Epic Human Failure on June 30, 2013

Nineteen Prescott Fire Department, Granite Mountain Hot Shot (GMHS) wildland firefighters and supervisors (WFF), perished on the June 2013 Yarnell Hill Fire (YHF) in Arizona. The firefighters left their Safety Zone during forecast, outflow winds, triggering explosive fire behavior in drought-stressed chaparral. Why would an experienced WFF Crew, leave ‘good black’ and travel downslope through a brush-filled chimney, contrary to their training and experience? An organized Serious Accident Investigation Team (SAIT) found, “… no indication of negligence, reckless actions, or violations of policy or protocol.” Despite this, many WFF professionals deemed the catastrophe, “… the final, fatal link, in a long chain of bad decisions with good outcomes.” This paper is a theoretical and realistic examination of plausible, faulty, human decisions with prior good outcomes; internal and external impacts, influencing the GMHS; and two explanations for this catastrophe: Individual Blame Logic and Organizational Function Logic, and proposed preventive mitigations

Topical clobetasol for the treatment of toxic epidermal necrolysis: study protocol for a randomized controlled trial.

BackgroundToxic epidermal necrolysis (TEN) is a rare systemic allergic drug eruption with high patient mortality. Currently, no established treatments have been shown to be effective for TEN beyond supportive care. Prior studies of systemic corticosteroids have yielded conflicting data, with some showing a possible benefit and others reporting in increased mortality. However, topical steroids have shown promise for treatment of ocular sequelae of TEN, such as scarring and vision loss. We have designed a randomized controlled trial to evaluate topical clobetasol for treatment of the epidermal manifestations of TEN. In addition, we propose genetic studies to characterize the TEN transcriptome and alterations in cutaneous gene expression that might occur following topical steroid treatment.Methods/designThis split-body randomized, double-blind, placebo-controlled Phase IIa proof-of-concept trial will evaluate the safety and efficacy of once-daily topical clobetasol applied to the skin of patients with TEN. This multicenter trial will recruit a total of 15 patients between the ages of 12 and 85 from the University of California Davis Medical Center and Shriners Hospital for Children inpatient burn units. Designated treatment areas on opposite sides of the body will be treated with blinded clobetasol 0.05% ointment or control petrolatum ointment daily for 14 days. On day 3 of therapy, a biopsy will be taken from the treated area for genetic studies. The primary study aims will be to establish the safety of topical clobetasol treatment and determine the time to cessation of skin detachment for the control and clobetasol-treated areas. Secondary endpoints will evaluate efficacy using parameters such as time to 90% re-epithelialization and percentage of affected skin at 0, 3, 6, 9, 12 and 15 days. Genomic DNA and RNA will be obtained from biopsy samples, to characterize the TEN transcriptome and identify changes in gene expression after topical steroid treatment.DiscussionTopical steroids have shown promise for treating ocular complications of TEN, but to date have not been evaluated for cutaneous manifestations of the disease. This trial will investigate clinical and molecular outcomes of topical clobetasol application and hopefully provide insight into the disease pathophysiology.Trial registrationClinicalTrials.gov NCT02319616. https://clinicaltrials.gov/ct2/show/NCT02351037

Using participatory and creative methods to facilitate emancipatory research with people facing multiple disadvantage: a role for health and care professionals

Participatory and creative research methods are a powerful tool for enabling active engagement in the research process of marginalised people. It can be particularly hard for people living with multiple disadvantage, such as disabled people from ethnic minority backgrounds, to access research projects that are relevant to their lived experience. This article argues that creative and participatory methods facilitate the co-researchers’ engagement in the research process, which thus becomes more empowering. Exploring the congruence of these methods with their professional ethos, health and care professionals can use their skills to develop them further. Both theory and practice examples are presented

Observation of Surface-Avoiding Waves: A New Class of Extended States in Periodic Media

Coherent time-domain optical experiments on GaAs-AlAs superlattices reveal the exis-tence of an unusually long-lived acoustic mode at ~ 0.6 THz, which couples weakly to the environment by evading the sample boundaries. Classical as well as quantum states that steer clear of surfaces are generally shown to occur in the spectrum of periodic struc-tures, for most boundary conditions. These surface-avoiding waves are associated with frequencies outside forbidden gaps and wavevectors in the vicinity of the center and edge of the Brillouin zone. Possible consequences for surface science and resonant cavity ap-plications are discussed.Comment: 16 pages, 3 figure

Dietary supplementation with Bifidobacterium longum subsp. infantis (B. infantis) in healthy breastfed infants: study protocol for a randomised controlled trial.

