Implementation status of error disclosure standards reported by Swiss hospitals

QUESTION UNDER STUDY To establish at what stage Swiss hospitals are in implementing an internal standard concerning communication with patients and families after an error that resulted in harm. METHODS Hospitals were identified via the Swiss Hospital Association's website. An anonymous questionnaire was sent during September and October 2011 to 379 hospitals in German, French or Italian. Hospitals were asked to specify their hospital type and the implementation status of an internal hospital standard that decrees that patients or their relatives are to be promptly informed about medical errors that result in harm. RESULTS Responses from a total of 205 hospitals were received, a response rate of 54%. Most responding hospitals (62%) had an error disclosure standard or planned to implement one within 12 months. The majority of responding university and acute care (75%) hospitals had introduced a disclosure standard or were planning to do so. In contrast, the majority of responding psychiatric, rehabilitation and specialty (53%) clinics had not introduced a standard. CONCLUSION It appears that Swiss hospitals are in a promising state in providing institutional support for practitioners disclosing medical errors to patients. This has been shown internationally to be one important factor in encouraging the disclosure of medical errors. However, many hospitals, in particular psychiatric, rehabilitation and specialty clinics, have not implemented an error disclosure policy. Further research is needed to explore the underlying reasons.

Evaluating a medical error taxonomy

Healthcare has been slow in using human factors principles to reduce medical errors. The Center for Devices and Radiological Health (CDRH) recognizes that a lack of attention to human factors during product development may lead to errors that have the potential for patient injury, or even death. In response to the need for reducing medication errors, the National Coordinating Council for Medication Errors Reporting and Prevention (NCC MERP) released the NCC MERP taxonomy that provides a standard language for reporting medication errors. This project maps the NCC MERP taxonomy of medication error to MedWatch medical errors involving infusion pumps. Of particular interest are human factors associated with medical device errors. The NCC MERP taxonomy of medication errors is limited in mapping information from MEDWATCH because of the focus on the medical device and the format of reporting.

Next-generation sequencing of HIV-1 RNA genomes: determination of error rates and minimizing artificial recombination.

Next-generation sequencing (NGS) is a valuable tool for the detection and quantification of HIV-1 variants in vivo. However, these technologies require detailed characterization and control of artificially induced errors to be applicable for accurate haplotype reconstruction. To investigate the occurrence of substitutions, insertions, and deletions at the individual steps of RT-PCR and NGS, 454 pyrosequencing was performed on amplified and non-amplified HIV-1 genomes. Artificial recombination was explored by mixing five different HIV-1 clonal strains (5-virus-mix) and applying different RT-PCR conditions followed by 454 pyrosequencing. Error rates ranged from 0.04-0.66% and were similar in amplified and non-amplified samples. Discrepancies were observed between forward and reverse reads, indicating that most errors were introduced during the pyrosequencing step. Using the 5-virus-mix, non-optimized, standard RT-PCR conditions introduced artificial recombinants in a fraction of at least 30% of the reads that subsequently led to an underestimation of true haplotype frequencies. We minimized the fraction of recombinants down to 0.9-2.6% by optimized, artifact-reducing RT-PCR conditions. This approach enabled correct haplotype reconstruction and frequency estimations consistent with reference data obtained by single genome amplification. RT-PCR conditions are crucial for correct frequency estimation and analysis of haplotypes in heterogeneous virus populations. We developed an RT-PCR procedure to generate NGS data useful for reliable haplotype reconstruction and quantification.

Estimating the mean and standard deviation of concentration distributions using censored samples

Environmental data sets of pollutant concentrations in air, water, and soil frequently include unquantified sample values reported only as being below the analytical method detection limit. These values, referred to as censored values, should be considered in the estimation of distribution parameters as each represents some value of pollutant concentration between zero and the detection limit. Most of the currently accepted methods for estimating the population parameters of environmental data sets containing censored values rely upon the assumption of an underlying normal (or transformed normal) distribution. This assumption can result in unacceptable levels of error in parameter estimation due to the unbounded left tail of the normal distribution. With the beta distribution, which is bounded by the same range of a distribution of concentrations, $\rm\lbrack0\le x\le1\rbrack,$ parameter estimation errors resulting from improper distribution bounds are avoided. This work developed a method that uses the beta distribution to estimate population parameters from censored environmental data sets and evaluated its performance in comparison to currently accepted methods that rely upon an underlying normal (or transformed normal) distribution. Data sets were generated assuming typical values encountered in environmental pollutant evaluation for mean, standard deviation, and number of variates. For each set of model values, data sets were generated assuming that the data was distributed either normally, lognormally, or according to a beta distribution. For varying levels of censoring, two established methods of parameter estimation, regression on normal ordered statistics, and regression on lognormal ordered statistics, were used to estimate the known mean and standard deviation of each data set. The method developed for this study, employing a beta distribution assumption, was also used to estimate parameters and the relative accuracy of all three methods were compared. For data sets of all three distribution types, and for censoring levels up to 50%, the performance of the new method equaled, if not exceeded, the performance of the two established methods. Because of its robustness in parameter estimation regardless of distribution type or censoring level, the method employing the beta distribution should be considered for full development in estimating parameters for censored environmental data sets. ^

