Improving the safety and security of the pharmaceutical supply chain

This paper discusses various techniques that may be used to combat counterfeiting in the pharmaceutical supply chain. These include the use of electronic pedigrees (to ensure the integrity of the supply chain), together with mass-serialization (to provide for a unique lifecycle history of each individual package) and authentication of the product (to check for any discrepancies in the various attributes of the product and its packaging are as intended for that individual package). Management of the pedigree process and product authentication is discussed in some detail, together with various other learnings from the Drug Security Network, including identification of some remaining vulnerabilities and suggestions for tightening these loopholes. © 2008 Springer-Verlag Berlin Heidelberg.

Safety of tetanus toxoid in pregnant women: A hospital-based case-control study of congenital anomalies

Reported are the results of the Latin American Collaborative Study of Congenital Malformations (ECLAMC), a hospital-based case-control study of 34 293 malformed and 34 477 matched nonmalformed newborn controls. No statistical differences were found between the malformed and control groups, exposed or not exposed to tetanus toroid.

龙游石窟洞室群稳定性分析及最佳旅游路线选择

The large ancient underground rock caverns in Longyou is an important component of grotto cultural. Current task facing the long-term preservation of these unmovable cultural relics is arduous and challenging. The deformation failure of the caverns' surrounding rock is deteriorating. The weathering velocity of these caverns is accelerating. With the strength of caverns' surrounding rock worsening, critical rocks were generated in local regions of the caverns' vault and posing a threat to the security of people passing by. Selection of a maximum-security route and construction a aisle in the caverns might be an efficient way to ensure the security of tourists and reach the target of long-term preservation. The deformation and destruction of the ancient underground caverns is primarily dominated by geological conditions and the special structure of caverns. Based on field investigation, several fundamental conditions for deformation and failure are recognized, and nine deformation and fracture patterns of the Longyou grotto are proposed. In order to judge the stability of caverns’ surrounding rock, the element safety coefficient method is presented. An explicit explanation for the meaning of the method is deduced using Mohr-Coulomb strength criterion. Numerical analyses are carried out in the dissertation through FLAC3D code. Through numerical analysis, the stress distribution regularities of the caverns’ roofs, piles and public side wall are analysed, and the stability properties of caverns’ surrounding rock are also assessed. At the same time, the element safety coefficient method is introduced to contrast the stability degree of different regions in caverns. The above analyses are bases for choosing the optimal tourism routes in the caverns of Longyou grotto. The impact of surface load on the stability of shallow buried cavities in Longyou grotto is evaluated, the results show that building load has significant influence on the stability of the No.1 cavern’s roof, pile and public side wall between the No.1 cavern and the No.2 cavern, pedestrian load has less impact on the stability of surrounding rock than building load. The principles for choosing the optimal tourism routes in the caverns are discussed. With these principles, the dissertation makes a systematic research on the geological analytic method, numerical analytic method and meeting tourism requirements method, which are used in selecting the optimal tourism routes in the caverns. In order to achieve the best effect in the process of tourism routes selection, the above three method are integrated through Theory of Engineering Geomechanics Meta-system(EGMS). According to field investigations, numerical analyses, tourism requirements and expert experiences, the optimal tourism routes through No.1 to No.5 cavern are determined preliminarily. The obtained results from the research work are useful for the security aisle's construction, they also have reference value to other projects in practice.

Effectiveness and safety of cryotherapy after arthroscopic anterior cruciate ligament reconstruction. A systematic review of the literature

Cryotherapy is widely used in rehabilitation; however, its effectiveness after anterior cruciate ligament (ACL) reconstruction remains uncertain. To investigate the effectiveness and safety of cryotherapy following ACL reconstruction through a systematic review, randomized and quasi-randomized clinical trials were searched in the databases: MEDLINE, EMBASE, CENTRAL PEDro, SportDiscus, CINAHL, LILACS (June 2013). the primary outcomes measures were pain, edema and adverse events; the secondary outcomes were knee function, analgesic medication use, range of motion, blood loss, hospital stay, quality of life and patient satisfaction. the methodological quality of studies was evaluated using the Cochrane Collaboration risk-of-bias tool. Ten trials (a total of 573 patients) were included. Results of meta-analysis showed that the use of cold compression devices produced a significant reduction in pain scores 48 h after surgery (p < 0.00001), compared to no cryotherapy. the risk for adverse events did not differ between patients receiving cryotherapy versus no treatment (p = 1.00). the limited evidence currently available is insufficient to draw definitive conclusions on the effectiveness of cryotherapy for other outcomes. There is a need for well designed, good quality randomized trials to answer other questions related to this intervention and increase the precision of future systematic reviews. (C) 2014 Elsevier B.V. All rights reserved.

