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Resumen Los fracasos y complicaciones en el campo de la cirugía bucal son analizados generalmente desde un punto de vista técnico o biológico. En términos generales, a partir del espíritu fragmentario del conocimiento, se tiende a enfocar la atención odontológica en la parte técnica y teórica. Actualmente se están produciendo cambios socioculturales que están generando modificaciones en los paradigmas de la atención odontológica, considerando también la comunicación con el paciente y la situación psicológica tanto del paciente como del equipo profesional. En este editorial se busca reflexionar sobre estos temas analizando perspectivas más integradas para lograr un mayor equilibrio en la atención profesional.
Abstract Failures and complications in the field of oral surgery are generally analyzed from a technical or biological point of view. In general terms, based on the fragmentary spirit of knowledge, dental care tends to be focused on the technical and theoretical knowledge. We are currently witnessing sociocultural changes that are producing modifications in the paradigms of dental care, also considering communication with the patient and the psychological situation of both the patient and the professional team. This editorial seeks to reflect on these issues, considering the most integrated visions to achieve greater balance in professional care.
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The problem of safe obstetrical care has special relevance in recent years due to the interest of health professionals in reducing adverse events and improving healthcare. However, this is pursued in complex, uncertain and variable scenarios and risks, where human behavior may increase the probability of error. We often have to make short term decisions when attending two patients simultaneously - mother and fetus-, and the mother expects a deferential treatment during pregnancy, delivery and the puerperium. These processes involve multiple activities and tasks, and failures may occur. Faced with the paradigm change of involving the patient in the care and decision making process, we have to provide them with the most complete evidence, to avoid contingencies and to obtain the best possible results.
En los últimos años, el problema de la seguridad de la atención en obstetricia ha tenido especial relevancia debido al interés de los profesionales de la salud en reducir los eventos adversos y mejorar su atención. Sin embargo, esta se realiza en escenarios de complejidad variable e incertidumbre, donde existen riesgos múltiples y el comportamiento del factor humano es proclive a incrementar la probabilidad de errores. Al atenderse dos pacientes simultáneamente -la madre y el feto-, en muchos casos debemos tomar decisiones a corto plazo y la madre espera un trato deferencial con expectativa permanente en cualquiera de los momentos de la atención prenatal, parto y puerperio. Estos procesos involucran excesivas actividades y tareas donde la frecuencia de fallas es significativamente alta. Ante el cambio de paradigma, donde el paciente es involucrado en el proceso de atención y colabora en la toma de decisiones, debemos de brindar la información más completa, basada en la mejor evidencia, para evitar eventos adversos prevenibles y lograr los mejores resultados.
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The purpose of this study is to compare the differences among neck muscle fatigue evaluation algorithms and to find a more effective algorithm which can provide a human factor quantitative evaluation method for neck muscle fatigue during bending over the desk. We collected surface electromyography signal of sternocleidomastoid muscle of 15 subjects using wireless physiotherapy Bio-Radio when they bent over the desk using memory pillows for 12 minutes. Five algorithms including mean power frequency, spectral moments ratio, discrete wavelet transform, fuzzy approximation entropy and the complexity algorithms were used to calculate the corresponding muscle fatigue index. The least squares method was used to calculate the corresponding coefficient of determination and slope of the linear regression of the muscle fatigue metric. The coefficient of determination evaluates anti-interference ability of algorithms. The maximum vertical distance which is obtained by the Kolmogorov-Smirnov test for the slopes evaluates the ability to distinguish fatigue of algorithms. The results indicate that in the aspect of anti-interference ability, the fuzzy approximation entropy has the largest when using memory pillows with different heights. When the fuzzy approximate entropy is compared with average power frequency or the discrete wavelet transform, the differences are significant ( < 0.05). In terms of distinguishing the degree of fatigue, the approximate entropy is still the largest, with a maximum of 0.496 7. Fuzzy approximation entropy is superior to other algorithms in ability of anti-interference and distinguishing fatigue. Therefore, fuzzy approximation entropy can be used as a better evaluation algorithm in the evaluation of cervical muscle fatigue.
