Safety Checks Research Articles

Second-order effects in URM walls subjected to compression and out-of-plane bending: From numerical evaluation to proposal of design procedures

Although the load-bearing capacity of masonry walls has been receiving researchers’ attention since the 1950s both analytically and experimentally, in the scientific and technical community there is still heated debate on the actual methodology to adopt for the verification of URM walls subjected to eccentrically loaded walls, considering second-order effects. Moreover, it is still not well recognised that safety checks on structural walls subjected to significant lateral (e.g. seismic) actions require to be verified in terms of lateral flexural capacity and that buckling effects also need to be properly considered in these cases. To date, possible design procedures for evaluating second-order effects in strength verification of walls are based on axial load and moment capacity reduction factors, here respectively called ϕm and ϕM. This paper offers a refinement of the numerical calculations of ϕm and ϕM, leading to polynomial-type models and analytical formulations that improve accuracy in evaluating both factors. Moreover, it has analytically and numerically been demonstrated that there is a one-to-one correspondence between the two reduction factors ϕ, since they represent two ways of characterising the same effect. The results on the reduction factors are finally compared with those from past experimental campaigns and from some standards and can serve as reference for codified procedures.

Safety Checks in Patch Clinic: 5 Hurdles in the Patch Testing Obstacle Course.

Accuracy in patch testing is critical for correct allergen identification. This multistep process is prone to error and risk increases with more staff (physicians, residents, fellows, technicians), antigens, and patients. Standardized safety checkpoints increase efficiency, consistency, and safety. In this article, we outline workflows developed for 20 years of experience, which maximize productivity and communication among team members to minimize system errors. We organize patch safety into 5 key "hurdles," or steps, and outline the specific safety procedures of each step via the use of checklists, easy visual cues, and double verification. The 5 hurdles include the following: (a) inventory (stocking sufficient antigens, maintaining chemical viability through appropriate storage, systematizing correct antigen identification); (b) patch preparation (consistent order communication, standardizing conformation and numbering of patches, accurate placement of antigens on patches); (c) application (maximizing patch contact with suitable skin on patient, minimizing risk of interference with patch test reactions); (d) documentation (accurate maps, avoiding "frame shift" misreads); and (e) education (promoting patient partnership, allergen avoidance).

Use of Integrated Clinical Decision Support Tools to Manage Parenteral Nutrition Ordering: Experience From an Academic Medical Center

Parenteral nutrition (PN) is a complex therapy with numerous opportunities for error during the prescribing, preparation, and administration processes. Advances in technology, such as computerized provider order entry (CPOE), electronic health records (EHRs), and clinical decision support (CDS) have helped decrease the risks associated with PN therapy. These technologies can be utilized to guide prescribing, provide automated safety checks, and increase overall safety and accuracy in PN ordering, compounding, and administration. In recent years, increased awareness of the risks associated with PN therapy, in particular issues with ordering and transcription, have magnified the need for improved support of PN ordering within currently available systems. Additionally, drug shortages continue to impact key components of PN admixtures, further increasing the risks associated with this complex therapy. These concerns and risks present an opportunity for the development of new functionality, as well as improvements in and innovative utilization of available technology within systems supporting the PN use process. This discussion will highlight the risks associated with PN, examine the role of drug shortages on the safety of this therapy, describe the application of available technology to manage shortages, and report the experience of using commercially available CDS tools at one academic medical center. It will also include a discussion of the transition from paper orders to CPOE/EHR-based orders for PN and the transition from one commercially available electronic system to another at this particular institution.

An Industry Perspective on Risks and Mitigation Strategies Associated with Post Conduct Phase of Clinical Trial.

