A systemic methodology for risk management in healthcare sector

The recent biomedical, technological, and normative changes have led healthcare organizations to the implementation of clinical governance as a way to ensure the best quality of care in an increasingly complex environment. Risk management is one of the most relevant aspects of clinical governance and approaches put forward in literature highlight the necessity to perform comprehensive analyses intended to uncover root causes of adverse events.Contributing to this field, the present paper applies Reason’s theory of failures to work out a systemic methodology to study risks impacting not only directly but also indirectly on patients. Also, the steps of such approach are organized around Human Reliability Assessment phases, in order to take into account the human component of healthcare systems. This framework is able to foster effective decision making about reducing failures and waste and to improve healthcare organizations’ maturity towards risk management.The developed methodology is applied to the pharmacy department of a large Italian hospital. An extensive validation in different healthcare settings is required to fully prove benefits and limitations.     

New tools for emergency managers: an assessment of obstacles to use and implementation

This paper focuses on the role of the formal response community's use of social media and crowdsourcing for emergency managers (EMs) in disaster planning, response and recovery in the United States. In‐depth qualitative interviews with EMs on the Eastern seaboard at the local, state and federal level demonstrate that emergency management tools are in a state of transition—from formal, internally regulated tools for crisis response to an incorporation of new social media and crowdsourcing tools. The first set of findings provides insight into why many EMs are not using social media, and describes their concerns that result in fear, uncertainty and doubt. Second, this research demonstrates how internal functioning and staffing issues within these agencies present challenges. This research seeks to examine the dynamics of this transition and offer lessons for how to improve its outcomes—critical to millions of people across the United States.     

Supplying honey bees with waterers: a precautionary measure to reduce exposure to pesticides

Environmental Science and Pollution Research - Water is essential for honey bees (Apis mellifera L.), but contaminated sources of water in agricultural environments represent a risk of exposure to...     

Constraints to implementation of sustainability indicator systems in five Asian cities

Contemporary studies on sustainability indicator systems (SISs) typically focus on the technical advancement of indicator construction, on qualitative impacts of indicator programmes and on impacts on governance, decision-making and sustainability as a social construct. Yet, their implementation so far has rarely been addressed, even though monitoring and the use of indicator results fall far behind the number of SISs developed. This study aims at the identification of requirements for the development of and constraints to the implementation of SISs in five Asian cities of developing countries. Interviews with local key actors are held, and a qualitative content analysis is carried out. Findings include evidence on the degree of indicator implementation in the case study cities, a hexagonal model for the classification of requirements and constraints, as well as general conclusions for barriers to the use of SISs.     

Monosomy X rescue explains discordant NIPT results and leads to uniparental isodisomy

Noninvasive prenatal testing accurately detects trisomy for chromosomes 13, 21, and 18, but has a significantly lower positive predictive value for monosomy X. Discordant monosomy X results are often assumed to be due to maternal mosaicism, usually without maternal follow-up. We describe a case of monosomy X-positive noninvasive prenatal testing that was discordant with the 46,XX results from amniocentesis and postnatal testing. This monosomy X pregnancy doubled the single X chromosome, leading to 45,X/46,XX mosaicism in the placenta and uniparental isodisomy X in the amniotic fluid. Thus, at least some discordant monosomy X results are due to true mosaicism in the pregnancy, which has important implications for clinical outcome and patient counseling.     

