Designing packaging to support the safe use of medicines at home

The design of pharmaceutical products, packaging, information and related materials is a major source of human error. These errors may be stressful, harmful or even fatal. Given the scale of the problems and the global use of medication, design solutions are urgently needed. This paper in Applied Ergonomics demonstrated how such improvements can be made, drawing on research that investigated how the design of methotrexate packaging can influence patient safety. The project, undertaken in light of a number of serious incidents in the UK resulting from accidental overdoses of methotrexate, aimed to collect evidence to provide a basis for the development of new concepts for revised designs by the pharmaceutical industry. Buckle et al. found that patients using methotrexate experience a number of difficulties in using their medicine’s packaging and, as a result, resourcefully adopt a variety of ‘coping strategies’ which may increase the risk of dosing errors. By investigating both the practices of methotrexate users, and the design of the system that supports methotrexate use, additional problems were observed across the healthcare system, meaning that the function of medicines packaging in ensuring safety may be even more critical than first suspected. Buckle contributed to this paper through the derivation of a suitable human-factors approach to studying fatalities, errors and ‘near misses’ associated with the use of packaging for medications. The human factors (human behaviour) associated with these and the need to consider the whole system were essential elements provided by Buckle in the research. As a result of the research project, the National Patient Safety Agency responded with a UK-wide programme of work to improve safety for patients, and continues to work with the pharmaceutical industry to develop more user-friendly packaging and labelling

A strategy for human factors/ergonomics: Developing the discipline and profession

Buckle was one of eight world experts in human factors/ergonomics (HFE) asked to prepare this future strategy paper for the International Ergonomics Association (IEA). HFE has great potential to contribute to the design of all kinds of systems involving people but faces challenges in the readiness of its market and in the supply of high-quality applications. Buckle et al. presented a strategy for the global HFE community to strengthen demand for and application of high-quality HFE, emphasising its key elements: systems approach, design driven, and performance and well-being goals. The ideas represent a consensus but Buckle proposed the emphasis on a design-led and socio-technical system approach. The authors argue that, to contribute to future system design, HFE must demonstrate its value more successfully to the main stakeholders of system design. HFE already has a strong value proposition (mainly well-being) and interactivity with the stakeholder group of ‘system actors’. Nonetheless, the value proposition and relationships with the stakeholder groups of ‘system experts’, and ‘system decision makers’, who have a strong power to influence system design, need to be developed. Therefore, the first main strategic direction is to strengthen the demand for high-quality HFE by increasing awareness of its value by communicating and building partnerships with stakeholders, and educating them. The second main strategic direction is to strengthen the application of high-quality HFE by promoting the education of HFE specialists, by ensuring high standards for HFE applications and HFE specialists, and by promoting HFE research excellence. The paper formed a keynote address at the IEA Congress, Brazil (2012). The study was awarded the Liberty Mutual Award 2012–13 for the best paper in the journal Ergonomics. The strategy proposed has been adopted by many countries as their blueprint for the human factors/ergonomics discipline development (e.g. Germany, Netherlands, Brazil)

Growth and volatility regime switching models for New Zealand GDP data

This paper fits hidden Markov switching models to New Zealand GDP data. A primary objective is to better understand the utility of these methods for modelling growth and volatility regimes present in the New Zealand data and their interaction. Properties of the models are developed together with a description of the estimation methods, including use of the Expectation Maximisation (EM) algorithm. The models are fitted to New Zealand GDP and production sector growth rates to analyse changes in their mean and volatility over time. The paper discusses applications of the methodology to identifying changes in growth performances, and examines the timing of growth and volatility regime switching between production sectors. Conclusions to emerge are that, in contrast to the 1980s, New Zealand GDP growth experienced an unusually long period of time in high growth and low volatility regimes during the 1990s. The paper evaluates sector contributions to this 1990s experience and discusses directions for further development.Hidden Markov models; regime switching; growth; business cycles; volatility; production sectors; GDP.

