Learning from patient safety incidents involving acutely sick adults in hospital assessment units in England and Wales: a mixed methods analysis for quality improvement

Objective: Six per cent of hospital patients experience a patient safety incident, of which 12% result in severe/fatal outcomes. Acutely sick patients are at heightened risk. Our aim was to identify the most frequently reported incidents in acute medical units and their characteristics. Design: Retrospective mixed methods methodology: (1) an a priori coding process, applying a multi-axial coding framework to incident reports; and, (2) a thematic interpretative analysis of reports. Setting: Patient safety incident reports (10 years, 2005–2015) collected from the National Reporting and Learning System, which receives reports from hospitals and other care settings across England and Wales. Participants: Reports describing severe harm/death in acute medical unit were identified. Main outcome measures: Incident type, contributory factors, outcomes and level of harm were identified in the included reports. During thematic analysis, themes and metathemes were synthesised to inform priorities for quality improvement. Results: A total of 377 reports of severe harm or death were confirmed. The most common incident types were diagnostic errors (n = 79), medication-related errors (n = 61), and failures monitoring patients (n = 57). Incidents commonly stemmed from lack of active decision-making during patient admissions and communication failures between teams. Patients were at heightened risk of unsafe care during handovers and transfers of care. Metathemes included the necessity of patient self-advocacy and a lack of care coordination. Conclusion: This 10-year national analysis of incident reports provides recommendations to improve patient safety including: introduction of electronic prescribing and monitoring systems; forcing checklists to reduce diagnostic errors; and increased senior presence overnight and at weekends

Introduction to a Biological Systems Science

Biological systems analysis and biodynamic modelling of physiological and biological interrelationships in human body and mammal

Uncertainty in Model Predictions of Vibrio Vulnificus Response to Climate Variability and Change: A Chesapeake Bay Case Study

The effect that climate change and variability will have on waterborne bacteria is a topic of increasing concern for coastal ecosystems, including the Chesapeake Bay. Surface water temperature trends in the Bay indicate a warming pattern of roughly 0.3-0.4 C per decade over the past 30 years. It is unclear what impact future warming will have on pathogens currently found in the Bay, including Vibrio spp. Using historical environmental data, combined with three different statistical models of Vibrio vulnificus probability, we explore the relationship between environmental change and predicted Vibrio vulnificus presence in the upper Chesapeake Bay. We find that the predicted response of V. vulnificus probability to high temperatures in the Bay differs systematically between models of differing structure. As existing publicly available datasets are inadequate to determine which model structure is most appropriate, the impact of climatic change on the probability of V. vulnificus presence in the Chesapeake Bay remains uncertain. This result points to the challenge of characterizing climate sensitivity of ecological systems in which data are sparse and only statistical models of ecological sensitivity exist

Variability in concentrations of potentially toxic elements in urban parks from six European cities

Use of a harmonised sampling regime has allowed comparison of concentrations of copper, chromium, nickel, lead and zinc in six urban parks located in different European cities differing markedly in their climate and industrial history. Wide concentrations ranges were found for copper, lead and zinc at most sites, but for chromium and nickel a wide range was only seen in the Italian park, where levels were also considerably greater than in other soils. As might be expected, the soils from older cities with a legacy of heavy manufacturing industry (Glasgow, Torino) were richest in potentially toxic elements (PTEs); soils from Ljubljana, Sevilla and Uppsala had intermediate metal contents, and soils from the most recently established park, in the least industrialised city (Aveiro), displayed lowest concentrations. When principal component analysis was applied to the data, associations were revealed between pH and organic carbon content; and between all five PTEs. When pH and organic carbon content were excluded from the PCA, a distinction became clear between copper, lead and zinc (the "urban" metals) on the one hand, and chromium and nickel on the other. Similar results were obtained for the surface (0-10 cm depth) and sub-surface (10-20 cm depth) samples. Comparisons with target or limit concentrations were limited by the existence of different legislation in different countries and the fact that few guidelines deal specifically with public-access urban soils intended for recreational use

Evaluation of outreach services for primary care and mental health; assessing the impact

Objectives: This paper reports an evaluation, carried out for London Health Libraries, of the impact of outreach services to primary care and mental health workers in thirteen different settings. The main aims of the project were to identify the impact being made by the service, and to produce best practice guidelines for outreach services in this kind of ‘difficult’ community setting. Methods: Methods used were: analysis of documents (all 13 services); analysis of any evaluation already performed by or for the service (all 13 services); interviews with outreach librarians (11 services); questionnaire survey of a representative sample of users (8 services, with 66 returned questionnaires, 35% response rate). The services evaluated were very diverse, in terms of setting, structure, functions and activities, and extent and nature of self-evaluation and reporting. The evaluation was therefore largely qualitative, in order to deal with the lack of a consistent ‘template’ for analysis. Emphasis was placed on trying to identify critical incidents , where it could be shown unambiguously that the outreach services made a difference to practice. Study limitations included the difficulty of summarising and comparing very different situations and diverse services, difficulty in identifying critical incidents, and an inability to study ‘non-users’. Findings: Service recipients felt better informed, more up- to-date, more aware of resources, more confident and supported in their work, and saved time. Services contributed to a richer information environment. Direct impacts, demonstrably improved patient care, cost savings etc., were more difficult to establish

Impact of bovine oocyte maturation media on oocyte transcript levels, blastocyst development, cell number, and apoptosis.

