The Swiss cheese model of safety incidents: are there holes in the metaphor?

BACKGROUND: Reason's Swiss cheese model has become the dominant paradigm for analysing medical errors and patient safety incidents. The aim of this study was to determine if the components of the model are understood in the same way by quality and safety professionals. METHODS: Survey of a volunteer sample of persons who claimed familiarity with the model, recruited at a conference on quality in health care, and on the internet through quality-related websites. The questionnaire proposed several interpretations of components of the Swiss cheese model: a) slice of cheese, b) hole, c) arrow, d) active error, e) how to make the system safer. Eleven interpretations were compatible with this author's interpretation of the model, 12 were not. RESULTS: Eighty five respondents stated that they were very or quite familiar with the model. They gave on average 15.3 (SD 2.3, range 10 to 21) "correct" answers out of 23 (66.5%) – significantly more than 11.5 "correct" answers that would expected by chance (p < 0.001). Respondents gave on average 2.4 "correct" answers regarding the slice of cheese (out of 4), 2.7 "correct" answers about holes (out of 5), 2.8 "correct" answers about the arrow (out of 4), 3.3 "correct" answers about the active error (out of 5), and 4.1 "correct" answers about improving safety (out of 5). CONCLUSION: The interpretations of specific features of the Swiss cheese model varied considerably among quality and safety professionals. Reaching consensus about concepts of patient safety requires further work

Generation and remote detection of THz sound using semiconductor superlattices

The authors introduce a novel approach to study the propagation of high frequency acoustic phonons in which the generation and detection involves two spatially separated superlattices $\sim 1 {\rm \mu m}$ apart. Propagating modes of frequencies up to $\sim 1 {\rm THz}$ escape from the superlattice where they are generated and reach the second superlattice where they are detected. The measured frequency spectrum reveals finite size effects, which can be accounted for by a continuum elastic model.Comment: Submitted to Applied Physics Letter

An investigation of surface deformations occurring at the contact edges of statically loaded discs

An investigation has been carried out, using statically loaded steel and 'Perspex' discs, into elastic displacements occurring at the axial extremities of the Hertzian flat. By employing the technique of 'Photostress', together with optical magnification, it has been found possible to inspect in detail the disposition of strain around these points. Using a 'step grinding' technique a qualitative three-dimensional envelope of surface displacements has been constructed. The effect of these displacements is considered in relation to 'edge pitting' of discs

Topical clobetasol for the treatment of toxic epidermal necrolysis: study protocol for a randomized controlled trial.

BackgroundToxic epidermal necrolysis (TEN) is a rare systemic allergic drug eruption with high patient mortality. Currently, no established treatments have been shown to be effective for TEN beyond supportive care. Prior studies of systemic corticosteroids have yielded conflicting data, with some showing a possible benefit and others reporting in increased mortality. However, topical steroids have shown promise for treatment of ocular sequelae of TEN, such as scarring and vision loss. We have designed a randomized controlled trial to evaluate topical clobetasol for treatment of the epidermal manifestations of TEN. In addition, we propose genetic studies to characterize the TEN transcriptome and alterations in cutaneous gene expression that might occur following topical steroid treatment.Methods/designThis split-body randomized, double-blind, placebo-controlled Phase IIa proof-of-concept trial will evaluate the safety and efficacy of once-daily topical clobetasol applied to the skin of patients with TEN. This multicenter trial will recruit a total of 15 patients between the ages of 12 and 85 from the University of California Davis Medical Center and Shriners Hospital for Children inpatient burn units. Designated treatment areas on opposite sides of the body will be treated with blinded clobetasol 0.05% ointment or control petrolatum ointment daily for 14 days. On day 3 of therapy, a biopsy will be taken from the treated area for genetic studies. The primary study aims will be to establish the safety of topical clobetasol treatment and determine the time to cessation of skin detachment for the control and clobetasol-treated areas. Secondary endpoints will evaluate efficacy using parameters such as time to 90% re-epithelialization and percentage of affected skin at 0, 3, 6, 9, 12 and 15 days. Genomic DNA and RNA will be obtained from biopsy samples, to characterize the TEN transcriptome and identify changes in gene expression after topical steroid treatment.DiscussionTopical steroids have shown promise for treating ocular complications of TEN, but to date have not been evaluated for cutaneous manifestations of the disease. This trial will investigate clinical and molecular outcomes of topical clobetasol application and hopefully provide insight into the disease pathophysiology.Trial registrationClinicalTrials.gov NCT02319616. https://clinicaltrials.gov/ct2/show/NCT02351037

