If All Else Fails: Impact of Silicon Accumulation in Maize Leaves on Volatile Emissions and Oviposition Site Selection of Spodoptera exigua Hübner.

Silicon (Si) fertilization alleviates biotic stresses in plants. Si enhances plant resistance against phytophagous insects through physical and biochemical mechanisms. In particular, Si modifies jasmonic acid levels and the emissions of herbivore-induced plant volatiles (HIPVs). Here, we investigated whether Si accumulation in the tissues of maize leaves modifies the emissions of constitutive and herbivore-induced plant volatiles, with cascade deterrent effects on oviposition site selection by Spodoptera exigua Hübner (Lepidoptera: Noctuidae). Maize plants were cultivated in a hydroponic system under three Si concentrations, resulting in three groups of plants expressing different Si concentrations in their tissues (0.31 ± 0.04, 4.69 ± 0.49, and 9.56 ± 0.30 g Si. Kg- 1 DW). We collected volatiles from undamaged and caterpillar-infested plants, and found that Si concentration in plant tissues had no significant impact. Jasmonic acid content was high in insect-infested plants, but was similar across all Si treatments. Oviposition site selection bioassays using fertilized S. exigua females showed that Si concentration in plant tissues did not affect the number of eggs laid on Si-treated plants. In conclusion, our study shows that the Si content in maize tissues does not impact the semiochemical interactions with S. exigua.

Silicon and Plant Natural Defenses against Insect Pests: Impact on Plant Volatile Organic Compounds and Cascade Effects on Multitrophic Interactions.

Environmental factors controlling silicon (Si) accumulation in terrestrial plant are key drivers to alleviate plant biotic stresses, including insect herbivory. While there is a general agreement on the ability of Si-enriched plant to better resist insect feeding, recent studies suggest that Si also primes biochemical defense pathways in various plant families. In this review, we first summarize how soil parameters and climate variables influence Si assimilation in plants. Then, we describe recent evidences on the ability of Si to modulate plant volatile emissions, with potential cascade effects on phytophagous insects and higher trophic levels. Even though the mechanisms still need to be elucidated, Si accumulation in plants leads to contrasting effects on the levels of the three major phytohormones, namely jasmonic acid, salicylic acid and ethylene, resulting in modified emissions of plant volatile organic compounds. Herbivore-induced plant volatiles would be particularly impacted by Si concentration in plant tissues, resulting in a cascade effect on the attraction of natural enemies of pests, known to locate their prey or hosts based on plant volatile cues. Since seven of the top 10 most important crops in the world are Si-accumulating Poaceae species, it is important to discuss the potential of Si mobility in soil-plant systems as a novel component of an integrated pest management.

Design and evaluation of a patient website to reduce crowding in emergency departments: a preliminary study.

The study aims to identify the information useful to support a patients' EDs' choice in order to design a patient Web-based system. For that purpose, a focus group and a formative user test have been performed. The results show that five types of information can be relevant. The spontaneous favored information is the "distance" to EDs. The "Wait time", that is sanctified in literature, is only used in a second time. A larger summative evaluation should be planned to evaluate and validate the befits of this kind of tool.

Improving access to clinical practice guidelines with an interactive graphical interface using an iconic language.

BACKGROUND: Clinical practice guidelines are useful for physicians, and guidelines are available on the Internet from various websites such as Vidal Recos. However, these guidelines are long and difficult to read, especially during consultation. Similar difficulties have been encountered with drug summaries of product characteristics. In a previous work, we have proposed an iconic language (called VCM, for Visualization of Concepts in Medicine) for representing patient conditions, treatments and laboratory tests, and we have used these icons to design a user interface that graphically indexes summaries of product characteristics. In the current study, our objective was to design and evaluate an iconic user interface for the consultation of clinical practice guidelines by physicians. METHODS: Focus groups of physicians were set up to identify the difficulties encountered when reading guidelines. Icons were integrated into Vidal Recos, taking human factors into account. The resulting interface includes a graphical summary and an iconic indexation of the guideline. The new interface was evaluated. We compared the response times and the number of errors recorded when physicians answered questions about two clinical scenarios using the interactive iconic interface or a textual interface. Users' perceived usability was evaluated with the System Usability Scale. RESULTS: The main difficulties encountered by physicians when reading guidelines were obtaining an overview and finding recommendations for patients corresponding to "particular cases". We designed a graphical interface for guideline consultation, using icons to identify particular cases and providing a graphical summary of the icons organized by anatomy and etiology. The evaluation showed that physicians gave clinical responses more rapidly with the iconic interface than the textual interface (25.2 seconds versus 45.6, p < 0.05). The physicians appreciated the new interface, and the System Usability Scale score value was 75 (between good and excellent). CONCLUSION: An interactive iconic interface can provide physicians with an overview of clinical practice guidelines, and can decrease the time required to access the content of such guidelines.

