Measuring human-error probabilities in drug preparation: a pilot simulation study

Objectives: Designing a safe medication process requires the ability to model its reliability using methods such as probabilistic risk assessment (PRA). However, lack of data, especially on human-error probabilities (HEPs), limits its use. To assess whether small-scale simulations could help generate HEP data, a pilot study was conducted among nurses and anaesthetists. It focused on two core activities, namely, the manual preparation of medications and the arithmetic necessary to prepare drugs. Its specific objectives were to evaluate whether HEPs could be high enough to be measurable and to determine whether these HEPs could be sensitive to individuals and task details. These would give some insight into the level of detail required by PRA analysis. Methods: Thirty nurse and 28 anaesthetist volunteers were involved in the experiment. Nurses and anaesthetists had to prepare medications for 20 patients and 22 syringes of various drugs, respectively. Both groups had to perform 22 calculations relating to the preparation of drugs. HEPs, distribution of HEPs and dependency of HEPs on individuals and task details were assessed. Results: In the preparation tasks, overall HEP was 3.0% for nurses and 6.5% for anaesthetists. In the arithmetic tasks, overall HEP was 23.8% for nurses and 8.9% for anaesthetists. A statistically significant difference was noted between the two groups. In both preparation and arithmetic tasks, HEPs were dependent on individual nurses but not on individual anaesthetists. In every instance, HEPs were dependent on task details. Conclusion: Our study illustrates that small-scale simulations represent an interesting way of generating HEPs. HEPs are, indeed, in the range of 10−2 and 10−1. But in most cases, HEPs depend heavily on operators and task details. This dependency means that the influence of these parameters must be determined before advanced PRA analysis. There is therefore an urgent need to develop experimental research into assessing this influence by means of randomised controlled trial

Understanding the Interconnectedness of Interna-tional Trade Theories: A Case in Point of Cuba in Transition

This paper summarizes the arguments and counterarguments within the academic discussion on the issue of international trade and various barriers that hinders it. The main purpose of this article is to provide an overview of several foundational international trade theories related to exporting, importing, and trade restrictions for the national economy of a small socialist country, Cuba, with the United States of America

Spectrophotometry of HII Regions, Diffuse Ionized Gas and Supernova Remnants in M31: The Transition from Photo- to Shock-Ionization

We present results of KPNO 4-m optical spectroscopy of discrete emission-line nebulae and regions of diffuse ionized gas (DIG) in M31. Long-slit spectra of 16 positions in the NE half of M31 were obtained over a 5-15 kpc range in radial distance from the center of the galaxy. The spectra have been used to confirm 16 supernova remnant candidates from the Braun & Walterbos (1993) catalog. The slits also covered 46 HII regions which show significant differences among the various morphological types (center-brightened, diffuse, rings). Radial gradients in emission-line ratios such as [OIII]/H$\beta$ and [OII]/[OIII] are observed most prominently in the center-brightened HII regions. These line ratio trends are either much weaker or completely absent in the diffuse and ring nebulae. The line ratio gradients previously seen in M31 SNRs (Blair, Kirshner, & Chevalier 1981; 1982) are well reproduced by our new data. The spectra of center-brightened HII regions and SNRs confirm previous determinations of the radial abundance gradient in M31. We use diagnostic diagrams which separate photoionized gas from shock-ionized gas to compare the spectral properties of HII regions, SNRs and DIG. This analysis strengthens earlier claims (Greenawalt, Walterbos, & Braun 1997) that the DIG in the disk of M31 is photoionized by a dilute radiation field.Comment: 45 pages, 9 figures, 7 tables, to appear in the Astronomical Journal (December 1999

Planetary Nebulae Kinematics in M31

We present kinematics of 135 planetary nebulae in M31 from a survey covering 3.9 square degrees and extending out to 15 kpc from the southwest major axis and more than 20 kpc along the minor axis. The majority of our sample, even well outside the disk, shows significant rotational support (mean line-of-sight velocity 116 km/s). We argue that these PN belong to the outer part of M31's large de Vaucouleurs bulge. Only five PN have velocities clearly inconsistent with this fast rotating bulge. All five may belong to tidal streams in M31's outer halo. One is projected on the Northern Spur, and is counter-rotating with respect to the disk there. Two are projected along the major axis at X=-10 kpc and have M32-like velocities; they could be debris from that galaxy. The remaining two halo PN are located near the center of the galaxy and their velocities follow the gradient found by Ibata et al. (2004), implying that these PN could belong to the Southern Stream. If M31 has a non-rotating, pressure-supported halo, we have yet to find it, and it must be a very minor component of the galaxy.Comment: accepted to ApJ; main body of paper is 36 pages, including 14 figure

High-resolution imaging of compact high-velocity clouds (II)

