Can Patient Safety Incident Reports Be Used to Compare Hospital Safety? Results from a Quantitative Analysis of the English National Reporting and Learning System Data.

BACKGROUND: The National Reporting and Learning System (NRLS) collects reports about patient safety incidents in England. Government regulators use NRLS data to assess the safety of hospitals. This study aims to examine whether annual hospital incident reporting rates can be used as a surrogate indicator of individual hospital safety. Secondly assesses which hospital characteristics are correlated with high incident reporting rates and whether a high reporting hospital is safer than those lower reporting hospitals. Finally, it assesses which health-care professionals report more incidents of patient harm, which report more near miss incidents and what hospital factors encourage reporting. These findings may suggest methods for increasing the utility of reporting systems. METHODS: This study used a mix methods approach for assessing NRLS data. The data were investigated using Pareto analysis and regression models to establish which patients are most vulnerable to reported harm. Hospital factors were correlated with institutional reporting rates over one year to examine what factors influenced reporting. Staff survey findings regarding hospital safety culture were correlated with reported rates of incidents causing harm; no harm and death to understand what barriers influence error disclosure. FINDINGS: 5,879,954 incident reports were collected from acute hospitals over the decade. 70.3% of incidents produced no harm to the patient and 0.9% were judged by the reporter to have caused severe harm or death. Obstetrics and Gynaecology reported the most no harm events [OR 1.61(95%CI: 1.12 to 2.27), p<0.01] and pharmacy was the hospital location where most near-misses were captured [OR 3.03(95%CI: 2.04 to 4.55), p<0.01]. Clinicians were significantly more likely to report death than other staff [OR 3.04(95%CI: 2.43 to 3.80) p<0.01]. A higher ratio of clinicians to beds correlated with reduced rate of harm reported [RR = -1.78(95%Cl: -3.33 to -0.23), p = 0.03]. Litigation claims per bed were significantly negatively associated with incident reports. Patient satisfaction and mortality outcomes were not significantly associated with reporting rates. Staff survey responses revealed that keeping reports confidential, keeping staff informed about incidents and giving feedback on safety initiatives increased reporting rates [r = 0.26 (p<0.01), r = 0.17 (p = 0.04), r = 0.23 (p = 0.01), r = 0.20 (p = 0.02)]. CONCLUSION: The NRLS is the largest patient safety reporting system in the world. This study did not demonstrate many hospital characteristics to significantly influence overall reporting rate. There were no association between size of hospital, number of staff, mortality outcomes or patient satisfaction outcomes and incident reporting rate. The study did show that hospitals where staff reported more incidents had reduced litigation claims and when clinician staffing is increased fewer incidents reporting patient harm are reported, whilst near misses remain the same. Certain specialties report more near misses than others, and doctors report more harm incidents than near misses. Staff survey results showed that open environments and reduced fear of punitive response increases incident reporting. We suggest that reporting rates should not be used to assess hospital safety. Different healthcare professionals focus on different types of safety incidents and focusing on these areas whilst creating a responsive, confidential learning environment will increase staff engagement with error disclosure

Stability and Hermitian-Einstein metrics for vector bundles on framed manifolds

We adapt the notions of stability of holomorphic vector bundles in the sense of Mumford-Takemoto and Hermitian-Einstein metrics in holomorphic vector bundles for canonically polarized framed manifolds, i.e. compact complex manifolds X together with a smooth divisor D such that K_X \otimes [D] is ample. It turns out that the degree of a torsion-free coherent sheaf on X with respect to the polarization K_X \otimes [D] coincides with the degree with respect to the complete K\"ahler-Einstein metric g_{X \setminus D} on X \setminus D. For stable holomorphic vector bundles, we prove the existence of a Hermitian-Einstein metric with respect to g_{X \setminus D} and also the uniqueness in an adapted sense.Comment: 21 pages, International Journal of Mathematics (to appear

