Improving health system responses when patients are harmed: a protocol for a multistage mixed-methods study

Introduction: At least 10% of hospital admissions in high-income countries, including Australia, are associated with patient safety incidents, which contribute to patient harm (‘adverse events’). When a patient is seriously harmed, an investigation or review is undertaken to reduce the risk of further incidents occurring. Despite 20 years of investigations into adverse events in healthcare, few evaluations provide evidence of their quality and effectiveness in reducing preventable harm. This study aims to develop consistent, informed and robust best practice guidance, at state and national levels, that will improve the response, learning and health system improvements arising from adverse events. Methods and analysis: The setting will be healthcare organisations in Australian public health systems in the states of New South Wales, Queensland, Victoria and the Australian Capital Territory. We will apply a multistage mixed-methods research design with evaluation and in-situ feasibility testing. This will include literature reviews (stage 1), an assessment of the quality of 300 adverse event investigation reports from participating hospitals (stage 2), and a policy/procedure document review from participating hospitals (stage 3) as well as focus groups and interviews on perspectives and experiences of investigations with healthcare staff and consumers (stage 4). After triangulating results from stages 1–4, we will then codesign tools and guidance for the conduct of investigations with staff and consumers (stage 5) and conduct feasibility testing on the guidance (stage 6). Participants will include healthcare safety systems policymakers and staff (n=120–255) who commission, undertake or review investigations and consumers (n=20–32) who have been impacted by adverse events. Ethics and dissemination: Ethics approval has been granted by the Northern Sydney Local Health District Human Research Ethics Committee (2023/ETH02007 and 2023/ETH02341). The research findings will be incorporated into best practice guidance, published in international and national journals and disseminated through conferences

Cohousing by Any Other Name: A Framing Study Exploring Ideological Barriers to Adoption of Collectivist Housing Options

Recent research suggests there is broader interest in cohousing in the US than its current niche market suggests. However, the lack of ideological diversity among cohousing adopters does not seem malleable. Cohousing adopters are predominately liberal and liberal ideology strongly predicts interest in cohousing. This research explored perceptions (including misperceptions) of cohousing and tested whether framing the concept differently could make it more appealing to Republicans and conservatives. Survey participants were randomly assigned to receive one of two versions of a survey, identical in all ways except in one version the term pocket neighborhoods was substituted for cohousing. Results revealed substantial misunderstanding of the concept of cohousing, particularly that it involves multiple unrelated households living under the same roof. There was no framing effect; those who identified as Republican or conservative did not find cohousing more appealing when it was called pocket neighborhoods. The most cited perceived benefits of cohousing were social interaction, relationships, and support, while lack of privacy and personal space topped the list of drawbacks. Understanding these common perceptions about cohousing can help stakeholders communicate more effectively about this model that promises many benefits to an apparently untapped prospective market

State-of-the-Science Review of Non-Chemical Stressors Found in a Child’s Social Environment

Background: Children are exposed to chemical and non-chemical stressors from their built, natural, and social environments. Research is needed to advance our scientific understanding of non-chemical stressors, evaluate how they alter the biological response to a chemical stressor, and determine how they impact children’s health and well-being. To do this, we conducted a state-of-the-science review of non-chemical stressors found in a child’s social environment. Methods: Studies eligible for inclusion in this review were identified through a search of the peer-reviewed literature using PubMed and PsycINFO. Combinations of words associated with non-chemical stressors and children were used to form search strings. Filters were used to limit the search to studies published in peer-reviewed journals from 2000–2016 and written in English. Publications found using the search strings and filters went through two rounds of screening. Results: A total of 146 studies met the inclusion criteria. From these studies, 245 non-chemical stressors were evaluated. The non-chemical stressors were then organized into 13 general topic areas: acculturation, adverse childhood experiences, economic, education, family dynamics, food, greenspace, neighborhood, social, stress, urbanicity, violence, and other. Additional information on health outcomes, studies evaluating both chemical and non-chemical stressors, and animal studies are provided. This review provides evidence that non-chemical stressors found in a child’s social environment do influence their health and well-being in both beneficial (e.g., salutatory effects of greenspace and social support) and adverse (e.g., poor relationships between health and selected non-chemical stressors such as economics, educational attainment, exposure to violence, stress) ways. Conclusions: This literature review identified a paucity of studies addressing the combined effects of chemical and non-chemical stressors and children’s health and well-being. This literature review was further complicated by inconsistencies in terminology, methodologies, and the value of non-chemical stressor research in different scientific disciplines. Despite these limitations, this review showed the importance of considering non-chemical stressors from a child’s social environment when addressing children’s environmental health considerations

Risks of toxic ash from artisanal mining of discarded cellphones.

The potential environmental and human health impacts of artisanal mining of electronic waste through open incineration were investigated. A market-representative set of cellphones was dismantled into four component categories-batteries, circuit boards, plastics and screens. The components were shredded, sieved and incinerated at 743-818 °C. The concentrations of 17 metals were determined using U.S. EPA methods 6010C (inductively coupled plasma-atomic emission spectrometry; 6020A (inductively coupled plasma-mass spectrometry, or 7471B and 7470A (cold-vapor atomic absorption). EPA Method 8270 (gas chromatography/mass spectrometry) was used to identify polyaromatic hydrocarbon compounds and polybrominated diphenyl ethers. EPA Method 8082A was used to measure polychlorinated biphenyls and EPA Method 8290 was used for dioxin/furans in the residue ash. The life cycle assessment model USEtox(®) was used to estimate impacts of the ash residue chemicals on human health and the ecosystem. Among metals, copper in printed circuit boards had the highest ecotoxicity impact (1610-1930PAFm(3)/kg); Beryllium in plastics had the highest impact on producing non-cancer diseases (0.14-0.44 cases/kg of ash); and Nickel had the largest impact on producing cancers (0.093-0.35 cases/kg of ash). Among organic chemicals, dioxins from incinerated batteries produced the largest ecotoxicological impact (1.07E-04 to 3.64E-04PAFm(3)/kg). Furans in incinerated batteries can generate the largest number of cancers and non-cancer diseases, representing 8.12E-09 to 2.28E-08 and 8.96E-10 and 2.52E-09 cases/kg of ash, respectively. The results reveal hazards of burning discarded cellphones to recover precious metals, and pinpoints opportunities for manufacturers to reduce toxic materials used in specific electronic components marketed globally