Evaluating environmental education,citizen science,and stewardship through naturalist programs

Amateur naturalists have played an important role in the study and conservation of nature since the 17th century. Today, naturalist groups make important contributions to bridge the gap between conservation science and practice around the world. We examined data from 2 regional naturalist programs to understand participant motivations, barriers, and perspectives as well as the actions they take to advance science, stewardship, and community engagement. These programs provide certification‐based natural history and conservation science training for adults that is followed by volunteer service in citizen science, education, and stewardship. Studies in California and Virginia include quantitative and qualitative evaluation data collected through pre‐ and postcourse surveys, interviews, and long‐term tracking of volunteer hours. Motivations of participants focused on learning about the local environment and plants and animals, connecting with nature, becoming certified, and spending time with people who have similar interests. Over half the participants surveyed were over 50 years old, two‐thirds were women, and a majority reported household incomes of over $50,000 (60% in California, 85% in Virginia), and <20% of those surveyed in both states described themselves as nonwhite. Thus, these programs need to improve participation by a wider spectrum of the public. We interviewed younger and underrepresented adults to examine barriers to participation in citizen science. The primary barrier was lack of time due to the need to work and focus on career advancement. Survey data revealed that participants’ ecological knowledge, scientific skills, and belief in their ability to address environmental issues increased after training. Documented conservation actions taken by the participants include invasive plant management, habitat restoration, and cleanups of natural areas and streams. Long‐term data from Virginia on volunteer hours dedicated to environmental citizen science show an increase from 14% in 2007 to 32% in 2014. In general, participants in the naturalist programs we examined increased their content knowledge about ecosystems, had greater confidence in conserving them, and continued to engage as citizen scientists after completing the program.     

Resistant weeds were controlled by the combined use of herbicides and bioherbicides

The intensive and abundant use of synthetic herbicides has been questioned in recent decades due to the strong dependence and also the resistance effects that are identified in weeds. Several grain crops suffer from the weed control system because many of the weeds are already resistant to the main herbicides that are used. In recent years, there has been a large gap in the market without the addition of new synthetic herbicides with mechanisms of action that differ from those already existing. The objective of this short piece is to address and overcome this challenge and bring an innovative and alternative solution that proposes a synergistic action system between bioherbicides produced by the fungus Trichoderma koningiopsis and synthetic herbicides (2,4‐dichlorophenoxyacetic acid, glyphosate, and ammonium glufosinate). The plants included in this study were Bidens pilosa (amor seco, or in the United States, beggar ticks or Spanish needle), Euphorbia heterophylla (adeus‐brasil), and Conyza bonariensis (margaridinha‐do‐campo, or, in the United States, hairy fleabane or asthmaweed). It was verified that, in the application of the biocomposites in the presence of chemical herbicides, potentiation of the phytotoxic action (100%) occurred under the target plants, emphasizing phytotoxicity to the weed, C. bonariensis, which is currently resistant to available herbicides. The bioherbicides studied have promising characteristics to be explored in the biocontrol of weeds.     

Reference values for heavy metals in soils of the Brazilian agricultural frontier in Southwestern Amazônia

Guideline values are used to identify polluted or contaminated areas based on background values. Brazilian law establishes three guideline values for pollutants: a quality reference value (QRV), a prevention value, and an intervention value. Reference values refer to the natural concentration of an element or a substance in soils that have not been modified by anthropogenic impacts. These values inform assessments of soil quality and are used to establish maximum permissible limits. The objective of this study was to determine the natural levels and reference values for Cd, Co, Cr, Cu, Ni, Pb, and Zn in samples from the surface layer (0–20 cm) of 19 representative soils of the states of Mato Grosso and Rondônia, on Brazil’s agricultural frontier. Pseudo-total metal concentrations were obtained following microwave-assisted digestion using the aqua regia and EPA3051 methods. QRVs were calculated for each element as the 75th and 90th percentiles of the frequency distribution of the data. Natural levels of heavy metals in the soil samples followed the order: Cr?>?Zn?>?Cu?>?Co?>?Pb?>?Ni?>?and Cd (aqua regia) and Cr?>?Co?>?Cu?>?Pb?>?Zn?>?Ni?>?Cd (EPA3051). These values are generally lower than those reported in the Brazilian and international literature, which highlights the importance of establishing reference values for each state or for each soil type, taking into account the geomorphological, pedological, and geological diversity of the region under study.