WorldWideScience

Sample records for reportable personnel errors

  1. Barriers to medical error reporting

    Directory of Open Access Journals (Sweden)

    Jalal Poorolajal

    2015-01-01

    Full Text Available Background: This study was conducted to explore the prevalence of medical error underreporting and associated barriers. Methods: This cross-sectional study was performed from September to December 2012. Five hospitals, affiliated with Hamadan University of Medical Sciences, in Hamedan,Iran were investigated. A self-administered questionnaire was used for data collection. Participants consisted of physicians, nurses, midwives, residents, interns, and staffs of radiology and laboratory departments. Results: Overall, 50.26% of subjects had committed but not reported medical errors. The main reasons mentioned for underreporting were lack of effective medical error reporting system (60.0%, lack of proper reporting form (51.8%, lack of peer supporting a person who has committed an error (56.0%, and lack of personal attention to the importance of medical errors (62.9%. The rate of committing medical errors was higher in men (71.4%, age of 50-40 years (67.6%, less-experienced personnel (58.7%, educational level of MSc (87.5%, and staff of radiology department (88.9%. Conclusions: This study outlined the main barriers to reporting medical errors and associated factors that may be helpful for healthcare organizations in improving medical error reporting as an essential component for patient safety enhancement.

  2. 护理人员给药错误报告障碍现状及其个人因素分析%Status quo of nursing personnel medication errors reporting obstacles and analysis of its personal factors

    Institute of Scientific and Technical Information of China (English)

    管玉梅; 陶艳玲; 陈娟慧; 洪晓丹; 曾秋华; 杨毅华

    2016-01-01

    Objective:To probe into the status quo of nursing personnel medication errors reporting obstacles and its personal influencing factors,and so as to provide the references for improving the reporting of nursing adverse events.Methods:A total of 392 cases of nursing personnel in a third grade A hospital in Shenzhen city received the questionnaire by using the medication errors reported obstacles questionnaire and self designed nursing personnel general scale.Results:The nursing personnel medication errors reporting obstacle was in the middle level.Not reporting of medication errors whether or not had influenced the total score of reported obsta-cles,and these dimensions including the fear,different understanding of medication errors,managers'reaction and face;whether taking care of the children or not had affected the total score of reporting obstacles,managers 'reaction and reporting labor dimensions;the average annual income affected fear and face dimensions;work ex-perience affected different understanding of medication errors dimension;position,the cognition of administra-tion time incorrect,present educational background,gender and class affected power distance dimension.Conclu-sion:Overcoming the reporting obstacles of medication errors should start from the systemic factors and per-sonal factors,improving the cognition of nursing personnel on medication errors reporting,eliminating the fear of nursing personnel about medication errors reporting,optimizing the reporting atmosphere.%[目的]探讨护理人员给药错误报告障碍现状及其个人影响因素,为完善护理不良事件的上报提供参考。[方法]采用给药错误报告障碍问卷和自行设计的护理人员一般情况表对深圳市某三级甲等医院的392名护理人员进行问卷调查。[结果]护理人员给药错误报告障碍处于中等水平,有无给药错误不上报情况影响报告障碍总分、畏惧、给药错误认识不统一、管理

  3. Errors in Radiologic Reporting

    Directory of Open Access Journals (Sweden)

    Esmaeel Shokrollahi

    2010-05-01

    Full Text Available Given that the report is a professional document and bears the associated responsibilities, all of the radiologist's errors appear in it, either directly or indirectly. It is not easy to distinguish and classify the mistakes made when a report is prepared, because in most cases the errors are complex and attributable to more than one cause and because many errors depend on the individual radiologists' professional, behavioral and psychological traits."nIn fact, anyone can make a mistake, but some radiologists make more mistakes, and some types of mistakes are predictable to some extent."nReporting errors can be categorized differently:"nUniversal vs. individual"nHuman related vs. system related"nPerceptive vs. cognitive errors"n1. Descriptive "n2. Interpretative "n3. Decision related Perceptive errors"n1. False positive "n2. False negative"n Nonidentification "n Erroneous identification "nCognitive errors "n Knowledge-based"n Psychological  

  4. Improving Patients\\\\\\' Care through Electronic Medical Error Reporting System

    Directory of Open Access Journals (Sweden)

    Fatemeh Rangraz Jeddi

    2015-06-01

    Full Text Available Medical errors are unintentional acts that take place due to the negligence or lead to undesirable consequences in medical practice. The purpose of this study was to design a conceptual model for medical error reporting system. This applied descriptive cross-sectional research employed Delphi method carried out from 2012 to 2013. The study population was medical and paramedical personnel of health workers and paramedical personnel of hospitals, deputy of treatment, faculty members of Kashan University of Medical Sciences in addition to the internet and library resources. Sample size included 30 expert individuals in the field of medical errors. The one-stage stratified sampling procedure was used. The items with opposition ranging 0 to 25 were confirmed and those exceeding 50 were rejected whereas the items with the opposition 25 to 50 were reevaluated in the second session. This process continued for three times and the items that failed to be approved were eliminated in the model. Based on the results of this research, repeated informing about and reporting operation at on-line bases that have access to the incidence of error detected on time, identifying cause and damage due to the incidence reported confidential and anonymously immediately after the occurrence is necessary. Analysis of data quantitatively and qualitatively by using computer software is needed. Classifying the errors reports based on feedback provision according to the cause of error is needed. In addition, confidential report and possible manual retrieval were suggested It is essential to determine the means of reporting and items in the reporting form including time, cause and damage of medical error, media of reporting and method of recording and analysis.

  5. Compensation of body shake errors in terahertz beam scanning single frequency holography for standoff personnel screening

    Science.gov (United States)

    Liu, Wei; Li, Chao; Sun, Zhao-Yang; Zhao, Yu; Wu, Shi-You; Fang, Guang-You

    2016-08-01

    In the terahertz (THz) band, the inherent shake of the human body may strongly impair the image quality of a beam scanning single frequency holography system for personnel screening. To realize accurate shake compensation in imaging processing, it is quite necessary to develop a high-precision measure system. However, in many cases, different parts of a human body may shake to different extents, resulting in greatly increasing the difficulty in conducting a reasonable measurement of body shake errors for image reconstruction. In this paper, a body shake error compensation algorithm based on the raw data is proposed. To analyze the effect of the body shake on the raw data, a model of echoed signal is rebuilt with considering both the beam scanning mode and the body shake. According to the rebuilt signal model, we derive the body shake error estimated method to compensate for the phase error. Simulation on the reconstruction of point targets with shake errors and proof-of-principle experiments on the human body in the 0.2-THz band are both performed to confirm the effectiveness of the body shake compensation algorithm proposed. Project supported by the Knowledge Innovation Program of the Chinese Academy of Sciences (Grant No. YYYJ-1123).

  6. Effect of emergency medicine pharmacists on medication-error reporting in an emergency department.

    Science.gov (United States)

    Weant, Kyle A; Humphries, Roger L; Hite, Kimberly; Armitstead, John A

    2010-11-01

    The effect of an emergency medicine (EM) clinical pharmacist on medication-error reporting in an emergency department (ED) was studied. The medication-error reports for patients seen at a university's ED between September 1, 2005, and February 28, 2009, were retrospectively reviewed. Errors reported before the addition of an EM pharmacist (from September 1, 2005, through February 28, 2006) were compared with those reported after the addition of two EM pharmacists (from September 1, 2008, through February 28, 2009). The severity of errors and the provider who reported the errors were characterized. A total of 402 medication errors were reported over the two time periods. Pharmacy personnel captured significantly more errors than did other health care personnel (94.5% versus 5.7%, p pharmacists resulted in 14.8 times as many medication-error reports as were made when no EM pharmacist was in the ED. More errors that actually occurred were captured with two pharmacists providing care (95.7% versus 4.3%, p errors documented were ordering errors (79.8%). Of these, 73.7% were captured after the addition of two EM pharmacists. Performance (40.0%) and knowledge (27.9%) deficits were the most common contributing factors to medication errors. During the study period after the addition of two EM pharmacists in the ED, 371 medication-error reports were completed, compared with 31 reports during the study period before the addition of the pharmacists. Pharmacy personnel reported the majority of medication errors during both study periods.

  7. Improving Mental Health Reporting Practices in Between Personnel Security Investigations

    Science.gov (United States)

    2017-06-01

    review and SME discussions underscore the need to further clarify mental health -related reporting requirements (generally) and to provide guidance to SMs... health issues of potential risk to national security. Training should stress reporting requirements and should address how to FINDINGS...influenced DoD requirements , specifically for self, co-worker, and supervisor reporting of security-relevant mental health issues. Early personnel

  8. Report on the Personnel Dosimetry at AB Atomenergi during 1965

    Energy Technology Data Exchange (ETDEWEB)

    Edvardsson, K.A.

    1966-10-15

    This report presents the results of the personnel dosimetry at AB Atomenergi during 1965. No doses exceeding the recommendations of ICRP were reported. For AB Atomenergi the average external total body dose during the year was 60 mrem which corresponds to 89.4 manrem. 31200 gamma films and 5850 neutron films were evaluated. 2067 urine analyses and 692 measurements of body activity were made.

  9. Error Analysis of Brailled Instructional Materials Produced by Public School Personnel in Texas

    Science.gov (United States)

    Herzberg, Tina

    2010-01-01

    In this study, a detailed error analysis was performed to determine if patterns of errors existed in braille transcriptions. The most frequently occurring errors were the insertion of letters or words that were not contained in the original print material; the incorrect usage of the emphasis indicator; and the incorrect formatting of titles,…

  10. Report: Management Alert - EPA Has Not Initiated Required Background Investigations for Information Systems Contractor Personnel

    Science.gov (United States)

    Report #17-P-0409, September 27, 2017. Not vetting contractor personnel before granting them network access exposes the EPA to risks. Contractor personnel with potentially questionable backgrounds who access sensitive agency data could cause harm.

  11. Error Analysis in Mathematics. Technical Report #1012

    Science.gov (United States)

    Lai, Cheng-Fei

    2012-01-01

    Error analysis is a method commonly used to identify the cause of student errors when they make consistent mistakes. It is a process of reviewing a student's work and then looking for patterns of misunderstanding. Errors in mathematics can be factual, procedural, or conceptual, and may occur for a number of reasons. Reasons why students make…

  12. Learning from medication errors through a nationwide reporting programme

    NARCIS (Netherlands)

    Cheung, K.C.

    2015-01-01

    One of the strategies to enhance patient safety is the spontaneous reporting and analysis of medication errors. Sharing this information with other healthcare providers will help to prevent the reoccurrence of similar medication errors. In The Netherlands medication errors can be reported to a natio

  13. Parsing error correction of medical phrases for semantic annotation of clinical radiology reports.

    Science.gov (United States)

    Nishimoto, Naoki; Terae, Satoshi; Uesugi, Masahito; Tanikawa, Takumi; Endou, Akira; Endoh, Akira; Ogasawara, Katsuhiko; Sakurai, Tsunetaro

    2008-11-06

    The purpose of this study is to develop a module for correcting errors in the product of a natural language parser. When tested with 300 CT reports, a total of 604 patterns were generated. The recall and precision was improved to 90.7% and 74.1% after processed by the module from initial 80.5% and 42.8% respectively. This rule-based module will help health care personnel reduce the cost of manual tagging correction for corpus building.

  14. Reporting and disclosing medical errors: pediatricians' attitudes and behaviors.

    Science.gov (United States)

    Garbutt, Jane; Brownstein, Dena R; Klein, Eileen J; Waterman, Amy; Krauss, Melissa J; Marcuse, Edgar K; Hazel, Erik; Dunagan, Wm Claiborne; Fraser, Victoria; Gallagher, Thomas H

    2007-02-01

    To characterize pediatricians' attitudes and experiences regarding communicating about errors with the hospital and patients' families. Cross-sectional survey. St Louis, Mo, and Seattle, Wash. University-affiliated hospital and community pediatricians and pediatric residents. Anonymous 68-item survey (paper or Web-based) administered between July 2003 and March 2004. Physician attitudes and experiences about error communication. Four hundred thirty-nine pediatric attending physicians and 118 residents participated (62% response rate). Most respondents had been involved in an error (39%, serious; 72%, minor; 61%, near miss; 7%, none). Respondents endorsed reporting errors to the hospital (97%, serious; 90%, minor; 82%, near miss), but only 39% thought that current error reporting systems were adequate. Most pediatricians had used a formal error reporting mechanism, such as an incident report (65%), but many also used informal reporting mechanisms, such as telling a supervisor (47%) or senior physician (38%), and discussed errors with colleagues (72%). Respondents endorsed disclosing errors to patients' families (99%, serious; 90%, minor; 39%, near miss), and many had done so (36%, serious; 52%, minor). Residents were more likely than attending physicians to believe that disclosing a serious error would be difficult (96% vs 86%; P = .004) and to want disclosure training (69% vs 56%; P = .03). Pediatricians are willing to report errors to hospitals and disclose errors to patients' families but believe current reporting systems are inadequate and struggle with error disclosure. Improving error reporting systems and encouraging physicians to report near misses, as well as providing training in error disclosure, could help prevent future errors and increase patient trust.

  15. An overview of intravenous-related medication administration errors as reported to MEDMARX, a national medication error-reporting program.

    Science.gov (United States)

    Hicks, Rodney W; Becker, Shawn C

    2006-01-01

    Medication errors can be harmful, especially if they involve the intravenous (IV) route of administration. A mixed-methodology study using a 5-year review of 73,769 IV-related medication errors from a national medication error reporting program indicates that between 3% and 5% of these errors were harmful. The leading type of error was omission, and the leading cause of error involved clinician performance deficit. Using content analysis, three themes-product shortage, calculation errors, and tubing interconnectivity-emerge and appear to predispose patients to harm. Nurses often participate in IV therapy, and these findings have implications for practice and patient safety. Voluntary medication error-reporting programs afford an opportunity to improve patient care and to further understanding about the nature of IV-related medication errors.

  16. Organizational safety culture and medical error reporting by Israeli nurses.

    Science.gov (United States)

    Kagan, Ilya; Barnoy, Sivia

    2013-09-01

    To investigate the association between patient safety culture (PSC) and the incidence and reporting rate of medical errors by Israeli nurses. Self-administered structured questionnaires were distributed to a convenience sample of 247 registered nurses enrolled in training programs at Tel Aviv University (response rate = 91%). The questionnaire's three sections examined the incidence of medication mistakes in clinical practice, the reporting rate for these errors, and the participants' views and perceptions of the safety culture in their workplace at three levels (organizational, departmental, and individual performance). Pearson correlation coefficients, t tests, and multiple regression analysis were used to analyze the data. Most nurses encountered medical errors from a daily to a weekly basis. Six percent of the sample never reported their own errors, while half reported their own errors "rarely or sometimes." The level of PSC was positively and significantly correlated with the error reporting rate. PSC, place of birth, error incidence, and not having an academic nursing degree were significant predictors of error reporting, together explaining 28% of variance. This study confirms the influence of an organizational safety climate on readiness to report errors. Senior healthcare executives and managers can make a major impact on safety culture development by creating and promoting a vision and strategy for quality and safety and fostering their employees' motivation to implement improvement programs at the departmental and individual level. A positive, carefully designed organizational safety culture can encourage error reporting by staff and so improve patient safety. © 2013 Sigma Theta Tau International.

  17. Attitudes to reporting medication error among differing healthcare professionals.

    Science.gov (United States)

    Sarvadikar, Ajit; Prescott, Gordon; Williams, David

    2010-08-01

    Medication error reporting is an important measure to prevent medication error incidents in a healthcare system and can serve as an important tool for improving patient safety. This study aimed to investigate attitudes of healthcare professionals (doctors, nurses, and pharmacists) in reporting medication errors. Fifty-six healthcare professionals working at a 900-bed tertiary referral hospital were surveyed. A questionnaire using two different clinical scenarios (involving oral and intravenous administration of a drug) and four questions with an ascending order of worsening patient outcome was used. A Likert scale ranging from 1 (unlikely) to 5 (likely) was used to describe the likelihood of reporting a medication error. The overall response rate was 57% (43% for doctors, 68% for nurses, and 64% for pharmacists). Results showed that doctors were unlikely to report less-serious medication errors (median value of 2 on the Likert scale). Nurses and pharmacists (median value of 5) were likely to report less-serious as well as serious medication errors despite their fears of receiving disciplinary action. All healthcare professionals were more likely to report an error as the clinical scenarios had a progressively worsening outcome for the patient. These results suggest that among healthcare professionals, there are differing attitudes to reporting medication errors. Differing approaches are therefore required to encourage medication error reporting among different healthcare professionals. Future study is required to further investigate these findings and improve reporting rates.

  18. Medication errors reported to the National Medication Error Reporting System in Malaysia: a 4-year retrospective review (2009 to 2012).

    Science.gov (United States)

    Samsiah, A; Othman, Noordin; Jamshed, Shazia; Hassali, Mohamed Azmi; Wan-Mohaina, W M

    2016-12-01

    Reporting and analysing the data on medication errors (MEs) is important and contributes to a better understanding of the error-prone environment. This study aims to examine the characteristics of errors submitted to the National Medication Error Reporting System (MERS) in Malaysia. A retrospective review of reports received from 1 January 2009 to 31 December 2012 was undertaken. Descriptive statistics method was applied. A total of 17,357 MEs reported were reviewed. The majority of errors were from public-funded hospitals. Near misses were classified in 86.3 % of the errors. The majority of errors (98.1 %) had no harmful effects on the patients. Prescribing contributed to more than three-quarters of the overall errors (76.1 %). Pharmacists detected and reported the majority of errors (92.1 %). Cases of erroneous dosage or strength of medicine (30.75 %) were the leading type of error, whilst cardiovascular (25.4 %) was the most common category of drug found. MERS provides rich information on the characteristics of reported MEs. Low contribution to reporting from healthcare facilities other than government hospitals and non-pharmacists requires further investigation. Thus, a feasible approach to promote MERS among healthcare providers in both public and private sectors needs to be formulated and strengthened. Preventive measures to minimise MEs should be directed to improve prescribing competency among the fallible prescribers identified.

  19. Human error mitigation initiative (HEMI) : summary report.

    Energy Technology Data Exchange (ETDEWEB)

    Stevens, Susan M.; Ramos, M. Victoria; Wenner, Caren A.; Brannon, Nathan Gregory

    2004-11-01

    Despite continuing efforts to apply existing hazard analysis methods and comply with requirements, human errors persist across the nuclear weapons complex. Due to a number of factors, current retroactive and proactive methods to understand and minimize human error are highly subjective, inconsistent in numerous dimensions, and are cumbersome to characterize as thorough. An alternative and proposed method begins with leveraging historical data to understand what the systemic issues are and where resources need to be brought to bear proactively to minimize the risk of future occurrences. An illustrative analysis was performed using existing incident databases specific to Pantex weapons operations indicating systemic issues associated with operating procedures that undergo notably less development rigor relative to other task elements such as tooling and process flow. Future recommended steps to improve the objectivity, consistency, and thoroughness of hazard analysis and mitigation were delineated.

  20. State In-Service Training for Correctional Personnel. Final Report. Volume II.

    Science.gov (United States)

    Kiefer, George W.

    This is part of the final report on a project that focused on the inservice training needs of correctional personnel in the Illinois penal system. Most of this volume is devoted to an overview of existing staff training for line personnel and parole agents; an assessment of unmet training needs; group discussion and other demonstration projects in…

  1. The Impact of Error-Management Climate, Error Type and Error Originator on Auditors’ Reporting Errors Discovered on Audit Work Papers

    NARCIS (Netherlands)

    A.H. Gold-Nöteberg (Anna); U. Gronewold (Ulfert); S. Salterio (Steve)

    2010-01-01

    textabstractWe examine factors affecting the auditor’s willingness to report their own or their peers’ self-discovered errors in working papers subsequent to detailed working paper review. Prior research has shown that errors in working papers are detected in the review process; however, such

  2. The Impact of Error-Management Climate, Error Type and Error Originator on Auditors’ Reporting Errors Discovered on Audit Work Papers

    NARCIS (Netherlands)

    A.H. Gold-Nöteberg (Anna); U. Gronewold (Ulfert); S. Salterio (Steve)

    2010-01-01

    textabstractWe examine factors affecting the auditor’s willingness to report their own or their peers’ self-discovered errors in working papers subsequent to detailed working paper review. Prior research has shown that errors in working papers are detected in the review process; however, such detect

  3. Legal consequences of the moral duty to report errors.

    Science.gov (United States)

    Hall, Jacqulyn Kay

    2003-09-01

    Increasingly, clinicians are under a moral duty to report errors to the patients who are injured by such errors. The sources of this duty are identified, and its probable impact on malpractice litigation and criminal law is discussed. The potential consequences of enforcing this new moral duty as a minimum in law are noted. One predicted consequence is that the trend will be accelerated toward government payment of compensation for errors. The effect of truth-telling on individuals is discussed.

  4. Pocket book {sup E}xpectations of operating personnel action and card criteria, previous meeting and precursor of error; Libro de bolsillo expectativas de actuacion del personal de operacion y tarjeta criterios reunion previa y precursores de error

    Energy Technology Data Exchange (ETDEWEB)

    Rodrigo Gonzalez, M.

    2012-07-01

    We have developed a pocket manual of performance expectations of operating personnel. Additionally, it has created a card pocket systematizing the application of previous meetings (pre-job) depending on the existence of error precursors and following the commission of an error. This manual serves to communicate expectations and performance expected to the Operation Staff. The results show a positive change in a short period of time working practices, both in training (simulator) and control room.

  5. Distribution of Errors Reported by LOD2 LODStats Project [Dataset

    NARCIS (Netherlands)

    Hoekstra, R.; Groth, P.

    2013-01-01

    These files can be used to plot a distribution of error types based on the LOD2 LODStats analysis of linked data published through the datahub.io. The statistics show that many errors reported in these statistics are the result of HTTP problems (40x and 50x codes) unknown responses and connection do

  6. Teamwork and clinical error reporting among nurses in Korean hospitals.

    Science.gov (United States)

    Hwang, Jee-In; Ahn, Jeonghoon

    2015-03-01

    To examine levels of teamwork and its relationships with clinical error reporting among Korean hospital nurses. The study employed a cross-sectional survey design. We distributed a questionnaire to 674 nurses in two teaching hospitals in Korea. The questionnaire included items on teamwork and the reporting of clinical errors. We measured teamwork using the Teamwork Perceptions Questionnaire, which has five subscales including team structure, leadership, situation monitoring, mutual support, and communication. Using logistic regression analysis, we determined the relationships between teamwork and error reporting. The response rate was 85.5%. The mean score of teamwork was 3.5 out of 5. At the subscale level, mutual support was rated highest, while leadership was rated lowest. Of the participating nurses, 522 responded that they had experienced at least one clinical error in the last 6 months. Among those, only 53.0% responded that they always or usually reported clinical errors to their managers and/or the patient safety department. Teamwork was significantly associated with better error reporting. Specifically, nurses with a higher team communication score were more likely to report clinical errors to their managers and the patient safety department (odds ratio = 1.82, 95% confidence intervals [1.05, 3.14]). Teamwork was rated as moderate and was positively associated with nurses' error reporting performance. Hospital executives and nurse managers should make substantial efforts to enhance teamwork, which will contribute to encouraging the reporting of errors and improving patient safety. Copyright © 2015. Published by Elsevier B.V.

  7. "Why Don't They Report?" Hospital Personnel Working with Children at Risk

    Science.gov (United States)

    Svärd, Veronica

    2017-01-01

    Hospital personnel have been shown to report child maltreatment to social services less frequently than other professionals. This quantitative study shows that one-half of the respondents within the four largest Swedish children's hospitals had never made a report. However, nurses' and nurse assistants' odds of being low reporters were…

  8. The Error Reporting in the ATLAS TDAQ system

    CERN Document Server

    Kolos, S; The ATLAS collaboration; Papaevgeniou, L

    2014-01-01

    The ATLAS Error Reporting feature, which is used in the TDAQ environment, provides a service that allows experts and shift crew to track and address errors relating to the data taking components and applications. This service, called the Error Reporting Service(ERS), gives software applications the opportunity to collect and send comprehensive data about errors, happening at run-time, to a place where it can be intercepted in real-time by any other system component. Other ATLAS online control and monitoring tools use the Error Reporting service as one of their main inputs to address system problems in a timely manner and to improve the quality of acquired data. The actual destination of the error messages depends solely on the run-time environment, in which the online applications are operating. When applications send information to ERS, depending on the actual configuration the information may end up in a local file, in a database, in distributed middle-ware, which can transport it to an expert system or dis...

  9. The Error Reporting in the ATLAS TDAQ System

    CERN Document Server

    Kolos, S; The ATLAS collaboration; Papaevgeniou, L

    2015-01-01

    The ATLAS Error Reporting feature, which is used in the TDAQ environment, provides a service that allows experts and shift crew to track and address errors relating to the data taking components and applications. This service, called the Error Reporting Service(ERS), gives software applications the opportunity to collect and send comprehensive data about errors, happening at run-time, to a place where it can be intercepted in real-time by any other system component. Other ATLAS online control and monitoring tools use the Error Reporting service as one of their main inputs to address system problems in a timely manner and to improve the quality of acquired data. The actual destination of the error messages depends solely on the run-time environment, in which the online applications are operating. When applications send information to ERS, depending on the actual configuration the information may end up in a local file, in a database, in distributed middle-ware, which can transport it to an expert system or dis...

  10. Child Maltreatment Reporting by Educational Personnel: Implications for Racial Disproportionality in the Child Welfare System

    Science.gov (United States)

    Krase, Kathryn Suzanne

    2015-01-01

    African American children are disproportionally overrepresented in the U.S. child protection system. Because educational personnel are a significant source of reports of suspected child maltreatment across the country and in all states, the present study examines the impact of these reports on racial disproportionality and disparity at the…

  11. The Error Reporting in the ATLAS TDAQ System

    Science.gov (United States)

    Kolos, Serguei; Kazarov, Andrei; Papaevgeniou, Lykourgos

    2015-05-01

    The ATLAS Error Reporting provides a service that allows experts and shift crew to track and address errors relating to the data taking components and applications. This service, called the Error Reporting Service (ERS), gives to software applications the opportunity to collect and send comprehensive data about run-time errors, to a place where it can be intercepted in real-time by any other system component. Other ATLAS online control and monitoring tools use the ERS as one of their main inputs to address system problems in a timely manner and to improve the quality of acquired data. The actual destination of the error messages depends solely on the run-time environment, in which the online applications are operating. When an application sends information to ERS, depending on the configuration, it may end up in a local file, a database, distributed middleware which can transport it to an expert system or display it to users. Thanks to the open framework design of ERS, new information destinations can be added at any moment without touching the reporting and receiving applications. The ERS Application Program Interface (API) is provided in three programming languages used in the ATLAS online environment: C++, Java and Python. All APIs use exceptions for error reporting but each of them exploits advanced features of a given language to simplify the end-user program writing. For example, as C++ lacks language support for exceptions, a number of macros have been designed to generate hierarchies of C++ exception classes at compile time. Using this approach a software developer can write a single line of code to generate a boilerplate code for a fully qualified C++ exception class declaration with arbitrary number of parameters and multiple constructors, which encapsulates all relevant static information about the given type of issues. When a corresponding error occurs at run time, the program just need to create an instance of that class passing relevant values to one

  12. Female genital mutilation and reporting duties for all clinical personnel.

    Science.gov (United States)

    Cropp, Gabrielle; Armstrong, Jane

    2016-07-01

    Female genital mutilation is illegal. It is now mandatory for health-care professionals to report female genital mutilation to the police. Professionals caring for women and girls of all ages must understand how female genital mutilation presents, and what action to take.

  13. Annotated Bibliography of the Personnel Research Division Reports (1973-1975).

    Science.gov (United States)

    Magness, P. J., Ed.

    An annotated bibliography of 60 technical reports and publications on research conducted by the Personnel Research Division of the Air Force Human Resources Laboratory (AFHRL) is presented. Research covers the identification and measurement of individual aptitude, motivation, morale, attitude, and environment factors. Keyword and personal author…

  14. Medication error report: Intrathecal administration of labetalol during obstetric anesthesia

    Directory of Open Access Journals (Sweden)

    Baisakhi Laha

    2015-01-01

    Full Text Available Labetalol, a combined alfa and beta-adrenergic receptor antagonist, is used as an antihypertensive drug. We report a case of an acute rise in blood pressure and lower limb pain due to the inadvertent intrathecal administration of labetalol, mistaking it for bupivacaine, during obstetric anesthesia. The situation was rescued by converting to general anesthesia. The cesarean delivery was uneventful, and mother as well as newborn child showed no ill-effect. This particular medication error was attributable to a failure on the part of the doctors administering the injection to read and cross-check medication labels and the practice of keeping multiple injections together. In the absence of an organized medication error reporting system and action on that basis, such events may recur in future.

  15. Organizational culture, continuous quality improvement, and medication administration error reporting.

    Science.gov (United States)

    Wakefield, B J; Blegen, M A; Uden-Holman, T; Vaughn, T; Chrischilles, E; Wakefield, D S

    2001-01-01

    This study explores the relationships among measures of nurses' perceptions of organizational culture, continuous quality improvement (CQI) implementation, and medication administration error (MAE) reporting. Hospital-based nurses were surveyed using measures of organizational culture and CQI implementation. These data were combined with previously collected data on perceptions of MAE reporting. A group-oriented culture had a significant positive correlation with CQI implementation, whereas hierarchical and rational culture types were negatively correlated with CQI implementation. Higher barriers to reporting MAE were associated with lower perceived reporting rates. A group-oriented culture and a greater extent of CQI implementation were positively (but not significantly) associated with the estimated overall percentage of MAEs reported. We conclude that health care organizations have implemented CQI programs, yet barriers remain relative to MAE reporting. There is a need to assess the reliability, validity, and completeness of key quality assessment and risk management data.

  16. TITLE III EVALUATION REPORT FOR THE MATERIAL AND PERSONNEL HANDLING SYSTEM

    Energy Technology Data Exchange (ETDEWEB)

    T. A. Misiak

    1998-05-21

    This Title III Evaluation Report (TER) provides the results of an evaluation that was conducted on the Material and Personnel Handling System. This TER has been written in accordance with the ''Technical Document Preparation Plan for the Mined Geologic Disposal System Title III Evaluation Reports'' (BA0000000-01717-4600-00005 REV 03). The objective of this evaluation is to provide recommendations to ensure consistency between the technical baseline requirements, baseline design, and the as-constructed Material and Personnel Handling System. Recommendations for resolving discrepancies between the as-constructed system, the technical baseline requirements, and the baseline design are included in this report. Cost and Schedule estimates are provided for all recommended modifications.

  17. Target registration and target positioning errors in computer-assisted neurosurgery: proposal for a standardized reporting of error assessment.

    Science.gov (United States)

    Widmann, Gerlig; Stoffner, Rudolf; Sieb, Michael; Bale, Reto

    2009-12-01

    Assessment of errors is essential in development, testing and clinical application of computer-assisted neurosurgery. Our aim was to provide a comprehensive overview of the different methods to assess target registration error (TRE) and target positioning error (TPE) and to develop a proposal for a standardized reporting of error assessment. A PubMed research on phantom, cadaver or clinical studies on TRE and TPE has been performed. Reporting standards have been defined according to (a) study design and evaluation methods and (b) specifications of the navigation technology. The proposed standardized reporting includes (a) study design (controlled, non-controlled), study type (non-anthropomorphic phantom, anthropomorphic phantom, cadaver, patient), target design, error type and subtypes, space of TPE measurement, statistics, and (b) image modality, scan parameters, tracking technology, registration procedure and targeting technique. Adoption of the proposed standardized reporting may help in the understanding and comparability of different accuracy reports. Copyright (c) 2009 John Wiley & Sons, Ltd.

  18. Investigating the Factors Affecting the Occurrence and Reporting of Medication Errors from the Viewpoint of Nurses in Sina Hospital, Tabriz, Iran

    Directory of Open Access Journals (Sweden)

    Massumeh gholizadeh

    2016-09-01

    Full Text Available Background and objectives: Medication errors can cause serious problems to patients and health system. Initial results of medication errors increase duration of hospitalization and costs. The aim of this study was to determine the reasons of medication errors and the barriers of errors reporting from nurses’ viewpoints. Material and Methods: A cross-sectional descriptive study was conducted in 2013. The study population included all of the nurses working in Tabriz Sina hospital. Study sample was calculated 124 by census method. The data collection tool was questionnaire and data were analyzed using SPSS software version 20 package. Results: In this study, from the viewpoint of nurses, the most important reasons of medication errors included the wrong infusion speed, illegible medication orders, work-related fatigue, noise of ambient and shortages of staff.  Regarding barriers of error reporting, the most important factors were the emphasis of the directors on the person regardless of other factors involved in medication errors and the lake of a clear definition of medication errors. Conclusion: Given the importance of ensuring patient safety, the following corrections can lead to improvement of hospital safety: establishing an effective system for reporting and recording errors, minimizing barriers to reporting by establishing a positive relationship between managers and staff and positive reaction towards reporting error. To reduce medication errors, establishing training classes in relation to drugs information for nurses and continuing evaluation of personnel in the field of drug information using the results of pharmaceutical information in the ward are recommended.

  19. Implementation of an error-reporting module within a biorepository IT application to enhance operations.

    Science.gov (United States)

    Wiles, Kerry R; Washington, M K

    2014-12-01

    The Collaborative (formerly the Cooperative) Human Tissue Network (CHTN) is a federally funded service oriented grant that provides high-quality biospecimens and services to the research community. The CHTN consists of six institutions located throughout the United States to assist investigators in obtaining research specimens required for basic research. The CHTN divisions have similar operating goals: however, each division is responsible for maintaining operations at their local institutions. This requires the divisions to identify ways to maintain and sustain operations in a challenging federally funded environment, especially when the number of investigators requesting services drives the operation. Sustainability plans and goals are often times patched together out of necessity rather than taking a thoughtful approach by clearly defining and aligning activities with business strategy and priorities. The CHTN Western Division at Vanderbilt University Medical Center (CHTN-WD) has responded to this challenge of biospecimen resource sustainability in the face of diminished funding by continually identifying ways to innovate our processes through IT enhancements and requiring that the innovation produce measurable and relevant criteria for credibly reporting our operations progress and performance issues. With these overarching goals in mind, CHTN-WD underwent a Lean Six Sigma (LSS) series to identify operational inefficiencies that could be addressed with redesigning workflow and innovating the processes using IT solutions. The result of this internal collaborative innovation process was the implementation of an error-reporting module (ERM) hosted within our biorepository donor IT application, which allowed staff to report errors immediately; determine the operational area responsible; assess the severity of the error; determine course of action; determine if standard operating procedure (SOPs) revisions were required; and through automated e-mails, alert the

  20. Implementation of an Error-Reporting Module Within a Biorepository IT Application to Enhance Operations

    Science.gov (United States)

    Washington, M.K.

    2014-01-01

    The Collaborative (formerly the Cooperative) Human Tissue Network (CHTN) is a federally funded service oriented grant that provides high-quality biospecimens and services to the research community. The CHTN consists of six institutions located throughout the United States to assist investigators in obtaining research specimens required for basic research. The CHTN divisions have similar operating goals: however, each division is responsible for maintaining operations at their local institutions. This requires the divisions to identify ways to maintain and sustain operations in a challenging federally funded environment, especially when the number of investigators requesting services drives the operation. Sustainability plans and goals are often times patched together out of necessity rather than taking a thoughtful approach by clearly defining and aligning activities with business strategy and priorities. The CHTN Western Division at Vanderbilt University Medical Center (CHTN-WD) has responded to this challenge of biospecimen resource sustainability in the face of diminished funding by continually identifying ways to innovate our processes through IT enhancements and requiring that the innovation produce measurable and relevant criteria for credibly reporting our operations progress and performance issues. With these overarching goals in mind, CHTN-WD underwent a Lean Six Sigma (LSS) series to identify operational inefficiencies that could be addressed with redesigning workflow and innovating the processes using IT solutions. The result of this internal collaborative innovation process was the implementation of an error-reporting module (ERM) hosted within our biorepository donor IT application, which allowed staff to report errors immediately; determine the operational area responsible; assess the severity of the error; determine course of action; determine if standard operating procedure (SOPs) revisions were required; and through automated e-mails, alert the

  1. Medication error reporting by community pharmacists in Vermont.

    Science.gov (United States)

    Kennedy, Amanda G; Littenberg, Benjamin

    2004-01-01

    To document community pharmacists' awareness and use of the United States Pharmacopeia Medication Errors Reporting (USP MER) program. Telephone survey. Community pharmacies in Vermont. One self-identified community pharmacist from each community pharmacy. Each operating community pharmacy in Vermont was contacted by telephone between June 2002 and February 2003. The first individual to self-identify himself or herself as a pharmacist was asked to participate. The telephone surveys were conducted using a standard script. Survey responses to questions about awareness and use of USP MER. A pharmacist was contacted in 98% (122/124) of all operating community pharmacies in Vermont. Nine (7%) pharmacists refused to participate, leaving 113 pharmacists who responded to the survey. Although more than one half of all respondents (70/113; 62%) had heard of USP MER, less than one quarter (24/113; 21%) had ever submitted a report. Significantly more pharmacists employed by independent pharmacies had submitted a report, compared with pharmacists from other pharmacy types (chain, supermarket, mass merchandiser; P = .03). Submitting reports through a corporate hierarchy or to a corporate program was the reason most frequently cited by pharmacists for not submitting reports directly to USP MER (37%). Whether corporate reports were forwarded to USP MER is unknown. The majority of Vermont community pharmacists were aware of USP MER. However, use was low. Barriers to reporting to a common system such as USP MER may differ depending on pharmacy type. Further research to document the barriers to submitting reports is warranted.

  2. Descriptive analysis of medication errors reported to the Egyptian national online reporting system during six months.

    Science.gov (United States)

    Shehata, Zahraa Hassan Abdelrahman; Sabri, Nagwa Ali; Elmelegy, Ahmed Abdelsalam

    2016-03-01

    This study analyzes reports to the Egyptian medication error (ME) reporting system from June to December 2014. Fifty hospital pharmacists received training on ME reporting using the national reporting system. All received reports were reviewed and analyzed. The pieces of data analyzed were patient age, gender, clinical setting, stage, type, medication(s), outcome, cause(s), and recommendation(s). Over the course of 6 months, 12,000 valid reports were gathered and included in this analysis. The majority (66%) came from inpatient settings, while 23% came from intensive care units, and 11% came from outpatient departments. Prescribing errors were the most common type of MEs (54%), followed by monitoring (25%) and administration errors (16%). The most frequent error was incorrect dose (20%) followed by drug interactions, incorrect drug, and incorrect frequency. Most reports were potential (25%), prevented (11%), or harmless (51%) errors; only 13% of reported errors lead to patient harm. The top three medication classes involved in reported MEs were antibiotics, drugs acting on the central nervous system, and drugs acting on the cardiovascular system. Causes of MEs were mostly lack of knowledge, environmental factors, lack of drug information sources, and incomplete prescribing. Recommendations for addressing MEs were mainly staff training, local ME reporting, and improving work environment. There are common problems among different healthcare systems, so that sharing experiences on the national level is essential to enable learning from MEs. Internationally, there is a great need for standardizing ME terminology, to facilitate knowledge transfer. Underreporting, inaccurate reporting, and a lack of reporter diversity are some limitations of this study. Egypt now has a national database of MEs that allows researchers and decision makers to assess the problem, identify its root causes, and develop preventive strategies. © The Author 2015. Published by Oxford University

  3. A comparative study of voluntarily reported medication errors among ...

    African Journals Online (AJOL)

    Pharmacotherapy Group, Faculty of Pharmacy, University of Benin, Benin City, ... errors among adult patients in intensive care (IC) and non- .... category include system error, documentation .... the importance of patient safety and further.

  4. How high are the personnel costs for OSCE? A financial report on management aspects.

    Science.gov (United States)

    Rau, Thea; Fegert, Jörg; Liebhardt, Hubert

    2011-01-01

    The OSCE (objective structured clinical examination) was put to the test in order to assess the clinical practical skills of students in medical studies in the medical faculties. For the implementation of an OSCE, a large number of personnel is necessary. In particular for subjects with limited resources, therefore, efficient cost planning is required. In the winter semester 09/10, the Department of Neurology at the Medical Faculty of the University of Ulm introduced the OSCE as a pilot project. A financial report retrospectively shows the personnel expenses. The report is intended as an example for an insight into the resources needed for the OSCE with simulated patients. Included in the calculation of the financial costs of the OSCE were: employment, status of staff involved in the OSCE, subject-matter and temporal dimension of the task. After the exam, acceptance of the examination format was reviewed by a focus group interview with the teachers and students. The total expenses for the personnel involved in the OSCE amounted to 12,468 €. The costing of the clinic's share was calculated at 9,576 €. Tuition fees from the students have been used to the amount of 2.892 €. For conversion of total expenditure to the number of examines the sum of 86 € per student was calculated. Both students and teachers confirmed the validity of the OSCE and recognised the added value in the learning effects. The high acceptance of the OSCE in neurology by both students and teachers favours maintaining the test format. Against the background of the high financial and logistical costs, however, in individual cases it should be assessed how in the long-term efficient examination procedure will be possible.

  5. FRamework Assessing Notorious Contributing Influences for Error (FRANCIE): Perspective on Taxonomy Development to Support Error Reporting and Analysis

    Energy Technology Data Exchange (ETDEWEB)

    Lon N. Haney; David I. Gertman

    2003-04-01

    Beginning in the 1980s a primary focus of human reliability analysis was estimation of human error probabilities. However, detailed qualitative modeling with comprehensive representation of contextual variables often was lacking. This was likely due to the lack of comprehensive error and performance shaping factor taxonomies, and the limited data available on observed error rates and their relationship to specific contextual variables. In the mid 90s Boeing, America West Airlines, NASA Ames Research Center and INEEL partnered in a NASA sponsored Advanced Concepts grant to: assess the state of the art in human error analysis, identify future needs for human error analysis, and develop an approach addressing these needs. Identified needs included the need for a method to identify and prioritize task and contextual characteristics affecting human reliability. Other needs identified included developing comprehensive taxonomies to support detailed qualitative modeling and to structure meaningful data collection efforts across domains. A result was the development of the FRamework Assessing Notorious Contributing Influences for Error (FRANCIE) with a taxonomy for airline maintenance tasks. The assignment of performance shaping factors to generic errors by experts proved to be valuable to qualitative modeling. Performance shaping factors and error types from such detailed approaches can be used to structure error reporting schemes. In a recent NASA Advanced Human Support Technology grant FRANCIE was refined, and two new taxonomies for use on space missions were developed. The development, sharing, and use of error taxonomies, and the refinement of approaches for increased fidelity of qualitative modeling is offered as a means to help direct useful data collection strategies.

  6. Voluntary Medical Incident Reporting Tool to Improve Physician Reporting of Medical Errors in an Emergency Department

    Directory of Open Access Journals (Sweden)

    Nnaemeka G. Okafor

    2015-12-01

    Full Text Available Introduction: Medical errors are frequently under-reported, yet their appropriate analysis, coupled with remediation, is essential for continuous quality improvement. The emergency department (ED is recognized as a complex and chaotic environment prone to errors. In this paper, we describe the design and implementation of a web-based ED-specific incident reporting system using an iterative process. Methods: A web-based, password-protected tool was developed by members of a quality assurance committee for ED providers to report incidents that they believe could impact patient safety. Results: The utilization of this system in one residency program with two academic sites resulted in an increase from 81 reported incidents in 2009, the first year of use, to 561 reported incidents in 2012. This is an increase in rate of reported events from 0.07% of all ED visits to 0.44% of all ED visits. In 2012, faculty reported 60% of all incidents, while residents and midlevel providers reported 24% and 16% respectively. The most commonly reported incidents were delays in care and management concerns. Conclusion: Error reporting frequency can be dramatically improved by using a web-based, userfriendly, voluntary, and non-punitive reporting system.

  7. Creation and implementation of department-wide structured reports: an analysis of the impact on error rate in radiology reports.

    Science.gov (United States)

    Hawkins, C Matthew; Hall, Seth; Zhang, Bin; Towbin, Alexander J

    2014-10-01

    The purpose of this study was to evaluate and compare textual error rates and subtypes in radiology reports before and after implementation of department-wide structured reports. Randomly selected radiology reports that were generated following the implementation of department-wide structured reports were evaluated for textual errors by two radiologists. For each report, the text was compared to the corresponding audio file. Errors in each report were tabulated and classified. Error rates were compared to results from a prior study performed prior to implementation of structured reports. Calculated error rates included the average number of errors per report, average number of nongrammatical errors per report, the percentage of reports with an error, and the percentage of reports with a nongrammatical error. Identical versions of voice-recognition software were used for both studies. A total of 644 radiology reports were randomly evaluated as part of this study. There was a statistically significant reduction in the percentage of reports with nongrammatical errors (33 to 26%; p = 0.024). The likelihood of at least one missense omission error (omission errors that changed the meaning of a phrase or sentence) occurring in a report was significantly reduced from 3.5 to 1.2% (p = 0.0175). A statistically significant reduction in the likelihood of at least one comission error (retained statements from a standardized report that contradict the dictated findings or impression) occurring in a report was also observed (3.9 to 0.8%; p = 0.0007). Carefully constructed structured reports can help to reduce certain error types in radiology reports.

  8. Medication Error Reporting Rate and its Barriers and Facilitators among Nurses

    Directory of Open Access Journals (Sweden)

    Snor Bayazidi

    2012-11-01

    Full Text Available Introduction: Medication errors are among the most prevalent medical errors leading to morbidity and mortality. Effective prevention of this type of errors depends on the presence of a well-organized reporting system. The purpose of this study was to explore medication error reporting rate and its barriers and facilitators among nurses in teaching hospitals of Urmia University of Medical Sciences (Iran.Methods: In a descriptive study in 2011, 733 nurses working in Urmia teaching hospitals were included. Data was collected using a questionnaire based on Haddon matrix. The questionnaire consisted of three items about medication error reporting rate, eight items on barriers of reporting, and seven items on facilitators of reporting. The collected data was analyzed by descriptive statistics in SPSS14.Results:The rate of reporting medication errors among nurses was far less than medication errors they had made. Nurses perceived that the most important barriers of reporting medication errors were blaming individuals instead of the system, consequences of reporting errors, and fear of reprimand and punishment. Some facilitating factors were also determined. Conclusion: Overall, the rate of medication errors was found to be much more than what had been reported by nurses. Therefore, it is suggested to train nurses and hospital administrators on facilitators and barriers of error reporting in order to enhance patient safety.

  9. The epidemiology and type of medication errors reported to the National Poisons Information Centre of Ireland.

    LENUS (Irish Health Repository)

    Cassidy, Nicola

    2012-02-01

    INTRODUCTION: Medication errors are widely reported for hospitalised patients, but limited data are available for medication errors that occur in community-based and clinical settings. Epidemiological data from poisons information centres enable characterisation of trends in medication errors occurring across the healthcare spectrum. AIM: The objective of this study was to characterise the epidemiology and type of medication errors reported to the National Poisons Information Centre (NPIC) of Ireland. METHODS: A 3-year prospective study on medication errors reported to the NPIC was conducted from 1 January 2007 to 31 December 2009 inclusive. Data on patient demographics, enquiry source, location, pharmaceutical agent(s), type of medication error, and treatment advice were collated from standardised call report forms. Medication errors were categorised as (i) prescribing error (i.e. physician error), (ii) dispensing error (i.e. pharmacy error), and (iii) administration error involving the wrong medication, the wrong dose, wrong route, or the wrong time. RESULTS: Medication errors were reported for 2348 individuals, representing 9.56% of total enquiries to the NPIC over 3 years. In total, 1220 children and adolescents under 18 years of age and 1128 adults (>\\/= 18 years old) experienced a medication error. The majority of enquiries were received from healthcare professionals, but members of the public accounted for 31.3% (n = 736) of enquiries. Most medication errors occurred in a domestic setting (n = 2135), but a small number occurred in healthcare facilities: nursing homes (n = 110, 4.68%), hospitals (n = 53, 2.26%), and general practitioner surgeries (n = 32, 1.36%). In children, medication errors with non-prescription pharmaceuticals predominated (n = 722) and anti-pyretics and non-opioid analgesics, anti-bacterials, and cough and cold preparations were the main pharmaceutical classes involved. Medication errors with prescription medication predominated for

  10. Evaluation of a Web-based Error Reporting Surveillance System in a Large Iranian Hospital.

    Science.gov (United States)

    Askarian, Mehrdad; Ghoreishi, Mahboobeh; Akbari Haghighinejad, Hourvash; Palenik, Charles John; Ghodsi, Maryam

    2017-08-01

    Proper reporting of medical errors helps healthcare providers learn from adverse incidents and improve patient safety. A well-designed and functioning confidential reporting system is an essential component to this process. There are many error reporting methods; however, web-based systems are often preferred because they can provide; comprehensive and more easily analyzed information. This study addresses the use of a web-based error reporting system. This interventional study involved the application of an in-house designed "voluntary web-based medical error reporting system." The system has been used since July 2014 in Nemazee Hospital, Shiraz University of Medical Sciences. The rate and severity of errors reported during the year prior and a year after system launch were compared. The slope of the error report trend line was steep during the first 12 months (B = 105.727, P = 0.00). However, it slowed following launch of the web-based reporting system and was no longer statistically significant (B = 15.27, P = 0.81) by the end of the second year. Most recorded errors were no-harm laboratory types and were due to inattention. Usually, they were reported by nurses and other permanent employees. Most reported errors occurred during morning shifts. Using a standardized web-based error reporting system can be beneficial. This study reports on the performance of an in-house designed reporting system, which appeared to properly detect and analyze medical errors. The system also generated follow-up reports in a timely and accurate manner. Detection of near-miss errors could play a significant role in identifying areas of system defects.

  11. Identifying medication error chains from critical incident reports: a new analytic approach.

    Science.gov (United States)

    Huckels-Baumgart, Saskia; Manser, Tanja

    2014-10-01

    Research into the distribution of medication errors usually focuses on isolated stages within the medication use process. Our study aimed to provide a novel process-oriented approach to medication incident analysis focusing on medication error chains. Our study was conducted across a 900-bed teaching hospital in Switzerland. All reported 1,591 medication errors 2009-2012 were categorized using the Medication Error Index NCC MERP and the WHO Classification for Patient Safety Methodology. In order to identify medication error chains, each reported medication incident was allocated to the relevant stage of the hospital medication use process. Only 25.8% of the reported medication errors were detected before they propagated through the medication use process. The majority of medication errors (74.2%) formed an error chain encompassing two or more stages. The most frequent error chain comprised preparation up to and including medication administration (45.2%). "Non-consideration of documentation/prescribing" during the drug preparation was the most frequent contributor for "wrong dose" during the administration of medication. Medication error chains provide important insights for detecting and stopping medication errors before they reach the patient. Existing and new safety barriers need to be extended to interrupt error chains and to improve patient safety.

  12. Error message recording and reporting in the SLC control system

    Energy Technology Data Exchange (ETDEWEB)

    Spencer, N.; Bogart, J.; Phinney, N.; Thompson, K.

    1985-04-01

    Error or information messages that are signaled by control software either in the VAX host computer or the local microprocessor clusters are handled by a dedicated VAX process (PARANOIA). Messages are recorded on disk for further analysis and displayed at the appropriate console. Another VAX process (ERRLOG) can be used to sort, list and histogram various categories of messages. The functions performed by these processes and the algorithms used are discussed.

  13. Error message recording and reporting in the SLC control system

    Energy Technology Data Exchange (ETDEWEB)

    Spencer, N.; Bogart, J.; Phinney, N.; Thompson, K.

    1985-10-01

    Error or information messages that are signaled by control software either in the VAX host computer or the local microprocessor clusters are handled by a dedicated VAX process (PARANOIA). Messages are recorded on disk for further analysis and displayed at the appropriate console. Another VAX process (ERRLOG) can be used to sort, list and histogram various categories of messages. The functions performed by these processes and the algorithms used are discussed.

  14. Effects of a pharmacist-led pediatrics medication safety team on medication-error reporting.

    Science.gov (United States)

    Costello, Jennifer L; Torowicz, Deborah Lloyd; Yeh, Timothy S

    2007-07-01

    The effects of a pharmacist-led pediatrics medication safety team (PMST) on the frequency and severity of medication errors reported were studied. This study was conducted in a pediatric critical care center (PCCC) in three phases. Phase 1 consisted of retrospective collection of medication-error reports before any interventions were made. Phases 2 and 3 included prospective collection of medication-error reports after several interventions. Phase 2 introduced a pediatrics clinical pharmacist to the PCCC. A pediatrics clinical pharmacist-led PMST (including a pediatrics critical care nurse and pediatrics intensivist), a new reporting form, and educational forums were added during phase 3 of the study. In addition, education focus groups were held for all intensive care unit staff. Outcomes for all phases were measured by the number of medication-error reports processed, the number of incidents, error severity, and the specialty of the reporter. Medication-error reporting increased twofold, threefold, and sixfold between phases 1 and 2, phases 2 and 3, and phases 1 and 3, respectively. Error severity decreased over the three time periods. In phases 1, 2, and 3, 46%, 8%, and 0% of the errors were classified as category D or E, respectively. Conversely, the reporting of near-miss errors increased from 9% in phase 1 to 38% in phase 2 and to 51% in phase 3. An increase in the number of medication errors reported and a decrease in the severity of errors reported were observed in a PCCC after implementation of a PMST, provision of education to health care providers, and addition of a clinical pharmacist.

  15. Republished error management: Descriptions of verbal communication errors between staff. An analysis of 84 root cause analysis-reports from Danish hospitals

    DEFF Research Database (Denmark)

    Rabøl, Louise Isager; Andersen, Mette Lehmann; Østergaard, Doris;

    2011-01-01

    incidents. The objective of this study is to review RCA reports (RCAR) for characteristics of verbal communication errors between hospital staff in an organisational perspective. Method Two independent raters analysed 84 RCARs, conducted in six Danish hospitals between 2004 and 2006, for descriptions...... and characteristics of verbal communication errors such as handover errors and error during teamwork. Results Raters found description of verbal communication errors in 44 reports (52%). These included handover errors (35 (86%)), communication errors between different staff groups (19 (43%)), misunderstandings (13...... (30%)), communication errors between junior and senior staff members (11 (25%)), hesitance in speaking up (10 (23%)) and communication errors during teamwork (8 (18%)). The kappa values were 0.44-0.78. Unproceduralized communication and information exchange via telephone, related to transfer between...