Calm after the Storm?: Supply-side contributions to New Zealand’s GDP volatility decline

The variance of New Zealand’s real GDP has declined since the mid-1980s. To investigate why, this paper decomposes the variance of chain-weighted estimates of production-based real GDP growth into sector shares, sector growth rate variances and co-variances. The principal explanation for the decline in GDP volatility is a fall in the sum of sector variances driven by a decline in the Services and Manufacturing sector production growth variances. Sector co-variances have had a dominant influence on the profile of GDP volatility and this influence has not diminished. Despite marked changes in sector shares, notably increases in Services and Primary sector shares and a decrease in the share of Manufacturing, this has not been a significant factor influencing the decline in GDP volatility. We postulate that policy interventions such as “Think Big”, regulatory interventions during the early 1980s, and the introduction of GST are key explanations for the higher volatility until the mid 1980s. Cessation of these interventions, deregulation and possibly changes in inventory management methods are important reasons why GDP volatility has fallen since then.Volatility, growth, production sector shares, manufacturing, services, primary, construction.

Going beyond Clustering in MD Trajectory Analysis: An Application to Villin Headpiece Folding

Recent advances in computing technology have enabled microsecond long all-atom molecular dynamics (MD) simulations of biological systems. Methods that can distill the salient features of such large trajectories are now urgently needed. Conventional clustering methods used to analyze MD trajectories suffer from various setbacks, namely (i) they are not data driven, (ii) they are unstable to noise and changes in cut-off parameters such as cluster radius and cluster number, and (iii) they do not reduce the dimensionality of the trajectories, and hence are unsuitable for finding collective coordinates. We advocate the application of principal component analysis (PCA) and a non-metric multidimensional scaling (nMDS) method to reduce MD trajectories and overcome the drawbacks of clustering. To illustrate the superiority of nMDS over other methods in reducing data and reproducing salient features, we analyze three complete villin headpiece folding trajectories. Our analysis suggests that the folding process of the villin headpiece is structurally heterogeneous

Team 3: Exploring the relationship of systems research to systems literacy

In this paper, the Systems Research Team (SRT) details the activities and outcomes of the 2016 IFSR Conversation in Linz, Austria. The 2016 SRT includes: Mary Edson (team leader), Pam Buckle Henning, Tim Ferris, Andreas Hieronymi, Ray Ison, Gary Metcalf, George Mobus, Nam Nguyen, David Rousseau, and Shankar Sankaran, with guest team member, Peter Tuddenham, anchoring the endeavor in Systems Literacy. While the 2014 SRT’s focus was answering the question, “What distinguishes Systems Research from other types of research?” an internal focus intended to provide grounding for researchers new to the Systems Sciences, the 2016 SRT’s focus is on reaching out to a broader community in order to provide a foundation for Systems Literacy. The team’s Conversation revolved around the question, “How can Systems Research be in service to Systems Literacy?” The team’s discussions were directed into two essential aspects, separate and integrated, of this question. First, Systems Research serves Systems Literacy by providing a credible foundation for the principles and practices of Systems Science and Systems Thinking in both systematic and systemic modes. Second, Systems Research provides a neutral frame for development of ethical applications of those principles and practices. The SRT recognizes the exigency in providing foundational principles that can be effectively adopted and disseminated through Systems Literacy. The team’s narrative begins with an understanding the urgency for application of Systems Sciences and Systems Thinking to critical issues. Systems research, as with other types of research, is typically a slow generation of results; however, the body of knowledge gained through this process can be confidently used to address complexity in timely ways. The criticality of the need for salient approaches to complexity is shown in a graphic representation of some possible trajectories of applying or not applying these Systems principles in practice. The choice of how we respond to these issues relates to a process model that can be applied. Through understanding the relationship of the process model to the trajectory, the team directed its focus to developing a MindMap (Eppler, 2006) of eight essential aspects or features of how Systems Research can support Systems Literacy. These include: Systems Science knowledge base, roles and personas, maturity models, role profile, ontology/vocabulary, perspective/framing choice, frameworks, and political ecology. Each of these eight has its own process of unpacking, which was demonstrated to the Conversation participants by delving more deeply into the aspect of knowledge base. The eight relate to unpacking the Systems landscape in a coherent but loosely coupled investment portfolio (economic, social, and relational) for building systemic sensibility in such a way as to be dis/aggregated for different audiences. The week’s work culminated in a plan for “Looking Ahead,” which outlines the intentions of the SRT to continue its activities in support of Systems Literacy in the upcoming months. An example of this continued work is a workshop, “Toward Systems Literacy, the Role of Systems Research,” that was conducted at the 60th Meeting of the International Society for the Systems Sciences in Boulder, July 25, 2016