To discuss the potential risks and their mitigation strategies in the post-conduct phase of the trial. Risk management is very important for the clinical trial (CT) to ensure that the trial delivers its desired outcome(s) in terms of achieving protocol objective and regulatory compliance. Experienced members of the clinical operation team of a pharmaceutical major underwent a series of sessions to identify risks associated with the post-conduct phase of CT and developed mitigation strategies based on own experiences and guidance documents. The risks were categorized into major, minor and critical risks. In the post-conduct phase of a clinical trial, critical risk identified were; failure to communicate to the stakeholder about premature termination of the trial, mismatch of statistical analysis results and protocol objective/ regulatory requirement, clinical study report (CSR) noncompliant with regulatory requirements or delay in CSR preparation. Safety checks suggested to mitigate these risks including the development of related checklist or shell of relevant documents and its review by clinical development, quality assurance (QA) and regulatory affairs (RA) team prior to finalization. Additionally, six major and five minor risk areas were identified and safety checks were suggested. Sponsors must act proactively to ensure a systematic approach to conduct various post conduct trial activities and the plans to mitigate the risks that could affect the quality and outcome of the clinical trial. Future Perspective: A close coordination with all stakeholders for timely anticipation of risks and execution of mitigation strategies are required for successful CT outcomes.

The Complex of the Galleria dell’Accademia of Florence: keeping in safety

In the last decades, several earthquakes occurred in Italy and the sensitivity of people regarding the seismic vulnerability is increased. In Italy, most part of buildings is “historical”, i.e. made before the last century, and there is a large amount of outstanding architectural, historical and artistic heritage. Such buildings sometimes represent the container of works of art and sometimes they are works of artistic value themselves. In most cases, historical and monumental buildings have been made in the total absence of seismic regulations, and they can evidence a high level of exposure, as a result of their artistic interest. In about 20 years (1997-2017), earthquakes with a magnitude between 5.8 ML scale and 6.5 Mw scale have affected Umbria, Marche, Emilia Romagna, Abruzzo and Central Italy causing not only loss of life but also damage to the historical and cultural heritage. Focusing attention in the Florentine area, it historically appears to be the site of moderate seismic activity that has led to local earthquakes with Imax VIII degree on the Mercalli scale (ML). The current work describes a comprehensive analysis of the seismic vulnerability of the Complex of the “Galleria dell’Accademia di Firenze”, where several art works are exhibited, such as the Michelangelo’s David. The aim of the study is to preserve the building from seismic events. The work involved a diagnostic campaign for the evaluation of the mechanical properties of the Complex. These tests were followed by safety checks as required by the Italian Code DM 14 January 2008 and by the specific Guide-Lines (GL) issued by the Italian Ministry of Cultural Heritage and Tourism (MIBACT) to evaluate and reduce seismic risk of cultural heritage (MIBACT 2010). All the three levels of evaluation provided by the GL have been developed, following a rigorous knowledge path that allowed to reach an exhaustive assessment of the seismic performance of the complex.

Partial Proportional Odds Analysis of Consumers’ Packaged Food Safety Precautionary Actions in Nsuta-Mampong, Ghana

Partial Proportional Odds Analysis of Consumers’ Packaged Food Safety Precautionary Actions in Nsuta-Mampong, Ghana Isaac Abunyuwah Abstract Food safety issues have received increased and sustained public attention and education in recent years in Ghana. With knowledge and information flow on food safety, it is expected that consumers‟ behaviour, attitudes and actions at point of purchases will match their levels of concern about food safety. The paper investigates and explains consumers‟ precautionary safety checks they undertake during purchases. Partial proportional odds model was applied in the framework of vector generalized additive models to explain how often consumers conduct precautionary checks during purchases of packaged goods. A randomly selected sample of 261 respondents from Nsuta-Mampong administrative area of Ghana was used for the study. About 32% and 27% of respondents indicated that they “always/very often” and “sometimes” conduct precautionary checks during purchases respectively. 41% “do not” engage in any precautionary food safety checks. Education, age, number of children in household, marital status, awareness and professional knowledge on food safety issues, occupation and concerns on unwholesomeness of food explained consumer‟s actions. Full Text: PDF DOI: 10.15640/jeds.v8n3a4

Sensitive detection of clenbuterol by hybrid iridium/silicon nanowire-enhanced laser desorption/ionization mass spectrometry.

