Investigating the prevalence and causes of prescribing errors in general practice: the PRACtICe Study

Aim: To determine the prevalence and nature of prescribing errors in general practice; to explore the causes, and to identify defences against error. Methods: 1) Systematic reviews; 2) Retrospective review of unique medication items prescribed over a 12 month period to a 2% sample of patients from 15 general practices in England; 3) Interviews with 34 prescribers regarding 70 potential errors; 15 root cause analyses, and six focus groups involving 46 primary health care team members Results: The study involved examination of 6,048 unique prescription items for 1,777 patients. Prescribing or monitoring errors were detected for one in eight patients, involving around one in 20 of all prescription items. The vast majority of the errors were of mild to moderate severity, with one in 550 items being associated with a severe error. The following factors were associated with increased risk of prescribing or monitoring errors: male gender, age less than 15 years or greater than 64 years, number of unique medication items prescribed, and being prescribed preparations in the following therapeutic areas: cardiovascular, infections, malignant disease and immunosuppression, musculoskeletal, eye, ENT and skin. Prescribing or monitoring errors were not associated with the grade of GP or whether prescriptions were issued as acute or repeat items. A wide range of underlying causes of error were identified relating to the prescriber, patient, the team, the working environment, the task, the computer system and the primary/secondary care interface. Many defences against error were also identified, including strategies employed by individual prescribers and primary care teams, and making best use of health information technology. Conclusion: Prescribing errors in general practices are common, although severe errors are unusual. Many factors increase the risk of error. Strategies for reducing the prevalence of error should focus on GP training, continuing professional development for GPs, clinical governance, effective use of clinical computer systems, and improving safety systems within general practices and at the interface with secondary care.

Implantação de sistemas de segurança e saúde no trabalho em empresas fabricantes de baterias automotivas

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Aging of nuclear power plant cables: in search of non-destructive diagnostic quantities

The safety systems of nuclear power plants rely on low-voltage power, instrumentation and control cables. Inside the containment area, cables operate in harsh environments, characterized by relatively high temperature and gamma-irradiation. As these cables are related to fundamental safety systems, they must be able to withstand unexpected accident conditions and, therefore, their condition assessment is of utmost importance as plants age and lifetime extensions are required. Nowadays, the integrity and functionality of these cables are monitored mainly through destructive test which requires specific laboratory. The investigation of electrical aging markers which can provide information about the state of the cable by non-destructive testing methods would improve significantly the present diagnostic techniques. This work has been made within the framework of the ADVANCE (Aging Diagnostic and Prognostics of Low-Voltage I\&C Cables) project, a FP7 European program. This Ph.D. thesis aims at studying the impact of aging on cable electrical parameters, in order to understand the evolution of the electrical properties associated with cable degradation. The identification of suitable aging markers requires the comparison of the electrical property variation with the physical/chemical degradation mechanisms of polymers for different insulating materials and compositions. The feasibility of non-destructive electrical condition monitoring techniques as potential substitutes for destructive methods will be finally discussed studying the correlation between electrical and mechanical properties. In this work, the electrical properties of cable insulators are monitored and characterized mainly by dielectric spectroscopy, polarization/depolarization current analysis and space charge distribution. Among these techniques, dielectric spectroscopy showed the most promising results; by means of dielectric spectroscopy it is possible to identify the frequency range where the properties are more sensitive to aging. In particular, the imaginary part of permittivity at high frequency, which is related to oxidation, has been identified as the most suitable aging marker based on electrical quantities.

