Doctors' thinking about the system as a threat to patient safety

‘Systems thinking’ is an important feature of the emerging ‘patient safety’ agenda. As a key component of a ‘safety culture’, it encourages clinicians to look past individual error to recognise the latent factors that threaten safety. This paper investigates whether current medical thinking is commensurate with the idea of ‘systems thinking’ together with its implications for policy. The findings are based on qualitative semistructured interviews with specialist physicians working within one NHS District General Hospital in the English Midlands. It is shown that, rather then favouring a 'person-centred’ perspective, doctors readily identify ‘the system’ as a threat to patient safety. This is not necessarily a reflection of the prevailing safety discourse or knowledge of policy, but reflects a tacit understanding of how services are (dis)organised. This line of thinking serves to mitigate individual wrong-doing and protect professional credibility by encouraging doctors to accept and accommodate the shortcomings of the system, rather than participate in new forms of organisational learning.

Subject categories used in Nuclear science abstracts, 1967-1975 /

"TID-26500/R1. Distribution category: UC-2."

Polio eradication efforts in regions of geopolitical strife: the Boko Haram threat to efforts in sub-Saharan Africa.

The World Health Organization aims to eradicate wild poliovirus worldwide by the end of 2018. Cameroon and Nigeria, neighboring countries, have been affected by the terrorist and militant activities of the Islamist sect Boko Haram. Impacted regions are mainly the far North of Cameroon and Northern Nigeria. Targets of Boko Haram aggression in these zones include violence against polio workers, disruption of polio immunization campaigns, with consequent reduced access to health care and immunization. In addition to this significant problem, Northern Nigeria has historically seen rejection of polio virus vaccine initiatives. It remains to know how health systems can continue operations against polio in areas where Boko Haram operates. If appropriate measures are not urgently taken, it will be not possible to meet the 2018 goal of polio virus eradication. The response should include specialized immunization activities in conflict zones, will engagement of leaders. Countries should also explore immunization activities by soldiers and military personnel.

Assessment of a Planned Municipal Solid Waste Management System in Sri Lanka

Systematic Municipal Solid Waste Management (MSWM) authorities of Sri Lanka contributes to exchange some productive outputs with localities; however it is still not in a successful mode due to limitations and environmental failures in their operation. Most of these local administrations are directly dumping Municipal Solid Waste (MSW) to an open dumping site, this manner of inappropriate disposal of MSW is become a major threat to the environment and public health in developing countries like Sri Lanka. This study was conducted for the MSWM practices of Balangoda Urban Council. The research was performed based on analyzing information obtained from field observations; reports; literature; questionnaire distribution among community; and a series of formal interviews with major stakeholders. The ongoing MSWM practices of Balangoda Urban Council encompass six categories as waste minimization and handling; waste collection; on-site separation; waste transportation; further management including grading, composting, recycling, producing sludge fertilizer; and final disposal to an open dump site. Apart from those, training sessions on MSWM are also being conducted. The purpose of this paper is to assess current status of urban waste management scenario and highlight strengths and weaknesses to understand the sustainability of the system which would help any local authority to improve MSWM.

Zika is not a reason for missing the Olympic Games in Rio de Janeiro: response to the open letter of Dr Attaran and colleagues to Dr Margaret Chan, Director - General, WHO, on the Zika threat to the Olympic and Paralympic Games

Attaran and colleagues in an open letter to WHO expressed their concern about the upcoming Olympic and Paralympic Games in Rio de Janeiro and the threat posed by the Zika epidemic (Attaran 2016). We agree that Zika virus is of great public health concern and much remains to be known about this disease. Care should be taken to reduce the risk of infection, especially to pregnant women. However, we argue that this is not sufficient reason for changing the original plans for the Games, in particular because of the time of the year when they will take place. The present article outlines several scientific results related to Zika and mosquito-borne infectious diseases dynamics that we believe ratify the current position of WHO in not endorsing the postponing or relocation of the 2016 Olympic and Paralympic Games (WHO 2016).

Tribes under threat : the collective behavior of firms during the stock market crisis

Due to their unpredictable behavior, stock markets are examples of complex systems. Yet, the dominant analysis of these markets as- sumes simple stochastic variations, eventually tainted by short-lived memory. This paper proposes an alternative strategy, based on a stochastic geometry defining a robust index of the structural dynamics of the markets and based on notions of topology defining a new coef- ficient that identifies the structural changes occurring on the S&P500 set of stocks. The results demonstrate the consistency of the random hypothesis as applied to normal periods but they also show its in- adequacy as to the analysis of periods of turbulence, for which the emergence of collective behavior of sectoral clusters of firms is mea- sured. This behavior is identified as a meta-routine.

Do hatchery-reared sea urchins pose a threat to genetic diversity in wild populations?

