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Failure to rescue events, or events involving preventable deaths from complications, are a significant contributor to inpatient mortality. While many interventions have been designed and implemented over several decades, this patient safety issue remains at the forefront of concern for most hospitals. In the first part of this study, the development and implementation of one type of highly studied and widely adopted rescue intervention, algorithm-based patient assessment tools, is examined. The analysis summarizes how a lack of systems-oriented approaches in the design and implementation of these tools has resulted in suboptimal understanding of patient risk of mortality and complications and the early recognition of patient deterioration. The gaps identified impact several critical aspects of excellent patient care, including information-sharing across care settings, support for the development of shared mental models within care teams, and access to timely and accurate patient information.

This chapter describes the use of several system-oriented design and implementation activities to establish design objectives, model clinical processes and workflows, and create an extensible information system model to maximize the benefits of patient state and risk assessment tools in the inpatient setting. A prototype based on the product of the design activities is discussed along with system-level considerations for implementation. This study also demonstrates the effectiveness and impact of applying systems design principles and practices to real-world clinical applications.

German legal historians of nineteenth and twentieth centuries defined the main characteristics of the corporations and believed that one renaissance institution, the Casa di San Giorgio at Genoa (1407–1805), was similar to the corporations of later centuries. This paper proposes to reverse this perspective: did the founders of early modern corporations know the financial model of the fifteenth century Casa di San Giorgio? The research shows the connection between the model of the Casa di San Giorgio and the Mississippi Company of John Law (1720), the famous financial scheme and bubble. The history of the Casa di San Giorgio was mainly transmitted through a passage of Machiavelli’s History of Florence (VIII, 29). The paper offers new biographical evidence that Law had been to Genoa and introduces sources connecting the genesis of Law’s scheme for the Mississippi Company in France with the model of the Casa di San Giorgio.

Power electronics used in consumer product assemblies require thermal management. Several current products rely on ‘printed wiring’ designs. These have copper patterns separated from a metal substrate by a performance dielectric. The acceptance of this design concept ensures the availability of insulated metal substrates (IMS) for these applications. Available design guides do not describe the design constraints forced on these assembly designs by the physical characteristics of the materials in use. The following three design issues are discussed in this paper: — Dielectric strength testing does not relate to the proof stress testing required for product agency approval. — There is a special case for conformal coating or the use of potting compounds when IMS assemblies are used. — The choice of the metal substrate is based on quantity, thermal coefficient of expansion and thermal conductivity, often in that order.

Dr Nihal Sinnadurai has taken up his new post as Professor of Electronics Technology at Middlesex University and head of its Microelectronics Centre.

A surface‐mount in‐line light emitting diode (LED) array was developed for mounting an LED dot matrix display on a single‐sided insulated metal substrate (IMS). This LED array has heat dissipating cathode leads and an anode lead that works as a jumper wire. Good heat dissipation of the LED array was obtained on an aluminium IMS.

US citizens who attend international medical schools (US IMGs) are more likely to be of Hispanic, Black American, or Asian descent compared to US medical students. As physicians, US IMGs contribute diversity to the health-care workforce; their experiences and perspectives have improved the health outcomes for populations typically underserved. To become a competent medical professional is a challenging experience, especially for IMGs who may have entered medical school with less than optimal academic histories. During this journey, some students develop academic and clinical deficiencies. Addressing these deficits through remediation interventions are critical to the student’s performance as a physician. This study measured the resiliency, self-efficacy, and self-compassion of IMGs who completed remediation while in medical school. Results indicate older students experienced failure more often and were found to have significantly higher levels of self-compassion compared to younger students. Males were assigned significantly more remedial interventions compared to the female participants. Finally, strong positive correlations suggested that the more remediation interventions students were provided, the more likely they were satisfied with their overall remediation experience. These findings indicate that by varying support strategies and encouraging student’s orientation to resiliency, self-efficacy, and self-compassion may assist them in overcoming their deficits.

A wire matrix has been developed for mounting LED dot matrix displays whereby insulated wires are ‘woven’ to produce a matrix that is fixed on an aluminium board with epoxy adhesive. This monolayer woven wire board simplifies the fabrication process of the display board while at the same time showing more than double the heat dissipation of conventional insulated aluminium printed circuit boards and five times that of conventional glass epoxy printed circuit boards when mounted with bare LED chips. In addition, it is suitable for high‐density and high‐brightness LED dot matrix displays.

During the first half of this year the Association has continued to expand its exhibition programme by increasing its presence at overseas shows. Two DTI sponsored joint venture groups have been formed, one to Nepcon West, the other to Nepcon Beijing. Anaheim saw the biggest UK group for over 10 years, with CEMA taking three separate blocks in different sectors of the show. There is no doubt from the reception we received that CEMA is now firmly established at Nepcon West. We enjoyed tremendous support from both the British Consulate and the British‐American Chamber of Commerce with their President making several visits to the CEMA booth.

Barriers to adequate healthcare in rural areas remain a grand challenge for local healthcare systems. In addition to patients' travel burdens, lack of health insurance, and lower health literacy, rural healthcare systems also experience significant resource shortages, as well as issues with recruitment and retention of healthcare providers, particularly specialists. These factors combined result in complex change management-focused challenges for rural healthcare systems. Change management initiatives are often resource intensive, and in rural health organizations already strapped for resources, it may be particularly risky to embark on change initiatives. One way to address these change management concerns is by leveraging socio-technical simulation models to estimate techno-economic feasibility (e.g., is it technologically feasible, and is it economical?) as well as socio-utility feasibility (e.g., how will the changes be utilized?). We present a framework for how healthcare systems can integrate modeling and simulation techniques from systems engineering into a change management process. Modeling and simulation are particularly useful for investigating the amount of uncertainty about potential outcomes, guiding decision-making that considers different scenarios, and validating theories to determine if they accurately reflect real-life processes. The results of these simulations can be integrated into critical change management recommendations related to developing readiness for change and addressing resistance to change. As part of our integration, we present a case study showcasing how simulation modeling has been used to determine feasibility and potential resistance to change considerations for implementing a mobile radiation oncology unit. Recommendations and implications are discussed.