The objectives were 1) to investigate the effects of oocyte maturation in serum-free and amino acid-supplemented defined media on oocyte transcript levels, blastocyst cell number, and apoptosis; 2) to investigate the influence of oocyte maturation culture atmosphere on blastocyst development, total cell number, and apoptosis; and 3) to examine the influence of epidermal growth factor (EGF) during oocyte maturation on blastocyst cell number and apoptosis. The results demonstrate that blastocysts derived from in vitro maturation, fertilization, and embryo culture protocols undergo apoptosis but that apoptotic levels are not greatly influenced by the oocyte maturation environment. Amino acid supplementation of oocyte maturation media was associated with enhanced developmental frequencies, increased blastocyst cell number, and elevated oocyte maternal mRNA levels. Oocyte maturation with supplemented synthetic oviduct fluid medium (cSOFMaa) resulted in blastocyst cell numbers comparable to those observed with Tissue Culture Medium 199 + newborn calf serum. Blastocyst development was reduced following oocyte maturation under a 5% CO(2), 7% O(2), 88% N(2) culture atmosphere. EGF supplementation of oocyte maturation medium resulted in a concentration-dependent increase in blastocyst development but did not influence blastocyst total cell number or apoptosis. Our findings indicate that cSOFMaa medium is an effective base medium for bovine oocyte maturation

Molecular Line Emission Towards High-Mass Clumps: The MALT90 Catalogue

The Millimetre Astronomy Legacy Team 90 GHz (MALT90) survey aims to characterise the physical and chemical evolution of high-mass clumps. Recently completed, it mapped 90 GHz line emission toward 3246 high-mass clumps identified from the ATLASGAL 870 �m Galactic plane survey. By utilising the broad frequency coverage of the Mopra telescope's spectrometer, maps in 16 different emission lines were simultaneously obtained. Here we describe the �first line catalog of the detected emission, generated by Gaussian profile �fitting to spectra extracted toward each clumps' dust peak. Synthetic spectra show that the catalog has a completeness of >95%, a probability of a false-positive detection of <0.3%, and a relative uncertainty in the measured quantities of <20% over the range of detection criteria. We find that the detection rates are highest for the (1{0) molecular transitions of HCO+, HNC, N2H+, and HCN (72{88%). The majority of clumps (~� 95%) are detected in at least one of the molecular transitions, just under half of the clumps (�~48%) are detected in 4 or more of the transitions, while only 2 clumps are detected in 13 or more transitions. We find several striking trends in the ensemble of properties for the different molecular transitions when plotted as a function of the clumps' evolutionary state. In particular, the optically thickest HCO+ emission shows a `blue-red asymmetry' that indicates overall collapse that monotonically decreases as the clumps evolve. This catalog represents the largest compiled database of molecular line emission toward high-mass clumps and is a valuable data set for detailed studies of these objects

State assignment for sequential circuits using multi-objective genetic algorithm

In this study, a new approach using a multi-objective genetic algorithm (MOGA) is proposed to determine the optimal state assignment with less area and power dissipations for completely and incompletely specified sequential circuits. The goal is to find the best assignments which reduce the component count and switching activity. The MOGA employs a Pareto ranking scheme and produces a set of state assignments, which are optimal in both objectives. The ESPRESSO tool is used to optimise the combinational parts of the sequential circuits. Experimental results are given using a personal computer with an Intel CPU of 2.4 GHz and 2 GB RAM. The algorithm is implemented using C++ and fully tested with benchmark examples. The experimental results show that saving in components and switching activity are achieved in most of the benchmarks tested compared with recent published research

X-ray and radio observations of central black holes in nearby low-mass early-type galaxies: Preliminary evidence for low Eddington fractions

We present new radio and X-ray observations of two nearby ($< 4$ Mpc) low-mass early-type galaxies with dynamically-confirmed central black holes: NGC 5102 and NGC 205. NGC 5102 shows a weak nuclear X-ray source and has no core radio emission. However, for the first time we demonstrate that it shows luminous extended radio continuum emission in low-resolution, low-frequency ($< 3$ GHz) data, consistent with jet lobes on scales $\gtrsim 100$ pc formed from past accretion and jet activity. By contrast, in new, extremely deep, strictly-simultaneous Very Large Array and Chandra observations, no radio or X-ray emission is detected from the black hole in NGC 205. We consider these measurements and upper limits in the context of the few other low-mass early-type galaxies with dynamically-confirmed black holes, and show that the mean ratio of bolometric to Eddington luminosity in this sample is only $\textrm{log} \, (L_{\rm bol}/L_{\rm Edd}) = -6.57\pm0.50$. These Eddington ratios are lower than typical in a comparison sample of more massive early-type galaxies, though this conclusion is quite tentative due to our small sample of low-mass galaxies and potential biases in the comparison sample. This preliminary result is in mild tension with previous work using less sensitive observations of more distant galaxies, which predict higher X-ray luminosities than we observe for low-mass galaxies. If it is confirmed that central black holes in low-mass galaxies typically have low Eddington ratios, this presents a challenge to measuring the occupation fraction of central black holes with standard optical emission line, X-ray, or radio surveys.Comment: 13 pages, 4 figures, 3 tables. Accepted for publication in Ap