This paper proposes an amendment of the classification of safety events based on their controllability and contemplates the potential of an event to escalate into higher severity classes. It considers (1) whether the end-user had the opportunity to intervene into the course of an event, (2) the level of end-user familiarity with the situation, and (3) the positive or negative effects of end-user intervention against expected outcomes. To examine its potential, we applied the refined classification to 296 aviation safety investigation reports. The results suggested that pilots controlled only three-quarters of the occurrences, more than three-thirds of the controlled cases regarded fairly unfamiliar situations, and the flight crews succeeded to mitigate the possible negative consequences of events in about 71% of the cases. Further statistical tests showed that the controllability-related characteristics of events had not significantly changed over time, and they varied across regions, aircraft, operational and event characteristics, as well as when fatigue had contributed to the occurrences. Overall, the findings demonstrated the value of using the controllability classification before considering the actual outcomes of events as means to support the identification of system resilience and successes. The classification can also be embedded in voluntary reporting systems to allow end-users to express the degree of each of the controllability characteristics so that management can monitor them over time and perform internal and external benchmarking. The mandatory reports concerned, the classification could function as a decision-making parameter for prioritising incident investigations.
DOCUMENT
Cervical spinal manipulations (CSM) are frequently employed techniques to alleviate neck pain and headache. Minor and major complications following CSM have been described, though clear consensus on definition and the classification of the complications had not yet been achieved. As a result, incidence rates may be underestimated. The aim of this study was to develop a consensus-based classification of adverse events following cervical spinal manipulations which has good feasibility in clinical practice and research. Design: A three round Delphi-study. Medical specialists, manual therapists, and patients (n=30) participated in an online survey. In Round 1, participants were invited to select a classification system of adverse events. Potential complications were inventoried and detailed in accordance with the ICF and the ICD-10. In Round 2, panel members categorized the potential complications in their selected classification. During the third round, it was inquired of the participants whether they concurred with the answer of the majority of participants. Results: Thirty four complications were defined. Consensus was achieved for 29 complications for all durations [hours, days, weeks]. For the remaining five complications, consensus was reached for two of the three durations [hours, days, weeks]. Conclusions: A consensus-based classification system of adverse events after cervical spinal manipulation was developed which comprises patients’ and clinicians’ perspectives and has only a small number of categories. The classification system includes a precise description of potential adverse events and is based on international accepted classifications (ICD-10 and ICF). This classification system may be useful for utilization in both clinical practice and research.
DOCUMENT
The Junior Adverse Drug Event Manager (J-ADEM) team is a multifaceted intervention focusing on real-life education for medical students that has been shown to assist healthcare professionals in managing and reporting suspected adverse drug reactions (ADRs) to the Netherlands Pharmacovigilance Centre Lareb. The aim of this study was to quantify and describe the ADRs reported by the J-ADEM team and to determine the clinical potential of this approach. The J-ADEM team consisted of medical students tasked with managing and reporting ADRs in hospitalized patients. All ADRs screened and reported by J-ADEM team were recorded anonymously, and categorized and analysed descriptively. From August 2018 through January 2020, 209 patients on two wards in an academic hospital were screened for ADR events. The J-ADEM team reported 101 ADRs. Although most ADRs (67%) were first identified by healthcare professionals and then reported by the J-ADEM team, the team also reported an additional 33 not previously identified serious ADRs. In 10% of all reported ADRs, the J-ADEM team helped optimize ADR treatment. The ADR reports were largely well-documented (78%), and ADRs were classified as type A (66%), had a moderate or severe severity (85%) and were predominantly avoidable reactions (69%). This study shows that medical students are able to screen patients for ADRs, can identify previously undetected ADRs and can help optimize ADR management. They significantly increased (by 300%) the number of ADR reports submitted, showing that the J-ADEM team can make a valuable clinical contribution to hospital care.
