train-track interaction. Multibody system (MBS) modelling techniques were combined with techniques based on the finite element method (FEM). MBS modelling was used for modelling the vehicle and FEM for simulating the elastic track. The simulation model was validated by comparing simulated results to experimental data obtained in field testing. During the simulations various safety indices, characteristic of derailment risk, were analysed. The simulations realised at the maximum running velocity of 110 km/h showed a similar behaviour for several track types. When reducing the running speed, the safety indices worsened for both cases. Although the worst behaviour was observed for the track with a greater elasticity, in none of the simulations did a derailment occur when running over the broken rail.

Safety assessment of underground vehicles passing over highly resilient curved tracks in the presence of a broken rail

Vehicle–track interaction for a new resilient slab track designed to reduce noise and vibration levels was analysed, in order to assess the derailment risk on a curved track when encountering a broken rail. Sensitivity of the rail support spacing of the relative position of the rail breakage between two adjacent rail supports and of running speed were analysed for two different elasticities of the rail fastening system. In none of the cases analysed was observed an appreciable difference between either of the elastic systems. As was expected, the most unfavourable situations were those with greater rail support spacing and those with greater distance from the breakage to the nearest rail support, although in none of the simulations performed did a derailment occur when running over the broken rail. When varying the running speed, the most favourable condition was obtained for an intermediate speed, due to the superposition of two antagonistic effects.

Application of gas-cooled Accelerator Driven System (ADS) transmutation devices to sustainable nuclear energy development

The conceptual design of a pebble bed gas-cooled transmutation device is shown with the aim to evaluate its potential for its deployment in the context of the sustainable nuclear energy development, which considers high temperature reactors for their operation in cogeneration mode, producing electricity, heat and Hydrogen. As differential characteristics our device operates in subcritical mode, driven by a neutron source activated by an accelerator that adds clear safety advantages and fuel flexibility opening the possibility to reduce the nuclear stockpile producing energy from actual LWR irradiated fuel with an efficiency of 45?46%, either in the form of Hydrogen, electricity, or both.

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

Making Transport Safer: V2V-Based Automated Emergency Braking System

An important goal in the field of intelligent transportation systems (ITS) is to provide driving aids aimed at preventing accidents and reducing the number of traffic victims. The commonest traffic accidents in urban areas are due to sudden braking that demands a very fast response on the part of drivers. Attempts to solve this problem have motivated many ITS advances including the detection of the intention of surrounding cars using lasers, radars or cameras. However, this might not be enough to increase safety when there is a danger of collision. Vehicle to vehicle communications are needed to ensure that the other intentions of cars are also available. The article describes the development of a controller to perform an emergency stop via an electro-hydraulic braking system employed on dry asphalt. An original V2V communication scheme based on WiFi cards has been used for broadcasting positioning information to other vehicles. The reliability of the scheme has been theoretically analyzed to estimate its performance when the number of vehicles involved is much higher. This controller has been incorporated into the AUTOPIA program control for automatic cars. The system has been implemented in Citroën C3 Pluriel, and various tests were performed to evaluate its operation.

Abstract Interpretation-based verification/certification in the ciaoPP system

CiaoPP is the abstract interpretation-based preprocessor of the Ciao multi-paradigm (Constraint) Logic Programming system. It uses modular, incremental abstract interpretation as a fundamental tool to obtain information about programs. In CiaoPP, the semantic approximations thus produced have been applied to perform high- and low-level optimizations during program compilation, including transformations such as múltiple abstract specialization, parallelization, partial evaluation, resource usage control, and program verification. More recently, novel and promising applications of such semantic approximations are being applied in the more general context of program development such as program verification. In this work, we describe our extensión of the system to incorpórate Abstraction-Carrying Code (ACC), a novel approach to mobile code safety. ACC follows the standard strategy of associating safety certificates to programs, originally proposed in Proof Carrying- Code. A distinguishing feature of ACC is that we use an abstraction (or abstract model) of the program computed by standard static analyzers as a certifícate. The validity of the abstraction on the consumer side is checked in a single-pass by a very efficient and specialized abstractinterpreter. We have implemented and benchmarked ACC within CiaoPP. The experimental results show that the checking phase is indeed faster than the proof generation phase, and that the sizes of certificates are reasonable. Moreover, the preprocessor is based on compile-time (and run-time) tools for the certification of CLP programs with resource consumption assurances.

