Managing unforeseen events in anesthesia: collective trade-off between "understanding" and "doing"

This study aims to describe how anesthesia teams handle unforeseen events that may affect the patients' health. More precisely, it investigates the mechanisms of decisions made by anesthesia teams to manage unthought-of situations, i.e. situations that have not been foreseen as "possible" ones before their occurrence. An empirical study, based on the analysis of simulated situations, was conducted in a pediatric anesthesia service of a university hospital in France. The results highlighted three ways of managing unthought-of situations (determined management, cautious management and overwhelmed management). They support the hypothesis of a collective cognitive trade-off, whereby teams would behave as virtual operators, with their own collective trade-off between "understanding" and "doing". The discussion of the results questions the assessment criteria, the safety perspectives we adopt and the possible ways to improve the management of unforeseen situations.     

The contribution of ergonomics to risk analysis in the design process: the case of a future control room

The aim of this paper is to highlight how ergonomics contributes to risk analysis and risk management in a design project for a new reactor, the French EPR (European Pressurized Reactor). An iterative ergonomics design process has been conducted over the last 10 years through a Human Factors Engineering program at the French energy company EDF. A parallel has been drawn between a risk management process and this ergonomics process based on International Organization for Standardization (ISO) publications such as ISO/IEC Guide 73, ISO Guide 51, etc. The contribution of ergonomics to risk analysis is illustrated by an example: the automatic diagnosis, which is a very important technical device for safety. Five main types of risk have been identified via ergonomic analyses during the different design stages. Counter-measures have been implemented and their efficacy tested within the scope of new campaigns to assess human factors. However, the management of risks in such a design project requires the participation both of the different design entities involved in the project and of other experts in aspects of risk management, such as human reliability. The organization of collaborative participation remains a challenge to be addressed.     

Manual flying skills under the influence of performance shaping factors

This paper describes an experimental study investigating pilots' manual flying skills. In today's line oriented flight training, basic flying skills are neglected frequently. So, the study examines the manual flying skills of commercial airline pilots under the influence of several performance shaping factors like training, practice or fatigue in a landing scenario. The landing phase shows a disproportionate high percentage of aircraft accidents and it is typically flown by hand. The study is to be undertaken with randomly selected pilots in a full motion flight simulator to ensure a high validity of the results.     

The perception of pleasantness in a product of collective use: the bus shelter

This article presents a study on the identification of a setting whose arrangement of attributes could lead to the perception of pleasantness of a bus shelter: a product that should welcome people while waiting for the bus. Two different bus shelters typologies in the city of Porto Alegre, state of Rio Grande do Sul, Brazil, were evaluated, where four attributes were under consideration. The relation between the shelters subject of the study and the surroundings was significant for defining the attributes. The setting with curve shaped cover, bench, rear wall, and surrounding vegetation was considered the most pleasant one. The seats and the rear wall were associated with the practical function of the product while the curve shaped cover and the surrounding vegetation were associated with the aesthetical function according to the participant users.     

Evaluation of a personal safety program with Latino preschoolers

This study evaluated a personal safety educational program designed for Latino families attending preschools in a large metropolis. Seventy-eight children who participated in the Kids Learning About Safety program were compared to 45 control children. Compared with controls, participating children demonstrated enhanced ability to recognize inappropriate touches, learned correct genital terminology, were able to recognize the inappropriateness of touch requests made by "good" people, demonstrated higher levels of personal safety skills, and learned general safety rules. Gains in knowledge were maintained at three-month follow-up testing for all content areas except genital terminology. Although feedback provided by participating families was positive, recruiting participants and maintaining attendance at sessions was difficult. Discussion includes recommendations for future research and engagement of this population.     

Mother-child communication about sexual abuse prevention

Two hundred and twelve Australian mothers completed an online survey examining features of mother-child communication about child sexual abuse prevention. Two-thirds (67.5%) of respondents had discussed child sexual abuse prevention with their children, with proportions varying according to age range (highest for mothers with children aged 5-12 years) and only-child status (lowest for mothers of only children). The number of topics discussed with their children differed according to child gender (greater number of topics discussed by mothers with both girls and boys) and age range (greater number of topics discussed by mothers with children aged 5-12 years). These findings provide new insights into mother-child communication about child sexual abuse prevention.     

News coverage of child sexual abuse and prevention, 2007-2009

News media coverage of child sexual abuse can help policymakers and the public understand what must be done to prevent future abuse, but coverage tends to focus on extreme cases. This article presents an analysis of newspaper coverage from 2007 to 2009 to describe how the daily news presents and frames day-to-day stories about child sexual abuse. When child sexual abuse receives news attention, the stories focus primarily on the criminal justice details of a specific incident rather than contextual information about causes of and solutions to child sexual abuse, and prevention is rarely addressed. We offer suggestions for strategies that advocates can use to help reporters improve news coverage so that it better contextualizes child sexual abuse and links it to prevention policies.     

Building a culture of learning through organizational development: the experiences of the Marin County Health and Human Services Department

After determining a need for organizational change informed by changes in workforce demographics, community demographics, the socio-political and economic environment, and constraints on resources, one agency sought to transform its organizational culture into that of a learning organization. An external organizational development consultant was hired to work with agency leadership to identify ways that would help move the agency's culture towards one that was conducive to learning. Specifically, the agency director sought to create a culture where communication is encouraged both vertically and horizontally, frontline level workers are engaged and their voices heard, cross-departmental problem solving is practiced, innovative ideas are supported, and evidence-informed practice regularly implemented. This case study describes the experiences of this agency and the process taken toward engaging an external consultant and moving towards the development of a culture of learning.     

Linking an agency strategic review to increase knowledge management: San Francisco County Human Service Agency

Led by the agency director, the agency engaged in a Strategic Review, based on a comprehensive assessment of agency performance that identified strategies to improve organizational effectiveness through increased data-informed practice and knowledge management. The Strategic Review gathered information on staff perceptions, perceptions of external stakeholders, changing citywide and neighborhood demographics, policy mandates, and budget and workload issues. The need for the review was based upon multiple, substantial changes not addressed in the 2000 Strategic Plan, including the 2004 merger of the Department of Human Services and the Department of Aging and Adult Services, changes among the executive management team, transitions among key political entities, new policy mandates and changing budget allocations. This case study describes the Strategic Review process and content, summarizing key challenges and lessons related to addressing workload demands, fostering positive staff attitudes, balancing internal and external information needs, and integrating data use and planning processes across the agency.     

Exercise self-regulation among older women participating in a heart disease-management intervention

Using behavioral self-regulation processes may facilitate exercise among older women with heart disease. Data from women in a heart disease-management program (n = 658, mean 73 years), was used to explore associations among exercise self-regulation components (i.e., choosing to improve exercise and observing, judging, and reacting to one's behavior) and exercise capacity. General linear models showed that choosing exercise predicted higher exercise self-regulation scores postprogram and 8 months later. In turn, these scores predicted greater improvements in exercise capacity concurrently and 8 months later. Interaction analyses revealed that the effect of self-regulation on exercise capacity was stronger among women who chose to work on exercise.