To Err Is Human

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Publisher : National Academies Press
ISBN 13 : 0309068371
Total Pages : 312 pages
Book Rating : 4.3/5 (9 download)

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Book Synopsis To Err Is Human by : Institute of Medicine

Download or read book To Err Is Human written by Institute of Medicine and published by National Academies Press. This book was released on 2000-03-01 with total page 312 pages. Available in PDF, EPUB and Kindle. Book excerpt: Experts estimate that as many as 98,000 people die in any given year from medical errors that occur in hospitals. That's more than die from motor vehicle accidents, breast cancer, or AIDSâ€"three causes that receive far more public attention. Indeed, more people die annually from medication errors than from workplace injuries. Add the financial cost to the human tragedy, and medical error easily rises to the top ranks of urgent, widespread public problems. To Err Is Human breaks the silence that has surrounded medical errors and their consequenceâ€"but not by pointing fingers at caring health care professionals who make honest mistakes. After all, to err is human. Instead, this book sets forth a national agendaâ€"with state and local implicationsâ€"for reducing medical errors and improving patient safety through the design of a safer health system. This volume reveals the often startling statistics of medical error and the disparity between the incidence of error and public perception of it, given many patients' expectations that the medical profession always performs perfectly. A careful examination is made of how the surrounding forces of legislation, regulation, and market activity influence the quality of care provided by health care organizations and then looks at their handling of medical mistakes. Using a detailed case study, the book reviews the current understanding of why these mistakes happen. A key theme is that legitimate liability concerns discourage reporting of errorsâ€"which begs the question, "How can we learn from our mistakes?" Balancing regulatory versus market-based initiatives and public versus private efforts, the Institute of Medicine presents wide-ranging recommendations for improving patient safety, in the areas of leadership, improved data collection and analysis, and development of effective systems at the level of direct patient care. To Err Is Human asserts that the problem is not bad people in health careâ€"it is that good people are working in bad systems that need to be made safer. Comprehensive and straightforward, this book offers a clear prescription for raising the level of patient safety in American health care. It also explains how patients themselves can influence the quality of care that they receive once they check into the hospital. This book will be vitally important to federal, state, and local health policy makers and regulators, health professional licensing officials, hospital administrators, medical educators and students, health caregivers, health journalists, patient advocatesâ€"as well as patients themselves. First in a series of publications from the Quality of Health Care in America, a project initiated by the Institute of Medicine

I Am Error

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Publisher : MIT Press
ISBN 13 : 0262534541
Total Pages : 439 pages
Book Rating : 4.2/5 (625 download)

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Book Synopsis I Am Error by : Nathan Altice

Download or read book I Am Error written by Nathan Altice and published by MIT Press. This book was released on 2017-09-08 with total page 439 pages. Available in PDF, EPUB and Kindle. Book excerpt: The complex material histories of the Nintendo Entertainment System platform, from code to silicon, focusing on its technical constraints and its expressive affordances. In the 1987 Nintendo Entertainment System videogame Zelda II: The Adventure of Link, a character famously declared: I AM ERROR. Puzzled players assumed that this cryptic mesage was a programming flaw, but it was actually a clumsy Japanese-English translation of “My Name is Error,” a benign programmer's joke. In I AM ERROR Nathan Altice explores the complex material histories of the Nintendo Entertainment System (and its Japanese predecessor, the Family Computer), offering a detailed analysis of its programming and engineering, its expressive affordances, and its cultural significance. Nintendo games were rife with mistranslated texts, but, as Altice explains, Nintendo's translation challenges were not just linguistic but also material, with consequences beyond simple misinterpretation. Emphasizing the technical and material evolution of Nintendo's first cartridge-based platform, Altice describes the development of the Family Computer (or Famicom) and its computational architecture; the “translation” problems faced while adapting the Famicom for the U.S. videogame market as the redesigned Entertainment System; Nintendo's breakthrough console title Super Mario Bros. and its remarkable software innovations; the introduction of Nintendo's short-lived proprietary disk format and the design repercussions on The Legend of Zelda; Nintendo's efforts to extend their console's lifespan through cartridge augmentations; the Famicom's Audio Processing Unit (APU) and its importance for the chiptunes genre; and the emergence of software emulators and the new kinds of play they enabled.

