The role of incident reporting in continuous quality improvement in the intensive care setting

Publisher's copy made available with the permission of the publisherU. Beckman, W.B. Runcimanhttp://www.aaic.net.au/Article.asp?D=199606

The Australian Incident Monitoring Study in intensive care: AIMS-ICU. An analysis of the first year of reporting.

Publisher's copy made available with the permission of the publisher Copyright © 1996 Australian Society of AnaesthetistsThe AIMS-ICU project is a national study set up to develop, introduce and evaluate an anonymous voluntary incident reporting system for intensive care. ICU staff members reported events which could have reduced, or did reduce, the safety margin for the patient. Seven ICUs contributed 536 reports, which identified 610 incidents involving the airway (20%), procedures (23%), drugs (28%), patient environment (21%), and ICU management (9%). Incidents were detected most frequently by rechecking the patient or the equipment, or by prior experience. No ill effects or only minor ones were experienced by most patients (short-term 76%, long-term 92%) as a result of the incident. Multiple contributing factors were identified, 33% system-based and 66% human factor-based. Incident monitoring promises to be a useful technique for improving patient safety in the ICU, when sufficient data have been collected to allow analysis of sets of incidents in defined “clinical situations”.U. Beckmann, I. Baldwin, G.K. Hart, W.B. Runcima

Nonlinear thermoelectric effects in high-field superconductor-ferromagnet tunnel junctions

Thermoelectric effects result from the coupling of charge and heat transport, and can be used for thermometry, cooling and harvesting of thermal energy. The microscopic origin of thermoelectric effects is a broken electron-hole symmetry, which is usually quite small in metal structures, and vanishes at low temperatures. We report on a combined experimental and theoretical investigation of thermoelectric effects in superconductor/ferromagnet hybrid structures. We investigate the depencence of thermoelectric currents on the thermal excitation, as well as on the presence of a dc bias voltage across the junction. Large thermoelectric effects are observed in superconductor/ferromagnet and superconductor/normal-metal hybrid structures. The spin-independent signals observed under finite voltage bias are shown to be reciprocal to the physics of superconductor/normal-metal microrefrigerators. The spin-dependent thermoelectric signals in the linear regime are due to the coupling of spin and heat transport, and can be used to design more efficient refrigeratorsComment: 11 pages, submitted to Beilstein Journal of Nanotechnolog

Chiral model for dense, hot and strange hadronic matter

Introduction: Until now it is not possible to determine the equation of state (EOS) of hadronic matter from QCD. One succesfully applied alternative way to describe the hadronic world at high densities and temperatures are effective models like the RMF-models [1], where the relevant degrees of freedom are baryons and mesons instead of quarks and gluons. Since approximate chiral symmetry is an essential feature of QCD, it should be a useful concept for building and restricting e ective models. It has been shown [2,3] that effective sigma-omega models including SU(2) chiral symmetry are able to obtain a reasonable description of nuclear matter and finite nuclei. Recently [4] we have shown that an extended SU(3) × SU(3) chiral sigma-omega model is able to describe nuclear matter ground state properties, vacuum properties and finite nuclei satisfactorily. This model includes the lowest SU(3) multiplets of the baryons (octet and decuplet[5]), the spin-0 and the spin-1 mesons as the relevant degrees of freedom. Here we will discuss the predictions of this model for dense, hot, and strange hadronic matter

Mutations and amplification of oncogenes in endometrial cancer

Alterations in oncogenes are critical steps in the development of endometrial cancer. To investigate the potential clinical relevance of the amplification of the oncogenes c-erbB2, c-myc, and int-2 and the mutation of K-ras in endometrial cancer, 112 tumors were examined using PCR-based fluorescent DNA technology. Amplification of the three oncogenes and the mutation of K-ras were correlated with age, tumor size, lymph node status, metastases, stage, histological types, grade, steroid hormone receptor expression (estrogen receptor, ER; progesterone receptor, PgR), family history of cancer, previous history of cancer or precursor lesions, and previous history of hormone replacement therapy. Oncogene amplification of c-erbB2 was detected in 18.9%, of c-myc in 2.7% and of int-2 in 4.2%, and K-ras mutation in 11.6%. No significant correlations could be detected between amplification of c-erbB2 and any of the other parameters. Mutation of K-ras is associated with positive expression of PgR. This might indicate that mutation and activation of K-ras are involved in the development of hormonal independence in endometrial cancer

