Can the Heinrich ratio be used to predict harm from medication errors?

The purpose of this study was to establish whether, for medication errors, there exists a fixed Heinrich ratio between the number of incidents which did not result in harm, the number that caused minor harm, and the number that caused serious harm. If this were the case then it would be very useful in estimating any changes in harm following an intervention. Serious harm resulting from medication errors is relatively rare, so it can take a great deal of time and resource to detect a significant change. If the Heinrich ratio exists for medication errors, then it would be possible, and far easier, to measure the much more frequent number of incidents that did not result in harm and the extent to which they changed following an intervention; any reduction in harm could be extrapolated from this

Absence of ZAP-70 prevents signaling through the antigen receptor on peripheral blood T cells but not on thymocytes.

Recently, a severe combined immunodeficiency syndrome with a deficiency of CD8+ peripheral T cells and a TCR signal transduction defect in peripheral CD4+ T cells was associated with mutations in ZAP-70. Since TCR signaling is required in developmental decisions resulting in mature CD4 (and CD8) T cells, the presence of peripheral CD4+ T cells expressing TCRs incapable of signaling in these patients is paradoxical. Here, we show that the TCRs on thymocytes, but not peripheral T cells, from a ZAP-70-deficient patient are capable of signaling. Moreover, the TCR on a thymocyte line derived from this patient can signal, and the homologous kinase Syk is present at high levels and is tyrosine phosphorylated after TCR stimulation. Thus, Syk may compensate for the loss of ZAP-70 and account for the thymic selection of at least a subset of T cells (CD4+) in ZAP-70-deficient patients

Relational Misperceptions in the Workplace: New Frontiers and Challenges

Understanding the social landscape at work helps employees accomplish organizational goals. A growing body of evidence, however, suggests that people are fallible perceivers of their work relationships. People do not always know how much others trust (or distrust) them, consider them a friend (or enemy), or rely on them for advice or information at work. Such relational misperceptions may be especially likely in the context of work organizations. Here, we develop theoretical accounts to explain how and why employees misinterpret the nature of their relationships with others at work—and what consequences ensue when they do. We direct attention to five key opportunities for future research on when and why relational misperceptions occur and matter in organizations. Building on the small body of organizational research and larger body of nonorganizational research on relationship misperception, we also identify areas that may be fruitful for exploration, highlighting several topics in the organizational literature that could be enlivened by considering the role of relational misperceptions. For example, we consider how employees’ relational misperceptions may affect how influential they are at work, how effectively they lead others, and how they navigate the social landscape in organizations

Methodological Individualism, the We-mode, and Team Reasoning

Raimo Tuomela is one of the pioneers of social action theory and has done as much as anyone over the last thirty years to advance the study of social action and collective intentionality. Social Ontology: Collective Intentionality and Group Agents (2013) presents the latest version of his theory and applications to a range of important social phenomena. The book covers so much ground, and so many important topics in detailed discussions, that it would impossible in a short space to do it even partial justice. In this brief note, I will concentrate on a single, though important, theme in the book, namely, the claim that we must give up methodological individualism in the social sciences and embrace instead irreducibly group notions. I wish to defend methodological individualism as up to the theoretical tasks of the social sciences while acknowledging what is distinctive about the social world and collective intentional action. Tuomela frames the question of the adequacy of methodological individualism in terms of a contrast between what he calls the I-mode and the we-mode. He argues that we-mode phenomena are not reducible to I-mode phenomena, and concludes that we must reject methodological individualism. I will argue that the irreducibility of the we-mode to the I-mode, given how the contrast is set up, does not entail the rejection of methodological individualism. In addition, I will argue that the three conditions that Tuomela places on genuine we-mode activities, the group reason, collectivity, and collective commitment conditions, if they are understood in a way that does not beg the question, can plausibly be satisfied by a reductive account. Finally, I will argue that the specific considerations advanced in the book do not give us reason to think that a reductive account cannot be adequate to the descriptive and explanatory requirements of a theory of the social worl

Analysis of the third WHO Global Safety Challenge 'Medication Without Harm' patient-facing materials: exploratory descriptive study

OBJECTIVES: To evaluate patients' views on the content and use of the 'Five Moments for Medication Safety' materials developed as part of the WHO's 'Medication Without Harm' Global Patient Safety Challenge. These comprise a booklet, flyer, infographic poster, pamphlet and mobile application. They include recommended questions for patients to ask healthcare professionals to gain a better understanding of their medication. METHODS: Structured interviews were conducted with members of the public who entered an outpatient pharmacy in a London teaching hospital, using a combination of open and closed questions. Qualitative data were analysed thematically. Quantitative data were analysed descriptively. χ2, Fisher's exact, Mann-Whitney U and Kruskal-Wallis tests were used to test for associations between responses and variables such as age. RESULTS: We approached 147 people; 100 (68%) agreed to take part. Of these, 83% thought that the materials would be 'quite' or 'very' useful. Potential barriers to their use were patients being of the view that they already ask healthcare professionals about their medicines or that there would be limited time available to answer their questions during consultations. Fifty-nine per cent of participants stated that they would prefer to be given the materials in waiting areas before seeing a healthcare professional; 61% thought they should be displayed on television screens in general practice surgeries. Age was significantly associated with preference for the mobile application (χ2 test, p<0.01), with younger people preferring this format. CONCLUSIONS: Patients' views of the Five Moments for Medication Safety materials were generally positive. Our findings suggest that they should be displayed on television screens in waiting areas and given to patients prior to appointments. More advice is needed for patients on how to incorporate the questions suggested in the resources into a brief healthcare consultation