Development of process control methodology for tracking the quality and safety of pain, agitation and sedation management in critical care units

Objective: To develop sedation, pain, and agitation quality measures using process control methodology and evaluate their properties in clinical practice. Design: A Sedation Quality Assessment Tool was developed and validated to capture data for 12-hour periods of nursing care. Domains included pain/discomfort and sedation-agitation behaviors; sedative, analgesic, and neuromuscular blocking drug administration; ventilation status; and conditions potentially justifying deep sedation. Predefined sedation-related adverse events were recorded daily. Using an iterative process, algorithms were developed to describe the proportion of care periods with poor limb relaxation, poor ventilator synchronization, unnecessary deep sedation, agitation, and an overall optimum sedation metric. Proportion charts described processes over time (2 monthly intervals) for each ICU. The numbers of patients treated between sedation-related adverse events were described with G charts. Automated algorithms generated charts for 12 months of sequential data. Mean values for each process were calculated, and variation within and between ICUs explored qualitatively. Setting: Eight Scottish ICUs over a 12-month period. Patients: Mechanically ventilated patients. Interventions: None. Measurements and Main Results: The Sedation Quality Assessment Tool agitation-sedation domains correlated with the Richmond Sedation Agitation Scale score (Spearman [rho] = 0.75) and were reliable in clinician-clinician (weighted kappa; [kappa] = 0.66) and clinician-researcher ([kappa] = 0.82) comparisons. The limb movement domain had fair correlation with Behavioral Pain Scale ([rho] = 0.24) and was reliable in clinician-clinician ([kappa] = 0.58) and clinician-researcher ([kappa] = 0.45) comparisons. Ventilator synchronization correlated with Behavioral Pain Scale ([rho] = 0.54), and reliability in clinician-clinician ([kappa] = 0.29) and clinician-researcher ([kappa] = 0.42) comparisons was fair-moderate. Eight hundred twenty-five patients were enrolled (range, 59-235 across ICUs), providing 12,385 care periods for evaluation (range 655-3,481 across ICUs). The mean proportion of care periods with each quality metric varied between ICUs: excessive sedation 12-38%; agitation 4-17%; poor relaxation 13-21%; poor ventilator synchronization 8-17%; and overall optimum sedation 45-70%. Mean adverse event intervals ranged from 1.5 to 10.3 patients treated. The quality measures appeared relatively stable during the observation period. Conclusions: Process control methodology can be used to simultaneously monitor multiple aspects of pain-sedation-agitation management within ICUs. Variation within and between ICUs could be used as triggers to explore practice variation, improve quality, and monitor this over time

Combining Functional and Structural Reasoning for Safety Analysis of Electrical Designs

C.J.Price, D.R.Pugh, N.A.Snooke, J.E.Hunt, M.S.Wilson, Combining Functional and Structural Reasoning for Safety Analysis of Electrical Designs, Knowledge Engineering Review, vol 12:3, pp.271-287, 1997.

A European Perspective on the Precautionary Principle, Food Safety and the Free Trade Imperative of the WTO

A European Perspective on the Precautionary Principle, Food Safety and the Free Trade Imperative of the WTO. European Law Review, Vol.27, No.2. April 2002, pp.138-155. RAE2008

Systematic Verification of Safety Properties of Arbitrary Network Protocol Compositions Using CHAIN

Formal correctness of complex multi-party network protocols can be difficult to verify. While models of specific fixed compositions of agents can be checked against design constraints, protocols which lend themselves to arbitrarily many compositions of agents-such as the chaining of proxies or the peering of routers-are more difficult to verify because they represent potentially infinite state spaces and may exhibit emergent behaviors which may not materialize under particular fixed compositions. We address this challenge by developing an algebraic approach that enables us to reduce arbitrary compositions of network agents into a behaviorally-equivalent (with respect to some correctness property) compact, canonical representation, which is amenable to mechanical verification. Our approach consists of an algebra and a set of property-preserving rewrite rules for the Canonical Homomorphic Abstraction of Infinite Network protocol compositions (CHAIN). Using CHAIN, an expression over our algebra (i.e., a set of configurations of network protocol agents) can be reduced to another behaviorally-equivalent expression (i.e., a smaller set of configurations). Repeated applications of such rewrite rules produces a canonical expression which can be checked mechanically. We demonstrate our approach by characterizing deadlock-prone configurations of HTTP agents, as well as establishing useful properties of an overlay protocol for scheduling MPEG frames, and of a protocol for Web intra-cache consistency.