MULTIFILE
Most safety oriented organizations have established their accidents classification taking into account the magnitude of the combined adverse outcomes on humans, assets and the environment without considering the accidents‟ potential and the actual attempts of the involved persons to intervene with the accident progress. The specific research exploited a large sample of an aviation organization accident records for an11 years‟ time period and employed frequency and chi-square analyses to test a new accident classification scheme based on the distinction among the safety events with or without human intervention on the accident scene, indicating the management or not of their ultimate consequences. Furthermore, the research depicted the effectiveness of personnel strains to alleviate the accident potential outcomes and studied the contribution of time, local and complexity factors on the accident control attempt and the humans‟ positive or negative interference. The specific newly proposed accident classification successfully addressed the “controlled” or “uncontrolled” traits of the safety events studies, prior their severities consideration, and unveiled the effectiveness of personnel efforts to compensate for the adverse accident march. The portion between controlled and uncontrolled accidents in terms of the human intervention along with the effectiveness of the later may comprise a useful safety performance indicator that can be adopted by any industry sector and may be recommended through international and state safety related authorities.
DOCUMENT
Objectives Patients who underwent corrective surgery for tetralogy of Fallot (TOF) have increased long-term risk of cardiovascular morbidity and mortality. Yet, limited information is available on how to evaluate the risk in this population. Therefore, the aim of this study was to investigate the prognostic value of aerobic exercise capacity, along with other related parameters, at medium-term follow-up in adult patients with tetralogy of Fallot. Methods and results Between 2000 and 2003, 92 adults (age 26.2 ± 7.8 years; 63 male) with corrected TOF or TOF-type morphology underwent a cardiopulmonary exercise test (CPET) until exhaustion and echocardiography. During a mean follow-up of 7.3 ± 1.2 years (range 0.9 to 9.3 years), 2 patients died and 26 patients required at least 1 cardiac-related intervention at a mean age of 28.9 ± 7.9 years. Event-free survival tended to be higher in patients with the classical type of TOF (P = 0.061). At multivariate Cox analysis, age at CPET [hazard ratio (HR): 1.13, P = 0.006], age at correction (HR: 0.82, P = 0.037), right ventricular (RV) function (HR: 4.94, P = 0.001), QRS duration (HR: 1.02, P = 0.007), percentage of predicted peak oxygen uptake (peak VO2%) (HR: 0.96, P = 0.029) and ventilatory effi ciency slope (VE/VCO2 slope) (HR: 1.13, P = 0.021) were signifi cantly related to the incidence of death/cardiac-related intervention during medium follow-up. Conclusions Early corrective surgery and a well-preserved RV are associated with a better outcome in adults with corrected TOF. Furthermore, CPET provides important prognostic information; peak VO2% and VE/VCO2 slope are independent predictors for event-free survival in patients with corrected TOF.
DOCUMENT
Current practice regarding risk assessment contemplates the severity and likelihood of risks and employs the use of matrices where these factors are classified and cross-referenced to evaluate risk levels. Depending on the adequacy and reliability of data, the likelihood is estimated with quantitative or qualitative methods; severity is estimated according to experience from past events. This standard technique for assessing risks has been negatively criticised regarding validity and reliability due to effects of cognitive biases and a deterministic view of the possible consequences of risks. Even more, because of the lack of standardisation in risk matrices, a benchmarking across systems and organisations is not feasible. Taking into account the limitations mentioned, as well as the fact that the classification of hazards/causal factors, risk event(s) and consequences always depend on the analyst's view, this study proposes the Safety Risk Avoidance Capability (SAREAC) metric for a defined system. This metric focus on the prevention of risk events and combines quantitative and qualitative parameters referred in the literature but not yet exploited. SAREAC consists of two parts: the influence of hazards and the remaining effects of hazards after implementing or designing controls. Each of the SAREAC parts is calculated through specific steps which they result in a normalized score that allows more reliable comparisons amongst systems or over time. Data from a published risk assessment case study were used to demonstrate the use of SAREAC.
DOCUMENT
Due to a lack of transparency in both algorithm and validation methodology, it is diffcult for researchers and clinicians to select the appropriate tracker for their application. The aim of this work is to transparently present an adjustable physical activity classification algorithm that discriminates between dynamic, standing, and sedentary behavior. By means of easily adjustable parameters, the algorithm performance can be optimized for applications using different target populations and locations for tracker wear. Concerning an elderly target population with a tracker worn on the upper leg, the algorithm is optimized and validated under simulated free-living conditions. The fixed activity protocol (FAP) is performed by 20 participants; the simulated free-living protocol (SFP) involves another 20. Data segmentation window size and amount of physical activity threshold are optimized. The sensor orientation threshold does not vary. The validation of the algorithm is performed on 10 participants who perform the FAP and on 10 participants who perform the SFP. Percentage error (PE) and absolute percentage error (APE) are used to assess the algorithm performance. Standing and sedentary behavior are classified within acceptable limits (+/- 10% error) both under fixed and simulated free-living conditions. Dynamic behavior is within acceptable limits under fixed conditions but has some limitations under simulated free-living conditions. We propose that this approach should be adopted by developers of activity trackers to facilitate the activity tracker selection process for researchers and clinicians. Furthermore, we are convinced that the adjustable algorithm potentially could contribute to the fast realization of new applications.