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BACKGROUND: The mining industry is known worldwide for its highly risky and hazardous working environment. Technological advancement in ore extraction techniques for proliferation of production levels has caused further concern for safety in this industry. Research so far in the area of safety has revealed that the majority of incidents in hazardous industry take place because of human error, the control of which would enhance safety levels in working sites to a considerable extent. METHODS: The present work focuses upon the analysis of human factors such as unsafe acts, preconditions for unsafe acts, unsafe leadership, and organizational influences. A modified human factor analysis and classification system (HFACS) was adopted and an accident predictive fuzzy reasoning approach (FRA)-based system was developed to predict the likelihood of accidents for manganese mines in India, using analysis of factors such as age, experience of worker, shift of work, etc. RESULTS: The outcome of the analysis indicated that skill-based errors are most critical and require immediate attention for mitigation. The FRA-based accident prediction system developed gives an outcome as an indicative risk score associated with the identified accident-prone situation, based upon which a suitable plan for mitigation can be developed. CONCLUSION: Unsafe acts of the worker are the most critical human factors identified to be controlled on priority basis. A significant association of factors (namely age, experience of the worker, and shift of work) with unsafe acts performed by the operator is identified based upon which the FRA-based accident prediction model is proposed.
Subject(s)
Humans , Classification , India , Leadership , Manganese , Mining , Risk AssessmentABSTRACT
A 62-year-old woman with severe aortic stenosis underwent apicoaortic bypass grafting. The graft was implanted inversely at first ; on the next day, it was re-implanted in the right direction. She recovered once from heart failure ; however, on postoperative day (POD) 74, she died from respiratory failure. On POD 16, an in-house multidisciplinary investigatory commission reviewed the human factors that had led to the surgical error. Throughout the investigation, we provided relevant information about the event and explanations. We presented our apologies the patient's family and offered to compensate them for their losses.
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El uso de dispositivos médicos en el hogar, originalmente diseñados para uso hospitalario, ha aumentado. Su uso es complejo e inseguro debido a la inexperiencia del usuario y el entorno no controlado. El objetivo de este estudio es evaluar la seguridad en el uso de este tipo de dispositivos a través de la creación de un modelo conceptual que identifica los riesgos que podrían surgir para un grupo de usuarios inexpertos que los operan. A través de un estudio de usabilidad y siguiendo la metodología Grounded Theory se identificaron problemas y errores que emergen a través del uso en el hogar de dos dispositivos médicos distintos con la finalidad de crear un modelo conceptual. El modelo conceptual obtenido es representado en una herramienta de evaluación, que permite a los interesados identificar el dispositivo médico más apropiado para un usuario específico, detectando las debilidades que pueden llevar a un uso inseguro. La herramienta creada efectivamente permite detectar las características de riesgo, considerando cada situación particular de uso.
The use of medical devices in the home environment, originally designed for hospital use has increased. Its use is complex and uncertain because of the inexperience of the lay user and the uncontrolled environment. The objective of this study is to evaluate the safety in the use of these devices through the creation of a conceptual model that identifies the risks that could arise for a group of lay users who operate them. Through a usability study and following the Grounded Theory methodology problems and errors were identified emerging through the home use of two different medical devices in order to create a conceptual model. The conceptual model obtained is reified as an evaluation tool that allows stakeholders to identify the most suitable medical device for a specific user, detecting the weaknesses that may lead to an unsafe use. The evaluation tool created effectively allows detecting risky characteristics, considering the particular situation of use.
