Getting to zero: evidence-based healthcare risk management is key.

In this article we call for a new approach to patient safety improvement, one based on the emerging field of evidence-based healthcare risk management (EBHRM). We explore EBHRM in the broader context of the evidence-based healthcare movement, assess the benefits and challenges that might arise in adopting an evidence-based approach, and make recommendations for meeting those challenges and realizing the benefits of a more scientific approach.

Polymer waveguide-based backplanes for board-level optical interconnects

Optical interconnects are increasingly considered for use in high-performance electronic systems. Multimode polymer waveguides are a promising technology for the formation of optical backplane as they enable cost-effective integration of optical links onto standard printed circuit boards. In this paper, two different types of polymer waveguide-based optical backplanes are presented. The first one implements a passive shuffle architecture enabling non-blocking on-board optical interconnection between different cards/modules, while the second one deploys a regenerative bus architecture allowing the interconnection of an arbitrary number of electrical cards over a common optical bus. The polymer materials and the multimode waveguide components used to form the optical backplanes are presented, while details of the interconnection architectures and design of the backplanes are described. Proof-of-principle demonstrators fabricated onto low-cost FR4 substrates, including a 10-card 1 Tb/s-capacity passive shuffle router and 4-channel 3-card polymeric bus modules, are reported and their optical performance characteristics are presented. Low-loss, low-crosstalk on-board interconnection is achieved and error-free (BER10 12) 10 Gb/s communication between different card/module interfaces is demonstrated in both polymeric backplane systems. © 2012 IEEE.

Insula and striatum mediate the default bias.

Humans are creatures of routine and habit. When faced with situations in which a default option is available, people show a consistent tendency to stick with the default. Why this occurs is unclear. To elucidate its neural basis, we used a novel gambling task in conjunction with functional magnetic resonance imaging. Behavioral results revealed that participants were more likely to choose the default card and felt enhanced emotional responses to outcomes after making the decision to switch. We show that increased tendency to switch away from the default during the decision phase was associated with decreased activity in the anterior insula; activation in this same area in reaction to "switching away from the default and losing" was positively related with experienced frustration. In contrast, decisions to choose the default engaged the ventral striatum, the same reward area as seen in winning. Our findings highlight aversive processes in the insula as underlying the default bias and suggest that choosing the default may be rewarding in itself.

Controlled growth orientation of carbon nanotube pillars by catalyst patterning in microtrenches

We present a novel method for controlling the growth orientation of individual carbon nanotube (CNT) microstructures on a silicon wafer substrate. Our method controls the CNT forest orientation by patterning the catalyst layer used in the CNTs growth on slanted KOH edges. The overlap of catalyst area on the horizontal bottom and sloped sidewall surfaces of the KOH-etched substrate enables precise variation of the growth direction. These inclined structures can profit from the outstanding mechanical, electrical, thermal, and optical properties of CNTs and can therefore improve the performance of several MEMS devices. Inclined CNT microstructures could for instance be used as cantilever springs in probe card arrays, as tips in dip-pen lithography, and as sensing element in advanced transducers. ©2009 IEEE.

A polymer waveguide-based 40 Gb/s optical bus backplane for board-level optical interconnects

Optical interconnects are increasingly considered for use in high-performance electronic systems. Multimode polymer waveguides are a promising technology for the formation of optical backplanes as they enable cost-effective integration of optical links onto standard printed circuit boards. In this paper, we present a 40 Gb/s optical backplane demonstrator based on the use of polymer multimode waveguides and a regenerative shared bus architecture. The system allows bus extension by cascading multiple polymeric bus modules through 3R regenerator units enabling the connection of an arbitrary number of electrical cards onto the bus. The proof-ofprinciple demonstrator reported here is formed with low-cost, commercially-available active devices and electronic components mounted on conventional FR4 substrates and achieves error-free 4×10 Gb/s optical interconnection between any two card interfaces on the bus. © 2013 IEEE.