DOCUMENT
We examined the neural correlates of facial attractiveness by presenting pictures of male or female faces (neutral expression) with low/intermediate/high attractiveness to 48 male or female participants while recording their electroencephalogram (EEG). Subjective attractiveness ratings were used to determine the 10% highest, 10% middlemost, and 10% lowest rated faces for each individual participant to allow for high contrast comparisons. These were then split into preferred and dispreferred gender categories. ERP components P1, N1, P2, N2, early posterior negativity (EPN), P300 and late positive potential (LPP) (up until 3000 ms post-stimulus), and the face specific N170 were analysed. A salience effect (attractive/unattractive > intermediate) in an early LPP interval (450–850 ms) and a long-lasting valence related effect (attractive > unattractive) in a late LPP interval (1000–3000 ms) were elicited by the preferred gender faces but not by the dispreferred gender faces. Multi-variate pattern analysis (MVPA)-classifications on whole-brain single-trial EEG patterns further confirmed these salience and valence effects. It is concluded that, facial attractiveness elicits neural responses that are indicative of valenced experiences, but only if these faces are considered relevant. These experiences take time to develop and last well beyond the interval that is commonly explored.
MULTIFILE
The term crowdsourcing was introduced by Jeff Howe (2006). It is the act of a company or organisation to take a function once performed by employees and outsourcing it to an undefined, and usually large, network of people in the form of an open call. As communication tools to organize work have become widely available, and a well-educated global work force has come online, crowdsourcing has become an increasingly important mechanism to organize work. We discuss a categorisation of crowdsourcing, its costs and benefits and several examples. The use of crowdsourcing begins with the question which strategic goal an organisation wants to achieve, and whether the benefits outweigh the costs. We give some recommendations for adopting crowdsourcing. This usually requires a certain amount of restructuring of existing workflows and a willingness to become more open which may or may not be a welcome side effect.
DOCUMENT
Individual and unorganized sports with a health-related focus, such as recreational running, have grown extensively in the last decade. Consistent with this development, there has been an exponential increase in the availability and use of electronic monitoring devices such as smartphone applications (apps) and sports watches. These electronic devices could provide support and monitoring for unorganized runners, who have no access to professional trainers and coaches. The purpose of this paper is to gain insight into the characteristics of event runners who use running-related apps and sports watches. This knowledge is useful from research, design, and marketing perspectives to adequately address unorganized runners’ needs, and to support them in healthy and sustainable running through personalized technology. Data used in this study are drawn from the standardized online Eindhoven Running Survey 2014 (ERS14). In total, 2,172 participants in the Half Marathon Eindhoven 2014 completed the questionnaire (a response rate of 40.0%). Binary logistic regressions were used to analyze the impact of socio-demographic variables, running-related variables, and psychographic characteristics on the use of running-related apps and sports watches. Next, consumer profiles were identified. The results indicate that the use of monitoring devices is affected by socio-demographics as well as sports-related and psychographic variables, and this relationship depends on the type of monitoring device. Therefore, distinctive consumer profiles have been developed to provide a tool for designers and manufacturers of electronic running-related devices to better target (unorganized) runners’ needs through personalized and differentiated approaches. Apps are more likely to be used by younger, less experienced and involved runners. Hence, apps have the potential to target this group of novice, less trained, and unorganized runners. In contrast, sports watches are more likely to be used by a different group of runners, older and more experienced runners with higher involvement. Although apps and sports watches may potentially promote and stimulate sports participation, these electronic devices do require a more differentiated approach to target specific needs of runners. Considerable efforts in terms of personalization and tailoring have to be made to develop the full potential of these electronic devices as drivers for healthy and sustainable sports participation.
DOCUMENT