Passively Track WiFi Users with an Enhanced Particle Filter using Power-based Ranging

Passive positioning systems produce user location information for third-party providers of positioning services. Since the tracked wireless devices do not participate in the positioning process, passive positioning can only rely on simple, measurable radio signal parameters, such as timing or power information. In this work, we provide a passive tracking system for WiFi signals with an enhanced particle filter using fine-grained power-based ranging. Our proposed particle filter provides an improved likelihood function on observation parameters and is equipped with a modified coordinated turn model to address the challenges in a passive positioning system. The anchor nodes for WiFi signal sniffing and target positioning use software defined radio techniques to extract channel state information to mitigate multipath effects. By combining the enhanced particle filter and a set of enhanced ranging methods, our system can track mobile targets with an accuracy of 1.5m for 50% and 2.3m for 90% in a complex indoor environment. Our proposed particle filter significantly outperforms the typical bootstrap particle filter, extended Kalman filter and trilateration algorithms.

A prototype from the Solar Decathlon Competition becomes an educational building in sustanaible architecture

In 2008, the City Council of Rivas-Vaciamadrid (Spain) decided to promote the construction of “Rivasecopolis”, a complex of sustainable buildings in which a new prototype of a zero-energy house would become the office of the Energy Agency. According to the initiative of the City Council, it was decided to recreate the dwelling prototype “Magic-box” which entered the 2005 Solar Decathlon Competition. The original project has been adapted to a new necessities programme, by adding the necessary spaces that allows it to work as an office. A team from university has designed and carried out the direction of the construction site. The new Solar House is conceived as a “testing building”. It is going to become the space for attending citizens in all questions about saving energy, energy efficiency and sustainable construction, having a permanent small exhibition space additional to the working places for the information purpose. At the same time, the building includes the use of experimental passive architecture systems and a monitoring and control system. Collected data will be sent to University to allow developing research work about the experimental strategies included in the building. This paper will describe and analyze the experience of transforming a prototype into a real durable building and the benefits for both university and citizens in learning about sustainability with the building

Risk assessment of the spanish national railway system

The principal risks in the railway industry are mainly associated with collisions, derailments and level crossing accidents. An understanding of the nature of previous accidents on the railway network is required to identify potential causes and develop safety systems and deploy safety procedures. Risk assessment is a process for determining the risk magnitude to assist with decision-making. We propose a three-step methodology to predict the mean number of fatalities in railway accidents. The first is to predict the mean number of accidents by analyzing generalized linear models and selecting the one that best fits to the available historical data on the basis of goodness-offit statistics. The second is to compute the mean number of fatalities per accident and the third is to estimate the mean number of fatalities. The methodology is illustrated on the Spanish railway system. Statistical models accounting for annual and grouped data for the 1992-2009 time period have been analyzed. After identifying the models for broad and narrow gauges, we predicted mean number of accidents and the number of fatalities for the 2010-18 time period.

Discriminación del estado de la carretera mediante procesado acústico en vehículo