Trust-Level Risk Evaluation and Risk Control Guidance in the NHS East of England

In recent years, the healthcare sector has adopted the use of operational risk assessment tools to help understand the systems issues that lead to patient safety incidents. But although these problem-focused tools have improved the ability of healthcare organizations to identify hazards, they have not translated into measurable improvements in patient safety. One possible reason for this is a lack of support for the solution-focused process of risk control. This article describes a content analysis of the risk management strategies, policies, and procedures at all acute (i.e., hospital), mental health, and ambulance trusts (health service organizations) in the East of England area of the British National Health Service. The primary goal was to determine what organizational-level guidance exists to support risk control practice. A secondary goal was to examine the risk evaluation guidance provided by these trusts. With regard to risk control, we found an almost complete lack of useful guidance to promote good practice. With regard to risk evaluation, the trusts relied exclusively on risk matrices. A number of weaknesses were found in the use of this tool, especially related to the guidance for scoring an event's likelihood. We make a number of recommendations to address these concerns. The guidance assessed provides insufficient support for risk control and risk evaluation. This may present a significant barrier to the success of risk management approaches in improving patient safety. © 2013 Society for Risk Analysis.

Origin and evolution of the RIG-I like RNA helicase gene family

Background: The DExD/H domain containing RNA helicases such as retinoic acid-inducible gene I (RIG-I) and melanoma differentiation-associated gene 5 (MDA5) are key cytosolic pattern recognition receptors (PRRs) for detecting nucleotide pathogen associated molecular patterns (PAMPs) of invading viruses. The RIG-I and MDA5 proteins differentially recognise conserved PAMPs in double stranded or single stranded viral RNA molecules, leading to activation of the interferon system in vertebrates. They share three core protein domains including a RNA helicase domain near the C terminus (HELICc), one or more caspase activation and recruitment domains (CARDs) and an ATP dependent DExD/H domain. The RIG-I/MDA5 directed interferon response is negatively regulated by laboratory of genetics and physiology 2 (LGP2) and is believed to be controlled by the mitochondria antiviral signalling protein (MAVS), a CARD containing protein associated with mitochondria. Results: The DExD/H containing RNA helicases including RIG-I, MDA5 and LGP2 were analysed in silico in a wide spectrum of invertebrate and vertebrate genomes. The gene synteny of MDA5 and LGP2 is well conserved among vertebrates whilst conservation of the gene synteny of RIG-I is less apparent. Invertebrate homologues had a closer phylogenetic relationship with the vertebrate RIG-Is than the MDA5/LGP2 molecules, suggesting the RIG-I homologues may have emerged earlier in evolution, possibly prior to the appearance of vertebrates. Our data suggest that the RIG-I like helicases possibly originated from three distinct genes coding for the core domains including the HELICc, CARD and ATP dependent DExD/H domains through gene fusion and gene/domain duplication. Furthermore, presence of domains similar to a prokaryotic DNA restriction enzyme III domain (Res III), and a zinc finger domain of transcription factor (TF) IIS have been detected by bioinformatic analysis. Conclusion: The RIG-I/MDA5 viral surveillance system is conserved in vertebrates. The RIG-I like helicase family appears to have evolved from a common ancestor that originated from genes encoding different core functional domains. Diversification of core functional domains might be fundamental to their functional divergence in terms of recognition of different viral PAMPs.

A 40 Gb/s scalable optical polymer backplane using a regenerative shared bus architecture

The first multi-channel optical backplane demonstrator using on-board multimode polymer waveguides and a scalable shared-bus regenerative architecture is reported. The system allows bus extension by cascading multiple polymeric bus modules, and enables error-free 4×10 Gb/s interconnection between any two card interfaces on the bus.

Generating Options for Active Risk Control (GO-ARC): introducing a novel technique.

BACKGROUND: After investing significant amounts of time and money in conducting formal risk assessments, such as root cause analysis (RCA) or failure mode and effects analysis (FMEA), healthcare workers are left to their own devices in generating high-quality risk control options. They often experience difficulty in doing so, and tend toward an overreliance on administrative controls (the weakest category in the hierarchy of risk controls). This has important implications for patient safety and the cost effectiveness of risk management operations. This paper describes a before and after pilot study of the Generating Options for Active Risk Control (GO-ARC) technique, a novel tool to improve the quality of the risk control options generation process. OUTCOME MEASURES: The quantity, quality (using the three-tiered hierarchy of risk controls), variety, and novelty of risk controls generated. RESULTS: Use of the GO-ARC technique was associated with improvement on all measures. CONCLUSIONS: While this pilot study has some notable limitations, it appears that the GO-ARC technique improved the risk control options generation process. Further research is needed to confirm this finding. It is also important to note that improved risk control options are a necessary, but not sufficient, step toward the implementation of more robust risk controls.

