Are clinical documents optimised for patient safety? A critical analysis of patient safety outcomes using the EDA error model

Iatrogenic errors and patient safety in clinical processes are an increasing concern. The quality of process information in hardcopy or electronic form can heavily influence clinical behaviour and decision making errors. Little work has been undertaken to assess the safety impact of clinical process planning documents guiding the clinical actions and decisions. This paper investigates the clinical process documents used in elective surgery and their impact on latent and active clinical errors. Eight clinicians from a large health trust underwent extensive semi- structured interviews to understand their use of clinical documents, and their perceived impact on errors and patient safety. Samples of the key types of document used were analysed. Theories of latent organisational and active errors from the literature were combined with the EDA semiotics model of behaviour and decision making to propose the EDA Error Model. This model enabled us to identify perceptual, evaluation, knowledge and action error types and approaches to reducing their causes. The EDA error model was then used to analyse sample documents and identify error sources and controls. Types of knowledge artefact structures used in the documents were identified and assessed in terms of safety impact. This approach was combined with analysis of the questionnaire findings using existing error knowledge from the literature. The results identified a number of document and knowledge artefact issues that give rise to latent and active errors and also issues concerning medical culture and teamwork together with recommendations for further work.

Large-scale dynamics of the mesosphere and lower thermosphere: an analysis using the extended Canadian Middle Atmosphere Model

The extended Canadian Middle Atmosphere Model is used to investigate the large-scale dynamics of the mesosphere and lower thermosphere (MLT). It is shown that the 4-day wave is substantially amplified in southern polar winter in the presence of instabilities arising from strong vertical shears in the MLT zonal mean zonal winds brought about by parameterized nonorographic gravity wave drag. A weaker 4-day wave in northern polar winter is attributed to the weaker wind shears that result from weaker parameterized wave drag. The 2-day wave also exhibits a strong dependence on zonal wind shears, in agreement with previous modeling studies. In the equatorial upper mesosphere, the migrating diurnal tide provides most of the resolved westward wave forcing, which varies semiannually in conjunction with the tide itself; resolved forcing by eastward traveling disturbances is dominated by smaller scales. Nonmigrating tides and other planetary-scale waves play only a minor role in the zonal mean zonal momentum budget in the tropics at these heights. Resolved waves are shown to play a significant role in the zonal mean meridional momentum budget in the MLT, impacting significantly on gradient wind balance. Balance fails at low latitudes as a result of a strong Reynolds stress associated with the migrating diurnal tide, an effect which is most pronounced at equinox when the tide is strongest. Resolved and parameterized waves account for most of the imbalance at higher latitudes in summer. This results in the gradient wind underestimating the actual eastward wind reversal by up to 40%.

Enhancement of aged and denatured fingerprints using the cyanoacrylate fuming technique following dusting with amino acid-containing powders

We have carried out experiments to investigate the ageing of latent fingerprints deposited on black PVC over a period of 4-15 weeks. A thumbprint was used in each case and before deposition of the print the donor rubbed their thumb around their nose to add sebaceous deposits. We have studied the effect of heat, light and moisture and we find that moisture is the most significant factor in the degradation of the latent print. We have attempted to enhance these latent prints by dusting with valine powder or powders composed of valine mixed with gold or red fluorescent commercial fingerprint powders. In order to make a direct comparison between “treated” and “untreated” prints, the prints were cut in half with one half being “treated” and one not. Our studies show the best results being obtained when powders of valine and red fluorescent powders are applied prior to cyanoacrylate fuming.

Comparison of polar ozone loss rates simulated by one-dimensional and three-dimensional models with Match observations in recent Antarctic and Arctic winters

