Improving disclosure of medical errors: Including patients and family members in the disclosure process

Over the last decade, adverse events and medical errors have become a main focus of interest for the standards of quality and safety in the U.S. healthcare system (Weinstein & Henderson, 2009). Particularly when a medical error occurs, the disclosure of medical errors and its practices have become a focal point of the healthcare process. Patients and family members who have experienced a medical error might be able to provide knowledge and insight on how to improve the disclose process. However, patient and family member are not typically involved in the disclosure process, thus their experiences go unnoticed. ^ The purpose of this research was to explore how best to include patients and family members in the disclosure process regarding a medical error. The research consisted of 28 qualitative interviews from three stakeholder groups: Hospital Administrators, Clinical Service Providers, and Patients and Family Members. They were asked for their ideas and suggestions on how best to include patients and family members in the disclosure process. Framework Analysis was used to analyze this data and find prevalent themes based on the primary research question. A secondary aim was to index categories created based on the interviews that were collected. Data was used from the Texas Disclosure and Compensation Study with Dr. Eric Thomas as the Principal Investigator. Full acknowledgement of access to this data is given to Dr. Thomas. ^ The themes from the research revealed that each stakeholder group was interested and open to including patients and family members in the disclosure process and that the disclosure process should not be a "one-way" avenue. The themes gave many suggestions regarding how to best include patients and family members in the disclosure process of a medical error. Secondary aims revealed several ways to assess the ideas and suggestion given by the stakeholders. Overall, acceptability of getting the perspective of patients and family members was the most common theme. Comparison of each stakeholder group revealed that including patients and family members would be beneficial to improving hospital disclosure practices. ^ Conclusions included a list of recommendations and measureable appropriate strategies that could provide hospital with key stakeholders insights on how to improve their disclosure process. Sharing patients and family members experience with healthcare providers can encourage a shift in culture where patients are valued and active in participating in hospital practices. To my knowledge, this research is the very first of its kind and moves the disclosure process conversation forward in a patient-family member inclusion direction that will assist in improving disclosure practices. Future research should implement and evaluate the success of the various inclusion strategies.^

Tool wear monitoring using neuro-fuzzy techniques: a comparative study in a turning process

Tool wear detection is a key issue for tool condition monitoring. The maximization of useful tool life is frequently related with the optimization of machining processes. This paper presents two model-based approaches for tool wear monitoring on the basis of neuro-fuzzy techniques. The use of a neuro-fuzzy hybridization to design a tool wear monitoring system is aiming at exploiting the synergy of neural networks and fuzzy logic, by combining human reasoning with learning and connectionist structure. The turning process that is a well-known machining process is selected for this case study. A four-input (i.e., time, cutting forces, vibrations and acoustic emissions signals) single-output (tool wear rate) model is designed and implemented on the basis of three neuro-fuzzy approaches (inductive, transductive and evolving neuro-fuzzy systems). The tool wear model is then used for monitoring the turning process. The comparative study demonstrates that the transductive neuro-fuzzy model provides better error-based performance indices for detecting tool wear than the inductive neuro-fuzzy model and than the evolving neuro-fuzzy model.

Dos modelos por ensayo y error: Villa Stonborough y Villa Moller = Two trial and error processes: Villa Stonborough and Villa Moller.

Uno de los procesos de desarrollo más comunes para llevar a cabo un proyecto arquitectónico es el ensayo y error. Un proceso de selección de pruebas que se suele abordar de dos maneras, o bien se efectúa con el fin de ir depurando una posición más óptima, o bien sirve para explorar nuevas vías de investigación. Con el fin de profundizar en esto, el artículo presenta el análisis de dos diferentes procesos de proyecto de viviendas desarrolladas por ensayo y error, obras referenciales en la historia de la arquitectura, la Villa Stonborough de Wittgenstein y la Villa Moller de Adolf Loos. Ambas aunque pertenecientes al mismo periodo histórico, están desarrolladas de maneras muy opuestas, casi enfrentadas. De su estudio se pretende localizar los conceptos que han impulsado sus diferentes vías de producción, para poder extrapolados a otros casos similares. ABSTRACT: One of the most common processes to develop an architectonic project is the trial and error method. The process of selection of tests is usually done on two different ways. Or it is done with the goal to find out the most optimized position, or it is used to explore new ways of research. In order to investigate this item, the article shows the analysis of two different processes of housing projects that have been done by trial and error. Constructions, that are references in the history of architecture, the Villa Stonborough by Wittgenstein and the Villa Moller by Adolf Loos. Although both of them belong to the same historical period, they are developed by different ways, almost confronted. Thanks to this analysis we will attempt to localize the concepts that drove into their different way of production and then we will try to extrapolate these properties to other similar cases.