La rápida adopción de dispositivos electrónicos en el automóvil, ha contribuido a mejorar en gran medida la seguridad y el confort. Desde principios del siglo 20, la investigación en sistemas de seguridad activa ha originado el desarrollo de tecnologías como ABS (Antilock Brake System), TCS (Traction Control System) y ESP (Electronic Stability Program). El coste de despliegue de estos sistemas es crítico: históricamente, sólo han sido ampliamente adoptados cuando el precio de los sensores y la electrónica necesarios para su construcción ha caído hasta un valor marginal. Hoy en día, los vehículos a motor incluyen un amplio rango de sensores para implementar las funciones de seguridad. La incorporación de sistemas que detecten la presencia de agua, hielo o nieve en la vía es un factor adicional que podría ayudar a evitar situaciones de riesgo. Existen algunas implementaciones prácticas capaces de detectar carreteras mojadas, heladas y nevadas, aunque con limitaciones importantes. En esta tesis doctoral, se propone una aproximación novedosa al problema, basada en el análisis del ruido de rodadura generado durante la conducción. El ruido de rodadura es capturado y preprocesado. Después es analizado utilizando un clasificador basado en máquinas de vectores soporte (SVM), con el fin de generar una estimación del estado del firme. Todas estas operaciones se realizan en el propio vehículo. El sistema propuesto se ha desarrollado y evaluado utilizando Matlabr, mostrando tasas de aciertos de más del 90%. Se ha realizado una implementación en tiempo real, utilizando un prototipo basado en DSP. Después se han introducido varias optimizaciones para permitir que el sistema sea realizable usando un microcontrolador de propósito general. Finalmente se ha realizado una implementación hardware basada en un microcontrolador, integrándola estrechamente con las ECU del vehículo, pudiendo obtener datos capturados por los sensores del mismo y enviar las estimaciones del estado del firme. El sistema resultante ha sido patentado, y destaca por su elevada tasa de aciertos con un tamaño, consumo y coste reducidos. ABSTRACT Proliferation of automotive electronics, has greatly improved driving safety and comfort. Since the beginning of the 20th century, investigation in active safety systems has resulted in the development of technologies such as ABS (Antilock Brake System), TCS (Traction Control System) and ESP (Electronic Stability Program). Deployment cost of these systems is critical: historically, they have been widely adopted only when the price of the sensors and electronics needed to build them has been cut to a marginal value. Nowadays, motor vehicles include a wide range of sensors to implement the safety functions. Incorporation of systems capable of detecting water, ice or snow on the road is an additional factor that could help avoiding risky situations. There are some implementations capable of detecting wet, icy and snowy roads, although with important limitations. In this PhD Thesis, a novel approach is proposed, based on the analysis of the tyre/road noise radiated during driving. Tyre/road noise is captured and pre-processed. Then it is analysed using a Support Vector Machine (SVM) based classifier, to output an estimation of the road status. All these operations are performed on-board. Proposed system is developed and evaluated using Matlabr, showing success rates greater than 90%. A real time implementation is carried out using a DSP based prototype. Several optimizations are introduced enabling the system to work using a low-cost general purpose microcontroller. Finally a microcontroller based hardware implementation is developed. This implementation is tightly integrated with the vehicle ECUs, allowing it to obtain data captured by its sensors, and to send the road status estimations. Resulting system has been patented, and is notable because of its high hit rate, small size, low power consumption and low cost.

Health monitoring of web plastifying dampers subjected to cyclic loading through vibration tests

This article investigates experimentally the application of health monitoring techniques to assess the damage on a particular kind of hysteretic (metallic) damper called web plastifying dampers, which are subjected to cyclic loading. In general terms, hysteretic dampers are increasingly used as passive control systems in advanced earthquake-resistant structures. Nonparametric statistical processing of the signals obtained from simple vibration tests of the web plastifying damper is used here to propose an area index damage. This area index damage is compared with an alternative energy-based index of damage proposed in past research that is based on the decomposition of the load?displacement curve experienced by the damper. Index of damage has been proven to accurately predict the level of damage and the proximity to failure of web plastifying damper, but obtaining the load?displacement curve for its direct calculation requires the use of costly instrumentation. For this reason, the aim of this study is to estimate index of damage indirectly from simple vibration tests, calling for much simpler and cheaper instrumentation, through an auxiliary index called area index damage. Web plastifying damper is a particular type of hysteretic damper that uses the out-of-plane plastic deformation of the web of I-section steel segments as a source of energy dissipation. Four I-section steel segments with similar geometry were subjected to the same pattern of cyclic loading, and the damage was evaluated with the index of damage and area index damage indexes at several stages of the loading process. A good correlation was found between area index damage and index of damage. Based on this correlation, simple formulae are proposed to estimate index of damage from the area index damage.