Simulations of ozone loss rates using a three-dimensional chemical transport model and a box model during recent Antarctic and Arctic winters are compared with experimental loss rates. The study focused on the Antarctic winter 2003, during which the first Antarctic Match campaign was organized, and on Arctic winters 1999/2000, 2002/2003. The maximum ozone loss rates retrieved by the Match technique for the winters and levels studied reached 6 ppbv/sunlit hour and both types of simulations could generally reproduce the observations at 2-sigma error bar level. In some cases, for example, for the Arctic winter 2002/2003 at 475 K level, an excellent agreement within 1-sigma standard deviation level was obtained. An overestimation was also found with the box model simulation at some isentropic levels for the Antarctic winter and the Arctic winter 1999/2000, indicating an overestimation of chlorine activation in the model. Loss rates in the Antarctic show signs of saturation in September, which have to be considered in the comparison. Sensitivity tests were performed with the box model in order to assess the impact of kinetic parameters of the ClO-Cl2O2 catalytic cycle and total bromine content on the ozone loss rate. These tests resulted in a maximum change in ozone loss rates of 1.2 ppbv/sunlit hour, generally in high solar zenith angle conditions. In some cases, a better agreement was achieved with fastest photolysis of Cl2O2 and additional source of total inorganic bromine but at the expense of overestimation of smaller ozone loss rates derived later in the winter.

Representativity error for temperature and humidity using the Met Office high-resolution model

The observation-error covariance matrix used in data assimilation contains contributions from instrument errors, representativity errors and errors introduced by the approximated observation operator. Forward model errors arise when the observation operator does not correctly model the observations or when observations can resolve spatial scales that the model cannot. Previous work to estimate the observation-error covariance matrix for particular observing instruments has shown that it contains signifcant correlations. In particular, correlations for humidity data are more significant than those for temperature. However it is not known what proportion of these correlations can be attributed to the representativity errors. In this article we apply an existing method for calculating representativity error, previously applied to an idealised system, to NWP data. We calculate horizontal errors of representativity for temperature and humidity using data from the Met Office high-resolution UK variable resolution model. Our results show that errors of representativity are correlated and more significant for specific humidity than temperature. We also find that representativity error varies with height. This suggests that the assimilation scheme may be improved if these errors are explicitly included in a data assimilation scheme. This article is published with the permission of the Controller of HMSO and the Queen's Printer for Scotland.

Simulated climate and biomes of Africa during the Late Quaternary: comparison with pollen and lake status data

New compilations of African pollen and lake data are compared with climate (CCM1, NCAR, Boulder) and vegetation (BIOME 1.2, GSG, Lund) simulations for the last glacial maximum (LGM) and early to mid-Holocene (EMH). The simulated LGM climate was ca 4°C colder and drier than present, with maximum reduction in precipitation in semi-arid regions. Biome simulations show lowering of montane vegetation belts and expansion of southern xerophytic associations, but no change in the distribution of deserts and tropical rain forests. The lakes show LGM conditions similar or drier than present throughout northern and tropical Africa. Pollen data indicate lowering of montane vegetation belts, the stability of the Sahara, and a reduction of rain forest. The paleoenvironmental data are consistent with the simulated changes in temperature and moisture budgets, although they suggest the climate model underestimates equatorial aridity. EMH simulations show temperatures slightly less than present and increased monsoonal precipitation in the eastern Sahara and East Africa. Biome simulations show an upward shift of montane vegetation belts, fragmentation of xerophytic vegetation in southern Africa, and a major northward shift of the southern margin of the eastern Sahara. The lakes indicate conditions wetter than present across northern Africa. Pollen data show an upward shift of the montane forests, the northward shift of the southern margin of the Sahara, and a major extension of tropical rain forest. The lake and pollen data confirm monsoon expansion in eastern Africa, but the climate model fails to simulate the wet conditions in western Africa.

Improvements in Aerosol Optical Depth Estimation Using Multiangle CHRIS/PROBA Images

A method has been developed to estimate aerosol optical depth (AOD) over land surfaces using high spatial resolution, hyperspectral, and multiangle Compact High Resolution Imaging Spectrometer (CHRIS)/Project for On Board Autonomy (PROBA) images. The CHRIS instrument is mounted aboard the PROBA satellite and provides up to 62 bands. The PROBA satellite allows pointing to obtain imagery from five different view angles within a short time interval. The method uses inversion of a coupled surface/atmosphere radiative transfer model and includes a general physical model of angular surface reflectance. An iterative process is used to determine the optimum value providing the best fit of the corrected reflectance values for a number of view angles and wavelengths with those provided by the physical model. This method has previously been demonstrated on data from the Advanced Along-Track Scanning Radiometer and is extended here to the spectral and angular sampling of CHRIS/PROBA. The values obtained from these observations are validated using ground-based sun-photometer measurements. Results from 22 image sets show an rms error of 0.11 in AOD at 550 nm, which is reduced to 0.06 after an automatic screening procedure.

