Towards safer, better healthcare: harnessing the natural properties of complex sociotechnical systems

Objectives: To sustain an argument that harnessing the natural properties of sociotechnical systems is necessary to promote safer, better healthcare. Methods: Triangulated analyses of discrete literature sources, particularly drawing on those from mathematics, sociology, marketing science and psychology. Results: Progress involves the use of natural networks and exploiting features such as their scale-free and small world nature, as well as characteristics of group dynamics like natural appeal (stickiness) and propagation (tipping points). The agenda for change should be set by prioritising problems in natural categories, addressed by groups who self select on the basis of their natural interest in the areas in question, and who set clinical standards and develop tools, the use of which should be monitored by peers. This approach will facilitate the evidence-based practice that most agree is now overdue, but which has not yet been realised by the application of conventional methods. Conclusion: A key to health system transformation may lie under-recognised under our noses, and involves exploiting the naturally-occurring characteristics of complex systems. Current strategies to address healthcare problems are insufficient. Clinicians work best when their expertise is mobilised, and they flourish in groupings of their own interests and preference. Being invited, empowered and nurtured rather than directed, micromanaged and controlled through a hierarchy is preferable.5 page(s

Land use/vegetation mapping in reservoir management. Merrimack River basin

This report consists of an analysis of: ERTS-1 Multispectral Scanner imagery obtained 10 August 1973; Skylab 3 S190A and S190B photography, track 29, taken 21 September 1973; and RB-57 high-altitude aircraft photography acquired 26 September 1973. These data products were acquired on three cloud-free days within a 47-day period. The objectives of this study were: (1) to make quantitative comparisons between high-altitude aircraft photography and satellite imagery, and (2) to demonstrate the extent to which high resolution (S190A and B) space-acquired data can be used for land use/vegetation mapping and management of drainage basins

Skylab imagery: Application to reservoir management in New England

The author has identified the following significant results. S190B imagery is superior to the LANDSAT imagery for land use mapping and is as useful for level 1 and 2 land use mapping as the RB-57/RC8 high altitude imagery. Detailed land use mapping at levels 3 and finer from satellite imagery requires better resolution. For evaluating factors that are required to determine volume runoff potentials in a watershed, the S190B imagery was found to be as useful as the RB-57/RC8 high altitude aircraft imagery

Do Automated Legal Threats Reduce Freedom of Expression Online? Results from a Natural Experiment

Automated law enforcement systems support privately-operated enforcement bots to take legal action in hundreds of millions of cases a year. In the area of copyright, legal scholars have hypothesized the existence of “chilling effects” that harm public discourse by influencing people to self-censor protected speech. We test this hypothesis in a large-scale quasi-experiment with 9,818 accounts on Twitter that made 5,171,111 tweets. In a confirmatory interrupted time-series analysis, we find evidence that people reduce how much they post online after receiving a take-down notice from a copyright enforcement bot. On average, accounts sent fewer tweets after enforcement (p\u3c0.001). Accounts also changed from a daily increase in public tweets to a decline on average (p\u3c0.001). We also report on novel software that conducts third-party monitoring of the behavioral outcomes of automated law-enforcement systems. Since automated law enforcement can influence public discourse, third-party monitoring like this report will be essential to governing the power of enforcement algorithms in society

Factors in perioperative care that determine blood loss in liver surgery

AbstractObjectivesExcessive blood loss during liver surgery contributes to postoperative morbidity and mortality and the minimizing of blood loss improves outcomes. This study examines pre- and intraoperative factors contributing to blood loss and identifies areas for improvement.MethodsAll patients who underwent elective hepatic resection between June 2007 and June 2009 were identified. Detailed information on the pre- and perioperative clinical course was analysed. Univariate and multivariate analyses were used to identify factors associated with intraoperative blood loss.ResultsA total of 175 patients were studied, of whom 95 (54%) underwent resection of three or more segments. Median blood loss was 782ml. Greater blood loss occurred during major resections and prolonged surgery and was associated with an increase in postoperative complications (P= 0.026). Peak central venous pressure (CVP) of >10cm H2O was associated with increased blood loss (P= 0.01). Although no differences in case mix were identified, blood loss varied significantly among anaesthetists, as did intraoperative volumes of i.v. fluids and transfusion practices.ConclusionsThis study confirms a relationship between CVP and blood loss in hepatic resection. Intraoperative CVP values were higher than those described in other studies. There was variation in the intraoperative management of patients. Collaboration between surgical and anaesthesia teams is required to minimize blood loss and the standardization of intraoperative anaesthesia practice may improve outcomes following liver surgery

MitoQ supplementation augments acute exercise-induced increases in muscle PGC1α mRNA and improves training-induced increases in peak power independent of mitochondrial content and function in untrained middle-aged men

The role of mitochondrial ROS in signalling muscle adaptations to exercise training has not been explored in detail. We investigated the effect of supplementation with the mitochondria-targeted antioxidant MitoQ on a) the skeletal muscle mitochondrial and antioxidant gene transcriptional response to acute high-intensity exercise and b) skeletal muscle mitochondrial content and function following exercise training. In a randomised, double-blind, placebo-controlled, parallel design study, 23 untrained men (age: 44 ± 7 years, VO2peak: 39.6 ± 7.9 ml/kg/min) were randomised to receive either MitoQ (20 mg/d) or a placebo for 10 days before completing a bout of high-intensity interval exercise (cycle ergometer, 10 × 60 s at VO2peak workload with 75 s rest). Blood samples and vastus lateralis muscle biopsies were collected before exercise and immediately and 3 h after exercise. Participants then completed high-intensity interval training (HIIT; 3 sessions per week for 3 weeks) and another blood sample and muscle biopsy were collected. There was no effect of acute exercise or MitoQ on systemic (plasma protein carbonyls and reduced glutathione) or skeletal muscle (mtDNA damage and 4-HNE) oxidative stress biomarkers. Acute exercise-induced increases in skeletal muscle peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PGC1-α) mRNA expression were augmented in the MitoQ group. Despite this, training-induced increases in skeletal muscle mitochondrial content were similar between groups. HIIT-induced increases in VO2peak and 20 km time trial performance were also similar between groups while training-induced increases in peak power achieved during the VO2peak test were augmented in the MitoQ group. These data suggest that training-induced increases in peak power are enhanced following MitoQ supplementation, which may be related to the augmentation of skeletal muscle PGC1α expression following acute exercise. However, these effects do not appear to be related to an effect of MitoQ supplementation on exercise-induced oxidative stress or training-induced mitochondrial biogenesis in skeletal muscle

New England reservoir management: Land use/vegetation mapping in reservoir management (Merrimack River Basin)

The author has identified the following significant results. It is evident from this comparison that for land use/vegetation mapping the S190B Skylab photography compares favorably with the RB-57 photography and is much superior to the ERTS-1 and Skylab 190A imagery. For most purposes the 12.5 meter resolution of the S190B imagery is sufficient to permit extraction of the information required for rapid land use and vegetation surveys necessary in the management of reservoir or watershed. The ERTS-1 and S190A data products are not considered adequate for this purpose, although they are useful for rapid regional surveys at the level 1 category of the land use/vegetation classification system