ATC System Error and Appraisal of Controller Proficiency

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Publisher :
ISBN 13 :
Total Pages : 20 pages
Book Rating : 4.:/5 (89 download)

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Book Synopsis ATC System Error and Appraisal of Controller Proficiency by : William F. O'Connor

Download or read book ATC System Error and Appraisal of Controller Proficiency written by William F. O'Connor and published by . This book was released on 1965 with total page 20 pages. Available in PDF, EPUB and Kindle. Book excerpt: The report presents suggestions for the design of an air traffic control (ATC) incident-reporting system aimed at maximizing the amount of corrective feedback to the ATC system. The approach taken is system-oriented rather than controller-oriented. Included is a discussion of a philosophy of corrective and punitive action relative to controller involvement in an incident. Recommendations and examples of format are included for the design of incident-report forms and incident chronology and of a checklist to be used in periodic appraisal of controller performance. Emphasis is given in format design to use of systems and human function, rather than regulatory and procedural terminology. Implementation and data-analysis techniques are also discussed. (Author).

Ten Questions About Human Error

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Publisher : CRC Press
ISBN 13 : 1410612066
Total Pages : 233 pages
Book Rating : 4.4/5 (16 download)

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Book Synopsis Ten Questions About Human Error by : Sidney Dekker

Download or read book Ten Questions About Human Error written by Sidney Dekker and published by CRC Press. This book was released on 2004-12-27 with total page 233 pages. Available in PDF, EPUB and Kindle. Book excerpt: Ten Questions About Human Error asks the type of questions frequently posed in incident and accident investigations, people's own practice, managerial and organizational settings, policymaking, classrooms, Crew Resource Management Training, and error research. It is one installment in a larger transformation that has begun to identify both deep-rooted constraints and new leverage points of views of human factors and system safety. The ten questions about human error are not just questions about human error as a phenomenon, but also about human factors and system safety as disciplines, and where they stand today. In asking these questions and sketching the answers to them, this book attempts to show where current thinking is limited--where vocabulary, models, ideas, and notions are constraining progress. This volume looks critically at the answers human factors would typically provide and compares/contrasts them with current research insights. Each chapter provides directions for new ideas and models that could perhaps better cope with the complexity of the problems facing human error today. As such, this book can be used as a supplement for a variety of human factors courses.

Just Giving

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Publisher : Princeton University Press
ISBN 13 : 0691202273
Total Pages : 258 pages
Book Rating : 4.6/5 (912 download)

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Book Synopsis Just Giving by : Rob Reich

Download or read book Just Giving written by Rob Reich and published by Princeton University Press. This book was released on 2020-05-05 with total page 258 pages. Available in PDF, EPUB and Kindle. Book excerpt: The troubling ethics and politics of philanthropy Is philanthropy, by its very nature, a threat to today’s democracy? Though we may laud wealthy individuals who give away their money for society’s benefit, Just Giving shows how such generosity not only isn’t the unassailable good we think it to be but might also undermine democratic values. Big philanthropy is often an exercise of power, the conversion of private assets into public influence. And it is a form of power that is largely unaccountable and lavishly tax-advantaged. Philanthropy currently fails democracy, but Rob Reich argues that it can be redeemed. Just Giving investigates the ethical and political dimensions of philanthropy and considers how giving might better support democratic values and promote justice.

Site Reliability Engineering

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Publisher : "O'Reilly Media, Inc."
ISBN 13 : 1491951176
Total Pages : 552 pages
Book Rating : 4.4/5 (919 download)

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Book Synopsis Site Reliability Engineering by : Niall Richard Murphy

Download or read book Site Reliability Engineering written by Niall Richard Murphy and published by "O'Reilly Media, Inc.". This book was released on 2016-03-23 with total page 552 pages. Available in PDF, EPUB and Kindle. Book excerpt: The overwhelming majority of a software system’s lifespan is spent in use, not in design or implementation. So, why does conventional wisdom insist that software engineers focus primarily on the design and development of large-scale computing systems? In this collection of essays and articles, key members of Google’s Site Reliability Team explain how and why their commitment to the entire lifecycle has enabled the company to successfully build, deploy, monitor, and maintain some of the largest software systems in the world. You’ll learn the principles and practices that enable Google engineers to make systems more scalable, reliable, and efficient—lessons directly applicable to your organization. This book is divided into four sections: Introduction—Learn what site reliability engineering is and why it differs from conventional IT industry practices Principles—Examine the patterns, behaviors, and areas of concern that influence the work of a site reliability engineer (SRE) Practices—Understand the theory and practice of an SRE’s day-to-day work: building and operating large distributed computing systems Management—Explore Google's best practices for training, communication, and meetings that your organization can use