  16. Reporting error in weight and its implications for bias in economic models.

    Science.gov (United States)

    Cawley, John; Maclean, Johanna Catherine; Hammer, Mette; Wintfeld, Neil

    2015-12-01

    Most research on the economic consequences of obesity uses data on self-reported weight, which contains reporting error that has the potential to bias coefficient estimates in economic models. The purpose of this paper is to measure the extent and characteristics of reporting error in weight, and to examine its impact on regression coefficients in models of the healthcare consequences of obesity. We analyze data from the National Health and Nutrition Examination Survey (NHANES) for 2003-2010, which includes both self-reports and measurements of weight and height. We find that reporting error in weight is non-classical: underweight respondents tend to overreport, and overweight and obese respondents tend to underreport, their weight, with underreporting increasing in measured weight. This error results in roughly 1 out of 7 obese individuals being misclassified as non-obese. Reporting error is also correlated with other common regressors in economic models, such as education. Although it is a common misconception that reporting error always causes attenuation bias, comparisons of models that use self-reported and measured weight confirm that reporting error can cause upward bias in coefficient estimates. For example, use of self-reports leads to overestimates of the probability that an obese man uses a prescription drug, has a healthcare visit, or has a hospital admission. These findings underscore that models of the consequences of obesity should use measurements of weight, when available, and that social science datasets should measure weight rather than simply ask subjects to report their weight.

  17. Using Personnel and Financial Data for Reporting Purposes: What Are the Challenges to Using Such Data Accurately?

    Science.gov (United States)

    Valcik, Nicolas A.; Stigdon, Andrea D.

    2008-01-01

    Although institutional researchers devote a great deal of time mining and using student data to fulfill mandatory federal and state reports and analyze institutional effectiveness, financial and personnel information is also necessary for such endeavors. In this article, the authors discuss the challenges that arise from extracting data from…

  18. Comparing Graphical and Verbal Representations of Measurement Error in Test Score Reports

    Science.gov (United States)

    Zwick, Rebecca; Zapata-Rivera, Diego; Hegarty, Mary

    2014-01-01

    Research has shown that many educators do not understand the terminology or displays used in test score reports and that measurement error is a particularly challenging concept. We investigated graphical and verbal methods of representing measurement error associated with individual student scores. We created four alternative score reports, each…

  19. Comparing Graphical and Verbal Representations of Measurement Error in Test Score Reports

    Science.gov (United States)

    Zwick, Rebecca; Zapata-Rivera, Diego; Hegarty, Mary

    2014-01-01

    Research has shown that many educators do not understand the terminology or displays used in test score reports and that measurement error is a particularly challenging concept. We investigated graphical and verbal methods of representing measurement error associated with individual student scores. We created four alternative score reports, each…

  20. Learning without Borders: A Review of the Implementation of Medical Error Reporting in Medecins Sans Frontieres.

    Directory of Open Access Journals (Sweden)

    Leslie Shanks

    Full Text Available To analyse the results from the first 3 years of implementation of a medical error reporting system in Médecins Sans Frontières-Operational Centre Amsterdam (MSF programs.A medical error reporting policy was developed with input from frontline workers and introduced to the organisation in June 2010. The definition of medical error used was "the failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim." All confirmed error reports were entered into a database without the use of personal identifiers.179 errors were reported from 38 projects in 18 countries over the period of June 2010 to May 2013. The rate of reporting was 31, 42, and 106 incidents/year for reporting year 1, 2 and 3 respectively. The majority of errors were categorized as dispensing errors (62 cases or 34.6%, errors or delays in diagnosis (24 cases or 13.4% and inappropriate treatment (19 cases or 10.6%. The impact of the error was categorized as no harm (58, 32.4%, harm (70, 39.1%, death (42, 23.5% and unknown in 9 (5.0% reports. Disclosure to the patient took place in 34 cases (19.0%, did not take place in 46 (25.7%, was not applicable for 5 (2.8% cases and not reported for 94 (52.5%. Remedial actions introduced at headquarters level included guideline revisions and changes to medical supply procedures. At field level improvements included increased training and supervision, adjustments in staffing levels, and adaptations to the organization of the pharmacy.It was feasible to implement a voluntary reporting system for medical errors despite the complex contexts in which MSF intervenes. The reporting policy led to system changes that improved patient safety and accountability to patients. Challenges remain in achieving widespread acceptance of the policy as evidenced by the low reporting and disclosure rates.

  1. Economic evaluation of the impact of medication errors reported by U.S. clinical pharmacists.

    Science.gov (United States)

    Samp, Jennifer C; Touchette, Daniel R; Marinac, Jacqueline S; Kuo, Grace M

    2014-01-01

    Medication errors defined as "any preventable event that may cause or lead to inappropriate medication use or patient harm" have been highlighted as a top national priority in a report issued by the Institute of Medicine. However, little information is available on precise costs of medication errors. This study estimated the cost of medication errors reported by clinical pharmacists using a modified societal perspective. Information on 779 medication errors was collected in the Medication Error Detection, Amelioration and Prevention (MEDAP) study that documented medication errors observed by clinical pharmacists during a consecutive 14-day period. The rate of medication errors, outcomes (number of errors resulting in temporary/permanent patient harm, prolonged hospitalization, or life-sustaining therapy), and interventions (communication, medication changes, patient monitoring, and treatment referrals) were collected. A decision model was developed to estimate the economic impact of medication errors reported by clinical pharmacists. Event probabilities were derived from MEDAP data. Direct costs were obtained through reviews of the literature, hospital charge data, and Medicare and Medicaid reimbursement. One-way and Monte Carlo sensitivity analyses were used to explore uncertainty in the values. In the base case, the mean expected cost of a medication error was $88.57. In the Monte Carlo simulation, the mean cost was $89.35 (± $30.17 SD). One-way sensitivity analysis revealed that changes in the probability of medication errors causing hospitalization and the cost of hospitalization had the greatest variability on the outcome ($50.44-$155.81 [probability of hospitalization], $32.59-$136.40 [cost of hospitalization]). Medication errors are costly to the health care system. A better understanding of medication error costs may be used to justify initiatives to reduce the risk and inefficiency associated with these errors. © 2013 American College of Clinical

  2. A human error taxonomy for analysing healthcare incident reports: assessing reporting culture and its effects on safety perfomance

    DEFF Research Database (Denmark)

    Itoh, Kenji; Omata, N.; Andersen, Henning Boje

    2009-01-01

    The present paper reports on a human error taxonomy system developed for healthcare risk management and on its application to evaluating safety performance and reporting culture. The taxonomy comprises dimensions for classifying errors, for performance-shaping factors, and for the maturity...

  3. 45 CFR 61.6 - Reporting errors, omissions, revisions or whether an action is on appeal.

    Science.gov (United States)

    2010-10-01

    ... the reporting entity and the subject of the report. The HIPDB will not edit the statement; only the... 45 Public Welfare 1 2010-10-01 2010-10-01 false Reporting errors, omissions, revisions or whether... HEALTH CARE PROVIDERS, SUPPLIERS AND PRACTITIONERS Reporting of Information § 61.6 Reporting...

  4. The Relationship between Reports of Psychological Capital and Reports of Job Satisfaction among Administrative Personnel at a Private Institution of Higher Education

    Science.gov (United States)

    Mello, James A.

    2012-01-01

    The purpose of this single-site case study was to investigate the relationship between administrative personnel's reports of psychological capital (Luthans, Youssef, & Avolio, 2007) and their reports of job satisfaction (Hackman & Oldham, 1980). Specifically, two surveys, the Psychological Capital Questionnaire (Luthans, Youssef, &…

  5. Perceptions and Attitudes towards Medication Error Reporting in Primary Care Clinics: A Qualitative Study in Malaysia.

    Science.gov (United States)

    Samsiah, A; Othman, Noordin; Jamshed, Shazia; Hassali, Mohamed Azmi

    2016-01-01

    To explore and understand participants' perceptions and attitudes towards the reporting of medication errors (MEs). A qualitative study using in-depth interviews of 31 healthcare practitioners from nine publicly funded, primary care clinics in three states in peninsular Malaysia was conducted for this study. The participants included family medicine specialists, doctors, pharmacists, pharmacist assistants, nurses and assistant medical officers. The interviews were audiotaped and transcribed verbatim. Analysis of the data was guided by the framework approach. Six themes and 28 codes were identified. Despite the availability of a reporting system, most of the participants agreed that MEs were underreported. The nature of the error plays an important role in determining the reporting. The reporting system, organisational factors, provider factors, reporter's burden and benefit of reporting also were identified. Healthcare practitioners in primary care clinics understood the importance of reporting MEs to improve patient safety. Their perceptions and attitudes towards reporting of MEs were influenced by many factors which affect the decision-making process of whether or not to report. Although the process is complex, it primarily is determined by the severity of the outcome of the errors. The participants voluntarily report the errors if they are familiar with the reporting system, what error to report, when to report and what form to use.

  6. Self-reported histories of disease and vaccination against measles, mumps, rubella and varicella in health care personnel in Japan.

    Science.gov (United States)

    Kumakura, Shunichi; Onoda, Keiichi; Hirose, Masahiro

    2014-03-01

    Health care personnel are required to be immune against vaccine-preventable diseases, such as measles, mumps, rubella, and varicella. The aim of this study is to evaluate the accuracy of self-reported histories of disease and vaccination against measles, mumps, rubella, and varicella in order to determine the immune status of health care personnel. A self-reported questionnaire of history of previous disease and vaccination against these diseases was administered to a total of 910 health care personnel in Shimane university hospital in Japan, whose results were compared with serological evidences. There were numerous subjects who did not remember a history of disease (greater than 33% each) and of vaccination (greater than 58% each). Self-reported history of disease and vaccination had high positive predictive value against either disease for testing positive for antiviral antibodies. However, a considerable number of false-negative subjects could be found; 88.9% of subjects for measles, 89.3% for mumps, 62.2% for rubella and 96.3% for varicella in the population who had neither a self-reported history of disease nor a vaccination against each disease. In addition, regardless of the disease in question, a negative predictive value in self-reported history of disease and vaccination was remarkably low. These results suggest that self-reported history of disease and vaccination was not predictive to determine the accurate immune status of health care personnel against measles, mumps, rubella, and varicella. A seroprevalence survey, followed by an adequate immunization program for susceptible subjects, is crucial to prevent and control infection in hospital settings.

  7. Exploring the Effectiveness of a Measurement Error Tutorial in Helping Teachers Understand Score Report Results

    Science.gov (United States)

    Zapata-Rivera, Diego; Zwick, Rebecca; Vezzu, Margaret

    2016-01-01

    The goal of this study was to explore the effectiveness of a short web-based tutorial in helping teachers to better understand the portrayal of measurement error in test score reports. The short video tutorial included both verbal and graphical representations of measurement error. Results showed a significant difference in comprehension scores…

  8. Exploring the Effectiveness of a Measurement Error Tutorial in Helping Teachers Understand Score Report Results

    Science.gov (United States)

    Zapata-Rivera, Diego; Zwick, Rebecca; Vezzu, Margaret

    2016-01-01

    The goal of this study was to explore the effectiveness of a short web-based tutorial in helping teachers to better understand the portrayal of measurement error in test score reports. The short video tutorial included both verbal and graphical representations of measurement error. Results showed a significant difference in comprehension scores…

  9. Perceptions and Attitudes towards Medication Error Reporting in Primary Care Clinics: A Qualitative Study in Malaysia

    Science.gov (United States)

    Samsiah, A.; Othman, Noordin; Jamshed, Shazia; Hassali, Mohamed Azmi

    2016-01-01

    Objective To explore and understand participants’ perceptions and attitudes towards the reporting of medication errors (MEs). Methods A qualitative study using in-depth interviews of 31 healthcare practitioners from nine publicly funded, primary care clinics in three states in peninsular Malaysia was conducted for this study. The participants included family medicine specialists, doctors, pharmacists, pharmacist assistants, nurses and assistant medical officers. The interviews were audiotaped and transcribed verbatim. Analysis of the data was guided by the framework approach. Results Six themes and 28 codes were identified. Despite the availability of a reporting system, most of the participants agreed that MEs were underreported. The nature of the error plays an important role in determining the reporting. The reporting system, organisational factors, provider factors, reporter’s burden and benefit of reporting also were identified. Conclusions Healthcare practitioners in primary care clinics understood the importance of reporting MEs to improve patient safety. Their perceptions and attitudes towards reporting of MEs were influenced by many factors which affect the decision-making process of whether or not to report. Although the process is complex, it primarily is determined by the severity of the outcome of the errors. The participants voluntarily report the errors if they are familiar with the reporting system, what error to report, when to report and what form to use. PMID:27906960

  10. Republished error management: Descriptions of verbal communication errors between staff. An analysis of 84 root cause analysis-reports from Danish hospitals

    DEFF Research Database (Denmark)

    Rabøl, Louise Isager; Andersen, Mette Lehmann; Østergaard, Doris;

    2011-01-01

    Introduction Poor teamwork and communication between healthcare staff are correlated to patient safety incidents. However, the organisational factors responsible for these issues are unexplored. Root cause analyses (RCA) use human factors thinking to analyse the systems behind severe patient safety...... incidents. The objective of this study is to review RCA reports (RCAR) for characteristics of verbal communication errors between hospital staff in an organisational perspective. Method Two independent raters analysed 84 RCARs, conducted in six Danish hospitals between 2004 and 2006, for descriptions...... and characteristics of verbal communication errors such as handover errors and error during teamwork. Results Raters found description of verbal communication errors in 44 reports (52%). These included handover errors (35 (86%)), communication errors between different staff groups (19 (43%)), misunderstandings (13...

  11. Changes to Hospital Inpatient Volume After Newspaper Reporting of Medical Errors.

    Science.gov (United States)

    Fukuda, Haruhisa

    2017-06-30

    The aim of this study was to investigate the influence of medical error case reporting by national newspapers on inpatient volume at acute care hospitals. A case-control study was conducted using the article databases of 3 major Japanese newspapers with nationwide circulation between fiscal years 2012 and 2013. Data on inpatient volume at acute care hospitals were obtained from a Japanese government survey between fiscal years 2011 and 2014. Panel data were constructed and analyzed using a difference-in-differences design. Acute care hospitals in Japan. Hospitals named in articles that included the terms "medical error" and "hospital" were designated case hospitals, which were matched with control hospitals using corresponding locations, nurse-to-patient ratios, and bed numbers. Medical error case reporting in newspapers. Changes to hospital inpatient volume after error reports. The sample comprised 40 case hospitals and 40 control hospitals. Difference-in-differences analyses indicated that newspaper reporting of medical errors was not significantly associated (P = 0.122) with overall inpatient volume. Medical error case reporting by newspapers showed no influence on inpatient volume. Hospitals therefore have little incentive to respond adequately and proactively to medical errors. There may be a need for government intervention to improve the posterror response and encourage better health care safety.

  12. Medication errors with the use of allopurinol and colchicine : A retrospective study of a national, anonymous Internet-accessible error reporting system

    NARCIS (Netherlands)

    Mikuls, TR; Curtis, [No Value; Allison, JJ; Hicks, RW; Saag, KG

    2006-01-01

    Objectives. To more closely assess medication errors in gout care, we examined data from a national, Internet-accessible error reporting program over a 5-year reporting period. Methods. We examined data from the MEDMARX (TM) database, covering the period from January 1, 1999 through December 31, 200

  13. Comparison of two self-reported measures of physical work demands in hospital personnel: a cross-sectional study

    DEFF Research Database (Denmark)

    Nabe-Nielsen, Kirsten; Fallentin, Nils; Christensen, Karl B

    2008-01-01

    BACKGROUND: Low back pain (LBP) is a frequent health complaint among health care personnel. Several work tasks and working postures are associated with an increased risk of LBP. The aim of this study was to compare two self-reported measures of physical demands and their association with LBP (the...... seems to be a more feasible measure of exposure when assessing the risk of LBP compared to more advanced measures of physical load on the lower lumbar spine....

  14. Delineation of Roles and Functions of Respiratory Therapy Personnel. Final Report.

    Science.gov (United States)

    American Association for Respiratory Therapy, Dallas, TX.

    Frequently assigned tasks performed by qualified respiratory therapy personnel are delineated in the document in such a manner that proficiency examinations within the profession can be prepared from them. Four distinct proficiency levels are identified and defined. Due to the fact that proficiency examinations will be assigned for them,…

  15. Development of Proficiency Examinations and Procedures for Two Levels of Respiratory Therapy Personnel. Final Report.

    Science.gov (United States)

    Psychological Corp., New York, NY.

    Under the guidance of an advisory committee from the American Association for Respiratory Therapy (AART), The Psychological Corporation developed three forms of two criterion-referenced proficiency examinations to measure the skills, understandings, and knowledge required in entry level jobs for two levels of respiratory therapy personnel. The…

  16. Medication Errors: A Characterisation of Spontaneously Reported Cases in EudraVigilance.

    Science.gov (United States)

    Newbould, Victoria; Le Meur, Steven; Goedecke, Thomas; Kurz, Xavier

    2017-07-11

    Medication errors recently became the focus of regulatory guidance in pharmacovigilance to support reporting, evaluation and prevention of medication errors. This study aims to characterise spontaneously reported cases of medication errors in EudraVigilance over the period 2002-2015 before the release of EU good practice guidance. Case reports were identified through the adverse reaction section where a Medical Dictionary for Regulatory Activities (MedDRA(®)) term is reported and included in the Standardised MedDRA(®) Query (SMQ) for medication errors. These case reports were further categorised by MedDRA(®) terms, geographical region, patient age group and Anatomical Therapeutic Chemical classification system of suspect medicinal product(s). A total of 147,824 case reports were retrieved, 41,355 of which were from the European Economic Area (EEA). Approximately 60% of these case reports were retrieved with the narrow SMQ. The absolute number of medication error case reports and the proportion to the total number of reports in EudraVigilance increased during the study period, with peaks seen around 2005 and 2012 for cases with EEA origin. Fifty-two percent of case reports in which age was provided occurred in adults, 30% in the elderly and 18% in children, with almost half of these in children aged 2 months to 2 years. Case reports of medication errors in EudraVigilance steadily increased between 2005 and 2015, the reasons for which may be multifactorial, including increased awareness, changes to the MedDRA(®) terminology and the 2012 EU pharmacovigilance legislation and associated guidance for stakeholders, or a generally increased risk for errors as more medications become available.

  17. [Preliminary Study on Error Control of Medical Devices Test Reports Based on the Analytic Hierarchy Process].

    Science.gov (United States)

    Huang, Yanhong; Xu, Honglei; Tu, Rong; Zhang, Xu; Huang, Min

    2016-01-01

    In this paper, the common errors in medical devices test reports are classified and analyzed. And then the main 11 influence factors for these inspection report errors are summarized. The hierarchy model was also developed and verified by presentation data using MATLAB. The feasibility of comprehensive weights quantitative comparison has been analyzed by using the analytic hierarchy process. In the end, this paper porspects the further research direction.

  18. Models of cognitive behavior in nuclear power plant personnel. A feasibility study: main report. Volume 2

    Energy Technology Data Exchange (ETDEWEB)

    Woods, D.D.; Roth, E.M.; Hanes, L.F.

    1986-07-01

    This report contains the results of a feasibility study to determine if the current state of models human cognitive activities can serve as the basis for improved techniques for predicting human error in nuclear power plants emergency operations. Based on the answer to this questions, two subsequent phases of research are planned. Phase II is to develop a model of cognitive activities, and Phase III is to test the model. The feasibility study included an analysis of the cognitive activities that occur in emergency operations and an assessment of the modeling concepts/tools available to capture these cognitive activities. The results indicated that a symbolic processing (or artificial intelligence) model of cognitive activities in nuclear power plants is both desirable and feasible. This cognitive model can be built upon the computational framework provided by an existing artificial intelligence system for medical problem solving called Caduceus. The resulting cognitive model will increase the capability to capture the human contribution to risk in probabilistic risk assessments studies. Volume I summarizes the major findings and conclusions of the study. Volume II provides a complete description of the methods and results, including a synthesis of the cognitive activities that occur during emergency operations, and a literature review on cognitive modeling relevant to nuclear power plants. 112 refs., 10 figs.

  19. The Relationship Between Nursing Experience and Education and the Occurrence of Reported Pediatric Medication Administration Errors.

    Science.gov (United States)

    Sears, Kim; O'Brien-Pallas, Linda; Stevens, Bonnie; Murphy, Gail Tomblin

    2016-01-01

    Medication errors are one of the most common incidents in the hospitals. They can be harmful, and they are even more detrimental for pediatric patients. This study explored the relationship between nursing experience, education, the frequency and severity of reported pediatric medication administration errors (PMAEs). The data for this study were collected from a larger pan Canadian study. A survey tool was developed to collect self-reported data from nurses. In addition to descriptive statistics, a Poisson regression or a multiple linear regression was completed to address the research questions, and a Boneferrai correction was conducted to adjust for the small sample size. Results demonstrated that on units with more nurses with a higher level of current experience, more PMAEs were reported (p=.001), however; the PMAEs reported by these nurses were not as severe (p=.003). Implications to advance both safe medication delivery in the pediatric setting and safe culture of reporting for both actual and potential errors are identified.

  20. Republished error management: Descriptions of verbal communication errors between staff. An analysis of 84 root cause analysis-reports from Danish hospitals.

    Science.gov (United States)

    Rabøl, Louise Isager; Andersen, Mette Lehmann; Ostergaard, Doris; Bjørn, Brian; Lilja, Beth; Mogensen, Torben

    2011-11-01

    Poor teamwork and communication between healthcare staff are correlated to patient safety incidents. However, the organisational factors responsible for these issues are unexplored. Root cause analyses (RCA) use human factors thinking to analyse the systems behind severe patient safety incidents. The objective of this study is to review RCA reports (RCAR) for characteristics of verbal communication errors between hospital staff in an organisational perspective. Two independent raters analysed 84 RCARs, conducted in six Danish hospitals between 2004 and 2006, for descriptions and characteristics of verbal communication errors such as handover errors and error during teamwork. Raters found description of verbal communication errors in 44 reports (52%). These included handover errors (35 (86%)), communication errors between different staff groups (19 (43%)), misunderstandings (13 (30%)), communication errors between junior and senior staff members (11 (25%)), hesitance in speaking up (10 (23%)) and communication errors during teamwork (8 (18%)). The kappa values were 0.44-0.78. Unproceduralized communication and information exchange via telephone, related to transfer between units and consults from other specialties, were particularly vulnerable processes. With the risk of bias in mind, it is concluded that more than half of the RCARs described erroneous verbal communication between staff members as root causes of or contributing factors of severe patient safety incidents. The RCARs rich descriptions of the incidents revealed the organisational factors and needs related to these errors.

  1. [Learning from mistakes in hospitals. A system perspective on errors and incident reporting systems].

    Science.gov (United States)

    Hofinger, G

    2009-06-01

    Analysis of incidents and near-incidents is an important factor for continuous improvement in patient safety in hospitals and for the promotion of organizational learning. From a system perspective, accidents occur when decision-making at several levels of a working system is faulty and the safety barriers fail. Human error is inevitable but accidents are not. Errors can be used as an opportunity for organizational learning and this is especially true for incidents when patients come to no harm. Starting with explanations of a system perspective on errors, this paper deals with the prerequisites for organizational learning and general rules for establishing incident reporting systems in hospitals.

  2. Error detection and reduction in blood banking.

    Science.gov (United States)

    Motschman, T L; Moore, S B

    1996-12-01

    Error management plays a major role in facility process improvement efforts. By detecting and reducing errors, quality and, therefore, patient care improve. It begins with a strong organizational foundation of management attitude with clear, consistent employee direction and appropriate physical facilities. Clearly defined critical processes, critical activities, and SOPs act as the framework for operations as well as active quality monitoring. To assure that personnel can detect an report errors they must be trained in both operational duties and error management practices. Use of simulated/intentional errors and incorporation of error detection into competency assessment keeps employees practiced, confident, and diminishes fear of the unknown. Personnel can clearly see that errors are indeed used as opportunities for process improvement and not for punishment. The facility must have a clearly defined and consistently used definition for reportable errors. Reportable errors should include those errors with potentially harmful outcomes as well as those errors that are "upstream," and thus further away from the outcome. A well-written error report consists of who, what, when, where, why/how, and follow-up to the error. Before correction can occur, an investigation to determine the underlying cause of the error should be undertaken. Obviously, the best corrective action is prevention. Correction can occur at five different levels; however, only three of these levels are directed at prevention. Prevention requires a method to collect and analyze data concerning errors. In the authors' facility a functional error classification method and a quality system-based classification have been useful. An active method to search for problems uncovers them further upstream, before they can have disastrous outcomes. In the continual quest for improving processes, an error management program is itself a process that needs improvement, and we must strive to always close the circle

  3. Outlier Removal and the Relation with Reporting Errors and Quality of Psychological Research

    Science.gov (United States)

    Bakker, Marjan; Wicherts, Jelte M.

    2014-01-01

    Background The removal of outliers to acquire a significant result is a questionable research practice that appears to be commonly used in psychology. In this study, we investigated whether the removal of outliers in psychology papers is related to weaker evidence (against the null hypothesis of no effect), a higher prevalence of reporting errors, and smaller sample sizes in these papers compared to papers in the same journals that did not report the exclusion of outliers from the analyses. Methods and Findings We retrieved a total of 2667 statistical results of null hypothesis significance tests from 153 articles in main psychology journals, and compared results from articles in which outliers were removed (N = 92) with results from articles that reported no exclusion of outliers (N = 61). We preregistered our hypotheses and methods and analyzed the data at the level of articles. Results show no significant difference between the two types of articles in median p value, sample sizes, or prevalence of all reporting errors, large reporting errors, and reporting errors that concerned the statistical significance. However, we did find a discrepancy between the reported degrees of freedom of t tests and the reported sample size in 41% of articles that did not report removal of any data values. This suggests common failure to report data exclusions (or missingness) in psychological articles. Conclusions We failed to find that the removal of outliers from the analysis in psychological articles was related to weaker evidence (against the null hypothesis of no effect), sample size, or the prevalence of errors. However, our control sample might be contaminated due to nondisclosure of excluded values in articles that did not report exclusion of outliers. Results therefore highlight the importance of more transparent reporting of statistical analyses. PMID:25072606

  4. The prevalence of statistical reporting errors in psychology (1985-2013)

    NARCIS (Netherlands)

    Nuijten, M.B.; Hartgerink, C.H.J.; van Assen, M.A.L.M.; Epskamp, S.; Wicherts, J.M.

    2016-01-01

    This study documents reporting errors in a sample of over 250,000 p-values reported in eight major psychology journals from 1985 until 2013, using the new R package “statcheck.” statcheck retrieved null-hypothesis significance testing (NHST) results from over half of the articles from this period. I

  5. Errors in self-reports of health services use: impact on alzheimer disease clinical trial designs.

    Science.gov (United States)

    Callahan, Christopher M; Tu, Wanzhu; Stump, Timothy E; Clark, Daniel O; Unroe, Kathleen T; Hendrie, Hugh C

    2015-01-01

    Most Alzheimer disease clinical trials that compare the use of health services rely on reports of caregivers. The goal of this study was to assess the accuracy of self-reports among older adults with Alzheimer disease and their caregiver proxy respondents. This issue is particularly relevant to Alzheimer disease clinical trials because inaccuracy can lead both to loss of power and increased bias in study outcomes. We compared respondent accuracy in reporting any use and in reporting the frequency of use with actual utilization data as documented in a comprehensive database. We next simulated the impact of underreporting and overreporting on sample size estimates and treatment effect bias for clinical trials comparing utilization between experimental groups. Respondents self-reports have a poor level of accuracy with κ-values often below 0.5. Respondents tend to underreport use even for rare events such as hospitalizations and nursing home stays. In analyses simulating underreporting and overreporting of varying magnitude, we found that errors in self-reports can increase the required sample size by 15% to 30%. In addition, bias in the reported treatment effect ranged from 3% to 18% due to both underreporting and overreporting errors. Use of self-report data in clinical trials of Alzheimer disease treatments may inflate sample size needs. Even when adequate power is achieved by increasing sample size, reporting errors can result in a biased estimate of the true effect size of the intervention.

  6. Survey of nursing perceptions of medication administration practices, perceived sources of errors and reporting behaviours.

    Science.gov (United States)

    Armutlu, Markirit; Foley, Mary-Lou; Surette, Judy; Belzile, Eric; McCusker, Jane

    2008-01-01

    In January 2003, St. Mary's Hospital Center in Montreal, Quebec, established an interdisciplinary Committee on the Systematic Approach to Medication Error Control to review the whole process of medication administration within the hospital and to develop a systematic approach to medication error control. A cross-sectional survey on medication administration practices, perceived sources of errors and medication error reporting of nurses, adapted from a nursing practice survey and medication variance report (Sim and Joyner 2002), was conducted over a two-week period in February 2004. The results were analyzed by years of experience (greater or less than five years) and patient care unit of practice. The perceived source of error most often cited was transcription (processing), and the second most frequently cited source was the legibility of handwritten medication orders (prescribing). The results demonstrate no significant difference in medication safety practices or in perceptions of errors by years of experience. Nurses appear to adapt to the safety culture of the unit rather quickly, certainly within their first five years on the unit. Good medication error reporting behaviour was noted, with no differences between all comparative groups within both years of experience and unit of practice. Quality improvement initiatives to improve the safety of medication administration practices have included the development of a nursing medication administration handbook, the revision of policies and procedures related to medication administration safety, the standardization of solutions and limited variety of high-risk medication dosages and the reduction of handwritten reorders. The need for ongoing education and information sessions on policies and procedures specific to safe medication practices for all nurses, regardless of years of experience, was identified.

  7. Radiological reporting that combine continuous speech recognition with error correction by transcriptionists.

    Science.gov (United States)

    Ichikawa, Tamaki; Kitanosono, Takashi; Koizumi, Jun; Ogushi, Yoichi; Tanaka, Osamu; Endo, Jun; Hashimoto, Takeshi; Kawada, Shuichi; Saito, Midori; Kobayashi, Makiko; Imai, Yutaka

    2007-12-20

    We evaluated the usefulness of radiological reporting that combines continuous speech recognition (CSR) and error correction by transcriptionists. Four transcriptionists (two with more than 10 years' and two with less than 3 months' transcription experience) listened to the same 100 dictation files and created radiological reports using conventional transcription and a method that combined CSR with manual error correction by the transcriptionists. We compared the 2 groups using the 2 methods for accuracy and report creation time and evaluated the transcriptionists' inter-personal dependence on accuracy rate and report creation time. We used a CSR system that did not require the training of the system to recognize the user's voice. We observed no significant difference in accuracy between the 2 groups and 2 methods that we tested, though transcriptionists with greater experience transcribed faster than those with less experience using conventional transcription. Using the combined method, error correction speed was not significantly different between two groups of transcriptionists with different levels of experience. Combining CSR and manual error correction by transcriptionists enabled convenient and accurate radiological reporting.

  8. Designing a national combined reporting form for adverse drug reactions and medication errors.

    Science.gov (United States)

    Tanti, A; Serracino-Inglott, A; Borg, J J

    2015-06-09

    The Maltese Medicines Authority was tasked with developing a reporting form that captures high-quality case information on adverse drug reactions (ADRs) and medication errors in order to fulfil its public-health obligations set by the European Union (EU) legislation on pharmacovigilance. This paper describes the process of introducing the first combined ADR/medication error reporting form in the EU for health-care professionals, the analysis of reports generated by it and the promotion of the system. A review of existing ADR forms was carried out and recommendations from the European Medicines Agency and World Health Organization audits integrated. A new, combined ADR/medication error reporting form was developed and pilot tested based on case studies. The Authority's quality system (ISO 9001 certified) was redesigned and a promotion strategy was deployed. The process used in Malta can be useful for countries that need to develop systems relative to ADR/medication error reporting and to improve the quality of data capture within their systems.

  9. Factors affecting nursing students' intention to report medication errors: An application of the theory of planned behavior.

    Science.gov (United States)

    Ben Natan, Merav; Sharon, Ira; Mahajna, Marlen; Mahajna, Sara

    2017-11-01

    Medication errors are common among nursing students. Nonetheless, these errors are often underreported. To examine factors related to nursing students' intention to report medication errors, using the Theory of Planned Behavior, and to examine whether the theory is useful in predicting students' intention to report errors. This study has a descriptive cross-sectional design. Study population was recruited in a university and a large nursing school in central and northern Israel. A convenience sample of 250 nursing students took part in the study. The students completed a self-report questionnaire, based on the Theory of Planned Behavior. The findings indicate that students' intention to report medication errors was high. The Theory of Planned Behavior constructs explained 38% of variance in students' intention to report medication errors. The constructs of behavioral beliefs, subjective norms, and perceived behavioral control were found as affecting this intention, while the most significant factor was behavioral beliefs. The findings also reveal that students' fear of the reaction to disclosure of the error from superiors and colleagues may impede them from reporting the error. Understanding factors related to reporting medication errors is crucial to designing interventions that foster error reporting. Copyright © 2017 Elsevier Ltd. All rights reserved.

  10. Medication errors: an analysis comparing PHICO's closed claims data and PHICO's Event Reporting Trending System (PERTS).

    Science.gov (United States)

    Benjamin, David M; Pendrak, Robert F

    2003-07-01

    Clinical pharmacologists are all dedicated to improving the use of medications and decreasing medication errors and adverse drug reactions. However, quality improvement requires that some significant parameters of quality be categorized, measured, and tracked to provide benchmarks to which future data (performance) can be compared. One of the best ways to accumulate data on medication errors and adverse drug reactions is to look at medical malpractice data compiled by the insurance industry. Using data from PHICO insurance company, PHICO's Closed Claims Data, and PHICO's Event Reporting Trending System (PERTS), this article examines the significance and trends of the claims and events reported between 1996 and 1998. Those who misread history are doomed to repeat the mistakes of the past. From a quality improvement perspective, the categorization of the claims and events is useful for reengineering integrated medication delivery, particularly in a hospital setting, and for redesigning drug administration protocols on low therapeutic index medications and "high-risk" drugs. Demonstrable evidence of quality improvement is being required by state laws and by accreditation agencies. The state of Florida requires that quality improvement data be posted quarterly on the Web sites of the health care facilities. Other states have followed suit. The insurance industry is concerned with costs, and medication errors cost money. Even excluding costs of litigation, an adverse drug reaction may cost up to $2500 in hospital resources, and a preventable medication error may cost almost $4700. To monitor costs and assess risk, insurance companies want to know what errors are made and where the system has broken down, permitting the error to occur. Recording and evaluating reliable data on adverse drug events is the first step in improving the quality of pharmacotherapy and increasing patient safety. Cost savings and quality improvement evolve on parallel paths. The PHICO data

  11. Knowledge, Attitude, and Practice towards Medication Errors and Adverse Drug Reaction Reporting among Medicine Students

    Directory of Open Access Journals (Sweden)

    Maryam Aghakouchakzadeh

    2017-03-01

    Full Text Available Background: The most common types of medical error are medication errors (MEs which defined as any preventable event that may be caused by an inappropriate medication usage and lead to an adverse drug reaction (ADR event in patients. In recent years, different approaches have been proposed to reduce MEs, one of which is reporting ADRs. The present study was designed to assess the Knowledge, Attitude and Practice (KAP of medicine students towards MEs and ADRs reporting.Method: The validated 12-item questionnaire included subsequently 4 questions, 5 items and the final 3 questions related to the knowledge, attitude, and practice that was given to each participant before and after of the clerkship course. The study population were 40 students of fourth-year of medicine.Results: Demographic features of the participants have no significant difference. Medicine students had a poor KAP towards MEs. Only 8% of respondents had general knowledge about MEs and 50% of students believed MEs are inevitable events, less than 20% of them were acquainted with 5 rules of prescriptions. Students had good knowledge and attitude but poor practice towards ADRs reporting. 55% of participants were aware of their responsibility of ADRs reporting but only 5% of respondents were acquainted with ADRs reporting method and the ADR center in the hospitals.Conclusion: The educational intervention, alteration in medicine student’s curriculum, and hold the interactive clerkship for health care professionals can improve the KAP towards ADRs reporting and diminish of the preventable medication errors.

  12. Factors influencing medication errors according to nurses' decisions to do self-report

    Directory of Open Access Journals (Sweden)

    Foad Rahimi

    2015-02-01

    Conclusions: The results of this study showed that the most important factors affecting the incidence of errors include workplace stress, working in the intensive care units, tiredness due to work load, and inappropriate nurse physician relationship. Hence, identification of these factors helps nurses to reduce errors and helps reduce other medical consequences and improve in the quality of patient care and patient safety. Regarding the importance of patient safety it is necessary to improve positive relationship between nurse managers and nursing staff. Therefore, an environment of close collaboration, in-service training for new nurses regarding medication errors, and creating a reporting system is necessary. [Int J Basic Clin Pharmacol 2015; 4(1.000: 130-133

  13. Measurement error of self-reported physical activity levels in New York City: assessment and correction.

    Science.gov (United States)

    Lim, Sungwoo; Wyker, Brett; Bartley, Katherine; Eisenhower, Donna

    2015-05-01

    Because it is difficult to objectively measure population-level physical activity levels, self-reported measures have been used as a surveillance tool. However, little is known about their validity in populations living in dense urban areas. We aimed to assess the validity of self-reported physical activity data against accelerometer-based measurements among adults living in New York City and to apply a practical tool to adjust for measurement error in complex sample data using a regression calibration method. We used 2 components of data: 1) dual-frame random digit dialing telephone survey data from 3,806 adults in 2010-2011 and 2) accelerometer data from a subsample of 679 survey participants. Self-reported physical activity levels were measured using a version of the Global Physical Activity Questionnaire, whereas data on weekly moderate-equivalent minutes of activity were collected using accelerometers. Two self-reported health measures (obesity and diabetes) were included as outcomes. Participants with higher accelerometer values were more likely to underreport the actual levels. (Accelerometer values were considered to be the reference values.) After correcting for measurement errors, we found that associations between outcomes and physical activity levels were substantially deattenuated. Despite difficulties in accurately monitoring physical activity levels in dense urban areas using self-reported data, our findings show the importance of performing a well-designed validation study because it allows for understanding and correcting measurement errors.

  14. Descriptions of verbal communication errors between staff. An analysis of 84 root cause analysis-reports from Danish hospitals

    DEFF Research Database (Denmark)

    Rabøl, Louise Isager; Østergaard, Doris; Jensen, Brian Bjørn

    2011-01-01

    incidents. The objective of this study is to review RCA reports (RCAR) for characteristics of verbal communication errors between hospital staff in an organisational perspective. Method Two independent raters analysed 84 RCARs, conducted in six Danish hospitals between 2004 and 2006, for descriptions...... and characteristics of verbal communication errors such as handover errors and error during teamwork. Results Raters found description of verbal communication errors in 44 reports (52%). These included handover errors (35 (86%)), communication errors between different staff groups (19 (43%)), misunderstandings (13...... units and consults from other specialties, were particularly vulnerable processes. Conclusion With the risk of bias in mind, it is concluded that more than half of the RCARs described erroneous verbal communication between staff members as root causes of or contributing factors of severe patient safety...

  15. Orientation/Disorientation Training of Flying Personnel: A Working Group Report

    Science.gov (United States)

    1974-11-01

    AEROSPACE RESEARCH AND DEVELOPMENT (ORGANISATION DU TRATTE DE L’ATLANTIQUE NORD ) I I I AGARD REPORT No.62S ORIENTATION/DISORIENTATION TRAINING OF...signal caused by malfunction or dynamic limitations. Vision impaired by nystagmus, glare, flash etc. c. Vestibular and other receptors: Fail to

  16. Focus on Crisis Prevention: A Manual for School Administrators and Student Activities Personnel. A Report.

    Science.gov (United States)

    Previdi, Caesar; Weiss, Mark

    Strategies, materials, techniques, and practices actually utilized to alleviate crisis conditions and to promote constructive school atmosphere in integrated schools in New York City are described in this report. The activities detailed here were developed as part of New York City's Easing Student Adjustment Program, but they are suitable for…

  17. Medication Errors in a Swiss Cardiovascular Surgery Department: A Cross-Sectional Study Based on a Novel Medication Error Report Method

    Directory of Open Access Journals (Sweden)

    Kaspar Küng

    2013-01-01

    Full Text Available The purpose of this study was (1 to determine frequency and type of medication errors (MEs, (2 to assess the number of MEs prevented by registered nurses, (3 to assess the consequences of ME for patients, and (4 to compare the number of MEs reported by a newly developed medication error self-reporting tool to the number reported by the traditional incident reporting system. We conducted a cross-sectional study on ME in the Cardiovascular Surgery Department of Bern University Hospital in Switzerland. Eligible registered nurses ( involving in the medication process were included. Data on ME were collected using an investigator-developed medication error self reporting tool (MESRT that asked about the occurrence and characteristics of ME. Registered nurses were instructed to complete a MESRT at the end of each shift even if there was no ME. All MESRTs were completed anonymously. During the one-month study period, a total of 987 MESRTs were returned. Of the 987 completed MESRTs, 288 (29% indicated that there had been an ME. Registered nurses reported preventing 49 (5% MEs. Overall, eight (2.8% MEs had patient consequences. The high response rate suggests that this new method may be a very effective approach to detect, report, and describe ME in hospitals.

  18. Continuing Assessment of Cleared Personnel in the Military Services. Report 2. Methodology, Analysis, and Results

    Science.gov (United States)

    1991-01-01

    contrast, the sources least likely to report information directly to the security office are dropboxes , chaplains, non-law enforcement databases...the polygraph, informants, subjects, family members, and dropboxes . Respondents were asked whether any additional sources of security-relevant...and Mean Ratings by Collateral Installation Security Managers of the Usefulness of These Sources Mean Source N Rating Dropboxes 1 10.0 Chaplains 1 10.0

  19. Modeling workplace contact networks: The effects of organizational structure, architecture, and reporting errors on epidemic predictions.

    Science.gov (United States)

    Potter, Gail E; Smieszek, Timo; Sailer, Kerstin

    2015-09-01

    Face-to-face social contacts are potentially important transmission routes for acute respiratory infections, and understanding the contact network can improve our ability to predict, contain, and control epidemics. Although workplaces are important settings for infectious disease transmission, few studies have collected workplace contact data and estimated workplace contact networks. We use contact diaries, architectural distance measures, and institutional structures to estimate social contact networks within a Swiss research institute. Some contact reports were inconsistent, indicating reporting errors. We adjust for this with a latent variable model, jointly estimating the true (unobserved) network of contacts and duration-specific reporting probabilities. We find that contact probability decreases with distance, and that research group membership, role, and shared projects are strongly predictive of contact patterns. Estimated reporting probabilities were low only for 0-5 min contacts. Adjusting for reporting error changed the estimate of the duration distribution, but did not change the estimates of covariate effects and had little effect on epidemic predictions. Our epidemic simulation study indicates that inclusion of network structure based on architectural and organizational structure data can improve the accuracy of epidemic forecasting models.

  20. Training Program for Louisiana Correctional, Probation and Parole Personnel; A Study of Present and Future Needs. Final Report.

    Science.gov (United States)

    Louisiana State Univ., Baton Rouge. Div. of Continuing Education.

    Training needs of probation and parole officers and personnel in penal institutions of Louisiana were determined by surveys of personnel background, education, age, experience, and expressed needs, in order to determine subject matter and potential enrollment of inservice classes. Questionnaires collected information from 53 probation and parole…

  1. Accounting for sampling variability, injury under-reporting, and sensor error in concussion injury risk curves.

    Science.gov (United States)

    Elliott, Michael R; Margulies, Susan S; Maltese, Matthew R; Arbogast, Kristy B

    2015-09-18

    There has been recent dramatic increase in the use of sensors affixed to the heads or helmets of athletes to measure the biomechanics of head impacts that lead to concussion. The relationship between injury and linear or rotational head acceleration measured by such sensors can be quantified with an injury risk curve. The utility of the injury risk curve relies on the accuracy of both the clinical diagnosis and the biomechanical measure. The focus of our analysis was to demonstrate the influence of three sources of error on the shape and interpretation of concussion injury risk curves: sampling variability associated with a rare event, concussion under-reporting, and sensor measurement error. We utilized Bayesian statistical methods to generate synthetic data from previously published concussion injury risk curves developed using data from helmet-based sensors on collegiate football players and assessed the effect of the three sources of error on the risk relationship. Accounting for sampling variability adds uncertainty or width to the injury risk curve. Assuming a variety of rates of unreported concussions in the non-concussed group, we found that accounting for under-reporting lowers the rotational acceleration required for a given concussion risk. Lastly, after accounting for sensor error, we find strengthened relationships between rotational acceleration and injury risk, further lowering the magnitude of rotational acceleration needed for a given risk of concussion. As more accurate sensors are designed and more sensitive and specific clinical diagnostic tools are introduced, our analysis provides guidance for the future development of comprehensive concussion risk curves.

  2. Latex glove sensitivity amongst diagnostic imaging healthcare personnel: a self-reporting investigation

    Energy Technology Data Exchange (ETDEWEB)

    Healy, Jan; Brennan, Patrick C. E-mail: patrick.brennan@ucd.ie; Bowden, Julie Anne

    2003-02-01

    The use of latex gloves has risen dramatically among healthcare workers resulting in an increase in the number of workers experiencing reactions to gloves. Little evidence of reactions among Irish healthcare workers is available. The current, self-reporting study investigated the prevalence to latex gloves amongst four professional groups within three Diagnostic Imaging Departments. Prevalence is similar to that demonstrated elsewhere with 18.3% of individuals expressing latex associated symptoms. Symptoms included itching and redness of hands, dry cracked skin, soreness of eyes and upper respiratory tract complaints. These results indicate that latex hypersensitivity is a real problem amongst Irish healthcare workers. This preliminary work provides the basis of a much larger controlled study currently being planned.

  3. Descriptions of verbal communication errors between staff. An analysis of 84 root cause analysis-reports from Danish hospitals.

    Science.gov (United States)

    Rabøl, Louise Isager; Andersen, Mette Lehmann; Østergaard, Doris; Bjørn, Brian; Lilja, Beth; Mogensen, Torben

    2011-03-01

    Poor teamwork and communication between healthcare staff are correlated to patient safety incidents. However, the organisational factors responsible for these issues are unexplored. Root cause analyses (RCA) use human factors thinking to analyse the systems behind severe patient safety incidents. The objective of this study is to review RCA reports (RCAR) for characteristics of verbal communication errors between hospital staff in an organisational perspective. Two independent raters analysed 84 RCARs, conducted in six Danish hospitals between 2004 and 2006, for descriptions and characteristics of verbal communication errors such as handover errors and error during teamwork. Raters found description of verbal communication errors in 44 reports (52%). These included handover errors (35 (86%)), communication errors between different staff groups (19 (43%)), misunderstandings (13 (30%)), communication errors between junior and senior staff members (11 (25%)), hesitance in speaking up (10 (23%)) and communication errors during teamwork (8 (18%)). The kappa values were 0.44-0.78. Unproceduralized communication and information exchange via telephone, related to transfer between units and consults from other specialties, were particularly vulnerable processes. With the risk of bias in mind, it is concluded that more than half of the RCARs described erroneous verbal communication between staff members as root causes of or contributing factors of severe patient safety incidents. The RCARs rich descriptions of the incidents revealed the organisational factors and needs related to these errors.

  4. Perceived usefulness of a usability issues reporting form to help understand "usability-induced use-errors": a preliminary study.

    Science.gov (United States)

    Marcilly, Romaric; Boog, Cesar; Leroy, Nicolas; Pelayo, Sylvia

    2014-01-01

    The Medical Device regulation requires manufacturers to anticipate and prevent risks of use errors of their medical device. However, manufacturers experience difficulties to understand the concept of "usability-induced use-errors". Based on a "usability framework" aiming at describing the relationship between usability design principles, usability flaws, usage problems, and outcomes, a usability evaluation reporting form had been designed to support understanding the use-error concept. This paper reports the preliminary evaluation of the perceived usefulness of this form. Results show that manufacturers found helpful the presentation of the results of a usability evaluation through this form for it supports the understanding of the usability origins and the consequences of use-errors. Even if the use of this reporting form should be made easier as usability experts experience difficulties to fill it, it seems a promising way to clearly present "usability-induced use-errors" to manufacturers.

  5. Personnel scheduling

    OpenAIRE

    Vanden Berghe, Greet

    2012-01-01

    Personnel scheduling can become a particularly difficult optimisation problem due to human factors. And yet: people working in healthcare, transportation and other round the clock service regimes perform their duties based on a schedule that was often manually constructed. The unrewarding manual scheduling task deserves more attention from the timetabling community so as to support computation of fair and good quality results. The present abstract touches upon a set of particular characterist...

  6. Energy and resource planning: report abstracts. [44 abstracts of reports by Livermore Lab. personnel, Nov. '73--Jan. '77

    Energy Technology Data Exchange (ETDEWEB)

    Borg, I.Y. (ed.)

    1977-04-27

    This document contains 44 chronologically arranged abstracts of reports written by the Energy and Resource Planning Group of the Lawrence Livermore Laboratory from November 1973 to January 1977. Subjects covered include energy, resources and resource development, transportation, and biological resources/fuels.

  7. Comparison of two self-reported measures of physical work demands in hospital personnel: A cross-sectional study

    Directory of Open Access Journals (Sweden)

    Jensen Jette N

    2008-04-01

    Full Text Available Abstract Background Low back pain (LBP is a frequent health complaint among health care personnel. Several work tasks and working postures are associated with an increased risk of LBP. The aim of this study was to compare two self-reported measures of physical demands and their association with LBP (the daily number of patient handling tasks and Hollmann's physical load index. Methods A questionnaire was distributed to 535 hospital employees in a psychiatric and an orthopedic ward in a Danish hospital. Of these 411 (77% filled in and returned the questionnaire. Only the 373 respondents who had non-missing values on both measures of physical demands were included in the analyses. The distribution of physical demands in different job groups and wards are presented, variance analysis models are employed, and logistic regression analysis is used to analyze the association between measures of physical demands and LBP. Results In combination, hospital ward and job category explained 56.6% and 23.3% of the variance in the self-reported physical demands measured as the daily number of patient handling tasks and as the score on the physical load index, respectively. When comparing the 6% with the highest exposure the prevalence odds ratio (POR for LBP was 5.38 (95% CI 2.03–14.29 in the group performing more than 10 patient handling tasks per day and 2.29 (95% CI 0.93–5.66 in the group with the highest score on the physical load index. Conclusion In specialized hospital wards the daily number of patient handling tasks seems to be a more feasible measure of exposure when assessing the risk of LBP compared to more advanced measures of physical load on the lower lumbar spine.

  8. Pediatric Nurses’ Medication Error: the Self-reporting of Frequency, Types and Causes

    Directory of Open Access Journals (Sweden)

    Mojtaba Miladinia

    2016-03-01

    Full Text Available Background Medication errors (MEs are the most common types of medical errors which effecting on pediatric safety. For decrease MEs, we should to have information about difference aspects of MEs. We have no study which assessed the frequency, types and causes of MEs made by pediatric nurses, in Iran. Material and Methods This was a cross-sectional study, which performed on 53 Pediatric Nurses. Data were collected by a self-structured questionnaire for assessment of MEs contained 3 parts: 1- one question about the fact that, do you had MEs in past 3 months; 2- types of MEs occurred (12 items; 3- causes of MEs from nurses’ perspective (20 items. The MEs in past 3 months gathered through pediatric nurses’ self-report. Descriptive statistics and Chi-square test were used for analysis. Data were analyzed using the SPSS. Results The majority of participants were female (77.3%, and initial (novice nurses (33.9%. The results showed that, 31 (58.4% of nurses were reported at least one MEs history and totally, 131 MEs were occurred in past 3 months. Most prevalent of MEs types were reported: wrong dose (36.6% and wrong drug preparation (14.5%. Also, most prevalent of MEs causes from Nurses’ perspective were reported: poor medication knowledge (96.2% and poor calculation skills (73.5%. Conclusion With using of this study results, we can program for prevention/decrease MEs and enhancing pediatric safety. On the basis of this study, actually we should enhancing level of nurses knowledge by education and to carry out special courses for pediatric nurses.

  9. Quantification of the reliability of personnel actions from the evaluation of actual German operational experience. Final report; Quantifizierung der Zuverlaessigkeit von Personalhandlungen durch Auswertung der aktuellen deutschen Betriebserfahrung. Abschlussbericht

    Energy Technology Data Exchange (ETDEWEB)

    Preischl, W.; Fassmann, W.

    2013-07-15

    characterizing human reliability from data source ''reportable events'', - Methods to select samples characterizing human reliability from data source ''safety relevant, undoubtedly error free performed personnel actions'', - Mathematical proven methodology to derive probabilistic human performance data based on samples taken from OE, - 85 new probabilistic human performance data based on operational experience in German nuclear power plants, - Approach based on accepted behavioural knowledge to structure the obtained results and to link them to the new ''second generation'' human reliability assessment methodologies. The obtained data are forming the first data base on human reliability completely derived from operational experience of German nuclear power plants. Many subject matter experts from the plants supported the research project and contributed considerably to the research results.

  10. Frequency and analysis of non-clinical errors made in radiology reports using the National Integrated Medical Imaging System voice recognition dictation software.

    Science.gov (United States)

    Motyer, R E; Liddy, S; Torreggiani, W C; Buckley, O

    2016-11-01

    Voice recognition (VR) dictation of radiology reports has become the mainstay of reporting in many institutions worldwide. Despite benefit, such software is not without limitations, and transcription errors have been widely reported. Evaluate the frequency and nature of non-clinical transcription error using VR dictation software. Retrospective audit of 378 finalised radiology reports. Errors were counted and categorised by significance, error type and sub-type. Data regarding imaging modality, report length and dictation time was collected. 67 (17.72 %) reports contained ≥1 errors, with 7 (1.85 %) containing 'significant' and 9 (2.38 %) containing 'very significant' errors. A total of 90 errors were identified from the 378 reports analysed, with 74 (82.22 %) classified as 'insignificant', 7 (7.78 %) as 'significant', 9 (10 %) as 'very significant'. 68 (75.56 %) errors were 'spelling and grammar', 20 (22.22 %) 'missense' and 2 (2.22 %) 'nonsense'. 'Punctuation' error was most common sub-type, accounting for 27 errors (30 %). Complex imaging modalities had higher error rates per report and sentence. Computed tomography contained 0.040 errors per sentence compared to plain film with 0.030. Longer reports had a higher error rate, with reports >25 sentences containing an average of 1.23 errors per report compared to 0-5 sentences containing 0.09. These findings highlight the limitations of VR dictation software. While most error was deemed insignificant, there were occurrences of error with potential to alter report interpretation and patient management. Longer reports and reports on more complex imaging had higher error rates and this should be taken into account by the reporting radiologist.

  11. Exploring behavioural determinants relating to health professional reporting of medication errors: a qualitative study using the Theoretical Domains Framework.