Roles of DNA polymerases V and II in SOS-induced error-prone and error-free repair in Escherichia coli

DNA polymerase V, composed of a heterotrimer of the DNA damage-inducible UmuC and UmuD\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \setlength{\oddsidemargin}{-69pt} \begin{document} \begin{equation*}{\mathrm{_{2}^{^{\prime}}}}\end{equation*}\end{document} proteins, working in conjunction with RecA, single-stranded DNA (ssDNA)-binding protein (SSB), β sliding clamp, and γ clamp loading complex, are responsible for most SOS lesion-targeted mutations in Escherichia coli, by catalyzing translesion synthesis (TLS). DNA polymerase II, the product of the damage-inducible polB (dinA ) gene plays a pivotal role in replication-restart, a process that bypasses DNA damage in an error-free manner. Replication-restart takes place almost immediately after the DNA is damaged (≈2 min post-UV irradiation), whereas TLS occurs after pol V is induced ≈50 min later. We discuss recent data for pol V-catalyzed TLS and pol II-catalyzed replication-restart. Specific roles during TLS for pol V and each of its accessory factors have been recently determined. Although the precise molecular mechanism of pol II-dependent replication-restart remains to be elucidated, it has recently been shown to operate in conjunction with RecFOR and PriA proteins.

The cook's oracle; containing receipts for plain cookery on the most economical plan for private families: also, the art of composing the most simple and most highly finished broths, gravies, soups, sauces, store sauces, and flavouring essences; pastry, preserves, puddings, etc. And an easy, certain, and economical process for preparing pickles. The quantity of each article is accurately stated by weight and measure.

First published in London in 1817 under title: Apicius redivivus; or, The cook's oracle.

Error recovery in a hospital pharmacy

A field study was performed in a hospital pharmacy aimed at identifying positive and negative influences on the process of detection of and further recovery from initial errors or other failures, thus avoiding negative consequences. Confidential reports and follow-up interviews provided data on 31 near-miss incidents involving such recovery processes. Analysis revealed that organizational culture with regard to following procedures needed reinforcement, that some procedures could be improved, that building in extra checks was worthwhile and that supporting unplanned recovery was essential for problems not covered by procedures. Guidance is given on how performance in recovery could be measured. A case is made for supporting recovery as an addition to prevention-based safety methods.

Factors affecting human reliability in the chemical process industry

This research was concerned with identifying factors which may influence human reliability within chemical process plants - these factors are referred to as Performance Shaping Factors (PSFs). Following a period of familiarization within the industry, a number of case studies were undertaken covering a range of basic influencing factors. Plant records and site `lost time incident reports' were also used as supporting evidence for identifying and classifying PSFs. In parallel to the investigative research, the available literature appertaining to human reliability assessment and PSFs was considered in relation to the chemical process plan environment. As a direct result of this work, a PSF classification structure has been produced with an accompanying detailed listing. Phase two of the research considered the identification of important individual PSFs for specific situations. Based on the experience and data gained during phase one, it emerged that certain generic features of a task influenced PSF relevance. This led to the establishment of a finite set of generic task groups and response types. Similarly, certain PSFs influence some human errors more than others. The result was a set of error type key words, plus the identification and classification of error causes with their underlying error mechanisms. By linking all these aspects together, a comprehensive methodology has been forwarded as the basis of a computerized aid for system designers. To recapitulate, the major results of this research have been: One, the development of a comprehensive PSF listing specifically for the chemical process industries with a classification structure that facilitates future updates; and two, a model of identifying relevant SPFs and their order of priority. Future requirements are the evaluation of the PSF listing and the identification method. The latter must be considered both in terms of `useability' and its success as a design enhancer, in terms of an observable reduction in important human errors.

Intelligent execution monitoring and error analysis in planning involving processes

An intelligent agent, operating in an external world which cannot be fully described in its internal world model, must be able to monitor the success of a previously generated plan and to respond to any errors which may have occurred. The process of error analysis requires the ability to reason in an expert fashion about time and about processes occurring in the world. Reasoning about time is needed to deal with causality. Reasoning about processes is needed since the direct effects of a plan action can be completely specified when the plan is generated, but the indirect effects cannot. For example, the action `open tap' leads with certainty to `tap open', whereas whether there will be a fluid flow and how long it might last is more difficult to predict. The majority of existing planning systems cannot handle these kinds of reasoning, thus limiting their usefulness. This thesis argues that both kinds of reasoning require a complex internal representation of the world. The use of Qualitative Process Theory and an interval-based representation of time are proposed as a representation scheme for such a world model. The planning system which was constructed has been tested on a set of realistic planning scenarios. It is shown that even simple planning problems, such as making a cup of coffee, require extensive reasoning if they are to be carried out successfully. The final Chapter concludes that the planning system described does allow the correct solution of planning problems involving complex side effects, which planners up to now have been unable to solve.

