Human error and violation of rules in industrial safety: A systematic literature review.

BACKGROUND: Human error and violation of rules are perceived as deviations from some desired behavior, appearing variably in literature as either similar or opposing concepts. Behavioral deviations may be linked to accidents or considered a protective factor against them. OBJECTIVE: This article aims to explore definitions, characteristics, classifications, and management approaches for behavioral deviations, specifically human error and violation of rules. METHODS: A systematic literature review was conducted. RESULTS: The authors differ in defining and classifying error and violation, associating them with generation of accidents or their prevention. The management proposals for deviations highlighted by the authors were emphasized. CONCLUSION: The findings of this article reinforce the prominence of authors Jens Rasmussen and James Reason in the field. They assert that deviations are a natural aspect of the work process and even serve as a preventive factor against accidents, although their frequent association with accidents remains common in organizations. This study contributes to theoretical understanding by systematizing prevalent perspectives on deviation, human error, and violation of rules. It proposes a taxonomy and emphasizing the need for managing deviations, rather than combating them, especially in an organizational context.

Innovation, systemic appropriation and prevention in the granite mining sector: The case of humidification.

BACKGROUND: This research was conducted in the Brazilian granite mining sector. After epidemiological studies, it was established that professional pneumoconiosis is related to the inhalation of dust. Therefore, the Brazilian mining health and safety regulatory standard made it compulsory to provide humidification throughout the extraction and mineral treatment processes. OBJECTIVE: To develop the concept of systemic appropriation of the technological innovations that aim to protect the worker's health. Until now, appropriation has usually been presented in its individual dimensions. In this article, the focus is placed on the collective and organizational aspects of this appropriation. METHODS: Two methodological approaches were used: interviews with the different individuals involved in order to report the history of the implementation of technical devices which meet the humidification norm; and ergonomic analysis of the work of the operators who used these devices. RESULTS: The appropriation of the technical devices occurred at two distinct levels: 1) Individual, related to the direct contact of the operator with the instrument; 2) Systemic, as the effects of the innovation propagated through the system affecting interdependent tasks, adaptation of the work organization and new production strategies. CONCLUSIONS: The implementation of prevention norms require innovations which are necessarily accompanied by transformations in the companies' techniques, work and management.

[Therapeutic Aggressiveness and Liquid Oncology]. / La Agresividad Terapéutica y la Oncología Líquida.

Aggressiveness criteria proposed in the scientific literature a decade ago provide a quality judgment and are a reference in the care of patients with advanced cancer, but their use is not generalized in the evaluation of Oncology Services. In this paper we analyze the therapeutic aggressiveness, according to standard criteria, in 1.001 patients with advanced cancer who died in our Institution between 2010 and 2013. The results seem to show that aggressiveness at the end of life is present more frequently than experts recommend. About 25% of patients fulfill at least one criterion of aggressiveness. This result could be explained by a liquid Oncology which does not prioritize the patient as a moral subject in the clinical appointment. Medical care is oriented to necessities and must be articulated in a model focused on dignity and communication. Its implementation through Advanced Care Planning, consideration of patient's values and preferences, and Limitation of therapeutic effort are ways to reduce aggressiveness and improve clinical practice at the end of life. We need to encourage synergic and proactive attitudes, adding the best of cancer research with the best clinical care for the benefit of human being, moral subject and main goal of Medicine.

The assessment of surgical skills as a complement to the training method. Revision.

CONTEXT AND OBJECTIVE: The acquisition and improvement of surgical skills constitute a fundamental element in the training of any practitioner. At present, however, the assessment of these skills is a scarcely developed area of research. The aim of this study was to analyse the peculiarities of the various assessment systems and establish the minimum criteria that a skills and knowledge assessment system should meet as a method for assessing surgical skills in urological surgery. ACQUISITION OF EVIDENCE: Scientific literature review aimed at the various currently available assessment systems for skills and competencies (technical and nontechnical), with a special focus on the systematic reviews and prospective studies. SUMMARY OF THE EVIDENCE: After conducting the review, we found that the various assessment systems for surgical competence have, in our opinion, a number of shortcomings. There is a certain degree of subjectivity in the assessment of surgeons by the evaluators. The assessment of nontechnical competencies is not formally recorded. There is no description of a follow-up assessment or any basic parameters associated with healthcare quality. There is no registration of associated competencies associated with the various surgical techniques. There is also no ranking of these competencies and the specific peculiarities for their application. CONCLUSIONS: We believe that the development of a new assessment system for surgical competencies (technical and nontechnical) aimed at assessing urologists in the various surgical techniques is necessary. To this end, our team has worked on developing the Evaluation System for Surgical Competencies on Laparoscopy, which is based on the definition, ranking and assessment of competencies demonstrated by surgeons.

