Patient safety in dentistry: development of a candidate 'never event' list for primary care

Introduction The 'never event' concept is often used in secondary care and refers to an agreed list of patient safety incidents that 'should not happen if the necessary preventative measures are in place'. Such an intervention may raise awareness of patient safety issues and inform team learning and system improvements in primary care dentistry. Objective To identify and develop a candidate never event list for primary care dentistry. Methods A literature review, eight workshops with dental practitioners and a modified Delphi with 'expert' groups were used to identify and agree candidate never events. Results Two-hundred and fifty dental practitioners suggested 507 never events, reduced to 27 distinct possibilities grouped across seven themes. Most frequently occurring themes were: 'checking medical history and prescribing' (119, 23.5%) and 'infection control and decontamination' (71, 14%). 'Experts' endorsed nine candidate never event statements with one graded as 'extreme risk' (failure to check past medical history) and four as 'high risk' (for example, extracting wrong tooth). Conclusion Consensus on a preliminary list of never events was developed. This is the first known attempt to develop this approach and an important step in determining its value to patient safety. Further work is necessary to develop the utility of this method

Disaster scenario simulation of the 2010 cloudburst in Leh, Ladakh, India

Leh district in the Ladakh region of north-western India experienced a disaster when a cloudburst generated debris flows, killed hundreds of people, destroyed houses, and damaged the hospital, communication infrastructure, the bus station, and vital roads. A simulation of the Leh cloudburst disaster analysed the disaster itself, disaster risk reduction plans in the region, gaps in existing response mechanisms and reducing hazard impacts in the future. The participant group comprised academic researchers and industry experts in natural hazards, social vulnerability, engineering, historical and social sciences, education, journalism, disaster management and disaster risk reduction. Many of the participants had extensive local knowledge of Ladakh or comparable neighbouring Himalayan regions. Following the disaster, Leh Autonomous Hill Development Council (LAHDC), produced a District Disaster Management Plan (DDMP), which addressed many of the gaps identified in the simulation. Most importantly, the document outlined a civil protection mechanism to respond to future hazardous events. This was utilised to assess future disaster response in the simulation scenario. From analysis of the scenario simulation, the role of the army was found to be key in minimizing the impact of the 2010 disaster, although in the future, the army may coordinate with the civil protection body as set out in the DDMP. Participants identified the lack of a local formalized civil protection plan as a major vulnerability, and the most vulnerable populations as the migrant communities. The group also discussed evidence of resilience among the population such as the role of monasteries and spirituality in psychological recovery and the impact of the initial local response. From broader discussion of the simulation scenario, it was possible to identify aspects of resilience for further study in a wider research project, such as identifying hazardous slopes from satellite mapping, informing the fieldwork program, designing social questionnaires to understand risk perception and formulating questions to guide focus-group discussions on community resilience

Indigenous Mountain People’s Risk Perception to Environmental Hazards in Border Conflict Areas

This study aims to understand community risk perception to environmental hazards in a border conflict zone context in high-mountain areas. Participatory rural appraisal (PRA) tools were applied by the social science team. The results were validated with a hazard map prepared by a separate team comprised of geologists. Turtuk, the northernmost village in Ladakh, India located near the line of control with Pakistan was undertaken as a case study. Turtuk represents a high mountain indigenous rural community which has experienced several major disasters (flash flooding and landslides in 2010, 2014, and 2015) and territorial conflicts (wars in 1971 and 1999 with Pakistan) in recent times. The villagers were able to identify various environmental hazards and associated risk zones through participatory timeline, hazard and dream mapping exercises. The PRA maps matched the geological hazard map of Turtuk, demonstrating that community people are highly aware of surrounding hazards regardless of differences in age, sex, education, occupation, and religion. They apply indigenous knowledge to deal with the adverse climate and calamities. The technique, of analysing community vulnerability in the context of conflict and disasters by applying qualitative PRA tools and validating the mapping results, as piloted in this study is novel and replicable in similar settings

Making subaltern shikaris: histories of the hunted in colonial central India

Academic histories of hunting or shikar in India have almost entirely focused on the sports hunting of British colonists and Indian royalty. This article attempts to balance this elite bias by focusing on the meaning of shikar in the construction of the Gond ‘tribal’ identity in late nineteenth and early twentieth-century colonial central India. Coining the term ‘subaltern shikaris’ to refer to the class of poor, rural hunters, typically ignored in this historiography, the article explores how the British managed to use hunting as a means of state penetration into central India’s forest interior, where they came to regard their Gond forest-dwelling subjects as essentially and eternally primitive hunting tribes. Subaltern shikaris were employed by elite sportsmen and were also paid to hunt in the colonial regime’s vermin eradication programme, which targeted tigers, wolves, bears and other species identified by the state as ‘dangerous beasts’. When offered economic incentives, forest dwellers usually willingly participated in new modes of hunting, even as impact on wildlife rapidly accelerated and became unsustainable. Yet as non-indigenous approaches to nature became normative, there was sometimes also resistance from Gond communities. As overkill accelerated, this led to exclusion of local peoples from natural resources, to their increasing incorporation into dominant political and economic systems, and to the eventual collapse of hunting as a livelihood. All of this raises the question: To what extent were subaltern subjects, like wildlife, ‘the hunted’ in colonial India