Strangers Drowning

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Publisher : Penguin
ISBN 13 : 0143109782
Total Pages : 338 pages
Book Rating : 4.1/5 (431 download)

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Book Synopsis Strangers Drowning by : Larissa MacFarquhar

Download or read book Strangers Drowning written by Larissa MacFarquhar and published by Penguin. This book was released on 2016-09-27 with total page 338 pages. Available in PDF, EPUB and Kindle. Book excerpt: What does it mean to devote yourself wholly to helping others? In Strangers Drowning, Larissa MacFarquhar seeks out people living lives of extreme ethical commitment and tells their deeply intimate stories; their stubborn integrity and their compromises; their bravery and their recklessness; their joys and defeats and wrenching dilemmas. A couple adopts two children in distress. But then they think: If they can change two lives, why not four? Or ten? They adopt twenty. But how do they weigh the needs of unknown children in distress against the needs of the children they already have? Another couple founds a leprosy colony in the wilderness in India, living in huts with no walls, knowing that their two small children may contract leprosy or be eaten by panthers. The children survive. But what if they hadn’t? How would their parents’ risk have been judged? A woman believes that if she spends money on herself, rather than donate it to buy life-saving medicine, then she’s responsible for the deaths that result. She lives on a fraction of her income, but wonders: when is compromise self-indulgence and when is it essential? We honor such generosity and high ideals; but when we call people do-gooders there is skepticism in it, even hostility. Why do moral people make us uneasy? Between her stories, MacFarquhar threads a lively history of the literature, philosophy, social science, and self-help that have contributed to a deep suspicion of do-gooders in Western culture. Through its sympathetic and beautifully vivid storytelling, Strangers Drowning confronts us with fundamental questions about what it means to be human. In a world of strangers drowning in need, how much should we help, and how much can we help? Is it right to care for strangers even at the expense of those we are closest to? Moving and provocative, Strangers Drowning challenges us to think about what we value most, and why.

Mastering Perl

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Publisher : "O'Reilly Media, Inc."
ISBN 13 : 1449364977
Total Pages : 397 pages
Book Rating : 4.4/5 (493 download)

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Book Synopsis Mastering Perl by : brian d foy

Download or read book Mastering Perl written by brian d foy and published by "O'Reilly Media, Inc.". This book was released on 2014-01-09 with total page 397 pages. Available in PDF, EPUB and Kindle. Book excerpt: Take the next step toward Perl mastery with advanced concepts that make coding easier, maintenance simpler, and execution faster. Mastering Perl isn't a collection of clever tricks, but a way of thinking about Perl programming for solving debugging, configuration, and many other real-world problems you’ll encounter as a working programmer. The third in O’Reilly’s series of landmark Perl tutorials (after Learning Perl and Intermediate Perl), this fully upated edition pulls everything together and helps you bend Perl to your will. Explore advanced regular expressions features Avoid common problems when writing secure programs Profile and benchmark Perl programs to see where they need work Wrangle Perl code to make it more presentable and readable Understand how Perl keeps track of package variables Define subroutines on the fly Jury-rig modules to fix code without editing the original source Use bit operations and bit vectors to store large data efficiently Learn how to detect errors that Perl doesn’t report Dive into logging, data persistence, and the magic of tied variables

Microsoft System Center Configuration Manager Field Experience

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Publisher : Microsoft Press
ISBN 13 : 073568460X
Total Pages : 92 pages
Book Rating : 4.7/5 (356 download)

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Book Synopsis Microsoft System Center Configuration Manager Field Experience by : Manoj Pal

Download or read book Microsoft System Center Configuration Manager Field Experience written by Manoj Pal and published by Microsoft Press. This book was released on 2013-10-15 with total page 92 pages. Available in PDF, EPUB and Kindle. Book excerpt: Part of a series of specialized guides on System Center - this book shares real-world expertise for using Configuration Manager capabilities to deliver more effective IT services. Series editor Mitch Tulloch and a team of System Center experts provide concise technical guidance as they step you through key deployment and management scenarios.