Time-order errors and standard-position effects in duration discrimination: An experimental study and an analysis by the sensation-weighting model

Studies have shown that the discriminability of successive time intervals depends on the presentation order of the standard (St) and the comparison (Co) stimuli. Also, this order affects the point of subjective equality. The first effect is here called the standard-position effect (SPE); the latter is known as the time-order error. In the present study, we investigated how these two effects vary across interval types and standard durations, using Hellström’s sensation-weighting model to describe the results and relate them to stimulus comparison mechanisms. In Experiment 1, four modes of interval presentation were used, factorially combining interval type (filled, empty) and sensory modality (auditory, visual). For each mode, two presentation orders (St–Co, Co–St) and two standard durations (100 ms, 1,000 ms) were used; half of the participants received correctness feedback, and half of them did not. The interstimulus interval was 900 ms. The SPEs were negative (i.e., a smaller difference limen for St–Co than for Co–St), except for the filled-auditory and empty-visual 100-ms standards, for which a positive effect was obtained. In Experiment 2, duration discrimination was investigated for filled auditory intervals with four standards between 100 and 1,000 ms, an interstimulus interval of 900 ms, and no feedback. Standard duration interacted with presentation order, here yielding SPEs that were negative for standards of 100 and 1,000 ms, but positive for 215 and 464 ms. Our findings indicate that the SPE can be positive as well as negative, depending on the interval type and standard duration, reflecting the relative weighting of the stimulus information, as is described by the sensation-weighting model.

ITEM: Inter-Texture Error Measurement for 3D Meshes

We introduce a simple and innovative method to compare any two texture maps, regardless of their sizes, aspect ratios, or even masks, as long as they are both meant to be mapped onto the same 3D mesh. Our system is based on a zero-distortion 3D mesh unwrapping technique which compares two new adapted texture atlases with the same mask but different texel colors, and whose every texel covers the same area in 3D. Once these adapted atlases are created, we measure their difference with ITEM-RMSE, a slightly modified version of the standard RMSE defined for images. ITEM-RMSE is more meaningful and reliable than RMSE because it only takes into account the texels inside the mask, since they are the only ones that will actually be used during rendering. Our method is not only very useful to compare the space efficiency of different texture atlas generation algorithms, but also to quantify texture loss in compression schemes for multi-resolution textured 3D meshes.

Error estimation for the linearized auto-localization algorithm

The Linearized Auto-Localization (LAL) algorithm estimates the position of beacon nodes in Local Positioning Systems (LPSs), using only the distance measurements to a mobile node whose position is also unknown. The LAL algorithm calculates the inter-beacon distances, used for the estimation of the beacons’ positions, from the linearized trilateration equations. In this paper we propose a method to estimate the propagation of the errors of the inter-beacon distances obtained with the LAL algorithm, based on a first order Taylor approximation of the equations. Since the method depends on such approximation, a confidence parameter τ is defined to measure the reliability of the estimated error. Field evaluations showed that by applying this information to an improved weighted-based auto-localization algorithm (WLAL), the standard deviation of the inter-beacon distances can be improved by more than 30% on average with respect to the original LAL method.

Efficient adaptive methods based on adjoint equations and truncation error estimation for unstructured grids