Perceived usefulness of a usability issues reporting form to help understand "usability-induced use-errors": a preliminary study.

The Medical Device regulation requires manufacturers to anticipate and prevent risks of use errors of their medical device. However, manufacturers experience difficulties to understand the concept of "usability-induced use-errors". Based on a "usability framework" aiming at describing the relationship between usability design principles, usability flaws, usage problems, and outcomes, a usability evaluation reporting form had been designed to support understanding the use-error concept. This paper reports the preliminary evaluation of the perceived usefulness of this form. Results show that manufacturers found helpful the presentation of the results of a usability evaluation through this form for it supports the understanding of the usability origins and the consequences of use-errors. Even if the use of this reporting form should be made easier as usability experts experience difficulties to fill it, it seems a promising way to clearly present "usability-induced use-errors" to manufacturers.

Economic benefits of safety-engineered sharp devices in Belgium - a budget impact model.

BACKGROUND: Measures to protect healthcare workers where there is risk of injury or infection from medical sharps became mandatory in the European Union (EU) from May 2013. Our research objective was to estimate the net budget impact of introducing safety-engineered devices (SEDs) for prevention of needlestick injuries (NSIs) in a Belgian hospital. METHODS: A 5-year incidence-based budget impact model was developed from the hospital inpatient perspective, comparing costs and outcomes with SEDs and prior-used conventional (non-safety) devices. The model accounts for device acquisition costs and costs of NSI management in 4 areas of application where SEDs are currently used: blood collection, infusion, injection and diabetes insulin administration. Model input data were sourced from the Institut National d'Assurance Maladie-Invalidité, published studies, clinical guidelines and market research. Costs are discounted at 3%. RESULTS: For a 420-bed hospital, 100% substitution of conventional devices by SEDs is estimated to decrease the cumulative 5-year incidence of NSIs from 310 to 75, and those associated with exposure to blood-borne viral diseases from 60 to 15. Cost savings from managing fewer NSIs more than offset increased device acquisition costs, yielding estimated 5-year overall savings of €51,710. The direction of these results is robust to a range of sensitivity and model scenario analyses. The model was most sensitive to variation in the acquisition costs of SEDs, rates of NSI associated with conventional devices, and the acquisition costs of conventional devices. CONCLUSIONS: NSIs are a significant potential risk with the use of sharp devices. The incidence of NSIs and the costs associated with their management can be reduced through the adoption of safer work practices, including investment in SEDs. For a Belgian hospital, the budget impact model reports that the incremental acquisition costs of SEDs are offset by the savings from fewer NSIs. The availability of more robust data for NSI reduction rates, and broadening the scope of the model to include ancillary measures for hospital conversion to SED usage, outpatient and paramedic device use, and transmission of other blood-borne diseases, would strengthen the model.

Software as a medical device: regulatory critical issues.

The revised Medical Device Directive has been adopted by the EU in 2010. A major change is that software for certain purposes is now considered a medical device. This entails that a new view needs to be developed on the design, development, evaluation and post-market surveillance of medical software that meets the definition of a medical device. This paper identifies some issues at stake and discusses them.

Human factors based recommendations for the design of medication related clinical decision support systems (CDSS).

This study is part of a research project aiming at developing advanced functions of medication related CDSS to support the monitoring of patients' therapeutic treatments based mainly on corresponding lab values. We adopted a user-centred approach to the design of these advanced CDSS functions. We collected existing recommendations in the literature and completed previous Human Factors (HF) field studies and analyses by focused observations and modeling. We present resulting HF based recommendations for the design of such advanced medication CDSS and focus more specifically on two innovative high level recommendations completing those already existing in the literature. For illustration purposes, an example of the operationalization of one of the recommendation is presented.

Medication related computerized decision support system (CDSS): make it a clinicians' partner!

Medication related Computerized Decision Support System (CDSS) are known to have a positive impact on Adverse Drug Events (ADE) prevention but they face acceptance problems due to over alerting and usability issues. We present here a Human factors approach to the design of these Clinical Decision Support (CDS) functions and to their integration into different Electronic Health Record (EHR) / Computerized Physicians Order Entry (CPOE) systems, so that the resulting CDSS corresponds to the users needs and fits clinical workflows and cognitive processes. We used ethnographic observations completed with semi-structured interviews to analyse existing work situations and work processes. These were then described in detail using the SHEL (Software, Hardware, Environment & Liveware) formalism, which enables a structured description of the work system and provides an appropriate classification of human errors potentially leading to ADEs. We then propose a Unified Modelling Language (UML) model supporting the characterization by the CDSS of the drug monitoring and clinical context of patients at risk of ADE. This model combines the status of the lab test orders on the one hand with the validity and normality of the lab results on the other hand. This makes the system able to catch the context of the monitoring of the drugs through their corresponding lab tests and lab results (e.g. kalemia for potassium) and also part of the context of the clinical status of the patient (actual lab values, but also diseases and other pathologies that are identified as potential causes of the ADE e.g. renal insufficiency and potassium). We show that making the system able to catch the monitoring and clinical contexts opens interesting opportunities for the design of the CDS information content and display mode. Implementing this model would allow the CDSS to take into account the actions already engaged by the healthcare team and to adapt the information delivered to the monitoring and clinical context, thus making the CDSS a partner to the clinicians, nurses and pharmacists.