There is increasing demand for anti-doping drug monitoring in sports and food safety checks by developing sensitive and fast analytical methods. Here we report the development of hybrid Ir/SiNW as a new MALDI matrix for the detection of small molecules. This matrix is characterized by sufficient UV absorption, low-noise background, and high efficiency in ionization of small molecules. Sensitive detection of clenbuterol (LOD: 0.18 pmol) and a variety of other small molecules has been achieved using the Ir/SiNW matrix with a reproducible performance. Compared to the individual components separately, the matrix of hybrid Ir/SiNW synthesized via in situ growth can promote the MS signal intensity by up to 10 fold under identical experimental conditions. We provide a unique mechanism for the high performance of the hybrid Ir/SiNW matrix with the characteristic properties of hydrogen atom transfer and enhanced protonation at the interface of the hybrid nanostructures. Our approach of using a hybrid Ir/SiNW matrix enables detection of clenbuterol quantitatively in complicated biological samples and in vivo experiments, promising a useful tool for food security and anti-doping drug monitoring in sports.

Decision making for autonomous vehicles: Combining safety and optimality

Abstract In this paper, we propose a novel decision maker design for an autonomous vehicle driving on a highway, considering safety and optimality, and which is scalable, i.e., remains computationally tractable for more complex situations. This is realized in two stages. First, all safe actions are found, and second, from these actions the optimal action is selected, according to (weighted) criteria that capture safety, comfort and efficiency. The design combines rule-based safety checks with the solution of a Markov decision process, found through a tree search algorithm, to fulfill the safe, smart and scalable requirements of the decision maker. The design is validated in simulation using eight different scenarios. The performance of the new design is compared to the performance of a rule-based controller. This comparison is done using three performance criteria that aim to capture safety, efficiency and comfort.

EarLy Elimination of Fatty Acids iN hypertriglyceridemia-induced acuTe pancreatitis (ELEFANT trial): Protocol of an open-label, multicenter, adaptive randomized clinical trial

IntroductionAcute pancreatitis (AP) is a life-threatening inflammatory disease, with no specific pharmacological treatment. However, concerning some etiologies, early specific intervention (such as ERCP in biliary AP) has proven to be remarkably beneficial. Hypertriglyceridemia (HTG) induces severe pancreatic damage by several direct (cellular damage) and indirect (deterioration of microcirculation) mechanisms. Published data suggest that early removal of triglycerides (TGs) and toxic free fatty acids (FFAs) may be advantageous; however, high-quality evidence is still missing in the literature. MethodsDesign: ELEFANT is a randomized controlled, multicenter, international trial testing the concept that early elimination of TGs and FFAs from the blood is beneficial in HTG-AP. The study will be performed with the adaptive “drop-the-loser” design, which supports the possibility of dropping the inferior treatment arm, based on the results of the interim analysis. Patients with HTG-AP defined by TG level over 11.3 mmol/l (1000 mg/dL) are randomized into three groups: (A) patients who undergo plasmapheresis and receive aggressive fluid resuscitation; (B) patients who receive insulin and heparin treatment with aggressive fluid resuscitation; and (C) patients with aggressive fluid resuscitation. Please note that all intervention must be started within 48 h from the onset of abdominal pain. Exclusion criteria are designed logically to decrease the possibility of any distorting effects of other diseases. The composite primary endpoint will include both severity and mortality. ResultsOur null hypothesis is that early elimination of HTG and FFAs reduces the risk of mortality and severity of AP. Sample size calculation suggests that 495 patients will need to be enrolled in order to confirm or reject the hypothesis with a 10% dropout, 80% power and 95% significance level. The general safety and quality checks required for high-quality evidence will be adhered to. The study will be organized between February 2020 and December 2025. ConclusionOur study would provide the first direct evidence for or against early intervention in HTG-induced AP.