We have imaged five compact high-velocity clouds in HI with arcmin angular- and km/s spectral-resolution using the WSRT. Supplementary total-power data, which is fully sensitive to both the cool and warm components of HI, is available for comparison for all the sources, albeit with angular resolutions that vary from 3' to 36'. The fractional HI flux in compact CNM components varies from 4% to 16% in our sample. All objects have at least one local peak in the CNM column which exceeds about 10^19 cm^-2 when observed with arcmin resolution. It is plausible that a peak column density of 1-2x10^19 cm^-2 is a prerequisite for the long-term survival of these sources. One object in our sample, CHVC120-20-443 (Davies' cloud), lies in close projected proximity to the disk of M31. This object is characterized by exceptionally broad linewidths in its CNM concentrations (more than 5 times greater than the median value). These CNM concentrations lie in an arc on the edge of the source facing the M31 disk, while the diffuse HI component of this source has a position offset in the direction of the disk. All of these attributes suggest that CHVC120-20-443 is in a different evolutionary state than most of the other CHVCs which have been studied. Similarly broad CNM linewidths have only been detected in one other object, CHVC111-07-466, which also lies in the Local Group barycenter direction and has the most extreme radial velocity known. A distinct possibility for Davies' cloud seems to be physical interaction of some type with M31. The most likely form of this interaction might be the ram-pressure or tidal- stripping by either one of M31's visible dwarf companions, M32 or NGC205, or else by a dark companion with an associated HI condensation.Comment: 12 pages, 11 (low res.) png figs, accepted for pub. in A&

Superbubble evolution including the star-forming clouds: Is it possible to reconcile LMC observations with model predictions?

Here we present a possible solution to the apparent discrepancy between the observed properties of LMC bubbles and the standard, constant density bubble model. A two-dimensional model of a wind-driven bubble expanding from a flattened giant molecular cloud is examined. We conclude that the expansion velocities derived from spherically symmetric models are not always applicable to elongated young bubbles seen almost face-on due to the LMC orientation. In addition, an observational test to differentiate between spherical and elongated bubbles seen face-on is discussed.Comment: 25 pages, 7 figures, accepted to ApJ (September, 1999 issue

Biodiversity Loss and the Taxonomic Bottleneck: Emerging Biodiversity Science

Human domination of the Earth has resulted in dramatic changes to global and local patterns of biodiversity. Biodiversity is critical to human sustainability because it drives the ecosystem services that provide the core of our life-support system. As we, the human species, are the primary factor leading to the decline in biodiversity, we need detailed information about the biodiversity and species composition of specific locations in order to understand how different species contribute to ecosystem services and how humans can sustainably conserve and manage biodiversity. Taxonomy and ecology, two fundamental sciences that generate the knowledge about biodiversity, are associated with a number of limitations that prevent them from providing the information needed to fully understand the relevance of biodiversity in its entirety for human sustainability: (1) biodiversity conservation strategies that tend to be overly focused on research and policy on a global scale with little impact on local biodiversity; (2) the small knowledge base of extant global biodiversity; (3) a lack of much-needed site-specific data on the species composition of communities in human-dominated landscapes, which hinders ecosystem management and biodiversity conservation; (4) biodiversity studies with a lack of taxonomic precision; (5) a lack of taxonomic expertise and trained taxonomists; (6) a taxonomic bottleneck in biodiversity inventory and assessment; and (7) neglect of taxonomic resources and a lack of taxonomic service infrastructure for biodiversity science. These limitations are directly related to contemporary trends in research, conservation strategies, environmental stewardship, environmental education, sustainable development, and local site-specific conservation. Today’s biological knowledge is built on the known global biodiversity, which represents barely 20% of what is currently extant (commonly accepted estimate of 10 million species) on planet Earth. Much remains unexplored and unknown, particularly in hotspots regions of Africa, South Eastern Asia, and South and Central America, including many developing or underdeveloped countries, where localized biodiversity is scarcely studied or described. ‘‘Backyard biodiversity’’, defined as local biodiversity near human habitation, refers to the natural resources and capital for ecosystem services at the grassroots level, which urgently needs to be explored, documented, and conserved as it is the backbone of sustainable economic development in these countries. Beginning with early identification and documentation of local flora and fauna, taxonomy has documented global biodiversity and natural history based on the collection of ‘‘backyard biodiversity’’ specimens worldwide. However, this branch of science suffered a continuous decline in the latter half of the twentieth century, and has now reached a point of potential demise. At present there are very few professional taxonomists and trained local parataxonomists worldwide, while the need for, and demands on, taxonomic services by conservation and resource management communities are rapidly increasing. Systematic collections, the material basis of biodiversity information, have been neglected and abandoned, particularly at institutions of higher learning. Considering the rapid increase in the human population and urbanization, human sustainability requires new conceptual and practical approaches to refocusing and energizing the study of the biodiversity that is the core of natural resources for sustainable development and biotic capital for sustaining our life-support system. In this paper we aim to document and extrapolate the essence of biodiversity, discuss the state and nature of taxonomic demise, the trends of recent biodiversity studies, and suggest reasonable approaches to a biodiversity science to facilitate the expansion of global biodiversity knowledge and to create useful data on backyard biodiversity worldwide towards human sustainability

Hepatitis C virus infection protein network

A proteome-wide mapping of interactions between hepatitis C virus (HCV) and human proteins was performed to provide a comprehensive view of the cellular infection. A total of 314 protein–protein interactions between HCV and human proteins was identified by yeast two-hybrid and 170 by literature mining. Integration of this data set into a reconstructed human interactome showed that cellular proteins interacting with HCV are enriched in highly central and interconnected proteins. A global analysis on the basis of functional annotation highlighted the enrichment of cellular pathways targeted by HCV. A network of proteins associated with frequent clinical disorders of chronically infected patients was constructed by connecting the insulin, Jak/STAT and TGFβ pathways with cellular proteins targeted by HCV. CORE protein appeared as a major perturbator of this network. Focal adhesion was identified as a new function affected by HCV, mainly by NS3 and NS5A proteins