Implementing recommendations from accident investigations: a case study of inter-organisational challenges

Abstract in UndeterminedIn many industries, a national accident investigation board conducts investigations following major accidents. For safety improvements to be achieved, however, it is essential that the recommendations presented in these investigations are followed by necessary actions. In this paper, challenges related to implementation of recommendations from accident investigations are studied. The theoretical framework providing the foundation for the study lies at the intersection between systems safety, risk governance, and implementation research. Empirical data for the case study was collected from the Swedish railway sector. The first part of the paper presents an analysis of the extent of recommendations that have not resulted in implemented actions. The second part consists of an interview study aiming at providing a deeper understanding of the difficulties related to transforming these recommendations into actual changes. Two key factors that give rise to challenges to implementation of recommendations are identified. The first factor is related to the different actors' views on their own and other stakeholders' roles in the implementation process, and can be described as a trade-off between being insider and outsider to the industry. The second factor is related to the scope of the accident investigations and their recommendations, and can be described as a trade-off between micro-level and macro-level factors. The opportunities for implementing recommendations, and achieving safety improvements at the industry level, are affected by the ways in which the different stakeholders manage these trade-offs at the local level. This study thus mainly contributes by highlighting the importance of co-ordinating the various actors involved in the implementation process, and the results show that challenges to implementation to a large extent arise in the interactions between these actors

Nucleozymes

Nucleozymes containing ribonucleotides and deoxyribonucleotides or nucleic acid analogues are described herein. The nucleozymes have catalytic activity and are significantly more resistant to degradation than their all-RNA ribozyme counterparts. Also described are methods for preparing the nucleozymes along with methods of using nucleozymes, e.g., as therapeutic agents

Personsäkerhet i tunnlar - Inventering

Banverket äger och förvaltar ett stort antal tunnlar samtidigt som planering och byggande pågår för ett flertal tunnlar. Syftet med föreliggande arbete är att öka kunskapen och på sikt förbättra och förenkla processen angående personsäkerhet i tunnlar. Rapporten beskriver det inventeringsarbete som utförts med avseende på både befintliga och nya tunnlar med fokus på personsäkerhet..

Insulating Josephson-junction chains as pinned Luttinger liquids

Quantum physics in one spatial dimension is remarkably rich, yet even with strong interactions and disorder, surprisingly tractable. This is due to the fact that the low-energy physics of nearly all one-dimensional systems can be cast in terms of the Luttinger liquid, a key concept that parallels that of the Fermi liquid in higher dimensions. Although there have been many theoretical proposals to use linear chains and ladders of Josephson junctions to create novel quantum phases and devices, only modest progress has been made experimentally. One major roadblock has been understanding the role of disorder in such systems. We present experimental results that establish the insulating state of linear chains of sub-micron Josephson junctions as Luttinger liquids pinned by random offset charges, providing a one-dimensional implementation of the Bose glass, strongly validating the quantum many-body theory of one-dimensional disordered systems. The ubiquity of such an electronic glass in Josephson-junction chains has important implications for their proposed use as a fundamental current standard, which is based on synchronisation of coherent tunnelling of flux quanta (quantum phase slips)

Staphylococcus aureus Protein A Binds to Osteoblasts and Triggers Signals That Weaken Bone in Osteomyelitis

Osteomyelitis is a debilitating infectious disease of the bone. It is predominantly caused by S. aureus and is associated with significant morbidity and mortality. It is characterised by weakened bones associated with progressive bone loss. Currently the mechanism through which either bone loss or bone destruction occurs in osteomyelitis patients is poorly understood. We describe here for the first time that the major virulence factor of S. aureus, protein A (SpA) binds directly to osteoblasts. This interaction prevents proliferation, induces apoptosis and inhibits mineralisation of cultured osteoblasts. Infected osteoblasts also increase the expression of RANKL, a key protein involved in initiating bone resorption. None of these effects was seen in a mutant of S. aureus lacking SpA. Complementing the SpA-defective mutant with a plasmid expressing spa or using purified protein A resulted in attachment to osteoblasts, inhibited proliferation and induced apoptosis to a similar extent as wildtype S. aureus. These events demonstrate mechanisms through which loss of bone formation and bone weakening may occur in osteomyelitis patients. This new information may pave the way for the development of new and improved therapeutic agents to treat this disease

Challenges in Designing Resilient Socio-technical Systems: A Case Study of Railway Tunnel Projects

This paper presents a case study of decision-making at the design stage of a socio-technical system where resilience at the global level of the system was constrained by the local perspectives adopted by the different stakeholders. The study is based on interviews with key decision-makers involved in the design stage of six railway tunnel projects in Sweden. The results show that differences in roles and perspectives among the involved actors created double binds and led to extensive discussions and deadlocks during decision-making in the majority of the studied projects. In these projects agreements could only be reached by relying on the outcome from previous railway tunnel projects, regardless differences in project-specific aspects. A significant impact from local actors during decision-making increased the potential for suboptimizations and resulted in a limited focus on the system’s resilience from a regional and national perspective. The findings point at the need for more emphasis in the field of resilience engineering on crossorganisational aspects in order to gain increased understanding of the challenges related to improving resilience of socio-technical systems