Improving Incident Investigation through Inclusion of Human Factors

Studies of offshore and maritime incidents (accidents and near-misses) show that 80% or more involve human error. By investigating incidents, we can identify safety problems and take corrective actions to prevent future such events. While many offshore and maritime companies have incident investigation programs in place, most fall short in identifying and dealing with human errors. This paper discusses how to incorporate human factors into an incident investigation program. Topics include data collection and analysis and how to determine the types of safety interventions appropriate to safeguard against the identified risks. Examples are provided from three organizations that have established their own human factors investigation programs

Hospital Volume Does Not Influence the Safety of Percutaneous Nephrolithotomy in England: A Population-Based Cohort Study.

PURPOSE: This study aims to investigate the relationship between hospital case volume and safety-related outcomes after percutaneous nephrolithotomy (PCNL) within the English National Health Service (NHS). PATIENTS AND METHODS: The study used the Hospital Episode Statistics (HES) database, a routine administrative database, recording information on operations, comorbidity, and outcomes for all NHS hospital admissions in England. Records for all patients undergoing an initial PCNL between April 1, 2006 and March 31, 2012 were extracted. NHS trusts were divided into low-, medium-, and high-volume groups, according to the average annual number of PCNLs performed. We used multiple regression analyses to examine the associations between hospital volume and outcomes incorporating risk adjustment for sex, age, comorbidity, and hospital teaching status. Postoperative outcomes included: Emergency readmission, infection, and hemorrhage. Mean length of stay was also measured. RESULTS: There were 7661 index elective PCNL procedures performed in 163 hospital trusts, between April 2006 and March 2012. There were 2459 patients who underwent PCNL in the 116 units performing fewer than 10 PCNL procedures per year; 2643 patients in the 37 units performing 10 to 19 procedures per year; and 2459 patients in the 9 hospitals performing more than 20 procedures per year. For low-, medium-, and high-volume trusts, there was little variation in the rates of emergency readmission (L 9.7%, M 9.3%, H 8.4%), infection (3.0%, 4.2%, 3.8%), or hemorrhage (1.3%, 1.5%, 1.5%), and there was no statistical evidence that volume was associated with adjusted outcomes. Mean length of stay was slightly shorter in the medium- (5.0 days) and high-volume (5.0) groups compared with the low-volume group (5.3). The effect remained statistically significant after adjusted for confounding. CONCLUSION: Hospital volume was not associated with emergency readmission, infection, or hemorrhage. Length of stay appears to be shorter in higher volume units

Randomized, placebo-controlled trial of the anti-tumor necrosis factor antibody fragment afelimomab in hyperinflammatory response during severe sepsis: The RAMSES study

SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Maturation of glycinergic inhibition in the gerbil medial superior olive after hearing onset

The neurones of the medial superior olive (MSO) are the most temporally sensitive neurones in the brain. They respond to the arrival time difference of sound at the two ears with a microsecond resolution; these interaural time differences are used to localize low-frequency sounds. In addition to the excitatory inputs from each ear, the MSO neurones also receive binaural glycinergic projections, which have a critical role in sound localization processing. Recently, it was shown that the glycinergic input to the MSO undergoes an experience-dependent structural reorganization after hearing onset. To explore the maturation of inhibition during the development of sound localization on a cellular level, glycinergic currents and potentials were measured in gerbil MSO principal cells from postnatal (P) day P12–P25 by whole-cell patch-clamp recordings. The synaptic glycinergic currents accelerated to rapid decay kinetics (∼2 ms) and rise times (∼0.4 ms) after hearing onset, reaching maturity around P17. Since the kinetics of miniature glycinergic currents did not change with age, it is likely that a higher degree of transmitter release synchrony is the underlying mechanism influencing the acceleration of the kinetics. During the same period, the synaptic glycinergic potentials accelerated four-fold, largely as a result of a prominent decrease in input resistance. In accordance with a reorganization of the glycinergic inputs, the evoked peak conductances decreased more than two-fold, together with a three-fold reduction in the frequency of miniature events after hearing onset. These age-dependent changes were absent in animals that had been reared in omni-directional noise, indicating that an experience-dependent pruning of synaptic inputs is important for the maturation of functional inhibition in the MSO. Taken together, these striking developmental adjustments of the glycinergic inhibition in the MSO most probably reflect an adaptation to improve the encoding of auditory cues with great temporal precision and fidelity during the maturation of sound localization behaviour