151 Falls in the United Kingdom: Magnitude, Risk, Disparities, and Solutions

Abstract In the UK each year there are over 250,000 emergency hospital admissions due to falls, costing £4.4 billion for falls-related fractures alone. To help reduce pressure on the NHS, the UK Fire Service are now providing home safety checks which include a review of falls hazards, provision of falls and loneliness advice and in some cases, immediate provision of aids such as grab rails. It is yet to be seen whether this will translate into a reduction in falls but it appears that the trust people place in the Fire Service is resulting in an uptake of falls prevention advice. Although we have reasonably good evidence that multifactorial falls interventions reduce the rate of falls, they are resource intensive and do not reduce the risk of falls. In contrast, exercise interventions reduce both the rate and the risk of falls and can be delivered in a group setting; however uptake and adherence is low. In an attempt to encourage local care providers to invest in falls prevention exercise, Public Health England created a Return-of-Investment tool (available online) for local commissioners to calculate the anticipated cost savings by investing in falls prevention exercise programmes. A recent, novel approach to falls prevention developed in the UK is a Massive Open Online Course (MOOC). This is a free, open-access, online course open to anyone with access to the Internet. The purpose of the ‘Ageing Well: Falls’ MOOC is to educate people about falls prevention and empower them to take action. In five years, the course has educated over 10,000 people from over 100 countries worldwide. One survey revealed that 95% of learners felt more empowered to manage their falls risk, with an increase in confidence to engage in falls prevention behaviours but also an increase in confidence to seek help for falls.

Evaluation of Tensile Performance of Steel Members by Analysis of Corroded Steel Surface Using Deep Learning

To conduct safety checks of corroded steel structures and formulate appropriate maintenance strategies, the residual strength of steel structural members must be assessed with high accuracy. Finite element method (FEM) analyses that precisely recreate the morphology of corroded surfaces using solid elements are expected to accurately assess the strength; however, the cost of conducting these calculations is extremely high. Therefore, a model that uses mean thickness as the thickness of the shell element is widely used but this method has precision issues, particularly regarding overestimation of risk. Thus, this study proposes a method of structural analysis in which the effective thickness of a shell element is assessed using the convolutional neural network (CNN), a type of deep learning performed on tensile structural members. An FEM model is then built based on the shell element that uses this effective thickness. We cross-validated this method by adding a feature extraction layer that reflects the domain knowledge, together with convolutional and pooling layers that are commonly used for CNN and found that a high level of accuracy could be achieved. Furthermore, regarding corroded steel plates and H-section steel, our method demonstrated results that were extremely close to those of models that used solid elements.

Developing an automated safety checking system using BIM: a case study in the Bangladeshi construction industry

Construction workers are backbone of this industry since construction industry is less mechanized and more labor intensive. So the major consideration is ensuring workers safety during construction in Bangladesh. As current practice of Bangladesh checks the construction safety manually, this checking process always leads to error-prone, inconsistency in assessments and delays the construction process as a whole. The aim of this study is to develop an automated fall safety checking system using BIM to solve this problem in the Bangladeshi context. A framework is developed and safety rule checking approach is illustrated during conceptual and legal stage and how these process works in two situations is proposed to identify fall hazard at planning phase. A case study is performed to illustrate its practical implementation on a building project in Bangladesh. Results show that the developed system demonstrates the feasibility of integrating safety into BIM for detecting and eliminating fall-related hazards. This study will contribute the construction professionals by introducing and informing automated safety checking platform to find the reports, why, where, when, and what safety measures are needed for preventing fall-related accidents at pre-construction phase. The significance of this study is to lead to safer designs early in a project.

우선순위 기반 멀티태스크 프로그램의 API 호출 안전성 검증을 위한 모델 기반 오경보 식별 기법

멀티태스크 프로그램은 다수의 태스크가 운영체제의 스케줄링에 맞추어 번갈아 수행되는 프로그램이다. 멀티태스크 프로그램을 검증하기 위해서는 운영체제의 행위를 고려해야하며 그렇지 않을 경우 우선순위가 낮은 태스크가 먼저 실행되는 등 오경보가 발생한다. 효과적인 멀티태스크 프로그램 검증을 위해 정형 운영체제 모델을 사용한 모델 검증 방법들이 소개되었으나 이들은 프로그램을 추상화함으로 인해 오경보를 보고할 수 있다는 단점이 있다. 본 연구에서는 모델 검증 결과 보고된 반례의 오경보 여부를 식별하기 위하여 반례와 동일한 순서로 API 함수 호출을 수행하는 프로그램 실행 경로의 존재 여부를 코드검증 기법을 이용하여 확인하는 방법을 소개한다. 본 연구의 효과를 입증하기 위해 차량전장용 운영체제를 위한 테스트 프로그램과 차량전장용 창문 제어 프로그램을 검증하고 보고된 반례의 오경보 여부를 식별한 결과 73%는 오경보임을 확인하였으며 각각 평균 0.199초와 17.95초의 식별 시간이 소요되었다.