A 40 Gb/s optical bus for optical backplane interconnections

Optical technologies have received large interest in recent years for use in board-level interconnects. Polymer multimode waveguides in particular, constitute a promising technology for high-capacity optical backplanes as they can be cost-effectively integrated onto conventional printed circuit boards (PCBs). This paper presents the first optical backplane demonstrator based on the use of PCB-integrated polymer multimode waveguides and a regenerative shared bus architecture. The backplane demonstrator is formed with commercially-available low-cost electronic and photonic components onto conventional FR4 substrates and comprises two opto-electronic (OE) bus modules interconnected via a prototype regenerator unit. The system enables interconnection between the connected cards over four optical channels, each operating at 10 Gb/s. Bus extension is achieved by cascading OE bus modules via 3R regenerator units, overcoming therefore the inherent limitation of optical bus topologies in the maximum number of cards that can be connected to the bus. Details of the design, fabrication, and assembly of the different parts of this optical bus backplane are presented and related optical and data transmission characterisation studies are reported. The optical layer of the OE bus modules comprises a four-channel three-card waveguide layout that is compatible with VCSEL/PD arrays and ribbon fibres. All on-board optical paths exhibit insertion losses below 13 dB and intra-channel crosstalk lower than -29 dB. The robustness of the signal distribution from the bus inputs to all respective bus output ports in the presence of input misalignment is demonstrated, while 1 dB input alignment tolerances of approximately ±10 μm are obtained. The electrical layer of the OE bus modules comprises the essential driving circuitry for 1×4 VCSEL and PD arrays and the corresponding control and power regulation circuits. The interface between the optical and electrical layers of the bus modules is achieved with simple OE connectors that enable end-fired optical coupling into and out of the on-board polymer waveguides. The backplane demonstrator achieves error-free (BER < 10-12) 10 Gb/s data transmission over each optical channel, enabling therefore, an aggregate interconnection capacity of 40 Gb/s between any connected cards. © 1983-2012 IEEE.

Rapid hologram generation utilizing layer-based approach and graphic rendering for realistic three-dimensional image reconstruction by angular tiling

An approach of rapid hologram generation for the realistic three-dimensional (3-D) image reconstruction based on the angular tiling concept is proposed, using a new graphic rendering approach integrated with a previously developed layer-based method for hologram calculation. A 3-D object is simplified as layered cross-sectional images perpendicular to a chosen viewing direction, and our graphics rendering approach allows the incorporation of clear depth cues, occlusion, and shading in the generated holograms for angular tiling. The combination of these techniques together with parallel computing reduces the computation time of a single-view hologram for a 3-D image of extended graphics array resolution to 176 ms using a single consumer graphics processing unit card. © 2014 SPIE and IS and T.

A power-saving scheme for IEEE 802.11 Ad hoc networks

In the Wireless Local Area Networks (WLANs), the terminals are often powered by battery, so the power-saving performance of the wireless network card is a very important issue. For IEEE 802.11 Ad hoc networks, a power-saving scheme is presented in Medium Access Control (MAC) layer to reduce the power consumption by allowing the nodes enter into the sleep mode, but the scheme is based on Time-Drive Scheme (TDS) whose power-saving efficiency becomes lower and lower with the network load increasing. This paper presented a novel energy-saving mechanism, called as Hybrid-Drive Scheme (HDS), which introduces into a Message.-Drive Scheme (MDS) and combines MDS with the conventional TDS. The MDS, could obtain high efficiency when the load is heavy; meanwhile the TDS has high efficiency when the network load is small. The analysis shows that the proposed HDS could obtain high energy-efficiency whether the network load is light or heavy and have higher energy-saving efficiency than conventional scheme in the IEEE 802.11 standard.