It is time to talk about people: a human-centered healthcare system

Examining vulnerabilities within our current healthcare system we propose borrowing two tools from the fields of engineering and design: a) Reason's system approach [1] and b) User-centered design [2,3]. Both approaches are human-centered in that they consider common patterns of human behavior when analyzing systems to identify problems and generate solutions. This paper examines these two human-centered approaches in the context of healthcare. We argue that maintaining a human-centered orientation in clinical care, research, training, and governance is critical to the evolution of an effective and sustainable healthcare system

Impact, host range and chemical ecology of the lily beetle, Lilioceris lilii

The lily beetle (Lilioceris lilii, Coleoptera: Chrysomelidae) has a univoltine life cycle and a limited host range (Lilium, Fritillaria and Cardiocrinum). A survey of 237 professional growers indicates that L. lilii is a problem for many in the UK lily industry. A three-year field trial using six different Lilium indicated that the species Lilium regale is more resistant to L. lilii than the hybrids L. ‘Tiber’, L. ‘Brindisi’, L. ‘Conca d’Or’, L. ‘Eliganzer’ and L. ‘Golden Joy’. Phenology observations between the trial and an established population of the beetle have provided base-line data to which further observations can be compared. Future host susceptibility trials should use a standard lily such as L. regale against which others can be compared. Behavioural bioassays using a linear-track olfactometer demonstrated that the responses of L. lilii to hosts and conspecifics are at least in part odour-mediated. Significantly more diapaused females moved into airstreams containing the odour of intact hosts over clean air, to that of hosts and beetles combined over that of undamaged or manually-damaged plants, and into airstreams from intact plants over larval-infested plants. Pre-diapause males moved into the airstreams of intact hosts in preference to L. lilii-infested plants. Using air entrainment, gas chromatography (GC) and coupled gas chromatography-mass spectrometry (GC-MS), headspace volatiles from beetleinfested host plants have been collected and identified. From these compounds, methyl salicylate, nonanal, cis-jasmone, linalool, 6-methyl-5-hepten-2-one and β-pinene elicited electrophysiological responses from L. lilii using electroantennography (EAG) and coupled GC-EAG. Bioassays indicate that diapaused female beetles move into the airstream of clean air in preference to cis-jasmone. Investigations from all areas of the project have progressed our understanding of the ecology of L. lilii but further studies are needed before more effective control strategies can be developed.EThOS - Electronic Theses Online ServiceHorticultural Development CouncilGBUnited Kingdo

Flight of Meligethes aeneus at a range of altitudes

The pollen beetle, Meligethes aeneus, is a significant pest of oilseed rape crops and there is considerable research effort focused on developing novel, sustainable methods of integrated control. These insects rely on flight for all dispersal movements and we have investigated their flight patterns using a novel combination of data from suction traps, vertical-looking radar and field counts. Analysis of these preliminary data will help determine the best timing for different control measures within an integrated pest management strategy

Chemically mediated intraguild predator avoidance by aphid parasitoids: interspecific variability in sensitivity to semiochemical trails of ladybird predators

The avoidance responses of aphid parasitoids with varying host ranges (Aphidius eadyi, Aphidius ervi, and Praon volucre) to chemical trails deposited by intraguild predatory ladybirds, Coccinella septempunctata and Adalia bipunctata, were investigated. Females of all three parasitoid species avoided leaves previously visited by C. septempunctata or A. bipunctata adults. The avoidance responses shown by the two Aphidius species were stronger to trails of C. septempunctata than to those of A. bipunctata. However, P. volucre avoided trails of both ladybird species to a similar degree. Dose responses of these three parasitoid species to the hydrocarbons n-tricosane (C23H48), n-pentacosane (C25H52), and n-heptacosane (C27H56), which are components of the trails of both C. septempunctata and A. bipunctata, were evaluated. Dual-choice bioassays indicated the following: (1) A. eadyi showed more sensitive avoidance responses to n-tricosane than did the other two parasitoid species, (2) all three species showed similar responses to n-pentacosane across a range of doses, and (3) only P. volucre showed avoidance responses to n-heptacosane. Quantitative analyses of each hydrocarbon in the trails of the two ladybird species showed that n-pentacosane and n-heptacosane occur in significantly greater amounts in C. septempunctata trails than in those of A. bipunctata. The trails of the two species also differ qualitatively in the other hydrocarbons present.http://www.springerlink.com/openurl.asp?genre=journal&issn=0098-033

The role of semiochemicals in the avoidance of the seven-spot ladybird, Coccinella septempunctata , by the aphid parasitoid, Aphidius ervi

The role of semiochemicals in mediating intraguild interactions between the seven-spot ladybird, Coccinella septempunctata, and the aphid parasitoid, Aphidius ervi, was investigated. Female parasitoids avoided leaves visited by C. septempunctata adults and larvae during the previous 24 hr. Ethanol extracts of C. septempunctata adults and larvae also induced avoidance responses by A. ervi. Two of the hydrocarbons identified by gas chromatography ( GC) and coupled GC-mass spectrometry (GC-MS), n-tricosane (C23H48), and n-pentacosane (C25H52), when tested individually at levels found in the adult extract, induced avoidance by A. ervi. Further investigation of the larvae extract, and footprint chemicals deposited by adults in glass Petri dishes, confirmed the presence of the hydrocarbons. Parasitism rates of the pea aphid, Acyrthosiphon pisum, on broad bean plants, Vicia faba, which had been sprayed with a mixture of the chemicals, were lower than those on control plants. The effect, however, was no longer evident if parasitoid foraging was delayed by 24 hr after the plants were treated. The ecological significance of intraguild avoidance behavior and implications for possible use of the semiochemicals involved in future biological control programs are discussed.http://www.springerlink.com/openurl.asp?genre=journal&issn=0098-033

Diffusing Aviation Innovations in a Hospital in the Netherlands

Background: Many authors have advocated the diffusion of innovations from other high-risk industries into health care to improve safety. The aviation industry is comparable to health care because of its similarities in (a) the use of technology, (b) the requirement of highly specialized professional teams, and (c) the existence of risk and uncertainties. For almost 20 years, The Rotterdam Eye Hospital (Rotterdam, the Netherlands) has been engaged in diffusing several innovations adapted from aviation. Methods: A case-study methodology was used to assess the application of innovations in the hospital, with a focus on the context and the detailed mechanism for each innovation. Data on hospital performance outcomes were abstracted from the hospital information data management system, quality and safety reports, and the incident reporting system. Information on the innovations was obtained from a document search; observations; and semistructured, face-to-face interviews. Innovations: Aviation industry-based innovations diffused into patient care processes were as follows: patient planning and booking system, taxi service/valet parking, risk analysis (as applied to wrong-site surgery), time-out procedure (also for wrong-site surgery), Crew Resource Management training, and black box. Observations indicated that the innovations had a positive effect on quality and safety in the hospital: Waiting times were reduced, work processes became more standardized, the number of wrong-site surgeries decreased, and awareness of patient safety was heightened. Conclusion: A near-20-year experience with aviation-based innovation suggests that hospitals start with relatively simple innovations and use a systematic approach toward the goal of improving safety