Micro- and macroergonomic changes in mental workload and medication safety following the implementation of new health IT

Health information technology (IT) is a promising way to achieve safer medication management in the delivery of healthcare. However, human factors/ergonomics dictates that in order to make the complex, cognitive work of healthcare delivery safer, health IT must properly support human cognition. This means, for example, that new health IT must reduce, not increase, workload during safety-critical tasks. The present study was the first to quantitatively assess the short- and long-term impact of bar coded medication administration (BCMA) IT on nurses' mental workload as well as on perceived medication safety. One-hundred seventy registered nurses across 3 dissimilar clinical units at an academic, freestanding pediatric hospital in the Midwest US participated in surveys administered before, 3 months after, and 12 months after the hospital implemented BCMA. Nurses rated their external mental workload (interruptions, divided attention, being rushed) and internal mental workload (concentration, mental effort) during medication administration tasks as well as the likelihood of each of three medication safety events: medication administration errors, medication errors on the clinical unit, and clinical unit-level adverse drug events. Clinical unit differences were assessed. Findings generally confirmed the hypothesis that external but not internal mental workload was associated with the perceived likelihood of a medication safety event. Comparisons of mental workload from pre- to post-BCMA revealed statistically significant changes in the critical care unit only. Medication safety appeared to improve over the long term in the hematology/oncology unit only. In the critical care and medical/surgical units, medication safety exhibited short-term improvements that were eliminated over time. Changes in mental workload and medication safety, two classically microergonomic constructs, were deeply embedded in macroergonomic phenomena. These included the fit between the BCMA system and the nature of nursing work, the process of BCMA implementation, and BCMA interactions with concurrent changes occurring in the hospital. Findings raise questions about achieving sustainable performance improvement with health IT as well as the balance between micro- and macroergonomic approaches to studying technology change.Relevance to industryDesigners must consider how technology changes cognitive work, including mental workload. Hospitals and other implementers of technology must ensure that new technology fits its users, their tasks, and the context of use, which may entail tailoring implementation, for example, to specific clinical units. Evaluators must look over time to assess both changes in cognitive work and implementation issues. Healthcare practitioners must also recognize that new technology means a complex transformation to an already complex sociotechnical system, which calls for a macroergonomic approach to design and analysis.     

C反应蛋白和降钙素原指导高危新生儿预防性应用抗生素的效果、安全性和经济性分析

目的:评价应用C反应蛋白（C reaction protein，CRP）和降钙素原（procalcitonin，PCT）指导高危新生儿预防性应用抗生素的效果、安全性和经济性。方法:选取2015年7月至2017年1月慈溪市妇幼保健院收治的高危新生儿124例作为研究对象，随机数表法分为对照组（62例）和实验组（62例），对照组患儿均给予预防性应用抗生素治疗，实验组根据CRP和PCT选择性应用抗生素。比较两组患儿的细菌培养阳性率、脓毒症发生率以及不良反应发生率。结果:两组患儿的CRP和PCT水平和阳性率间均不存在统计学差异（t/χ2=0.299，-0.461，0.292，0.544，0.186，P=0.766，0.646，0.589，0.461，0.666）。两组患儿治疗前后的菌培养阳性率间均不存在统计学差异（χ2=0.040，0.287，P=0.842，0.592）；两组治疗后的菌培养阳性率均明显低于治疗前（χ2=47.825，40.367，P=0.000，0.000）；两组患儿脓毒症的发生率分别为12.90%和14.52%，差异无统计学意义（χ2=0.068，P=0.794）。实验组的NICU治疗和住院时间、机械通气时间以及治疗费用均显著低于对照组（t=2.904，2.729，2.152，5.337，P=0.004，0.007，0.033，0.000），两组的机械通气率间无统计学差异（χ2=0.372，P=0.542）。对照组患儿不良反应发生率为19.35%，明显高于实验组的6.46%（χ2=4.593，P=0.032）。结论:应用CRP和PCT指导高危新生儿预防性应用抗生素的效果与普遍性应用相似，可以明显减少治疗时间和治疗费用，明显降低治疗相关不良反应。     

Why do small business butcher shops fail to fully implement HACCP?

This study aims to assess the degree of HACCP implementation in small business butcher shops and understand which factors most influence butchers' intention to fully implement it, through the application of the Theory of Planned Behaviour. One hundred and one butchers managing or owning small butcher's responded to the interview regarding their Attitudes, Subjective Norm, Perceived Behavioural Control, Personal Norm, and Knowledge with regard to their Intention to fully implement a HACCP system in their shops. Before the interviews, a certified veterinarian visited all the shops. Visits included an inspection of the establishments using the Official Portuguese Control Plan checklist for meat retailers. Conformance level measured past performance regarding food safety practices. Based on past performance, butchers were divided into “high performers” and “low performers”. “High performers” yielded high values of Attitude and Intention towards the Behaviour. For these, Attitude and Personal Norm emerge as predictors of the Intention to fully implement a HACCP system. For “low performers”, Personal Norm was the strongest predictor of Intention, with results pointing to the need for an intervention from the authorities to promote increased conformance to food safety practices. For both groups, neither Social Norm nor Perceived Behavioural Control acted as significant predictors of Intention.     