Safety study of cast-in-situ support for double track railway on wide channel beam bridge

Prestress concrete channel beam bridge is a new structure suitable for railway bridges. Due to its advantages under stress, construction and economy, channel beam has been widely used and developed rapidly in engineering construction. However, the concrete track bed plate of channel beam bridge has the characteristics of large transverse width and weight, the stress of inclined wall box girder, complicated construction process, difficult control of concrete crack, and high construction technical difficulty. Therefore, it is necessary to study the wide channel beam bridge. This paper carries out safety checking calculation on the support structure of Bailey beams of channel beam bridge. The results showed that the supporting structure can be considered to be safe. The relevant structural safety design can provide reference to similar projects.

Microsurgical Clipping of Anterior Choroidal Artery Aneurysms: A Systematic Approach to Reducing Ischemic Complications in an Experience with 146 Patients.

Aneurysms of the anterior choroidal artery (AChA) have been associated with high treatment-associated morbidity due to ischemic complications. To report a large clinical experience of microsurgically treated AChA aneurysms and describe a systematic approach to reduce ischemic complications. One hundred forty-six patients with AChA aneurysms were retrospectively reviewed from a prospectively maintained database. Clinical characteristics, surgical techniques, clinical outcomes, arterial infarction, and use of intraoperative adjuncts (ie, ultrasonography, indocyanine green videoangiography, and neuromonitoring) were analyzed. In total, one hundred forty-three aneurysms (97.9%) were clipped. Temporary clipping was utilized in 47 cases (32.2%) with mean occlusion time of 5.6 min. Arterial infarction occurred in 12 patients (8.2%). In clipped aneurysms, 90.5% were completely obliterated, 8.8% had minimal residual (<5% of original), and 0.7% were incompletely occluded (>5% of original). Mortality (2.7%) was limited to patients with high-grade subarachnoid hemorrhage. Indocyanine green videoangiography and neuromonitoring altered operative technique in ∼20% of cases. Multivariate logistic regression identified intraoperative rupture as the sole predictor for arterial infarction. Open microsurgical clipping remains a safe, effective treatment for AChA aneurysms. Microsurgical technique is paramount in preserving AChA patency and reducing ischemic complications. Despite increasing reliance on qualitative measures of AChA blood flow (videoangiography and ultrasonography) and neurophysiological monitoring, these technologies aid us infrequently. However, these adjuncts provide important safety checks for AChA patency. Temporary clipping must be used judiciously to lower the risk of intraoperative rupture while limiting possible ischemia in the AChA territory.

Compliance with the principles of the perioperative safety process in the context of the work of perioperative nurses

Aim: The main aim was to describe the current state of perioperative safety processes with reference to perioperative nurses' work. Design: To achieve the stated goal, a custom-built "ad hoc&#x2EE; research design was created, using a combination of qualitative and quantitative methods. The findings of the exploratory qualitative survey were verified by the quantitative survey focused on in this article. Methods: The exploratory survey and Surgical Safety Checklist were the basis for a questionnaire which was designed to be used as a tool for investigation among a set of perioperative nurses in Czech hospitals. The target group of respondents was operating room managers, one representative per healthcare institution. The obtained data were analysed by exploratory statistical methods. Results: More than 96% of the healthcare institutions included in the research sample have formally established procedures: patient identification, verification of the type and side of the operation, checks for patient's history of allergies, and checks of the number of medical devices (n = 68). The survey showed that the respondents perceive safety checks to be of utmost importance in the perioperative procedure (modal value of seven on a scale from one to seven). Conclusion: Using the Surgical Safety Checklist should lead to safety improvements in nursing perioperative care. In most cases, the nursing safety practices formally introduced at respondents' workplaces correspond to WHO recommendations in the form of this Checklist.

