Epic Human Failure on June 30, 2013

Nineteen Prescott Fire Department, Granite Mountain Hot Shot (GMHS) wildland firefighters and supervisors (WFF), perished on the June 2013 Yarnell Hill Fire (YHF) in Arizona. The firefighters left their Safety Zone during forecast, outflow winds, triggering explosive fire behavior in drought-stressed chaparral. Why would an experienced WFF Crew, leave ‘good black’ and travel downslope through a brush-filled chimney, contrary to their training and experience? An organized Serious Accident Investigation Team (SAIT) found, “… no indication of negligence, reckless actions, or violations of policy or protocol.” Despite this, many WFF professionals deemed the catastrophe, “… the final, fatal link, in a long chain of bad decisions with good outcomes.” This paper is a theoretical and realistic examination of plausible, faulty, human decisions with prior good outcomes; internal and external impacts, influencing the GMHS; and two explanations for this catastrophe: Individual Blame Logic and Organizational Function Logic, and proposed preventive mitigations

An investigation of surface deformations occurring at the contact edges of statically loaded discs

An investigation has been carried out, using statically loaded steel and 'Perspex' discs, into elastic displacements occurring at the axial extremities of the Hertzian flat. By employing the technique of 'Photostress', together with optical magnification, it has been found possible to inspect in detail the disposition of strain around these points. Using a 'step grinding' technique a qualitative three-dimensional envelope of surface displacements has been constructed. The effect of these displacements is considered in relation to 'edge pitting' of discs

Topical clobetasol for the treatment of toxic epidermal necrolysis: study protocol for a randomized controlled trial.

BackgroundToxic epidermal necrolysis (TEN) is a rare systemic allergic drug eruption with high patient mortality. Currently, no established treatments have been shown to be effective for TEN beyond supportive care. Prior studies of systemic corticosteroids have yielded conflicting data, with some showing a possible benefit and others reporting in increased mortality. However, topical steroids have shown promise for treatment of ocular sequelae of TEN, such as scarring and vision loss. We have designed a randomized controlled trial to evaluate topical clobetasol for treatment of the epidermal manifestations of TEN. In addition, we propose genetic studies to characterize the TEN transcriptome and alterations in cutaneous gene expression that might occur following topical steroid treatment.Methods/designThis split-body randomized, double-blind, placebo-controlled Phase IIa proof-of-concept trial will evaluate the safety and efficacy of once-daily topical clobetasol applied to the skin of patients with TEN. This multicenter trial will recruit a total of 15 patients between the ages of 12 and 85 from the University of California Davis Medical Center and Shriners Hospital for Children inpatient burn units. Designated treatment areas on opposite sides of the body will be treated with blinded clobetasol 0.05% ointment or control petrolatum ointment daily for 14 days. On day 3 of therapy, a biopsy will be taken from the treated area for genetic studies. The primary study aims will be to establish the safety of topical clobetasol treatment and determine the time to cessation of skin detachment for the control and clobetasol-treated areas. Secondary endpoints will evaluate efficacy using parameters such as time to 90% re-epithelialization and percentage of affected skin at 0, 3, 6, 9, 12 and 15 days. Genomic DNA and RNA will be obtained from biopsy samples, to characterize the TEN transcriptome and identify changes in gene expression after topical steroid treatment.DiscussionTopical steroids have shown promise for treating ocular complications of TEN, but to date have not been evaluated for cutaneous manifestations of the disease. This trial will investigate clinical and molecular outcomes of topical clobetasol application and hopefully provide insight into the disease pathophysiology.Trial registrationClinicalTrials.gov NCT02319616. https://clinicaltrials.gov/ct2/show/NCT02351037

Using participatory and creative methods to facilitate emancipatory research with people facing multiple disadvantage: a role for health and care professionals

Participatory and creative research methods are a powerful tool for enabling active engagement in the research process of marginalised people. It can be particularly hard for people living with multiple disadvantage, such as disabled people from ethnic minority backgrounds, to access research projects that are relevant to their lived experience. This article argues that creative and participatory methods facilitate the co-researchers’ engagement in the research process, which thus becomes more empowering. Exploring the congruence of these methods with their professional ethos, health and care professionals can use their skills to develop them further. Both theory and practice examples are presented

How explicit are the barriers to failure in safety arguments?

Safety cases embody arguments that demonstrate how safety properties of a system are upheld. Such cases implicitly document the barriers that must exist between hazards and vulnerable components of a system. For safety certification, it is the analysis of these barriers that provide confidence in the safety of the system. The explicit representation of hazard barriers can provide additional insight for the design and evaluation of system safety. They can be identified in a hazard analysis to allow analysts to reflect on particular design choices. Barrier existence in a live system can be mapped to abstract barrier representations to provide both verification of barrier existence and a basis for quantitative measures between the predicted barrier behaviour and performance of the actual barrier. This paper explores the first stage of this process, the binding between explicit mitigation arguments in hazard analysis and the barrier concept. Examples from the domains of computer-assisted detection in mammography and free route airspace feasibility are examined and the implications for system certification are considered

Curcumin: A review of anti-cancer properties and therapeutic activity in head and neck squamous cell carcinoma

