Silence That Can Be Dangerous: A Vignette Study to Assess Healthcare Professionals' Likelihood of Speaking up about Safety Concerns

PURPOSE To investigate the likelihood of speaking up about patient safety in oncology and to clarify the effect of clinical and situational context factors on the likelihood of voicing concerns. PATIENTS AND METHODS 1013 nurses and doctors in oncology rated four clinical vignettes describing coworkers' errors and rule violations in a self-administered factorial survey (65% response rate). Multiple regression analysis was used to model the likelihood of speaking up as outcome of vignette attributes, responder's evaluations of the situation and personal characteristics. RESULTS Respondents reported a high likelihood of speaking up about patient safety but the variation between and within types of errors and rule violations was substantial. Staff without managerial function provided significantly higher levels of decision difficulty and discomfort to speak up. Based on the information presented in the vignettes, 74%-96% would speak up towards a supervisor failing to check a prescription, 45%-81% would point a coworker to a missed hand disinfection, 82%-94% would speak up towards nurses who violate a safety rule in medication preparation, and 59%-92% would question a doctor violating a safety rule in lumbar puncture. Several vignette attributes predicted the likelihood of speaking up. Perceived potential harm, anticipated discomfort, and decision difficulty were significant predictors of the likelihood of speaking up. CONCLUSIONS Clinicians' willingness to speak up about patient safety is considerably affected by contextual factors. Physicians and nurses without managerial function report substantial discomfort with speaking up. Oncology departments should provide staff with clear guidance and trainings on when and how to voice safety concerns.

Dangerous unions : mapping human smuggling and human trafficking in international marriage through Japan's legal response

This working paper explores human smuggling and human trafficking through international marriage. It focuses on Japan's criminal justice response, while examining the major stakeholders involved in this activity. The paper focuses on the time period from 2008-2013. International marriages, particularly commercially brokered arrangements, have rapidly increased throughout East and Southeast Asia, with more women from less developed countries moving to richer destinations. The increasing prevalence of brokered marriages, and the overall numbers of marriage migrants, provides cover for criminal organizations to smuggle labor migrants on false marriages, and to send some migrants into what are clearly human trafficking situations.

Energy efficiency: comparison between the CALENER certificate and real consumptions

Modelización de una vivienda sostenible y comparación con los resultados obtenidos con los programas reconocidos en España de certificación.

Modeling of dangerous phenomena and innovative techniques for hazard evaluation and risk mitigation

Society is frequently exposed to and threatened by dangerous phenomena in many parts of the world. Different types of such phenomena require specific actions for proper risk management, from the stages of hazard identification to those of mitigation (including monitoring and early-warning) and/or reduction. The understanding of both predisposing factors and triggering mechanisms of a given danger and the prediction of its evolution from the source to the overall affected zone are relevant issues that must be addressed to properly evaluate a given hazard.

Nueva tecnología para la separación de gases atmosféricos y captura de dióxido de carbono por aplicación de campos electromagnéticos y fotoionización