An econometric analysis of international tourism demand in Hong Kong : a cointegration and error correction approach

The purpose of this study is to develop econometric models to better understand the economic factors affecting inbound tourist flows from each of six origin countries that contribute to Hong Kong’s international tourism demand. To this end, we test alternative cointegration and error correction approaches to examine the economic determinants of tourist flows to Hong Kong, and to produce accurate econometric forecasts of inbound tourism demand. Our empirical findings show that permanent income is the most significant determinant of tourism demand in all models. The variables of own price, weighted substitute prices, trade volume, the share price index (as an indicator of changes in wealth in origin countries), and a dummy variable representing the Beijing incident (1989) are also found to be important determinants for some origin countries. The average long-run income and own price elasticity was measured at 2.66 and – 1.02, respectively. It was hypothesised that permanent income is a better explanatory variable of long-haul tourism demand than current income. A novel approach (grid search process) has been used to empirically derive the weights to be attached to the lagged income variable for estimating permanent income. The results indicate that permanent income, estimated with empirically determined relatively small weighting factors, was capable of producing better results than the current income variable in explaining long-haul tourism demand. This finding suggests that the use of current income in previous empirical tourism demand studies may have produced inaccurate results. The share price index, as a measure of wealth, was also found to be significant in two models. Studies of tourism demand rarely include wealth as an explanatory forecasting long-haul tourism demand. However, finding a satisfactory proxy for wealth common to different countries is problematic. This study indicates with the ECM (Error Correction Models) based on the Engle-Granger (1987) approach produce more accurate forecasts than ECM based on Pesaran and Shin (1998) and Johansen (1988, 1991, 1995) approaches for all of the long-haul markets and Japan. Overall, ECM produce better forecasts than the OLS, ARIMA and NAÏVE models, indicating the superiority of the application of a cointegration approach for tourism demand forecasting. The results show that permanent income is the most important explanatory variable for tourism demand from all countries but there are substantial variations between countries with the long-run elasticity ranging between 1.1 for the U.S. and 5.3 for U.K. Price is the next most important variable with the long-run elasticities ranging between -0.8 for Japan and -1.3 for Germany and short-run elasticities ranging between – 0.14 for Germany and -0.7 for Taiwan. The fastest growing market is Mainland China. The findings have implications for policies and strategies on investment, marketing promotion and pricing.

The application of robotics to the turbine blade encapsulation process

A survey of the existing state-of-the-art of turbine blade manufacture highlights two operations that have not been automated namely that of loading of a turbine blade into an encapsulation die, and that of removing a machined blade from the encapsulation block. The automation of blade decapsulation has not been pursued. In order to develop a system to automate the loading of an encapsulation die a prototype mechanical handling robot has been designed together with a computer controlled encapsulation die. The robot has been designed as a mechanical handling robot of cylindrical geometry, suitable for use in a circular work cell. It is the prototype for a production model to be called `The Cybermate'. The prototype robot is mechanically complete but due to unforeseen circumstances the robot control system is not available (the development of the control system did not form a part of this project), hence it has not been possible to fully test and assess the robot mechanical design. Robot loading of the encapsulation die has thus been simulated. The research work with regard to the encapsulation die has focused on the development of computer controlled, hydraulically actuated, location pins. Such pins compensate for the inherent positional inaccuracy of the loading robot and reproduce the dexterity of the human operator. Each pin comprises a miniature hydraulic cylinder, controlled by a standard bidirectional flow control valve. The precision positional control is obtained through pulsing of the valves under software control, with positional feedback from an 8-bit transducer. A test-rig comprising one hydraulic location pin together with an opposing spring loaded pin has demonstrated that such a pin arrangement can be controlled with a repeatability of +/-.00045'. In addition this test-rig has demonstrated that such a pin arrangement can be used to gauge and compensate for the dimensional error of the component held between the pins, by offsetting the pin datum positions to allow for the component error. A gauging repeatability of +/- 0.00015' was demonstrated. This work has led to the design and manufacture of an encapsulation die comprising ten such pins and the associated computer software. All aspects of the control software except blade gauging and positional data storage have been demonstrated. Work is now required to achieve the accuracy of control demonstrated by the single pin test-rig, with each of the ten pins in the encapsulation die. This would allow trials of the complete loading cycle to take place.