The development of absorptive capacity-based innovation in a construction SME

Traditionally, construction has been a transaction-oriented industry. However, it is changing from the design-bid-build process into a business based on innovation capability and performance management, in which contracts are awarded on the basis of factors such as knowledge, intellectual capital and skills. This change presents a challenge to construction-sector SMEs with scarce resources, which must find ways to innovate based on those attributes to ensure their future competitiveness. This paper explores how dynamic capability, using an absorptive capacity framework in response to these challenges, has been developed in a construction-based SME. The paper also contributes to the literature on absorptive capacity and innovation by showing how the construct can be operationalized within an organization. The company studied formed a Knowledge Transfer Partnership using action research over a two-year period with a local university. The aim was to increase its absorptive capacity and hence its ability to meet the changing market challenges. The findings show that absorptive capacity can be operationalized into a change management approach for improving capability-based competitiveness. Moreover, it is important for absorptive capacity constructs and language to be contextualized within a given organizational setting (as in the case of the construction-based SME in the present study)

Target value design: using collaboration and a lean approach to reduce construction cost

Target Costing is an effective management technique that has been used in manufacturing for decades to achieve cost predictability during new products development. Adoption of this technique promises benefits for the construction industry as it struggles to raise the number of successful outcomes and certainty of project delivery in terms of cost, quality and time. Target Value Design is a management approach that takes the best features of Target Costing and adapts them to the peculiarities of construction. In this paper the concept of Target Value Design is introduced based on the results of action research carried out on 12 construction projects in the USA. It has been shown that systemic application of Target Value Design leads to significant improvement of project performance – the final cost of projects was on average 15% less than market cost. The construction industry already has approaches that have similarities with elements of the Target Value Design process or uses the same terminology, e.g. Partnering and Target Cost Contracts, Cost planning, etc. Following an exploration of the similarities and differences Target Value Design is positioned as a form of Target Costing for construction that offers a more reliable route to successful projects outcomes

Research to develop Spiritual Pedagogy, Awareness and Change

This is an Accepted Manuscript of an article published by Taylor & Francis in British Journal of Guidance and Counselling on 21-4-16, available online: http://dx.doi.org/10.1080/03069885.2016.1174976A co-operative inquiry group consisting of 8 counsellors met for 11 months to explore their experience of spirituality in their counselling training and in their work with clients (Swinton, 2010; 2015). The aim was to explore whether spirituality was absent from the process of counselling training, specifically to discover (1) how counsellors perceived and described their experience of spirituality in their training and (2) with a view to developing spiritual pedagogy; how spirituality could be incorporated into the training process of practitioner

Learning from accidents: Analysis of multi-attribute events and implications to improve design and reduce human errors

High-technology accidents are likely to occur under a complex interaction of multiple active failures and latent conditions, and recent major accidents investigations are increasingly highlighting the role of human error or human-related factors as significant contributors. Latent conditions might have long incubation periods, which implies that a number of design failures may be embedded in systems until human errors trigger an accident sequence. Consequently, there is a need to scrutinise the relationship between enduring design deficiencies and human erroneous actions as a conceivable way to minimise accidents. This study will tackle this complex problem by applying an artificial neural network approach to a proprietary multi-attribute accident dataset, in order to disclose multidimensional relationships between human errors and design failures. Clustering and data mining results are interpreted to offer further insight into the latent conditions embedded in design. Implications to support the development of design failure prevention schemes are then discussed

Observation of Surface-Avoiding Waves: A New Class of Extended States in Periodic Media

Coherent time-domain optical experiments on GaAs-AlAs superlattices reveal the exis-tence of an unusually long-lived acoustic mode at ~ 0.6 THz, which couples weakly to the environment by evading the sample boundaries. Classical as well as quantum states that steer clear of surfaces are generally shown to occur in the spectrum of periodic struc-tures, for most boundary conditions. These surface-avoiding waves are associated with frequencies outside forbidden gaps and wavevectors in the vicinity of the center and edge of the Brillouin zone. Possible consequences for surface science and resonant cavity ap-plications are discussed.Comment: 16 pages, 3 figure