Some techniques for automated, resource-aware distributed and mobile computing in a multi-paradigm programming system

Distributed parallel execution systems speed up applications by splitting tasks into processes whose execution is assigned to different receiving nodes in a high-bandwidth network. On the distributing side, a fundamental problem is grouping and scheduling such tasks such that each one involves sufñcient computational cost when compared to the task creation and communication costs and other such practical overheads. On the receiving side, an important issue is to have some assurance of the correctness and characteristics of the code received and also of the kind of load the particular task is going to pose, which can be specified by means of certificates. In this paper we present in a tutorial way a number of general solutions to these problems, and illustrate them through their implementation in the Ciao multi-paradigm language and program development environment. This system includes facilities for parallel and distributed execution, an assertion language for specifying complex programs properties (including safety and resource-related properties), and compile-time and run-time tools for performing automated parallelization and resource control, as well as certification of programs with resource consumption assurances and efñcient checking of such certificates.

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.

QL-CONST1: an expert system for quality level prediction in concrete structures

Current trends in the fields of artifical intelligence and expert systems are moving towards the exciting possibility of reproducing and simulating human expertise and expert behaviour into a knowledge base, coupled with an appropriate, partially ‘intelligent’, computer code. This paper deals with the quality level prediction in concrete structures using the helpful assistance of an expert system, QL-CONST1, which is able to reason about this specific field of structural engineering. Evidence, hypotheses and factors related to this human knowledge field have been codified into a knowledge base. This knowledge base has been prepared in terms of probabilities of the presence of either hypotheses or evidence and the conditional presence of both. Human experts in the fields of structural engineering and the safety of structures gave their invaluable knowledge and assistance to the construction of the knowledge base. Some illustrative examples for, the validation of the expert system behaviour are included.

Power system stability of a small sized isolated network supplied by a combined wind-pumped storage generation system: a case study in the Canary Islands

Massive integration of renewable energy sources in electrical power systems of remote islands is a subject of current interest. The increasing cost of fossil fuels, transport costs to isolated sites and environmental concerns constitute a serious drawback to the use of conventional fossil fuel plants. In a weak electrical grid, as it is typical on an island, if a large amount of conventional generation is substituted by renewable energy sources, power system safety and stability can be compromised, in the case of large grid disturbances. In this work, a model for transient stability analysis of an isolated electrical grid exclusively fed from a combination of renewable energy sources has been studied. This new generation model will be installed in El Hierro Island, in Spain. Additionally, an operation strategy to coordinate the generation units (wind, hydro) is also established. Attention is given to the assessment of inertial energy and reactive current to guarantee power system stability against large disturbances. The effectiveness of the proposed strategy is shown by means of simulation results.

Risk assessment of the spanish national railway system

The principal risks in the railway industry are mainly associated with collisions, derailments and level crossing accidents. An understanding of the nature of previous accidents on the railway network is required to identify potential causes and develop safety systems and deploy safety procedures. Risk assessment is a process for determining the risk magnitude to assist with decision-making. We propose a three-step methodology to predict the mean number of fatalities in railway accidents. The first is to predict the mean number of accidents by analyzing generalized linear models and selecting the one that best fits to the available historical data on the basis of goodness-offit statistics. The second is to compute the mean number of fatalities per accident and the third is to estimate the mean number of fatalities. The methodology is illustrated on the Spanish railway system. Statistical models accounting for annual and grouped data for the 1992-2009 time period have been analyzed. After identifying the models for broad and narrow gauges, we predicted mean number of accidents and the number of fatalities for the 2010-18 time period.