PCI Express System Architecture

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Publisher : Addison-Wesley Professional
ISBN 13 : 9780321156303
Total Pages : 354 pages
Book Rating : 4.1/5 (563 download)

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Book Synopsis PCI Express System Architecture by : Ravi Budruk

Download or read book PCI Express System Architecture written by Ravi Budruk and published by Addison-Wesley Professional. This book was released on 2004 with total page 354 pages. Available in PDF, EPUB and Kindle. Book excerpt: ••PCI EXPRESS is considered to be the most general purpose bus so it should appeal to a wide audience in this arena.•Today's buses are becoming more specialized to meet the needs of the particular system applications, building the need for this book.•Mindshare and their only competitor in this space, Solari, team up in this new book.

A Human Error Approach to Aviation Accident Analysis

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Publisher : Routledge
ISBN 13 : 1351962353
Total Pages : 174 pages
Book Rating : 4.3/5 (519 download)

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Book Synopsis A Human Error Approach to Aviation Accident Analysis by : Douglas A. Wiegmann

Download or read book A Human Error Approach to Aviation Accident Analysis written by Douglas A. Wiegmann and published by Routledge. This book was released on 2017-12-22 with total page 174 pages. Available in PDF, EPUB and Kindle. Book excerpt: Human error is implicated in nearly all aviation accidents, yet most investigation and prevention programs are not designed around any theoretical framework of human error. Appropriate for all levels of expertise, the book provides the knowledge and tools required to conduct a human error analysis of accidents, regardless of operational setting (i.e. military, commercial, or general aviation). The book contains a complete description of the Human Factors Analysis and Classification System (HFACS), which incorporates James Reason's model of latent and active failures as a foundation. Widely disseminated among military and civilian organizations, HFACS encompasses all aspects of human error, including the conditions of operators and elements of supervisory and organizational failure. It attracts a very broad readership. Specifically, the book serves as the main textbook for a course in aviation accident investigation taught by one of the authors at the University of Illinois. This book will also be used in courses designed for military safety officers and flight surgeons in the U.S. Navy, Army and the Canadian Defense Force, who currently utilize the HFACS system during aviation accident investigations. Additionally, the book has been incorporated into the popular workshop on accident analysis and prevention provided by the authors at several professional conferences world-wide. The book is also targeted for students attending Embry-Riddle Aeronautical University which has satellite campuses throughout the world and offers a course in human factors accident investigation for many of its majors. In addition, the book will be incorporated into courses offered by Transportation Safety International and the Southern California Safety Institute. Finally, this book serves as an excellent reference guide for many safety professionals and investigators already in the field.

Noise

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Publisher : Little, Brown
ISBN 13 : 031645138X
Total Pages : 429 pages
Book Rating : 4.3/5 (164 download)

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Book Synopsis Noise by : Daniel Kahneman

Download or read book Noise written by Daniel Kahneman and published by Little, Brown. This book was released on 2021-05-18 with total page 429 pages. Available in PDF, EPUB and Kindle. Book excerpt: From the Nobel Prize-winning author of Thinking, Fast and Slow and the coauthor of Nudge, a revolutionary exploration of why people make bad judgments and how to make better ones—"a tour de force” (New York Times). Imagine that two doctors in the same city give different diagnoses to identical patients—or that two judges in the same courthouse give markedly different sentences to people who have committed the same crime. Suppose that different interviewers at the same firm make different decisions about indistinguishable job applicants—or that when a company is handling customer complaints, the resolution depends on who happens to answer the phone. Now imagine that the same doctor, the same judge, the same interviewer, or the same customer service agent makes different decisions depending on whether it is morning or afternoon, or Monday rather than Wednesday. These are examples of noise: variability in judgments that should be identical. In Noise, Daniel Kahneman, Olivier Sibony, and Cass R. Sunstein show the detrimental effects of noise in many fields, including medicine, law, economic forecasting, forensic science, bail, child protection, strategy, performance reviews, and personnel selection. Wherever there is judgment, there is noise. Yet, most of the time, individuals and organizations alike are unaware of it. They neglect noise. With a few simple remedies, people can reduce both noise and bias, and so make far better decisions. Packed with original ideas, and offering the same kinds of research-based insights that made Thinking, Fast and Slow and Nudge groundbreaking New York Times bestsellers, Noise explains how and why humans are so susceptible to noise in judgment—and what we can do about it.