Implementation of a taxonomy aiming to support the design of a contextualised clinical decision support system.

Clinical Decision Support Systems (CDSS) are recently implemented in hospital settings to improve the reliability of drug ordering. However, such systems have limited effects due to their tendency to overalert. To healthcare professionals consider alerts, it is necessary to adapt the CDSS to their activity. Thus, it is necessary to consider contextualisation aspects in the system design. In this article, we propose a taxonomy integrating contextualisation elements issued from an activity analysis to guide the design of a contextualised CDSS. This taxonomy has been developed within the framework of the European project PSIP (Patient Safety through Intelligent Procedures in medication) aiming to make easier the identification and the prevention of Adverse Drug Events.

How emotional pictures influence visuospatial binding in short-term memory in ageing and Alzheimer's disease?

The present study examines the prediction that emotion can facilitate short-term memory. Nevertheless, emotion also recruits attention to process information, thereby disrupting short-term memory when tasks involve high attentional resources. In this way, we aimed to determine whether there is a differential influence of emotional information on short-term memory in ageing and Alzheimer's disease (AD). Fourteen patients with mild AD, 14 healthy older participants (NC), and 14 younger adults (YA) performed two tasks. In the first task, involving visual short-term memory, participants were asked to remember a picture among four different pictures (negative or neutral) following a brief delay. The second task, a binding memory task, required the recognition by participants of a picture according to its spatial location. The attentional cost involved was higher than for the first task. The pattern of results showed that visual memory performance was better for negative stimuli than for neutral ones, irrespective of the group. In contrast, binding memory performance was essentially poorer for the location of negative pictures in the NC group, and for the location of both negative and neutral stimuli in the AD group, in comparison to the YA group. Taken together, these results show that emotion has beneficial effects on visual short-term memory in ageing and AD. In contrast, emotion does not improve their performances in the binding condition.

Augmented notebooks for pervasive learning in medical practice.

Medical e-learning can benefit from the new technologies, and pervasive learning resources and tools worth to be introduced in the medical context. Micro-learning seems to be an interesting way for pervasive learning. But it is still difficult to propose pedagogical resources that are built by learners, from meaningful experiments. We conducted an analysis of the exchanges performed by Health care professionals in the hospital in order to understand where and when educational exchanges appear. We analyzed the type of documents exchanged. The residents' paper notebooks caught our attention first because it answers some clinician-needs and second because the computerization of such a notebook could add a collaborative dimension to the pedagogical resources. We propose a model of an augmented resident's notebook and we briefly describe an implementation using Content Management System and WIKI, before setting the discussion and the conclusion sections.

Integrating the SE and HCI models in the human factors engineering cycle for re-engineering Computerized Physician Order Entry systems for medications: basic principles illustrated by a case study.

OBJECTIVES: The integration of Human Factors is still insufficient in the design and implementation phases of complex interactive systems such as Computerized Physician Order Entry (CPOE) systems. One of the problems is that human factors specialists have difficulties to communicate their data and to have them properly understood by the computer scientists in the design and implementation phases. This paper presents a solution to this problem based on the creation of common documentation supports using Software Engineering (SE) and Human-Computer Interaction (HCI) methods. METHOD: The integration of SE and HCI methods and models is an interesting means for modelling an organization's activities, with software applications being part of these activities. Integrating these SE and HCI methods and models allows case studies to be seen from the technical, organizational and ergonomic perspectives, and also makes it easier to compare current and future work situations. RESULTS: The exploitation of these techniques allows the creation of common work supports that can be easily understandable by computer scientists and relevant for re-engineering or design. In this paper, the basic principles behind such communication supports are described and illustrated by a real case study.

The expert explorer: a tool for hospital data visualization and adverse drug event rules validation.