    Science.gov (United States)

    Alqubaisi, Mai; Tonna, Antonella; Strath, Alison; Stewart, Derek

    2016-07-01

    Effective and efficient medication reporting processes are essential in promoting patient safety. Few qualitative studies have explored reporting of medication errors by health professionals, and none have made reference to behavioural theories. The objective was to describe and understand the behavioural determinants of health professional reporting of medication errors in the United Arab Emirates (UAE). This was a qualitative study comprising face-to-face, semi-structured interviews within three major medical/surgical hospitals of Abu Dhabi, the UAE. Health professionals were sampled purposively in strata of profession and years of experience. The semi-structured interview schedule focused on behavioural determinants around medication error reporting, facilitators, barriers and experiences. The Theoretical Domains Framework (TDF; a framework of theories of behaviour change) was used as a coding framework. Ethical approval was obtained from a UK university and all participating hospital ethics committees. Data saturation was achieved after interviewing ten nurses, ten pharmacists and nine physicians. Whilst it appeared that patient safety and organisational improvement goals and intentions were behavioural determinants which facilitated reporting, there were key determinants which deterred reporting. These included the beliefs of the consequences of reporting (lack of any feedback following reporting and impacting professional reputation, relationships and career progression), emotions (fear and worry) and issues related to the environmental context (time taken to report). These key behavioural determinants which negatively impact error reporting can facilitate the development of an intervention, centring on organisational safety and reporting culture, to enhance reporting effectiveness and efficiency.

  12. Errors and Misconceptions in College Level Theorem Proving. Technical Report. No. 2003-3

    Science.gov (United States)

    Selden, Annie; Selden, John

    2003-01-01

    In this paper we describe a number of types of errors and underlying misconceptions that arise in mathematical reasoning. Other types of mathematical reasoning errors, not associated with specific misconceptions, are also discussed. We hope the characterization and cataloging of common reasoning errors will be useful in studying the teaching of…

  13. Why are chemotherapy administration errors not reported? Perceptions of oncology nurses in a Nigerian tertiary health institution

    Directory of Open Access Journals (Sweden)

    Chinomso Ugochukwu Nwozichi

    2015-01-01

    Full Text Available Objective: The administration of chemotherapy forms a major part of the clinical role of oncology nurses. When a mistake is made during chemotherapy administration, admitting and reporting the error timely could save the lives of cancer patients. The main objective of this study was to assess the perceptions of oncology nurses about why chemotherapy administration errors are not reported. Methods: This is a descriptive study that surveyed a convenient sample of 128 oncology nurses currently practicing in the Ogun State University Teaching Hospital, Nigeria. The tool for data collection was a structured questionnaire that consisted of two sections. The first section was for the demographic data of participants and the second section consisted of questions constructed based on the Medication Administration Error (MAE reporting survey developed by Wakefield and his team. Results: Findings showed that majority of the nurses (89.8% have made at least one MAE in the course of their professional practice. Fear (mean = 3.63 and managerial response (mean = 2.87 were the two major barriers to MAE reporting perceived among oncology nurses. Conclusion: Critically analyzing why medication errors are not reported among oncology nurses is crucial to identifying strategic interventions that would promote reporting of all errors, especially those related to chemotherapy administration. It is therefore recommended that nurse managers and health care administrators should create a favorable atmosphere that does not only prevent medication errors but also supports nurses′ voluntary reporting of MAEs. Education, information and communication strategies should also be put in place to train nurses on the need to report, if possible prevent, all medication errors.

  14. An Analysis of the Relationship between Select Organizational Climate Factors and Job Satisfaction Factors as Reported by Community College Personnel

    Science.gov (United States)

    San Giacomo, Rose-Marie Carla

    2011-01-01

    The purpose of this study was to investigate the overall satisfaction with organizational climate factors across seven studies of various levels of community college personnel. A secondary purpose was to determine if there was a significant relationship between satisfaction with organizational climate factors and the importance of job satisfaction…

  15. An Analysis of the Relationship between Select Organizational Climate Factors and Job Satisfaction Factors as Reported by Community College Personnel

    Science.gov (United States)

    San Giacomo, Rose-Marie Carla

    2011-01-01

    The purpose of this study was to investigate the overall satisfaction with organizational climate factors across seven studies of various levels of community college personnel. A secondary purpose was to determine if there was a significant relationship between satisfaction with organizational climate factors and the importance of job satisfaction…

  16. Report on errors in pretransfusion testing from a tertiary care center: A step toward transfusion safety

    Directory of Open Access Journals (Sweden)

    Meena Sidhu

    2016-01-01

    Full Text Available Introduction: Errors in the process of pretransfusion testing for blood transfusion can occur at any stage from collection of the sample to administration of the blood component. The present study was conducted to analyze the errors that threaten patients′ transfusion safety and actual harm/serious adverse events that occurred to the patients due to these errors. Materials and Methods: The prospective study was conducted in the Department Of Transfusion Medicine, Shri Maharaja Gulab Singh Hospital, Government Medical College, Jammu, India from January 2014 to December 2014 for a period of 1 year. Errors were defined as any deviation from established policies and standard operating procedures. A near-miss event was defined as those errors, which did not reach the patient. Location and time of occurrence of the events/errors were also noted. Results: A total of 32,672 requisitions for the transfusion of blood and blood components were received for typing and cross-matching. Out of these, 26,683 products were issued to the various clinical departments. A total of 2,229 errors were detected over a period of 1 year. Near-miss events constituted 53% of the errors and actual harmful events due to errors occurred in 0.26% of the patients. Sample labeling errors were 2.4%, inappropriate request for blood components 2%, and information on requisition forms not matching with that on the sample 1.5% of all the requisitions received were the most frequent errors in clinical services. In transfusion services, the most common event was accepting sample in error with the frequency of 0.5% of all requisitions. ABO incompatible hemolytic reactions were the most frequent harmful event with the frequency of 2.2/10,000 transfusions. Conclusion: Sample labeling, inappropriate request, and sample received in error were the most frequent high-risk errors.

  17. Benefit Analysis on the Medication Error Reporting System in the Information Age%信息化时代异常处方通报系统的效益分析

    Institute of Scientific and Technical Information of China (English)

    蔡春玉; 卢瑞珍; 陈玉莹; 谭延辉; 周大为

    2009-01-01

    To discuss the impact of setting up medication error reporting system on the incidence of medication error. METHODS: By a retrospective study, the medication error events reported between Aug. 1, 2003 and Dec. 31, 2006 collected from our hospital were analyzed in respect of the causes and probability of the medication error. RESULTS: The use of CPOE (computerized prescriber order entry) alert system resulted in marked improvement of all kinds of controversial prescriptions, down 45.6%~90.3% in medication error rate. CONCLUSION: The medication error reporting system enables pharmacists to identify and report medication errors. Doctor and patient-centered health care can be carried out more effectively by establishing a multidisciplinary prescription review group consisting of pharmacists, nursing staff, information personnel and risk-management personnel with physicians and patients as the core that affiliated to pharmaceutical affairs council in which the members can discuss the controversial prescriptions together and regularly share their experiences.%目的:探讨架设异常处方通报系统后对于处方异常发生率的影响.方法:采用回溯性方法,搜集我院2003年8月1日~2006年12月31日处方异常通报事件,分析发生处方异常的原因与几率.结果:由计算机医嘱提示后,各种争议性处方类型获得明显改善,改善成效范围在45.6%~90.3%之间.结论:该系统的架设有益于药师的提报,然而若能以医师及病患为中心,跨部门的合作,纳入药师、护理人员、信息人员等,共同组成一附属于药事委员会的争议性处方讨论小组,定期讨论分享经验,才更能落实"以病人为中心"的健康照护.

  18. Drug errors and related interventions reported by United States clinical pharmacists: the American College of Clinical Pharmacy practice-based research network medication error detection, amelioration and prevention study.

    Science.gov (United States)

    Kuo, Grace M; Touchette, Daniel R; Marinac, Jacqueline S

    2013-03-01

    To describe and evaluate drug errors and related clinical pharmacist interventions. Cross-sectional observational study with an online data collection form. American College of Clinical Pharmacy practice-based research network (ACCP PBRN). A total of 62 clinical pharmacists from the ACCP PBRN who provided direct patient care in the inpatient and outpatient practice settings. Clinical pharmacist participants identified drug errors in their usual practices and submitted online error reports over a period of 14 consecutive days during 2010. The 62 clinical pharmacists submitted 924 reports; of these, 779 reports from 53 clinical pharmacists had complete data. Drug errors occurred in both the inpatient (61%) and outpatient (39%) settings. Therapeutic categories most frequently associated with drug errors were systemic antiinfective (25%), hematologic (21%), and cardiovascular (19%) drugs. Approximately 95% of drug errors did not result in patient harm; however, 33 drug errors resulted in treatment or medical intervention, 6 resulted in hospitalization, 2 required treatment to sustain life, and 1 resulted in death. The types of drug errors were categorized as prescribing (53%), administering (13%), monitoring (13%), dispensing (10%), documenting (7%), and miscellaneous (4%). Clinical pharmacist interventions included communication (54%), drug changes (35%), and monitoring (9%). Approximately 89% of clinical pharmacist recommendations were accepted by the prescribers: 5% with drug therapy modifications, 28% due to clinical pharmacist prescriptive authority, and 56% without drug therapy modifications. This study provides insight into the role clinical pharmacists play with regard to drug error interventions using a national practice-based research network. Most drug errors reported by clinical pharmacists in the United States did not result in patient harm; however, severe harm and death due to drug errors were reported. Drug error types, therapeutic categories, and

  19. Implementation of an audit with feedback knowledge translation intervention to promote medication error reporting in health care: a protocol.

    Science.gov (United States)

    Hutchinson, Alison M; Sales, Anne E; Brotto, Vanessa; Bucknall, Tracey K

    2015-05-19

    Health professionals strive to deliver high-quality care in an inherently complex and error-prone environment. Underreporting of medical errors challenges attempts to understand causative factors and impedes efforts to implement preventive strategies. Audit with feedback is a knowledge translation strategy that has potential to modify health professionals' medical error reporting behaviour. However, evidence regarding which aspects of this complex, multi-dimensional intervention work best is lacking. The aims of the Safe Medication Audit Reporting Translation (SMART) study are to: 1. Implement and refine a reporting mechanism to feed audit data on medication errors back to nurses 2. Test the feedback reporting mechanism to determine its utility and effect 3. Identify characteristics of organisational context associated with error reporting in response to feedback A quasi-experimental design, incorporating two pairs of matched wards at an acute care hospital, is used. Randomisation occurs at the ward level; one ward from each pair is randomised to receive the intervention. A key stakeholder reference group informs the design and delivery of the feedback intervention. Nurses on the intervention wards receive the feedback intervention (feedback of analysed audit data) on a quarterly basis for 12 months. Data for the feedback intervention come from medication documentation point-prevalence audits and weekly reports on routinely collected medication error data. Weekly reports on these data are obtained for the control wards. A controlled interrupted time series analysis is used to evaluate the effect of the feedback intervention. Self-report data are also collected from nurses on all four wards at baseline and at completion of the intervention to elicit their perceptions of the work context. Additionally, following each feedback cycle, nurses on the intervention wards are invited to complete a survey to evaluate the feedback and to establish their intentions to change

  20. The Impact of Bar Code Medication Administration Technology on Reported Medication Errors

    Science.gov (United States)

    Holecek, Andrea

    2011-01-01

    The use of bar-code medication administration technology is on the rise in acute care facilities in the United States. The technology is purported to decrease medication errors that occur at the point of administration. How significantly this technology affects actual rate and severity of error is unknown. This descriptive, longitudinal research…

  1. Sampling of Common Items: An Unrecognized Source of Error in Test Equating. CSE Report 636

    Science.gov (United States)

    Michaelides, Michalis P.; Haertel, Edward H.

    2004-01-01

    There is variability in the estimation of an equating transformation because common-item parameters are obtained from responses of samples of examinees. The most commonly used standard error of equating quantifies this source of sampling error, which decreases as the sample size of examinees used to derive the transformation increases. In a…

  2. Nurse perceptions of organizational culture and its association with the culture of error reporting: a case of public sector hospitals in Pakistan

    OpenAIRE

    Jafree, Sara Rizvi; Zakar, Rubeena; Zakria Zakar, Muhammad; Fischer, Florian

    2016-01-01

    Background There is an absence of formal error tracking systems in public sector hospitals of Pakistan and also a lack of literature concerning error reporting culture in the health care sector. Nurse practitioners have front-line knowledge and rich exposure about both the organizational culture and error sharing in hospital settings. The aim of this paper was to investigate the association between organizational culture and the culture of error reporting, as perceived by nurses. Methods The ...

  3. Monitoring and reporting of preanalytical errors in laboratory medicine: the UK situation.

    Science.gov (United States)

    Cornes, Michael P; Atherton, Jennifer; Pourmahram, Ghazaleh; Borthwick, Hazel; Kyle, Betty; West, Jamie; Costelloe, Seán J

    2016-03-01

    Most errors in the clinical laboratory occur in the preanalytical phase. This study aimed to comprehensively describe the prevalence and nature of preanalytical quality monitoring practices in UK clinical laboratories. A survey was sent on behalf of the Association for Clinical Biochemistry and Laboratory Medicine Preanalytical Working Group (ACB-WG-PA) to all heads of department of clinical laboratories in the UK. The survey captured data on the analytical platform and Laboratory Information Management System in use; which preanalytical errors were recorded and how they were classified and gauged interest in an external quality assurance scheme for preanalytical errors. Of the 157 laboratories asked to participate, responses were received from 104 (66.2%). Laboratory error rates were recorded per number of specimens, rather than per number of requests in 51% of respondents. Aside from serum indices for haemolysis, icterus and lipaemia, which were measured in 80% of laboratories, the most common errors recorded were booking-in errors (70.1%) and sample mislabelling (56.9%) in laboratories who record preanalytical errors. Of the laboratories surveyed, 95.9% expressed an interest in guidance on recording preanalytical error and 91.8% expressed interest in an external quality assurance scheme. This survey observes a wide variation in the definition, repertoire and collection methods for preanalytical errors in the UK. Data indicate there is a lot of interest in improving preanalytical data collection. The ACB-WG-PA aims to produce guidance and support for laboratories to standardize preanalytical data collection and to help establish and validate an external quality assurance scheme for interlaboratory comparison. © The Author(s) 2015.

  4. Effectiveness comparison between Thai traditional massage and Chinese acupuncture for myofascial back pain in Thai military personnel: a preliminary report.

    Science.gov (United States)

    Kumnerddee, Wipoo

    2009-02-01

    The objective of this randomized comparative study was to provide preliminary data of comparative effectiveness of Thai traditional massage (TTM) and Chinese acupuncture for the treatment of myofascial back pain in young military personnel. Eighteen Thai military personnel, aged ranging from 20-40 years were randomly divided into TTM and acupuncture groups. Each group received 5 sessions of massage or acupuncture during a 10-day period. The Thai version McGill Pain Questionnaire, 100-mm, visual analog scale (VAS) and summation of pain threshold in each trigger point measured by pressure algometer were assessed at day 0, 3, 8 and 10. At the end of treatment protocols, McGill scores decreased significantly in TTM and acupuncture groups (p = 0.024 and 0.002, respectively). VAS also decreased significantly (p = 0.029 and 0.003, respectively). However, the pain pressure threshold increased significantly in the acupuncture group but not in the TTM group (p = 0.006 and 0.08, respectively). When outcomes were compared between the two groups, no significant difference was found in the VAS (p = 0.115) and pain pressure threshold (p = 0.116), whereas the acupuncture group showed significantly lower McGill scores than the TTM group (p = 0.039). In conclusion, five sessions of Thai traditional massage and Chinese acupuncture were effective for the treatment of myofascial back pain in young Thai military personnel. Significant effects in both groups begin after the first session. Acupuncture is more effective than Thai traditional massage when affective aspect is also evaluated.

  5. Exploring the relationship between safety culture and reported dispensing errors in a large sample of Swedish community pharmacies.

    Science.gov (United States)

    Nordén-Hägg, Annika; Kälvemark-Sporrong, Sofia; Lindblad, Åsa Kettis

    2012-08-13

    The potential for unsafe acts to result in harm to patients is constant risks to be managed in any health care delivery system including pharmacies. The number of reported errors is influenced by a various elements including safety culture. The aim of this study is to investigate a possible relationship between reported dispensing errors and safety culture, taking into account demographic and pharmacy variables, in Swedish community pharmacies. A cross-sectional study was performed, encompassing 546 (62.8%) of the 870 Swedish community pharmacies. All staff in the pharmacies on December 1st, 2007 were included in the study. To assess safety culture domains in the pharmacies, the Safety Attitudes Questionnaire (SAQ) was used. Numbers of dispensed prescription items as well as dispensing errors for each pharmacy across the first half year of 2008 were summarised. Intercorrelations among a number of variables including SAQ survey domains, general properties of the pharmacy, demographic characteristics, and dispensing errors were calculated. A negative binomial regression model was used to further examine the relationship between the variables and dispensing errors. The first analysis demonstrated a number of significant correlations between reported dispensing errors and the variables examined. Negative correlations were found with SAQ domains Teamwork Climate, Safety Climate, Job Satisfaction as well as mean age and response rates. Positive relationships were demonstrated with Stress Recognition (SAQ), number of employees, educational diversity, birth country diversity, education country diversity and number of dispensed prescription items. Variables displaying a significant relationship to errors in this analysis were included in the regression analysis. When controlling for demographic variables, only Stress Recognition, mean age, educational diversity and number of dispensed prescription items and employees, were still associated with dispensing errors. This study

  6. Pure anarthria with predominantly sequencing errors in phoneme articulation: a case report.

    Science.gov (United States)

    Tanji, K; Suzuki, K; Yamadori, A; Tabuchi, M; Endo, K; Fujii, T; Itoyama, Y

    2001-12-01

    A 77-year-old left-handed man presented with pure anarthria following cerebral infarction. The lesion was restricted to the right precentral gyrus extending to the immediately underlying subcortical white matter and the frontal part of the insular cortex. Qualitative analysis of anarthria revealed that half of the phonemic-articulatory errors in spontaneous speech were sequencing ones. Sequential errors were detected at the phoneme level in both consonants and vowels, and at the syllable level. Most of the sequential errors were pre-positioning. Sequential errors were observed both within and across words. In clear contrast with anarthria, writing and comprehension was preserved, which suggested the problem was limited to oral expression. Our findings provide further support that the precentral gyrus and/or the insular cortex of the language dominant hemisphere is responsible for the temporal sequencing of the articulatory programming.

  7. Medication error reporting in rural critical access hospitals in the North Dakota Telepharmacy Project.

    Science.gov (United States)

    Scott, David M; Friesner, Daniel L; Rathke, Ann M; Doherty-Johnsen, Shelly

    2014-01-01

    Results of a study of medication "quality-related events" (QREs) at critical access hospitals (CAHs) participating in a telepharmacy project are reported. Rates and types of medication QREs (i.e., all types of drug therapy problems requiring pharmacist intervention) were evaluated at 17 CAHs receiving telepharmacy services from a central order-entry site in the North Dakota Telepharmacy Project (NDTP). During the 17-month study, remote pharmacists used telepharmacy technology to review medication orders prepared at the CAH sites, identify and address QREs, and code clinical interventions. The collected data were analyzed via chi-square testing. Cumulative monthly medication orders at the CAH study sites ranged from a low of 12,535 in the first month of the study to a high of 18,257. Monthly rates of visual medication verification and clinical intervention ranged from 8.0% to 14.2% and from 1.3% to 3.1%, respectively. Overall, the most frequently identified QREs were transcription errors, which accounted for 2,389 interventions (43.3%); 2,078 interventions (37.7%) targeted prescribing-related QREs. The most frequently cited intervention codes were for dosage adjustments (n = 547), deep venous thrombosis prophylaxis (n = 437), pharmacokinetic consultation (n = 268), renal dosing (n = 182), and the prevention of minor (n = 148) and major (n = 94) adverse drug events. The study results indicate that the NDTP telepharmacy model is effective in identifying and resolving QREs in CAHs. The use of the telepharmacy services increased over the study period, suggesting that CAH practitioners became more comfortable using the technology on a regular basis to enhance patient safety.

  8. A survey of mindset theories of intelligence and medical error self-reporting among pediatric housestaff and faculty.

    Science.gov (United States)

    Jegathesan, Mithila; Vitberg, Yaffa M; Pusic, Martin V

    2016-02-11

    Intelligence theory research has illustrated that people hold either "fixed" (intelligence is immutable) or "growth" (intelligence can be improved) mindsets and that these views may affect how people learn throughout their lifetime. Little is known about the mindsets of physicians, and how mindset may affect their lifetime learning and integration of feedback. Our objective was to determine if pediatric physicians are of the "fixed" or "growth" mindset and whether individual mindset affects perception of medical error reporting.  We sent an anonymous electronic survey to pediatric residents and attending pediatricians at a tertiary care pediatric hospital. Respondents completed the "Theories of Intelligence Inventory" which classifies individuals on a 6-point scale ranging from 1 (Fixed Mindset) to 6 (Growth Mindset). Subsequent questions collected data on respondents' recall of medical errors by self or others. We received 176/349 responses (50 %). Participants were equally distributed between mindsets with 84 (49 %) classified as "fixed" and 86 (51 %) as "growth". Residents, fellows and attendings did not differ in terms of mindset. Mindset did not correlate with the small number of reported medical errors. There is no dominant theory of intelligence (mindset) amongst pediatric physicians. The distribution is similar to that seen in the general population. Mindset did not correlate with error reports.

  9. Assessing the Distribution of Fiscal and Personnel Resources across Schools. A Report Prepared for Twin Rivers Unified School District. SSFR Research Report #01 (TRUSD)

    Science.gov (United States)

    Chambers, Jay G.; Levin, Jesse; Brodziak, Iliana; Chan, Derek

    2010-01-01

    Using fiscal data provided by the finance office of the school district, and personnel data obtained from the California Basic Education Data System (maintained by the California Department of Education, or CDE), the authors present analyses to provide a foundation for local policymakers that may be used to assess whether there are inequities in…

  10. 5 CFR 1604.6 - Error correction.

    Science.gov (United States)

    2010-01-01

    ... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Error correction. 1604.6 Section 1604.6 Administrative Personnel FEDERAL RETIREMENT THRIFT INVESTMENT BOARD UNIFORMED SERVICES ACCOUNTS § 1604.6 Error correction. (a) General rule. A service member's employing agency must correct the service member's...

  11. Report: Low Frequency Predictive Skill Despite Structural Instability and Model Error

    Science.gov (United States)

    2013-09-30

    Structural Instability and Model Error Andrew J. Majda New York University Courant Institute of Mathematical Sciences 251 Mercer Street New York, NY...NUMBER 5e. TASK NUMBER 5f. WORK UNIT NUMBER 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) New York University, Courant Institute of

  12. Word Order Errors. Swedish-English Contrastive Studies, Report No. 2.

    Science.gov (United States)

    Carlbom, Ulla

    The materials employed in this investigation were 769 translations from Swedish into English made by Swedish university students studying English. The principal objective was to study aspects of learner behavior (in treating English word order) to obtain information about the types of errors Swedish students commit in English production and…

  13. Standardizing Medication Error Event Reporting in the U.S. Department of Defense

    Science.gov (United States)

    2005-01-01

    States due to medical errors is between 44,000 and 98,000. This number far exceeds the annual number of deaths resulting from AIDS, breast cancer , or...Potassium Chloride Furosemide Diazepam Fentanyl Ketorolac Potassium Chloride Furosemide Meperidine Metoprolol Ipatropium Hydromorphone Vancomycin * 2002

  14. Associative Errors in Children's Analogical Reasoning: A Cognitive Process Analysis. Technical Report No. 279.

    Science.gov (United States)

    Tirre, William C.

    A common error in children's attempts to solve verbal analogies is to respond with a word strongly associated with the third term in the analogy. This is known as associative response. A study was conducted to investigate the cognitive processes underlying this response. Subjects, 112 fifth grade students, were administered a battery of tests…

  15. Survey of Nurses\\' Viewpoints on Causes of Medicinal Errors and Barriers to Reporting in Pediatric Units in Hospitals of Mashhad University of Medical Sciences

    Directory of Open Access Journals (Sweden)

    Masoomeh Seidi

    2012-12-01

    Full Text Available Background and Objective: Patient safety is the principal concern of current health care delivery systems, and several recent studies initiated by the Institute of Medicine have reported a high incidence of medicinal errors. Of the approximately 44000-98000 patient deaths reported each year because of medical errors, 7000 are attributed to medicinal errors. The purpose of this study was to determine nurses' perceptions of causes of medicinal errors and barriers to reporting them in the pediatric wards of Mashhad University of Medical Sciences. Materials and Methods: This cross-sectional descriptive study recruited156 nurses working in general pediatric units via the convenience sample method. A questionnaire containing four sections was used: the first section on demographic information; the second on the reasons for medicinal errors; the third on the estimation of the percentage of medicinal errors occurring in the units; and the final section on the reasons for failing to report the medicinal errors. Results: The most important medicinal errors from the nurses' viewpoint were failure to check medicinal orders (73.9% and errors in the medication administration (64%. The nurses estimated that only 45% of all the medicinal errors were reported, and they cited a lack of knowledge about unit policies and routines (59.8% and negligence to report (59.8% as the most important reasons for the failure to report the errors. Conclusion: We need to improve the accuracy of medicinal error reporting by nurses and to provide a hospital environment conducive to preventing errors from occurring.

  16. The content of lexical stimuli and self-reported physiological state modulate error-related negativity amplitude.

    Science.gov (United States)

    Benau, Erik M; Moelter, Stephen T

    2016-09-01

    The Error-Related Negativity (ERN) and Correct-Response Negativity (CRN) are brief event-related potential (ERP) components-elicited after the commission of a response-associated with motivation, emotion, and affect. The Error Positivity (Pe) typically appears after the ERN, and corresponds to awareness of having committed an error. Although motivation has long been established as an important factor in the expression and morphology of the ERN, physiological state has rarely been explored as a variable in these investigations. In the present study, we investigated whether self-reported physiological state (SRPS; wakefulness, hunger, or thirst) corresponds with ERN amplitude and type of lexical stimuli. Participants completed a SRPS questionnaire and then completed a speeded Lexical Decision Task with words and pseudowords that were either food-related or neutral. Though similar in frequency and length, food-related stimuli elicited increased accuracy, faster errors, and generated a larger ERN and smaller CRN than neutral words. Self-reported thirst correlated with improved accuracy and smaller ERN and CRN amplitudes. The Pe and Pc (correct positivity) were not impacted by physiological state or by stimulus content. The results indicate that physiological state and manipulations of lexical content may serve as important avenues for future research. Future studies that apply more sensitive measures of physiological and motivational state (e.g., biomarkers for satiety) or direct manipulations of satiety may be a useful technique for future research into response monitoring. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. The impact of safety organizing, trusted leadership, and care pathways on reported medication errors in hospital nursing units.

    Science.gov (United States)

    Vogus, Timothy J; Sutcliffe, Kathleen M

    2011-01-01

    Prior research has found that safety organizing behaviors of registered nurses (RNs) positively impact patient safety. However, little research exists on the joint benefits of safety organizing and other contextual factors that help foster safety. Although we know that organizational practices often have more powerful effects when combined with other mutually reinforcing practices, little research exists on the joint benefits of safety organizing and other contextual factors believed to foster safety. Specifically, we examined the benefits of bundling safety organizing with leadership (trust in manager) and design (use of care pathways) factors on reported medication errors. A total of 1033 RNs and 78 nurse managers in 78 emergency, internal medicine, intensive care, and surgery nursing units in 10 acute-care hospitals in Indiana, Iowa, Maryland, Michigan, and Ohio who completed questionnaires between December 2003 and June 2004. Cross-sectional analysis of medication errors reported to the hospital incident reporting system for the 6 months after the administration of the survey linked to survey data on safety organizing, trust in manager, use of care pathways, and RN characteristics and staffing. Multilevel Poisson regression analyses indicated that the benefits of safety organizing on reported medication errors were amplified when paired with high levels of trust in manager or the use of care pathways. Safety organizing plays a key role in improving patient safety on hospital nursing units especially when bundled with other organizational components of a safety supportive system.

  18. 5 CFR 1601.34 - Error correction.

    Science.gov (United States)

    2010-01-01

    ... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Error correction. 1601.34 Section 1601.34... Contribution Allocations and Interfund Transfer Requests § 1601.34 Error correction. Errors in processing... in the wrong investment fund, will be corrected in accordance with the error correction...

  19. Unintentional Pharmaceutical-Related Medication Errors Caused by Laypersons Reported to the Toxicological Information Centre in the Czech Republic.

    Science.gov (United States)

    Urban, Michal; Leššo, Roman; Pelclová, Daniela

    2016-07-01

    The purpose of the article was to study unintentional pharmaceutical-related poisonings committed by laypersons that were reported to the Toxicological Information Centre in the Czech Republic. Identifying frequency, sources, reasons and consequences of the medication errors in laypersons could help to reduce the overall rate of medication errors. Records of medication error enquiries from 2013 to 2014 were extracted from the electronic database, and the following variables were reviewed: drug class, dosage form, dose, age of the subject, cause of the error, time interval from ingestion to the call, symptoms, prognosis at the time of the call and first aid recommended. Of the calls, 1354 met the inclusion criteria. Among them, central nervous system-affecting drugs (23.6%), respiratory drugs (18.5%) and alimentary drugs (16.2%) were the most common drug classes involved in the medication errors. The highest proportion of the patients was in the youngest age subgroup 0-5 year-old (46%). The reasons for the medication errors involved the leaflet misinterpretation and mistaken dose (53.6%), mixing up medications (19.2%), attempting to reduce pain with repeated doses (6.4%), erroneous routes of administration (2.2%), psychiatric/elderly patients (2.7%), others (9.0%) or unknown (6.9%). A high proportion of children among the patients may be due to the fact that children's dosages for many drugs vary by their weight, and more medications come in a variety of concentrations. Most overdoses could be prevented by safer labelling, proper cap closure systems for liquid products and medication reconciliation by both physicians and pharmacists.

  20. Research results reported by OEO summer (1981) student employees of LLNL working with Earth Sciences (K) Division personnel

    Energy Technology Data Exchange (ETDEWEB)

    Doyle, M. C.; Griffith, P. J.; Kreevoy, E. P.; Turner, III, H. J.; Tatman, D. A.

    1982-01-01

    Significant experimental results were achieved in a number of research programs that were carried out during the summer of 1981 by students sponsored by the Office of Equal Opportunity at the Lawrence Livermore National Laboratory. These students were working with Earth Sciences (K) Division personnel. Accomplishments include the following: (1) preparation of post-burn stratigraphic sections for the Hoe Creek III experiment, Underground Coal Gasification project; (2) preparation of miscellaneous stratigraphic sections in the Climax granite near the Spent Fuel Test, Nevada Test Site, for the Waste Isolation Project; (3) confirmation of the applicability of a new theory relating to subsidence (solid matrix movement); (4) experimental confirmation that organic groundwater contaminants produced during an underground coal gasification experiment can be removed by appropriate bacterial treatment; (5) development of data supporting the extension of the Greenville Fault Zone into the Northern Diablo Range (Alameda and Santa Clara Counties, California); (6) completion of a literature review on hazardous waste (current disposal technology, regulations, research needs); (7) preparation of a map showing levels of background seismic noise in the USSR; (8) demonstration of a correlation of explosion size with the P-wave magnitude of the seismic signal produced by the explosion; and (9) reduction of data showing the extent of ground motion resulting from subsidence in the vicinity of the Hoe Creek III experiment, Underground Coal Gasification Project.

  1. Learning from incident reports in the Australian medical imaging setting: handover and communication errors.

    Science.gov (United States)

    Hannaford, N; Mandel, C; Crock, C; Buckley, K; Magrabi, F; Ong, M; Allen, S; Schultz, T

    2013-02-01

    To determine the type and nature of incidents occurring within medical imaging settings in Australia and identify strategies that could be engaged to reduce the risk of their re-occurrence. 71 search terms, related to clinical handover and communication, were applied to 3976 incidents in the Radiology Events Register. Detailed classification and thematic analysis of a subset of incidents that involved handover or communication (n=298) were undertaken to identify the most prevalent types of error and to make recommendations about patient safety initiatives in medical imaging. Incidents occurred most frequently during patient preparation (34%), when requesting imaging (27%) and when communicating a diagnosis (23%). Frequent problems within each of these stages of the imaging cycle included: inadequate handover of patients (41%) or unsafe or inappropriate transfer of the patient to or from medical imaging (35%); incorrect information on the request form (52%); and delayed communication of a diagnosis (36%) or communication of a wrong diagnosis (36%). The handover of patients and clinical information to and from medical imaging is fraught with error, often compromising patient safety and resulting in communication of delayed or wrong diagnoses, unnecessary radiation exposure and a waste of limited resources. Corrective strategies to address safety concerns related to new information technologies, patient transfer and inadequate test result notification policies are relevant to all healthcare settings. Handover and communication errors are prevalent in medical imaging. System-wide changes that facilitate effective communication are required.

  2. Medication review and transitions of care: a case report of a decade-old medication error.

    Science.gov (United States)

    Comer, Rachel; Lizer, Mitsi

    2015-03-01

    A 69-year-old Caucasian male with a 25-year history of paranoid schizophrenia was brought to the emergency department because of violence toward the staff in his nursing facility. He was diagnosed with a urinary tract infection and was admitted to the behavioral health unit for medication stabilization. History included a five-year state psychiatric hospital admission and nursing facility placement. Because of poor cognitive function, the patient was unable to corroborate medication history, so the pharmacy student on rotation performed an in-depth chart review. The review revealed a transcription error in 2003 deleting amantadine 100 mg twice daily and adding amiodarone 100 mg twice daily. Subsequent hospitalization resulted in another transcription error increasing the amiodarone to 200 mg twice daily. All electrocardiograms conducted were negative for atrial fibrillation. Once detected, the consulted cardiologist discontinued the amiodarone, and the primary care provider was notified via letter and discharge papers. An admission four months later revealed that the nursing facility restarted the amiodarone. Amiodarone was discontinued and the facility was again notified. This case reviews how a 10-year-old medication error went undetected in the electronic medical records through numerous medication reconciliations, but was uncovered when a single comprehensive medication review was conducted.

  3. Refusing to Report the Medication Errors and It\\'s Effects on Patient\\'s Safety in Razi Teaching Hospital during 2014-2015

    Directory of Open Access Journals (Sweden)

    Sahar Geravandi

    2016-07-01

    Full Text Available Background & Aims of the Study: one of the most important health aspects health care systems is patient safety and medication errors can threaten this safety. The purpose of this research was evaluation of refusing to report the medication errors and effect on Patent safety in Razi teaching hospital after healthcare reform during 2014-2015. Materials and Methods: This study is cross-sectional study that has been accomplished in way of descriptive-analytical. The environment of research is Razi teaching hospital of Ahwaz. The population studied consisted of nurses working in different wards of selected hospital. The data collection tool was a questionnaire. The results were analyzed by Excel and SPSS 16.0. Results: The results showed 60% of medication errors report by nurses. The results showed that the most important reasons for not reporting medication errors were related to the managerial factors (3.85 ± 1.512. This factor can be very important on patent safety. Factors related to the fear of the consequences of reporting 3.80 ± 1.301 and process of reporting were 3.21 ± 1.231, respectively. Conclusion: The results of this study showed that the management factors was important reason not reporting medication errors. Encourage nursing, good drug administration, Training of appropriate, using instruments suitable and decrease direct contact with patient can increase causes report errors. Increase the report of medication errors can help to management these errors and reduction of injures to patients.

  4. Fatigue and mental health in Australian rural and regional ambulance personnel.

    Science.gov (United States)

    Pyper, Zoe; Paterson, Jessica L

    2016-02-01

    Australian ambulance personnel experience stress, fatigue and exposure to traumatic events. These risks have been extensively researched in metropolitan paramedics. However, there has been limited research in rural and regional personnel. Rural and regional ambulance personnel make up a significant proportion of the Australian ambulance workforce and may be exposed to unique stressors. The aim of the current study was to investigate levels of fatigue, stress, and emotional trauma in rural and regional ambulance personnel. A sample of 134 (103 male, 31 female) rural and regional ambulance personnel completed a mixed methods survey assessing fatigue, stress and emotional trauma. Data were analysed using a combination of descriptive analysis and qualitative, deductive analysis that involved data immersion, coding, and categorisation. Participants reported high levels of fatigue and emotional trauma. Qualitative data revealed stressors including community expectations and 'office politics'. Participants also reported negative effects of fatigue including errors in drug administration and falling asleep while driving. The majority of participants reported normal levels of stress. It may be the case that working with known individuals in a community offers some degree of 'protective' impact for stress in rural and regional ambulance personnel. This is one of the first studies to investigate fatigue, stress, and emotional trauma in a rural and regional ambulance population. Results indicate a complex and unique profile of risks and challenges for this critical and understudied community resource. © 2015 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  5. Classification errors in contingency tables analyzed with hierarchical log-linear models. Technical report No. 20

    Energy Technology Data Exchange (ETDEWEB)

    Korn, E L

    1978-08-01

    This thesis is concerned with the effect of classification error on contingency tables being analyzed with hierarchical log-linear models (independence in an I x J table is a particular hierarchical log-linear model). Hierarchical log-linear models provide a concise way of describing independence and partial independences between the different dimensions of a contingency table. The structure of classification errors on contingency tables that will be used throughout is defined. This structure is a generalization of Bross' model, but here attention is paid to the different possible ways a contingency table can be sampled. Hierarchical log-linear models and the effect of misclassification on them are described. Some models, such as independence in an I x J table, are preserved by misclassification, i.e., the presence of classification error will not change the fact that a specific table belongs to that model. Other models are not preserved by misclassification; this implies that the usual tests to see if a sampled table belong to that model will not be of the right significance level. A simple criterion will be given to determine which hierarchical log-linear models are preserved by misclassification. Maximum likelihood theory is used to perform log-linear model analysis in the presence of known misclassification probabilities. It will be shown that the Pitman asymptotic power of tests between different hierarchical log-linear models is reduced because of the misclassification. A general expression will be given for the increase in sample size necessary to compensate for this loss of power and some specific cases will be examined.

  6. Development of a call alert system for paging mine personnel. Contract research report Jun 76-Jun 77

    Energy Technology Data Exchange (ETDEWEB)

    Trombly, J.E.; Lipoff, S.; O' Brien, P.

    1979-06-01

    This report presents system objectives and design criteria for an in-mine ultralow frequency radio paging system. Coding formats, frequency and bandwidth selection criteria leading to the system design are discussed. The prototype call alert transmitter and pocket page receiver is functionally described. The report includes circuit descriptions, schematics, parts lists, printed circuit fabrication, and assembly drawings. The report concludes with an estimate of the manufacturing cost for each assembly.

  7. Report: Human biochemical genetics: an insight into inborn errors of metabolism

    Institute of Scientific and Technical Information of China (English)

    YU Chunli; SCOTT C. Ronald

    2006-01-01

    Inborn errors of metabolism (IEM) include a broad spectrum of defects of various gene products that affect intermediary metabolism in the body. Studying the molecular and biochemical mechanisms of those inherited disorder, systematically summarizing the disease phenotype and natural history, providing diagnostic rationale and methodology and treatment strategy comprise the context of human biochemical genetics. This session focused on: (1) manifestations of representative metabolic disorders; (2) the emergent technology and application of newborn screening of metabolic disorders using tandem mass spectrometry; (3) principles of managing IEM; (4) the concept of carrier testing aiming prevention. Early detection of patients with IEM allows early intervention and more options for treatment.

  8. Incident reporting in nurse-led national telephone triage in Sweden: the reported errors reveal a pattern that needs to be broken.

    Science.gov (United States)

    Ernesäter, Annica; Engström, Maria; Holmström, Inger; Winblad, Ulrika

    2010-01-01

    We conducted a retrospective study of incident reports concerning the national, nurse-led telephone triage system in Sweden. The Swedish Health Care Direct organization (SHD) is staffed by registered nurses who act as telenurses and triage the callers' need for care, using a computerized decision support system. Data were collected during 2007 from all county councils that participated in the SHD and were analysed using content analysis. Incident reports were then compared concerning differences in reported categories and who reported the errors. The 426 incident reports included 452 errors. Of the analysed incident reports, 41% concerned accessibility problems, 25% incorrect assessment, 15% routines/guidelines, 13% technical problems and 6% information and communication. The most frequent outgoing incident reports (i.e. sent from SHD to other health-care providers) concerned accessibility problems and the most frequently incoming reports (i.e. sent to SHD from other health-care providers) concerned incorrect assessment. There was a significant difference (P triage or under-triage the callers' need for care. This over-triage or under-triage may in turn cause other health-care providers to report incorrect assessment to SHD. The implications for practice are that poor accessibility is a matter that should be addressed and that the reasons for incorrect assessment should be explored.

  9. When ab ≠ c - c': published errors in the reports of single-mediator models.

    Science.gov (United States)

    Petrocelli, John V; Clarkson, Joshua J; Whitmire, Melanie B; Moon, Paul E

    2013-06-01

    Accurate reports of mediation analyses are critical to the assessment of inferences related to causality, since these inferences are consequential for both the evaluation of previous research (e.g., meta-analyses) and the progression of future research. However, upon reexamination, approximately 15% of published articles in psychology contain at least one incorrect statistical conclusion (Bakker & Wicherts, Behavior research methods, 43, 666-678 2011), disparities that beget the question of inaccuracy in mediation reports. To quantify this question of inaccuracy, articles reporting standard use of single-mediator models in three high-impact journals in personality and social psychology during 2011 were examined. More than 24% of the 156 models coded failed an equivalence test (i.e., ab = c - c'), suggesting that one or more regression coefficients in mediation analyses are frequently misreported. The authors cite common sources of errors, provide recommendations for enhanced accuracy in reports of single-mediator models, and discuss implications for alternative methods.

  10. An investigation of the relationship between patient safety climate and barriers to nursing error reporting in Social Security Hospitals of Kerman Province, Iran

    Directory of Open Access Journals (Sweden)

    Noohi E

    2015-02-01

    Full Text Available Background and Objective: The receipt of appropriate and safe health care is of the basic rights of patiants and its provision is the main task of the health care delivery system. The role of error reporting in the reduction of future occurrence of that error is undeniable. Therefore, the removal of barriers to error reporting has particular importance. The present study aimed to investigate the association between patient safety climate and barriers to reporting of nursing error in Social Security Hospitals in Kerman province, Iran. Materials and Method: This was a cross-sectional, descriptive-correlative study. The study population consisted of all nurses of Social Security Hospitals in Kerman in 2014. Sampling was performed using the census method (n = 233. The Patient Safety Climate Questionnaire and Barriers to Nursing Error Reporting Questionnaire were used after obtaining satisfactory reliability and validity. Data were analyzed using SPSS software version 16 and frequency distribution tables and central indices. To achieve goals, the parametric test of t-test, one way ANOVA, and Pearson correlation coefficient were used. Results: The mean and standard deviations of the safety climate score (66 ± 10 and the barriers to nursing error reporting score (69 ± 13 were obtained: both were at a medium level. A significant inverse relationship was observed between patient safety climate and barriers to error reporting (P < 0.020 (r = -0.15. Conclusion: Based on the results, the error reporting barriers and safety climate scores were at an average level. Given the inverse relationship between safety climate and barriers to reporting error, it can be concluded that the most important step toward removing barriers is creating an atmosphere in which each of the nursing staff voluntarily reports her/his error and its causes to other members of the treatment team.

  11. The School Personnel Administrator.

    Science.gov (United States)

    Knox, Rodney F.

    This paper provides an overview of the development of the school-personnel administrator role. It first describes the influence of the science-management and human-relations movements and the behavioral sciences on personnel administration and human resource management. It next discusses the role of the personnel-performance-appraisal system and…

  12. Inducible error-prone repair in B. subtilis. Final report, September 1, 1979-June 30, 1981

    Energy Technology Data Exchange (ETDEWEB)

    Yasbin, R. E.

    1981-06-01

    The research performed under this contract has been concentrated on the relationship between inducible DNA repair systems, mutagenesis and the competent state in the gram positive bacterium Bacillus subtilis. The following results have been obtained from this research: (1) competent Bacillus subtilis cells have been developed into a sensitive tester system for carcinogens; (2) competent B. subtilis cells have an efficient excision-repair system, however, this system will not function on bacteriophage DNA taken into the cell via the process of transfection; (3) DNA polymerase III is essential in the mechanism of the process of W-reactivation; (4) B. subtilis strains cured of their defective prophages have been isolated and are now being developed for gene cloning systems; (5) protoplasts of B. subtilis have been shown capable of acquiring DNA repair enzymes (i.e., enzyme therapy); and (6) a plasmid was characterized which enhanced inducible error-prone repair in a gram positive organism.

  13. A circadian rhythm in skill-based errors in aviation maintenance.

    Science.gov (United States)

    Hobbs, Alan; Williamson, Ann; Van Dongen, Hans P A

    2010-07-01

    In workplaces where activity continues around the clock, human error has been observed to exhibit a circadian rhythm, with a characteristic peak in the early hours of the morning. Errors are commonly distinguished by the nature of the underlying cognitive failure, particularly the level of intentionality involved in the erroneous action. The Skill-Rule-Knowledge (SRK) framework of Rasmussen is used widely in the study of industrial errors and accidents. The SRK framework describes three fundamental types of error, according to whether behavior is under the control of practiced sensori-motor skill routines with minimal conscious awareness; is guided by implicit or explicit rules or expertise; or where the planning of actions requires the conscious application of domain knowledge. Up to now, examinations of circadian patterns of industrial errors have not distinguished between different types of error. Consequently, it is not clear whether all types of error exhibit the same circadian rhythm. A survey was distributed to aircraft maintenance personnel in Australia. Personnel were invited to anonymously report a safety incident and were prompted to describe, in detail, the human involvement (if any) that contributed to it. A total of 402 airline maintenance personnel reported an incident, providing 369 descriptions of human error in which the time of the incident was reported and sufficient detail was available to analyze the error. Errors were categorized using a modified version of the SRK framework, in which errors are categorized as skill-based, rule-based, or knowledge-based, or as procedure violations. An independent check confirmed that the SRK framework had been applied with sufficient consistency and reliability. Skill-based errors were the most common form of error, followed by procedure violations, rule-based errors, and knowledge-based errors. The frequency of errors was adjusted for the estimated proportion of workers present at work/each hour of the day

  14. Personnel preferences in personnel planning and scheduling

    OpenAIRE

    Veen, van der, M.Q.

    2013-01-01

    The personnel of an organization often has seemingly conflicting goals. On the one hand, the common goal is to achieve operational efficiency and to be available for work when needed in the organization. On the other hand, individual employees like to have a good work-life balance, by having personal working hour preferences taken into account. We develop and apply Operations Research methods and tools and show that operational efficiency can be achieved while taking personnel preferences int...

  15. The Relationships Among Perceived Patients' Safety Culture, Intention to Report Errors, and Leader Coaching Behavior of Nurses in Korea: A Pilot Study.

    Science.gov (United States)

    Ko, YuKyung; Yu, Soyoung

    2017-09-01

    This study was undertaken to explore the correlations among nurses' perceptions of patient safety culture, their intention to report errors, and leader coaching behaviors. The participants (N = 289) were nurses from 5 Korean hospitals with approximately 300 to 500 beds each. Sociodemographic variables, patient safety culture, intention to report errors, and coaching behavior were measured using self-report instruments. Data were analyzed using descriptive statistics, Pearson correlation coefficient, the t test, and the Mann-Whitney U test. Nurses' perceptions of patient safety culture and their intention to report errors showed significant differences between groups of nurses who rated their leaders as high-performing or low-performing coaches. Perceived coaching behavior showed a significant, positive correlation with patient safety culture and intention to report errors, i.e., as nurses' perceptions of coaching behaviors increased, so did their ratings of patient safety culture and error reporting. There is a need in health care settings for coaching by nurse managers to provide quality nursing care and thus improve patient safety. Programs that are systematically developed and implemented to enhance the coaching behaviors of nurse managers are crucial to the improvement of patient safety and nursing care. Moreover, a systematic analysis of the causes of malpractice, as opposed to a focus on the punitive consequences of errors, could increase error reporting and therefore promote a culture in which a higher level of patient safety can thrive.

  16. Collecting close-contact social mixing data with contact diaries: reporting errors and biases.

    Science.gov (United States)

    Smieszek, T; Burri, E U; Scherzinger, R; Scholz, R W

    2012-04-01

    The analysis of contact networks plays a major role to understanding the dynamics of disease spread. Empirical contact data is often collected using contact diaries. Such studies rely on self-reported perceptions of contacts, and arrangements for validation are usually not made. Our study was based on a complete network study design that allowed for the analysis of reporting accuracy in contact diary studies. We collected contact data of the employees of three research groups over a period of 1 work week. We found that more than one third of all reported contacts were only reported by one out of the two involved contact partners. Non-reporting is most frequent in cases of short, non-intense contact. We estimated that the probability of forgetting a contact of ≤5 min duration is greater than 50%. Furthermore, the number of forgotten contacts appears to be proportional to the total number of contacts.

  17. Development of Course Content Materials For Training Research and Research Related Personnel to Appraise Research Critically. Final Report.

    Science.gov (United States)

    Millman, Jason; Gowin, D. Bob

    A description of the development of the print materials to improve the ability of learners to appraise critically educational research is provided in this report. The completed materials consist of the following: an introductory statement about the nature of criticism, a statement about the contents of the materials and suggestions for use, and…

  18. Region VI Inservice Training for Vocational-Technical Personnel (Arlington, Texas, October 7-10, 1975). Conference Report.

    Science.gov (United States)

    EPD Consortium D, Richardson, TX.

    This conference report contains a collection of thirteen papers delivered at the Region VI (New Mexico, Texas, Mississippi, Louisiana, and Oklahoma) inservice training conference, which focused on special needs groups (i.e., those with academic, socioeconomic, or physical handicaps that prevent them from succeeding in regular vocational programs).…

  19. A Team Approach to Training Early Intervention and Preschool Personnel in Speech-Language Pathology, 1998-2000. Final Report.

    Science.gov (United States)

    San Jose State Univ., CA.

    This final report discusses the activities and outcomes of a project designed to train specialists to work collaboratively across settings to improve the outcomes of young children with language and learning disabilities. It provided education for trainees that led to a Masters degree in speech-language pathology with a specialty in early…

  20. Associations of reported bruxism with insomnia and insufficient sleep symptoms among media personnel with or without irregular shift work

    Directory of Open Access Journals (Sweden)

    Hublin Christer

    2008-02-01

    Full Text Available Abstract Background The aims were to investigate the prevalence of perceived sleep quality and insufficient sleep complaints, and to analyze whether self-reported bruxism was associated with perceptions of sleep, and awake consequences of disturbed sleep, while controlling confounding factors relative to poor sleep. Methods A standardized questionnaire was mailed to all employees of the Finnish Broadcasting Company with irregular shift work (n = 750 and to an equal number of randomly selected controls in the same company with regular eight-hour daytime work. Results The response rate in the irregular shift work group was 82.3% (56.6% men and in the regular daytime work group 34.3% (46.7% men. Self-reported bruxism occurred frequently (often or continually in 10.6% of all subjects. Altogether 16.8% reported difficulties initiating sleep (DIS, 43.6% disrupted sleep (DS, and 10.3% early morning awakenings (EMA. The corresponding figures for non-restorative sleep (NRS, tiredness, and sleep deprivation (SLD were 36.2%, 26.1%, and 23.7%, respectively. According to logistic regression, female gender was a significant independent factor for all insomnia symptoms, and older age for DS and EMA. Frequent bruxism was significantly associated with DIS (p = 0.019 and DS (p = 0.021. Dissatisfaction with current work shift schedule and frequent bruxism were both significant independent factors for all variables describing insufficient sleep consequences. Conclusion Self-reported bruxism may indicate sleep problems and their adherent awake consequences in non-patient populations.

  1. Associations of reported bruxism with insomnia and insufficient sleep symptoms among media personnel with or without irregular shift work

    Science.gov (United States)

    Ahlberg, Kristiina; Jahkola, Antti; Savolainen, Aslak; Könönen, Mauno; Partinen, Markku; Hublin, Christer; Sinisalo, Juha; Lindholm, Harri; Sarna, Seppo; Ahlberg, Jari

    2008-01-01

    Background The aims were to investigate the prevalence of perceived sleep quality and insufficient sleep complaints, and to analyze whether self-reported bruxism was associated with perceptions of sleep, and awake consequences of disturbed sleep, while controlling confounding factors relative to poor sleep. Methods A standardized questionnaire was mailed to all employees of the Finnish Broadcasting Company with irregular shift work (n = 750) and to an equal number of randomly selected controls in the same company with regular eight-hour daytime work. Results The response rate in the irregular shift work group was 82.3% (56.6% men) and in the regular daytime work group 34.3% (46.7% men). Self-reported bruxism occurred frequently (often or continually) in 10.6% of all subjects. Altogether 16.8% reported difficulties initiating sleep (DIS), 43.6% disrupted sleep (DS), and 10.3% early morning awakenings (EMA). The corresponding figures for non-restorative sleep (NRS), tiredness, and sleep deprivation (SLD) were 36.2%, 26.1%, and 23.7%, respectively. According to logistic regression, female gender was a significant independent factor for all insomnia symptoms, and older age for DS and EMA. Frequent bruxism was significantly associated with DIS (p = 0.019) and DS (p = 0.021). Dissatisfaction with current work shift schedule and frequent bruxism were both significant independent factors for all variables describing insufficient sleep consequences. Conclusion Self-reported bruxism may indicate sleep problems and their adherent awake consequences in non-patient populations. PMID:18307774

  2. Newly Reported Respiratory Symptoms and Conditions Among Military Personnel Deployed to Iraq and Afghanistan: A Prospective Population-Based Study

    Science.gov (United States)

    2009-01-01

    of breath), 2) chronic bronchitis or emphysema , and 3) asthma . Deployers had a higher rate of newly reported respiratory symptoms than nondeployers (14...vs. 10%), while similar rates of chronic bronchitis or emphysema (1% vs. 1%) and asthma (1% vs. 1%) were observed. Deployment was associated with...respiratory outcomes: 1) respiratory symptoms (persistent or recurring cough or shortness of breath), 2) chronic bronchitis or emphysema , and 3) asthma

  3. Brief report: errorless versus errorful learning as a memory rehabilitation approach in Alzheimer's Disease.

    Science.gov (United States)

    Metzler-Baddeley, Claudia; Snowden, Julie S

    2005-11-01

    Previous studies concerned with the use of errorless learning (EL) in memory rehabilitation of patients with Alzheimer's disease (AD) combined EL with other techniques, such as expanded rehearsal, to facilitate learning. These studies focused on the re-learning of previously familiar information and did not investigate the learning of novel information. The aim of the present study was to investigate if EL provides a better training technique for AD patients than errorful learning (EF). For this purpose, learning of familiar material and learning of novel associations in four patients with probable AD was compared under EL and EF conditions. Combined data analysis demonstrated a significant advantage of EL over EF both for old and novel learning. However, patients also learned significantly in the EF condition and the EL effect was not large enough to reach significance on an individual level. It is suggested that EL may be most beneficial for patients with profound amnesia, and in situations that make effortful processing difficult, but that residual explicit memory capacities may override EL benefits.

  4. Nurse perceptions of organizational culture and its association with the culture of error reporting: a case of public sector hospitals in Pakistan.