Computer simulation for tube-making by the cold roll-forming process

The conventional design of forming rolls depends heavily on the individual skill of roll designers which is based on intuition and knowledge gained from previous work. Roll design is normally a trial an error procedure, however with the progress of computer technology, CAD/CAM systems for the cold roll-forming industry have been developed. Generally, however, these CAD systems can only provide a flower pattern based on the knowledge obtained from previously successful flower patterns. In the production of ERW (Electric Resistance Welded) tube and pipe, the need for a theoretical simulation of the roll-forming process, which can not only predict the occurrence of the edge buckling but also obtain the optimum forming condition, has been recognised. A new simulation system named "CADFORM" has been devised that can carry out the consistent forming simulation for this tube-making process. The CADFORM system applied an elastic-plastic stress-strain analysis and evaluate edge buckling by using a simplified model of the forming process. The results can also be visualised graphically. The calculated longitudinal strain is obtained by considering the deformation of lateral elements and takes into account the reduction in strains due to the fin-pass roll. These calculated strains correspond quite well with the experimental results. Using the calculated strains, the stresses in the strip can be estimated. The addition of the fin-pass roll reduction significantly reduces the longitudinal compressive stress and therefore effectively suppresses edge buckling. If the calculated longitudinal stress is controlled, by altering the forming flower pattern so it does not exceed the buckling stress within the material, then the occurrence of edge buckling can be avoided. CADFORM predicts the occurrence of edge buckling of the strip in tube-making and uses this information to suggest an appropriate flower pattern and forming conditions which will suppress the occurrence of the edge buckling.

Parametric Identification and Diagnosis of Integrated Navigation Systems in Bench Test Process

Growth of complexity and functional importance of integrated navigation systems (INS) leads to high losses at the equipment refusals. The paper is devoted to the INS diagnosis system development, allowing identifying the cause of malfunction. The proposed solutions permit taking into account any changes in sensors dynamic and accuracy characteristics by means of the appropriate error models coefficients. Under actual conditions of INS operation, the determination of current values of the sensor models and estimation filter parameters rely on identification procedures. The results of full-scale experiments are given, which corroborate the expediency of INS error models parametric identification in bench test process.

Real-time error compensation of a three-axis machine tool using a laser tracker

The concept of measurement-enabled production is based on integrating metrology systems into production processes and generated significant interest in industry, due to its potential to increase process capability and accuracy, which in turn reduces production times and eliminates defective parts. One of the most promising methods of integrating metrology into production is the usage of external metrology systems to compensate machine tool errors in real time. The development and experimental performance evaluation of a low-cost, prototype three-axis machine tool that is laser tracker assisted are described in this paper. Real-time corrections of the machine tool's absolute volumetric error have been achieved. As a result, significant increases in static repeatability and accuracy have been demonstrated, allowing the low-cost three-axis machine tool to reliably reach static positioning accuracies below 35 μm throughout its working volume without any prior calibration or error mapping. This is a significant technical development that demonstrated the feasibility of the proposed methods and can have wide-scale industrial applications by enabling low-cost and structural integrity machine tools that could be deployed flexibly as end-effectors of robotic automation, to achieve positional accuracies that were the preserve of large, high-precision machine tools.

Impact of high pCO2 and warmer temperatures on the process of silica biomineralization in the sponge Mycale grandis

Siliceous sponges have survived pre-historical mass extinction events caused by ocean acidification and recent studies suggest that siliceous sponges will continue to resist predicted increases in ocean acidity. In this study, we monitored silica biomineralization in the Hawaiian sponge Mycale grandis under predicted pCO2 and sea surface temperature scenarios for 2100. Our goal was to determine if spicule biomineralization was enhanced or repressed by ocean acidification and thermal stress by monitoring silica uptake rates during short-term (48 h) experiments and comparing biomineralized tissue ratios before and after a long-term (26 d) experiment. In the short-term experiment, we found that silica uptake rates were not impacted by high pCO2 (1050 µatm), warmer temperatures (27°C), or combined high pCO2 with warmer temperature (1119 µatm; 27°C) treatments. The long-term exposure experiments revealed no effect on survival or growth rates of M. grandis to high pCO2 (1198 µatm), warmer temperatures (25.6°C), or combined high pCO2 with warmer temperature (1225 µatm, 25.7°C) treatments, indicating that M. grandis will continue to prosper under predicted increases in pCO2 and sea surface temperature. However, ash-free dry weight to dry weight ratios, subtylostyle lengths, and silicified weight to dry weight ratios decreased under conditions of high pCO2 and combined pCO2 warmer temperature treatments. Our results show that rising ocean acidity and temperature have marginal negative effects on spicule biomineralization and will not affect sponge survival rates of M. grandis.