Tracebook : a dynamic checklist support system

It has recently been demonstrated that checklist scan enable significant improvements to patient safety. However, their clinical acceptance is significantly lower than expected. This is due to the lack of good support systems. Specifically, support systems are too static: this holds for paper-based support as well as for electronic systems that digitize paper-based support naively. Both approaches are independent from clinical process and clinical context. In this paper, we propose a process-oriented and context-aware dynamic checklist support system: Tracebook. This system supports the execution of complex clinical processes and rules involving data from Electronic Medical Record systems. Workflow activities and forms are specific to individual patients based on clinical rules and they are dispatched to the right user automatically based on a process model. Besides describing the Tracebook functionality in general, this paper demonstrates the support system specifically on an example application that we are preparing for a controlled clinical evaluation. At last we discuss the difference between Tracebook and other support systems which also rely on a checklist format

Age of diagnosis for congenital hearing loss at Universitas Hospital, Bloemfontein

Background. Congenital hearing loss affects 3 - 6/1 000 children worldwide. The benefits of early identification of hearing loss and early intervention have been clearly established. There are no previous studies reporting on the age of diagnosis of congenital hearing loss in the Free State province.Objectives. To determine the age of diagnosis of congenital hearing loss in the Otorhinolaryngology Clinic at Universitas Hospital. Secondary aims included determining age at first visit, as well as the time delay between first visit and diagnosis, and documenting any interventions which took  place.Methods. A retrospective, descriptive study was undertaken, analysing data from 2001 to 2010.Results. A total of 260 cases of congenital hearing loss were analysed. The median age of diagnosis of hearing loss was 44.5 months. The median age of first visit was 40.9 months, and the median delay between first visit and diagnosis was 49 days.Conclusions. The median age of diagnosis far exceeds national and  international benchmarks. This has a profoundly negative impact on the development and outcomes of children with hearing loss. These results have been used to motivate for the expansion of hearing screening and diagnostic services in the province

DCCSS:a meta-model for dynamic clinical checklist support systems

Clinical safety checklists receive much research attention since they can reduce medical errors and improve patient safety. Computerized checklist support systems are also being developed actively. Such systems should individualize checklists based on information from the patient’s medical record while also considering the context of the clinical workflows. Unfortunately, the form definitions, database queries and workflow definitions related to dynamic checklists are too often hard-coded in the source code of the support systems. This increases the cognitive effort for the clinical stakeholders in the design process, it complicates the sharing of dynamic checklist definitions as well as the interoperability with other information systems. In this paper, we address these issues by contributing the DCCSS meta-model which enables the model-based development of dynamic checklist support systems. DCCSS was designed as an incremental extension of standard meta-models, which enables the reuse of generic model editors in a novel setting. In particular, DCCSS integrates the Business Process Model and Notation (BPMN) and the Guideline Interchange Format (GLIF), which represent best of breed languages for clinical workflow modeling and clinical rule modeling respectively. We also demonstrate one of the use cases where DCCSS has already been applied in a clinical setting

Essential oil vapours suppress the development of anthracnose and enhance defence related and antioxidant enzyme activities in avocado fruit

Anthracnose caused by Colletotrichum gloeosporioides is a major postharvest disease in avocados that causes significant losses during transportation and storage. Complete inhibition of the radial mycelia growth of C. gloeosporioides in vitro was observed with citronella or peppermint oils at 8 μL plate−1 and thyme oil at 5 μL plate−1. Thyme oil at 66.7 μL L−1 significantly reduced anthracnose from 100% (untreated control) to 8.3% after 4 days, and to 13.9% after 6 days in artificially wounded and inoculated ‘Fuerte’ and ‘Hass’ fruit with C. gloeosporioides. GC/MS analysis revealed thymol (53.19% RA), menthol (41.62% RA) and citronellal (23.54% RA) as the dominant compounds in thyme, peppermint and citronella oils respectively. The activities of defence enzymes including chitinase, 1, 3-β-glucanase, phenylalanine ammonia-lyase and peroxidase were enhanced by thyme oil (66.7 μL L−1) treatment and the level of total phenolics in thyme oil treated fruit was higher than that in untreated (control) fruit. In addition, the thyme oil (66.7 μL L−1) treatment enhanced the antioxidant enzymes such as superoxide dismutase and catalase. These observations suggest that the effects of thyme oil on anthracnose in the avocado fruit are due to the elicitation of biochemical defence responses in the fruit and inducing the activities of antioxidant enzymes. Thus postharvest thyme oil treatment has positive effects on reducing anthracnose in avocados.Post-Harvest Innovation Programme (Fresh Produce Exporter Forum, South Africa and Department of Science and Technology).http://www.elsevier.com/locate/postharvbiohb201