    Science.gov (United States)

    Jafree, Sara Rizvi; Zakar, Rubeena; Zakar, Muhammad Zakria; Fischer, Florian

    2016-01-05

    There is an absence of formal error tracking systems in public sector hospitals of Pakistan and also a lack of literature concerning error reporting culture in the health care sector. Nurse practitioners have front-line knowledge and rich exposure about both the organizational culture and error sharing in hospital settings. The aim of this paper was to investigate the association between organizational culture and the culture of error reporting, as perceived by nurses. The authors used the "Practice Environment Scale-Nurse Work Index Revised" to measure the six dimensions of organizational culture. Seven questions were used from the "Survey to Solicit Information about the Culture of Reporting" to measure error reporting culture in the region. Overall, 309 nurses participated in the survey, including female nurses from all designations such as supervisors, instructors, ward-heads, staff nurses and student nurses. We used SPSS 17.0 to perform a factor analysis. Furthermore, descriptive statistics, mean scores and multivariable logistic regression were used for the analysis. Three areas were ranked unfavorably by nurse respondents, including: (i) the error reporting culture, (ii) staffing and resource adequacy, and (iii) nurse foundations for quality of care. Multivariable regression results revealed that all six categories of organizational culture, including: (1) nurse manager ability, leadership and support, (2) nurse participation in hospital affairs, (3) nurse participation in governance, (4) nurse foundations of quality care, (5) nurse-coworkers relations, and (6) nurse staffing and resource adequacy, were positively associated with higher odds of error reporting culture. In addition, it was found that married nurses and nurses on permanent contract were more likely to report errors at the workplace. Public healthcare services of Pakistan can be improved through the promotion of an error reporting culture, reducing staffing and resource shortages and the

  5. Systematic Review of Errors in Inhaler Use

    DEFF Research Database (Denmark)

    Sanchis, Joaquin; Gich, Ignasi; Pedersen, Søren

    2016-01-01

    A systematic search for articles reporting direct observation of inhaler technique by trained personnel covered the period from 1975 to 2014. Outcomes were the nature and frequencies of the three most common errors; the percentage of patients demonstrating correct, acceptable, or poor technique; and variations...... were extracted from 144 articles reporting on a total number of 54,354 subjects performing 59,584 observed tests of technique. The most frequent MDI errors were in coordination (45%; 95% CI, 41%-49%), speed and/or depth of inspiration (44%; 40%-47%), and no postinhalation breath-hold (46%; 42...... no significant differences between the first and second 20-year periods of scrutiny. Conclusions Incorrect inhaler technique is unacceptably frequent and has not improved over the past 40 years, pointing to an urgent need for new approaches to education and drug delivery. © 2016 The Authors...

  6. Measurement Error in the Reported Reasons for Entry into the Foster Care System

    OpenAIRE

    Debra Dwyer

    2001-01-01

    To date, much of the research on foster dependence hinges on the validity of the reasons for entry into the foster care system. Yet, no one has tested these data. Since these reasons for entry help to assess individual differences in foster care children, the purpose of this study is to more closely examine these reasons. Using data from the Adoption and Foster Care Analysis Reporting System, we begin with exploratory factor analysis on the reported reasons for entry. Next, we specify and tes...

  7. Research and development report. Eureka 147: Tests of the error performance of the DAB system

    Science.gov (United States)

    Gilchrist, N. H. C.

    This Report describes tests carried out by the BBC and other members of Eureka 147 Working Group 2-A, to assess the performance of the DAB (Digital Audio Broadcasting) system with a low carrier-to-noise ratio at the receiver. The tests were conducted using a number of listeners to judge the audio quality, making collaborative decisions with the knowledge of the conditions under which the system was operating at all times. The primary purpose of the work described in this Report was to inform the Eureka 147 project about the failure characteristics of the DAB system as the carrier-to-noise ratio is reduced.

  8. Self-reported hand hygiene perceptions and barriers among companion animal veterinary clinic personnel in Ontario, Canada

    Science.gov (United States)

    Anderson, Maureen E.C.; Weese, J. Scott

    2016-01-01

    The objective of this study was to describe the perceived importance of and barriers to hand hygiene among companion animal clinic staff. An anonymous, voluntary written questionnaire was completed by 356 of approximately 578 individuals (62%) from 49/51 clinics. On a scale of 1 (not important) to 7 (very important), the percentage of respondents who rated hand hygiene as a 5 or higher was at least 82% in all clinical scenarios queried. The most frequently reported reason for not performing hand hygiene was forgetting to do so (40%, 141/353). Specific discussion of hand hygiene practices at work was recalled by 32% (114/354) of respondents. Although veterinary staff seem to recognize the importance of hand hygiene, it should be emphasized more during staff training. Other barriers including time constraints and skin irritation should also be addressed, possibly through increased access to and use of alcohol-based hand sanitizers. PMID:26933265

  9. NASA Model of "Threat and Error" in Pediatric Cardiac Surgery: Patterns of Error Chains.

    Science.gov (United States)

    Hickey, Edward; Pham-Hung, Eric; Nosikova, Yaroslavna; Halvorsen, Fredrik; Gritti, Michael; Schwartz, Steven; Caldarone, Christopher A; Van Arsdell, Glen

    2017-04-01

    We introduced the National Aeronautics and Space Association threat-and-error model to our surgical unit. All admissions are considered flights, which should pass through stepwise deescalations in risk during surgical recovery. We hypothesized that errors significantly influence risk deescalation and contribute to poor outcomes. Patient flights (524) were tracked in real time for threats, errors, and unintended states by full-time performance personnel. Expected risk deescalation was wean from mechanical support, sternal closure, extubation, intensive care unit (ICU) discharge, and discharge home. Data were accrued from clinical charts, bedside data, reporting mechanisms, and staff interviews. Infographics of flights were openly discussed weekly for consensus. In 12% (64 of 524) of flights, the child failed to deescalate sequentially through expected risk levels; unintended increments instead occurred. Failed deescalations were highly associated with errors (426; 257 flights; p < 0.0001). Consequential errors (263; 173 flights) were associated with a 29% rate of failed deescalation versus 4% in flights with no consequential error (p < 0.0001). The most dangerous errors were apical errors typically (84%) occurring in the operating room, which caused chains of propagating unintended states (n = 110): these had a 43% (47 of 110) rate of failed deescalation (versus 4%; p < 0.0001). Chains of unintended state were often (46%) amplified by additional (up to 7) errors in the ICU that would worsen clinical deviation. Overall, failed deescalations in risk were extremely closely linked to brain injury (n = 13; p < 0.0001) or death (n = 7; p < 0.0001). Deaths and brain injury after pediatric cardiac surgery almost always occur from propagating error chains that originate in the operating room and are often amplified by additional ICU errors. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  10. latrogenic fracture of humerus – complication of a diagnostic error in a shoulder dislocation: a case report

    Directory of Open Access Journals (Sweden)

    Ahmad Riaz

    2007-07-01

    Full Text Available Abstract Shoulder dislocation is the commonest dislocation presenting to the emergency department, anterior being more common than posterior. The latter being less common has a tendency of being missed; this is supported by many cases in the literature. Kocher's method is one of the many methods of reducing anterior dislocation; there are many reported complications of employing this method. To the best of our knowledge we are reporting the first case of an iatrogenic fracture of the proximal humerus, due to the use of Kocher's method of shoulder reduction in a posterior dislocation following a diagnostic error which led to an avoidable difficult surgical intervention. We also discuss the mechanism of the iatrogenic fracture and the measures that can be undertaken to prevent it.

  11. [Survey in hospitals. Nursing errors, error culture and error management].

    Science.gov (United States)

    Habermann, Monika; Cramer, Henning

    2010-09-01

    Knowledge on errors is important to design safe nursing practice and its framework. This article presents results of a survey on this topic, including data of a representative sample of 724 nurses from 30 German hospitals. Participants predominantly remembered medication errors. Structural and organizational factors were rated as most important causes of errors. Reporting rates were considered low; this was explained by organizational barriers. Nurses in large part expressed having suffered from mental problems after error events. Nurses' perception focussing on medication errors seems to be influenced by current discussions which are mainly medication-related. This priority should be revised. Hospitals' risk management should concentrate on organizational deficits and positive error cultures. Decision makers are requested to tackle structural problems such as staff shortage.

  12. Traumatic events, other operational stressors and physical and mental health reported by Australian Defence Force personnel following peacekeeping and war-like deployments

    Directory of Open Access Journals (Sweden)

    Waller Michael

    2012-07-01

    Full Text Available Abstract Background The association between stressful events on warlike deployments and subsequent mental health problems has been established. Less is known about the effects of stressful events on peacekeeping deployments. Methods Two cross sectional studies of the Australian Defence Force were used to contrast the prevalence of exposures reported by a group deployed on a peacekeeping operation (Bougainville, n = 1704 and those reported by a group deployed on operations which included warlike and non-warlike exposures (East Timor, n = 1333. A principal components analysis was used to identify groupings of non-traumatic exposures on deployment. Multiple regression models were used to assess the association between self-reported objective and subjective exposures, stressors on deployment and subsequent physical and mental health outcomes. Results The principal components analysis produced four groups of non-traumatic stressors which were consistent between the peacekeeping and more warlike deployments. These were labelled ‘separation’, ‘different culture’, ‘other people’ and ‘work frustration’. Higher levels of traumatic and non-traumatic exposures were reported by veterans of East Timor compared to Bougainville. Higher levels of subjective traumatic exposures were associated with increased rates of PTSD in East Timor veterans and more physical and psychological health symptoms in both deployed groups. In Bougainville and East Timor veterans some non-traumatic deployment stressors were also associated with worse health outcomes. Conclusion Strategies to best prepare, identify and treat those exposed to traumatic events and other stressors on deployment should be considered for Defence personnel deployed on both warlike and peacekeeping operations.

  13. The Impact of a Patient Safety Program on Medical Error Reporting

    Science.gov (United States)

    2005-05-01

    incident severity showed 172 (86 percent) near misses (no impact on patient) in 1998 and 251 (91 percent) in 2001. In 1998 there were 28 (14 percent...aviation mishaps. Crew Resource Management also emphasizes the need for anonymous reporting of near misses and the removal of blame as a deterrent to the...Management Office), and each is categorized as a near miss , an adverse event, or a sentinel event. A near miss is a mistake that is caught and corrected

  14. Caffeine Use among Active Duty Navy and Marine Corps Personnel

    Directory of Open Access Journals (Sweden)

    Joseph J. Knapik

    2016-10-01

    Full Text Available Data from the National Health and Nutrition Examination Survey (NHANES indicate 89% of Americans regularly consume caffeine, but these data do not include military personnel. This cross-sectional study examined caffeine use in Navy and Marine Corps personnel, including prevalence, amount of daily consumption, and factors associated with use. A random sample of Navy and Marine Corps personnel was contacted and asked to complete a detailed questionnaire describing their use of caffeine-containing substances, in addition to their demographic, military, and lifestyle characteristics. A total of 1708 service members (SMs completed the questionnaire. Overall, 87% reported using caffeinated beverages ≥1 time/week, with caffeine users consuming a mean ± standard error of 226 ± 5 mg/day (242 ± 7 mg/day for men, 183 ± 8 mg/day for women. The most commonly consumed caffeinated beverages (% users were coffee (65%, colas (54%, teas (40%, and energy drinks (28%. Multivariable logistic regression modeling indicated that characteristics independently associated with caffeine use (≥1 time/week included older age, white race/ethnicity, higher alcohol consumption, and participating in less resistance training. Prevalence of caffeine use in these SMs was similar to that reported in civilian investigations, but daily consumption (mg/day was higher.

  15. Caffeine Use among Active Duty Navy and Marine Corps Personnel.

    Science.gov (United States)

    Knapik, Joseph J; Trone, Daniel W; McGraw, Susan; Steelman, Ryan A; Austin, Krista G; Lieberman, Harris R

    2016-10-09

    Data from the National Health and Nutrition Examination Survey (NHANES) indicate 89% of Americans regularly consume caffeine, but these data do not include military personnel. This cross-sectional study examined caffeine use in Navy and Marine Corps personnel, including prevalence, amount of daily consumption, and factors associated with use. A random sample of Navy and Marine Corps personnel was contacted and asked to complete a detailed questionnaire describing their use of caffeine-containing substances, in addition to their demographic, military, and lifestyle characteristics. A total of 1708 service members (SMs) completed the questionnaire. Overall, 87% reported using caffeinated beverages ≥1 time/week, with caffeine users consuming a mean ± standard error of 226 ± 5 mg/day (242 ± 7 mg/day for men, 183 ± 8 mg/day for women). The most commonly consumed caffeinated beverages (% users) were coffee (65%), colas (54%), teas (40%), and energy drinks (28%). Multivariable logistic regression modeling indicated that characteristics independently associated with caffeine use (≥1 time/week) included older age, white race/ethnicity, higher alcohol consumption, and participating in less resistance training. Prevalence of caffeine use in these SMs was similar to that reported in civilian investigations, but daily consumption (mg/day) was higher.

  16. Medication Errors in Hospitals: A Study of Factors Affecting Nursing Reporting in a Selected Center Affiliated with Shahid Beheshti University of Medical Sciences

    Directory of Open Access Journals (Sweden)

    HamidReza Mirzaee

    2015-10-01

    Full Text Available Background: Medication errors are mentioned as the most common important challenges threatening healthcare system in all countries worldwide. This study is conducted to investigate the most significant factors in refusal to report medication errors among nursing staff.Methods: The cross-sectional study was conducted on all nursing staff of a selected Education& Treatment Center in 2013. Data was collected through a teacher made questionnaire. The questionnaires’ face and content validity was confirmed by experts and for measuring its reliability test-retest was used. Data was analyzed by descriptive and analytic statistics. 16th  version of SPSS was also used for related statistics.Results: The most important factors in refusal to report medication errors respectively are: lack of reporting system in the hospital(3.3%, non-significance of reporting medication errors to hospital authorities and lack of appropriate feedback(3.1%, and lack of a clear definition for a medication error (3%. there was a significant relationship between the most important factors of refusal to report medication errors and work shift (p:0.002, age(p:0.003, gender(p:0.005, work experience(p<0.001 and employment type of nurses(p:0.002.Conclusion: Factors pertaining to management in hospitals as well as the fear of the consequences of reporting are two broad fields among the factors that make nurses not report their medication errors. In this regard, providing enough education to nurses, boosting the job security for nurses, management support and revising related processes and definitions are some factors that can help decreasing medication errors and increasing their report in case of occurrence.

  17. Understanding nurses' and physicians' fear of repercussions for reporting errors: clinician characteristics, organization demographics, or leadership factors?

    Science.gov (United States)

    Castel, Evan S; Ginsburg, Liane R; Zaheer, Shahram; Tamim, Hala

    2015-08-14

    Identifying and understanding factors influencing fear of repercussions for reporting and discussing medical errors in nurses and physicians remains an important area of inquiry. Work is needed to disentangle the role of clinician characteristics from those of the organization-level and unit-level safety environments in which these clinicians work and learn, as well as probing the differing reporting behaviours of nurses and physicians. This study examines the influence of clinician demographics (age, gender, and tenure), organization demographics (teaching status, location of care, and province) and leadership factors (organization and unit leadership support for safety) on fear of repercussions, and does so for nurses and physicians separately. A cross-sectional analysis of 2319 nurse and 386 physician responders from three Canadian provinces to the Modified Stanford patient safety climate survey (MSI-06). Data were analyzed using exploratory factor analysis, multiple linear regression, and hierarchical linear regression. Age, gender, tenure, teaching status, and province were not significantly associated with fear of repercussions for nurses or physicians. Mental health nurses had poorer fear responses than their peers outside of these areas, as did community physicians. Strong organization and unit leadership support for safety explained the most variance in fear for both nurses and physicians. The absence of associations between several plausible factors including age, tenure and teaching status suggests that fear is a complex construct requiring more study. Substantially differing fear responses across locations of care indicate areas where interventions may be needed. In addition, since factors affecting fear of repercussions appear to be different for nurses and physicians, tailoring patient safety initiatives to each group may, in some instances, be fruitful. Although further investigation is needed to examine these and other factors in detail, supportive

  18. Nasogastric Tube Placement Errors and Complications in Pediatric Intensive Care Unit: A Case Report

    Directory of Open Access Journals (Sweden)

    Mahin Seyedhejazi

    2011-11-01

    Full Text Available Nasal ala pressure sores are among complications of nasogastric tube in Pediatric Intensive Care Unit (PICU. The severity of the injury is usually minor and easily ignored. However, the complication could be easily avoided. This is a case of nasal ala sore after the place-ment of nasal enteral tube in a pediatric intensive care unit in our center. A 5-month-old female with pulmonary hypertension secondary to bronchiectasis with nasal ala pressure sore were reported. She was hospitalized in pediatric intensive care unit at Tabriz Children Hospital in 2010.After 53 days of PICU hospitalization she had nasal ala sore. Conclusion: We know that nasal ala pressure sores could easily be avoided when preventive procedures were performed during nasogastric tube insertion.

  19. Personnel preferences in personnel planning and scheduling

    NARCIS (Netherlands)

    van der Veen, Egbert

    2013-01-01

    Summary The personnel of an organization often has two conflicting goals. Individual employees like to have a good work-life balance, by having personal preferences taken into account, whereas there is also the common goal to work efficiently. By applying techniques and methods from Operations Resea

  20. Personnel preferences in personnel planning and scheduling

    NARCIS (Netherlands)

    van der Veen, Egbert

    2013-01-01

    Summary The personnel of an organization often has two conflicting goals. Individual employees like to have a good work-life balance, by having personal preferences taken into account, whereas there is also the common goal to work efficiently. By applying techniques and methods from Operations

  1. Personnel preferences in personnel planning and scheduling

    NARCIS (Netherlands)

    Veen, van der Egbert

    2013-01-01

    The personnel of an organization often has seemingly conflicting goals. On the one hand, the common goal is to achieve operational efficiency and to be available for work when needed in the organization. On the other hand, individual employees like to have a good work-life balance, by having persona

  2. Fifth personnel dosimetry intercomparison study

    Energy Technology Data Exchange (ETDEWEB)

    Sims, C.S.

    1980-02-01

    The fifth Personnel Dosimetry Intercomparison Study (PDIS) was conducted at the Oak Ridge National Laboratory's (ORNL) Dosimetry Applications Research (DOSAR) facility on March 20-22, 1979. This study is the latest PDIS in the continuing series started at the DOSAR facility in 1974. The PDIS is a three day study, typically in March, where personnel dosimeters are mailed to the DOSAR facility, exposed to a range of low-level neutron radiation doses (1 to 15 mSv or equivalently, 100 to 1500 mrem) and neutron-to-gamma ratios (1:1-10:1) using the Health Physics Research Reactor (HPRR) as the radiation source, and returned to the participants for evaluation. This report is a summary and analysis of the results reported by the various participants. The participants are able to intercompare their results with those of others who made dose measurements under identical experimental conditions.

  3. Caffeine consumption among active duty United States Air Force personnel.

    Science.gov (United States)

    Knapik, Joseph J; Austin, Krista G; McGraw, Susan M; Leahy, Guy D; Lieberman, Harris R

    2017-07-01

    Data from the National Health and Nutrition Examination Survey (NHANES) indicated that 89% of Americans regularly consumed caffeinated products, but these data did not include military personnel. This cross-sectional study examined caffeine consumption prevalence, amount of daily consumption, and factors associated with caffeine intake in active duty United States (US) Air Force personnel. Service members (N = 1787) stationed in the US and overseas completed a detailed questionnaire describing their intake of caffeine-containing products in addition to their demographic, lifestyle, and military characteristics. Overall, 84% reported consuming caffeinated products ≥1 time/week with caffeine consumers ingesting a mean ± standard error of 212 ± 9 mg/day (224 ± 11 mg/day for men, 180 ± 12 mg/day for women). The most commonly consumed caffeinated products (% users) were sodas (56%), coffee (45%), teas (36%), and energy drinks (27%). Multivariate logistic regression modeling indicated that characteristics independently associated with caffeine consumption (≥1 time/week) included older age, ethnicity other than black, tobacco use, less aerobic training, and less sleep; energy drink use was associated with male gender, younger age, tobacco use, and less sleep. Compared to NHANES data, the prevalence of caffeine consumption in Air Force personnel was similar but daily consumption (mg/day) was higher. Published by Elsevier Ltd.

  4. Validity of self-reported weight, height and resultant body mass index in Chinese adolescents and factors associated with errors in self-reports

    Directory of Open Access Journals (Sweden)

    Ouyang Xue

    2010-04-01

    Full Text Available Abstract Background Validity of self-reported height and weight has not been adequately evaluated in diverse adolescent populations. In fact there are no reported validity studies conducted in Asian children and adolescents. This study aims to examine the accuracy of self-reported weight, height, and resultant BMI values in Chinese adolescents, and of the adolescents' subsequent classification into overweight categories. Methods Weight and height were self-reported and measured in 1761 adolescents aged 12-16 years in a cross-sectional survey in Xi'an city, China. BMI was calculated from both reported values and measured values. Bland-Altman plots with 95% limits of agreement, Pearson's correlation and Kappa statistics were calculated to assess the agreement. Results The 95% limits of agreement were -11.16 and 6.46 kg for weight, -4.73 and 7.45 cm for height, and -4.93 and 2.47 kg/m2 for BMI. Pearson correlation between measured and self-reported values was 0.912 for weight, 0.935 for height and 0.809 for BMI. Weighted Kappa was 0.859 for weight, 0.906 for height and 0.754 for BMI. Sensitivity for detecting overweight (includes obese in adolescents was 56.1%, and specificity was 98.6%. Subjects' area of residence, age and BMI were significant factors associated with the errors in self-reporting weight, height and relative BMI. Conclusions Reported weight and height does not have an acceptable agreement with measured data. Therefore, we do not recommend the application of self-reported weight and height to screen for overweight adolescents in China. Alternatively, self-reported data could be considered for use, with caution, in surveillance systems and epidemiology studies.

  5. Self-Reported and Observed Punitive Parenting Prospectively Predicts Increased Error-Related Brain Activity in Six-Year-Old Children.

    Science.gov (United States)

    Meyer, Alexandria; Proudfit, Greg Hajcak; Bufferd, Sara J; Kujawa, Autumn J; Laptook, Rebecca S; Torpey, Dana C; Klein, Daniel N

    2015-07-01

    The error-related negativity (ERN) is a negative deflection in the event-related potential (ERP) occurring approximately 50 ms after error commission at fronto-central electrode sites and is thought to reflect the activation of a generic error monitoring system. Several studies have reported an increased ERN in clinically anxious children, and suggest that anxious children are more sensitive to error commission--although the mechanisms underlying this association are not clear. We have previously found that punishing errors results in a larger ERN, an effect that persists after punishment ends. It is possible that learning-related experiences that impact sensitivity to errors may lead to an increased ERN. In particular, punitive parenting might sensitize children to errors and increase their ERN. We tested this possibility in the current study by prospectively examining the relationship between parenting style during early childhood and children's ERN approximately 3 years later. Initially, 295 parents and children (approximately 3 years old) participated in a structured observational measure of parenting behavior, and parents completed a self-report measure of parenting style. At a follow-up assessment approximately 3 years later, the ERN was elicited during a Go/No-Go task, and diagnostic interviews were completed with parents to assess child psychopathology. Results suggested that both observational measures of hostile parenting and self-report measures of authoritarian parenting style uniquely predicted a larger ERN in children 3 years later. We previously reported that children in this sample with anxiety disorders were characterized by an increased ERN. A mediation analysis indicated that ERN magnitude mediated the relationship between harsh parenting and child anxiety disorder. Results suggest that parenting may shape children's error processing through environmental conditioning and thereby risk for anxiety, although future work is needed to confirm this

  6. Exploring the Role Played by Error Correction and Models on Children's Reported Noticing and Output Production in a L2 Writing Task

    Science.gov (United States)

    Coyle, Yvette; Roca de Larios, Julio

    2014-01-01

    This article reports an empirical study in which we explored the role played by two forms of feedback--error correction and model texts--on child English as a foreign language learners' reported noticing and written output. The study was carried out with 11- and 12-year-old children placed in proficiency-matched pairs who engaged in a…

  7. Dietary reporting errors on 24 h recalls and dietary questionnaires are associated with BMI across six European countries as evaluated with recovery biomarkers for protein and potassium intake

    NARCIS (Netherlands)

    Freisling, Heinz; van Bakel, Marit M. E.; Biessy, Carine; May, Anne M.; Byrnes, Graham; Norat, Teresa; Rinaldi, Sabina; de Magistris, Maria Santucci; Grioni, Sara; Bueno-de-Mesquita, H. Bas; Ocke, Marga C.; Kaaks, Rudolf; Teucher, Birgit; Vergnaud, Anne-Claire; Romaguera, Dora; Sacerdote, Carlotta; Palli, Domenico; Crowe, Francesca L.; Tumino, Rosario; Clavel-Chapelon, Francoise; Boutron-Ruault, Marie-Christine; Khaw, Kay-Tee; Wareham, Nicholas J.; Trichopoulou, Antonia; Naska, Androniki; Orfanos, Philippos; Boeing, Heiner; Illner, Anne-Kathrin; Riboli, Elio; Peeters, Petra H.; Slimani, Nadia

    2012-01-01

    Whether there are differences between countries in the validity of self-reported diet in relation to BMI, as evaluated using recovery biomarkers, is not well understood. We aimed to evaluate BMI-related reporting errors on 24 h dietary recalls (24-HDR) and on dietary questionnaires (DQ) using biomar

  8. Influence of tooth profile error in gear rattle (2nd report; In the case of multi-step gear system)

    OpenAIRE

    濱野, 崇; 吉武, 裕; 田村, 尋徳; 濵田, 知宏; 原田, 晃; 小林, 敦

    2009-01-01

    Gear rattle of multi-step helical gear system is treated. Mesh stiffness variations and tooth profile errors are considered within the system. The effects of mesh stiffness variations, the ratio of static torque to dynamic one and tooth profile errors on the rattle are studied by a highly accurate numerical analysis called the shooting method. As a result, the followings were made clear. (1) Because of the tooth profile errors, the amplitude of resonances like gear noise becomes large and the...

  9. Patient identification errors: the detective in the laboratory.

    Science.gov (United States)

    Salinas, Maria; López-Garrigós, Maite; Lillo, Rosa; Gutiérrez, Mercedes; Lugo, Javier; Leiva-Salinas, Carlos

    2013-11-01

    The eradication of errors regarding patients' identification is one of the main goals for safety improvement. As clinical laboratory intervenes in 70% of clinical decisions, laboratory safety is crucial in patient safety. We studied the number of Laboratory Information System (LIS) demographic data errors registered in our laboratory during one year. The laboratory attends a variety of inpatients and outpatients. The demographic data of outpatients is registered in the LIS, when they present to the laboratory front desk. The requests from the primary care centers (PCC) are made electronically by the general practitioner. A manual step is always done at the PCC to conciliate the patient identification number in the electronic request with the one in the LIS. Manual registration is done through hospital information system demographic data capture when patient's medical record number is registered in LIS. Laboratory report is always sent out electronically to the patient's electronic medical record. Daily, every demographic data in LIS is manually compared to the request form to detect potential errors. Fewer errors were committed when electronic order was used. There was great error variability between PCC when using the electronic order. LIS demographic data manual registration errors depended on patient origin and test requesting method. Even when using the electronic approach, errors were detected. There was a great variability between PCC even when using this electronic modality; this suggests that the number of errors is still dependent on the personnel in charge of the technology. © 2013.

  10. INTOR critical issue D: maintainability. Tritium containment and personnel access vs remote maintenance, Chapter VI of the US INTOR report for Phase Two A, Part 2

    Energy Technology Data Exchange (ETDEWEB)

    Spampinato, P.T.; Finn, P.A.; Gohar, Y.; Yang, S.T.; Stasko, R.R.; Morrison, C.; Russell, S.; Shaw, G.; Bussell, G.T.; Watts, R.

    1984-01-01

    The purpose of this study is to compare the benefits and costs associated with personnel access mmaintenance procedures compared to those of all-remote maintenance procedures. The INTOR Phase Two A, Part I configuration was used to make this comparison. For both approaches, capital and operating costs were considered to first order, maintenance equipment requirements were investigated, maintenance requirements common to both approaches and unique to each were identified, tritium handling requirements were outlined, and maintenance scenarios and device downtime were developed for both. In addition, estimates of person-rem exposure were made for the personnel access approach.

  11. Strategies for Improving the Value of the Radiology Report: A Retrospective Analysis of Errors in Formally Over-read Studies.

    Science.gov (United States)

    Kabadi, Suraj Jay; Krishnaraj, Arun

    2017-04-01

    The radiology report is a critical component of the Imaging Value Chain. Unfortunately, the quality of this aspect of a radiologist's work is often heterogeneous and fails to add significant value to the referring provider and, ultimately, the patient. Gauging what defines quality can be elusive; however, we elucidate techniques that can be employed to ensure that reports are more comprehensible, actionable, and useful to our customers. Four hundred consecutive studies (July-August 2015) submitted to our institution with request for a formal over-read were reviewed retrospectively, specifically focused on analyzing differences in language, organization, and impression between the outside reports and the formal over-reads performed at our institution. The formal over-reads were classified into one of the following categories: (1) no clinically significant change; (2) emergent clinically significant change; (3) nonemergent clinically significant change. Clinically significant changes were further classified as either perceptual or cognitive errors. A total of 12.4% of formally over-read reports had clinically significant changes. Of these, 22.2% were emergent changes. Clinically significant changes were composed of 64.4% perceptual error and 35.6% cognitive error. Four strategies were discovered specifically related to reporting techniques that helped mitigate these errors on formal over-reads: (1) synthesizing varied anatomic findings into a cohesive disease process; (2) integration of relevant electronic health record data; (3) use of structured reporting; and (4) forming actionable impressions. We identify, through examples, four strategies for reporting that add value through reduction of radiologic error, helping to mitigate the 12.4% clinically significant error rate found in reinterpretation of outside studies. Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  12. Determinants of Personnel Practices.

    Science.gov (United States)

    1987-05-01

    headquartered in Japan, Singapore, Malaysia , Indonesia, or India, and 48 were local companies with all their establishments in Singapore. 4.w V jm , i...appraisal data, a well developed 2ILM, and written job descriptions and HRM philosophy will be considered to represent sophisticated personnel...resources management( HRM ) or personnel department with at least one professional staff member. Seventy two percent of responding organizations did

  13. Wheelchairmanship Project. A Program to Educate Personnel in the Transportation, Hotel and Restaurant, and Entertainment Industries in Improved Techniques for Serving Disabled People. Final Report.

    Science.gov (United States)

    Smith, Anita P.; And Others

    In a project designed to train customer service personnel in improved methods of assisting the physically disabled, audio-visual training materials were developed and presented during 2-week courses involving 1,058 employees at transportation, hotel/restaurant, and entertainment centers in 25 cities. The participants judged the training program…

  14. RCRA (Resource Conservation and Recovery Act) personnel training guidance manual for owners or operators of hazardous-waste-management facilities. Draft report

    Energy Technology Data Exchange (ETDEWEB)

    1980-09-01

    The manual provides guidance to an audience consisting of owners or operators of hazardous waste-management facilities and also regulatory personnel responsible for facility permitting. Information is provided concerning general training strategies and program design, types of training, training modules pertinent to hazardous-waste management, suggested training module elements, and sources of information.

  15. [A rare inborn error of intracellular processing of cobalamine presenting with microcephalus and megaloblastic anemia: a report of 3 children].

    Science.gov (United States)

    Müller, P; Horneff, G; Hennermann, J B

    2007-01-01

    Defects of methionine synthase or methionine synthase reductase result in an impaired remethylation of homocysteine to methionine. Patients present with megaloblastic anemia, failure to thrive and various neurological manifestations including mental retardation, cerebral atrophy, muscular hypotonia or hypertonia, ataxia, seizures, nystagmus and visual disturbances. We report on three children (two girls, one boy), aged 3.5-7.5 years, who presented with severe megaloblastic anemia, micro-cephalus and partly nystagmus (2/3) due to a rare inborn error of remethylation. Methionine synthase reductase deficiency, cblE type of homocystinuria (OMIM 236270), is a rare autosomal recessive inherited disorder described only in 14 patients worldwide. Metabolic hallmarks of the disease are hyperhomocysteinemia (median 98 micromol/l, normal range megaloblastic anemia. Measurements of homocysteine and methionine in plasma as well as methylmalonic acid in urine is required for confirming the diagnosis. Early treatment im-proves the outcome, although mental disability may not be prevented. Treatment has a positive impact on megaloblastic anemia but only slight effect on hyperhomocysteinemia. The long-term cardiovascular risk of hyperhomocysteinemia in cblE deficient patients is not known yet.

  16. Using spirometry results in occupational medicine and research: Common errors and good practice in statistical analysis and reporting

    Directory of Open Access Journals (Sweden)

    Wagner N

    2006-01-01

    Full Text Available Spirometry appears to be a simple and inexpensive method to measure disorders of the respiratory tract. In reality however, a simple spirometry test requires knowledge and skill to correctly conduct and evaluate the test and its results. This review addresses common misunderstandings in using, evaluating and reporting spirometry results in Occupational Health practice, clinical medicine and research. Results of spirometry need to be evaluated in relation to reference values. The factory medical officer has to decide first whether the test was technically correctly executed and is acceptable for medical interpretation. The next step is to compare results of the individual to published reference values. A 10% reduction of reference values for North Indians and Pakistanis and a 12 to 13% reduction for South Indians is recommended when Caucasian reference tables are used. In occupational health practice the worker′s spirometry performance over time needs to be considered. Common errors in reporting summarized results, for instance from groups of workers, are the incorrect use of tests of significance and incorrect presentation of aggregated spirometry results. The loss of respiratory function is recommended as an indicator of difference between two groups. That way, early changes in function can seen without waiting for a drop of function below the usually used 80%-of-predicted limit. This procedure increases the sensitivity of medical surveillance. In research the more precise Lower Limit of Normal should be calculated and used. Correct reference equations, good patient coaching, decision on the technical quality (acceptability of each spirometry test and critical re-evaluation of the machine′s readout are essential parts of a correct spirometry test. A good understanding how results are calculated is crucial for further statistical evaluation.

  17. Evoked Brain Activity and Personnel Performance

    Science.gov (United States)

    1987-10-01

    Eysenck and Barrett (1985) reviewed at considerable length this error rate theory , as well as other proposed interactions of psychophysiology and...Include Security CItuification) EVOKED BRAIN ACTIVITY AND PERSONNEL PERFORMANCE 12 PERSONAL AUTHOR(S) Lewis, G. W., and Sorenson, R. C. 13a. TYPE...aptitude tests and the MM PI and other personality tests were developed along with tests designed for military purposes. The latter include the Armed

  18. PR Personnel and Print Journalists: A Comparison of Professionalism

    Science.gov (United States)

    Nayman, Oguz; And Others

    1977-01-01

    Reports on a comparison of Colorado public relations personnel and newspaper journalists, which focused on demographic characteristics, professional orientation, job satisfaction, and attitude toward professional improvement. (GW)

  19. Personnel Policy and Profit

    DEFF Research Database (Denmark)

    Bingley, Paul; Westergård-Nielsen, Niels Chr.

    2004-01-01

    of the firm. Here we follow the population of 7118 medium-to-large sized private sector Danish firms over the period 1992-95. In an instrumental variables framework, we use changes in the personnel composition of different firms operating in the same local labour market to provide exogenous identifying...... personnel structure variation. It is found that personnel policy is strongly related to economic performance. At the margin, more hires are associated with lower profit, and more separations with higher profit. For the average firm, one new job, all else equal, is associated with ?2680 (2000 prices) lower...... annual profit. Higher wage level and lower wage growth is associated with higher profit. A workforce that has less tenure, all else equal, is more profitable....

  20. Personnel Policy and Profit

    DEFF Research Database (Denmark)

    Bingley, Paul; Westergård-Nielsen, Niels Chr.

    2004-01-01

    personnel structure variation. It is found that personnel policy is strongly related to economic performance. At the margin, more hires are associated with lower profit, and more separations with higher profit. For the average firm, one new job, all else equal, is associated with ?2680 (2000 prices) lower......There is a growing awareness of large differences in worker turnover and pay between firms. However, there is little knowledge about the effects of this on firm performance. This paper describes how personnel policies with respect to pay, tenure and worker flows are related to economic performance...... annual profit. Higher wage level and lower wage growth is associated with higher profit. A workforce that has less tenure, all else equal, is more profitable....

  1. Role of Clinical Pharmacists in Early Detection, Reporting and Prevention of Medication Errors in a Medical Ward

    Directory of Open Access Journals (Sweden)

    Solmaz Hassani

    2017-03-01

    Full Text Available Background: Drug utilization evaluation (DUE is an effective process in order to identifying variability in drug use and subsequent application of effective interventions for improving  patient outcomes. In this study, appropriate uses of drugs were evaluated by pharmacy service.Methods: A prospective, interventional study was designed for determining frequency and type of clinical pharmacists’ interventions and medication errors occurred in the infectious disease ward of Loghman hospital, affiliated to Shahid Beheshti University of Medical Sciences, Tehran, Iran during 8 months. Results: During the 8 months of the study period, 498 errors were detected among 419 patients that admitted to infectious disease ward of Loghman hospital. Most common errors were related to DVT prophylaxis, SUP and vancomycin monitoring. Discussion: Our result showed that clinical pharmacy interventions can have an important role in reducing adverse drug events and their activities can be effective for reducing of medication error.

  2. Children’s School-Breakfast Reports and School-Lunch Reports (in 24-hour Dietary Recalls): Conventional and Reporting-Error-Sensitive Measures Show Inconsistent Accuracy Results for Retention Interval and for Breakfast Location

    Science.gov (United States)

    Baxter, Suzanne Domel; Guinn, Caroline H.; Smith, Albert F.; Hitchcock, David B.; Royer, Julie A.; Puryear, Megan P.; Collins, Kathleen L.; Smith, Alyssa L.

    2017-01-01

    Validation-study data were analyzed to investigate retention interval (RI) and prompt effects on accuracy of fourth-grade children’s reports of school-breakfast and school-lunch (in 24-hour recalls), and accuracy of school-breakfast reports by breakfast location (classroom; cafeteria). Randomly-selected fourth-grade children at 10 schools in four districts were observed eating school-provided breakfast and lunch, and interviewed under one of eight conditions (two RIs [short (prior-24-hour recall obtained in afternoon); long (previous-day recall obtained in morning)] crossed with four prompts [forward (distant-to-recent), meal-name (breakfast, etc.), open (no instructions), reverse (recent-to-distant)]). Each condition had 60 children (half girls). Of 480 children, 355 and 409 reported meals satisfying criteria for reports of school-breakfast and school-lunch, respectively. For breakfast and lunch separately, a conventional measure—report rate—and reporting-error-sensitive measures—correspondence rate and inflation ratio—were calculated for energy per meal-reporting child. Correspondence rate and inflation ratio—but not report rate—showed better accuracy for school-breakfast and school-lunch reports with the short than long RI; this pattern was not found for some prompts for each sex. Correspondence rate and inflation ratio showed better school-breakfast report accuracy for the classroom than cafeteria location for each prompt, but report rate showed the opposite. For each RI, correspondence rate and inflation ratio showed better accuracy for lunch than breakfast, but report rate showed the opposite. When choosing RI and prompts for recalls, researchers and practitioners should select short RIs to maximize accuracy. Recommendations for prompt selections are less clear. As report rates distort validation-study accuracy conclusions, reporting-error-sensitive measures are recommended. PMID:26865356

  3. A systematic approach of tracking and reporting medication errors at a tertiary care university hospital, Karachi, Pakistan

    Directory of Open Access Journals (Sweden)

    Khurshid Khowaja

    2008-09-01

    Full Text Available Khurshid Khowaja1, Rozmin Nizar1, Rashida J Merchant2, Jacqueline Dias3, Irma Bustamante-Gavino4, Amina Malik11Division of Nursing Services, 2Nursing Education Services, 3Diploma Programme, Nurudin Jivraj Professorship of Nursing, Aga Khan University, Karachi, Pakistan; 4The Ahmed Shivji Professorship of Nursing, The Aga Khan University School of Nursing, Karachi, PakistanIntroduction: Administering medication is one of the high risk areas for any health professional. It is a multidisciplinary process, which begins with the doctor’s prescription, followed by review and provision by a pharmacist, and ends with preparation and administration by a nurse. Several studies have highlighted a high medication incident rate at several healthcare institutions.Methods: Our study design was exploratory and evaluative and used methodological triangulation. Sample size was of two types. First, a convenient sample of 1000 medication dosages to estimate the medication error (95% CI. We took another sample from subjects involved in medication usage processes such as physicians, nurses, pharmacists, and patients. Two sets of instruments were designed via extensive literature review: a medication tracking error form and a focus group interview questionnaire.Results: Our study findings revealed 100% compliance with a computerized physician order entry (CPOE system by physicians, nurses, and pharmacists. The main error rate was 5.5% and pharmacists contributed an higher error rate of 2.6% followed by nurses (1.1% and physicians (1%. Major areas for improvement in error rates were identified: delay in medication delivery, lab results reviewed electronically before prescription, dispension, and administration.Keywords: medication error rate, associate error rate, physician, nurse, pharmacist

  4. Personnel Management. Universities.

    Science.gov (United States)

    Ohio Board of Regents, Columbus. Management Improvement Program.

    This manual is one of 10 completed in the Ohio Management Improvement Program (MIP) during the 1971-73 biennium. In this project, Ohio's 34 public universities and colleges, in an effort directed and staffed by the Ohio Board of Regents, have developed manuals of management practices, in this case, concerning personnel management. Emphasis in this…

  5. Personnel Scheduling in Laboratories

    NARCIS (Netherlands)

    Franses, Philip; Post, Gerhard; Burke, Edmund; De Causmaecker, Patrick

    2003-01-01

    We describe an assignment problem particular to the personnel scheduling of organisations such as laboratories. Here we have to assign tasks to employees. We focus on the situation where this assignment problem reduces to constructing maximal matchings in a set of interrelated bipartite graphs. We d

  6. Evaluating School Personnel Today.

    Science.gov (United States)

    Poliakoff, Lorraine L.

    This document, an evaluation of school personnel, is based on a review of the literature on evaluation in the ERIC system. Emphasis is placed on the evaluation of school administrators, teacher evaluation by students, and the teacher's role in evaluation. A 23-item bibliography is included. (MJM)

  7. Harmonious personnel scheduling

    NARCIS (Netherlands)

    Fijn van Draat, Laurens; Post, Gerhard; Veltman, Bart; Winkelhuijzen, Wessel

    2006-01-01

    The area of personnel scheduling is very broad. Here we focus on the ‘shift assignment problem’. Our aim is to discuss how ORTEC HARMONY handles this planning problem. In particular we go into the structure of the optimization engine in ORTEC HARMONY, which uses techniques from genetic algorithms, l

  8. Harmonious personnel scheduling

    NARCIS (Netherlands)

    Fijn van Draat, Laurens; Post, Gerhard F.; Veltman, Bart; Winkelhuijzen, Wessel

    2006-01-01

    The area of personnel scheduling is very broad. Here we focus on the ‘shift assignment problem’. Our aim is to discuss how ORTEC HARMONY handles this planning problem. In particular we go into the structure of the optimization engine in ORTEC HARMONY, which uses techniques from genetic algorithms,

  9. Electronic Official Personnel Folder System

    Data.gov (United States)

    US Agency for International Development — The eOPF is a digital recreation of paper personnel folder that stores electronic personnel data spanning an individual's Federal career. eOPF allows employees to...

  10. Associations between errors and contributing factors in aircraft maintenance

    Science.gov (United States)

    Hobbs, Alan; Williamson, Ann

    2003-01-01

    In recent years cognitive error models have provided insights into the unsafe acts that lead to many accidents in safety-critical environments. Most models of accident causation are based on the notion that human errors occur in the context of contributing factors. However, there is a lack of published information on possible links between specific errors and contributing factors. A total of 619 safety occurrences involving aircraft maintenance were reported using a self-completed questionnaire. Of these occurrences, 96% were related to the actions of maintenance personnel. The types of errors that were involved, and the contributing factors associated with those actions, were determined. Each type of error was associated with a particular set of contributing factors and with specific occurrence outcomes. Among the associations were links between memory lapses and fatigue and between rule violations and time pressure. Potential applications of this research include assisting with the design of accident prevention strategies, the estimation of human error probabilities, and the monitoring of organizational safety performance.

  11. A Report on The Personnel Systems in the British and the French Universities%英法大学人事制度考察报告

    Institute of Scientific and Technical Information of China (English)

    赵丹龄; 杨鸿; 王磊; 王希勤; 许安国

    2013-01-01

    The appearance of the modern university system ushered in a new epoch in the history of world higher education. Personnel management of a university hinges on a mature system of regulations, the successful enforcement of which depends on the legitimacy of the regulations themselves. After a study of the historical development of the personnel systems in the British and the French universities, this paper has arrived at such conclusions: 1) the relations between the government, the society and the universities must be straightened out so that the autonomy of the university can be guaranteed. 2) It is imperative to change the government's methods of macro-control on the university and to improve the management structure of the university. 3) Advanced foreign models can be introduced when the concrete situations of China is taken into full consideration, so that the integration can contribute to the building of a modern personnel system with Chinese characteristics.%现代大学制度建设一直是高等教育改革中至关重要的一环。大学人事管理的核心在于成熟制度建设,而决定制度建设成功与否及能否最大程度实现制度预期的关键则在于制度本身是否具有合理性。通过对英、法两国大学人事制度形成背景、发展脉络及其变革成效的考察,可以获得一些有益启示:一是构建中国特色现代大学制度要理顺政府、社会和大学的关系,扩大和落实大学办学自主权;二是改革高等教育政府宏观管理模式、完善大学内部治理结构势在必行;三是要正确处理引入先进制度和把握自身国情之间的关系,坚定不移地走中国特色现代大学人事制度改革之路。

  12. A comprehensive overview of medical error in hospitals using incident-reporting systems, patient complaints and chart review of inpatient deaths.

    Directory of Open Access Journals (Sweden)

    Jeantine M de Feijter

    Full Text Available BACKGROUND: Incident reporting systems (IRS are used to identify medical errors in order to learn from mistakes and improve patient safety in hospitals. However, IRS contain only a small fraction of occurring incidents. A more comprehensive overview of medical error in hospitals may be obtained by combining information from multiple sources. The WHO has developed the International Classification for Patient Safety (ICPS in order to enable comparison of incident reports from different sources and institutions. METHODS: The aim of this paper was to provide a more comprehensive overview of medical error in hospitals using a combination of different information sources. Incident reports collected from IRS, patient complaints and retrospective chart review in an academic acute care hospital were classified using the ICPS. The main outcome measures were distribution of incidents over the thirteen categories of the ICPS classifier "Incident type", described as odds ratios (OR and proportional similarity indices (PSI. RESULTS: A total of 1012 incidents resulted in 1282 classified items. Large differences between data from IRS and patient complaints (PSI = 0.32 and from IRS and retrospective chart review (PSI = 0.31 were mainly attributable to behaviour (OR = 6.08, clinical administration (OR = 5.14, clinical process (OR = 6.73 and resources (OR = 2.06. CONCLUSIONS: IRS do not capture all incidents in hospitals and should be combined with complementary information about diagnostic error and delayed treatment from patient complaints and retrospective chart review. Since incidents that are not recorded in IRS do not lead to remedial and preventive action in response to IRS reports, healthcare centres that have access to different incident detection methods should harness information from all sources to improve patient safety.

  13. 影响护理人员报告给药错误的相关因素分析%Factors influencing reporting of medication errors by nurses

    Institute of Scientific and Technical Information of China (English)

    陆秀文; 徐红; 楼建华; 马圣念

    2011-01-01

    Objectives To investigate the reporting rate of medication errors by the nurses,and to identify the factors influencing reporting of medication errors by the nurses. Methods A total of 210 nurses were recruited by convenience sampling method. They were investigated with a 23-item self-designed questionnaire on the factors influencing reporting of medication errors. Results Totally 22.4 percent of respondents indicated that less than 60 percent of all medication errors were formally reported.The main barriers to reporting the medication errors were fearing adverse consequences,physician reprimand,patient's or family's negative responses. Head nurse's response to medication error was the main predictor of reporting.Conclusions Suggestions for development of organizational strategies to improve reporting of medication errors by nurses include establishing non-punitive organizational culture,improving the reporting process and communication means,providing the training related to the process and significance of reporting system,and developing a nursing management team that are expert at identifying and analyzing the complicated systematic problem.%目的 描述护理人员给药错误的报告率;识别影响护理人员报告给药错误的因素.方法 运用描述性研究设计,自制"影响护理人员报告给药错误的因素"问卷,共23个条目,CVI为0.84,Cronbach's α为0.83.运用方便抽样的方法,对210护理人员进行问卷调查.结果 22.4%的护理人员认为,给药错误的报告率在60%以下.护理人员报告给药错误的主要障碍是害怕报告后带来不良后果、害怕医生的责备、害怕患者及家属的反应.护士长对于给药错误的处理方式是报告给药错误的预测因子.结论 鼓励护理人员报告给药错误的有效策略是营造不责备、无惩罚的工作环境,改进给药错误的报告流程和沟通方法,加强对护理人员有关意外事件报告流程及重要性的培训,建立

  14. Refractive Errors

    Science.gov (United States)

    ... does the eye focus light? In order to see clearly, light rays from an object must focus onto the ... The refractive errors are: myopia, hyperopia and astigmatism [See figures 2 and 3]. What is hyperopia (farsightedness)? Hyperopia occurs when light rays focus behind the retina (because the eye ...

  15. Medication Errors

    Science.gov (United States)

    ... Proprietary Names (PDF - 146KB) Draft Guidance for Industry: Best Practices in Developing Proprietary Names for Drugs (PDF - 279KB) ... or (301) 796-3400 druginfo@fda.hhs.gov Human Drug ... in Medication Errors Resources for You Agency for Healthcare Research and Quality: ...

  16. Seasonal performance of air conditioners - an analysis of the DOE test procedures: the thermostat and measurement errors. Report No. 2

    Energy Technology Data Exchange (ETDEWEB)

    Lamb, G.D.; Tree, D.R.

    1981-01-01

    Two aspects of the DOE test procedures are analyzed. First, the role of the thermostat in controlling the cycling of conditioning equipment is investigated. The test procedures call for a cycling scheme of 6 minutes on, 24 minutes off for Test D. To justify this cycling scheme as being representative of cycling in the field, it is assumed that the thermostat is the major factor in controlling the cycle rate. This assumption is examined by studying a closed-loop feedback model consisting of a thermostat, a heating/cooling plant and a conditioned space. Important parameters of this model are individually studied to determine their influence on the system. It is found that the switch differential and the anticipator gain are the major parameters in controlling the cycle rate. This confirms the thermostat's dominant role in the cycling of a system. The second aspect of the test procedures concerns transient errors or differences in the measurement of cyclic capacity. In particular, errors due to thermocouple response, thermocouple grid placement, dampers and nonuniform velocity and temperature distributions are considered. Problems in these four areas are mathematically modeled and the basic assumptions are stated. Results from these models help to clarify the problem areas and give an indication of the magnitude of the errors involved. It is found that major disagreement in measured capacity can arise in these four areas and can be mainly attributed to test set-up differences even though such differences are allowable in the test procedures. An understanding of such differences will aid in minimizing many problems in the measurement of cyclic capacity.

  17. Enlisted Personnel Allocation System

    Science.gov (United States)

    1990-07-01

    0 0 0 0 0 0 0 CSP/AD DATE[: 11/iS/SB TIMH MAGIU: EC01G MAP: EC011IO2 HSL: 0~3401 1 2 2 4 5 6 7 ] 11102 IELI~STED PERSONNEL ALL.OCATION SYS TD ...DD4OGRAPIC GROUP #1] 10 J j9>>>)>>>>>>> Z’<<<<<<<<’((<t Jt>>>>>F Z•<<<<t 3 1 11 I II II .III 1 . ] I I IIIA IIIB .11 3 T; 1/1 HZj 2/3 REUNT3ANMEU

  18. Personnel Audit Process

    Directory of Open Access Journals (Sweden)

    Wojciech Pająk

    2012-06-01

    Full Text Available Audit is one of the basic issues in organisation and management. It consists of a number of constituent problems. One of them is the problem of research methodology. On the other hand, internal audit plays an increasingly important role in improvement of the functioning of an organisation . An attempt to apply the concept of internal audit for the purposes of diagnosing human resource management is the subject matter of this paper. Apart from the problems strictly related to the essence of methodology of personnel audit, an attempt was made to determine the problem range determined by this audit.

  19. Suicide rate among former Swedish peacekeeping personnel.

    Science.gov (United States)

    Michel, Per-Olof; Lundin, Tom; Larsson, Gerry

    2007-03-01

    Increased suicide rates for military personnel suffering from post-traumatic stress disorders have been reported in various countries. Although it is known that some peacekeepers are exposed to potentially traumatic events and are thus at risk of suffering from post-traumatic stress reactions, only a few studies have examined suicide rates in this group. Therefore, the aim of this study was to investigate the suicide rate among former Swedish peacekeeping personnel. We compared 39,768 former Swedish peacekeepers to the general population in the National General Population Registry and the Cause-of-Death Registry. A lower number of suicides was found among former Swedish peacekeepers than in the general population. In conclusion, Swedish personnel serving in international peace-keeping operations do not show a higher suicide rate than the general population. Unique problems associated with this research area are discussed.

  20. Errors in neuroradiology.

    Science.gov (United States)

    Caranci, Ferdinando; Tedeschi, Enrico; Leone, Giuseppe; Reginelli, Alfonso; Gatta, Gianluca; Pinto, Antonio; Squillaci, Ettore; Briganti, Francesco; Brunese, Luca

    2015-09-01

    Approximately 4 % of radiologic interpretation in daily practice contains errors and discrepancies that should occur in 2-20 % of reports. Fortunately, most of them are minor degree errors, or if serious, are found and corrected with sufficient promptness; obviously, diagnostic errors become critical when misinterpretation or misidentification should significantly delay medical or surgical treatments. Errors can be summarized into four main categories: observer errors, errors in interpretation, failure to suggest the next appropriate procedure, failure to communicate in a timely and a clinically appropriate manner. Misdiagnosis/misinterpretation percentage should rise up in emergency setting and in the first moments of the learning curve, as in residency. Para-physiological and pathological pitfalls in neuroradiology include calcification and brain stones, pseudofractures, and enlargement of subarachnoid or epidural spaces, ventricular system abnormalities, vascular system abnormalities, intracranial lesions or pseudolesions, and finally neuroradiological emergencies. In order to minimize the possibility of error, it is important to be aware of various presentations of pathology, obtain clinical information, know current practice guidelines, review after interpreting a diagnostic study, suggest follow-up studies when appropriate, communicate significant abnormal findings appropriately and in a timely fashion directly with the treatment team.

  1. Sugar-sweetened beverage consumption and central and total adiposity in older children: a prospective study accounting for dietary reporting errors.