Son numerosos los expertos que predicen que hasta pasado 2050 no se utilizarán masivamente las energías de origen renovable, y que por tanto se mantendrá la emisión de dióxido de carbono de forma incontrolada. Entre tanto, y previendo que este tipo de uso se mantenga hasta un horizonte temporal aún más lejano, la captura, concentración y secuestro o reutilización de dióxido de carbono es y será una de las principales soluciones a implantar para paliar el problema medioambiental causado. Sin embargo, las tecnologías existentes y en desarrollo de captura y concentración de este tipo de gas, presentan dos limitaciones: las grandes cantidades de energía que consumen y los grandes volúmenes de sustancias potencialmente dañinas para el medioambiente que producen durante su funcionamiento. Ambas razones hacen que no sean atractivas para su implantación y uso de forma extensiva. La solución planteada en la presente tesis doctoral se caracteriza por la ausencia de residuos producidos en la operación de captura y concentración del dióxido de carbono, por no utilizar substancias químicas y físicas habituales en las técnicas actuales, por disminuir los consumos energéticos al carecer de sistemas móviles y por evitar la regeneración química y física de los materiales utilizados en la actualidad. Así mismo, plantea grandes retos a futuras innovaciones sobre la idea propuesta que busquen fundamentalmente la disminución de la energía utilizada durante su funcionamiento y la optimización de sus componentes principales. Para conseguir el objetivo antes citado, la presente tesis doctoral, una vez establecido el planteamiento del problema al que se busca solución (capítulo 1), del estudio de las técnicas de separación de gases atmosféricos utilizadas en la actualidad, así como del de los sistemas fundamentales de las instalaciones de captura y concentración del dióxido de carbono (capítulo 2) y tras una definición del marco conceptual y teórico (capítulo 3), aborda el diseño de un prototipo de ionización fotónica de los gases atmosféricos para su posterior separación electrostática, a partir del estudio, adaptación y mejora del funcionamiento de los sistemas de espectrometría de masas. Se diseñarán y desarrollarán los sistemas básicos de fotoionización, mediante el uso de fuentes de fotones coherentes, y los de separación electrostática (capítulo 4), en que se basa el funcionamiento de este sistema de separación de gases atmosféricos y de captura y concentración de dióxido de carbono para construir un prototipo a nivel laboratorio. Posteriormente, en el capítulo 5, serán probados utilizando una matriz experimental que cubra los rangos de funcionamiento previstos y aporte suficientes datos experimentales para corregir y desarrollar el marco teórico real, y con los que se pueda establecer y corregir un modelo físico– matemático de simulación (capítulo 6) aplicable a la unidad en su conjunto. Finalmente, debido a la utilización de unidades de ionización fotónica, sistemas láseres intensos y sistemas eléctricos de gran potencia, es preciso analizar el riesgo biológico a las personas y al medioambiente debido al impacto de la radiación electromagnética producida (capítulo 7), minimizando su impacto y cumpliendo con la legislación vigente. En el capítulo 8 se planteará un diseño escalable a tamaño piloto de la nueva tecnología propuesta y sus principales modos de funcionamiento, así como un análisis de viabilidad económica. Como consecuencia de la tesis doctoral propuesta y del desarrollo de la unidad de separación atmosférica y de captura y concentración de dióxido de carbono, surgen diversas posibilidades de estudio que pueden ser objeto de nuevas tesis doctorales y de futuros desarrollos de ingeniería. El capítulo 9 tratará de incidir en estos aspectos indicando líneas de investigación para futuras tesis y desarrollos industriales. ABSTRACT A large number of experts predict that until at least 2050 renewable energy sources will not be massively used, and for that reason, current Primary Energy sources based on extensive use of fossil fuel will be used maintaining out of control emissions, Carbon Dioxide above all. Meanwhile, under this scenario and considering its extension until at least 2050, Carbon Capture, Concentration, Storage and/or Reuse is and will be one of the main solutions to minimise Greenhouse Gasses environmental effect. But, current Carbon Capture and Storage technology state of development has two main problems: it is a too large energy consuming technology and during normal use it produces a large volume of environmentally dangerous substances. Both reasons are limiting its development and its extensive use. This Ph Degree Thesis document proposes a solution to get the expected effect using a new atmospheric gasses separation system with the following characteristics: absence of wastes produced, it needs no chemical and/or physical substances during its operation, it reduces to minimum the internal energy consumptions due to absence of mobile equipment and it does not need any chemical and/or physical regeneration of substances. This system is beyond the State of the Art of current technology development. Additionally, the proposed solution raises huge challenges for future innovations of the proposed idea finding radical reduction of internal energy consumption during functioning, as well as regarding optimisation of main components, systems and modes of operation. To achieve this target, once established the main problem, main challenge and potential solving solutions (Chapter 1), it is established an initial starting point fixing the Atmospheric Gasses Separation and Carbon Capture and Storage developments (Chapter 2), as well as it will be defined the theoretical and basic model, including existing and potential new governing laws and mathematical formulas to control its system functioning (Chapter 3), this document will deal with the design of an installation of an operating system based on photonic ionization of atmospheric gasses to be separated in a later separation system based on the application of electrostatic fields. It will be developed a basic atmospheric gasses ionization prototype based on intense radioactive sources capable to ionize gasses by coherent photonic radiation, and a basic design of electrostatic separation system (Chapter 4). Both basic designs are the core of the proposed technology that separates Atmospheric Gasses and captures and concentrates Carbon Dioxide. Chapter 5 will includes experimental results obtained from an experimental testing matrix covering expected prototype functioning regimes. With the obtained experimental data, theoretical model will be corrected and improved to act as the real physical and mathematical model capable to simulate real system function (Chapter 6). Finally, it is necessary to assess potential biological risk to public and environment due to the proposed use of units of intense energy photonic ionization, by laser beams or by non–coherent sources and large electromagnetic systems with high energy consumption. It is necessary to know the impact in terms of and electromagnetic radiation taking into account National Legislation (Chapter 7). On Chapter 8, an up scaled pilot plant will be established covering main functioning modes and an economic feasibility assessment. As a consequence of this PhD Thesis, a new field of potential researches and new PhD Thesis are opened, as well as future engineering and industrial developments (Chapter 9).

Hydrogen Peroxide in Biocatalysis. A Dangerous Liaison

Hydrogen peroxide is a substrate or side-product in many enzyme-catalyzed reactions. For example, it is a side-product of oxidases, resulting from the re-oxidation of FAD with molecular oxygen, and it is a substrate for peroxidases and other enzymes. However, hydrogen peroxide is able to chemically modify the peptide core of the enzymes it interacts with, and also to produce the oxidation of some cofactors and prostetic groups (e.g., the hemo group). Thus, the development of strategies that may permit to increase the stability of enzymes in the presence of this deleterious reagent is an interesting target. This enhancement in enzyme stability has been attempted following almost all available strategies: site-directed mutagenesis (eliminating the most reactive moieties), medium engineering (using stabilizers), immobilization and chemical modification (trying to generate hydrophobic environments surrounding the enzyme, to confer higher rigidity to the protein or to generate oxidation-resistant groups), or the use of systems capable of decomposing hydrogen peroxide under very mild conditions. If hydrogen peroxide is just a side-product, its immediate removal has been reported to be the best solution. In some cases, when hydrogen peroxide is the substrate and its decomposition is not a sensible solution, researchers coupled one enzyme generating hydrogen peroxide “in situ” to the target enzyme resulting in a continuous supply of this reagent at low concentrations thus preventing enzyme inactivation. This review will focus on the general role of hydrogen peroxide in biocatalysis, the main mechanisms of enzyme inactivation produced by this reactive and the different strategies used to prevent enzyme inactivation caused by this “dangerous liaison”.