Reconstructing pedigrees: some identifiability questions for a recombination-mutation model

Pedigrees are directed acyclic graphs that represent ancestral relationships between individuals in a population. Based on a schematic recombination process, we describe two simple Markov models for sequences evolving on pedigrees - Model R (recombinations without mutations) and Model RM (recombinations with mutations). For these models, we ask an identifiability question: is it possible to construct a pedigree from the joint probability distribution of extant sequences? We present partial identifiability results for general pedigrees: we show that when the crossover probabilities are sufficiently small, certain spanning subgraph sequences can be counted from the joint distribution of extant sequences. We demonstrate how pedigrees that earlier seemed difficult to distinguish are distinguished by counting their spanning subgraph sequences.Comment: 40 pages, 9 figure

The Search for the Missing Baryons at Low Redshift

At low redshift, only about one-tenth of the known baryons lie in galaxies or the hot gas seen in galaxy clusters and groups. Models posit that these "missing baryons" are in gaseous form in overdense filaments that connect the much denser virialized groups and clusters. About 30% are cool (<1E5 K) and are detected in Ly alpha absorption studies, but about half is predicted to lie in the 1E5-1E7 K regime. Gas is detected in the 2-5E5 K range through OVI absorption studies (7% of the baryons) and possibly near 1E5 K from broad Ly absorption (20% of the baryons). Hotter gas (0.5-2E6 K) is detected at zero redshift by OVII and OVIII K X-ray absorption, and the OVII line strengths seem to correlate with the Galactic soft X-ray background, so it is probably produced by Galactic Halo gas, rather than a Local Group medium. There are no compelling detections of the intergalactic hot gas (0.5-10E6 K) either in absorption or emission and these upper limits are consistent with theoretical models. Claimed X-ray absorption lines are not confirmed, while most of the claims of soft emission are attributable to artifacts of background subtraction and field-flattening. The missing baryons should become detectable with moderate improvements in instrumental sensitivity.Comment: To appear in Annual Review of Astronomy and Astrophysics, Vol 45 (Sept 2007) 44 pages, including 11 figure

Global cell-by-cell evaluation of endothelial viability after two methods of graft preparation in Descemet membrane endothelial keratoplasty

PURPOSE: To describe a novel method of global cell viability assessment for Descemet membrane endothelial keratoplasty (DMEK) and the comparison of two contemporary methods of donor tissue preparation. METHODS: DMEK transplants were prepared using two different methods: liquid bubble separation and manual peeling (n=8 each group). Samples were incubated with Hoechst, calcein-AM and ethidium homodimer prior to mounting on a curved imaging chamber. Z-stacked fluorescence microscopy images were combined to produce an in-focus global image capable of resolving all cell nuclei. Image processing software was used to define a calcein-positive live cell area, count all cell nuclei within this area and subtract ethidium-positive dead cells to derive the total viable endothelial cell count. Corrected global cell density was calculated by dividing the number of viable cells by the graft area, which had been corrected for imaging a curved surface. RESULTS: Corrected global cell density was lower than the central endothelial cell density in both groups: 85.5% of the pre-preparation central endothelial cell density in the peel group and 75.8% in the bubble group. Corrected global cell density was significantly lower in the liquid bubble separation group than in the peel group (p=0.04). CONCLUSIONS: Eye bank estimations of central endothelial cell density overestimate true cell density after graft preparation in DMEK. A peel method is less damaging and more consistent than a liquid bubble method. Cell loss correlated strongly with the degree of stromal hydration prior to bubble separation in the liquid bubble group

Organ culture storage of pre-prepared corneal donor material for Descemet's membrane endothelial keratoplasty

Purpose To evaluate the effect of media composition and storage method on pre-prepared Descemet's membrane endothelial keratoplasty (DMEK) grafts. Methods 50 corneas were used. Endothelial wound healing and proliferation in different media were assessed using a standard injury model. DMEK grafts were stored using three methods: peeling with free scroll storage; partial peeling with storage on the stroma and fluid bubble separation with storage on the stroma. Endothelial cell (EC) phenotype and the extent of endothelial overgrowth were examined. Global cell viability was assessed for storage methods that maintained a normal cell phenotype. Results 1 mm wounds healed within 4 days. Enhanced media did not increase EC proliferation but may have increased EC migration into the wounded area. Grafts that had been trephined showed evidence of EC overgrowth, whereas preservation of a physical barrier in the bubble group prevented this. In grafts stored in enhanced media or reapposed to the stroma after trephination, endothelial migration occurred sooner and cells underwent endothelial-mesenchymal transformation. Ongoing cell loss, with new patterns of cell death, was observed after returning grafts to storage. Grafts stored as free scrolls retained more viable ECs than grafts prepared with the fluid bubble method (74.2± 3% vs 60.3±6%, p=0.04 (n=8). Conclusion Free scroll storage is superior to liquid bubble and partial peeling techniques. Free scrolls only showed overgrowth of ECs after 4 days in organ culture, indicating a viable time window for the clinical use of pre-prepared DMEK donor material using this method. Methods for tissue preparation and storage media developed for whole corneas should not be used in pre-prepared DMEK grafts without prior evaluation