Centennial variations in sunspot number, open solar flux and streamer belt width: 2. Comparison with the geomagnetic data

We investigate the relationship between interdiurnal variation geomagnetic activity indices, IDV and IDV(1d), corrected sunspot number, R{sub}C{\sub}, and the group sunspot number R{sub}G{\sub}. R{sub}C{\sub} uses corrections for both the “Waldmeier discontinuity”, as derived in Paper 1 [Lockwood et al., 2014c], and the “Wolf discontinuity” revealed by Leussu et al. [2013]. We show that the simple correlation of the geomagnetic indices with R{sub}C{\sub}{sup}n{\sup} or R{sub}G{\sub}{sup}n{\sup} masks a considerable solar cycle variation. Using IDV(1d) or IDV to predict or evaluate the sunspot numbers, the errors are almost halved by allowing for the fact that the relationship varies over the solar cycle. The results indicate that differences between R{sub}C{\sub} and R{sub}G{\sub} have a variety of causes and are highly unlikely to be attributable to errors in either R{sub}G{\sub} alone, as has recently been assumed. Because it is not known if R{sub}C{\sub} or R{sub}G{\sub} is a better predictor of open flux emergence before 1874, a simple sunspot number composite is suggested which, like R{sub}G{\sub}, enables modelling of the open solar flux for 1610 onwards in Paper 3, but maintains the characteristics of R{sub}C{\sub}.

Using an individual-based model to select among alternative foraging strategies of woodpigeons: data support a memory-based model with a flocking mechanism

Population modelling is increasingly recognised as a useful tool for pesticide risk assessment. For vertebrates that may ingest pesticides with their food, such as woodpigeon (Columba palumbus), population models that simulate foraging behaviour explicitly can help predicting both exposure and population-level impact. Optimal foraging theory is often assumed to explain the individual-level decisions driving distributions of individuals in the field, but it may not adequately predict spatial and temporal characteristics of woodpigeon foraging because of the woodpigeons’ excellent memory, ability to fly long distances, and distinctive flocking behaviour. Here we present an individual-based model (IBM) of the woodpigeon. We used the model to predict distributions of foraging woodpigeons that use one of six alternative foraging strategies: optimal foraging, memory-based foraging and random foraging, each with or without flocking mechanisms. We used pattern-oriented modelling to determine which of the foraging strategies is best able to reproduce observed data patterns. Data used for model evaluation were gathered during a long-term woodpigeon study conducted between 1961 and 2004 and a radiotracking study conducted in 2003 and 2004, both in the UK, and are summarised here as three complex patterns: the distributions of foraging birds between vegetation types during the year, the number of fields visited daily by individuals, and the proportion of fields revisited by them on subsequent days. The model with a memory-based foraging strategy and a flocking mechanism was the only one to reproduce these three data patterns, and the optimal foraging model produced poor matches to all of them. The random foraging strategy reproduced two of the three patterns but was not able to guarantee population persistence. We conclude that with the memory-based foraging strategy including a flocking mechanism our model is realistic enough to estimate the potential exposure of woodpigeons to pesticides. We discuss how exposure can be linked to our model, and how the model could be used for risk assessment of pesticides, for example predicting exposure and effects in heterogeneous landscapes planted seasonally with a variety of crops, while accounting for differences in land use between landscapes.

Measuring the impacts of distortions in the European Union cotton sector: a partial equilibrium analysis using the ATPSM model framework

The “cotton issue” has been a topic of several academic discussions for trade policy analysts. However the design of trade and agricultural policy in the EU and the USA has become a politically sensitive matter throughout the last five years. This study utilizing the Agricultural Trade Policy Simulation Model (ATPSM) aims to gain insights into the global cotton market, to explain why domestic support for cotton has become an issue, to quantify the impact of the new EU agricultural policy on the cotton sector, and to measure the effect of eliminating support policies on production and trade. Results indicate that full trade liberalization would lead the four West African countries to better terms of trade with the EU. If tariff reduction follows the so-called Swiss formula, world prices would increase by 3.5%.