The ADHM Construction of Instantons on Noncommutative Spaces

We present an account of the ADHM construction of instantons on Euclidean space-time $\mathbb{R}^4$ from the point of view of noncommutative geometry. We recall the main ingredients of the classical construction in a coordinate algebra format, which we then deform using a cocycle twisting procedure to obtain a method for constructing families of instantons on noncommutative space-time, parameterised by solutions to an appropriate set of ADHM equations. We illustrate the noncommutative construction in two special cases: the Moyal-Groenewold plane $\mathbb{R}^4_\hbar$ and the Connes-Landi plane $\mathbb{R}^4_\theta$.Comment: Latex, 40 page

A cusp electron gun for millimeter wave gyrodevices

The experimental results of a thermionic cusp electron gun, to drive millimeter and submillimeter wave harmonic gyrodevices, are reported in this paper. Using a "smooth" magnetic field reversal formed by two coils this gun generated an annular-shaped, axis-encircling electron beam with 1.5 A current, and an adjustable velocity ratio alpha of up to 1.56 at a beam voltage of 40 kV. The beam cross-sectional shape and transported beam current were measured by a witness plate technique and Faraday cup, respectively. These measured results were found to be in excellent agreement with the simulated results using the three-dimensional code MAGIC

A microprocessor-based cardiotachometer

The development of a highly accurate and reliable cardiotachometer for measuring the heart rate of test subjects is discussed. It measures heart rate over the range of 30 to 250 beats/minute and gives instantaneous (beat to beat) updates on the system output so that occasional noise artifacts or ectopic beats could be more easily identified except that occasional missed beats caused by switching ECG leads should not cause a change in the output. The cardiotachometer uses an improved analog filter and R-wave detector and an Intel 8080A microprocessor to handle all of the logic and arithmetic necessary. By using the microprocessor, future hardware modifications could easily be made if functional changes were needed

Hamiltonian 2-forms in Kahler geometry, III Extremal metrics and stability

This paper concerns the explicit construction of extremal Kaehler metrics on total spaces of projective bundles, which have been studied in many places. We present a unified approach, motivated by the theory of hamiltonian 2-forms (as introduced and studied in previous papers in the series) but this paper is largely independent of that theory. We obtain a characterization, on a large family of projective bundles, of those `admissible' Kaehler classes (i.e., the ones compatible with the bundle structure in a way we make precise) which contain an extremal Kaehler metric. In many cases, such as on geometrically ruled surfaces, every Kaehler class is admissible. In particular, our results complete the classification of extremal Kaehler metrics on geometrically ruled surfaces, answering several long-standing questions. We also find that our characterization agrees with a notion of K-stability for admissible Kaehler classes. Our examples and nonexistence results therefore provide a fertile testing ground for the rapidly developing theory of stability for projective varieties, and we discuss some of the ramifications. In particular we obtain examples of projective varieties which are destabilized by a non-algebraic degeneration.Comment: 40 pages, sequel to math.DG/0401320 and math.DG/0202280, but largely self-contained; partially replaces and extends math.DG/050151

Forward and Inverse Processing in Electromagnetic NDE Using Squid

Electromagnetic NDE has been successfully applied to the detection of surface cracks and is routinely used to locate flaws in airframes, pipelines and in steel offshore oil platforms. However, there are still many problems to be solved, particularly in the aviation industry, which require the detection of deeper flaws such as corrosion in multi-layered structures and cracks around rivet holes which are obscured by the head of the rivet. Most systems use coils as detectors (though Hall probes are occasionally used), which have low sensitivity at low frequencies due to the fact that the induced voltage is proportional to the rate of change of magnetic flux through the coil. Unfortunately it is necessary to use low frequencies to detect deep subsurface flaws on account of the skin-depth effect, otherwise the electromagnetic field cannot propagate down to the depth of the flaw. SQUID (Superconducting Quantum Interference Device) sensors are ideally suited to overcome the deficiencies of coils, because they are primarily detectors of magnetic flux which, together with their high sensitivity, makes the detection of deep flaws more likely. SQUIDs have been successfully used for measuring very low magnetic fields, particularly in the field of biomagnetism, and it is hoped to exploit this sensitivity to detect flaws at large stand-off distances for example in pipelines which are surrounded by thick layers of cladding