    Science.gov (United States)

    Bigornia, Sherman J; LaValley, Michael P; Noel, Sabrina E; Moore, Lynn L; Ness, Andy R; Newby, P K

    2015-05-01

    To determine the prospective relationship between changes in sugar-sweetened beverage (SSB) intake and central adiposity in older children. Dietary intakes of children were obtained by 3 d food records at ages 10 and 13 years. Waist circumference (WC) and weight and height to determine BMI were measured at 10 and 13 years and total body fat mass (TBFM) at 13 years by dual-energy X-ray absorptiometry. Analyses were conducted using multivariable linear regression. Reporting errors were measured and participants were categorized as under-, plausible and over-reporters of dietary intakes. Community-based British cohort of children participating in the Avon Longitudinal Study of Parents and Children. Among 2455 older children, increased SSB consumption from ages 10 to 13 years was associated with higher WC (standardized β=0.020, P=0.19), BMI (β=0.028, P=0.03) and TBFM (β=0.017, P=0.20) at 13 years. Effects were strengthened among plausible dietary reporters (n 1059): WC (β=0.097, Pconsumption of SSB from ages 10 to 13 years was associated with a larger WC at age 13 years independent of differences in total adiposity. Accounting for dietary reporting errors strengthened associations. Our findings further support recommendations to limit intakes of SSB to reduce excess weight gain in children and suggest that SSB have an additional deleterious effect on central adiposity.

  2. 76 FR 78658 - Webinar Overview of the National Vaccine Advisory Committee Healthcare Personnel Influenza...

    Science.gov (United States)

    2011-12-19

    ... Influenza Vaccination Subgroup's Draft Report and Draft Recommendations for Achieving the Healthy People 2020 Annual Coverage Goals for Influenza Vaccination in Healthcare Personnel AGENCY: National Vaccine... of the National Vaccine Advisory Committee (NVAC), Healthcare Personnel Influenza...

  3. Correction of errors in power measurements

    DEFF Research Database (Denmark)

    Pedersen, Knud Ole Helgesen

    1998-01-01

    Small errors in voltage and current measuring transformers cause inaccuracies in power measurements.In this report correction factors are derived to compensate for such errors.......Small errors in voltage and current measuring transformers cause inaccuracies in power measurements.In this report correction factors are derived to compensate for such errors....

  4. Assessing the Distribution of Fiscal and Personnel Resources across Schools. A Report Prepared for Los Angeles Unified School District. SSFR Research Report #01 (LAUSD). Strategic School Funding for Results (SSFR)

    Science.gov (United States)

    Chambers, Jay G.; Levin, Jesse; Brodziak, Iliana; Chan, Derek

    2010-01-01

    Using fiscal data provided by the finance office of the school district, and personnel data obtained from the California Basic Education Data System maintained by the California Department of Education (CDE), the authors present analyses to provide a foundation for local policymakers that may be used to assess whether there are inequities in the…

  5. Internal consistency, test-retest reliability and measurement error of the self-report version of the social skills rating system in a sample of Australian adolescents.

    Directory of Open Access Journals (Sweden)

    Sharmila Vaz

    Full Text Available The social skills rating system (SSRS is used to assess social skills and competence in children and adolescents. While its characteristics based on United States samples (US are published, corresponding Australian figures are unavailable. Using a 4-week retest design, we examined the internal consistency, retest reliability and measurement error (ME of the SSRS secondary student form (SSF in a sample of Year 7 students (N = 187, from five randomly selected public schools in Perth, western Australia. Internal consistency (IC of the total scale and most subscale scores (except empathy on the frequency rating scale was adequate to permit independent use. On the importance rating scale, most IC estimates for girls fell below the benchmark. Test-retest estimates of the total scale and subscales were insufficient to permit reliable use. ME of the total scale score (frequency rating for boys was equivalent to the US estimate, while that for girls was lower than the US error. ME of the total scale score (importance rating was larger than the error using the frequency rating scale. The study finding supports the idea of using multiple informants (e.g. teacher and parent reports, not just student as recommended in the manual. Future research needs to substantiate the clinical meaningfulness of the MEs calculated in this study by corroborating them against the respective Minimum Clinically Important Difference (MCID.

  6. The Global School Personnel Survey: a cross‐country overview

    Science.gov (United States)

    Group, The GTSS Collaborative

    2006-01-01

    Teachers and administrators are role models for students, conveyors of tobacco prevention curricula, and key opinion leaders for school tobacco control policies. School teachers and administrators have daily interaction with students and thus represent an influential group for tobacco control. Data collected by the Global School Personnel Survey between 2000 and 2005 have shown that an alarming proportion of school personnel smoke cigarettes and use other forms of tobacco. At the regional level, current cigarette smoking is between 15% and 19% among school personnel included in this report around the world. The scarcity of tobacco‐free schools and the high level of smoking on school grounds by school personnel reported in this study indicate how seriously school practice and staff actions undermine the educational messages and other prevention efforts to reduce adolescent smoking prevalence. However, the majority of school personnel in most sites strongly agreed that they should receive specific training to help students avoid or stop using tobacco. PMID:16731521

  7. The Global School Personnel Survey: a cross-country overview.

    Science.gov (United States)

    2006-06-01

    Teachers and administrators are role models for students, conveyors of tobacco prevention curricula, and key opinion leaders for school tobacco control policies. School teachers and administrators have daily interaction with students and thus represent an influential group for tobacco control. Data collected by the Global School Personnel Survey between 2000 and 2005 have shown that an alarming proportion of school personnel smoke cigarettes and use other forms of tobacco. At the regional level, current cigarette smoking is between 15% and 19% among school personnel included in this report around the world. The scarcity of tobacco-free schools and the high level of smoking on school grounds by school personnel reported in this study indicate how seriously school practice and staff actions undermine the educational messages and other prevention efforts to reduce adolescent smoking prevalence. However, the majority of school personnel in most sites strongly agreed that they should receive specific training to help students avoid or stop using tobacco.

  8. Reporting errors in siblings' survival histories and their impact on adult mortality estimates: results from a record linkage study in Senegal.

    Science.gov (United States)

    Helleringer, Stéphane; Pison, Gilles; Kanté, Almamy M; Duthé, Géraldine; Andro, Armelle

    2014-04-01

    Estimates of adult mortality in countries with limited vital registration (e.g., sub-Saharan Africa) are often derived from information about the survival of a respondent's siblings. We evaluated the completeness and accuracy of such data through a record linkage study conducted in Bandafassi, located in southeastern Senegal. We linked at the individual level retrospective siblings' survival histories (SSH) reported by female respondents (n = 268) to prospective mortality data and genealogies collected through a health and demographic surveillance system (HDSS). Respondents often reported inaccurate lists of siblings. Additions to these lists were uncommon, but omissions were frequent: respondents omitted 3.8 % of their live sisters, 9.1 % of their deceased sisters, and 16.6 % of their sisters who had migrated out of the DSS area. Respondents underestimated the age at death of the siblings they reported during the interview, particularly among siblings who had died at older ages (≥45 years). Restricting SSH data to person-years and events having occurred during a recent reference period reduced list errors but not age and date errors. Overall, SSH data led to a 20 % underestimate of 45 q 15 relative to HDSS data. Our study suggests new quality improvement strategies for SSH data and demonstrates the potential use of HDSS data for the validation of "unconventional" demographic techniques.

  9. Recommendations for Nuclear Medicine Technologists Drawn from an Analysis of Errors Reported in Australian Radiation Incident Registers.

    Science.gov (United States)

    Kearney, Nicole; Denham, Gary

    2016-12-01

    When a radiation incident occurs in nuclear medicine in Australia, the incident is reported to the relevant state or territory authority, which performs an investigation and sends its findings to the Australian Radiation Protection and Nuclear Safety Agency. The agency then includes these data in its Australian Radiation Incident Register and makes them available to the public as an annual summary report on its website. The aim of this study was to analyze the radiation incidents included in these annual reports and in the publically available state and territory registers, identify any recurring themes, and make recommendations to minimize future incidents.

  10. Medication Errors - A Review

    OpenAIRE

    Vinay BC; Nikhitha MK; Patel Sunil B

    2015-01-01

    In this present review article, regarding medication errors its definition, medication error problem, types of medication errors, common causes of medication errors, monitoring medication errors, consequences of medication errors, prevention of medication error and managing medication errors have been explained neatly and legibly with proper tables which is easy to understand.

  11. Medication Errors - A Review

    OpenAIRE

    Vinay BC; Nikhitha MK; Patel Sunil B

    2015-01-01

    In this present review article, regarding medication errors its definition, medication error problem, types of medication errors, common causes of medication errors, monitoring medication errors, consequences of medication errors, prevention of medication error and managing medication errors have been explained neatly and legibly with proper tables which is easy to understand.

  12. Dietary reporting errors on 24 h recalls and dietary questionnaires are associated with BMI across six European countries as evaluated with recovery biomarkers for protein and potassium intake.

    Science.gov (United States)

    Freisling, Heinz; van Bakel, Marit M E; Biessy, Carine; May, Anne M; Byrnes, Graham; Norat, Teresa; Rinaldi, Sabina; Santucci de Magistris, Maria; Grioni, Sara; Bueno-de-Mesquita, H Bas; Ocké, Marga C; Kaaks, Rudolf; Teucher, Birgit; Vergnaud, Anne-Claire; Romaguera, Dora; Sacerdote, Carlotta; Palli, Domenico; Crowe, Francesca L; Tumino, Rosario; Clavel-Chapelon, Françoise; Boutron-Ruault, Marie-Christine; Khaw, Kay-Tee; Wareham, Nicholas J; Trichopoulou, Antonia; Naska, Androniki; Orfanos, Philippos; Boeing, Heiner; Illner, Anne-Kathrin; Riboli, Elio; Peeters, Petra H; Slimani, Nadia

    2012-03-01

    Whether there are differences between countries in the validity of self-reported diet in relation to BMI, as evaluated using recovery biomarkers, is not well understood. We aimed to evaluate BMI-related reporting errors on 24 h dietary recalls (24-HDR) and on dietary questionnaires (DQ) using biomarkers for protein and K intake and whether the BMI effect differs between six European countries. Between 1995 and 1999, 1086 men and women participating in the European Prospective Investigation into Cancer and Nutrition completed a single 24-HDR, a DQ and one 24 h urine collection. In regression analysis, controlling for age, sex, education and country, each unit (1 kg/m²) increase in BMI predicted an approximately 1·7 and 1·3 % increase in protein under-reporting on 24-HDR and DQ, respectively (both P 0·15). In women, but not in men, the DQ yielded higher mean intakes of protein that were closer to the biomarker-based measurements across BMI groups when compared with 24-HDR. Results for K were similar to those of protein, although BMI-related under-reporting of K was of a smaller magnitude, suggesting differential misreporting of foods. Under-reporting of protein and K appears to be predicted by BMI, but this effect may be driven by 'low-energy reporters'. The BMI effect on under-reporting seems to be the same across countries.

  13. Personnel Practices for Small Colleges.

    Science.gov (United States)

    Bouchard, Ronald A.

    Personnel administration in higher education is the focus of this "hands-on, how-to-do-it" guide that provides fundamental materials for developing and maintaining a sound personnel program. Part One (Employment) examines government regulations, employee recruitment and selection, pre-employment inquiries and screening, post-employment process,…

  14. Personnel Officers: Judging Their Qualifications.

    Science.gov (United States)

    Webb, Gisela

    1988-01-01

    Discusses the backgrounds and qualifications appropriate for a library personnel administrator, including (1) a master's degree in library science; (2) library work experience; (3) additional training in administration, personnel management, organizational development, and psychology; and (4) personal attributes such as good communication skills,…

  15. 42 CFR 493.1425 - Standard; Testing personnel responsibilities.

    Science.gov (United States)

    2010-10-01

    ... Testing Laboratories Performing Moderate Complexity Testing § 493.1425 Standard; Testing personnel... reporting test results. (a) Each individual performs only those moderate complexity tests that are... education, training or experience, and technical abilities. (b) Each individual performing moderate...

  16. Increased error rates in preliminary reports issued by radiology residents working more than 10 consecutive hours overnight.

    Science.gov (United States)

    Ruutiainen, Alexander T; Durand, Daniel J; Scanlon, Mary H; Itri, Jason N

    2013-03-01

    To determine if the rate of major discrepancies between resident preliminary reports and faculty final reports increases during the final hours of consecutive 12-hour overnight call shifts. Institutional review board exemption status was obtained for this study. All overnight radiology reports interpreted by residents on-call between January 2010 and June 2010 were reviewed by board-certified faculty and categorized as major discrepancies if they contained a change in interpretation with the potential to impact patient management or outcome. Initial determination of a major discrepancy was at the discretion of individual faculty radiologists based on this general definition. Studies categorized as major discrepancies were secondarily reviewed by the residency program director (M.H.S.) to ensure consistent application of the major discrepancy designation. Multiple variables associated with each report were collected and analyzed, including the time of preliminary interpretation, time into shift study was interpreted, volume of studies interpreted during each shift, day of the week, patient location (inpatient or emergency department), block of shift (2-hour blocks for 12-hour shifts), imaging modality, patient age and gender, resident identification, and faculty identification. Univariate risk factor analysis was performed to determine the optimal data format of each variable (ie, continuous versus categorical). A multivariate logistic regression model was then constructed to account for confounding between variables and identify independent risk factors for major discrepancies. We analyzed 8062 preliminary resident reports with 79 major discrepancies (1.0%). There was a statistically significant increase in major discrepancy rate during the final 2 hours of consecutive 12-hour call shifts. Multivariate analysis confirmed that interpretation during the last 2 hours of 12-hour call shifts (odds ratio (OR) 1.94, 95% confidence interval (CI) 1.18-3.21), cross

  17. Normal accidents: human error and medical equipment design.

    Science.gov (United States)

    Dain, Steven

    2002-01-01

    High-risk systems, which are typical of our technologically complex era, include not just nuclear power plants but also hospitals, anesthesia systems, and the practice of medicine and perfusion. In high-risk systems, no matter how effective safety devices are, some types of accidents are inevitable because the system's complexity leads to multiple and unexpected interactions. It is important for healthcare providers to apply a risk assessment and management process to decisions involving new equipment and procedures or staffing matters in order to minimize the residual risks of latent errors, which are amenable to correction because of the large window of opportunity for their detection. This article provides an introduction to basic risk management and error theory principles and examines ways in which they can be applied to reduce and mitigate the inevitable human errors that accompany high-risk systems. The article also discusses "human factor engineering" (HFE), the process which is used to design equipment/ human interfaces in order to mitigate design errors. The HFE process involves interaction between designers and endusers to produce a series of continuous refinements that are incorporated into the final product. The article also examines common design problems encountered in the operating room that may predispose operators to commit errors resulting in harm to the patient. While recognizing that errors and accidents are unavoidable, organizations that function within a high-risk system must adopt a "safety culture" that anticipates problems and acts aggressively through an anonymous, "blameless" reporting mechanism to resolve them. We must continuously examine and improve the design of equipment and procedures, personnel, supplies and materials, and the environment in which we work to reduce error and minimize its effects. Healthcare providers must take a leading role in the day-to-day management of the "Perioperative System" and be a role model in

  18. Duties and Responsibilities of the Campus Personnel Director: 1970 vs. 1977

    Science.gov (United States)

    Boxx, W. Randy; Howell, D. L.

    1978-01-01

    The findings of a recently completed study comparing the responsibilities and duties of personnel directors in 1970 with those in 1977 are reported. Personnel departments grew both in scope of function and staff size, and staff members now take a much more active role in academic as well as non-academic personnel matters due to federal regulations…

  19. Error monitoring in musicians

    Directory of Open Access Journals (Sweden)

    Clemens eMaidhof

    2013-07-01

    Full Text Available To err is human, and hence even professional musicians make errors occasionally during their performances. This paper summarizes recent work investigating error monitoring in musicians, i.e. the processes and their neural correlates associated with the monitoring of ongoing actions and the detection of deviations from intended sounds. EEG Studies reported an early component of the event-related potential (ERP occurring before the onsets of pitch errors. This component, which can be altered in musicians with focal dystonia, likely reflects processes of error detection and/or error compensation, i.e. attempts to cancel the undesired sensory consequence (a wrong tone a musician is about to perceive. Thus, auditory feedback seems not to be a prerequisite for error detection, consistent with previous behavioral results. In contrast, when auditory feedback is externally manipulated and thus unexpected, motor performance can be severely distorted, although not all feedback alterations result in performance impairments. Recent studies investigating the neural correlates of feedback processing showed that unexpected feedback elicits an ERP component after note onsets, which shows larger amplitudes during music performance than during mere perception of the same musical sequences. Hence, these results stress the role of motor actions for the processing of auditory information. Furthermore, recent methodological advances like the combination of 3D motion capture techniques with EEG will be discussed. Such combinations of different measures can potentially help to disentangle the roles of different feedback types such as proprioceptive and auditory feedback, and in general to derive at a better understanding of the complex interactions between the motor and auditory domain during error monitoring. Finally, outstanding questions and future directions in this context will be discussed.

  20. Medical error

    African Journals Online (AJOL)

    QuickSilver

    Michael Berk. Department of Psychiatry, University of Melbourne, Australia .... inaccurate and inflammatory media reports their community accepted the ex- ... non-medical situations such as the aviation industry and nuclear power tech- nology ...

  1. Epidemiologic investigation of health effects in Air Force personnel following exposure to herbicides. Summary mortality update, 1989. Interim report 1979-1987

    Energy Technology Data Exchange (ETDEWEB)

    Wolfe, W.H.; Michalek, J.E.; Miner, J.C.

    1989-04-17

    The purpose of the Air Force Health Study is to determine whether those individuals involved in the spraying of herbicides in Vietnam during the Ranch Hand operation have experienced any adverse health effects as a result of their participation in that program. The study is designed to evaluate both the mortality (death) and morbidity (disease) in these individuals over a 20-year beginning in 1982. The Baseline Mortality Report was released in June 1983, the Baseline Morbidity Report in February 1984. Follow-up mortality reports were released in 1984, 1985, and 1986. This study has not demonstrated health effects which can be conclusively attributed to herbicide or dioxin exposure. This report contains analyses of cumulative deaths occurring up to 31 December 1987. The overall cumulative mortality of the Ranch Hands remains statistically indistinguishable from that of both their matched Comparisons and the entire Comparison, population, although there is a statistically significant increasing trend in post-1983 death rates among Ranch Hand flying officers and a statistically significant increase in Ranch Hand digestive system deaths relative to the Comparison population; these findings are not suggestive of a herbicide effect. Ranch Hands are equivalent to all Comparisons in cumulative accidental, malignant neoplasm and circulatory system mortality.

  2. Hanford personnel dosimeter supporting studies FY-1981

    Energy Technology Data Exchange (ETDEWEB)

    1982-08-01

    This report examined specific functional components of the routine external personnel dosimeter program at Hanford. Components studied included: dosimeter readout; dosimeter calibration; dosimeter field response; dose calibration algorithm; dosimeter design; and TLD chip acceptance procedures. Additional information is also presented regarding the dosimeter response to light- and medium-filtered x-rays, high energy photons and neutrons. This study was conducted to clarify certain data obtained during the FY-1980 studies.

  3. Quantifying behavioural determinants relating to health professional reporting of medication errors: a cross-sectional survey using the Theoretical Domains Framework.

    Science.gov (United States)

    Alqubaisi, Mai; Tonna, Antonella; Strath, Alison; Stewart, Derek

    2016-11-01

    The aims of this study were to quantify the behavioural determinants of health professional reporting of medication errors in the United Arab Emirates (UAE) and to explore any differences between respondents. A cross-sectional survey of patient-facing doctors, nurses and pharmacists within three major hospitals of Abu Dhabi, the UAE. An online questionnaire was developed based on the Theoretical Domains Framework (TDF, a framework of behaviour change theories). Principal component analysis (PCA) was used to identify components and internal reliability determined. Ethical approval was obtained from a UK university and all hospital ethics committees. Two hundred and ninety-four responses were received. Questionnaire items clustered into six components of knowledge and skills, feedback and support, action and impact, motivation, effort and emotions. Respondents generally gave positive responses for knowledge and skills, feedback and support and action and impact components. Responses were more neutral for the motivation and effort components. In terms of emotions, the component with the most negative scores, there were significant differences in terms of years registered as health professional (those registered longest most positive, p = 0.002) and age (older most positive, p Theoretical Domains Framework to quantify the behavioural determinants of health professional reporting of medication errors. • Questionnaire items relating to emotions surrounding reporting generated the most negative responses with significant differences in terms of years registered as health professional (those registered longest most positive) and age (older most positive) with no differences for gender and health profession. • Interventions based on behaviour change techniques mapped to emotions should be prioritised for development.

  4. Perceived orofacial pain and its associations with reported bruxism and insomnia symptoms in media personnel with or without irregular shift work.

    Science.gov (United States)

    Ahlberg, Kristiina; Ahlberg, Jari; Könönen, Mauno; Alakuijala, Anniina; Partinen, Markku; Savolainen, Aslak

    2005-08-01

    A standardized questionnaire was mailed to all employees of the Finnish Broadcasting Company with irregular shift work (n = 750) and to an equal number of randomly selected controls in the same company with regular 8-hour daytime work. The aims were to investigate the prevalence and severity of perceived orofacial pain (Research Diagnostic Criteria for Temporomandibular Disorders Axis II) and to analyze whether current orofacial pain was associated with reported bruxism and insomnia symptoms (Diagnostic and Statistical Manual of Mental Disorders-IV and the International Classification of Sleep Disorders Revised). The response rate in the irregular shift-work group was 82.3% (56.6% men) and in the regular daytime-work group 34.3% (46.7% men). Current orofacial pain was found overall in 19.6%, of which 88.3% had experienced the pain over 6 months. All claimed that their pain fluctuated. No subjects with chronic orofacial pain reported disabling pain, and grades III and IV were not found. Insomnia symptoms and frequent bruxism were significantly more prevalent in chronic pain grade II than in lower grades. According to logistic regression, current orofacial pain was significantly positively associated with frequent bruxism (p orofacial pain and reported bruxism. The association held with both chronic orofacial pain intensity and current pain. Based on the multivariate analyses, it can be concluded that disrupted sleep and bruxism may be concomitantly involved in the development of orofacial pain.

  5. Methodological and Reporting Errors in Meta-Analytic Reviews Make Other Meta-Analysts Angry: A Commentary on Ferguson (2015).

    Science.gov (United States)

    Rothstein, Hannah R; Bushman, Brad J

    2015-09-01

    Although Ferguson's (2015, this issue) meta-analysis addresses an important topic, we have serious concerns about how it was conducted. Because there was only one coder, we have no confidence in the reliability or validity of the coded variables. Two independent raters should have coded the studies. Ferguson synthesized partial correlations as if they were zero-order correlations, which can increase or decrease (sometimes substantially) the variance of the partial correlation. Moreover, he partialled different numbers of variables from different effects, partialled different variables from different studies, and did not report what was partialled from each study. Ferguson used an idiosyncratic "tandem procedure" for detecting publication bias. He also "corrected" his results for publication bias, even though there is no such thing as a "correction" for publication bias. Thus, we believe that Ferguson's meta-analysis is fatally flawed and should not have been accepted for publication in Perspective on Psychological Science (or any other journal).

  6. Personnel Investigations and Clearance Tracking (OPI)

    Data.gov (United States)

    Office of Personnel Management — Security file-related information for the U.S. Office of Personnel Management (OPM)'s employee and contractor personnel. The data is OPM-specific, not government-wide.

  7. Citizen's Report

    Data.gov (United States)

    Office of Personnel Management — The fiscal year (FY) 2008 Citizen's Report is a summary of performance and financial results for the U.S. Office of Personnel Management (OPM). OPM chose to produce...

  8. Hematology point of care testing and laboratory errors: an example of multidisciplinary management at a children's hospital in northeast Italy

    Directory of Open Access Journals (Sweden)

    Parco S

    2014-01-01

    Full Text Available Sergio Parco, Patrizia Visconti, Fulvia Vascotto Institute for Maternal and Child Health, Trieste, Italy Abstract: Involvement of health personnel in a medical audit can reduce the number of errors in laboratory medicine. The checked control of point of care testing (POCT could be an answer to developing a better medical service in the emergency department and decreasing the time taken to report tests. The performance of sanitary personnel from different disciplines was studied over an 18-month period in a children's hospital. Clinical errors in the emergency and laboratory departments were monitored by: nursing instruction using specific courses, POCT, and external quality control; improvement of test results and procedural accuracy; and reduction of hemolyzed and nonprotocol-conforming samples sent to the laboratory department. In January 2012, point of care testing (POCT was instituted in three medical units (neonatology, resuscitation, delivery room at the Children's Hospital in Trieste, northeast Italy, for analysis of hematochemical samples. In the same period, during the months of January 2012 and June 2013, 1,600 samples sent to central laboratory and their related preanalytical errors were examined for accuracy. External quality control for POCT was also monitored in the emergency department; three meetings were held with physicians, nurses, and laboratory technicians to highlight problems, ie, preanalytical errors and analytical methodologies associated with POCT. During the study, there was an improvement in external quality control for POCT from -3 or -2 standard deviations or more to one standard deviation for all parameters. Of 800 samples examined in the laboratory in January 2012, we identified 64 preanalytical errors (8.0%; in June 2013, there were 17 preanalytical errors (2.1%, representing a significant decrease (P<0.05, χ2 test. Multidisciplinary management and clinical audit can be used as tools to detect errors caused by

  9. Office of Personnel Management (OPM)

    Data.gov (United States)

    Social Security Administration — The purpose of this agreement is for SSA to verify SSN information for the Office of Personnel Management. OPM will use the SSN verifications in its investigative...

  10. Outplacement: An Established Personnel Function

    Science.gov (United States)

    Scherba, John

    1978-01-01

    Every professional personnel department has the basic skills to provide at least minimum outplacement services such as resume preparation, resume typing and reproduction, counseling, and suggestions of job leads. (Author)

  11. Outplacement: An Established Personnel Function

    Science.gov (United States)

    Scherba, John

    1978-01-01

    Every professional personnel department has the basic skills to provide at least minimum outplacement services such as resume preparation, resume typing and reproduction, counseling, and suggestions of job leads. (Author)

  12. Personnel Aspects of Library Automation

    Directory of Open Access Journals (Sweden)

    David C. Weber

    1971-03-01

    Full Text Available Personnel of an automation project is discussed in terms of talents needed in the design team, their qualifications and organization, the attitudes to be fostered, and the communication and documentation that is important for effective teamwork. Discussion is based on Stanford University's experience with Protect BALLOTS and includes comments on some specific problems which have personnel importance and may be faced in major design efforts.

  13. Does the implementation of an electronic prescribing system create unintended medication errors? A study of the sociotechnical context through the analysis of reported medication incidents

    Directory of Open Access Journals (Sweden)

    Hodson James

    2011-05-01

    Full Text Available Abstract Background Even though electronic prescribing systems are widely advocated as one of the most effective means of improving patient safety, they may also introduce new risks that are not immediately obvious. Through the study of specific incidents related to the processes involved in the administration of medication, we sought to find out if the prescribing system had unintended consequences in creating new errors. The focus of this study was a large acute hospital in the Midlands in the United Kingdom, which implemented a Prescribing, Information and Communication System (PICS. Methods This exploratory study was based on a survey of routinely collected medication incidents over five months. Data were independently reviewed by two of the investigators with a clinical pharmacology and nursing background respectively, and grouped into broad types: sociotechnical incidents (related to human interactions with the system and non-sociotechnical incidents. Sociotechnical incidents were distinguished from the others because they occurred at the point where the system and the professional intersected and would not have occurred in the absence of the system. The day of the week and time of day that an incident occurred were tested using univariable and multivariable analyses. We acknowledge the limitations of conducting analyses of data extracted from incident reports as it is widely recognised that most medication errors are not reported and may contain inaccurate data. Interpretation of results must therefore be tentative. Results Out of a total of 485 incidents, a modest 15% (n = 73 were distinguished as sociotechnical issues and thus may be unique to hospitals that have such systems in place. These incidents were further analysed and subdivided into categories in order to identify aspects of the context which gave rise to adverse situations and possible risks to patient safety. The analysis of sociotechnical incidents by time of day and day of

  14. Errors in Neonatology

    Directory of Open Access Journals (Sweden)

    Antonio Boldrini

    2013-06-01

    Full Text Available Introduction: Danger and errors are inherent in human activities. In medical practice errors can lean to adverse events for patients. Mass media echo the whole scenario. Methods: We reviewed recent published papers in PubMed database to focus on the evidence and management of errors in medical practice in general and in Neonatology in particular. We compared the results of the literature with our specific experience in Nina Simulation Centre (Pisa, Italy. Results: In Neonatology the main error domains are: medication and total parenteral nutrition, resuscitation and respiratory care, invasive procedures, nosocomial infections, patient identification, diagnostics. Risk factors include patients’ size, prematurity, vulnerability and underlying disease conditions but also multidisciplinary teams, working conditions providing fatigue, a large variety of treatment and investigative modalities needed. Discussion and Conclusions: In our opinion, it is hardly possible to change the human beings but it is likely possible to change the conditions under they work. Voluntary errors report systems can help in preventing adverse events. Education and re-training by means of simulation can be an effective strategy too. In Pisa (Italy Nina (ceNtro di FormazIone e SimulazioNe NeonAtale is a simulation center that offers the possibility of a continuous retraining for technical and non-technical skills to optimize neonatological care strategies. Furthermore, we have been working on a novel skill trainer for mechanical ventilation (MEchatronic REspiratory System SImulator for Neonatal Applications, MERESSINA. Finally, in our opinion national health policy indirectly influences risk for errors. Proceedings of the 9th International Workshop on Neonatology · Cagliari (Italy · October 23rd-26th, 2013 · Learned lessons, changing practice and cutting-edge research

  15. Toward a cognitive taxonomy of medical errors.

    Science.gov (United States)

    Zhang, Jiajie; Patel, Vimla L; Johnson, Todd R; Shortliffe, Edward H

    2002-01-01

    One critical step in addressing and resolving the problems associated with human errors is the development of a cognitive taxonomy of such errors. In the case of errors, such a taxonomy may be developed (1) to categorize all types of errors along cognitive dimensions, (2) to associate each type of error with a specific underlying cognitive mechanism, (3) to explain why, and even predict when and where, a specific error will occur, and (4) to generate intervention strategies for each type of error. Based on Reason's (1992) definition of human errors and Norman's (1986) cognitive theory of human action, we have developed a preliminary action-based cognitive taxonomy of errors that largely satisfies these four criteria in the domain of medicine. We discuss initial steps for applying this taxonomy to develop an online medical error reporting system that not only categorizes errors but also identifies problems and generates solutions.

  16. Error and its meaning in forensic science.

    Science.gov (United States)

    Christensen, Angi M; Crowder, Christian M; Ousley, Stephen D; Houck, Max M

    2014-01-01

    The discussion of "error" has gained momentum in forensic science in the wake of the Daubert guidelines and has intensified with the National Academy of Sciences' Report. Error has many different meanings, and too often, forensic practitioners themselves as well as the courts misunderstand scientific error and statistical error rates, often confusing them with practitioner error (or mistakes). Here, we present an overview of these concepts as they pertain to forensic science applications, discussing the difference between practitioner error (including mistakes), instrument error, statistical error, and method error. We urge forensic practitioners to ensure that potential sources of error and method limitations are understood and clearly communicated and advocate that the legal community be informed regarding the differences between interobserver errors, uncertainty, variation, and mistakes.

  17. Wie hoch liegen die Personalkosten für die Durchführung einer OSCE? Eine Kostenaufstellung nach betriebswirtschaftlichen Gesichtspunkten [How high are the personnel costs for OSCE? A financial report on management aspects

    Directory of Open Access Journals (Sweden)

    Rau, Thea

    2011-02-01

    Full Text Available [english] Objective: The OSCE (objective structured clinical examination was put to the test in order to assess the clinical practical skills of students in medical studies in the medical faculties. For the implementation of an OSCE, a large number of personnel is necessary. In particular for subjects with limited resources, therefore, efficient cost planning is required. In the winter semester 09/10, the Department of Neurology at the Medical Faculty of the University of Ulm introduced the OSCE as a pilot project. A financial report retrospectively shows the personnel expenses. The report is intended as an example for an insight into the resources needed for the OSCE with simulated patients. Method: Included in the calculation of the financial costs of the OSCE were: employment, status of staff involved in the OSCE, subject-matter and temporal dimension of the task. After the exam, acceptance of the examination format was reviewed by a focus group interview with the teachers and students. Result: The total expenses for the personnel involved in the OSCE amounted to 12,468 €. The costing of the clinic’s share was calculated at 9,576 €. Tuition fees from the students have been used to the amount of 2.892 €. For conversion of total expenditure to the number of examines the sum of 86 € per student was calculated. Both students and teachers confirmed the validity of the OSCE and recognised the added value in the learning effects.Conclusion: The high acceptance of the OSCE in neurology by both students and teachers favours maintaining the test format. Against the background of the high financial and logistical costs, however, in individual cases it should be assessed how in the long-term efficient examination procedure will be possible.[german] Zielsetzung: Um die klinisch-praktischen Fertigkeiten von Studierenden im Medizinstudium zu bewerten, wurde in den medizinischen Fakultäten die OSCE (objective structured clinical examination

  18. Positioning of personnel dosimeters - comments on replies

    Energy Technology Data Exchange (ETDEWEB)

    Field, R.W. (Academy of Health Sciences, U.S. Army, Fort Sam Houston, TX); Wiatrowski, W.A. (Audi L. Murphy Memorial Veterans Hospital, San Antonio, TX (USA)); Bushong, S.C. (Baylor Univ., Houston, TX (USA). Coll. of Medicine)

    1982-02-01

    Comments are made on a paper published in 1980 concerning the positioning of personnel dosimeters on individuals wearing protective aprons in diagnostic radiology. The main issue under discussion is whether an additional film badge should be worn on the collar to monitor head and neck exposure while wearing the lead apron over the whole body badge to avoid misinterpretations of reported 'whole body' exposure data. The recommendations on this issue are conflicting in NRCP Reports 57 and 59 and thus clarification is sought.

  19. Medication errors detected in non-traditional databases

    DEFF Research Database (Denmark)

    Perregaard, Helene; Aronson, Jeffrey K; Dalhoff, Kim

    2015-01-01

    AIMS: We have looked for medication errors involving the use of low-dose methotrexate, by extracting information from Danish sources other than traditional pharmacovigilance databases. We used the data to establish the relative frequencies of different types of errors. METHODS: We searched four...... errors, whereas knowledge-based errors more often resulted in near misses. CONCLUSIONS: The medication errors in this survey were most often action-based (50%) and knowledge-based (34%), suggesting that greater attention should be paid to education and surveillance of medical personnel who prescribe...

  20. Inappropriate use of standard error of the mean when reporting variability of study samples: a critical evaluation of four selected journals of obstetrics and gynecology.

    Science.gov (United States)

    Ko, Wen-Ru; Hung, Wei-Te; Chang, Hui-Chin; Lin, Long-Yau

    2014-03-01

    The study was designed to investigate the frequency of misusing standard error of the mean (SEM) in place of standard deviation (SD) to describe study samples in four selected journals published in 2011. Citation counts of articles and the relationship between the misuse rate and impact factor, immediacy index, or cited half-life were also evaluated. All original articles in the four selected journals published in 2011 were searched for descriptive statistics reporting with either mean ± SD or mean ± SEM. The impact factor, immediacy index, and cited half-life of the journals were gathered from Journal Citation Reports Science edition 2011. Scopus was used to search for citations of individual articles. The difference in citation counts between the SD group and SEM group was tested by the Mann-Whitney U test. The relationship between the misuse rate and impact factor, immediacy index, or cited half-life was also evaluated. The frequency of inappropriate reporting of SEM was 13.60% for all four journals. For individual journals, the misuse rate was from 2.9% in Acta Obstetricia et Gynecologica Scandinavica to 22.68% in American Journal of Obstetrics & Gynecology. Articles using SEM were cited more frequently than those using SD (p = 0.025). An approximate positive correlation between the misuse rate and cited half-life was observed. Inappropriate reporting of SEM is common in medical journals. Authors of biomedical papers should be responsible for maintaining an integrated statistical presentation because valuable articles are in danger of being wasted through the misuse of statistics. Copyright © 2014. Published by Elsevier B.V.

  1. 临床护士对给药错误上报态度的现状调查分析%The current status of clinical nurses' attitudes of reporting medication errors

    Institute of Scientific and Technical Information of China (English)

    万文洁; 吴茜; 施雁

    2013-01-01

    目的:调查分析临床护士对给药错误的上报态度及上报可能性.方法:采用自制调查表,对1家医院6个科室的89名护士进行调查.结果:护士给药错误上报率低,17.9%的护士认为所发生的给药错误全部被上报了,护士对不同类型给药错误的上报态度存在差异.结论:护士这种偏向于上报某几类给药错误,将给药错误告知医生的做法,应引起管理者重视,应加强培训、营造医院无责罚上报环境.%Objective: To investigate the current status of clinical nurses' attitudes of reporting medication errors. Methods: Eighty-nine nurses from 6 departments in a hospital were recruited and investigated by a self-designed questionnaire. Results: The reporting rate of medication errors was low and only 17.9% nurses reported all the medication errors to the nursing managers. Nurses' attitudes were different in reporting different types of medication errors. Conclusions: Clinical nurses trend to report certain types of medication errors and report them to doctors, other than nursing managers. Nursing managers should pay more attention to the low reporting rate, strengthen nurses' training and create an no penalty environment for medication errors reporting.

  2. 76 FR 47516 - Personnel Management in Agencies

    Science.gov (United States)

    2011-08-05

    ... MANAGEMENT 5 CFR PART 250 RIN 3206-AL98 Personnel Management in Agencies AGENCY: U.S. Office of Personnel Management. ACTION: Proposed rule. SUMMARY: The U.S. Office of Personnel Management is issuing proposed... and Veterans Support, U.S. Office of Personnel Management, Room 7460, 1900 E Street, NW., Washington...

  3. 21 CFR 606.20 - Personnel.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 7 2010-04-01 2010-04-01 false Personnel. 606.20 Section 606.20 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) BIOLOGICS CURRENT GOOD MANUFACTURING PRACTICE FOR BLOOD AND BLOOD COMPONENTS Organization and Personnel § 606.20 Personnel. (a) (b) The personnel responsible for...

  4. 48 CFR 752.7007 - Personnel compensation.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Personnel compensation... Personnel compensation. The following clause shall be used in all USAID cost-reimbursement contracts. Personnel Compensation (JUL 2007) (a) Direct compensation of the Contractor's personnel will be...

  5. Reducing errors in emergency surgery.

    Science.gov (United States)

    Watters, David A K; Truskett, Philip G

    2013-06-01

    Errors are to be expected in health care. Adverse events occur in around 10% of surgical patients and may be even more common in emergency surgery. There is little formal teaching on surgical error in surgical education and training programmes despite their frequency. This paper reviews surgical error and provides a classification system, to facilitate learning. The approach and language used to enable teaching about surgical error was developed through a review of key literature and consensus by the founding faculty of the Management of Surgical Emergencies course, currently delivered by General Surgeons Australia. Errors may be classified as being the result of commission, omission or inition. An error of inition is a failure of effort or will and is a failure of professionalism. The risk of error can be minimized by good situational awareness, matching perception to reality, and, during treatment, reassessing the patient, team and plan. It is important to recognize and acknowledge an error when it occurs and then to respond appropriately. The response will involve rectifying the error where possible but also disclosing, reporting and reviewing at a system level all the root causes. This should be done without shaming or blaming. However, the individual surgeon still needs to reflect on their own contribution and performance. A classification of surgical error has been developed that promotes understanding of how the error was generated, and utilizes a language that encourages reflection, reporting and response by surgeons and their teams. © 2013 The Authors. ANZ Journal of Surgery © 2013 Royal Australasian College of Surgeons.

  6. Tunnel personnel positioning method based on TOA and modified location-fingerprint positioning

    Institute of Scientific and Technical Information of China (English)

    Sun Jiping; Li Chenxin

    2016-01-01

    To position personnel in mines, the study discussed in this paper built on the tunnel personnel positioning method on the basis of both TOA and location-finger print (LFP) positioning. Given non-line of sight (NLOS) time delay in signal transmission caused by facilities and equipment shielding in tunnels and TOA measurement errors in both LFP database data and real-time data, this paper puts forth a database data de-noising algorithm based on distance threshold limitation and modified mean filtering (MMF), as well as a real-time data suppression algorithm based on speed threshold limitation and MMF. On this basis, a nearest neighboring data matching algorithm based on historical location and the speed threshold limitation is used to estimate personnel location and realize accurate personnel positioning. The results from both simulation and the experiment suggest that:compared with the basic LFP position-ing method and the method that only suppresses real-time data error, the tunnel personnel positioning methods based on TOA and modified LFP positioning permits effectively eliminating error in TOA mea-surement, making the measured data close to the true positional data, and dropping the positioning error:the maximal positioning error in measurements from experiment drops by 9 and 3 m, respectively, and the positioning accuracy of 3 m is achievable in the condition used in the experiment.

  7. Personnel Management theories and applications

    Institute of Scientific and Technical Information of China (English)

    Yanni Feng

    2010-01-01

    @@ 1.Introduction Many new businesses are opened in the whole world every day.Unfortunately,only a minor part of them has success and continues its activity.There is a variety of reasons which determine the hankruptcy of companies.Most of them are included in running a business,and more and more people come to realize the significance of management,especially personnel management,as personnel represents the relationship between people in the company,which is a key point for the development of enterprise.

  8. 屈光不正的矫正与飞行%Refractive error correction and flying

    Institute of Scientific and Technical Information of China (English)

    杨国庆; 张作明

    2011-01-01

    目的 综述屈光不正的矫正方法及其与飞行关系的研究进展.资料来源与选择 该领域的相关研究论文、研究报告与专著.资料引用 国内外公开发表的论文和著作56篇.资料综合 阐述屈光不正的各种矫正方法在飞行人员中应用的优缺点,着重阐述了对飞行人员进行角膜屈光手术的应用可行性.结论 相对于其他矫正方法,对飞行人员进行角膜屈光手术具有较好的应用前景.目前国外民航飞行人员以准分子激光原位角膜磨镶术(laser in situ keratomileusis,LASIK)为主,而军航飞行人员则以准分子激光角膜切削术(photorefractive kerateetomy,PRK)为主;美国军航飞行人员已被允许进行飞秒激光LASIK手术,对我军飞行人员有借鉴意义.%Objective To review the development subject to the researches of refractive error correction and its effects to flying.Literature resource and selection Research papers,study reports and monographs in this field.Literature quotation Fifty-six papers and writings in this field were cited.Literature synthesis The advantages and disadvantages of applying refractive error correction for the flying personnel were discussed.Application feasibility of corneal refractive surgery was emphasized.Conclusions Comparing with other correction methods,such as glasses wearing,corneal contact lens and intra-ocular refraction surgery,corneal refractive surgery would have a prospect result for the flying personnel.At present,many foreign civilian flying personnel choose laser in situ keratomileusis (LASIK) as the method of correction while military flying personnel choose photorefractive keratectomy (PRK).Femtosecond laser LASIK has been approved in refractive error correction of American military flying personnel,and those lessons would be consulted to Chinese military flying personnel.

  9. Axial length estimation error caused by hidden double-peak on partial coherence interferometry in an eye with epiretinal membrane: a case report

    Directory of Open Access Journals (Sweden)

    Kitaguchi Y

    2014-03-01

    Full Text Available Yoshiyuki Kitaguchi, Shinsaku Yano, Fumi Gomi Department of Ophthalmology, Sumitomo Hospital, Osaka, Japan Abstract: Here we report a patient in whom there was a myopic shift after combined cataract surgery and pars plana vitrectomy against the epiretinal membrane, related to axial measurement estimation error caused by a hidden double-peak appearance on partial coherence interferometry measurement. A 52-year-old female presented with epiretinal membrane and underwent combined cataract surgery and pars plana vitrectomy. Axial length was measured with partial coherence interferometry. Although the signal curve in the summary display showed a single peak, a 1.6 diopter myopic shift occurred. Viewed retrospectively, six of 20 individual signal curves showed a double peak. Most of them showed a higher anterior peak, with only one having a higher posterior peak. The other 14 curves showed a single peak at a similar distance to an anterior peak. The anterior peak appeared to be derived from the epiretinal membrane. The possibility of a double peak should always be considered in patients with epiretinal membrane even if the summary display of the partial coherence interferometry measurement shows a single peak. Checking all signal curves would reduce the risk of missing a hidden double peak. Keywords: intraocular lens, master, double peak, epiretinal membrane

  10. Nuclear power plant personnel errors in decision-making as an object of probabilistic risk assessment. Methodological extensions on the basis of a differentiated analysis of safety-relevant goals; Entscheidungsfehler des Betriebspersonals von Kernkraftwerken als Objekt probabilistischer Risikoanalysen; Methodische Erweiterungen auf der Basis einer differenzierten Betrachtungsweise sicherheitsgerichteter Ziele

    Energy Technology Data Exchange (ETDEWEB)

    Reer, B.

    1993-09-01

    Integration of human error (man-machine system analysis (MMSA)) is an essential part of probabilistic risk assessment (PRA). A method is presented for systematic, comprehensive PRA inclusions of decision-based errors due to conflicts or similarities. For error identification procedure, new question techniques are developed. These errors are identified by looking at retroactions caused by subordinate goals as components of overall safety relevant goal. New quantification methods for estimating situation-specific probabilities are developed. The factors conflict and similarity are operationalized in a way that allows their quantification based on informations usually available in PRA. Quantification procedure uses extrapolations and interpolations based on a poor set of data related to decision-based errors. Moreover, for passive errors in decision-making a completely new approach is presented where errors are quantified via a delay initiating the required action rather than via error probabilities. Practicability of this dynamic approach is demonstrated by probabilistic analysis of the actions required during the total loss of feedwater event at the Davis-Besse plant 1985. The extensions of the classical PRA method developed in this work are applied to a MMSA of the decay heat removal (DHR) of the HTR-500. Errors in decision-making - as potential roots of extraneous acts - are taken into account in a comprehensive and systematic manner. Five additional errors are identified. However, the probabilistic quantification results a nonsignificant increase of the DHR failure probability. (orig.) [Deutsch] Einbeziehung von Operateurfehlern (Mensch-Maschine-Systemanalyse (MMSA)) ist Bestandteil einer probabilistischen Risikoanalyse (PRA). Es wird eine Methode vorgestellt, mit der sich Entscheidungsfehler aufgrund der Faktoren Konflikt und Aehnlichkeit systematisch und umfassend in MMSA integrieren lassen. Zur Identifizierung der entsprechenden Situationen im Stoerfallablauf

  11. Reserve Manpower, Personnel, and Training Research.

    Science.gov (United States)

    1986-09-01

    ucM) q 24 WWESWEEPMR (MCJ/M"𔃾 28 MOBLE NHORE UNDERSEA WAAR LHTS 4 ADPICIIA 94PS (LST/LSf) 22 CRAFT OF OPPORTIJT UNITS (COOP) 4 SALVAE SUPS (ARS) 4...Centers with the aid of computer technology . Once decentralized, personnel data would .- be captured, maintained, and reported at the local level. In... Technology Mr. Eugene R. Hall 202/696-4844 Novel Training Systems Center 305/646-4498 ,- CDR George Connor, USU Office of the CNO, Op-091 Dr. Stanley A

  12. Project Management Personnel Competencies Evaluation

    Directory of Open Access Journals (Sweden)

    Paul POCATILU

    2006-01-01

    Full Text Available An important factor for the success management of IT projects is the human resource. People involved in the project management process have to be evaluated. In order to do that, same criteria has to be specified. This paper describes some aspects regarding the personnel evaluation.

  13. Health Instruction Packages: Dental Personnel.

    Science.gov (United States)

    Hayes, Gary E.; And Others

    Text, illustrations, and exercises are utilized in this set of four learning modules designed to instruct non-professional dental personnel in selected job-related skills. The first module, by Gary E. Hayes, describes how to locate the hinge axis point of the jaw, place and secure a bitefork, and perform a facebow transfer. The second module,…

  14. Preventing statistical errors in scientific journals.

    NARCIS (Netherlands)

    Nuijten, M.B.

    2016-01-01

    There is evidence for a high prevalence of statistical reporting errors in psychology and other scientific fields. These errors display a systematic preference for statistically significant results, distorting the scientific literature. There are several possible causes for this systematic error pre

  15. [Current state and prospects of military personnel health monitoring].

    Science.gov (United States)

    Rezvantsev, M V; Kuznetsov, S M; Ivanov, V V; Zakurdaev, V V

    2014-01-01

    The current article is dedicated to some features of the Russian Federation Armed Forces military personnel health monitoring such as legal and informational provision, methodological basis of functioning, historical aspect of formation and development of the social and hygienic monitoring in the Russian Federation Armed Forces. The term "military personnel health monitoring" is defined as an analytical system of constant and long-term observation, analysis, assessment, studying of factors determined the military personnel health, these factors correlations, health risk factors management in order to minimize them. The current state of the military personnel health monitoring allows coming to the conclusion that the military health system does have forces and resources for state policy of establishing the population health monitoring system implementation. The following directions of the militarily personnel health monitoring improvement are proposed: the Russian Federation Armed Forces medical service record and report system reorganization bringing it closer to the civilian one, implementation of the integrated approach to the medical service informatisation, namely, military personnel health status and medical service resources monitoring. The leading means in this direction are development and introduction of a military serviceman individual health status monitoring system on the basis of a serviceman electronic medical record card. Also it is proposed the current Russian Federation Armed Forces social and hygienic monitoring improvement at the expense of informational interaction between the two subsystems on the basis of unified military medical service space.

  16. A Review of Mercury Exposure and Health of Dental Personnel

    Directory of Open Access Journals (Sweden)

    Natasha Nagpal

    2017-03-01

    Full Text Available Considerable effort has been made to address the issue of occupational health and environmental exposure to mercury. This review reports on the current literature of mercury exposure and health impacts on dental personnel. Citations were searched using four comprehensive electronic databases for articles published between 2002 and 2015. All original articles that evaluated an association between the use of dental amalgam and occupational mercury exposure in dental personnel were included. Fifteen publications from nine different countries met the selection criteria. The design and quality of the studies showed significant variation, particularly in the choice of biomarkers as an indicator of mercury exposure. In several countries, dental personnel had higher mercury levels in biological fluids and tissues than in control groups; some work practices increased mercury exposure but the exposure levels remained below recommended guidelines. Dental personnel reported more health conditions, often involving the central nervous system, than the control groups. Clinical symptoms reported by dental professionals may be associated with low-level, long-term exposure to occupational mercury, but may also be due to the effects of aging, occupational overuse, and stress. It is important that dental personnel, researchers, and educators continue to encourage and monitor good work practices by dental professionals.

  17. Experimental demonstration of topological error correction

    OpenAIRE

    2012-01-01

    Scalable quantum computing can only be achieved if qubits are manipulated fault-tolerantly. Topological error correction - a novel method which combines topological quantum computing and quantum error correction - possesses the highest known tolerable error rate for a local architecture. This scheme makes use of cluster states with topological properties and requires only nearest-neighbour interactions. Here we report the first experimental demonstration of topological error correction with a...

  18. Data Science at the Defense Personnel and Security Research Center. Mission: Improve the Effectiveness, Efficiency, and Fairness of DoD Personnel Security and Suitability Programs

    Science.gov (United States)

    2015-05-14

    Mission: Improve the Effectiveness, Efficiency, and Fairness of DoD Personnel Security and Suitability Programs Report Documentation Page Form... fairness of personnel security in the DoD In the wake of events like 9-11, Ft. Hood, and the Washington Navy Yard shootings, we expanded our

  19. Analgesic medication errors in North Carolina nursing homes.

    Science.gov (United States)

    Desai, Rishi J; Williams, Charrlotte E; Greene, Sandra B; Pierson, Stephanie; Caprio, Anthony J; Hansen, Richard A

    2013-06-01

    The objective of this study was to characterize analgesic medication errors and to evaluate their association with patient harm. The authors conducted a cross-sectional analysis of individual medication error incidents reported by North Carolina nursing homes to the Medication Error Quality Initiative (MEQI) during fiscal years 2010-2011. Bivariate associations between analgesic medication errors with patient factors, error-related factors, and impact on patients were tested with chi-square tests. A multivariate logistic regression model explored the relationship between type of analgesic medication errors and patient harm, controlling for patient- and error-related factors. A total of 32,176 individual medication error incidents were reported over a 2-year period in North Carolina nursing homes, 12.3% (n = 3949) of which were analgesic medication errors. Of these analgesic medication errors, opioid and nonopioid analgesics were involved in 3105 and 844 errors, respectively. Opioid errors were more likely to be wrong drug errors, wrong dose errors, and administration errors compared with nonopioid errors (P errors were found to have higher odds of patient harm compared with nonopioid errors (odds ratio [OR] = 3, 95% confodence interval [CI]: 1.1-7.8). The authors conclude that opioid analgesics represent the majority of analgesic error reports, and these error reports reflect an increased likelihood of patient harm compared with nonopioid analgesics.

  20. Generalized Gaussian Error Calculus

    CERN Document Server

    Grabe, Michael

    2010-01-01

    For the first time in 200 years Generalized Gaussian Error Calculus addresses a rigorous, complete and self-consistent revision of the Gaussian error calculus. Since experimentalists realized that measurements in general are burdened by unknown systematic errors, the classical, widespread used evaluation procedures scrutinizing the consequences of random errors alone turned out to be obsolete. As a matter of course, the error calculus to-be, treating random and unknown systematic errors side by side, should ensure the consistency and traceability of physical units, physical constants and physical quantities at large. The generalized Gaussian error calculus considers unknown systematic errors to spawn biased estimators. Beyond, random errors are asked to conform to the idea of what the author calls well-defined measuring conditions. The approach features the properties of a building kit: any overall uncertainty turns out to be the sum of a contribution due to random errors, to be taken from a confidence inter...

  1. Personnel Management: A J/A Perspective

    Science.gov (United States)

    Tasca, A. J.

    1974-01-01

    Recently, personnel executives and their staffs are being asked to help management solve an increasing number of human resource and business problems. Personnel management must undergo some changes if it is to achieve its full potential. (Author/AJ)

  2. National Finance Center Personnel/Payroll System

    Data.gov (United States)

    US Agency for International Development — The NFC system is an USDA system used for processing transactions for payroll/personnel systems. Personnel processing is done through EPIC/HCUP, which is web-based....

  3. Contact dermatitis in military personnel.

    Science.gov (United States)

    Dever, Tara T; Walters, Michelle; Jacob, Sharon

    2011-01-01

    Military personnel encounter the same allergens and irritants as their civilian counterparts and are just as likely to develop contact dermatitis from common exposures encountered in everyday life. In addition, they face some unique exposures that can be difficult to avoid owing to their occupational duties. Contact dermatitis can be detrimental to a military member's career if he or she is unable to perform core duties or avoid the inciting substances. An uncontrolled contact dermatitis can result in the member's being placed on limited-duty (ie, nondeployable) status, needing a job or rate change, or separation from military service. We present some common causes of contact dermatitis in military personnel worldwide and some novel sources of contact dermatitis in this population that may not be intuitive.