Clinical guideline SEOM: cancer of unknown primary site.

Cancer of unknown primary site is a histologically confirmed cancer which is manifested in advanced stage, with no identifiable primary site after the use of standard diagnostic procedures. Patients are initially placed into one of categories based upon the examination of the initial biopsy: adenocarcinoma, squamous cell carcinoma, neuroendocrine carcinoma and poorly differentiated carcinoma. Appropriate patient management requires an understanding of several clinicopathologic features that help to identify several subsets of patients with more responsive tumors.

Objective analysis of surgeons' ergonomy during laparoendoscopic single-site surgery through the use of surface electromyography and a motion capture data glove.

BACKGROUND: Adding to the ergonomic inconveniences already presented by traditional laparoscopy (LAP), laparoendoscopic single-site (LESS) surgery has been found to entail other more specific problems, including greater reduction in movement freedom, in-line vision with loss of triangulation, and greater proximity of instruments. The objective of this study was to evaluate surgeons' ergonomy during LESS surgery, through the study of muscular activity, wrist angle, and hand movements, and compare it with conventional laparoscopy. METHODS: The study group was composed by 14 experienced laparoscopic surgeons, all right-handed. Each one performed dissection tasks on a physical simulator through LAP and LESS approaches. For LAP, straight laparoscopic scissors and dissector were used, whilst for LESS articulating tip scissors and dissector were chosen. During both tasks, muscular activity of biceps brachii, triceps brachii, forearm flexors and extensors, and trapezius muscles was registered through surface electromyography. Simultaneously right-hand movements and wrist angles were obtained through a motion capture data glove (CyberGlove(®)), which allowed for the use of a modified RULA test applied to the recorded angles with subsequent establishment of risk levels for the wrist joint. RESULTS: Muscular activity for trapezius (LAP 6.94 ± 4.12 vs. LESS 11.32 ± 4.68; p ≤ 0.05) and forearm extensor muscles (LAP 9.2 ± 2.45 vs. LESS 37.07 ≤ 16.05; p ≤ 0.001) was significantly lower in conventional laparoscopy compared with LESS approach. No statistical significance was obtained between the different sensors, except in 3 of the 11 analyzed CyberGlove(®) sensors. The modified RULA test showed a score of 3 for laparoscopy (unacceptable), whereas for LESS a score of 2 was obtained (acceptable), with statistically significant differences between them (p ≤ 0.05). CONCLUSIONS: The LESS approach entails greater level of muscular activity in the trapezius and forearm extensor muscles, but we have found evidences of a better wrist position during LESS compared with traditional laparoscopy.

A phase II trial of erlotinib as maintenance treatment after concurrent chemoradiotherapy in stage III non-small-cell lung cancer (NSCLC): a Galician Lung Cancer Group (GGCP) study.

PURPOSE: This single arm, phase II study aims to evaluate the role of epidermal growth factor receptor-tyrosine-kinase inhibitor erlotinib as maintenance therapy following concurrent chemoradiotherapy (cCRT) in unresectable locally advanced non-small-cell lung cancer (NSCLC). METHODS: Patients with unresectable stage IIIA o dry IIIB NSCLC with no evidence of tumor progression after receiving a standard cCRT regimen with curative intent were included. Oral erlotinib 150 mg/day was administered within 4-6 weeks after the end of the cCRT for a maximum of 6 months if no disease progression or intolerable toxicity occurred. Primary end point was the progression-free rate (PFR) at 6 months. Secondary end points included time to progression (TTP) and overall survival (OS). RESULTS: Sixty-six patients were enrolled and received maintenance treatment with erlotinib [average: 4.5 months (95 % CI 4.0-5.0)]. PFR at 6 months was 63.5 % (41/66). With a median follow-up of 22.7 months (95 % CI 13.5-37.1), the median TTP was 9.9 months (95 % CI 6.2-12.1), and the median OS was 24.0 months (95 % CI 17.3-48.6). Most common adverse events (AEs) related to erlotinib were rash (78.8 %; 16.7 % grade 3), diarrhea (28.8 %; 1.5 % grade 3), fatigue (15.2 %; 1.5 % grade 3), anorexia (7.6 %; 1.5 % grade 3) and vomiting (4.6 %; none grade 3). Five patients (7.6 %) were withdrawn due to AEs. CONCLUSIONS: Erlotinib as maintenance therapy is an active treatment after cCRT in unselected patients with stage III NSCLC, reaching a 6-month PFR of 63.5 % and a median OS of 24 months. The safety profile of maintenance erlotinib was as expected and manageable.

