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Our journey started by gaining a better understanding of what defines safety events and how they occur. The Swiss cheese model of safety acknowledges that despite all best efforts, humans, processes, policies, technology, and environmental factors all have gaps that can allow errors to slip through and reach the patient. Healthcare performance improvement HPI defines safety events as any variation in practice or expected outcome that reaches the patient; serious safety events are those in which the patient incurs moderate to severe harm or death.

A near-miss event is one that might have caused harm but was identified by a team member before the error reached the patient. To think like an HRO, we needed to encourage our staff to report safety events, especially near-miss events, which when analyzed and then corrected, can mitigate similar events from occurring. Simply put: To fix it, we must know about it. But first, we needed to overcome a significant barrier: Staff felt that by reporting an event, they were reporting a person, which carried a negative connotation.


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To tackle this challenge, we needed to make a culture change. We now apply the principle of a just culture, which states that no punishment will occur as a result of unintentional human error or mistakes caused by system problems. Fair consequences do exist for those who intentionally choose to not follow the rules. In addition to maintaining a just culture, we recognize staff for great catches and self-reporting. When reported events lead to causal analyses, we invite team members to share not only the events, but also their recommendations for how to prevent them from happening again.

One of the HRO must-haves is executive leadership support and commitment.

Article excerpt

Our leadership team guided us in weaving safety into our organizational fabric and making safety efforts real. As a result, we begin every meeting with a safety story or a quick win, using specific safety language, and safety huddles. Leadership-led safety huddles occur every morning including holidays and weekends in every department and focus on hour reflection and next hour anticipation. Safety coaches from each department hold monthly unit-based high-reliability meetings.

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In addition, safety efforts are recognized at department and manager meetings and at celebratory events such as during National Nurses Week. My head scarf wearing friends avoid public transport, get verbally abused while shopping regularly, I think the establishment figure of a politician should be looking for ways to make GB a safer place for headscarf wearing women than looking for ways to further incite mischief against them. On the religious, Ruth Davidson, the leader of the Scottish Conservatives, claimed that the row about wearing the burqa was similar to controversies about Christians wearing crucifixes.

A burqa is worn by Muslim women, not men, because throughout the patriarchal Islamic world women are invariably viewed and treated as inferior to men. A crucifix is worn by both Christian women and men, because in Christ there is neither male nor female. The burqa is a symbol of oppression and misogyny; the crucifix a symbol of liberty and equality. The burqa dehumanises, covers the face and conceals identity; the crucifix personalises, looks at God face-to-face and reveals true identity.

The burqa has no quranic legitimacy; the crucifix is the nexus of biblical authority. The burqa divides Muslims because it segregates and aggravates; the crucifix unites Christians because it saves and sanctifies. This leads to the second issue: that the burqa is not so much a religious symbol but an expression of a particular culture, a subset of the culture of Islamic countries. Tell thy wives and thy daughters and the women of the believers to draw their cloaks close round them when they go abroad. That will be better, so that they may be recognised and not annoyed.

Allah is ever Forgiving, Merciful. Surah 34 verse An obvious response to these verses is to note that the responsibility for sexual temptation is apportion to women as the temptresses, rather than men as the tempted. It is therefore no wonder that many of the countries that have banned the burqa have done so in response to the threat of jihadist Muslim violence. In our culture, because those who cover their faces typically only do so because they offer some sort of threat, or are in a situation of conflict and need to remain anonymous, then we naturally feel threatened, and the other seems depersonalised.

But in this regard, our culture is surely in line with basic realities of human life. Recognising facial expressions, and learning what they mean and imitating them, is the most primary form of development in infants. And those who are not able to recognise facial expressions and interpret them appropriately struggle through life. All cultural and religious traditions actually express, in an embedded way, values about what it means to be human. Even more basically, what does it mean to have a national identity, and what does it mean to be hospitable to other identities?

The ideas of welcome and inclusion need to have actual content. In Denmark they appear to understand what that means, so that some aspects of other cultures are welcomed in the country, but others are not. In Britain perhaps because of our imperial past and our lingering guilt about that? Thanks Evan. No, I think the link merits a serious interrogation of the issue—not a flippant remark made as a rhetorical flourish….

Islam must be a suitable subject for ridicule, including in its treatment of women or indeed their treatment of themselves.