In salmonids, the release of hatchery-reared fish has been shown to cause irreversible genetic impacts on wild populations. However, although responsible practices for producing and releasing genetically diverse, hatchery-reared juveniles have been published widely, they are rarely implemented. Here, we investigated genetic differences between wild and early-generation hatchery-reared populations of the purple sea urchin Paracentrotus lividus (a commercially important species in Europe) to assess whether hatcheries were able to maintain natural levels of genetic diversity. To test the hypothesis that hatchery rearing would cause bottleneck effects (that is, a substantial reduction in genetic diversity and differentiation from wild populations), we compared the levels and patterns of genetic variation between two hatcheries and four nearby wild populations, using samples from both Spain and Ireland. We found that hatchery-reared populations were less diverse and had diverged significantly from the wild populations, with a very small effective population size and a high degree of relatedness between individuals. These results raise a number of concerns about the genetic impacts of their release into wild populations, particularly when such a degree of differentiation can occur in a single generation of hatchery rearing. Consequently, we suggest that caution should be taken when using hatchery-reared individuals to augment fisheries, even for marine species with high dispersal capacity, and we provide some recommendations to improve hatchery rearing and release practices. Our results further highlight the need to consider the genetic risks of releasing hatchery-reared juveniles into the wild during the establishment of restocking, stock enhancement and sea ranching programs.

Prevalence of chronic diseases in private healthcare sector of South Africa: A threat to public health

Purpose: To evaluate the prevalence of patients suffering from registered chronic disease list (CDL) conditions in a section of the South African private health sector from 2008 - 2012. Methods: This study was a retrospective analysis of the medicine claims database of a nationally (South African) representative Pharmacy Benefit Management (PBM) company data between 2008 and 2012. Statistical analysis was used to analyse the data. Descriptive analysis was performed to calculate the prevalence of CDL conditions for the entire population, and stratified by age and gender. However, MIXED linear modelling was used to determine changes in the average number of CDL conditions per patient, adjusted for age and gender from 2008 - 2012. Results: An increase of 0.20 in chronic diseases was observed from 2008 - 2012 in patients having any CDL condition, with an average of 1.57 (1.57 - 1.58, 95 % CI) co-morbid CDL conditions in 2008 and 1.77 (1.77 - 1.78, 95 % CI) in 2012. This increase in average number of CDL conditions per patient between 2008 and 2012 was statistically significant (p < 0.05), but with no large practical significance (d < 0.8). Conclusion: Prevalence of patients with CDL conditions along with risk of co-morbidity has been increasing with time in the private health sector of South Africa. Risk of increased co-morbidity with age and among different genders was prevalent.

Establishing IUCN red list criteria for threatened ecosystems

The potential for conservation of individual species has been greatly advanced by the International Union for Conservation of Nature's (IUCN) development of objective, repeatable, and transparent criteria for assessing extinction risk that explicitly separate risk assessment from priority setting. At the IV World Conservation Congress in 2008, the process began to develop and implement comparable global standards for ecosystems. A working group established by the IUCN has begun formulating a system of quantitative categories and criteria, analogous to those used for species, for assigning levels of threat to ecosystems at local, regional, and global levels. A final system will require definitions of ecosystems; quantification of ecosystem status; identification of the stages of degradation and loss of ecosystems; proxy measures of risk (criteria); classification thresholds for these criteria; and standardized methods for performing assessments. The system will need to reflect the degree and rate of change in an ecosystem's extent, composition, structure, and function, and have its conceptual roots in ecological theory and empirical research. On the basis of these requirements and the hypothesis that ecosystem risk is a function of the risk of its component species, we propose a set of four criteria: recent declines in distribution or ecological function, historical total loss in distribution or ecological function, small distribution combined with decline, or very small distribution. Most work has focused on terrestrial ecosystems, but comparable thresholds and criteria for freshwater and marine ecosystems are also needed. These are the first steps in an international consultation process that will lead to a unified proposal to be presented at the next World Conservation Congress in 2012.

Mechanisms of influence: alcohol industry submissions to the inquiry into fetal alcohol spectrum disorders

INTRODUCTION AND AIMS: Industry groups with vested interests in policy regularly work to protect their profits via the endorsement of ineffective voluntary regulation and interventions, extensive lobbying activity and minimising the health impact of consumption behaviours. This study aims to examine all alcohol industry submissions to the Australian House of Representatives Standing Committee on Social Policy and Legal Affairs into Fetal Alcohol Spectrum Disorders (FASD), to assist in understanding how those with vested interests contribute to policy development. The analysis aims to document the strategies and arguments used by alcohol industry bodies in their submissions and to compare these with known strategies of vested-interest groups. DESIGN AND METHODS: All 92 submissions to the Inquiry were screened to include only those submitted by alcohol industry bodies (five submissions). Content domains were derived based on the major themes emerging from the industry submissions and on common vested-interest behaviours identified in previous literature. RESULTS: The following content categories were identified: Concerns about FASD; Current industry activities and FASD prevention; Value of mandatory warning labels; and Credibility of independent public health researchers and organisations. DISCUSSION AND CONCLUSIONS: Alcohol industry submissions sought to undermine community concern, debate the evidence, promote ineffective measure which are no threat to the profit margins and attack independent health professionals and researchers. In doing so, their behaviour is entirely consistent with their responses to other issues, such as violence and chronic health, and copies the tactics employed by the tobacco industry.