Arf6 recruits the Rac GEF Kalirin to the plasma membrane facilitating Rac activation

<p>Abstract</p> <p>Background</p> <p>Many studies implicate Arf6 activity in Rac-mediated membrane ruffling and cytoskeletal reorganization. Although Arf6 facilitates the trafficking of Rac1 to the plasma membrane and in many cases Arf6 activation leads to the activation of Rac1, the details of how Arf6 influences Rac function remain to be elucidated.</p> <p>Results</p> <p>We demonstrate in binding assays and by co-immunoprecipitation that GDP-bound Arf6 binds to Kalirin5, a Rho family guanine nucleotide exchange factor, through interaction with the spectrin repeat region. In cells, expression of wild type Arf6 recruits spectrin repeat 5 and Kalirin to the plasma membrane and leads to enhanced Kalirin5-induced ruffling. By contrast, expression of an Arf6 mutant that cannot become activated, Arf6 T27N, still recruits spectrin repeat 5 and Kalirin to membranes but inhibits Kalirin5-induced ruffling in HeLa cells. Kalirin5-induced Rac1 activation is increased by the expression of wild type Arf6 and decreased by Arf6T27N. Furthermore, expression of a catalytically-inactive mutant of Kalirin5 inhibits cytoskeletal changes observed in cells expressing EFA6, an Arf6 guanine nucleotide exchange factor that leads to activation of Rac.</p> <p>Conclusion</p> <p>We show here with over-expressed proteins that the GDP-bound form of Arf6 can bind to the spectrin repeat regions in Kalirin Rho family GEFs thereby recruiting Kalirin to membranes. Although Kalirin is recruited onto membranes by Arf6-GDP, subsequent Rac activation and membrane ruffling requires Arf6 activation. From these results, we suggest that Arf6 can regulate through its GTPase cycle the activation of Rac.</p

Herschel PACS Observations and Modeling of Debris Disks in the Tucana-Horologium Association

We present Herschel PACS photometry of seventeen B- to M-type stars in the 30 Myr-old Tucana-Horologium Association. This work is part of the Herschel Open Time Key Programme "Gas in Protoplanetary Systems" (GASPS). Six of the seventeen targets were found to have infrared excesses significantly greater than the expected stellar IR fluxes, including a previously unknown disk around HD30051. These six debris disks were fitted with single-temperature blackbody models to estimate the temperatures and abundances of the dust in the systems. For the five stars that show excess emission in the Herschel PACS photometry and also have Spitzer IRS spectra, we fit the data with models of optically thin debris disks with realistic grain properties in order to better estimate the disk parameters. The model is determined by a set of six parameters: surface density index, grain size distribution index, minimum and maximum grain sizes, and the inner and outer radii of the disk. The best fitting parameters give us constraints on the geometry of the dust in these systems, as well as lower limits to the total dust masses. The HD105 disk was further constrained by fitting marginally resolved PACS 70 micron imaging.Comment: 15 pages, 7 figures, Accepted to Ap

Brst Cohomology and Invariants of 4D Gravity in Ashtekar Variables

We discuss the BRST cohomologies of the invariants associated with the description of classical and quantum gravity in four dimensions, using the Ashtekar variables. These invariants are constructed from several BRST cohomology sequences. They provide a systematic and clear characterization of non-local observables in general relativity with unbroken diffeomorphism invariance, and could yield further differential invariants for four-manifolds. The theory includes fluctuations of the vierbein fields, but there exits a non-trivial phase which can be expressed in terms of Witten's topological quantum field theory. In this phase, the descent sequences are degenerate, and the corresponding classical solutions can be identified with the conformally self-dual sector of Einstein manifolds. The full theory includes fluctuations which bring the system out of this sector while preserving diffeomorphism invariance.Comment: 15 page