Can dissonance engineering improve risk analysis of human–machine systems?

The paper discusses dissonance engineering and its application to risk analysis of human–machine systems. Dissonance engineering relates to sciences and technologies relevant to dissonances, defined as conflicts between knowledge. The richness of the concept of dissonance is illustrated by a taxonomy that covers a variety of cognitive and organisational dissonances based on different conflict modes and baselines of their analysis. Knowledge control is discussed and related to strategies for accepting or rejecting dissonances. This acceptability process can be justified by a risk analysis of dissonances which takes into account their positive and negative impacts and several assessment criteria. A risk analysis method is presented and discussed along with practical examples of application. The paper then provides key points to motivate the development of risk analysis methods dedicated to dissonances in order to identify the balance between the positive and negative impacts and to improve the design and use of future human–machine system by reinforcing knowledge

Sphingomonas paucimobilis bacteraemia and shock in a patient with rheumatic carditis

Acute rheumatic fever (ARF) carditis is treated with steroids, which can cause changes in the cellular immune response, especially decreased CD3 (+) T cells. Nosocomial infections due to steroid use for treatment of ARF carditis or secondary to the changes in the cellular immune response have not been reported in the literature. Sphingomonas paucimobilis is a Gram-negative bacillus causing community- and hospital-acquired infections. It has been reported as causing bacteraemia/sepsis, pneumonia or peritonitis in patients with malignancies, immunosuppression or diabetes. We present a case with S. paucimobilis bacteraemia/sepsis and shock after administration of steroids for treatment of ARF carditis. We suggest early identification of the causative agent and appropriate adjustments of the treatment plan to avoid shock and possible mortality. This is the first reported case of S. paucimobilis bacteraemia/sepsis in the setting of steroid use for ARF carditis