The Jurassic (Pliensbachian to Kimmeridgian) palynology of the Algarve Basin and the Carrapateira outlier, southern Portugal

The palynology of the Jurassic (Upper Pliensbachian to Lower Kimmeridgian) fill of the Algarve Basin and the Carrapateira outlier, southern Portugal was investigated. Samples were collected from Armação Nova Bay, Mareta Beach, Cilheta Beach and the Carrapateira outlier. At Armação Nova Bay the Upper Pliensbachian–Lower Toarcian succession proved barren, or yielded sparse, non age-diagnostic palynomorphs. Dinoflagellate cysts are confined to the Upper Bajocian to Upper Callovian sedimentary rocks exposed at Mareta and Cilheta beaches and the Lower Kimmeridgian strata of the Carrapateira outlier. At Mareta Beach, the Upper Bajocian, Bathonian and Callovian produced relatively low to moderate diversity dinoflagellate cyst assemblages. Several key bioevents confirm the Bathonian and Callovian ages of the succession; no age-significant Late Bajocian bioevents were noted. The Upper Callovian of Cilheta Beach yielded moderately diverse dinoflagellate cyst associations dominated by Ctenidodinium spp. Key Late Callovian bioevents confirm the age of this succession. Many familiar marker forms known from northwest Europe were not encountered. No typically Arctic forms were recovered throughout the Upper Bajocian to Callovian of this part of the Algarve Basin. It is clear that there was no significant Late Bajocian to Late Callovian dinoflagellate cyst provincialism within southern and northern Europe and adjacent regions. The Carrapateira outlier yielded a moderately diverse Early Kimmeridgian dinoflagellate cyst flora. The Early Kimmeridgian age assessment based on corals and foraminifera is confirmed. Amphorula and Histiophora are present; these are typical of the Late Jurassic of the Tethyan Realm, and their presence is consistent with Late Jurassic provincialism within Europe. The relatively low diversity nature of these Late Bajocian to Early Kimmeridgian dinoflagellate cyst floras is probably mainly due to the relatively deep water, partially enclosed depositional setting. The partially enclosed nature of this part of the Algarve Basin and the Carrapateira outlier seems to have prevented the free migration of dinoflagellates between southern Portugal and elsewhere in Europe

Middle – Late Jurassic (Late Bathonian – Tithonian) Palynomorphs

Abstract. INTRODUCTIONJurassic palynomorph assemblages have been recovered in numerous wells in northeast Libya. Jurassic rocks reflect changing sedimentary environments which have greatly influenced the composition of the palynological assemblages.In the northernmost area, Jurassic sediments unconformably overlie the Palaeozoic or Triassic and show a mixed marine and continental influence. In the northeastern part of the area thicker and deeper water marine sediments are known, while shallow marine sediments overlie the platform facies immediately to the south. Pollen and miospores are fairly well preserved and are dominant in most samples. Dinoflagellate cysts are richly represented especially in the deposits of the north and northeast. Most samples contain abundant variably sorted cuticular debris and structured wood fragments. This significant influx of terrestrial debris together with the associated palynomorph assemblages indicate deposition in a shallow marine environment in close proximity to the shoreline for most of the Jurassic deposits in the northern area.In the central and southern region, sandstone, silt stone and red shale deposited in non-marine fluvial to lacustrine or lagoonal environment, unconformably overlie the metamorphic or igneous Precambrian Basement. These sediments show a general lack of well preserved palynomorphs. Miospores, though present are generally long ranging and terrestially derived detrital kerogen dominate the assemblages.MICROFLORAL SUCCESSIONMiospore assemblages present in most of the samples investigated are dominated by small gymnosperm pollen. Classopollis spp., Exesipollenites spp., Sphaeripollenites spp., and nonaperturate pollen assigned to Araucariacites spp. Saccate pollen assigned to Concentrisporites spp., Perinopollenites spp., Callialasporites spp., and Inaperturopollenites spp., are often common . . . </jats:p

Mid Jurassic (Late Callovian) dinoflagellate cysts from the Lotena Formation of the Neuquén Basin, Argentina and their palaeogeographical significance

The Lotena Formation from two localities, Picún Leufú and Portada Covunco, in the Neuquén Basin of westcentral Argentina was studied palynologically. The material examined produced moderately diverse Late Callovian dinoflagellate cyst assemblages. This age assignment is consistent with ammonite evidence. The dinoflagellate cyst floras are reminiscent of the Middle Jurassic associations of northwest Europe and surrounding areas. Marine palynomorphs typical of Australasia and the Arctic are absent. The similarity with Europe is strongly suggestive of an open marine connection between western Tethys and the Neuquén Basin during the Late Callovian. This is interpreted as being via the Hispanic Corridor, with the palynofloras being passively dispersed to the southwest by the circum-Tropical Marine Current. Earlier studies indicate that this trans-Pangean equatorial seaway first began to allow biotic interchange during the Mid Jurassic and this study proves that this open marine connection was established by the Late Callovian. The similarities between the dinoflagellate cyst assemblages of Europe and the Neuquén Basin are consistent with the distribution of other marine fossils and the existence of geographically continuous marine facies belts

Jurassic–Cretaceous biostratigraphy of Norway, with comments on the British Rasenia cymodoce Zone

Volume: 21Start Page: 31End Page: 6