El propósito de esta tesis es la implementación de métodos eficientes de adaptación de mallas basados en ecuaciones adjuntas en el marco de discretizaciones de volúmenes finitos para mallas no estructuradas. La metodología basada en ecuaciones adjuntas optimiza la malla refinándola adecuadamente con el objetivo de mejorar la precisión de cálculo de un funcional de salida dado. El funcional suele ser una magnitud escalar de interés ingenieril obtenida por post-proceso de la solución, como por ejemplo, la resistencia o la sustentación aerodinámica. Usualmente, el método de adaptación adjunta está basado en una estimación a posteriori del error del funcional de salida mediante un promediado del residuo numérico con las variables adjuntas, “Dual Weighted Residual method” (DWR). Estas variables se obtienen de la solución del problema adjunto para el funcional seleccionado. El procedimiento habitual para introducir este método en códigos basados en discretizaciones de volúmenes finitos involucra la utilización de una malla auxiliar embebida obtenida por refinamiento uniforme de la malla inicial. El uso de esta malla implica un aumento significativo de los recursos computacionales (por ejemplo, en casos 3D el aumento de memoria requerida respecto a la que necesita el problema fluido inicial puede llegar a ser de un orden de magnitud). En esta tesis se propone un método alternativo basado en reformular la estimación del error del funcional en una malla auxiliar más basta y utilizar una técnica de estimación del error de truncación, denominada _ -estimation, para estimar los residuos que intervienen en el método DWR. Utilizando esta estimación del error se diseña un algoritmo de adaptación de mallas que conserva los ingredientes básicos de la adaptación adjunta estándar pero con un coste computacional asociado sensiblemente menor. La metodología de adaptación adjunta estándar y la propuesta en la tesis han sido introducidas en un código de volúmenes finitos utilizado habitualmente en la industria aeronáutica Europea. Se ha investigado la influencia de distintos parámetros numéricos que intervienen en el algoritmo. Finalmente, el método propuesto se compara con otras metodologías de adaptación de mallas y su eficiencia computacional se demuestra en una serie de casos representativos de interés aeronáutico. ABSTRACT The purpose of this thesis is the implementation of efficient grid adaptation methods based on the adjoint equations within the framework of finite volume methods (FVM) for unstructured grid solvers. The adjoint-based methodology aims at adapting grids to improve the accuracy of a functional output of interest, as for example, the aerodynamic drag or lift. The adjoint methodology is based on the a posteriori functional error estimation using the adjoint/dual-weighted residual method (DWR). In this method the error in a functional output can be directly related to local residual errors of the primal solution through the adjoint variables. These variables are obtained by solving the corresponding adjoint problem for the chosen functional. The common approach to introduce the DWR method within the FVM framework involves the use of an auxiliary embedded grid. The storage of this mesh demands high computational resources, i.e. over one order of magnitude increase in memory relative to the initial problem for 3D cases. In this thesis, an alternative methodology for adapting the grid is proposed. Specifically, the DWR approach for error estimation is re-formulated on a coarser mesh level using the _ -estimation method to approximate the truncation error. Then, an output-based adaptive algorithm is designed in such way that the basic ingredients of the standard adjoint method are retained but the computational cost is significantly reduced. The standard and the new proposed adjoint-based adaptive methodologies have been incorporated into a flow solver commonly used in the EU aeronautical industry. The influence of different numerical settings has been investigated. The proposed method has been compared against different grid adaptation approaches and the computational efficiency of the new method has been demonstrated on some representative aeronautical test cases.

Practical scheme for error control using feedback

We describe a scheme for quantum-error correction that employs feedback and weak measurement rather than the standard tools of projective measurement and fast controlled unitary gates. The advantage of this scheme over previous protocols [for example, Ahn Phys. Rev. A 65, 042301 (2001)], is that it requires little side processing while remaining robust to measurement inefficiency, and is therefore considerably more practical. We evaluate the performance of our scheme by simulating the correction of bit flips. We also consider implementation in a solid-state quantum-computation architecture and estimate the maximal error rate that could be corrected with current technology.

Zero-non-zero patterned vector error correction modeling for I(2) cointegrated time series with applications in testing PPP and stock market relationships

Vector error-correction models (VECMs) have become increasingly important in their application to financial markets. Standard full-order VECM models assume non-zero entries in all their coefficient matrices. However, applications of VECM models to financial market data have revealed that zero entries are often a necessary part of efficient modelling. In such cases, the use of full-order VECM models may lead to incorrect inferences. Specifically, if indirect causality or Granger non-causality exists among the variables, the use of over-parameterised full-order VECM models may weaken the power of statistical inference. In this paper, it is argued that the zero–non-zero (ZNZ) patterned VECM is a more straightforward and effective means of testing for both indirect causality and Granger non-causality. For a ZNZ patterned VECM framework for time series of integrated order two, we provide a new algorithm to select cointegrating and loading vectors that can contain zero entries. Two case studies are used to demonstrate the usefulness of the algorithm in tests of purchasing power parity and a three-variable system involving the stock market.

10-Gb/s transmission over 100 Mm of standard fiber using 2R regeneration in an optical loop mirror

The transmission of a 10-Gb/s data stream was demonstrated experimentally over a practically unlimited distance in a standard single-mode fiber system using nonlinear optical loop mirrors as simple in-line 2R regenerators. Error-free propagation over 100 000 km has been achieved with terrestrial amplifier spacing. © 2004 IEEE.

All-Raman amplified transmission at 40 Gbit/s in standard single mode fibre

We investigate a 40 Gbit/s all-Raman amplified standard single mode fibre (SMF) transmission system with the mid-range amplifier spacing of 80-90 km. The impact of span configuration on double Rayleigh back scattering (DRBS) was studied. Four different span configurations were compared experimentally. A transmission distance of 1666 km in SMF has been achieved without forward error correcting (FEC) for the first time. The results demonstrate that the detrimental effects associated with high pump power Raman amplification in standard fibre can be minimised by dispersion map optimisation. © 2003 IEEE.

1220km propagation of 40Gbit/s single channel RZ data over dispersion managed standard (non-dispersion shifted) fibre

Error free propagation of a single polarisation optical time division multiplexed 40 Gbit/s dispersion managed pulsed data stream over dispersion (non-shifted) fibre. This distance is twice the previous record at this data rate.