When Catholics turn right: the effects of the Islamic terrorism threat on the fragmented Catholic Italian voters

Italy, as well as most European countries, has been hit by a wave of anxiety arising from groups such as ISIS and Al Qaeda, whose effects on political attitudes are still under-examined. This article investigates the effect of the perceived threat of Islamic terrorism as a potential driver for a ‘right turn’ in the Catholic Italian electorate with open-ended interviews and an Internet-based experiment in which voters were randomly assigned to a terrorism threat manipulation and to a control condition (N = 138). The results show that the Islamic terroristic threat significantly increased the support for centre-right leaders who promoted in-group identity and out-group hostility towards Muslims. Implications for the debate about the effects of perceived threat on political opinions and the relevance of the findings beyond the Italian case are discussed at the end of the article.

Constructing Threat: How Americans Identify Economic Competitors

China’s emergence as an economic powerhouse has often been portrayed as threatening to America’s economic strength and to its very identity as “the global hegemon.” The media’s alarmist response to an economic competitor is familiar to those who remember US-Japanese relations in the 1980s. In order to better understand the basis of American threat perception, this study explores the independent and interactive impact of three variables (perceptions of the Other’s capabilities, perceptions of the Other as a threat versus as an opportunity, and perceptions of the Other’s political culture) on attitudes toward two different economic competitors (Japan 1977-1995 and China 1985-2011). Utilizing four methods (historical process tracing, public polling data analysis, social scientific experimentation, and content analysis), this study demonstrates that increases in the Other’s economic capabilities have a much smaller impact on attitudes than is commonly believed. It further shows that while perceptions of threat/opportunity played a significant role in shaping attitudinal response toward Japan, perceptions of political culture are the most important factor driving attitudes toward China today. This study contributes to a better understanding of how states react to threats and construct negative images of their economic rivals. It also helps to explain the current Sino-American relationship and enables better predictions as to its potential future course. Finally, these findings contribute to cultural explanations of the democratic peace phenomenon and provide a boundary condition (political culture) for the liberal proposition that opportunity ameliorates conflict in the economic realm.

In the name of humanity: the government of threat and care

In this volume, editors Ilana Feldman and Miriam Ticktin have drawn together an outstanding collection of essays exploring the concept of ‘humanity’ in a range of contexts and from a rich variety of perspectives. Tracing the categorisation of humanity throughout history in their introductory chapter, Feldman and Ticktin highlight the perennial tension inherent in its definition and use. The ever-shifting boundaries of humanity serve to include and protect even as they reject and threaten those identified as ‘other’. Each of the eleven chapters engages with the fundamental question of what it means to be human, and the implications of possible responses to this for the practice of governance. However, despite the pervasive theme of government— which is explored explicitly in the context of humanitarian law (Richard Ashby Wilson) and aid (Didier Fassin), healthcare (Joao Biehl; S. Lochlann Jain; Adriana Petryna), and the regulation of human interactions with nature (Arun Agrawal; Charles Zerner)—it is the more personal aspect of the human experience that takes centre stage in most chapters, and which offers the deepest insights into that elusive concept: ‘humanity’. It offers readers a multifaceted and open-ended account of humanity, which will inform better governance and more effective research in this field.

The threat of autocracy diffusion in consolidated democracies? The case of China, Singapore and Australia

The majority of today’s authoritarian regimes have little hope of promoting autocracy beyond their own borders, let alone to consolidated democratic countries. However, China and Singapore are two prominent examples of non-democratic countries whose soft power arsenals have given them some global appeal beyond that enjoyed by most authoritarian regimes. But to what extent has China’s and Singapore’s power of example influenced consolidated democracies in terms that the latter wanting to replicate some political practices or even norms in these non-democratic regimes? In this article, we engage recent works to examine this question in relation to how Australians perceive the political example offered by China and Singapore. Focusing our analysis on several prominent polls conducted recently by the Lowy Institute for International Policy, we suggest that at present there is little evidence of a causal impact of the rise of authoritarian powerhouses such as China and Singapore on how Australians view democracy at home. Through these case studies, this article sheds some light on the theoretical as well as practical questions about the inherent impediments of authoritarian diffusion in consolidated democracies.

Purposeful exploratory learning with video using analysis categories

There is still much to be learnt about best practices in leveraging digital resources for learning in higher education. Research on student interactions with online video indicates such practices are as minimal as setting passive-receptive viewing through to teacher-structured purposeful engagement. This position paper focuses on teacher-set analysis categories to guide student exploration of digital video content and to help novices to scaffold their thinking. Various uses of analysis categories within one Australian university in conjunction with a video annotation tool are reviewed. Then practice examples from other universities are reviewed to demonstrate the use of analysis categories in higher education settings without an annotation tool. The literature indicates that the use of categories to inform the design of digital video analysis needs to ensure that the learning challenge is retained. Analysis guided by teacher-set categories tends to be beneficial for performance evaluation in particular. Further research on university teacher practices with digital video is required.