Characterization of the lipoxygenase (LOX) gene family in the Chinese white pear (Pyrus bretschneideri) and comparison with other members of the Rosaceae

Background Lipoxygenases (LOXs), a type of non-haem iron-containing dioxygenase, are ubiquitous enzymes in plants and participate in the formation of fruit aroma which is a very important aspect of fruit quality. Amongst the various aroma volatiles, saturated and unsaturated alcohols and aldehydes provide the characteristic aroma of the fruit. These compounds are formed from unsaturated fatty acids through oxidation, pyrolysis and reduction steps. This biosynthetic pathway involves at least four enzymes, including LOX, the enzyme responsible for lipid oxidation. Although some studies have been conducted on the LOX gene family in several species including Arabidopsis, soybean, cucumber and apple, there is no information from pear; and the evolutionary history of this gene family in the Rosaceae is still not resolved. Results In this study we identified 107 LOX homologous genes from five Rosaceous species (Pyrus bretschneideri, Malus × domestica, Fragaria vesca, Prunus mume and Prunus persica); 23 of these sequences were from pear. By using structure analysis, phylogenic analysis and collinearity analysis, we identified variation in gene structure and revealed the phylogenetic evolutionary relationship of this gene family. Expression of certain pear LOX genes during fruit development was verified by analysis of transcriptome data. Conclusions 23 LOX genes were identified in pear and these genes were found to have undergone a duplication 30–45 MYA; most of these 23 genes are functional. Specific gene duplication was found on chromosome4 in the pear genome. Useful information was provided for future research on the evolutionary history and transgenic research on LOX genes.

Open solar flux estimates from near-Earth measurements of the interplanetary magnetic field: comparison of the first two perihelion passes of the Ulysses spacecraft

Results from all phases of the orbits of the Ulysses spacecraft have shown that the magnitude of the radial component of the heliospheric field is approximately independent of heliographic latitude. This result allows the use of near- Earth observations to compute the total open flux of the Sun. For example, using satellite observations of the interplanetary magnetic field, the average open solar flux was shown to have risen by 29% between 1963 and 1987 and using the aa geomagnetic index it was found to have doubled during the 20th century. It is therefore important to assess fully the accuracy of the result and to check that it applies to all phases of the solar cycle. The first perihelion pass of the Ulysses spacecraft was close to sunspot minimum, and recent data from the second perihelion pass show that the result also holds at solar maximum. The high level of correlation between the open flux derived from the various methods strongly supports the Ulysses discovery that the radial field component is independent of latitude. We show here that the errors introduced into open solar flux estimates by assuming that the heliospheric field’s radial component is independent of latitude are similar for the two passes and are of order 25% for daily values, falling to 5% for averaging timescales of 27 days or greater. We compare here the results of four methods for estimating the open solar flux with results from the first and second perehelion passes by Ulysses. We find that the errors are lowest (1–5% for averages over the entire perehelion passes lasting near 320 days), for near-Earth methods, based on either interplanetary magnetic field observations or the aa geomagnetic activity index. The corresponding errors for the Solanki et al. (2000) model are of the order of 9–15% and for the PFSS method, based on solar magnetograms, are of the order of 13–47%. The model of Solanki et al. is based on the continuity equation of open flux, and uses the sunspot number to quantify the rate of open flux emergence. It predicts that the average open solar flux has been decreasing since 1987, as Correspondence to: M. Lockwood (m.lockwood@rl.ac.uk) is observed in the variation of all the estimates of the open flux. This decline combines with the solar cycle variation to produce an open flux during the second (sunspot maximum) perihelion pass of Ulysses which is only slightly larger than that during the first (sunspot minimum) perihelion pass.