Lessons Learned From a 20-Year Collaborative Study on American Black Bears

In the 1980s, black bears (Ursus americanus) began expanding into historic habitats in northwestern Nevada, USA. Over a period of \u3e30 years, black bears recolonized areas where human populations have also increased. Our research represents one of, if not the longest-running and earliest comparative studies of a black bear population at wildland–urban interface and wildland areas in North America. As the population increased, we observed: 1) increasing human–bear conflicts in areas where several generations of people had lived in almost total absence of bears (70–80+ years); 2) changes in attitudes by the public toward bears and in the social realm regarding garbage management; and 3) changes in the demographics, behavior, and ecology of this bear population, due to an increasing human footprint on the landscape. Herein, we discuss a few of the lessons learned from this long-term study and the value of a collaborative approach between a state agency, a university, and an international conservation organization. Our collaborative approach allowed us to better understand the ecological, demographic, and behavioral changes in a large, recolonizing carnivore that is a functional omnivore, often residing at the wildland-urban interface, and to use these data to impact conservation and management. Throughout the study, our data were used extensively by various media, emphasizing public education about human–bear conflicts. This media platform proved important because of the impact it had on wildlife conservation. For example, partly in response to media coverage of our data-based education efforts, 3 Nevada counties enacted garbage management ordinances, and the Nevada legislature passed a state law prohibiting the feeding of large game mammals. Further, several million dollars in bear-resistant garbage containers are now used in the region by the public and government entities. The end result of these conservation measures has been a recolonization of the Great Basin Desert by bears from the Lake Tahoe Basin and Sierra-Nevada Range into portions of Nevada where bears have been absent for \u3e80 years

The Australian Incident Monitoring Study in Intensive Care: AIMS-ICU. The development and evaluation of an incident reporting system in intensive care

Publisher's copy made available with the permission of the publisher © 1996 Australian Society of AnaesthetistsIntensive care units are complex, dynamic patient management environments. Incidents and accidents can be caused by human error, by problems inherent in complex systems, or by a combination of these. Study objectives were to develop and evaluate an incident reporting system. A report form was designed eliciting a description of the incident, contextual information and contributing factors. Staff group sessions using open-ended questions, observations in the workplace and a review of earlier narratives were used to develop the report form. Three intensive care units participated in a two-month evaluation study. Feedback questionnaires were used to assess staff attitudes and understanding, project design and organization. These demonstrated a positive attitude and good understanding by more than 90% participants. Errors in communication, technique, problem recognition and charting were the predisposing factors most commonly chosen in the 128 incidents reported. It was concluded that incident monitoring may be a suitable technique for improving patient safety in intensive care.U. Beckman, L.F. West, G.J. Groombridge, I. Baldwin, G.K. Hart, D.G. Clayton, R.K. Webb, W.B. Runcima

The role of learning in complex problem solving using MicroDYN

It is still an open question which cognitive and non-cognitive personality traits are useful for describing and explaining behaviour and performance in complex problems. During complex problem solving (CPS), problem solvers have to interact with the task in a way in which learning ability might be beneficial for successful task completion. By investigating the relationship between learning ability and CPS, while accounting for interactions between complex system characteristics and person characteristics, this paper aims to understand the role of learning processes in CPS more closely. In a sample of N = 241 participants, we performed a preregistered analysis to investigate the relationship between knowledge acquisition performance in a CPS test (MicroDYN) and learning test performance (ADAFI) with a multilevel modeling approach across 10 CPS systems with various characteristics. In line with our expectations, we replicated previous findings on a relationship between learning test and MicroDYN performance and found this relationship to be more pronounced in systems with (vs. without) autonomous changes. Further system and person characteristics also showed effects as expected, with better performance in systems with lower complexity, with more experience with the task, and with more strategic exploration behaviour. Our results provide further evidence for the notion that learning is an important component for the successful completion of CPS tasks

Dimensionality effects on non-equilibrium electronic transport in Cu nanobridges

We report on non-equilibrium electronic transport through normal-metal (Cu) nanobridges coupled to large reservoirs at low temperatures. We observe a logarithmic temperature dependence of the zero-bias conductance, as well as a universal scaling behavior of the differential conductance. Our results are explained by electron-electron interactions in diffusive metals in the zero-dimensional limit.Comment: RevTex, 4 page