Quality of probiotic products for preterm infants: Contamination and missing strains.

Probiotics are effective in reducing necrotising enterocolitis in preterm infants, but routine use is not generally adopted. We describe a safety issue concerning contamination by pathogenic bacteria and missing of labelled strains in a probiotic product widely used in neonatal care. We recommend all centres using probiotics in the care of vulnerable patients to consider product safety checks in addition to the quality reports of manufacturers. Meanwhile, clinicians and manufacturers should collaborate to define quality standards for probiotic products in clinical settings as long as specific international regulations are lacking.

Impact of early release of oral investigational prescriptions on safety and efficiency at a comprehensive cancer center.

257 Background: At Dana-Farber Cancer Institute (DFCI), timing of order release to the pharmacy is a contributing factor to safety and processing concerns for oral investigational medications. Day-of release can lead to delayed delivery to the patient, creating a risk of missing timed specific protocol data collection, and rushed critical pharmacy safety checks, an issue raised in a comprehensive proactive systems safety risk assessment. We conducted a pilot project aimed at improving the safety and efficiency of oral investigational medication processing within the pharmacy by releasing prescription orders at least 24 hours in advance of a patient’s appointment. Methods: A team of pharmacists, nurses, process improvement professionals, and a physician designed a pilot project where the prescriber released oral investigational prescriptions, from 9 selected research protocols, at least 24 hours before a patient’s appointment. From 11/2/2018-3/1/2019, we used manual timestamp data to compare prescription processing times for prescriptions released at least 24 hours in advance (“released early”) to prescriptions released less than 24-hours in advance (“not released early”). Qualitative feedback was obtained to assess pilot impact on prescription processing safety. Results: As shown in the table below, prescription processing time on day of patient appointment for prescriptions released early was shorter, on average, compared to those not released early (p &lt; 0.05). Due to orders being released early, pharmacy staff noted feeling less pressure during prescription checks and a better ability to proactively assess inventory and prescription issues. Conclusions: Releasing oral investigational prescriptions early reduced the prescription processing time and increased time available for safety checks. Expanding this workflow change to all investigational medication orders can increase the safety and efficiency of prescription processing at DFCI. [Table: see text]

Evaluation of different planning methods of 3DCRT, IMRT, and RapidArc for localized prostate cancer patients: planning and dosimetric study

BackgroundDifferent planning methods of IMRT planning techniques (IMRT (DMLC) and RapidArc) vs. stander techniques (three-dimensional radiation therapy (3DCRT)) will be evaluated for prostate cancer patients’ planning and verification. Three groups of localized prostate cancer patients are planned and evaluated regarding DVHs and practical radiation dosimetry, and ten 3DCRT plans are assessed statistically for each patient.ResultsPlan (7) with parameters of five equally weighted fields with angles of 0°, 45°, 90°, 270°, and 315° and energy of 15MV is the most suitable plan both for PTV coverage and for OAR sparing with a fewer number of fields and fewer number of gantry angles. IMRT complexity involves the requirement of long treatment times and additional effort for planning, safety checks, and quality control before the patient start the treatment and proceed.ConclusionsThe selected plan also is more safe on patients up to 7400 cGy than other plans and is easier to be applied compared to IMRT and RapidArc plans, depending on patient geometry. IMRT radiation doses are more effective and can safely be delivered to PTV with little side effects compared with 3D conformal and conventional techniques. RapidArc has the advantage of re-optimizing and small arcs of variable parameters in dose delivery, taking into account the maximum speed of gantry and MLCs.

Developing assistive robots for people with mild cognitive impairment and mild dementia: a qualitative study with older adults and experts in aged care

ObjectivesThis research is part of an international project to design and test a home-based healthcare robot to help older adults with mild cognitive impairment (MCI) or early dementia. The aim...