Redes de seguridad para cierre vertical de fachadas

Entre otros medios de protección colectiva, en los últimos años se vienen utilizando en España redes verticales de cierre de fachadas, a paño completo entre forjados en fase de estructura, y también para huecos menores como ventanas o puertas, en fases posteriores. Este tipo de protección no cuenta hasta el momento con ningún tipo de regulación oficial, si bien en el grupo de trabajo AEN/CTN81/SC2/GT7 se desarrolla actualmente el borrador de la norma Pr UNE 81651 a tal fin. Desde el Dtº. de Ing. de la Construcción de la Universidad de Alicante, varios miembros del grupo de trabajo han desarrollado, contando con la experiencia en otros sistemas de protección, algunos modelos numéricos con elementos finitos para valorar y cuantificar variables mecánicas asociadas al episodio de una eventual caída de una persona sobre este tipo de redes, caracterizado por una menor energía cinética que para otros tipos de ellas. En el artículo se exponen los resultados obtenidos para ambos tipos de paños, grandes y pequeños, donde se han valorado la separación de anclajes de la red, las aberturas generadas en su perímetro durante la retención, los esfuerzos en anclajes y elementos textiles, el factor de impacto que sufriría el accidentado y la repercusión de la disposición geométrica de la red, al cuadro o al rombo.

Optimization of test and maintenance of ageing components consisting of multiple items and addressing effectiveness

There are many models in the literature that have been proposed in the last decades aimed at assessing the reliability, availability and maintainability (RAM) of safety equipment, many of them with a focus on their use to assess the risk level of a technological system or to search for appropriate design and/or surveillance and maintenance policies in order to assure that an optimum level of RAM of safety systems is kept during all the plant operational life. This paper proposes a new approach for RAM modelling that accounts for equipment ageing and maintenance and testing effectiveness of equipment consisting of multiple items in an integrated manner. This model is then used to perform the simultaneous optimization of testing and maintenance for ageing equipment consisting of multiple items. An example of application is provided, which considers a simplified High Pressure Injection System (HPIS) of a typical Power Water Reactor (PWR). Basically, this system consists of motor driven pumps (MDP) and motor operated valves (MOV), where both types of components consists of two items each. These components present different failure and cause modes and behaviours, and they also undertake complex test and maintenance activities depending on the item involved. The results of the example of application demonstrate that the optimization algorithm provide the best solutions when the optimization problem is formulated and solved considering full flexibility in the implementation of testing and maintenance activities taking part of such an integrated RAM model.

Landfill Leachate Toxicity to Oncorhynchus mykiss (Rainbow Trout) at the Merrick Landfill

At the Merrick Landfill, located outside of North Bay (Ontario, CA), an investigation into the potential for an environmental impact to the Little Sturgeon River as a result of landfill leachate discharge was undertaken using toxicity testing using 96 hour acute lethality on Oncorhynchus mykiss (Rainbow Trout). Landfill leachate may present a risk to receiving environments as it is comprised of an array of chemicals including organics, ammonia, and metals. Testing was conducted in three phases, firstly testing was completed on site throughout an existing natural attenuation zone where the presence of several groundwater seeps down gradient of the site had been identified to determine the effectiveness of the existing leachate control features at reducing the environmental risks. These tests indicated that the existing capture strategies were largely effective at reducing toxicity risks to the receiving environment. Testing was also completed on two pilot-scale hybrid-passive treatment systems to determine their effectiveness for leachate treatment. Summer performance of a constructed gravel wetland system was also shown to be effective at reducing the toxicity of the landfill leachate at the site. Lastly in order to support evaluation of leachate treatment requirements, a toxicity identification evaluation (TIE) was performed to determine the principle cause of toxicity within the leachate. Based on water chemistry analyses of samples collected at various locations at the site, the TIE identified ammonia toxicity as the primary source of toxicity in the leachate, with a secondary focus on metal toxicity.

FMVSS 208 RM crash simulation support: a crash test of a 1986 Volkswagen Golf into a fixed 30 degree oblique barrier with a closing velocity of 48.4 kph. Test report.

Mode of access: Internet.

FMVSS no. 208 extension to light trucks, vans, and MPV's - cost/leadtime study. Final report.

National Highway Traffic Safety Administration, Washington, D.C.

Vehicle barrier impact testing on a 1987 Subaru XT 2-door coupe with Hybrid III dummies. Test report.

Mode of access: Internet.

Vehicle barrier impact testing with Hybrid III dummies in a 1987 Ford Escort 5-door hatchback. Test report.

Mode of access: Internet.