Improving Patient Outcomes Through Closed-Claims Analysis: Salient Characteristics and Patterns Associated With Respiratory Events.

A retrospective, exploratory research design was used to analyze salient characteristics and patterns associated with closed claims involving Certified Registered Nurse Anesthetists (CRNAs) in which a respiratory event caused the adverse outcome. Alleged malpractice acts found in these claims occurred between 2003 and 2012. Respiratory events were the most frequent cause of adverse outcomes in the current database (34%). The respiratory adverse outcomes often resulted in mortality or significant and permanent morbidity (69%) and were largely preventable (81%). Of these respiratory outcomes, inadequate ventilation and oxygenation associated with respiratory depressant medications accounted for 37% of the adverse outcomes (hypoventilation = 27.4%; respiratory arrest = 9.5%). In every hypoventilation claim, regardless of the type of anesthetic technique, a failure to optimally monitor the patient's ventilation was identified as a sentinel, contributory practice pattern. Payouts for CRNAs were made in 55% of respiratory claims and averaged $282,840. Claims judged to have an AANA standard-of-practice guideline violation that directly contributed to the adverse outcome were more likely to result in a payout vs those involving no violation (P <.01). Costs to defend against the malpractice allegation for all respiratory event claims averaged $51,996 (SD = $52,658) and ranged from $525 to $227,153.

A Content and Thematic Analysis of Closed Claims Resulting in Death.

The analyses of malpractice closed claims conducted by the AANA Foundation Closed Claims Research Team are scientific studies of adverse anesthetic events where a Certified Registered Nurse Anesthetist was identified as potentially contributing to the outcome. From July 2013 to March 2014, the AANA Foundation Closed Claims Researchers evaluated 245 closed claims from the CNA Insurance Companies spanning from 2003 to 2012. An adverse event leading to death occurred in 87 of the claims. This article describes the use of content and thematic analysis in the evaluation of these closed claims. The purpose of the study was to establish themes that would provide unique insights into the events leading up to death with a focus on the role anesthesia may or may not have had in the outcome. Major themes identified include: (1) patient factors, (2) provider factors, (3) environmental factors, and (4) team/group factors.

Evolution of the courtship display of Melittobia (Hymenoptera: Eulophidae).

Melittobia, a polyphagous pupal parasitoid of many solitary bees and wasps, has a complex courtship display, the evolutionary history of which is poorly understood. The current phylogeny of this genus suggests the complexity of the courtship has increased over time. We test this hypothesis using Bayesian and Maximum likelihood techniques to construct a molecular phylogeny of Melittobia-the first for this genus using modern techniques--using two intergenic regions (Internal Transcribed Spacer regions 1 and 2) and Cytochrome Oxidase 1 (CO1), and reconstruct the ancestral state of each major node in the phylogeny for five behaviors coincidental to major shifts in display complexity. We show that species-groups identified solely on behavioral characters are reliable, although the relationships among groups are different than those previously hypothesized. We also show that behaviors traditionally used in the courtship studies do not support a hypothesis of increasing display complexity over time.

Interspecific nest parasitism by Pseudabispa paragioides, a solitary Australian wasp.

In morphology, coloration, and size, Pseudabispa wasps (Hymenoptera: Vespidae: Eumeninae) closely resemble mason wasps in the genus Abispa, and their distributions overlap. Although these two genera are among the largest solitary wasps in Australia, the biology of Pseudabispa was not previously known. Field observations from near Katherine, Northern Territory, strongly suggest that P. paragioides (Meade-Waldo) females attack and kill female A. ephippium (Fabricius) and usurp their nests, then appropriate cells, mass provision them with caterpillars acquired by theft from still other nests, and close them with mud taken from the host nest. Despite an abundance of potentially available cells in nests of three other large solitary wasps common at the same site, P. paragioides was found associated only with nests of A. ephippium. This unusual report of apparently forcible and lethal interspecific nest takeover for a non-social wasp parallels behaviors previously known only from socially parasitic eusocial Hymenoptera. Exploitation by P. paragioides may help explain why its host displays some of the most highly developed parental care known in any solitary eumenid, and why its nests are spaced widely from one another.

Biology of the parasitoid Melittobia (Hymenoptera: Eulophidae).

As parasitoids upon solitary bees and wasps and their nest cohabitants, Melittobia have an intricate life history that involves both female cooperation and variably expressed male siblicidal conflict. Inter- and intrasexual dimorphism includes blind, flightless males and (probably nutritionally determined) short- and long-winged females. Thought to be highly inbred, Melittobia do not conform to local mate competition (LMC) theory but exhibit simple forms of many social insect traits, including overlapping adult generations, different female phenotypes, close kinship ties, parental care, and altruistic cooperative escape behaviors. Most host records and research findings are based on only 3 species--M. acasta, M. australica, and M. digitata--but any of the 12 species could have pest potential due to their polyphagy, explosive population growth, cryptic habits, and behavioral plasticity. Readily cultured in the laboratory, Melittobia offer considerable potential as a model for genetic, developmental, and behavioral studies.

