Identifying common problems in the acquisition and deployment of large-scale,safety–critical,software projects in the US and UK healthcare systems

Public and private organisations are investing increasing amounts into the development of healthcare software. These applications are perceived to offer numerous benefits. Software systems can improve the exchange of information between healthcare facilities. They support standardized procedures that can help to increase consistency between different service providers. Electronic patient records ensure minimum standards across the trajectory of care when patients move between different specializations. Healthcare information systems also offer economic benefits through efficiency savings; for example by providing the data that helps to identify potential bottlenecks in the provision and administration of care. However, a number of high-profile failures reveal the safety concerns that arise when staff must cope with the loss of these applications. In particular, teams have to retrieve paper based records that often lack the detail of electronic systems. Individuals who have only used electronic information systems face particular problems in learning how to apply paper-based fallbacks. The following pages compare two different failures of healthcare information systems in the UK and North America. The intention is to ensure that future initiatives to extend the integration of electronic patient records will build on the ‘lessons learned’ from previous systems.     

Do mitigation strategies reduce global warming potential in the northern U.S. corn belt?

Agricultural management practices that enhance C sequestration, reduce greenhouse gas emission (nitrous oxide [N?O], methane [CH?], and carbon dioxide [CO?]), and promote productivity are needed to mitigate global warming without sacrificing food production. The objectives of the study were to compare productivity, greenhouse gas emission, and change in soil C over time and to assess whether global warming potential and global warming potential per unit biomass produced were reduced through combined mitigation strategies when implemented in the northern U.S. Corn Belt. The systems compared were (i) business as usual (BAU); (ii) maximum C sequestration (MAXC); and (iii) optimum greenhouse gas benefit (OGGB). Biomass production, greenhouse gas flux change in total and organic soil C, and global warming potential were compared among the three systems. Soil organic C accumulated only in the surface 0 to 5 cm. Three-year average emission of N?O and CH was similar among all management systems. When integrated from planting to planting, N?O emission was similar for MAXC and OGGB systems, although only MAXC was fertilized. Overall, the three systems had similar global warming potential based on 4-yr changes in soil organic C, but average rotation biomass was less in the OGGB systems. Global warming potential per dry crop yield was the least for the MAXC system and the most for OGGB system. This suggests management practices designed to reduce global warming potential can be achieved without a loss of productivity. For example, MAXC systems over time may provide sufficient soil C sequestration to offset associated greenhouse gas emission.     

Differential Individual Particle Analysis (DIPA): applications in particulate matter characterization

Operator-controlled and computer-controlled scanning electron microscopy (CCSEM) are used extensively to characterize particulate matter in environmental media. Analysis in a scanning electron microscope (SEM) coupled with chemical extraction is a potentially powerful tool that is capable of determining how various sample components are associated at the individual particle level. This involves initial characterization in a SEM, after which the material is exposed to a liquid or gas phase reaction for a specified time, and once exposure is concluded, the particles are reanalyzed in the SEM. This particle analysis by difference, or differential individual particle analysis (DIPA), possesses considerable potential for describing the behavior of environmental particles under changing chemical conditions. Here we describe DIPA applications with illustrative examples drawn from the analysis of particulate matter modified by reactions in a fluid environment. In situ DIPA permits the same particles to be analyzed in the SEM before and after modification. Repeated exposure to the same, or different modifying conditions, provides information on the time dependence of specific reactions. Significant numbers of particles can be analyzed using CCSEM, and the same particles can be analyzed after the reaction by accurate sample relocation in the SEM. Ex situ DIPA, which involves a bulk sample modification, uses CCSEM to characterize significant numbers of particles pre- and postreaction. The CCSEM approach is extremely efficient; recent developments in silicon drift detectors have increased the speed of characteristic X-rays detection, and very large numbers of particles can be analyzed in a short period of time.     