Organizational factors related to occupational accidents in construction.

The purpose of this paper is to understand the influence of organizational factors on occupational accident causation. A field study was undertaken and focused on the phase of concreting the floors of a residential block in a building project in Brazil. The methodological approach was based on the analysis of carpenters' work practices and of the workers' accounts of minor falls. Observations were noted on work practices over this stage. Furthermore, interviews were conducted with the workers hired by the subcontractors and with professionals working for the main contractor. The results show that falls were related to the introduction of new building technology and its use by the workforce. The production planning and organization of activities by the subcontracted firms also led to temporary demands that were additional determining factors for falls on site. The work analysis reveals the need to consider organizational factors in prevention practices.

[Design and validation of a training model on paediatric and neonatal surgery]. / Diseño y validación de un programa formativo en cirugía laparoscópica pediátrica y neonatal.

We present our experience in the design and development of a training program in paediatric and neonatal laparoscopic surgery, and the determination of face validity by the attendants. Data included in the present study was obtained from five consecutive editions of our Neonatal and Paediatric Laparoscopic Surgery Course. Our training model, with a total duration of 21 hours, begins with acquisition of knowledge in ergonomics and instrument concepts, after which the attendants develop basic laparoscopic dexterity through the performance of hands-on physical simulator tasks. During the second and third days of the course, surgeons undertook various surgical techniques hands-on animal model. At the end of the training program, a subjective evaluation questionnaire was handed out to the attendants, in which different didactic and organizational aspects were considered. We obtained a highly positive score on all questions concerning the different topics and techniques included in the training program (> or = 9 points over 10). 78,5% of the 54 attendants was in accordance with the course total duration, whilst 21,5% considered that it should be of longer duration. Regarding abilities' self assessment, 79,1% considered themselves capacitated to perform trained procedures on live patients. The presented training model has obtained a very positive valuation score, leading to an increase in the attendants' self confidence in the application of learned techniques to their clinical practice.

Asymmetric intramolecular aldol reactions of substituted 1,7-dicarbonylic compounds. A mechanistic study.

The diastereo- and enantioselectivity obtained experimentally by List on the proline-catalyzed intramolecular aldol reaction of substituted 1,7-dicarbonylic compounds was accurately predicted using density functional theory methods at the B3LYP/6-31++G** level. A polarizable continuum model was used to describe solvent effects. The theoretical data agree in good extension with List's experimental results, both in enantioselectivity and diastereoselectivity, and allow for the confirmation of our previous rationalization of the main factors contributing to the reaction selectivity. While the enantioselectivity results from an important electrostatic contact between the forming alkoxyde group and the proline moiety, the calculated diasteroselectivity results from several steric contacts that can be established between the different substituents and from their relative orientation in respect to the ring conformation. However, for dialdehydes that can originate two diastereomeric enamine intermediates, the proline attack and the immonium formation steps can also be of major importance in the rationalization of the final reaction selectivity, as is the case in two of the six studied systems. The obtained data allows for a full rationalization of the known experimental systems as well as for the extrapolation to new ones with variable substitution at the carbonylic chain.

Coherent electrically excited organic semiconductors: visibility of interferograms and emission linewidth.

Recently, a tandem organic light-emitting diode structure, excited electrically in the pulsed domain and confined within a double interferometric configuration, was observed to emit a low-divergence beam (approximately 1.1 times the diffraction limit) with a near-Gaussian spatial distribution. The emission originates from the laser dye Coumarin 545 T used as dopant. It has since been determined that the visibility of the interferograms, from the spatially coherent emission, is V approximately 0.90. This result is compared with the visibility obtained from a known narrow linewidth laser source (V approximately 0.95) and with various published values from the relevant literature. The significance of this result is discussed in addition to an interferometric estimate of the emission linewidth that yields Delta lambda approximately 11 nm. The present interferometric analysis indicates that the spectral component of the spatially coherent radiation is comparable with the spectral characteristics of well-known broadband dye lasers.

Coherence characteristics of electrically excited tandem organic light-emitting diodes.

A tandem organic light-emitting diode structure, excited electrically in the pulsed domain and confined within a double spatial filter configuration, is observed to emit a low-divergence beam (deltatheta approximately 2.53 mrad, or approximately 1.1 times the diffraction limit) with a near-Gaussian spatial distribution. The emission originates from the laser dye Coumarin 545 T, which is used as a dopant. Spectral coherence was determined by use of a double-slit interferometer. The interferometric distribution from our device approximates the interferometric pattern obtained from well-known lasers emitting at lambda approximately 540 nm.