Wolbachia in two populations of Melittobia digitata Dahms (Hymenoptera: Eulophidae) / Wolbachia en dos poblaciones de Melittobia digitata Dahms (Hymenoptera: Eulophidae)

We investigated two populations of Melittobia digitata Dahms, a gregarious parasitoid (primarily upon a wide range of solitary bees, wasps, and flies), in search of Wolbachia infection. The first population, from Xalapa, Mexico, was originally collected from and reared on Mexican fruit fly pupae, Anastrepha ludens Loew (Diptera: Tephritidae); the other, from Athens, Georgia, was collected from and reared on prepupae of mud dauber wasps, Trypoxylon politum Say (Hymenoptera: Crabronidae). PCR studies of the ITS2 region corroborated that both parasitoid populations were the same species; this potentially provides a useful molecular taxonomic profile since females of Melittobia species are superficially similar. Amplification of the Wolbachia surface protein gene (wsp) confirmed the presence of this endosymbiont in both populations. Sequencing revealed that the Wolbachia harbored in both populations exhibited a wsp belonging to a unique subgroup (denoted here as Dig) within the B-supergroup of known wsp genes. This new subgroup of wsp may either belong to a different strain of Wolbachia from those previously found to infect Melittobia or may be the result of a recombination event. In either case, known hosts of Wolbachia with a wsp of this subgroup are only distantly related taxonomically. Reasons are advanced as to why Melittobia - an easily reared and managed parasitoid - holds promise as an instructive model organism of Wolbachia infection amenable to the investigation of Wolbachia strains among its diverse hosts.

Se investigaron dos poblaciones de Melittobia digitata Dahms, un parasitoide gregario (principalmente sobre un rango amplio de abejas solitarias, avispas y moscas), en busca de infección por Wolbachia. La primera población, provenía de Xalapa, México, y fue originalmente colectada y criada sobre pupas de la Mosca Mexicana de la Fruta, Anastrepha ludens Loew (Diptera: Tephritidae). La segunda población, originaria de Athens, Georgia, fue colectada y criada sobre prepupas de avispas de barro, Trypoxylon politum Say (Hymenoptera: Crabronidae). Estudios de PCR de la región ITS2 confirmaron que ambas poblaciones del parasitoide pertenecen a la misma especie; lo que nos provee de un perfil molecular taxonómico muy útil debído a que las hembras de las diversas especies de Melittobia son superficialmente similares. La amplificación del gen de superficie de proteina (wsp) de Wolbachia confirmó la presencia de este endosimbionte en ambas poblaciones. La ejecución de la secuencia reveló que Wolbachia alojada en ambas poblaciones exibe un wsp que pertenece a un subgrupo único (denominado aquí como Dig) dentro del supergrupo B de los genes wsp conocidos. Este nuevo subgrupo de wsp podría pertenecer o a un lineaje de Wolbachia de los previamente conocidos infectando a Melittobia o podría ser el resultado de algún evento recombinante. En cualquier caso, los huéspedes conocidos de Wolbachia con un wsp en este subgrupo están relacionados taxonómicamente en forma lejana. Se presentan razones posibles del por qué Melittobia - un parasitoide fácil de criar y manipular - es prometedor como un organismo modelo conveniente para el estudio de líneas de Wolbachia entre diversos huéspedes.

Wolbachia in two populations of Melittobia digitata Dahms (Hymenoptera: Eulophidae).

We investigated two populations of Melittobia digitata Dahms, a gregarious parasitoid (primarily upon a wide range of solitary bees, wasps, and flies), in search of Wolbachia infection. The first population, from Xalapa, Mexico, was originally collected from and reared on Mexican fruit fly pupae, Anastrepha ludens Loew (Diptera: Tephritidae); the other, from Athens, Georgia, was collected from and reared on prepupae of mud dauber wasps, Trypoxylon politum Say (Hymenoptera: Crabronidae). PCR studies of the ITS2 region corroborated that both parasitoid populations were the same species; this potentially provides a useful molecular taxonomic profile since females of Melittobia species are superficially similar. Amplification of the Wolbachia surface protein gene (wsp) confirmed the presence of this endosymbiont in both populations. Sequencing revealed that the Wolbachia harbored in both populations exhibited a wsp belonging to a unique subgroup (denoted here as Dig) within the B-supergroup of known wsp genes. This new subgroup of wsp may either belong to a different strain of Wolbachia from those previously found to infect Melittobia or may be the result of a recombination event. In either case, known hosts of Wolbachia with a wsp of this subgroup are only distantly related taxonomically. Reasons are advanced as to why Melittobia - an easily reared and managed parasitoid - holds promise as an instructive model organism of Wolbachia infection amenable to the investigation of Wolbachia strains among its diverse hosts.

