The development of a structure for the design of hazard audits.

Hazard auditing, which is a formal, systematic, critical examination of a situation or set of circumstances to identify hazards, is fundamental to hazard management. Auditing is facilitated by "an audit" that details activities, procedures, systems and artefacts, where hazards might be identified. This thesis describes the development of a structure, in the form of a hierarchy, that can be used in the design of hazard audits. An examination of systems such as manufacturing and process plants, for hazards, is usually undertaken by examining the subsystems, (i.e. activities, systems, and procedures). Existing audits therefore, tend to be specific, as for example, audits of unsafe acts, unsafe conditions, technical functioning of materials and machinery, management. This type of audit restricts the examination to a closed system within observable and well described physical and organisational boundaries. It is argued in this thesis that examinations for hazards should go beyond this closed system and also look for hazards within the larger systems of society and industry. An examination of hazards can be seen as a search for evidence of proneness to failure. The hierarchy developed in this research focuses on hazard auditing for a construction project. Construction, which is associated with the construction industry, is only one phase in a larger system, the project, which encompasses development, use, and withdrawal from use. It is argued that evidence of proneness to failure of a construction project may be found in these systems, (project and industry), in the larger system of a social environment, and in the subsystems that are part of a construction project. These hazards are described in terms cf concepts, and presented in the form of a hierarchy that indicates inter-dependencies between concepts. This hierarchy is a basic structure to be used in the design of hazard audits. The concepts incorporated into the hierarchy are discussed and described in terms of their potential to provide evidence of proneness to failure. Sections of hierarchy are built up and presented at appropriate positions in the thesis. It is proposed that this approach to hazard auditing will allow for flexibility in dealing with specific situations, yet provide for the identification of hazards that can exist and develop outside of those situations. It is suggested that such an approach should be regarded as a specialist activity of hazard management. Further, it is argued that the activity of hazard engineering should be recognized as a separate discipline within its own right

Mortality and pulmonary complications in patients undergoing surgery with perioperative sars-cov-2 infection: An international cohort study

Background The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (740%) had emergency surgery and 280 (248%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (261%) patients. 30-day mortality was 238% (268 of 1128). Pulmonary complications occurred in 577 (512%) of 1128 patients; 30-day mortality in these patients was 380% (219 of 577), accounting for 817% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 175 [95% CI 128-240], p<00001), age 70 years or older versus younger than 70 years (230 [165-322], p<00001), American Society of Anesthesiologists grades 3-5 versus grades 1-2 (235 [157-353], p<00001), malignant versus benign or obstetric diagnosis (155 [101-239], p=0046), emergency versus elective surgery (167 [106-263], p=0026), and major versus minor surgery (152 [101-231], p=0047). Interpretation Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Can mHealth Technology Help Mitigate the Effects of the COVID-19 Pandemic?

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Reviewing the past to learn in the future: Making sense of design errors and failures in construction

Design errors can severely jeopardise safety and contribute to failures in construction and engineering projects. Such failures can have devastating economic, environmental and social consequences. Significant efforts have been made to reduce the incidence of failures through learning from previous disasters and events by modifying building and engineering codes and standards accordingly. Design errors, however, remain an innate feature of construction and engineering projects despite the considerable amount of knowledge that has been accumulated to date. Most errors are identified during construction and require rework, but there is always a potential for some to remain undetected and contribute to failure, and as a result potentially contribute to accidents and loss of life. An examination of the literature research suggests that a series of pathogenic influences contribute to errors and failure. Thus, this paper article examines the circumstances and issues that contributed to a series of construction and engineering failures to enable development of a learning framework that can be used to mitigate design errors and potential failures and accidents. © 2013 Copyright Taylor and Francis Group, LLC