Inability to Ventilate after Tube Exchange Postoperative to Pneumonectomy

We report a case of inability to ventilate a patient after completion of pneumonectomy, due to migrated tumor tissue to the contralateral side. This represents an unusual complication with a high mortality rate. We have managed to find the cause in time and were able to remove the obstructive tissue using bronchoscopy

Occurrence, fate and toxic effects of the industrial endocrine disrupter, nonylphenol, on plants - a review

Nonylphenol (NP) and its detrimental effects on the environment, humans, wildlife, fish and birds is an increasingly important global research focus. The number of investigations on the toxicity and metabolic fate of NP in plants is however limited. This paper reviews the prevalence and source of NP in plants and the effect it has on its morphological, physiological and ultrastructural status. Fruit and vegetables have been found to contain levels of NP that is twenty-fold exceeding the no observable effect level (NOEL) of freshwater algae. Apart from the potential risk this poses to the health of consumers, it can overburden the plant’s natural defence system, leading to growth disorders. Plants exposed to NP show signs of overall growth reduction, changes in organelle structure and oxidative damage. These adverse effects may exacerbate the food security dilemma faced by many countries and impede their progress towards attaining the sustainable development goals.The South African National Research Foundation (NRF), the Institute for Food, Nutrition and Well-being (University of Pretoria) and the Centre of Excellence in Food Security, funded by the NRF and Department of Science and Technology.http://www.elsevier.com/locate/ecoenv2020-10-15hj2019Plant Production and Soil ScienceSchool of Health Systems and Public Health (SHSPH

Low Sensitivity of BinaxNOW RSV in Infants

BACKGROUND: Respiratory syncytial virus (RSV) is a major cause of hospitalization in infants. Early detection of RSV can optimize clinical management and minimize use of antibiotics. BinaxNOW RSV (BN) is a rapid antigen detection test that is widely used. We aimed to validate the sensitivity of BN in hospitalized and nonhospitalized infants against the gold standard of molecular diagnosis. METHODS: We evaluated the performance of BN in infants with acute respiratory tract infections with different degrees of disease severity. Diagnostic accuracy of BN test results were compared with molecular diagnosis as reference standard. RESULTS: One hundred sixty-two respiratory samples from 148 children from October 2017 to February 2019 were studied. Sixty-six (40.7%) samples tested positive for RSV (30 hospitalizations, 31 medically attended episodes not requiring hospitalization, and 5 nonmedically attended episodes). Five of these samples tested positive with BN, leading to an overall sensitivity of BN of 7.6% (95% confidence interval [CI], 3.3%-16.5%) and a specificity of 100% (95% CI, 96.2%-100%). Sensitivity was low in all subgroups. CONCLUSIONS: We found a low sensitivity of BN for point-of-care detection of RSV infection. BinaxNOW RSV should be used and interpreted with caution

Genetic, environmental and stochastic factors in monozygotic twin discordance with a focus on epigenetic differences

PMCID: PMC3566971This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited

Genetic modification for disease resistance: a position paper

This Position Paper was prepared by members of the Task Force on Global Food Security of the International Society for Plant Pathology. An objective approach is proposed to the assessment of the potential of genetic modification (GM) to reduce the impact of crop diseases. The addition of GM to the plant breeder’s conventional toolbox facilitates gene-by-gene introduction into breeding programmes of well defined characters, while also allowing access to genes from a greatly extended range of organisms. The current status of GM crops is outlined. GM could make an additional contribution to food security but its potential has been controversial, sometimes because of fixed views that GM is unnatural and risky. These have no factual basis: GM technology, where adopted, is widely regulated and no evidence has been reported of adverse consequences for human health. The potential benefits of GM could be particularly valuable for the developing world but there are numerous constraints. These include cost, inadequate seed supply systems, reluctance to adopt unfamiliar technology, concern about markets, inadequacy of local regulatory systems, mismatch between research and growers’ needs, and limited technical resources. The lower cost of new gene-editing methods should open the practice of GM beyond multinational corporations. As yet there are few examples of utilization of GM-based resistance to plant diseases. Two cases, papaya ringspot virus and banana xanthomonas wilt, are outlined. In the developing world there are many more potential cases whose progress is prevented by the absence of adequate biosafety regulation. It is concluded that there is untapped potential for using GM to introduce disease resistance. An objective approach to mobilizing this potential is recommended, to address the severe impact of plant disease on food security