BackgroundThe development of probiotics as therapies to cure or prevent disease lags far behind that of other investigational medications. Rigorously designed phase I clinical trials are nearly non-existent in the field of probiotic research, which is a contributing factor to this disparity. As a consequence, how to appropriately dose probiotics to study their efficacy is unknown. Herein we propose a novel phase I ascending dose trial of Bifidobacterium longum subsp. infantis (B. infantis) to identify the dose required to produce predominant gut colonisation in healthy breastfed infants at 6 weeks of age.Methods/designThis is a parallel-group, placebo-controlled, randomised, double-blind ascending dose phase I clinical trial of dietary supplementation with B. infantis in healthy breastfed infants. The objective is to determine the pharmacologically effective dose (ED) of B. infantis required to produce predominant (>50 %) gut colonisation in breastfed infants at 6 weeks of age. Successively enrolled infant groups will be randomised to receive two doses of either B. infantis or placebo on days 7 and 14 of life. Stool samples will be used to characterise the gut microbiota at increasing doses of B. infantis.DiscussionProbiotic supplementation has shown promising results for the treatment of a variety of ailments, but evidence-based dosing regimes are currently lacking. The ultimate goal of this trial is to establish a recommended starting dose of B. infantis for further efficacy-testing phase II trials designed to evaluate B. infantis for the prevention of atopic dermatitis and food allergies in at-risk children.Trial registrationClinicaltrials.gov # NCT02286999 , date of trial registration 23 October 2014

How explicit are the barriers to failure in safety arguments?

Safety cases embody arguments that demonstrate how safety properties of a system are upheld. Such cases implicitly document the barriers that must exist between hazards and vulnerable components of a system. For safety certification, it is the analysis of these barriers that provide confidence in the safety of the system. The explicit representation of hazard barriers can provide additional insight for the design and evaluation of system safety. They can be identified in a hazard analysis to allow analysts to reflect on particular design choices. Barrier existence in a live system can be mapped to abstract barrier representations to provide both verification of barrier existence and a basis for quantitative measures between the predicted barrier behaviour and performance of the actual barrier. This paper explores the first stage of this process, the binding between explicit mitigation arguments in hazard analysis and the barrier concept. Examples from the domains of computer-assisted detection in mammography and free route airspace feasibility are examined and the implications for system certification are considered

Action research in physical education: focusing beyond myself through cooperative learning

This paper reports on the pedagogical changes that I experienced as a teacher engaged in an action research project in which I designed and implemented an indirect, developmentally appropriate and child‐centred approach to my teaching. There have been repeated calls to expunge – or at least rationalise – the use of traditional, teacher‐led practice in physical education. Yet despite the advocacy of many leading academics there is little evidence that such a change of approach is occurring. In my role as teacher‐as‐researcher I sought to implement a new pedagogical approach, in the form of cooperative learning, and bring about a positive change in the form of enhanced pupil learning. Data collection included a reflective journal, post‐teaching reflective analysis, pupil questionnaires, student interviews, document analysis, and non‐participant observations. The research team analysed the data using inductive analysis and constant comparison. Six themes emerged from the data: teaching and learning, reflections on cooperation, performance, time, teacher change, and social interaction. The paper argues that cooperative learning allowed me to place social and academic learning goals on an even footing, which in turn placed a focus on pupils’ understanding and improvement of skills in athletics alongside their interpersonal development

Western Indian Ocean marine and terrestrial records of climate variability: a review and new concepts on land-ocean interactions since AD 1660

We examine the relationship between three tropical and two subtropical western Indian Ocean coral oxygen isotope time series to surface air temperatures (SAT) and rainfall over India, tropical East Africa and southeast Africa. We review established relationships, provide new concepts with regard to distinct rainfall seasons, and mean annual temperatures. Tropical corals are coherent with SAT over western India and East Africa at interannual and multidecadal periodicities. The subtropical corals correlate with Southeast African SAT at periodicities of 16–30 years. The relationship between the coral records and land rainfall is more complex. Running correlations suggest varying strength of interannual teleconnections between the tropical coral oxygen isotope records and rainfall over equatorial East Africa. The relationship with rainfall over India changed in the 1970s. The subtropical oxygen isotope records are coherent with South African rainfall at interdecadal periodicities. Paleoclimatological reconstructions of land rainfall and SAT reveal that the inferred relationships generally hold during the last 350 years. Thus, the Indian Ocean corals prove invaluable for investigating land–ocean interactions during past centuries

What lies beneath? The role of informal and hidden networks in the management of crises

Crisis management research traditionally focuses on the role of formal communication networks in the escalation and management of organisational crises. Here, we consider instead informal and unobservable networks. The paper explores how hidden informal exchanges can impact upon organisational decision-making and performance, particularly around inter-agency working, as knowledge distributed across organisations and shared between organisations is often shared through informal means and not captured effectively through the formal decision-making processes. Early warnings and weak signals about potential risks and crises are therefore often missed. We consider the implications of these dynamics in terms of crisis avoidance and crisis management

The purpose of mess in action research: building rigour though a messy turn

Mess and rigour might appear to be strange bedfellows. This paper argues that the purpose of mess is to facilitate a turn towards new constructions of knowing that lead to transformation in practice (an action turn). Engaging in action research - research that can disturb both individual and communally held notions of knowledge for practice - will be messy. Investigations into the 'messy area', the interface between the known and the nearly known, between knowledge in use and tacit knowledge as yet to be useful, reveal the 'messy area' as a vital element for seeing, disrupting, analysing, learning, knowing and changing. It is the place where long-held views shaped by professional knowledge, practical judgement, experience and intuition are seen through other lenses. It is here that reframing takes place and new knowing, which has both theoretical and practical significance, arises: a 'messy turn' takes place