An important part of adverse drug events (ADEs) detection is the validation of the clinical cases and the assessment of the decision rules to detect ADEs. For that purpose, a software called "Expert Explorer" has been designed by Ideea Advertising. Anonymized datasets have been extracted from hospitals into a common repository. The tool has 3 main features. (1) It can display hospital stays in a visual and comprehensive way (diagnoses, drugs, lab results, etc.) using tables and pretty charts. (2) It allows designing and executing dashboards in order to generate knowledge about ADEs. (3) It finally allows uploading decision rules obtained from data mining. Experts can then review the rules, the hospital stays that match the rules, and finally give their advice thanks to specialized forms. Then the rules can be validated, invalidated, or improved (knowledge elicitation phase).

Contribution of human factors for the review of automatically detected ADE.

The European project PSIP (Patient Safety through Intelligent Procedures in Medication) aims at semi-automatically identifying and preventing ADE. Automatically detected Adverse Drug Events have to be reviewed and validated by human experts. Existing methods usually have the experts review the cases and document their rating in a structured form. One of the limitations of these methods is their poor ability to analyze and clear the disagreements between the experts and the system. This paper presents an innovative Human Factors based method to support the review by clinicians and pharmacologists of these automatically detected ADE. We use think aloud methods and portable labs to track and record the experts reasoning and their reviewing cognitive procedures. We present preliminary results obtained with this method, which allows identifying the key data and information used to characterize the ADE. This method provides useful feedbacks allowing a continuous refinement and improvement of the automated detection system.

The PSIP approach to account for human factors in Adverse Drug Events: preliminary field studies.

This paper presents a preliminary contribution of a Human Factors (HF) approach to prevention of Adverse Drug Events (ADEs), developed within the European research project Patient Safety through Intelligent Procedures in medication (PSIP). Following an introduction on the role and relevance of HF in ADEs prevention, a number of systemic weaknesses encountered during the field activity analysis are presented and discussed. Semi-structured interviews and observations of medication cycle activities led to infer potential unreliability of some decision-making and drug administration procedures. In particular, the usage of current electronic support systems emerged as a crucial related element. These findings represent an initial contribution which will be further developed within PSIP, as HF have been recognised fundamental contributors to ADEs epidemiological knowledge and appropriate prevention.

Human factors methods to support the experts' review of automatically detected adverse drug events.

The European project Patient Safety through Intelligent Procedures in Medication (PSIP) aims at semi-automatically identifying and preventing Adverse Drug Events (ADEs). Data mining of the structured hospital data bases provides a list of potential ADEs, along with their frequencies and probabilities. Once a set of ADEs has been detected by data mining techniques, it is necessary to have them validated by human experts. This paper presents the methods used to support the review by clinicians and pharmacologists of these automatically detected ADEs. We use think-aloud methods and portable labs to track and record the experts reasoning and their reviewing cognitive procedures. We present preliminary results obtained with this method, which allows identifying the key data and information used to characterize the ADEs.

Toward automatic detection and prevention of adverse drug events.

Adverse Drug Events (ADE) due to medication errors and human factors are a major public health issue. They endanger patient safety and cause considerable extra healthcare costs. The European project PSIP (Patient Safety through Intelligent Procedures in medication) aims to identify and prevent ADE. Data mining of the structured hospital data bases will give a list of observed ADE with frequencies and probabilities, thereby giving a better understanding of potential risks. The main objective of the project is to develop innovative knowledge based on the mining results and to deliver to professionals and patients, in the form of alerts and decision support functions, a contextualized knowledge fitting the local risk parameters.

Cognitive analysis of physicians' medication ordering activity.

Computerized Physician Order Entry (CPOE) addresses critical functions in healthcare systems. As the name clearly indicates, these systems focus on order entry. With regard to medication orders, such systems generally force physicians to enter exhaustively documented orders. But a cognitive analysis of the physician's medication ordering task shows that order entry is the last (and least) important step of the entire cognitive therapeutic decision making task. We performed a comparative analysis of these complex cognitive tasks in two working environments, computer-based and paper-based. The results showed that information gathering, selection and interpretation are critical cognitive functions to support the therapeutic decision making. Thus the most important requirement from the physician's perspective would be an efficient display of relevant information provided first in the form of a summarized view of the patient's current treatment, followed by in a more detailed focused display of those items pertinent to the current situation. The CPOE system examined obviously failed to provide the physicians this critical summarized view. Following these results, consistent with users' complaints, the Company decided to engage in a significant re-engineering process of their application.

Comparative evaluation of two applications for delivering a multimedia medical course in the French-speaking Virtual Medical University (UMVF).

This paper describes a comparative evaluation of two applications delivering a multimedia course: a conventional web server (WS) and an integrated e-learning platform in the form of a virtual campus (VC). We used a qualitative method for comparing their acceptance of the on-line course provided by the two different interfaces. The two groups were globally satisfied. However, a decrease in satisfaction was noted at the end of the experimentation in the VC group. This may be explained by a more complex graphic user interface of the VC and some constraints which do not exist with the WS. Students from both groups also had limitations about the multimedia environment.