  4. Personnel

    CERN Multimedia

    Schopper,H; Andersen

    1985-01-01

    Le président du conseil M.Doran explique la décision que le conseil du Cern vient de prendre sur la 4.étape du régime complémentaire des pensions. Le président du comité des finances le Dr.Andersen ainsi que le Prof.Connor(?) prennent aussi la parole

  5. 5 CFR 293.302 - Establishment of Official Personnel Folder.

    Science.gov (United States)

    2010-01-01

    ... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Establishment of Official Personnel Folder. 293.302 Section 293.302 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PERSONNEL RECORDS Official Personnel Folder § 293.302 Establishment of Official Personnel Folder...

  6. Classification of Spreadsheet Errors

    OpenAIRE

    Rajalingham, Kamalasen; Chadwick, David R.; Knight, Brian

    2008-01-01

    This paper describes a framework for a systematic classification of spreadsheet errors. This classification or taxonomy of errors is aimed at facilitating analysis and comprehension of the different types of spreadsheet errors. The taxonomy is an outcome of an investigation of the widespread problem of spreadsheet errors and an analysis of specific types of these errors. This paper contains a description of the various elements and categories of the classification and is supported by appropri...

  7. IMHE Report.

    Science.gov (United States)

    International Journal of Institutional Management in Higher Education, 1985

    1985-01-01

    European university administrators report their impressions and conclusions about academic restructuring, personnel policy, and retrenchment following a visit to institutions in the United States. (MSE)

  8. Personnel marketing focused on graduates' attraction

    OpenAIRE

    Solovská, Petra

    2012-01-01

    This diploma thesis refers to the topic of personnel marketing focused on graduates' attraction. In theoretical part it describes concepts of personnel marketing, its components, tools and parts, then it focuses on personnel marketing in a context of social system of organization and on specifics of graduates. The empirical part is searching for answers why is it important for organizations to attract graduates, which methods of personnel marketing are used to attract them, what is the strate...

  9. PERSONNEL DEMOTIVATING: THE REASONS, FACTORS, ELIMINATION METHODS

    OpenAIRE

    Kuznetsova Ekaterina Andreevna

    2012-01-01

    The motivation of the personnel in any economic conditions remains a leading link in an enterprise control system. At creation of system of motivation tracking of extent of its impact on productivity of work of the personnel is important. The boomerang effect which is shown in a demotivating of separate groups of the personnel is often observed. In article features of manifestation of demotivating factors at various stages of work of the personnel are analyzed, the circle of the reasons bring...

  10. Control for occupationally exposed personnels

    Energy Technology Data Exchange (ETDEWEB)

    Murakami, Hiroyuki [Japan Atomic Energy Research Inst., Tokai, Ibaraki (Japan). Tokai Research Establishment; Momose, Takuma

    1999-03-01

    The present status of the technology for the measurement of personnel exposure dose was reviewed based on the basic concept of ICRP Recommendation on new assessment of exposure dose. The personnel dosimeter which has been mostly used by occupationally exposed personnels in Japan is film badge or thermoluminescence dosimeter. Now, photoluminescent glass dosimeter has been paid attention because pulse excitation method by UV laser has been developed. Measurement at an accuracy of 0.1 mSv or more became possible by using this dosimeter at present. In addition, characteristic studies for practical application of electronic, photostimulated luminescence and neutron dosimeters are progressing now. Revision of kinetic model of in vivo metabolism of radioactive substances is progressing based on the recent findings since ICRP Recommendation in 1990. Monitoring an individual internal exposure is made by two methods; direct measurement of the radiation emitted from the body and indirect one by radioanalysis of excretes etc. The latter is inferior to the former in respect of the accuracy of dose assessment, but the direct method is more suitable to detect a little amount of radioactive substance incorporated because of its high sensitivity. In future, it is needed to provide a considerable number of whole body counters against a large-scale nuclear accident. (M.N.)

  11. A Global Perspective of Vaccination of Healthcare Personnel against Measles: Systematic Review

    Science.gov (United States)

    Fiebelkorn, Amy Parker; Seward, Jane F.; Orenstein, Walter

    2015-01-01

    Measles transmission has been well documented in healthcare facilities. Healthcare personnel who are unvaccinated and who lack other evidence of measles immunity put themselves and their patients at risk for measles. We conducted a systematic literature review of measles vaccination policies and their implementation in healthcare personnel, measles seroprevalence among healthcare personnel, measles transmission and disease burden in healthcare settings, and impact/costs incurred by healthcare facilities for healthcare-associated measles transmission. Five database searches yielded 135 relevant articles; 47 additional articles were found through cross-referencing. The risk of acquiring measles is estimated to be 2 to 19 times higher for susceptible healthcare personnel than for the general population. Fifty-three articles published worldwide during 1989–2013 reported measles transmission from patients to healthcare personnel; many of the healthcare personnel were unvaccinated or had unknown vaccination status. Eighteen articles published worldwide during 1982–2013 described examples of transmission from healthcare personnel to patients or to other healthcare personnel. Half of European countries have no measles vaccine policies for healthcare personnel. There is no global policy recommendation for the vaccination of healthcare personnel against measles. Even in countries such as the United States or Finland that have national policies, the recommendations are not uniformly implemented in healthcare facilities. Measles serosusceptibility in healthcare personnel varied widely across studies (median 6.5%, range 0%-46%) but was consistently higher among younger healthcare personnel. Deficiencies in documentation of two doses of measles vaccination or other evidence of immunity among healthcare personnel presents challenges in responding to measles exposures in healthcare settings. Evaluating and containing exposures and outbreaks in healthcare settings can be

  12. The Changing World of Personnel Management.

    Science.gov (United States)

    Anderson, Eileen R.

    Although personnel management in the public sector has become increasingly difficult because of recent social changes, more worker and middle management involvement in decision-making processes can improve all levels of personnel management. The social changes affecting personnel management have assumed three forms: (1) the entrance into the work…

  13. 46 CFR 107.113 - Industrial personnel.

    Science.gov (United States)

    2010-10-01

    ... 46 Shipping 4 2010-10-01 2010-10-01 false Industrial personnel. 107.113 Section 107.113 Shipping... CERTIFICATION General § 107.113 Industrial personnel. Industrial personnel are all persons, exclusive of the... unit for the sole purpose of carrying out the industrial business or functions of the unit....

  14. 49 CFR 193.2711 - Personnel health.

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 3 2010-10-01 2010-10-01 false Personnel health. 193.2711 Section 193.2711 Transportation Other Regulations Relating to Transportation (Continued) PIPELINE AND HAZARDOUS MATERIALS SAFETY...: FEDERAL SAFETY STANDARDS Personnel Qualifications and Training § 193.2711 Personnel health. Each...

  15. 33 CFR 157.154 - Assistant personnel.

    Science.gov (United States)

    2010-07-01

    ... 33 Navigation and Navigable Waters 2 2010-07-01 2010-07-01 false Assistant personnel. 157.154 Section 157.154 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED... Crude Oil Washing (COW) System on Tank Vessels Personnel § 157.154 Assistant personnel. The owner...

  16. 14 CFR 91.1049 - Personnel.

    Science.gov (United States)

    2010-01-01

    ... scheduling or flight release personnel are on duty to schedule and release program aircraft during all hours... 14 Aeronautics and Space 2 2010-01-01 2010-01-01 false Personnel. 91.1049 Section 91.1049... Management § 91.1049 Personnel. (a) Each program manager and each fractional owner must use in...

  17. 40 CFR 264.16 - Personnel training.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 25 2010-07-01 2010-07-01 false Personnel training. 264.16 Section 264... Facility Standards § 264.16 Personnel training. (a)(1) Facility personnel must successfully complete a program of classroom instruction or on-the-job training that teaches them to perform their duties in a...

  18. Human factors evaluation of remote afterloading brachytherapy: Human error and critical tasks in remote afterloading brachytherapy and approaches for improved system performance. Volume 1

    Energy Technology Data Exchange (ETDEWEB)

    Callan, J.R.; Kelly, R.T.; Quinn, M.L. [Pacific Science and Engineering Group, San Diego, CA (United States)] [and others

    1995-05-01

    Remote Afterloading Brachytherapy (RAB) is a medical process used in the treatment of cancer. RAB uses a computer-controlled device to remotely insert and remove radioactive sources close to a target (or tumor) in the body. Some RAB problems affecting the radiation dose to the patient have been reported and attributed to human error. To determine the root cause of human error in the RAB system, a human factors team visited 23 RAB treatment sites in the US The team observed RAB treatment planning and delivery, interviewed RAB personnel, and performed walk-throughs, during which staff demonstrated the procedures and practices used in performing RAB tasks. Factors leading to human error in the RAB system were identified. The impact of those factors on the performance of RAB was then evaluated and prioritized in terms of safety significance. Finally, the project identified and evaluated alternative approaches for resolving the safety significant problems related to human error.

  19. Experimental demonstration of topological error correction.

    Science.gov (United States)

    Yao, Xing-Can; Wang, Tian-Xiong; Chen, Hao-Ze; Gao, Wei-Bo; Fowler, Austin G; Raussendorf, Robert; Chen, Zeng-Bing; Liu, Nai-Le; Lu, Chao-Yang; Deng, You-Jin; Chen, Yu-Ao; Pan, Jian-Wei

    2012-02-22

    Scalable quantum computing can be achieved only if quantum bits are manipulated in a fault-tolerant fashion. Topological error correction--a method that combines topological quantum computation with quantum error correction--has the highest known tolerable error rate for a local architecture. The technique makes use of cluster states with topological properties and requires only nearest-neighbour interactions. Here we report the experimental demonstration of topological error correction with an eight-photon cluster state. We show that a correlation can be protected against a single error on any quantum bit. Also, when all quantum bits are simultaneously subjected to errors with equal probability, the effective error rate can be significantly reduced. Our work demonstrates the viability of topological error correction for fault-tolerant quantum information processing.

  20. L’errore nel laboratorio di Microbiologia

    Directory of Open Access Journals (Sweden)

    Paolo Lanzafame

    2006-03-01

    Full Text Available Error management plays one of the most important roles in facility process improvement efforts. By detecting and reducing errors quality and patient care improve. The records of errors was analysed over a period of 6 months and another was used to study the potential bias in the registrations.The percentage of errors detected was 0,17% (normalised 1720 ppm and the errors in the pre-analytical phase was the largest part.The major rate of errors was generated by the peripheral centres which send only sometimes the microbiology tests and don’t know well the specific procedures to collect and storage biological samples.The errors in the management of laboratory supplies were reported too. The conclusion is that improving operators training, in particular concerning samples collection and storage, is very important and that an affective system of error detection should be employed to determine the causes and the best corrective action should be applied.

  1. NATIONAL SYNCHROTRON LIGHT SOURCE MEDICAL PERSONNEL PROTECTION INTERLOCK

    Energy Technology Data Exchange (ETDEWEB)

    BUDA,S.; GMUR,N.F.; LARSON,R.; THOMLINSON,W.

    1998-11-03

    This report is founded on reports written in April 1987 by Robert Hettel for angiography operations at the Stanford Synchrotron Research Laboratory (SSRL) and a subsequent report covering angiography operations at the National Synchrotron Light Source (NSLS); BNL Informal Report 47681, June 1992. The latter report has now been rewritten in order to accurately reflect the design and installation of a new medical safety system at the NSLS X17B2 beamline Synchrotron Medical Research Facility (SMERF). Known originally as the Angiography Personnel Protection Interlock (APPI), this system has been modified to incorporate other medical imaging research programs on the same beamline and thus the name has been changed to the more generic Medical Personnel Protection Interlock (MPPI). This report will deal almost exclusively with the human imaging (angiography, bronchography, mammography) aspects of the safety system, but will briefly explain the modular aspects of the system allowing other medical experiments to be incorporated.

  2. Impact of Measurement Error on Synchrophasor Applications

    Energy Technology Data Exchange (ETDEWEB)

    Liu, Yilu [Univ. of Tennessee, Knoxville, TN (United States); Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Gracia, Jose R. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Ewing, Paul D. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Zhao, Jiecheng [Univ. of Tennessee, Knoxville, TN (United States); Tan, Jin [Univ. of Tennessee, Knoxville, TN (United States); Wu, Ling [Univ. of Tennessee, Knoxville, TN (United States); Zhan, Lingwei [Univ. of Tennessee, Knoxville, TN (United States)

    2015-07-01

    Phasor measurement units (PMUs), a type of synchrophasor, are powerful diagnostic tools that can help avert catastrophic failures in the power grid. Because of this, PMU measurement errors are particularly worrisome. This report examines the internal and external factors contributing to PMU phase angle and frequency measurement errors and gives a reasonable explanation for them. It also analyzes the impact of those measurement errors on several synchrophasor applications: event location detection, oscillation detection, islanding detection, and dynamic line rating. The primary finding is that dynamic line rating is more likely to be influenced by measurement error. Other findings include the possibility of reporting nonoscillatory activity as an oscillation as the result of error, failing to detect oscillations submerged by error, and the unlikely impact of error on event location and islanding detection.

  3. Errors associated with outpatient computerized prescribing systems

    Science.gov (United States)

    Rothschild, Jeffrey M; Salzberg, Claudia; Keohane, Carol A; Zigmont, Katherine; Devita, Jim; Gandhi, Tejal K; Dalal, Anuj K; Bates, David W; Poon, Eric G

    2011-01-01

    Objective To report the frequency, types, and causes of errors associated with outpatient computer-generated prescriptions, and to develop a framework to classify these errors to determine which strategies have greatest potential for preventing them. Materials and methods This is a retrospective cohort study of 3850 computer-generated prescriptions received by a commercial outpatient pharmacy chain across three states over 4 weeks in 2008. A clinician panel reviewed the prescriptions using a previously described method to identify and classify medication errors. Primary outcomes were the incidence of medication errors; potential adverse drug events, defined as errors with potential for harm; and rate of prescribing errors by error type and by prescribing system. Results Of 3850 prescriptions, 452 (11.7%) contained 466 total errors, of which 163 (35.0%) were considered potential adverse drug events. Error rates varied by computerized prescribing system, from 5.1% to 37.5%. The most common error was omitted information (60.7% of all errors). Discussion About one in 10 computer-generated prescriptions included at least one error, of which a third had potential for harm. This is consistent with the literature on manual handwritten prescription error rates. The number, type, and severity of errors varied by computerized prescribing system, suggesting that some systems may be better at preventing errors than others. Conclusions Implementing a computerized prescribing system without comprehensive functionality and processes in place to ensure meaningful system use does not decrease medication errors. The authors offer targeted recommendations on improving computerized prescribing systems to prevent errors. PMID:21715428

  4. Vaccine cold chain: Part 2. Training personnel and program management.

    Science.gov (United States)

    Rogers, Bonnie; Dennison, Kim; Adepoju, Nikki; Dowd, Shelia; Uedoi, Kenneth

    2010-09-01

    The Centers for Disease Control and Prevention reports that professionals in clinic settings may not be adequately storing and handling vaccine, leading to insufficient immunity of vaccinated individuals. Part 2 of this article provides information about the importance of adequate personnel training and program management policies and procedures needed to implement and maintain an effective vaccine cold chain program. Copyright 2010, SLACK Incorporated.

  5. Error tracking in a clinical biochemistry laboratory

    DEFF Research Database (Denmark)

    Szecsi, Pal Bela; Ødum, Lars

    2009-01-01

    BACKGROUND: We report our results for the systematic recording of all errors in a standard clinical laboratory over a 1-year period. METHODS: Recording was performed using a commercial database program. All individuals in the laboratory were allowed to report errors. The testing processes were cl...

  6. Reducing medication errors.

    Science.gov (United States)

    Nute, Christine

    2014-11-25

    Most nurses are involved in medicines management, which is integral to promoting patient safety. Medicines management is prone to errors, which depending on the error can cause patient injury, increased hospital stay and significant legal expenses. This article describes a new approach to help minimise drug errors within healthcare settings where medications are prescribed, dispensed or administered. The acronym DRAINS, which considers all aspects of medicines management before administration, was devised to reduce medication errors on a cardiothoracic intensive care unit.

  7. Unmasking the health problems faced by the police personnel

    Directory of Open Access Journals (Sweden)

    G.Jahnavi

    2012-11-01

    Full Text Available Aim: To assess the health problems of the police personnel under Vijayawada police commisionerate 2. To make the health check ups regular and 3. To make the physical fitness programme mandatory for them.Study design: cross sectional study Methodology: Health check up was done for 617 police personnel from 12.11.09 to 4.12.09. In the morning hours, a group of junior doctors, paramedical staff and technicians visited the police dispensary to do the general check up, take blood samples and ECG. The following afternoon a group of specialists visited to check the same patients along with their reports to make the final diagnosis. Results: Out of 617 police personnel 259 (42% were overweight/obese, lack of physical activity was found in 397 (64% of them, alcohol consumption was present in 148 (24% and smoking in 136 (22% of the police personnel. Diabetes was diagnosed in 229 (37% and hypertension in 203 (33%. Anemia was detected in 154 (25%, visual abnormalities in 59 (10%, lipid abnormalities in 185 (30%, liver function test abnormalities in 31 (5%, ECG abnormalities in 25 (4%, renal function abnormalities in 6 (1%. Conclusion: A Physical fitness Schedule along with Stress alleviation techniques to be made mandatory for the police personnel to keep them physically and mentally fit, to perform critical job functions, to alleviate stress, and to improve their quality of life. Routine health checkups should be done to detect lurking dangers.

  8. Psychiatric personnel, risk management and the new institutionalism.

    Science.gov (United States)

    Hazelton, M

    1999-12-01

    This article reports the findings of a series of ethnographic research interviews conducted with psychiatric personnel in one region of Tasmania between 1995 and 1997. These interviews formed part of a more wide-ranging project examining changes in the regulatory practices of psychiatric personnel in the light of the professional, media and policy discourses that inform them, especially in relation to the impact of social justice reforms spelt out in recent Australian mental health policy. In discussing the nature of psychiatric work the personnel interviewed returned repeatedly to the themes of safety and risk management. The study presents an analysis of discourses deployed around these themes and argues that concerns over safety and risk are central to the emergence of a new institutionalism in acute in-patient psychiatric services.

  9. Understanding Human Error Based on Automated Analyses

    Data.gov (United States)

    National Aeronautics and Space Administration — This is a report on a continuing study of automated analyses of experiential textual reports to gain insight into the causal factors of human errors in aviation...

  10. Demand Forecasting Errors

    OpenAIRE

    Mackie, Peter; Nellthorp, John; Laird, James

    2005-01-01

    Demand forecasts form a key input to the economic appraisal. As such any errors present within the demand forecasts will undermine the reliability of the economic appraisal. The minimization of demand forecasting errors is therefore important in the delivery of a robust appraisal. This issue is addressed in this note by introducing the key issues, and error types present within demand fore...

  11. When errors are rewarding

    NARCIS (Netherlands)

    Bruijn, E.R.A. de; Lange, F.P. de; Cramon, D.Y. von; Ullsperger, M.

    2009-01-01

    For social beings like humans, detecting one's own and others' errors is essential for efficient goal-directed behavior. Although one's own errors are always negative events, errors from other persons may be negative or positive depending on the social context. We used neuroimaging to disentangle br

  12. Medication Errors: New EU Good Practice Guide on Risk Minimisation and Error Prevention.

    Science.gov (United States)

    Goedecke, Thomas; Ord, Kathryn; Newbould, Victoria; Brosch, Sabine; Arlett, Peter

    2016-06-01

    A medication error is an unintended failure in the drug treatment process that leads to, or has the potential to lead to, harm to the patient. Reducing the risk of medication errors is a shared responsibility between patients, healthcare professionals, regulators and the pharmaceutical industry at all levels of healthcare delivery. In 2015, the EU regulatory network released a two-part good practice guide on medication errors to support both the pharmaceutical industry and regulators in the implementation of the changes introduced with the EU pharmacovigilance legislation. These changes included a modification of the 'adverse reaction' definition to include events associated with medication errors, and the requirement for national competent authorities responsible for pharmacovigilance in EU Member States to collaborate and exchange information on medication errors resulting in harm with national patient safety organisations. To facilitate reporting and learning from medication errors, a clear distinction has been made in the guidance between medication errors resulting in adverse reactions, medication errors without harm, intercepted medication errors and potential errors. This distinction is supported by an enhanced MedDRA(®) terminology that allows for coding all stages of the medication use process where the error occurred in addition to any clinical consequences. To better understand the causes and contributing factors, individual case safety reports involving an error should be followed-up with the primary reporter to gather information relevant for the conduct of root cause analysis where this may be appropriate. Such reports should also be summarised in periodic safety update reports and addressed in risk management plans. Any risk minimisation and prevention strategy for medication errors should consider all stages of a medicinal product's life-cycle, particularly the main sources and types of medication errors during product development. This article

  13. [Preventive vaccinations for medical personnel].

    Science.gov (United States)

    Kerwat, Klaus; Goedecke, Marcel; Wulf, Hinnerk

    2014-05-01

    Vaccinations are among the most efficient and important preventive medical procedures. Modern vaccines are well tolerated. In Germany there are no longer laws for mandatory vaccinations, either for the general public or for medical personnel. Vaccinations are now merely "officially recommended" by the top health authorities on the basis of recommendations from the Standing Committee on Vaccinations (STIKO) of the Robert Koch Institute (RKI) according to § 20 para 3 of the Protection against Infection law (IfSG). The management of vaccine damage due to officially recommended vaccinations is guaranteed by the Federal States. Whereas vaccinations in childhood are generally considered to be a matter of course, the willingness to accept them decreases markedly with increasing age. In the medical sector vaccinations against, for example, hepatitis B are well accepted while other vaccinations against, for example, whooping cough or influenza are not considered to be so important. The fact that vaccinations, besides offering protection for the medical personnel, may also serve to protect the patients entrusted to medical care from nosocomial infections is often ignored. © Georg Thieme Verlag Stuttgart · New York.

  14. An error management system in a veterinary clinical laboratory.

    Science.gov (United States)

    Hooijberg, Emma; Leidinger, Ernst; Freeman, Kathleen P

    2012-05-01

    Error recording and management is an integral part of a clinical laboratory quality management system. Analysis and review of recorded errors lead to corrective and preventive actions through modification of existing processes and, ultimately, to quality improvement. Laboratory errors can be divided into preanalytical, analytical, and postanalytical errors depending on where in the laboratory cycle the errors occur. The purpose of the current report is to introduce an error management system in use in a veterinary diagnostic laboratory as well as to examine the amount and types of error recorded during the 8-year period from 2003 to 2010. Annual error reports generated during this period by the error recording system were reviewed, and annual error rates were calculated. In addition, errors were divided into preanalytical, analytical, postanalytical, and "other" categories, and their frequency was examined. Data were further compared to that available from human diagnostic laboratories. Finally, sigma metrics were calculated for the various error categories. Annual error rates per total number of samples ranged from 1.3% in 2003 to 0.7% in 2010. Preanalytical errors ranged from 52% to 77%, analytical from 4% to 14%, postanalytical from 9% to 21%, and other error from 6% to 19% of total errors. Sigma metrics ranged from 4.1 to 4.7. All data were comparable to that reported in human clinical laboratories. The incremental annual reduction of error shows that use of an error management system led to quality improvement.

  15. The Association Between Psychological Distress and Decision Regret During Armed Conflict Among Hospital Personnel.

    Science.gov (United States)

    Ben-Ezra, Menachem; Bibi, Haim

    2016-09-01

    The association between psychological distress and decision regret during armed conflict among hospital personnel is of interest. The objective of this study was to learn of the association between psychological distress and decision regret during armed conflict. Data was collected from 178 hospital personnel in Barzilai Medical Center in Ashkelon, Israel during Operation Protective Edge. The survey was based on intranet data collection about: demographics, self-rated health, life satisfaction, psychological distress and decision regret. Among hospital personnel, having higher psychological distress and being young were associated with higher decision regret. This study adds to the existing knowledge by providing novel data about the association between psychological distress and decision regret among hospital personnel during armed conflict. This data opens a new venue of future research to other potentially detrimental factor on medical decision making and medical error done during crisis.

  16. 76 FR 21270 - Interpretation of Duty and Rest Provisions for Maintenance Personnel

    Science.gov (United States)

    2011-04-15

    ..., 2010 interpretation changes the plain language of the regulation and requests that it be withdrawn. The... an increase in the number of errors made for maintenance personnel. In light of these factors, the... facility. The second explores the extent to which Pratt may view as non-duty time the time an...

  17. 5 CFR 250.202 - Office of Personnel Management responsibilities.

    Science.gov (United States)

    2010-01-01

    ... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Office of Personnel Management responsibilities. 250.202 Section 250.202 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PERSONNEL MANAGEMENT IN AGENCIES Strategic Human Capital Management § 250.202 Office of Personnel...

  18. Systematic error revisited

    Energy Technology Data Exchange (ETDEWEB)

    Glosup, J.G.; Axelrod, M.C.

    1996-08-05

    The American National Standards Institute (ANSI) defines systematic error as An error which remains constant over replicative measurements. It would seem from the ANSI definition that a systematic error is not really an error at all; it is merely a failure to calibrate the measurement system properly because if error is constant why not simply correct for it? Yet systematic errors undoubtedly exist, and they differ in some fundamental way from the kind of errors we call random. Early papers by Eisenhart and by Youden discussed systematic versus random error with regard to measurements in the physical sciences, but not in a fundamental way, and the distinction remains clouded by controversy. The lack of a general agreement on definitions has led to a plethora of different and often confusing methods on how to quantify the total uncertainty of a measurement that incorporates both its systematic and random errors. Some assert that systematic error should be treated by non- statistical methods. We disagree with this approach, and we provide basic definitions based on entropy concepts, and a statistical methodology for combining errors and making statements of total measurement of uncertainty. We illustrate our methods with radiometric assay data.

  19. PDCA Cycle Applied in Reducing Error Reporting Rate of Routine Blood Test%PDCA循环在降低血常规错误报告率中的应用

    Institute of Scientific and Technical Information of China (English)

    马春红; 韩庆志; 郑延红

    2014-01-01

    Objective Application of PDCA circulation management mode, reduce blood error report rate, ensuring patient safty.Methods Application of PDCA cycle management model to find out the factors of blood wrong, in view of the main reasons, formulate rectification measures, make blood error report rate to achieve the desired ef ect. Results After administration of PDCA cycle of 1 years, blood routine error report rate by the management of 5.1 ‰ to 1.9 ‰, achieve the expected ef ect (target value<2.0‰).Conclusion The PDCA cycle management method is to reduce the ef ective management method error reporting rate of routine.%目的应用PDCA循环的管理模式,降低血常规错误报告率,保证患者安全。方法应用PDCA循环的管理模式找出产生血常规错误的各种因素,针对主要原因,制定整改措施,使血常规错误报告率达到预期效果。结果经过1年的PDCA循环管理,血常规错误报告率由管理前5.1‰降到1.9‰,达到预期效果(目标值<2.0‰)。结论 PDCA循环管理方法是降低血常规错误报告率行之有效的管理方法。

  20. Error Detection and Error Classification: Failure Awareness in Data Transfer Scheduling

    Energy Technology Data Exchange (ETDEWEB)

    Louisiana State University; Balman, Mehmet; Kosar, Tevfik

    2010-10-27

    Data transfer in distributed environment is prone to frequent failures resulting from back-end system level problems, like connectivity failure which is technically untraceable by users. Error messages are not logged efficiently, and sometimes are not relevant/useful from users point-of-view. Our study explores the possibility of an efficient error detection and reporting system for such environments. Prior knowledge about the environment and awareness of the actual reason behind a failure would enable higher level planners to make better and accurate decisions. It is necessary to have well defined error detection and error reporting methods to increase the usability and serviceability of existing data transfer protocols and data management systems. We investigate the applicability of early error detection and error classification techniques and propose an error reporting framework and a failure-aware data transfer life cycle to improve arrangement of data transfer operations and to enhance decision making of data transfer schedulers.

  1. Predictors of Dietary Supplement Use by U.S. Coast Guard Personnel.

    Directory of Open Access Journals (Sweden)

    Krista G Austin

    Full Text Available Personnel in Armed Forces entities such as the US Coast Guard (USCG engage in strenuous tasks requiring high levels of physiological and psychological fitness. Previous reports have found increased prevalence of dietary supplement (DS use by military personnel to meet the demands of their occupation.This study assessed DS prevalence and patterns of use in USCG personnel and compared these findings to reports from other Armed Forces personnel.Use of DS by USCG personnel (n = 1059 was assessed by survey at USCG installations. Data were weighted by age, sex, and rank to be representative of total USCG demographics.Seventy percent of USCG personnel reported using a DS at least 1 time/wk. Thirty-three percent used 1-2 DS ≤ 1 time/wk, 18% 3-4 DS ≥ 1 time/wk, and almost 19% ≥ 5 DS ≥ 1 time/wk. Average expenditure on DSs by UCSG personnel was $40/mo. More than 47% of USCG personnel used a multivitamin and mineral, 33% consumed protein supplements, 22% used individual vitamins and minerals, 23% reported taking combination products, and 9% consumed herbal supplements. Increased use of DS use was associated with high intensity operational occupations, participating in high volumes of aerobic exercise and strength training. Use of DS was not associated with age, education or body mass index.Occupation is an important determinate of DS use. Prevalence of DS use by USCG personnel is greater than reported for other Armed Forces personnel and reflects high levels of participation in aerobic and strength training activities.

  2. Predictors of Dietary Supplement Use by U.S. Coast Guard Personnel

    Science.gov (United States)

    Austin, Krista G.; Price, Lori Lyn; McGraw, Susan M.; Lieberman, Harris R.

    2015-01-01

    Background Personnel in Armed Forces entities such as the US Coast Guard (USCG) engage in strenuous tasks requiring high levels of physiological and psychological fitness. Previous reports have found increased prevalence of dietary supplement (DS) use by military personnel to meet the demands of their occupation. Objective This study assessed DS prevalence and patterns of use in USCG personnel and compared these findings to reports from other Armed Forces personnel. Design Use of DS by USCG personnel (n = 1059) was assessed by survey at USCG installations. Data were weighted by age, sex, and rank to be representative of total USCG demographics. Results Seventy percent of USCG personnel reported using a DS at least 1 time/wk. Thirty-three percent used 1–2 DS ≤ 1 time/wk, 18% 3–4 DS ≥ 1 time/wk, and almost 19% ≥ 5 DS ≥ 1 time/wk. Average expenditure on DSs by UCSG personnel was $40/mo. More than 47% of USCG personnel used a multivitamin and mineral, 33% consumed protein supplements, 22% used individual vitamins and minerals, 23% reported taking combination products, and 9% consumed herbal supplements. Increased use of DS use was associated with high intensity operational occupations, participating in high volumes of aerobic exercise and strength training. Use of DS was not associated with age, education or body mass index. Conclusion Occupation is an important determinate of DS use. Prevalence of DS use by USCG personnel is greater than reported for other Armed Forces personnel and reflects high levels of participation in aerobic and strength training activities. PMID:26230407

  3. Predictors of Dietary Supplement Use by U.S. Coast Guard Personnel.

    Science.gov (United States)

    Austin, Krista G; Price, Lori Lyn; McGraw, Susan M; Lieberman, Harris R

    2015-01-01

    Personnel in Armed Forces entities such as the US Coast Guard (USCG) engage in strenuous tasks requiring high levels of physiological and psychological fitness. Previous reports have found increased prevalence of dietary supplement (DS) use by military personnel to meet the demands of their occupation. This study assessed DS prevalence and patterns of use in USCG personnel and compared these findings to reports from other Armed Forces personnel. Use of DS by USCG personnel (n = 1059) was assessed by survey at USCG installations. Data were weighted by age, sex, and rank to be representative of total USCG demographics. Seventy percent of USCG personnel reported using a DS at least 1 time/wk. Thirty-three percent used 1-2 DS ≤ 1 time/wk, 18% 3-4 DS ≥ 1 time/wk, and almost 19% ≥ 5 DS ≥ 1 time/wk. Average expenditure on DSs by UCSG personnel was $40/mo. More than 47% of USCG personnel used a multivitamin and mineral, 33% consumed protein supplements, 22% used individual vitamins and minerals, 23% reported taking combination products, and 9% consumed herbal supplements. Increased use of DS use was associated with high intensity operational occupations, participating in high volumes of aerobic exercise and strength training. Use of DS was not associated with age, education or body mass index. Occupation is an important determinate of DS use. Prevalence of DS use by USCG personnel is greater than reported for other Armed Forces personnel and reflects high levels of participation in aerobic and strength training activities.

  4. Director general presentation to personnel

    CERN Multimedia

    2016-01-01

    Dear Colleagues, Many important discussions are scheduled for the upcoming Council Week (13-17 June) on topics including the Medium-Term Plan, the Pension Fund and other matters of great relevance to us.   I would therefore like to share the main outcome of the week with you and I invite you to join me and the Directors in the Main Auditorium at 10 a.m. on Thursday 23 June. The meeting will last about one hour and a webcast will also be available. Best regards, Fabiola Gianotti DG presentation to personnel Thursday 23 June at 10 am Main Auditorium Retransmission in Council Chamber, IT Auditorium, Kjell Jonhsen Auditorium, Prevessin 864-1-C02 Webcast on cern.ch/webcast More information on the event page.

  5. 33 CFR 127.707 - Security personnel.

    Science.gov (United States)

    2010-07-01

    ...) WATERFRONT FACILITIES WATERFRONT FACILITIES HANDLING LIQUEFIED NATURAL GAS AND LIQUEFIED HAZARDOUS GAS Waterfront Facilities Handling Liquefied Natural Gas Security § 127.707 Security personnel. The...

  6. Musculoskeletal disorders in main battle tank personnel

    DEFF Research Database (Denmark)

    Nissen, Lars Ravnborg; Guldager, Bernadette; Gyntelberg, Finn

    2009-01-01

    PURPOSE: To compare the prevalence of musculoskeletal disorders of personnel in the main battle tank (MBT) units in the Danish army with those of personnel in other types of army units, and to investigate associations between job function in the tank, military rank, and musculoskeletal problems......, and ankle. RESULTS AND CONCLUSIONS: There were only 4 women in the MBT group; as a consequence, female personnel were excluded from the study. The participation rate was 58.0% (n = 184) in the MBT group and 56.3% (n = 333) in the reference group. The pattern of musculoskeletal disorders among personnel...

  7. Office of Personnel Management Catch 62 Match

    Data.gov (United States)

    Social Security Administration — SSA provides the Office of Personnel Management (OPM) with tax returns, Social Security benefits, and military retirement information for the purpose of correctly...

  8. Group representations, error bases and quantum codes

    Energy Technology Data Exchange (ETDEWEB)

    Knill, E

    1996-01-01

    This report continues the discussion of unitary error bases and quantum codes. Nice error bases are characterized in terms of the existence of certain characters in a group. A general construction for error bases which are non-abelian over the center is given. The method for obtaining codes due to Calderbank et al. is generalized and expressed purely in representation theoretic terms. The significance of the inertia subgroup both for constructing codes and obtaining the set of transversally implementable operations is demonstrated.

  9. Medical errors recovered by critical care nurses.

    Science.gov (United States)

    Dykes, Patricia C; Rothschild, Jeffrey M; Hurley, Ann C

    2010-05-01

    : The frequency and types of medical errors are well documented, but less is known about potential errors that were intercepted by nurses. We studied the type, frequency, and potential harm of recovered medical errors reported by critical care registered nurses (CCRNs) during the previous year. : Nurses are known to protect patients from harm. Several studies on medical errors found that there would have been more medical errors reaching the patient had not potential errors been caught earlier by nurses. : The Recovered Medical Error Inventory, a 25-item empirically derived and internally consistent (alpha =.90) list of medical errors, was posted on the Internet. Participants were recruited via e-mail and healthcare-related listservs using a nonprobability snowball sampling technique. Investigators e-mailed contacts working in hospitals or who managed healthcare-related listservs and asked the contacts to pass the link on to others with contacts in acute care settings. : During 1 year, 345 CCRNs reported that they recovered 18,578 medical errors, of which they rated 4,183 as potentially lethal. : Surveillance, clinical judgment, and interventions by CCRNs to identify, interrupt, and correct medical errors protected seriously ill patients from harm.

  10. [Exposure to the risk of loss of life or detriment to health as a consequence of an organizational error--a case report].

    Science.gov (United States)

    Chowaniec, Czesław; Jabłoński, Christian; Kobek, Mariusz; Chowaniec, Małgorzata

    2007-01-01

    Frequent changes in organization of the Polish health care sector observed over the past few years may lead to disruption of work in health care institutions, particularly in tertiary, highly specialist centers. Such a situation may result in decreasing the quality of services, what may potentially cause exposing the patient to the risk of death or severe detriment to health. To illustrate the problem, the authors present a case of a 45-year old man, where some organizational errors led to a delay in rendering medical care and in consequence to a poorer therapeutic outcome and poorer prognosis.

  11. Tenth ORNL Personnel Dosimetry Intercomparison Study

    Energy Technology Data Exchange (ETDEWEB)

    Swaja, R.E.; Chou, T.L.; Sims, C.S.; Greene, R.T.

    1985-03-01

    The Tenth Personnel Dosimetry Intercomparison Study was conducted at the Oak Ridge National Laboratory during April 9-11, 1984. Dosemeter badges from 31 participating organizations were mounted on 40cm Lucite phantoms and exposed to a range of dose equivalents which could be encountered during routine personnel monitoring in mixed radiation fields. The Health Physics Research Reactor served as the only source of radiation for eight of the ten irradiations which included a low (approx. 0.50 mSv) and high (approx. 10.00 mSv) neutron dose equivalent run for each of four shield conditions. Two irradiations were also conducted for which concrete- and Lucite-shield reactor irradiations were gamma-enhanced using a /sup 137/Cs source. Results indicated that some participants had difficulty obtaining measurable indication of neutron and gamma exposures at dose equivalents less than about 0.50 mSv and 0.20 mSv, respectively. Albedo dosemeters provided the best overall accuracy and precision for the neutron measurements. Direct interaction TLD systems showed significant variation in accuracy with incident spectrum, and threshold neutron dosemeters (film and recoil track) underestimated reference values by more than 50%. Gamma dose equivalents estimated in the mixed fields were higher than reference values with TL gamma dosemeters generally yielding more accurate results than film. Under the conditions of this study in which participants had information concerning exposure conditions and radiation field characteristics prior to dosemeter evaluation, only slightly more than half of all reported results met regulatory standards for neutron and gamma accuracy. 19 refs., 2 figs., 29 tabs.

  12. Probabilistic quantum error correction

    CERN Document Server

    Fern, J; Fern, Jesse; Terilla, John

    2002-01-01

    There are well known necessary and sufficient conditions for a quantum code to correct a set of errors. We study weaker conditions under which a quantum code may correct errors with probabilities that may be less than one. We work with stabilizer codes and as an application study how the nine qubit code, the seven qubit code, and the five qubit code perform when there are errors on more than one qubit. As a second application, we discuss the concept of syndrome quality and use it to suggest a way that quantum error correction can be practically improved.

  13. The District Nursing Clinical Error Reduction Programme.

    Science.gov (United States)

    McGraw, Caroline; Topping, Claire

    2011-01-01

    The District Nursing Clinical Error Reduction (DANCER) Programme was initiated in NHS Islington following an increase in the number of reported medication errors. The objectives were to reduce the actual degree of harm and the potential risk of harm associated with medication errors and to maintain the existing positive reporting culture, while robustly addressing performance issues. One hundred medication errors reported in 2007/08 were analysed using a framework that specifies the factors that predispose to adverse medication events in domiciliary care. Various contributory factors were identified and interventions were subsequently developed to address poor drug calculation and medication problem-solving skills and incorrectly transcribed medication administration record charts. Follow up data were obtained at 12 months and two years. The evaluation has shown that although medication errors do still occur, the programme has resulted in a marked shift towards a reduction in the associated actual degree of harm and the potential risk of harm.

  14. An information system for Korean military personnel management

    OpenAIRE

    Bak, Gwang U.; Kim, Chong-hun

    1982-01-01

    Approved for public release; distribution is unlimited A personnel information systems is designed for the management of Korean military officer personnel. The objective of this thesis is to apply the computer-based personnel information system in the area of military officer personnel management. Personnel systems of the Korean military are defined, and input/output requirements of the system are states. A data base for the personnel system requirement is formulated. A personnel infor...

  15. Analysis of Pronominal Errors: A Case Study.

    Science.gov (United States)

    Oshima-Takane, Yuriko

    1992-01-01

    Reports on a study of a normally developing boy who made pronominal errors for about 10 months. Comprehension and production data clearly indicate that the child persistently made pronominal errors because of semantic confusion in the use of first- and second-person pronouns. (28 references) (GLR)

  16. Management and Evaluation System on Human Error, Licence Requirements, and Job-aptitude in Rail and the Other Industries

    Energy Technology Data Exchange (ETDEWEB)

    Koo, In Soo; Suh, S. M.; Park, G. O. (and others)

    2006-07-15

    Rail system is a system that is very closely related to the public life. When an accident happens, the public using this system should be injured or even be killed. The accident that recently took place in Taegu subway system, because of the inappropriate human-side task performance, showed demonstratively how its results could turn out to be tragic one. Many studies have shown that the most cases of the accidents have occurred because of performing his/her tasks in inappropriate way. It is generally recognised that the rail system without human element could never be happened quite long time. So human element in rail system is going to be the major factor to the next tragic accident. This state of the art report studied the cases of the managements and evaluation systems related to human errors, license requirements, and job aptitudes in the areas of rail and the other industries for the purpose of improvement of the task performance of personnel which consists of an element and finally enhancement of rail safety. The human errors, license requirements, and evaluation system of the job aptitude on people engaged in agencies with close relation to rail do much for development and preservation their abilities. But due to various inside and outside factors, to some extent it may have limitations to timely reflect overall trends of society, technology, and a sense of value. Removal and control of the factors of human errors will have epochal roles in safety of the rail system through the case studies of this report. Analytical results on case studies of this report will be used in the project 'Development of Management Criteria on Human Error and Evaluation Criteria on Job-aptitude of Rail Safe-operation Personnel' which has been carried out as a part of 'Integrated R and D Program for Railway Safety'.

  17. Personnel Management: Stewardship of Human Resources

    Science.gov (United States)

    MacLean, Douglas G.

    1976-01-01

    The personnel function of top management is examined by first studying the environment in which top management functions. The basic skills required to perform the function are discussed. Against this background, six elements of personnel management in colleges and universities are considered: goals and objectives, organization for personnel…

  18. Job Satisfaction of Journalists and PR Personnel.

    Science.gov (United States)

    Olson, Laury D. (Masher)

    1989-01-01

    Surveys job satisfaction of journalists and public relations personnel in the San Francisco Bay Area. Finds public relations personnel significantly more satisfied with both their jobs and profession. Concludes that the relatively lower levels of job satisfaction for journalists are largely a result of lack of autonomy. (SR)

  19. Roadmap for Navy Civilian Personnel Research

    Science.gov (United States)

    1984-05-10

    Steinhauer Head, Staffing and Pay Systems Branch Civilian Personnel Policy Division "Mr. Joseph K. Taussig , Jr. Deputy Assistant Secretary of the Navy...Society of Naval Engineers, 1953, 65, 9-22. Frank, Michael . "Position Classification: A State of the Art Review and Analysis," Public Personnel

  20. 40 CFR 792.29 - Personnel.

    Science.gov (United States)

    2010-07-01

    ...) GOOD LABORATORY PRACTICE STANDARDS Organization and Personnel § 792.29 Personnel. (a) Each individual..., and experience, or combination thereof, to enable that individual to perform the assigned functions. (b) Each testing facility shall maintain a current summary of training and experience and job...

  1. Reserve Component Personnel Issues: Questions and Answers

    Science.gov (United States)

    2013-07-12

    align reserve capabilities with active component requirements. See prepared statement of Vice Admiral John C. Harvey , Chief of Naval Personnel...before the Senate Armed Services Personnel Subcommittee, February 27, 2008, p. 5, http://armed-services.senate.gov/ statemnt/2008/February/ Harvey %2002-27...security and disaster relief missions in the aftermath of Hurricanes Katrina and Rita

  2. 21 CFR 820.25 - Personnel.

    Science.gov (United States)

    2010-04-01

    ... shall have sufficient personnel with the necessary education, background, training, and experience to assure that all activities required by this part are correctly performed. (b) Training. Each manufacturer shall establish procedures for identifying training needs and ensure that all personnel are trained...

  3. 34 CFR 300.207 - Personnel development.

    Science.gov (United States)

    2010-07-01

    ... 34 Education 2 2010-07-01 2010-07-01 false Personnel development. 300.207 Section 300.207 Education Regulations of the Offices of the Department of Education (Continued) OFFICE OF SPECIAL EDUCATION... CHILDREN WITH DISABILITIES Local Educational Agency Eligibility § 300.207 Personnel development. The...

  4. Recent trends and challenges in personnel selection

    NARCIS (Netherlands)

    Lievens, F.; van Dam, K.; Anderson, N.

    2002-01-01

    The aim of this article is to identify recent developments in personnel selection and to review existing research with regard to these recent developments. To this end, 26 human resource representatives were asked to list current or future trends in personnel selection. In addition, existing academi

  5. 33 CFR 154.840 - Personnel training.

    Science.gov (United States)

    2010-07-01

    ... 33 Navigation and Navigable Waters 2 2010-07-01 2010-07-01 false Personnel training. 154.840... Personnel training. (a) A person in charge of a transfer operation utilizing a vapor control system must have completed a training program covering the particular system installed at the facility....

  6. Perceptual learning eases crowding by reducing recognition errors but not position errors.

    Science.gov (United States)

    Xiong, Ying-Zi; Yu, Cong; Zhang, Jun-Yun

    2015-08-01

    When an observer reports a letter flanked by additional letters in the visual periphery, the response errors (the crowding effect) may result from failure to recognize the target letter (recognition errors), from mislocating a correctly recognized target letter at a flanker location (target misplacement errors), or from reporting a flanker as the target letter (flanker substitution errors). Crowding can be reduced through perceptual learning. However, it is not known how perceptual learning operates to reduce crowding. In this study we trained observers with a partial-report task (Experiment 1), in which they reported the central target letter of a three-letter string presented in the visual periphery, or a whole-report task (Experiment 2), in which they reported all three letters in order. We then assessed the impact of training on recognition of both unflanked and flanked targets, with particular attention to how perceptual learning affected the types of errors. Our results show that training improved target recognition but not single-letter recognition, indicating that training indeed affected crowding. However, training did not reduce target misplacement errors or flanker substitution errors. This dissociation between target recognition and flanker substitution errors supports the view that flanker substitution may be more likely a by-product (due to response bias), rather than a cause, of crowding. Moreover, the dissociation is not consistent with hypothesized mechanisms of crowding that would predict reduced positional errors.

  7. Estimating IMU heading error from SAR images.

    Energy Technology Data Exchange (ETDEWEB)

    Doerry, Armin Walter

    2009-03-01

    Angular orientation errors of the real antenna for Synthetic Aperture Radar (SAR) will manifest as undesired illumination gradients in SAR images. These gradients can be measured, and the pointing error can be calculated. This can be done for single images, but done more robustly using multi-image methods. Several methods are provided in this report. The pointing error can then be fed back to the navigation Kalman filter to correct for problematic heading (yaw) error drift. This can mitigate the need for uncomfortable and undesired IMU alignment maneuvers such as S-turns.

  8. Correction for quadrature errors

    DEFF Research Database (Denmark)

    Netterstrøm, A.; Christensen, Erik Lintz

    1994-01-01

    In high bandwidth radar systems it is necessary to use quadrature devices to convert the signal to/from baseband. Practical problems make it difficult to implement a perfect quadrature system. Channel imbalance and quadrature phase errors in the transmitter and the receiver result in error signal...

  9. ERRORS AND CORRECTION

    Institute of Scientific and Technical Information of China (English)

    1998-01-01

    To err is human . Since the 1960s, most second language teachers or language theorists have regarded errors as natural and inevitable in the language learning process . Instead of regarding them as terrible and disappointing, teachers have come to realize their value. This paper will consider these values, analyze some errors and propose some effective correction techniques.

  10. ERROR AND ERROR CORRECTION AT ELEMENTARY LEVEL

    Institute of Scientific and Technical Information of China (English)

    1994-01-01

    Introduction Errors are unavoidable in language learning, however, to a great extent, teachers in most middle schools in China regard errors as undesirable, a sign of failure in language learning. Most middle schools are still using the grammar-translation method which aims at encouraging students to read scientific works and enjoy literary works. The other goals of this method are to gain a greater understanding of the first language and to improve the students’ ability to cope with difficult subjects and materials, i.e. to develop the students’ minds. The practical purpose of using this method is to help learners pass the annual entrance examination. "To achieve these goals, the students must first learn grammar and vocabulary,... Grammar is taught deductively by means of long and elaborate explanations... students learn the rules of the language rather than its use." (Tang Lixing, 1983:11-12)

  11. Errors on errors - Estimating cosmological parameter covariance

    CERN Document Server

    Joachimi, Benjamin

    2014-01-01

    Current and forthcoming cosmological data analyses share the challenge of huge datasets alongside increasingly tight requirements on the precision and accuracy of extracted cosmological parameters. The community is becoming increasingly aware that these requirements not only apply to the central values of parameters but, equally important, also to the error bars. Due to non-linear effects in the astrophysics, the instrument, and the analysis pipeline, data covariance matrices are usually not well known a priori and need to be estimated from the data itself, or from suites of large simulations. In either case, the finite number of realisations available to determine data covariances introduces significant biases and additional variance in the errors on cosmological parameters in a standard likelihood analysis. Here, we review recent work on quantifying these biases and additional variances and discuss approaches to remedy these effects.

  12. Proofreading for word errors.

    Science.gov (United States)

    Pilotti, Maura; Chodorow, Martin; Agpawa, Ian; Krajniak, Marta; Mahamane, Salif

    2012-04-01

    Proofreading (i.e., reading text for the purpose of detecting and correcting typographical errors) is viewed as a component of the activity of revising text and thus is a necessary (albeit not sufficient) procedural step for enhancing the quality of a written product. The purpose of the present research was to test competing accounts of word-error detection which predict factors that may influence reading and proofreading differently. Word errors, which change a word into another word (e.g., from --> form), were selected for examination because they are unlikely to be detected by automatic spell-checking functions. Consequently, their detection still rests mostly in the hands of the human proofreader. Findings highlighted the weaknesses of existing accounts of proofreading and identified factors, such as length and frequency of the error in the English language relative to frequency of the correct word, which might play a key role in detection of word errors.

  13. 5 CFR 300.706 - Office of Personnel Management adjudication.

    Science.gov (United States)

    2010-01-01

    ... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Office of Personnel Management adjudication. 300.706 Section 300.706 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE... Service Law § 300.706 Office of Personnel Management adjudication. (a) OPM will determine whether failure...

  14. 5 CFR 772.102 - Interim personnel actions.

    Science.gov (United States)

    2010-01-01

    ... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Interim personnel actions. 772.102 Section 772.102 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) INTERIM RELIEF General § 772.102 Interim personnel actions. When an employee or...

  15. Description of 44 biosecurity errors while entering and exiting poultry barns based on video surveillance in Quebec, Canada.

    Science.gov (United States)

    Racicot, Manon; Venne, Daniel; Durivage, André; Vaillancourt, Jean-Pierre

    2011-07-01

    The effectiveness of biosecurity measures depends largely on the consistency of their applications by all those involved in poultry production. Unfortunately, poor biosecurity compliance has been reported repeatedly in poultry, as well in all other major animal productions. As part of a larger study, we conducted an investigation on eight poultry farms in Quebec, Canada, to evaluate compliance of existing biosecurity measures using hidden cameras. The objectives were to evaluate and describe the application of biosecurity measures when entering and exiting poultry barns. A total of 44 different mistakes were observed from 883 visits done by 102 different individuals. On average, four errors were recorded per visit. The maximum number of errors made by one individual during one visit was 14. People observed over several visits made on average six different errors. Twenty-seven out of the 44 errors (61.4%) were related to area delimitation (clean versus contaminated), six to boots (13.6%), five to hand washing (11.4%), three to coveralls (6.8%) and three to logbooks (6.8%). The nature and frequency of errors suggest a lack of understanding of biosecurity principles. There is thus a need to improve biosecurity training by making educational material available to all poultry personnel demonstrating why and how to apply biosecurity measures.

  16. Uncorrected refractive errors

    Directory of Open Access Journals (Sweden)

    Kovin S Naidoo

    2012-01-01

    Full Text Available Global estimates indicate that more than 2.3 billion people in the world suffer from poor vision due to refractive error; of which 670 million people are considered visually impaired because they do not have access to corrective treatment. Refractive errors, if uncorrected, results in an impaired quality of life for millions of people worldwide, irrespective of their age, sex and ethnicity. Over the past decade, a series of studies using a survey methodology, referred to as Refractive Error Study in Children (RESC, were performed in populations with different ethnic origins and cultural settings. These studies confirmed that the prevalence of uncorrected refractive errors is considerably high for children in low-and-middle-income countries. Furthermore, uncorrected refractive error has been noted to have extensive social and economic impacts, such as limiting educational and employment opportunities of economically active persons, healthy individuals and communities. The key public health challenges presented by uncorrected refractive errors, the leading cause of vision impairment across the world, require urgent attention. To address these issues, it is critical to focus on the development of human resources and sustainable methods of service delivery. This paper discusses three core pillars to addressing the challenges posed by uncorrected refractive errors: Human Resource (HR Development, Service Development and Social Entrepreneurship.

  17. Uncorrected refractive errors.

    Science.gov (United States)

    Naidoo, Kovin S; Jaggernath, Jyoti

    2012-01-01

    Global estimates indicate that more than 2.3 billion people in the world suffer from poor vision due to refractive error; of which 670 million people are considered visually impaired because they do not have access to corrective treatment. Refractive errors, if uncorrected, results in an impaired quality of life for millions of people worldwide, irrespective of their age, sex and ethnicity. Over the past decade, a series of studies using a survey methodology, referred to as Refractive Error Study in Children (RESC), were performed in populations with different ethnic origins and cultural settings. These studies confirmed that the prevalence of uncorrected refractive errors is considerably high for children in low-and-middle-income countries. Furthermore, uncorrected refractive error has been noted to have extensive social and economic impacts, such as limiting educational and employment opportunities of economically active persons, healthy individuals and communities. The key public health challenges presented by uncorrected refractive errors, the leading cause of vision impairment across the world, require urgent attention. To address these issues, it is critical to focus on the development of human resources and sustainable methods of service delivery. This paper discusses three core pillars to addressing the challenges posed by uncorrected refractive errors: Human Resource (HR) Development, Service Development and Social Entrepreneurship.