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OBJECTIVES: There has been continuous development in the area of stereoscopic medical imaging devices, and many stereoscopic imaging devices have been realized and applied in the medical field. In this article, we review past and current trends pertaining to the application stereo-imaging technologies in the medical field. METHODS: We describe the basic principles of stereo vision and visual issues related to it, including visual discomfort, binocular disparities, vergence-accommodation mismatch, and visual fatigue. We also present a brief history of medical applications of stereo-imaging techniques, examples of recently developed stereoscopic medical devices, and patent application trends as they pertain to stereo-imaging medical devices. RESULTS: Three-dimensional (3D) stereo-imaging technology can provide more realistic depth perception to the viewer than conventional two-dimensional imaging technology. Therefore, it allows for a more accurate understanding and analysis of the morphology of an object. Based on these advantages, the significance of stereoscopic imaging in the medical field increases in accordance with the increase in the number of laparoscopic surgeries, and stereo-imaging technology plays a key role in the diagnoses of the detailed morphologies of small biological specimens. CONCLUSIONS: The application of 3D stereo-imaging technology to the medical field will help improve surgical accuracy, reduce operation times, and enhance patient safety. Therefore, it is important to develop more enhanced stereoscopic medical devices.
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Asthenopia , Depth Perception , Diagnostic Imaging , Laparoscopy , Patient Safety , Vision Disparity , Vision, OcularABSTRACT
We explored the potential of fusion of hepatic locus control region 1 (HCR-1) with HCR-2 to express B-domain-deleted human factor VIII (FVIII) in four cell lines. B-domain-deleted human FVIII expression was controlled by HCR-1/HCR-2, followed by liver specific and ubiquitous promoters. Chimera enhancer HCR-1/HCR-2, followed by cytomegalovirus (CMV) promoter, gave 2-fold more FVIII expression in all cell lines (105.6 ± 2.8 for Hek-293, 68.8 ± 3.8 for HepG2, 34.8 ± 1.3 for CHO, and 27.2 ± 1.6 ng-mL-1-106 cells-1 for L.N.) when compared to the vector with CMV alone (54.8 ± 3.3 for Hek-293, 32.4 ± 1.2 for HepG2, 18.6 ± 1.1 for CHO, and 10.1 ± 1.7 ng-mL-1-106 cells-1 for L.N.). Elongation factor 1-α gene and human CMV promoters were more efficient than the promoters from the human α-1-antitrypsin gene, and fviii was less efficient in hepatic cell lines. HCR-1/HCR-2, followed by strong promoters, increases FVIII expression in vitro. Our results underscore the importance of cis sequences for enhancing in vitro FVIII expression; this may be helpful for designing new strategies to improve heterologous expression systems.
Subject(s)
Humans , Animals , Enhancer Elements, Genetic/genetics , Factor VIII/genetics , Promoter Regions, Genetic/genetics , Genetic Vectors/genetics , Cell Line , Cell Line, Tumor , CHO Cells , Cricetinae , Cricetulus , Cytomegalovirus/genetics , Factor VIII/metabolism , Immunohistochemistry , Microscopy, Fluorescence , Plasmids , Recombinant Fusion Proteins/genetics , Recombinant Fusion Proteins/metabolism , Green Fluorescent Proteins/genetics , Green Fluorescent Proteins/metabolism , Reverse Transcriptase Polymerase Chain ReactionABSTRACT
BACKGROUND: Hemophilia B is an inheritable X-linked bleeding disorder that occurs as a consequence of genetic alterations within the factor IX (IX) gene. In the present study, pseudotyped HIV-I-derived lentiviral vectors expressing human IX (lentivirus-IX) were assessed for the ability to produce an active human IX in the animals transduced with lentivirus-IX. METHODS: The IX concentrations and activated partial thromboplastin times (aPTT) were measured from the supernatants of HeLa cells that were transduced with lentivirus-IX. In an animal study, we injected 1microgram of lentivirus-IX into the hind limbs of Sparague-Dawley (SD) rats. The IX concentrations were measured from the plasma of the vehicle injected rats and the plasma of the lentivirus-IX injected rats for 8 weeks. RESULTS: The in vitro expression of human IX was detected in a dose-dependent manner following the transduction of lentivirus-IX into the HeLa cells (control: 10+/-3 vs. 100 ng of lentivirus-IX: 1486+/-50 ng/mL, P<0.05). The aPTT also showed the tendency of dose-dependent decrease (control: 83.9+/-0.5 vs. 50 ng of lentivirus-IX: 80.1+/- 0.8 sec), but this was not statistically significant. In the animal experiment, the plasma IX concentration from the lentivirus-IX transduced rats (n=3) was significantly increased compared to the vehicle-injected rats (n=4) (5.9+/-3.9 vs. 46.4+/-20.6 ng/mL) at post-injection 1 week. CONCLUSION: This study demonstrated that in vivo delivery of lentiviral vectors expressing human IX to the muscle cells has the potential to be a therapeutic modality for hemophilia B.