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I note though like many others that Johnson is far from the first to make these kinds of unflattering comments and comparisons, but they have usually come from the Left. Is it a coincidence that this is the first time anyone has made a fuss about it? You ask a good question about liberal compatibility.


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    4. A further question is about whether accommodation is best achieved through integration e. Further questions then arise about difficulties when enclaves of foreign cultures become large eg whole neighbourhoods and even cities , and how foreign cultures should be reflected in a national culture without demolishing the national culture or fuelling resentment among those of indigenous culture.

    Thanks Ian, my view has been 1. It can be viewed as a benzyl group substituted for the methyl group of alanine , or a phenyl group in place of a terminal hydrogen of alanine.

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    This essential amino acid is classified as neutral, and nonpolar because of the inert and hydrophobic nature of the benzyl side chain. The L -isomer is used to biochemically form proteins , coded for by DNA. Phenylalanine is a precursor for tyrosine , the monoamine neurotransmitters dopamine , norepinephrine noradrenaline , and epinephrine adrenaline , and the skin pigment melanin. Phenylalanine is found naturally in the breast milk of mammals.

    It is used in the manufacture of food and drink products and sold as a nutritional supplement for its reputed analgesic and antidepressant effects. It is a direct precursor to the neuromodulator phenethylamine , a commonly used dietary supplement. As an essential amino acid, phenylalanine is not synthesized de novo in humans and other animals, who must ingest phenylalanine or phenylalanine-containing proteins. The first description of phenylalanine was made in , when Schulze and Barbieri identified a compound with the empirical formula , C 9 H 11 NO 2 , in yellow lupine Lupinus luteus seedlings.

    In , Erlenmeyer and Lipp first synthesized phenylalanine from phenylacetaldehyde , hydrogen cyanide , and ammonia.

    Background

    The genetic codon for phenylalanine was first discovered by J. Heinrich Matthaei and Marshall W. Nirenberg in They showed that by using mRNA to insert multiple uracil repeats into the genome of the bacterium E. This discovery helped to establish the nature of the coding relationship that links information stored in genomic nucleic acid with protein expression in the living cell.

    Good sources of phenylalanine are eggs, chicken, liver, beef, milk, and soybeans. L -Phenylalanine is biologically converted into L - tyrosine , another one of the DNA-encoded amino acids. L -tyrosine in turn is converted into L-DOPA , which is further converted into dopamine , norepinephrine noradrenaline , and epinephrine adrenaline. The latter three are known as the catecholamines. Phenylalanine uses the same active transport channel as tryptophan to cross the blood—brain barrier. In excessive quantities, supplementation can interfere with the production of serotonin and other aromatic amino acids [ citation needed ] as well as nitric oxide due to the overuse eventually, limited availability of the associated cofactors, iron or tetrahydrobiopterin.

    Phenylalanine is the starting compound used in the synthesis of flavonoids. Lignan is derived from phenylalanine and from tyrosine. Phenylalanine is converted to cinnamic acid by the enzyme phenylalanine ammonia-lyase. The genetic disorder phenylketonuria PKU is the inability to metabolize phenylalanine because of a lack of the enzyme phenylalanine hydroxylase. Individuals with this disorder are known as "phenylketonurics" and must regulate their intake of phenylalanine.

    Phenylketonurics often use blood tests to monitor the amount of phenylalanine in their blood. A rare "variant form" of phenylketonuria called hyperphenylalaninemia is caused by the inability to synthesize a cofactor called tetrahydrobiopterin , which can be supplemented. Pregnant women with hyperphenylalaninemia may show similar symptoms of the disorder high levels of phenylalanine in blood , but these indicators will usually disappear at the end of gestation.

    Pregnant women with PKU must control their blood phenylalanine levels even if the fetus is heterozygous for the defective gene because the fetus could be adversely affected due to hepatic immaturity. A non-food source of phenylalanine is the artificial sweetener aspartame. This compound is metabolized by the body into several chemical byproducts including phenylalanine. The breakdown problems phenylketonurics have with the buildup of phenylalanine in the body also occurs with the ingestion of aspartame, although to a lesser degree.

    Accordingly, all products in Australia, the U. These warnings are placed to help individuals avoid such foods. Geneticists sequenced the genome of macaques in Their investigations found "some instances where the normal form of the macaque protein looked like the diseased human protein" including markers for PKU.