Curcumin (diferuloylmethane) is a polyphenol derived from the Curcuma longa plant, commonly known as turmeric. Curcumin has been used extensively in Ayurvedic medicine for centuries, as it is nontoxic and has a variety of therapeutic properties including anti-oxidant, analgesic, anti-inflammatory and antiseptic activity. More recently curcumin has been found to possess anti-cancer activities via its effect on a variety of biological pathways involved in mutagenesis, oncogene expression, cell cycle regulation, apoptosis, tumorigenesis and metastasis. Curcumin has shown anti-proliferative effect in multiple cancers, and is an inhibitor of the transcription factor NF-κB and downstream gene products (including c-myc, Bcl-2, COX-2, NOS, Cyclin D1, TNF-α, interleukins and MMP-9). In addition, curcumin affects a variety of growth factor receptors and cell adhesion molecules involved in tumor growth, angiogenesis and metastasis. Head and neck squamous cell carcinoma (HNSCC) is the sixth most common cancer worldwide and treatment protocols include disfiguring surgery, platinum-based chemotherapy and radiation, all of which may result in tremendous patient morbidity. As a result, there is significant interest in developing adjuvant chemotherapies to augment currently available treatment protocols, which may allow decreased side effects and toxicity without compromising therapeutic efficacy. Curcumin is one such potential candidate, and this review presents an overview of the current in vitro and in vivo data supporting its therapeutic activity in head and neck cancer as well as some of the challenges concerning its development as an adjuvant chemotherapeutic agent

Dietary supplementation with Bifidobacterium longum subsp. infantis (B. infantis) in healthy breastfed infants: study protocol for a randomised controlled trial.

BackgroundThe development of probiotics as therapies to cure or prevent disease lags far behind that of other investigational medications. Rigorously designed phase I clinical trials are nearly non-existent in the field of probiotic research, which is a contributing factor to this disparity. As a consequence, how to appropriately dose probiotics to study their efficacy is unknown. Herein we propose a novel phase I ascending dose trial of Bifidobacterium longum subsp. infantis (B. infantis) to identify the dose required to produce predominant gut colonisation in healthy breastfed infants at 6 weeks of age.Methods/designThis is a parallel-group, placebo-controlled, randomised, double-blind ascending dose phase I clinical trial of dietary supplementation with B. infantis in healthy breastfed infants. The objective is to determine the pharmacologically effective dose (ED) of B. infantis required to produce predominant (>50 %) gut colonisation in breastfed infants at 6 weeks of age. Successively enrolled infant groups will be randomised to receive two doses of either B. infantis or placebo on days 7 and 14 of life. Stool samples will be used to characterise the gut microbiota at increasing doses of B. infantis.DiscussionProbiotic supplementation has shown promising results for the treatment of a variety of ailments, but evidence-based dosing regimes are currently lacking. The ultimate goal of this trial is to establish a recommended starting dose of B. infantis for further efficacy-testing phase II trials designed to evaluate B. infantis for the prevention of atopic dermatitis and food allergies in at-risk children.Trial registrationClinicaltrials.gov # NCT02286999 , date of trial registration 23 October 2014

Towards a science of qualities in organizations: Lessons from complexity theory and postmodern biology.

Abstract The development of complexity theory in the natural sciences is described, and summarized in six principles of complex emergent wholes. It is suggested that complexity theory is leading biology toward a science of qualities based on participation and intuition. It is argued on metaphorical and epistemological grounds that these principles which describe the emergence of complex wholes can be applied to social and organizational life. The six principles are then applied to qualitative and action research practice, with a particular reference to co-operative inquiry, in order to provide principles for good practice and theoretical support for the nature of valid inquiry processes. Acknowledgement

Observation of Surface-Avoiding Waves: A New Class of Extended States in Periodic Media

Coherent time-domain optical experiments on GaAs-AlAs superlattices reveal the exis-tence of an unusually long-lived acoustic mode at ~ 0.6 THz, which couples weakly to the environment by evading the sample boundaries. Classical as well as quantum states that steer clear of surfaces are generally shown to occur in the spectrum of periodic struc-tures, for most boundary conditions. These surface-avoiding waves are associated with frequencies outside forbidden gaps and wavevectors in the vicinity of the center and edge of the Brillouin zone. Possible consequences for surface science and resonant cavity ap-plications are discussed.Comment: 16 pages, 3 figure

Action research in physical education: focusing beyond myself through cooperative learning

This paper reports on the pedagogical changes that I experienced as a teacher engaged in an action research project in which I designed and implemented an indirect, developmentally appropriate and child‐centred approach to my teaching. There have been repeated calls to expunge – or at least rationalise – the use of traditional, teacher‐led practice in physical education. Yet despite the advocacy of many leading academics there is little evidence that such a change of approach is occurring. In my role as teacher‐as‐researcher I sought to implement a new pedagogical approach, in the form of cooperative learning, and bring about a positive change in the form of enhanced pupil learning. Data collection included a reflective journal, post‐teaching reflective analysis, pupil questionnaires, student interviews, document analysis, and non‐participant observations. The research team analysed the data using inductive analysis and constant comparison. Six themes emerged from the data: teaching and learning, reflections on cooperation, performance, time, teacher change, and social interaction. The paper argues that cooperative learning allowed me to place social and academic learning goals on an even footing, which in turn placed a focus on pupils’ understanding and improvement of skills in athletics alongside their interpersonal development