Methods for Addressing Technology-induced Errors: The Current State.

OBJECTIVES: The objectives of this paper are to review and discuss the methods that are being used internationally to report on, mitigate, and eliminate technology-induced errors. METHODS: The IMIA Working Group for Health Informatics for Patient Safety worked together to review and synthesize some of the main methods and approaches associated with technology- induced error reporting, reduction, and mitigation. The work involved a review of the evidence-based literature as well as guideline publications specific to health informatics. RESULTS: The paper presents a rich overview of current approaches, issues, and methods associated with: (1) safe HIT design, (2) safe HIT implementation, (3) reporting on technology-induced errors, (4) technology-induced error analysis, and (5) health information technology (HIT) risk management. The work is based on research from around the world. CONCLUSIONS: Internationally, researchers have been developing methods that can be used to identify, report on, mitigate, and eliminate technology-induced errors. Although there remain issues and challenges associated with the methodologies, they have been shown to improve the quality and safety of HIT. Since the first publications documenting technology-induced errors in healthcare in 2005, we have seen in a short 10 years researchers develop ways of identifying and addressing these types of errors. We have also seen organizations begin to use these approaches. Knowledge has been translated into practice in a short ten years whereas the norm for other research areas is of 20 years.

Patient-Centred Coordinated Care in Times of Emerging Diseases and Epidemics. Contribution of the IMIA Working Group on Patient Safety.

OBJECTIVES: In this paper the researchers describe how existing health information technologies (HIT) can be repurposed and new technologies can be innovated to provide patient-centered care to individuals affected by new and emerging diseases. METHODS: The researchers conducted a focused review of the published literature describing how HIT can be used to support safe, patient-centred, coordinated care to patients who are affected by Ebola (an emerging disease). RESULTS: New and emerging diseases present opportunities for repurposing existing technologies and for stimulating the development of new HIT innovation. Innovative technologies may be developed such as new software used for tracking patients during new or emerging disease outbreaks or by repurposing and extending existing technologies so they can be used to support patients, families and health professionals who may have been exposed to a disease. The paper describes the development of new technologies and the repurposing and extension of existing ones (such as electronic health records) using the most recent outbreak of Ebola as an example.

High interaction alginate-hyaluronate associations by hyaluronate deacetylation for the preparation of efficient biomaterials.

The paper presents fundamental investigations of alginate-hyaluronate association with significant polymer interactions for preparation of efficient biomaterials. For this purpose, acetamide functions of hyaluronate were partly cleaved by hydrazine at high temperature, yielding amino groups accessible to carboxylic functions of the alginate chain. Alginate-hyaluronate association was studied both in dissolved state by rheological measurements and CD, and in the form of gel slabs prepared after calcium diffusion. Appreciable interaction between carboxylic groups of alginate and the released amino groups of hyaluronate was put into evidence by enhanced values of the viscosity of mixed solutions, and by assessment of the properties of the gel formed: moderate deacetylation allowed gels of improved hardness and viscosity. Nevertheless, high deacetylation was observed to hinder the gel formation by Ca(2+) complexation of alginate, by the significant competition of COOH-NH(2) association. Interaction between alginate and modified hyaluronate results in regular gel structure, with small cavities.

Hyaluronate-alginate gel as a novel biomaterial: mechanical properties and formation mechanism.

With the aim of producing a biomaterial for surgical applications, the alginate-hyaluronate association has been investigated to combine the gel-forming properties of alginate with the healing properties of hyaluronate. Gels were prepared by diffusion of calcium into alginate-hyaluronate mixtures, with an alginate content of 20 mg/mL. The hyaluronate source was shown to have significant effect on the aspect and the properties of the gels. The gels have viscoelastic behaviour and the transient measurements carried out in creep mode could be interpreted through a Kelvin-Voigt generalised model: experimental data led to the steady state hardness and a characteristic viscosity of the gel. Gels prepared from Na rooster comb hyaluronate with weight ratio up to 0.50 have satisfactory mechanical properties, and fully stable gels are obtained after a few days; on the contrary, use of lower molecular weight hyaluronate led to loose gels for hyaluronate contents over 0.25. Gel formation was investigated by measurements of the exchange fluxes between the calcium chloride solution and the forming gel, which allowed thorough investigations of the occuring diffusion phenomena of water, calcium ion and hyaluronate. Strong interactions of water with hyaluronate reduce significantly the rate of weight loss from the gel beads and allows higher water content in steady-state gels. Calcium content in the gel samples could be correlated to the actual alginate concentration, whatever the nature and the weight ratio of hyaluronate.

Ultrastructural localization of ATPase activity in the Pinus sylvestris/Laccaria laccata ectomycorrhizal association.

Ultrastructural localization of the plasmalemmal ATPase activity has been studied in basidiomycete ectomycorrhizas synthesized between Pinus sylvestris L, and Laccaria laccata Scop, ex Fries. The cortical cells showed a strong plasmalemma-bound ATPase activity. The activity was also associated with the fungal plasmalemma in the external hyphae, sheath and Hartig net. The plasmalemmal ATPase activity disappeared in degenerating cortical cells. In the Hartig net, only the parts of the plasmalemma adjacent to other hyphae were active. When the Hartig net hyphae adjoined on one side a living cortical cell and, on the other side, a dead cortical cell, the ATPase activity of fungus plasmalemma was asymmetrically distributed. These observations are discussed in relation to the possible function of ATPase in ectomycorrhizas.

Ectomycorrhizal ability of genetically different homokaryotic and dikaryotic mycelia of Hebeloma cylindrosporum.

Ectomycorrhizas were synthesized under axenic conditions between Pinus pinaster (Ait.) Sol. and different mycelial cultures of Hebeloma cylindrosporum Romagnesi. These included a wild dikaryon and four sib-homokaryons (one for each mating type) belonging to the progeny of this fruiting strain. The homokaryotic mycelia formed typical ectomyeorrhizas showing a morphology and an ultrastructural organization similar to that of ectomyeorrhizas obtained with the parental dikaryon. The ultrastructural localization of acid phosphatase activities was also comparable for homokaryotic and dikaryotic mycorrhizas. These results demonstrate that the ectomycorrhizal ability is not restricted to the dikaryotic state of fungal life-cycle since homokaryotic mycelia also formed typical and functional ectomyeorrhizas. The formation of normal mycorrhizas by homokaryotic mycelia confirms the usefulness of H. cylindrosporum as a model for genetical studies and improvement of ectomycorrhizal fungi by means of chromosomal genetics.