Ergonomics of using a mouse or other non-keyboard input device

Ten years ago, when the Health and Safety (Display Screen Equipment) Regulations (HSE, 1992) were drafted, the majority of computer interaction occurred with text driven interfaces, using a keyboard. It is not surprising then that the guidance accompanying the DSE Regulations included virtually no mention of the computer mouse or other non-keyboard input devices (NKID). In the intervening period, graphical user interfaces, incorporating ‘windows, icons and pull down menus’ (WIMPS), with a heavy reliance on pointing devices such as the mouse, have transformed user computer interaction. Accompanying this, however, have been increasing anecdotal reports of musculoskeletal health problems affecting NKID users. While the performance aspects of NKID (e.g. accuracy and speed) have been the subject of detailed research, the possible implications for user health have received comparatively little attention. The research presented in this report was commissioned by the Health and Safety Executive to improve understanding of the nature and extent of NKID health problems. This investigation, together with another project examining mobile computing (Heasman et. al., 2000), was intended to contribute to a planned review and updating of the DSE Regulations and accompanying guidance

What is the relationship between human factors & ergonomics and quality improvement in healthcare?

© 2015 Taylor & Francis.A recent initiative in the National Health Service (NHS, UK) has led to an increased interest in Human Factors & Ergonomics (HFE). As part of initial discussions there have been questions about the similarities and differences between HFE and Quality Improvement (QI).We believe that there are considerable advantages from a more structured relationship between HFE and QI in healthcare and have comparatively mapped a range of dimensions (origins, drivers, philosophy, focus, role and methods). Our conclusion is that HFE in healthcare should use four criteria to maximise the benefits from this opportunity, including the use of HFE methods to design systems, environments, products etc. and the direct involvement of qualified (chartered) HFE professionals

COVID-19 testing in English care homes and implications for staff and residents

Introduction: Care home residents are at high risk of dying from coronavirus disease 2019 (COVID-19). Regular testing, producing rapid and reliable results is important in this population because infections spread quickly, and presentations are often atypical or asymptomatic. This study evaluated current testing pathways in care homes to explore the role of point-of-care tests (POCTs). Methods: A total of 10 staff from eight care homes, purposively sampled to reflect care organisational attributes that influence outbreak severity, underwent a semi-structured remote videoconference interview. Transcripts were analysed using process mapping tools and framework analysis focussing on perceptions about, gaps within and needs arising from current pathways. Results: Four main steps were identified in testing: infection prevention, preparatory steps, swabbing procedure and management of residents. Infection prevention was particularly challenging for mobile residents with cognitive impairment. Swabbing and preparatory steps were resource-intensive, requiring additional staff resource. Swabbing required flexibility and staff who were familiar to the resident. Frequent approaches to residents were needed to ensure they would participate at a suitable time. After-test management varied between sites. Several homes reported deviating from government guidance to take more cautious approaches, which they perceived to be more robust. Conclusion: Swab-based testing is organisationally complex and resource-intensive in care homes. It needs to be flexible to meet the needs of residents and provide care homes with rapid information to support care decisions. POCT could help address gaps but the complexity of the setting means that each technology must be evaluated in context before widespread adoption in care homes