Projections of highway vehicle population,energy demand,and CO2 emissions in India to 2040

This paper presents projections of motor vehicles, oil demand, and carbon dioxide (CO₂) emissions for India through the year 2040. The populations of highway vehicles and two‐wheelers are projected under three different scenarios on the basis of economic growth and average household size in India. The results show that by 2040, the number of highway vehicles in India would be 206‐309 million. The oil demand projections for the Indian transportation sector are based on a set of nine scenarios arising out of three vehicle‐growth and three fuel‐economy scenarios. The combined effects of vehicle‐growth and fuel‐economy scenarios, together with the change in annual vehicle usage, result in a projected demand in 2040 by the transportation sector in India of 404‐719 million metric tons (8.5‐15.1 million barrels per day). The corresponding annual CO₂ emissions are projected to be 1.2‐2.2 billion metric tons.     

Dispersal potential of invasive algae: the determinants of buoyancy in <Emphasis Type="Italic">Codium fragile</Emphasis> ssp. <Emphasis Type="Italic">fragile</Emphasis>

The capacity for long-distance dispersal is an important factor in determining the spread of invasive species. For algae, positive buoyancy generally is correlated with increased dispersal potential, and the light environment has been previously identified as a possible determinant of buoyancy in several species. We examined the effect of light intensity on the buoyancy of fragments of the invasive green alga Codium fragile ssp. fragile. Under natural and controlled conditions, the buoyancy of samples taken from the thallus tip was higher than those from near the holdfast. Both laboratory and field experiments also showed that buoyancy was dynamic and switched from positive to negative under reduced light intensity, but this change required several days. We also observed seasonal changes in buoyancy, presumably due to natural variations in light intensity, with the buoyancy of fragments washed up on the shore highest in mid-summer. These results show that buoyancy is a dynamic property of the C. fragile ssp. fragile thallus and suggest that buoyant fragments contribute to long-range dispersal and accelerated regional spread of this invader. This finding suggests that dispersal is more likely during conditions of high light intensity and illustrates the need to understand how variations in the natural environment can affect the dispersal potential of invasive species.     

Assessing ecosystem vulnerability to invasive rusty crayfish (Orconectes rusticus)

Despite the widespread introduction of nonnative species and the heterogeneity of ecosystems in their sensitivity to ecological impacts, few studies have assessed ecosystem vulnerability to the entire invasion process, from arrival to establishment and impacts. Our study addresses this challenge by presenting a probabilistic, spatially explicit approach to predicting ecosystem vulnerability to species invasions. Using the freshwater-rich landscapes of Wisconsin, USA, we model invasive rusty crayfish (Orconectes rusticus) as a function of exposure risk (i.e., likelihood of introduction and establishment of O. rusticus based on a species distribution model) and the sensitivity of the recipient community (i.e., likelihood of impacts on native O. virilis and O. propinquus based on a retrospective analysis of population changes). Artificial neural networks predicted that approximately 10% of 4200 surveyed lakes (n = 388) and approximately 25% of mapped streams (23 523 km total length) are suitable for O. rusticus introduction and establishment. A comparison of repeated surveys before vs. post-1985 revealed that O. virilis was six times as likely and O. propinquus was twice as likely to be extirpated in streams invaded by O. rusticus, compared to streams that were not invaded. Similarly, O. virilis was extirpated in over three-quarters of lakes invaded by O. rusticus compared to half of the uninvaded lakes, whereas no difference was observed for O. propinquus. We identified 115 lakes (approximately 3% of lakes) and approximately 5000 km of streams (approximately 6% of streams) with a 25% chance of introduction, establishment, and extirpation by O. rusticus of either native congener. By identifying highly vulnerable ecosystems, our study offers an effective strategy for prioritizing on-the-ground management action and informing decisions about the most efficient allocation of resources. Moreover, our results provide the flexibility for stakeholders to identify priority sites for prevention efforts given a maximum level of acceptable risk or based on budgetary or time restrictions. To this end, we incorporate the model predictions into a new online mapping tool with the intention of closing the communication gap between academic research and stakeholders that requires information on the prospects of future invasions.