  18. Total Quality Management Implementation Plan for Military Personnel Management

    Science.gov (United States)

    1989-09-01

    2050.. )ATE 3. REPORT TYPE AND DATES CO VERED 4. TITLE AND SUBTITLE 5,rrmir18 . FUNDING NUMBERS Total Quality Management Implementation Plan for...SUBJECT TERMS 15. NUMBER OF PAGES TQM ( Total Quality Management ), Military Personnel Management, Continuous Process Improvement 16. PRICE CODE 17. SECURITY...UNCLASSIFIED UNCLASSIFIED UL NSN 7540-01-280-5500 Standard Form 298 (Rev. 2-89) Prescribed by ANSI Std Z39-16 296-102 TOTAL QUALITY MANAGEMENT I

  19. Analyzing temozolomide medication errors: potentially fatal.

    Science.gov (United States)

    Letarte, Nathalie; Gabay, Michael P; Bressler, Linda R; Long, Katie E; Stachnik, Joan M; Villano, J Lee

    2014-10-01

    The EORTC-NCIC regimen for glioblastoma requires different dosing of temozolomide (TMZ) during radiation and maintenance therapy. This complexity is exacerbated by the availability of multiple TMZ capsule strengths. TMZ is an alkylating agent and the major toxicity of this class is dose-related myelosuppression. Inadvertent overdose can be fatal. The websites of the Institute for Safe Medication Practices (ISMP), and the Food and Drug Administration (FDA) MedWatch database were reviewed. We searched the MedWatch database for adverse events associated with TMZ and obtained all reports including hematologic toxicity submitted from 1st November 1997 to 30th May 2012. The ISMP describes errors with TMZ resulting from the positioning of information on the label of the commercial product. The strength and quantity of capsules on the label were in close proximity to each other, and this has been changed by the manufacturer. MedWatch identified 45 medication errors. Patient errors were the most common, accounting for 21 or 47% of errors, followed by dispensing errors, which accounted for 13 or 29%. Seven reports or 16% were errors in the prescribing of TMZ. Reported outcomes ranged from reversible hematological adverse events (13%), to hospitalization for other adverse events (13%) or death (18%). Four error reports lacked detail and could not be categorized. Although the FDA issued a warning in 2003 regarding fatal medication errors and the product label warns of overdosing, errors in TMZ dosing occur for various reasons and involve both healthcare professionals and patients. Overdosing errors can be fatal.

  20. Masculinity and Lifting Accidents among Danish Ambulance Personnel

    DEFF Research Database (Denmark)

    Hansen, Claus D.; Nielsen, Kent J

    Background Work injuries related to lifting are the most prevalent among ambulance personnel (AP) despite the introduction of ‘assistive technologies’ (AT) that help reduce situations of manual lifting. One third of the AP report using AT only ‘sometimes’ and 10% report having lifted a patient...... alone. For those 5% scoring lowest on MRNI the probability of reporting lifting alone was 6% while this figure was 17% for those scoring above the 95th percentile. Conclusion This study suggests that male ambulance workers performance of masculinity might pose a threat to their safety. AP...

  1. [Personnel reduction in clinics and legal responsibility].

    Science.gov (United States)

    Schelling, P

    2011-06-01

    Executive clinical physicians are increasingly being made jointly responsible for the economic success of clinics and it is to be expected that this joint responsibility will result in measures to reduce personnel. In this article it will be explained to which limits a reduction in medical personnel can be justified with respect to liability and from what level a reduction in staff can result in forensic risks. Furthermore, it will be discussed which liability or even penal responsibility in this connection affects the physicians, the hospital and especially the senior medical personnel.

  2. Flexible Personnel Scheduling in the Parallel Environment

    Institute of Scientific and Technical Information of China (English)

    XU Ben-zhu; ZHANG Xing-ling

    2014-01-01

    In the view of staff shortages and the huge inventory of products in the current market, we put forward a personnel scheduling model in the target of closing to the delivery date considering the parallelism. Then we designed a scheduling algorithm based on genetic algorithm and proposed a flexible parallel decoding method which take full use of the personal capacity. Case study results indicate that the flexible personnel scheduling considering the order-shop scheduling, machine automatic capabilities and personnel flexible in the target of closing to the delivery date optimize the allocation of human resources, then maximize the efficiency.

  3. Inpatients’ medical prescription errors

    Directory of Open Access Journals (Sweden)

    Aline Melo Santos Silva

    2009-09-01

    Full Text Available Objective: To identify and quantify the most frequent prescription errors in inpatients’ medical prescriptions. Methods: A survey of prescription errors was performed in the inpatients’ medical prescriptions, from July 2008 to May 2009 for eight hours a day. Rresults: At total of 3,931 prescriptions was analyzed and 362 (9.2% prescription errors were found, which involved the healthcare team as a whole. Among the 16 types of errors detected in prescription, the most frequent occurrences were lack of information, such as dose (66 cases, 18.2% and administration route (26 cases, 7.2%; 45 cases (12.4% of wrong transcriptions to the information system; 30 cases (8.3% of duplicate drugs; doses higher than recommended (24 events, 6.6% and 29 cases (8.0% of prescriptions with indication but not specifying allergy. Cconclusion: Medication errors are a reality at hospitals. All healthcare professionals are responsible for the identification and prevention of these errors, each one in his/her own area. The pharmacist is an essential professional in the drug therapy process. All hospital organizations need a pharmacist team responsible for medical prescription analyses before preparation, dispensation and administration of drugs to inpatients. This study showed that the pharmacist improves the inpatient’s safety and success of prescribed therapy.

  4. Patient and personnel exposure during extracorporeal lithotripsy

    Energy Technology Data Exchange (ETDEWEB)

    Glaze, S.; LeBlanc, A.D.; Bushong, S.C.; Griffith, D.P.

    1987-12-01

    Extracorporeal shock wave lithotripsy (ESWL) has provided a nonsurgical approach to treatment of renal stones. The Dornier lithotripter uses dual image intensified x-ray systems to center the stone before treatment. Three imaging modes are offered: a fluoroscopic mode and two video spot filming modes. The average entrance exposure to the stone side of the typical patient at our facility is 2.6 X 10(-3) C kg-1 (10 R) (range: 0.5-7.7 X 10(-3) C kg-1 (2-30 R)) which is comparable and often much less than that reported for percutaneous lithotripsy. Recommendations are made for minimizing patient exposure. Scattered radiation levels in the lithotripter room are presented. We have determined that Pb protective apparel is not required during this procedure provided x-ray operation is temporarily halted should personnel be required to lean directly over the tub to attend to the patient. If the walls of the ESWL room are greater than 1.83 m (6 feet) from the tub, shielding in addition to conventional construction is not required.

  5. Patient and personnel exposure during extracorporeal lithotripsy.

    Science.gov (United States)

    Glaze, S; LeBlanc, A D; Bushong, S C; Griffith, D P

    1987-12-01

    Extracorporeal shock wave lithotripsy (ESWL) has provided a nonsurgical approach to treatment of renal stones. The Dornier lithotripter uses dual image intensified x-ray systems to center the stone before treatment. Three imaging modes are offered: a fluoroscopic mode and two video spot filming modes. The average entrance exposure to the stone side of the typical patient at our facility is 2.6 X 10(-3) C kg-1 (10 R) [range: 0.5-7.7 X 10(-3) C kg-1 (2-30 R)] which is comparable and often much less than that reported for percutaneous lithotripsy. Recommendations are made for minimizing patient exposure. Scattered radiation levels in the lithotripter room are presented. We have determined that Pb protective apparel is not required during this procedure provided x-ray operation is temporarily halted should personnel be required to lean directly over the tub to attend to the patient. If the walls of the ESWL room are greater than 1.83 m (6 feet) from the tub, shielding in addition to conventional construction is not required.

  6. Influenza Vaccination Coverage Among Health Care Personnel - United States, 2015-16 Influenza Season.

    Science.gov (United States)

    Black, Carla L; Yue, Xin; Ball, Sarah W; Donahue, Sara M A; Izrael, David; de Perio, Marie A; Laney, A Scott; Williams, Walter W; Lindley, Megan C; Graitcer, Samuel B; Lu, Peng-Jun; DiSogra, Charles; Devlin, Rebecca; Walker, Deborah K; Greby, Stacie M

    2016-09-30

    The Advisory Committee on Immunization Practices recommends annual influenza vaccination for all health care personnel to reduce influenza-related morbidity and mortality among both health care personnel and their patients (1-4). To estimate influenza vaccination coverage among U.S. health care personnel for the 2015-16 influenza season, CDC conducted an opt-in Internet panel survey of 2,258 health care personnel during March 28-April 14, 2016. Overall, 79.0% of survey participants reported receiving an influenza vaccination during the 2015-16 season, similar to the 77.3% coverage reported for the 2014-15 season (5). Coverage in long-term care settings increased by 5.3 percentage points compared with the previous season. Vaccination coverage continued to be higher among health care personnel working in hospitals (91.2%) and lower among health care personnel working in ambulatory (79.8%) and long-term care settings (69.2%). Coverage continued to be highest among physicians (95.6%) and lowest among assistants and aides (64.1%), and highest overall among health care personnel who were required by their employer to be vaccinated (96.5%). Among health care personnel working in settings where vaccination was neither required, promoted, nor offered onsite, vaccination coverage continued to be low (44.9%). An increased percentage of health care personnel reporting a vaccination requirement or onsite vaccination availability compared with earlier influenza seasons might have contributed to the overall increase in vaccination coverage during the past 6 influenza seasons.

  7. Influence of Spirituality on Depression, Posttraumatic Stress Disorder, and Suicidality in Active Duty Military Personnel

    Directory of Open Access Journals (Sweden)

    Laurel L. Hourani

    2012-01-01

    Full Text Available Understanding the role of spirituality as a potential coping mechanism for military personnel is important given growing concern about the mental health issues of personnel returning from war. This study seeks to determine the extent to which spirituality is associated with selected mental health problems among active duty military personnel and whether it moderates the relationship between combat exposure/deployment and (a depression, (b posttraumatic stress disorder (PTSD, and (c suicidality in active duty military personnel. Data were drawn from the 2008 Department of Defense Survey of Health Related Behaviors Among Active Duty Military Personnel. Over 24,000 randomly selected active duty personnel worldwide completed an anonymous self-report questionnaire. High spirituality had a significant protective effect only for depression symptoms. Medium, as opposed to high or low, levels of spirituality buffered each of the mental health outcomes to some degree. Medium and low spirituality levels predicted depression symptoms but only among those with moderate combat exposure. Medium spirituality levels also predicted PTSD symptoms among those with moderate levels of combat exposure and predicted self-reported suicidal ideation/attempt among those never deployed. These results point to the complex relationship between spirituality and mental health, particularly among military personnel and the need for further research.

  8. WebPASS PP (HR Personnel Management)

    Data.gov (United States)

    US Agency for International Development — WebPass Explorer (WebPASS Framework): USAID is partnering with DoS in the implementation of their WebPass Post Personnel (PS) Module. WebPassPS does not replace...

  9. Office of Personnel Management (OPM) Earnings

    Data.gov (United States)

    Social Security Administration — Each year the Office of Personnel Management (OPM) sends SSA a file to be verified and matched against the Master Earnings File (MEF) and Employer Information File...

  10. Personnel selection as a signaling game.

    Science.gov (United States)

    Bangerter, Adrian; Roulin, Nicolas; König, Cornelius J

    2012-07-01

    Personnel selection involves exchanges of information between job market actors (applicants and organizations). These actors do not have an incentive to exchange accurate information about their ability and commitment to the employment relationship unless it is to their advantage. This state of affairs explains numerous phenomena in personnel selection (e.g., faking). Signaling theory describes a mechanism by which parties with partly conflicting interests (and thus an incentive for deception) can nevertheless exchange accurate information. We apply signaling theory to personnel selection, distinguishing between adaptive relationships between applicants and organizations, among applicants, and among organizations. In each case, repeated adaptations and counteradaptations between actors can lead to situations of equilibrium or escalation (arms races). We show that viewing personnel selection as a network of adaptive relationships among job market actors enables an understanding of both classic and underexplored micro- and macro-level selection phenomena and their dynamic interactions.

  11. 42 CFR 485.604 - Personnel qualifications.

    Science.gov (United States)

    2010-10-01

    ... Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION CONDITIONS OF PARTICIPATION: SPECIALIZED PROVIDERS Conditions of Participation: Critical Access Hospitals (CAHs) § 485.604 Personnel qualifications. Staff that furnish...

  12. Outplacement--The New Personnel Practice.

    Science.gov (United States)

    Driessnack, Carl H.

    1980-01-01

    Outlines the advantages of outplacement of redundant personnel both for the company and for the person terminated. Argues that companies should use outside consultants to run their outplacement programs. (IRT)

  13. WebPASS Explorer (HR Personnel Management)

    Data.gov (United States)

    US Agency for International Development — WebPass Explorer (WebPASS Framework): USAID is partnering with DoS in the implementation of their WebPass Post Personnel (PS) Module. WebPassPS does not replace...

  14. Outplacement--The New Personnel Practice.

    Science.gov (United States)

    Driessnack, Carl H.

    1980-01-01

    Outlines the advantages of outplacement of redundant personnel both for the company and for the person terminated. Argues that companies should use outside consultants to run their outplacement programs. (IRT)

  15. Central Personnel Data File (CPDF) Status Data

    Data.gov (United States)

    Office of Personnel Management — Precursor to the Enterprise Human Resources Integration-Statistical Data Mart (EHRI-SDM). It contains data about the employee and their position, along with various...

  16. Propylene Glycol Toxicity with Stoss Therapy; State Drug Tracking Database Helps Prevent an Error; Where Did That Medication Come From?; Expiration Date Difficult to Read.

    Science.gov (United States)

    Cohen, Michael R; Smetzer, Judy L

    2015-04-01

    These medication errors have occurred in health care facilities at least once. They will happen again-perhaps where you work. Through education and alertness of personnel and procedural safeguards, they can be avoided. You should consider publishing accounts of errors in your newsletters and/or presenting them at your inservice training programs. Your assistance is required to continue this feature. The reports described here were received through the Institute for Safe Medication Practices (ISMP) Medication Errors Reporting Program. Any reports published by ISMP will be anonymous. Comments are also invited; the writers' names will be published if desired. ISMP may be contacted at the address shown below. Errors, close calls, or hazardous conditions may be reported directly to ISMP through the ISMP Web site (www.ismp.org), by calling 800-FAIL-SAFE, or via e-mail at ismpinfo@ismp.org. ISMP guarantees the confidentiality and security of the information received and respects reporters' wishes as to the level of detail included in publications.

  17. The Full Cost of Military Personnel

    Science.gov (United States)

    2016-03-01

    enlisted member for each Service  This may not accurately reflect marginal cost  Variation in mix of ranks. A rifle company is relatively cheap...keep people with marketable skills 4 Indirect military personnel costs are high ($M 2007) Medical Support 8,029 Schools for Dependents 1,586...hand  Indirect costs are important  Personnel cost much more than is generally recognized  Much of the cost is deferred  Some is not in the DoD

  18. Improving human performance in maintenance personnel

    Energy Technology Data Exchange (ETDEWEB)

    Gonzalez Anez, Francisco [Maintenance Training Centre, TECNATOM, S.A, Avd. Montes de Oca, 1. 28709-San Sebastian de los Reyes, Madrid (Spain); Agueero Agueero, Jorge [Technologic Institute, TECNATOM, S.A, Avd. Montes de Oca, 1. 28709-San Sebastian de los Reyes, Madrid (Spain)

    2010-07-01

    The continuous evolution and improvement of safety-related processes has included the analysis, design and development of training plans for the qualification of maintenance nuclear power plant personnel. In this respect, the international references in this area recommend the establishment of systematic qualification programmes for personnel performing functions or carrying out safety related tasks. Maintenance personnel qualification processes have improved significantly, and training plans have been designed and developed based on Systematic Approach to Training methodology to each job position. These improvements have been clearly reflected in recent training programmes with new training material and training facilities focused not only on developing technical knowledge and skills but also on improving attitudes and safety culture. The objectives of maintenance training facilities such as laboratories, mock-ups real an virtual, hydraulic loops, field simulators and other training material to be used in the maintenance training centre are to cover training necessities for initial and continuous qualification. Evidently, all these improvements made in the qualification of plant personnel should be extended to include supplemental personnel (external or contracted) performing safety-related tasks. The supplemental personnel constitute a very spread group, covering the performance of multiple activities entailing different levels of responsibility. Some of these activities are performed permanently at the plant, while others are occasional or sporadic. In order to establish qualification requirements for these supplemental workers, it is recommended to establish a rigorous analysis of job positions and tasks. The objective will be to identify the qualification requirements to assure competence and safety. (authors)

  19. Hepatitis C virus infection among transmission-prone medical personnel.

    Science.gov (United States)

    Zaaijer, H L; Appelman, P; Frijstein, G

    2012-07-01

    Hepatitis C virus (HCV)-infected physicians have been reported to infect some of their patients during exposure-prone procedures (EPPs). There is no European consensus on the policy for the prevention of this transmission. To help define an appropriate preventive policy, we determined the prevalence of HCV infection among EPP-performing medical personnel in the Academic Medical Center in Amsterdam, the Netherlands. The prevalence of HCV infection was studied among 729 EPP-performing health care workers. Serum samples, stored after post-hepatitis B virus (HBV) vaccination testing in the years 2000-2009, were tested for HCV antibodies. Repeat reactive samples were confirmed by immunoblot assay and the detection of HCV RNA. The average age of the 729 health care workers was 39 years (range 18-66), suggesting a considerable cumulative occupational exposure to the blood. Nevertheless, only one of the 729 workers (0.14%; 95% confidence interval [CI]: <0.01% to 0.85%) was tested and confirmed to be positive for anti-HCV and positive for HCV RNA, which is comparable to the prevalence of HCV among Amsterdam citizens. Against this background, for the protection of personnel and patients, careful follow-up after needlestick injuries may be sufficient. If a zero-risk approach is desirable and costs are less relevant, the recurrent screening of EPP-performing personnel for HCV is superior to the follow-up of reported occupational exposures.

  20. Burnout syndrome indices in Greek intensive care nursing personnel.

    Science.gov (United States)

    Karanikola, Maria N K; Papathanassoglou, Elizabeth D E; Mpouzika, Meropi; Lemonidou, Chrysoula

    2012-01-01

    Burnout symptoms in Greek intensive care unit (ICU) nurses have not been explored adequately. The aim of this descriptive, correlational study was to investigate the prevalence and intensity of burnout symptoms in Greek ICU nursing personnel and any potential associations with professional satisfaction, as well as with demographic, educational, and vocational characteristics. Findings showed that the overall burnout level reported by Greek ICU nursing personnel was at a moderate to high degree. The most pronounced symptom of burnout was depersonalization, whereas emotional exhaustion was found to be a strong predictor of job satisfaction. This is a factor connected with the nurses' intention to quit the job. It appears that work factors have a more powerful influence over the development of burnout in comparison to personality traits.

  1. Flux Sampling Errors for Aircraft and Towers

    Science.gov (United States)

    Mahrt, Larry

    1998-01-01

    Various errors and influences leading to differences between tower- and aircraft-measured fluxes are surveyed. This survey is motivated by reports in the literature that aircraft fluxes are sometimes smaller than tower-measured fluxes. Both tower and aircraft flux errors are larger with surface heterogeneity due to several independent effects. Surface heterogeneity may cause tower flux errors to increase with decreasing wind speed. Techniques to assess flux sampling error are reviewed. Such error estimates suffer various degrees of inapplicability in real geophysical time series due to nonstationarity of tower time series (or inhomogeneity of aircraft data). A new measure for nonstationarity is developed that eliminates assumptions on the form of the nonstationarity inherent in previous methods. When this nonstationarity measure becomes large, the surface energy imbalance increases sharply. Finally, strategies for obtaining adequate flux sampling using repeated aircraft passes and grid patterns are outlined.

  2. Smoothing error pitfalls

    Science.gov (United States)

    von Clarmann, T.

    2014-09-01

    The difference due to the content of a priori information between a constrained retrieval and the true atmospheric state is usually represented by a diagnostic quantity called smoothing error. In this paper it is shown that, regardless of the usefulness of the smoothing error as a diagnostic tool in its own right, the concept of the smoothing error as a component of the retrieval error budget is questionable because it is not compliant with Gaussian error propagation. The reason for this is that the smoothing error does not represent the expected deviation of the retrieval from the true state but the expected deviation of the retrieval from the atmospheric state sampled on an arbitrary grid, which is itself a smoothed representation of the true state; in other words, to characterize the full loss of information with respect to the true atmosphere, the effect of the representation of the atmospheric state on a finite grid also needs to be considered. The idea of a sufficiently fine sampling of this reference atmospheric state is problematic because atmospheric variability occurs on all scales, implying that there is no limit beyond which the sampling is fine enough. Even the idealization of infinitesimally fine sampling of the reference state does not help, because the smoothing error is applied to quantities which are only defined in a statistical sense, which implies that a finite volume of sufficient spatial extent is needed to meaningfully discuss temperature or concentration. Smoothing differences, however, which play a role when measurements are compared, are still a useful quantity if the covariance matrix involved has been evaluated on the comparison grid rather than resulting from interpolation and if the averaging kernel matrices have been evaluated on a grid fine enough to capture all atmospheric variations that the instruments are sensitive to. This is, under the assumptions stated, because the undefined component of the smoothing error, which is the

  3. Nursing student medication errors involving tubing and catheters: a descriptive study.

    Science.gov (United States)

    Wolf, Zane Robinson; Hicks, Rodney W; Altmiller, Geralyn; Bicknell, Patricia

    2009-08-01

    This retrospective case study examined reports (N=27) of medication errors made by nursing students involving tubing and catheter misconnections. Characteristics of misconnection errors included attributes of events recorded on MEDMARX error reports of the United States Pharmacopeia. Two near miss errors or Category B errors (medication error occurred, did not reach patient) were identified, with 21 Category C medication errors (occurred, with no resulting patient harm), and four Category D errors (need for increased patient monitoring, no patient harm) reported. Reported intravenous tubing errors were more frequent than other type of tubing errors and problems with clamps were present in 12 error reports. Registered nurses discovered most of the errors; some were implicated in the mistakes along with the students.

  4. Learning from Errors

    Directory of Open Access Journals (Sweden)

    MA. Lendita Kryeziu

    2015-06-01

    Full Text Available “Errare humanum est”, a well known and widespread Latin proverb which states that: to err is human, and that people make mistakes all the time. However, what counts is that people must learn from mistakes. On these grounds Steve Jobs stated: “Sometimes when you innovate, you make mistakes. It is best to admit them quickly, and get on with improving your other innovations.” Similarly, in learning new language, learners make mistakes, thus it is important to accept them, learn from them, discover the reason why they make them, improve and move on. The significance of studying errors is described by Corder as: “There have always been two justifications proposed for the study of learners' errors: the pedagogical justification, namely that a good understanding of the nature of error is necessary before a systematic means of eradicating them could be found, and the theoretical justification, which claims that a study of learners' errors is part of the systematic study of the learners' language which is itself necessary to an understanding of the process of second language acquisition” (Corder, 1982; 1. Thus the importance and the aim of this paper is analyzing errors in the process of second language acquisition and the way we teachers can benefit from mistakes to help students improve themselves while giving the proper feedback.

  5. Error Correction in Classroom

    Institute of Scientific and Technical Information of China (English)

    Dr. Grace Zhang

    2000-01-01

    Error correction is an important issue in foreign language acquisition. This paper investigates how students feel about the way in which error correction should take place in a Chinese-as-a foreign-language classroom, based on empirical data of a large scale. The study shows that there is a general consensus that error correction is necessary. In terms of correction strategy, the students preferred a combination of direct and indirect corrections, or a direct only correction. The former choice indicates that students would be happy to take either so long as the correction gets done.Most students didn't mind peer correcting provided it is conducted in a constructive way. More than halfofthe students would feel uncomfortable ifthe same error they make in class is corrected consecutively more than three times. Taking these findings into consideration, we may want to cncourage peer correcting, use a combination of correction strategies (direct only if suitable) and do it in a non-threatening and sensitive way. It is hoped that this study would contribute to the effectiveness of error correction in a Chinese language classroom and it may also have a wider implication on other languages.

  6. Medical errors and patient safety strategies to reduce and disclose medical errors and improve patient safety

    CERN Document Server

    Kalra, Jay

    2011-01-01

    This book shows with real cases from health care and beyond that most errors come from flaws in the system. It also shows why they don't get reported and how medical error disclosure around the world is shifting away from blaming people to a ?no-fault? model. The book will examine issues that stymie efforts made to reduce preventable adverse events and medical errors, and will moreover highlight their impact on clinical laboratories and other areas. It identifies possible intelligent system approaches that can be adopted to help control and eliminate these errors.

  7. Error Free Software

    Science.gov (United States)

    1985-01-01

    A mathematical theory for development of "higher order" software to catch computer mistakes resulted from a Johnson Space Center contract for Apollo spacecraft navigation. Two women who were involved in the project formed Higher Order Software, Inc. to develop and market the system of error analysis and correction. They designed software which is logically error-free, which, in one instance, was found to increase productivity by 600%. USE.IT defines its objectives using AXES -- a user can write in English and the system converts to computer languages. It is employed by several large corporations.

  8. LIBERTARISMO & ERROR CATEGORIAL

    Directory of Open Access Journals (Sweden)

    Carlos G. Patarroyo G.

    2009-01-01

    Full Text Available En este artículo se ofrece una defensa del libertarismo frente a dos acusaciones según las cuales éste comete un error categorial. Para ello, se utiliza la filosofía de Gilbert Ryle como herramienta para explicar las razones que fundamentan estas acusaciones y para mostrar por qué, pese a que ciertas versiones del libertarismo que acuden a la causalidad de agentes o al dualismo cartesiano cometen estos errores, un libertarismo que busque en el indeterminismo fisicalista la base de la posibilidad de la libertad humana no necesariamente puede ser acusado de incurrir en ellos.

  9. Analysis of Task Types and Error Types of the Human Actions Involved in the Human-related Unplanned Reactor Trip Events

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jae Whan; Park, Jin Kyun; Jung, Won Dea

    2008-02-15

    This report provides the task types and error types involved in the unplanned reactor trip events that have occurred during 1986 - 2006. The events that were caused by the secondary system of the nuclear power plants amount to 67 %, and the remaining 33 % was by the primary system. The contribution of the activities of the plant personnel was identified as the following order: corrective maintenance (25.7 %), planned maintenance (22.8 %), planned operation (19.8 %), periodic preventive maintenance (14.9 %), response to a transient (9.9 %), and design/manufacturing/installation (9.9%). According to the analysis of error modes, the error modes such as control failure (22.2 %), wrong object (18.5 %), omission (14.8 %), wrong action (11.1 %), and inadequate (8.3 %) take up about 75 % of all the unplanned trip events. The analysis of the cognitive functions involved showed that the planning function makes the highest contribution to the human actions leading to unplanned reactor trips, and it is followed by the observation function (23.4%), the execution function (17.8 %), and the interpretation function (10.3 %). The results of this report are to be used as important bases for development of the error reduction measures or development of the error mode prediction system for the test and maintenance tasks in nuclear power plants.

  10. Translating Theory into Practice: Implications of Japanese Management Theory for Student Personnel Administrators. NASPA Monograph Series Volume 3. First Edition.

    Science.gov (United States)

    Deegan, William L.; And Others

    Japanese management theory was studied to identify specific models for consideration by student personnel administrators. The report is organized into three sections: major components of Japanese management theory, potential implications for student personnel administration, and three models, based on components of Japanese management theory, for…

  11. Carcinosarcoma of the Ureter with a Small Cell Component: Report of a Rare Pathologic Entity and Potential for Diagnostic Error on Biopsy

    Directory of Open Access Journals (Sweden)

    Kent Newsom

    2014-01-01

    Full Text Available Carcinosarcomas of the ureter are rare biphasic neoplasms, composed of both malignant epithelial (carcinomatous and malignant mesenchymal (sarcomatous components. Carcinosarcomas of the urinary tract are exceedingly rare. We report a unique case of a carcinosarcoma of the ureter with a chondrosarcoma and small cell tumor component arising in a 68-year-old male who presented with microscopic hematuria. CT intravenous pyelogram revealed right-sided hydroureter and hydronephrosis with thickening and narrowing of the right ureter. The patient underwent robot-assisted ureterectomy with bladder cuff excision and subsequent adjuvant chemotherapy. The patient is disease-free at 32 months after treatment. We provide a brief synoptic review of carcinosarcoma of the ureter and bladder with utilization of immunohistochemical (IHC stains and potential diagnostic pitfalls.

  12. Potential time savings to radiology department personnel in a PACS-based environment

    Science.gov (United States)

    Saarinen, Allan O.; Wilson, M. C.; Iverson, Scott C.; Loop, John W.

    1990-08-01

    A purported benefit of digital imaging and archiving of radiographic procedures is the presumption of time savings to radiologists, radiology technologists, and radiology departmentpersonnel involved with processingfilms and managing theflimfile room. As part of the University of Washington's evaluation of Picture Archiving and Communication Systems (PACS)for the U.S. Army Medical Research and Development Command, a study was performed which evaluated the current operationalpractices of the film-based radiology department at the University of Washington Medical Center (UWMC). Industrial engineering time and motion studies were conducted to document the length of time requiredforfilm processing in various modalities, the proportion of the total exam time usedforfilm processing, the amount of time radiologists spent searchingfor and looking at images, and the amount of time file room personnel spent collating reports, making loans, updatingfilm jacket information, and purging files. This evaluation showed that better than one-half of the tasks in the file room may be eliminated with PACS and radiologists may save easily 10 percent of the time they spend reading films by no longer having to searchforfilms. Radiology technologists may also save as much as 10 percent of their time with PACS, although this estimate is subject to significant patient mix aberrations and measurement error. Given that the UWMC radiology department operates efficiently, similar improvements are forecast for other radiology departments and larger improvements areforecastfor less efficient departments.

  13. A Wireless Sensor Network Based Personnel Positioning Scheme in Coal Mines with Blind Areas

    Directory of Open Access Journals (Sweden)

    Shaobo Geng

    2010-11-01

    Full Text Available This paper proposes a novel personnel positioning scheme for a tunnel network with blind areas, which compared with most existing schemes offers both low-cost and high-precision. Based on the data models of tunnel networks, measurement networks and mobile miners, the global positioning method is divided into four steps: (1 calculate the real time personnel location in local areas using a location engine, and send it to the upper computer through the gateway; (2 correct any localization errors resulting from the underground tunnel environmental interference; (3 determine the global three-dimensional position by coordinate transformation; (4 estimate the personnel locations in the blind areas. A prototype system constructed to verify the positioning performance shows that the proposed positioning system has good reliability, scalability, and positioning performance. In particular, the static localization error of the positioning system is less than 2.4 m in the underground tunnel environment and the moving estimation error is below 4.5 m in the corridor environment. The system was operated continuously over three months without any failures.

  14. Orwell's Instructive Errors

    Science.gov (United States)

    Julian, Liam

    2009-01-01

    In this article, the author talks about George Orwell, his instructive errors, and the manner in which Orwell pierced worthless theory, faced facts and defended decency (with fluctuating success), and largely ignored the tradition of accumulated wisdom that has rendered him a timeless teacher--one whose inadvertent lessons, while infrequently…

  15. Challenge and Error: Critical Events and Attention-Related Errors

    Science.gov (United States)

    Cheyne, James Allan; Carriere, Jonathan S. A.; Solman, Grayden J. F.; Smilek, Daniel

    2011-01-01

    Attention lapses resulting from reactivity to task challenges and their consequences constitute a pervasive factor affecting everyday performance errors and accidents. A bidirectional model of attention lapses (error [image omitted] attention-lapse: Cheyne, Solman, Carriere, & Smilek, 2009) argues that errors beget errors by generating attention…

  16. Passport officers' errors in face matching.

    Directory of Open Access Journals (Sweden)

    David White

    Full Text Available Photo-ID is widely used in security settings, despite research showing that viewers find it very difficult to match unfamiliar faces. Here we test participants with specialist experience and training in the task: passport-issuing officers. First, we ask officers to compare photos to live ID-card bearers, and observe high error rates, including 14% false acceptance of 'fraudulent' photos. Second, we compare passport officers with a set of student participants, and find equally poor levels of accuracy in both groups. Finally, we observe that passport officers show no performance advantage over the general population on a standardised face-matching task. Across all tasks, we observe very large individual differences: while average performance of passport staff was poor, some officers performed very accurately--though this was not related to length of experience or training. We propose that improvements in security could be made by emphasising personnel selection.

  17. Personnel management system during restructuring (the case of retail company)

    OpenAIRE

    Leonova Olesia Igorevna; Leonov Aleksei Vladimirovich

    2014-01-01

    The paper presents results of investigation into the system of the personnel management in restructured company. The following parameters of personnel management system efficiency were studied: staffing level, ratio of personnel management to total staff of the company, company staff turnover, automation of personnel management process, labor satisfaction, and system of relationships of superiors and inferiors. Personnel management system was evaluated before and after restructuring proced...

  18. Patient error: a preliminary taxonomy.

    NARCIS (Netherlands)

    Buetow, S.; Kiata, L.; Liew, T.; Kenealy, T.; Dovey, S.; Elwyn, G.

    2009-01-01

    PURPOSE: Current research on errors in health care focuses almost exclusively on system and clinician error. It tends to exclude how patients may create errors that influence their health. We aimed to identify the types of errors that patients can contribute and help manage, especially in primary ca

  19. Automatic Error Analysis Using Intervals

    Science.gov (United States)

    Rothwell, E. J.; Cloud, M. J.

    2012-01-01

    A technique for automatic error analysis using interval mathematics is introduced. A comparison to standard error propagation methods shows that in cases involving complicated formulas, the interval approach gives comparable error estimates with much less effort. Several examples are considered, and numerical errors are computed using the INTLAB…

  20. Imagery of Errors in Typing

    Science.gov (United States)

    Rieger, Martina; Martinez, Fanny; Wenke, Dorit

    2011-01-01

    Using a typing task we investigated whether insufficient imagination of errors and error corrections is related to duration differences between execution and imagination. In Experiment 1 spontaneous error imagination was investigated, whereas in Experiment 2 participants were specifically instructed to imagine errors. Further, in Experiment 2 we…

  1. Seroconversion for infectious pathogens among UK military personnel deployed to Afghanistan, 2008-2011.

    Science.gov (United States)

    Newman, Edmund N C; Johnstone, Penelope; Bridge, Hannah; Wright, Deborah; Jameson, Lisa; Bosworth, Andrew; Hatch, Rebecca; Hayward-Karlsson, Jenny; Osborne, Jane; Bailey, Mark S; Green, Andrew; Ross, David; Brooks, Tim; Hewson, Roger

    2014-12-01

    Military personnel are at high risk of contracting vector-borne and zoonotic infections, particularly during overseas deployments, when they may be exposed to endemic or emerging infections not prevalent in their native countries. We conducted seroprevalence testing of 467 UK military personnel deployed to Helmand Province, Afghanistan, during 2008-2011 and found that up to 3.1% showed seroconversion for infection with Rickettsia spp., Coxiella burnetii, sandfly fever virus, or hantavirus; none showed seroconversion for infection with Crimean-Congo hemorrhagic fever virus. Most seroconversions occurred in personnel who did not report illness, except for those with hantavirus (70% symptomatic). These results indicate that many exposures to infectious pathogens, and potentially infections resulting from those exposures, may go unreported. Our findings reinforce the need for continued surveillance of military personnel and for education of health care providers to help recognize and prevent illnesses and transmission of pathogens during and after overseas deployments.

  2. Seroconversion for Infectious Pathogens among UK Military Personnel Deployed to Afghanistan, 2008–2011

    Science.gov (United States)

    Johnstone, Penelope; Bridge, Hannah; Wright, Deborah; Jameson, Lisa; Bosworth, Andrew; Hatch, Rebecca; Hayward-Karlsson, Jenny; Osborne, Jane; Bailey, Mark S.; Green, Andrew; Ross, David; Brooks, Tim; Hewson, Roger

    2014-01-01

    Military personnel are at high risk of contracting vector-borne and zoonotic infections, particularly during overseas deployments, when they may be exposed to endemic or emerging infections not prevalent in their native countries. We conducted seroprevalence testing of 467 UK military personnel deployed to Helmand Province, Afghanistan, during 2008–2011 and found that up to 3.1% showed seroconversion for infection with Rickettsia spp., Coxiella burnetii, sandfly fever virus, or hantavirus; none showed seroconversion for infection with Crimean-Congo hemorrhagic fever virus. Most seroconversions occurred in personnel who did not report illness, except for those with hantavirus (70% symptomatic). These results indicate that many exposures to infectious pathogens, and potentially infections resulting from those exposures, may go unreported. Our findings reinforce the need for continued surveillance of military personnel and for education of health care providers to help recognize and prevent illnesses and transmission of pathogens during and after overseas deployments. PMID:25418685

  3. PAMTRAK: A personnel and material tracking system

    Energy Technology Data Exchange (ETDEWEB)

    Anspach, D.A. [Sandia National Labs., Albuquerque, NM (United States); Anspach, J.P. [Allied-Signal, Inc., Albuquerque, NM (United States). Kansas City Operations; Walters, B.G. [Argonne National Lab., Idaho Falls, ID (United States); Crain, B. Jr. [Science Applications International Corp., Aiken, SC (United States)

    1996-06-01

    There is a need for an automated system for protecting and monitoring sensitive or classified parts and material. Sandia has developed a real-time personnel and material tracking system (PAMTRAK) that has been installed at selected DOE facilities. It safeguards sensitive parts and material by tracking tags worn by personnel and by monitoring sensors attached to the parts or material. It includes remote control and alarm display capabilities and a complementary program in Keyhole to display measured material attributes remotely. This paper describes the design goals, the system components, current installations, and the benefits a site can expect when using PAMTRAK.

  4. SIXTH ERDA WORKSHOP ON PERSONNEL NEUTRON DOSIMETRY

    Energy Technology Data Exchange (ETDEWEB)

    Vallario, E. J.; Hankins, D. E.; Bramson, P. E.

    1977-07-11

    This workshop was the sixth of a series and was held on July 11 and 12, 1977, at the Oak Ridge National Laboratory in Oak Ridge, Tennessee. Those presenting papers at the Sixth Workshop prepared summary reports of their recent work for inclusion in this document. The reports are reproduced here as submitted by the participants, with only minor editing. This year's Workshop took a decidedly international flavor, with participants from seven countries in addition to the United States. The significance of this group's contributions has raised the possibility that the next Neutron Dosimetry Workshop may be held in Europe. Of particular interest at the Workshop was the keynote address by Dr. Harald Rossi. He commented that there is evidence that 1) accepted values of RBE for low absorbed doses of neutrons may be low by an order of magnitude or more and 2) the risk of leukemia is significant at 0.5 rad to the bone narrow. A reduction of the limit for permissible neutron exposure, which could result from consideration of this information, would necessitate major improvements in our "middle ages" neutron dosimetry. A number of participants reported conversions to thermoluminescent dosimeter (TLD) systems. This move has not been unanimous, however, as there were several reports of apparently satisfactory fission fragment, activation foil, and NTA film dosimeters. While thementionof NTA film resulted in the usual discussion of energy cut off and humidity effects, it seems the use of NTA in accelerator environments still has some merit. Discussion of fission fragment dosimeters centered around track etching techniques, which have shown some improvement. Of particular interest was Tommasino's report on the use of polycarbonate centrifuge tubes as the sensitive element. Thermally stimulated exoelectron emission (TSEE), never very popular for personnel dosimetry, has lost additional ground with the report that the neutron/gamma response ratio is much less than

  5. Tobacco use habits of naval personnel during Desert Storm.

    Science.gov (United States)

    Forgas, L B; Meyer, D M; Cohen, M E

    1996-03-01

    This study examined availability and usage of tobacco products, and their potential impact on the oral health of naval personnel deployed to Desert Storm. Of 4,200 surveys mailed to a randomly selected sample, 45.6% were returned (N = 1,915). The respondents included 55.9% who reported a present or former smoking habit, 34.1% who identified themselves as current smokers (SM), and 23.8% who were smokeless tobacco (ST) users. Tobacco products were easily and inexpensively accessible through ship stores, exchange, or military support organizations (USO). While in the Persian Gulf, 7.0% started SM and 9.3% started ST, resulting in an overall 4.7 and 6.1% increase in SM and ST, respectively. Of those who were already tobacco users, 29.2% reported more SM use and 19.0% used ST more often. Stress (35.1%) and boredom (21.4%) were the most frequently cited reasons to start or increase use. Although 30.5% of respondents reported military personnel have encouraged them to quit, 77.2% reported that anti-smoking efforts have been unsuccessful in influencing them to quit. Since the tobacco usage rate is higher in the military than in the civilian sector, greater emphasis on preventive efforts in warranted to promote health and wellness.

  6. Personnel reliability impact on petrochemical facilities monitoring system's failure skipping probability

    Science.gov (United States)

    Kostyukov, V. N.; Naumenko, A. P.

    2017-08-01

    The paper dwells upon urgent issues of evaluating impact of actions conducted by complex technological systems operators on their safe operation considering application of condition monitoring systems for elements and sub-systems of petrochemical production facilities. The main task for the research is to distinguish factors and criteria of monitoring system properties description, which would allow to evaluate impact of errors made by personnel on operation of real-time condition monitoring and diagnostic systems for machinery of petrochemical facilities, and find and objective criteria for monitoring system class, considering a human factor. On the basis of real-time condition monitoring concepts of sudden failure skipping risk, static and dynamic error, monitoring systems, one may solve a task of evaluation of impact that personnel's qualification has on monitoring system operation in terms of error in personnel or operators' actions while receiving information from monitoring systems and operating a technological system. Operator is considered as a part of the technological system. Although, personnel's behavior is usually a combination of the following parameters: input signal - information perceiving, reaction - decision making, response - decision implementing. Based on several researches on behavior of nuclear powers station operators in USA, Italy and other countries, as well as on researches conducted by Russian scientists, required data on operator's reliability were selected for analysis of operator's behavior at technological facilities diagnostics and monitoring systems. The calculations revealed that for the monitoring system selected as an example, the failure skipping risk for the set values of static (less than 0.01) and dynamic (less than 0.001) errors considering all related factors of data on reliability of information perception, decision-making, and reaction fulfilled is 0.037, in case when all the facilities and error probability are under

  7. Error bars in experimental biology.

    Science.gov (United States)

    Cumming, Geoff; Fidler, Fiona; Vaux, David L

    2007-04-09

    Error bars commonly appear in figures in publications, but experimental biologists are often unsure how they should be used and interpreted. In this article we illustrate some basic features of error bars and explain how they can help communicate data and assist correct interpretation. Error bars may show confidence intervals, standard errors, standard deviations, or other quantities. Different types of error bars give quite different information, and so figure legends must make clear what error bars represent. We suggest eight simple rules to assist with effective use and interpretation of error bars.

  8. PERCEPTION OF RADIOLOGISTS ABOUT DIAGNOSTIC ERRORS IN RADIOLOGY IN YEMEN

    Directory of Open Access Journals (Sweden)

    Hameed M Aklan

    2014-12-01

    Full Text Available Background: Errors of diagnosis in Radiology are common affecting patient’s care and management. Several types of radiological errors such as misperception, miscommunication, and procedure misconduct have been reported highlighting the important of Radiologists’ awareness about their own errors. However, no data are available from Yemen. The aim of this study is to assess radiological errors in Yemen. Method: A standard questionnaire of radiological errors was distributed conveniently to radiologists in the main public and private hospitals in Sana'a city, Yemen. Results: Of 80 questionnaires distributed, 58 were returned back (the response rate was 72.5%. About 88% participants had diagnostic errors in 2013. The radiology errors were classified as under-call (false negative (29.3%, communication errors (27.6%, overcall (false positive (25.9%, procedural complication (24.1% and interpretation errors (15.5%. Unavailability of previous studies and inadequate clinical information were mentioned as cause’s errors (37.9% and 36.2%, respectively. The majority of radiologists (70.7% did not keep record for their own errors, and only 24.1% of radiologists had errors meeting in their departments. Conclusion: It has been concluded that errors in radiology are still a significant problem affecting patient safety. Collaborative efforts must be established to reduce diagnostic errors in radiology through organizing regular meetings to educate radiologists about such matter and create a good environment for learning and improvement rather than blaming and embarrassing.

  9. Video Error Correction Using Steganography

    Directory of Open Access Journals (Sweden)

    Robie David L

    2002-01-01

    Full Text Available The transmission of any data is always subject to corruption due to errors, but video transmission, because of its real time nature must deal with these errors without retransmission of the corrupted data. The error can be handled using forward error correction in the encoder or error concealment techniques in the decoder. This MPEG-2 compliant codec uses data hiding to transmit error correction information and several error concealment techniques in the decoder. The decoder resynchronizes more quickly with fewer errors than traditional resynchronization techniques. It also allows for perfect recovery of differentially encoded DCT-DC components and motion vectors. This provides for a much higher quality picture in an error-prone environment while creating an almost imperceptible degradation of the picture in an error-free environment.

  10. Error-Free Software

    Science.gov (United States)

    1989-01-01

    001 is an integrated tool suited for automatically developing ultra reliable models, simulations and software systems. Developed and marketed by Hamilton Technologies, Inc. (HTI), it has been applied in engineering, manufacturing, banking and software tools development. The software provides the ability to simplify the complex. A system developed with 001 can be a prototype or fully developed with production quality code. It is free of interface errors, consistent, logically complete and has no data or control flow errors. Systems can be designed, developed and maintained with maximum productivity. Margaret Hamilton, President of Hamilton Technologies, also directed the research and development of USE.IT, an earlier product which was the first computer aided software engineering product in the industry to concentrate on automatically supporting the development of an ultrareliable system throughout its life cycle. Both products originated in NASA technology developed under a Johnson Space Center contract.

  11. A Characterization of Prediction Errors

    OpenAIRE

    Meek, Christopher

    2016-01-01

    Understanding prediction errors and determining how to fix them is critical to building effective predictive systems. In this paper, we delineate four types of prediction errors and demonstrate that these four types characterize all prediction errors. In addition, we describe potential remedies and tools that can be used to reduce the uncertainty when trying to determine the source of a prediction error and when trying to take action to remove a prediction errors.

  12. Error Analysis and Its Implication

    Institute of Scientific and Technical Information of China (English)

    崔蕾

    2007-01-01

    Error analysis is the important theory and approach for exploring the mental process of language learner in SLA. Its major contribution is pointing out that intralingual errors are the main reason of the errors during language learning. Researchers' exploration and description of the errors will not only promote the bidirectional study of Error Analysis as both theory and approach, but also give the implication to second language learning.

  13. Error bars in experimental biology

    OpenAIRE

    2007-01-01

    Error bars commonly appear in figures in publications, but experimental biologists are often unsure how they should be used and interpreted. In this article we illustrate some basic features of error bars and explain how they can help communicate data and assist correct interpretation. Error bars may show confidence intervals, standard errors, standard deviations, or other quantities. Different types of error bars give quite different information, and so figure legends must make clear what er...

  14. 5 CFR 410.601 - Reporting.

    Science.gov (United States)

    2010-01-01

    ... agency shall report the training data for its employees' training and development at such times and in... in the Guide to Personnel Recordkeeping and the Guide to Human Resources Reporting. (c) Each agency... Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS TRAINING Reporting § 410.601...

  15. First direct exposure to lunar material for Crew Reception personnel

    Science.gov (United States)

    1969-01-01

    The first direct exposure to lunar material for Crew Reception personnel probably happened late Friday, July 25, 1969. Terry Slezak (displaying moon dust on his left hand fingers), Manned Spacecraft Center (MSC) photographic technician, was removing film magazines from the first of two containers when the incident occurred. As he removed the plastic seal from Magazine S, one of the 70mm magazines taken during Apollo 11 Extravehicular Activity (EVA), it was apparent that the exterior of the cassette displayed traces of a black powdery substance. Apollo 11 Commander Neil Armstrong reported during the mission that he had retrieved a 70mm cassette which had dropped to the lunar surface.

  16. (Errors in statistical tests3

    Directory of Open Access Journals (Sweden)

    Kaufman Jay S

    2008-07-01

    Full Text Available Abstract In 2004, Garcia-Berthou and Alcaraz published "Incongruence between test statistics and P values in medical papers," a critique of statistical errors that received a tremendous amount of attention. One of their observations was that the final reported digit of p-values in articles published in the journal Nature departed substantially from the uniform distribution that they suggested should be expected. In 2006, Jeng critiqued that critique, observing that the statistical analysis of those terminal digits had been based on comparing the actual distribution to a uniform continuous distribution, when digits obviously are discretely distributed. Jeng corrected the calculation and reported statistics that did not so clearly support the claim of a digit preference. However delightful it may be to read a critique of statistical errors in a critique of statistical errors, we nevertheless found several aspects of the whole exchange to be quite troubling, prompting our own meta-critique of the analysis. The previous discussion emphasized statistical significance testing. But there are various reasons to expect departure from the uniform distribution in terminal digits of p-values, so that simply rejecting the null hypothesis is not terribly informative. Much more importantly, Jeng found that the original p-value of 0.043 should have been 0.086, and suggested this represented an important difference because it was on the other side of 0.05. Among the most widely reiterated (though often ignored tenets of modern quantitative research methods is that we should not treat statistical significance as a bright line test of whether we have observed a phenomenon. Moreover, it sends the wrong message about the role of statistics to suggest that a result should be dismissed because of limited statistical precision when it is so easy to gather more data. In response to these limitations, we gathered more data to improve the statistical precision, and

  17. Comprehensive Training of Personnel and Technical Assistance in Establishment of Home Intervention Programs for Families of Infants, Toddlers, and Preschool-Aged Children with Hearing Impairments. Project SKI*HI Outreach. Final Report.

    Science.gov (United States)

    Barringer, Donald; Johnson, Dorothy

    This monograph reports achievements of the SKI*HI project, a 3-year outreach project to improve access and development of services to presently unserved or underserved infants and young children with hearing impairments as well as to provide leadership and technical assistance to agencies implementing the SKI*HI model. The project provided direct…

  18. Computer Anxiety Levels of Virginia Extension Personnel.

    Science.gov (United States)

    Martin, Brenda L.; Stewart, Daisy L.; Hillison, John

    2001-01-01

    Survey responses from 402 Virginia extension personnel showed that secretaries and younger staff had the lowest computer anxiety, technicians and older staff the highest. Time spent using computers, age, and years of employment were somewhat associated with anxiety. Training recommendations were made. (SK)

  19. Job Attitudes of Military Airlift Command Personnel

    Science.gov (United States)

    1986-04-01

    nutbers of available youth. John haisbitt, author of Megatrends, predicts that labor short.ges are beginning to occur and will continue throughout the...available resources (e.g., personnel and material). 81. Your work group’s performance in compariscn to similar work groups is very high. ORGANIZATION CLIMA "E

  20. Antibodies to staphylococcal enterotoxin in laboratory personnel.

    OpenAIRE

    Jozefczyk, Z; Robbins, R N; Spitz, J M; Bergdoll, M S

    1980-01-01

    Eighty-five percent of laboratory personnel working with staphylococcal enterotoxin had antibodies to enterotoxin in their sera, whereas only 23% of the control group had antibodies specific for enterotoxin. Two persons who carried enterotoxin B-producing staphylococci in their noses, throats, or both, had antibodies to enterotoxin B in their sera.

  1. 42 CFR 485.705 - Personnel qualifications.

    Science.gov (United States)

    2010-10-01

    ..., educational or vocational guidance, psychology, social work, special education or personnel administration... area of nursing from an accredited educational institution; and, (iii) Be certified as a clinical nurse... graduated from a physician assistant educational program that is accredited by the Commission...

  2. Personnel practices can help discourage unionization.

    Science.gov (United States)

    Hoffman, H L

    1989-09-01

    Unionization presents a potential source of cost escalation for hospitals, particularly involving health benefits. The best way to minimize chances that staff members will opt for union representation is to develop personnel practices that demonstrate management's commitment to treating employees fairly, such as providing competitive salaries and benefits, scheduling regular meetings to address worker questions, and developing detailed policy handbooks.

  3. Survey of Army Personnel Interested in Teaching

    Science.gov (United States)

    1992-11-01

    Demographic prof’de CurrentActive Army Personnel rent Teachers Actie - ifl~ = -Employment Active Actve Active Outside Army Officers Enlted Educaion Base: 607...Base: 607 345 206 301 1144 2380 0^ PA Desire to work with young people 71 69 70 64 70 78 Value or significance of education in society 69 68 68 75

  4. Systematic approach in petroleum personnel competence assessment

    Science.gov (United States)

    Romanyuk, Vera; Nekhoda, Evgeniya; Dmitriev, Andrey; Khudyakov, Dmitriy; Pozdeeva, Galina

    2016-09-01

    The article is devoted to professional competence improvement of personnel in the petroleum industry. The technique for competence assessment optimization in oil and gas well drilling is developed. The specification for the oil and gas industry competence profiles has been provided.

  5. 34 CFR 300.156 - Personnel qualifications.

    Science.gov (United States)

    2010-07-01

    ... education teacher in the State who teaches in an elementary school, middle school, or secondary school is... comparable requirements that apply to the professional discipline in which those personnel are providing... in their discipline or profession— (i) Meet the requirements of paragraph (b)(1) of this section;...

  6. Privacy Issues and Personnel Information Systems.

    Science.gov (United States)

    Grenard, Nancy C.

    1982-01-01

    Records management policy and clear guidelines, communicated campus-wide, are needed so that requests for personnel information are handled consistently and with respect for the privacy of employees. Suggestions for policy formation and current efforts on campuses are outlined. (MSE)

  7. 32 CFR 9.4 - Commission personnel.

    Science.gov (United States)

    2010-07-01

    ... TRIALS BY MILITARY COMMISSIONS OF CERTAIN NON-UNITED STATES CITIZENS IN THE WAR AGAINST TERRORISM § 9.4... United States armed forces (“Military Officer”), including without limitation reserve personnel on active... Presiding Officer shall be a Military Officer who is a judge advocate of any United States armed force. (5...

  8. 45 CFR 1301.31 - Personnel policies.

    Science.gov (United States)

    2010-10-01

    ... 45 Public Welfare 4 2010-10-01 2010-10-01 false Personnel policies. 1301.31 Section 1301.31 Public Welfare Regulations Relating to Public Welfare (Continued) OFFICE OF HUMAN DEVELOPMENT SERVICES... of each staff position, addressing, as appropriate, roles and responsibilities, relevant...

  9. Bullying and Inappropriate Behaviour among Faculty Personnel

    Science.gov (United States)

    Meriläinen, Matti; Sinkkonen, Hanna-Maija; Puhakka, Helena; Käyhkö, Katinka

    2016-01-01

    This study focuses on the degree, nature and consequences of bullying or inappropriate behaviour among faculty personnel (n = 303) in a Finnish university. A total of 114 (38%) faculty members answered the email questionnaire. According to the results, 15% of the respondents had experienced bullying; in addition, 45% had experienced inappropriate…

  10. 9 CFR 2.32 - Personnel qualifications.

    Science.gov (United States)

    2010-01-01

    ... least the following areas: (1) Humane methods of animal maintenance and experimentation, including: (i... 9 Animals and Animal Products 1 2010-01-01 2010-01-01 false Personnel qualifications. 2.32 Section 2.32 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF...