Tunable solid-state lasers incorporating dye-doped, polymer-nanoparticle gain media.

Tunable laser action in the visible spectrum has been established for what is believed to be the first time by use of dye-doped, polymer-silica nanoparticle gain media. The silica nanoparticles, ranging from 9 to 12 nm in diameter, appear to be uniformly dispersed in the poly(methyl methacrylate) matrix because the optical homogeneity of the gain medium is maintained. With Rhodamine 6G dye and 30% weight-by-weight silica nanoparticles, laser action was established in the 567-603-nm range. At the peak wavelength (lambda approximately 580 nm), laser conversion efficiency is approximately 63% at a beam divergence of 1.9 mrad (approximately 1.3 times the diffraction limit). The new solid-state gain medium also exhibits a reduction in /deltan/deltaT/.

Multiple-return-pass beam divergence and the linewidth equation.

A multiple-return-pass equation for beam divergence that is applicable to multiple-prism grating tunable laser oscillators is derived by use of ray-transfer matrices. This beam divergence is then incorporated into the multiple-return-pass dispersive linewidth equation. A discussion of the application of the equation is given.

[Pneumonia from Nocardia nova in lung cancer]. / Neumonía por Nocardia nova en cáncer de pulmón.

The clinical and radiographic manifestations of pulmonary nocardiosis are nonspecific. The diagnosis depends of the clinical suspicion for alerting the microbiology laboratory to use special culture and identification methods to initiate the appropriate therapy early. A nocardia pneumonia in a locally advanced non small cell lung cancer patients is present. Even after initiate the treatment the patient died. It is important to suspect the diagnosis of uncommon infection to begin the therapy.

Diagnóstico y tratamiento de cáncer de origen desconocido / Diagnosis and treatment of cancer of unknown primary site

El cáncer de origen desconocido es un diagnóstico frecuente en la práctica médica y representa un grupo heterogéneo de neoplasias. A pesar de que los datos de la literatura indican que excepcionalmente se identifica el tumor primario, estos pacientes son evaluados exhaustivamente. El tratamiento está orientado principalmente por el diagnóstico anatomopatológico de la lesión, siendo fundamental las técnicas anatomopatológicas especiales para la correcta identificación de aquellas neoplasias quimiocurables y aquellas que se benefician de un tratamiento específico. Los pacientes que por sus características no pertenezcan a estos grupos deberían ser incluidos dentro de ensayo clínico (AU)

Neumonía por Nocardia nova en cáncer de pulmón / Pneumonia by nocardia nova in lung cancer

Las manifestaciones clínicas y radiográficas de nocardiosis pulmonar son inespecíficas. El diagnóstico depende de un alto grado de sospecha, altertando al laboratorio de microbiología para obtener un aislamiento y cultivo precoz e iniciar el tratamiento antibiótico específico. Presentamos un caso de neumonía por Nocardia nova en un paciente diagnosticado de carcinoma epidermoide de pulmón localmente avanzado, iniciándose el tratamiento antibiótico específico (AU)

[Diagnosis and treatment of cancer of unknown origin]. / Diagnóstico y tratamiento de cáncer de origen desconocido.

The carcinoma of unknown primary is a frequent clinical problem and represents a very heterogeneous group of neoplasms. Despite data in the literature indicating minimal success in determining the location of primary carcinomas, these patients continue to be evaluated exhaustively. Clinical treatment is guide by the pathological evaluation of the lesion and is very important the special pathologic techniques characterizing a potentially curable malignancy or patients for whom there is are a specific treatment. The majority of the patients are not included in these groups and they should be received treatment in clinical trials.

Multiple-prism grating solid-state dye laser oscillator: optimized architecture.

A multiple-prism grating solid-state dye laser oscillator was demonstrated with its grating, deployed in a Littrow configuration, under total illumination at reduced intracavity beam expansion. This compact cavity yields laser linewidths in the 350-MHz range and smooth temporal pulses with a near-Gaussian profile.

Long-pulse narrow-linewidth dispersive solid-state dye-laser oscillator.

We report on narrow-linewidth long-pulse laser emission from a dispersive solid-state dye-laser oscillator. Output energy was ~0.4 mJ/pulse at laser linewidths of 650 MHz and pulse lengths of 105 ns FWHM. The solid-state gain medium utilized was Rhodamine 6G dye-doped 2-hydroxyethyl methacrylate:methyl methacrylate.