Methodology for optimization of pouring variables using bottom pour for low masses of SS304 (<300 kg) in investment casting process (case study)

Bottom pour ladles with stopper rod systems are commonly used in the metal casting industry. However, stopper rod bottom-pouring systems have not yet been developed for the lower thermal masses of alloys typically used in the investment casting industry. Large thermal masses used with bottom pour systems are typically limited for ladles larger than 700 kg and to certain alloys with higher fluidity and longer solidification time like cast iron, aluminum alloys etc. In this study, bottom pour ladle designs and low thermal mass refractory systems have been developed and evaluated in production investment foundry trials with 300 kg pouring ladle. The ladles system and pouring practices used will be described along with the results from the pouring trials for SS304 that represents typical alloys used in Investment casting industries. Optimization of the variables used in an experimentation using Genetic algorithm is also explained.     

关于信息化测绘时代工程测量发展的思考

如今我国信息化技术全面发展，尤其对于工程测量工作领域来讲，不管是在工程建设和管理方面都产生不小的支撑引导效用。由此，笔者具体结合如今工程建设信息化测绘核心任何以及设备布置细节，进行结构整体安全管理周期和周边地理空间信息技术发展能效整理解析，试图将工程测量最新发展机遇和技术挑战问题处理完全。希望能够借此为日后一定时期范围内相关工程测量规划主体提供合理指导性建议内容，最终为我国各类工程事业可持续发展前景绽放奠定深刻适应基础。     

Suitability,efficiency and microbiological safety of novel physical technologies for the processing of ready‐to‐eat meals,meats and pumpable products

Consumer studies and market reports show an increase in consumption of ready‐to‐eat (RTE) foods. Although conventional processing technologies can in most cases produce safe products, they can also lead to the degradation of nutritional compounds and negatively affect quality characteristics. Consumers strongly prefer food that is minimally processed with the maximum amount of health‐promoting substances. Novel processing technologies as pre‐ or post‐treatment decontamination methods or as substitutes of conventional technologies have the potential to produce foods that are safe, rich in nutrient content and with superior organoleptic properties. Combining novel with conventional processes can eliminate potential drawbacks of novel technologies. This review examines available scientific information and critically evaluates the suitability and efficiency of various novel thermal and nonthermal technologies in terms of microbial safety, quality as well as nutrient content on the production of RTE meals, meats and pumpable products.     

Survey of domestic food purchases and related home handling practices in the Abruzzo region (central Italy): Data collection and analysis through a language-independent classification system

A telephone survey was carried out on 13,486 randomly selected households located in the Abruzzo region (central Italy). Three questionnaires were specifically designed in relation to three different groups of foods (Meat and meat products, Fishery products, Fruit and vegetables). Questions were mainly focused on the amount and number of purchases, type of retailer, and home food handling practices with respect to the week prior to the interview. Data were classified according to a multilingual thesaurus system (LanguaL). Results allowed to estimate domestic purchases (in kg) per capita for different food categories. The category “Red meat/Cattle” accounted for a large part of purchases in the “meat and meat products” group (10.9 kg per capita/year; 32.2% of purchases in the group) while the category “Fish or related organism/Fish” was the most purchased in the “fishery products” group (6.9 kg per capita/year; 63.3%). The aggregation of more detailed characteristics enabled the identification of popular categories of foods, such as “Red meat/Cattle/Divided into pieces” (25% of the “meat and meat products” group). Significant differences (p < 0.05) were found between the four different provinces (L'Aquila, Chieti, Pescara and Teramo) with respect to “Poultry/Chicken” and “Red meat/Cattle” categories. Householders were also asked about post-purchase food handling practices that might be hazardous to food safety. More than 20% of those surveyed stated that they thawed frozen meat at room temperature. The degree of doneness after cooking of different food categories was generally high: over 90% of products purchased in the majority of meat and fish categories were properly cooked. However a noticeable proportion of householders (about 15%) reported medium or rare cooking of “Red meat/Cattle” and “Red meat/Swine”. Differences (p < 0.05) were also found between consumers of different ages, with people over 65 years old being more prone to freeze meat and cook it thoroughly.The survey was carried out in a specific geographic area and on a statistically significant sample of households, thus allowing a collection of data on domestic habits relating to food purchases and home food handling practices. This information should be included in the framework of quantitative microbial risk assessment (QMRA) models as a measure of the actual exposure of consumers to pathogenic microorganism. The LanguaL system also proved to be a practical language-independent method useful not only to identify and describe food items but also to classify them according to specific food safety characteristics.     

石油化工生产火灾危险性分析

针对石油化工生产的特点,从物料特性、上艺装置、工艺控制参数、防火防爆安全装置、作业性质和消防安全设施等几方面综合分析其火灾危险性,并提出相应的防范措施,为消防安全评价提供依据。     

石油化工可燃气体或蒸气排放系统的消防安全设计

石油化工生产装置大多是通过火炬燃烧排放易燃易爆气体或通过放空管将易爆气体直接排入大气中。文章分析了火炬系统和放空管的火灾危险因素,并从火炬的布置、高度、排放能力、自动监控装置以及放空管的气体排放浓度、安装位置、安全装置等方面,重点论述了火炬系统和放空管的消防安全设计要点。