Sources, sinks, and transatlantic transport of North African dust aerosol: a multimodel analysis and comparison with remote sensing data

This study evaluates model-simulated dust aerosols over North Africa and the North Atlantic from five global models that participated in the Aerosol Comparison between Observations and Models phase II model experiments. The model results are compared with satellite aerosol optical depth (AOD) data from Moderate Resolution Imaging Spectroradiometer (MODIS), Multiangle Imaging Spectroradiometer (MISR), and Sea-viewing Wide Field-of-view Sensor, dust optical depth (DOD) derived from MODIS and MISR, AOD and coarse-mode AOD (as a proxy of DOD) from ground-based Aerosol Robotic Network Sun photometer measurements, and dust vertical distributions/centroid height from Cloud Aerosol Lidar with Orthogonal Polarization and Atmospheric Infrared Sounder satellite AOD retrievals. We examine the following quantities of AOD and DOD: (1) the magnitudes over land and over ocean in our study domain, (2) the longitudinal gradient from the dust source region over North Africa to the western North Atlantic, (3) seasonal variations at different locations, and (4) the dust vertical profile shape and the AOD centroid height (altitude above or below which half of the AOD is located). The different satellite data show consistent features in most of these aspects; however, the models display large diversity in all of them, with significant differences among the models and between models and observations. By examining dust emission, removal, and mass extinction efficiency in the five models, we also find remarkable differences among the models that all contribute to the discrepancies of model-simulated dust amount and distribution. This study highlights the challenges in simulating the dust physical and optical processes, even in the best known dust environment, and stresses the need for observable quantities to constrain the model processes.

Impacts of increasing the aerosol complexity in the Met Office global numerical weather prediction model.

The inclusion of the direct and indirect radiative effects of aerosols in high-resolution global numerical weather prediction (NWP) models is being increasingly recognised as important for the improved accuracy of short-range weather forecasts. In this study the impacts of increasing the aerosol complexity in the global NWP configuration of the Met Office Unified Model (MetUM) are investigated. A hierarchy of aerosol representations are evaluated including three-dimensional monthly mean speciated aerosol climatologies, fully prognostic aerosols modelled using the CLASSIC aerosol scheme and finally, initialised aerosols using assimilated aerosol fields from the GEMS project. The prognostic aerosol schemes are better able to predict the temporal and spatial variation of atmospheric aerosol optical depth, which is particularly important in cases of large sporadic aerosol events such as large dust storms or forest fires. Including the direct effect of aerosols improves model biases in outgoing long-wave radiation over West Africa due to a better representation of dust. However, uncertainties in dust optical properties propagate to its direct effect and the subsequent model response. Inclusion of the indirect aerosol effects improves surface radiation biases at the North Slope of Alaska ARM site due to lower cloud amounts in high-latitude clean-air regions. This leads to improved temperature and height forecasts in this region. Impacts on the global mean model precipitation and large-scale circulation fields were found to be generally small in the short-range forecasts. However, the indirect aerosol effect leads to a strengthening of the low-level monsoon flow over the Arabian Sea and Bay of Bengal and an increase in precipitation over Southeast Asia. Regional impacts on the African Easterly Jet (AEJ) are also presented with the large dust loading in the aerosol climatology enhancing of the heat low over West Africa and weakening the AEJ. This study highlights the importance of including a more realistic treatment of aerosol–cloud interactions in global NWP models and the potential for improved global environmental prediction systems through the incorporation of more complex aerosol schemes.

Location and characteristics of the reconnection X line deduced from low-altitude satellite and ground-based observations: 1. Theory

A method for estimating both the Alfvén speed and the field-aligned flow of the magnetosheath at the magnetopause reconnection site is presented. The method employs low-altitude cusp ion observations and requires the identification of a feature in the cusp ion spectra near the low-energy cutoff which will often be present for a low-latitude dayside reconnection site. The appearance of these features in data of limited temporal, energy, and pitch angle resolution is illustrated by using model calculations of cusp ion distribution functions. These are based on the theory of ion acceleration at the dayside magnetopause and allow for the effects on the spectrum of flight times of ions precipitating down newly opened field lines. In addition, the variation of the reconnection rate can be evaluated, and comparison with ground-based observations of the corresponding sequence of transient events allows the field-aligned distance from the ionosphere to the reconnection site to be estimated.