  11. Preparing School Personnel: Early Childhood Education.

    Science.gov (United States)

    Poliakoff, Lorraine, Comp.

    This bibliography contains 25 citations of published and unpublished documents ranging in date from 1964 through 1969 on "the means and methods by which school personnel are prepared to work with preschool age children in such settings as Head Start programs and nursery and kindergarten classes." Citations are subsumed under three headings: 1)…

  12. Recent Trends in Evaluating School Personnel

    Science.gov (United States)

    Poliakoff, Lorraine

    1973-01-01

    The trends in evaluating school personnel today focus on the participation of the person evaluated and on his needs and rights as a professional and human being. This article is based on a review of the literature on evaluation in the ERIC system. (Author)

  13. Legal constraints imposed on security force personnel

    Energy Technology Data Exchange (ETDEWEB)

    Cadwell, J.J.

    1983-01-01

    It is argued that the penalty for most mistakes made by security is the payment of money by the utility. The security personnel has only to act reasonably and not in a negligent manner. Preventing of sabotage is more important than obtaining a conviction, so it is better to search and not get a conviction than it is not to search. (DLC)

  14. Strategic personnel management in an educational institution

    OpenAIRE

    KOROTKOVA M.V.; RYBKINA M.V.; NIKITINA S.O.; SCHERNYKH A.V.

    2016-01-01

    The article analyzes the strategic human resource management in an educational institution. Analyzes the basic normative-legal documents regulating educational activities, including the part of management. Particular importance is given to the types of educational institutions (budgetary, state, and autonomous). The stages of strategic management of staff in educational institutions and development model of strategic management personnel are shown.

  15. SAPLE: Sandia Advanced Personnel Locator Engine.

    Energy Technology Data Exchange (ETDEWEB)

    Procopio, Michael J.

    2010-04-01

    We present the Sandia Advanced Personnel Locator Engine (SAPLE) web application, a directory search application for use by Sandia National Laboratories personnel. SAPLE's purpose is to return Sandia personnel 'results' as a function of user search queries, with its mission to make it easier and faster to find people at Sandia. To accomplish this, SAPLE breaks from more traditional directory application approaches by aiming to return the correct set of results while placing minimal constraints on the user's query. Two key features form the core of SAPLE: advanced search query interpretation and inexact string matching. SAPLE's query interpretation permits the user to perform compound queries when typing into a single search field; where able, SAPLE infers the type of field that the user intends to search on based on the value of the search term. SAPLE's inexact string matching feature yields a high-quality ranking of personnel search results even when there are no exact matches to the user's query. This paper explores these two key features, describing in detail the architecture and operation of SAPLE. Finally, an extensive analysis on logged search query data taken from an 11-week sample period is presented.

  16. 48 CFR 752.7027 - Personnel.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Personnel. 752.7027 Section 752.7027 Federal Acquisition Regulations System AGENCY FOR INTERNATIONAL DEVELOPMENT CLAUSES AND... normally be appointed for a minimum of 2 years which period includes orientation (less language...

  17. When Violence Threatens the Workplace: Personnel Issues.

    Science.gov (United States)

    Willits, Robert L.

    1997-01-01

    Discusses violence in the workplace and suggests a three-tier approach to dealing with violence in libraries that focuses on personnel issues: (1) preventive measures, including applicant screening, supervisory training, and employee assistance programs; (2) threat management, including policy formation and legal action; and (3) crisis/post-trauma…

  18. symptoms in health personnel exposed to disinfectants

    African Journals Online (AJOL)

    2001-03-01

    Mar 1, 2001 ... (31.7%), watering of eyes (25%), skin rash (10%) and chronic cough (8.3%). Among users ... Further studies involving larger sample sizes, are necessary to ... exposure to disinfectants among health personnel in some. Kenyan health ..... Sun H.W., Feigal R.J. and Messer H.H. Cytotoxicity of gutaraldehyde ...

  19. 40 CFR 265.16 - Personnel training.

    Science.gov (United States)

    2010-07-01

    ... successfully complete a program of classroom instruction or on-the-job training that teaches them to perform... hazardous waste management procedures, and must -include instruction which teaches -facility personnel... hazardous waste management, and the name of the employee filling each job; (2) A written job description for...

  20. 29 CFR 1917.27 - Personnel.

    Science.gov (United States)

    2010-07-01

    ...) MARINE TERMINALS Marine Terminal Operations § 1917.27 Personnel. (a) Qualifications of machinery... apparatus, or any power operated vehicle, or give signals to the operator of any hoisting apparatus. Exception: Employees being trained and supervised by a designated person may operate such machinery and...

  1. Personnel radiation dosimetry symposium: program and abstracts

    Energy Technology Data Exchange (ETDEWEB)

    1984-10-01

    The purpose was to provide applied and research dosimetrists with sufficient information to evaluate the status and direction of their programs relative to the latest guidelines and techniques. A technical program was presented concerning experience, requirements, and advances in gamma, beta, and neutron personnel dosimetry.

  2. Navy Personnel Survey (NPS) 1990 Survey Report, Statistical Tables. Volume 1. Enlisted Personnel.

    Science.gov (United States)

    1991-08-01

    I 6.1 +---------------------------- 10 I .4 I .8 I .5 I 45 MINECRAFT I I I I .7 ---------------------------- 11 I 2.5 I 5.5 I 4.6 I 305I SUBMARINE I I...Destroyer Types [2] Training Command [10] Minecraft [31 Shore or Staff Command [11] Submarine [4] Reserve Unit [12] Service Force ship [5] Aircraft

  3. Navy Personnel Survey (NPS) 1990 Survey Report, Statistical Tables. Volume 2. Officer Personnel.

    Science.gov (United States)

    1991-08-01

    2.7 +---------------------------- 9 I 4.2 1 6.8 1 1.8 I 219 DESTROYER I I I I 5.0 +---------------------------- 10 I I .9 I .3 I 30 MINECRAFT I I I 1...26. To what type of ship/activity are you assigned? [1] Aviation Squadron [9] Destroyer Types [2] Training Commana [10] Minecraft [3] Shore or Staff

  4. Unpredicted spontaneous extrusion of a renal calculus in an adult male with spina bifida and paraplegia: report of a misdiagnosis. Measures to be taken to reduce urological errors in spinal cord injury patients

    Directory of Open Access Journals (Sweden)

    Singh Gurpreet

    2001-12-01

    Full Text Available Abstract Background A delay in diagnosis or a misdiagnosis may occur in patients with spinal cord injury (SCI or spinal bifida as typical symptoms of a clinical condition may be absent because of their neurological impairment. Case presentation A 29-year old male, who was born with spina bifida and hydrocephalus, became unwell and developed a swelling and large red mark in his left loin eighteen months ago. Pyonephrosis or perinephric abscess was suspected. X-ray of the abdomen showed left-sided staghorn calculus. Since ultrasound scan showed no features of pyonephrosis or perinephric abscess, he was prescribed a prolonged course of antibiotics for infection presumed to arise from the site of metal implant in spine. He developed a discharging sinus, following which the loin swelling and red mark subsided. About three months ago, he again developed a red mark and minimal swelling in the left loin. Ultrasound scan detected no abnormality in the renal or perinephric region. Therefore, the red mark and swelling were attributed to pressure from the backrest of his chair. Five weeks later, the swelling in the left loin burst open and a large stone was extruded spontaneously. An X-ray of the abdomen showed that he had extruded the central portion of the staghorn calculus from left kidney. With hindsight, the extruded renal calculus could be seen lying in the subcutaneous tissue of left loin lateral to the 10th rib in the X-ray of abdomen, which was taken when he presented with red mark and minimal swelling. Conclusion This case illustrates how mistakes in diagnosis could occur in spinal cord injury patients, and highlights the need for corrective measures to reduce urological errors in these patients. Voluntary reporting of urological errors is recommended to facilitate learning from our mistakes. In the patients who have marked spinal curvature, ultrasonography of kidneys and perinephric region may not be entirely reliable. As clinical symptoms and

  5. SEVENTH DOE WORKSHOP ON PERSONNEL NEUTRON DOSIMETRY

    Energy Technology Data Exchange (ETDEWEB)

    Vallario, E J

    1978-10-24

    This workshop was the seventh of a series and was held on October 23-24. 1978, at the Central Electricity Generating Board, HQ, London, England. Typically~ attendees at the Workshop were concerned with one of three activities: studying and refining existing techniques in an attempt to quantify already-known parameters with greater precision, looking for ways to apply existing neutron dosirr:etry techniques to a specific local problem, identifying the needs and weaknesses of existing systems, with the goal of improving and passibly simplifying field measurements. The types of neutron dosimetry techniques discussed by participants included albedo dosimeters, track etch, and TLD. One speaker reported on NTA film, noting that fading could be eliminated by drying the emulsion in dry nitrogen before field use. There were no reports on tissue equivalent proportional counters or activation analysis. One participant discussed a metal oxide silicon dosimeter. The need to develop a consistent standard terminology, as well as calibration sources and techniques, on both the national and international level was evident. The need for standardization is particularly acute in the U.S. Techniques for evaluating dosimeter response in the field should he standardized, since several different instruments with widely different response characteristics are currently being used. The choice of instruments is often parochial. Also. the type and use of phantoms should be standardized. Neutron dose assignment is significantly affected by the position of the dosimeter on the body. for example, a typical albedo dosimeter may give differences of up to 20% depending on whether it is worn on the belt or chest. Larger errors are encountered with front-to-back (angular} orientation. 1n an attempt to minimize such errors~ at least two European facilities are using neutron dosimeter belts, which provide dosimeters both in front and in back of the wearer. The gamma-to-neutron ratio around nuclear power

  6. Diagnostic errors in pediatric radiology

    Energy Technology Data Exchange (ETDEWEB)

    Taylor, George A.; Voss, Stephan D. [Children' s Hospital Boston, Department of Radiology, Harvard Medical School, Boston, MA (United States); Melvin, Patrice R. [Children' s Hospital Boston, The Program for Patient Safety and Quality, Boston, MA (United States); Graham, Dionne A. [Children' s Hospital Boston, The Program for Patient Safety and Quality, Boston, MA (United States); Harvard Medical School, The Department of Pediatrics, Boston, MA (United States)

    2011-03-15

    Little information is known about the frequency, types and causes of diagnostic errors in imaging children. Our goals were to describe the patterns and potential etiologies of diagnostic error in our subspecialty. We reviewed 265 cases with clinically significant diagnostic errors identified during a 10-year period. Errors were defined as a diagnosis that was delayed, wrong or missed; they were classified as perceptual, cognitive, system-related or unavoidable; and they were evaluated by imaging modality and level of training of the physician involved. We identified 484 specific errors in the 265 cases reviewed (mean:1.8 errors/case). Most discrepancies involved staff (45.5%). Two hundred fifty-eight individual cognitive errors were identified in 151 cases (mean = 1.7 errors/case). Of these, 83 cases (55%) had additional perceptual or system-related errors. One hundred sixty-five perceptual errors were identified in 165 cases. Of these, 68 cases (41%) also had cognitive or system-related errors. Fifty-four system-related errors were identified in 46 cases (mean = 1.2 errors/case) of which all were multi-factorial. Seven cases were unavoidable. Our study defines a taxonomy of diagnostic errors in a large academic pediatric radiology practice and suggests that most are multi-factorial in etiology. Further study is needed to define effective strategies for improvement. (orig.)

  7. Exploration of Non-punitive Strategies for Medication Error Administration%治理用药差错的非惩罚性策略探讨

    Institute of Scientific and Technical Information of China (English)

    陈金秀; 秦玉花; 赵红卫; 张伟; 陈琪; 黄文广

    2012-01-01

    OBJECTIVE: To explore non-punitive strategies of administering medication error, and to promote safety of drug use in patients. METHODS: The traditional handling method and malpractice of medication error were analyzed, and the content of medication safety culture and countermeasures were introduced. RESULTS & CONCLUSIONS: Medication safety culture included the establishment of non-punitive share culture, and analysis of reasons for medication error but no punishment, etc. Medical personnel could report medication error and non-error event with voluntary, active, positive and true attitude; the protection of patients medication safety was maximized. A sound and effective medication error reporting system is the countermeasure of non-punitive strategies of administering medication error.%目的:探讨治理用药差错的非惩罚性策略,促进患者用药安全.方法:对用药差错的传统处理方法和弊端进行分析,介绍非惩罚性策略涉及的用药安全文化的内容及相关措施.结果:用药安全文化表现为建立无惩罚的差错分享文化、出现用药差错时重点是分析事由而不是惩罚等,促使医务人员能够自愿、主动、积极、真实地报告用药差错及非差错性事件,最大限度保护患者的用药安全;非惩罚性策略的措施即倡导建立完善、有效的用药差错报告系统.

  8. PERM Error Rate Findings and Reports

    Data.gov (United States)

    U.S. Department of Health & Human Services — Federal agencies are required to annually review programs they administer and identify those that may be susceptible to significant improper payments, to estimate...

  9. An Internet-style Approach to Managing Wireless Link Errors

    Science.gov (United States)

    2002-05-01

    solutions for the behaviors of many codes under a variety of error models. Error coding books exist at several levels of abstraction: handbooks [94...A new channel access method for packet radio. In Proceedings of the 9th ARRL /CRRL Amateur Radio Computer Networking Conference, September 1992. [64...SIGCOMM Conference, Cannes, France, September 1997. [94] Joseph P. Odenwalder. Error control coding handbook (final report). Technical report, LINKABIT

  10. How prediction errors shape perception, attention and motivation

    Directory of Open Access Journals (Sweden)

    Hanneke EM Den Ouden

    2012-12-01

    Full Text Available Prediction errors are a central notion in theoretical models of reinforcement learning, perceptual inference, decision-making and cognition, and prediction error signals have been reported across a wide range of brain regions and experimental paradigms. Here, we will make an attempt to see the forest for the trees, considering the commonalities and differences of reported prediction errors signals in light of recent suggestions that the computation of prediction errors forms a fundamental mode of brain function. We discuss where different types of prediction errors are encoded, how they are generated, and the different functional roles they fulfil. We suggest that while encoding of prediction errors is a common computation across brain regions, the content and function of these error signals can be very different, and are determined by the afferent and efferent connections within the neural circuitry in which they arise.

  11. Factors which affect the occurrence of nursing errors in medication administration and the errors' management

    Directory of Open Access Journals (Sweden)

    Theodore Kapadohos

    2012-04-01

    Full Text Available Nursing, as a humanitarian science, offers its services, on the comprehensive care of patients. Each nurse handling, involves the possibility of error. Meurier appointed nursing error as "any act, any decision or omission by a nurse, assessed as incorrect, by more experienced colleagues, and have adverse consequences for patients". Medication errors are the most common category of nursing errors. They affect health, patient safety and also have a high economic impact to health systems of each country. Aim: The present study investigated the causative factors of nursing errors, the frequency of medication errors and the ways of reporting, recording and managing these errors in the hospitals of Greece. Method: For the purpose of this study, a descriptive cross-sectional design was used. The sample consisted of 176 registered nurses, from eight public and three private hospitals, working in the ICU and their duties included the administration of drugs. Data collection was performed using an anonymous structured questionnaire that included demographic characteristics of the sample and closed questions about the factors implicated in the occurrence of errors and their management. To investigate the existence of correlation between demographics and various questions referred to the management of errors by nurses, the criterion of heterogeneity X2 of Pearson was used and to check for correlation between questions that reflect the participants' views on working conditions and management of errors, the non-parametric correlation coefficient of Spearman (Spearman rho was applied. The statistical analysis was performed using SPSS 17 software. Results: After statistical analysis of data, the most important causative factors for the occurrence of errors are the nursing workload (78.9%, the distraction of nurses (75.8% and the burnout (56.8%. More than 9 out of 10 nurses have made errors in drug administration (91.5%, especially with the wrong dose (34.7% and

  12. Drug Administration Errors in Hospital Inpatients: A Systematic Review

    Science.gov (United States)

    Berdot, Sarah; Gillaizeau, Florence; Caruba, Thibaut; Prognon, Patrice; Durieux, Pierre; Sabatier, Brigitte

    2013-01-01

    Context Drug administration in the hospital setting is the last barrier before a possible error reaches the patient. Objectives We aimed to analyze the prevalence and nature of administration error rate detected by the observation method. Data Sources Embase, MEDLINE, Cochrane Library from 1966 to December 2011 and reference lists of included studies. Study Selection Observational studies, cross-sectional studies, before-and-after studies, and randomized controlled trials that measured the rate of administration errors in inpatients were included. Data Extraction Two reviewers (senior pharmacists) independently identified studies for inclusion. One reviewer extracted the data; the second reviewer checked the data. The main outcome was the error rate calculated as being the number of errors without wrong time errors divided by the Total Opportunity for Errors (TOE, sum of the total number of doses ordered plus the unordered doses given), and multiplied by 100. For studies that reported it, clinical impact was reclassified into four categories from fatal to minor or no impact. Due to a large heterogeneity, results were expressed as median values (interquartile range, IQR), according to their study design. Results Among 2088 studies, a total of 52 reported TOE. Most of the studies were cross-sectional studies (N=46). The median error rate without wrong time errors for the cross-sectional studies using TOE was 10.5% [IQR: 7.3%-21.7%]. No fatal error was observed and most errors were classified as minor in the 18 studies in which clinical impact was analyzed. We did not find any evidence of publication bias. Conclusions Administration errors are frequent among inpatients. The median error rate without wrong time errors for the cross-sectional studies using TOE was about 10%. A standardization of administration error rate using the same denominator (TOE), numerator and types of errors is essential for further publications. PMID:23818992

  13. Transient Error Data Analysis.

    Science.gov (United States)

    1979-05-01

    Analysis is 3.2 Graphical Data Analysis 16 3.3 General Statistics and Confidence Intervals 1" 3.4 Goodness of Fit Test 15 4. Conclusions 31 Acknowledgements...MTTF per System Technology Mechanism Processor Processor MT IE . CMUA PDP-10, ECL Parity 44 hrs. 800-1600 hrs. 0.03-0.06 Cm* LSI-1 1, NMOS Diagnostics...OF BAD TIME ERRORS: 6 TOTAL NUMBER OF ENTRIES FOR ALL INPUT FILESs 18445 TIME SPAN: 1542 HRS., FROM: 17-Feb-79 5:3:11 TO: 18-1Mj-79 11:30:99

  14. Minimum Error Entropy Classification

    CERN Document Server

    Marques de Sá, Joaquim P; Santos, Jorge M F; Alexandre, Luís A

    2013-01-01

    This book explains the minimum error entropy (MEE) concept applied to data classification machines. Theoretical results on the inner workings of the MEE concept, in its application to solving a variety of classification problems, are presented in the wider realm of risk functionals. Researchers and practitioners also find in the book a detailed presentation of practical data classifiers using MEE. These include multi‐layer perceptrons, recurrent neural networks, complexvalued neural networks, modular neural networks, and decision trees. A clustering algorithm using a MEE‐like concept is also presented. Examples, tests, evaluation experiments and comparison with similar machines using classic approaches, complement the descriptions.

  15. Official personnel dosimetry for medical personnel; Amtliche Personendosimetrie fuer Medizin-Personal

    Energy Technology Data Exchange (ETDEWEB)

    Hupe, Oliver [Physikalisch-Technische Bundesanstalt (PTB), Braunschweig (Germany). Arbeitsgruppe ' Photonendosimetrie'

    2013-06-15

    After a description of the quality assurance of dosemeters by construction testing and calibration practical personnel dosimetry is considered. In this connection legally fixed dose limits are presented, which are based on the EURATOM directive 96/29. (HSI)

  16. Knowledge of healthcare professionals about medication errors in hospitals

    Science.gov (United States)

    Abdel-Latif, Mohamed M. M.

    2016-01-01

    Context: Medication errors are the most common types of medical errors in hospitals and leading cause of morbidity and mortality among patients. Aims: The aim of the present study was to assess the knowledge of healthcare professionals about medication errors in hospitals. Settings and Design: A self-administered questionnaire was distributed to randomly selected healthcare professionals in eight hospitals in Madinah, Saudi Arabia. Subjects and Methods: An 18-item survey was designed and comprised questions on demographic data, knowledge of medication errors, availability of reporting systems in hospitals, attitudes toward error reporting, causes of medication errors. Statistical Analysis Used: Data were analyzed with Statistical Package for the Social Sciences software Version 17. Results: A total of 323 of healthcare professionals completed the questionnaire with 64.6% response rate of 138 (42.72%) physicians, 34 (10.53%) pharmacists, and 151 (46.75%) nurses. A majority of the participants had a good knowledge about medication errors concept and their dangers on patients. Only 68.7% of them were aware of reporting systems in hospitals. Healthcare professionals revealed that there was no clear mechanism available for reporting of errors in most hospitals. Prescribing (46.5%) and administration (29%) errors were the main causes of errors. The most frequently encountered medication errors were anti-hypertensives, antidiabetics, antibiotics, digoxin, and insulin. Conclusions: This study revealed differences in the awareness among healthcare professionals toward medication errors in hospitals. The poor knowledge about medication errors emphasized the urgent necessity to adopt appropriate measures to raise awareness about medication errors in Saudi hospitals. PMID:27330261

  17. Errors in CT colonography.

    Science.gov (United States)

    Trilisky, Igor; Ward, Emily; Dachman, Abraham H

    2015-10-01

    CT colonography (CTC) is a colorectal cancer screening modality which is becoming more widely implemented and has shown polyp detection rates comparable to those of optical colonoscopy. CTC has the potential to improve population screening rates due to its minimal invasiveness, no sedation requirement, potential for reduced cathartic examination, faster patient throughput, and cost-effectiveness. Proper implementation of a CTC screening program requires careful attention to numerous factors, including patient preparation prior to the examination, the technical aspects of image acquisition, and post-processing of the acquired data. A CTC workstation with dedicated software is required with integrated CTC-specific display features. Many workstations include computer-aided detection software which is designed to decrease errors of detection by detecting and displaying polyp-candidates to the reader for evaluation. There are several pitfalls which may result in false-negative and false-positive reader interpretation. We present an overview of the potential errors in CTC and a systematic approach to avoid them.

  18. We need to talk about error: causes and types of error in veterinary practice.

    Science.gov (United States)

    Oxtoby, C; Ferguson, E; White, K; Mossop, L

    2015-10-31

    Patient safety research in human medicine has identified the causes and common types of medical error and subsequently informed the development of interventions which mitigate harm, such as the WHO's safe surgery checklist. There is no such evidence available to the veterinary profession. This study therefore aims to identify the causes and types of errors in veterinary practice, and presents an evidence based system for their classification. Causes of error were identified from retrospective record review of 678 claims to the profession's leading indemnity insurer and nine focus groups (average N per group=8) with vets, nurses and support staff were performed using critical incident technique. Reason's (2000) Swiss cheese model of error was used to inform the interpretation of the data. Types of error were extracted from 2978 claims records reported between the years 2009 and 2013. The major classes of error causation were identified with mistakes involving surgery the most common type of error. The results were triangulated with findings from the medical literature and highlight the importance of cognitive limitations, deficiencies in non-technical skills and a systems approach to veterinary error.

  19. Error Analysis in Mathematics Education.

    Science.gov (United States)

    Rittner, Max

    1982-01-01

    The article reviews the development of mathematics error analysis as a means of diagnosing students' cognitive reasoning. Errors specific to addition, subtraction, multiplication, and division are described, and suggestions for remediation are provided. (CL)

  20. Payment Error Rate Measurement (PERM)

    Data.gov (United States)

    U.S. Department of Health & Human Services — The PERM program measures improper payments in Medicaid and CHIP and produces error rates for each program. The error rates are based on reviews of the...

  1. Errors of measurement by laser goniometer

    Science.gov (United States)

    Agapov, Mikhail Y.; Bournashev, Milhail N.

    2000-11-01

    The report is dedicated to research of systematic errors of angle measurement by a dynamic laser goniometer (DLG) on the basis of a ring laser (RL), intended of certification of optical angle encoders (OE), and development of methods of separation the errors of different types and their algorithmic compensation. The OE was of the absolute photoelectric angle encoder type with an informational capacity of 14 bits. Cinematic connection with a rotary platform was made through mechanical connection unit (CU). The measurement and separation of a systematic error to components was carried out with applying of a method of cross-calibration at mutual turns OE in relation to DLG base and CU in relation to OE rotor. Then the Fourier analysis of observed data was made. The research of dynamic errors of angle measurements was made with use of dependence of measured angle between reference direction assigned by the interference null-indicator (NI) with an 8-faced optical polygon (OP), and direction defined by means of the OE, on angular rate of rotation. The obtained results allow to make algorithmic compensation of a systematic error and in the total considerably to reduce a total error of measurements.

  2. [Medication errors in Spanish intensive care units].

    Science.gov (United States)

    Merino, P; Martín, M C; Alonso, A; Gutiérrez, I; Alvarez, J; Becerril, F

    2013-01-01

    To estimate the incidence of medication errors in Spanish intensive care units. Post hoc study of the SYREC trial. A longitudinal observational study carried out during 24 hours in patients admitted to the ICU. Spanish intensive care units. Patients admitted to the intensive care unit participating in the SYREC during the period of study. Risk, individual risk, and rate of medication errors. The final study sample consisted of 1017 patients from 79 intensive care units; 591 (58%) were affected by one or more incidents. Of these, 253 (43%) had at least one medication-related incident. The total number of incidents reported was 1424, of which 350 (25%) were medication errors. The risk of suffering at least one incident was 22% (IQR: 8-50%) while the individual risk was 21% (IQR: 8-42%). The medication error rate was 1.13 medication errors per 100 patient-days of stay. Most incidents occurred in the prescription (34%) and administration (28%) phases, 16% resulted in patient harm, and 82% were considered "totally avoidable". Medication errors are among the most frequent types of incidents in critically ill patients, and are more common in the prescription and administration stages. Although most such incidents have no clinical consequences, a significant percentage prove harmful for the patient, and a large proportion are avoidable. Copyright © 2012 Elsevier España, S.L. and SEMICYUC. All rights reserved.

  3. Simulation-aided planning of quality-oriented personnel structures in production systems.

    Science.gov (United States)

    Zülch, Gert; Krüger, Jan; Schindele, Hermann; Rottinger, Sven

    2003-07-01

    This paper presents research activities associated with the development of a simulation tool for modelling human reliability in production systems. This dynamic model enables the planner to determine the consequences of changes in human reliability on the quality of the production processes and the products. The model is built upon the basis of a tool for human reliability analysis ESAT (Experten-System zur Aufgaben-Taxonomie; Aufgabentaxonomie: Ein Verfahren zur Ermittlung der menschlichen Leistung bei der Durchführung von Aufgaben, Messerschmitt-Bölkow-Blohm, Ottobrunn, 1990.) and a personnel-oriented simulation programme ESPE (Engpassorientierte Simulation von Personalstrukturen; Ein engpassorientierter Ansatz zur simulationsunterstützten Planung von Personalstrukturen, Dissertation, Karlsruhe University, 1994), developed at the ifab-Institute of Human and Industrial Engineering at the University of Karlsruhe. In addition to the definition and the calculation of the human error probabilities, the consequences of the human errors (i.e. rework and waste) for the quality of the processes and the products were also implemented. This method is able to systematically plan quality-oriented assignments of personnel to functions and workplaces (personnel structures) in production systems. The effectiveness of the method is demonstrated by a case study.

  4. Error bounds from extra precise iterative refinement

    Energy Technology Data Exchange (ETDEWEB)

    Demmel, James; Hida, Yozo; Kahan, William; Li, Xiaoye S.; Mukherjee, Soni; Riedy, E. Jason

    2005-02-07

    We present the design and testing of an algorithm for iterative refinement of the solution of linear equations, where the residual is computed with extra precision. This algorithm was originally proposed in the 1960s [6, 22] as a means to compute very accurate solutions to all but the most ill-conditioned linear systems of equations. However two obstacles have until now prevented its adoption in standard subroutine libraries like LAPACK: (1) There was no standard way to access the higher precision arithmetic needed to compute residuals, and (2) it was unclear how to compute a reliable error bound for the computed solution. The completion of the new BLAS Technical Forum Standard [5] has recently removed the first obstacle. To overcome the second obstacle, we show how a single application of iterative refinement can be used to compute an error bound in any norm at small cost, and use this to compute both an error bound in the usual infinity norm, and a componentwise relative error bound. We report extensive test results on over 6.2 million matrices of dimension 5, 10, 100, and 1000. As long as a normwise (resp. componentwise) condition number computed by the algorithm is less than 1/max{l_brace}10,{radical}n{r_brace} {var_epsilon}{sub w}, the computed normwise (resp. componentwise) error bound is at most 2 max{l_brace}10,{radical}n{r_brace} {center_dot} {var_epsilon}{sub w}, and indeed bounds the true error. Here, n is the matrix dimension and w is single precision roundoff error. For worse conditioned problems, we get similarly small correct error bounds in over 89.4% of cases.

  5. Prevalence of Pre-Analytical Errors in Clinical Chemistry Diagnostic Labs in Sulaimani City of Iraqi Kurdistan.

    Science.gov (United States)

    Najat, Dereen

    2017-01-01

    Laboratory testing is roughly divided into three phases: a pre-analytical phase, an analytical phase and a post-analytical phase. Most analytical errors have been attributed to the analytical phase. However, recent studies have shown that up to 70% of analytical errors reflect the pre-analytical phase. The pre-analytical phase comprises all processes from the time a laboratory request is made by a physician until the specimen is analyzed at the lab. Generally, the pre-analytical phase includes patient preparation, specimen transportation, specimen collection and storage. In the present study, we report the first comprehensive assessment of the frequency and types of pre-analytical errors at the Sulaimani diagnostic labs in Iraqi Kurdistan. Over 2 months, 5500 venous blood samples were observed in 10 public diagnostic labs of Sulaimani City. The percentages of rejected samples and types of sample inappropriateness were evaluated. The percentage of each of the following pre-analytical errors were recorded: delay in sample transportation, clotted samples, expired reagents, hemolyzed samples, samples not on ice, incorrect sample identification, insufficient sample, tube broken in centrifuge, request procedure errors, sample mix-ups, communication conflicts, misinterpreted orders, lipemic samples, contaminated samples and missed physician's request orders. The difference between the relative frequencies of errors observed in the hospitals considered was tested using a proportional Z test. In particular, the survey aimed to discover whether analytical errors were recorded and examine the types of platforms used in the selected diagnostic labs. The analysis showed a high prevalence of improper sample handling during the pre-analytical phase. In appropriate samples, the percentage error was as high as 39%. The major reasons for rejection were hemolyzed samples (9%), incorrect sample identification (8%) and clotted samples (6%). Most quality control schemes at Sulaimani

  6. Error bounds for set inclusions

    Institute of Scientific and Technical Information of China (English)

    ZHENG; Xiyin(郑喜印)

    2003-01-01

    A variant of Robinson-Ursescu Theorem is given in normed spaces. Several error bound theorems for convex inclusions are proved and in particular a positive answer to Li and Singer's conjecture is given under weaker assumption than the assumption required in their conjecture. Perturbation error bounds are also studied. As applications, we study error bounds for convex inequality systems.

  7. Uncertainty quantification and error analysis

    Energy Technology Data Exchange (ETDEWEB)

    Higdon, Dave M [Los Alamos National Laboratory; Anderson, Mark C [Los Alamos National Laboratory; Habib, Salman [Los Alamos National Laboratory; Klein, Richard [Los Alamos National Laboratory; Berliner, Mark [OHIO STATE UNIV.; Covey, Curt [LLNL; Ghattas, Omar [UNIV OF TEXAS; Graziani, Carlo [UNIV OF CHICAGO; Seager, Mark [LLNL; Sefcik, Joseph [LLNL; Stark, Philip [UC/BERKELEY; Stewart, James [SNL

    2010-01-01

    UQ studies all sources of error and uncertainty, including: systematic and stochastic measurement error; ignorance; limitations of theoretical models; limitations of numerical representations of those models; limitations on the accuracy and reliability of computations, approximations, and algorithms; and human error. A more precise definition for UQ is suggested below.

  8. Feature Referenced Error Correction Apparatus.

    Science.gov (United States)

    A feature referenced error correction apparatus utilizing the multiple images of the interstage level image format to compensate for positional...images and by the generation of an error correction signal in response to the sub-frame registration errors. (Author)

  9. Military Officer Personnel Management: Key Concepts and Statutory Provisions

    Science.gov (United States)

    2016-05-10

    Military Officer Personnel Management : Key Concepts and Statutory Provisions Lawrence Kapp Specialist in Military Manpower Policy May 10......Congressional Research Service Summary Congress and the executive branch are currently considering changes to the officer personnel management system

  10. Knowledge and attitude of Nigerian personnel working at Federal ...

    African Journals Online (AJOL)

    Knowledge and attitude of Nigerian personnel working at Federal Medical ... was carried out on personnel working at the Federal Medical Centre, Owo, Nigeria. ... Results: One hundred and seventy-six health workers participated, and 157 ...

  11. Personnel Audit Using a Forensic Mining Technique

    Directory of Open Access Journals (Sweden)

    Adesesan B. Adeyemo

    2010-11-01

    Full Text Available This paper applies forensic data mining to determine the true status of employees and thereafter provide useful evidences for proper administration of administrative rules in a Typical Nigerian Teaching Service. The conventional technique of personnel audit was studied and a new technique for personnel audit was modeled using Artificial Neural Networks and Decision Tree algorithms. Atwo-layer classifier architecture was modeled. The outcome of the experiment proved that Radial Basis Function Artificial Neural Network is better than Feed-forward Multilayer Perceptron in modeling of appointment and promotion audit in layer 1 while Logitboost Multiclass Alternating Decision Tree in Layer 2 is best in modeling suspicious appointment audit and abnormal promotion audit among the tested Decision Trees. The evidential rules derived from the decision trees for determining the suspicious appointment and abnormal promotion were also presented.

  12. Personnel Selection Using Fuzzy Axiomatic Design Principles

    Directory of Open Access Journals (Sweden)

    Anant V. Khandekar

    2016-09-01

    Full Text Available Overall competency of the working personnel is often observed to ultimately affect the productivity of an organization. The globalised competitive atmosphere coupled with technological improvements demands for efficient and specialized manpower for the industrial operations. A set of typical technological skills and attitudes is thus demanded for every job profile. Most often, these skills and attitudes are expressed imprecisely and hence, necessitating the support of fuzzy sets for their effective understanding and further processing. In this paper, a method based on fuzzy axiomatic design principles is applied for solving the personnel selection problems. Selecting a middle management staff of a service department for a large scale organization is demonstrated here as a real life example. Five shortlisted candidates are assessed with respect to a set of 18 evaluation criteria, and the selection committee with experts from the related fields also realizes the outcome of the adopted approach to be quite appropriate, befitting and in agreement with their expectations.

  13. Errors in causal inference: an organizational schema for systematic error and random error.

    Science.gov (United States)

    Suzuki, Etsuji; Tsuda, Toshihide; Mitsuhashi, Toshiharu; Mansournia, Mohammad Ali; Yamamoto, Eiji

    2016-11-01

    To provide an organizational schema for systematic error and random error in estimating causal measures, aimed at clarifying the concept of errors from the perspective of causal inference. We propose to divide systematic error into structural error and analytic error. With regard to random error, our schema shows its four major sources: nondeterministic counterfactuals, sampling variability, a mechanism that generates exposure events and measurement variability. Structural error is defined from the perspective of counterfactual reasoning and divided into nonexchangeability bias (which comprises confounding bias and selection bias) and measurement bias. Directed acyclic graphs are useful to illustrate this kind of error. Nonexchangeability bias implies a lack of "exchangeability" between the selected exposed and unexposed groups. A lack of exchangeability is not a primary concern of measurement bias, justifying its separation from confounding bias and selection bias. Many forms of analytic errors result from the small-sample properties of the estimator used and vanish asymptotically. Analytic error also results from wrong (misspecified) statistical models and inappropriate statistical methods. Our organizational schema is helpful for understanding the relationship between systematic error and random error from a previously less investigated aspect, enabling us to better understand the relationship between accuracy, validity, and precision. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. Ambiguous Course Dosing Leads to Errors; Farxiga and Fetzima Mix-Ups; Transdermal Patches and Heat Sources; Patient-Controlled Analgesia Pump Security Issue; Bloxiverz and Vazculep Mix-Ups.

    Science.gov (United States)

    Cohen, Michael R; Smetzer, Judy L

    2015-05-01

    These medication errors have occurred in health care facilities at least once. They will happen again-perhaps where you work. Through education and alertness of personnel and procedural safeguards, they can be avoided. You should consider publishing accounts of errors in your newsletters and/or presenting them at your inservice training programs. Your assistance is required to continue this feature. The reports described here were received through the Institute for Safe Medication Practices (ISMP) Medication Errors Reporting Program. Any reports published by ISMP will be anonymous. Comments are also invited; the writers' names will be published if desired. ISMP may be contacted at the address shown below. Errors, close calls, or hazardous conditions may be reported directly to ISMP through the ISMP Web site (www.ismp.org), by calling 800-FAIL-SAFE, or via e-mail at ismpinfo@ismp.org. ISMP guarantees the confidentiality and security of the information received and respects reporters' wishes as to the level of detail included in publications.

  15. 5 CFR 250.101 - Standards and requirements for agency personnel actions.

    Science.gov (United States)

    2010-01-01

    ... personnel actions. 250.101 Section 250.101 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PERSONNEL MANAGEMENT IN AGENCIES Authority for Personnel Actions in Agencies § 250.101... Personnel Management (OPM), the instructions OPM has published in the Guide to Processing Personnel Actions...

  16. MANPRINT (Manpower and Personnel Integration Program) Primer

    Science.gov (United States)

    1988-06-24

    artificial intelligence, robotics , directed energy weapons, millimeter/microwave integrated circuits and composite materials can lead to systems that...Group MOS Military Occupational Specialty MPT Manpower Personnel Training MPTTA Manpower, Petsonnel and Training Trade-off Analysis A-2 .. . .. . MRSA ...Army is investigating and developing robotic systems to 0 G-1 meet threat scenarios and to reduce MPT demads. This example is provided to illustrate the

  17. Multimodal Sensor Fusion for Personnel Detection

    Science.gov (United States)

    2011-07-01

    Multimodal Sensor Fusion for Personnel Detection Xin Jin Shalabh Gupta Asok Ray Department of Mechanical Engineering The Pennsylvania State...have con- sidered relations taken only two at a time, but we propose to explore relations between higher order cliques as future work. D. Feature...detection,” IEEE Transactions on Pattern Analysis and Machine Intelligence, vol. 23, no. 6, pp. 577–589, 2001. [11] A. Ray , “Symbolic dynamic analysis

  18. PERSONNEL DIVISION BECOMES HUMAN RESOURCES DIVISION

    CERN Document Server

    Division des ressources humaines

    2000-01-01

    In the years to come, CERN faces big challenges in the planning and use of human resources. At this moment, Personnel (PE) Division is being reorganised to prepare for new tasks and priorities. In order to accentuate the purposes of the operation, the name of the division has been changed into Human Resources (HR) Division, with effect from 1st January 2000. Human Resources DivisionTel.73222

  19. Information Characteristics and Errors in Expectations

    DEFF Research Database (Denmark)

    Antoniou, Constantinos; Harrison, Glenn W.; Lau, Morten I.

    2017-01-01

    that the strength-weight bias affects expectations but that its magnitude is significantly lower than originally reported. Controls for nonlinear utility further reduce the bias. Our results suggest that incentive compatibility and controls for risk attitude considerably affect inferences on errors in expectations....

  20. Firewall Configuration Errors Revisited

    CERN Document Server

    Wool, Avishai

    2009-01-01

    The first quantitative evaluation of the quality of corporate firewall configurations appeared in 2004, based on Check Point FireWall-1 rule-sets. In general that survey indicated that corporate firewalls were often enforcing poorly written rule-sets, containing many mistakes. The goal of this work is to revisit the first survey. The current study is much larger. Moreover, for the first time, the study includes configurations from two major vendors. The study also introduce a novel "Firewall Complexity" (FC) measure, that applies to both types of firewalls. The findings of the current study indeed validate the 2004 study's main observations: firewalls are (still) poorly configured, and a rule-set's complexity is (still) positively correlated with the number of detected risk items. Thus we can conclude that, for well-configured firewalls, ``small is (still) beautiful''. However, unlike the 2004 study, we see no significant indication that later software versions have fewer errors (for both vendors).

  1. Beta systems error analysis

    Science.gov (United States)

    1984-01-01

    The atmospheric backscatter coefficient, beta, measured with an airborne CO Laser Doppler Velocimeter (LDV) system operating in a continuous wave, focussed model is discussed. The Single Particle Mode (SPM) algorithm, was developed from concept through analysis of an extensive amount of data obtained with the system on board a NASA aircraft. The SPM algorithm is intended to be employed in situations where one particle at a time appears in the sensitive volume of the LDV. In addition to giving the backscatter coefficient, the SPM algorithm also produces as intermediate results the aerosol density and the aerosol backscatter cross section distribution. A second method, which measures only the atmospheric backscatter coefficient, is called the Volume Mode (VM) and was simultaneously employed. The results of these two methods differed by slightly less than an order of magnitude. The measurement uncertainties or other errors in the results of the two methods are examined.

  2. Catalytic quantum error correction

    CERN Document Server

    Brun, T; Hsieh, M H; Brun, Todd; Devetak, Igor; Hsieh, Min-Hsiu

    2006-01-01

    We develop the theory of entanglement-assisted quantum error correcting (EAQEC) codes, a generalization of the stabilizer formalism to the setting in which the sender and receiver have access to pre-shared entanglement. Conventional stabilizer codes are equivalent to dual-containing symplectic codes. In contrast, EAQEC codes do not require the dual-containing condition, which greatly simplifies their construction. We show how any quaternary classical code can be made into a EAQEC code. In particular, efficient modern codes, like LDPC codes, which attain the Shannon capacity, can be made into EAQEC codes attaining the hashing bound. In a quantum computation setting, EAQEC codes give rise to catalytic quantum codes which maintain a region of inherited noiseless qubits. We also give an alternative construction of EAQEC codes by making classical entanglement assisted codes coherent.

  3. Personnel of Civil Aviation as a Systematic Formation

    OpenAIRE

    2016-01-01

    Personnel of civil aviation as a systematic formation is considered in the article. During the research the author presents scientific views on the definition of «system», reveals the essence of the organization of personnel of civil aviation as a systematic formation. Essential characteristics of the integral system of personnel of civil aviation and its systematic qualities are determined.English abstractThe personnel of civil aviation is a system organized formation of trained workers of c...

  4. TO ALL MEMBERS OF THE PERSONNEL

    CERN Multimedia

    2002-01-01

    Temporary work for children of members of the personnel During the period mid-June to mid-September 2002, there will be a limited number of vacancies for temporary work at CERN (normally unskilled work of routine nature) which will be made available to children of members of the personnel (i.e. anyone holding an employment or association contract with CERN). It should be noted that candidates must be aged between 18 and 24 inclusive on the first day of the contract, and that they must have insurance cover for both illness and accident. In view of the limited number of vacancies available, no children previously appointed at CERN under this scheme can be considered. The duration of all appointments will be 4 weeks, the allowance being CHF 1564.- for this period. Application form can be obtained from Martine PLAZA, Personnel Management Group (by using the slip below or by electronic mail to Martine.Plaza@cern.ch)) or on the web. Completed application forms must be returned to this service by 3 May 2002 at the l...

  5. To all members of the personnel

    CERN Multimedia

    2005-01-01

    Temporary work for children of members of the personnel During the period mid-June to mid-September 2005, a limited number of vacancies for temporary work at CERN (normally unskilled work of a routine nature) will be available to children of members of the personnel (i.e. anyone holding an employment or association contract with CERN). It should be noted that candidates must be aged between 18 and 24 inclusive on the first day of the contract, and that they must have insurance cover for both illness and accident. In view of the limited number of vacancies available, no children having previously worked at CERN under this scheme can be considered. The duration of all appointments will be 4 weeks and the allowance for the period will be CHF 1621.- net. Candidates should apply via the HR Department's electronic recruitment system (E-rt) : http://humanresources.web.cern.ch/humanresources/internal/personnel/pmd/cr/Staff-kids-05.pdf Completed application forms must be returned to this Service by 8 April 2005 ...

  6. TO ALL MEMBERS OF THE PERSONNEL

    CERN Multimedia

    2003-01-01

    Temporary work for children of members of the personnel During the period mid-June to mid-September 2003, there will be a limited number of vacancies for temporary work at CERN (normally unskilled work of routine nature) which will be made available to children of members of the personnel (i.e. anyone holding an employment or association contract with CERN). It should be noted that candidates must be aged between 18 and 24 inclusive on the first day of the contract, and that they must have insurance cover for both illness and accident. In view of the limited number of vacancies available, no children previously appointed at CERN under this scheme can be considered. The duration of all appointments will be 4 weeks, the allowance being CHF 1582.- for this period. Application form can be obtained from Martine PLAZA, HR Division (by electronic mail to Martine.Plaza@cern.ch) or at http://cern.ch/hr-web/internal/general/HN-personnel/ Completed application forms must be returned to this service by 2 May 2003 at t...

  7. TO ALL MEMBERS OF THE PERSONNEL

    CERN Multimedia

    2002-01-01

    Temporary work for children of members of the personnel During the period mid-June to mid-September 2002, there will be a limited number of vacancies for temporary work at CERN (normally unskilled work of routine nature) which will be made available to children of members of the personnel (i.e. anyone holding an employment or association contract with CERN). It should be noted that candidates must be aged between 18 and 24 inclusive on the first day of the contract, and that they must have insurance cover for both illness and accident. In view of the limited number of vacancies available, no children previously appointed at CERN under this scheme can be considered. The duration of all appointments will be 4 weeks, the allowance being CHF 1564.- for this period. Application form can be obtained from Martine PLAZA, Personnel Management Group (by using the slip below or by electronic mail to Martine.Plaza@cern.ch)) or on the web. Completed application forms must be returned to this service by 3 May 2002 at the l...

  8. TO ALL MEMBERS OF THE PERSONNEL

    CERN Multimedia

    2003-01-01

    Temporary work for children of members of the personnel During the period mid-June to mid-September 2003, there will be a limited number of vacancies for temporary work at CERN (normally unskilled work of routine nature) which will be made available to children of members of the personnel (i.e. anyone holding an employment or association contract with CERN). It should be noted that candidates must be aged between 18 and 24 inclusive on the first day of the contract, and that they must have insurance cover for both illness and accident. In view of the limited number of vacancies available, no children previously appointed at CERN under this scheme can be considered. The duration of all appointments will be 4 weeks, the allowance being CHF 1582.- for this period. Application form can be obtained from Martine PLAZA, HR Division (by electronic mail to Martine.Plaza@cern.ch) or at http://cern.ch/hr-web/internal/general/HN-personnel/ Completed application forms must be returned to this service by 2 May 2003 at th...

  9. TO ALL MEMBERS OF THE PERSONNEL

    CERN Multimedia

    2003-01-01

    Temporary work for children of members of the personnel During the period mid-June to mid-September 2003, there will be a limited number of vacancies for temporary work at CERN (normally unskilled work of routine nature) which will be made available to children of members of the personnel (i.e. anyone holding an employment or association contract with CERN). It should be noted that candidates must be aged between 18 and 24 inclusive on the first day of the contract, and that they must have insurance cover for both illness and accident. In view of the limited number of vacancies available, no children previously appointed at CERN under this scheme can be considered. The duration of all appointments will be 4 weeks, the allowance being CHF 1582.- for this period. Application form can be obtained from Martine PLAZA, HR Division (by using the slip in the bulletin or by electronic mail to Martine.Plaza@cern.ch) or at http://cern.ch/hr-web/internal/general/HN-personnel/ Completed application forms must be returne...

  10. Types and causes of medication errors from nurse's viewpoint.

    Science.gov (United States)

    Cheragi, Mohammad Ali; Manoocheri, Human; Mohammadnejad, Esmaeil; Ehsani, Syyedeh R

    2013-05-01

    The main professional goal of nurses is to provide and improve human health. Medication errors are among the most common health threatening mistakes that affect patient care. Such mistakes are considered as a global problem which increases mortality rates, length of hospital stay, and related costs. This study was conducted to evaluate the types and causes of nursing medication errors. This cross-sectional study was conducted in 2009. A total number of 237 nurses were randomly selected from nurses working in Imam Khomeini Hospital (Tehran, Iran). They filled out a questionnaire including 10 items on demographic characteristics and 7 items about medication errors. Data were analyzed using descriptive and inferential statistics in SPSS for Windows 16.0. Medication errors had been made by 64.55% of the nurses. In addition, 31.37% of the participants reported medication errors on the verge of occurrence. The most common types of reported errors were wrong dosage and infusion rate. The most common causes were using abbreviations instead of full names of drugs and similar names of drugs. Therefore, the most important cause of medication errors was lack of pharmacological knowledge. There were no statistically significant relationships between medication errors and years of working experience, age, and working shifts. However, a significant relationship was found between errors in intravenous injections and gender. Likewise, errors in oral administration were significantly related with number of patients. Medication errors are a major problem in nursing. Since most cases of medication errors are not reported by nurses, nursing managers must demonstrate positive responses to nurses who report medication errors in order to improve patient safety.

  11. A Six Sigma Trial For Reduction of Error Rates in Pathology Laboratory.

    Science.gov (United States)

    Tosuner, Zeynep; Gücin, Zühal; Kiran, Tuğçe; Büyükpinarbaşili, Nur; Turna, Seval; Taşkiran, Olcay; Arici, Dilek Sema

    2016-01-01

    A major target of quality assurance is the minimization of error rates in order to enhance patient safety. Six Sigma is a method targeting zero error (3.4 errors per million events) used in industry. The five main principles of Six Sigma are defining, measuring, analysis, improvement and control. Using this methodology, the causes of errors can be examined and process improvement strategies can be identified. The aim of our study was to evaluate the utility of Six Sigma methodology in error reduction in our pathology laboratory. The errors encountered between April 2014 and April 2015 were recorded by the pathology personnel. Error follow-up forms were examined by the quality control supervisor, administrative supervisor and the head of the department. Using Six Sigma methodology, the rate of errors was measured monthly and the distribution of errors at the preanalytic, analytic and postanalytical phases was analysed. Improvement strategies were reclaimed in the monthly intradepartmental meetings and the control of the units with high error rates was provided. Fifty-six (52.4%) of 107 recorded errors in total were at the pre-analytic phase. Forty-five errors (42%) were recorded as analytical and 6 errors (5.6%) as post-analytical. Two of the 45 errors were major irrevocable errors. The error rate was 6.8 per million in the first half of the year and 1.3 per million in the second half, decreasing by 79.77%. The Six Sigma trial in our pathology laboratory provided the reduction of the error rates mainly in the pre-analytic and analytic phases.

  12. Experimental repetitive quantum error correction.

    Science.gov (United States)

    Schindler, Philipp; Barreiro, Julio T; Monz, Thomas; Nebendahl, Volckmar; Nigg, Daniel; Chwalla, Michael; Hennrich, Markus; Blatt, Rainer

    2011-05-27

    The computational potential of a quantum processor can only be unleashed if errors during a quantum computation can be controlled and corrected for. Quantum error correction works if imperfections of quantum gate operations and measurements are below a certain threshold and corrections can be applied repeatedly. We implement multiple quantum error correction cycles for phase-flip errors on qubits encoded with trapped ions. Errors are corrected by a quantum-feedback algorithm using high-fidelity gate operations and a reset technique for the auxiliary qubits. Up to three consecutive correction cycles are realized, and the behavior of the algorithm for different noise environments is analyzed.

  13. Register file soft error recovery

    Science.gov (United States)

    Fleischer, Bruce M.; Fox, Thomas W.; Wait, Charles D.; Muff, Adam J.; Watson, III, Alfred T.

    2013-10-15

    Register file soft error recovery including a system that includes a first register file and a second register file that mirrors the first register file. The system also includes an arithmetic pipeline for receiving data read from the first register file, and error detection circuitry to detect whether the data read from the first register file includes corrupted data. The system further includes error recovery circuitry to insert an error recovery instruction into the arithmetic pipeline in response to detecting the corrupted data. The inserted error recovery instruction replaces the corrupted data in the first register file with a copy of the data from the second register file.

  14. 32 CFR 154.42 - Evaluation of personnel security information.

    Science.gov (United States)

    2010-07-01

    ... 32 National Defense 1 2010-07-01 2010-07-01 false Evaluation of personnel security information... SECURITY DEPARTMENT OF DEFENSE PERSONNEL SECURITY PROGRAM REGULATION Adjudication § 154.42 Evaluation of personnel security information. (a) The criteria and adjudicative policy to be used in applying...

  15. CONTROLLING OF THE PERSONNEL IN SYSTEM OF MANAGEMENT

    Directory of Open Access Journals (Sweden)

    N.A. Golovin

    2008-12-01

    Full Text Available The article focuses on the issue of controlling the personnel and their objectives. The special work conditions of bank officers are also identified. The author presents his own concept about controlling the bank personnel. The main aspects of analysis of personnel controlling are specified for the bank management system.

  16. 76 FR 5729 - Department of Defense Personnel Security Program (PSP)

    Science.gov (United States)

    2011-02-02

    ... of the Secretary 32 CFR Part 156 Department of Defense Personnel Security Program (PSP) AGENCY... for the Department of Defense (DoD) Personnel Security Program (PSP) in accordance with the provisions... Department of Defense Directive (DoDD) 5200.2, Personnel Security Program (PSP), codified at 32 CFR 156,...

  17. 46 CFR 4.03-6 - Qualified medical personnel.

    Science.gov (United States)

    2010-10-01

    ... 46 Shipping 1 2010-10-01 2010-10-01 false Qualified medical personnel. 4.03-6 Section 4.03-6 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY PROCEDURES APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Definitions § 4.03-6 Qualified medical personnel. The term qualified medical personnel means a physician, physician's...

  18. Work stress and health effects among university personnel.

    NARCIS (Netherlands)

    Donders, N.C.G.M.; Gulden, J.W.J. van der; Furer, J.W.; Tax, L.C.M.M.; Roscam Abbing, E.W.

    2003-01-01

    OBJECTIVE. (1) To investigate the contribution of job characteristics and personal characteristics to the explanation of health effects among university personnel; (2) to investigate the differences between scientific personnel (SP) and non-scientific personnel (NSP); (3) to investigate whether heal

  19. 49 CFR 1542.217 - Law enforcement personnel.

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 9 2010-10-01 2010-10-01 false Law enforcement personnel. 1542.217 Section 1542... Law enforcement personnel. (a) Each airport operator must ensure that law enforcement personnel used... section must— (1) Meet the training standard for law enforcement officers prescribed by either the State...

  20. 49 CFR 1542.219 - Supplementing law enforcement personnel.

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 9 2010-10-01 2010-10-01 false Supplementing law enforcement personnel. 1542.219... Operations § 1542.219 Supplementing law enforcement personnel. (a) When TSA decides, after being notified by... private law enforcement personnel are available to carry out the requirements of § 1542.215, TSA may...