Development of Melittobia australica Girault and M. digitata Dahms (Parker) (Hymenoptera: Eulophidae) parasitizing Neobellieria bullata (Parker) (Diptera: Sarcophagidae) puparia / Desenvolvimento de Melittobia australica Girault e M. digitata Dahms (Hymenoptera: Eulophidae) parasitando pupários de Neobellieria bullata (Parker) (Diptera: Sarcophagidae)

The development of Melittobia australica Girault and M. digitata Dahms were studied parasitizing blow fly puparia Neobellieria (=Sarcophaga) bullata (Parker) using from one to five foundress females per host. Aspects of parasitoids biology such as number of descendents produced, longevity, and progeny body size can be affected as the number of foundress increases per host. The percentage of puparia parasitized was higher overall for M. digitata than for M. australica. Regardless of foundress numbers, the average total number of descendents produced was significantly higher for M. digitata (66.5 158.0) than for M. australica (10.9 55.5). The number of descendents produced per female was inversely proportional to the number of foundresses on a host for both species. Developmental time increased for M. australica and decreased for M. digitata, as the number of foundresses increased. Life spans of adult progeny of both species, deprived of host and food, were longer for progeny derived from fewer foundresses. Body size as measured by forewing and hind-tibia lengths of descendents showed significant reduction as number of foundresses increased for both species, except for the forewing of M. digitata. Changing foundress number did not affect offspring sex ratios (0.95 0.98 for M. australica, and 0.95 0.97 for M. digitata). These results indicated that M. digitata achieved better performance parasitizing N. bullata compared to M. australica, and both parasitoid species had their performance affected by increasing the parasitoid densities per host, suggesting that progeny competition occurred.

O desenvolvimento de Melittobia australica Girault e M. digitata Dahms parasitando pupários de Neobellieria (=Sarcophaga) bullata (Parker) foram estudados com densidades de um a cinco parasitóides fêmeas por pupário. Aspectos da biologia dos parasitóides tais como: número de descendentes produzidos, longevidade, e tamanho do corpo dos descendentes, podem ser afetados em função do número de parasitoides por pupário. Em geral, a porcentagem de pupários parasitados foi maior para M. digitata do que para M. australica. Independentemente da densidade de parasitóides por pupário, o número total de descendentes produzidos foi significativamente maior para M. digitata (66,5 a 158,0)que para M. australica (10,9 a 55,5). Para ambas espécies, o número de descendentes produzidos por fêmea dos parasitóides foi inversamente proporcional à densidade dos parasitóides. O aumento da densidade dos parasitóides prolongou o tempo de desenvolvimento M. australica, e ocasionou redução em M. digitata. A longevidade dos adultos emergidos de M. australica e M. digitata foi maior quando oriundos das densidades até três parasitóides por pupário, e o tamanho do corpo dos decendentes, mostrou significante redução quando aumentou a densidade de fêmeas dos parasitóides por pupário. Entretanto, a razão sexual dos descendentes não foi afetada, variando de 0,95 a 0,98 para M. australica, e de 0,95 a 0,97 para M. digitata. Os resultados mostram que M. digitata apresentou melhor desempenho que M. australica parasitando N. bullata, e ambas espécies apresentaram redução no desempenho aumentando a densidade de parasitoides por hospedeiro, sugerindo haver competição entre os descendentes.

A simple technique for milking the venom of a small parasitic wasp, Melittobia digitata (Hymenoptera: Eulophidae).

We describe a simple method for obtaining good a quantity of pure venom from a small parasitoid wasp, Melittobia digitata. Crushing the insect's head causes venom to be extruded from the ovipositor that dries rapidly as it is collected onto an insect pin. This technique may be applicable to other parasitic Hymenoptera.

Trans-bergamotenes-male pheromone of the ectoparasitoid Melittobia digitata.

The first male-produced sex attractant pheromone in the parasitic Hymenoptera has been identified. The elaborate courtship behavior of Melittobia digitata, an idiobiont that parasitizes the last larval instar or the pupal stage of solitary bees and wasps, involves a series of coordinated movements of legs, wings, and antennae, initiated after the female is attracted to the blind, flightless male. We identified alpha- and beta-trans-bergamotene as the active compounds of the male M. digitata sex attractant. Variation in the release of the sex pheromone by males and the pheromone load during aging is also described.