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Animals , Humans , Rats , Animal Experimentation , Blood Coagulation Factors , Extremities , Factor IX , Genetic Therapy , HeLa Cells , Hemophilia A , Hemophilia B , Hemorrhage , Lentivirus , Muscle Cells , Plasma , ThromboplastinABSTRACT
OBJECTIVE: This study investigated the driving habits of taxi drivers, in order to examine the characteristics of human factors causing traffic accidents and unsafe driving behavior and to determine any relevancy among them. METHOD: Taxi drivers (N=335) answered a questionnaire investigating various measures of human factors, unsafe driving behaviors, and number of traffic accident experiences in the previous year. In factor analysis, the characteristics of human factors were classified into 5 common factors: job, mental health, age, health habit and sleep factor. A contextual mediated model was proposed to distinguish the distal (5 common factors) and proximal (unsafe driving behaviors) factors in predicting traffic accident involvement by hierarchical multiple regression. RESULT: In hierarchical multiple regression, job factor(beta: 0.122), sleep factor (beta: 0.114) and unsafe driving behaviors (beta: 0.018) yielded a direct effect on the rate of traffic accidents. Mental health factor beta: 6.429), job factor (beta: 1.319) and health habit factor(beta: 1.177) yielded a indirect effect on the rate of traffic accidents by unsafe driving behaviors. CONCLUSION: Various human factors co-related by the unique characteristics that exist in the taxi service industry have significant effects on the rate of traffic accidents mediated by unsafe driving behaviors. Therefore a proper countermeasure against these factors should be established in order to effectively reduce the rate of taxi accidents.
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Humans , Accidents, Traffic , Mental Health , Surveys and QuestionnairesABSTRACT
Medical defects are the main reason for medical disputes,also the important factors which influence the health care order and medical service quality and cause tension between doctors and patients. The occurrence of medical defects highlights deficiency of humanism. We should reinforce liberal education in the medical services and medical education,prevent the occurrence of medical defects fundamentally,and improve the quality of medical services comprehensively.
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Flightdeck behaviour and flight safety are influenced by the national, organizational, and professional cultures of crewmembers. National complexity of the operating environment ensure that error will be an inevitable occurrence. The influences of three cultures that are relevant to the cockpit are described; the professional culture of the pilots, organizational cultures, and the national cultures surrounding individuals and their organizations. This study review the cultural difference of crewmember in Korea based on Hofstede and Helmreich study. The study concludes with a suggestion of CRM in Korea as strategy necessary for a safety culture considering the multi-cultures cockpit.
Subject(s)
Humans , Korea , Organizational Culture , TransportationABSTRACT
The causes of aviation accidents are not simple. Human error could possibly be caused by outside factors such as an environmental factor, laws and regulations, organizational, and national culture. An approach to an organizational factor on safety management and aircraft accident investigation is indispensable to improve aviation safety. Data collection from diversified sources is very important. Therefore, safety management focuses on safety inspections within the organization, and understanding the organization and employees' culture. Data from people who work in the aviation field must be merged with information technology to produce information and knowledge. Decision and policy making must be executed using knowledge-based aviation information. Policy makers must make it a priority to create an infrastructure for collecting data, transforming the data to information and the using information knowledge in amending aviation acts and regulations. The system that uses the infrastructure is composed of data collection from multi-channel, analysis and feedback to understand different culture organization-to-organization and country-to-country factors. Policy must be established and be enforced using this system to make it function positively. This study is a fundamental research to enhance aviation safety and to improve Korea's aviation acts and regulations.