Mass populations of toxin-producing cyanobacteria are an increasingly common occurrence in inland and coastal waters used for recreational purposes. These mass populations pose serious risks to human and animal health and impose potentially significant economic costs on society. In this study, we used contingent valuation (CV) methods to elicit public willingness to pay (WTP) for reductions in the morbidity risks posed by blooms of toxin-producing cyanobacteria in Loch Leven, Scotland. We found that 55% of respondents (68% excluding protest voters) were willing to pay for a reduction in the number of days per year (from 90, to either 45 or 0 days) that cyanobacteria pose a risk to human health at Loch Leven. The mean WTP for a risk reduction was UK£9.99-12.23/household/year estimated using a logistic spike model. In addition, using the spike model and a simultaneous equations model to control for endogeneity bias, we found the respondents' WTP was strongly dependent on socio-demographic characteristics, economic status and usage of the waterbody, but also individual-specific attitudes and perceptions towards health risks. This study demonstrates that anticipated health risk reductions are an important nonmarket benefit of improving water quality in recreational waters and should be accounted for in future cost-benefit analyses such as those being undertaken under the auspices of the European Union's Water Framework Directive, but also that such values depend on subjective perceptions of water-related health risks and general attitudes towards the environment.

BACKGROUND: Community pharmacists are an important link between methadone patients and the health service in the United Kingdom. However, many pharmacists feel ill prepared to deal with methadone patients, with aggressive behavior a particular concern. OBJECTIVE: To assess the perceived impact of methadone patient aggression on pharmacy practice. METHODS: Sixteen registered pharmacists with a minimum of 3 years' work experience were recruited from within 3 Scottish health boards. Critical incident interviews were conducted to assess pharmacist behavior during an interaction with an aggressive methadone patient. RESULTS: Factors considered by pharmacists to have a negative impact on an interaction with an aggressive methadone patient included intoxication of the patient, the presence of a new or an inexperienced pharmacist, and a restricted time frame for dispensing methadone. Positive factors when dealing with aggressive patients were authoritative behavior by the pharmacist, a separate dispensing area for methadone patients, or a solid counter and a positive relationship between pharmacist and patient. CONCLUSION: Aggression from methadone patients is a risk when dispensing methadone. However, action can be taken by the pharmacist to minimize the impact of that aggression on pharmacy practice. The provision of further training and support, particularly to inexperienced pharmacists, could further reduce the negative impact of patient aggression. The present study indicates that such training could be based on nontechnical skills to strengthen current leadership and teamwork behaviors.

OBJECTIVE There is a growing literature on the relationship between teamwork and patient outcomes in intensive care, providing new insights into the skills required for effective team performance. The purpose of this review is to consolidate the most robust findings from this research into an intensive care unit (ICU) team performance framework. DATA SOURCES Studies investigating teamwork within the ICU using PubMed, Science Direct, and Web of Knowledge databases. STUDY SELECTION Studies investigating the relationship between aspects of teamwork and ICU outcomes, or studies testing factors that are found to influence team working in the ICU. DATA EXTRACTION Teamwork behaviors associated with patient or staff-related outcomes in the ICU were identified. DATA SYNTHESIS Teamwork behaviors were grouped according to the team process categories of "team communication,""team leadership,""team coordination," and "team decision making." A prototype framework explaining the team performance in the ICU was developed using these categories. The purpose of the framework is to consolidate the existing ICU teamwork literature and to guide the development and testing of interventions for improving teamwork. CONCLUSIONS Effective teamwork is shown as crucial for providing optimal patient care in the ICU. In particular, team leadership seems vital for guiding the way in which ICU team members interact and coordinate with others.

OBJECTIVE To change the culture of healthcare organisations and improve patient safety, new professionals need to be taught about adverse events and how to trap and mitigate against errors. A literature review did not reveal any patient safety courses in the core undergraduate medical curriculum. Therefore a new module was designed and piloted. DESIGN A 5-h evidence-based module on understanding error in healthcare was designed with a preliminary evaluation using self-report questionnaires. SETTING A UK medical school. PARTICIPANTS 110 final year students. MEASUREMENTS AND MAIN RESULTS Participants completed two questionnaires: the first questionnaire was designed to measure students' self-ratings of knowledge, attitudes and behaviour in relation to patient safety and medical error, and was administered before and approximately 1 year after the module; the second formative questionnaire on the teaching process and how it could be improved was administered after completion of the module. CONCLUSIONS Before attending the module, the students reported they had little understanding of patient safety matters. One year later, only knowledge and the perceived personal control over safety had improved. The students rated the teaching process highly and found the module valuable. Longitudinal follow-up is required to provide more information on the lasting impact of the module.