Early warning sign attributes for the safety of drinking water treatment works

A proactive risk management strategy seeks to prevent accidents from taking place and maintain the safety of a system. In this context, the task of identifying and disseminating early warning signs and signals is among the most important. The problem is that warning signs that are present before an accident takes place are often being overlooked and not picked up or identified as warning signs. If these warning signs were responded to, then an accident may be averted. Accidents occuring in the critical domain of a drinking water treatments works can have serious implications for the public health of consumers of the water supplied. Realising and comprehending early warning signs is a major challenge for the domain of systems safety and especially in the domain of a water treatment works. The approaches that are typically used to enhance the realisation, comprehension and dissemination of early warning signs in the water treatment domain in Ireland mainly involves the creation of accident scenarios, the use of monitoring data and procedures for the dissemination of warnings. While all of these approaches are all useful to inform the mental or process models of possible accident scenarios, nevertheless, accidents are still occurring in this domain. Therefore, a new approach to enhance the comprehension of and effective dissemination of early warning signs is required in order to improve safety and proactive risk management strategies. The contributions of this thesis is the provision of a set of attributes associated with the early warning sign concept that provides meaningful data on the early warning signs and allows recipients to better comprehend them. The values of these attributes were customised for application in the water treatment domain. This research proves that early warning signs at a water treatment works received with information on their attributes are comprehended and communicated more effectively and efficiently than the usual pragmatic approach and thereby improves the safety and proactive risk management strategies.

Integration of micro- and macroscopic models for pedestrian evacuation simulation

Simulation of pedestrian evacuations of smart buildings in emergency is a powerful tool for building analysis, dynamic evacuation planning and real-time response to the evolving state of evacuations. Macroscopic pedestrian models are low-complexity models that are and well suited to algorithmic analysis and planning, but are quite abstract. Microscopic simulation models allow for a high level of simulation detail but can be computationally intensive. By combining micro- and macro- models we can use each to overcome the shortcomings of the other and enable new capability and applications for pedestrian evacuation simulation that would not be possible with either alone. We develop the EvacSim multi-agent pedestrian simulator and procedurally generate macroscopic flow graph models of building space, integrating micro- and macroscopic approaches to simulation of the same emergency space. By “coupling” flow graph parameters to microscopic simulation results, the graph model captures some of the higher detail and fidelity of the complex microscopic simulation model. The coupled flow graph is used for analysis and prediction of the movement of pedestrians in the microscopic simulation, and investigate the performance of dynamic evacuation planning in simulated emergencies using a variety of strategies for allocation of macroscopic evacuation routes to microscopic pedestrian agents. The predictive capability of the coupled flow graph is exploited for the decomposition of microscopic simulation space into multiple future states in a scalable manner. By simulating multiple future states of the emergency in short time frames, this enables sensing strategy based on simulation scenario pattern matching which we show to achieve fast scenario matching, enabling rich, real-time feedback in emergencies in buildings with meagre sensing capabilities.

Teaching yoga to seniors: essential considerations to enhance safety and reduce risk in a uniquely vulnerable age group.

BACKGROUND: Seniors age 65 and older represent the fastest-growing sector of the population and, like many Americans, are increasingly drawn to yoga. This presents both an extraordinary opportunity and a serious challenge for yoga instructors who must be both a resource and guardians of safety for this uniquely vulnerable group. A typical class of seniors is likely to represent the most diverse mix of abilities of any age group. While some may be exceedingly healthy, most fit the profile of the average older adult in America, 80% of whom have at least one chronic health condition and 50% of whom have at least two. OBJECTIVES: This article discusses the Therapeutic Yoga for Seniors program, offered since 2007 at Duke Integrative Medicine to fill a critical need to help yoga instructors work safely and effectively with the increasing number of older adults coming to yoga classes, and explores three areas that pose the greatest risk of compromise to older adult students: sedentary lifestyle, cardiovascular disease, and osteoporosis. To provide a skillful framework for teaching yoga to seniors, we have developed specific Principles of Practice that integrate the knowledge gained from Western medicine with yogic teachings.