Advanced R

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Publisher : CRC Press
ISBN 13 : 1498759807
Total Pages : 476 pages
Book Rating : 4.4/5 (987 download)

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Book Synopsis Advanced R by : Hadley Wickham

Download or read book Advanced R written by Hadley Wickham and published by CRC Press. This book was released on 2015-09-15 with total page 476 pages. Available in PDF, EPUB and Kindle. Book excerpt: An Essential Reference for Intermediate and Advanced R Programmers Advanced R presents useful tools and techniques for attacking many types of R programming problems, helping you avoid mistakes and dead ends. With more than ten years of experience programming in R, the author illustrates the elegance, beauty, and flexibility at the heart of R. The book develops the necessary skills to produce quality code that can be used in a variety of circumstances. You will learn: The fundamentals of R, including standard data types and functions Functional programming as a useful framework for solving wide classes of problems The positives and negatives of metaprogramming How to write fast, memory-efficient code This book not only helps current R users become R programmers but also shows existing programmers what’s special about R. Intermediate R programmers can dive deeper into R and learn new strategies for solving diverse problems while programmers from other languages can learn the details of R and understand why R works the way it does.

Making Healthcare Safe

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Publisher : Springer Nature
ISBN 13 : 3030711234
Total Pages : 450 pages
Book Rating : 4.0/5 (37 download)

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Book Synopsis Making Healthcare Safe by : Lucian L. Leape

Download or read book Making Healthcare Safe written by Lucian L. Leape and published by Springer Nature. This book was released on 2021-05-28 with total page 450 pages. Available in PDF, EPUB and Kindle. Book excerpt: This unique and engaging open access title provides a compelling and ground-breaking account of the patient safety movement in the United States, told from the perspective of one of its most prominent leaders, and arguably the movement’s founder, Lucian L. Leape, MD. Covering the growth of the field from the late 1980s to 2015, Dr. Leape details the developments, actors, organizations, research, and policy-making activities that marked the evolution and major advances of patient safety in this time span. In addition, and perhaps most importantly, this book not only comprehensively details how and why human and systems errors too often occur in the process of providing health care, it also promotes an in-depth understanding of the principles and practices of patient safety, including how they were influenced by today’s modern safety sciences and systems theory and design. Indeed, the book emphasizes how the growing awareness of systems-design thinking and the self-education and commitment to improving patient safety, by not only Dr. Leape but a wide range of other clinicians and health executives from both the private and public sectors, all converged to drive forward the patient safety movement in the US. Making Healthcare Safe is divided into four parts: I. In the Beginning describes the research and theory that defined patient safety and the early initiatives to enhance it. II. Institutional Responses tells the stories of the efforts of the major organizations that began to apply the new concepts and make patient safety a reality. Most of these stories have not been previously told, so this account becomes their histories as well. III. Getting to Work provides in-depth analyses of four key issues that cut across disciplinary lines impacting patient safety which required special attention. IV. Creating a Culture of Safety looks to the future, marshalling the best thinking about what it will take to achieve the safe care we all deserve. Captivatingly written with an “insider’s” tone and a major contribution to the clinical literature, this title will be of immense value to health care professionals, to students in a range of academic disciplines, to medical trainees, to health administrators, to policymakers and even to lay readers with an interest in patient safety and in the critical quest to create safe care.

Kingpin

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Publisher : Crown
ISBN 13 : 0307588696
Total Pages : 290 pages
Book Rating : 4.3/5 (75 download)

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Book Synopsis Kingpin by : Kevin Poulsen