INTRODUCTION There are numerous diverse papers that have addressed issues within maritime safety; to date there has been no comprehensive review of this literature to aggregate the causal factors within accidents in shipping and surmise current knowledge. METHODS This paper reviewed the literature on safety in three key areas: common themes of accidents, the influence of human error, and interventions to make shipping safer. The review included 20 studies of seafaring across the following areas: fatigue, stress, health, situation awareness, teamwork, decision-making, communication, automation, and safety culture. RESULTS The review identifies the relative contributions of individual and organizational factors in shipping accidents, and also presents the methodological issues with previous research. CONCLUSIONS The paper concludes that monitoring and modifying the human factors issues presented in this paper could contribute to maritime safety performance. IMPACT ON INDUSTRY This review illustrates which human factors issues are prevalent in incidents therefore this gives shipping practitioners a focus for interventions.

CONTEXT To improve patient safety, medical students should be taught about human error and the factors influencing adverse events. The optimal evaluation of new curricula for patient safety requires tools for baseline measurement of medical students' attitudes and knowledge. OBJECTIVES The aim of the study was to design and evaluate a questionnaire for measuring the attitudes of Year 1 medical students to patient safety and medical error. METHODS A questionnaire entitled 'Medical Students' Patient Safety Questionnaire (Year 1)' was designed to assess Year 1 medical students' attitudes and anticipated behaviours relating to medical error and patient safety. This was administered to two cohorts of Year 1 medical students in a UK medical school during 2008 (n = 296) and the data subjected to psychometric analyses. RESULTS Medical students' attitudes to good patient safety practices were generally positive, but the students had little knowledge of how to report errors and were unsure about what to do if a colleague made an error or if a patient indicated that an error had been made. On the five scales of the questionnaire, Cronbach's alpha values ranged from 0.59 (Attitudes to patient safety scale) to 0.88 (Knowledge of error and patient safety scale) and three scales showed internal consistencies below the recommended value of 0.70. Exploratory factor analysis showed that the five factors explain 51.7% of variance. CONCLUSIONS With some minor item trimming and re-allocation, the Medical Students' Patient Safety Questionnaire (Year 1) can function as an instrument with which to assess the attitudes of new medical students to patient safety and medical error. To assess the suitability of the instrument beyond the UK would require additional work.

Safety culture is an important topic for managers in high-hazard industries because a deficient safety culture has been linked to organizational accidents. Many researchers have argued that trust plays a central role in models of safety culture but trust has rarely been measured in safety culture/climate studies. This article used explicit (direct) and implicit (indirect) measures to assess trust at a UK gas plant. Explicit measures assessed trust by asking workers to consider and state their attitude to attitude objects. Implicit measures assessed trust in a more subtle way by using a priming task that relies on automatic attitude activation. The results show that workers expressed explicit trust for their workmates, supervisors, and senior managers, but only expressed implicit trust for their workmates. The article proposes a model that conceptualizes explicit trust as part of the surface levels of safety culture and implicit trust as part of the deeper levels of safety culture. An unintended finding was the positive relationship between implicit measures of trust and distrust, which suggests that trust and distrust are separate constructs. The article concludes by considering the implications for safety culture and trust and distrust in high-hazard industries.

This research aimed to test the relative value of developing and using job-specific facets of effort and testing them using J. Siegrist's (1996) effort-reward imbalance (ERI) theory to extend understanding of how one might determine job strain in urban bus driving. In addition, the interactive effects of the ERI model are further investigated to address the lack of research into the relationships of the model's constructs. Using focus groups and published papers, a measure of bus driver effort was created, which was subsequently completed by 186 male U.K. bus drivers as part of a questionnaire study. The results were factor analyzed to create 4 facets of effort, which demonstrated additional variance in predicting strain, above and beyond J. Siegrist's original effort construct. One facet, workload and fatigue, was observed to be a particularly important contributor to strain. The analyses further indicated that the ERI model's assumptions that ERI creates job strain could not be completely upheld, although poorer levels of reward and higher levels of overcommitment were strong main predictors of job strain. Research and applied implications are considered.