Download or read book Kingpin written by Kevin Poulsen and published by Crown. This book was released on 2012-02-07 with total page 290 pages. Available in PDF, EPUB and Kindle. Book excerpt: Former hacker Kevin Poulsen has, over the past decade, built a reputation as one of the top investigative reporters on the cybercrime beat. In Kingpin, he pours his unmatched access and expertise into book form for the first time, delivering a gripping cat-and-mouse narrative—and an unprecedented view into the twenty-first century’s signature form of organized crime. The word spread through the hacking underground like some unstoppable new virus: Someone—some brilliant, audacious crook—had just staged a hostile takeover of an online criminal network that siphoned billions of dollars from the US economy. The FBI rushed to launch an ambitious undercover operation aimed at tracking down this new kingpin; other agencies around the world deployed dozens of moles and double agents. Together, the cybercops lured numerous unsuspecting hackers into their clutches. . . . Yet at every turn, their main quarry displayed an uncanny ability to sniff out their snitches and see through their plots. The culprit they sought was the most unlikely of criminals: a brilliant programmer with a hippie ethic and a supervillain’s double identity. As prominent “white-hat” hacker Max “Vision” Butler, he was a celebrity throughout the programming world, even serving as a consultant to the FBI. But as the black-hat “Iceman,” he found in the world of data theft an irresistible opportunity to test his outsized abilities. He infiltrated thousands of computers around the country, sucking down millions of credit card numbers at will. He effortlessly hacked his fellow hackers, stealing their ill-gotten gains from under their noses. Together with a smooth-talking con artist, he ran a massive real-world crime ring. And for years, he did it all with seeming impunity, even as countless rivals ran afoul of police. Yet as he watched the fraudsters around him squabble, their ranks riddled with infiltrators, their methods inefficient, he began to see in their dysfunction the ultimate challenge: He would stage his coup and fix what was broken, run things as they should be run—even if it meant painting a bull’s-eye on his forehead. Through the story of this criminal’s remarkable rise, and of law enforcement’s quest to track him down, Kingpin lays bare the workings of a silent crime wave still affecting millions of Americans. In these pages, we are ushered into vast online-fraud supermarkets stocked with credit card numbers, counterfeit checks, hacked bank accounts, dead drops, and fake passports. We learn the workings of the numerous hacks—browser exploits, phishing attacks, Trojan horses, and much more—these fraudsters use to ply their trade, and trace the complex routes by which they turn stolen data into millions of dollars. And thanks to Poulsen’s remarkable access to both cops and criminals, we step inside the quiet, desperate arms race that law enforcement continues to fight with these scammers today. Ultimately, Kingpin is a journey into an underworld of startling scope and power, one in which ordinary American teenagers work hand in hand with murderous Russian mobsters and where a simple Wi-Fi connection can unleash a torrent of gold worth millions.

Advances in Patient Safety

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Author :
Publisher :
ISBN 13 :
Total Pages : 526 pages
Book Rating : 4.7/5 (54 download)

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Book Synopsis Advances in Patient Safety by : Kerm Henriksen

Download or read book Advances in Patient Safety written by Kerm Henriksen and published by . This book was released on 2005 with total page 526 pages. Available in PDF, EPUB and Kindle. Book excerpt: v. 1. Research findings -- v. 2. Concepts and methodology -- v. 3. Implementation issues -- v. 4. Programs, tools and products.

B2B Integration

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Publisher : Springer Science & Business Media
ISBN 13 : 3662051699
Total Pages : 428 pages
Book Rating : 4.6/5 (62 download)

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Book Synopsis B2B Integration by : Christoph Bussler

Download or read book B2B Integration written by Christoph Bussler and published by Springer Science & Business Media. This book was released on 2013-06-29 with total page 428 pages. Available in PDF, EPUB and Kindle. Book excerpt: Business-to-business (B2B) integration is a buzzword which has been used a lot in recent years, with a variety of meanings. Starting with a clear technical definition of this term and its relation to topics like A2A (Application-to-Application), ASP (Application Service Provider), A2A, and B2C (Business-to-Consumer), Christoph Bussler outlines a complete and consistent B2B integration architecture based on a coherent conceptual model. He shows that B2B integration not only requires the exchange of business events between distributed trading partners across networks like the Internet, but also demands back-end application integration within business processes, and thus goes far beyond traditional approaches to enterprise application integration approaches. His detailed presentation describes how B2B integration standards like RosettaNet or SWIFT, the application integration standard J2EE Connector Architecture and basic standards like XML act together in order to enable business process integration. The book is the first of its kind that discusses B2B concepts and architectures independent of specific and short-term industrial or academic approaches and thus provides solid and long-lasting knowledge for researchers, students, and professionals interested in the field of B2B integration.